A case of recurrent peritoneal dialysis-related peritonitis caused by Stenotrophomonas maltophilia during ongoing antibiotic treatment for Enterococcus faecalis-induced peritonitis.

Recurrent peritonitis is a serious complication of peritoneal dialysis (PD), which could result in PD withdrawal and mortality. However, cases of recurrent peritonitis occurring during ongoing antimicrobial therapy are rarely reported. Herein, we present a 71-year-old man who experienced initial peritonitis due to Enterococcus faecalis. Despite effective antimicrobial therapy, he developed recurrent peritonitis while on antimicrobial therapy. PD fluid culture analysis yielded Stenotrophomonas maltophilia (S. maltophilia). He was treated with multiple antimicrobials, and the peritoneal catheter was removed. To the best of our knowledge, this is the first case of recurrent peritonitis caused by S. maltophilia, which was developed during antimicrobial treatment. Our report findings suggest the importance of considering S. maltophilia infection in an atypical case of very early recurrent peritonitis.

A Case of Cholestatic Liver Involvement Secondary to Amyloid Light Chain Amyloidosis With New-Onset Hypercholesterolemia and Elevated Gamma-Glutamyltransferase Level.

Amyloid light chain (AL) amyloidosis is a rare disorder caused by the deposit of misfolded light chain proteins. AL amyloidosis causes multiple organ involvement and rarely causes fatal liver failure. We present a 68-year-old man who showed cholestatic liver injury and was diagnosed with AL amyloidosis. Due to rapidly progressing cholestatic liver involvement, the patient died five days after the renal biopsy. Preclinically, there was hypercholesterolemia, and levels of gamma-glutamyltransferase (GGT) were elevated. Previous studies have suggested hypercholesterolemia and elevated GGT levels in patients with AL amyloidosis and liver involvement; however, its clinical relevance remains unknown. Our report suggests that in addition to serum kappa/lambda, the combination of new-onset GGT level elevation and hypercholesterolemia could be preclinical characteristics of cholestatic liver involvement in AL amyloidosis.

Usefulness of aliasing phenomenon for diagnosing venous valve stenosis of arteriovenous fistula in a hemodialysis patient.

We present venous valve stenosis, which is an uncommon cause of arteriovenous fistula (AVF) dysfunction. Owing to the thin structure in echography, venous valves are challenging to observe; however, we have found that the aliasing phenomenon is useful for diagnosing venous valve stenosis.

Phenotypic differences of mutation-negative cases in Gitelman syndrome clinically diagnosed in adulthood.

Gitelman syndrome (GS), an autosomal recessive kidney disorder, is characterized by hypokalemia, hypomagnesemia, hypocalciuria, and metabolic alkalosis. Generally, diagnosis is made in school-aged children but multiple cases have been diagnosed in adulthood. This study examines the phenotypic differences between genetically confirmed cases and mutation-negative cases in adults. A comprehensive screening of 168 genes, including GS-related genes, was performed for 84 independent individuals who were referred to our institute with a clinical diagnosis of GS. The cases of pseudo-Bartter syndrome (BS)/GS because of diuretic abuse or other causes, which was determined based on patients' medical records, were excluded during registration. Of these 70 eligible cases for analysis, 27 (38.6%) had genetic confirmation of GS, while 37 (52.8%) had no known variants associated with GS and were considered to be unsolved cases. Note that unsolved cases comprised older, mostly female, individuals with decreased kidney function and multiple basic features of GS. The phenotype of unsolved cases is similar to that of pseudo BS/GS cases, although these cases were excluded in advance. However, the genetic and autoimmune profiles of these unsolved cases have not yet been investigated to date. Therefore, these cases may be categorized into new disease groups.

Highly selective sorption of small unsaturated hydrocarbons by nonporous flexible framework with silver ion.

Ag2[Cr3O(OOCC2H5)6(H2O)3]2[alpha-SiW12O40] [1] is a nonporous flexible ionic crystal composed of 2D-layers of polyoxometalates ([alpha-SiW12O40](4-)) and macrocations ([Cr3O(OOCC2H5)6(H2O)3](+)) stacking along the b-axis. The silver ions are located in the vicinity of the oxygen atoms of the polyoxometalates. The sorption amounts of small unsaturated hydrocarbons such as ethylene, propylene, n-butene, acetylene, and methyl acetylene into 1 are comparable to or larger than 1.0 mol mol(-1) and large hystereses are observed, while those of paraffins and larger unsaturated hydrocarbons are smaller than the adsorption on the external surface (<0.2 mol mol(-1)). Fine crystals of 1 exhibit ethylene/ethane and propylene/propane sorption ratios over 100 at 298 K and 100 kPa, and the values are larger by 1 order of magnitude among those reported. The results of sorption kinetics, in situ IR spectroscopy, single crystal X-ray crystallography, and in situ powder XRD studies show that small unsaturated hydrocarbons penetrate into the solid bulk of 1 through the pi-complexation with Ag(+). The sorption property of 1 is successfully applied to the collection of ethylene from the gas mixture of ethane and ethylene.

Control of structures and sorption properties of ionic crystals of A2[Cr3O(OOCC2H5)6(H2O)3]2[alpha-SiW12O40] (A = Na, K, Rb, NH4, Cs, TMA).

The complexation of Keggin-type polyoxometalate [alpha-SiW 12O 40] (4-), macrocation [Cr 3O(OOCC 2H 5) 6(H 2O) 3] (+), and monovalent cation A (+) forms ionic crystals of A 2[Cr 3O(OOCC 2H 5) 6(H 2O) 3] 2[alpha-SiW 12O 40]. nH 2O [A = Na ( 1a), K ( 2a), Rb ( 3a), NH 4 ( 4a), Cs ( 5a), and tetramethylammonium (TMA) ( 6a)]. Single crystal (1a- 4a and 6a) and powder (5a) X-ray analyses have shown that the ionic crystals possess 2D layers of polyoxometalates and macrocations. Compounds 2a- 5a had almost the same structure, while the layers in 1a and 6a stack in different ways. The structures and sorption properties of 2b- 5b are investigated in more detail. The interlayer distances of guest free phases 2b- 5b increase with the increase in the ionic radii of the monovalent cations, which reside between the layers. Compounds 2b- 5b possess hydrophobic and hydrophilic channels, which exist between the layers and through the layers, respectively. The volumes of the hydrophobic channels increase in the order of 2b < 3b approximately 4b < 5b, and those of the hydrophilic channels increase in the order of 2b < or = 3b < or = 4b < 5b. Single-crystal X-ray structure analyses of 2a- 4a have shown that the water of crystallization resides in the hydrophilic channel. It is probable that the water of crystallization in 5a resides in the hydrophilic channel in the same manner as those in 2a- 4a since 2a- 5a have almost the same structure. The water vapor sorption profiles of 2b- 5b are approximately reproduced by a linear driving force model. Therefore, water molecules sorbed in 2b- 5b probably reside in the hydrophilic channel. The n-propanol sorption profiles are reproduced by the summation of the linear driving force model, showing that two independent barriers exist in the n-propanol sorption. The in situ IR spectra of n-propanol sorbed showed the presence of two n-propanol species. These data show that n-propanol is sorbed into both hydrophilic and hydrophobic channels. Compound 5b sorbs halocarbons in the hydrophobic channel, while 2b- 4b exclude them.

2D-grid layered Pd-based cationic infinite coordination polymer/polyoxometalate crystal with hydrophilic sorption.

The inorganic-organic hybrid compound composed of the novel infinite-chain Pd(II) complex and the polyoxometalate ({[(en)Pd(p-bpy)]2[alpha-SiW12O40].8DMSO.4DMF}infinity (1a:1 with 8DMSO.4DMF; monoclinic P2(1)/c (No. 14), a = 15.0188(3) A, b = 15.6962(3) A, c = 26.9793(6) A, beta = 106.3580(10) degrees , V = 6102.6(2) A(3)) has been successfully synthesized by the reaction of [(en)Pd(OH2)2]2[alpha-SiW12O40] (2) with 4,4'-bipyridine (p-bpy). The treatment in dry N(2) at 50 degrees C or evacuation at room temperature forms {[(en)Pd(p-bpy)](2)[alpha-SiW(12)O(40)].6.0DMSO}(infinity) (1b:1 with 6DMSO) with a drastic reduction of the interlayer spacing, which is characterized by the powder diffraction analysis and the single-crystal analysis of 1c (1 with 4.5DMSO.3.5DMF; monoclinic P2(1)/a (No. 14), a = 14.200(9) A, b = 22.8865(8) A, c = 14.8558(5) A, beta = 114.7990(10) degrees , V = 4383.0(2) A(3)). Compound 1b reversibly sorbs the hydrophilic molecules with the maintenance of the intrinsic structure, which is much different from hydrophobic guest-inclusion properties reported in the other Pd-based supramolecular systems.

Channel-selective independent sorption and collection of hydrophilic and hydrophobic molecules by Cs2[Cr3O(OOCC2H5)6(H2O)3]2[alpha-SiW12O40] ionic crystal.

An ionic crystal of Cs2[Cr3O(OOCC2H5)6(H2O)3]2[alpha-SiW12O40].4H2O 1a with hydrophilic and hydrophobic channels has been designed and successfully synthesized. The guest-free phase 1b sorbs dichloromethane and water in the hydrophobic and hydrophilic channels, respectively. The rate and equilibrium amount of the dichloromethane sorption into the hydrophobic channel and those of water into the hydrophilic channel were independent of each other. The sorption properties can be applied to the channel-selective sorption and collection of hydrophobic (dichloromethane) and hydrophilic (water) molecules from the mixture.

Recognition of small polar molecules with an ionic crystal of alpha-Keggin-type polyoxometalate with a macrocation.

The complexation of Keggin-type polyoxometalates [alpha-XW12O40]n- (X = P, Si, B, Co), macrocation [Cr3O(OOCH)6(H2O)3]+, and alkali-metal ions forms ionic crystals of Na2[Cr3O(OOCH)6(H2O)3][alpha-PW12O40].16H2O (1a), K3[Cr3O(OOCH)6(H2O)3][alpha-SiW12O40].16H2O (2a), Rb4[Cr3O(OOCH)6(H2O)3][alpha-BW12O40].16H2O (3a), and Cs5[Cr3O(OOCH)6(H2O)3][alpha-CoW12O40].7.5H2O (4a). The space volumes of the ionic crystals decrease in the order of 1a > 2a > 3a > 4a. The water of crystallization in 1a-3a is completely desorbed by evacuation at room temperature, while about 50% of the water of crystallization in 4a is desorbed. The respective 1a-4a after evacuation at room temperature are denoted by 1b-4b, which show the close packing of the constituent ions. The calculated cell volumes per formula decreased in the order of 1b > 2b > 3b > 4b, which would be related to the increase in n. Compound 1b sorbs various < or =C5 polar organic molecules such as 1-butanol, valeronitrile, and methyl propionate. Compound 2b sorbs ethanol, acetonitrile, and methyl formate. Compound 3b sorbs water and methanol, and 4b sorbs only water. Thus, the ionic crystals can discriminate < or =C5 polar organic molecules such as alcohols, nitriles, and esters by one methylene chain, and the decrease in n of [alpha-XW12O40]n- enables the sorption of molecules with the longer methylene chain. The nature of the sorption properties of 1b-4b can be explained by the lattice energy needed for the expansion of 1b-4b. The selective sorption properties of 1b-4b are successfully applied to the separation of mixtures of alcohols, nitriles, esters, and water.

Amphiphilic guest sorption of K2[Cr3O(OOCC2H5)6(H2O)3]2[alpha-SiW12O40] ionic crystal.

An ionic crystal K2[Cr3O(OOCC2H5)6(H2O)3]2[alpha-SiW12O40] x 3H2O (1a) is synthesized by the complexation of a Keggin-type polyoxometalate of [alpha-SiW12O40]4- with K+ and a macrocation of [Cr3O(OOCC2H5)6(H2O)3]+. Compound 1a possesses both hydrophilic and hydrophobic channels in the crystal lattice. The 3 mol mol(-1) of the water of crystallization in 1a resides in the hydrophilic channel. The water of crystallization is removed by the evacuation at 303 K to form the guest-free phase 1b with small changes in the lattice lengths (+/-0.2 A). The water sorption profile is reproduced by the single rate constant. Therefore, the water sorbed probably resides in the hydrophilic channel. Compound 1b sorbs various kinds of polar organic molecules, and the amounts of < or = C3 alcohols are comparable to or larger than that of water, while chlorocarbons with no hydrogen-bonding ability and nonpolar molecules are excluded. Thus, 1b showed the amphiphilic sorption property. The states of the polar organic molecules sorbed in 1b have been quantitatively investigated using ethanol as a probe molecule. The IR, NMR, and single-crystal X-ray diffraction studies combined with the sorption kinetics reveal that ethanol molecules are mainly sorbed into the hydrophilic channel at P/P0 < or = 0.5, while the sorption into the hydrophobic channel is dominant at P/P0 > or = 0.6. Thus, it is demonstrated that ethanol molecules enter both hydrophilic and hydrophobic channels of 1b.