Search

Background and objectivesCognitive symptoms persisting beyond three months following COVID-19 present a considerable disease burden. We aimed to establish a domain-specific cognitive profile of post-COVID syndrome (PCS) and relationships with subjective cognitive complaints and clinical variables to provide relevant information for the understanding of cognitive dysfunction and its predictors in a clinical cohort with PCS.MethodsIn this cross-sectional study, we compared cognitive performance on the clinically viable Oxford Cognitive Screen-Plus between a large post-COVID cohort (n= 282) and a socio-demographically matched healthy control group (n= 52). We assessed group differences in terms of fatigue and depression as well as relationships between cognitive dysfunction and clinical and patient-reported outcomes.ResultsOn a group-level, patients scored significantly lower on delayed verbal memory (non-parametric effect sizer= .13), attention (r= .1), and executive functioning (r=.1) than healthy controls. In each of these domains, 10-20% of patients performed more than 1.5 SD below the healthy control mean. Delayed Memory was particularly affected and a small proportion of its variance was explained by hospitalisation (β= -.72,p< .01) and age (β= -.03,p< .05; R2adj. = .08). Attention scores were significantly predicted by hospitalisation (β= -.78,p< .01) and fatigue (β= -.04,p< .05; R2adj. = .06).DiscussionPCS is associated with long-term cognitive dysfunction, particularly in delayed verbal memory, attention, and executive functioning. Deficits in delayed memory performance seem to be of particular relevance to patients’ subjective experience of impairment. Initial disease severity, current level of fatigue, and age seem to predict cognitive performance, while time since infection, depression, and pre-existing conditions do not. Longitudinal data are needed to map long-term course of cognitive dysfunction in PCS.

173 renal transplantations were done over a period of 12 years. Among these were 162 first, 10 second and one third transplantation. The one year survival rate of transplanted kidneys (all cases) was around 50%, patient survival was 81.6%. Survival rates did not depend statistically on tissue compatibility, immediate function of kidney, duration of kidney conservation, donor age, commencement of graft versus host reaction, and duration of preoperative dialysis. Although the number of HLA identity has increased during the observation period, there was no increase of transplant survival rate. This may possibly be explained by the negative influence of the steady increase of conservation time during the same period.

Sarcoidosis of the kidneys and liver without radiologically demonstrable lung involvement in a 44-year-old woman was shown to be the cause of a hypercalcaemia syndrome. The hypercalcaemia was presumably due to an increased production of 1,25-(OH)2-vitamin D3 which--like the increased angiotensin converting enzyme--is produced in the epithelioid and giant cells. Corticoid treatment normalized serum calcium and ACE levels and improved renal function. These observations demonstrate that measurement of ACE and 1,25-(OH)2-vitamin D3 levels is helpful in the differential diagnosis of hypercalcaemia, in view of the possibility of sarcoidosis, and should be among the diagnostic tests.

Although there is an abundance of published literature about interprofessional education (IPE) and research as a way to enhance patient-centered outcomes, there is no published literature that specifically addresses guidelines for conducting interprofessional team research that includes health care students. Guidelines for conducting interprofessional research (IPR), within an interprofessional model, are helpful to provide an infrastructure to guide the research team and form a foundation for future IPR teams. IPR guidelines clarify investigator team member roles and encourage the dissemination of study results (Eccott et al., 2012). The purpose of this article is to describe guidelines that provide a structured approach for interprofessional teams to conduct research.DEVELOPMENT OF RESEARCH GUIDELINESInitial interest in developing the guidelines came from a unique community research consortium (CRC) in northeast Indiana. The CRC was initially established by local universities and hospitals as a forum to exchange ideas and discuss and support research being conducted by the founding organizations. The mission of this unique consortium is to foster collaborative research among health care organizations, higher education institutions, and community organizations in the region.The CRC supports the development of IPR skills while engaging in research projects that address local health care concerns, including care for underserved, vulnerable, marginalized populations and the reduction of health care disparities. There is collaboration across several disciplines (physicians, family medicine residents, medical students, nurses, nurse practitioners, physician assistants, occupational and physical therapists, pharmacists, and behavioral scientists) and institutions, including hospitals and other practice settings, to form research teams to carry out projects in the community.An IPE approach provides the promise of effective, patientcentered care with enhanced outcomes. IPR also values the roles of all investigators while simultaneously learning about their respective roles (Eccott et al., 2012). One of the positive results of the CRC has been the ability for diverse health care professionals to collaborate about strategies to improve health outcomes of underserved populations. The CRC has provided support for several research projects that have led to enhanced patient care outcomes. These successful projects led to the decision to develop guidelines to assist in coordinating research projects utilizing all individuals and their respective skill sets. …

Yeast microsomes contain a heptameric Sec complex involved in post-translational protein transport that is composed of a heterotrimeric Sec61p complex and a tetrameric Sec62-Sec63 complex. The trimeric Sec61p complex also exists as a separate entity that probably functions in co-translational protein transport, like its homolog in mammals. We have now discovered in the yeast endoplasmic reticulum membrane a second, structurally related trimeric complex, named Ssh1p complex. It consists of Ssh1p1 (Sec sixty-one homolog 1), a rather distant relative of Sec61p, of Sbh2p, a homolog of the Sbh1p subunit of the Sec61p complex, and of Sss1p, a component common to both trimeric complexes. In contrast to Sec61p, Ssh1p is not essential for cell viability but it is required for normal growth rates. Sbh1p and Sbh2p individually are also not essential, but cells lacking both proteins are impaired in their growth at elevated temperatures and accumulate precursors of secretory proteins; microsomes isolated from these cells also exhibit a reduced rate of post-translational protein transport. Like the Sec61p complex, the Ssh1p complex interacts with membrane-bound ribosomes, but it does not associate with the Sec62-Sec63p complex to form a heptameric Sec complex. We therefore propose that it functions exclusively in the co-translational pathway of protein transport.

We study numerically the dynamo transition of an incompressible electrically conducting fluid filling the gap between two concentric spheres. In a first series of simulations, the fluid is driven by the rotation of a smooth inner sphere through no-slip boundary conditions, whereas the outer sphere is stationary. In a second series a volume force intended to simulate a rough surface drives the fluid next to the inner sphere within a layer of thickness one tenth of the gap width. We investigate the effect of the boundary layer thickness on the dynamo threshold in the turbulent regime. The simulations show that the boundary forcing simulating the rough surface lowers the necessary rotation rate, which may help to improve spherical dynamo experiments.

Cerebral visual disorders are frequent after brain damage (20-40%). Among them, homonymous field defects and associated reading and visual exploration disorders, reduced visual acuity, contrast sensitivity and light/dark adaptation, fusional disorders, visuospatial deficits, multimodal hemineglect, and Balint-Holmes syndrome are the most common. Prototypical symptoms are the omission of obstacles and hemianopic alexia in visual field disorders, blurred vision in reduced acuity and/or contrast sensitivity or impaired fusion, blinding in impaired light adaptation and dark vision in impaired dark adaptation, and impaired action and orientation in visuospatial deficits. Neglect is characterized by omissions of stimuli on the contralesional side in space or the body. Patients with Balint-Holmes syndrome show severe spatial and attentional deficits. Systematic treatments can be categorized as restitution, compensation, and substitution approaches. Hemineglect can be ameliorated by novel, more effective treatment approaches, whereas only initial stages of treatment are available for Balint-Holmes syndrome.

Technical aspects of the three major components of the H1 detector at the electron-proton storage ring HERA are described. This paper covers the detector status up to the end of 1994 when a major upgrading of some of its elements was undertaken. A description of the other elements of the detector and some performance figures from luminosity runs at HERA during 1993 and 1994 are given in a paper previously published in this journal.

General aspects of the H1 detector at the electron-proton storage ring HERA as well as technical descriptions of the magnet, luminosity system, trigger, slow-control, data acquisition and off-line data handling are given. The three major components of the detector, the tracking, calorimeter and muon detectors, will be described in a forthcoming article. The present paper describes the detector that was used from 1992 to the end of 1994. After this a major upgrade of some components was undertaken. Some performance figures from luminosity runs at HERA during 1993 and 1994 are given.

The aerodynamic design and rig test evaluation of a small counter-rotating turbine system is described. The technology represented by this turbine is being developed for application in an advanced upper stage rocket engine turbopump. This engine will employ an oxygen/hydrogen expander cycle and achieve high performance through efficient combustion, high combustion pressure, and high area ratio exhaust nozzle expansion. Engine performance goals require that the turbopump drive turbines achieve high efficiency at low gas flow rates. The low flow rates result in very small airfoil diameter, height and chord. The high efficiency and small size requirements present a challenging turbine design problem. The unconventional approach employed to meet this challenge is described, along with the detailed design process and resulting airfoil configurations. The method and results of full scale aerodynamic performance evaluation testing of both one and two stage configurations, as well as operation without the secondary stage stator are presented. The overall results of this effort illustrate that advanced aerodynamic design tools and hardware fabrication techniques have provided improved capability to produce small high performance turbines for advanced rocket engines.

The paper describes some of the design solutions that were adopted in the realization of a small two shaft, counterrotating turbine rig. The turbine, for a small space engine technology upper stage liquid propellant rocket turbo pump system, was only 100mm tip diameter with a correspondingly small annulus height. Detailed flow measurements were provided by 3 axis actuators at inlet and outlet of the working section. Torque and Power were measured on each shaft using Radio Frequency (R.F.) telemetry torquemeters. A modular design allowed the rig to be rebuilt rapidly in one and two stage configurations with different blade sets. This enabled the effect of changing turbine configurations to be studied.

In a retrospective study over three years, 23 patients were provided with a swan-neck Tenckhoff catheter (SNC) and 49 patients (control group) with a straight Tenckhoff catheter (STC) at the beginning of CAPD and were observed over a follow-up period of 608 patient-months. The aim of the study was to examine the reduction of complications in the course of CAPD with SNC resulting from technical causes, such as catheter dislocations, infections at the catheter's point of exit, the tunnel and the peritoneum. The causes of renal insufficiency, the reasons for choosing CAPD as a dialytic procedure, the causes of catheter loss as well as the frequency of infections associated with CAPD were analyzed. The main reasons for catheter loss were peritonitis and dislocations. In the SNC group a significant reduction of dislocations to 8.7% was observed as against 26.5% with STC. On the other hand, with SNC significantly more cases of peritonitis were observed in terms of statistics, with 1.1 episodes per patient-year (EOP/PY) compared with 0.3 EOP/PY with STC. The frequency of the exit site and tunnel infections and the cumulative survival probability of the catheters did not differ. The SNC is an interesting alternative to the STC; however, the expectations were only partly met.

We monitored the plasma levels of mexiletine in 20 dialysis patients with severe cardiac arrhythmias after repeated oral administration and the elimination by various dialysis procedures. The levels of mexiletine in plasma and dialysate were assayed by high-pressure liquid chromatography. After repeated administration of mexiletine 400–600 mg/day trough levels were in the range from 500–2,000 ng/ml. Treatment controlled by Holter monitoring was effective in 13/20 patients. Doses of 600 mg/day and more often were not tolerated by patients with dialysis after some weeks. There was no important removal of mexiletine from plasma during hemodialysis, hemofiltration, peritoneal dialysis, or plasmapheresis. In conclusion, we recommend a slightly reduced dosage of 400–600 mg mexiletine/day (usually 600–800 mg) for patients with end-stage renal insufficiency, irrespective of dialysis.

The hypothalamus-pituitary-Leydig cell axis was investigated in 20 male patients undergoing intermittent hemodialysis and in 21 male patients following renal transplantation compared to normal controls. Plasma testosterone as well as luteinizing hormone and follicle stimulating hormone were determined by radioimmunoassay under basal conditions and after stimulation with choriongonadotropic hormone and hypothalamus releasing hormone respectively. Suppressed Leydig cell function has been demonstrated in dialysed patients as well as in patients after renal transplantation. The Leydig cell insufficiency is more pronounced in the hemodialysed patients. None of these showed testosterone levels in the normal range. They are different in various dialysis schedules. In contrast Leydig cell function is much better in patients after renal transplantation compared to those undergoing intermittent hemodialysis. But even after renal transplantation a diminished Leydig cell function takes place. The degree of Leydig cell insufficiency however varies individually. In a few cases Leydig cell function is restored completely after transplantation. It remains uncertain whether the duration of the posttransplantation period or the function of the graft effects Leydig cell function. Anterior lobe insufficiency has been excluded since plasma concentrations of gonadotropins were slightly elevated before and after LH-RH stimulation as compared to normals.

173 renal transplantations were done over a period of 12 years. Among these were 162 first, 10 second and one third transplantation. The one year survival rate of transplanted kidneys (all cases) was around 50%, patient survival was 81.6%. Survival rates did not depend statistically on tissue compatibility, immediate function of kidney, duration of kidney conservation, donor age, commencement of graft versus host reaction, and duration of preoperative dialysis. Although the number of HLA identity has increased during the observation period, there was no increase of transplant survival rate. This may possibly be explained by the negative influence of the steady increase of conservation time during the same period.

Sarcoidosis of the kidneys and liver without radiologically demonstrable lung involvement in a 44-year-old woman was shown to be the cause of a hypercalcaemia syndrome. The hypercalcaemia was presumably due to an increased production of 1,25-(OH)2-vitamin D3 which--like the increased angiotensin converting enzyme--is produced in the epithelioid and giant cells. Corticoid treatment normalized serum calcium and ACE levels and improved renal function. These observations demonstrate that measurement of ACE and 1,25-(OH)2-vitamin D3 levels is helpful in the differential diagnosis of hypercalcaemia, in view of the possibility of sarcoidosis, and should be among the diagnostic tests.

The corneas of 100 patients on dialysis for renal failure were observed. In 52 patients follow up studies were possible. 55 patients demonstrated limbal changes. On slit lamp biomicroscopy these changes showed to be similar to the white limbus girdle described by Vogt. Small limbal biopsies from five patients on dialysis were studies histopathologically and compared to biopsies from three patients with normal renal function. Only patients on dialysis showed senile elastosis and three of them epithelial and subepithelial hyaline deposits. Calcium deposition was the same in both groups.

We monitored the plasma levels of mexiletine in 20 dialysis patients with severe cardiac arrhythmias after repeated oral administration and the elimination by various dialysis procedures. The levels of mexiletine in plasma and dialysate were assayed by high-pressure liquid chromatography. After repeated administration of mexiletine 400-600 mg/day trough levels were in the range from 500-2,000 ng/ml. Treatment controlled by Holter monitoring was effective in 13/20 patients. Doses of 600 mg/day and more often were not tolerated by patients with dialysis after some weeks. There was no important removal of mexiletine from plasma during hemodialysis, hemofiltration, peritoneal dialysis, or plasmapheresis. In conclusion, we recommend a slightly reduced dosage of 400-600 mg mexiletine/day (usually 600-800 mg) for patients with end-stage renal insufficiency, irrespective of dialysis.

In 102 patients on dialysis for renal failure late fundus controls have been done to studie the response of retinal vessels to blood pressure reduction. In 52 patients follow up studies were possible. Only 4 patients showed reversible changes of the vessels, in 4 other patients changes increased. In the majority of the patients hypertensive vascular changes (stage I or II) remained unchanged. Young age and deep diastolic pressure seems to be necessary for normalization of the fundus vessels. Vessel changes did not improve if the diastolic pressure was 90--100 mmHg and more.

The retrospective investigation of 54 patients with analgesic nephropathy showed the relatively early occurrence of coronary sclerosis and an increased frequency of arteriosclerotic renal artery stenosis. Angina pectoris was found in 14 patients with a mean age of 48 1/2 years. Summation of risk factors is the probable cause of the tendency for arteriosclerosis: hypercholesterolaemia and hypertriglyceridaemia was found in 29 patients, arterial hypertension in 42 patients, which was so severe in half of the patients that combined treatment with two or more drugs was necessary. The causes of lipid metabolism disturbances as well as the pathogenesis of arterial hypertension are not known. Arteriosclerotic renal artery stenoses observed in 8 patients are not likely to be the cause of hypertension.

Die Zahl der in der BRD mit Dialyse und Transplantation versorgten Patienten liegt wesentlich hoher, als fruhere Schatzungen der EDTA vorhersagten (Abb. 1). Ende 1979 wurden 161 Patienten/1 Mio. Einwohner versorgt, davon uber 140 mittels Dialyse (2).

So far the question has not been elucidated whether latent ESF-deficiency exists in patients with chronic renal disease during initial development of renal anemia. Therefore, ESF was determined in urine and serum of non anemic patients being exposed to acute hypoxia: 8 healthy volunteers and 8 patients who had a Ccreat below 48 ml/min were studied while in a hypobaric chamber for 4 subsequent periods of 10 h each (simulated maximal altitude 4000 m INA = 462 mm Hg). We also determined plasma iron turnover and reticulocyte counts. 10 h after the study began, the patients showed a significantly higher ESF-level than the normal volunteers. In the course of 48 h collection periods of urine under hypoxic conditions the mean ESF excretion in patients corresponded to 9.9 and in healthy persons to 7.3 Units. With regard to plasma iron turnover and reticulocyte count an increase was shown, but no significant differences existed between the two groups. A latent ESF-deficiency as the initial cause of renal anemia does not exist.

Serum levels and urinary excretion rates of sisomicin were measured after a single i.v. injection of 1 mg/kg body wt. in 24 patients with various degrees of impaired renal function. A good correlation was found between the elimination constants and the half-lives on the one hand and creatinine clearances, serum creatinine and blood urea levels on the other hand. The retention of sisomicin increases with decreasing renal function. On the basis of these results a dosage regimen for the sisomicin therapy in patients with renal insufficiency is suggested.

A group of 252 chronic hemodialysis patients was examined for various risk factors. Special emphasis was placed upon the comparison of patients who had marked cardiovascular alterations with the remainder of the group. The seriousness of the risk factors was determined by hypertension and hyperlipoproteinemia. 78% of the patients received antihypertensive medication or had changes in the fundus of the eye or both. In 74% of the patients there were pathological changes in the plasma lipids or lipoproteins or both. Hypertriglyceridemia (49%) and a HDL cholesterol decrease (61%) were the most striking findings. The average VLDL cholesterol value was significantly higher and the HDL cholesterol significantly lower in the coronary heart disease group than in the remaining group. These results show that hyperlipoproteinemia and a decrease in HDL, together with other risk factors such as hypertension and anemia, play an important role in the accelerated development of atherosclerosis in a hemodialysis group.

A patient on chronic intermittent hemodialysis at home showed signs of acute encephalopathy after an 8-day's treatment with a total dose of 78 g cephacetril (Celospor). Features included papilledema, loss of visual fields, severe generalized EEG changes and bilateral occipital abnormalities on a brain scintigram. Psychopathological findings consisted of a severe psychosis. The visual fields defects were the last sign of the encephalopathy to disappear.

The clinical picture of the panarteritis nodosa is characterized by vague early symptoms, manifestations in various organs and a changing prognosis. In seven patients with histologically proven panarteritis nodosa the clinical course was followed up over a long period. The commonest early symptoms were fever of unknown origin and a considerable loss of weight. Three out of seven patients showed in the initial phase a hypertension, in two other patients the blood pressure rose as the disease progressed. Those patients, whose renal function was impaired when the diagnosis was established, had a poor prognosis in spite of immunosuppressive therapy and dialysis. The life expectancy of these patients was between two and 16 months (in average 6,4 months). On the other side the clinical course in two patients without renal failure was more favourable; they are alive eight months and 15 years respectively after the diagnosis was confirmed.