Glucosuria Predicts the Severity of Puumala Hantavirus Infection

Introduction: Puumala hantavirus (PUUV) causes a mild type of hemorrhagic fever with renal syndrome characterized by acute kidney injury (AKI), increased capillary leakage, and thrombocytopenia. Albuminuria and hematuria in dipstick urine test at hospital admission are known to predict the severity of upcoming AKI. Methods: We analyzed dipstick urine glucose in 195 patients with acute PUUV infection at hospital admission, and divided them into 2 categories according to the presence or absence of glucose in the dipstick urine test. Determinants of disease severity were analyzed in glucosuric and nonglucosuric patients. Results: Altogether, 24 of 195 patients (12%) had glucosuria. The patients with glucosuria had more severe AKI than patients without glucosuria (median maximum creatinine concentration 459 mmol/l, range 78-1041 mmol/l vs. 166 mmol/l, range 51-1499 mmol/l; P <0.001). The glucosuric patients had more severe thrombocytopenia (median minimum platelet count 41 x 10(9)/l, range 5-102 x 10(9)/l vs. 62 x 10(9)/l, range 3249 x 10(9)/l; P = 0.006), and more pronounced signs of increased capillary leakage (change in weight, maximum plasma hematocrit, minimum plasma albumin). The glucosuric patients were more often in clinical shock at admission (20.8% vs. 1.2%; P <0.001) and the length of hospital stay was longer (median 7.5 days, range 4-22 days vs. 6 days, range 2-30 days; P = 0.009). Conclusion: Glucosuria is relatively rare, but when present it predicts a more severe disease course in patients with acute PUUV infection.Peer reviewe

Phosphate Binding with Sevelamer Preserves Mechanical Competence of Bone Despite Acidosis in Advanced Experimental Renal Insufficiency

Introduction Phosphate binding with sevelamer can ameliorate detrimental histomorphometric changes of bone in chronic renal insufficiency (CRI). Here we explored the effects of sevelamer-HCl treatment on bone strength and structure in experimental CRI. Methods Forty-eight 8-week-old rats were assigned to surgical 5/6 nephrectomy (CRI) or renal decapsulation (Sham). After 14 weeks of disease progression, the rats were allocated to untreated and sevelamer-treated (3% in chow) groups for 9 weeks. Then the animals were sacrificed, plasma samples collected, and femora excised for structural analysis (biomechanical testing, quantitative computed tomography). Results Sevelamer-HCl significantly reduced blood pH, and final creatinine clearance in the CRI groups ranged 30%-50% of that in the Sham group. Final plasma phosphate increased 2.4- to 2.9-fold, and parathyroid hormone 13- to 21-fold in CRI rats, with no difference between sevelamer-treated and untreated animals. In the femoral midshaft, CRI reduced cortical bone mineral density (-3%) and breaking load (-15%) (p Conclusions In this model of stage 3-4 CRI, sevelamer-HCl treatment ameliorated the decreases in femoral midshaft and neck mineral density, and restored bone strength despite prevailing acidosis. Therefore, treatment with sevelamer can efficiently preserve mechanical competence of bone in CRI.Peer reviewe

Efficient Implementation of the Well-founded and Stable Model Semantics

An implementation of the well-founded and stable model semantics for range-restricted function-free normal programs is presented. It includes two modules: an algorithm for implementing the two semantics for ground programs and an algorithm for computing a grounded version of a range-restricted function-free normal program. The latter algorithm does not produce the whole set of ground instances of the program but a subset which is sufficient in the sense that no stable models are lost. The implementation of the stable model semantics for ground programs is based on bottom-up backtracking search. It works in linear space and employs a powerful pruning method based on an approximation technique for stable models which is closely related to the well-founded semantics. The implementation includes an efficient algorithm for computing the well-founded model of a ground program. The implementation has been tested extensively and compared with a state of the art implementation of the stable mod..

Implementing Circumscription Using a Tableau Method

A tableau calculus for first-order circumscriptive reasoning is developed. The aim is to handle parallel circumscription with fixed and varying predicates with respect to Herbrand models. First a new clausal tableau calculus for first-order reasoning is developed where a hyper-type rule is combined with a restricted analytical cut rule. Then the calculus is extended to handle parallel circumscription. The calculus is sound in the general case and complete when no function symbols are allowed. A low space complexity is obtained by employing a groundedness property of minimal models that enables a one branch at a time approach to constructing tableaux for circumscriptive inference. The use of a cut rule offers the advantages that when deciding logical consequence the space of counter-models is searched with a preference to minimal models and each counter-model is not generated more than once. 1 Introduction We study the automation of first-order circumscriptive reasoning. Circumscriptio..

A Tableau Calculus for Minimal Model Reasoning

The paper studies the automation of minimal model inference, i.e., determining whether a formula is true in every minimal model of the premises. A novel tableau calculus for propositional minimal model reasoning is presented in two steps. First an analytic clausal tableau calculus employing a restricted cut rule is introduced. Then the calculus is extended to handle minimal model inference by employing a groundedness property of minimal models. A decision procedure based on the basic calculus is devised and then it is extended to minimal model inference. The basic decision procedure and its extension enjoy some interesting properties. When deciding logical consequence, the basic procedure explores the search space of counter-models with a preference to minimal models and each counter-model is not generated more than once. The procedures can be implemented to run in polynomial space, and they provide polynomial time decision procedures for Horn clauses. The extended decision procedure c..