Recent progress in the treatment of lupus nephritis

The treatment of lupus nephritis has seen significant advances during the past decade mainly due to the publication of well-designed randomized clinical trials (RCTs). The choice of treatment is guided by the histopathologic classification but is also influenced by demographic, clinical, and laboratory characteristics that allow for the identification of patients at risk for more aggressive disease. For the induction arm, low-dose cyclophosphamide regimens and mycophenolate mofetil have been validated as alternatives to the established National Institutes of Health regimen of high-dose cyclophosphamide; for the maintenance phase, azathioprine and mycophenolate compete for treatment of first choice. Rituximab is efficacious in real-life clinical practice but ineffective in clinical trials. The role of recently approved belimumab in lupus nephritis eagerly awaits further documentation. Aggressive management of comorbid conditions, such as hypertension and dyslipidemia, is of utmost importance. Here, we review the latest advances in lupus nephritis therapy with a focus on recent RCTs as well as new biologic agents under development. Furthermore, we propose a therapeutic algorithm in an effort to facilitate clinical decision-making in this gradually changing landscape. Upcoming European and American recommendations should provide further clarification.     

HIV patients treated with low-dose prednisolone exhibit lower immune activation than untreated patients

Background  

HIV-associated general immune activation is a strong predictor for HIV disease progression, suggesting that chronic immune activation may drive HIV pathogenesis. Consequently, immunomodulating agents may decelerate HIV disease progression.     

CRP evolution pattern in CPAP-treated obstructive sleep apnea patients. Does gender play a role?

Background??aim

C-reactive protein (CRP) is directly implicated in atherogenesis and associated cardiovascular morbidity in patients with obstructive sleep apnea (OSA). Effective continuous positive airway pressure (CPAP) treatment has been shown to gradually decrease CRP levels and thus consequently improve disease-related cardiovascular morbidity. However, the influence of gender on the CRP evolution pattern has never been assessed before. The aim of our study was to investigate possible gender differences in CRP evolution in OSA patients 3 and 6?months after the start of effective CPAP treatment.

Methods

The study population consisted of 436 patients (252 males/184 females) with newly diagnosed moderate to severe OSA and good CPAP compliance assessed by a thorough follow up. High-sensitivity C-reactive protein (hs-CRP) was assessed before CPAP initiation and at the third and sixth month of the follow-up period.

Results

C-reactive protein values showed a statistically significant decrease at the third and sixth month of CPAP therapy [initial values 0.79?±?0.65?mg/dL versus 0.70?±?0.52?mg/dL (p?p?p?p?>?0.05). After 6?months?? treatment, CRP decreased significantly in both genders (males from 0.74?±?0.53?mg/dL to 0.28?±?0.32?mg/dL, p?p?Conclusion Our results suggest a delay in the normalization of CRP levels in females despite effective CPAP treatment. A time period of at least 6?months appeared to be required in women in order to reduce CRP levels and consequent cardiovascular risk. In contrast, CPAP??s protective role in males is achieved at an earlier time point. Gender-related hormonal and genetic factors may influence the above CRP evolution pattern.     

Brain volume dynamics in multiple sclerosis. A case-control study

ABSTRACT

Objectives: In this study, we aimed to explore the extent and clinical relevance of brain volume dynamics in relapsing remitting multiple sclerosis (RRMS).

Methods: Sixty-three patients with RRMS with a disease duration of about 5 years (36 women, mean age 39.9 ± 9.4 years; mean EDSS1.4 ± 1.2, mean relapse rate 0.98 ± 1.17) and 50 healthy control individuals (24 women, mean age 39.1 ± 10.2 years) were recruited and imaged on a MRI scanner by using post-gadolinium high-resolution3D T1W sequences. Cross-sectional and longitudinal volumetric data were obtained by using SIENA(X) and FIRST software.

Results: Patients showed significantly lower subcortical volumes compared to healthy controls. Interestingly, the educational level predicted the rate of right thalamus atrophy. The mean annualized percentage of brain volume change (aPBVC) was ?0.92% (±1.64%) and was presented in higher rates during the first five years after MS diagnosis.

Conclusion: Brain atrophy mainly involved subcortical grey matter structures and was more conspicuous during the first years of MS diagnosis. The buffering role of education in atrophy was also corroborated by this study.     

Neuromuscular differences between boys with and without intellectual disability during squat jump

The purpose of this study was to identify the differences in vertical squat jump (SJ) between volunteers with and without intellectual disability (ID). Thirteen boys with ID (average intelligence quotient, estimated by Wisk III test: 55.6 ± 11.2) and 13 peers without disabilities performed maximal SJ on a force platform. Kinematic data were captured using a six-camera 3D motion analysis system and electromyographic (EMG) activity was recorded using surface electrodes. Unpaired T-test determined the statistical difference between the two groups. The obtained results indicated that the group with ID, jumped lower, developed lower vertical ground reaction forces, knee power output, knee angular velocity, and take-off velocity, and showed longer propulsion duration, decreased mean to maximum agonist EMG activity and higher antagonist/agonist activity ratio. The deficit in the SJ observed in individuals with ID was attributed to a deficit in the examined mechanical and neuromuscular parameters, and especially to the agonist and antagonist co-contraction.     

Trends in suicidality amid the economic crisis in Greece

For the decade 2000–2010, suicidal rates appear to be both low and stable in Greece and unrelated to the socioeconomic environment. It is highly possible that the recent crisis caused a significant increase in dysphoria, stress, depression and maybe suicidal ideation in the general population, but completed suicides do not seem to have increased so far. Measures are needed to make sure there will be no increase in completed suicides in the near future, since historically, periods of socioeconomic instability might be related to increased suicidality. Community interventions reduce stigma and enhance help-seeking. However, only those including the creation of social support networks are essential in the fight against suicidality.     

The acute effect of exercise intensity on free throws in young basketball players

Purpose

Free throws (FT) accuracy is a major determinant of performance in basketball game. However, the effect of exercise intensities on FT accuracy has not been well studied. The aim of the present study was to examine the effect of different exercise intensities on FT accuracy in young male basketball players.

Methods

For this aim, 22 basketball players (age 16.12 ± 1.16 years, body mass 76.4 ± 13.3 kg and height 186.4 ± 8.9 cm), classified into 2 age groups (younger 15.28 ± 0.48 years, n = 11; older 16.97 ± 1.00 years, n = 11). The participants performed 50 FT under five conditions (i.e. 10 FT per condition): after rest (A), after 3 min shuttle running with ~9 km h^?1 (B), ~9.5 km h^?1 (C), ~10 km h^?1 (D) and ~10.5 km h^?1 (E).

Results

The analysis of variance showed a main effect of exercise intensity on FT accuracy (p = 0.003, η ² = 0.585), heart rate (HR) (p < 0.001, η ² = 0.990) and rate of perceived exertion (RPE) (p < 0.001, η ² = 0.703): (a) FT accuracy in the C and D conditions was higher than the A condition (p ≤ 0.004); (b) all conditions differed for HR (p ≤ 0.047), the higher was the exercise intensity the higher was the HR, whereas no difference was revealed between D and E conditions; (c) the same trend as in the HR was observed in RPE (i.e. the higher the exercise intensity, the higher the RPE), too, where all conditions differed (p ≤ 0.047), except between C and D, and between D and E conditions.

Conclusions

There was a significant exercise intensity × age interaction for RPE (p = 0.011, η ² = 0.516), but not for FT accuracy (p = 0.336, η ² = 0.224) or HR (p = 0.128, η ² = 0.329). The findings of the present study showed that a minimum of exercise intensity was necessary to achieve peak FT performance and a shape of inverse U was suggested for the relationship between FT accuracy and exercise intensity.

     

Sleep disorders in pediatric chronic kidney disease patients

The prevalence of sleep disorders during childhood has been estimated to range from 25 to 43 %. The aim of this review is to determine the prevalence of sleep disorders and possible associations with chronic kidney disease (CKD)-related factors and health-related quality of life (HRQOL) in children with CKD. An electronic systematic literature search for sleep disorders in children with CKD in Pubmed, Embase and the Cochrane Library Databases identified seven relevant articles for review, all of which reported an increased prevalence of sleep disorders in children with CKD. Five studies included children with CKD undergoing dialysis, and two studies included only non-dialysis patients. In all studies the presence of sleep disturbances was assessed by questionnaires; only one study compared the results of a validated questionnaire with laboratory-based polysomnography. The prevalence of any sleep disorder ranged from 77 to 85 % in dialysis patients, to 32–50 % in transplanted patients and 40–50 % in non-dialysis patients. The most commonly studied disorder was restless legs syndrome, which presented at a prevalence of 10–35 %. Three studies showed significant associations between presence of sleep disorders and HRQOL. We found consistent evidence of an increased prevalence of sleep disturbances in children with CKD, and these seemed to play a critical role in HRQOL.