Predictive Factors of Renal Recovery and Progression to End-Stage Kidney Disease in Patients With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis With Severe Kidney Disease.

Introduction: A significant number of patients with antineutrophil cytoplasmic antibodies (ANCA)- associated vasculitis (AAV) with glomerulonephritis (AAV-GN) still progress to end-stage kidney disease (ESKD, estimated glomerular filtration rate [eGFR] <15 ml/min per 1.73 m2) despite advances in remission-induction treatment. Methods: This is a retrospective cohort study on myeloperoxidase (MPO)-ANCA or proteinase 3 (PR3)-ANCA positive patients with AAV (microscopic polyangiitis, MPA; or granulomatosis with polyangiitis, GPA) and eGFR <15 ml/min per 1.73 m2 or ESKD at presentation. Renal recovery, dialysis discontinuation, and persistence of ESKD after standard remission-induction, with or without the use of plasma exchange (PLEX) were analyzed. Results: We analyzed 166 patients with biopsy-proven active AAV-GN and eGFR <15 ml/min per 1.73 m2 at the time of diagnosis. Patients received glucocorticoids with cyclophosphamide (CYC) (n = 84) or with rituximab (RTX) (n = 72) for remission-induction, and 49 received PLEX. The predictors of renal recovery were erythrocyte sedimentation rate, serum creatinine (SCr) at diagnosis, and minimal or mild chronicity changes. We further analyzed 71 patients who started dialysis with or without PLEX within 4 weeks of AAV-GN diagnosis. The predictors of dialysis discontinuation were minimal chronicity changes in kidney biopsy at diagnosis (odds ratio = 6.138; 95% confidence interval [CI]: 1.389-27.118; P = 0.017). Predictors of persistence of ESKD within 12 months included higher SCr at diagnosis (incidence rate ratio [IRR] = 1.086; 95% CI: 1.005-1.173; P = 0.037), and moderate (IRR = 3.797; 95% CI: 1.090-13.225; P = 0.036), or severe chronicity changes in kidney biopsy (IRR = 5.883; 95% CI: 1.542-22.439; P =0.009). Conclusion: In our cohort, kidney recovery, dialysis discontinuation, and persistence of ESKD in patients with AAV-GN and eGFR <15 ml/min per 1.73 m2 depended on SCr and histologic findings on kidney biopsies at the time of diagnosis and was not affected by the addition of PLEX.

Nutritional facts regarding commercially available gluten-free bread worldwide: Recent advances and future challenges.

Recently, there has been an increase in demand for gluten-free (GF) products due to the growing number of gluten-intolerant and healthy individuals choosing to follow a gluten-free diet. Gluten-free bread (GFB) is a staple food product; therefore, many recent studies have reported the nutritional properties of GFB. However, an overview of the current ingredients and nutritional labeling of GFB worldwide has not yet been provided. This review aimed to gather the latest information regarding the most used ingredients in GFB formulations and the nutritional quality of these products from different countries, based on studies published in the last decade (2010-2020). Our analysis showed that GFB had a lower protein and a higher fat content than gluten-containing bread, and the dietary fiber content was highly variable between countries. Some studies have revealed a high glycaemic index in most products, which is associated with the extensive use of rice flour and starch as the main ingredients in GFB formulation. Label information presented significant differences from the data obtained through the chemical analysis of fiber and other nutritional components. Micronutrient fortification is not common in the GFB. The nutritional quality of commercial GFB is a crucial issue that needs to be addressed.

Maintenance of Remission and Risk of Relapse in Myeloperoxidase-Positive ANCA-Associated Vasculitis with Kidney Involvement.

BACKGROUND: The optimal strategy for remission-maintenance therapy in patients with myeloperoxidase-ANCA (MPO-ANCA)-associated vasculitis is not established. Defining parameters to guide maintenance therapy is required. METHODS: This was a retrospective cohort study of all patients with MPO-ANCA-associated vasculitis (microscopic with polyangiitis and granulomatosis with polyangiitis) and GN followed at the Mayo Clinic between 1996 and 2015. Relapse rate, MPO-ANCA status, and remission-maintenance therapies were reviewed. Logistic regression models, Kaplan-Meier method, and Cox proportional hazards regression models were applied. RESULTS: We analyzed 159 patients with active MPO-ANCA-associated vasculitis with GN. Sixty-six (42%) patients had at least one relapse, and 52 (33%) relapsed before 60 months. Patients with MPO-ANCA who became persistently negative did not relapse (hazard ratio [HR], 0.03; 95% confidence interval [95% CI], 0.002 to 0.431; P =0.01). The reappearance of MPO-ANCA was associated with a higher risk of relapse (HR, 1.91; 95% CI, 1.109 to 3.293; P =0.02). Immunosuppression was withdrawn in 80 (50%) patients, and this was less likely in those who received cyclophosphamide for remission induction or in patients with persistently positive MPO-ANCA (odds ratio [OR], 0.44; 95% CI, 0.228 to 0.861; P =0.02 and OR, 0.42; 95% CI, 0.213 to 0.820; P =0.01, respectively). Relapse frequency was not different between patients with persistently positive MPO-ANCA and patients with MPO-ANCA reappearance (44% versus 39%, P =0.49), irrespective of remission-maintenance treatment. Ear, nose, and throat involvement (OR, 6.10; 95% CI, 1.280 to 29.010; P =0.02) and MPO-ANCA reappearance (OR, 9.25; 95% CI, 3.126 to 27.361; P <0.001) were independently associated with relapse after treatment withdrawal. CONCLUSIONS: Patients persistently MPO-ANCA negative are at low risk for relapse even without remission-maintenance therapy. Persistence or subsequent reappearance of MPO-ANCA is associated with a higher risk of relapse. PODCAST: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast.aspx?p=CJASN&e=2023_01_10_CJN06460622.mp3.

An integrated instrumental and sensory techniques for assessing liking, softness and emotional related of gluten-free bread based on blended rice and bean flour.

Despite recent scientific advances and the growth of the gluten-free market, important issues such as the improvement of the sensory and nutritional quality of gluten-free bread (GFB) still need to be addressed. Therefore, the aim of the present study was to integrate instrumental and sensory techniques for assessing liking, softness, and emotions related to GFB based on rice flour (RF) and bean flour (BF). Results shows that common BF increases the ash, protein, and dietary fiber content of bread. The RF and BF blend improves dough thermomechanical properties, bread volume, instrumental texture properties and acceptability, as well as being the formulation indicated by consumers as presenting ideal softness, all of which subsequently correlated with positive food-related emotions, based on a facial emojis list. Thus, a RF and BF blend is a valuable ingredient producing nutrient-dense and acceptable GFB, which is important for consumers who choose or must adhere to a gluten-free diet. This research highlights promising predictors able to correlate dough parameters, as well as physical properties of bread with the sensory quality of GFB; this could be helpful to food scientists and producers to conduct extensive sensory and consumer research regarding both commercial and experimental GFB to establish whether those products meet consumer expectations, showing the relevance of continuing studies.

Influence of pseudocereals on gluten-free bread quality: A study integrating dough rheology, bread physical properties and acceptability.

This study describes the use of the Mixture Design for simultaneals to improve the physical properties and acceptability of gluten-free bread (GFB) based on whole pseudocereals flour, as well as to define dough and bread instrumental predictors of the sensory quality of GFB. Three simplex-centroid designs were used to study the effects of each pseudocereal flour (amaranth - AF, buckwheat - BF, and quinoa - QF) blended with rice flour (RF) and potato starch (PS) on dough and bread properties. A total of 30 GFB formulations were produced and evaluated. Results reveal relationships between dough Mixolab parameters, such as C3 and C4, related to gelatinization and starch stability, with crumb moisture and firmness of GFB formulation, in which higher values of these parameters related to higher acceptability scores (>7 on a 10 cm hydroid hedonic scale). However, higher values of the secondary parameter C3-C4 was related to lower loaf-specific volume, impairing appearance and texture acceptability, as well as overall liking. The interaction effects between pseudocereal flour and RF increases dough consistency, bread volume, softness, and acceptability. Blends of 50% AF, BF, or QF with 50% RF results in GFB with high acceptability (overall liking of 8). The maximum pseudocereal proportions to obtain acceptable GFB (scores ≥ 7 for appearance, color, odor, texture, flavor acceptability and overall liking) were 60% AF, 85% BF, and 82% QF blended with RF. The combination of instrumental and sensory methods was useful to identify parameters capable of predicting the GFB quality, which may be useful for food scientists and producers to face the challenges regarding the development of healthier and better quality GFB to meet consumer needs.

Analysis of ingredient and nutritional labeling of commercially available gluten-free bread in Brazil.

This study aimed at evaluating the ingredients and nutritional information of commercially-available gluten-free bread (GFB) in Brazil. A total of 128 products were studied, of which 87% presented the sandwich loaf shape. Traditional GFBs (n = 114) had as main ingredient the refined rice flour and starches, whereas alternative ones (n = 14) presented whole rice flour. Raw materials suggested by science to improve nutrients and bioactive compounds of gluten-free foodstuffs were observed in the ingredient list of most products (n = 86); however, they were used in lower levels, thus no significant differences were observed for nutritional information between the different categories of GFB. No products with added vitamins or minerals were found, though 77% of them included hydrocolloids in their formulations - other food additives were also observed. Despite the increased gluten-free food market, there is still a gap between science and market, especially regarding the approaches to improve the GFB diversity and nutritional quality.

Mixture Design Applied to the Development of Chickpea-Based Gluten-Free Bread with Attractive Technological, Sensory, and Nutritional Quality.

The aim of the study was utilized chickpea to create appealing, nutritious, and palatable gluten-free bread (GFB). The performance of chickpea flour (CF) in single and composite GFB formulations was studied with a mixture design and response surface methodology. Six simplex-centroid designs for 3 ingredients were used to identify the ideal proportions of CF in various blends with cassava starch (CS), maize starch (MS), potato starch (PS), and rice flour (RF) achieving the best physical properties. For each design, 3 single, 3 binary, and 3 ternary formulations were prepared. The results showed that CF alone is suitable for bread production, resulting in GFB with higher volume and crumb firmness and lower crumb moisture than single formulations of other raw materials. However, the interactions between CF and PS or CS enhanced the loaf volume and decreased the crumb firmness values. The GFB prepared with only CF was accepted (overall acceptability score of 7.1- on a 10-cm scale). Nevertheless, the composite formulations prepared with CF75:PS25 or CF75:CS25 (flour basis) received overall acceptability scores of 8.2, like those of their white GFB, prepared with RF50:PS50 blend (flour basis), and wheat bread counterparts, used as positive controls. Compared to white GFB, both composite formulations presented nearly a twofold increase in ash and protein contents and a threefold increase in total fiber content. These results show that blends of CF75:PS25 or CF75:CS25 can be used to develop GFB with a good physical and sensory properties, as well as an enhanced nutritional composition. PRACTICAL APPLICATION: Gluten-free bread (GFB) made with 75% chickpea flour (CF) blend with 25% potato or cassava starch showed improved total minerals, protein and dietary fiber content and bread quality characteristics. Therefore, CF is a valuable ingredient for food technologists in manufacturing better-tasting and healthy GFB, which is important for consumers with gluten-related disorders since GFB often lack nutrition content, appearance, texture, and mouthfeel.

Enhanced TH17 Responses in Patients with IL10 Receptor Deficiency and Infantile-onset IBD.

BACKGROUND: IL10 receptor (IL10R) deficiency causes severe infantile-onset inflammatory bowel disease. Intact IL10R-dependent signals have been shown to be important for innate and adaptive immune cell functions in mice. We have previously reported a key role of IL10 in the generation and function of human anti-inflammatory macrophages. Independent of innate immune cell defects, the aim of the current study was to determine the role of IL10R signaling in regulating human CD4 T-cell function. METHODS: Peripheral blood mononuclear cells and intestinal biopsies cells were collected from IL10/IL10R-deficient patients and controls. Frequencies of CD4 T-cell subsets, naive T-cell proliferation, regulatory T cell (Treg)-mediated suppression, and Treg and TH17 generation were determined by flow cytometry. Transcriptional profiling was performed by NanoString and quantitative real-time polymerase chain reaction. RNA in situ hybridization was used to determine the quantities of various transcripts in intestinal mucosa. RESULTS: Analysis of 16 IL10- and IL10R-deficient patients demonstrated similar frequencies of peripheral blood and intestinal Tregs, compared with control subjects. In addition, in vitro Treg suppression of CD4 T-cell proliferation and generation of Treg were not dependent on IL10R signaling. However, IL10R-deficient T naive cells exhibited higher proliferative capacity, a strong TH17 signature, and an increase in polarization toward TH17 cells, compared with controls. Moreover, the frequency of TH17 cells was increased in the colon and ileum of IL10R-deficient patients. Finally, we show that stimulation of IL10R-deficient Tregs in the presence of IL1ß leads to enhanced production of IL17A. CONCLUSIONS: IL10R signaling regulates TH17 polarization and T-cell proliferation in humans but is not required for the generation and in vitro suppression of Tregs. Therapies targeting the TH17 axis might be beneficial for IL10- and IL10R-deficient patients as a bridge to allogeneic hematopoietic stem cell transplantation.

Development of gluten-free bread formulations containing whole chia flour with acceptable sensory properties.

Increasing the variety of better-tasting and healthier gluten-free products is important for consumers with gluten-related disorders. This work aimed to develop a gluten-free bread formulation containing whole chia flour with acceptable sensory properties. A mixture design for three ingredients and response surface methodology were used to identify the proportions of potato starch, rice flour and whole chia flour to achieve the best physical properties and result in sensory-accepted products. The physical properties and visual appearance showed that whole chia flour alone is not suitable for bread production. Nevertheless, it is possible to add up to 14% whole chia flour to a rice flour-based gluten-free bread formulation while negligibly diminishing the loaf volume, crumb firmness and crumb moisture. The best formulations were prepared from rice flour blends with 5, 10, and 14% whole chia flour, which received overall acceptability scores of 8.7, 8.1 and 7.9 on a 10-cm scale, respectively, similar to those of their white gluten-free bread and wheat bread counterparts. Incorporating 5%-14% whole chia flour in the formulation increased the levels of ash, lipid, protein and dietary fiber compared to those of the white gluten-free bread.

Antibacterial Performance of a PCL-PDMAEMA Blend Nanofiber-Based Scaffold Enhanced with Immobilized Silver Nanoparticles.

In the present study, nanofiber meshes (NFs), composed of polycaprolactone and poly[(2-dimethylamino)ethyl methacrylate] at 80/20 and 50/50 PCL/PDMAEMA blend ratios, were obtained through electrospinning. Silver nanoparticles (AgNPs) formed in situ were then immobilized on NF surfaces through adsorption processes at different pHs. It was possible to observe that the amount of NF-AgNPs can be tuned by changing the pH of AgNPs immobilization and the PCL/PDMAEMA ratio in the blend. The neat NF and NF-AgNPs were characterized with respect to their morphology and mechanical properties. The effects of AgNPs on the antibacterial activities and cytotoxicity of meshes were also evaluated. The antibacterial performance of such NF was improved by the presence of AgNPs. The NF-AgNPs presented good antibacterial effect against S. aureus and partial toxicity against E. coli and P. aeruginosa. Also, compared with neat PCL/PDMAEMA the NF-AgNPs presented lower cytotoxicity against VERO cells, showing their potential for applications in tissue engineering for different types of cell growth.

Interleukin-10 receptor signaling in innate immune cells regulates mucosal immune tolerance and anti-inflammatory macrophage function.

Intact interleukin-10 receptor (IL-10R) signaling on effector and T regulatory (Treg) cells are each independently required to maintain immune tolerance. Here we show that IL-10 sensing by innate immune cells, independent of its effects on T cells, was critical for regulating mucosal homeostasis. Following wild-type (WT) CD4(+) T cell transfer, Rag2(-/-)Il10rb(-/-) mice developed severe colitis in association with profound defects in generation and function of Treg cells. Moreover, loss of IL-10R signaling impaired the generation and function of anti-inflammatory intestinal and bone-marrow-derived macrophages and their ability to secrete IL-10. Importantly, transfer of WT but not Il10rb(-/-) anti-inflammatory macrophages ameliorated colitis induction by WT CD4(+) T cells in Rag2(-/-)Il10rb(-/-) mice. Similar alterations in the generation and function of anti-inflammatory macrophages were observed in IL-10R-deficient patients with very early onset inflammatory bowel disease. Collectively, our studies define innate immune IL-10R signaling as a key factor regulating mucosal immune homeostasis in mice and humans.

Chronic Low Back Pain in Women: Muscle Activation during Task Performance.

[Purpose] The aim of this study was to compare the activities of the trunk and hip muscles in chronic low back pain (CLBP) women and asymptomatic subjects during the kneeling to half-kneeling task. [Subjects] Twenty-nine CLBP women and thirty asymptomatic subjects (C) participated in this study. [Methods] Electromyography activity (EMG) of the obliquus internus abdominis (OI), the lumbar erector spinae (LES) and the gluteus medius (GM) muscles was recorded bilaterally. The peak amplitude, the time of peak amplitude and the integrated linear envelope EMG for each muscle were obtained. [Results] The C group bilateral OI and GM muscles displayed higher peak amplitudes and earlier times of peak amplitude. They also had higher integrated linear envelope EMG values. The CLBP group bilateral LES muscles had higher peak amplitudes and earlier times of peak amplitude. They also showed an increased integrated linear envelope EMG values. [Conclusion] The CLBP women activate the LES muscles in the kneeling to half-kneeling task, showing different patterns of motor planning activity.