Diagnostik bei Glomerulonephritis: Rationaler Abklärungsgang

Zusammenfassung: Glomerulonephritiden sind eine wichtige und häufige Ursache der fortgeschrittenen Niereninsuffizienz. Hinsichtlich Therapierbarkeit und Prognose sind eine frühzeitige Abklärung und Diagnosestellung von entscheidender Bedeutsamkeit. Die wichtigsten klinischen Zeichen der Glomerulonephritis per se sind arterielle Hypertonie, Ödeme, Proteinurie, Hämaturie und Niereninsuffizienz. Dazu kommen Symptome allfälliger Systemerkrankungen. Der Abklärungsgang umfasst Erhebung der Anamnese, klinische Untersuchung, Laboruntersuchungen im Blut und Urin, bildgebende Verfahren wie Sonographie und Magnetresonanzuntersuchung und in den meisten Fällen die perkutane Nierenbiopsie. Bei der Diagnostik ist es besonders wichtig, eine behandelbare Ursache - wie Medikamentennebenwirkung, Infekt, Tumor oder entzündliche Systemerkrankung - zu erkennen. Glomerulonephritiden können einerseits aufgrund ihrer klinischen Präsentation und andererseits basierend auf den histologischen Veränderungen genauer klassifiziert werde

Long-term evolution of renal function in patients with ovarian cancer after whole abdominal irradiation with or without preceding cisplatin

Background: The upper limit of the natural decline in creatinine clearance is 1 ml/min/year. To define the loss of renal function, we started a long-term assessment of patients with ovarian cancer treated by whole abdominal irradiation (WAI) with preceding cisplatin chemotherapy (CDDP) and second-look laparotomy (SLL). Patients and methods: We analyzed the creatinine clearance over time of 56 patients treated from 1982 to 1988 for ovarian cancer. Thirty-one of 56 patients had received WAI after their initial surgery, and 25 of 56 patients had undergone CDDP therapy followed by SLL, and then WAI after their initial surgery. Median follow-up was 99 months (7-156). Twenty of 56 patients accepted our invitation for additional assessment of tubular function, nine of the 31 patients without CDDP therapy and SLL, and 11 of the 25 patients with CDDP followed by SLL and WAI. Ten of twenty patients had received four to six cycles CDDP, 80 mg/m2/cycle, and one patient nine cycles. The median total dose for each kidney was 1450 cGy (480-1690). Results: The mean creatinine clearance decreased from 84 ml/min to 66 ml/min. Seventy-six percent of the 25 patients who had undergone CDDP therapy, SLL and WAI had declines of more than 1 ml/min/year, 64% of these patients of more than 2 ml/min/year. For the 31 patients who had received WAI after their initial surgery, the corresponding numbers were 71% and 55%, respectively. The tubular function of the 20 patients who had undergone the additional investigations was not impaired. Conclusion: The decline in renal function after WAI is more pronounced than in healthy subjects. The treatment with cisplatin and SLL prior to WAI does not seem to contribute to this loss of kidney functio

Near-infrared synchrotron emission from the compact jet of GX339-4

We have compiled contemporaneous broadband observations of the black hole candidate X-ray binary GX 339-4 when in the low/hard X-ray state in 1981 and 1997. The data clearly reveal the presence of two spectral components, with thermal and non-thermal spectra, overlapping in the optical -- near-infrared bands. The non-thermal component lies on an extrapolation of the radio spectrum of the source, and we interpret it as optically thin synchrotron emission from the powerful, compact jet in the system. Detection of this break from self-absorbed to optically thin synchrotron emission from the jet allows us to place a firm lower limit on the ratio of jet (synchrotron) to X-ray luminosities of $\geq 5$%. We further note that extrapolation of the optically thin synchrotron component from the near-infrared to higher frequencies coincides with the observed X-ray spectrum, supporting models in which the X-rays could originate via optically thin synchrotron emission from the jet (possibly instead of Comptonisation).Comment: Accepted for publication in ApJ Lette

A bacteriorhodopsin analog reconstituted with a nonisomerizable 13-trans retinal derivative displays light insensitivity

With the aim of preparing a light-insensitive bacteriorhodopsin-like pigment, bacterio-opsin expressed in Escherichia coli was treated in phospholipid-detergent micelles with the retinal analog II, in which the C13-C14 trans-double bond cannot isomerize due to inclusion in a cyclopentene ring. The formation of a complex with a fine structure (λmax, 439 nm) was first observed. This partially converted over a period of 12 days to a bacteriorhodopsin-like chromophore (ebR-II) with λmax, 555 nm. An identical behavior has been observed previously upon reconstitution of bleached purple membrane with the analog II. Purification by gel filtration gave pure ebR-II with λmax, 558 nm, similar to that of light-adapted bacterio-opsin reconstituted with all-trans retinal (ebR-I). Spectrophotometric titration of ebR-II as a function of pH showed that the purple to blue transition of bacteriorhodopsin at acidic pH was altered, and the apparent pKa of Schiff base deprotonation at alkaline pH was lowered by 2.4 units, relative to that of ebR-I. ebR-II showed no light-dark adaptation, no proton pumping, and no intermediates characteristic of the bacteriorhodopsin photocycle. In addition, the rates of reaction with hydroxylamine in the dark and in the light were similar. These results show, as expected, that isomerization of the C13-C14 double bond is required for bacteriorhodopsin function and that prevention of this isomerization confers light insensitivity

Spin-phonon coupling in Gd(Co1/2Mn1/2)O3 perovskite

We have investigated the temperature-dependent Raman-active phonons and the magnetic properties of Gd(Co1/2Mn1/2)O3 perovskite ceramics in the temperature range from 40 K to 300 K. The samples crystallized in an orthorhombic distorted simple perovskite, whose symmetry belongs to the Pnma space group. The data reveals spin-phonon coupling near the ferromagnetic transition occurring at around 120 K. The correlation of the Raman and magnetization data suggests that the structural order influences the magnitude of the spin-phonon coupling.Comment: 3 Figures, suplementary materia

Hysteresis of spectral evolution in the soft state of black-hole binary LMC X-3

We report the discovery of hysteresis between the x-ray spectrum and luminosity of black-hole binary LMC X-3. Our observations, with the Proportional Counter Array on the Rossi X-ray Timing Explorer, took place entirely within the soft spectral state, dominated by a spectral component that was fitted well with a multicolor disk blackbody. A power-law component was seen only during times when the luminosity of the disk blackbody was declining. The x-ray luminosity at these times was comparable to that seen in transient systems (x-ray novae) when they return to the hard state at the end of an outburst. Our observations may represent partial transitions to the hard state; complete transitions have been seen in this system by Wilms et al. (2001). If they are related to the soft-to-hard transition in transients, then they demonstrate that hysteresis effects can appear without a full state transition. We discuss these observations in the context of earlier observations of hysteresis within the hard state of binaries 1E 1740.7-2942 and GRS 1758-258 and in relation to published explanations of hysteresis in transients.Comment: 14 pages, 6 figures, accepted by The Astrophysical Journa

Complete-Graph Tensor Network States: A New Fermionic Wave Function Ansatz for Molecules

We present a new class of tensor network states that are specifically designed to capture the electron correlation of a molecule of arbitrary structure. In this ansatz, the electronic wave function is represented by a Complete-Graph Tensor Network (CGTN) ansatz which implements an efficient reduction of the number of variational parameters by breaking down the complexity of the high-dimensional coefficient tensor of a full-configuration-interaction (FCI) wave function. We demonstrate that CGTN states approximate ground states of molecules accurately by comparison of the CGTN and FCI expansion coefficients. The CGTN parametrization is not biased towards any reference configuration in contrast to many standard quantum chemical methods. This feature allows one to obtain accurate relative energies between CGTN states which is central to molecular physics and chemistry. We discuss the implications for quantum chemistry and focus on the spin-state problem. Our CGTN approach is applied to the energy splitting of states of different spin for methylene and the strongly correlated ozone molecule at a transition state structure. The parameters of the tensor network ansatz are variationally optimized by means of a parallel-tempering Monte Carlo algorithm

The economic burden of cancer in the UK: a study of survivors treated with curative intent.

OBJECTIVE: We aim to describe the economic burden of UK cancer survivorship for breast, colorectal and prostate cancer patients treated with curative intent, 1 year post-diagnosis. METHODS: Patient-level data were collected over a 3-month period 12-15 months post-diagnosis to estimate the monthly societal costs incurred by cancer survivors. Self-reported resource utilisation data were obtained via the electronic Patient-reported Outcomes from Cancer Survivors system and included community-based health and social care, medications, travel costs and informal care. Hospital costs were retrieved through data linkage. Multivariate regression analysis was used to examine cost predictors. RESULTS: Overall, 298 patients were included in the analysis, including 136 breast cancer, 83 colorectal cancer and 79 prostate cancer patients. The average monthly societal cost was $US409 (95$US316-$US502) [mean: £260, 95$US279, 95%CI: $US207-$US351) [mean: £177, 95%CI: £131-£224], patients' out-of-pocket (OOP) expenses (mean: $US40, 95$US15-$US65) [mean: £25, 95$US110, 95%CI: $US57-$US162) [mean: £70, 95%CI: £38-£102]. The distribution of costs was skewed with a small number of patients incurring very high costs. Multivariate analyses showed higher societal costs for breast cancer patients. Significant predictors of OOP costs included age and socioeconomic deprivation. CONCLUSIONS: This study found the economic burden of cancer survivorship is unevenly distributed in the population and that cancer survivors may still incur substantial costs over 1 year post-diagnosis. In addition, this study illustrates the feasibility of using an innovative online data collection platform to collect patient-reported resource utilisation information. Copyright © 2015 John Wiley & Sons, Ltd