Machine Learning for Seed Quality Classification: An Advanced Approach Using Merger Data from FT-NIR Spectroscopy and X-ray Imaging.

Optical sensors combined with machine learning algorithms have led to significant advances in seed science. These advances have facilitated the development of robust approaches, providing decision-making support in the seed industry related to the marketing of seed lots. In this study, a novel approach for seed quality classification is presented. We developed classifier models using Fourier transform near-infrared (FT-NIR) spectroscopy and X-ray imaging techniques to predict seed germination and vigor. A forage grass (Urochloa brizantha) was used as a model species. FT-NIR spectroscopy data and radiographic images were obtained from individual seeds, and the models were created based on the following algorithms: linear discriminant analysis (LDA), partial least squares discriminant analysis (PLS-DA), random forest (RF), naive Bayes (NB), and support vector machine with radial basis (SVM-r) kernel. In the germination prediction, the models individually reached an accuracy of 82% using FT-NIR data, and 90% using X-ray data. For seed vigor, the models achieved 61% and 68% accuracy using FT-NIR and X-ray data, respectively. Combining the FT-NIR and X-ray data, the performance of the classification model reached an accuracy of 85% to predict germination, and 62% for seed vigor. Overall, the models developed using both NIR spectra and X-ray imaging data in machine learning algorithms are efficient in quickly, non-destructively, and accurately identifying the capacity of seed to germinate. The use of X-ray data and the LDA algorithm showed great potential to be used as a viable alternative to assist in the quality classification of U. brizantha seeds.

Comparison of Spot Urine Protein to Creatinine Ratio to 24-Hour Proteinuria to Identify Important Change Over Time in Proteinuria in Lupus.

OBJECTIVES: The aim of this study was to determine whether spot urine protein-to-creatinine ratio (PCR) accurately measures the change in proteinuria compared with 24-hour proteinuria (24H-P). METHODS: This was a retrospective analysis on patients' paired visits and paired urine samples for PCR and 24H-P. Patients with both abnormal 24H-P (>0.5 g/d) and PCR (>0.05 g/mmol) or both normal 24H-P (≤0.5 g/d) and PCR (≤0.05 g/mmol) at baseline visit were identified.The first follow-up visit with partial recovery (50% decrease in proteinuria) or complete recovery (≤0.5 g/d) was identified for those with abnormal baseline 24H-P, and new proteinuria (>0.5 g/d) was identified for those with normal 24H-P. Twenty-four-hour urine collection and PCR end-point frequencies were compared. Twenty-four-hour urine collection results were converted to 24H-PCR. Twenty-four-hour PCR and PCR were utilized to measure the magnitude of change (by standardized response mean [SRM]) in patients who achieved the end points. RESULTS: Of 230 patients, at baseline, 95 patients had abnormal and 109 had normal 24H-P and PCR. On follow-up, 57 achieved partial recovery, and 53 achieved complete recovery by 24H-P. Standardized response mean was -1.03 and -1.10 for 24H-PCR and PCR, respectively. By PCR, 53 patients had partial recovery, and 27 had complete recovery. Standardized response mean was -1.25 and -0.86 by 24H-PCR and PCR, respectively.For new proteinuria, 28 patients were identified by 24H-P and 21 by PCR. Twenty-four-hour PCR SRM was 0.80, and PCR SRM was 0.68. CONCLUSIONS: Protein-to-creatinine ratio does not have sufficient accuracy compared with 24H-P for improvement and worsening to be used in lieu of 24H-P.

Soil organic carbon sequestration potential explained by mineralogical and microbiological activity using spectral transfer functions.

The ability of soil to sequester carbon and reduce atmospheric CO2 concentrations is limited and depends on the soil minerals and their interaction with the microbiota. Microbial activities are closely associated with the types and amounts of soil organic matter (SOM) and clay minerals that have functional groups that interact with energy in Vis NIR-SWIR and Mid-IR wavelengths. The main objective of this research was to determine, based on these spectral ranges, the relation between mineralogical and organic compounds, as their sequestration and specialization in soils from Brazil. It was possible to map microbiological activity by spectral transfer functions and digital soil mapping reaching R2 from 0.77 to 0.85. Multiple regression equations were constructed to quantify enzymatic activity, microbial biomass carbon (MBC), particulate organic matter (POM), and resistant forms of carbon, and SOM associated with the mineral fraction (MAOM). All these properties were detected by specific bands obtained with the recursive feature elimination (RFE) algorithm, reaching correlations from 0.64 to 0.98 in specific ranges. The prediction model of the carbon sequestration potential was adjusted with microbiological and mineralogical variables from Vis-NIR-SWIR and the Mid-IR spectral range. A SARAR double autoregressive model was adjusted with r 0.61 and to a spatial error model (SEM) with r 0.7. The explanatory variables were associated with kaolinite, hematite, goethite, gibbsite, and the abundance of fungi, actinomycetes, vesico-arbuscular mycorrhizal fungi, enzymatic activity of beta-glucosidase, urease and phosphatase, and POM. Among the microbiological variables, the general abundance of fungi was the most important, in contrast to enzymatic activity that was the least important. The interaction between the different maps constructed and historical land use allowed the identification of areas that contribute to sequestering new carbon and could be the key to climate change mitigation strategies.

Geotechnologies on the phosphorus stocks determination in tropical soils: General impacts on society.

Phosphorus (P) is a critical nutrient for primary production in terrestrial and aquatic ecosystems. As P mineral reserves are finite and non-renewable, there is an increasing discussion on its sustainable utilization to safeguard food security for future generations. Understanding the spatial distribution of soil P is central in advancing effective phosphorus management and fostering sustainable agricultural practices. This study aims to digitally map the stocks of available P (AP) and total P (TP) in Brazil at a fine resolution (30 m). Using the Random Forest machine learning algorithm and a database of topsoil (0-20 cm) with 28,572 samples for AP and 3154 for TP, we predicted P stocks based on environmental covariates related to soil formation processes. By dividing Brazil into two sub-regions, representing areas with native coverage and anthropogenic ones, we built independent predictive models for each sub-region. Our results show that Brazil has a TP stock of 531 Tg and an AP stock of 17.4 Tg. The largest soil TP stocks are in the Atlantic Forest biome (73.8 g.m2), likely due to higher organic carbon stocks in this biome. The largest AP stocks were in the Caatinga biome (2.51 g.m2) because of younger soils with low P adsorption capacity. We also found that fertilizer use significantly increased AP stocks in agricultural areas compared to native ones. Our results indicated that AP stocks strongly influenced Brazil's agricultural production, with a correlation coefficient ranging from 0.20 for coffee crops to 0.46 for soybean. The maps generated in this study are expected to contribute to the sustainable use of P in agriculture and environmental systems.

Femoroplasty: a new option for femur metastasis.

Bone metastases are very frequent in patients with cancer and usually are located in the patient's long bones and spine. Various approaches to pain relief and stability to the affected bone have been used. The aim of the study is to report our experience with a new minimally invasive percutaneous technique in patients with bone metastases located in the head, neck, and proximal femur. The technique is performed under fluoroscopic guidance through the application of polymethylmethacrylate bone cement. Our descriptive, retrospective, longitudinal case series included 15 patients who underwent femoroplasty. All patients reported pain reduction and improved mobility, with no complications observed. The femoroplasty procedure caused pain relief by stabilizing the bone through the consolidation of the microfractures because of bone metastases.

Remote sensing imagery detects hydromorphic soils hidden under agriculture system.

The pressure for food production has expanded agriculture frontiers worldwide, posing a threat to water resources. For instance, placing crop systems over hydromorphic soils (HS), have a direct impact on groundwater and influence the recharge of riverine ecosystems. Environmental regulations improved over the past decades, but it is difficult to detect and protect these soils. To overcome this issue, we applied a temporal remote sensing strategy to generate a synthetic soil image (SYSI) associated with random forest (RF) to map HS in an 735,953.8 km2 area in Brazil. HS presented different spectral patterns from other soils, allowing the detection by satellite sensors. Slope and SYSI contributed the most for the prediction model using RF with cross validation (accuracy of 0.92). The assessments showed that 14.5% of the study area represented HS, mostly located inside agricultural areas. Soybean and pasture areas had up to 14.9% while sugar cane had just 3%. Here we present an advanced remote sensing technique that may improve the identification of HS under agriculture and assist public policies for their conservation.

Digital mapping of the soil available water capacity: tool for the resilience of agricultural systems to climate change.

Soil available water capacity (AWC) is a key function for human survival and well-being. However, its direct measurement is laborious and spatial interpretation is complex. Digital soil mapping (DSM) techniques emerge as an alternative to spatial modeling of soil properties. DSM techniques commonly apply machine learning (ML) models, with a high level of complexity. In this context, we aimed to perform a digital mapping of soil AWC and interpret the results of the Random Forest (RF) algorithm and, in a case study, to show that digital AWC maps can support agricultural planning in response to the local effects of climate change. To do so, we divided this research into two approaches: In the first approach, we showed a DSM using 1857 sample points in a southeastern region of Brazil with laboratory-determined soil attributes, together with a pedotransfer function (PTF), remote sensing and DSM techniques. In the second approach, the constructed AWC digital soil map and weather station data were used to calculate climatological soil water balances for the periods between 1917-1946 and 1991-2020. The result showed the selection of covariates using Shapley values as a criterion contributed to the parsimony of the model, obtaining goodness-of-fit metrics of R2 0.72, RMSE 16.72 mm m-1, CCC 0.83, and Bias of 0.53 over the validation set. The highest contributing covariates for soil AWC prediction were the Landsat multitemporal images with bare soil pixels, mean diurnal, and annual temperature range. Under the current climate conditions, soil available water content (AW) increased during the dry period (April to August). May had the highest increase in AW (∼17 mm m-1) and decrease in September (∼14 mm m-1). The used methodology provides support for AWC modeling at 30 m resolution, as well as insight into the adaptation of crop growth periods to the effects of climate change.

Rhino-Orbital-Cerebral Mucormycosis in a Post-COVID-19 Patient from Peru.

Mucormycosis has been reported increasingly in patients affected by COVID-19, especially in India where the first cases were described. In Latin America, there is limited information about this association, mainly coming from Brazil, Mexico, and Peru. Herein, we report the case of a 66-year-old female that presented with rhino-orbital-cerebral mucormycosis, diabetic ketoacidosis, and COVID-19. The patient had the compromise of all the sinuses, orbital invasion, and intracranial extension. Isavuconazole was promptly initiated because amphotericin B was not available. She had a single open surgical debridement of necrotic tissues at the beginning of the diagnosis then multiple manual sessions to clear the residual or recurrent disease during approximately 5 months. Isavuconazole was effective and well-tolerated for 10 months without side effects. We highlight the importance of considering mucormycosis in post-COVID-19 patients with uncontrolled diabetes. The report emphasizes the favorable outcome of isavuconazole as an alternative therapy.

Assessment of Vegetative Growth and Genetic Integrity of Vanilla planifolia Regenerants after Cryopreservation.

Vanilla planifolia Jacks. ex Andrews is the vanilla species with the most commercial and greatest economic importance. It has been used as a case study in different cryopreservation studies that involve three vitrification-based approaches: droplet-vitrification (D-V), V-cryoplate (V-Cp) and D-cryoplate (D-Cp). The aim of this study was to compare the impact of these cryogenic techniques on vegetative growth (survival, stem length and leaf number) between cryo-derived plants and in vitro-derived controls during 12 months of greenhouse growth. Genetic stability was also assessed using the inter-simple sequence repeat (ISSR) markers. There were no significant differences found in the survival and stem lengths of the in vitro-derived regenerants and cryo-derived plants. A significant increase in the number of leaves was only detected in cryo-derived plants when using the V-Cp method. The electrophoretic profiles, based on seven ISSR primers, detected low variability: 81 total bands and 27% polymorphism. This is the first report on the assessment of vegetative growth and genetic integrity in cryo-derived V. planifolia plants recovered under greenhouse conditions. Of the three cryogenic approaches, D-Cp appears to yield V. planifolia regenerants plants with more vigorous vegetative growth and a lower level of polymorphism. Future research should focus on the reproductive growth of vanilla regenerants.

Discrimination and mental health in the minority sexual population: Cross-sectional analysis of the first peruvian virtual survey.

OBJECTIVE: This study sought to evaluate the association between discrimination and having mental health problems in the past 12 months in the sexual minority population in Peru. METHODS: We conducted a cross-sectional analysis of a secondary database corresponding to the first LGBTI survey in Peru in 2017. We included adults who self-identified their sexual orientation as gay, lesbian, bisexual, pansexual, or asexual/others. Both the exposure and dependent variables were self-reported by the participants. Multivariable Poisson regression was used to determine the association by calculating adjusted prevalence ratios (APR) with 95% confidence intervals (95% CI). RESULTS: Out of 9760 respondents, more than two-thirds of the participants reported having been discriminated against or having experienced violence at some time in their lives (70.3%) and one-fourth reported having mental health problems (23.8%). In the multivariable regression model, the prevalence of mental health problems in the last 12 months was 72% higher for the group of individuals who experienced discrimination when compared with the group that did not experience discrimination (APR = 1.72, 95% CI 1.57-1.88). The association was stronger among who self-identified lesbians (APR = 2.08, 95% CI 1.65-2.64). CONCLUSION: The prevalence of mental health problems and discrimination was high in this population. In addition, we found a statistically significant association between discrimination and the occurrence of mental health problems in the last 12 months.

A remote sensing framework to map potential toxic elements in agricultural soils in the humid tropics.

Soil contamination by potentially toxic elements (PTEs) is one of the greatest threats to environmental degradation. Knowing where PTEs accumulated in soil can mitigate their adverse effects on plants, animals, and human health. We evaluated the potential of using long-term remote sensing images that reveal the bare soils, to detect and map PTEs in agricultural fields. In this study, 360 soil samples were collected at the superficial layer (0-20 cm) in a 2574 km2 agricultural area located in São Paulo State, Brazil. We tested the Soil Synthetic Image (SYSI) using Landsat TM/ETM/ETM+, Landsat OLI, and Sentinel 2 images. The three products have different spectral, temporal, and spatial resolutions. The time series multispectral images were used to reveal areas with bare soil and their spectra were used as predictors of soil chromium, iron, nickel, and zinc contents. We observed a strong linear relationship (-0.26 > r > -0.62) between the selected PTEs and the near infrared (NIR) and shortwave infrared (SWIR) bands of Sentinel (ensemble of 4 years of data), Landsat TM (35 years data), and Landsat OLI (4 years data). The clearest discrimination of soil PTEs was obtained from SYSI using a long term Landsat 5 collection over 35 years. Satellite data could efficiently detect the contents of PTEs in soils due to their relation with soil attributes and parent materials. Therefore, distinct satellite sensors could map the PTEs on tropics and assist in understanding their spatial dynamics and environmental effects.

Interposition Arthroplasty in Untreated Chronic Dislocation of the Elbow.

OBJECTIVE: To describe the clinical outcomes of interposition arthroplasty with transposition of the medial epicondyle to the coronoid process and articulated external fixation in patients with untreated chronic dislocation of the elbow. METHODS: Fourteen consecutive patients diagnosed with untreated chronic elbow dislocation performed a complete radiological and physical examination. The same surgeon treated all patients with a same technique. Passive mobilization started immediately in addition to the vigorous care of the surgical wound and surrounding skin. RESULTS: A total of 14 patients were treated, with a mean age of 31 years, with the nondominant side being the most affected (65%). In the immediate postoperative period, the initial Mayo Elbow Performance Score was 60 pts. In all cases, the distraction from the articulated fixator was removed, and there was an average of 16 pts improvement at the time of removal. A hinged elbow orthosis was placed for 4 weeks starting strengthening and obtained radiographic integration of the neocoronoids; ranges of motion of flexion 122°, extension -6°, and pronosupination 70°, without data of any direction instability. CONCLUSION: Considering that this is one of the longest series with a follow-up of more than 60 months of evolution in our patients, the result is completely satisfactory, achieving the objective of a minimum range of motion of 100° in addition to elbow stability.

Ghrelin level as a biomarker for knee osteoarthritis severity and appearance in HIV + patients.

BACKGROUND: Knee Osteoarthritis (KOA) is a multifactorial disease with several mechanisms to promote articular cartilage damage. New molecules, such as ghrelin, have been recently reported to participate in the pathogenesis and progression of KOA. In HIV + patients, arthralgias are the most frequent musculoskeletal manifestations, mainly affecting joints such as the knee. Also, it has been reported that HIV + patients have a reduction of ghrelin even with treatment compared to HIV- patients. However, there is no report in the literature evaluating ghrelin and KOA in the HIV + population. We aimed to evaluate whether serum ghrelin levels can function as a biomarker for OA in HIV + patients. METHODS: We recruited 40 patients, 20 HIV+, and 20 HIV- controls, and grouped as follows: HIV+/KOA+; HIV+/KOA-; HIV-/KOA+; HIV-/KOA-. Clinical features were obtained during clinical visits. Peripheral blood samples were acquired to measure serum ghrelin levels. RESULTS: The HIV+/KOA + group significantly reduced serum ghrelin levels when compared with the other groups. Comparing the ghrelin levels with the patients' nadir of CD4+ T-cells count, we identified a statistically significant negative correlation in the KOA- group (r = -0.80, P < 0.007). An ROC curve analysis, for the accuracy of ghrelin levels to identified HIV+/KOA + from HIV+/KOA- patients, found an area under the curve of 0.83 (95 % CI 0.65-0.10; P = 0.017), with a cut-off < 4026 pg/mL serum ghrelin levels, with a sensitivity of 0.62 (95 % CI 0.32-0.86), and a specificity of 0.10 (95 % CI 0.59-0.10). CONCLUSION: This study shows the potential use of ghrelin levels as a biomarker for KOA in the high-risk HIV population that should be further analyzed.

Metastable Brominated Nanodiamond Surface Enables Room Temperature and Catalysis-Free Amine Chemistry.

Bromination of high-pressure, high-temperature (HPHT) nanodiamond (ND) surfaces has not been explored and can open new avenues for increased chemical reactivity and diamond lattice covalent bond formation. The large bond dissociation energy of the diamond lattice-oxygen bond is a challenge that prevents new bonds from forming, and most researchers simply use oxygen-terminated NDs (alcohols and acids) as reactive species. In this work, we transformed a tertiary-alcohol-rich ND surface to an amine surface with ∼50% surface coverage and was limited by the initial rate of bromination. We observed that alkyl bromide moieties are highly labile on HPHT NDs and are metastable as previously found using density functional theory. The strong leaving group properties of the alkyl bromide intermediate were found to form diamond-nitrogen bonds at room temperature and without catalysts. This robust pathway to activate a chemically inert ND surface broadens the modalities for surface termination, and the unique surface properties of brominated and aminated NDs are impactful to researchers for chemically tuning diamond for quantum sensing or biolabeling applications.

A real-time tool positioning sensor for machine-tools.

In machining, natural oscillations, and elastic, gravitational or temperature deformations, are still a problem to guarantee the quality of fabricated parts. In this paper we present an optical measurement system designed to track and localize in 3D a reference retro-reflector close to the machine-tool's drill. The complete system and its components are described in detail. Several tests, some static (including impacts and rotations) and others dynamic (by executing linear and circular trajectories), were performed on two different machine tools. It has been integrated, for the first time, a laser tracking system into the position control loop of a machine-tool. Results indicate that oscillations and deformations close to the tool can be estimated with micrometric resolution and a bandwidth from 0 to more than 100 Hz. Therefore this sensor opens the possibility for on-line compensation of oscillations and deformations.

Brief Report: How Do Patients With Newly Diagnosed Systemic Lupus Erythematosus Present? A Multicenter Cohort of Early Systemic Lupus Erythematosus to Inform the Development of New Classification Criteria.

OBJECTIVE: Systemic lupus erythematosus (SLE) presents with nonspecific signs and symptoms that are also found in other conditions. This study aimed to evaluate manifestations at disease onset and to compare early SLE manifestations to those of diseases mimicking SLE. METHODS: Academic lupus centers in Asia, Europe, North America, and South America collected baseline data on patients who were referred to them during the previous 3 years for possible SLE and who had a symptom duration of <1 year. Clinical and serologic manifestations were compared between patients diagnosed as having SLE and those diagnosed as having SLE-mimicking conditions. Diagnostic performance of the 1997 American College of Rheumatology (ACR) SLE classification criteria and the 2012 Systemic Lupus International Collaborating Clinics (SLICC) SLE classification criteria was tested. RESULTS: Data were collected on 389 patients with early SLE and 227 patients with SLE-mimicking conditions. Unexplained fever was more common in early SLE than in SLE-mimicking conditions (34.5% versus 13.7%, respectively; P < 0.001). Features less common in early SLE included Raynaud's phenomenon (22.1% versus 48.5%; P < 0.001), sicca symptoms (4.4% versus 34.4%; P < 0.001), dysphagia (0.3% versus 6.2%; P < 0.001), and fatigue (28.3% versus 37.0%; P = 0.024). Anti-double-stranded DNA, anti-ß2 -glycoprotein I antibodies, positive Coombs' test results, autoimmune hemolytic anemia, hypocomplementemia, and leukopenia were more common in early SLE than in SLE-mimicking conditions. Symptoms detailed in the ACR and SLICC classification criteria were significantly more frequent among those with early SLE. Fewer patients with early SLE were not identified as having early SLE with use of the SLICC criteria compared to the ACR criteria (16.5% versus 33.9%), but the ACR criteria demonstrated higher specificity than the SLICC criteria (91.6% versus 82.4%). CONCLUSION: In this multicenter cohort, clinical manifestations that could help to distinguish early SLE from SLE-mimicking conditions were identified. These findings may aid in earlier SLE diagnosis and provide information for ongoing initiatives to revise SLE classification criteria.

Effect of complete or partial proteinuria recovery on long-term outcomes of lupus nephritis.

BACKGROUND/PURPOSE: We aimed to evaluate the effect of complete recovery (CR), partial recovery (PR), and no recovery (NR) of proteinuria at 2 years from the diagnosis of LN on long-term renal and extra-renal outcomes. METHODS: Patients with LN and proteinuria attending the Lupus Center from 1970 to 2015 were analyzed. At 2 years from diagnosis of LN, patients were divided into three groups (CR, PR, and NR), and long-term outcomes were studied up to 15 years or last visit available. CR was defined as resolution of proteinuria, PR as a reduction ≥50% in baseline proteinuria, and NR as a reduction <50% compared to baseline. Long-term outcomes examined included renal outcomes [low eGFR, ESRD, and composite renal (low eGFR, ESRD, and dialysis/transplant)], cardiovascular outcomes, damage, and death. Kaplan-Meier plots, time-independent and time-dependent Cox proportional hazards models were applied to examine the effect of CR, PR, or NR on long-term outcomes. RESULTS: Of 277 patients, 71.8% achieved CR, 18.4% PR, and 9.8% NR at 2 years. CR compared to NR and CR compared to PR were protective against low eGFR and composite renal outcome in time-independent and time-dependent analyses. CR compared to PR protected against damage in the time-independent analysis. Overall, the comparison of CR and PR favored CR for long-term renal outcomes. CONCLUSION: CR at 2 years from diagnosis of LN protected against renal outcomes (low eGFR, ESRD/dialysis, and transplant). CR is more favorable compared to PR and clinicians should aim for CR to improve long-term outcomes in LN.

What is the prevalence of cognitive impairment in lupus and which instruments are used to measure it? A systematic review and meta-analysis.

OBJECTIVES: To systematically review the literature on the prevalence of Cognitive Dysfunction (CD) in SLE patients in studies that used a specified neuropsychological instrument. METHODS: This review was prepared with a protocol following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Protocols statement. Literature search in Ovid Medline, Embase, and Psyc INFO for articles on CD in adult SLE patients was conducted. Included studies were critically appraised (Newcastle-Ottawa Evaluation Scale) and the Pooled Prevalence (PP) of CD was studied for all instruments. The association between demographics and CD, the risk of CD in SLE compared to healthy subjects and patients with RA, and the course of CD over time were studied narratively whenever sufficient information was available. RESULT: Of 8054 references, 670 were selected for detailed review and 78 were included in the final analysis. Comprehensive Battery (CB) was utilized in 35 studies in 2463 SLE patients and PP was 38% (95%; CI: 33-43%). The CD prevalence was higher in NPSLE [PP 39% (95% CI: 24-55%]. Automated Neuropsychological Assessment Metric (ANAM) was utilized in 7 studies in 438 patients (PP of CD 26% (95% CI: 12-42%). Other less frequently utilized tools were the Modified Mini-Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA), Controlled Oral Word Association Test (COWAT) and The Hopkins Verbal Learning Test-Revised (HVLT-R) and subjective tools and others. The relative risk for CD in SLE was greater when compared to RA and to healthy individuals; RR being 1.80 and 2.80, respectively. Information on demographics and its association with CD was very heterogeneous among studies. CONCLUSION: Patients with lupus have a high prevalence of CD. The delay in diagnosis of CD is complex; although caregivers and patients express concerns about cognitive function, testing for CD often imposes administrative and cost burdens. There is an unmet need to identify the best screening, diagnostic metrics of CD. The assessment of cognitive function over time, and the association of demographics with CD, will require further research.

Canadian Rheumatology Association Recommendations for the Assessment and Monitoring of Systemic Lupus Erythematosus.

OBJECTIVE: To develop recommendations for the assessment of people with systemic lupus erythematosus (SLE) in Canada. METHODS: Recommendations were developed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. The Canadian SLE Working Group (panel of Canadian rheumatologists and a patient representative from Canadian Arthritis Patient Alliance) was created. Questions for recommendation development were identified based on the results of a previous survey of SLE practice patterns of members of the Canadian Rheumatology Association. Systematic literature reviews of randomized trials and observational studies were conducted. Evidence to Decision tables were prepared and presented to the panel at 2 face-to-face meetings and online. RESULTS: There are 15 recommendations for assessing and monitoring SLE, with varying applicability to adult and pediatric patients. Three recommendations focus on diagnosis, disease activity, and damage assessment, suggesting the use of a validated disease activity score per visit and annual damage score. Strong recommendations were made for cardiovascular risk assessment and measuring anti-Ro and anti-La antibodies in the peripartum period and conditional recommendations for osteoporosis and osteonecrosis. Two conditional recommendations were made for peripartum assessments, 1 for cervical cancer screening and 2 for hepatitis B and C screening. A strong recommendation was made for annual influenza vaccination. CONCLUSION: These are considered the first guidelines using the GRADE method for the monitoring of SLE. Existing evidence is largely of low to moderate quality, resulting in more conditional than strong recommendations. Additional rigorous studies and special attention to pediatric SLE populations and patient preferences are needed.

The utility of lupus serology in predicting outcomes of renal transplantation in lupus patients: Systematic literature review and analysis of the Toronto lupus cohort.

OBJECTIVES: To study the utility of lupus serology as a predictor for kidney graft outcome in (a) a systematic literature review (SLR) and (b) the Toronto lupus cohort (TLC). METHODS: For the SLR, a comprehensive literature search was performed to identify the articles reporting on the serology at renal transplantation (RT) and on the outcome of RT. Studies were critically appraised using the Newcastle Ottawa Scale (NOS). Patients who underwent RT in the TLC were identified and grouped into graft failure and graft survival. The serology in both groups was studied. RESULTS: Of the 749 references, 742 did not have serological status of the patient or were not relevant to the research question. Seven studies in addition to TLC (n = 76) were included in the SLR. The NOS revealed limitations because of small sample size and a short follow-up period. The majority of the grafts survived to at least 1 year regardless of the serology results pre-transplant which is consistent with results of the TLC. Overall, 32 of 1783 patients in the TLC had a RT. In all, 2 patients had a nonfunctional graft, 5 patients had graft failure, and 25 patients had graft survival. Overall, 40% of the graft failures had positive serology compared to 52% in the graft survival, 1 year prior to RT. CONCLUSION: The results of this SLR found that the persistence of serological abnormalities at the time of RT was not associated with graft failure. These results are consistent with the results of the TLC.