Review of soil environment quality in India near coal mining regions: current and future predictions.

Production and utilization of coal are one of the primary routes of accumulation of Toxic Elements (TEs) in the soil. The exploration of trends in the accumulation of TEs is essential to establishing a soil pollution strategy, implementing cost-effective remediation, and early warnings of ecological risks. This study provides a comprehensive review of soil concentrations and future accumulation trends of various TEs (Cr, Ni, Pb, Co, Cu, Cd, Zn, Fe, Mn, and As) in Indian coal mines. The findings revealed that average concentrations of Cr, Mn, Ni, Cu, Zn, Pb, and Co surpass India's natural background soil levels by factors of 2, 4.05, 5.32, 1.77, 9.6, and 6.15, respectively. Geo-accumulation index values revealed that 27.3%, 14.3%, and 7.7% of coal mines are heavily polluted by Ni, Co, and Cu, respectively. Also, the Potential Ecological Risk Index indicates that Cd and Ni are primary contaminants in coal mines. Besides, the health risk assessment reveals oral ingestion as the main exposure route for soil TMs. Children exhibit a higher hazard index than adults, with Pb and Cr being major contributors to their non-carcinogenic risk. In addition, carcinogenic risks exist for females and children, with Cr and Cu as primary contributors. Multivariate statistical analysis revealed that TEs (except Cd) accumulated in the soil from anthropogenic sources. The assessment of future accumulation trends in soil TE concentrations reveals dynamic increases that significantly impact both the ecology and humans at elevated levels. This study signifies a substantial improvement in soil quality and risk management in mining regions.

Efficacy and safety of topical brepocitinib cream for mild-to-moderate chronic plaque psoriasis: a phase IIb randomized double-blind vehicle-controlled parallel-group study.

BACKGROUND: Plaque psoriasis (PsO) is an inflammatory skin disease driven, in part, by the activation of Janus kinase (JAK) signalling pathways. OBJECTIVES: To assess the efficacy and safety of multiple doses of topical brepocitinib, a tyrosine kinase 2/JAK1 inhibitor, in participants with mild-to-moderate PsO. METHODS: This phase IIb multicentre randomized double-blind study was conducted in two stages. In stage 1, participants received one of eight treatments for 12 weeks: brepocitinib 0.1% once daily, 0.3% once or twice daily, 1.0% once or twice daily, 3.0% once daily, or vehicle once or twice daily. In stage 2, participants received brepocitinib 3.0% twice daily or vehicle twice daily. The primary endpoint was the change from baseline in Psoriasis Area and Severity Index (PASI) score at week 12, analysed using analysis of covariance. The key secondary endpoint was the proportion of participants who achieved a Physician Global Assessment response [score of clear (0) or almost clear (1) and an improvement of ≥ 2 points from baseline] at week 12. Additional secondary endpoints included the difference vs. vehicle in change from baseline in PASI, using mixed-model repeated measures, and the change from baseline in Peak Pruritus Numerical Rating Scale at week 12. Safety was monitored. RESULTS: Overall, 344 participants were randomized. Topical brepocitinib did not result in statistically significant changes compared with respective vehicle controls in the primary or key secondary efficacy endpoints for any dose group. At week 12, least squares mean change from baseline in PASI score ranged from -1.4 to -2.4 for the brepocitinib once-daily groups vs. -1.6 for vehicle once daily, and from -2.5 to -3.0 for the brepocitinib twice-daily groups vs. -2.2 for vehicle twice daily. From week 8, change from baseline in PASI score separated from vehicle in all brepocitinib twice daily groups. Brepocitinib was well tolerated, with adverse events (AEs) occurring at similar rates across groups. One participant in the brepocitinib 1.0% once-daily group developed a treatment-related AE of herpes zoster in the neck area. CONCLUSIONS: Topical brepocitinib was well tolerated but did not result in statistically significant changes compared with vehicle when administered at the doses evaluated to treat signs and symptoms of mild-to-moderate PsO.

Molecular iodine catalyzed C(sp2)-H sulfenylation of biologically active enaminone compounds under mechanochemical conditions and studies on their biocidal activity including molecular docking and DFT.

Here we demonstrated a solvent free, mechanochemical I2 catalyzed C(sp2)-H sulfenylation of enaminones under grinding condition. Only catalytic amount of I2 is required on silica surface without any external heating. The reaction time has reduced to a great extent in comparison to their solution based counterpart. The frictional energy created by ball-mill on mesoporous silica materials has attracted much attention towards this mechanochemical approach for molecular heterogeneous catalysis. Their large surface area and well defined porous architecture certainly increase the catalytic ability of iodine in this developed protocol. Anti-microbial activities of our synthesized compounds were investigated against two gram positive (Staphylococcus aureus and Bacillus cereus) and two gram negative (Escherichia coli and Klebsiella pneumonia) bacteria. To understand the potency of these compounds (3a-3m) as antimalarial agents, molecular docking studies were also performed. Density functional theory was also used to investigate the chemical reactivity and kinetic stability of the compound 3a-3m.

Environmentally benign approach towards C-S cross-coupling reaction by organo-copper(II) complex.

C-S cross-coupling reaction in water giving an excellent yield of the desired C-S coupled product by using a newly developed Bis[2-(4,5-diphenyl-1H-imidazol-2-yl)-4-nitrophenolato] copper(II) dehydrate complex as catalyst. Although it was the first report of the synthesis of such a novel organo-copper complex from our laboratory, its potential catalytic application was not tested so far. Keeping this in mind and based on our anticipation, we developed a greener route for the C-S coupling reaction. The result is very interesting and comprises the subject matter of this report.

Robust group sequential designs for trials with survival endpoints and delayed response.

Randomized clinical trials in oncology typically utilize time-to-event endpoints such as progression-free survival or overall survival as their primary efficacy endpoints, and the most commonly used statistical test to analyze these endpoints is the log-rank test. The power of the log-rank test depends on the behavior of the hazard ratio of the treatment arm to the control arm. Under the assumption of proportional hazards, the log-rank test is asymptotically fully efficient. However, this proportionality assumption does not hold true if there is a delayed treatment effect. Cancer immunology has evolved over time and several cancer vaccines are available in the market for treating existing cancers. This includes sipuleucel-T for metastatic hormone-refractory prostate cancer, nivolumab for metastatic melanoma, and pembrolizumab for advanced nonsmall-cell lung cancer. As cancer vaccines require some time to elicit an immune response, a delayed treatment effect is observed, resulting in a violation of the proportional hazards assumption. Thus, the traditional log-rank test may not be optimal for testing immuno-oncology drugs in randomized clinical trials. Moreover, the new immuno-oncology compounds have been shown to be very effective in prolonging overall survival. Therefore, it is desirable to implement a group sequential design with the possibility of early stopping for overwhelming efficacy. In this paper, we investigate the max-combo test, which utilizes the maximum of two weighted log-rank statistics, as a robust alternative to the log-rank test. The new test is implemented for two-stage designs with possible early stopping at the interim analysis time point. Two classes of weights are investigated for the max-combo test: the Fleming and Harrington (1981) Gρ,γ$G^{\rho , \gamma }$ weights and the Magirr and Burman (2019) modest (τ∗)$ (\tau ^{*})$  weights.

Adaptive multiarm multistage clinical trials.

Two methods for designing adaptive multiarm multistage (MAMS) clinical trials, originating from conceptually different group sequential frameworks are presented, and their operating characteristics are compared. In both methods pairwise comparisons are made, stage-by-stage, between each treatment arm and a common control arm with the goal of identifying active treatments and dropping inactive ones. At any stage one may alter the future course of the trial through adaptive changes to the prespecified decision rules for treatment selection and sample size reestimation, and notwithstanding such changes, both methods guarantee strong control of the family-wise error rate. The stage-wise MAMS approach was historically the first to be developed and remains the standard method for designing inferentially seamless phase 2-3 clinical trials. In this approach, at each stage, the data from each treatment comparison are summarized by a single multiplicity adjusted P-value. These stage-wise P-values are combined by a prespecified combination function and the resultant test statistic is monitored with respect to the classical two-arm group sequential efficacy boundaries. The cumulative MAMS approach is a more recent development in which a separate test statistic is constructed for each treatment comparison from the cumulative data at each stage. These statistics are then monitored with respect to multiplicity adjusted group sequential efficacy boundaries. We compared the powers of the two methods for designs with two and three active treatment arms, under commonly utilized decision rules for treatment selection, sample size reestimation and early stopping. In our investigations, which were carried out over a reasonably exhaustive exploration of the parameter space, the cumulative MAMS designs were more powerful than the stage-wise MAMS designs, except for the homogeneous case of equal treatment effects, where a small power advantage was discernable for the stage-wise MAMS designs.

Amine-functionalized graphene oxide nanosheets (AFGONs): an efficient bifunctional catalyst for selective formation of 1,4-dihydropyridines, acridinediones and polyhydroquinolines.

We report here selective formation of functionalized 1,4-dihydropyridines (DHP), acridinediones and polyhydroquinolines in high yields using amine-functionalized graphene oxide nanosheets (AFGONs) as the bifunctional catalyst. The method overcomes the limitations of previous protocols affording a mixture of DHP and pyridine derivatives using graphene oxide as the catalyst. The mild reaction conditions are found compatible with a wide range of functional groups. It is presumed that a cooperative effect between the acidic and basic functionalities present in AFGONs may have exerted high catalytic efficiency as well as prevented further oxidation to pyridine derivatives. A plausible mechanism is proposed on the basis of some control experiments. The reactions can be scaled up conveniently, and the catalyst can be recycled for five consecutive runs without loss of its activity.

Development of a sulfidogenic bioreactor system for removal of co-existent selenium, iron and nitrate from drinking water sources.

The present study showed for the first time that selenium, iron, and nitrate could be simultaneously removed in a sulfidogenic bioreactor to meet drinking water standards. A bioreactor inoculated with mixed bacterial consortium was operated for around 330 days in anoxic environment at 30 °C under varying combination of influent selenate (200-1000 µg/L as selenium), and iron (3-10 mg/L) in presence of 50 mg/L of nitrate. Required amount of acetic acid (as carbon source) and sulfate were supplied and the reactor was operated at different empty bed contact time (EBCT) of 45-120 min. Along with complete removal of nitrate, the reactor removed both selenium and iron to meet the drinking water standards. Field emission transmission electron microscopy (FETEM) and X-ray diffraction (XRD) analyses confirmed the formation of selenium sulfide (SeS), achavalite (FeSe) and pyrite (FeS2), which were the possible removal mechanisms of selenium and iron. Thus, this study exhibited that selenium, iron, and nitrate can be simultaneously removed to meet the drinking water standards in a sulfidogenic bioreactor.

Bacterially-assisted recovery of cadmium and nickel as their metal sulfide nanoparticles from spent Ni-Cd battery via hydrometallurgical route.

Soaring demand for technology metals (e.g., Cd, Ni) and its ever-depleting primary resources ask for alternative recovery from secondary sources. Ni-Cd battery is one such source that can abridge the gap between demand and supply of such metals. Biogenic recovery, being environmentally benign, is explored for Cd and Ni recovery to manage the menace of spent Ni-Cd battery. Studies with 20, 40 and 60 mg/L Cd2+ initial concentrations in batch mode (in triplicates) at pH 7.0 ± 0.2, 30 ± 0.5 °C and 120 rpm were conducted using sulfate-reducing bacteria for 10 days. Analysis of extracellular polymeric substance revealed that protein secretion was enhanced, thereby forming Cd-EPS binding. Biosolids were collected and freeze-dried for morphological analysis viz. FESEM/EDX, PXRD and TEM, which revealed the formation of CdS nanoparticles (JCPDS card #00-042-1411) in range of 2-6 nm. Similarly, combined effect with 5, 10 and 20 mg/L Ni2+ at 20 mg/L Cd2+ were also investigated. Furthermore, to test the efficacy for real field application, spent Ni-Cd battery was dismantled and its powder was characterized, digested with concentrated HCl at 70 °C and was fed in batch mode after cooling, wherein nanoparticles of Ni and Cd sulfides were formed that has potential as semi-conducting material.

Concurrent removal of nitrate, arsenic and iron from simulated and real-life groundwater to meet drinking water standards: Effects of operational and environmental parameters.

The aim of this work was to study concurrent removal of nitrate, arsenic and iron in an attached growth reactor (AGR) based on bio-sulphidogenesis treating simulated and real-life ground water. A lab-scale bioreactor system was monitored for a period of 511 days under conditions identical to those prevailing at full-scale to assess the relative influence of empty bed contact time (EBCT) (20-90 min), backwash strategies (water-nitrogen and water-air), temperature (20-50 °C), pH (6.6-8.4) and shut down on reactor performance and recovery. Complete removal of nitrate (50 mg/L) and over 95% removal of iron (3 mg/L) occurred. Arsenic removal efficiency was around 99% (500 µg/L) and treated water arsenic concentration was in compliance with the World Health Organization and Indian Standard of 10 µg/L. Port sampling along the depth of bioreactor shows shifting of terminal electron accepting process zones at lower EBCT of 20 min and after air assisted backwashing. The temperature range of 20-50 °C and pH range of 6.6-8.4 were applicable for arsenic removal in natural conditions. Precipitated biosolids were analysed using electron microscopy. Biogenic sulphides resulted in the precipitation of arsenosulphides and iron sulphides, which concurrently removed arsenic and iron. This study suggests that a sulphidogenic bioreactor may help to set the basis for concurrent removal of nitrate, arsenic and iron from real-life groundwater using mixed biofilm bacterial community.

Effects of phenol on sulfate reduction by mixed microbial culture: kinetics and bio-kinetics analysis.

Mixed microbial culture collected from the wastewater treatment plant of Indian Institute of Technology Guwahati (IITG) was further grown in anaerobic condition in presence of sulfate where lactate was added as a carbon source. Sulfate addition was increased stepwise up to 1,000 mg l-1 before phenol was added at increasing concentrations from 10 mg l-1 to 300 mg l-1. Kinetics of sulfate, phenol and chemical oxygen demand reduction were studied and experimental findings were analyzed using various bio-models to estimate the bio-kinetic coefficients. This is the first detailed report on kinetics and bio-kinetic studies of sulfate reduction in presence of phenol. Experimental results showed that there was no inhibition of sulfate reduction and microbial growth up to 100 mg l-1 phenol addition. However, inhibition to different degrees was observed at higher phenol addition. The experimental data of microbial growth and substrate consumption in presence of phenol fitted well to the Edward model (R2 = 0.85, root mean square error = 0.001011) with maximum specific growth rate = 0.052 h-1, substrate inhibition constant = 88.05 mg l-1 and half saturation constant = 58.22 mg l-1. The characteristics of the cultured microbes were determined through a series of analysis and microbial tests.

Design and monitoring of multi-arm multi-stage clinical trials.

Two-arm group sequential designs have been widely used for over 40 years, especially for studies with mortality endpoints. The natural generalization of such designs to trials with multiple treatment arms and a common control (MAMS designs) has, however, been implemented rarely. While the statistical methodology for this extension is clear, the main limitation has been an efficient way to perform the computations. Past efforts were hampered by algorithms that were computationally explosive. With the increasing interest in adaptive designs, platform designs, and other innovative designs that involve multiple comparisons over multiple stages, the importance of MAMS designs is growing rapidly. This article provides break-through algorithms that can compute MAMS boundaries rapidly thereby making such designs practical. For designs with efficacy-only boundaries the computational effort increases linearly with number of arms and number of stages. For designs with both efficacy and futility boundaries the computational effort doubles with successive increases in number of stages.

Effect of the ortho-hydroxy group of salicylaldehyde in the A3 coupling reaction: A metal-catalyst-free synthesis of propargylamine.

The synthesis of propargylamines via A3 coupling mostly under metal-catalyzed procedures is well known. This work invented an unprecedented effect of salicylaldehyde, one of the A3 coupling partners, which could lead to the formation of propargylamine, an important pharmaceutical building block, in the absence of any metal catalyst and under mild conditions. The role of the hydroxy group in ortho position of salicylaldehyde has been explored, which presumably activates the Csp-H bond of the terminal alkyne leading to the formation of propargylamines in good to excellent yields, thus negating the function of the metal catalyst. This observation is hitherto unknown, tested for a variety of salicylaldehyde, amine and acetylene, established as a general protocol, and is believed to be of interest for synthetic chemists from green chemistry.

Biodegradation of 4-bromophenol by Arthrobacter chlorophenolicus A6 in batch shake flasks and in a continuously operated packed bed reactor.

The present study investigated growth and biodegradation of 4-bromophenol (4-BP) by Arthrobacter chlorophenolicus A6 in batch shake flasks as well as in a continuously operated packed bed reactor (PBR). Batch growth kinetics of A. chlorophenolicus A6 in presence of 4-BP followed substrate inhibition kinetics with the estimated biokinetic parameters value of µ max = 0.246 h(-1), K i = 111 mg L(-1), K s  = 30.77 mg L(-1) and K = 100 mg L(-1). In addition, variations in the observed and theoretical biomass yield coefficient and maintenance energy of the culture were investigated at different initial 4-BP concentration. Results indicates that the toxicity tolerance and the biomass yield of A. chlorophenolicus A6 towards 4-BP was found to be poor as the organism utilized the substrate mainly for its metabolic maintenance energy. Further, 4-BP biodegradation performance by the microorganism was evaluated in a continuously operated PBR by varying the influent concentration and hydraulic retention time in the ranges 400-1,200 mg L(-1) and 24-7.5 h, respectively. Complete removal of 4-BP was achieved in the PBR up to a loading rate of 2,276 mg L(-1) day(-1).

Evaluation of 4-bromophenol biodegradation in mixed pollutants system by Arthrobacter chlorophenolicus A6 in an upflow packed bed reactor.

Bromophenol is listed as priority pollutant by U.S. EPA, however, there is no report so far on its removal in mixed pollutants system by any biological reactor operated in continuous mode. Furthermore, bromophenol along with chlorophenol and nitrophenol are usually the major constituents of paper pulp and pesticide industrial effluent. The present study investigated simultaneous biodegradation of these three pollutants with specially emphasis on substrate competition and crossed inhibition by Arthrobacter chlorophenolicus A6 in an upflow packed bed reactor (UPBR). A 2(3) full factorial design was employed with these pollutants at two different levels by varying their influent concentration in the range of 250-450 mg l(-1). Almost complete removal of all these pollutants and 97 % effluent toxicity removal were achieved in the UPBR at a pollutant loading rate of 1707 mg l(-1) day(-1) or lesser. However, at higher loading rates, the reactor performance deteriorated due to transient accumulation of toxic intermediates. Statistical analysis of the results revealed a strong negative interaction of 4-CP on 4-NP biodegradation. On the other hand, interaction effect between 4-CP and 4-BP was found to be insignificant. Among these three pollutants 4-NP preferentially degraded, however, 4-CP exerted more inhibitory effect on 4-NP biodegradation. This study demonstrated the potential of A. chlorophenolicus A6 for biodegradation of 4-BP in mixed pollutants system by a flow through UPBR system.

Hexavalent chromium [Cr(VI)] removal by the electrochemical ion-exchange process.

In the present investigation, the performance of a laboratory-scale plate and frame-type electrochemical ion-exchange (EIX) cell on removal ofhexavalent chromium from synthetic wastewater containing 5 mg/l of Cr(VI) was evaluated under varying applied voltages. Ruthenium dioxide-coated titanium plate (RuO2/Ti) was used as anode and stainless steel plates as cathode. The EIX cell was run at different hydraulic retention time (HRT). Before using in the electrochemical cell, the capacity of ion-exchange resin was evaluated through kinetic and isotherm equilibrium tests in batch mode. The batch kinetic study result showed that the equilibrium time for effective ion exchange with resin is 2 h. The isotherm equilibrium data fit well to both Freundlich and Langmuir isotherms. Maximum capacity (qm) of resin calculated from Langmuir isotherm was 71.42 mg/g. Up to 99% of chromium removal was noticed in the EIX cell containing fresh resin at applied voltages of 10 V and higher. Migration of chromium ion to anode chamber was not noticed while performing the experiment with fresh resin. As high as 50% removal of chromium was observed from the middle chamber containing exhausted resin at an applied voltage of 25 V when the influent flow rate was maintained at 45 min of HRT. The performance of the reactor was increased to 72% when the influent flow rate was decreased to maintain at 90 min of HRT. Build-up of chromium in the anode chamber took place when exhausted resin was used in the process.

KI mediated one-pot cascade reaction for synthesis of 1,3,4-selenadiazoles.

An efficient catalytic system consisting of KI and K2S2O8 for a one-pot pseudo three-component cascade reaction in the preparation of a diverse array of 1,3,4-selenadiazole derivatives from easily accessible precursors aldehydes, hydrazine and elemental selenium is demonstrated in this paper. Here, KI is used as the surrogate of iodine and K2S2O8 as the oxidant. The key advantages of this protocol include an easy reaction set up, operational simplicity, high functional group tolerance and utilisation of low toxicity chemicals. Further, a radical quenching reaction was also performed to confirm the mechanistic pathway.

Brepocitinib, Zimlovisertib, and Ropsacitinib in Hidradenitis Suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a debilitating, inflammatory skin disease with limited treatment options and partially understood pathophysiology. Using an umbrella trial design, three kinase inhibitor immunomodulators with different mechanisms of action were evaluated. METHODS: This phase 2a, double-blind, parallel-group trial enrolled adults with moderate to severe HS who were then randomly assigned (1:1:1:1) to once-daily brepocitinib 45 mg (a JAK1/TYK2 inhibitor), zimlovisertib 400 mg (an IRAK4 inhibitor), ropsacitinib 400 mg (a TYK2 inhibitor), or matching placebo for 16 weeks. The primary end point was the percentage of participants achieving HS clinical response (HiSCR) at week 16. Safety, including treatment-emergent adverse events (TEAEs), was monitored throughout. RESULTS: Totals of 52, 47, 47, and 48 participants were assigned to brepocitinib, zimlovisertib, ropsacitinib, and placebo, respectively. At week 16, 28% were lost to follow-up and assumed to be nonresponders; HiSCR occurred in 33.3% (16/48) of participants receiving placebo and in 51.9% (27/52), 34.0% (16/47), and 37.0% (17/46) of those receiving brepocitinib, zimlovisertib, and ropsacitinib (difference in percentage points vs. placebo [90% confidence interval], 18.7 [2.7 to 34.6], 0.7 [−15.2 to 16.7], and 3.5 [−12.6 to 19.6]), respectively. TEAEs occurred more frequently with active treatment (brepocitinib, 30 [57.7%]; zimlovisertib, 26 [55.3%]; ropsacitinib, 29 [61.7%]; placebo, 23 [47.9%]). Most TEAEs (infections, skin disorders, and gastrointestinal symptoms) were mild; there were no deaths. CONCLUSIONS: Participants with moderate to severe HS treated with brepocitinib experienced greater clinical response, whereas those on zimlovisertib and ropsacitinib did not, compared with placebo. These results favor the JAK/STAT pathway as an immunologic target in HS and did not confirm a role for selective IRAK4 or TYK2 inhibition. These results should be confirmed in larger studies with longer follow-up. (Funded by Pfizer; ClinicalTrials.gov registration number, NCT04092452.)

ß-Cyclodextrin: a green supramolecular catalyst assisted eco-friendly one-pot three-component synthesis of biologically active substituted pyrrolidine-2-one.

A green, novel and eco-efficient synthetic route towards the synthesis of highly substituted bio-active pyrrolidine-2-one derivatives was demonstrated using ß-cyclodextrin, a water-soluble supramolecular solid as a green and eco-benign catalyst at room temperature under water-ethanol solvent medium. The exploration of the green catalyst ß-cyclodextrin for the metal-free one-pot three-component synthesis of a wide range of highly functionalized bio-active heterocyclic pyrrolidine-2-one moieties from easily available aldehydes and amines explains the superiority and uniqueness of this protocol.

Performance of Modified ALMS and BLISS Criteria with Standard of Care Treatment in Two US Health Care Systems.

OBJECTIVE: A retrospective cohort study was undertaken in a predominantly Black population undergoing standard treatment for lupus nephritis (LN) to estimate the incidence of, and risk factors for, complete response (CR) according to modified Aspreva Lupus Management Study (mALMS) and modified Belimumab International Study in Lupus Nephritis (mBLISS) criteria by 12 months. METHODS: Patients with biopsy-proven LN class III or IV ± V, urine protein-to-creatinine ratio of ≥1gm/gm and estimated glomerular filtration rate of >50 ml/minute/1.73 m2 at the time of the incident LN flare were included. The clinical, treatment, and laboratory factors associated with CR were identified using multivariable Cox regression. RESULTS: Of 173 patients, 86.1% were women, 77.5% were Black, and over half (59.5%) had non-commercial insurance. By 12 months, 20.6% (95% confidence interval (95% CI) 14.6-28.6%) achieved mALMS CR and 33.7% (95% CI 26.4-42.4%) achieved mBLISS CR. Factors associated with mBLISS CR were commercial insurance (adjusted CR ratio = 3.5 [95% CI 1.9-6.7]; P < 0.001), albumin (adjusted CR ratio = 1.8 per 1 gm/dl increase in albumin; P = 0.02), and low C4 (adjusted CR ratio = 2.6; P = 0.03). Cumulative incidence of end-stage renal disease (ESRD) at 3 years was 23.1% (95% CI 15.7-31.3%) and 6.1% (95% CI 2.8-11.1%) for death. Patients with non-commercial insurance were more likely to develop ESRD, with cumulative incidence of 30.4% (95% CI 19.6-41.9%) compared to 12.7% (95% CI 5.0-24.2%) for patients with commercial insurance (P = 0.024). CONCLUSION: In a primarily Black, uninsured LN population, despite achieving similar CR rates at 12 months, the incidence of ESRD and death exceeded those observed in controlled clinical trials with placebo arms.