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The prevalence of oropharyngeal dysphagia in older persons is high. Because it is frequently undetected, screening tests should be applied in risk groups. If the screening test is positive or typical risk factors are present, an instrumental assessment should be utilized. Objective diagnostic tools such as endoscopic evaluation and videofluoroscopy allow the description of the individual dysphagia pattern, which is the basis for an individualized treatment. The endoscopic evaluation of swallowing is increasingly used because it includes several advantages. Potential therapeutic strategies are multifaceted. The evidence for the effectiveness of adaptive, compensatory and rehabilitative strategies is growing, supporting the evolution of dysphagia therapy to an evidence based treatment., Competing Interests: Rainer Wirth hat Honorare für Vortragstätigkeiten und/oder Beratungen von folgenden Firmen erhalten: Nutricia, B.Braun, Fresenius kabi, Nestle, Infectopharm und apetito.Gero Lueg hat keine potentiellen Interessenskonflikte.Rainer Dziewas hat Honorare für Vortragstätigkeiten und/oder Beratungen von folgenden Firmen erhalten: Nutricia, Fresenius kabi, Nestle, Infectopharm., (© Georg Thieme Verlag KG Stuttgart · New York.)

The refeeding syndrome is a life-threatening complication that can occur after initiation of a nutrition therapy in malnourished patients. If the risk factors and pathophysiology are known, the refeeding syndrome can effectively be prevented and treated, if recognized early. A slow increase of food intake and the close monitoring of serum electrolyte levels play an important role. Because the refeeding syndrome is not well known and the symptoms may vary extremely, this complication is poorly recognized, especially against the background of geriatric multimorbidity. This overview is intended to increase the awareness of the refeeding syndrome in the risk group of geriatric patients.

Older people suffering from dementia are at increased risk of malnutrition due to various nutritional problems, and the question arises which interventions are effective in maintaining adequate nutritional intake and nutritional status in the course of the disease. In an international expert group, initiated by the European Society for Clinical Nutrition and Metabolism (ESPEN), 26 evidence-based recommendations for nutritional care of older persons with dementia have been developed, covering the topics of screening and assessment of malnutrition, strategies to support oral nutrition, oral supplementation and artificial nutrition. This article is a short version of the guideline., (© Georg Thieme Verlag KG Stuttgart · New York.)

Leaf-cutting ants (Atta spp.) have become a topical issue in Neotropical ecology, particularly because they are reaching hyper-abundance due to escalating levels of fragmentation in recent years. Yet, despite intensive research on their role as dominant herbivores, there is still insufficient documentation on the impacts of their large, long-lived nests on plant assemblage structure and ecosystem functioning. Our study aimed at investigating the magnitude, nature, and spatial extent of nest influence by assessing 11 attributes of ant nest, canopy structure, light environment and sapling assemblage for 20 colonies in four plots along nest-understorey gradients in a large remnant of Atlantic forest. We also monitored the performance of seeds and seedlings of Chrysophyllum viride, an abundant shade-tolerant species. Previously unrecognized canopy gaps above ant nests (0.04-87.9 m(2)) occurred in 95% of all colonies surveyed. Overall, canopy openness and light availability at least doubled in ant nest plots compared with distant understorey plots. These drastic changes in the light environment paralleled those in plant assemblage: sapling density almost tripled (mean +/- SE: 0.42 +/- 0.1 saplings m(-2)) and sapling species richness doubled (0.16 +/- 0.02 species m(-2)) in distant plots, as did shade-tolerant species. After a 1-year period, only 33 +/- 15.6% of the seeds germinated and all seedlings died on nests, whereas seed germination reached 68 +/- 5.1% in distant plots and 66.4 +/- 7.6% of their seedlings survived after 12 months. Therefore, plot location was the most significant explanatory variable for predictable and conspicuous changes in the light environment and structure of sapling assemblages. Our findings greatly extend knowledge on the role played by leaf-cutting ants as ecosystem engineers by demonstrating that ant nest-mediated disturbance promotes environmental modifications in tens of meters around nests and is thus, strong enough to drive plant recruitment and consequently alter both the floristic and functional signature of plant assemblages.

Gastrostomy site infections following percutaneous endoscopic gastrostomy (PEG) are the most common complication after PEG placement. Recent meta-analyses were able to show that PEG site infections can be reduced significantly with a systemic antimicrobial prophylaxis. This mostly cephalosporin- or penicillin-based prophylaxis does not cover fungal infections. Although Candida skin infections after PEG placement are rarely described, a mucosal colonization or infection of the upper GI tract with Candida species is very common, especially in severely ill patients such as those requiring artificial nutrition. The authors report a rare and lethal case of a necrotizing PEG site infection with Candida albicans in a patient with diabetes with multiple comorbidities, presenting like gas gangrene. In patients with probable immunodeficiency or visible candidiasis of the skin, oropharynx, or esophagus, a Candida infection should be considered in case of a gastrostomy site infection.

In Germany sales of vitamin and trace element supplements are 1,2 billion Euros per year. In the light of this dimension and the increasing tendency toward food fortification, medicine and nutritional science have to state their point of view, where supplementation is useful, where it might be useful, and where it is useless or possibly dangerous. Supposing a balanced diet, nutritional requirements are covered in adults. Only in the area of calcium, folic acid, iodine, and vitamin D a gap in supplies can be discovered in average nutrition. Those requirements should be covered with a balanced diet. The intention of supplementation in this field is the potential health benefit of a requirement-exceeding supplementation. Especially antioxidants are sometimes suggested to have such effects. From a scientific view a general recommendation, especially for multivitamin supplementation, cannot be given. In contrast to young adults, elderly persons frequently suffer from single or general micronutrient deficiencies. The intention of supplementation in this field is the coverage of nutritional requirements and the therapy of specific nutritional deficiencies, which should be compensated, even though scientific evidence in some fields is weak.