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1.
Umut Kalyoncu Yahya Buyukasık Ali Akdogan Omer Karadag Sule A. Bilgen Sedat Kiraz Ihsan Ertenli Meral Calguneri 《Joint, bone, spine : revue du rhumatisme》2010,77(2):131-134
BackgroundAdult-onset Still's disease (AOSD) can be complicated by reactive macrophage activation syndrome (rMAS). The objective of this study was to evaluate vitamin B12 values in AOSD with and without rMAS.MethodsAll patients’ files with AOSD in one center were retrospectively reviewed. Hemophagocytosis was defined as phagocytosis of various hematopoietic cells by macrophages. Clinical data including fever, rash, sore throat, arthritis, lymphadenopathy were recorded. Laboratory tests included complete blood count, serum ferritin, transaminases, serum triglyceride and vitamin B12 level. The control group was selected from our AOSD pool who had AOSD without rMAS.ResultsSeven patients (5 female) had AOSD with rMAS. Median age at the diagnosis of rMAS was 32 (range, 27–37) and median follow-up duration after rMAS diagnosis was 18 months (range, 2–60). All of the patients with rMAS had fever, sore throat, rash, arthritis, anemia and hyperferritenemia. Five of seven patients had hepatosplenomegaly and lymphadenopathy. Four of seven patients had normal or low leucocyte count, three of seven patients had increased triglyceride level. The patients with AOSD and rMAS mean ± standard deviation (S.D.) vitamin B12 levels were significantly higher than without rMAS (1903 ± 960 vs 542 ± 328 pg/ml, p = 0.001). The specificity (75%) of increased vitamin B12 level was high and sensitivity (100%) was excellent.ConclusionElevated vitamin B12 levels seems to be a good marker for diagnostic marker in AOSD when complicated with rMAS. 相似文献
2.
Manuel Rojas Yhojan Rodriguez Yovana Pacheco Elizabeth Zapata Diana M. Monsalve Rubén D. Mantilla Monica Rodríguez-Jimenez Carolina Ramírez-Santana Nicolás Molano-González Juan-Manuel Anaya 《Joint, bone, spine : revue du rhumatisme》2018,85(6):715-720
Objective
To evaluate the relationship between resilience and clinical outcomes in patients with autoimmune rheumatic diseases.Methods
Focus groups, individual interviews, and chart reviews were done to collect data on 188 women with autoimmune rheumatic diseases, namely rheumatoid arthritis (n = 51), systemic lupus erythematosus (n = 70), systemic sclerosis (n = 35), and Sjögren's syndrome (n = 32). Demographic, clinical, and laboratory variables were assessed including disease activity by patient reported outcomes. Resilience was evaluated by using the Brief Resilience Scale. Bivariate, multiple linear regression, and classification and regression trees were used to analyse data.Results
Resilience was influenced by age, duration of disease, and socioeconomic status. Lower resilience scores were observed in younger patients (< 48 years) with systemic lupus erythematosus, rheumatoid arthritis, and systemic sclerosis who had low socioeconomic status, whereas older patients (> 50 years) had higher resilience scores regardless of socioeconomic status. There was no influence of disease activity on resilience. A particular behaviour was observed in systemic sclerosis in which patients with high socioeconomic status and regular physical activity had higher resilience scores.Conclusion
Resilience in patients with autoimmune rheumatic diseases is a continuum process influenced by age and socioeconomic status. The ways in which these variables along with exercise influence resilience deserve further investigation. 相似文献3.
David M. Hill Sai R. Velamuri Julio Lanfranco Ivan Romero Legro Scott E. Sinclair William L. Hickerson 《Burns : journal of the International Society for Burn Injuries》2019,45(2):423-432
Objective
Vancomycin empirical dosing studies in thermally injured patients have netted low successful target attainment and most excluded renal dysfunction, limiting applicability. In a previous study, the authors performed a retrospective analysis of 124 patients’ measured pharmacokinetic parameters to calculate optimal dose and interval for intermittent infusion regimens and find predictors of clearance and total daily dose. The objective of this study was to improve the accuracy of attaining goal therapeutic targets with initial vancomycin regimens in patients with thermal injury through retrospective modeling.Methods
In this phase 2 study, variables collected and calculated regimens in phase 1 were utilized to try and create an improved empiric vancomycin dosing algorithm in patients with thermal injury. Logistic regression was utilized to determine best predictors of dosing vancomycin every 6 and 8 h. The strongest models were built as individual algorithms and tested for accuracy of target attainment. Each algorithm produced a regimen for each patient that was then tested utilizing each patient’s actual measured pharmacokinetic parameters.Results
Univariable logistic regression of 41 variables identified 27 and 23 to be predictive of dosing every 8 or 6 h, respectively. The most predictive multivariable model for dosing every 8 h consisted of creatinine clearance (CrCl) ≥ 80 ml/min, Acute Kidney Injury Network classification <1, and total body surface area burned ≥ 10 percent. For dosing every 6 h, CrCl ≥ 80 ml/min, age ≤ 40 years old, days since injury ≤ 6, and serum creatinine (SCr) ≤ 0.8 were most predictive. Based on the top 5 multivariable models for each dosing interval, 7 algorithms were built to produce recommended regimens. The highest performing algorithm resulted in trough concentrations of <10 mg/L (23%), 10–20 mg/L (65%), 15–20 mg/L (26%), and >20 mg/L (11%); area under the concentration curve (AUC) > 400 mg hr/L (83%); and AUC > 400 mg hr/L without having a trough >20 mg/L (72%).Conclusions
The algorithm that resulted in the highest target attainment without overdosing recommended 15 mg/kg dosed every 24 h for CrCl ≥ 30, every 12 h for CrCl 31–79, every 8 h for patients with CrCl ≥ 80 ml/min, and every 6 h only if the patient with a CrCl ≥ 80 ml/min is also ≤ 40 years old and has a SCr ≤ 0.8. Caution is warranted for groups underrepresented in this study, such as those with very low CrCl, a low BMI, or receiving renal replacement therapy. This algorithm should be validated in other centers for patients with thermal injuries. 相似文献4.
Esther Ebstein Baptiste Coustet Vanina Masson-Behar Marine Forien Elisabeth Palazzo Philippe Dieudé Sébastien Ottaviani 《Joint, bone, spine : revue du rhumatisme》2018,85(5):577-581
Objective
We aimed to compare the prevalence of enthesopathy seen on ultrasonography (US) in spondyloarthritis (SpA) and rheumatoid arthritis (RA) and compared it to healthy controls.Methods
All included patients with RA (2010 ACR/EULAR criteria) and SpA (ASAS criteria) and healthy controls underwent clinical and US evaluation of enthesis at seven sites (quadriceps, proximal and distal patellar, Achilles and triceps tendons, plantar aponeurosis and lateral epicondyle enthesis). The Glasgow Ultrasound Enthesitis Scoring System (GUESS) and the Madrid Sonographic Enthesitis Index (MASEI) scores were determined by two sonographers blinded to clinical data.Results
We included 30 patients with RA (mean age: 55.7 ± 14.8 years, mean disease duration 10.5 ± 7.9 years); 41 with SpA (mean age: 45.3 ± 15.4 years, mean disease duration 9.2 ± 8.7 years) and 26 healthy controls (HC) (mean age: 50.4 ± 17.3 years). Patients with SpA and RA had similar prevalence of painful enthesis of examined sites (17% vs. 14%, non-significant [ns]), but more than among in healthy controls (3%, P < 0.05 for RA and SpA comparison). Comparison between SpA and RA patients revealed that at least one US enthesis abnormality was found with similar frequency (46% and 48% sites [ns]) but both rheumatic diseases had higher frequency of US enthesis abnormality than HC (31%, P < 0.05 for RA and SpA comparison). The mean MASEI score was 8.5 ± 7.3 for RA patients, 7.8 ± 6.5 for SpA patients (ns) and 3.4 ± 2.8 for healthy controls (P < 0.05 for RA and SpA comparison). Overall, 6 RA (20%) and 4 SpA (10%) patients had a MASEI score ≥ 18 (ns). None of the healthy controls had a MASEI score ≥ 18 (P < 0.05 for RA and SpA comparison). The mean GUESS score was 5.8 ± 3.1 and 6.3 ± 3.9 for RA and SpA patients (ns), and 4.0 ± 3.1 for healthy controls (P < 0.01 vs. SpA and < 0.05 vs. RA).Conclusions
RA and SpA patients did not differ in entheseal abnormalities seen on US. Such US features may have low specificity in inflammatory conditions affecting joints and enthesis such as SpA and RA. 相似文献5.
Hein J.E.M. Janssens Paul G.J. Arts Bianca W.M. Schalk Marion C.J. Biermans 《Joint, bone, spine : revue du rhumatisme》2017,84(1):59-64
Objectives
To assess in one time window cardiovascular risks for both patients with gout and patients with rheumatoid arthritis in a Dutch primary care population.Methods
Retrospective matched cohort study with data from the electronic health records of 51 Dutch general practices. Participants were patients aged 30 years or older with an incident diagnosis of gout (n = 2655) or rheumatoid arthritis (n = 513), and matched non-disease controls (n = 7891 and n = 1850 respectively). At disease incidence date, patients and controls were compared for prevalence of hypertension, diabetes mellitus, hypercholesterolemia, and prior cardiovascular diseases. Patients without prior cardiovascular disease were followed for a first cardiovascular disease, and compared to controls using Kaplan-Meier survival curves and Cox proportional hazard analyses.Results
Compared to controls, gout patients suffered more from hypertension (44.8%), diabetes (20.1%), hypercholesterolemia (13.7%), and prior cardiovascular disease (30%) (P < 0.01), whereas rheumatoid arthritis patients (hypertension 28.5%; diabetes 11.7%; hypercholesterolemia 7.4%; prior cardiovascular disease 11.3%) did not (P > 0.05). After adjustment, both gout and rheumatoid arthritis patients without prior cardiovascular disease were more likely to get a cardiovascular disease: hazard ratio (95% confidence interval) 1.44 (1.18 to 1.76), and 2.06 (1.34 to 3.16) respectively.Conclusions
This primary care study indicates that gout and rheumatoid arthritis are both independent risk factors for cardiovascular diseases, rheumatoid arthritis to some greater extent, whereas gout patients at first diagnosis had already an increased cardiovascular risk profile. It gives strong arguments for implementation of both rheumatic diseases in primary care guidelines on cardiovascular risk management. 相似文献6.
S.E. Wu H.W. Charles J.S. Park A.S. Goldenberg A.R. Deipolyi 《Diagnostic and interventional imaging》2017,98(1):37-42
Purpose
The purpose of this retrospective study was to evaluate the impact of obesity on radiologic outcomes in patients with hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE).Materials and methods
A total of 100 TACE procedures performed in 57 patients (42 men, 15 women) with a mean age of 62 years ± 8.4 (SD) (range: 39–83 years) were retrospectively reviewed. The 1–2-month follow-up computed tomography or magnetic resonance imaging examinations was assessed for new or residual disease and radiologic response using mRECIST criteria. Patients were categorized into two groups according to body mass index (BMI). Patients with BMI < 25 kg/m2 were further referred as to low BMI patients and those with BMI ≥ 25 kg/m2 as high BMI patients. Outcomes were compared between the two groups.Results
Low and high BMI patients were similar in regard to age, gender, HCC etiology and stage, and pre-procedure disease burden. TACE for high BMI, compared to low BMI, patients resulted in lower complete response (39% vs. 66%) and higher progressive disease (21% vs. 5%) rates (P = 0.04), and higher rates of residual disease (63% vs. 39%, P = 0.02) and new lesions in untreated liver (39% vs. 18%, P = 0.04) on 1–2-month follow-up imaging.Conclusions
High BMI is associated with significantly more residual disease, new lesions, and progressive disease in patients with HCC treated by TACE. 相似文献7.
Kuan-Hsun Lin Chi-Ming Chu Yu-Kai Lin Hao-Yu Chiao Ta-Wei Pu Yuan-Ming Tsai Ying-Yi Chen Hsu-Kai Huang Shih-Chun Lee Tsai-Wang Huang 《Burns : journal of the International Society for Burn Injuries》2018,44(6):1573-1578
Here, we investigated whether the abbreviated burn severity index (ABSI) scoring system predicts acute respiratory distress syndrome (ARDS) in a retrospective analysis of a severe flammable starch-based powder burn population. Demographics, total body surface area (TBSA) burn, the presence of mouth and nose burn, ABSI, inhalation injury, and clinical outcomes for each patient were analysed for association with inpatient ARDS based on the Berlin definition. We treated 53 patients (64% male, 36% female) and observed no fatalities. The median age, TBSA burn, and the ABSI were 22.2 ± 3.6, 42.2 ± 21, and 7.8 ± 2.8, respectively. Inhalation injury was present in 56.6% of the cases, and mouth and nose burn was present in 30.2%. ARDS was prevalent at 30%. The mean abbreviated burn severity index (ABSI) was 10.6 ± 1.5 in the ARDS group and 6.6 ± 2.3 in the non-ARDS (P < 0.001) group. The mean TBSA burn percentage for ARDS and the non-ARDS groups were 61.4 ± 13.9% and 34 ± 18%, respectively (P < 0.001). The area under the curve of the receiver operating characteristic curves for an ABSI ≥ 9 was 0.905. Our results show that the ABSI is effective for predicting ARDS in young individuals with severe starch-based powder burn. 相似文献
8.
Marine Ferreyra Guillaume Coiffier Jean-David Albert Claire David Aleth Perdriger Pascal Guggenbuhl 《Joint, bone, spine : revue du rhumatisme》2017,84(1):65-70
Objective
To evaluate the performance of combined cytology and microcrystal detection in joint fluid for diagnosing septic arthritis.Methods
Retrospective single-center study of joint fluid samples from patients with manifestations suggesting acute or chronic arthritis. The absolute leukocyte count (/mm3) was recorded; as well as the differential counts, particularly of neutrophils (%). Microcrystals were sought and bacteriological cultures performed. Septic arthritis was defined as positive cultures of joint fluid or blood samples. Diagnostic performance was assessed based on sensitivity, specificity, the receiver-operating characteristics (ROC) curve with the area under the curve (AUC), and the positive and negative likelihood ratios (LR+ and LR?).Results
Two hundred and eight joint fluid samples were included. The diagnoses were septic arthritis (n = 28), chondrocalcinosis (n = 41), gout (n = 28), rheumatoid arthritis (n = 33), spondyloarthritis (n = 31), osteoarthritis (n = 18), and undifferentiated arthritis (n = 29). Among cytological parameters, those having the best diagnostic performance were the neutrophil count (cutoff, > 50,000/mm3), the leukocyte count (cutoff, > 50,000/mm3), and the percentage of neutrophils (cutoff, > 95%); corresponding LR+ values were 8.93, 5.76, and 4.55, respectively. Neutrophil percentages lower than 80% had an LR? value of 0.07. Combining these cytological variables with the absence of crystals improved the diagnostic performance, yielding LR+ values of 11.36, 10.94, and 10.82 for neutrophils > 95%, neutrophils > 50,000/mm3, and leukocytes > 50,000/mm3, respectively.Conclusion
Combining cytological characteristics of joint fluid with the absence of crystals benefits the diagnosis of septic arthritis. 相似文献9.
Thomas Reygaerts Stéphane Mitrovic Bruno Fautrel Laure Gossec 《Joint, bone, spine : revue du rhumatisme》2018,85(4):405-410
Objectives
Fatigue is a significant issue in psoriatic arthritis. The objective was to assess the effect of biological disease modifying antirheumatic drugs and apremilast on fatigue in psoriatic arthritis randomised controlled trials and to compare this effect with the effect in the same trials, on pain, through a systematic literature review and meta-analysis.Methods
A systematic literature review was performed up to January 2017 in PubMed, Embase and Cochrane databases. All randomized controlled trials in psoriatic arthritis of biological disease modifying antirheumatic drugs or apremilast, assessing fatigue (whatever the score used), were included. Data were collected by 2 assessors regarding levels of fatigue and pain at baseline and at the time point closest to 24 weeks after the treatment introduction. Pooled standardized mean differences were calculated using RevMan.Results
After screening 295 publications, 7 randomised controlled trials were analysed: they pertained to adalimumab (n = 2), certolizumab pegol (n = 1), secukinumab (n = 2), ustekinumab (n = 1) and apremilast (n = 1), compared to placebo. The studies included 2341 patients: weighted mean ± standard deviation age: 48.6 ± 1.3 years, disease duration: 7.7 ± 1.6 years, 51.6% were females. Fatigue levels were high at baseline (Functional Assessment of Chronic Illness Therapy score: 28.7 ± 2.4). The pooled standardized mean difference was, for fatigue ?0.44 (95% confidence interval: ?0.54, ?0.35) and for pain, ?0.62 (?0.73, ?0.52).Conclusions
Biological disease modifying antirheumatic drugs and apremilast had a small effect on fatigue at 24 weeks in psoriatic arthritis randomized controlled trials and a higher effect on pain. These results are important to take into account in shared decision-making. 相似文献10.
Sarah B. Lieber Mary Louise Fowler Clara Zhu Andrew Moore Robert H. Shmerling Ziv Paz 《Joint, bone, spine : revue du rhumatisme》2018,85(4):469-473
Objectives
Septic polyarthritis is rarer than septic monoarthritis, but associated with higher mortality. Septic polyarthritis may be difficult to distinguish clinically from noninfectious inflammatory arthritis. We describe one of the largest samples of septic polyarthritis with the aim of distinguishing septic monoarthritis from polyarthritis.Methods
We conducted a retrospective study of adults admitted to tertiary care with septic monoarthritis and polyarthritis. Baseline characteristics, microbial profiles, joint involvement, length of stay, and 60-day readmission rates were determined.Results
We identified 464 and 42 cases of septic monoarthritis and polyarthritis, respectively, including 7 cases of septic polyarthritis with comorbid rheumatoid arthritis. Compared to those with septic monoarthritis, patients with septic polyarthritis were more likely to have rheumatoid arthritis (P < 0.01), sepsis (P < 0.01), and higher peripheral (P < 0.001) and synovial (P < 0.001) white blood cell counts. Operative intervention rates were similar, but mean length of stay was longer in polyarticular septic arthritis (P < 0.001). Patients with septic polyarthritis with/without underlying rheumatoid arthritis were similar in terms of presenting features and outcomes, except for more frequent immunosuppressive therapy in rheumatoid arthritis (P < 0.01).Conclusions
In this sample of patients with septic arthritis, patients with septic polyarthritis were more likely to have systemic infection at presentation than those with septic monoarthritis. Despite this difference, patients with septic monoarthritis and polyarthritis tended to have similar outcomes. While rheumatoid arthritis was observed more frequently among patients with septic polyarthritis, those with/without underlying rheumatoid arthritis had similar presenting features and outcomes. 相似文献11.
Pedro Videira Reis Gabriela Sousa Ana Martins Lopes Ana Vera Costa Alice Santos Fernando José Abelha 《Brazilian Journal of Anesthesiology》2018,68(3):244-253
Background
Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non‐cardiac surgery.Methods
Adult patients admitted at our surgical intensive care unit between January 2006 and July 2013 was included. Univariate analysis was carried using Mann–Whitney, Chi‐square or Fisher's exact test. Logistic regression was performed to assess independent factors with calculation of odds ratio and 95% confidence interval (95% CI).Results
4398 patients were included. Mortality was 1.4% in surgical intensive care unit and 7.4% during hospital stay. Independent predictors of mortality in surgical intensive care unit were APACHE II (OR = 1.24); emergent surgery (OR = 4.10), serum sodium (OR = 1.06) and FiO2 at admission (OR = 14.31). Serum bicarbonate at admission (OR = 0.89) was considered a protective factor. Independent predictors of hospital mortality were age (OR = 1.02), APACHE II (OR = 1.09), emergency surgery (OR = 1.82), high‐risk surgery (OR = 1.61), FiO2 at admission (OR = 1.02), postoperative acute renal failure (OR = 1.96), heart rate (OR = 1.01) and serum sodium (OR = 1.04). Dying patients had higher scores in severity of disease scoring systems and longer surgical intensive care unit stay.Conclusion
Some factors influenced both surgical intensive care unit and hospital mortality. 相似文献12.
Alexandra Fochtmann-Frana Christian Freystätter Vera Vorstandlechner André Barth Michael Bolliger Elisabeth Presterl Gerald Ihra Gabriela Muschitz Martina Mittlboeck Athanasios Makristathis Thomas Rath Christine Radtke Christina Forstner 《Burns : journal of the International Society for Burn Injuries》2018,44(4):784-792
Objectives
The objective was primarily to identify risk factors for bloodstream infections (BSI) caused by different pathogens.Methods
A retrospective single-center cohort study was performed on 472 burn patients with an abbreviated burn severity index (ABSI) ≥ 3, a total burn surface area (TBSA) ≥ 10%, and an ICU stay of at least 24 h. Risk factors for different BSI pathogens were analyzed by competing risks regression model of Fine and Gray.Results
A total of 114 burn patients developed 171 episodes of BSIs caused by gram-negative bacteria (n = 78;46%), gram-positive bacteria (n = 69;40%), and fungi (n = 24;14%) median after 14 days (range, 1–164), 16 days (range, 1–170), and 16 days (range, 0–89), respectively. A total of 24/114 patients (21%) had fatal outcomes. Isolation of the most common bloodstream isolates Enterococcus sp. (n = 26), followed by Candida sp. and Pseudomonas sp. (n = 22 for both) was significantly associated with increased TBSA (p ≤ 0.006) and ABSI (p < 0.0001) and need for fasciotomy (p < 0.01). The death risk of patients with MDR gram-negative bacteremia was significantly increased by a hazard ratio of 12.6 (95% CI:4.8–32.8; p < 0.0001).Conclusions
A greater TBSA and ABSI were associated with a significantly higher incidence of BSIs caused by Pseudomonas sp., Enterococcus sp. and Candida sp. 相似文献13.
Juliet Schurder Tiphaine Goulenok Romain Jouenne Antoine Dossier Damien Van Gysel Thomas Papo Karim Sacre 《Joint, bone, spine : revue du rhumatisme》2018,85(3):333-336
Objective
Our study aimed to analyze the risk factors associated with the occurrence and severity of pneumococcal infection (PI) in systemic lupus erythematosus (SLE) patients.Methods
Medical records of all SLE patients admitted in our department from January 2005 to December 2014 were retrospectively reviewed. SLE patients were separated in 2 groups according to whether they had PI or not. Medical records of all consecutive patients (with and without SLE) admitted in our department for PI over the same period of time were also reviewed. Clinical characteristics associated with PI occurrence and severity were analyzed in SLE patients.Results
One hundred and ninety SLE patients (42.2 + 14.9 years; 87.4% females) were hospitalized over a 10-year period. PI was the reason for admission in 6 (3.2%) patients, including 5 cases of invasive infection. With a follow-up of 2112.8 patient-years for the total cohort, incidence of invasive PI in SLE was of 236/100,000 patient-years. PI occurred at a younger age (43.5 + 14.9 versus 65.3 + 18.7 years, P < 0.01) and were more severe, with a higher frequency of invasive infection (P < 0.001) and higher need for ICU admission (P < 0.05) in SLE as compared to non SLE patients. Risk factors associated with PI in SLE patients were a serum gammaglobulin level < 5 g/L (P < 0.01) and a past history of lupus nephritis (P < 0.05), only. Steroids (P < 0.001) and immunosuppressive drugs (P < 0.05) were associated with infection severity.Conclusion
SLE is a disease of high susceptibility for invasive pneumococcal infections. Our study points to the need for vaccination against Streptococcus pneumoniae in SLE. 相似文献14.
Ping-Han Tsai Kuang-Hui Yu I-Jun Chou Shue-Fen Luo Wen-Yi Tseng Lu-Hsiang Huang Chang-Fu Kuo 《Joint, bone, spine : revue du rhumatisme》2018,85(5):599-603
Objectives
To determine whether offspring of Taiwanese mothers with systemic lupus erythematosus or rheumatoid arthritis have a higher risk of autism spectrum disorder.Methods
Using the National Health Insurance database and National Birth Registry, we identified a cohort of all live births in Taiwan between 2001 and 2012. Children born to mothers with systemic lupus erythematosus or rheumatoid arthritis were identified and matched with up to 8 controls by maternal age, 1-minute Apgar score, 5-minute Apgar score, mode of delivery, sex of the child, gestational age, birth weight and place of residence. Marginal Cox proportional hazard models were used to estimate relative risk (RR) with 95% confidence intervals (CI) for ASD in offspring.Results
Of 1,893,244 newborns, 0.08% (n = 1594) were born to systemic lupus erythematosus mothers, and 0.04% (n = 673) were born to rheumatoid arthritis mothers. Overall, 5 of 673 (0.74%) offspring of rheumatoid arthritis mothers, 7 of 1594 (0.44%) offspring of systemic lupus erythematosus mothers and 10,631 of 1,893,244 (0.56%) offspring of all mothers developed autism spectrum disorder. Autism spectrum disorder incidence (per 100,000 person–years) was 140.39 (95% CI, 45.58–327.62) for the rheumatoid arthritis group and 76.19 (95% CI, 30.63–156.97) for the systemic lupus erythematosus group. Autism spectrum disorder risk was not significantly higher for children born to mothers with rheumatoid arthritis (HR, 1.42; 95% CI, 0.60–3.40) or systemic lupus erythematosus (HR, 0.76; 95% CI, 0.36–1.59).Conclusions
Children born to women with systemic lupus erythematosus or rheumatoid arthritis do not have a higher risk of autism spectrum disorder. 相似文献15.
Francis Berenbaum Thao Pham Pascal Claudepierre Thibault de Chalus Jean-Michel Joubert Carine Saadoun Lionel Riou França Bruno Fautrel 《Joint, bone, spine : revue du rhumatisme》2018,85(1):59-64
Objectives
To compare different early clinical criteria of non-response determined at three months as predictors of clinical failure at one year in patients with rheumatoid arthritis starting therapy with certolizumab pegol.Methods
Data were derived from a randomised Phase III clinical trial in patients with rheumatoid arthritis who failed to respond to methotrexate monotherapy. Patients included in this post-hoc analysis were treated with certolizumab pegol (400 mg qd reduced to 200 mg qd after one month) and with methotrexate. The study duration was twelve months. Response at three months was determined with the American College of Rheumatology-50, Disease Assessment Score-28 ESR, Health Assessment Questionnaire and the Clinical Disease Activity Index. The performance of these measures at predicting treatment failure at twelve months defined by the American College of Rheumatology-50 criteria was determined, using the positive predictive values as the principal evaluation criterion.Results
Three hundred and eighty two patients were available for analysis and 225 completed the twelve-month follow-up. At Week 52, 149 (38.1%) patients met the American College of Rheumatology-50 response criterion. Positive predictive values ranged from 81% for a decrease in Health Assessment Questionnaire- Disability index score since baseline > 0.22 to 95% for a decrease in Disease Assessment Score-28 score since baseline ≥ 1.2. Sensitivity was ≤ 70% in all cases. Performance of these measures was similar irrespective of the definition of treatment failure at 12 months.Conclusions
Simple clinical measures of disease activity can predict future treatment failure reliably and are appropriate for implementing treat-to-target treatment strategies in everyday practice. 相似文献16.
Statin use and knee osteoarthritis progression: Results from a post-hoc analysis of the SEKOIA trial
Florent Eymard Camille Parsons Mark H. Edwards Florence Petit-Dop Jean-Yves Reginster Olivier Bruyère Xavier Chevalier Cyrus Cooper Pascal Richette 《Joint, bone, spine : revue du rhumatisme》2018,85(5):609-614
Objective
Epidemiological and experimental studies have suggested that lipid disorders might be involved in the pathophysiology of knee osteoarthritis (OA). Studies assessing the effect of statins on knee OA progression have shown conflicting results. We investigated the impact of statin use on radiological progression in patients with radiological and symptomatic knee OA.Methods
In total, 336 patients from the placebo arm of SEKOIA trial completed the 3-year follow-up and were included in this post-hoc analysis. Statin use was recorded at baseline interview. Minimal medial tibiofemoral joint space was measured on plain radiographs by an automated method at baseline and then annually. Radiologic progression was defined as joint space narrowing ≥ 0.5 mm over 3 years.Results
Overall, 71 patients were statin users (21.1%). They had a higher BMI (31.1 ± 5.3 vs. 29.3 ± 5.2 kg/m2, P = 0.008), a higher sum of metabolic factors (≥ 3 factors: 43.7% vs 7.2%; P for trend < 0.001) and a higher rate of radiological progression (49.3% vs. 32.1%, P = 0.007) as compared to statin non-users. The significant association between radiological progression and statin use was independent of age, gender, WOMAC global score, disease duration, baseline joint space width, hypertension, type 2 diabetes, obesity (BMI > 30 kg/m2) and cardiovascular diseases [relative risk 1.49 (95% CI: 1.10–2.02), P = 0.010].Conclusion
Among patients with knee OA, statin use was associated with radiological worsening over 3 years, regardless of other potential confounding factors (obesity, type 2 diabetes, hypertension, disease duration, symptom intensity and radiological severity). 相似文献17.
Suman Arora Priyanka Gupta Virender Kumar Arya Nidhi Bhatia 《Brazilian Journal of Anesthesiology》2018,68(2):128-134
Background
Efficacy of preoxygenation depends upon inspired oxygen concentration, its flow rate, breathing system configuration and patient characteristics. We hypothesized that in actual clinical scenario, where breathing circuit is not primed with 100% oxygen, patients may need more time to achieve EtO2 ≥ 90%, and this duration may be different among various breathing systems. We thus studied the efficacy of preoxygenation using unprimed Mapleson A, Bain's and Circle system with tidal volume breathing at oxygen flow rates of 5 L.min?1 and 10 L.min?1.Methods
Patients were randomly allocated into one of the six groups, wherein they were preoxygenated using either Mapleson A, Bain's or Circle system at O2 flow rate of either 5 L.min?1 or 10 L.min?1. The primary outcome measure of our study was the time taken to achieve EtO2 ≥ 90% at 5 and 10 L.min?1 flow rates.Results
At oxygen flow rate of 5 L.min?1, time to reach EtO2 ≥ 90% was significantly longer with Bain's system (3.7 ± 0.67 min) than Mapleson A and Circle system (2.9 ± 0.6, 3.3 ± 0.97 min, respectively). However at oxygen flow rate of 10 L.min?1 this time was significantly shorter and comparable among all the three breathing systems (2.33 ± 0.38 min with Mapleson, 2.59 ± 0.50 min with Bain's and 2.60 ± 0.47 min with Circle system).Conclusions
With spontaneous normal tidal volume breathing at oxygen flow rate of 5 L.min?1, Mapleson A can optimally preoxygenate patients within 3 min while Bain's and Circle system require more time. However at O2 flow rate of 10 L.min?1 all the three breathing systems are capable of optimally preoxygenating the patients in less than 3 min. 相似文献18.
Isabelle Legroux-Gérot Jean Vignau Odile Viltart Pierre Hardouin Christophe Chauveau Bernard Cortet 《Joint, bone, spine : revue du rhumatisme》2019,86(1):95-101
Introduction
Bone loss in anorexia nervosa (AN) is multifactorial; its mechanisms are not yet clearly understood and may vary depending on disease duration and severity. To determine to what extent adipokines may be involved in the bone alterations found in anorexic patients, we evaluated plasma levels for leptin, adiponectin and Pref-1 against other clinical and biological parameters in a population of anorexic patients split according to weight and bone status.Methods
Plasma concentrations of leptin, total adiponectin, high molecular weight (HMW) adiponectin, and Pref-1 were measured. The ratio of HMW adiponectin to total adiponectin — HMW (percentage) — was calculated. We divided our population into 5 groups with different phenotypes characterizing the severity of the disease and/or the severity of bone involvement: 1 – Normal BMD and body mass index (BMI): recovery from AN; 2 – Osteopenia (?2 < Z-score < ?1) and BMI > 17 kg/m2; 3 – Osteopenia and BMI ≤ 17 kg/m2; 4 – Osteoporosis (Z-score ≤ ?2) and BMI > 17 kg/m2; 5 – Osteoporosis and BMI ≤ 17 kg/m2.Results
The study involved 80 anorexia nervosa patients. Mean BMI was 16.8 ± 2.4 kg/m2. No significant difference was found in total and HMW adiponectin plasma concentrations between the 5 groups. HMW (percentage) was significantly higher in group 5 compared to group 1. Leptin was significantly lower in groups 3 and 5 compared to the other groups. For the whole group femoral neck and hip BMD correlated negatively with total adiponectin and HMW adiponectin. No correlation was found between BMD (whatever the site) and plasma leptin. Multivariate analysis revealed that 2 factors — leptin and BMI — explained 10% of the variance in spine BMD. For femoral neck BMD, the 2 explanatory factors were BMI and total adiponectin which explained 14% of the variance in BMD. For total hip BMD, 27% of the variance in BMD was explained by 3 factors: leptin, BMI, and total adiponectin.Conclusion
Bone status in anorexia nervosa is mainly determined by BMI, leptin and adiponectin. 相似文献19.
Anti-citrullinated peptides antibodies in systemic sclerosis: Meta-analysis of frequency and meaning
Guillaume Laustriat Adeline Ruyssen-Witrand Arnaud Constantin Thomas Barnetche Daniel Adoue Alain Cantagrel Yannick Degboé 《Joint, bone, spine : revue du rhumatisme》2018,85(2):147-153
Objectives
Diagnosis of systemic sclerosis (SSc) is partially determined by the presence of specific autoantibodies often associated with specific clinical features. Recent studies report the presence of ACPA in SSc. We aimed to evaluate the prevalence of ACPA in SSc and to assess their influence on clinical presentation of SSc.Methods
A systematic literature search was performed using PubMed and Cochrane databases’ publications between 1999 and March 2017. Search terms were: “systemic sclerosis [MeSH] AND (ACPA OR anti-CCP OR rheumatoid factor OR cohort OR value diagnostic)”. In a first step, we selected cohorts with > 50 SSc patients with ACPA identification, for ACPA frequency determination. In a second step, we included studies that analysed clinical profiles according to ACPA status. Meta-analyses were performed when at least two studies were available.Results
First, we identified 13 observational studies with a total of 1231 SSc patients. The mean prevalence of ACPA in SSc was 9.2%. Secondly, we identified nine studies reporting clinical aspects according to ACPA status. Our meta-analyses showed a significant association between ACPA positivity and the presence of arthritis (odds ratio (OR) = 22.48 [10.71–47.21]), joint erosions seen on X-rays (OR = 14.79 [6.38–34.28]), pulmonary fibrosis (OR = 2.75 [1.21–6.24]), oesophagus involvement (OR = 2.72 [1.05–7.07]), and diffuse skin involvement (OR = 2.21 [1.21–4.03]).Conclusions
The prevalence of ACPA in scleroderma is 9.2%. Our meta-analysis shows an increased risk for erosive arthritis, pulmonary fibrosis, oesophagus involvement and diffuse skin involvement, in patients with ACPA-positive SSc. ACPA should be systematically included in SSc assessment. 相似文献20.
Inhaled dry powder mannitol in children with cystic fibrosis: A randomised efficacy and safety trial
K De Boeck E Haarman J Hull LC Lands A Moeller A Munck J Riethmüller H Tiddens S Volpi J Leadbetter B Charlton A Malfroot 《Journal of cystic fibrosis》2017,16(3):380-387