Chronic hyperglycemia is associated with acute kidney injury in patients undergoing CABG surgery – a cohort study

Background Chronic hyperglycemia (CHG) with HbA1c as an indicator affects postoperative mortality and morbidity after coronary artery bypass grafting surgery (CABG). Acute kidney injury (AKI) is one of the frequent postoperative complications after CABG impacting short-and long-term outcomes. We investigated the association between CHG and postoperative incidence of AKI in CABG patients with and without history of diabetes mellitus (DM). Methods This cohort study consecutively enrolled patients undergoing CABG in 2009 at the department for cardiovascular surgery. CHG was defined as HbA1c ≥ 6.0 %. Patients with advanced chronic kidney disease (CKD) were excluded. The incidence of postoperative AKI and its association with CHG was analyzed by univariate and multivariate logistic regression modeling. Results Three-hundred-seven patients were analyzed. The incidence of AKI was 48.2 %. Patients with CHG (n = 165) were more likely to be female and had greater waist circumference as well as other comorbid conditions, such as smoking, history of DM, CKD, hypertension, pulmonary hypertension, and chronic obstructive pulmonary disease (all p ≤ 0.05). Preoperative eGFR, atrial fibrillation (AF), history of DM and CHG were associated with an increased risk of postoperative AKI in univariate analyses. In multivariate modelling, history of DM as well as preoperative eGFR and AF lost significance, while age, CHG and prolonged OP duration (p < 0.05) were independently associated with postoperative AKI. Conclusions Our results suggest that CHG defined on a single measurement of HbA1c ≥ 6.0 % was associated with the incidence of AKI after CABG. This finding might implicate that treatment decisions, including the selection of operative strategies, could be based on HbA1c measurement rather than on a recorded history of diabetes

Effiziente Wärmesysteme für Wohngebäude

Die Entwicklung effizienter Wärmesysteme für Wohngebäude ist eine zentrale Aufgabe der Energieforschung. Der Wohngebäudesektor hat seit Jahren einen – witterungsbedingt leicht schwankenden – Anteil von 25 – 30 % am Endenergieverbrauch in Deutschland. Dabei werden über 80 % der im Sektor Haushalte verbrauchten Energie zur Bereitstellung von Wärme verwendet, im Jahr 2013 z. B. 585 TWh oder mehr als ein Fünftel des gesamtdeutschen Endenergieverbrauchs. Da die Wärmeversorgung hauptsächlich noch über die fossilen Energieträger Erdgas und Heizöl betrieben wird, bieten Wärmesysteme für Wohngebäude ein erhebliches Potenzial für CO2-Einsparungen. Die Energiewende im Heizungskeller beruht dabei – genau wie in anderen Sektoren auch – auf den beiden Säulen erneuerbare Energieversorgung und Effizienz. Durch verschärfte Regelungen für Neubauten und energetische Sanierungen von Bestandsimmobilien wurde in den vergangenen Jahren ein leichter Rückgang des durchschnittlichen flächenspezifischen Heizenergiebedarfs in Wohngebäuden erreicht. Diesem Trend stand jedoch ein steigender Wohnflächenverbrauch pro Person entgegen, so dass der gesamte Heizenergieverbrauch langsamer sinkt als der spezifische Heizenergiebedarf in den Gebäuden. Die jährliche Totalsanierungsquote im Wohnbereich liegt zudem weit unterhalb der als für die Erreichung der Effizienzziele 2050 nötigen postulierten 2,7 %. Ein verstärkter Ausbau des Einsatzes erneuerbarer Energien im Heizungskeller bietet einen zusätzlichen Freiheitsgrad, der zur Erreichung der angestrebten CO2-Minderung beitragen kann

COVID-19 and the kidney: A retrospective analysis of 37 critically ill patients using machine learning.

IntroductionThere is evidence that SARS-CoV2 has a particular affinity for kidney tissue and is often associated with kidney failure.MethodsWe assessed whether proteinuria can be predictive of kidney failure, the development of chronic kidney disease, and mortality in 37 critically ill COVID-19 patients. We used machine learning (ML) methods as decision trees and cut-off points created by the OneR package to add new aspects, even in smaller cohorts.ResultsAmong a total of 37 patients, 24 suffered higher-grade renal failure, 20 of whom required kidney replacement therapy. More than 40% of patients remained on hemodialysis after intensive care unit discharge or died (27%). Due to frequent anuria proteinuria measured in two-thirds of the patients, it was not predictive for the investigated endpoints; albuminuria was higher in patients with AKI 3, but the difference was not significant. ML found cut-off points of >31.4 kg/m2 for BMI and >69 years for age, constructed decision trees with great accuracy, and identified highly predictive variables for outcome and remaining chronic kidney disease.ConclusionsDifferent ML methods and their clinical application, especially decision trees, can provide valuable support for clinical decisions. Presence of proteinuria was not predictive of CKD or AKI and should be confirmed in a larger cohort

Complement factor H binds malondialdehyde epitopes and protects from oxidative stress

Oxidative stress and enhanced lipid peroxidation are linked to many chronic inflammatory diseases, including age-related macular degeneration (AMD). AMD is the leading cause of blindness in Western societies, but its aetiology remains largely unknown. Malondialdehyde (MDA) is a common lipid peroxidation product that accumulates in many pathophysiological processes, including AMD. Here we identify complement factor H (CFH) as a major MDA-binding protein that can block both the uptake of MDA-modified proteins by macrophages and MDA-induced proinflammatory effects in vivo in mice. The CFH polymorphism H402, which is strongly associated with AMD, markedly reduces the ability of CFH to bind MDA, indicating a causal link to disease aetiology. Our findings provide important mechanistic insights into innate immune responses to oxidative stress, which may be exploited in the prevention of and therapy for AMD and other chronic inflammatory diseases

Up close & personal with atoms & molecules

Nature is the best example of a system functioning on the nanometer scale, where the involved materials, energy consumption and data handling are optimized. Opening the doors to the nanoworld the emergence of the scanning tunneling microscope in 1982 and the atomic force microscope in 1986 led to a shift of paradigm in the understanding and perception of matter at its most fundamental level. As a consequence new revolutionary concepts stimulated already a number of new technologies in meeting the somewhat still mechanistic top down approach with the bottom-up approach of self-assembly and self-organisation that has been so successfully implemented in the natural world. However to keep this worldwide effort alive the interdisciplinary structure of Nano requires a new breed of scientists educated in all science disciplines with no language barriers ready to make an impact on all the global challenges ahead where Nanotechnology can be applied.