Objective To evaluate the effect of rituximab on pathogenic autoantibodies and total immunoglobulin levels, and to identify serious adverse events, in patients with ANCA vasculitis treated with continuous B cell depletion. Methods We conducted a retrospective analysis of 239 patients with ANCA vasculitis treated with rituximab-induced continuous B cell depletion. Two treatment cohorts were analyzed: an induction group (n= 53) and a maintenance group (n=237). The change in ANCA titers and total immunoglobulin levels over time were evaluated using mixed-effects models. Risk factors for serious infections during maintenance were evaluated with Poisson regression. Results During induction, IgG levels fell at a rate of 6% per month (95% CI, 4 to 8%), while ANCA levels declined at 47% per month (95% CI, 42 to 52%) and 48% per month (95% CI, 42 to 54%) for anti-MPO and anti-PR3 titers, respectively. During maintenance treatment, with a median duration of 2.4 (IQR, 1.5- 4.0) years, IgG levels declined at 0.6% per year (95% CI, -0.2 to 1.4%). New significant hypogammaglobulinemia (IgG < 400 mg/dL) during maintenance occurred in 4.6% of patients, all of whom were in the lowest baseline IgG quartile. Serious infections during maintenance occurred at a rate of 0.85 [95% CI, 0.66 to 1.1] per 10 patient years and were independently associated with an IgG level < 400mg/dL. Conclusion B cell targeted therapy causes a preferential decline in ANCA titers relative to total IgG levels. Despite prolonged maintenance therapy with rituximab, IgG levels remain essentially constant. Serious infections were rare.

The impact system for ultrafast synchrotron experiments, or IMPULSE, is a 12.6-mm bore light-gas gun (<1 km/s projectile velocity) designed specifically for performing dynamic compression experiments using the advanced imaging and X-ray diffraction methods available at synchrotron sources. The gun system, capable of reaching projectile velocities up to 1 km/s, was designed to be portable for quick insertion/removal in the experimental hutch at Sector 32 ID-B of the Advanced Photon Source (Argonne, IL) while allowing the target chamber to rotate for sample alignment with the beam. A key challenge in using the gun system to acquire dynamic data on the nanosecond time scale was synchronization (or bracketing) of the impact event with the incident X-ray pulses (80 ps width). A description of the basic gun system used in previous work is provided along with details of an improved launch initiation system designed to significantly reduce the total system time from launch initiation to impact. Experiments were performed to directly measure the gun system time and to determine the gun performance curve for projectile velocities ranging from 0.3 to 0.9 km/s. All results show an average system time of 21.6 ± 4.5 ms, making it possible to better synchronize the gun system and detectors to the X-ray beam.

BackgroundMembranous nephropathy is a common cause of the nephrotic syndrome. Treatment with standard regimens fails to induce complete remission in most patients. We evaluated the efficacy of combination therapy with rituximab, low-dose, oral cyclophosphamide, and an accelerated prednisone taper (RCP) for the treatment of idiopathic membranous nephropathy.MethodsWe analyzed 15 consecutive patients with idiopathic membranous nephropathy treated with RCP at Massachusetts General Hospital. Seven patients (47%) received RCP as initial therapy, and the other eight patients (53%) received RCP for relapsing or refractory disease. All patients had at least 1 year of follow-up. The co-primary outcomes were attainment of partial and complete remission. Partial remission was defined as a urinary protein to creatinine ratio (UPCR) < 3 g/g and a 50% reduction from baseline. Complete remission was defined as a UPCR < 0.3 g/g. Secondary outcomes were serious adverse events and the change in proteinuria, serum creatinine, serum albumin, cholesterol, triglycerides, and immunoglobulin G levels after 1 year of treatment.ResultsOver a median follow-up time of 37 (IQR, 34–44) months, 100% of patients achieved partial remission and 93% of patients achieved complete remission at a median time of 2 and 13 months, respectively. After 1 year of treatment, median (IQR) UPCR declined from 8.2 (6.6–11.1) to 0.3 (0.2–0.7) g/g (P < 0.001). Three serious adverse events occurred over 51 patient years. No patients died or progressed to ESKD.ConclusionsTreatment of idiopathic membranous nephropathy with RCP resulted in high rates of complete remission. Larger studies evaluating this regimen are warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0459-z) contains supplementary material, which is available to authorized users.

We have perfonned a eries of plate impact experiments to study the strength and spall damage behavior of S200F Be. Peak stresses achieved were in th e range from 5.6-19.2 GPa VISAR data show long rise times in the approach to the shocked state believed to be the result of twinning occurring alongside. or in defference to slip, in this hcp material, wi th its free surface never achieving a steady velocity. This data indicate brittle spall behavior with spall strengths in the range of 0.8-0.9 GPa. In experiments where target thicknes. is varied, we see evidence of precursor decay and present calculations of the Hugoniot Elastic Limit (HEL).

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