A nomogram predicting the histologic activity of lupus nephritis from clinical parameters

BACKGROUND

The 2021 clinical guidelines of the Kidney Disease: Improving Global Outcomes emphasize the importance of the histological activity index (AI) in the management of lupus nephritis (LN). Patients with LN and a high AI have poor renal outcomes and high rates of nephritic relapse. In this study we constructed prediction models for the AI in LN.

METHODS

The study population comprised 337 patients diagnosed with LN using kidney biopsy. The participants were randomly divided into training and testing cohorts. They were further divided into high-activity (AI >2) and low-activity (AI ≤2) groups. This study developed two clinical prediction models using logistic regression and least absolute shrinkage and selection operator (LASSO) analyses with laboratory test results collected at the time of kidney biopsy. The performance of models was assessed using 5-fold cross-validation and validated in the testing cohort. A nomogram for individual assessment was constructed based on the preferable model.

RESULTS

Multivariate analysis showed that higher mean arterial pressure, lower estimated glomerular filtration rate, lower complement 3 level, higher urinary erythrocytes count and anti-double-stranded DNA seropositivity were independent risk factors for high histologic activity in LN. Both models performed well in the testing cohort regarding the discriminatory ability to identify patients with an AI >2. The average area under the curve of 5-fold cross-validation was 0.855 in the logistic model and 0.896 in the LASSO model. A webtool based on the LASSO model was created for clinicians to enter baseline clinical parameters to produce a probability score of an AI >2.

CONCLUSIONS

The established nomogram provides a quantitative auxiliary tool for distinguishing LN patients with a high AI and helps physicians make clinical decisions in their comprehensive assessment.

Serum IgE anti-dsDNA autoantibodies in patients with proliferative lupus nephritis are associated with tubulointerstitial inflammation

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the overproduction of multiple autoantibodies. Lupus nephritis (LN), the most common cause of morbidity and mortality, requires early detection. However, only a limited number of serum biomarkers have been associated with the disease activity of LN. Serum IgE anti-dsDNA autoantibodies are prevalent in patients with SLE and may be associated with the pathogenesis of LN. In this study, serum samples from 88 patients with biopsy-proven proliferative LN were collected along with complete clinical and pathological data to investigate the clinical and pathological associations of anti-dsDNA IgE autoantibodies using ELISA. This study found that the prevalence of IgE anti-dsDNA autoantibodies in patients with proliferative LN was 38.6% (34/88). Patients with anti-dsDNA IgE autoantibodies were more prone to acute kidney injury (17/34 vs. 14/54; p = .025). Levels of anti-dsDNA IgE autoantibodies were associated with interstitial inflammation (r = 0.962, p = .017). Therefore, anti-dsDNA IgE autoantibody levels are associated with tubulointerstitial inflammation in patients with proliferative LN.

The Influence of Visual Input on Electromyographic Activity and Patterns of Masticatory and Cervical Spine Muscles in Emmetropic Caucasian Subjects by Gender

(1) Background: The objective of the research was to analyze the change of visual input on electromyographic activity and patterns of masticatory and cervical spine muscles in emmetropic Caucasian subjects by gender. Supposedly, visual input should not influence activity and electromyographic patterns of masticatory and cervical spine muscles in emmetropic Caucasian subjects by gender. (2) Methods: After applying the inclusion criteria, 50 emmetropic Caucasian subjects were included in the study. Four muscle pairs were analyzed: the temporalis muscle (TA), the masseter muscle (MM), the digastric muscle (DA), and the sternocleidomastoid muscle (SCM), during resting and functional activity. (3) Results: It was observed that there were no significant statistical differences in activity and bioelectrical patterns between open and closed eyes in women and men, with the exception of clenching on dental cotton rollers in DA-left and DA mean between tests in women. The observed statistical results had a small effect size, successively equal to 0.32 and 0.29. (4) Conclusions: Changes in the influence of visual input do not affect electromyographic activity and patterns of masticatory and cervical spine muscles in emmetropic Caucasian women and men.

Multi-item Measures for Pediatric Inflammatory Bowel Diseases: The ABCs of All Those Acronyms

With the recent acceptance of multiple treatment goals for inflammatory bowel diseases (IBD), it becomes increasingly important to accurately quantify the measurable concepts. These include patient-reported symptoms, intestinal damage, mucosal activity, transmural inflammation, and histologic appearance, as well as quality of life, disability, and other patient-centered attributes. Standardized indices which show sufficient validity, reliability, and responsiveness to change are not only mandatory for implementing the treat-to-target approach but are also critical for assessing the effectiveness of emerging medications in clinical trial settings. Some concepts can be accurately assessed through the use of existing measurement tools used for adults (e.g. capsule endoscopy, ultrasonic, endoscopic, and histologic scoring) while others may be age-specific. Although several pediatric indices and scales are well established (e.g. IMPACT questionnaire, PCDAI, and PUCAI), recent years have seen the development of newer indices for children, including the MINI to predict endoscopic healing in Crohn's disease, MRI indices that measure inflammation (i.e. PICMI) and perianal disease (i.e. PEMPAC), and patient-reported outcome measures in ulcerative colitis (i.e. TUMMY-UC), upper gastrointestinal inflammatory score (i.e. UGI-SES-CD), simplified endoscopic mucosal assessment score for Crohn's disease (SEMA-CD), and the parent-completed IMPACT questionnaire (i.e. IMPACT-III-P). Despite these advances, quantifiable pediatric IBD-specific tools are still lacking for disability and fatigue. In this review, we provide a contemporary, clinically-focused overview of the indices that a pediatric gastroenterologist can use to quantify disease status.

Feasibility Study of Grinding Circulating Fluidized Bed Ash as Cement Admixture

With the widespread application of circulating fluidized bed (CFB) combustion technology, the popularity of CFB ash (CFBA) has increased dramatically and its production and large-scale utilization have become increasingly important. In the context of carbon neutrality peaking, using CFBA as a cement admixture as an effective method of resource utilization not only reduces the pressures caused by carbon emissions in the cement industry but also solves the environmental problems caused by CFBA depositing. However, the formation conditions of CFBA are worse than those of traditional pulverized coal boilers. CFB ash is the combustion product of coal at 850 °C-950 °C, and the characteristics of CFBA usually include a loose and porous structure with many amorphous substances. Furthermore, it has the disadvantages of large particle size, high water-demand ratio, and low activity index when it is directly used as a cement admixture. In this study, CFBA (including fly ash (CFBFA) and bottom ash (CFBBA)) produced by a CFB boiler without furnace desulfurization with limestone was used as a cement admixture material, and the effect of grinding on the fineness, water-demand ratio, and activity index of CFBA were studied. The experimental results showed that the grinding effect could significantly reduce the fineness and water-demand ratio of CFBA as a cement mixture and improve the activity index. With the increase in the grinding time, the water-demand ratio of CFBA first decreased and then increased. CFBBA ground for 10 min and CFBFA ground for 4 min can reduce the water-demand ratio of CFBA by up to 105% and increase the compressive strength of 28-day-old CFBA cement by 7.05%. The grinding process can ensure that CFBA meets the Chinese standards for a cement admixture and realize the resource utilization of CFBA.

Clinical characteristics and long-term outcomes in patients with mixed Class III/IV + V and pure proliferative lupus nephritis: A single-center experience

OBJECTIVES

Proliferative lupus nephritis (LN) is a crucial complication in systemic lupus erythematosus (SLE). This study evaluated the clinical implications of coexistence of membranous LN in proliferative LN in terms of clinical characteristics and long-term outcome.

METHODS

We retrospectively reviewed the medical records of patients with SLE who underwent renal biopsy between 2005 and 2018. Patients with proliferative LN based on the 2003 International Society of Nephrology/Renal Pathology Society classification were subclassified into pure (Class III or IV only) and mixed (Class III or IV + Class V) proliferative LN. The clinical features at the time of renal biopsy, incidence of end-stage renal disease (ESRD), and all-cause mortality were compared between patients with mixed or pure proliferative LN.

RESULTS

Of the 171 patients, 30 and 141 were classified into mixed and pure proliferative LN groups, respectively. Patients with pure proliferative LN showed higher anti-dsDNA antibody and lower hemoglobin, platelet, and complement 3 levels than patients with mixed proliferative LN. The SLE disease activity index was also higher in patients with pure proliferative LN (p = 0.047). The pure proliferative LN group showed a higher proportion of Class IV and higher histologic activity index scores (p < 0.001 and p = 0.004, respectively). During the follow-up period of 58.3 months, 18 patients developed ESRD and 15 patients died. ESRD was exclusively observed in patients with pure proliferative LN, although the incidence of ESRD was not statistically different (p = 0.055). All-cause mortality was comparable between the two groups.

CONCLUSION

Pure proliferative LN was associated with higher clinical and histological activities and modestly increased risk of ESRD. Active immunosuppressive treatment would be required to control the renal inflammation in patients with proliferative LN, regardless of the coexistence of membranous LN.

Early onset left ventricular remodeling in juvenile systemic lupus erythematosus; Insight from 3-dimensional speckle tracking echocardiography

BACKGROUND

Early diagnosis and treatment of myocardial affection in patients with systemic lupus erythematosus (SLE) are crucial.

OBJECTIVES

To evaluate the ventricular systolic function in juvenile-onset systemic lupus erythematosus (j-SLE) patients by 3-D speckle tracking echocardiography (3D-STE) and to determine the predictors of left ventricular (LV) dysfunction if present.

METHODS

Twenty-six SLE patients without heart failure and 21 healthy controls were studied by standard echocardiogram and 3D-STE. Conventional parameters included LV ejection fraction (EF), fractional shortening (FS), and mitral annular plane systolic excursion (MAPSE). Global LV strain (GLS) and global area strain (GAS) were obtained by 3D-STE. Medical records, including diagnosis criteria, duration of disease, and SLE disease activity index (SLEDAI) were evaluated.

RESULTS

The mean age was similar in patients and controls 11.42 vs 11.48 years p  =  0.93. The mean duration of the disease was 1.87 ± 1.02 years and SLEDAI ranged from 0 to 9. By conventional and tissue Doppler imaging echocardiography, only MAPSE was significantly lower in SLE patients compared to controls (14.56 vs 18.46 mm, p < 0.001). By 3D speckle tracking echocardiography, GLS and GAS were significantly reduced in SLE patients compared to controls (-15.07 vs -19.9.4%, -34.6% vs -39.7%, respectively, p < 0.001). Multiple linear regression and ROC analyses indicated that the SLEDAI score was the only predictive factor for the left ventricular remodeling.

CONCLUSIONS

These results indicate that early subclinical LV dysfunction occur in jSLE patients even with normal EF and SLE disease activity might be a potential driver for LV deformation.

The Influence of Visual Input on Electromyographic Patterns of Masticatory and Cervical Spine Muscles in Subjects with Myopia

This study aimed to analyze the change of visual input on electromyographic patterns of masticatory and cervical spine muscles in subjects with myopia. After applying the inclusion criteria, 50 subjects (18 males and 32 females) with myopia ranging from −0.5 to −5.75 Diopters (D), were included in the study. Four muscle pairs were analyzed: the anterior part of the temporalis muscle (TA), the superficial part of the masseter muscle (MM), the anterior belly of the digastric muscle (DA), and the middle part of the sternocleidomastoid muscle belly (SCM) during resting and functional activity. Statistical analysis showed a significant decrease within functional indices (FCI) for the sternocleidomastoid muscle (FCI SCM R, FCI SCM L, FCI SCM total) during clenching in the intercuspal position with eyes closed compared to eyes open. During maximum mouth opening, a statistically significant increase of functional opening index for the left temporalis muscle (FOI TA L) was observed. Within the activity index (AcI), there was a statistically significant decrease during clenching on dental cotton rollers with eyes closed compared to eyes open.

Zinc Supplements Taken with Food Increase Essential Fatty Acid Desaturation Indices in Adult Men Compared with Zinc Taken in the Fasted State

BACKGROUND

Zinc intake is associated with reduced risk of metabolic disease in adults, possibly due in part to zinc's role in essential fatty acid (EFA) desaturation. Although plasma zinc is the accepted indicator of zinc status, product-to-precursor activity indices of fatty acid desaturase (FADS) 1 and 2 have also been proposed as response indicators for changes in zinc intake.

OBJECTIVES

To examine zinc supplement effects on plasma zinc concentration (PZC) and estimated FADS 1 and 2 activities, when zinc supplements are taken with food compared with fasted.

METHODS

Apparently healthy adult men were randomly allocated to take 25 mg zinc as zinc gluconate either in the fasted state 30 min before breakfast [zinc before breakfast (ZBB)] or with breakfast [zinc with breakfast (ZWB)] daily for 13 d. Fasting PZC was measured by inductively coupled plasma optical emission spectrometry. Selected EFAs for FADS activity indices were measured by LC-MS/MS at study baseline and end.

RESULTS

A total of 35 men completed the study (ZBB, n = 18; ZWB, n = 17). Mean ± SEM PZC was 86.2 ± 1.64 μg/dL at baseline. After 2 wk of zinc supplementation, the PZCs were 18% higher in the ZBB compared with the ZWB groups (105 ± 5.88 compared with 88.7 ± 2.36 μg/dL, P = < 0.05). However, the geometric mean (95% CI) FADS1 activity indices were 15% higher in the ZWB than the ZBB participants, 6.45 (5.84, 7.13) compared with 5.57 (5.05, 6.14), P < 0.05.

CONCLUSIONS

These data demonstrate a lack of congruence between the effects of zinc supplements on PZC and EFA metabolism in response to whether a zinc supplement is taken with or without food. Additional research is needed to determine how absorbed zinc may be directed differently toward metabolic processes, when coabsorbed with food. This trial was registered at clinicaltrials.gov as NCT03619421.

Expert Consensus on Optimal Acquisition and Development of the International Bowel Ultrasound Segmental Activity Score [IBUS-SAS]: A Reliability and Inter-rater Variability Study on Intestinal Ultrasonography in Crohn's Disease

BACKGROUND AND AIMS

Intestinal ultrasound [IUS] is an accurate, patient-centreed monitoring tool that objectively evaluates Crohn's disease [CD] activity. However no current, widely accepted, reproducible activity index exists to facilitate consistent IUS identification of inflammatory activity. The aim of this study is to identify key parameters of CD inflammation on IUS, evaluate their reliability, and develop an IUS index reflecting segmental activity.

METHODS

There were three phases: [1] expert consensus Delphi method to derive measures of IUS activity; [2] an initial, multi-expert case acquisition and expert interpretation of 20 blinded cases, to measure inter-rater reliability for individual measures; [3] refinement of case acquisition and interpretation by 12 international experts, with 30 blinded case reads with reliability assessment and development of a segmental activity score.

RESULTS

Delphi consensus: 11 experts representing seven countries identified four key parameters including: [1] bowel wall thickness [BWT]; [2] bowel wall stratification; [3] hyperaemia of the wall [colour Doppler imaging]; and [4] inflammatory mesenteric fat. Blind read: each variable exhibited moderate to substantial reliability. Optimal, standardised image and cineloop acquisition were established. Second blind read and score development: intra-class correlation coefficient [ICC] for BWT was almost perfect at 0.96 [0.94-0.98]. All four parameters correlated with the global disease activity assessment and were included in the final International Bowel Ultrasound Segmental Activity Score with almost perfect ICC (0.97 [0.95-0.99, p <0.001]).

CONCLUSIONS

Using expert consensus and standardised approaches, identification of key activity measurements on IUS has been achieved and a segmental activity score has been proposed, demonstrating excellent reliability.

Reactivity and Pozzolanic Properties of Biomass Ashes Generated by Wheat and Soybean Straw Combustion

A sustainable use of locally available wastes from agriculture as supplementary cementitious materials (SCMs) is an alternative solution for the prevention of excessive raw material usage, reduction of CO₂ emission and cost-effective concrete production. This paper studies the reactivity of non-traditional waste SCMs: Wheat straw ash (WSA), mixture of wheat and soybean straw ash (WSSA) and soybean straw ash (SSA), which are abundant as agricultural by-products in Serbia. The chemical evaluation using XRF technique, thermal analysis (TGA/DSC), XRD and FTIR methods were performed along with physical properties tests to investigate the feasibility of utilizing biomass ashes as cement substitutes. The obtained results demonstrate a high pozzolanic activity of WSA, which is attributed to a high reactive silica content of the ash and its satisfactory level of fineness. A wider hump in XRD pattern of WSA compared to WSSA and SSA confirmed that it abounds in amorphous (reactive) phase. The insufficient activity index of soybean-based biomass ashes, characterized with a low silica content, was improved by additional grinding and/or blending with amorphous silica-rich material. This points out the mechanical activation, i.e., grinding procedure, and chemical activation, i.e., modification of the chemical composition, as techniques efficient at producing pozzolanic materials from biomass wastes. Tested biomass ashes are characterized with negligible leaching values of heavy metals, thereby satisfying eco-friendly principles of SCM utilization. The application of biomass ashes as SCMs leads to substantial cost savings, as well as benefits to the environment, such as lower consumption of cement, reduction of CO₂ emissions during the production of cement and sustainable waste management.

Excess Zinc Alters Cell Wall Class III Peroxidase Activity and Flavonoid Content in the Maize Scutellum

Maize is one of the most important cereal crop species due to its uses for human and cattle nourishment, as well as its industrial use as a raw material. The yield and grain quality of maize depend on plant establishment, which starts with germination. Germination is dependent on embryo vigor and the stored reserves in the scutellum and endosperm. During germination, the scutellum epidermis changes and secretes enzymes and hormones into the endosperm. As a result, the hydrolysis products of the reserves and the different soluble nutrients are translocated to the scutellum through epithelial cells. Then, the reserves are directed to the embryo axis to sustain its growth. Therefore, the microenvironment surrounding the scutellum modulates its function. Zinc (Zn) is a micronutrient stored in the maize scutellum and endosperm; during imbibition, Zn from the endosperm is solubilized and mobilized towards the scutellum. During this process, Zn first becomes concentrated and interacts with cell wall charges, after which excess Zn is internalized in the vacuole. Currently, the effect of high Zn concentrations on the scutellum function and germinative processes are not known. In this paper, we show that, as a function of the concentration and time of exposure, Zn causes decreases in the radicle and plumule lengths and promotes the accumulation of reactive oxygen species (ROS) and flavonoids as well as changes in the activity of the cell wall Class III peroxidase (POD), which was quantified with guaiacol or catechin in the presence of H2O2. The relationship between the activity index or proportion of POD activity in the scutellum and the changes in the flavonoid concentration is proposed as a marker of stress and the state of vigor of the embryo.

Sleeping Beauties of Coronavirus Research

A "Sleeping Beauty" (SB) in science is a metaphor for a scholarly publication that remains relatively unnoticed by the related communities for a long time; - the publication is "sleeping". However, suddenly due to the appearance of some phenomenon, such a "forgotten" publication may become a center of scientific attention; - the SB is "awakened". Currently, there are specific scientific areas for which sleeping beauties (SBs) are awakened. For example, as the world is experiencing the COVID-19 global pandemic (triggered by SARS-CoV-2), publications on coronaviruses appear to be awakened. Thus, one can raise questions of scientific interest: are these publications coronavirus related SBs? Moreover, while much literature exists on other coronaviruses, there seems to be no comprehensive investigation on COVID-19, - in particular in the context of SBs. Nowadays, such SB papers can be even used for sustaining literature reviews and/or scientific claims about COVID-19. In our study, in order to pinpoint pertinent SBs, we use the "beauty score" (B-score) measure. The Activity Index (AI) and the Relative Specialization Index (RSI) are also calculated to compare countries where such SBs appear. Results show that most of these SBs were published previously to the present epidemic time (triggered by SARS-CoV or SARS-CoV-1), and are awakened in 2020. Besides outlining the most important SBs, we show from what countries and institutions they originate, and the most prolific author(s) of such SBs. The citation trend of SBs that have the highest B-score is also discussed.

Seasonal and spatial overlap in activity between domestic dogs and dingoes in remote Indigenous communities of northern Australia

Free-roaming domestic dogs in Indigenous communities of northern Australia have the potential to spread diseases at the wild-domestic dog interface. Hunting activities with domestic dogs, commonly practiced in Indigenous communities, also create opportunities for wild-domestic dog interactions in the bush, providing pathways for potential disease spread. Data from a camera-trap study conducted in remote Indigenous communities of northern Australia were used to explore spatial and seasonal opportunities for interactions between dingoes and unsupervised domestic dogs. For each type of dog, activity indices, based on detection events per camera station with an adjustment for sampling effort, were mapped across the study area and plotted against distance to communities. Unsupervised domestic dogs were mostly active in proximity (<1 km) to the communities. However, there was a noticeable peak of activity further in the bush away from the communities, especially in the wet season, coinciding with areas commonly used for hunting activities. In contrast, the activity of dingoes was more homogeneous within the study area, with a higher peak of activity around the communities during the dry season, and in bush areas distant (>10 km) to communities during the wet season. Overall, our findings suggest that interactions between dingoes and unsupervised community dogs are more likely to occur around the communities, particularly during the dry season, whereas in the wet season, there is increased opportunity for interactions in distant areas in the bush between dingoes and, presumably, hunting dogs.

The assessment of patients with the antiphospholipid antibody syndrome: where are we now?

The antiphospholipid antibody syndrome (APS), a chronic autoimmune thrombophilia with an increased mortality and morbidity, has been recognized for more than three decades. Unlike other autoimmune rheumatic conditions such as systemic lupus erythematosus, myositis and Sjögren's syndrome, relatively few attempts have been made to develop activity, damage or disease-specific quality of life indices for APS. In this review of the literature, we consider those attempts that have been made to develop assessment tools for patients with APS, but also reflect upon the nature of the condition, to discuss, in particular, whether an activity index is appropriate for this disease.

Accuracy of Broiler Activity Index as Affected by Sampling Time Interval

Simple Summary

Broiler activity index is a measure of bird movement through determining bird-representative pixel changes between consecutive images. Since the concept of activity index was coined, different sampling time intervals of consecutive images have been used to determine broiler activity. In this study, we found that accuracy of broiler activity decreased at longer sampling time intervals, with the 0.04-s interval yielding the most accurate activity index among all intervals investigated. In addition, broiler activity in the commercial house generally decreased as birds aged and varied at different monitoring locations. The research provides insights into image-sampling strategies for accurately determining broiler activity index, which may help to address growing public concerns on poultry welfare and health.

Abstract

Different time intervals between consecutive images have been used to determine broiler activity index (AI). However, the accuracy of broiler AI as affected by sampling time interval remains to be explored. The objective of this study was to investigate the effect of the sampling time interval (0.04, 0.2, 1, 10, 60, and 300 s) on the accuracy of broiler AI at different bird ages (1–7 weeks), locations (feeder, drinker, and open areas) and times of day (06:00–07:00 h, 12:00–13:00 h, and 18:00–19:00 h). A ceiling-mounted camera was used to capture top-view videos for broiler AI calculations. The results show that the sampling time interval of 0.04 s yielded the highest broiler AI because more bird motion details were captured at this short time interval. The broiler AIs at longer time intervals were 1–99% of that determined at the 0.04-s interval. The broiler AI at 0.2-s interval showed an acceptable accuracy with 80% less computational resources. Broiler AI decreased as birds aged but increased after week 4 at the drinker area. Broiler AI was the highest at the open area for weeks 1–4 and at the feeder and drinker areas for weeks 5–7. It is concluded that the accuracy of broiler AI was significantly affected by sampling time intervals. Broiler AI in commercial housing showed both temporal and spatial variations.

Development and Validation of a Simple Ultrasound Activity Score for Crohn's Disease

BACKGROUND AND AIMS

To improve management of patients with Crohn's disease, objective measurements of disease activity are needed. Ileocolonoscopy is the current reference standard but has limitations that restrict repeated use. Ultrasonography is potentially useful for activity monitoring, but no validated sonographic activity index is currently in widespread use. Thus, we aimed to construct and validate a simple ultrasound score for Crohn's disease.

METHODS

Forty patients were prospectively examined with ultrasound and endoscopy in the development phase. The Simple Endoscopic Score for Crohn's Disease [SES-CD] was used as a reference standard. Seven ultrasound variables [bowel wall thickness, length, colour Doppler, stenosis, fistula, stratification and fatty wrapping] were initially included, and multiple linear regression was used to select the variables that should be included in the final score. Second, the ultrasound data from each patient were re-examined for interobserver assessment using weighted kappa and intraclass correlation. Finally, the activity index was validated in a new cohort of 124 patients.

RESULTS

Length, fistula and stenosis were excluded. The combination of the remaining variables provided a multiple correlation coefficient of r = 0.78. Interobserver analysis revealed poor agreement for stratification and fatty wrapping and these were thus excluded. There was excellent interobserver agreement for the remaining score consisting of wall thickness and colour Doppler. In both patient cohorts, the ultrasound score correlated well with SES-CD [Development cohort: rho = 0.83, p < 0.001, Validation cohort: rho = 0.78, p < 0.001]. A receiver operating characteristic curve analysis revealed an area under the curve of 0.92 and 0.88 for detecting endoscopic activity and moderate endoscopic activity, respectively.

CONCLUSIONS

A simple ultrasound activity index for Crohn's disease consisting of bowel wall thickness and colour Doppler was constructed and validated and correlated well with endoscopic disease activity.ClinicalTrials. gov ID: NCT03481751.

Association of Urine sCD163 With Proliferative Lupus Nephritis, Fibrinoid Necrosis, Cellular Crescents and Intrarenal M2 Macrophages

CD163 is a marker for alternatively activated macrophages, which have been implicated in the pathogenesis of lupus nephritis (LN). In our preliminary screening of urine proteins in LN, urine soluble CD163 (sCD163) was significantly elevated in patients with active LN. To evaluate the potential of sCD163 as a biomarker in LN, urine sCD163 was assayed in patients with active LN, active non-renal lupus patients (ANR), inactive SLE and healthy controls (HC), using ELISA and normalized to urine creatinine. The correlation of urine sCD163 with clinical parameters and renal pathological attributes was further investigated in LN patients with concurrent renal biopsies. A total of 228 SLE patients and 56 HC were included from three cohorts. Results demonstrated that urine sCD163 was significantly elevated in active LN when compared with HC, inactive SLE, or ANR in African-American, Caucasian and Asian subjects (all P < 0.001). In LN patients with concurrent renal biopsies, urine sCD163 was significantly increased in patients with proliferative LN when compared with non-proliferative LN (P < 0.001). Urine sCD163 strongly correlated with SLEDAI, rSLEDAI, activity index (AI) of renal pathology, fibrinoid necrosis, cellular crescents, and interstitial inflammation on biopsies (all P < 0.01). Macrophages, particularly M2 macrophages, the predominant cells expressing CD163 within LN kidneys, represented a potential source of elevated urine sCD163, based on single-cell RNA sequencing analysis. To conclude, urine sCD163 discriminated patients with active LN from other SLE patients and was significantly elevated in proliferative LN. It strongly correlated with concurrent AI and several specific pathological attributes, demonstrating its potential in predicting renal pathology.

Azathioprine dosing and metabolite measurement in pediatric inflammatory bowel disease: does one size fit all?

Background

Azathioprine is widely used for the maintenance of remission in children with inflammatory bowel disease (IBD). Measuring thiopurine metabolites 6-thioguanine (6-TGN) and 6-methyl-mercaptopurine (6-MMP) can aid in optimizing treatment and preventing toxicity. We report a proactive approach combining early metabolite measurements with IBD activity index to achieve optimal azathioprine dosing.

Methods

The reporting of azathioprine dosing, IBD activity indexes and thiopurine metabolites was evaluated retrospectively in 40 children with IBD. Additional treatments and the effect of azathioprine on blood counts were also examined.

Results

Forty children (40% female) with IBD (26 Crohn's disease, 12 ulcerative colitis, and 2 unclassified IBD), mean age 12.2±3.4 years, were included in the study. The mean azathioprine dose was 1.3±0.4 mg/kg; mean 6-TGN level was 280±151 pmol/8 × 10⁸ red blood cells (RBC) and mean 6-MMP level 1022±1007 pmol/8 × 10⁸ RBC. Disease activity index (Crohn's and ulcerative colitis, pediatric specific) at the time of metabolite measurement was 6.5±8. Twenty-eight children did not require azathioprine dose adjustment, while it was increased in 12. Data from children with azathioprine monotherapy were analyzed separately and the results were similar.

Conclusion

Timely measurement of thiopurine metabolites and clinical assessment can provide a powerful tool to optimize azathioprine dosing and reduce serious adverse effects in children with IBD.

Theoretical Studies on the Electronic Structure Parameters and Reactive Activity of Neu5Gc and Neu5Ac under Food Processing Solvent Environment

The animal product hazard factor N-glycolylneuraminic (Neu5Gc) and brain nutrient substance N-acetylneuraminic acid (Neu5Ac) were studied at the M062X/6-311 + G(d,p) geometry optimization level. We considered the electronic structure parameters with different solvents: (benzene ε = 2.27, acetic acid ε = 6.25, ethanol ε = 24.85, lactic acid ε = 22.00, formic acid ε = 51.1, water ε = 78.35). The maximum molecular surface electrostatic potentials, which were 62.77 for Neu5Gc and 60.90 kcal/mol for Neu5Ac, are both located on the carboxyl group hydrogen. The orbital analysis showed that the amide group and carboxyl group confer the sites with susceptibility to nucleophilic and electrophilic attack, respectively. The solvent effect showed that polar solvents, such as formic acid and water, can enhance the two molecules’ nucleophilic activity. To better understand the roles of the hydroxyl group in the two molecules, the independent gradient model theory confirmed the four intramolecular hydrogen bonds of Neu5Gc at gas phase, whereas Neu5Ac only has two. The lowest bond dissociation energy in solvent occurs at O7-H, which is 104.03 kcal/mol in water for Neu5Gc and 104.57 kcal/mol in lactic acid for Neu5Ac. The lowest proton affinity value for Neu5Gc (20.34 kcal/mol) and Neu5Ac (20.76 kcal/mol) was both occur at the carboxyl group O6-H under ethanol. The antioxidant mechanisms of the two sialic acid are prone to sequential proton-loss electron transfer under polar or non-polar solvents.

Prognostic factors of budesonide therapy for the management of Crohn's disease: A meta-analysis

BACKGROUND

This study aimed to identify factors that affect the prognosis of budesonide therapy for Crohn's disease patients.

METHOD

Change in Crohn's disease activity index (CDAI) scores at latest follow-up after budesonide therapy reported by individual studies were pooled to gain overall effect size under random effects model and then metaregression analyses were performed to identify factors affecting the change in CDAI scores after budesonide treatment.

RESULTS

Fifteen studies (1875 patients; age, 35.6 years [95% confidence interval (CI): 34.1, 37.0]; 41.66% [95% CI: 37.44, 45.88] males; 33.3% [95% CI: 24.3, 42.3] smokers; weight, 64.7 kg [95% CI: 62.71 66.6] and height, 168 cm [95% CI: 165, 171]) were included. Disease duration was 7.0 years [95% CI: 5.7, 8.2] and duration of the current episode was 3.1 months [95% CI: 1.7, 4.4]. Proportion of patients with prior resection was 42% [95% CI: 34%, 50%]. The disease was 21% in the ileum, 61% in ileocecum, and 18% in the colon. Budesonide dose was 8.83 mg/d [95% CI: 7.52, 10.14]. In a follow-up duration of 21.0 weeks [95% CI: 15.2, 26.8], budesonide treatment was associated with improvement in CDAI score of -117.8 [95% CI: -134.0, -102.0]. The magnitude of the change in CDAI score at the latest follow-up was significantly inversely associated with the percentage of smokers, but positively associated with the baseline CDAI score and duration of the current episode.

CONCLUSION

Budesonide therapy to Crohn's disease patients appears to be more effective in patients with the more serious condition. Smoking may also affect the prognosis.

Histologic versus clinical remission in proliferative lupus nephritis

BACKGROUND

Treatment response in lupus nephritis (LN) is defined clinically, without consideration of renal histology. Few studies have systematically examined histologic responses to induction therapy. In LN patients who underwent protocol kidney biopsies after induction immunosuppression, we describe the renal histology of the second biopsy and correlate histologic activity and damage with short- and long-term kidney outcomes.

METHODS

Patients with suspected LN were biopsied for diagnosis (Biopsy 1), and those with proliferative LN were rebiopsied after induction (Biopsy 2). Histologic activity and damage at each biopsy were calculated as the National Institutes of Health activity and chronicity indices. Complete and partial renal responses after induction and after long-term follow-up were determined clinically.

RESULTS

One-third of patients who achieved a complete clinical response after induction had persistently high histologic activity, and 62% of patients who had complete histologic remission on rebiopsy were still clinically active. Chronic renal damage increased after induction even in complete clinical responders. Chronicity at Biopsy 2 associated with long-term kidney function and development of chronic kidney disease.

CONCLUSIONS

Early clinical and histologic outcomes are discordant in proliferative LN, and neither correlates with long-term renal outcome. The kidney accrues chronic damage rapidly and despite clinical response in LN. Preservation of kidney function may require therapeutic targeting of both chronic damage and inflammation during LN induction treatment.

Serum Interleukin-34 Levels Are Elevated in Patients with Systemic Lupus Erythematosus

Interleukin-34 (IL-34) was initially identified as an alternative ligand for the colony-stimulating factor-1 receptor (CSF-1R) to mediate the biology of mononuclear phagocytic cells. Recently, IL-34 was found to be associated with chronic inflammation, such as in rheumatoid arthritis (RA). Both RA and systemic lupus erythematosus (SLE) are multifactorial autoimmune diseases and are characterized by excessive immune and inflammatory responses. Thus, we investigated whether IL-34 is involved in the pathogenesis of SLE. In all, 78 SLE patients and 53 healthy controls were enrolled in the research. Enzyme-linked immunosorbent assay (ELISA) was employed to measure the concentrations of serological IL-34. Then serum IL-34 levels between the SLE group and healthy controls were analyzed by the Mann-Whitney U test. Meanwhile, the correlations between the serum IL-34 levels and disease activity indexes and other established serum markers were assessed. Furthermore, the serum IL-34 levels of 20 active SLE patients were reevaluated when diseases were in the remission stage from corticosteroids or immunosuppressive drugs. Serum IL-34 levels were significantly higher in SLE patients compared to healthy controls. Their levels were remarkably associated with accumulation of the clinical features of SLE. Additionally, IL-34 titers were positively correlated with the SLE disease activity indexes, anti-double-stranded DNA antibody (anti-dsDNA) titers and C-reactive protein (CRP) levels, and inversely with complement3 (C3) levels. Moreover, serum IL-34 levels were significantly decreased after successful treatment of SLE. Serum IL-34 could be a candidate biomarker for SLE as there are elevated serum levels in treatment-naive SLE patients and we saw a significant decrease after effective treatment.

Spot urine protein/creatinine ratio is unreliable estimate of 24 h proteinuria in lupus nephritis when the histological scores of activity index are higher

OBJECTIVES

The aim of this study was to evaluate the correlation and agreement of spot urine protein/creatinine (P/C) ratio with 24 h proteinuria in patients with lupus nephritis (LN) under different scores of activity index (AI).

METHODS

In total, 90 pairs of 24 h urine and spot urine samples from 90 patients with biopsy-proven LN were analyzed. The correlation and agreement between the two sample types were assessed by Pearson correlation and intra-class correlation coefficient (ICC) using mixed model for repeated measurements, respectively.

RESULTS AND CONCLUSIONS

Overall, 24 h proteinuria correlated strongly with the spot urine P/C ratio (r = 0.671, p < 0.001) with a good agreement (ICC = 0.656, 95% confidence interval (CI): 0.52-0.76). Subgroup analyses revealed that the correlation remained high in all groups (r = 0.825, p < 0.001; r = 0.567, p = 0.001; r = 0.686, p = 0.020), the agreement in group A (low AI) was good (ICC = 0.824, 95% CI: 0.70-0.89), but in group B (middle AI) and group C (high AI), the agreements were weak (ICC = 0.503, 95% CI: 0.19-0.72; ICC = 0.532, 95% CI: 0.06-0.84). Our work suggests that over the range of a higher AI, however, correlation was present but agreement was poor.

ESSPRI and other patient-reported indices in patients with primary Sjogren's syndrome during 100 consecutive outpatient visits at one rheumatological clinic

OBJECTIVE

A European League Against Rheumatism (EULAR) SS disease activity index (ESSDAI) and a patient-reported index (ESSPRI) have recently been developed and validated. In our previous study the ESSDAI correlated significantly with serum β2 microglobulin concentration. We now aim to establish whether the ESSPRI is also associated with serum β2 microglobulin or with other patient-reported indices.

METHODS

The data on 100 consecutive visits of patients with primary SS (pSS) were reviewed from the patient charts. Patients who had filled out the ESSPRI questionnaire and fulfilled at least four of the revised American-European consensus group criteria for pSS were included. Data were gathered on the ESSPRI (0-10 cm) and on the patient's global health assessment [visual analogue scale (VAS) 0-10 cm] (PGH-VAS), pain-VAS (0-10 cm) and HAQ (range 0-3).

RESULTS

The ESSPRI correlated significantly with the PGH-VAS (r = 0.753, P < 0.0001), pain-VAS (r = 0.656, P < 0.0001) and HAQ (r = 0.542, P < 0.0001) (Spearman's correlation). It also correlated weakly with serum β2 microglobulin (r = 0.214, P = 0.043) and ESR levels (r = 0.235, P = 0.019).

CONCLUSION

The ESSPRI correlated significantly with other patient-reported indices, serum β2 microglobulin and ESR in patients with pSS. Our results support the view that the ESSPRI is a useful tool in the follow-up of patients with pSS.

The value of repeat kidney biopsy in quiescent Argentinian lupus nephritis patients

BACKGROUND

The duration of maintenance therapy after induction therapy for lupus nephritis has not been rigorously established. A common practice is to maintain immunosuppression for 1-2 years after complete remission, and longer for partial remission. The present work addresses whether a repeat kidney biopsy might be informative in deciding who should continue immunosuppression after complete or partial remission.

METHODS

The practice in a large Buenos Aires nephrology unit is to repeat a kidney biopsy before finalizing the decision to withdraw or continue immunosuppression. This work reports on a cohort of 25 Hispanic patients that had two or more kidney biopsies, the last occurring after at least 24 months of clinically quiescent disease.

RESULTS

Despite normalization of serum creatinine and reduction of proteinuria to <500 mg/d, 30% of patients still had significant activity at the last biopsy. Conversely, 60% of patients with ongoing proteinuria (500-1000 mg/d), or stable but abnormal serum creatinine, had no activity by biopsy. Univariate association analyses demonstrated that improvement in the activity index (AI) of the last biopsy was associated with choice of induction therapy (cyclophosphamide or mycophenolate), improvement in serum creatinine over the first six months of treatment, and improvement in complement component C4. By multivariate regression analyses, two AI prediction models emerged. Cyclophosphamide plus change in serum creatinine or cyclophosphamide plus change in C4 accounted for 50% of the improvement in AI.

CONCLUSION

These data suggest that a repeat biopsy may be useful in making the decision to withdraw or continue maintenance immunosuppression.

Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS)

BACKGROUND

Variability in endoscopic assessment necessitates rigorous investigation of descriptors for scoring severity of ulcerative colitis (UC).

OBJECTIVE

To evaluate variation in the overall endoscopic assessment of severity, the intra- and interindividual variation of descriptive terms and to create an Ulcerative Colitis Endoscopic Index of Severity which could be validated.

DESIGN

A two-phase study used a library of 670 video sigmoidoscopies from patients with Mayo Clinic scores 0-11, supplemented by 10 videos from five people without UC and five hospitalised patients with acute severe UC. In phase 1, each of 10 investigators viewed 16/24 videos to assess agreement on the Baron score with a central reader and agreed definitions of 10 endoscopic descriptors. In phase 2, each of 30 different investigators rated 25/60 different videos for the descriptors and assessed overall severity on a 0-100 visual analogue scale. κ Statistics tested inter- and intraobserver variability for each descriptor. A general linear mixed regression model based on logit link and β distribution of variance was used to predict overall endoscopic severity from descriptors.

RESULTS

There was 76% agreement for 'severe', but 27% agreement for 'normal' appearances between phase I investigators and the central reader. In phase 2, weighted κ values ranged from 0.34 to 0.65 and 0.30 to 0.45 within and between observers for the 10 descriptors. The final model incorporated vascular pattern, (normal/patchy/complete obliteration) bleeding (none/mucosal/luminal mild/luminal moderate or severe), erosions and ulcers (none/erosions/superficial/deep), each with precise definitions, which explained 90% of the variance (pR(2), Akaike Information Criterion) in the overall assessment of endoscopic severity, predictions varying from 4 to 93 on a 100-point scale (from normal to worst endoscopic severity).

CONCLUSION

The Ulcerative Colitis Endoscopic Index of Severity accurately predicts overall assessment of endoscopic severity of UC. Validity and responsiveness need further testing before it can be applied as an outcome measure in clinical trials or clinical practice.

EULAR Sjogren's syndrome disease activity index: development of a consensus systemic disease activity index for primary Sjogren's syndrome

OBJECTIVE

To develop a disease activity index for patients with primary Sjögren's syndrome (SS): the European League Against Rheumatism (EULAR) Sjögren's syndrome disease activity index (ESSDAI).

METHODS

Thirty-nine SS experts participated in an international collaboration, promoted by EULAR, to develop the ESSDAI. Experts identified 12 organ-specific 'domains' contributing to disease activity. For each domain, features of disease activity were classified in three or four levels according to their severity. Data abstracted from 96 patients with systemic complications of primary SS were used to generate 702 realistic vignettes for which all possible systemic complications were represented. Using the 0-10 physician global assessment (PhGA) scale, each expert scored the disease activity of five patient profiles and 20 realistic vignettes. Multiple regression modelling, with PhGA used as the dependent variable, was used to estimate the weight of each domain.

RESULTS

All 12 domains were significantly associated with disease activity in the multivariate model, domain weights ranged from 1 to 6. The ESSDAI scores varied from 2 to 47 and were significantly correlated with PhGA for both real patient profiles and realistic vignettes (r=0.61 and r=0.58, respectively, p<0.001). Compared with 57 (59.4%) of the real patient profiles, 468 (66.7%) of the realistic vignettes were considered likely or very likely to be true.

CONCLUSIONS

The ESSDAI is a clinical index designed to measure disease activity in patients with primary SS. Once validated, such a standardised evaluation of primary SS should facilitate clinical research and be helpful as an outcome measure in clinical trials.