Not only disease activity but also chronic hypertension and overweight are determinants of pregnancy outcomes in patients with systemic lupus erythematosus

INTRODUCTION

Pregnancies in women with lupus nephritis are at high-risk of complications, while scarcity of scientific knowledge on prognostic factors impedes a fair medical counseling. We aimed to identify determinants associated with maternal and fetal complications.

MATERIALS

We retrospectively reviewed medical charts of pregnancies that lasted more than 22 weeks in 66 patients with pre-existing lupus nephritis between 2004 and 2013 in France. Univariate and multivariate analyses were conducted to identify determinants for maternal complications, lupus renal flare and fetal prematurity or death.

RESULTS

Eighty-four pregnancies were identified. A maternal complication occurred in 31 pregnancies (36.9%): mostly preeclampsia (17 pregnancies, 20.2%) and renal flares (12 pregnancies, 14.3%). Overall fetal survival was 94.0% (79/84). Maternal pregnancy complications were independently associated with prepregnancy body mass index >25 kg/m² (OR 3.81, 95% CI 1.03-14.09) and immunological activity (positive anti-dsDNA antibodies or Farr assay lupus) (OR 4.95, 95% CI 1.33-18.43). Renal lupus flares were independently associated with maternal age (OR 1.50, 95% CI 1.12-2.01) and prepregnancy immunological activity (OR 15.99, 95% CI 1.57-162.68) while a remission time >12 months had a protective effect (OR 0.17, 95% CI 0.04-0.68). Three parameters were associated with a higher risk of fetal prematurity or death: a prepregnancy body mass index >25 kg/m² (HR 3.58, 95% CI 1.45-8.83), hypertension (HR 8.97, 95% CI 3.32-24.25), and immunological activity (HR 3.34, 95% CI 1.30-8.63).

CONCLUSION

Maternal age, prepregnancy hypertension, body mass index >25 kg/m² and lupus immunological activity may be considered as the main determinants for fetal and maternal complications. A remission time above 12 months for patients with lupus nephritis could be associated with a reduced risk of renal flare during pregnancy.

Attempts to Optimize the Dispersion State during Twin-Screw Extrusion of Polypropylene/Clay Nanocomposites

Polypropylene/organoclay nanocomposites were prepared by melt-mixing in a twin-screw extruder. Polypropylene grafted with maleic anhydride was used as compatibilizer. The evolution of the microstructure along the screw profile was characterized through dead-stop experiments. In order to quantify the multi-scale dispersion state of the nanocomposites, different techniques have been used: scanning electronic microscopy (SEM) to observe the large remaining aggregates, X-Ray diffraction measurements to characterize the intercalation state by measuring the interlamellar distance, and finally rheological characterizations in the molten state to assess the dispersion state at the nanoscale. The effects of low barrel temperatures and high matrix viscosity were tested, in order to improve exfoliation by an increase in shear stresses.

Matrix Degradation during High Speed Extrusion of Polypropylene/Clay Nanocomposites – Influence on Filler Dispersion

We prepared polypropylene/organoclay nanocomposites by melt blending in a twin-screw extruder, exploring the domain of high screw speeds (up to 1 100 min−1). The samples were characterized at both microscale (size of agglomerates) and nanoscale (level of exfoliation). We show that, despite a satisfactory exfoliation, the polymer matrix suffered important thermomechanical degradation by chain scission. We propose a way to correct this degradation on the viscosity curves and we confirm that high screw speeds are not necessarily favorable to clay exfoliation, essentially because of the too high melt temperatures encountered during the process.

Structure of 12Be: intruder d-wave strength at N=8

The breaking of the N=8 shell-model magic number in the 12Be ground state has been determined to include significant occupancy of the intruder d-wave orbital. This is in marked contrast with all other N=8 isotones, both more and less exotic than 12Be. The occupancies of the [FORMULA: SEE TEXT]orbital and the [FORMULA: SEE TEXT], intruder orbital were deduced from a measurement of neutron removal from a high-energy 12Be beam leading to bound and unbound states in 11Be.

Neurotrophic growth factors stimulate glycosaminoglycan synthesis in identified retinal cell populations in vitro

Glycosaminoglycans (GAG) are known to participate in central nervous system processes such as development, cell migration, and neurite outgrowth, but little is known with respect to their regulation through soluble neurotrophic factors. In the present study, we have addressed this issue using cell culture models of three distinct cell populations derived from young rat retinas, namely, purified M uller glia, pigmented epithelium, and neurons respectively. Cultures were maintained in chemically defined media in the presence or absence of either basic fibroblast or epidermal growth factor. In control glial and epithelial cultures, hyaluronic acid dominated the soluble GAG pool, with lesser contributions from dermatan sulfate, chondroitin sulfate, and heparan sulfate (in decreasing order). Retinal neuronal GAG were almost exclusively chondroitin sulfate (approximately 90%). Treatment of glial and epithelial cultures with either factor led to dose-dependent increases in especially hyaluronic acid synthesis (a maximum 6-fold increase relative to control levels), with smaller but consistent changes in chondroitin sulfate. Similar treatment of retinal neurons did not lead to any changes in GAG synthesis. These data indicate that glia and pigment epithelia are the principal sources of GAG components in retina at least in vitro, and that endogenous neurotrophic growth factors can greatly modify GAG synthesis in these two retinal cell populations. Such data suggest that a delicate balance may exist between growth factor availability and glycoconjugate metabolism in vivo, participating in normal or pathological states of the retina.

[Anesthesia for thermocoagulation of the trigeminal nerve. Use of propofol]

Propofol has been used in anesthesia for trigeminal nerve thermocoagulation. 9 patients were studied. This anesthetic agent allows speedy arousal of good enough quality for patient questioning. No cardiovascular or respiratory complications were noted.

Spontaneous intracerebral hematomas from vascular causes. Predictive value of CT compared with angiography

The aim of the present study was to assess the diagnostic accuracy of CT in determining the underlying causes of brain hematomas with a state-of-the art CT. For this purpose, CT and angiographic data of 149 subjects with spontaneous intracerebral hematomas (ICH) were statistically compared in a blind, retrospective study, taking angiography, supported when possible by surgical findings, as providing the correct diagnoses. 5 groups were distinguished on the basis of CT data: 103 patients with isolated deep ICH had normal angiograms; 9 patients with isolated superficial ICH and 8 with deep ICH and intraventricular hemorrhage (IVH) had arteriovenous malformations (AVMs). 4 with this combination showed no angiographic abnormalities, one had an aneurysm. 14 subjects with ICH and subarachnoid hemorrhage (SAH) had a middle cerebral or carotid artery aneurysm; and 10 with ICH, SAH and IVH had also an aneurysm, in 7 on the anterior communicating artery. Sensitivity, specificity, positive and negative predictive values were respectively: for AVMs 100, 96, 77 and 100%; and for aneurysms 96, 100, 100 and 99%. Kendall coefficient was 0.95, indicating close correlation between the two modalities. This study confirms that CT can accurately predict the likelihood, nature and location of vascular ICHs. It indicates whether angiography is necessary or not, and if so, what vascular tree ought to be explored.

Developing rat cerebellum--II. Effects of abnormal thyroid states and undernutrition on hyaluronic acid

The early postnatal pattern of hyaluronic acid (HA) deposition in rat cerebellum is affected by thyroid deficiency, thyroxine treatment and undernutrition. The modification of HA ontogenesis apparently reflects the smaller number of cells formed in undernourished rats, or alterations of cell maturation (accelerated in thyroxine-treated and slowed down in thyroid-deficient rats). The developmentally regulated loss of tissue water is also affected in the three conditions; this can be correlated with the roughly simultaneous disappearance of extracellular, but not of total, HA.

Developing rat cerebellum--I. Effects of abnormal thyroid states and undernutrition on sulfated glycosaminoglycans

Sulfated glycosaminoglycans deposition during rat postnatal cerebellar developmental is affected by altered thyroid states and undernutrition. These ontogenetic alterations seem not to be specific but to be one aspect of the general acceleration, slowing down and reduction of the cerebellar development occurring in thyroid-deficient, hyperthyroid and undernourished rats, respectively.

Isolation and immunohistochemical localization of a chondroitin sulfate proteoglycan from adult rat brain

A chondroitin sulfate proteoglycan called PGM1 has been isolated from the particulate fraction of adult rat forebrain. Delipidation of the material, solubilization of proteoglycans in guanidinium chloride, precipitation at low ionic strength, and final extraction at pH 5.0 were used for its isolation. Proteoglycans were subjected to further purification by diethylaminoethyl-cellulose chromatography. Individual components were separated by gel filtration. PGM1 appeared to be a high-molecular-weight chondroitin sulfate proteoglycan, capable of strong interaction with hyaluronic acid. It was finally isolated by gel filtration on Ultrogel AcA 22 in the presence of 4 M guanidinium chloride. Monospecific antibodies obtained in rabbits against the purified molecule did not cross-react with other brain proteoglycans. Immunocytochemical techniques revealed an almost unique association of this compound with axons, particularly those known to contain neurofilaments. However, not all these axons and all parts of these axons contained PGM1. This component was not detectable in liver, intestine, spleen, kidney, lung, heart, skin, hair, lens, and muscle, a finding suggesting a specificity for the nervous tissue. This component is expressed in neural cell cultures. Despite the preservation of the neuronal specificity, it seems to lose its specific axonal localization in vitro.