Background A subset of patients without overt systemic lupus erythematosus (SLE) present with biopsy findings typically seen in lupus nephritis (LN). Although a minority eventually develops SLE, many do not. It remains unclear how to classify or treat these patients. Our study attempted to further understand the clinical and pathological characteristics of cases with lupus-like nephritis (LLN). Methods Among 2700 native kidney biopsies interpreted at University of Rochester Medical Center (URMC) from 2010 to 2019, we identified 27 patients with biopsies showing lupus-like features (LL-fx) and 96 with LN. Of those with LL-fx, 17 were idiopathic LLN and 10 were associated with a secondary etiology (e.g., infection/drugs). Results At the time of biopsy, the LLN-group tended to be slightly older (44 vs. 35), male (58.8 vs. 17.7%, p = .041), and Caucasian (47.0 vs. 28.1%, p = .005). Chronic kidney disease was the most common biopsy indication in LLN (21.4 vs. 2.8%, p = .001). Both LN and LLN presented with nephrotic-range proteinuria (mean 5.73 vs. 4.40 g/d), and elevated serum creatinine (mean 1.66 vs. 1.47 mg/dL). Tubuloreticular inclusions (TRIs; p < .001) and fibrous crescents (p = .04) were more often seen in LN, while more tubulointerstitial scarring was seen in LLN (p = .011). At mean follow-up of 1684 d (range: 31-4323), none of the LLN patients developed ESRD. A subset of both LN and cases with LL-fx overlapped with other autoimmune diseases. Conclusions Lupus-like pathologic features are seen in a wide array of disease processes. The findings suggest that LLN may be a manifestation of an autoimmune process that overlaps with SLE.

BACKGROUND Despite a body of evidence demonstrating reduced incidence of post-lumbar puncture headache associated with pencil-point (vs bevelled-edge) needles, their use remains variable in the UK. METHODS A multimodal longitudinal intervention was performed over a 12-month period at a tertiary neurology referral centre. In addition to simulation training using pencil-point needles and an electronic documentation pro forma, a change in the default needles presented in clinical environments was performed. RESULTS Prior to the intervention, pencil-point needle usage was minimal. Documentation significantly improved throughout the intervention period. Simulation training interventions only resulted in transient, moderate improvements in pencil-point needle usage. However, changing the default produced a marked increase in use that was sustained. No significant changes in operator success rate were found. CONCLUSIONS In the context of wider literature on the power of default options in driving behavioural choices, changing defaults may be an effective, inexpensive and acceptable intervention to improve lumbar puncture practice.

Lumbar puncture (LP) is a key diagnostic investigation in neurology. Post-dural puncture headache (PDPH) is a known complication of lumbar puncture, resulting in significant patient morbidity. Fine-gauge and atraumatic-tip needles have been shown to reduce significantly the risk of PDPH. While uptake of such needles has been universal in anaesthetics, neurology has lagged behind. Here we investigate a multimodal intervention to increase the usage of atraumatic needles in neurology. Over a 15 month period, LPs were reviewed at the neurology day case unit of the John Radcliffe Hospital, a large tertiary centre. We present results from 218 LPs performed, and outcome data including documentation score and atraumatic needle usage. Simulation training interventions were associated with moderate improvement in practice, with a gradual reduction over time. This may be associated with staff turnover. Changing the default needle to an atraumatic (Sprotte 22G) needle was associated with a marked and sustained improvement in practice. There was no difference in success rate with the new needle and proforma usage remained high. Default options have previously been shown to be a powerful determinant of human behaviour in clinical medicine. Our results suggest that this may be an important tool to improve clinical practice in LP in Neurology, though staff engagement and monitoring for unintended consequences of changes in default equipment are essential.

Molecular dynamics simulations were used to study the structural perturbations of lipids surrounding transmembrane ion channel forming helices/helical bundles and the movement of water within the pores of the ion-channels/bundles. Specifically, helical monomers to hexameric helical bundles embedded in palmitoyl-oleoyl-phosphatidyl-choline (POPC) lipid bilayer were studied. Two amphipathic α-helices with the sequence Ac-(LSLLLSL)3-NH2 (LS2), and Ac-(LSSLLSL)3-NH2 (LS3), which are known to form ion channels, were used. To investigate the surrounding lipid environment, we examined the hydrophobic mismatch, acyl chain order parameter profiles, lipid head-to-tail vector projection on the membrane surface, and the lipid headgroup vector projection. We find that the lipid structure is perturbed within approximately two lipid solvation shells from the protein bundle for each system (~15.0 Å). Beyond two lipid “solvation” shells bulk lipid bilayer properties were observed in all systems. To understand water flow, we enumerated each time a water molecule enters or exited the channel, which allowed us to calculate the number of water crossing events and their rates, and the residence time of water in the channel. We correlate the rate of water crossing with the structural properties of these ion channels and find that the movements of water are predominantly governed by the packing and pore diameter, rather than the topology of each peptide or the pore (hydrophobic or hydrophilic). We show that the crossing events of water fit quantitatively to a stochastic process and that water molecules are traveling diffusively through the pores. These lipid and water findings can be used for understanding the environment within and around ion channels. Furthermore, these findings can benefit various research areas such as rational design of novel therapeutics, in which the drug interacts with membranes and transmembrane proteins to enhance the efficacy or reduce off-target effects.

The nation is struggling with the challenges and inefficiencies in the current healthcare environment, the increased demand for primary care services, and growing shortage of primary care providers to meet that demand. Although nurse practitioners (NPs) are highly educated, licensed, and certified healthcare professionals who are qualified to provide primary care services, the restrictive policies for physician oversight that exist in many states impede full utilization of the skills possessed by NPs in primary care provider roles. NPs are a crucial part of the solution to the growing demands for primary care in the United States and the transformation of the healthcare system to one in which accessible, patient-centered, essential health services are provided while improving the quality of care and controlling healthcare costs.

Acute interstitial nephritis (AIN) is a common cause of acute kidney injury and has been associated with a variety of medications. This is the case of 30-year-old man with Hodgkin's lymphoma who on routine labs before chemotherapy was found to have acute nonoliguric renal failure. A kidney biopsy was performed and confirmed the diagnosis of acute interstitial nephritis. The patient had taken several medications including a higher dose of Carnivora, a Venus flytrap extract, composed of numerous amino acids. The medication was discontinued and kidney function improved towards the patient's baseline indicating that this may be the possible cause of his AIN. Proximal tubular cell uptake of amino acids increasing transcription of nuclear factor-kappaB is a proposed mechanism of AIN from this compound.

The purposes of this integrative review are to (1) summarize research from the prior 10 years about sex after stroke, including sexual function, sexual self-concept, and sexual relationships; (2) make recommendations for future research; and (3) provide clinical recommendations for practitioners caring for stroke survivors and their intimate partners. Seventeen international studies conducted in several disciplines from 1999 to 2009 confirm findings from earlier research that, after a stroke, some couples experience decreased sexual desire, decreased erections, vaginal dryness, and decreased frequency of sexual intercourse, as well as problems with masculine and feminine self-concept and with intimacy and sexual relationships with their partners. However, these studies also confirm that some couples do not experience these problems and some even experience a positive impact on sex and intimacy after stroke. All seventeen studies illustrate how study designs raise as many questions as they answer about the reasons for these sexual changes. Future research needs to focus on why some couples experience sex and intimacy gains, why some do not change, and why others experience losses. Future research also needs to test interventions by clinical practitioners to assist couples to overcome or compensate for changes in sex and intimacy after stroke. Potential interventions and resources for clinicians are included in this article.