Background and objectives Remission in the majority of ANCA vasculitis patients is not sustained after a single course of rituximab, and risk of relapse warrants development of a successful strategy to ensure durable remission.Design, setting, participants, & measurements A retrospective analysis of ANCA vasculitis patients who underwent maintenance therapy using rituximab-induced continuous B-cell depletion for up to 7 years was performed. Maintenance therapy with rituximab was initiated after achieving remission or converting from other prior maintenance therapy. Continuous B-cell depletion was achieved in all patients by scheduled rituximab administration every 4 months. Disease activity, serologic parameters, adverse events, and survival were examined.Results In the study, 172 patients (mean age=60 years, 55% women, 57% myeloperoxidase-ANCA) treated from Conclusion This analysis provides evidence for long-term disease control using continuous B-cell depletion. This treatment strategy in ANCA vasculitis patients also seems to result in survival rates comparable with rates in a matched reference population. These findings suggest that prospective remission maintenance treatment trials using continuous B-cell depletion are warranted.
A previously unknown chemical reaction in which selenate is reduced to elemental selenium may prove to be the basis of a chemical process to remove selenate from water systems and to control selenate in agricultural wastewater. The reaction occurs between selenate and ferrous hydroxide under alkaline conditions, producing magnetic iron oxides (magnetite and maghemite) and elemental selenium. The reaction rate reaches a maximum at about pH 9, dropping sharply below pH 8 or above pH 10. In the presence of excess ferrous hydroxide, magnetite is the predominant product. As the ratio of selenate to ferrous hydroxide increases, more maghemite seems to form. The reaction may proceed in a stepwise fashion, with selenate first reduced to selenite and then to selenium. The Gibbs free energy of the selenate reduction reaction is calculated to be -83.1 kcal/mol, assuming magnetite is the final iron oxide produced. The elemental selenium remains trapped in the iron oxide. This chemistry may find application in the recovery and refining of selenium and provide insight into the selenium cycle in the environment.
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