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BK polyomavirus (BKPyV) and cytomegalovirus (CMV) are the main viral pathogens affecting the graft and recipient outcome after allogenic kidney transplantation. It has recently been found that infection with both viruses has a greater impact on kidney graft function than a single infection. We retrospectively analyzed a cohort of 723 recipients who received kidney transplantation between 2007 and 2015 after living and postmortal donation for differences in risk and outcome parameters regarding BKPyV (DNAemia) and CMV (CMV DNAemia) co-infection compared to sole viremias and to patients without viremia. Of all kidney allograft recipients in our cohort, 8.2% developed co-infection with BKPyV DNAemia and CMV DNAemia, 15.1% showed BKPyV viremia alone and 25.2% sole CMV DNAemia. Acute rejection was closely linked with co-infection (multivariable analysis, p = 0.001). Despite the fact that the estimated glomerular filtration rate of patients with co-infection was noticeably reduced compared to patients with BKV or CMV infection alone, transplant survival and patient survival were not significantly reduced. Co-infection with BKPyV and CMV in kidney transplanted patients is significantly associated with inferior allograft function. Since co-infection is strongly associated with acute rejection, co-infected individuals should be considered a risk collective., Finanziert über die DEAL-Vereinbarung mit Wiley 2019-2022.

Several studies reported a high prevalence of cardiovascular risk factors among police officers and office workers, and adequate cardiorespiratory fitness was reported to have protective effects in reducing cardiovascular risk. Therefore, the present study aimed to evaluate the effects of cardiorespiratory fitness on reducing cardiovascular risk factors in these occupational groups. This cross-sectional study enrolled 101 male participants (55 police officers and 46 office workers). Cardiorespiratory fitness was assessed via spiroergometry. Cardiovascular risk factors were also examined, and the 10-year cardiovascular risk and heart/vascular age were reported using the Framingham risk score. In both groups, higher cardiorespiratory fitness was associated with lower cardiovascular risk factors. Police officers and office workers with higher cardiorespiratory fitness demonstrated significantly lower values in BMI, waist circumference, body fat percentage, diastolic resting blood pressure, heart rate, triglycerides and total cholesterol values, and 10-year cardiovascular risk and heart/vascular age (all factors p < 0.0077, age adjusted). Police officers and office workers mostly presented low levels of cardiorespiratory fitness: 60% of police officers and 58% of office workers were considered “not fit and obese”. Despite different working conditions, both occupational groups had a high rate of low cardiorespiratory fitness levels and showed no differences in their cardiovascular risk profiles. In both groups, cardiorespiratory fitness reduced cardiovascular risk factors, but there was no difference in the influence of cardiorespiratory fitness on cardiovascular risk factors., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Introduction: Increase in the prevalence of metabolic syndrome (MetS) has become a worldwide major health problem. So far, there are limited data about the impact of occupation types and the development of metabolic risks in females. This study aimed to compare the metabolic risk profiles and in two extremely different female occupational groups: police officers (PO) and office workers (OW). Methods: The prospective study included a total number of 97 female subjects (37 POs and 60 OWs) from Germany. Anthropometric characteristics, metabolic risk parameters as well as laboratory parameters were taken. The diagnosis of MetS was based on the criteria of the International Diabetes Federation (IDF). Results: Female OWs presented a high prevalence of obesity, shown in average abdominal waist circumference (85.3 ± 14.5 cm) above the threshold of ≥ 80 cm recommended by the IDF to define abdominal obesity. Sixty percent of OWs versus 25% of POs had an abnormal abdominal waist circumference. Concerning other metabolic risk factors (HDL, triglycerides, body mass index, blood pressure) no significant differences were found, but a tendency toward a higher prevalence of abnormal values is presented in OWs than POs. MetS was detected in almost 8% of OWs as compared with 5% in POs (p = 0.705). Conclusion: In an international comparison, German female POs showed one of the lowest prevalence of MetS, whereas the prevalence in OWs is equal to results in other countries. In conclusion, especially the occupational type of female OWs presented elevated factors, that are associated with increased metabolic risk. There is a relevant need for further prospective studies with larger sample sizes in female workers to determine the influence between occupational type and metabolic system., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Background. Alport syndrome results from a hereditary defect of collagen IV synthesis. This causes progressive glomerular disease, ocular abnormalities, and inner ear impairment. Case Presentation. Herein, we present a case of Alport syndrome in a 28-year-old woman caused by a novel mutation (Gly1436del) in the COL4A4 gene that was not unveiled until her first pregnancy. Within the 29th pregnancy week, our patient presented with massive proteinuria and nephrotic syndrome. Light microscopic examination of a kidney biopsy showed typical histological features of segmental sclerosis, and electron microscopy revealed extensive podocyte alterations as well as thickness of glomerular basement membranes with splitting of the lamina densa. One and a half years after childbirth, renal function deteriorated to a preterminal stage, whereas nephrotic syndrome subsided quickly after delivery. Conclusion. This case report highlights the awareness of atypical AS courses and emphasizes the importance of genetic testing in such cases.

Background: Following a medical habilitation or equivalent qualification after continuous scientific activity, one can apply for a position as an adjunct professor (außerplanmäßige Professur). The medical faculties in Germany have issued regulations for these appointments. The aim of this paper was to compare the requirements for appointment as an adjunct professor among medical faculties. Methods: The currently valid regulations of medical faculties in Germany were analyzed for the target criteria of publication performance, teaching performance, possibility of shortening the procedure, consideration of appointment for junior professor, patents, acquisition of third-party funding, medical didactic qualifications, and/or special scientific achievements, and review procedure. Results: An analysis of 38 currently valid regulations showed large differences between the requirements. The number of required first/senior authorships differs significantly within the regulations (from 4 to 16). The median of the required number of first/senior authorships is six (Q1 = 5, Q3 = 7). In total, 93% (n = 35) of the universities provide information on the publication medium or the value of the publication. Third-party funding is desired or required in 68% (n = 26) of the regulations. There are also clear differences in the scope of required teaching activities, which range from two to a maximum of six years of teaching. Shortening the time to apply for an adjunct professorship is possible in 45% (n = 17) of the cases. In total, 97% (n = 37) of the faculties provide information on external review, with 71% (n = 27) most frequently requesting one or two external reviews. Conclusion: The regulations show clear differences among individual requirements for adjunct professorship. Standardization would be desirable and would lead to comparable conditions and therefore also to a fair recognition of scientific achievements.

Fast metabolism of immediate-release tacrolimus (IR-Tac) is associated with decreased kidney function after renal transplantation (RTx) compared to slow metabolizers. We hypothesized, by analogy, that fast metabolism of extended-release tacrolimus (ER-Tac) is associated with worse renal function. We analyzed data from patients who underwent RTx at three different transplant centers between 2007 and 2016 and received an initial immunosuppressive regimen with ER-Tac, mycophenolate, and a corticosteroid. Three months after RTx, a Tac concentration to dose ratio (C/D ratio) < 1.0 ng/ml · 1/mL defined fast ER-Tac metabolism and ≥ 1.0 ng/ml · 1/mL slow metabolism. Renal function (estimated glomerular filtration rate, eGFR), first acute rejection (AR), conversion from ER-Tac, graft and patient survival were observed up to 60-months. 610 RTx patients were divided into 192 fast and 418 slow ER-Tac metabolizers. Fast metabolizers showed a decreased eGFR at all time points compared to slow metabolizers. The fast metabolizer group included more patients who were switched from ER-Tac (p < 0.001). First AR occurred more frequently (p = 0.008) in fast metabolizers, while graft and patient survival rates did not differ between groups (p = 0.529 and p = 0.366, respectively). Calculation of the ER-Tac C/D ratio early after RTx may facilitate individualization of immunosuppression and help identify patients at risk for an unfavorable outcome., Finanziert über die DEAL-Vereinbarung mit Wiley 2019-2022.

Background: The police force has the mandate to protect citizens and enforce the law for public safety. Employment in the police force is recognized as a dangerous occupation and characterized by job-related physical hazards. Therefore, good health and adequate physical condition are necessary. This study aimed to determine cardiovascular, cardiorespiratory, and metabolic risk parameters of German police officers (POs) in comparison to POs from other nations. Methods: 55 male police officers from Germany participated in the survey. We examined anthropometric measurements, cardiovascular/metabolic risk factors and blood parameters. Additionally, we calculated 10-year cardiovascular risk using the Framingham Risk Score. The diagnosis of metabolic syndrome bases on the criteria of the International Diabetes Federation. We assessed cardiorespiratory status by exercise spirometry. Results: The analyzed group of POs demonstrated a high prevalence of pre obesity (BMI: 28.0±3.2 kg/m², waist circumference: 97.8±12.4 cm). 61.8 % of POs showed an increased waist circumference. POs showed high prevalence of abnormal values of triglyceride (n: 24, 43,6%), and systolic (n: 29, 52,7%) and diastolic (n: 27, 49%) blood pressure. The average 10-year cardiovascular risk (by Framingham) was classified as moderate (9.6 ± 7.4 %). 32 % (n: 18) of POs in our study group were diagnosed with metabolic syndrome. Maximal relative oxygen uptake of POs was 34.1 ± 8.0 ·ml/kg-1 ·min-1. Conclusions: To our knowledge, this study was one of the first to assess data on cardiovascular health, metabolic syndrome and cardiorespiratory status of police officers in Germany. The results of our study demonstrated an increased cardiovascular and metabolic risk and decreased cardiorespiratory fitness in German police officers. The present study results underline the need to implement health-promoting interventions and concepts like corporate sports activities or nutrition courses to counteract cardiovascular and metabolic risk factors. We have to reduce the subsequent development of cardiovascular and metabolic disease in this occupational group., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Despite screening, effective anti-viral drugs and risk-balanced prophylaxis, cytomegalovirus (CMV) remains a major cause of morbidity in transplant patients. The objective of this study was to retrospectively analyze the risk factors associated with CMV viremia after kidney transplantation in a large European cohort with standardized valganciclovir prophylaxis in the present era. A special focus was placed on the comparison of living and postmortal donation. We conducted a longitudinal observational study involving 723 adult patients with a total of 3292 patient-years who were transplanted at our center between 2007 and 2015. Valganciclovir prophylaxis was administered over 100 days for CMV+ donors (D) or recipients (R), over 200 days for D+/R&minus, and none in D&minus, /R&minus, A CMV+ donor, rejection episodes, and deceased donor transplantation were identified to be associated with increased incidences of CMV viremia. Although we did not find a reduced overall survival rate for patients with CMV viremia, it was associated with worse graft function. Since we observed a relevant number of CMV infections despite prescribing valganciclovir prophylaxis, a pre-emptive strategy in patients with (suspected) adherence restrictions could be favored. Our data can help transplant physicians educate their patients about their individual CMV risk and choose the most appropriate CMV treatment approach.