Background: Low plasma glutamine concentration is an independent prognostic factor for an unfavourable outcome in the intensive care unit (ICU). Intravenous (i.v.) supplementation with glutamine is ...reported to improve outcome. In a multi‐centric, double‐blinded, controlled, randomised, pragmatic clinical trial of i.v. glutamine supplementation for ICU patients, we investigated outcomes regarding sequential organ failure assessment (SOFA) scores and mortality. The hypothesis was that the change in the SOFA score would be improved by glutamine supplementation.
Methods: Patients (n=413) given nutrition by an enteral and/or a parenteral route with the aim of providing full nutrition were included within 72 h after ICU admission. Glutamine was supplemented as i.v. l‐alanyl‐l‐glutamine, 0.283 g glutamine/kg body weight/24 h for the entire ICU stay. Placebo was saline in identical bottles. All included patients were considered as intention‐to‐treat patients. Patients given supplementation for >3 days were considered as predetermined per protocol (PP) patients.
Results: There was a lower ICU mortality in the treatment arm as compared with the controls in the PP group, but not at 6 months. For change in the SOFA scores, no differences were seen, 1 (0,3) vs. 2 (0.4), P=0.792, for the glutamine group and the controls, respectively.
Conclusion: In summary, a reduced ICU mortality was observed during i.v. glutamine supplementation in the PP group. The pragmatic design of the study makes the results representative for a broad range of ICU patients.
Test beam measurements have been carried out with a 3D sensor on a Timepix3 ASIC and the time measurements are presented. The measurements are compared to those of a thin planar sensor on Timepix3. ...It is shown that for a perpendicularly incident beam the time resolution of both detectors is dominated by the Timepix3 front-end. The 3D detector is dominated by the time-to-digital conversion whereas the analog front-end jitter also gives a significant contribution for the thin planar detector. The 3D detector reaches an overall time resolution of 567(6)ps compared to 683(8)ps for the thin planar detector. For a grazing angle beam, however, the thin planar detector achieves a better time resolution because it has a lower pixel capacitance, and therefore suffers less from jitter in the analog front-end for the low charge signals that mainly occur in this type of measurement. Finally, it is also shown that the 3D and thin planar detector can achieve time resolutions for large clusters of about 100ps and 250ps, respectively, by combining many single hit measurements.
Two patients, a man aged 45 years and a woman aged 61 years, were diagnosed with syringomyelia. They later developed Charcot's arthropathy of the elbow and shoulder, respectively. The second patient ...was misdiagnosed with multiple sclerosis during the pre-MRI era. The 3 hallmarks of syringomyelia are impairment of vital or non-vital sensory perception, muscle weakness with atrophy and areflexia of the arms. Syringomyelia often occurs in association with other disorders, such as Chiari's malformation type I or tumours of the spinal column. Diagnosis should include scanning of the entire spinal column and the region surrounding the foramen magnum. Various treatment options exist: watchful waiting is possible or surgery, including decompression of the foramen magnum or placement of a syringosubarachnoidal or syringoperitoneal shunt. In the first patient, the elbow became infected, necessitating surgery. The joint later became non-functional. In the second patient, a conservative approach was followed.
Merkel cell carcinoma (MCC) is a very aggressive small cell tumour of neuro-endocrine origin, usually arising on sun-exposed parts of the skin. Only four cases of intra-oral MCC excluding the lips ...are reported with a maximum survival of 26
months. A new case with a MCC on the right glossopharyngeal fold is presented. Because of the aggressive behaviour and the fact that wide excision with 3
cm resection margins as recommended for skin lesions is anatomically not attainable, a MCC in the oral cavity has a very poor prognosis.
Alterations in the bacteria that reside in our gastrointestinal tract play a role in the pathogenesis and progression of many disorders including liver and gastrointestinal diseases. Both qualitative ...(composition) and quantitative (amount) changes in gut microbes are associated with increased susceptibility to liver disease. Importantly, the intestinal microbiota is involved in the regulation of many host signalling pathways via the generation of different metabolites. Hence, dysbiosis influences disease development and progression by directly affecting the host–bacteria metabolic interaction. Microbe‐derived harmful metabolites can translocate to distant organs due to increased intestinal permeability as observed during dysbiosis. Contrary, certain bacterial metabolites such as tryptophan metabolites contribute to intestinal and systemic homeostasis. Here, we provide an overview of current evidence describing to what extent microbial metabolites modulate the development of chronic liver diseases such as alcoholic steatohepatitis and nonalcoholic fatty liver disease with a special emphasis on indoles.
A negotiation between agents is typically an incomplete information game, where the agents initially do not know their opponent’s preferences or strategy. This poses a challenge, as efficient and ...effective negotiation requires the bidding agent to take the other’s wishes and future behavior into account when deciding on a proposal. Therefore, in order to reach better and earlier agreements, an agent can apply learning techniques to construct a
model
of the opponent. There is a mature body of research in negotiation that focuses on modeling the opponent, but there exists no recent survey of commonly used opponent modeling techniques. This work aims to advance and integrate knowledge of the field by providing a comprehensive survey of currently existing opponent models in a bilateral negotiation setting. We discuss all possible ways opponent modeling has been used to benefit agents so far, and we introduce a taxonomy of currently existing opponent models based on their underlying learning techniques. We also present techniques to measure the success of opponent models and provide guidelines for deciding on the appropriate performance measures for every opponent model type in our taxonomy.
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