Smoking increases the risk of multiple sclerosis in Queensland,Australia

There is growing evidence for the role of smoking in the aetiology of multiple sclerosis (MS). We have undertaken a large case-control study of smoking in MS and assessed this using a regression model. We have confirmed an association between increased risk of MS and smoking in Queensland, Australia, a region of intermediate risk for MS. The overall adjusted odds ratio was 1.9 (95% confidence interval 1.5–2.5) for ever smokers. There was no statistically significant difference in the risks for males and females. A number of potential mechanisms to explain this association have been postulated including direct and indirect (via vitamin D) effects on the immune system.     

山东省癫癎流行病学调查研究

目的 了解中国山东省的癫癎）病流行现况及其危险因素.方法 以调查问卷为基础,运用国际统一癫癎诊断标准,采用多级分层随机整群抽样方法,逐户进行调查.结果 调查人数251 492名,癫癎患者335例,癫（痫）患病率为1.33‰;男性患病率为1.35‰o,女性患病率为1.31‰;城市患病率为1.20‰,农村患病率为1.39‰,均差异无统计学意义.癫癎发病率为18.69/10万.发作类型以全面性发作为主为60.90％;部分性发作为34.33％;发作不能分类为4.78％.首次发病平均年龄为（15.37±15.77）岁.特发性癫癎为60.90％,症状性癫（痫）为39.10％.大部分患者未进行正规治疗,治疗缺口为54.33％.结论 山东省癫癎患病率、发病率处于全国较低水平,治疗缺口与国内文献报道一致.癫癎发作类型以全面性发作为主;癫癎发病以特发性癫（痫）为主,症状性癫癎病因中以脑炎为主.     

Mid-Adulthood Risk Factor Profiles for CKD

Early identification of CKD risk factors may allow risk factor modification and prevention of CKD progression. We investigated the hypothesis that risk factors are present ≥30 years before the diagnosis of CKD in a case-control study using data from the Framingham Offspring Study. Patients with incident CKD (eGFR≤60 ml/min per 1.73 m²) at examination cycles 6, 7, and 8 were age- and sex-matched 1:2 to patients without CKD at baseline (examination 5). CKD risk factors were measured at each examination cycle. Logistic regression models, adjusted for age, sex, and time period, were constructed to compare risk factor profiles at each time point between cases and controls. During follow-up, 441 new cases of CKD were identified and matched to 882 controls (mean age 69.2 years, 52.4% women). Those who ultimately developed CKD were more likely to have hypertension (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.23 to 2.51), obesity (OR, 1.71; 95% CI, 1.14 to 2.59), and higher triglyceride levels (OR, 1.43; 95% CI, 1.12 to 1.83) 30 years before CKD diagnosis, and were more likely to have hypertension (OR, 1.38; 95% CI, 1.07 to 1.79), higher triglyceride levels (OR, 1.35; 95% CI, 1.11 to 1.64), lower HDL_c (OR, 0.89; 95% CI, 0.81 to 0.97), and diabetes (OR, 2.90; 95% CI, 1.59 to 5.29) 20 years before CKD diagnosis. These findings demonstrate that risk factors for CKD are identifiable ≥30 years before diagnosis and suggest the importance of early risk factor identification in patients at risk for CKD.     

Lupus Nephritis Susceptibility Loci in Women with Systemic Lupus Erythematosus

Lupus nephritis is a manifestation of SLE resulting from glomerular immune complex deposition and inflammation. Lupus nephritis demonstrates familial aggregation and accounts for significant morbidity and mortality. We completed a meta-analysis of three genome-wide association studies of SLE to identify lupus nephritis–predisposing loci. Through genotyping and imputation, >1.6 million markers were assessed in 2000 unrelated women of European descent with SLE (588 patients with lupus nephritis and 1412 patients with lupus without nephritis). Tests of association were computed using logistic regression adjusting for population substructure. The strongest evidence for association was observed outside the MHC and included markers localized to 4q11-q13 (PDGFRA, GSX2; P=4.5×10⁻⁷), 16p12 (SLC5A11; P=5.1×10⁻⁷), 6p22 (ID4; P=7.4×10⁻⁷), and 8q24.12 (HAS2, SNTB1; P=1.1×10⁻⁶). Both HLA-DR2 and HLA-DR3, two well established lupus susceptibility loci, showed evidence of association with lupus nephritis (P=0.06 and P=3.7×10⁻⁵, respectively). Within the class I region, rs9263871 (C6orf15-HCG22) had the strongest evidence of association with lupus nephritis independent of HLA-DR2 and HLA-DR3 (P=8.5×10⁻⁶). Consistent with a functional role in lupus nephritis, intra-renal mRNA levels of PDGFRA and associated pathway members showed significant enrichment in patients with lupus nephritis (n=32) compared with controls (n=15). Results from this large-scale genome-wide investigation of lupus nephritis provide evidence of multiple biologically relevant lupus nephritis susceptibility loci.     

Soluble TNF Receptors and Kidney Dysfunction in the Elderly

The importance of TNF-α and its soluble receptors (sTNFR1 and sTNFR2) in the development of kidney disease is being unraveled. Yet, community-based data regarding the role of sTNFRs are lacking. We assessed serum sTNFRs and aspects of kidney damage cross-sectionally in two independent community-based cohorts of elderly participants: Prospective Investigation of the Vasculature in Uppsala Seniors (n=815; mean age, 75 years; 51% women) and Uppsala Longitudinal Study of Adult Men (n=778; mean age, 78 years). Serum sTNFR1 correlated substantially with different aspects of kidney pathology in the Uppsala Longitudinal Study of Adult Men cohort (R=−0.52 for estimated GFR, R=0.22 for urinary albumin-to-creatinine ratio, and R=0.17 for urinary kidney injury molecule-1; P<0.001 for all), with similar correlations in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort. These associations remained significant after adjustment for age, sex, inflammatory markers, and cardiovascular risk factors and were also evident in participants without diabetes. Serum sTNFR2 was associated with all three markers in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort (P<0.001 for all). Our findings from two independent community-based cohorts confirm and extend results of previous studies supporting circulating sTNFRs as relevant biomarkers for kidney damage and dysfunction in elderly individuals, even in the absence of diabetes.