The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes.

Background: Up to 50-60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR. Methods: We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan-Meier and Cox regression analyses. Results: Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6%) had DR. During a follow-up of 10 years, 288/760 (37.9%) patients with follow-up data needed KRT and 157/760 (20.7%) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR [103/175 (58.9%)] than among patients without DR [88/216 (40.7%), P < .0001]. The incidence of KRT was also higher among patients with only NDKD and DR than among those without DR [18/46 (39.1%) versus 79/331 (23.9%), P < .0001]. In multivariate analysis, DR or DN were independent risk factors for KRT {hazard ratio [HR] 2.48 [confidence interval (CI) 1.85-3.31], P < .001}. DN (with or without DR) was also identified as an independent risk factor for mortality [HR 1.81 (CI 1.26-2.62), P = .001]. Conclusions: DR is associated with a higher risk of progression to kidney failure in patients with histological DN and in patients with NDKD.

Effect of Relaxations on the Conductivity of La1/2+1/2x Li1/2-1/2x Ti1-x Al x O3 Fast Ion Conductors.

Perovskite-type solid-state electrolytes, Li3x La2/3-x TiO3 (LLTO), are considered among the most promising candidates for the development of all-solid-state batteries based on lithium metal. Their high bulk ionic conductivity can be modulated by substituting part of the atoms hosted in the A- or B-site of the LLTO structure. In this work, we investigate the crystal structure and the long-range charge migration processes characterizing a family of perovskites with the general formula La1/2+1/2x Li1/2-1/2x Ti1-x Al x O3 (0 ≤ x ≤ 0.6), in which the charge balance and the nominal A-site vacancies (n A = 0) are preserved. X-ray diffraction (XRD) and high-resolution transmission electron microscopy (HRTEM) investigations reveal the presence of a very complex nanostructure constituted by a mixture of two different ordered nanoregions of tetragonal P4/mmm and rhombohedral R3̅c symmetries. Broadband electrical spectroscopy studies confirm the presence of different crystalline domains and demonstrate that the structural fluctuations of the BO6 octahedra require to be intra- and intercell coupled, to enable the long-range diffusion of the lithium cation, in a similar way to the segmental mode that takes place in polymer-ion conductors. These hypotheses are corroborated by density functional theory (DFT) calculations and molecular dynamic simulations.

Risk factors for non-diabetic renal disease in diabetic patients.

BACKGROUND: Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied. The aim of our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal biopsy findings in patients with diabetes. METHODS: Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to 2014. RESULTS: In total, 832 patients were included: 621 men (74.6%), mean age of 61.7 ± 12.8 years, creatinine was 2.8 ± 2.2 mg/dL and proteinuria 2.7 (interquartile range: 1.2-5.4) g/24 h. About 39.5% (n = 329) of patients had DN, 49.6% (n = 413) NDRD and 10.8% (n = 90) mixed forms. The most frequent NDRD was nephroangiosclerosis (NAS) (n = 87, 9.3%). In the multivariate logistic regression analysis, older age [odds ratio (OR) = 1.03, 95% CI: 1.02-1.05, P < 0.001], microhaematuria (OR = 1.51, 95% CI: 1.03-2.21, P = 0.033) and absence of diabetic retinopathy (DR) (OR = 0.28, 95% CI: 0.19-0.42, P < 0.001) were independently associated with NDRD. Kaplan-Meier analysis showed that patients with DN or mixed forms presented worse renal prognosis than NDRD (P < 0.001) and higher mortality (P = 0.029). In multivariate Cox analyses, older age (P < 0.001), higher serum creatinine (P < 0.001), higher proteinuria (P < 0.001), DR (P = 0.007) and DN (P < 0.001) were independent risk factors for renal replacement therapy. In addition, older age (P < 0.001), peripheral vascular disease (P = 0.002), higher creatinine (P = 0.01) and DN (P = 0.015) were independent risk factors for mortality. CONCLUSIONS: The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD. These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and subsequently treatment and prognosis.

Coexistence between personality disorders and substance use disorder. Madrid study about prevalence of dual pathology.

INTRODUCTION: Personality disorders (PD) and substance use disorders (SUD) have a high prevalence and an important health and socioeconomic impact so, it is interesting to study the relationship between them. The objectives of the study are: to compare the prevalence of SUD between patients with and without diagnosis of PD, to analyze if any PD is related to the SUD, and if a specific PD is associated with a specific SUD. MATERIAL AND METHODS: Cross-sectional study in 837 patients from centers of attention to drug addiction and mental health in Madrid, Spain. The Mini International Neuropsychiatric Interview (MINI) and the Personality Diagnostic Questionnaire-4+ (PDQ4+) are used to detect mental disorder and PD, respectively. RESULTS: SUD is significantly higher in antisocial PD (p<0.01); sedative (p<0.01) and alcohol (p<0.05) use disorder in borderline PD; cocaine (p<0.05) and alcohol (p<0.01) use disorder in paranoid PD; and alcohol use disorder in histrionic PD (p<0.01). The SUD for cocaine is lower in obsessive- compulsive PD (p<0.05) and depressive PD (p<0.01). There is a positive correlation between the number of PD of a subject and the number of SUD that it presents. The risk of an alcohol [OR of 1,08 CI (1,01-1,16)] or sedatives [OR of 1,08 CI (1,001-1,17)] use disorders increases if an individual presents more than one type of PD. CONCLUSIONS: There is not differences of SUD prevalence between PD and not PD groups. We found an association between SUD and PD of cluster B (antisocial, borderline and histrionic) and also with paranoid PD. The SUD are more common among man with the exception of sedatives.

Coexistencia entre los trastornos de personalidad y el trastorno por uso de sustancias. Estudio Madrid sobre prevalencia de patologia dual / Coexistence between personality disorders and substance use disorder. Madrid study about prevalence of dual pathology

INTRODUCCIÓN: Los trastornos de personalidad (TP) y los trastornos por uso de sustancias (TUS) presentan una alta prevalencia y un impacto sanitario y socioeconómico importante. Por este motivo es interesante estudiar la posible relación entre ambos trastornos. Los objetivos del trabajo son: comparar la prevalencia de TUS entre pacientes con y sin diagnóstico de TP, analizar si algún TP se relaciona con el TUS, y si algún TP específico se asocia con un TUS concreto. MATERIAL Y MÉTODOS: Estudio transversal en 837 pacientes procedentes de centros de atención a drogodependencias y de salud mental de Madrid, España. Se utiliza la Mini International Neuropsychiatric Interview (MINI) y el cuestionario Personality Diagnostic Questionnaire-4+ (PDQ4+) para detectar trastorno mental y TP respectivamente. RESULTADOS: No se encuentran diferencias en la prevalencia de TUS entre los sujetos con TP y sin él. Dentro de los sujetos con TP son más frecuentes los TUS en el TP antisocial (p < 0,01). En el TP límite es más prevalente el trastorno por uso de sedantes (p < 0,01) y de alcohol (p < 0,05); en el TP paranoide el trastorno por uso de cocaína (p < 0,05) y de alcohol (p < 0,01); y en el TP histriónico el trastorno por uso de alcohol (p < 0,01). El TUS de cocaína es menor en el TP obsesivo-compulsivo (p < 0,05) y depresivo (p < 0,01). El riesgo de un trastorno por uso de alcohol [OR de 1,08 IC (1,01-1,16)] y sedantes [OR de 1,08 IC (1,001-1,17)] aumenta si un individuo presenta más de un tipo de TP. CONCLUSIONES: No se encuentran mayor prevalencia de TUS en los TP que en los no TP. Encontramos asociación entre los TUS y los TP del clúster B (antisocial, límite e histriónico) y con el TP paranoide. Todos los TUS son más prevalentes entre varones, salvo el TUS de hipnóticos

INTRODUCTION: Personality disorders (PD) and substance use disorders (SUD) have ahigh prevalence and an important health and socioeconomic impact so, it is interesting to study the relationship between them. The objectives of the study are: to compare the prevalence of SUD between patients with and without diagnosis of PD, to analyze if any PD is related to the SUD, and if a specific PD is associated with a specific SUD. MATERIAL AND METHODS: Cross-sectional study in 837 patients from centers of attention to drug addiction and mental health in Madrid, Spain. The Mini International Neu-ropsychiatric Interview (MINI) and the Personality Diagnostic Questionnaire-4+ (PDQ4+) are used to detect mental disorder and PD, respectively. RESULTS: SUD is significantly higher in antisocial PD (p < 0.01); sedative (p < 0.01) and alcohol (p < 0.05) use disor-der in borderline PD; cocaine (p < 0.05) and alcohol (p < 0.01) use disorder in paranoid PD; and alcohol use disorder in histrionic PD (p < 0.01). The SUD for cocaine is lower in obsessive-compulsive PD (p < 0.05) and depressive PD (p < 0.01). There is a positive correlation between the number of PD of a subject and the number of SUD that it presents. The risk of an-alcohol [OR of 1,08 CI (1,01-1,16)] or sedatives [OR of 1,08 CI (1,001-1,17)] use disorders increases if an individual presents more than one type of PD. CONCLUSIONS: There is not differences of SUD prevalence between PD and not PD groups. We found an association between SUD and PD of cluster B (antisocial, borderline and histrionic) and also with paranoid PD. The SUD are more common among man with the exception of sedatives

Unravelling the complex nanostructure of La0.5-xLi0.5-xSr2xTiO3 Li ionic conductors.

The origin of the intricate nanostructure of La0.5-xLi0.5-xSr2xTiO3 (0.0625 ≤ x ≤ 0.25) perovskite-type Li ion conductors has been investigated. Reciprocal space electron diffraction analysis and aberration-corrected STEM by combining annular bright field (ABF) and high angle annular dark field (HAADF) imaging methods have been used to elucidate the complex local atomic arrangements which cannot be adequately described by average crystal structure models. Two different local crystal structures endotaxially-related at the nanoscale without compositional phase separation associated, constituting the crystals. Self-organization of the two different ordered regions arises as a consequence of the competition between two distortive forces in the crystal lattice: octahedral tilting and second-order Jahn-Teller distortion of TiO6 octahedra. Changes in the distribution of A species suggest different Li ion conduction pathways for the two structures and this scenario has difficult long-range Li mobility. The detailed study performed may be helpful in understanding the local structural changes affecting Li and their relation to the conductivity in LLTO-derived ionic conductors.

A new genotype of bovine leukemia virus in South America identified by NGS-based whole genome sequencing and molecular evolutionary genetic analysis.

BACKGROUND: Bovine leukemia virus (BLV) is a member of retroviridae family, together with human T cell leukemia virus types 1 and 2 (HTLV-1 and -2) belonging to the genes deltaretrovirus, and infects cattle worldwide. Previous studies have classified the env sequences of BLV provirus from different geographic locations into eight genetic groups. To investigate the genetic variability of BLV in South America, we performed phylogenetic analyses of whole genome and partial env gp51 sequences of BLV strains isolated from Peru, Paraguay and Bolivia, for which no the molecular characteristics of BLV have previously been published, and discovered a novel BLV genotype, genotype-9, in Bolivia. RESULTS: In Peru and Paraguay, 42.3 % (139/328) and over 50 % (76/139) of samples, respectively, were BLV positive. In Bolivia, the BLV infection rate was up to 30 % (156/507) at the individual level. In Argentina, 325/420 samples were BLV positive, with a BLV prevalence of 77.4 % at the individual level and up to 90.9 % at herd level. By contrast, relatively few BLV positive samples were detected in Chile, with a maximum of 29.1 % BLV infection at the individual level. We performed phylogenetic analyses using two different approaches, maximum likelihood (ML) tree and Bayesian inference, using 35 distinct partial env gp51 sequences from BLV strains isolated from Peru, Paraguay, and Bolivia, and 74 known BLV strains, representing eight different BLV genotypes from various geographical locations worldwide. The results indicated that Peruvian and Paraguayan BLV strains were grouped into genotypes-1, -2, and -6, while those from Bolivia were clustered into genotypes-1, -2, and -6, and a new genotype, genotype-9. Interestingly, these results were confirmed using ML phylogenetic analysis of whole genome sequences obtained by next generation sequencing of 25 BLV strains, assigned to four different genotypes (genotypes-1, -2, -6, and -9) from Peru, Paraguay, and Bolivia. Comparative analyses of complete genome sequences clearly showed some specific substitutions, in both structural and non-structural BLV genes, distinguishing the novel genotype-9 from known genotypes. CONCLUSIONS: Our results demonstrate widespread BLV infection in South American cattle and the existence of a new BLV genotype-9 in Bolivia. We conclude that at least seven BLV genotypes (genotypes-1, -2, -4, -5, -6, -7, and -9) are circulating in South America.

Changes in the aetiology, clinical presentation and management of acute interstitial nephritis, an increasingly common cause of acute kidney injury.

Acute interstitial nephritis (AIN) is an important cause of acute kidney injury that has experienced significant epidemiological and clinical changes in the last years. The classical presentation, mostly induced by antibiotics and accompanied by evident hypersensitivity manifestations (skin rash, eosinophilia, fever) has been largely replaced by oligosymptomatic presentations that require a higher index of suspicion and are increasingly recognized in the elderly, having non-steroidal anti-inflammatory agents and proton pump inhibitors as frequent offending drugs. Drug-induced AIN continues to be the commonest type, but it requires a careful differential diagnosis with other entities (tubulointerstitial nephritis with uveitis syndrome, IgG4-related disease, drug reaction with eosinophilia and systemic symptom syndrome, sarcoidosis and other systemic diseases) that can also induce AIN. Cortico-dependant, relapsing AIN is a recently recognized entity that poses an important therapeutic challenge. Although corticosteroids are widely used in drug-induced AIN to speed kidney function recovery and avoid chronic kidney disease, their efficacy has not been tested by randomized controlled trials. New diagnostic tests and biomarkers, as well as prospective therapeutic studies are needed to improve AIN diagnosis and management.

Multielement crystalline and pseudocrystalline oxides as efficient catalysts for the direct transformation of glycerol into acrylic acid.

Glycerol surplus from biodiesel synthesis still represents a major problem in the biofuel production chain. Meanwhile, those in the acrylic acid market are looking for new processes that are able to offer viable alternatives to propylene-based production. Therefore, acrylic acid synthesis from glycerol could be an effective solution to both issues. Among the viable routes, one-pot synthesis theoretically represents the most efficient process, but it is also highly challenging from the catalyst design standpoint. A new class of complex W--Mo--V mixed-oxide catalysts, which are strongly related to the hexagonal tungsten bronze structure, able to directly convert glycerol into acrylic acid with yields of up to 51 % are reported.

Multiple kidney cysts in thin basement membrane disease with proteinuria and kidney function impairment.

BACKGROUND: Some patients with thin basement membrane disease (TBMD) develop proteinuria, hypertension and different degrees of CKD, besides the persistent microhaematuria characteristic of the disease. Little is known about factors associated with this unfavourable outcome. METHODS: We reviewed clinical, pathological and radiological features of 32 patients with biopsy-proven TBMD. Patients were divided in two groups: those with persistent normal kidney function and negative or minimal proteinuria (n = 16) and those with persistent proteinuria >0.5 g/day (n = 16). RESULTS: Patients with proteinuria had a worse kidney function at baseline than those with negative proteinuria. Global or segmental glomerulosclerosis, together with interstitial fibrosis, was found in 37% of patients with proteinuria. All proteinuric patients were treated with renin-angiotensin system blockers. At the end of follow-up (198 months in proteinuric patients and 210 months in patients with negative proteinuria) the prevalence of hypertension was 68% in proteinuric patients (12% at baseline), compared with 12 and 6%, respectively, in non-proteinuric patients. A slow decline of renal function was observed in proteinuric patients, although no patient developed end-stage kidney disease. Ultrasound studies showed bilateral kidney cysts in nine patients (56%) with proteinuria. Cysts were bilateral and countless in six patients, and bilateral but with a limited number of cysts in the three remaining patients. No cysts were found in patients with negative proteinuria. CONCLUSIONS: Some patients with TBMD develop hypertension, proteinuria and CKD. Multiple bilateral kidney cysts were found in a majority (56%) of these patients. Further studies are needed to investigate the pathogenesis and the influence on long-term outcome of this TBMD-associated multiple kidney cysts.

Presence of Gumprecht shadows (smudge cells) in bovine leukemia virus-positive cattle.

Enzootic Bovine Leukosis is a chronic disease caused by the bovine leukemia virus (BLV). Smudge cells, also known as Gumprecht shadows, are not simple artifacts of slide preparation, but ragged lymphoid cells found mainly in peripheral blood smears from human patients with chronic lymphocytic leukemia. In this study, we report the presence of Gumprecht shadows in peripheral blood from BLV-positive cattle.

Expression of p24 gag protein of bovine leukemia virus in insect cells and its use in immunodetection of the disease.

Bovine leukemia is a common retroviral infection of cattle. The disease is characterized by a strong immunological response to several viral proteins, but the antibodies against p24 and gp51 are predominant. In this study, a recombinant baculovirus containing the gag gene p24 was constructed and the protein, used as antigen, analyzed by western blot and an indirect in-house rp24-ELISA test. This allowed detecting the presence of antibodies for bovine leukemia virus in a panel of cattle sera. The authentication of the protein expands its potential use for different medical applications, from improved diagnosis of the disease to source of antigens to be included in a subunit vaccine.

Analysis of the pX region of bovine leukemia virus in different clinical stages of Enzootic Bovine Leukemia in Argentine Holstein cattle.

Bovine leukemia virus (BLV) infection in cattle causes Enzootic Bovine Leukemia (EBL). About 30% of infected cattle develop persistent lymphocytosis (PL), a 0.1-5% develops tumors, and a 70% remains asymptomatic in an aleukemic stage (AL). Regulatory genes of BLV (Tax, Rex, R3 and G4) are located in a region known as pX(BLV). The variability of those genes had been postulated with the progression of the disease. The aim of this work was to compare the wild-type proviral pX(BLV) region at different stages of BLV natural infected cattle from Argentine Holstein. Pairs of primers were designed to amplify the proviral pX region of 12 cattle by PCR, and products were then sequenced, aligned and compared both with each other and with the reference sequence. Results show a divergence percentage from 0 to 6.1 for the Tax gene, from 0 to 9.4% for the Rex gene, from 0 to 12.1% for the R3 gene and finally from 0 to 6.5% for the G4 gene. Results obtained with hierarchical clustering showed two clusters well differentiated, where the members of each cluster are cattle that had tumor, PL and AL, not allowing differentiate those two cluster by clinical stage.

Ateroembolia de colesterol y tratamiento combinado con esteroides e iloprost / Cholesterol atheroembolism and combined treatment with steroids and iloprost

La ateroembolia de colesterol (AEC) es una enfermedad sistémica cuya incidencia ha aumentado en las últimas décadas y que presenta una elevada morbimortalidad. En el momento actual se desconocen cuáles son las alternativas terapéuticas más efectivas en esta entidad. En este artículo presentamos el caso de una paciente diagnosticada de AEC con afectación cutánea, intestinal y renal, que presentó una buena evolución tras el inicio de terapia combinada con esteroides y análogos de las prostaglandinas. A pesar de que no existen estudios concluyentes, sugerimos esta alternativa para el manejo de AEC con afectación orgánica (AU)

Cholesterol atheroembolism (CAE) is a systemic disorder whose incidence has increased in recent decades and that presents high morbidity and mortality. Although several therapeutic alternatives have been reported, there is no consensus about the best treatment for this disease. In this paper we report the case of a patient with CAE with skin, bowel and kidney involvement who presented a good response to combined therapy with steroids and prostaglandin analogues. Although there are no conclusive studies, we recommend this therapeutic alternative in the management of CAE with organic failure (AU)

On the feasibility of interoperable schemes in hand biometrics.

Personal recognition through hand-based biometrics has attracted the interest of many researchers in the last twenty years. A significant number of proposals based on different procedures and acquisition devices have been published in the literature. However, comparisons between devices and their interoperability have not been thoroughly studied. This paper tries to fill this gap by proposing procedures to improve the interoperability among different hand biometric schemes. The experiments were conducted on a database made up of 8,320 hand images acquired from six different hand biometric schemes, including a flat scanner, webcams at different wavelengths, high quality cameras, and contactless devices. Acquisitions on both sides of the hand were included. Our experiment includes four feature extraction methods which determine the best performance among the different scenarios for two of the most popular hand biometrics: hand shape and palm print. We propose smoothing techniques at the image and feature levels to reduce interdevice variability. Results suggest that comparative hand shape offers better performance in terms of interoperability than palm prints, but palm prints can be more effective when using similar sensors.

Structural effects behind the low temperature nonconventional relaxor behavior of the Sr2NaNb5O15 bronze.

An exhaustive temperature dependent structural and dielectric study of the tetragonal tungsten bronze-type Sr(2)NaNb(5)O(15) (SNN) compound has been performed in the 300-100 K temperature range, by combining X-ray, neutron diffraction, and transmission electron microscopy with dielectric measurements, in order to clarify the structural effects responsible for the observed low temperature dielectric properties. Interestingly, a relevant second anomaly in the dielectric constant, in addition to the ferroelectric (FE) to paraelectric (PE) transition at T(C) = 518 K is found at T ≈ 240 K, revealing a relaxor-like behavior of the material at low temperature. This phenomenon has been previously observed in FE perovskite-type phases and referred to as the re-entrant phenomenon. However, FE polarization tends to vanish below this low temperature dielectric anomaly and this fact is not expected for a classical relaxor-ferroelectric phase. Although there is no structural transition from RT to 100 K, there is a change in the elastic properties of the material in the considered temperature range and the intense anomaly at ~240 K could be associated to a smeared-out phase transition to a frustrated FE/ferroelastic (FEL) low temperature state in correlation with subtle structural effects.

Transmission electron microscopy evidence of spontaneous B-cation layered distribution in NaNb(1-x)Ta(x)O3.

A transmission electron microscopy (TEM) study of the complex NaNb(1-x)Ta(x)O(3) (0.4 < or = x < or = 0.6) perovskites, combining high-resolution TEM and high-angle annular dark-field scanning TEM, has revealed the formation of extended areas on the crystals where niobium and tantalum order into layers in a 1:1 ratio. NaNb(1-x)Ta(x)O(3) oxides are stoichiometric, and there is neither charge difference nor significant ionic size discrepancy between Nb(V) and Ta(V) cations. As d(0) octahedrally coordinated cations, they show a propensity to second-order Jahn-Teller distortion. This distortion, however, manifests itself to different extents for the two cations and is considered the driving force for the layered ordered distribution observed. The niobium-tantalum segregation we have found can also be interpreted as a naturally occurring nanometer-scale phase separation. Albeit occurring in wide regions of the crystals and not in the entire grains, it shows a clear trend toward a long-range ordered disposition. This is reminiscent of the more general behavior of a recently documented class of perovskites that suffer spontaneous nanoscale phase separation to form a superlattice.

Acute interstitial nephritis.

Acute interstitial nephritis (AIN) represents a frequent cause of acute kidney injury, accounting for 15-27% of renal biopsies performed because of this condition. By and large, drug-induced AIN is currently the commonest etiology of AIN, with antimicrobials and nonsteroidal anti-inflammatory drugs being the most frequent offending agents. Pathogenesis is based on an immunologic reaction against endogenous nephritogenic antigens or exogenous antigens processed by tubular cells, with cell-mediated immunity having a major pathogenic role. The characteristic interstitial infiltrates, mostly composed of lymphocytes, macrophages, eosinophils, and plasma cells, experience a rapid transformation into areas of interstitial fibrosis. A significant proportion of AIN has nowadays an oligosymptomatic presentation, although the presence of specific extrarenal symptoms such as fever, skin rash, arthralgias, and peripheral eosinophilia has an important role to orientate clinical diagnosis. Identification and removal of the offending drug are the mainstay of the treatment, but recent studies strongly suggest that early steroid administration (within 7 days after diagnosis) improves the recovery of renal function, decreasing the risk of chronic renal impairment. Delayed steroid treatment, when interstitial fibrosis has taken place, would have a less pronounced or nule therapeutic benefit.

Multiphase transformations controlled by ostwald's rule in nanostructured Ce(0.5)Zr(0.5)O(2) powders prepared by a modified Pechini route.

The thermal stability of nanostructured Ce(0.5)Zr(0.5)O(2) powders prepared by the Pechini method was studied on the nanometric scale by X-ray diffraction (XRD), energy-dispersive spectrometry (EDS), transmission electron microscopy (TEM), nuclear magnetic resonance (NMR), and Raman techniques. Obtained results demonstrate that amorphous powders coming from the thermal decomposition of the precursor transform into the stable crystalline state through one highly disordered and metastable intermediate. This is a new example of successive reactions controlled by Ostwald's rule in inorganic systems. At low calcination temperatures, the combination of Raman spectroscopy, high-resolution electron microscopy, and EDS nanoanalysis showed the formation from the precursor powder of a disordered pseudocubic phase. At 900 degrees C, metastable T' and stable T and C phases were detected in XRD patterns. As increasing temperature, crystallites growth and proportions of stable T and C phases increased at the expense of the T' phase, which completely disappeared at 1300 degrees C. In analyzed samples, the Raman technique and (crystal by crystal) EDS nanoanalyses were used to detect local phase inhomogeneity. Compositions and relative percentages of phases were investigated by XRD Rietveld analysis and discussed in terms of phase diagrams previously reported.

Rituximab treatment of adult patients with steroid-resistant focal segmental glomerulosclerosis.

BACKGROUND AND OBJECTIVES: Isolated case reports have shown a beneficial effect of rituximab on pediatric patients with primary FSGS, but there is no information about rituximab treatment of FSGS in adults. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All patients who had biopsy-proven FSGS and were treated with rituximab in Spain were identified, independent of their positive or negative response, among the nephrology departments that belong to the Spanish Group for the Study of Glomerular Diseases (GLOSEN). Their characteristics and outcome after rituximab treatment were studied. RESULTS: Eight patients were identified. Rituximab failed to improve nephrotic syndrome in five of eight patients, who continued to show massive proteinuria and exhibited a rapidly deteriorating renal function in two cases. Among the remaining three patients, two of them showed an improvement of renal function and a remarkable proteinuria reduction and one experienced a beneficial but transitory effect after rituximab. There were no differences in clinical or laboratory characteristics or in the CD20 B lymphocyte count after rituximab between these three patients and the five who had a negative response. The only difference was in the regimen of rituximab administration: Whereas the five patients with a negative response received only four weekly consecutive infusions of 375 mg/m(2), the three remaining patients received additional doses of rituximab. CONCLUSIONS: Only a minority (three of eight) of patients in our series of adult patients with FSGS showed a positive influence of rituximab. More studies are necessary to characterize further the optimal dosages and the mechanisms of action of rituximab in FSGS.