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Objective To evaluate the risk of end-stage kidney disease (ESKD) in LN patients using tubulointerstitial lesion scores. Methods Clinical profiles and histopathological presentations of 151 biopsy-proven LN patients were retrospectively examined. Risk factors of ESKD based on characteristics and scoring of their tubulointerstitial lesions [e.g. interstitial inflammation (II), tubular atrophy (TA) and interstitial fibrosis (IF)] were analysed. Results The mean age of 151 LN patients was 36 years old, and 136 (90.1%) were female. The LN cases examined included: class I/II (n  = 3, 2%), class III/IV (n  = 119, 78.8%), class V (n  = 23, 15.2%) and class VI (n  = 6, 4.0%). The mean serum creatinine level was 1.4 mg/dl. Tubulointerstitial lesions were recorded in 120 (79.5%) patients. Prior to receiving renal biopsy, nine (6.0%) patients developed ESKD. During the follow-up period (mean, 58 months), an additional 47 patients (31.1%) progressed to ESKD. Multivariate analyses identified serum creatinine [hazard ratio (HR): 1.7, 95% CI: 1.42–2.03, P   <  0.001] and IF (HR: 3.2, 95% CI: 1.58–6.49, P   =  0.001) as independent risk factors of ESKD. Kaplan–Meier analysis further confirmed a heightened risk of ESKD associated with IF. Conclusion Tubulointerstitial involvement is commonly observed in the histopathological presentation of LN. However, IF, rather than II or TA, was found to increase the risk of ESKD in our cohort. Therefore, to predict renal outcome in LN patients prior to adjusting immunosuppressive treatment, the degree of IF should be reviewed. [ABSTRACT FROM AUTHOR]

Background. Aged people are considered prone to gram-negative bacteremia and septic shock. This relationship was tested in murine endotoxin shock. Methods. Balb/c mice of various ages (1.4-13.4 months) were intraperitoneally injected with lipopolysaccharide (LPS), and rates of survival were observed. The production of TNF-[Alpha] in vivo induced by LPS was measured. Results. The survival rates were the smallest in the oldest and youngest groups. Production of TNF-[Alpha] attained a maximum at 2 h after LPS injection and was smaller in the oldest group; it had a reciprocal relationship to survival rates in each group except the youngest group. Conclusion. Old and young mice had smaller rates of survival and greater production of TNF-[Alpha] following endotoxin shock induced by LPS.

Background: Immunosuppressants can induce hepatitis B virus (HBV) reactivation; however, informative data about the risk of different immunosuppressive regimens, including biologics, on HBV reactivation (HBVr) among patients with rheumatoid arthritis (RA) are incomplete.Methods: Among 2334 RA patients who had available hepatitis B surface antigen (HBsAg) data, 123 patients positive for HBsAg who were not receiving anti-HBV prophylaxis were enrolled. These patients were undergoing varied mono or combination immunosuppressive therapy, including 36 who were receiving biological disease-modifying antirheumatic drugs (bDMARDs).Results: During 3459 person-months of follow-up, 30 (24.4%) patients developed HBVr. The multivariate Cox proportional hazard models showed that glucocorticoid significantly increased the risk of HBVr. Among all kinds of immunosuppressive treatments, glucocorticoid in combination with bDMARDs and synthetic disease-modifying antirheumatic drugs (sDMARDs) had the highest risk of HBVr (adjusted hazard ratio [HR] = 5.14; 95% confidence interval [CI] = 1.77-14.92; P = .003). Rituximab had the greatest risk for HBVr (adjusted HR = 16.51; 95% CI = 1.82-149.67; P = .01) among the patients who received bDMARDs.Conclusions: Glucocorticoid has a detrimental effect on HBVr in RA patients. Antiviral prophylactic strategies should be justified according to the risk of HBVr under different combinations of immunosuppressive therapy in rheumatic patients. [ABSTRACT FROM AUTHOR]

Background: This study sought to assess the risk factors of herpes zoster (HZ) in rheumatoid arthritis (RA) patients treated with tofacitinib (TOFA)., Methods: This retrospective study reviewed RA patients receiving TOFA. We compared clinical characteristics, laboratory profiles, concomitant medication use, and HZ incidence in patients with and without recent biologic synthetic disease-modifying antirheumatic drugs (bDMARDs) treatment, which is defined as their administration ≤180 days before the initiation of TOFA treatment. We used univariate Cox proportional hazards models and Kaplan-Meier analysis to assess risk factors., Results: Among 304 RA patients, 97 had recent bDMARDs use and 207 did not. Patients with recent bDMARDs use typically had lower weekly doses of methotrexate, less hydroxychloroquine use, and shorter follow-up. In the recent bDMARDs group, 64 (66.0%) used tumor necrosis factor inhibitors (TNFi), 19 (19.6%) used tocilizumab, and 14 (14.4%) used abatacept. The overall incidence rate (IR) of HZ was 5.62 per 100 person-years. Patients with recent bDMARDs use exhibited a higher HZ risk compared to those without recent bDMARDs use (IR ratio: 2.34, 95% CI, 1.04-5.19, p = 0.028). Recent bDMARDs use (hazard ratio: 2.4, 95% CI, 1.12-4.95, p = 0.024) was an independent risk factor for HZ among multivariable analysis. Kaplan-Meier analysis confirmed increased HZ risk in RA patients on TOFA with recent bDMARDs use (log-rank p = 0.015)., Conclusion: HZ is common in RA patients treated with TOFA, and recent bDMARDs (TNFi, tocilizumab, and abatacept) use is a risk factor for HZ. HZ vaccination, therefore, should be recommended for this group., Competing Interests: Conflicts of interest: Dr. Chih-Yu Yang, an editorial board member at Journal of the Chinese Medical Association , had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2024, the Chinese Medical Association.)

Objective: To evaluate the role of cytomegaloviral or Pneumocystis jiroveci pneumonia (CMV/PJP) in systemic lupus erythematosus (SLE) patients with pulmonary hemorrhage (PH)., Methods: We retrospectively examined hospital records for 27 SLE patients with PH who received bronchoalveolar lavage fluid (BALF) analyses. Clinical profile and mortality rates were compared between groups with and without CMV/PJP. Risk factors for PH-related mortality were analyzed., Results: Among 27 SLE patients with PH, 15 had pathogens from BALF samples, and 8 had CMV/PJP. Although CMV/PJP was treated, the RR for 90- and 180-day mortality rates of SLE patients with CMV/PJP were higher than those without these infections (5.94, 95% CI 1.44-24.48; 7.13, 95% CI 1.81-28.06, respectively). Risk factors for 90- and 180-day mortality were presence of CMV/PJP (OR 14.2, 95% CI 1.83-109.9; OR 25.5, 95% CI 2.91-223.3, respectively) and use of pulse methylprednisolone for PH treatment (OR 12.0, 95% CI 1.48-97.2; OR 8.5, 95% CI 1.13-63.9, respectively). Factors increasing the 90-day mortality rate were duration of mechanical ventilation exceeding 14 days (OR 11.1, 95% CI 1.11-112.0) and use of aggressive immunosuppression close to PH onset (OR 7.56, 95% CI 1.09-52.4). Three of the 7 patients receiving aggressive immunosuppression died with the presence of CMV/PJP., Conclusion: Owing to the high prevalence of CMV/PJP and its association with mortality, routine BALF analysis is recommended for all suitable SLE patients with PH. Use of aggressive immunosuppression does not benefit SLE patients with opportunistic infections during PH attack.

Background: Sleep disturbances and hypertension are common health issues in patients with systemic lupus erythematosus (SLE). Limited information is available regarding the objective sleep quality and the variation of diurnal blood pressure (BP) in patients with SLE. Moreover, the relationship between sleep patterns and diurnal BP variation in SLE patients is not clear., Purpose: To explore the subjective/objective sleep patterns and the diurnal BP variation in women with SLE, to identify the factors associated with diurnal BP variation, and to identify the predictors of this variation., Methods: A cross-sectional, descriptive, correlational study was conducted and 42 women with SLE were recruited. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, and Brief Pain Inventory. Rheumatologists rated current lupus disease activity. Additionally, the participants wore a wrist actigraph for 7 consecutive days and underwent 24h ambulatory BP monitoring for one day., Results: The mean Global PSQI score was 7.74 ± 3.21; 69% of the participants reported poor subjective sleep quality; the actigraphy-measured sleep efficiency was 85.29 ± 5.95%; and 42.9% had poor objective sleep quality. Total sleep time at night was positively associated with diurnal change in diastolic BP (r = .315. p < .05) and pain severity was negatively associated with diurnal change in systolic BP (r = -.430, p < .01) and diastolic BP (r = -.371, p < .05). Multiple linear regression analysis was used to predict diurnal BP variation. Moreover, pain was a significant predictor of diurnal change in systolic BP (β = -0.397, p < .01) and diurnal change in diastolic BP (β = -0.325, p < .05)., Conclusions / Implications for Practice: The findings of the present study suggest that healthcare professionals should routinely evaluate sleep quality and pain in SLE patients. Improving both the poor sleep and pain management of these patients is clinically important. Further studies of the association between pain management and diurnal BP variation are needed.

The activity of ammonia-oxidizing bacteria (AOB) in different layers of Integrated vertical-flow constructed wetlands (IVCW) treating eutrophic scenic water was measured, and the diversity and spatial distribution of AOB community structure in IVCW was investigated using PCR-DGGE. The results indicated that because of the integrated influence of competition of plant rhizodeposition, heterotrophic bacteria, DO and ammonia concentration, there were significant spatial differences in the activity and diversity of AOB along the flow direction of wetland. The activity of AOB was 0.79 mg x (kg x h)(-1) (in NO3- -N, the same below) near the surface of down-flow system in IVCW. From the surface of down-flow system to up-flow system, the activity of AOB decreased gradually, and slightly increased to 0.17 mg x (kg x h)(-1) near the surface of up-flow system. The spatial variation of diversity of AOB showed the similar change trend with the activity in IVCW and the diversity index in down-flow system (1.92) were higher than those in up-flow system (1.65). Most of AOB belong to oligotrophic bacterium in IVCW, and the population of ammonia-oxidizing bacteria showed a higher percentage of Nitrosomonas-like sequences from the wetland samples. Uncultured beta proteobacterium, Comamonas sp., Nitrosomonas oligotropha were also detected. The variation of the AOB community demonstrated spatial pattern in IVCW, which might be related to different wetland environment.