Light chain cast nephropathy caused by plasmablastic lymphoma of the bladder.

INTRODUCTION: Plasmablastic lymphoma (PBL) is a rare form of B-cell lymphoma typically seen in patients with underlying immunosuppression such as HIV, autoimmune disease, and organ transplantation. PBL in HIV-positive patients usually originates from the gastrointestinal tract, with a predilection for the oral cavity. Bladder involvement by PBL is exceedingly rare, and cast nephropathy due to κ light chain-secreting PBL has not been reported previously. CASE REPORT: We report a patient who presented with acute kidney injury (AKI) in the setting of HIV, and was found to have a bladder tumor. Bladder pathology revealed a high-grade PBL with κ light chain restriction. Renal biopsy showed κ light chain cast nephropathy, presumably secondary to κ light chain-secreting PBL. CONCLUSION: Although the prognosis of PBL is poor, our patient recovered from AKI, achieved complete hematologic remission with chemotherapy, and underwent successful autologous stem cell transplant.

Repeat cesarean section in a COVID-19 positive mother in the United States.

In our report, we present a case of repeat cesarean section in a 29-year-old Ecuadorian mother who contracted COVID-19 and traveled to the United States during her last trimester of pregnancy. We assembled a multidisciplinary team to safely deliver the mother by cesarean section. She received supportive care for her COVID-19 infection. Infection prevention procedures were based on early available data, and the baby was delivered without complications.

Update on role of direct renin inhibitor in diabetic kidney disease.

BACKGROUND: Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease (ESRD). Renin-angiotensin-aldosterone system (RAAS) plays a critical role in the development of DKD with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) being the mainstay of treatment. Systemic RAAS activity has been implicated in the pathogenesis of DKD, but lately interest has shifted to intrarenal RAAS effect. With the discovery of the (pro)renin receptor and ACE independent pathways of angiotensin II production, our understanding of role of renin in end organ damage has improved significantly. SUMMARY: We summarize our current understanding of ACE dependent and independent pathways in the development of DKD and the preclinical models demonstrating renal effects of direct renin inhibitors (DRIs). We then review clinical studies and trials performed so far evaluating the efficacy of aliskiren on renal outcomes and safety in DKD. KEY MESSAGE: At present, there is little evidence for renal benefit of aliskiren in DKD beyond that offered by ACEIs or ARBs. Combining aliskiren with ACEI or ARB in DKD did not significantly improve renal outcomes in comparison with ACEI or ARB monotherapy in clinical trials. Slightly more adverse events including hyperkalemia, acute kidney injury and hypotension were observed in the combination therapy as compared to the monotherapy. Thus, current evidence suggests that aliskiren, because of its antihypertensive and antiproteinuric effects, maybe used as monotherapy in DKD and considered an equivalent alternative to ACEIs or ARBs. Careful monitoring for renal adverse effects would allow safe clinical use of DRI.

Generation and properties of antibacterial coatings based on electrostatic attachment of silver nanoparticles to protein-coated polypropylene fibers.

We present a simple method for attaching silver nanoparticles to polypropylene (PP) fibers in a two-step process to impart antibacterial properties. Specifically, PP fibers are pretreated by the adsorption from an aqueous solution of heat-denatured lysozyme (LYS) followed by LYS cross-linking using glutaraldehyde and sodium borohydride. At neutral pH, the surface of the adsorbed LYS layer is enriched with numerous positive charges. Silver nanoparticles (AgNPs) capped with trisodium citrate are subsequently deposited onto the protein-coated PP. Nanoparticle binding is mediated by electrostatic interactions between the positively charged LYS layer and the negatively charged AgNPs. The density of AgNPs deposited on PP depends on the amount of protein adsorbed on the surface. UV-vis spectroscopy, transmission electron microscopy, Fourier transform infrared spectroscopy, and scanning electron microscopy are employed to follow all preparation steps and to characterize the resulting functional surfaces. The antibacterial activity of the modified surfaces is tested against gram negative bacteria Escherichia coli (E. coli). Overall, our results show that PP surfaces coated with AgNPs exhibit excellent antibacterial activity with 100% removal efficiency.

Formation and antifouling properties of amphiphilic coatings on polypropylene fibers.

We describe the formation of amphiphilic polymeric assemblies via a three-step functionalization process applied to polypropylene (PP) nonwovens and to reference hydrophobic self-assembled n-octadecyltrichlorosilane (ODTS) monolayer surfaces. In the first step, denatured proteins (lysozyme or fibrinogen) are adsorbed onto the hydrophobic PP or the ODTS surfaces, followed by cross-linking with glutaraldehyde in the presence of sodium borohydride (NaBH(4)). The hydroxyl and amine functional groups of the proteins permit the attachment of initiator molecules, from which poly (2-hydroxyethyl methacrylate) (PHEMA) polymer grafts are grown directly through "grafting from" atom transfer radical polymerization. The terminal hydroxyls of HEMA's pendent groups are modified with fluorinating moieties of different chain lengths, resulting in amphiphilic brushes. A palette of analytical tools, including ellipsometry, contact angle goniometry, Fourier transform infrared spectroscopy in the attenuated total reflection mode, and X-ray photoelectron spectroscopy is employed to determine the changes in physicochemical properties of the functionalized surfaces after each modification step. Antifouling properties of the resultant amphiphilic coatings on PP are analyzed by following the adsorption of fluorescein isothiocyanate-labeled bovine serum albumin as a model fouling protein. Our results suggest that amphiphilic coatings suppress significantly adsorption of proteins as compared with PP fibers or PP surfaces coated with PHEMA brushes. The type of fluorinated chain grafted to PHEMA allows modulation of the surface composition of the topmost layer of the amphiphilic coating and its antifouling capability.

Generation of functional coatings on hydrophobic surfaces through deposition of denatured proteins followed by grafting from polymerization.

Hydrophilic coatings were produced on flat hydrophobic substrates featuring n-octadecyltrichlorosilane (ODTS) and synthetic polypropylene (PP) nonwoven surfaces through the adsorption of denatured proteins. Specifically, physisorption from aqueous solutions of α-lactalbumin, lysozyme, fibrinogen, and two soy globulin proteins (glycinin and ß-conglycinin) after chemical (urea) and thermal denaturation endowed the hydrophobic surfaces with amino and hydroxyl functionalities, yielding enhanced wettability. Proteins adsorbed strongly onto ODTS and PP through nonspecific interactions. The thickness of adsorbed heat-denatured proteins was adjusted by varying the pH, protein concentration in solution, and adsorption time. In addition, the stability of the immobilized protein layer was improved significantly after interfacial cross-linking with glutaraldehyde in the presence of sodium borohydride. The amino and hydroxyl groups present on the protein-modified surfaces served as reactive sites for the attachment of polymerization initiators from which polymer brushes were grown by surface-initiated atom-transfer radical polymerization of 2-hydroxyethyl methacrylate. Protein denaturation and adsorption as well as the grafting of polymeric brushes were characterized by circular dichroism, ellipsometry, contact angle, and Fourier transform infrared spectroscopy in the attenuated total reflection mode.

Multilayers of weak polyelectrolytes of low and high molecular mass assembled on polypropylene and self-assembled hydrophobic surfaces.

Hydrophobic self-assembled octadecyltrichlorosilane (ODTS), ultrathin films of polypropylene, and ODTS modified with cationic dioctadecyldimethylammonium bromide are employed as substrates for deposition of multilayers of poly(allylamine hydrochloride) and poly(acrylic acid) from aqueous solution. The assembly of highly dissipative polyelectrolyte multilayers (PEMs) is demonstrated by quartz crystal microgravimetry. The initial rate of adsorption is faster and the adsorbed amount larger on the cationic surface, while the detailed structure of the PEMs, as determined by atomic force microscopy imaging, is related primarily to the molecular weight of the adsorbing polymers. A more extensive PEM adsorption on the hydrophobic surfaces takes place with increasing ionic strength of the background electrolyte solution. The water contact angle depends on the type of polymer adsorbed as the outermost layer, indicating that, despite the expected interdiffusion for the different polymer chains, there is a net macromolecular segregation to the free surface. Surface modification with the high molecular weight PEMs produces a more marked reduction of the hydrophilicity of the substrate.