Die gesundheitliche Abwärtsspirale stoppt beim Eintritt in die Sozialhilfe

Wer sich bei der Sozialhilfe meldet, hat oft bereits gesundheitliche Probleme. Dies zeigt eine Studie der BFH, die verschiedene Datensätze miteinander verknüpft. Was kann die quantitative Arbeit leisten? Was bedeuten die Befunde, und was können Sozialdienste tun? Das Gespräch zwischen einem «Datenjongleur» und einem Sozialdienstkenner ordnet ein

Case report: Early onset de novo FSGS in a child after kidney transplantation—a successful treatment

BackgroundEarly onset de novo focal segmental glomerular sclerosis (FSGS) in the kidney allograft in patients without FSGS in the native kidney is a rare disorder in children. It usually occurs mostly beyond the first year after kidney transplantation and often leads to graft loss. Standardized treatment protocols have not yet been established.Case descriptionWe describe a boy with early onset de novo FSGS in the transplanted kidney and non-selective glomerular proteinuria (maximum albumin-to-creatinine ratio of 3.8 g/g; normal range, ≤0.03 g/g creatinine). Manifestation occurred at 30 days posttransplant and was accompanied by a significant graft dysfunction (eGFR 61 ml/min per 1.73 m2). Treatment with 25 sessions of plasmapheresis over 14 weeks and three consecutive days of methylprednisolone pulse therapy (10 mg/kg per day) followed by oral prednisolone as rejection prophylaxis (3.73 mg/m2 per day) led to sustained remission of proteinuria (albumin-to-creatinine ratio of 0.028 g/g) and normalization of graft function (eGFR 92 ml/min per 1.73 m2) after 14 weeks. The follow-up period was 36 months.ConclusionsThis case underlines the efficacy of immunosuppressive and antibody eliminating therapy in early onset de novo FSGS after kidney transplantation

Design and performance of the multiplexing spectrometer CAMEA

The cold neutron multiplexing secondary spectrometer CAMEA (Continuous Angle Multiple Energy Analysis) was commissioned at the Swiss spallation neutron source SINQ at the Paul Scherrer Institut at the end of 2018. The spectrometer is optimised for an efficient data collection in the horizontal scattering plane, allowing for detailed and rapid mapping of excitations under extreme conditions. The novel design consists of consecutive, upward scattering analyzer arcs underneath an array of position sensitive detectors mounted inside a low permeability stainless-steel vacuum vessel. The construction of the world's first continuous angle multiple energy analysis instrument required novel solutions to many technical challenges, including analyzer mounting, vacuum connectors, and instrument movement. These were solved by extensive prototype experiments and in-house developments. Here we present a technical overview of the spectrometer describing in detail the engineering solutions and present our first experimental data taken during the commissioning. Our results demonstrate the tremendous gains in data collection rate for this novel type of spectrometer design

Hemoconcentration and predictors in Shiga toxin-producing E. coli-hemolytic uremic syndrome (STEC-HUS)

Background!#!Hemoconcentration has been identified as a risk factor for a complicated course in Shiga toxin-producing E. coli-hemolytic uremic syndrome (STEC-HUS). This single-center study assesses hemoconcentration and predictors at presentation in STEC-HUS treated from 2009-2017.!##!Methods!#!Data of 107 pediatric patients with STEC-HUS were analyzed retrospectively. Patients with mild HUS (mHUS, definition: max. serum creatinine < 1.5 mg/dL and no major neurological symptoms) were compared to patients with severe HUS (sHUS, definition: max. serum creatinine ≥ 1.5 mg/dL ± major neurological symptoms). Additionally, predictors of complicated HUS (dialysis ± major neurological symptoms) were analyzed.!##!Results!#!Sixteen of one hundred seven (15%) patients had mHUS. Admission of patients with sHUS occurred median 2 days earlier after the onset of symptoms than in patients with mHUS. On admission, patients with subsequent sHUS had significantly higher median hemoglobin (9.5 g/dL (3.6-15.7) vs. 8.5 g/dL (4.2-11.5), p = 0.016) than patients with mHUS. The product of hemoglobin (g/dL) and LDH (U/L) (cutoff value 13,302, sensitivity 78.0%, specificity of 87.5%) was a predictor of severe vs. mild HUS. Creatinine (AUC 0.86, 95% CI 0.79-0.93) and the previously published score hemoglobin (g/dL) + 2 × creatinine (mg/dL) showed a good prediction for development of complicated HUS (AUC 0.87, 95% CI 0.80-0.93).!##!Conclusions!#!At presentation, patients with subsequent severe STEC-HUS had a higher degree of hemoconcentration. This underlines that fluid loss or reduced fluid intake/administration may be a risk factor for severe HUS. The good predictive value of the score hemoglobin (g/dL) + 2 × creatinine (mg/dL) for complicated HUS could be validated in our cohort. A higher resolution version of the Graphical abstract is available as Supplementary Information

Analysis of IL-6 serum levels and CAR-T cell specific digital PCR in the context of cytokine release syndrome (CRS).

CAR-T cell therapies are more and more frequently applied for relapsed B-cell lymphomas and acute lymphoblastic leukemia. Considering the frequency of cytokine release and CAR-T-cell related encephalopathy syndrome (CRS/CRES) following CAR-T administration, strategies enabling timely prediction of impending CRS/CRES are a clinical need. We evaluated the dynamics of serum IL-6 levels and CAR-T transgene copy numbers by digital droplet PCR (ddPCR) in the peripheral blood of eleven consecutive patients with aggressive B-cell malignancies. Four of eleven patients developed CRS, and three patients had CRES (33%), with two of them with previous CRS. IL-6 levels raised on the day of clinical manifestation of CRS. All CRS patients showed increased IL-6 peak levels (median IL-6 peak 606 in CRS patients vs. 22 pg/ml in non-CRS; p=0.0061). Different patterns emerged from the dynamics of CAR-T/µg genomic DNA: "rapid increase and rapid decrease with complete disappearance", "rapid increase and slow decrease with higher persistence", "rapid increase and rapid decrease with lower persistence", and "slow increase and rapid decrease with almost disappearance". Patients with the pattern "rapid increase and slow decrease with higher persistence" of CAR-T/µg genomic DNA concentration seemed at higher risk to develop CRS/CRES. Thus, dynamics of CAR-T transgene copy numbers merit further evaluation for a possible association with manifestation of CRS. Increased IL-6 serum levels at CRS manifestation may contribute to the interpretation of symptoms

Design and Test of a Small React-and-Wind MgB2 Double Pancake

International audienceIn the framework of the project on development of an integrated system for the production of PET tracers based on a dry NbTi supraconducting cyclotron called Lotus, the CEA and SigmaPhi examine the possibility of replacing the NbTi by MgB2. The aim of this work is to develop design tools and technologies for dry MgB2 magnet winding by the react-and-wind process. To validate this work, two dry prototype magnets have been developed: a solenoid of 1 T and a double pancake. To test these prototypes in conditions close to the Lotus cyclotron, a dry test facility, previously developed, will be used up to 3 T. This paper presents the double pancake design, fabrication, instrumentation, and the first test. The critical current and the n-value of the double pancake have been measured and compared with the sample measurement