A Randomized Controlled Trial Comparing Remission Induction with Modified Multitarget Therapy with Intravenous Cyclophosphamide in Proliferative Lupus Nephritis.

Introduction: Therapy of proliferative lupus nephritis (PLN) is yet to be optimized. Standard of care for induction consists of intravenous (IV) cyclophosphamide (CYC) and steroids, which shows an improved outcome, but end-stage renal disease (ESRD) progression, increased mortality, and therapy-related adverse effects remain a major concern. The other treatment reported to induce early remission was the multitarget therapy comprising tacrolimus, mycophenolate, and steroid, but infections were high in the multitarget therapy. Considering azathioprine as a potentially safer and effective alternative anti-B-cell therapy, modified multitarget therapy (MMTT) was planned replacing mycophenolate with azathioprine. Material and Methods: A single-center, 24-week, open-label, randomized controlled trial comprising adults of age 18-65 years with biopsy-proven PLN was carried out. The intervention groups were 1) MMTT: tacrolimus 0.075 mg/kg/day and azathioprine 2 mg/kg/day and 2) IV CYC group with a starting dose of 0.75 (adjusted to 0.5-1.0) g/m2 every 4 weeks for 6 months. Both groups received 3 days of pulse methylprednisolone followed by a tapering course of oral prednisone therapy. Results: Among 100 randomized patients, 48 were in MMTT arm and 52 were in IV CYC arm. At the end of 24 weeks, overall remission (complete and partial) was comparable in both the arms: MMTT (86.36%) and IV CYC (87.75%). There was comparable proteinuria reduction and systemic lupus erythematosus disease activity index (SLEDAI) score improvement with recovery of complement level C3 in both groups. Major adverse events were numerically more in the IV CYC group, including one death from pneumonia. Conclusion: The MMTT arm is as effective as IV CYC in improving short-term outcome in PLN, with a comparable safety profile.

Remote Ischemic Preconditioning for Prevention of Contrast-Induced Acute Kidney Injury in Patients of CKD Stage III and IV Undergoing Elective Coronary Angiography: A Randomized Controlled Trial.

INTRODUCTION: Contrast-induced acute kidney injury (CI-AKI) is a serious complication of coronary angiography (CA). The aim of this randomized, parallel group, single blind, sham-controlled trial was to assess the safety and efficacy of the remote ischemic preconditioning on the prevention of CI-AKI. METHODS: Patients of 18-80 years of age with CKD 3 and 4, who were admitted for elective coronary angiography in a tertiary care hospital in eastern India were randomized in a 1:1 ratio to standard care with ischemic preconditioning (n = 45; intermittent arm ischemia through 4 cycles of 5-min inflation and 5-min deflation of a blood pressure cuff) or with standard care and sham ischemic preconditioning (n = 42). Overall, both study groups were at moderate risk of developing CI-AKI according to the Mehran risk score. The primary endpoint was the incidence of CI-AKI, defined as an increase in serum creatinine ≥25% or ≥0.5 mg/dL above baseline at 48 h after contrast medium exposure. RESULTS: CI-AKI occurred in 8 patients (19.04%) in the control group and 2 (4.4%) in the remote ischemic preconditioning group (odds ratio, 0.198, 95% confidence interval, 0.087 to 0.452; P = 0.04). No major adverse events were related to remote ischemic preconditioning. CONCLUSIONS: This study indicates that remote ischemic preconditioning is a simple and well-tolerated procedure, which reduces the incidence of CI-AKI in CKD 3 and 4 patients undergoing coronary angiography.

The changing face of pregnancy-related acute kidney injury from eastern part of India: A hospital-based, prospective, observational study.

This study was initiated to look into the etiologies, prevalence, and outcome of pregnancy-related acute kidney injury (PRAKI) in a tertiary care hospital. Women admitted with PRAKI from January 2015 to December 2016 were included in the study. All patients were investigated and treated and followed up for the next six months.. For statistical analysis, Chi- square test and analysis of variance were performed to analyze the data. Multivariate analysis was applied to compare the risk of nonrecovery of renal function in different etiologies of PRAKI. During the study period, 81 patients were admitted with PRAKI, of whom 68 (84%) received hemodialysis (HD). A total of 449 patients including all cases of AKI underwent HD from January 2015 to June 2016. The incidence of dialysis requiring PRAKI was 68 out of the 449 patients (15%). Sixty-eight (84%) patients required dialysis support while the most common cause was sepsis (49%), with the second being pregnancy-associated atypical hemolytic-uremic syndrome (P-aHUS) (17%) followed by obstetric hemorrhages (16%). There was a significant reduction of first-trimester AKI (8.6%) compared to a previous study published from this institute (19.3%). The maternal mortality (25%) and fetal mortality (23.5%) were high. Nearly 39% of the patients had complete recovery of renal function. This study revealed significant PRAKI burden due to a largely preventable cause, puerperal sepsis. Renal survival was poor in P- aHUS. The gaps in the obstetric care may be identified for the improvement of fetomaternal outcome.

Primary Pulmonary Diffuse Large B Cell Non-Hodgkin's Lymphoma: A Case Report and Literature Review.

BACKGROUND Primary pulmonary diffuse large B cell lymphoma (DLBCL) is extremely rare neoplasm representing only 0.5-1% of primary pulmonary malignancies. These patients usually have non-specific clinical presentation and radiological findings. Therefore, it is important to increase awareness of this rare disease, as the correct characterization of the tumors will have therapeutic and prognostic implications. CASE REPORT We present the case of a middle-aged Hispanic woman with chronic cough and an abnormal chest X-ray revealing a lung mass, who was found to have primary pulmonary DLBCL. She underwent 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy and attained complete remission. CONCLUSIONS With its non-specific presentation, the diagnosis of primary pulmonary DLBCL is very challenging and often leads to misdiagnosis or delayed diagnosis. The pathogenesis of primary pulmonary DLBCL is still poorly understood. The choice of treatment approach should be based on the biological characteristic of the tumor, stage, and performance status.

Ratiometric two-photon fluorescent probe for quantitative detection of ß-galactosidase activity in senescent cells.

We reported a ratiometric two-photon fluorescent probe (SG1) for ß-galactosidase (ß-gal) and its application to quantitative detection of ß-gal activity during cellular senescence in live cells and in aged tissues. This probe is characterized by a significant two-photon excited fluorescence, a marked blue-to-yellow emission color change in response to ß-gal, easy loading, insensitivity to pH and reactive oxygen species (ROS), high photostability, and low cytotoxicity. In addition, we show that SG1 labeling is an effective tool for quantitative detection of senescence-associated ß-gal activity at the subcellular level in situ. This finding demonstrates that SG1 will find useful applications in biomedical research, including studies of cell aging.

One new and two known species of Dorylaimoides Thorne and Swanger, 1936 (Nematoda: Mydonomidae) from West Bengal, India.

A few specimens of were collected from the soil around the roots of guava (Psidium guajava L.) and litchi (Litchi chinensis Sonn.) plantations in South 24-Parganas district of West Bengal, India. It yielded a few species of which one is new to science. Dorylaimoides (Dorylaimoides) geraldi sp. n. is characterized in having long odontostyle (9.5-11 µm), amphidelphic genital system in females, and by short rounded tail. The male is characterized by shorter body length, shorter spicules, and three regularly spaced ventromedian supplements with an adanal pair. Although D. (D.) geraldi sp. n. comes closer to D. (D.) buccinator D. (D.) indicus, D. (D.) parateres, D. (D.) teres and D. (D.) websteri among the didelphic-amphidelphic species of the genus having short tails, it differs in having shorter body length, longer odontostyle, amphidelphic genital system in females, absence of pars dialata in oviduct, short rounded tail and by different morphometric ratios. The male differs from the closely related species in having shorter body, different number and arrangements of ventromedian supplements, shorter spicule and tail. The known species agree well with the earlier reported specimens except some morphometric variations.

A ratiometric two-photon fluorescent probe reveals reduction in mitochondrial H2S production in Parkinson's disease gene knockout astrocytes.

Hydrogen sulfide (H2S) is a multifunctional signaling molecule that exerts neuroprotective effects in oxidative stress. In this article, we report a mitochondria-localized two-photon probe, SHS-M2, that can be excited by 750 nm femtosecond pulses and employed for ratiometric detection of H2S in live astrocytes and living brain slices using two-photon microscopy (TPM). SHS-M2 shows bright two-photon-excited fluorescence and a marked change in emission color from blue to yellow in response to H2S, low cytotoxicity, easy loading, and minimum interference from other biologically relevant species including reactive sulfur, oxygen, and nitrogen species, thereby allowing quantitative analysis of H2S levels. Molecular TPM imaging with SHS-M2 in astrocytes revealed that there is a correlation between the ratiometric analysis and expression levels of cystathionine ß-synthase (CBS), the major enzyme that catalyzes H2S production. In studies involving DJ-1, a Parkinson's disease (PD) gene, attenuated H2S production in comparison with wild-type controls was observed in DJ-1-knockout astrocytes and brain slices, where CBS expression was decreased. These findings demonstrate that reduced H2S levels in astrocytes may contribute to the development of PD and that SHS-M2 may be useful as a marker to detect a risk of neurodegenerative diseases, including PD.

Contrast induced nephropathy: our experience.

Even in the light of newer and less nephrotoxic contrast media solutions, their increased use during standard and new radiological procedures has resulted in the growing incidence of contrast-induced nephropathy, an iatrogenic disorder caused by exposure to contrast media. This retrospective study was conducted among the patients admitted in North Bengal Medical College from January 2007 to December 2010 with significant rise in serum creatinine level within 48 to 72 hours of systemic administration of contrast media. The study sample constituted 14 patients with mean age being 45.2 years. Among them, 10 patients (71.4%) required haemodialysis. One patient (7.1%) expired after receiving three sessions of haemodialysis. Three patients (21.4%) became dependent on haemodialysis. Once developed, contrast induced nephropathy is associated with high morbidity, long hospital-stay and patient becomes dependent on haemodialysis. Till now, no available current treatment can reverse or ameliorate the condition once it develops. Some precautionary measures taken in the high risk patients before administration of contrast medium is essential to reduce the incidence.

A new rhodamine based colorimetric 'off-on' fluorescence sensor selective for Pd2+ along with the first bound X-ray crystal structure.

A new fluorescence rhodamine derivative bearing an 8-aminoquinoline moiety has been designed and synthesized for selective sensing of Pd(2+) in the presence of other competing metal ions in aqueous media. Pd(2+) induced spirolactam ring opening of rhodamine is confirmed for the first time by the X-ray crystal structure of the bound Pd(2+)-complex.

A new highly selective, ratiometric and colorimetric fluorescence sensor for Cu(2+) with a remarkable red shift in absorption and emission spectra based on internal charge transfer.

A new 1,8-diaminonaphthalene based ratiometric and highly selective colorimetric "off-on" type of fluorescent probe, receptor 2 has been designed and synthesized that senses only Cu(2+) among the other heavy and transition metal ions examined on the basis of internal charge transfer (ICT). The visual sensitivity of the receptor 2 is remarkable, showing dual color changes from colorless (receptor) to purple followed by blue and a large red shift in emission upon Cu(2+) complexation.

N-(6-Bromo-meth-yl-2-pyrid-yl)acetamide.

The title acetamide compound, C(8)H(9)BrN(2)O, crystallizes with three crystallographically independent mol-ecules (A, B and C) in the asymmetric unit. In mol-ecule A, the mean plane through the acetamide unit is inclined at a dihedral angle of 4.40 (11)° with respect to the pyridine ring [10.31 (12) and 2.27 (11)°, respectively, for mol-ecules B and C]. In the crystal structure, mol-ecules are inter-connected into sheets parallel to the ac plane by N-H⋯O, C-H⋯Br, C-H⋯O and C-H⋯N hydrogen bonds. The structure is further stabilized by weak inter-molecular C-H⋯π inter-actions.

N-(6-{2-[6-(2,2-Dimethyl-propanamido)-2-pyrid-yl]eth-yl}-2-pyrid-yl)-2,2-dimethyl-propanamide.

The title compound, C(22)H(30)N(4)O(2), lies about a crystallographic inversion center. The whole mol-ecule is disordered over two positions with a refined occupancy ratio of 0.636 (10):0.364 (10). The pyridine rings are approximately planar, with maximum deviations of 0.033 (10) and 0.063 (17) Šfor the major and minor components, respectively. The mean planes of the pyridine rings form dihedral angles of 17 (2)° in the major component and 18 (2)° in the minor component with the respective formamide groups attached to them. In the crystal packing, inter-molecular N-H⋯O and C-H⋯O hydrogen bonds link the mol-ecules into two-dimensional networks parallel to the ab plane.

7-(2,2-Dimethylpropanamido)-2-methyl-1,8-naphthyridin-1-ium chloride monohydrate.

The asymmetric unit of the title compound, C(14)H(18)N(3)O(+)·Cl(-)·H(2)O, comprises a substituted amido-naphthyridine cation, a chloride anion and a water mol-ecule of crystallization. Intra-molecular C-H⋯O hydrogen bonds generate six-membered rings, producing an S(6) ring motif. The amido group is twisted from the naphthyridine ring, making a dihedral angle of 17.65 (7)°. The crystal structure is stabilized by inter-molecular N-H⋯O, N-H⋯Cl, O-H⋯Cl (× 2), and C-H⋯O (× 2) hydrogen bonds. These inter-actions linked neighbouring mol-ecules into chains along the a and b axes of the crystal, thus forming mol-ecular sheets parallel to the (001) plane.