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ZusammenfassungEpidemiologische Untersuchungen zeigen, dass etwa 2–3 % aller Österreicher*innen einen Diabetes mellitus mit Nierenbeteiligung aufweisen. Dies betrifft somit in Österreich etwa 250.000 Menschen. Das Risiko des Auftretens und Fortschreitens der diabetischen Nierenerkrankung kann durch Lebensstilinterventionen und Optimierung des arteriellen Blutdrucks, Blutzuckers und spezielle Medikamentenklassen vermindert werden. In diesem gemeinsamen Artikel der Österreichischen Gesellschaften für Nephrologie und Diabetologie werden die entsprechende Diagnostik und therapeutische Strategien bei diabetischer Nierenerkrankung vorgeschlagen.

Summary Background A discrepancy between sex-specific treatment of kidney failure by dialysis (higher in men) and the prevalence of chronic kidney disease in the general population (higher in women) has been reported internationally, but the prevalence by sex has not been described for Austria. Sex disparity among nephrology outpatients has not been studied. Methods We employed two formulae (2009 CKD-EPI suppressing the race factor, and race-free 2021 CKD-EPI) to estimate the sex distribution of CKD in Austrian primary care, based on creatinine measurements recorded in a medical sample of 39,800 patients from general practitioners’ offices (1989–2008). Further, we collected information from all clinic appointments scheduled at nephrology departments of 6 Austrian hospitals (Wien, Linz, Wels, St. Pölten, Villach, Innsbruck) during 2019 and calculated visit frequencies by sex. Results Using the 2009 CKD-EPI formula, the prevalence of CKD in stages G3–G5 (estimated glomerular filtration rate 2) was 16.4% among women and 8.5% among men aged > 18 years who had attended general practitioners’ offices in Austria between 1989 and 2008 and had at least one creatinine measurement performed. Using the 2021 CKD-EPI formula, the respective CKD prevalence was 12.3% among women and 6.1% among men. In 2019, 45% of all outpatients at 6 participating nephrology departments were women. The median of nephrology clinic visits in 2019 was two (per year) for both sexes. Conclusion CKD is more prevalent among Austrian women than men. Men are more prevalent in nephrology outpatient services. Research into causes of this sex disparity is urgently needed.

Arterial hypertension is a global burden leading to over 10.8 million deaths per year worldwide. May Measurement Month (MMM) is a global project initiated by the International Society of Hypertension to raise the awareness of high blood pressure (BP) in the population. Following the MMM protocol 2508 participants ≥18 years had their BP measured in Austria in MMM18 and MMM19. Of those screened, 54.6% were found to be hypertensive, defined as a BP ≥140/90 mmHg and/or being on treatment for hypertension. Among those individuals with hypertension, 56.1% were on medication but only 42.0% of those treated had controlled BP (

Recent epidemiological investigations have shown that approximately 2-3% of all Austrians suffer from diabetes with renal involvement, i. e. 250,000 people in Austria are affected. The risk of occurrence and progression of this disease can be ameliorated by life style interventions as well as optimization of blood pressure, blood glucose levels and special drug classes. The present article represents the joint recommendations of the Austrian Diabetes Association and the Austrian Society for Nephrology for the diagnostics and treatment strategies of diabetic kidney disease.

The Wadden Sea is one of the most important stop-over sites for breeding and migrating birds. About 10–12 million birds per year use the area for foraging and consume about 25%–45% of the standing stock of macrozoobenthos. However, little is known about the influence of birds on the entire ecosystem. We conducted ecological network analysis (ENA) on an important bird breeding and resting site, the Norderaue tidal basin in the northern German Wadden Sea, to determine the influence of birds on the entire food web. The model was based on the yearly average biomass of system compartments empirically sampled every season at the study site. The analysis revealed a complex and well-connected food web (high flow diversity and effective link-density) dominated by short pathways but with a high throughput of energy. The system's energy had a high degree of freedom for its development. However, there is a strong dependency on external imports of phytoplankton due to the dominance of suspension feeders suggested by a low recycling and the detritivory to herbivory ratio. A large variety of bird species uses the area for foraging and induces a negative impact on their prey items revealed by the mixed trophic impact analysis. The food sources and also the competitors of the birds' prey items were positively influenced by the birds via indirect pathways in the network. Furthermore, there is a negative impact among the bird compartments probably due to competition between the bird species. A sensitivity analysis, conducted by changing the bird biomass in the model, revealed only small changes in the activity, complexity and connectivity of the system. The linkage to other system components could amplify these changes in the system functioning. It is therefore recommended to include birds in coastal food web studies which has rarely been done before. The use of holistic approaches such as ENA would facilitate decisions on management measures by providing a simplified representation of the entire ecosystem including all direct and indirect connections between the system components.

Patients with advanced chronic kidney disease should be vaccinated against hepatitis B. In observational studies vitamin D insufficiency is associated with a reduced seroconversion rate. The effect of cholecalciferol supplementation on hepatitis B vaccination response in haemodialysis patients with vitamin D insufficiency is unknown.In this randomized open label pilot study 40 unvaccinated haemodialysis patients with 25(OH)D insufficiency (30 ng/mL) were enrolled. In the supplementation group, we administered cholecalciferol orally in a dose of 28,000 IU weekly for a maximum of 12 weeks. Hepatitis B vaccination (HBvaxPRO 40 µg i.m. months 0, 1, 6) was performed after achieving a 25(OH)D level30 ng/mL or after completing three months of supplementation despite failure to achieve the target level. In the control group, patients were vaccinated immediately after randomization. Anti-hepatitis B-antibody titer (anti-HBs) was measured eight weeks after completing the vaccination course.Thirty-seven (26 male, 11 female) patients aged 65 (13.5) years underwent randomization with 17 patients allocated to the control group and 20 patients included in the supplementation group. After 12 weeks of cholecalciferol supplementation, mean (SD) 25(OH)D concentration increased from 15.0 (8.0) to 31.0 (7.1) ng/mL, but remained unchanged in the control group (14.0 (7.1) to 11.6 (7.5) mg/mL). Neither the number of patients with seroconversion (anti-HBs titer ≥ 10 IU/L; n = 6 (35.3%) vs n = 3 (27.3%), p = 0.704), nor the number of patients with seroprotection (anti-HBs titer100 IU/L; n = 4 (23.5%) vs n = 2 (18.2%) differed between treatment groups. Cholecalciferol supplementation was safe without treatment-related adverse events.In this small pilot study, high-dose oral cholecalciferol supplementation did not improve the hepatitis B vaccination response in haemodialysis patients with vitamin D insufficiency. This clinical trial was registered within EudraCT (EudraCT number 2011-004621-26).

Special issue: Marine ecosystem restoration: theory, practice and future perspectives.-- 13 pages, 7 figures, supporting information https://doi.org/10.1111/rec.13328, In contrast to the global trend, seagrass beds have recovered in size and density in the northern part of the European Wadden Sea, but ecosystem effects of seagrass recovery and the impacts to ecosystem services are largely unknown. We used temporal-dynamic food web modeling Ecopath with Ecosim to assess potential ecosystem effects of seagrass recovery in the semi-enclosed Sylt-Rømø Bight at the German-Danish border. In addition to changes in the system's structure and functioning over time, the model predicted changes in biomass of seagrass-associated species. For seagrass consumers, we projected an increase in biomass as a result of an increase in food supply. Likewise, the model predicted an increase in biomass of seagrass meadow inhabitants from decreased predation pressure. Correspondingly, the main predators of these inhabitants decreased in biomass according to model results. Proxies representing ecosystem services predicted an increase of tourism appeal of the site with increasing seagrass meadows. Indirect mediation effects of seagrass severely influenced the model output and are thus crucial to forecast potential effects of the recovery of habitat-forming species. Our study illustrates that holistic approaches such as food web models could provide a suitable basis for predicting ecosystem effects of changes in the biomass of habitat-forming species such as seagrasses, This study was funded by the project MERCES of the European Union's Horizon 2020 research program (Grant agreement number 689518, www.merces-project.eu), With the funding support of the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2019-000928-S), of the Spanish Research Agency (AEI)

The reduced sea ice extent and duration in the Arctic releases the rocky shores from one of its key physical disturbances shaping the zonation and depth extension of seaweed assemblages. In order to determine the consequences of reduced disturbance by sea ice, we studied the changes in the functioning and structure of the kelp belt at Hansneset, Kongsfjorden, between 1996-1998 and 2012–2014 using ecological network analysis (ENA). For each time period, a kelp belt flow network was constructed for 2.5 m and 5 m water depths in summer (June–July). We conducted a data-guided uncertainty analyses to evaluate the strength of the difference observed in the ENA results. At 2.5 m, the total system throughput –indicating the size of the system-significantly increased between the two periods. The number of parallel pathways (relative redundancy), the number of interactions (flow diversity) and the number of indirect interactions (Indirect/Direct) in the system were as well significantly higher at 2.5 m and 5 m in 2012–2014 compared to 1996–1998. These changes were related to the persistent colonization of the shallow sublittoral by kelps, which led to a diversification of filter feeders and an increase in omnivorous species. At 5 m, however, the kelp biomass and production decreased most likely due to the reduction of the underwater light climate between 1996-1998 and 2012–2014. In contrast, the macrozoobenthic biomass increased with a higher contribution of opportunistic and carnivorous species between these two periods. The increased values of these total system indicators suggest a more complex and mature kelp belt ecosystem in 2012–2014 compared to 1996–1998 probably due to the reduction of physical disturbances by ice. A future warming of the Arctic Ocean might enhance sea urchins grazing activity of kelp production as herbivory already increased between both periods. In a context of fast changes on ecosystem level triggered by concurrent multiple stressors, management objectives in the Arctic should be based on holistic approaches such as ENA. To do this, consistent monitoring of relevant food web components for model construction and data-guided uncertainty should be put in place.

Ecological network analysis (ENA) is an efficient tool to conduct holistic evaluation of the functioning and structure of ecosystems. ENA results can be used to support management decisions, but further development is needed to improve ENA application. We compared the food web functioning of three areas of the Wadden Sea: the Sylt-Romo Bight, the Norderaue tidal basin and the Jade Bay, and present an example application of ENA indices in decision making processes. We used a sequential increase in uniform uncertainty from 50% to 99% using 10% increments to evaluate the robustness of the network comparisons. The results showed that the Jade Bay differed in its system functioning from the Sylt-Romo Bight and the Norderaue tidal basin which represent the Northern Wadden Sea. The Jade Bay system, which is dominated by mudflats, had a heavier reliance on detritivory pathways, while the Northern Wadden Sea, which is dominated by Arenicola-sand flats, relied more on exchanges with the North Sea. Higher recycling, redundant pathways and flow diversity in the Jade Bay indicated that this system is probably more resilient against external perturbations than the Northern Wadden Sea systems which are more organized and specialized. This was related to the high standing stocks of suspension feeders in the Northern Wadden Sea, resulting from the establishment of several invasive suspension feeders, such as the Pacific oysters, the American razor clams and the common slipper shell. This study showed that 1- uncertainty analyses are crucial for the interpretation of ENA results and their use in management, 2- temporal measurable trends of indices which are robust to model uncertainty would be more appropriate for decision making than single reference values, 3- using ENA for assessment purposes in the Wadden Sea must be based on several representative sites taking into account their habitat types as well as morphological and physical characteristics, in terms of water depth, hydrodynamics and degree of enclosure of back barrier areas.

An der Universitat Bremen ist in allen lehrer*innenbildenden Studiengangen eine Forschungstatigkeit im Rahmen der Masterarbeit vorgesehen. Die dafur erforderlichen Kompetenzen zur Vorbereitung, Durchfuhrung, Auswertung und Prasentation von Forschungsprojekten werden bisher nur punktuell in die Curricula der lehrer*innenbildenden Studiengange (B.A. und M.Ed.) einbezogen. Mit dem Projekt Lehramt3 (Dauer: Mai 2017 – November 2019) wird das ubergeordnete Ziel verfolgt, Forschendes Lernen systematisch und nachhaltig in einem modulubergreifenden Studiengangskonzept B.A./M.Ed. Gymnasium/Oberschule am Beispiel der Facher Englisch, Geschichte und Kunst mit dem Schwerpunkt Integration und Vernetzung der Praxisphasen zu verankern. Im Projekt Lehramt3 soll ein spiralformiger Zuwachs von (Teil-) Kompetenzen Forschenden Lernens angebahnt werden, indem Praxisphasen miteinander verzahnt und facherubergreifend Theorie und Praxis aufeinander bezogen werden.

Elevated blood pressure remains a major cause of cardiovascular disease, disability, and premature death in Austria, with suboptimal rates of detection, treatment and control also in recent years. Management of hypertension is a common challenge for physicians with different spezializations. In an attempt to standardize diagnostic and therapeutic strategies and, ultimately, to increase the rate of patients with controlled blood pressure and to decrease the burden of cardiovascular disease, 13 Austrian medical societies reviewed the evidence regarding prevention, detection, workup, treatment and consequences of high blood pressure in general and in various clinical scenarios. The result is presented as the first national consensus on blood pressure. The authors and societies involved are convinced that a joint national effort is needed to decrease hypertension-related morbidity and mortality in our country.

Recent epidemiological investigations have shown that approximately 2-3% of all Austrians suffer from diabetes with renal involvement, i. e. 250,000 people in Austria are affected. The risk of occurrence and progression of this disease can be ameliorated by life style interventions as well as optimization of blood pressure, blood glucose levels and special drug classes. The present article represents the joint recommendations of the Austrian Diabetes Association and the Austrian Society for Nephrology for the diagnostics and treatment strategies of diabetic kidney disease.

Top predators are relevant indicators of the ecological status of a system and can have a high impact on food webs. But top predators are difficult to include in network analyses because their biomass in ash free dry weight or carbon content ismissing. Regression equations were determined for the relationships between fresh weight and dry weight, ash free dryweight, carbon and nitrogen contents respectively for six of the most abundant bird species in theWadden Sea (Calidris canutus, Limosa lapponica, Haematopus ostralegus, Chroicocephalus ridibundus, Larus canus, Anas penelope) and harbor seals (Phoca vitulina). The relationships for all specieswere interpreted as linear through the origin. Carbon content vs. freshweight ratios for birds ranged from0.16±0.01 to 0.22±0.02. Carbon content vs. fresh weight ratio was 0.17± 0.02 on average for harbor seals. This work highlights that the biomass of top predatorswas often over- or underestimated in previous studies. The determined conversion factors will be useful for future studies to generate more realistic food web models.

Summary In 2010, eight Austrian medical societies proposed a joint position statement on the management of metabolic lipid disorders for the prevention of vascular complications. An updated and extended version of these recommendations according to the current literature is presented, referring to the primary and secondary prevention of vascular complications in adults, taking into consideration the guidelines of other societies. The “Austrian Lipid Consensus – 2016 update” provides guidance for individualized risk stratification and respective therapeutic targets, and discusses the evidence for reducing vascular endpoints with available lipid-lowering therapies. Furthermore, specific management in key patient groups is outlined, including subjects presenting with coronary, cerebrovascular, and/or peripheral atherosclerosis; diabetes mellitus and/or metabolic syndrome; nephropathy; and familial hypercholesterolemia.

The Wadden Sea undergoes large seasonal changes in species abundance and biomass comprising its complex food web. This study examined four carbon food web models of the Sylt-Romo Bight, one for each season. Each flow model consisted of 66 compartments depicting the respective biomass and energy budget of each ecosystem component and the flows between them. Ecological network analysis (ENA), a set of algorithms to evaluate the functioning of ecological networks, was used to assess the seasonal variability in the system properties of the Sylt-Romo Bight food webs. We used an uncertainty analysis to quantitatively evaluate the significance of inter-seasonal differences. Clear seasonal variation was observed in most of the whole system indicators such as the flow diversity, the effective link density and the relative redundancy which varied by 12.8%, 17.3% and 10.3% respectively between the highest in summer and the lowest during fall and winter, whereas the relevant ascendency ratio was the highest in winter during the least active months. Other indices such as the average mutual information index, which fluctuated between 1.73 in fall and 1.79 in spring, showed no significant variation between seasons. Results from ENA have great potential for ecosystem management, as it provides a holistic assessment of the functioning of ecosystems.

About 10 to 12 million birds per year use the intertidal flats of the Wadden Sea in north-eastern Europe as a food source during their moulting, wintering or breeding season and as a stop-over site along the East Atlantic Flyway. The tidal flats are inhabited by a highly productive benthic fauna representing an important link between the marine microflora and -fauna and higher trophic levels such as birds. Due to differences in the food preference, bird species might distribute on different habitat types formed in the Wadden Sea. In the present study, the diversity of foraging birds was studied in four intertidal habitats (seagrass meadow, sand flat, mud flat, Elbe tidal flat) and their macrozoobenthic food sources were analysed. Samples of benthic macrofauna were taken seasonally while foraging birds were counted monthly at the studied sites. Results revealed different benthic communities in each of the studied sites with large variation in abundance and diversity of foraging birds. Peak numbers of birds during spring and autumn reflected migration through the region. While the majority of bird species shows an opportunistic habitat choice, some species (e.g. Bucephala clangula, Philomachus pugnax) were observed foraging at one site only. However, results revealed only a weak link between bird assemblages and benthic communities within the tidal flats. As indicated by clear relationships between bird species abundance and tidal stage, avian distribution patterns are probably also strongly dependent on abiotic factors such as distance to roosting sites, inundation time and anthropogenic influences. Therefore, it is not sufficient to study the distribution of favoured prey items in the tidal flats alone but additional information needs to be taken into account to understand the complex distribution patterns of birds in the intertidal environment.

Neobiotic species can have profound impacts on food webs and entire ecosystems. The American razor clam Ensis leei was introduced into the Wadden Sea by vessels in the late 1970s and has since spread widely. It has been suggested that Ensis does not interact strongly with other benthic species. The abundance and biomass of E. leei were recorded in 2393 samples in the north-eastern Wadden Sea and 800 samples in the south-eastern Wadden Sea over a total period of 9 years. Using an interdisciplinary approach, we developed a habitat prediction model using sedimentological and hydrodynamic predictors to help understand the shape of the ecological niche occupied by Ensis in the Wadden Sea. Our model showed that Ensis preferred areas with moderately high bed shear stress and prolonged or constant water coverage. Ensis preferred coarse sediments in the northern sub-area but coarse and muddy sediments in the southern sub-area and was negatively affected by the sand mason worm Lanice conchilega in the northern sub-area. Predictions of the spatial distribution of Ensis using the northern and southern datasets revealed major differences in predicted hot-spots throughout the entire study site. This study thus highlights the need to collect a sufficiently large dataset from different sub-areas of the Wadden Sea to allow valid conclusions to be drawn regarding the spatial distribution of Ensis. The negative effects of L. conchilega on Ensis abundance and biomass as well as the occurrence of Ensis in muddy sediments in the south suggest that the ecological niche of this neobiotic species is likely to overlap partly with the native fauna of the Wadden Sea.

There is substantial evidence that climate warming affects terrestrial and marine ecosystems. In addition to the geographic shifts of marine species and communities, comprehensive mesocosm experiments provide insight in the behavior of species and simplified ecosystems under climate warming conditions. Food web dynamics and stability has been topical in contemporary ecology, and while these aspects receive considerable attention, few studies have quantitatively examined the impact of climate warming on complex marine ecosystems and their food webs. Here we examine the response of a large marine ecosystem, the Sylt-Romo Bight in the northern German Wadden Sea, to warmer temperatures by means of ecological network analysis (ENA). Three quantitative network models (of 67 model compartments each) were constructed for each of 4 non-consecutive years (1995, 2007, 2011, 2013). A base-line model at the mean annual ambient temperature, and models at +3 °C and +5 °C above the annual mean were constructed for each year (a total of 12 models) and assessed by ENA protocols. Results showed i.a. an intensification of detrital production and consumption, substantial increase in the total system throughput (TSTP), decline in consumption of phytoplankton and macrophytes, an increase in the total overhead, an increase in community respiration, and an increase in the system's P/B and R/B ratios. The mean relative ascendency declined compared to the base models by 2.35% and 2.28% in the +3 °C and +5 °C networks models respectively. It is clear from the suite of system metrics and ratios that the ecosystem becomes less organized, more dissipative and shifts towards detritus based food webs at higher water temperatures.

Dialysis patients, receiving erythropoiesis stimulating agents, typically show signs of hemoglobin variability as a consequence of their dosing patterns, bleeding, infection, etc., which is commonly managed adjusting the dose regimen of the erythropoiesis stimulating agent. However, information on dosing strategies used in daily clinical practice and their outcomes in relation to hemoglobin variability is limited. To investigate clinical practice in Austria in relation with the management of hemoglobin variability, defined as a decrease of ³ 1 g/dL within 4 weeks from ³ 11 g/dL to £ 11 g/dL during maintenance therapy with darbepoetin alfa. The nature and incidence of clinical events related to the hemoglobin drop were also assessed. The MAINTAIN non-interventional study was conducted in hemodialysis patients, receiving darbepoetin alfa in accordance to the label approved in the European Union at that time. Patient data were documented retrospectively for the 3 months prior to the hemoglobin drop. Data for the 6 months post hemoglobin drop were collected retrospectively or prospectively, depending on the time of patient inclusion respective to the Hb drop. A hundred thirty six of 154 patients fulfilled all inclusion/exclusion criteria and had prospective documentation of 6 months. The main causes for the hemoglobin drop included surgical and medical procedures (36.1 %), and infections or infestations (24.4 %). The median treatment period was 273 days. The mean hemoglobin drop was − 1.74 g/dL (95 % confidence interval (CI): − 1.60 to − 1.87). Consequently, 81 % of the patients had their dose of darbepoetin alfa increased within a median Kaplan–Meier time to dose increase of 12.5 days (95 % CI: 6–22). The geometric mean weekly darbepoetin alfa dose increased by a factor of 1.1 from 29.1 mg (95 % CI: 24.6–34.4) in the 3 months before hemoglobin drop to 32.4 (95 % CI: 27.2–38.6) in months 4–6 post hemoglobin drop. Three patients had red blood cell transfusions before hemoglobin drop and nine patients after hemoglobin drop. The mean hemoglobin increase was 0.43 g/dL (95 % CI: 0.24–0.62) from immediately prior to 2 weeks after dose increase. The median Kaplan–Meier time to achieve a hemoglobin ³ 11 g/dL after hemoglobin drop was 36 days (95 % CI: 32–45). Frequent darbepoetin alfa dose adjustments were necessary to sustain maintenance levels. No drug-related adverse events were reported. This observational study describes physicians’ reactions to a drop in hemoglobin in clinical practice. Using darbepoetin alfa, the drop was generally compensated without leading to overcorrection.

The wide range of immunosuppressive therapies and protocols permits tailored planning of the initial regimen according to the immunological risk status of individual patients. Pre-transplant risk assessment can include many factors, but there is no clear consensus on which parameters to take into account, and their relative importance. In general younger patients are known to be at higher risk for acute rejection, compounded by higher rates of non-adherence in adolescents. Donor age and recipient gender do not appear to exert a meaningful effect on risk of rejection per se, but black recipient ethnicity remains a well-established risk factor even under modern immunosuppression regimens. Little difference in risk is now observed between deceased- and living-donor recipients. Immunological risk assessment has developed substantially in recent years. Cross-match testing with cytotoxic analysis has long been supplemented by flow cytometry, but development of solid-phase single-bead antigen testing of solubilized human leukocyte antigens (HLA) to detect donor-specific antibodies (DSA) permits a far more nuanced stratification of immunological risk status, including the different classes and intensities of HLA antibodies Class I and/or II, including HLA-DSA. Immunologic risk evaluation is now often based on a combination of these tests, but other assessments are becoming more widely introduced, such as measurement of non-HLA antibodies against angiotensin type 1 (AT1) receptors or T-cell ELISPOT assay of alloantigen-specific donor. Targeted densensitization protocols can improve immunological risk, notably for DSA-positive patients with negative cytotoxicity and flow cross-match. HLA mismatch remains an important and undisputed risk factor for rejection. Delayed graft function also increases the risk of subsequent acute rejection, and the early regimen can be modified in such cases. Overall, there is a shift towards planning the immunosuppressive regimen based on pre-transplant immunology testing although certain conventional risk factors retain their importance.

Carbazole linked porphyrin dimers were synthesized in good yields via stepwise Suzuki coupling reactions using bromoporphyrins and borylated carbazoles as the precursors, the latter of which were synthesized via known procedures from biphenyl derivatives. For comparative purposes porphyrin–carbazole monomers were synthesized. Single layer organic light emitting diodes (OLEDs) were created to demonstrate the optical properties of these materials. Light emission from these carbazole substituted porphyrins showed better results compared to previously examined bromo substituted porphyrins with better electroluminescence and lower turn-on voltages. Dimers exhibited turn-on voltages of 3 V compared to 6 V for monomeric porphyrin–carbazoles.

N-Heterocyclic carbene (NHC) ruthenium complexes consisting of different donor substituents attached to the NHC ligand efficiently catalyse the transfer hydrogenation of ketones and of activated olefins in α,β-unsaturated ketones to give saturated alcohols. The most active catalyst precursor contains a tethered olefin as a hemilabile donor site. This complex also converts nitriles and, depending on the reaction conditions, either benzylamines are produced by means of transfer hydrogenation, or amides from formal addition of H2O. Kinetic analysis of the double hydrogenation of α,β-unsaturated ketones indicates fast isomerisation of the enol intermediate to its saturated ketone tautomer prior to the second hydrogenation. European Research Council Swiss National Science Foundation

The importance of inductive instruction in medical education is increasingly growing. Little is known about the relevance of prior knowledge regarding students' inductive reasoning abilities.The purpose is to evaluate this inductive teaching method as a means of fostering higher levels of learning and to explore how individual differences in prior knowledge (high [HPK] vs. low [LPK]) contribute to students' inductive reasoning skills.Twenty-six LPK and 18 HPK students could train twice with an interactive computer-based training object to discover the underlying concept before doing the final comprehension check.Students had a median of 76.9% of correct answers in the first, 90.9% in the second training, and answered 92% of the final assessment questions correctly. More important, 86% of all students succeeded with inductive learning, among them 83% of the HPK students and 89% of the LPK students.Prior knowledge did not predict performance on overall comprehension. This inductive instructional strategy fostered students' deep approaches to learning in a time-effective way.

The synthesis and characterisation of a series of dinuclear ruthenium and osmium polypyridyl metal complexes based on the bridging ligands [5-(5′-bipyridin-2′,2′-yl)-3-(pyridin-2-yl)]-1,2,4-triazole (Hpytr-bipy), 2,2′-bis(pyridin-2′yl)-5,5′-bis(pyridin-3′-yl) (bipy-bipy) and 5,5′-bis(pyridin-2′-yl)-3,3′-bis(1,2,4-triazole) (Hpytr-Hpytr) are reported. The dinuclear complexes have been synthesised via a Ni(0) catalysed cross-coupling reaction from brominated precursors. With this approach a mixture of three products is obtained, which are separated by chromatographic methods. The compounds obtained are characterised by elemental analysis, 1H NMR, absorption and emission spectroscopy. The synthetic approach developed offers a new route to asymmetric multinuclear supramolecular structures that is complimentary to the complexes as ligands/complexes as metal approaches.

PUBLISHED, A general method that uses potassium organotrifluoroborates in the Suzuki?Miyaura cross-coupling reaction with ring-brominated porphyrins has been investigated. The reaction conditions tolerate various functional groups and are applicable to the meso- and ?-position as well as to aryl- and alkyl-substituted porphyrins. Depending on the nature of the potassium organotrifluoroborate, the coupling products can be obtained in yields of up to 75%., Science Foundation Ireland Research Professorship grant (SFI/04/RP1/B482)

Recent developments in the synthesis and transformation of porphyrins and their derivatives are presented. In connection with the Fifth International Conference on Porphyrins and Phthalocyanines (ICPP-5) a survey of current method developments and reactivity studies is made. The review focuses on synthetic advances in porphyrin chemistry. A brief survey of important developments covers selectively the literature from 2004 to late 2007.

Epstein-Barr virus (EBV) associated central nervous system (CNS) infection is a rare disease. We report an atypical manifestation of EBV encephalitis initially presenting with a tumor-like lesion of the optic tract in an immunocompromised patient 8 years after a combined kidney and pancreas transplantation had been performed. Polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF) and antibody testing confirmed the diagnosis of EBV encephalitis, most likely as a consequence of a reactivated persistent EBV infection. After cessation of the immunosuppressive therapy and induction of treatment with ganciclovir, clinical and magnetic resonance imaging (MRI) findings rapidly improved.

High blood pressure is a major modifiable risk factor for all clinical manifestations of coronary artery disease (CAD). In people without known cardiovascular disease, the lowest systolic (down to 90-114 mmHg) and the lowest diastolic (down to 60-74 mmHg) pressures are associated with the lowest risk for developing CAD. Although diastolic blood pressure is the strongest predictor of CAD in younger and middle-aged people, this relationship becomes inverted and pulse pressure shows the strongest direct relationship with CAD in people above 60 years of age.Pathophysiological mechanisms of blood pressure as a risk factor for CAD are complex and include the influence of blood pressure as a physical force on the development of the atherosclerotic plaque, and the relationship between pulsatile hemodynamics/arterial stiffness and coronary perfusion. Treatment of arterial hypertension has been proven to prevent coronary events in patients without clinical CAD. In patients with established CAD, the effect of blood pressure lowering per se is beneficial, probably more than specific drugs or drug classes. The important exceptions are beta blockers (BBs), which are superior to all other drug classes for use after a recent myocardial infarction. Blood pressure targets in patients with established CAD have created controversy in the light of the so-called J-curve phenomenon, which describes an increase in coronary events at lower diastolic blood pressures. One explanation for this observation is that perfusion of the left ventricle occurs predominantly during diastole, and that coronary autoregulation may be exhausted with low diastolic blood pressure in the setting of left ventricular hypertrophy and atherosclerotic narrowing of the epicardial coronaries. The worst situation is a high systolic blood pressure in the presence of a low diastolic blood pressure, both a hallmark of increased aortic stiffness. However, the lowering of systolic blood pressure is clearly beneficial in this setting, even at the price of further lowering diastolic pressure. Primary blood pressure goal in patients with established CAD is below 140/90 mmHg. Recent studies suggest that a lower systolic blood pressure may be appropriate, whereas caution is advised with diastolic blood pressure below 60 mmHg.

A new route to alpha,beta-unsaturated formylporphyrins begins with the synthesis of allyl-substituted porphyrins via the Suzuki cross-coupling reaction of bromoporphyrins and allylboronic acid pinacol ester in 50-95% yield. Treatment of allyl-substituted porphyrins with nickel acetate in N,N-dimethylformamide (DMF) then affords mono- and diacroleinylporphyrins in up to 70% yield.

The synthesis, characterization, and electrochemical, photophysical, and photochemical properties of the binuclear compounds [(Ru(H-8-bpy)(2))(2)((Metr)(2)Pz)](PF6)(2) (1) and [(Ru(D-8-bpy)(2))(2)((Metr)(2)Pz)](PF6)(2) (2), where bpy is 2,2'-bipyridine and H-2(Metr)(2)Pz is the planar ligand 2,5-bis(5'-methyl-4'H-[1,2,4]triaz-3'-yl)-pyrazine, are reported. Electrochemical and spectro-electrochemical investigations indicate that the ground-state interaction between each metal center is predominantly electrostatic and in the mixed-valence form only a low level of ground-state delocalization is present. Resonance Raman, transient, and time-resolved spectroscopies enable a detailed assignment to be made of the excited-state photophysical properties of the complexes. Deuteriation is employed to both facilitate spectroscopic characterization and investigate the nature of the lowest excited states.

Graft dysfunction is a common occurrence during the first weeks following renal transplantation. The current study was designed to evaluate the potential of renal magnetic resonance (MR) perfusion imaging to differentiate acute allograft rejection (AAR) from acute tubular necrosis (ATN) during the post-transplant period. Twenty-three consecutive patients with clinically suspected ATN and/or AAR and eight consecutive control patients (asymptomatic, serum creatinine concentration < 1.5 mg/dL) underwent MR perfusion imaging of the renal allograft within 64 days after transplantation. Histopathology was obtained in all cases with clinical suspicion of ATN or AAR. Sixty sequential fast gradient-recalled-echo MR images were acquired in each patient after intravenous administration of gadolinium-DTPA (0.1 mmol/kg). Histopathology revealed 6 patients with pure AAR, 4 patients with a combination of AAR and ATN, 12 patients with ATN and 1 patient with normal findings. Kidney graft recipients with normal renal function showed a moderate increase in signal intensity (SI) of the renal cortex and medulla after administration of contrast agent followed by an immediate and short decrease in SI of the medulla (biphasic medullary enhancement pattern). The increase in cortical SI of patients with AAR was significantly smaller (61 ± 4% increase above baseline) than that measured in normal allografts (136 ± 9% increase above baseline) (p < 0.05) and patients with ATN (129 ± 3% increase above baseline) (p < .05). Patients with ATN had a slightly delayed and diminished cortical enhancement and an uniphasic and lesser medullary enhancement pattern compared to that observed in normal allografts (p < 0.05). A close correlation (r = 0.72) was found between serum creatinine concentration levels and changes in SI. Thus, MR imaging results and histopathology were in agreement in 22 of 23 patients (96%). MR perfusion imaging of renal allografts can be used to noninvasively differentiate ATN from AAR during the post-transplant period, and may also be helpful in cases where covert AAR is superimposing ATN during a phase of anuria. Patients with ATN can be separated from normals in the majority of cases as reflected by an uniphasic medullary enhancement pattern.

Summary: A computer-based method of system identification and estimation of parameter variance for two-compartment models matched to dynamic sinistrin concentration profiles for the determination of glomerular filtration rate is described. Thereby a procedure for the judgment of the optimal sampling time horizon is presented. Since single-injection techniques are suspected of yielding systematic overestimation of the glomerular filtration rate, a method is demonstrated confirming that such a technique employing sinistrin kinetics can be used to correctly determine the glomerular filtration rate. The validation of the system parameters gained by the single-injection method is made through prediction of the concentration contour under a constant infusion regimen in the same subject on a different occasion. This was performed in healthy controls and in patients with various degrees of renal insufficiency. Upon consideration of the dependence of the clearance estimates and their variances on the protocol duration in test subjects examined from four to ten hours, an adaptive design of the protocol length is developed.