Usefulness of soluble CD163 as a biomarker for macrophage activation syndrome associated with systemic lupus erythematosus.

OBJECTIVE: We aimed to study the usefulness of serum soluble CD163 (sCD163) as a biomarker for macrophage activation syndrome (MAS) associated with systemic lupus erythematosus (SLE). METHODS: Serum sCD163 levels were retrospectively measured by enzyme-linked immunosorbent assay for SLE patients associated with MAS (SLE-MAS), lupus nephritis (LN), or autoimmune hemolytic anemia (AIHA) and/or immune thrombocytopenia (ITP) and healthy controls (HCs). Posttreatment samples were also evaluated in the available SLE-MAS patients. The associations between serum sCD163 levels and clinical information were statistically analyzed. RESULTS: The serum sCD163 levels in SLE-MAS, LN and SLE-AIHA/ITP groups were significantly higher than those in HCs (n = 17, 29, 13, and 68, respectively; p < 0.01 for all comparisons). In addition, the serum sCD163 levels in the SLE-MAS group were even higher than those in the LN and SLE-AIHA/ITP groups (p < 0.01 for both comparisons). Serum sCD163 levels were correlated with the SLE Disease Activity Index 2000 scores (r = 0.53), whereas they were not correlated with the serum ferritin levels. With the determined cut-off value, the sensitivity and specificity of serum sCD163 for the diagnosis of SLE-MAS were 59% and 86%, respectively. Retesting showed that the serum sCD163 levels decreased significantly following treatment in parallel with disease amelioration in the SLE-MAS group (p < 0.01). CONCLUSIONS: The present study suggests the usefulness of serum sCD163 as a diagnostic and disease-activity biomarker for SLE-associated MAS. Serum sCD163 might also have a different role as a biomarker for SLE-associated MAS than serum ferritin does.

Multi-factorial investigation of various housing systems for laying hens.

1. The advantages and disadvantages of various housing systems for laying hens were compared as a pilot study for work in commercial conditions. 2. At 16 weeks of age, 284 hens were introduced into one of 6 housing systems: two types of conventional cages (small: SC; large: LC), furnished cages (small: SF; large: LF), and non-cage systems (single-tiered aviary: SA; free-range: FR). 3. We evaluated the welfare, egg production, and immune response of the birds in these housing systems, built in the same location, for 18 months. For welfare evaluation, we examined their ethology, physiology, anatomy, production, and physical condition. 4. The non-cage systems, especially FR, had a low score for freedom from pain, injury, and disease, together with other disadvantages, such as pale eggs and increased feed intake for production. However, the score for freedom to express normal behaviour was high and immune response was good in the non-cage systems. 5. In the furnished cages, behaviour was more diverse in SF than in LF, and in SF immune response was comparable with the non-cage systems. 6. For freedom from fear and distress, the non-cage systems had high scores for some indicators such as TI duration, H/L ratio and claw length, while aggressive pecking and feather pecking was worse in the housing systems with large group sizes.

Relation between social order and use of resources in small and large furnished cages for laying hens.

1. The objective was to determine the relation between social rank and use of resources in a small furnished cage with sufficient resources per hen (SF) and a commercial large one with less adequate allowance of facilities per hen (LF). 2. Ninety-two cross layers were used. At the age of 16 weeks, the hens were divided at random into two groups. There were 4 furnished cages with 5 birds per cage and 4 large furnished cages with 18 birds per cage. The dominance hierarchy was determined, in which highest, medium and lowest ranking hens in each cage were identified. Behaviour, use of facilities and physical conditions of these hens were measured (one in each rank category in SF, two in each in LF). 3. Dustbathing and litter scratching were more frequent in the high ranking hens than the medium and low ranked hens in LF, while no significant difference was found between them in SF. 4. No significant difference between SF and LF was found in use of nest boxes. However, pre-laying sitting tended to be less frequent in low ranking than medium and high ranking hens in LF (Social order x Cage design). In the nest box most of time was spent in pre-laying sitting by SF hens, LF high and medium ranked hens (average 94.9%). However, LF low ranking hens spent their time escaping (33.1%), pre-laying sitting (27.7%) standing (25.7%) and moving (13.5%) in the nest. 5. In the large furnished cages with less facilities per hen, high ranking hens may be expected to have priority using the dust bath. In contrast, low ranking hens rarely performed nesting behaviour fully, and spend more time using the nest box as a refuge than for laying.

Pecking behaviour of laying hens in single-tiered aviaries with and without outdoor area.

1. The objective of the present study was to examine the behaviour of laying hens in single-tiered aviaries with and without outdoor areas with particular reference to the proportion of each behaviour and the ways it changed. 2. In all, 144 interbred cross layers (WL/RIR cross-breed) were used. At the age of 16 weeks, the hens were divided at random into two groups and moved to single-tiered aviary (SA) and free-range systems (FR, SA with in addition an outdoor range area covered with clover) with 18 hens per pen. Behavioural observations were conducted before, during and after access to the range. 3. All behaviours using the beak (eating, grazing, drinking, preening, aggressive pecking, feather pecking, litter pecking, object pecking and mate pecking) were recorded as pecking behaviour. 4. While most of the FR hens spent their time outside foraging, the proportion of hens eating, preening, litter pecking, object pecking, aggressive pecking and feather pecking was higher in SA than in FR hens. 5. The proportion of hens performing pecking behaviour of all types was very similar in SA (61.7 +/- 2.0%) and in FR (64.0 +/- 0.8%). The proportion of hens performing overall pecking behaviour increased as pre-laying sitting decreased. 6. The proportion of hens feather pecking decreased in FR during access to range and a similar tendency was found for aggressive pecking. 7. In conclusion, the total proportion of hens pecking was almost the same regardless of whether an outdoor area was provided or not, but the incidence of different types of pecking behaviour differed between SA and FR. The risk of feather pecking in FR may be lower when an outdoor grazing area is provided, although further testing on a larger scale would be essential.

[Current status and problems of home care for patients with terminal cancer from the viewpoint of local clinics].

On the basis of investigations of 15 patients from our clinic with terminal cancer who were treated by home hospice care, and questionnaires filled out by their caretakers, we examined the current status and problems of the home hospice care system with respect to four phases, namely, the period of preparation for home care (hospitalization period), stable period, terminal period, and the period immediately before death. [Preparation period] The following problems occurred in this phase: introduction of pain management and nutrition management was insufficient; there were only a few cases in which the patient chose home care of his or her own will; and sufficient instructions were not given to caretakers on discharge from the hospital, with respect to medical treatment at home. [Stable period] In two of the four cases in which patients complained of severe pain, the pain was not alleviated because pain management was provided only at the outpatient clinics of the hospital, and collaboration between hospitals and our clinic was insufficient. [Terminal period] Two patients could not be admitted to the hospital upon sudden exacerbation of the condition, suggesting the need to establish a system in which large hospitals can cope with sudden exacerbation of their condition of patients with terminal cancer treated at home. [Period immediately before death] Of the 14 patients who died, 7 died at home and 7 died in the hospital or during transport to the hospital. Three subjects died within a few days after admission. Two of the subjects who died in the hospital or during transport had hoped to stay home until the last moment. Further improvement of the system is necessary in order to meet the needs of terminal cancer patients who wish to die at home. On the basis of the cases taken care of at our clinic, we examined the home care system according classification into three types; hospital-outpatient clinic type; hospital-home care type; and clinic-home care type. An ideal system for the treatment of patients with terminal cancer who hope to stay at home until the last possible moment seems to be the clinic-home care type in which a primary care team that is able to dispatch physicians and nurses, and an around-the-clock support system, are supported by outside organizations and specialists.