Mean Activity Index Research Articles

Peripheral Eosinophil Count Associated with Disease Activity and Clinical Outcomes in Hospitalized Patients with Lupus Nephritis

Introduction: The aim of this study was to evaluate the association of peripheral eosinophil (EOS) count with disease activity and kidney outcomes in lupus nephritis (LN) patients. Methods: A total of 453 hospitalized and biopsy-proven LN patients at our hospital from 2006 to 2013 were enrolled, of which 388 patients had repeated measurements of EOS. Relationships were explored between average EOS and disease activity at baseline, using the systemic lupus erythematosus disease activity (SLEDAI) and activity index (AI) on kidney biopsy. Follow-up data were available through December 2016. The primary outcome measure was a composite of doubling of serum creatinine and end-stage kidney disease after a median follow-up of 51 months. Results: The mean age of the enrolled 388 LN patients was 33.1 ± 10.8 years old, and 335 (86%) were female. The median average peripheral EOS count was 0.033 (0.015–0.057) ×10⁹/L. Mean AI and SLEDAI score were 6.8 ± 2.5 and 14.9 ± 5.4, respectively. Logistic regression models showed that decreased average EOS was independently associated with higher AI (≥6) and higher SLEDAI (≥15) (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.90–0.97; and OR 0.96, 95% CI: 0.93–0.99, respectively). There was a parabolic relationship between average EOS and the primary outcome, with hazard ratio (HR) > 1 for both levels ≤0.033 and >0.16 × 10⁹/L. Conclusion: Lower EOS count was independently associated with severe disease activity and kidney progression in LN.

Associations of adverse childhood experiences (ACEs) with sleep duration and quality: the BCOPS study

BackgroundAdverse Childhood Experiences (ACEs) are associated with numerous adverse health outcomes in adulthood. Our objective was to investigate associations between ACEs and sleep measures among 206 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress study. MethodsACEs (independent variable) was assessed using the ACE questionnaire. Sleep measures were assessed using the Pittsburgh Sleep Quality Index and actigraphy. ANOVA/ANCOVA were used to investigate associations between ACEs and sleep measures. ResultsThe mean self-reported sleep duration was significantly lower among participants who reported ≥1 ACEs compared to those who reported no ACEs (6.0 ± 0.11 vs. 6.4 ± 0.14 h; multivariate-adjusted p = 0.035). Sleep efficiency was significantly lower among participants who reported ≥1 ACEs compared to those who reported none (mean = 88.7%, 95% CI = 87.7–89.6 vs. 90.2%, 89.2–91.2; unadjusted p = 0.031) but was slightly attenuated and lost statistical significance after multivariate-adjustment (88.8%, 87.8–89.7 vs. 90.1%, 88.9–91.1; p = 0.094). Compared to participants who reported no ACEs, those who reported ≥1 ACEs had a higher mean activity index score (36.9 ± 0.96 vs. 31.2 ± 1.25; multivariate-adjusted p = 0.001); a higher mean wake after sleep onset (WASO) (44.3 ± 2.24 vs. 35.3 ± 2.92 min; multivariate-adjusted p = 0.019); and a higher sleep fragmentation index (3.8 ± 1.65 vs. 3.3 ± 1.20 unadjusted p = 0.044 and 3.8 ± 0.13 vs. 3.3 ± 0.18; multivariate-adjusted p = 0.062). Among men (but not women) who reported ≥1 ACEs, self-reported sleep duration was significantly lower (5.9 ± 0.13 vs. 6.4 ± 0.15 h; multivariate-adjusted p = 0.025) and activity index was significantly higher (39.1 ± 1.3 vs. 33.2 ± 1.51; multivariate-adjusted p = 0.004) compared to those who reported no ACEs. ConclusionExposure to ≥1 ACE was associated with worse sleep measures.

Treatment outcomes in refractory lupus nephritis: Data from an observational study.

Despite current advances in treatment, refractory lupus nephritis (RLN) continues to pose a challenge. The present paper studies the clinical profile and treatment outcomes in patients with RLN. This observational, bidirectional study enrolled consecutive lupus nephritis (LN) patients from August 2018 to January 2019, who either failed to improve within three months, did not achieve partial renal response (PR) at six months, or did not achieve complete renal response (CR) after two years of treatment. Patients were followed every three months; treatment details and outcomes [CR, PR, no renal response (NR)], doubling serum creatinine, and death were recorded. Group comparisons were made using ANOVA and chi-square test. Factors affecting renal response were studied using linear regression. Forty-five of forty-eight enrolled patients completed at least nine months of follow-up and were included in outcome analysis. The median (IQR) SLE duration was three years (2-6 years). The majority of patients (n = 25) had proliferative LN (ISN/RPS class III/IV), with nine patients having pure membranous LN (class V). The mean activity and chronicity indices were 8 and 0. Over a median (IQR) follow-up period of 15 (12-27) months, 28 had CR, 9 had PR, and 8 showed no response to a switch in an immunosuppressive (IS) agent. Repeat renal biopsy (n = 8) with a mean (±SD) biopsy interval of 2 (±1) years showed histological class transformation in more than half of the patients. There was no significant difference in treatment outcome and time to attain response based on individual IS agent or sequence of IS agents used. None of the variables (duration of SLE or nephritis, baseline SLEDAI, leukopenia, hypertension, elevated anti-dsDNA, low complements, serum albumin, 24-hour urinary protein, biopsy class) predicted renal response on univariate analysis. No patient had a doubling of serum creatinine or progression to end-stage renal disease. There were three deaths, all related to infection. A change in immunosuppression produces response in most RLN patients while a fifth of them showed no response to therapy. No predictor of renal response was identified. Histologic class switch was frequent. Renal function did not decline over a year of follow-up.

Quantifying shoulder activity after rotator cuff repair: Technique and preliminary results.

Repair tissue healing after rotator cuff repair remains a significant clinical problem, and excessive shoulder activity after surgical repair is believed to contribute to re-tears. In contrast, small animal studies have demonstrated that complete removal of activity impairs tendon healing and have advocated for an "appropriate" level of activity, but in humans the appropriate amount of shoulder activity to enhance healing is not known. As an initial step toward understanding the relationship between postoperative shoulder activity and repair tissue healing, the objectives of this study were to assess the precision, accuracy, and feasibility of a wrist-worn triaxial accelerometer for measuring shoulder activity. Following assessments of precision (±0.002 g) and accuracy (±0.006 g), feasibility was assessed by measuring 1 week of shoulder activity in 14 rotator cuff repair patients and 8 control subjects. Shoulder activity was reported in terms of volume (mean acceleration, activity count, mean activity index, active time) and intensity (intensity gradient). Patients had significantly less volume (p ≤ .03) and intensity (p = .01) than controls. Time post-surgery was significantly associated with the volume (p ≤ .05 for mean acceleration, activity count, and mean activity index) and intensity (p = .03) of shoulder activity, but not active time (p = .08). These findings indicate this approach has the accuracy and precision necessary to continuously monitor shoulder activity with a wrist-worn sensor. The preliminary data demonstrate the ability to discriminate between healthy control subjects and patients recovering from rotator cuff repair and provide support for using a wearable sensor to monitor changes over time in shoulder activity.

Clinico-histomorphologic Characteristics of Lupus Nephritis, Experience at a Center at Dhaka.

Lupus nephritis (LN) is one of the most serious systemic lupus erythematosus complications since it is the major predictor of poor prognosis. We present the clinico-histomorphologic characteristics of LN at a center in Dhaka. The study group comprised diagnosed cases of LN on core-needle renal biopsy specimens received in the Department of Histopathology, Armed Forces Institute of Pathology, Dhaka, from January 2018 to June 2019. Histological evaluation and direct immunofluorescence (DIF) study was carried out on each specimen. Each case was classified according to the International Society for Nephrology/Renal Pathology Society (ISN/RPS) Classification 2003 of LN. A total of 104 (9.20%) LN cases were included of total 1130 nonneoplastic renal biopsy specimens. The mean age was 28.29 ± 12.24 years, with a male:female ratio of 1:4.47. According to the ISN/RPS 2003 classification, most of the LN belong to class IV (42, 40.38%), followed by class III (27, 25.96%), class II (22, 21.15%), and so on. The mean age of class IV LN was 25.95 ± 10.15 years, with M:F = 1:4.25. The mean urinary total protein (UTP) was 4.62 ± 4.47 g/24 h and the mean serum creatinine was 1.87 ± 1.12 mg/dL. On histopathology, 22 (52.38%) had crescent formation, 27 (64.28%) had wire loop formation with subendothelial thrombi, and 30 (71.42%) had necrotizing lesion. Interstitial fibrosis and tubular atrophy (IFTA) was ≥25% in eight (19.04%) class IV LN. Among the subclasses, most common was IV-G (A/C) - 16 (38.09%), followed by IV-S (A/C) - nine (21.42%) and IV-S (A) and IV-G (A) each eight (19.04%). In four (9.52%) cases, class IV + V lesion was found. The mean age of class III LN was 26 ± 11.02 years, with a male:female of 1:26. The mean UTP was 3.45 ± 2.4 and serum creatinine was 1.71 ± 1.51. Among these, crescent was found in eight (29.63%) cases, wire loop and subendothelial thrombi in 11 (37.04%) cases, and necrotizing lesions in eight (29.63%) cases. IFTA was >25% in 14.81% of cases of class III LN. Among 27 class III LN, 17 (62.96%) were classified as III (A) and 10 (37.04%) as III (A/C). Two class III LN had an association with class V and two have presented with TMA. The mean age of class II LN was 29.95+ 12.26 years, with M:F = 1:2.66. UTP was 3.53 ± 2.43 g/24 h and serum creatinine was 1.52 ± 1.5 mg/dL for class II LN. Histologically, these cases had focal/diffuse mesangial proliferation with 25% IFTA in 9.09% of cases. One of the class II LN had associated amyloidosis. Among class V LN, the mean age was 45.12 + 13.64 years, with M:F = 1:3. The mean UTP was 4.06 ± 1.71 g/24 h and serum creatinine was 1.64 ± 0.94 mg/dL. Histologically, 37.5% had >25% IFTA. The mean age of class I lesion was 27.25 ± 17.42 years with equal number of males and females. The mean serum creatinine level was 0.65 ± 0.18 mg/dL and UTP was 2.71 ± 2.3 g/24 h for class I lesion. Only one class VI LN case was found which had IFTA 40% and presented with generalized edema. On DIF, among 100 cases, 86 were found with full-house immune deposits of different intensity; IgM was lacking in 10 cases and IgA was lacking in seven cases, while three cases lacked C3 deposits. The mean activity index was 7.10 and the mean chronicity index was 3.23 among 69 cases of proliferative LN. Among different histological classes of LN, the prevalence of class IV was more in this study which had the most severe form of clinical presentation, biochemical parameters (raised serum creatinine level), and histological findings (crescent formation and IFTA).

SAT-413 LUPUS NEPHRITIS IN CHILDREN AND ADULTS FROM A RESOURCE LIMITED SETTING- A CLINICOPATHOLOGICAL COMPARISON

Childhood-onset systemic lupus erythematosus (SLE) differs from adult-onset disease in important ways especially renal manifestations. Pediatric Lupus Nephritis (ped LN) which is 30% more prevalent, causes significant morbidity and mortality. In general, treatment for ped LN is based on standard approaches in adults with Lupus Nephritis, because of the lack of large randomized trials in pediatric disease regarding the appropriate drug doses and treatment duration for children who have longer life expectancy and has the concerns of growth and development. Hence we aimed to compare the clinicopathological profile and response to induction treatment in ped LN with that of adults. Data was collected from 36 cases of ped LN and 55 adult LN cases from the year 2010 to 2016 (7 years). Clinicopathological findings at the time of presentation were noted. Renal biopsies were reported by the same renal pathologist and ISN/RPS (2003) classification was followed. The Activity Index (AI) and Chronicity Index (CI) were calculated using NIH scoring system. All patients received treatment as per NIH protocol. The correlation between clinical features, class of lupus nephritis, morphological indices and response to induction treatment in childhood lupus nephritis was assessed and compared in both the groups. Among 36 pediatric patients, 75% were females. 33.33% had nephrotic range proteinuria and 5.56 % had no proteinuria.63.9% had hematuria and 36.1 % had pyuria. Majority had proliferative lupus nephritis Class III- 41.67%, Class Iv- 44.44%). Mean AI was 5.4 (range (0 to 16). Majority were not having any chronicity. ( mean CI-0.33; Range - 0-3). Children who attained complete remission following 6 months induction treatment(n=25), had a mean AI of 4.98 while those who had only partial/no remission had a mean of 6.09. Out of 55 adults, Class IV was the commonest type and the mean AI was 7.83 and mean CI was 2.04. Patients who attained complete remission (n=30) had a mean AI of 7.15 and mean CI of 1.54. where as those adults who had only partial /no remission had higher mean AI (8.88) and CI (2.6) Though the distribution of major classes of LN were similar in both adults and children, ped LN has lesser activity and minimal or nil chronicity compered to adults. Morphological indices in renal biopsy are useful in predicting response to induction treatment. The finding of more chance of attaining complete remission in ped LN compared to adult LN needs validation in future larger studies.

Clinical impact of repeat renal biopsies in patients with lupus nephritis: Renal biopsy is essential especially later in the course of the disease.

The clinical impact of repeat renal biopsies in patients with lupus nephritis (LN) is still debatable. The aim of this retrospective analysis was to assess whether repeat renal biopsy is a reliable tool in guiding therapeutic decisions. Laboratory and histological parameters and therapeutic changes in 35 patients with LN and repeat renal biopsies were retrospectively analyzed. Biopsies were performed in the presence of clinical evidence of an active glomerular disease. Biopsy specimens were retrospectively re-assessed by two renal pathologists and were compared according to the last International Society of Nephrology/ Renal Pathology Society classification. Thirty-five patients had two, 13 had three, 5 had four, 4 had five, and 1 had six renal biopsies. Fifty-eight comparisons of renal biopsies were made. Median times between the first and second, second and third, third and fourth, and fourth and fifth biopsies were 31, 27, 34, and 28 months, respectively. The mean activity indices from the first to the fifth biopsy were 8.7, 6.6, 7.8, 9.4, and 4.7, whereas the mean chronicity indices were 1.7, 2.3, 4.3, 5.2, and 7.7, respectively. Conversion was observed in 65.5% of cases with the most frequent (21%) being between classes III and IV. Conversion to a more severe type of nephritis occurred in 19% of cases. There was no correlation of laboratory parameters to the type of nephritis upon conversion. In 79% of cases, immunosuppressive therapy was modified after repeat biopsy. Repeat biopsy is a reliable tool for monitoring the activity and chronicity status of LN and for tailoring immunosuppressive therapy to the needs of the patient, especially late in the course of the disease.

Association of ankylosing spondylitis activity indicators in a Russian population of patients with STAT4 rs7574865 gene polymorphism

Family and twin studies have shown that ankylosing spondylitis (AS) has a hereditary nature that is based on a strong association with the leukocyte antigen HLA-B27. However, only 1–5% of HLA-B27 carriers develop AS, which indicates that there are other genetic markers involved in the formation of a predisposition to this disease. A number of genome-wide association studies have convincingly confirmed the role of the STAT4 gene. This gene encodes the protein – the signal transducer and activator of transcription (STAT) protein, which is a predisposing factor for the development of many autoimmune diseases. There are not so many studies of the relationship of STAT4 polymorphisms to the predisposition to AS, and there are no these studies regarding the Russian population.Objective: to study whether there is a possible association of STAT4 rs7574865 gene polymorphism with the predisposition to AS and to assess the activity of this disease using BASDAI and ASDAS scores in the Russian patient population.Patients and methods. A cohort of 203 individuals, including 100 patients (79 men and 21 women) with AS, and 103 healthy volunteers (a control group) was surveyed. Age, gender, duration, and specific features of AS onset, ESR, and CRP levels were assessed. BASDAI and ASDAS scores were calculated to evaluate disease activity.Results and discussion. There was a significant relationship between STAT4 polymorphism and C-reactive protein (CRP) levels and BASDAI and ASDAS-CRP scores. The TT genotype carriers had significantly higher mean activity indices compared to the GG (p=0.001) and GT (p=0.005) genotype carriers for CRP, BASDAI (p=0.0001 and p=0.009, respectively) and ASDAS-CRP (p=0.009 and p=0.001, respectively). High disease activity (BASDAI >4 and ASDAS-CRP >3.5) was also associated with the high frequency of the T allele (p=0.046 and p=0.004, respectively). The value of STAT4 rs7574865 gene polymorphism in the pathogenesis of autoimmune diseases is confirmed by a study in which the T allele in STAT4 rs7574865 enhances mRNA transcription and protein expression. Italian authors have shown that there is a relationship between the minor T allele of rs7574865 and the high risk of arthritis. We have previously established a relationship between the T allele and the predisposition to diffuse systemic scleroderma, interstitial lung damage, and elevated anti-topoisomerase I antibody levels.Conclusion. The present study has shown for the first time a significant association of STAT4 rs7574865 polymorphism with the main AS activity indicators: CRP levels, BASDAI and ASDAS-CRP scores. The studied polymorphism may be a new genetic marker for predicting the severity of AS.

Activity levels following hip resurfacing arthroplasty: A tool to help manage patient expectations

BackgroundWhen compared to total hip arthroplasty (THA), hip resurfacing arthroplasty (HRA) is usually undertaken in younger, more active patients with hip osteoarthritis. Previous research has noted that patients are able to return to pre-operative activity levels, with many even increasing their activity post HRA, but patterns in post-operative recovery have been less well investigated. Materials and MethodologyA randomised controlled trial dataset was analysed to explore activity levels attained after HRA. Data was collected on 80 male patients. The primary outcome of focus was the University of California, Los Angeles (UCLA) Activity Index, with follow-up at 6 weeks, 16 weeks and 1 year. ResultsMean UCLA at baseline was 5.4 (SD; 2.1) which, after an initial fall to 4.7 (SD; 1.6, p = 0.008) at 6 weeks, increased at both the 16 week and 1 year follow ups (p < 0.001), with a final mean activity index of 7.2 (SD; 1.7). Mode UCLA at 1 year was 7 or 8, representing patients who are regularly taking part in activities such as cycling and golf. ConclusionFollowing HRA, patients can achieve significant improvements in activity measured using the UCLA Activity Index. Activity levels have been shown to initially decrease following HRA, with improvement throughout the first postoperative year. The results of this study provide clinicians with a simple tool to help patients visualise their post-operative recovery. This may have implications when managing patient expectations of post-operative activity level in both HRA and large head THA populations.

Outcome of childhood lupus nephritis in Saudi children.

Our aim in this study is to report the long-term renal outcome of a cohort of Saudi children with systemic lupus erythematosus (SLE). All patients with childhood lupus nephritis (cLN) proved by renal biopsy seen between January 2000 and June 2015 were reviewed. The renal outcome was assessed according to serum creatinine level, protein/creatinine ratio at the last follow-up visit, and/or evidence of renal impairment during follow-up period and end-stage renal disease (ESRD). Additional outcome measures include accrual damage measured by pediatric adaptation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (pSDI), and death related to SLE was determined. A total of 84 (72 females) cLN patients with follow-up duration of 9.3 years (±5.2) were included in this study. The mean current age was 19.4 years (±5.5) and mean age at onset was 9.2 years (±2.4). The most frequent histopathological class was proliferative glomerulonephritis (64.3%) followed by membranous nephritis (27.4%). The mean activity and chronicity indices were 5.9 (±3.9) and 2.9 (±2.2), respectively. Renal microthrombosis was found in 9 (10.7%) patients. All patients treated with immunosuppressive medications; cyclophosphamide used in 64 followed by mycophenolate mofetil in 42, then azathioprine in 19 patients, while rituximab used in 24 patients. At the last follow-up visit, the mean serum creatinine was 147 umol/L (±197) and the mean protein/ creatinine ratio was 0.8 (± 1.1) while the mean total pSDI was 1.9 (±1.9) and mean renal SDI was 0.7 (±1.1). Sixteen (19%) patients had ESRD and eight of them had class IV nephritis. However, there was no significant difference in ESRD by histological class. The overall survival rates were five years: 94% and 10 years: 87%. Infection was the leading cause of mortality. Our patients had severe cLN and required intensive treatment. Despite the survival rate is comparable to other studies, ESRD is more frequent and this may be attributed to genetic or ethnic factors.

Electromyographic activity of the jaw muscles and mandibular kinematics in young adults with theoretically ideal dental occlusion: Reference values.

BackgroundA necessary step to use neuromuscular analysis as diagnostic tool is to establish normal reference values for the physiological range in a healthy population. Surface electromyographic (sEMG) activity of the jaw muscles and mandibular kinematics were measured in young adults with theoretically ideal dental occlusion to determine normal reference values during different tasks. Differences between the sexes were evaluated.Material and MethodsForty young adults (20 men, 20 women; mean age 22.8 ± 3.9 years) with theoretically ideal dental occlusion were selected using very restrictive criteria. sEMG activity of the anterior temporalis (AT), posterior temporalis, masseter (MA), and suprahyoid muscles were evaluated in the rest position and during swallowing, mastication, and clenching. Mandibular kinematics in the rest position and during maximum excursions were assessed. Asymmetry, activity, and torque indices and MA/AT ratios were calculated.ResultsFor all muscles, sEMG values were 1.01-3.57 µV at rest, 3.50-10.85 µV during swallowing, and 41.04-86.59 µV during mastication. During clenching, values were 230.08-243.55 µV for the AT and MA muscles. Mean total asymmetry, activity, and torque indices at rest were 20.34 %, -15.04 %, and 19.02 %, respectively; during clenching, these values were 6.14 %, -2.62 %, and 4.46 %. MA/AT ratios were near 1. Kinematic measurements during lateral excursion, protrusive and maximum opening were 7.54, 8.44, and 37.38 mm respectively; lateral mandibular shift was 1.41 mm; free way and lateral displacement at rest were 1.40 and 0.26 mm. Right MA activity during mastication and clenching was higher in men than women.ConclusionsReference values for sEMG activity and mandibular kinematics were determined. Some muscular asymmetry and torque were observed. Key words:Electromyography, masticatory muscles, kinesiography, jaw movements, normal dental occlusion, sexual dimorphism.

Fragmentation of daily rhythms associates with obesity and cardiorespiratory fitness in adolescents: The HELENA study

Chronobiology studies periodic changes in living organisms and it has been proposed as a promising approach to investigate obesity. We analyze the association of the characteristics of the rest-activity rhythms with obesity, cardiorespiratory fitness and metabolic risk in adolescents from nine European countries. 1044 adolescents (12.5-17.5y) were studied. Circadian health was evaluated by actigraphy with accelerometers (Actigraph GT1M). Characteristics of the daytime activity such as fragmentation (intradaily variability), estimated acrophase, and 10h mean daytime activity index were obtained. Body composition was assessed using Bioelectrical-Impedance-Analysis, skinfold thickness, air-displacement-plethysmography and Dual-energy-X-ray-Absorptiometry. Cardiorespiratory fitness (VO2max) and metabolic risk were studied. Highly fragmented activity rhythms were associated with obesity and central adiposity (P<0.05). Obese adolescents had ∼3 times higher odds of having a high fragmentation of daytime activity compared to normal weight adolescents OR (95% CI)=2.8 (1.170, 6.443). A highly fragmented rhythm was also related to lower cardiorespiratory fitness and higher metabolic risk (P<0.05) so those adolescents classified as low fitness showed a significantly higher fragmentation of daytime activity than those included in the high fitness group (P<0.0001). Other characteristics of the rhythms such as smaller 10h daytime mean activity index and delayed estimated acrophase were also related to obesity and metabolic risk (P<0.05). Our results indicate that the daily organization of the rest-activity cycle is more fragmented in obese and less fit adolescents and correlates with higher metabolic risk. This fact reinforces our hypothesis that disturbances in daily rhythms can be considered as sensitive markers of poorer adolescent's health.

Actigraphic Sleep Pattern of Preschoolers With ADHD

Objective: To assess the features of sleep in preschoolers with ADHD by means of questionnaire and actigraphy. Method: Twenty-five ADHD and 21 age-matched typically developing (TD) preschool children underwent the Child Behavior Checklist (CBCL) for ages 1½ to 5 and Pre-School-Age Psychiatric Assessment interview. Sleep was assessed by means of a modified Sleep Disturbance Scale for Children and wrist actigraphy for at least 5 days. Results: Children with ADHD, compared with TD, showed higher scores in CBCL Withdrawal (58.83 vs. 51.15, p < .0001), Attention Problems (69.88 vs. 51.54, p < .0001), and Aggressive Behavior (59.46 vs. 51.08, p < .0001) dimensions; they also showed increased actigraphic nocturnal activity (activity index 31.57 vs. 25.74, p < .05); and night-to-night variability for sleep minutes (56.44 vs. 32.79, p < .01), mean wake episodes (1.34 vs. 0.98, p < .05), mean activity (2.64 vs. 1.71, p < .05), and activity index (5.15 vs. 3.77, p < .05). Conclusion: This pilot study in preschoolers with ADHD showed increased motor activity during sleep and night-to-night variability for sleep duration and motor activity.

FRI0403 Mesangial Proliferative Lupus Nephritis (ISN/RPS CLASS II): Clinical and Prognosis in A Cohort of 45 Patients

BackgroundMesangial proliferative lupus nephritis (MPLN) or class II has traditionally been considered a mild form of nephritis, with good response to corticosteroid treatment. However, recently some studies have been published...

Tubulo-reticular inclusions in lupus nephritis: are they relevant?

Tubulo-reticular inclusions (TRIs) are organized subcellular structures that may be found in endothelial cells of patients with systemic lupus erythematosus (SLE). This study was conducted to determine the presence or absence of TRIs and their correlation with the activity index (AI) and lupus nephritis (LN) class. A retrospective analysis of 57 cases of LN over a three-year period (2008-2011) was performed from medical records of the King Khalid University Hospital (KKUH), Riyadh. After reviewing and sorting them by class as per the International Society of Nephrology (ISN/RPS) 2004 classification of LN, the cases were divided according to the presence or absence of TRIs. The relationships between the presence or absence of TRIs and the AI were determined. Of the 57 kidney biopsies reviewed, 49 were proliferative cases (Class III and IV), of which 12 (24.5%) had TRIs. The mean AI was 6.01 ± 3.8 and the mean chronic index was 3.0 ± 1.5. Four (11.4%) class IV cases had a high AI, while no Class III cases with TRIs showed increased activity. The presence of TRIs was significantly associated with the AI (r = 9.40, P = 0.002), but not with LN class (r = 0.099, P = 0.753). Examining for TRIs in LN is still favorable and helpful in cases where the diagnosis of SLE is pending or not yet established, although the presence of TRIs is not a specific finding.

Sleep Posture Affects Sleep Parameters Differently in Young and Senior Japanese as Assessed by Actigraphy

In an attempt to study the relationship between sleep postures and sleep parameters assessed by actigraphy, we applied the newly developed Activity Monitoring and Evaluation System (A-MES) and actigraphy at the same time to younger and senior Japanese volunteer groups. It was found that sleep postures and diurnal activity determines, to some extent, sleep parameters including activity mean score (AMS), activity index (ACTX), waking episodes (WEP) and sleep fragmentation index (SFX). It was also found that sleep properties are different in younger and senior Japanese. For example, increase in the proportion of time in the supine position resulted in enhancement and deterioration of the sleep in the younger and senior groups, respectively. Furthermore, there were correlations between supine posture and AMS, ACTX, SFX, total minutes scored as awake (TMSA) and WEP obtained by actigraphy in the younger group, but only AMS and ACTX in senior group. In addition, we also assessed sleep parameters by use of questionnaires, and found that objective sleep quality was rather poor but subjective sleep quality was better in the senior group. In the younger group, in contrast, objective sleep quality was better but subjective sleep quality was poor. On the other hand, there was no correlation between sleep parameters assessed by actigraphy and self-report at all. The present study with A-MES and actigraphy provides the first evidence that sleep posture affects sleep quality and is a convenient, inexpensive and home-based method for studying sleep.

Long-term Clinical Experience with Vedolizumab in Patients with Inflammatory Bowel Disease

Vedolizumab, a gut-selective, anti-inflammatory monoclonal antibody, has shown preliminary efficacy in ulcerative colitis (UC) and Crohn's disease (CD). We report long-term experience with vedolizumab for active UC and CD. After a placebo-controlled study, 38 patients with UC were randomized to a loading regimen of vedolizumab 2, 6, or 10 mg/kg on days 1, 15, and 43, followed by maintenance dosing every 8 weeks. Thirty-four vedolizumab-naive patients (15 UC; 19 CD) were randomized to vedolizumab 2, 6, or 10 mg/kg on the same schedule. Rollover patients were treated up to 630 days and treatment-naive patients were treated up to 547 days. Seventy-two patients were dosed; 52 (72%) completed the study. In exploratory analyses, 28 of 72 (39%; UC: 21 of 53, CD: 7 of 19) achieved clinical response and 42 of 72 (58.3%; UC: 38 of 53, CD: 4 of 19) achieved clinical remission. Mean partial Mayo scores declined from baseline through day 155 in both treatment-naive patients with UC (5.4 to 1.7, respectively) and rollover patients with UC (2.3 to 1.4, respectively), leveling off thereafter. Mean Crohn's Disease Activity Index scores decreased from 295 (baseline) to 238 at day 43, continued to trend downward through day 155, and remained below baseline through day 491. Mean Inflammatory Bowel Disease Questionnaire scores increased in all treatment groups. No deaths or systemic opportunistic infections were reported. Vedolizumab every 8 weeks for up to 78 weeks had an adverse event profile similar to that previously observed. Mean disease activity indices (partial Mayo score and Crohn's Disease Activity Index score) improved with all 3 doses investigated.

Labelling the Behaviour of Piglets and Activity Monitoring from Video as a Tool of Assessing Interest in Different Environmental Enrichments / Oznaczanie zachowania i monitorowanie aktywności prosiąt na podstawie zapisu wideo jako narzędzie oceny ich zainteresowania różnymi elementami wzbogacającymi środowisko

Abstract The aim of this study was to explore the preference and the duration of interest of weaned pigs to two different types of environmental enrichments using labelling techniques and activity monitoring. Two pens each housing 14 Dalland piglets were monitored using a video camera. The videos were labelled during the weaning phase from 30 to 60 days of age. During this time, the video recording software continuously calculated the activity index of the pigs. To detect pig exploratory and playing behaviour, a wooden block and chain enrichment were introduced into each pen for 30 days. Each video frame was manually labelled during the Day 1, 5 and 30 (24 hours a day) for each pen using the Labelling Tool software. To identify the duration and frequency of interactive episodes with environmental enrichments, pig behaviour was labelled as either: no activity, interacting with chain or interacting with the wooden block. The mean duration of interactive episodes for the chain was greater than for the wooden block (P&lt;0.001), while the frequency of interactive episodes was 28.8% higher for the wooden block than for the chain. By day 5, the mean duration of interaction episodes decreased in both pens and by day 30, only a few interaction episodes were observed. The number of interactive episodes were strictly related to the activity index and depended on the time of the day. The peaks of the mean number of interactive episodes calculated for all days of observations corresponded to the peaks of the mean activity index.

THU0323 Subsettting Proliferative Lupus Nephritis According to the ISN/RPS Classification Does not Provide Valuable Prognostic Information

ObjectivesTo evaluate, including through repeated renal biopsy, whether the different ISN/RPS classes of proliferative lupus nephritis (LN) have similar short- and long-term responses to immunosuppression and have distinct long-term prognosis.MethodsNinety-eight...

Analysis of clinicopathologic correlations in Iranian patients with lupus nephritis

To determine clinical features of different histopathological presentations in patients with lupus nephritis (LN). Clinical and pathological features of 71 biopsy-proven LN patients were analyzed in a cross-sectional study during 2005-2011. Sixty-five women (91.5%) and six men (8.5%) were studied. The mean Activity Index (AI) and Chronicity Index (CI) were 6.2 ± 3.1 and 1.7 ± 1.5, respectively. The most common histopathologic presentation of kidneys was class IV (52.1%). Patients with more advanced International Society of Nephrology and the Renal Pathology Society (ISN/RPS) classes, had longer disease duration (P = 0.007), higher levels of blood urea nitrogen (P = 0.004) and serum creatinine (P = 0.035). The most frequent active lesion seen in renal biopsies was endocapillary hypercellularity (83.1%) while glomerular sclerosis was the most common chronic lesion (52.1%). Patients with chronic lesions, including glomerular sclerosis (P = 0.032), fibrous crescent (P = 0.001), interstitial fibrosis (P = 0.025) and tubular atrophy (P = 0.049) had higher serum creatinine levels. Hypertension was mainly seen in patients who had interstitial fibrosis and tubular atrophy (P = 0.026, 0.002 respectively). Moreover, subjects with renal failure had been more frequently involved with fibrinoid necrosis/karyorrhexis (P = 0.003), interstitial inflammation (P = 0.009), fibrous crescents (P = 0.041), tubular atrophy (P = 0.008) and interstitial fibrosis (P < 0.001). We found that both histopathologic classification (ISN/RPS criteria) and histopathologic grading (US National Institutes of Health activity and chronicity indices) correlate to some clinical manifestations of LN. Considering these correlations may help to determine the patients' clinicopathologic status, prognosis and the need to immediate treatment. Nevertheless, it is necessary to clarify the accuracy of these findings in larger-scale prospective studies.