Validation of the Japanese version of the Systemic Lupus Activity Questionnaire that includes physician-based assessments in a large observational cohort

The Systemic Lupus Activity Questionnaire (SLAQ) is a patient-reported outcome for systemic lupus erythematosus (SLE). We aimed to translate it into Japanese and further investigate its validity and reliability. The English version of the SLAQ was translated into Japanese and administered to Japanese SLE patients at our university clinic. Physicians assessed disease activity using the SLE Disease Activity Index 2000 (SLEDAI-2K). The patients were prospectively followed for repeat assessment a year later. Ultimately, 255 patients participated. The patients’ 10-point ratings of disease activity and SLAQ scores were significantly correlated (Spearman’s ρ = 0.53). The SLAQ score was weakly correlated with the SLE Disease Activity Index 2000 (SLEDAI-2K)-nolab (omitting laboratory items; ρ = 0.18) but not with the SLEDAI-2K ( ρ = 0.02). These results suggested its convergent and discriminant validity. The SLAQ demonstrated acceptable internal consistency (Cronbach’s α = 0.80), and good test–retest reliability (intraclass correlation coefficient = 0.85). The effect sizes and the standardized response means of the SLAQ were as follows: clinical worsening, 0.26 and 0.31, and improvement, −0.39 and −0.41, respectively, which indicated a small but significant responsiveness. The Japanese version of the SLAQ demonstrated acceptable reliability and validity; its performance was comparable to that of the original version.

Psychological distress in corticosteroid-naive patients with systemic lupus erythematosus: A prospective cross-sectional study

OBJECTIVE

Psychological distress, such as depression and anxiety, has been intensively studied in patients with systemic lupus erythematosus (SLE). However, those studies have mostly included patients who were treated with corticosteroids, which might themselves induce mood disturbances. We investigated psychological distress in corticosteroid-naive patients with SLE who did not exhibit any overt neuropsychiatric manifestations.

METHODS

Forty-three SLE in-patients with no current or past abnormal neuropsychiatric history participated in the study. Patients and 30 healthy control subjects with similar demographic and personality characteristics were administered a comprehensive battery of psychological/neuropsychological tests. The Profile of Mood States (POMS) was used to assess depression and anxiety. Results of clinical, laboratory, and neurological tests were compared with regard to their presence.

RESULTS

Prevalence of depression was higher in patients (n = 11, 25.6%) than in controls (n = 2, 6.7%; p = 0.035), although prevalence of anxiety did not differ across groups (patients: 34.9%, n = 15; controls: 16.7%, n = 5; p = 0.147). Using multiple logistic regression analysis, we identified avoidance coping methods (OR, 1.3; 95% CI 1.030-1.644; p = 0.027) as an independent risk factor for depression.

CONCLUSION

Our results indicate that depression presents more frequently in corticosteroid-naive patients with early-stage, active SLE than in the normal population, but anxiety does not. Depression may be related to psychological reactions to suffering from the disease.

Association of oral health literacy with oral health behaviour and oral health status in Belarus

OBJECTIVES

To explore the level of oral health literacy among adults in Belarus, a former part of the Soviet Union, and to analyse the associations between oral health literacy, socio-demographics, health behaviour and oral health status.

BASIC RESEARCH DESIGN

A cross-sectional study. Participants: 281 adult (18-60 years old) dental patients.

MAIN OUTCOME MEASURE

The participants completed a self-administered questionnaire collecting information about socio-demographics and health behaviours, and oral health literacy test (the R-OHLI). Clinical oral examination followed the questionnaire survey.

RESULTS

Among participants, 68.7% had adequate, 18.9% had marginal and 12.4% inadequate oral health literacy levels. Females and those with higher education were more likely to have adequate oral health literacy (p<0.05 and p<0.001). Participants with adequate oral health literacy had fewer missing and more filled teeth than those with inadequate literacy (p<0.001). This association remained significant after adjusting for socio-demographics, behavioural characteristics and oral hygiene status (p<0.05 and p<0.001).

CONCLUSIONS

Adequate oral health literacy was strongly related with better oral health status. Improvement of oral health literacy should be addressed when developing community oral health promotions.

Plasma levels of vitamin D metabolites in renal diseases

Plasma levels of 25-OH-D, 1,25-(OH)2-D and 24,25-(OH)2-D in acute renal failure, chronic glomerulonephritis and chronic renal failure were determined by competitive protein binding assay and evaluated for the correlation with the degree of renal impairment and the influence of dialysis, renal transplantation and the administration of vitamin D and 1-alpha-OH-D3. In this study it is revealed that 25-OH-D deficiency could be normalized by the administration of vitamin D2. Plasma levels of 1,25-(OH)2-D are decreased in proportion to the degree of renal impairment and it is clearly depressed in patients, with a Ccr of 30 ml/min or less. Although biosynthesis of 24,25-(OH)2-D is not remarkably depressed, it is necessary to resolve various questions including the methods of measurement in this respect. It is also disclosed in the present study that 1-alpha-OH-D3 is faster in action than vitamin D2 when used to correct 1,25-(OH)2-D3 deficiency.

Learning curve for laparoscopic major hepatectomy

BACKGROUND

Laparoscopic major hepatectomy (LMH) is evolving as an important surgical approach in hepatopancreatobiliary surgery. The present study aimed to evaluate the learning curve for LMH at a single centre.

METHODS

Data for all patients undergoing LMH between January 1998 and September 2013 were recorded in a prospective database and analysed. The learning curve for operating time (OT) was evaluated using the cumulative sum (CUSUM) method.

RESULTS

Of 173 patients undergoing major hepatectomy, left hepatectomy was performed in 28 (16·2 per cent), left trisectionectomy in nine (5·2 per cent), right hepatectomy in 115 (66·5 per cent), right trisectionectomy in 13 (7·5 per cent) and central hepatectomy in eight (4·6 per cent). Median duration of surgery was 270 (range 100-540) min and median blood loss was 300 (10-4500) ml. There were 20 conversions to an open procedure (11·6 per cent). Vascular clamping was independently associated with conversion on multivariable analysis (hazard ratio 5·95, 95 per cent c.i. 1·24 to 28·56; P = 0·026). The CUSUMOT learning curve was modelled as a parabola (CUSUMOT  = 0·2149 × patient number(2)  - 30·586 × patient number - 1118·3; R(2)  = 0·7356). The learning curve comprised three phases: phase 1 (45 initial patients), phase 2 (30 intermediate patients) and phase 3 (the subsequent 98 patients). Although right hepatectomy was most common in phase 1, a significant decrease was observed from phase 1 to 3 (P = 0·007) in favour of more complex procedures.

CONCLUSION

The learning curve for LMH consisted of three characteristic phases identified by CUSUM analysis. The data suggest that the learning phase of LMH included 45 to 75 patients.

The Composition Pulling Effect in MOVPE Grown InGaN on GaN and AlGaN and its TEM Characterization

InGaN films have been grown on GaN and AlGaN epitaxial layers by metalorganic vapor phase epitaxy. The “composition pulling effect” during the initial InGaN growth stages has been studied as a function of the lattice mismatch between the InGaN and the underlying epitaxial layer. The crystalline quality of the InGaN is good near the InGaN/GaN interface and the composition is close to that of GaN. However, with increasing InGaN film thickness, the crystal quality deteriorates and the indium mole fraction increases. The composition pulling effect becomes stronger with increasing lattice mismatch. It is suggested that indium atoms are excluded from the InGaN lattice during the early growth stages to reduce the deformation energy from the lattice mismatch. TEM observations of the InGaN/GaN structure reveal that the degradation of the crystalline quality of InGaN films grown on GaN is caused by pit formation which arises from edge dislocations propagating through the InGaN film from the underlying GaN.