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Ultrasonic emulsification (USE) assisted by cavitation is an effective method to produce emulsion droplets. However, the role of gas bubbles in the USE process still remains unclear. Hence, in the present paper, high-speed camera observations of bubble evolution and emulsion droplets formation in oil and water were used to capture in real-time the emulsification process, while experiments with different gas concentrations were carried out to investigate the effect of gas bubbles on droplet size. The results show that at the interface of oil and water, gas bubbles with a radius larger than the resonance radius collapse and sink into the water phase, inducing (oil–water) blended liquid jets across bubbles to generate oil-in-water-in-oil (O/W/O) and water-in-oil (W/O) droplets in the oil phase and oil-in-water (O/W) droplets in the water phase, respectively. Gas bubbles with a radius smaller than the resonance radius at the interface always move towards the oil phase, accompanied with the generation of water droplets in the oil phase. In the oil phase, gas bubbles, which can attract bubbles nearby the interface, migrate to the interface of oil and water due to acoustic streaming, and generate numerous droplets. As for the gas bubbles in the water phase, those can break neighboring droplets into numerous finer ones during bubble oscillation. With the increase in gas content, more bubbles undergo chaotic oscillation, leading to smaller and more stable emulsion droplets, which explains the beneficial role of gas bubbles in USE. Violently oscillating microbubbles are, therefore, found to be the governing cavitation regime for emulsification process. These results provide new insights to the mechanisms of gas bubbles in oil–water emulsions, which may be useful towards the optimization of USE process in industry.

The application of ultrasound to casting processes is a subject of great interest: the resulting degassing, sonocrystallization, wetting, fragmentation, de-agglomeration and dispersion yield an improved cast material with fine grain structure. However, due to the lack of understanding of certain fundamentals involved in the process, the transfer and scale-up of this promising technology to industry has been hindered by difficulties in treating large volumes of liquid metal. Experimental results of ultrasonic processing of liquid aluminium with a 5-kW magnetostrictive transducer and a 20-mm niobium sonotrode producing 17-kHz ultrasonic waves are reported in this study. A high-temperature cavitometer sensor that is placed at different locations in the liquid melt, measured cavitation activity at various acoustic power levels and in different temperature ranges. The highest cavitation intensity in the liquid bulk is achieved below the surface of the sonotrode, at the lowest temperature, and when the applied power was 3.5 kW. Understanding these ultrasonication mechanisms in liquid metals will result in a major breakthrough for the optimization of ultrasound applications in metal industries. Keywords: Ultrasonic treatment, Aluminium, Cavitation bubbles, Frequency spectrum, Acoustic pressure

This study experimentally investigates the role of cavitation-induced shock waves in initiating and destabilizing capillary (surface) waves on a droplet surface, preceding atomization. Acoustic emissions and interfacial wave dynamics were simultaneously monitored in droplets of different liquids (water, isopropyl alcohol and glycerol), using a calibrated fiber-optic hydrophone and high-speed imaging. Spectral analysis of the hydrophone data revealed distinct subharmonic frequency peaks in the acoustic spectrum correlated with the wavelength of capillary waves, which were optically captured during the onset of atomization from the repetitive imploding bubbles. This finding provides the first direct evidence that the wavelength of the growing surface waves, which governs capillary instability resulting in droplet breakup, is linked to the periodicity of shock waves responsible for the onset of the subharmonic frequencies detected in the acoustic spectra. This work contributes to a deeper understanding of ultrasonic atomization, signifying the role of cavitation and shock waves in the atomization process., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background/objective: Primary Focal and Segmental glomerulosclerosis (FSGS) is one of the most common causes of idiopathic nephrotic syndrome. Our aim was to describe a large cohort of patients with primary FSGS, identify risk factors associated with worse renal survival and assess the impact of different immunosuppressive regiments on renal survival., Methods: This was a historical cohort study of adults who were diagnosed with primary FSGS from March 26, 1982, to September 16, 2020. The primary outcome was progression to ESRD., Results: We included 579 patients. The mean age was 46 (±15) years of age, with 378 (65%) males and median 24-hour proteinuria was 3.8 (2-6) g. In multivariable analysis only eGFR (HR: 0.97 per ml/min increase, 95% CIs 0.95-0.98) and remission status (complete remission (HR: 0.03, 95% CIs 0.003-0.22) and partial remission (HR: 0.28, 95% CIs 0.13-0.61) compared to no remission) were associated with renal survival. Among patients who received immunosuppression compared to those that did not, there was a higher percentage of complete remission (121 (41%) vs. 40 (24%), p<0.001), and higher percentage of relapses (135 (64%) vs. 27 (33%), p<0.001). Immunosuppression and its type (glucocorticoids vs. cyclosporine ± glucocorticoids) were not associated with renal survival., Conclusion: In primary FSGS, complete and partial remission were associated with improved renal survival. Further randomized studies are needed to assess the efficacy of different therapeutic agents and guide treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Marinaki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In this work, we implement a dual frequency (24 kHz and 1174 kHz) ultrasonic assisted liquid phase exfoliation (ULPE) technique in deionized water (DIW) and other eco-friendly solvents, to produce a variety of high-quality few-layer graphene (FLG) solutions under controlled ultrasonication conditions. The resulting FLG dispersions of variable sizes (∼0.2-1.5 μm 2 ) confirmed by characterisation techniques comprising UV-Vis spectroscopy, Raman spectroscopy and high-resolution transmission electron microscopy (HR-TEM). For the first time we demonstrate that high yield of FLG flakes with minimal defects, stable for 6 + months in a solution (stability ∼ 70 %), can be obtained in less than 1-hour of treatment in either water/ethanol (DIW:EtOH) or water/isopropyl alcohol (DIW:IPA) eco-friendly mixtures. We also scrutinized the underlying mechanisms of cavitation using high-speed imaging synchronized with acoustic pressure measurements. The addition of ethanol or IPA to deionized water is proposed to play a central role in exfoliation as it regulates the extend of the cavitation zone, the intensity of the ultrasonic field and, thus, the cavitation effectiveness. Our study revealed that lateral sizes of the obtained FLG depend on the choice of exfoliating media and the diameter of a sonotrode used. This variability offers flexibility in producing FLG of different sizes, applicable in a wide spectrum of size-specific applications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: The aim of this prospective study was to evaluate the impact of hemodialysis (HD) on myocardial injury, of both right and left ventricle function as well as their association with venous oxygen saturation (ScvO2) alterations., Material and Methods: We included in the study stable consecutive patients with end-stage renal disease (ESRD) undergoing regular HD. Right and left ventricular speckle-tracking echocardiographies were performed in all patients. The examination calculates the global systolic longitudinal strain (GLS). Blood samples were obtained from the central vein in order to measure the O2 saturation (ScvO2) levels prior and post HD. High sensitive troponin (HST) was also measured in all patients before and after HD., Results: Thirty seven patients were evaluated. We found that both mean ScvO2 and left ventricle GLS (LV GLS) were deteriorated after the dialysis session: 76.47 ±1.98 to 71.54 ±5.10, p < 0.05 and -17.73 ±3.44 to -14.21 ±3.44%, p < 0.01, respectively. HST levels were increased at the end of hemodialysis, 22.45 ±13.26 to 106.78 ±146.19 pg/ml, p < 0.01. A significant correlation was also found between the decrease of LV GLS with the ScvO2 reduction, p = 0.001 , as well as with the increase of the HST levels, p = 0.001., Conclusions: Our data demonstrate that there is a significant worsening of the GLS of the left ventricle at the end of the dialysis, which is strongly associated with the concomitant deterioration of ScvO2. The may be a reliable index of circulatory stress indicating a subclinical myocardial dysfunction during HD., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Termedia & Banach.)

This paper follows our earlier work where a strong high frequency pressure peak has been observed as a consequence of the formation of shock waves due to the collapse of cavitation bubbles in water, excited by an ultrasonic source at 24 kHz. We study here the effects of liquid physical properties on the shock wave characteristics by replacing water as the medium successively with ethanol, glycerol and finally a 1:1 ethanol-water solution. The pressure frequency spectra obtained in our experiments (from more than 1.5 million cavitation collapsing events) show that the expected prominent shockwave pressure peak was barely detected for ethanol and glycerol, particularly at low input powers, but was consistently observed for the 1:1 ethanol-water solution as well as in water, with a slight shift in peak frequency for the solution. We also report two distinct features of shock waves in raising the frequency peak at MHz (inherent) and contributing to the raising of sub-harmonics (periodic). Empirically constructed acoustic pressure maps revealed significantly higher overall pressure amplitudes for the ethanol-water solution than for other liquids. Furthermore, a qualitative analysis revealed that mist-like patterns are developed in ethanol-water solution leading to higher pressures., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Achieving a sustainable production of pristine high-quality graphene and other layered materials at a low cost is one of the bottlenecks that needs to be overcome for reaching 2D material applications at a large scale. Liquid phase exfoliation in conjunction with N -methyl-2-pyrrolidone (NMP) is recognized as the most efficient method for both the exfoliation and dispersion of graphene. Unfortunately, NMP is neither sustainable nor suitable for up-scaling production due to its adverse impact on the environment. Here, we show the real potential of green solvents by revealing the independent contributions of their exfoliation efficiency and graphene dispersibility to the graphene yield. By experimentally separating these two factors, we demonstrate that the exfoliation efficiency of a given solvent is independent of its dispersibility. Our studies revealed that isopropanol can be used to exfoliate graphite as efficiently as NMP. Our finding is corroborated by the matching ratio between the polar and dispersive energies of graphite and that of the solvent surface tension. This direct evidence of exfoliation efficiency and dispersibility of solvents paves the way to developing a deeper understanding of the real potential of sustainable graphene manufacturing at a large scale., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

Introduction: Dipeptidyl peptidase-4 (DPP4) inhibitors (gliptins) are commonly prescribed for glucose control in patients with advanced chronic kidney disease (CKD) in whom other oral glucose-lowering agents are contraindicated. In the past few years, new reports of drug-induced bullous pemphigoid associated with DPP4 inhibitors have emerged. However, there is not enough information about the renal function of the patients with DPP4 inhibitor-induced bullous pemphigoid, and it remains unknown whether the risk of this complication is increased among patients with CKD., Case Reports: Five patients with stage 3b-5 CKD received a diagnosis of DPP4 inhibitor-associated bullous pemphigoid in our institution within a period of 17 months (between December 2018 and May 2020). All patients in the current series were male. Skin biopsies were performed in all patients. Three cases were secondary to vildagliptin, and 2 cases were attributed to linagliptin. In each of these patients, treatment consisted of permanent discontinuation of the DPP4 inhibitor and administration of corticosteroids., Conclusion: We report here the first single-center experience of DPP4 inhibitor-induced bullous pemphigoid in patients with CKD. Our case series highlights the importance of considering bullous pemphigoid in patients with CKD taking DPP4 inhibitors presenting with bullous or pruritic cutaneous lesions. By calling attention to this important complication, we hope to minimize the delay in diagnosing DPP4 inhibitor-induced bullous pemphigoid among patients with CKD., (© 2022 S. Karger AG, Basel.)

Alport syndrome (AS) is the most frequent monogenic inherited glomerulopathy and is also genetically and clinically heterogeneous. It is caused by semi-dominant pathogenic variants in the X-linked COL4A5 (NM&#95;000495.5) gene or recessive variants in the COL4A3 / COL4A4 (NM&#95;000091.4/NM&#95;000092.4) genes. The disease manifests in early childhood with persistent microhematuria and can progress to proteinuria and kidney failure in adolescence or early adulthood if left untreated. On biopsy, pathognomonic features include alternate thinning, thickening and lamellation of the glomerular basement membrane (GBM), in the presence of podocyte foot process effacement. Although previous studies indicate a prevalence of AS of about 1/50,000, a recent publication reported a predicted rate of pathogenic COL4A5 variants of 1/2320. We herewith present 98 patients (40 M/58 F) from 26 Greek families. We are selectively presenting the families segregating the X-linked form of AS with pathogenic variants in the COL4A5 gene. We found 21 different pathogenic variants, 12 novel: eight glycine and one proline substitutions in the collagenous domain, one cysteine substitution in the NC1 domain, two premature termination of translation codons, three splicing variants, one 5-bp insertion/frameshift variant, one indel-frameshift variant and four gross deletions. Notably, patients in six families we describe here and three families we reported previously, carried the COL4A5 -p.G624D substitution, a founder defect encountered all over Europe which is hypomorphic with mostly milder symptomatology. Importantly, on several occasions, the correct genetic diagnosis reclassified patients as patients with AS, leading to termination of previous immunosuppressive/cyclosporine A therapy and a switch to angiotensin converting enzyme inhibitors (ACEi). With the understanding that all 98 patients span a wide range of ages from infancy to late adulthood, 15 patients (11 M/4 F) reached kidney failure and 11 (10 M/1 F) received a transplant. The prospects of avoiding lengthy diagnostic investigations and erroneous medications, and the advantage of delaying kidney failure with very early administration of renin-angiotensin-aldosterone system (RAAS) blockade, highlights the importance of timely documentation of AS by genetic diagnosis.

Graphene dispersions in water are highly desirable for a range of applications such as biomedicines, separation membranes, coatings, inkjet printing and more. Recent novel research has been focussed on developing a green approach for scalable production of graphene. However, one important parameter, which is often neglected is the bulk temperature of the processing liquid. This paper follows our earlier work where optimal sono-exfoliation parameters of graphite in aqueous solutions were determined based on the measured acoustic pressure fields at various temperatures and input powers. Here, we take the next step forward and demonstrate using systematic characterisation techniques and acoustic pressure measurements that sonication-assisted liquid phase exfoliation (LPE) of graphite powder can indeed produce high quality few layer graphene flakes in pure water at a specific temperature, i.e. 40 °C, and at an optimised input generator power of 50%, within 2-h of processing. UV-vis analysis also revealed that the exfoliation, stability and uniformity of dispersions were improved with increasing temperature. We further confirmed the successful exfoliation of graphene sheets with minimal level of defects in the optimized sample with the help of Raman microscopy and transmission electron microscopy. This study demonstrated that understanding and controlling processing temperature is one of the key parameters for graphene exfoliation in water which offers a potential pathway for its large-scale production., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

The volume of fluid (VOF) and continuous surface force (CSF) methods were used to develop a bubble dynamics model for the simulation of bubble oscillation and implosion dynamics under ultrasound. The model was calibrated and validated by the X-ray image data acquired by ultrafast synchrotron X-ray. Coupled bubble interactions with bulk graphite and freely moving particles were also simulated based on the validated model. Simulation and experiments quantified the surface instability developed along the bubble surface under the influence of ultrasound pressure fields. Once the surface instability exceeds a certain amplitude, bubble implosion occurs, creating shock waves and highly deformed, irregular gas-liquid boundaries and smaller bubble fragments. Bubble implosion can produce cyclic impulsive stresses sufficient enough to cause µs fatigue exfoliation of graphite layers. Bubble-particle interaction simulations reveal the underlying mechanisms for efficient particle dispersion or particle wrapping which are all strongly related to the oscillation dynamics of the bubbles and the particle surface properties., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)

Grain refinement in alloys is a well-known effect of ultrasonic melt processing. Fragmentation of primary crystals by cavitation-induced action in liquid metals is considered as one of the main driving mechanisms for producing finer and equiaxed grain structures. However, in-situ observations of the fragmentation process are generally complex and difficult to follow in opaque liquid metals, especially for the free-floating crystals. In the present study, we develop a transparent test rig to observe in real time the fragmentation potential of free-floating primary Al 3 Zr particles under ultrasonic excitation in water (an established analogue medium to liquid aluminium for cavitation studies). An effective treatment domain was identified and fragmentation time determined using acoustic pressure field mapping. For the first time, real-time high-speed imaging captured the dynamic interaction of shock waves from the collapsing bubbles with floating intermetallic particles that led to their fragmentation. The breakage sequence as well as the cavitation erosion pattern were studied by means of post-treatment microscopic characterisation of the fragments. Fragment size distribution and crack patterns on the fractured surface were then analysed and quantified. Application of ultrasound is shown to rapidly (<10 s) reduce intermetallic size (from 5 mm down to 10 μm), thereby increasing the number of potential nucleation sites for the grain refinement of aluminium alloys during melt treatment., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Ultrasonic de-agglomeration and dispersion of oxides is important for a range of applications. In particular, in liquid metal, this is one of the ways to produce metal-matrix composites reinforced with micron and nano sized particles. The associated mechanism through which the de-agglomeration occurs has, however, only been conceptualized theoretically and not yet been validated with experimental observations. In this paper, the influence of ultrasonic cavitation on SiO 2 and MgO agglomerates (commonly found in lightweight alloys as reinforcements) with individual particle sizes ranging between 0.5 and 10 μm was observed for the first time in-situ using high-speed imaging. Owing to the opacity of liquid metals, a de-agglomeration imaging experiment was carried out in de-ionised water with sequences captured at frame rates up to 50 kfps. In-situ observations were further accompanied by synchronised acoustic measurements using an advanced calibrated cavitometer, to reveal the effect of pressure amplitude arising from oscillating microbubbles on oxide de-agglomeration. Results showed that ultrasound-induced microbubble clusters pulsating chaotically, were predominantly responsible for the breakage and dispersion of oxide agglomerates. Such oscillating cavitation clusters were seen to capture the floating agglomerates resulting in their immediate disintegration. De-agglomeration of oxides occurred from both the surface and within the bulk of the aggregate. Microbubble clusters oscillating with associated emission frequencies at the subharmonic, 1st harmonic and low order ultra-harmonics of the driving frequency were deemed responsible for the breakage of the agglomerates., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Scaling up ultrasonic cavitation melt treatment (UST) requires effective flow management with minimised energy requirements. To this end, container dimensions leading to the resonance play a crucial role in amplifying pressure amplitude for cavitation. To quantify the importance of resonance length during the treatment of liquid aluminium, we used calibrated high-temperature cavitometers (in the range of 8-400 kHz), to measure and record the acoustic pressure profiles inside the cavitation-induced environment of liquid Al and deionized water (used as an analogue to Al) excited at 19.5 kHz. To achieve a comprehensive map of the acoustic pressure field, measurements were conducted at three different cavitometer positions relative to the vibrating sonotrode probe and for a number of resonant and non-resonant container lengths based on the speed of sound in the treated medium. The results showed that the resonance length affected the pressure magnitude in liquid Al in all cavitometer positions, while water showed no sensitivity to resonance length. An important practical application of UST in aluminium processing concerns grain refinement. For this reason, grain size analysis of UST-treated Al-Cu-Zr-Ti alloy was used as an indicator of the melt treatment efficiency. The result showed that the treatment in a resonance tank of L=λ Al (the wavelength of sound in Al) gave the best structure refinement as compared to other tested lengths. The data given here contribute to the optimisation of the ultrasonic process in continuous casting, by providing an optimum value for the critical compartment (e.g. in a launder of direct-chill casting) dimension., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

One of the main applications of ultrasonic melt treatment is the grain refinement of aluminium alloys. Among several suggested mechanisms, the fragmentation of primary intermetallics by acoustic cavitation is regarded as very efficient. However, the physical process causing this fragmentation has received little attention and is not yet well understood. In this study, we evaluate the mechanical properties of primary Al 3 Zr intermetallics by nano-indentation experiments and correlate those with in-situ high-speed imaging (of up to 1 Mfps) of their fragmentation process by laser-induced cavitation (single bubble) and by acoustic cavitation (cloud of bubbles) in water. Intermetallic crystals were chemically extracted from an Al-3 wt% Zr alloy matrix. Mechanical properties such as hardness, elastic modulus and fracture toughness of the extracted intermetallics were determined using a geometrically fixed Berkovich nano-diamond and cube corner indenter, under ambient temperature conditions. The studied crystals were then exposed to the two cavitation conditions mentioned. Results demonstrated for the first time that the governing fragmentation mechanism of the studied intermetallics was due to the emitted shock waves from the collapsing bubbles. The fragmentation caused by a single bubble collapse was found to be almost instantaneous. On the other hand, sono-fragmentation studies revealed that the intermetallic crystal initially underwent low cycle fatigue loading, followed by catastrophic brittle failure due to propagating shock waves. The observed fragmentation mechanism was supported by fracture mechanics and pressure measurements using a calibrated fibre optic hydrophone. Results showed that the acoustic pressures produced from shock wave emissions in the case of a single bubble collapse, and responsible for instantaneous fragmentation of the intermetallics, were in the range of 20-40 MPa. Whereas, the shock pressure generated from the acoustic cavitation cloud collapses surged up to 1.6 MPa inducing fatigue stresses within the crystal leading to eventual fragmentation., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Patients with end-stage renal disease (ESRD) require specialized therapeutic interventions. The decreased renal function that modulates the physiology and presence of comorbidities is often associated with variations in the pharmacological response, thus increasing the risk of adverse drug events or reactions (ADE/ADRs) from co-administered drugs., Methods: A cross-sectional study to record comorbidities, drug-drug interactions (DDIs), ADE/ADRs in patients with chronic kidney disease of stage five in Greece. The study enrolled 60 patients of mean age 64.8 ± 12.9 years, undergoing hemodialysis three times a week. Demographic and social factors, comorbidities, laboratory test data, medication regimens, DDIs and the reporting of ADE/ADRs were analyzed., Results: Cardiovascular diseases and diabetes were the main comorbidities. In total, 50 different DDIs of various clinical significance were identified. CNS, GI-track, and musculoskeletal-system-related ADE/ADRs were most often reported by patients. ADE/ADRs as clinical outcome from DDIs were associated in 64% of the total identified DDIs. There was a positive trend between number of medications, ADE/ADRs report and DDIs., Conclusions: The impact of ADE/ADRs in ESRD patients should be always considered. Guidelines as well as continuous training in the context of evidence-based clinical practice by healthcare personnel on therapy administration and prevention of adverse events are important.

Quantitative understanding of the interactions of ultrasonic waves with liquid and solidifying metals is essential for developing optimal processing strategies for ultrasound processing of metal alloys in the solidification processes. In this research, we used the synchrotron X-ray high-speed imaging facility at Beamline I12 of the Diamond Light Source, UK to study the dynamics of ultrasonic bubbles in a liquid Sn-30wt%Cu alloy. A new method based on the X-ray attenuation for a white X-ray beam was developed to extract quantitative information about the bubble clouds in the chaotic and quasi-static cavitation regions. Statistical analyses were made on the bubble size distribution, and velocity distribution. Such rich statistical data provide more quantitative information about the characteristics of ultrasonic bubble clouds and cavitation in opaque, high-temperature liquid metals.

Aims: Diagnosis of primary membranous nephropathy (PMN) is mainly based on immunofluorescence/immunohistochemistry findings. However, assessment of specific features on optical microscopy can help to estimate the severity of the disease, guide treatment and predict the response. The aim of this study was to identify, classify and grade the precise histological findings in PMN to predict renal function outcome and guide treatment., Methods and Results: Histological parameters, including focal segmental sclerosis (FSGS), tubular atrophy (TA), interstitial fibrosis (IF) and vascular hyalinosis (VH), were re-evaluated in 752 patients with PMN. Their predictive value was estimated separately, and also in a combination score (FSTIV) graded from 0 to 4. Finally, the impact of histology was assessed in the response to immunosuppressive treatment. Mean age of patients was 53.3 (15-85) years and most presented with nephrotic syndrome. FSGS was present in 32% and VH in 51% of the patients, while TA and IF were graded as stage ≥1 in 52% and 51.4%, respectively. The follow-up period was 122.3 (112-376) months. FSGS, TA and IF and VH were associated with impaired renal function at diagnosis (P = 0.02, P < 0.0001, P = 0.001 and P = 0.02, respectively) and at the end of follow-up (P = 0.004, P < 0.0001, P < 0.0001 and P = 0.04, respectively). In multiple regression and binary logistic analysis, the presence of FSGS and degree of TA were the most significant parameters predicting renal function outcome, defined either by eGFR (end), FSGS (r = 0.6, P < 0.0001) and TA (r = 0.6, P < 0.0001), or by the endpoint of >50% eGFR reduction, FSGS (P = 0.001) and TA (P = 0.02). Also, patients presented with FSGS, IF, VH and/or with FSTIV > 1 could benefit from immunosuppression, regardless of clinical presentation., Conclusions: The presence and degree of four histological indices, FSGS, VH, TA and IF, assessed separately or in combination, and FSTIV score not only predict renal function outcome after long-term follow-up, but can also help in the choice of appropriate treatment. Decisions concerning immunosuppressive treatment can be guided by pathology regardless of clinical findings., (© 2019 The Authors. Histopathology published by John Wiley & Sons Ltd.)

The prediction of the acoustic pressure field and associated streaming is of paramount importance to ultrasonic melt processing. Hence, the last decade has witnessed the emergence of various numerical models for predicting acoustic pressures and velocity fields in liquid metals subject to ultrasonic excitation at large amplitudes. This paper summarizes recent research, arguably the state of the art, and suggests best practice guidelines in acoustic cavitation modelling as applied to aluminium melts. We also present the remaining challenges that are to be addressed to pave the way for a reliable and complete working numerical package that can assist in scaling up this promising technology.

Introduction: Management of the Primary Membranous Nephropathy (PMN) usually involves administration of immunosuppressives. Cyclophosphamide (Cyclo) and Calcineurin Inhibitors (CNIs) are both widely used but only limited data exist to compare their efficacy in long term follow-up., Aim: The aim of the present study was to estimate and compare long term effects of Cyclo and CNIs in patients with PMN., Patients-Methods: Clinical data, histologic findings and long term outcome were retrospectively studied. The response to treatment and rate of relapse was compared between patients treated with CNIs or Cyclo based immunosuppressive regimens., Results: Twenty three centers participated in the study, with 752 PMN patients (Mean age 53.4(14-87) yrs, M/F 467/285), followed for 10.1±5.7 years. All patients were initially treated with Renin Angiotensin Aldosterone System inhibitors (RAASi) for at least 6 months. Based on their response and tolerance to initial treatment, patients were divided into 3 groups, group I with spontaneous remission, who had no further treatment, group II, continued on RAASi only, and group III on RAASi+immunosuppression. Immunosuppressive regimes were mainly based on CNIs or Cyclo. Frequent relapses and failure to treatment were more common between patients who had started on CNIs (n = 381) compared to those initially treated with Cyclo (n = 110), relapse rate: 25.2% vs. 6.4%, p<0.0001, and no response rate: 22.5% vs. 13.6%, p = 0.04, respectively., Conclusions: Long term follow up showed that administration of Cyclo in PMN is followed by better preservation of renal function, increased response rate and less frequent relapses, compared to CNIs., Competing Interests: The authors have declared that no competing interests exist.

The acoustic streaming behaviour below an ultrasonic sonotrode in water was predicted by numerical simulation and validated by experimental studies. The flow was calculated by solving the transient Reynolds-Averaged Navier-Stokes equations with a source term representing ultrasonic excitation implemented from the predictions of a nonlinear acoustic model. Comparisons with the measured flow field from Particle Image Velocimetry (PIV) water experiments revealed good agreement in both velocity magnitude and direction at two power settings, supporting the validity of the model for acoustic streaming in the presence of cavitating bubbles. Turbulent features measured by PIV were also recovered by the model. The model was then applied to the technologically important area of ultrasonic treatment of liquid aluminium, to achieve the prediction of acoustic streaming for the very first time that accounts for nonlinear pressure propagation in the presence of acoustic cavitation in the melt. Simulations show a strong dependence of the acoustic streaming flow direction on the cavitating bubble volume fraction, reflecting PIV observations. This has implications for the technological use of ultrasound in liquid metal processing., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Acoustic streaming and its attendant effects in the sump of a direct-chill (DC) casting process are successfully predicted under ultrasonic treatment for the first time. The proposed numerical model couples acoustic cavitation, fluid flow, heat and species transfer, and solidification to predict the flow pattern, acoustic pressure, and temperature fields in the sump. The model is numerically stable with time steps of the order of 0.01 s and therefore computationally attractive for optimization studies necessitating simulation times of the order of a minute. The sump profile is altered by acoustic streaming, with the slurry region depressed along the centreline of the billet by a strong central jet. The temperature gradient in the transition zone is increased, potentially interfering with grain refinement. The cooling rate in the sump is also altered, thereby modifying the dendrite arm spacing of the as-cast billet. The relative position of the sonotrode affects the sump profile, with the sump depth decreased by around 5 mm when the sonotrode is moved above the graphite ring level by 100 mm. The acoustic streaming jet penetrates into the slurry zone and, as a result, the growth direction of dendritic grains in the off-centre position is altered., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Hydraulic components are coated by thermal spraying to protect them against cavitation erosion. These coatings are built up by successive deposition of single splats. The behavior of a single splat under mechanical loading is still very vaguely understood. Yttria-stabilized zirconia (YSZ) and stainless-steel splats were obtained by plasma spraying onto stainless steel substrates. The velocity and temperature of particles upon impact were measured and the samples were subsequently exposed to cavitation erosion tests. An acoustic cavitation simulation estimated the water jet velocity and hammer stresses exerted by bubble collapse on the surface of the specimen. Although the results suggested that high stress levels resulted from cavitation loading, it was clear that weak adhesion interfaces played a crucial role in the accelerated cavitation-induced degradation., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Ultrasonic (cavitation) melt processing attracts considerable interest from both academic and industrial communities as a promising route to provide clean, environment friendly and energy efficient solutions for some of the core issues of the metal casting industry, such as improving melt quality and providing structure refinement. In the last 5 years, the authors undertook an extensive research programme into fundamental mechanisms of cavitation melt processing using state-of-the-art and unique facilities and methodologies. This overview summarises the recent results on the evaluation of acoustic pressure and melt flows in the treated melt, direct observations and quantitative analysis of cavitation in liquid aluminium alloys, in-situ and ex-situ studies of the nucleation, growth and fragmentation of intermetallics, and de-agglomeration of particles. These results provide valuable new insights and knowledge that are essential for upscaling ultrasonic melt processing to industrial level., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

A 50-year-old man with type II diabetes, hypertension and dyslipidemia, presented with non-oliguric acute kidney injury (AKI) and anemia. Renal biopsy showed acute tubular necrosis (ATN) with extensive cytoplasmic vacuolization and areas of tubulitis. These findings were ultimately attributed to dapagliflozin, which he started 3 months earlier due to poor glycemic control. ATN with similar microscopic findings has been described with larger doses of dapagliflozin in non-clinical trials. Our patient was started on dialysis and remained dialysis-dependent for 4 weeks while his renal function improved gradually thereafter. Sixteen months after initial presentation he is being followed as an outpatient with chronic kidney disease (CKD) stage 3a. Dapagliflozin belongs to a novel class of antidiabetic drugs for which clinical trials show great beneficial effects on cardiovascular outcomes and glycemic control and as with many new drugs, their safety profile is being constantly revised. We report the first biopsy-proven ATN caused by dapagliflozin. Great caution together with continuous monitoring of renal function is advised when implementing SGLT-2 inhibitors in clinical practice.

In an attempt to quantify the instantaneous pressure field in cavitating liquids at large forcing signals, pressures were measured in four different liquids contained in vessels with a frequency mode in resonance with the forcing signal. The pressure field in liquid metal was quantified for the first time, with maximum pressures of the order of 10-15 MPa measured in liquid aluminium. These high pressures are presumed to be responsible for deagglomeration and fragmentation of dendritic intermetallics and other inclusions. Numerical modelling showed that acoustic shielding attenuates pressure far from the sonotrode and it is prominent in the transparent liquids studied but less so in aluminium, suggesting that aluminium behaviour is different. Due to acoustic shielding, the numerical model presented cannot adequately capture the pressure field away from the intense cavitation zone, but gives a good qualitative description of the cavitation activity. The results obtained contribute to understanding the process of ultrasonic melt treatment (UST) of metal alloys, while facilitating further the guidelines formulation and reproducible protocols for controlling UST at industrial levels., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Natural history, predisposing factors to an unfavourable outcome and the effect of various therapeutic regimens were evaluated in a cohort of 457 patients with immunoglobulin A nephropathy (IgAN) and follow-up of at least 12 months., Methods: Patients with normal renal function and proteinuria <1 g/24 h as well as those with serum creatinine (SCr) >2.5 mg/dL and/or severe glomerulosclerosis received no treatment. Patients with normal or impaired renal function and proteinuria >1 g/24 h for >6 months received daily oral prednisolone or a 3-day course of intravenous (IV) methylprednisolone followed by oral prednisolone per os every other day or a combination of prednisolone and azathioprine. The clinical outcome was estimated using the primary endpoints of end-stage renal disease and/or doubling of baseline SCr., Results: The overall 10-year renal survival was 90.8%, while end-stage renal disease and doubling of baseline SCr developed in 9.2% and 14.7% of patients, respectively. Risk factors related to the primary endpoints were elevated baseline SCr, arterial hypertension, persistent proteinuria >0.5 g/24 h and severity of tubulointerstial fibrosis. There was no difference in the clinical outcome of patients treated by the two regimens of corticosteroids; nevertheless, remission of proteinuria was more frequent in patients who received IV methylprednisolone (P = 0.000). The combination of prednisolone with azathioprine was not superior to IV methylprednisolone followed by oral prednisolone. Side effects related to immunossuppressive drugs were observed in 12.8% of patients., Conclusion: The clinical outcome of patients with IgAN was related to the severity of clinical and histological involvement. The addition of azathioprine to a corticosteroid-based regimen for IgAN does not improve renal outcome.

Objectives: Several population-based studies on systemic lupus erythematosus (SLE) have been reported, yet community-based, individual-case validated, comprehensive reports are missing. We studied the SLE epidemiology and burden on the island of Crete during 1999-2013., Methods: Multisource case-finding included patients ≥15 years old. Cases were ascertained by the ACR 1997, SLICC 2012 criteria and rheumatologist diagnosis, and validated through synthesis of medical charts, administrative and patient-generated data., Results: Overall age-adjusted/sex-adjusted incidence was 7.4 (95% CI 6.8 to 7.9) per 100 000 persons/year, with stabilising trends in women but increasing in men, and average (±SD) age of diagnosis at 43 (±15) years. Adjusted and crude prevalence (December 2013) was 123.4 (113.9 to 132.9) and 143 (133 to 154)/10 5 (165/10 5 in urban vs 123/10 5 in rural regions, p<0.001), respectively. Age-adjusted/sex-adjusted nephritis incidence was 0.6 (0.4 to 0.8) with stable trends, whereas that of neuropsychiatric SLE was 0.5 (0.4 to 0.7) per 100 000 persons/year and increasing. Although half of prevalent cases had mild manifestations, 30.5% developed organ damage after 7.2 (±6.6) years of disease duration, with the neuropsychiatric domain most frequently afflicted, and 4.4% of patients with nephritis developed end-stage renal disease. The ACR 1997 and SLICC 2012 classification criteria showed high concordance (87%), yet physician-based diagnosis occurred earlier than criteria-based in about 20% of cases., Conclusions: By the use of a comprehensive methodology, we describe the full spectrum of SLE from the community to tertiary care, with almost half of the cases having mild disease, yet with significant damage accrual. SLE is not rare, affects predominantly middle-aged women and is increasingly recognised in men. Neuropsychiatric disease is an emerging frontier in lupus prevention and care., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

The cavitation-induced fragmentation of primary crystals formed in Al alloys were investigated for the first time by high-speed imaging using a novel experimental approach. Three representative primary crystal types, Al 3 Ti, Si and Al 3 V with different morphologies and mechanical properties were first extracted by deep etching of the corresponding Al alloys and then subjected to ultrasonic cavitation processing in distilled water. The dynamic interaction between the cavitation bubbles and primary crystals was imaged in situ and in real time. Based on the recorded image sequences, the fragmentation mechanisms of primary crystals were studied. It was found that there are three major mechanisms by which the primary crystals were fragmented by cavitation bubbles. The first one was a slow process via fatigue-type failure. A cyclic pressure exerted by stationary pulsating bubbles caused the propagation of a crack pre-existing in the primary crystal to a critical length which led to fragmentation. The second mechanism was a sudden process due to the collapse of bubbles in a passing cavitation cloud. The pressure produced upon the collapse of the cloud promoted rapid monotonic crack growth and fast fracture in the primary crystals. The third observed mechanism was normal bending fracture as a result of the high pressure arising from the collapse of a bubble cloud and the crack formation at the branch connection points of dendritic primary crystals. The fragmentation of dendrite branches due to the interaction between two freely moving dendritic primary crystals was also observed. A simplified fracture analysis of the observed phenomena was performed. The specific fragmentation mechanism for the primary crystals depended on their morphology and mechanical properties., (Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.)

Familial microscopic hematuria (FMH) is associated with a genetically heterogeneous group of conditions including the collagen-IV nephropathies, the heritable C3/CFHR5 nephropathy and the glomerulopathy with fibronectin deposits. The clinical course varies widely, ranging from isolated benign familial hematuria to end-stage renal disease (ESRD) later in life. We investigated 24 families using next generation sequencing (NGS) for 5 genes: COL4A3, COL4A4, COL4A5, CFHR5 and FN1. In 17 families (71%), we found 15 pathogenic mutations in COL4A3/A4/A5, 9 of them novel. In 5 families patients inherited classical AS with hemizygous X-linked COL4A5 mutations. Even more patients developed later-onset Alport-related nephropathy having inherited heterozygous COL4A3/A4 mutations that cause thin basement membranes. Amongst 62 heterozygous or hemizygous patients, 8 (13%) reached ESRD, while 25% of patients with heterozygous COL4A3/A4 mutations, aged >50-years, reached ESRD. In conclusion, COL4A mutations comprise a frequent cause of FMH. Heterozygous COL4A3/A4 mutations predispose to renal function impairment, supporting that thin basement membrane nephropathy is not always benign. The molecular diagnosis is essential for differentiating the X-linked from the autosomal recessive and dominant inheritance. Finally, NGS technology is established as the gold standard for the diagnosis of FMH and associated collagen-IV glomerulopathies, frequently averting the need for invasive renal biopsies., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

To address difficulties in treating large volumes of liquid metal with ultrasound, a fundamental study of acoustic cavitation in liquid aluminium, expressed in an experimentally validated numerical model, is presented in this paper. To improve the understanding of the cavitation process, a non-linear acoustic model is validated against reference water pressure measurements from acoustic waves produced by an immersed horn. A high-order method is used to discretize the wave equation in both space and time. These discretized equations are coupled to the Rayleigh-Plesset equation using two different time scales to couple the bubble and flow scales, resulting in a stable, fast, and reasonably accurate method for the prediction of acoustic pressures in cavitating liquids. This method is then applied to the context of treatment of liquid aluminium, where it predicts that the most intense cavitation activity is localised below the vibrating horn and estimates the acoustic decay below the sonotrode with reasonable qualitative agreement with experimental data., (Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.)

A bespoke cavitometer that measures acoustic spectrum and is capable of operating in a range of temperatures (up to 750°C) was used to study the cavitation behaviour in three transparent liquids and in molten aluminium. To relate these acoustic measurements to cavitation development, the dynamics of the cavitation bubble structures was observed in three Newtonian, optically transparent liquids with significantly different physical properties: water, ethanol, and glycerine. Each liquid was treated at 20kHz with a piezoelectric ultrasonic transducer coupled to a titanium sonotrode with a tip diameter of 40mm. Two different transducer power levels were deployed: 50% and 100%, with the maximum power corresponding to a peak-to-peak amplitude of 17μm. The cavitation structures and the flow patterns were filmed with a digital camera. To investigate the effect of distance from the ultrasound source on the cavitation intensity, acoustic emissions were measured with the cavitometer at two points: below the sonotrode and near the edge of the experimental vessel. The behaviour of the three tested liquids was very different, implying that their physical parameters played a decisive role in the establishment of the cavitation regime. Non dimensional analysis revealed that water shares the closest cavitation behaviour with liquid aluminium and can therefore be used as its physical analogue in cavitation studies; this similarity was also confirmed when comparing the measured acoustic spectra of water and liquid aluminium., (Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.)

Knowledge of the kinetics of gas bubble formation and evolution under cavitation conditions in molten alloys is important for the control casting defects such as porosity and dissolved hydrogen. Using in situ synchrotron X-ray radiography, we studied the dynamic behaviour of ultrasonic cavitation gas bubbles in a molten Al-10 wt%Cu alloy. The size distribution, average radius and growth rate of cavitation gas bubbles were quantified under an acoustic intensity of 800 W/cm(2) and a maximum acoustic pressure of 4.5 MPa (45 atm). Bubbles exhibited a log-normal size distribution with an average radius of 15.3 ± 0.5 μm. Under applied sonication conditions the growth rate of bubble radius, R(t), followed a power law with a form of R(t)=αt(β), and α=0.0021 &β=0.89. The observed tendencies were discussed in relation to bubble growth mechanisms of Al alloy melts., (Copyright © 2016 Elsevier B.V. All rights reserved.)

An in situ synchrotron radiographic study of a molten Al-10 wt% Cu alloy under the influence of an external ultrasonic field was carried out using the Diamond-Manchester Branchline pink X-ray imaging at the Diamond Light Source in UK. A bespoke test rig was used, consisting of an acoustic transducer with a titanium sonotrode coupled with a PID-controlled resistance furnace. An ultrasonic frequency of 30 kHz, with a peak to peak amplitude at 140 microns, was used, producing a pressure output of 16.9 MPa at the radiation surface of the 1-mm diameter sonotrode. This allowed quantification of not only the cavitation bubble formation and collapse, but there was also evidence of the previously hypothesised ultrasonic capillary effect (UCE), providing the first direct observations of this phenomenon in a molten metallic alloy. This was achieved by quantifying the re-filling of a pre-existing groove in the shape of a tube (which acted as a micro-capillary channel) formed by the oxide envelope of the liquid sample. Analytical solutions of the flow suggest that the filling process, which took place in very small timescales, was related to micro-jetting from the collapsing cavitation bubbles. In addition, a secondary mechanism of liquid penetration through the groove, which is related with the density distribution of the oxides inside the groove, and practically to the filtration of aluminium melt from oxides, was revealed. The observation of the almost instantaneous re-filling of a micro-capillary channel with the metallic melt supports the hypothesised sono-capillary effect in technologically important liquids other than water, like metallic alloys with substantially higher surface tension and density., (Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.)