Nutritional Management and Outcomes in Malnourished Medical Inpatients in 2020: The Evidence Is Growing!

Access to adequate food is a fundamental human right [...]

Multistep greedy algorithm identifies community structure in real-world and computer-generated networks

We have recently introduced a multistep extension of the greedy algorithm for modularity optimization. The extension is based on the idea that merging l pairs of communities (l>1) at each iteration prevents premature condensation into few large communities. Here, an empirical formula is presented for the choice of the step width l that generates partitions with (close to) optimal modularity for 17 real-world and 1100 computer-generated networks. Furthermore, an in-depth analysis of the communities of two real-world networks (the metabolic network of the bacterium E. coli and the graph of coappearing words in the titles of papers coauthored by Martin Karplus) provides evidence that the partition obtained by the multistep greedy algorithm is superior to the one generated by the original greedy algorithm not only with respect to modularity but also according to objective criteria. In other words, the multistep extension of the greedy algorithm reduces the danger of getting trapped in local optima of modularity and generates more reasonable partitions.Comment: 17 pages, 2 figure

Lymphocyte counts in patients with ANCA-associated vasculitis

How lymphocyte counts relate to treatment-response in patients with ANCA-associated vasculitis (AAV) is controversial, and data on short-term variability of lymphocyte counts are lacking. Retrospective single center evaluation of disease activity and lymphocyte counts in patients with AAV, and of lymphocyte counts in kidney transplant-recipients, were done; both at the University Hospital Basel, Switzerland. Twenty-three patients with AAV were included. Remission was achieved in all patients. Ten patients experienced a relapse after a median of 66weeks (range 15-189weeks). Median lymphocyte counts at diagnosis were significantly higher than at remission (1.38×109/L vs. 0.99×109/L; P=0.007). By contrast, median lymphocyte counts at remission and relapse did not differ significantly. However, intra-individual variability of lymphocyte counts early after diagnosis was high [median lymphocyte variability-range during the first 3weeks of treatment 1.57 (range 0.27-3.95), n=17]. This variability was not specific to patients with AAV, but was also observed in patients after kidney transplantation [variability of 1.76 (range 0.74-3.95, n=31)]. The significantly higher median lymphocyte counts at diagnosis of AAV make lymphocyte counts a valuable surrogate for the treatment-efficiency in clinical studies. By contrast, on a patient-level, variability of lymphocyte counts impedes meaningful interpretation of individual measurement

Procalcitonin: Importance for the diagnosis of bacterial infections

In contrast to calcitonin which is primarily synthesized in the thyroid, procalcitonin is a prohormone which is synthesized in many different tissues of infected organs. To diagnose mild, localized, or early infections an assay needs to have a functional assay sensivity of approximately 0.02μg/L. We demonstrated that procalcitonin modifies the outcome of respiratory infections with regard to minimizing the use of antibiotics and duration of antibiotic treatment. High concentrations, especially over time, indicate high risk of a severe outcome. In this respect, procalcitonin is superior to other infection markers, such as C-reactive protein. High procalcitonin levels can also be found in non-bacterial diseases, such as malaria, severe trauma, burns, and medullar carcinoma of the thyroid. Procalcitonin, as a marker, has improved the diagnosis of bacterial infections. However, procalcitonin needs to be used in conjunction with other laboratory markers, clinical examination, and medical histor

District Power-To-Heat/Cool Complemented by Sewage Heat Recovery

District heating and cooling (DHC), when combined with waste or renewable energy sources, is an environmentally sound alternative to individual heating and cooling systems in buildings. In this work, the theoretical energy and economic performances of a DHC network complemented by compression heat pump and sewage heat exchanger are assessed through dynamic, year-round energy simulations. The proposed system comprises also a water storage and a PV plant. The study stems from the operational experience on a DHC network in Budapest, in which a new sewage heat recovery system is in place and provided the experimental base for assessing main operational parameters of the sewage heat exchanger, like effectiveness, parasitic energy consumption and impact of cleaning. The energy and economic potential is explored for a commercial district in Italy. It is found that the overall seasonal COP and EER are 3.10 and 3.64, while the seasonal COP and EER of the heat pump alone achieve 3.74 and 4.03, respectively. The economic feasibility is investigated by means of the levelized cost of heating and cooling (LCOHC). With an overall LCOHC between 79.1 and 89.9 €/MWh, the proposed system can be an attractive solution with respect to individual heat pumps.This research was funded by the European Commission, H2020-project Heat4Cool, grant number 723925. The work has also been supported by the Swiss State Secretariat for Education, Research and Innovation (SERI) under Contract No. 16.0082

Procalcitonin und seine Bedeutung für die Diagnose bakterieller Infektionen

Procalcitonin ist das Pro-Hormon von Calcitonin. Im Gegensatz zu Calcitonin, welches primär in der Schilddrüse gebildet wird, wird Procalcitonin bei einer bakteriellen Infektion im Körper von allen infizierten parenchymatösen Organen produzier

Delamination detection in a 90-year-old glulam block with scanning dry point-contact ultrasound

Glued laminated timber (glulam) is known in timber constructions since more than 100 years. Glulam members can delaminate due to aging and excessive changes of temperature and humidity. This results in significantly reduced load bearing capability of the affected structural members. This contribution focuses on the ultrasonic point-contact inspection of gluing plane delamination as a nondestructive method. Ultrasonic measurements on a section of a 90-year-old roofing glulam member are presented. The results are compared with manual detection and evaluation of delamination with a feeler gauge, with X-ray computed tomography analyses, and with numerical simulations. Appropriate data evaluation of the mechanized ultrasonic results allows the determination of material separation that are deeper than 20 mm in the signature of the surface wave and large-scale delamination (>80% of the complete bonding width) in the back-wall echo. Numerical simulations based on the finite-difference time-domain method shed light into the details of the wave propagation and support the experimental finding

In the back of your mind: Cortical mapping of paraspinal afferent inputs

Topographic organisation is a hallmark of vertebrate cortex architecture, characterised by ordered projections of the body's sensory surfaces onto brain systems. High-resolution functional magnetic resonance imaging (fMRI) has proven itself as a valuable tool to investigate the cortical landscape and its (mal-)adaptive plasticity with respect to various body part representations, in particular extremities such as the hand and fingers. Less is known, however, about the cortical representation of the human back. We therefore validated a novel, MRI-compatible method of mapping cortical representations of sensory afferents of the back, using vibrotactile stimulation at varying frequencies and paraspinal locations, in conjunction with fMRI. We expected high-frequency stimulation to be associated with differential neuronal activity in the primary somatosensory cortex (S1) compared with low-frequency stimulation and that somatosensory representations would differ across the thoracolumbar axis. We found significant differences between neural representations of high-frequency and low-frequency stimulation and between representations of thoracic and lumbar paraspinal locations, in several bilateral S1 sub-regions, and in regions of the primary motor cortex (M1). High-frequency stimulation preferentially activated Brodmann Area (BA) regions BA3a and BA4p, whereas low-frequency stimulation was more encoded in BA3b and BA4a. Moreover, we found clear topographic differences in S1 for representations of the upper and lower back during high-frequency stimulation. We present the first neurobiological validation of a method for establishing detailed cortical maps of the human back, which might serve as a novel tool to evaluate the pathological significance of neuroplastic changes in clinical conditions such as chronic low back pain

Refeeding Syndrome: A Critical Reality in Patients with Chronic Disease

Malnutrition is one of the most frequent metabolic challenges in the population of chronically ill patients. This results in increased administration of nutritional therapy in inpatient settings, which poses the risk of side effects, in particular, the development of refeeding syndrome. If not managed accordingly, it leads to a significant rise in morbidity and mortality. However, despite its importance, evidence-based recommendations on the management of refeeding syndrome are largely lacking, and only a few randomized controlled trials have been conducted. In light of this, the aim of this review is to raise awareness of refeeding syndrome in chronically ill patients by critically reviewing recent literature and providing a short overview as well as diagnosis and treatment algorithms of this underreported metabolic condition. In summary, recent findings suggest undergoing risk assessment and stratification for every patient receiving nutritional therapy. According to this, adaptation of energy and fluid support during the replenishment phase should be implemented in the nutritional therapy for patients at high risk. Additionally, continuous monitoring should take place, and appropriate actions should be initiated when necessary