Quality of life measures in Systemic Lupus Erythematosus: A systematic review.

In this study we systematically investigated the health-related quality of life (HRQoL) tools, which have been most often used over the last five years to evaluate the QoL in patients with systemic lupus erythematosus (SLE), focusing on their items and applications. A detailed literature search was conducted: the inclusion criteria were as follows: 1) studies including at least 50 patients; 2) studies including at least 25 patients with SLE; 3) quality of life testing with validated measures. The systematic review was based on 119 studies for a total of 32,449 SLE patients and 3092 controls. A total of 35 different patients-reported quality of life measures, applied in cohorts of patients with SLE, were retrieved with the 36-item Medical Outcome Short Form (SF-36) (63 studies of 119 =52.95%), Lupus Quality of Life (LupusQoL) (17 studies =14.3%) and Lupus Patient-Reported Outcome (LupusPRO) (12 studies =10%) being the most commonly used tools. Overall, this systematic review of the literature indicated that quality of life in patients with SLE appears to be poor and generally lower compared to both the general population and patients with other chronic conditions, as was shown by a few studies that used SF-36 and LupusPRO. The use of HRQoL scoring in SLE is gaining increasing interest and is used both in randomized controlled trials and in real-life. Future efforts are needed to improve the understanding of the impact of the disease burden on quality of life from the patient's perspective.

The Influence of Spatial Effects on the Dynamics of Solutions in Keynes' Mathematical Model of the Business Cycle.

We consider the special case of the mathematical model of Keynes' business cycle with the spatial interaction. In this model we assume that macroeconomic factors affect a certain geographical region and economic indicators. The dependence occurs on the spatial (geographical) coordinates in addition to the dependence on the temporal evolution, even if the economic subject is externally homogeneous in space. Spatial interaction led us to analyze a system of two differential equations of the 'reaction-diffusion' type, which replaces a system of two ordinary differential equations. This method is often used to analyze the dynamics of complex nonlinear systems and macroeconomic entities. An analysis of such a mathematical model is based on the use of modern methods of the theory of dynamical systems indicate the presence of new nonlinear effects in addition to those used in the traditional version of the Keynes model. We encountered the loss of stability of the homogeneous economic equilibrium state and the occurrence of economic cycles for some values of the parameters while investigating the characteristics of such a system. Meanwhile, another version of instability of a homogeneous economic equilibrium state with a different choice of parameters occurs, which in many cases leads to the appearance of a spatially non-homogeneous equilibrium state, which is characterized by the dependence of the corresponding economic indicators on the spatial (geographical) coordinates of the area in which the assigned macroeconomic entity is located.

Synchronization of Fluctuations in the Interaction of Economies within the Framework of the Keynes's Business Cycle Model.

In this paper, we will study two independent economies in a country (national, regional and urban), where the dynamics of fluctuations in each economy is described by Keynes's mathematical business cycle model. This is an interaction of two economies which include trade and competition. In the resulting system that consists of two independent economic entities, we show that fluctuations can emerge as two possible types of economic indicators (synchronous and antiphase) when the peaks and downturns of business activities in each of the economies are completely synchronized or on the contrary when the rise of one economy is accompanied by a recession (antiphase cycles). Our aim is to examine the stability question of solutions of the cognate mathematical model. Our analysis of the mathematical model will render methods of the theory of dynamical systems, such as the method of integral manifolds and the Poincare normal forms. This approach will provide a sufficient analysis of the dynamics of solutions of a system of differential equations, which is used as a mathematical model. Asymptotic formulas will be obtained for solutions that depict economic cycles.

The risk of ischaemic stroke in primary antiphospholipid syndrome patients: a prospective study.

BACKGROUND AND PURPOSE: The most common neurological manifestation of antiphospholipid syndrome (APS) is ischaemic stroke. Identifying patients with APS at high risk for developing any thrombotic event remains a major challenge. In this study, the aim was to identify predictive factors of ischaemic stroke in a cohort of primary APS (PAPS) patients who presented with new onset symptoms suggestive of acute stroke. METHODS: This prospective multicentre study included 36 consecutive PAPS patients who presented with new onset symptoms suggestive of an acute stroke. Patients were prospectively followed up for 12 months. RESULTS: In 10 (28%) out of 36 PAPS patients [mean age 41 years (SD 13.4), 70% female], the suspicion of an acute stroke was confirmed by brain magnetic resonance imaging. Sixty per cent of these patients were <50 years old. Eight of the 10 patients had a history of previous venous thrombosis and were receiving vitamin K antagonist (VKA), with international normalized ratio target 2-3; one patient had a history of a previous arterial event receiving treatment with VKA target international normalized ratio 2-3 plus low dose aspirin; and one patient had a history of previous pregnancy morbidity receiving only low dose aspirin. Time in the therapeutic range for patients receiving VKA was 77.7% (SD 6.6%). Hypercholesterolaemia was significantly higher in patients with confirmed stroke compared to those without (P < 0.05). Similarly, a significantly higher rate of anti-ß2 glycoprotein-I (ß2GPI) antibodies (immunoglobulin G/immunoglobulin M; P < 0.05) and higher adjusted global APS score (aGAPSS) values were found in patients with a confirmed stroke [mean aGAPSS 8.9 (SD 4.7) vs. mean aGAPSS 6.4 (SD 2.5); P < 0.05]. CONCLUSIONS: Patients with PAPS, including young patients, have a high risk of recurrent thrombosis despite anticoagulation treatment. A careful risk assessment is mandatory to identify patients at risk for recurrence.

Infodemiology of systemic lupus erythematous using Google Trends.

Objective People affected by chronic rheumatic conditions, such as systemic lupus erythematosus (SLE), frequently rely on the Internet and search engines to look for terms related to their disease and its possible causes, symptoms and treatments. 'Infodemiology' and 'infoveillance' are two recent terms created to describe a new developing approach for public health, based on Big Data monitoring and data mining. In this study, we aim to investigate trends of Internet research linked to SLE and symptoms associated with the disease, applying a Big Data monitoring approach. Methods We analysed the large amount of data generated by Google Trends, considering 'lupus', 'relapse' and 'fatigue' in a 10-year web-based research. Google Trends automatically normalized data for the overall number of searches, and presented them as relative search volumes, in order to compare variations of different search terms across regions and periods. The Menn-Kendall test was used to evaluate the overall seasonal trend of each search term and possible correlation between search terms. Results We observed a seasonality for Google search volumes for lupus-related terms. In the Northern hemisphere, relative search volumes for 'lupus' were correlated with 'relapse' (τ = 0.85; p = 0.019) and with fatigue (τ = 0.82; p = 0.003), whereas in the Southern hemisphere we observed a significant correlation between 'fatigue' and 'relapse' (τ = 0.85; p = 0.018). Similarly, a significant correlation between 'fatigue' and 'relapse' (τ = 0.70; p < 0.001) was seen also in the Northern hemisphere. Conclusion Despite the intrinsic limitations of this approach, Internet-acquired data might represent a real-time surveillance tool and an alert for healthcare systems in order to plan the most appropriate resources in specific moments with higher disease burden.

Differential cardiotoxicity in response to chronic doxorubicin treatment in male spontaneous hypertension-heart failure (SHHF), spontaneously hypertensive (SHR), and Wistar Kyoto (WKY) rats.

Life threatening complications from chemotherapy occur frequently in cancer survivors, however little is known about genetic risk factors. We treated male normotensive rats (WKY) and strains with hypertension (SHR) and hypertension with cardiomyopathy (SHHF) with 8 weekly doses of doxorubicin (DOX) followed by 12weeks of observation to test the hypothesis that genetic cardiovascular disease would worsen delayed cardiotoxicity. Compared with WKY, SHR demonstrated weight loss, decreased systolic blood pressure, increased kidney weights, greater cardiac and renal histopathologic lesions and greater mortality. SHHF showed growth restriction, increased kidney weights and renal histopathology but no effect on systolic blood pressure or mortality. SHHF had less severe cardiac lesions than SHR. We evaluated cardiac soluble epoxide hydrolase (sEH) content and arachidonic acid metabolites after acute DOX exposure as potential mediators of genetic risk. Before DOX, SHHF and SHR had significantly greater cardiac sEH and decreased epoxyeicosatrienoic acid (EET) (4 of 4 isomers in SHHF and 2 of 4 isomers in SHR) than WKY. After DOX, sEH was unchanged in all strains, but SHHF and SHR rats increased EETs to a level similar to WKY. Leukotriene D4 increased after treatment in SHR. Genetic predisposition to heart failure superimposed on genetic hypertension failed to generate greater toxicity compared with hypertension alone. The relative resistance of DOX-treated SHHF males to the cardiotoxic effects of DOX in the delayed phase despite progression of genetic disease was unexpected and a key finding. Strain differences in arachidonic acid metabolism may contribute to variation in response to DOX toxicity.

The [Formula: see text] channel of proton-proton scattering in new chiral effective field theory power counting.

In this paper, the chiral effective field theory is used to investigate the spin singlet channel [Formula: see text], of proton-proton (pp) scattering according to the new suggested power counting. For this purpose, the pp zero scattering amplitude is reproduced by inserting one pion exchange at leading order (LO) and the Coulomb interaction between protons at next-to-leading order (NLO). This leads to a systematic improvement up to NLO compared to the result obtained from Nijm93 potential model.

Toxicology Case Presentations.

Owners are often not aware that some common household products, medications, and plants are toxic to dogs and cats. Six cases of toxicoses due to ingestion of xylitol, amatoxin-containing mushrooms, anticoagulant rodenticide, zinc, vitamin D, and lily are presented with typical clinical and laboratory data findings. Changes in the laboratory data are explained in the context of the mechanism of action of the toxin and the organ systems affected.

Relativistic nucleon-nucleon potentials in a spin-dependent three-dimensional approach.

The matrix elements of relativistic nucleon-nucleon (NN) potentials are calculated directly from the nonrelativistic potentials as a function of relative NN momentum vectors, without a partial wave decomposition. To this aim, the quadratic operator relation between the relativistic and nonrelativistic NN potentials is formulated in momentum-helicity basis states. It leads to a single integral equation for the two-nucleon (2N) spin-singlet state, and four coupled integral equations for two-nucleon spin-triplet states, which are solved by an iterative method. Our numerical analysis indicates that the relativistic NN potential obtained using CD-Bonn potential reproduces the deuteron binding energy and neutron-proton elastic scattering differential and total cross-sections with high accuracy.

A three-dimensional momentum-space calculation of three-body bound state in a relativistic Faddeev scheme.

In this paper, we study the relativistic effects in a three-body bound state. For this purpose, the relativistic form of the Faddeev equations is solved in momentum space as a function of the Jacobi momentum vectors without using a partial wave decomposition. The inputs for the three-dimensional Faddeev integral equation are the off-shell boost two-body t-matrices, which are calculated directly from the boost two-body interactions by solving the Lippmann-Schwinger equation. The matrix elements of the boost interactions are obtained from the nonrelativistic interactions by solving a nonlinear integral equation using an iterative scheme. The relativistic effects on three-body binding energy are calculated for the Malfliet-Tjon potential. Our calculations show that the relativistic effects lead to a roughly 2% reduction in the three-body binding energy. The contribution of different Faddeev components in the normalization of the relativistic three-body wave function is studied in detail. The accuracy of our numerical solutions is tested by calculation of the expectation value of the three-body mass operator, which shows an excellent agreement with the relativistic energy eigenvalue.

Formulae to correct sodium concentrations for serum water fraction in cases of hypo- and hyperproteinemia in cats.

BACKGROUND: Biochemistry analyzers in many high-throughput laboratories use indirect potentiometry to determine serum electrolyte concentrations, which involves a pre-analytical dilution step that may be associated with artifactual increases or decreases in electrolyte concentrations under circumstances of altered serum water fraction (SWF). Severe hypo- and hyperproteinemia, conditions that cause altered SWF, are recognized but under-emphasized causes of falsely measured serum sodium concentrations. OBJECTIVES: The goals of this study were to determine the average actual SWF (SWFA ) and establish formulae to correct serum sodium concentration measured by indirect potentiometry in hypo- and hyperproteinemic cats. METHODS: Serum samples from 112 feline patients were analyzed for electrolytes (measured by both indirect and direct potentiometry), total protein, albumin, triglycerides, and cholesterol. Each serum sample was also lyophilized to determine the SWFA . A feline-specific formula to estimate SWF (SWFE-FEL ) was developed and evaluated with a multivariable linear model. RESULTS: The mean SWFA in this population of cats was 91.2%, which was significantly different (P < .0001) than the mean (93.9%) calculated using the human estimated formula (SWFE-HUM ). The formula devised for the SWFE-FEL better recapitulated the SWFA than did the SWFE-HUM , and the corrected sodium concentrations calculated using the feline formula were better correlated with serum sodium measured by direct potentiometry than those determined using the human formula. CONCLUSIONS: Application of feline-specific formulae is expected to limit the misinterpretation of electrolyte data from indirect potentiometry when altered SWF occurs. To demonstrate this, a case example of a hypoproteinemic cat is provided.

Pregnancy success rate and response to heparins and/or aspirin differ in women with antiphospholipid antibodies according to their Global AntiphosPholipid Syndrome Score.

BACKGROUND: The current treatment to prevent pregnancy morbidity (PM) associated with antiphospholipid antibodies (aPL) is based on the use of low dose aspirin and low molecular weight heparin (henceforth defined as standard of care (SoC) treatment). Despite the SoC, up to 30% of women with aPL continue to have pregnancy complications. The global antiphospholipid syndrome (APS) score (GAPSS) is a tool to quantify the risk for the aPL-related clinical manifestations. In this study, we investigated the individual clinical response to SoC in women with aPL after stratifying them according to their GAPSS. METHODS: One-hundred-fourty-three women (352 pregnancies) with aPL ever pregnant treated with SoC therapy were included. The patients GAPSS was then grouped according to the patients' GAPSS into low risk (< 6), medium risk (6-11), and high risk (≥12). RESULTS: The live birth rate was 70.5% (248 out of the 352 pregnancies), 45 patients (31%) experienced at least one event of PM, defined as early or late. Patients were stratified according to GAPSS values, in order to identify a low risk group (GAPSS <6, n = 72), a medium risk group (GAPSS 6-11, n = 66) and a high risk group (GAPSS ≥12, n = 5). When considering patients who ever experienced any PM while treated with SoC, all patients in the high risk group experienced PM, while patients in the medium group had a significant higher rate of PM when compared to the low risk group [29 (43.9%) patients V.s. 11 (15.3%), respectively; p < 0.001]. When analysing the number of pregnancies in the three groups, patients in the high risk group had significantly lower live birth rates, when compared to the other groups [11 (40.7%) live births vs. 100 (62.1%) and 137 (82.5%), respectively; p < 0.05]. Furthermore, patients with medium risk group also had significantly lower live birth rates, when compared to the lower risk group (p < 0.001). CONCLUSIONS: GAPSS might be a valuable tool for to identify patients with a higher likelihood of response to SoC.

Adipokines: a review of biological and analytical principles and an update in dogs, cats, and horses.

In addition to its role as an energy storage depot, adipose tissue is now recognized as a complex endocrine organ. Adipose tissue releases a variety of factors, termed adipokines, that regulate energy metabolism, cardiovascular function, reproductive status, and immune function. Some of the better-studied adipokines include leptin, adiponectin, and components of the renin-angiotensin system such as angiotensinogen. The function of more recently discovered adipokines such as resistin are under intense scrutiny. Abnormal production or regulation of adipokines occurs in obese individuals and is implicated in the development of a variety of associated co-morbidities including metabolic syndrome, type 2 diabetes, atherosclerosis, heart disease, and cancer in people, although evaluation in domestic species is just beginning. Adipokines are now being examined as potential biomarkers for risk assessment for development of complications related to obesity. This article summarizes the function and regulation of some better-characterized adipokines. It also reviews the current information on the characterization of adipokines in some domestic species in which rates of obesity and obesity-related disorders are increasing, such as the dog, cat, and horse.

Salt-induced cardiac hypertrophy is independent of blood pressure and endothelin in obese, heart failure-prone SHHF rats.

The interaction of salt sensitivity and obesity in development of cardiac hypertrophy is incompletely understood. The SHHF/Mcc-fa(cp) (SHHF) rat model was used to examine the effect of high salt on cardiac hypertrophy and expression of endothelin (ET) and nitric oxide synthase (NOS) isoforms. Homozygous lean (+/+) and obese (fa(cp)/fa(cp)) SHHF were fed a low-salt diet (0.3% NaCl) for seven days followed by a high-salt diet (8.0% NaCl) for seven days. To assess the role of ET in mediating cardiac hypertrophy and gene expression with high salt, additional groups were treated with an ET(A)/ET(B) receptor antagonist (bosentan) while on high salt. Obese SHHF showed an increase in systolic blood pressure and cardiac hypertrophy in response to the high-salt diet. High salt resulted in decreased expression of preproET as well as all three NOS isoforms in the Obese, while cytokine induced NOS (iNOS) and neuronal NOS (nNOS) increased in Leans. Though the salt-sensitive component of the hypertension observed in the Obese was prevented by bosentan, cardiac hypertrophy still occurred and expression of all NOS isoforms remained lower in Obese compared to Lean. Endothelial NOS (eNOS) expression increased in the Lean with bosentan. These studies suggest that cardiac hypertrophy is independent of the level of hypertension and may be mediated by altered production of NOS isoforms in salt-sensitive, obese SHHF.

IgM paraprotein interference with hemoglobin measurement using the CELL-DYN 3500.

A 10-year-old male Labrador Retriever was presented for a 6-week history of polyuria, polydipsia, rear limb weakness, and ocular discharge. The dog had marked hyperproteinemia with an IgM monoclonal gammopathy, as determined by serum protein electrophoresis and immunoelectrophoresis. Cytologic findings in a lymph node aspirate were suggestive for lymphoma, which was confirmed and identified as B cell lineage by immunophenotyping and PCR antigen receptor rearrangement. In the CBC results, marked discrepancy was observed in the hemoglobin (HGB) concentration and MCHC obtained on a CELL-DYN 3500 analyzer (HGB 13.3 g/dL, MCHC 61.4 g/dL) as compared with an IDEXX LaserCyte analyzer (HGB 7.0 g/dL, MCHC 39.2 g/dL). To investigate this discrepancy, plasma was removed from an EDTA-anticoagulated blood sample from the patient, replaced with an equal volume of CELL-DYN diluent, and analyzed on the CELL-DYN. The resulting HGB (6.72 g/dL) and MCHC (33.5 g/dL) results were similar to those obtained initially on the LaserCyte. We concluded that precipitation of IgM paraprotein by the CELL-DYN lyzing reagent, which contains quaternary ammonium salts, falsely increased the spectrophotometric measurement of HGB on the CELL-DYN. The high MCHC was attributed to the false increase in HGB concentration. No interference with HGB measurement occurred with the LaserCyte, which uses a hypotonic solution to lyse RBCs before HGB determination. Paraprotein interference should be considered in veterinary patients with monoclonal gammopathy and unexpectedly high HGB and MCHC values.