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In this article we describe the causes and diagnostic work-up of unintentional weight loss. It is defined as loss of weight of at least 5% in 6 months. There is both attention to somatic and functional causes of weight loss, as well as iatrogenic causes like side-effects of medication. Referrals to medical specialists for diagnostics are discussed and also the role of dieticians in screening and treatment. Special attention is given to weight loss by malabsorption. Although malignancies as a reason of weight loss is rare in primary care, in secondary care it may be present up to 30%. Treatment of unintentional weight loss may be necessary by high caloric dietary foods when functional decline is obvious, although there is hardly indication for prescribed medication, guidelines for treatment is given.

Background. The skin microbiota plays a key role in the pathogenesis of several skin diseases, but its role in cellulitis remains unknown. We investigated the skin microbiota in patients with cellulitis, studied whether its analysis could help determine the causative pathogen, and explored whether skin microbiota composition was associated with clinical outcomes.Methods. We prospectively included 58 patients hospitalized for cellulitis. Skin swabs obtained from the lesion sites were compared with swabs from identical sites on the contralateral unaffected limbs and with swabs obtained from 19 age-and sex-matched control subjects without cellulitis. Bacterial profiling of the skin microbiota was performed by interspacer profiling (IS-pro).Results. A large interpersonal variation in the skin microbiota composition of patients hospitalized with cellulitis was observed. Firmicutes were the dominant phylum, and Staphylococcus and Streptococcus the dominant genera. In most patients, a strong correlation between the microbiota of the affected lesion and the microbiota of the unaffected, contralateral limb was seen. Overall, the composition of the cellulitis microbiota could not be distinguished from the skin microbiota of controls. No consistent association could be found between traditional culture results and skin microbiota signatures in patients with cellulitis. Lastly, we found that neither microbiota composition nor diversity were associated with clinical parameters and outcomes in patients with cellulitis.Conclusions. In this exploratory study on the skin microbiota in patients hospitalized with cellulitis, we were unable to identify a typical cellulitis microbiota. The diagnostic and prognostic information that could be derived from skin microbiota profiling in this patient cohort was limited.

The application of simulation models in sheet metal forming in automotive industry has proven to be beneficial to reduce tool costs in the designing stage and for optimising current processes. Moreover, it is a promising tool for a material supplier to optimise material choice and development for both its final application and its forming capacity. The present practice requires a high predictive value of these simulations. The material models in these simulation models need to be developed sufficiently to meet the requirement of the predictions. For the determination of parameters for the material models, mechanical tests at different strain paths are necessary 1. Usually, the material models implemented in the simulation models are not able to describe the plastic material behaviour during monotonic strain paths sufficiently accurate 2. This is true for the strain hardening model, the influence of strain rate and the description of the yield locus in these models. A first stage is to implement the improved material models which describe this single strain path behaviour in a better way. In this work, different yield criteria, a hardening model and their comparison to experiments are described extensively. The improved material model has been validated initially on forming limit curves which are determined experimentally with Nakazima strips. These results will be compared with predictions using Marciniak-Kuczinsky-analysis with both the new material model and the conventional material model. Finally, the validation on real pressed products will be shown by comparing simulation results using different material models with the experimental data. The next challenge is the description of the material after a change of strain path. Experimental evidence given here shows that this behaviour cannot be treated using the classical approach of an equivalent strain as the only history variable.

Clarithromycin is a relatively new antibiotic with many applications. Its frequent use explains why side-effects previously reported seldom now become clear. Two patients, a man aged 74 and a woman aged 56 years, developed delirium after treatment with clarithromycin as part of eradication treatment of Helicobacter pylori, presumably as a result of an ideosyncratic reaction to the clarithromycin. Preclinical and clinical investigations did not reveal side effects on the central nervous system. By now the appearance of a delirium presumably related to the use of clarithromycin has been described in several patients. Furthermore some patients had a positive rechallenge. Finally, 17 reports on psychiatric side effects, of which 7 were delirium, after the use of clarithromycin reached the Netherlands Pharmacovigilance Foundation (Lareb). This combination of facts makes a causal relationship probable.

A new material description for sheet metal forming using Finite Elements has been developed. The description consists of a yield criterion and a hardening rule. In contrast to most former criteria the new criterion is based on multi-axial stress states. The yield criterion is extended with a physically based hardening rule, in which the flow stress depends on the strain and strain rate. A Limiting Dome Height test is used to examine the material description.