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Study Type – Therapy (case series)
Level of Evidence 4OBJECTIVETo analyse the factors predicting the mortality and need for nephrectomy in patients with emphysematous pyelonephritis (EPN).PATIENTS AND METHODSClinical features, laboratory variables, imaging studies, management strategy and the final outcomes were analysed in 39 consecutive patients with EPN. The mean (sd) age was 57 (7.2) years and the male to female ratio was 2:11. The baseline risk factors (clinical, laboratory and radiological) were compared among three groups; group 1, survived with renal salvage (26); group 2, survived after nephrectomy (eight); and group 3, died (five).RESULTSThe overall survival rate was 87% (34/39) and the kidney was salvaged in 67% (26) patients at a median follow‐up of 18 months. Altered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation were significantly associated with mortality rate. There was no significant difference in final outcome based on radiological classification. Extensive renal parenchymal destruction of >50% (based on computed tomography) significantly predicted the need for nephrectomy (P < 0.001) and death (P = 0.02). Early (<1 week) nephrectomy resulted in a higher mortality rate (three of seven patients) than initial conservative management. There were no deaths in selected patients who received antibiotics alone or had delayed nephrectomy (four patients each). Of 24 patients who had minimally invasive treatment alone, two (8%) died. Minimally invasive treatment resulted in high renal salvage (22/24, 92%).CONCLUSIONAltered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation are associated with higher mortality rates, whereas extensive renal parenchymal destruction is associated with a need for nephrectomy. Early nephrectomy is associated with higher mortality rates than is initial conservative management.

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This study examines the characteristics of binding of berberine to the human telomeric d[AG3(T2AG3)3] quadruplex. By employing UV‐visible spectroscopy, fluorescence spectroscopy and isothermal titration calorimetry, we found that the binding affinity of berberine to the human telomeric quadruplex is 106. The complete thermodynamic profile for berberine binding to the quadruplex, at 25 °C, shows a small negative enthalpy (ΔH) of −1.7 kcal·mol−1, an entropy change with TΔS of +6.5 kcal·mol−1, and an overall favorable free energy (ΔG) of −8.2 kcal·mol−1 .Through the temperature dependence of ΔH, we obtained a heat capacity (ΔCp) of −94 (± 5) cal·mol−1·K−1. The osmotic stress method revealed that there is an uptake of 13 water molecules in the complex relative to the free reactants. Furthermore, the molecular modeling studies on different quadruplex–berberine complexes show that berberine stacking at the external G‐quartet is mainly aided by the π–π interaction and the stabilization of the high negative charge density of O6 of guanines by the positively charged N7 of berberine. The theoretical heat capacity (ΔCp) values for quadruplex–berberine models are −89 and −156 cal·mol−1·K−1.

UV-Vis spectra are calculated using time-dependent density functional theory for several organic dyes--4-(N, N-dimethylamino) benzonitrile, alizarin, squaraine, polyene-linker dyes, oligothiophene-containing coumarin dyes (NKX series) and triphenylamine-donor dyes. Most of these dyes (except, for the first two) or their derivatives are considered to be promising organic dyes for dye-sensitized solar cells. An accurate description of the photophysics of such dyes is imperative for understanding and creating better dyes. To this end, we studied the dyes within several approximations to the exchange-correlation functional. The chosen functionals--PBE, M06L, B3LYP, M06, CAM-B3LYP, and wB97--represent the various classes of approximations that are currently being used to study material properties. From amongst the six approximations studied here, CAM-B3LYP outperformed the others in its description of charge-transfer excitations in most (though, not all) of the dyes. This study shows why it is difficult to choose a particular functional a priori, especially when starting out with a new dye for solar cell application. A possible way to judge the fitness of an approximation is used in this work and it is shown to provide a good quantitative guideline for subsequent research in this field.