Acute Tubulo-interstitial Nephritis with Positive Anti-Neutrophil Cytoplasmic Antibodies

Introduction: Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis involving the kidney usually comprises pauci-immune, necrotizing glomerulonephritis with crescents. Mononuclear tubulo-interstitial infiltrates are common in ANCA associated vasculitis, but these have usually been described in conjunction with glomerulitis. Acute tubulo-interstitial nephritis (ATIN) is a common cause of acute kidney injury that is most frequently induced by drugs or infections. Idiopathic ATIN has rarely been reported in association with the presence of a positive ANCA. These two entities seem to share a common immunological basis.Case report: We report a 75 years-old male patient who presented with acute kidney injury and his serum tested positive for p-ANCA by indirect immunofluoresence with a titer of 1/320. Testing by ELISA demonstrated anti-myeloperoxidase (MPO) specificity with a level of 28.8 IU/mL. His kidney biopsy showed features of ATIN with no glomerular involvement. Treatment with corticosteroids led to improvement of his kidney function and serology for ANCA became negative. In this case report ATIN seems to be associated with ANCA positivity, in the absence of other obvious causes for the acute tubulo-interstitial insult.Conclusion: ATIN can be associated with positive ANCA without features of renal-limited vasculitis or systemic vasculitis. This can occur in the absence of drug exposure. The outcome in our case was favorable with corticosteroid therapy.Key words: ANCA; Acute Tubulo-interstitial Nephritis; Pathogenesi

Myelodysplastic syndrome and extracapillary glomerulonephritis: is there a link?

Introduction: The association of myelodysplastic syndrome and extracapillary glomerulonephritis is exceptional. Only two other cases have been reported.Reported case: A 52-year-old patient with a history of myelodysplastic syndrome developed rapidly progressive glomerulonephritis. Renal biopsy identified extracapillary glomerulonephritis.Discussion: The association of myelodysplastic syndrome with glomerulopathy is rare and often regarded as fortuitous. Only a few cases are described in literature on the subject. A relationship between the two diseases is possible but the causal link between these two diseases remains unknown.Conclusion: The notion that myelodysplastic syndrome may be associated with various glomerular nephropathies involves looking for renal disease in this haematologic disorder

Parameters to Assess Nutritional Status in a Moroccan Hemodialysis Cohort

Introduction: Malnutrition is common in maintenance hemodialysis (HD) and is associated with increased mortality and morbidity in affected patients. The aim of this study was to determine the prevalence of malnutrition and correlate the methods of nutritional assessment.Methods: We evaluated the nutritional status of 40 prevalent HD patients by subjective global assessment (SGA) score, anthropometrics [body mass index (BMI), arm circumference (AC), triceps skin-fold thicknesses (TSF), arm muscle circumference (AMC)], biochemical tests [normalized protein equivalent to total nitrogen appearance (nPNA), and pre-dialysis serum albumin and serum prealbumin levels] and bio-electrical impedance (BEI) analysis to estimate body composition [lean tissue index (LTI) and fat tissue index (FTI)].Results: The study assessed 40 patients (20 males and 20 females) with a mean age of 50.7±16.5 years. The prevalence of malnutrition according to the different methods ranged from 5 % to 65%. There were highly significant gender-specific differences in AMC (p < 0.001) and TSF (p < 0.001). The BEI revealed a highly significant difference in LTI (p < 0.001) but no difference in FTI (p = 0.14) according to gender. There was a positive correlation between LTI and both serum albumin (r = 0.37; p = 0.018) and serum prealbumin (r = 0.53; p < 0.001). Also, there was a significant positive correlation between FTI and BMI (r = 0.59; p < 0.001), AC (r = 0.44; p = 0.004) and TSF (r = 0.61; p < 0.001).Conclusion: Our data suggest that BEI analysis provides a useful means of assessing nutritional status and was correlated with anthropometrics and biochemical findings.Keywords: Anthropometric Measurements; Bioelectrical Impedance; Hemodialysis; Malnutrition; Subjective Global Assessmen

Nylon/Ag fiber sensor for real-time damage monitoring of composites subjected to dynamic loading

In this article, the goal is to monitor the deformation and damage behavior of composites in real-time using a Nylon/Ag fiber sensor when subjected to dynamic loading. Composite samples are integrated with Nylon/Ag fiber sensors at distinct locations and directions between the plies. Then, these samples are experimentally impacted with low-velocity impact using the Taylor Cannon Gun apparatus at three different velocities i.e. 2.5 m s−1, 3 m s−1, and 6.5 m s−1, respectively. These three sets of tests are conducted to determine the detection performance of the Nylon/Ag fiber sensor when the composite sample experiences no damage, some microdamage, and overall breakage. Besides, the fiber sensor placed in each position showed distinct electrical behavior in all three tests and detected the deformation, damage initiation, quantification, identification, and damage propagation. The results confirmed the ability of the fiber sensor to monitor and identify the mechanical deformation during dynamic loading and showed that the sensor can be used as a flexible sensor reinforcement in composites for in-situ monitoring as well

Applying Sodium Profile with or without Ultrafiltration Profile Failed to Show Beneficial Effects on the Incidence of Intra- dialytic Hypotension in Susceptible Hemodilaysis Patients

Introduction: Intra-dialytic hypotension (IDH) is a common complication during hemodialysis (HD) treatment. Previous studies have reportedthat modulating dialysate sodium concentration combined or not with modulation of ultrafiltration (UF) rate may reduce the incidence of IDH. The aim of the present study was to evaluate the effect of sodium and UF profiles on the occurrence of intra-dialytic complications and dialysis quality.Methods: From a total of 64 patients, we selected 18 patients who suffered from recurrent IDH. Every patient received ten HD sessions utilizing each of the following treatments: (1) Control: constant sodium concentrationand UF rates. (2) Sodium and UF profiles: a linearly decreasing sodium concentration combined with a linearly decreasing UF rate. (3) Sodium profile:decreasing sodium concentration with constant UF rate.Results: Fourteen patients completed the study protocol. The incidence of IDH, mean inter-dialytic weight gain and the delivered dialysis dose were not different between the three treatments. However, symptomatic episodes of IDH were more commonand pre-dialysis systolic bloodpressure was higher during the second and third treatment modalities compared to controls. Isolated sodium profile was associated with more malaise and less achievement of target session duration compared to the other two treatments. Isolated sodium profile was associated withless achievement of target UF while combined sodium and UF profiles were associated with more achievement of target UF compared to controls.Conclusion: Our results indicate that sodium profile with or without UF profile does not have a beneficial effect on the incidence of IDH, achievement of target session duration or the delivered dialysis dose

Mathematical Modeling, Design, and Optimization of a Multisegment Multiaddition Plug-Flow Crystallizer for Antisolvent Crystallizations

This document is the Accepted Manuscript version of a Published Work that appeared in final form in Organic Process Research and Development, copyright © American Chemical Society after peer review and technical editing by the publisher. To access the final edited and published work see http://dx.doi.org/10.1021/acs.oprd.5b00110In the pharmaceutical industries, the requirements of rapid process development and scalable design have made the tubular crystallizer a promising platform for continuous manufacturing and crystallization processes, capable of replacing conventional capital- and labor-intensive batch operations. This paper takes a process systems engineering (PSE) approach to the optimal design of a continuous antisolvent addition crystallizer to deliver the most promising product qualities, such as the crystal size distribution. A multisegment multiaddition plug-flow crystallizer (MSMA-PFC) is considered as an example of a continuous antisolvent crystallization process, in which the total number, location, and distribution of antisolvent additions are to be optimized. First-principles dynamic and steady-state mathematical models for the MSMA-PFC are presented, based on example kinetic models for nucleation and growth of paracetamol crystallizing in acetone, with water as the antisolvent. The performances of different crystallizer configurations operated under optimal design conditions are then compared. The configuration in which antisolvent could be added at a variety of different locations along the tube length and at optimal flow rates was able to outperform previous designs in the literature which considered equally spaced antisolvent additions. The use of dynamic models to detect problems during startup of an MSMA-PFC was also highlighted

Bronchodilation induced by PGE2 is impaired in Group-III pulmonary hypertension

BACKGROUND AND PURPOSE: In patients with pulmonary hypertension (PH) associated with lung disease and/or hypoxia (Group III), a reduction of pulmonary vascular tone and tissue hypoxia are considered therapeutically beneficial. Prostaglandin (PG) E2 and PGI2 induce potent relaxation of human bronchi from non-PH (control) patients via EP4 and IP receptors, respectively. However, the effects of PGE2 /PGI2 and their mimetics on human bronchi from PH-patients are unknown. Our aim was to compare the relaxant effects of several PGI2 -mimetics approved for treating PH-Group I with several PGE2 -mimetics in bronchial preparations derived from PH-Group III and control patients. EXPERIMENTAL APPROACH: Using an organ bath system, the tone of bronchial muscle was investigated in tissue from either control or PH-Group III patients. Expression of prostanoid receptors were analyzed by Western blot and real-time PCR and endogenous PGE2 , PGI2 and cAMP levels were determined by ELISA. KEY RESULTS: Maximal relaxations induced by different EP4 agonists (PGE2 , L-902688, ONO-AE1-329) were significantly decreased in human bronchi from PH-patients versus controls. In contrast, the maximal relaxations produced by PGI2 -mimetics (iloprost, treprostinil, beraprost) were similar for both groups of patients. Both EP4 and IP receptor protein and mRNA expressions were significantly lower in human bronchi from PH-patients. cAMP levels significantly correlated with PGI2 but not with PGE2 levels. CONCLUSION AND IMPLICATIONS: This study shows that PGI2 -mimetics have preserved maximal bronchodilation in PH-Group III patients. The decreased bronchodilation induced by EP4 agonists suggests that restoration of EP4 expression in airways of PH-patients with respiratory diseases could bring additional therapeutic benefit

Effect of a cluster on gas–solid drag from lattice Boltzmann simulations

Fast fluidization of fine particles leads to formation of particle clusters, which significantly affects the drag force between the phases. Existing gas–solid drag models, both empirical and theoretical, do not account for the effect of the clusters on the drag force, and as a result, the computational studies using them are unable to capture the inherent heterogeneity of fast fluidization beds. The limitation of the current drag models is generally attributed to poor understanding of the effect of the clusters. In this study, the effect of a single cluster on the drag force has been investigated by conducting lattice Boltzmann simulations of gas–particle flow under a wide range of the overall voidage and particle Reynolds numbers. It was observed that simulations with the particles in a cluster configuration gave considerably lower drag than those with particles in a random arrangement. Furthermore, for the cluster voidage between maximum to 0.7, a significant drag reduction was observed when the inter-particle distances within a cluster was decreased. The simulations with a constant cluster voidage of 0.7 showed that the drag force decreased on decreasing the overall voidage from the maximum voidage to approximately 0.96; however any further decrease in the overall voidage caused a steep increase in the drag force. The results of this study are important in quantifying the drag reduction due to the formation of clusters