Search

Quality of care is receiving increased attention in systemic lupus erythematosus (SLE). We developed quality indicators (QIs) for SLE based on the 2019 update of European League Against Rheumatism recommendations. A total of 44 candidate QIs corresponding to diagnosis, monitoring and treatment, were independently rated for validity and feasibility by 12 experts and analysed by a modified Research and Development Corporation/University of California Los Angeles model. Adherence to the final set of QIs and correlation with disease outcomes (flares, hospitalisations and organ damage) was tested in a cohort of 220 SLE patients with a median monitoring of 2 years (IQR 2–4). The panel selected a total of 18 QIs as valid and feasible. On average, SLE patients received 54% (95% CI 52.3% to 56.2%) of recommended care, with adherence ranging from 44.7% (95% CI 40.8% to 48.6%) for diagnosis-related QIs to 84.3% (95% CI 80.6% to 87.5%) for treatment-related QIs. Sustained remission or low disease activity were achieved in 26.8% (95% CI 21.1% to 33.2%). Tapering of prednisone dose to less than 7.5 mg/day was achieved in 93.6% (95% CI 88.2% to 97.0%) while 73.5% (95% CI 66.6% to 79.6%) received the recommended hydroxychloroquine dose. Higher adherence to monitoring-related QIs was associated with reduced risk for a composite adverse outcome (flare, hospitalisation or damage accrual) during the last year of observation (OR 0.97 per 1% adherence rate, 95% CI 0.96 to 0.99). We developed QIs for assessing and improving the care of SLE patients. Initial real-life data suggest face validity, but a variable degree of adherence and a need for further improvement. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Systemic Lupus Erythematosus (SLE) is associated with increased risk for accelerated atherosclerosis and cardiovascular (CV) events including coronary heart disease, cerebrovascular and peripheral artery disease. CV events occur both early and late during the disease course, with younger patients being at much higher risk than age-matched counterparts. The risk cannot be fully accounted for by the increased prevalence of traditional atherosclerotic factors and may be due to pathophysiologic intermediates such as type I interferons and other inflammatory cytokines, oxidative stress, activated granulocytes and production of extracellular chromatin traps, antiphospholipid and other autoantibodies causing dysfunction of lipoproteins, altogether resulting in endothelial injury and pro-atherogenic dyslipidaemia. These mechanisms may be further aggravated by chronic intake of prednisone (even at doses

Objective To update the 2012 EULAR/ERA-EDTA recommendations for the management of lupus nephritis (LN). Methods Following the EULAR standardised operating procedures, a systematic literature review was performed. Members of a multidisciplinary Task Force voted independently on their level of agreeement with the formed statements. Results The changes include recommendations for treatment targets, use of glucocorticoids and calcineurin inhibitors (CNIs) and management of end-stage kidney disease (ESKD). The target of therapy is complete response (proteinuria 1 g/24 hours despite renin-Angiotensin-Aldosterone blockade, MMF in combination with glucocorticoids is preferred. Assessment for kidney and extra-renal disease activity, and management of comorbidities is lifelong with repeat kidney biopsy in cases of incomplete response or nephritic flares. In ESKD, transplantation is the preferred kidney replacement option with immunosuppression guided by transplant protocols and/or extra-renal manifestations. Treatment of LN in children follows the same principles as adult disease. Conclusions We have updated the EULAR recommendations for the management of LN to facilitate homogenization of patient care. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Purpose of Review: Update on the diagnosis, treatment, and monitoring of lupus nephritis. Recent Findings: The recent criteria enable the earlier classification of lupus nephritis based on kidney biopsy and compatible serology. Treatment of active nephritis includes low-dose intravenous cyclophosphamide or mycophenolate, followed by maintenance immunosuppression. Recent trials have suggested superiority of regimens combining mycophenolate with either calcineurin inhibitor or belimumab, although their long-term benefit/risk ratio has not been determined. Encouraging results with novel anti-CD20 antibodies confirm the effectiveness of B cell depletion. Achievement of low-grade proteinuria (< 700–800 mg/24 h) at 12-month post-induction is linked to favorable long-term outcomes and could be considered in a treat-to-target strategy. Also, repeat kidney biopsy can guide the duration of maintenance immunosuppression. Lupus nephritis has increased cardiovascular disease burden necessitating risk-reduction strategies. Summary: An expanding spectrum of therapies coupled with ongoing basic/translational research can lead to individualized medical care and improved outcomes in lupus nephritis. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

Objectives To analyse the current evidence for the management of lupus nephritis (LN) informing the 2019 update of the EULAR/European Renal Association-European Dialysis and Transplant Association recommendations. Methods According to the EULAR standardised operating procedures, a PubMed systematic literature review was performed, from January 1, 2012 to December 31, 2018. Since this was an update of the 2012 recommendations, the final level of evidence (LoE) and grading of recommendations considered the total body of evidence, including literature prior to 2012. Results We identified 387 relevant articles. High-quality randomised evidence supports the use of immunosuppressive treatment for class III and class IV LN (LoE 1a), and moderate-level evidence supports the use of immunosuppressive treatment for pure class V LN with nephrotic-range proteinuria (LoE 2b). Treatment should aim for at least 25% reduction in proteinuria at 3 months, 50% at 6 months and complete renal response (

Objective: This study aimed to analyse the phenotype of systemic lupus erythematosus (SLE) at first presentation and during follow-up in a newly established SLE cohort based at ‘Attikon’ University Hospital. The hospital combines primary, secondary and tertiary care for the region of Western Attica, Greece. Methods: This study comprised a mixed prevalent and incident cohort of 555 Caucasian patients diagnosed with SLE according to American College of Rheumatology 1997 criteria and/or the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) 2012 criteria. Demographic and clinical characteristics, patterns of severity, treatments and SLICC damage index were recorded for each patient at the time of diagnosis and at last evaluation. Results: The mean age at lupus diagnosis was 38.3 years (standard deviation = 15.6 years), with a median disease duration at last follow-up of two years (interquartile range 1-11). At initial presentation, the most common ‘classification’ manifestations were arthritis (73.3%), acute cutaneous lupus (65%) and unexplained fever (25%), while among symptoms not included in any criteria set, Raynaud’s phenomenon (33%) was the most common. Kidney and neuropsychiatric involvement as presenting manifestations were present in 10.3% and 11.5% cases, respectively. Irreversible damage accrual was present in 17.8% within six months of disease diagnosis, attributed mainly to thrombotic and neuropsychiatric disease. At last evaluation, 202 (36.4%) patients had developed severe disease, of whom more than half were treated with pulse cyclophosphamide. Conclusion: In this cohort of Caucasian patients, lupus nephritis is not as common as in older cohorts, while neuropsychiatric disease is emerging as a major frontier in lupus prevention and care. These data may help to document changes in the natural history and treatment of SLE over time and may have implications for its early recognition and management. © The Author(s) 2020.

Background: The goal of this systematic review is to synthesize the published meta-analyses assessing the role of nutritional, behavioral and physical activity factors/interventions on the prevention or treatment of pediatric and adolescent obesity. Methods: An online search was conducted in PubMed (end-of-search: September 30, 2015); English-language meta-analyses pooling observational and/or interventional studies examining weight-related indices on children and adolescents were included. Results: Sixty-six meta-analyses corresponding to more than 900,000 children and adolescents were retrieved. The majority of meta-analyses included interventional studies most of which referred to mixed or combined interventions, including components such as diet, physical activity and sedentary behavior reduction. Discrepancies between meta-analyses on observational and interventional studies were noted. Combined interventions including physical activity and nutritional modifications seemed to represent the most effective means for tackling childhood obesity. Conclusions: Synthesis of interventional or observational evidence may yield discrepant results. The combination of enhanced physical activity and improved nutrition emerged as a promising intervention in the fight against childhood/adolescent obesity. However, further research is needed about the most effective multidimensional prevention strategy. © 2019, Children's Hospital, Zhejiang University School of Medicine.

Our objective was to update the EULAR recommendations for the management of systemic lupus erythematosus (SLE), based on emerging new evidence. We performed a systematic literature review (01/2007-12/2017), followed by modified Delphi method, to form questions, elicit expert opinions and reach consensus. Treatment in SLE aims at remission or low disease activity and prevention of flares. Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight. During chronic maintenance treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn. Appropriate initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can expedite the tapering/discontinuation of GC. In persistently active or flaring extrarenal disease, add-on belimumab should be considered; rituximab (RTX) may be considered in organ-threatening, refractory disease. Updated specific recommendations are also provided for cutaneous, neuropsychiatric, haematological and renal disease. Patients with SLE should be assessed for their antiphospholipid antibody status, infectious and cardiovascular diseases risk profile and preventative strategies be tailored accordingly. The updated recommendations provide physicians and patients with updated consensus guidance on the management of SLE, combining evidence-base and expert-opinion. © 2019 Author(s).

Marine sediment contamination was evaluated in a set of sediment specimens collected from Izmir Bay (Turkey) and from Mytilene Harbor (Greece) in the Aegean Sea. Eight sediment specimens from Izmir (#IZ to #IZ8) and seven sediment specimens from Mytilene (#MYT1 to #MYT7) were analyzed for their content in different classes of contaminants, i.e. inorganics, organic carbon (OC), and seven polycyclic aromatic hydrocarbons (PAHs). Significantly higher levels of inorganic contaminants were detected in Izmir vs. Mytilene sediment, and the highest inorganic contamination was detected in the innermost sampling sites in Izmir Bay, namely sites #IZ1 to #IZ4. This was the case for Al, As, Cr, Cu, Fe, Li, Mn, Pb, Ti and Zn. Granulometric analysis, OC and individual PAH congeners failed to show any significant differences between total Mytilene and total Izmir Bay sediment samples. Nevertheless, the sum of PAHs in sites #IZ2 to #IZ4 displayed significantly higher levels both vs. the other Izmir sites and vs. all Mytilene sediment samples. The overall results point to higher pollution status in Izmir Bay, especially in the innermost sampling sites, compared to Mytilene harbor, detected as inorganic contamination and as PAH contamination in some Izmir sampling sites.

The aim of the present study was to evaluate marine contamination and toxicity in sediment and pore water from the areas of Izmir Bay (Turkey) and Mytilene Harbor (Greece). The evaluation was performed in terms of selected toxic metals, polycyclic aromatic compounds (PAH) and toxicity to sea urchin (Paracentrotus lividus) early development and fertilization. Significantly higher levels of metals and total PAH were detected in Izmir vs. Mytilene sediment, and the highest contamination was detected in Izmir Bay innermost sites. Bioassays were carried out in P. lividus embryos and sperm, by evaluating developmental defects and changes in fertilization success by exposing sea urchin embryos or sperm to sediment/seawater suspensions. Whole sediment (WS) showed a higher toxicity of Izmir vs. Mytilene samples both in terms of developmental defects and of spermiotoxicity. Pore water (PW) and solid phase (SP) were separated by WS centrifugation and tested on embryos or sperm. The induction of developmental defects showed a significantly higher toxicity of WS compared to SP and, even more so, to PW. A significant decrease in fertilization success was observed following sperm suspension in SP from both Izmir and Mytilene sediment samples, whereas PW-exposed sperm failed to display any decrease of fertilization success vs. controls. The use of WS bioassays is suggested as a default procedure in sediment toxicity testing, especially in a topographic characterization of polluted sediments.

'Thought-shape fusion' (TSF) is a cognitive distortion specific in patients with eating disorders and occurs when the thought about eating a forbidden food increases a person's estimate of her weight/shape, elicits a perception of moral wrongdoing and makes her feel fat. This study aimed to experimentally induce, study and compare TSF between patients with bulimia nervosa (BN) and patients with anorexia nervosa (AN). 31 patients diagnosed with a current eating disorder, of which 20 met DSM-IV-TR criteria for BN and 11 for AN, participated in a mixed-model experimental design with the aim of eliciting TSF and investigating the effects of corrective behaviors (checking and mental neutralizing). Verbal analogue scales constituted the main outcome measures. TSF was experimentally induced and expressed in a similar way in both clinical groups, apart from 'feeling fat' which was higher in BN patients. TSF induction triggered heightened levels of anxiety, guilt and urges to engage in corrective behaviors in both groups. Body dissatisfaction only increased in the BN patients. Mental neutralizing and to a lesser extent checking reduced most effects of the experimental procedure, but this effect was larger for BN patients. The nature of TSF seems to have similarities between BN and AN patients; however, the precise connection between TSF and different types of eating disorders remains to be explored in future clinical trials. © 2013 Springer International Publishing Switzerland.

For the Mediterranean Sea, and indeed most of the world's oceans, the biodiversity and biogeography of eukaryotic pathogens infecting marine macroalgae remains poorly known, yet their ecological impact is probably significant. Based on 2 sampling campaigns on the Greek island of Lesvos in 2009 and 1 in northern Greece in 2012, this study provides first records of 3 intracellular eukaryotic pathogens infecting filamentous brown algae at these locations: Eurychasma dicksonii, Anisolpidium sphacellarum, and A. ectocarpii. Field and microscopic observations of the 3 pathogens are complemented by the first E. dicksonii large subunit ribosomal RNA (LSU rRNA) gene sequence analyses of isolates from Lesvos and other parts of the world. The latter highlights the monophyly of E. dicksonii worldwide and confirms the basal position of this pathogen within the oomycete lineage (Peronosporomycotina). The results of this study strongly support the notion that the geographic distribution of the relatively few eukaryotic seaweed pathogens is probably much larger than previously thought and that many of the world's marine bioregions remain seriously undersampled and understudied in this respect. © Inter-Research 2013.

The aim of the present study was to evaluate marine contamination and toxicity in sediment and pore water from the areas of Izmir Bay (Turkey) and Mytilene Harbor (Greece). The evaluation was performed in terms of selected toxic metals, polycyclic aromatic compounds (PAH) and toxicity to sea urchin (Paracentrotus lividus) early development and fertilization. Significantly higher levels of metals and total PAH were detected in Izmir vs. Mytilene sediment, and the highest contamination was detected in Izmir Bay innermost sites. Bioassays were carried out in P. lividus embryos and sperm, by evaluating developmental defects and changes in fertilization success by exposing sea urchin embryos or sperm to sediment/seawater suspensions. Whole sediment (WS) showed a higher toxicity of Izmir vs. Mytilene samples both in terms of developmental defects and of spermiotoxicity. Pore water (PW) and solid phase (SP) were separated by WS centrifugation and tested on embryos or sperm. The induction of developmental defects showed a significantly higher toxicity of WS compared to SP and, even more so, to PW. A significant decrease in fertilization success was observed following sperm suspension in SP from both Izmir and Mytilene sediment samples, whereas PW-exposed sperm failed to display any decrease of fertilization success vs. controls. The use of WS bioassays is suggested as a default procedure in sediment toxicity testing, especially in a topographic characterization of polluted sediments. © Published by Central Fisheries Research Institute (CFRI) Trabzon, Turkey.

The aim of the present study was to experimentally investigate a cognitive distortion, 'Thought Shape Fusion' (TSF), in patients with bulimia nervosa (BN). TSF has been postulated as a specific distortion in patients with eating disorders and occurs when the thought about eating a forbidden food increases a person's estimate of her weight / shape, elicits a perception of moral wrongdoing and makes her feel fat. Previous psychometric measures of TSF in clinical and control groups, experiments eliciting TSF in a student sample and in patients with anorexia nervosa, all confirm a strong association between TSF and eating disorder psychopathology. Twenty patients diagnosed with BN participated in a within-participants experimental design with the aim of eliciting TSF and investigating further the possible effects of corrective behaviours (checking and mental neutralizing). Verbal analogue scales constituted the main outcome measures. TSF triggered a perception of moral wrongdoing, heightened levels of body dissatisfaction, elevated feelings of anxiety and guilt and prompted urges to engage in checking and mental neutralizing. Corrective behaviours significantly reduced the effects of the experimental procedure. Components of TSF are present in BN and are likely to play a mediating role in the maintenance of the disorder. The precise connection between TSF and BN remains to be explored in future clinical trials. ©2011, Editrice Kurtis.

The pollution of the surface waters of Greece from the priority compounds of 76/464/EEC Directive was evaluated. The occurrence of 92 toxic compounds, 64 of which belong to priority compounds of List II, candidates for List I, of 76/464/EEC Directive, was studied in surface waters and wastewater through the developed network of 62 sampling stations, which covers the whole Greek territory. The analytical determination was performed by Purge and Trap-Gas chromatography-Mass spectrometry for volatile and semivolatile organic compounds (VOCs), Gas Chromatography-Electron Capture Detection for organochlorine insecticides, Gas Chromatography-Nitrogen Phosphorous Detection for organophosphorous insecticides, High Performance Liquid Chromatography-Photodiode Array Detection for herbicides, and Electrothermal Atomic Absorption Spectrophotometry and Inductively Coupled Plasma-Atomic Emission Spectrometry (ICP-AES) for metals and the toluene extractable organotin compounds. The concentrations of VOCs and insecticides detected in the surface waters of Greece were very low, whereas the concentrations of herbicides and metals ranged generally at moderate levels. VOCs were detected almost exclusively in the rivers and very rarely in the lakes, while the frequency of occurrence of insecticides, herbicides and metals was similar for rivers and lakes. Water quality objectives (WQO) and emission limit values (ELV) have been laid down in national legal framework for a number of compounds detected in the samples, in order to safeguard the quality of surface waters from any future deterioration. © 2004 Elsevier Ltd. All rights reserved.

International audience; Confrontés aux chocs énergétiques, la France, l'Italie, le Japon et l'Allemagne ont chacun adopté une politique différente : d'une part en se dotant plus ou moins d'une capacité d'auto-approvisionnement (ainsi la France avec son parc électronucléaire et l'Allemagne avec le charbon par opposition à l'Italie et au Japon) ; d'autre part en abaissant dans des proportions fort diverses le contenu énergétique du PIB (découplage énergie/croissance) et plus spécifiquement de l'industrie. Plus fondamentalement, les auteurs montrent que la France a traité le choc pétrolier frontalement (priorité à l'offre nationale, effort d'économie d'énergie), tandis que l'Allemagne a adopté une stratégie de contournement (accumulation d'excédents commerciaux contre-balançant la facture énergétique) et que l'Italie et le Japon ont adopté une stratégie de mouvement (indirectement par les restructurations industrielles, directement en jouant sur le taux de change). Les auteurs étudient les effets de ces différentes options mais surtout ils analysent - et là, d'une certaine manière, les chocs énergétiques ne sont qu'un prétexte - comment peuvent être expliquées ces différentes options ou, plus précisément, quels sont les critères qui ont présidé aux décisions. Leur conclusion est claire : "le futur est moins déterminé par des contraintes technico-économiques que par le jeu des acteurs et leur capacité à s'entendre sur des conventions communément acceptées pour résoudre une controverse et légitimer un projet". Mieux encore, disent-ils, "toute société réagit en fonction des codes qu'elle a appris pour recevoir un message (...) et ces coûts d'information constituent typiquement un investissement irréversible..."