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Die herkömmliche Methode der Untersuchung anatomischer Verhältnisse bei Insekten ist die manuelle Präparation und das Erstellen von Schnittserien eines eingebetteten Objektes in zwei, besser drei orthogonalen Raumrichtungen (frontal, axial und sagittal). Diese Schnitte werden dann spezifisch angefärbt und über Zeichnungen und / oder Fotographien ausgewertet. Mit speziellen zeichnerischen Verfahren oder mittels Graphikprogrammen können daraus 3D-Objekte „rekonstruiert“ werden. Eine neue vielversprechende Methode in der Insektenmorphologie ist die (phasenverstärkte) Synchrotron Mikro-Röntgentomographie. Ähnlich wie etwa bei den von Hörnschemeyer et al. (2002) genutzten Desktopgeräten wird hier mit relativ geringem Zeitaufwand der Vergleich kompletter „virtueller“ Schnittserien auch einer größeren Anzahl von Taxa, wie sie zum Beispiel für vergleichend-morphologische evolutionsbiologische Studien erforderlich sind, ermöglicht. Man erhält mittels der Tomographie-Datensätze die Möglichkeit, beliebige Schnittrichtungen am Computer zu bearbeiten und auszuwerten. Die Methode arbeitet zerstörungsfrei und ist somit auch für Museumsleihgaben oder seltene Einzelfunde geeignet.
Purpose: Acute kidney injury (AKI) is a severe complication in medical and surgical intensive care units accounting for a high morbidity and mortality. Incidence, risk factors, and prognostic impact of this deleterious condition are well established in this setting. Data concerning the neurocritically ill patients is scarce. Therefore, aim of this study was to determine the incidence of AKI and elucidate risk factors in this special population.
Methods: Patients admitted to a specialized neurocritical care unit between 2005 and 2011 with a length of stay above 48 hours were analyzed retrospectively for incidence, cause, and outcome of AKI (AKI Network-stage ≥2).
Results: The study population comprised 681 neurocritically ill patients from a mixed neurosurgical and neurological intensive care unit. The prevalence of chronic kidney disease (CKD) was 8.4% (57/681). Overall incidence of AKI was 11.6% with 36 (45.6%) patients developing dialysis-requiring AKI. Sepsis was the main cause of AKI in nearly 50% of patients. Acute kidney injury and renal replacement therapy are independent predictors of worse outcome (hazard ratio [HR]: 3.704; 95% confidence interval [CI]: 1.867-7.350; P < .001; and HR: 2.848; CI: 1.301-6.325; P = .009). Chronic kidney disease was the strongest independent risk factor (odds ratio: 12.473; CI: 5.944-26.172; P < .001), whereas surgical intervention or contrast agents were not associated with AKI.
Conclusions: Acute kidney injury in neurocritical care has a high incidence and is a crucial risk factor for mortality independently of the underlying neurocritical condition. Sepsis is the main cause of AKI in this setting. Therefore, careful prevention of infectious complications and considering CKD in treatment decisions may lower the incidence of AKI and hereby improve outcome in neurocritical care.
Organisms are complex entities whose study has necessitated an increasingly reductionistic stance in modern biology (CAPLAN 1987). As a consequence, biology as a science has been split up into numerous sub-disciplines. However, this extremely reductionistic philosophy must not be taken as marking the endpoint of biological research but should be reappraised as the beginning of a new integrative approach encompassing the entire organism (SAUER 1992). This view has been promoted since the second half of the 20th century with the rise of new disciplines such as ecophysiology and ethoecology. Moreover, in morphology, an integrative approach with regard to the form and function of organisms in their relationship to the external environment is becoming increasingly important (e.g. KARR & JAMES 1975, MOTTA & KOTRSCHAL 1992, REILLY & WAINWRIGHT 1994).
Background: Chronic renal disease is a serious complication of long-term intravenous drug use (IVDU). Recent reports have postulated a changing pattern of underlying nephropathy over the last decades.
Methods: Retrospective investigation including all patients with prior or present IVDU that underwent renal biopsy because of chronic kidney disease between 01.04.2002 and 31.03.2012 in the city of Frankfurt/Main, Germany.
Results: Twenty four patients with IVDU underwent renal biopsy because of progressive chronic kidney disease or proteinuria. Renal AA-amyloidosis was the predominant cause of renal failure in 50% of patients. Membranoproliferative glomerulonephritis (GN) was the second most common cause found in 21%. Patients with AA-amyloidosis were more likely to be HIV infected (67 vs.17%; p=0.036) and tended to have a higher rate of repeated systemic infections (92 vs. 50%; p=0.069). Patients with AA-amyloidosis presented with progressive renal disease and nephrotic-range proteinuria but most patients had no peripheral edema or systemic hypertension. Development of proteinuria preceded the decline of GFR for approximately 1--2 years.
Conclusions: AA-amyloidosis was the predominant cause of progressive renal disease in the last 10 years in patients with IVDU. The highest rate of AA-amyloidosis observed was seen in HIV infected patients with IVDU. We speculate that chronic HIV-infection as well as the associated immunosuppression might promote development of AA-amyloidosis by increasing frequency and duration of infections acquired by IVDU.