Soluble MICB in Plasma and Urine Explains Population Expansions of NKG2D⁺CD4 T Cells Inpatients with Juvenile-Onset Systemic Lupus Erythematosus

Abnormal NKG2D ligand expression has been implicated in the initiation and maintenance of various auto-inflammatory disorders including systemic lupus erythematosus (SLE). This study’s goal was to identify the cellular contexts providing NKG2D ligands for stimulation of the immunosuppressive NKG2D+CD4 T cell subset that has been implicated in modulating juvenile-onset SLE disease activity. Although previous observations with NKG2D+CD4 T cells in healthy individuals pointed towards peripheral B cell and myeloid cell compartments as possible sites of enhanced NKG2DL presence, we found no evidence for a disease-associated increase of NKG2DL-positivity among juvenile-onset SLE B cells and monocytes. However, juvenile-onset SLE patient plasma and matched urine samples were positive by ELISA for the soluble form of the NKG2D ligands MICA and MICB, suggesting that kidney and/or peripheral blood may constitute the NKG2DL positive microenvironments driving NKG2D+CD4 T cell population expansions in this disease.

DNA immunoadsorption for childhood-onset systemic lupus erythematosus

We present a retrospective review of DNA immunoadsorption (DNA-IA) therapy on clinical symptoms as well as indicators in pediatric cases with systemic lupus erythematosus (SLE), and follow up the short-term curative effects. 16 SLE cases were treated by DNA-IA for 3 times every other day. We observed the changes on clinical manifestations and immunological indicators, in order to compare the alteration of these indicators including clinical manifestations, Systemic Lupus Erythematosus Disease Active Index (SLEDAI) scores, 24 hurinary protein excretion, autoantibodies, serum IgG and complement C3. 13 cases were followed up regularly, within 3 months after DNA-IA therapy, 12 cases of clinical manifestations improved (92.3%). SLEDAI scores in 10 cases decreased from (16.20 ± 12.54) to less than 5 (76.9%), 8 cases of ANA, anti-DNA antibodies were negative (61.5%), 13 cases with IgG level in serum recovered to normal (10.39 ± 4.38) g/L, C3 level rose to normal (1.06 ± 0.23) g/L. 3 to 6 months after IA, clinical manifestations and laboratory examinations in all cases got maximum improved. 9 months after IA, SLEDAI score in 2 cases (15.4%) rose to more than 5, anti-DNA antibody in 2 cases (15.4%) became positive, and 1case (7.7%) with serum C3 decreased again. 2 cases died from multiple organs dysfunction within 3 to 6 months after IA. No serious complications were found during DNA-IA. We recommend that DNA immunoadsorption is a safe and effective therapy for active childhood-onset SLE, which could improve clinical symptoms, eliminate ANA and anti-DNA antibodies. Combining with corticosteroids and immunosuppressive drugs, DNA-IA could significantly reduce the activity of disease and protect vital organs function in the short term.

Differences in Precipitation and Related Wind Dynamics and Moisture and Heat Features in Separate Areas of the South China Sea before and after Summer Monsoon Onset

Using surface and balloon-sounding measurements, satellite retrievals, and ERA5 reanalysis during 2011–20, this study compares the precipitation and related wind dynamics, moisture and heat features in different areas of the South China Sea(SCS) before and after SCS summer monsoon onset(SCSSMO). The rainy sea around Dongsha(hereafter simply referred to as Dongsha) near the north coast, and the rainless sea around Xisha(hereafter simply referred to as Xisha) in the western SCS, are selected as two typical research subregions. It is found that Dongsha, rather than Xisha, has an earlier and greater increase in precipitation after SCSSMO under the combined effect of strong low-level southwesterly winds, coastal terrain blocking and lifting, and northern cold air. When the 950-h Pa southwesterly winds enhance and advance northward, accompanied by strengthened moisture flux, there is a strong convergence of wind and moisture in Dongsha due to a sudden deceleration and rear-end collision of wind by coastal terrain blocking. Moist and warm advection over Dongsha enhances early and deepens up to 200 h Pa in association with the strengthened upward motion after SCSSMO, thereby providing ample moisture and heat to form strong precipitation. However, when the 950-h Pa southwesterly winds weaken and retreat southward, Xisha is located in a wind-break area where strong convergence and upward motion centers move in. The vertical moistening and heating by advection in Xisha enhance later and appear far weaker compared to that in Dongsha, consistent with later and weaker precipitation.

Clinical characteristics of patients with early-and late-onset optic neuromyelitis optica spectrum disease

Objective:To analyze the different clinical features of patients with early-onset(EO-NMOSDs)and late-onset neuromyelitis optica spectrum diseases(LO-NMOSDs).Methods:A total of 51patients with neuromyelitis optica spectrum disease who were diagnosed in our hospital for the first time from January 2015 to December 2022 were included in the First Affiliated Hospital of Hainan Medical College and divided into 22 cases in the EO-NMOSDs group and 29 cases in the LO-NMOSDs group according to whether the age of onset was 50 years old.The basic data,Extended Disability Status Scale(EDSS)score,blood and cerebrospinal fluid test indicators of the two groups were statistically analyzed.Results:There were no significant differences in demographic characteristics,clinical features and serum AQP-4 antibody positivity rate between the two groups(all P>0.05),and there were significant differences in triglycerides(TG),low-density lipoprotein(LDL),apolipoprotein A(APOA),apolipoprotein B(APOB)and lipoprotein a(P=0.010,P=0.048,P=0.014,P=0.061,P=0.001,respectively),and cerebrospinal fluid LDH,There were significant differences between microprotein quantification and EDSS score(P=0.018,P=0.034,P=0.025,respectively),and the level of microprotein quantification in cerebrospinal fluid of LO-NMOSDs had a certain correlation with the degree of disability(r=0.52,P<0.03).Conclusion:LO-NMOSDs and EO-NMOSDs group patients have similar demographic characteristics,serum AQP-4 antibody positive rate and clinical features,but compared with EO-NMOSDs,patients in LO-NMOSDs group are prone to abnormal lipid metabolism,higher trace proteins in cerebrospinal fluid and more likely to be disabled,and among LO-NMOSDs,the higher the trace protein in the cerebrospinal fluid,the more severe the disability status of patients.

A Comparison between Late Preterm and Term Infants with Respiratory Distress Syndrome, Early-Onset Sepsis, and Neonatal Jaundice in Ecuadorian Newborns

Background: To examine the differences in prevalence of respiratory distress syndrome, early-onset sepsis and jaundice, between late preterm infants versus term infants in Ecuadorian newborns. Methods: Study design: Epidemiological, observational, and cross-sectional, with two cohorts of patients. Settings: IESS Quito Sur Hospital at Quito, Ecuador, from February to April of 2020. Participants: This study included 204 newborns, 102 preterm infants, 102 term infants. Results: There are significant differences between late preterm infants and term infants, with a p-value of 0.000 in the prevalence of early sepsis, 70.59% vs. 35.29%. In respiratory distress syndrome between late and term premature infants, significant differences were observed with a p-value of 0.000, the proportion being 55.58% vs. 24.51% respectively. The prevalence of jaundice is higher in term infants with a p value of 0.002, 72.55%, versus 51.96% in late preterm infants, and the mean value of bilirubins in mg/dL was higher in term infants 14.32 versus 12.33 in late preterm infants;this difference is statistically significant with a p value of 0.004. Admission to the NICU is more frequent in late preterm infants with a p-value of 0.000, being 42.16% for late preterm infants vs. 7.84% in term infants;the mean of the hospital days with p-value 0.005, was higher in late preterm infants 4.97 days vs. 3.55 days for term newborns. Conclusion: Due to the conditions of their immaturity, late preterm infants are 2.86 times more likely to present early sepsis than full-term newborns. It is shown that late preterm infants are 2.69 times more likely to have respiratory distress syndrome compared to term infants, therefore, late preterm infants have a longer hospital stay of 4.97 days versus 3.55 days in term infants. Jaundice and mean bilirubin levels are higher in term infants due to blood group incompatibility and insufficient breastfeeding.

Chinese Systemic Lupus Erythematosus Treatment and Research Group Registry IX： Clinical Features and Survival of Childhood-Onset Systemic Lupus Erythematosus in China

Background： Approximately 15-20% cases of systemic lupus erythematosus （SLE） are diagnosed in children. There have been a Few studies reporting the epidemiological data of pediatric-onset SLE （cSLE） in China, neither comparing the differences between cSLE and adult-onset SLE （aSLE）. The aim of this study was to describe the impact of age of onset on clinical features and survival in cSLE patients in China based on the Chinese SLE Treatment and Research group （CSTAR） database. Methods： We made a prospective study of 225 cSLE patients （aged 〈16 years） and 1759 patients aged 16-50 years based on CSTAR registry. We analyzed initial symptoms, clinical presentations, SLE disease activity, damages, and outcomes ofcSLE, as well as compared with aSLE patients. Results： The mean age ofcSLE patients was 12.16 ± 2.92 years, with 187 （83.1%） females. Fever （P 〈 0.001） as well as mucocutaneous （P 〈 0.001 ） and renal （P = 0.006） disorders were found to be significantly more frequent in cSLE patients as initial symptoms, while muscle and joint lesions were significantly less common compared to aSLE subjects （P 〈 0.001 ）. The eSLE patients were found to present more fi＇equently with malar rash （P = 0.001; odds ratio {OR], 0.624; 95% confidence interval [CI ], 0.470 0.829） but less tYequently with arthritis （P 〈 0.001 ; OR, 2.013; 95% CI, 1.512-2.679） and serositis （P = 0.030; OR, 1.629; 95% CI, 1.053 2.520）. There was no significant difl＇erence in SLE disease activity index scores between cSLE and aSLE groups （P = 0.478）. Cox regression indicated that childhood onset was the risk factor for organ damage in lupus patients （hazard ratio 0.335 [0.170 0.658], P = 0.001）. The survival curves between the cSLE and aSLE groups had no significant difference as determined by the log-rank test （0.557, P = 0.455）. Conclusions： cSLE in China has different clinical features and more inflammation than aSLE patients. Damage may be less in children and there is no difl＇erence in 5- year survival between cSLE and aSLE groups.

Characterization of microbiota in systemic-onset juvenile idiopathic arthritis with different disease severities

BACKGROUND Systemic-onset juvenile idiopathic arthritis (SoJIA) is one of most serious subtypes of juvenile idiopathic arthritis. Although the pathogenesis of SoJIA remains unclear, several studies have suggested a correlation between gut dysbiosis and JIA. Further understanding of the intestinal microbiome may help to establish alternative ways to treat, or even prevent, the disease. AIM To explore alterations in fecal microbiota profiles in SoJIA patients and to evaluate the correlations between microbiota and clinical parameters. METHODS We conducted an observational single-center study at the Pediatric Department of Peking Union Medical College Hospital. Children who were diagnosed with SoJIA at our institution and followed for a minimum period of six months after diagnosis were recruited for the study. Healthy children were recruited as a control group (HS group) during the same period. Clinical data and stool samples were collected from SoJIA patients when they visited the hospital. RESULTS The SoJIA group included 17 active and 15 inactive consecutively recruited children;the control group consisted of 32 children. Firmicutes and Bacteroidetes were the two most abundant phyla among the total sample of SoJIA children and controls. There was a significant difference among the three groups in observed species, which was the highest in the Active-SoJIA group, followed by the Inactive-SoJIA group and then HS group (Active-SoJIA vs HS: P = 0.000;and Inactive-SoJIA vs HS: P = 0.005). We observed a lower Firmicutes/Bacteroidetes ratio in SoJIA patients (3.28 ± 4.47 in Active-SoJIA, 5.36 ± 8.39 in Inactive-SoJIA,and 5.67 ± 3.92 in HS). We also observed decreased abundances of Ruminococcaceae (14.9% in Active-SoJIA, 17.3% in Inactive-SoJIA, and 22.8% in HS;Active-SoJIA vs HS: P = 0.005) and Faecalibacterium (5.1% in Active-SoJIA, 9.9% in Inactive-SoJIA, and 13.0% in HS;Active-SoJIA vs HS: P = 0.000) in SoJIA compared with HS. By contrast, the abundance of Bacteroidaceae was the highest in the Active-SoJIA group, followed by the Inactive-SoJIA and HS groups (16.5% in Active-SoJIA, 12.8% in Inactive-SoJIA, and 9.7% in HS;Active-SoJIA vs HS: P = 0.03). The Spearman correlation analysis revealed a negative correlation between Proteobacteria or Enterobacteriaceae and juvenile arthritis disease activity score on 27 joints (JADAS-27). CONCLUSION The composition of the intestinal microbiota is different in SoJIA patients compared with healthy children. The dysbiosis presents partial restoration in inactive status patients.

Detection of Alzheimer’s disease onset using MRI and PET neuroimaging:longitudinal data analysis and machine learning

The scientists are dedicated to studying the detection of Alzheimer’s disease onset to find a cure, or at the very least, medication that can slow the progression of the disease. This article explores the effectiveness of longitudinal data analysis, artificial intelligence, and machine learning approaches based on magnetic resonance imaging and positron emission tomography neuroimaging modalities for progression estimation and the detection of Alzheimer’s disease onset. The significance of feature extraction in highly complex neuroimaging data, identification of vulnerable brain regions, and the determination of the threshold values for plaques, tangles, and neurodegeneration of these regions will extensively be evaluated. Developing automated methods to improve the aforementioned research areas would enable specialists to determine the progression of the disease and find the link between the biomarkers and more accurate detection of Alzheimer’s disease onset.

Sub-seasonal Prediction of the South China Sea Summer Monsoon Onset in the NCEP Climate Forecast System Version 2

This study depicts the sub-seasonal prediction of the South China Sea summer monsoon onset(SCSSMO)and investigates the associated oceanic and atmospheric processes,utilizing the hindcasts of the National Centers for Environmental Prediction(NCEP)Climate Forecast System version 2(CFSv2).Typically,the SCSSMO is accompanied by an eastward retreat of the western North Pacific subtropical high(WNPSH),development of the cross-equatorial flow,and an increase in the east-west sea surface temperature(SST)gradient.These features are favorable for the onset of westerlies and strengthening of convection and precipitation over the South China Sea(SCS).A more vigorous SCSSMO process shows a higher predictability,and vice versa.The NCEP CFSv2 can successfully predict the onset date and evolution of the monsoon about 4 pentads(20 days)in advance(within 1–2 pentads)for more forceful(less vigorous)SCSSMO processes.On the other hand,the climatological SCSSMO that occurs around the 27th pentad can be accurately predicted in one pentad,and the predicted SCSSMO occurs 1–2 pentads earlier than the observed with a weaker intensity at longer leadtimes.Warm SST biases appear over the western equatorial Pacific preceding the SCSSMO.These biases induce a weaker-thanobserved WNPSH as a Gill-type response,leading to weakened low-level easterlies over the SCS and hence an earlier and less vigorous SCSSMO.In addition,after the SCSSMO,remarkable warm biases over the eastern Indian Ocean and the SCS and cold biases over the WNP induce weaker-than-observed westerlies over the SCS,thus also contributing to the less vigorous SCSSMO.

A Single-Center Experience of Systemic Onset Juvenile Idiopathic Arthritis at a Tertiary Hospital in Jeddah, Saudi Arabia

Background and Objective: Systemic-onset juvenile idiopathic arthritis (JIA) is a major and prevalent subset of arthritis among children and it has a broad spectrum of clinical presentation, course and prognosis. This study described the clinical presentation of systemic-onset JIA in a Saudi-based cohort. Methods: A retrospective chart review was performed of the medical records of children with systemic-onset JIA who were followed up at King Abdul Aziz University Hospital, Jeddah, between January 1997 and December 2013. Patients’ files were reviewed for demographic, clinical, and paraclinical data, which were analyzed using the statistical Package for the Social Sciences. Results: We included 20 patients of both genders (8 boys and 12 girls). The mean age of disease onset was 7 (4.5) years. The most common presenting symptoms were fever (100%), arthritis (100%), and rash (55%). Hepatomegaly (5%), abdominal (5%) and pulmonary manifestations (3%) were less frequent manifestations. Most patients had high white blood cell counts (50%), elevated erythrocyte sedimentation rates (80%) and C-reactive protein levels (90%). The interval between onset of symptoms and diagnosis was 9.4 (12.5) weeks. Patients were treated with non-steroidal anti-inflammatory drugs, methotrexate, steroids, anti-tumor necrosis agents, and disease-modifying anti-rheumatic drugs. Bone marrow biopsy was conducted to exclude malignancy in 20% of the patients. Conclusion: Saudi children with systemic-onset JIA present with prolonged fever and arthritis (mainly oligoarticular rather than polyarticular). Physicians should be aware of the presentation of systemic-onset JIA in our setting in order to make prompt diagnosis and treatment decisions as early as possible. Carful follow-up of febrile patients is paramount to reaching the diagnosis early and initiating treatment.

Influences of MJO-induced Tropical Cyclones on the Circulation-Convection Inconsistency for the 2021 South China Sea Summer Monsoon Onset

The South China Sea Summer Monsoon(SCSSM)onset is characterized by an apparent seasonal conversion of circulation and convection.Accordingly,various indices have been introduced to identify the SCSSM onset date.However,the onset dates as determined by various indices can be very inconsistent.It not only limits the determination of onset dates but also misleads the assessment of prediction skills.In 2021,the onset time as identified by the circulation criteria was 20 May,which is 12 days earlier than that deduced by also considering the convection criteria.The present study mainly ascribes such circulation-convection inconsistency to the activities of tropical cyclones(TCs)modulated by the Madden-Julian Oscillation(MJO).The convection of TC“Yaas”(2021)acted as an upper-level diabatic heat source to the north of the SCS,facilitating the circulation transition.Afterward,TC“Choi-wan”(2021)over the western Pacific aided the westerlies to persist at lower levels while simultaneously suppressing moist convection over the SCS.Accurate predictions using the ECMWF S2S forecast system were obtained only after the MJO formation.The skillful prediction of the MJO during late spring may provide an opportunity to accurately predict the establishment of the SCSSM several weeks in advance.

Elabela is a reliable biomarker for predicting early onset preeclampsia:A comparative study

BACKGROUND Preeclampsia(PE)is a multisystemic metabolic disease with an undetermined etiology.PE is a worldwide cause of maternal and perinatal morbidity,subdivided into early(EoPE)and late-onset(LoPE)according to 34 wk of gestation as a divider.Many researchers investigated biomarkers for predicting PE to halt its consequences on the feto-maternal outcome.Elabela(Ela)is a newly discovered peptide hormone that was implicated in PE pathogenesis.Earlier rodent studies discussed Ela’s role in controlling blood pressure.Moreover,Ela deficiency was associated with PE development.AIM To test whether plasma Ela could serve as a reliable marker for predicting PE based on the time of onset(EoPE vs LoPE)compared to age and body mass matched healthy controls since no definitive treatment exists for PE but to terminate a pregnancy.METHODS This case-control study recruited(n=90)pregnant who fulfilled inclusion criteria;they were allocated into three groups:EoPE(30/90)(<34 wk of gestation);LoPE(30/90)(≥34 wk of gestation);and healthy pregnant(30/90).Demographic criteria;biochemical,hematological,and maternal plasma Ela levels were recorded for comparison.RESULTS Serum Ela was significantly reduced in EoPE compared to LoPE and healthy controls(P=0.0023).The correlation confirmed a strong inverse relationship with mean atrial blood pressure(r=-0.7,P<0.001),while gestational age and platelets count showed a moderate correlation with(r=0.4 with P<0.0001).No correlation was confirmed between the body mass index(BMI)and urine albumin.The predictive ability of 25 centile serum Ela had an Odds ratio of 5.21,95%confidence interval(1.28,21.24),P=0.02 for predicting EoPE.The receiver operator characteristic curve defined the Ela cutoff value at>9.156 with 96.7%and 93.3%sensitivity and specificity,P<0.0001 in predicting EoPE.CONCLUSION A strong correlation of serum Ela with PE parameters with excellent sensitivity and specificity in distinguishing EoPE independent of the BMI,age,and blood pressure which makes Ela a recommendable marker in screening.Further research is warranted to explore prognostic and therapeutic applications for Ela in PE.

The Inter-Annual Variability of Rainfall Onset and Its Implication on Crop Planting in Selected East Africa Countries

The inter-annual variability of rainfall onset and crop replanting in East Africa (EA) was assessed using daily estimated rainfall data from climate hazard group infrared precipitation (CHIRPS Ver2.0) and monthly Sea Surface Temperature (SST) indices [Indian Ocean Dipole (IOD) and El-Ni?o Southern Oscillation (ENSO) at NINO3.4 region] from the National Center for Environmental Prediction (NCEP) and the National Center for Atmospheric Research (NCAR). The data covered a period of 40 years from1981 to 2020. The methods of cumulative of daily mean rainfall, percentage of onset date departure (PODD), Mann-Kendall (MK) trend test, student t-test, and correlation were applied in the analysis. The results showed that early onset with dry spell (WDS) consideration frequently occurs in Uganda between the first and second dekads of September, while late rainfall onset WDS occurs in the first and second dekads of December over central and Northern Kenya as well as in the Northeastern highlands, parts of the northern coast and unimodal regions in Tanzania. Rainfall onset with no dry spell (WnDS) portrayed an average of 10 days before the occurrence of true onset WDS, with maximum onset departure days (ODD) above 30 days across the Rift Valley area in Kenya and the Northeastern highlands in Tanzania. The high chance of minimum ODD is seen over entire Uganda and the area around Lake Victoria. However, few regions, such as Nakuru (Kenya) Gulu and Kibale (Uganda), and Gitega (Burundi), revealed a slight positive linear trend while others showed negative trend. Significant positive patterns for correlation between onset WDS and SST indices (IOD and NINO 3.4) were discovered in Northern and Northeastern Kenya, as well as areas along the Indian Ocean (over Tanzania’s Northern Coast). Inter-annual relationship between onset dates WDS and IOD (NINO3.4) indices exhibits a high correlation coefficient r = 0.23 (r = 0.48) in Uganda and r = 0.44 (r = 0.36) in Kenya. On the other hand, a negative correlation was revealed over Burundi and Tanzania (over a unimodal region). A high percentage of PODD was observed, ranging from 40% to 70% over the Rift Valley in Kenya and at the Northeastern highlands in Tanzania. However, a strong PODD above 70% was observed over Tanga and the Northern Pwani Region in Tanzania. These findings will help farmers to understand the appropriate time for crop planting, as well as help other socio-economic activities that strongly depend on rainfall.

Clinical implication of platelet to lymphocyte ratio in early onset preeclampsia:A single-center experience

BACKGROUND Preeclampsia(PE)is a pregnancy syndrome of undetermined etiology;inflammation was one of the proposed theories for its development.AIM To examine the platelet to lymphocyte ratio(PLR),an inflammatory biomarker,as a marker to predict poor maternal-neonatal outcomes in early-onset PE(EoPE).METHODS A cross-sectional study enrolled 60 pregnant women with EoPE(at 32-30 wk of gestation)at a university hospital.Demographic criteria and hematological indices were collected,including platelet counts and indices(mean platelet volume and platelet distribution width),PLR,and the Doppler study,which calculated estimated fetal weight(EFW),amniotic fluid index(AFI),resistance index(RI),and pulsatility index(PI).Participants were followed until delivery,where maternal outcomes were recorded,including;delivery mode and reason for cesarean section,and neonatal outcomes,including fetal growth restriction(FGR),meconium-stained liquid,the 5-min Apgar score,and admission to the intensive care unit.RESULTS There was a trend of insignificant increases in cesarean sections.Sixty-one-point two percent(37/60)fetuses were admitted to the neonatal care unit;70.0%of admitted fetuses were meconium-stained liquor,and 56.7%of them had FGR.PLR was positively correlated with AFI and EFW as r=0.98,0.97,P<0.001;PLR showed negative correlations with PI and RI as r=-0.99,-0.98,P<0.001.The Apgar score and the number of days admitted to the intensive care unit had a positive and negative correlation(0.69,-0.98),P<0.0001,respectively.Receiver operating characteristic calculated a PLR cutoff value(7.49)that distinguished FGR at 100%sensitivity and 80%specificity.CONCLUSION Strong,meaningful relationships between PLR and FGR parameters and a poor neonatal outcome with a significant P value make it a recommendable biomarker for screening EoPE-related complications.Further studies are suggested to see the impact on maternal-neonatal health.

Atypical Symptoms of Early Onset Bipolar Disorder

Juvenile bipolar disorder can be a challenging diagnosis, given its atypical presentation and tendency to have other comorbid psychiatric disorders. In this case study, we describe a case of a young patient with some atypical symptoms of early-onset bipolar disorder.

Timing of Elective Repeat Cesarean Delivery at 38 Weeks versus 39 Weeks: Rate of Spontaneous Onset of Labor before Planned Cesarean Section and Impact on Maternal Outcome: A Retrospective Cohort Study

Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to aid decision-making regarding the timing of elective repeat cesarean delivery. Objectives: To estimate the rate of spontaneous onset of labor before the planned gestational age for repeat cesarean section in women who were booked at gestational age of (39 0/7 - 39 6/7) weeks (W39) versus (38 0/7 - 38 6/7) weeks (W38) and to compare the rate of maternal composite outcome between these groups. Design: Retrospective cohort. Setting: This study was conducted at King Abdulaziz Medical City, Jeddah, KSA. Method: Delivery registry books were reviewed to identify all deliveries from 1 January 2014 to 31 December 2016 (3 years). All low-risk pregnant women who had 2 or more cesarean deliveries and who met the inclusion criteria were included. Results: A total of 440 women were included of whom 318 (72.3%) were planned for elective cesarean section at W38 gestational age and 122 women at W39 gestational age. Mothers planned at W39 had higher rate of emergency cesarean deliveries versus those planned at W38 (18.0% versus 10.4%, p = 0.030;RR = 13.06), most frequently due to early onset of contractions (16.4% versus 8.2%, p = 0.012;RR = 12.17) or cervical dilatation (11.6% versus 5.4%, p = 0.024, RR = 16.15). No difference in the incidence of individual or composite maternal complications was noted between the two groups. Mother’s age (OR 0.93, p = 0.018) and schedule date at W39 (OR = 1.94, p = 0.028) were independently associated with spontaneous onset of labor before the scheduled gestational age, while no association was found with parity, previous number of spontaneous vaginal deliveries, number of previous cesarean deliveries or interval from last cesarean delivery. Conclusion: Elective cesarean section scheduled at 39 weeks of gestation or beyond carries a higher risk of emergency cesarean section, with no significant increase in maternal complications. The identification of factors associated with spontaneous onset of labor before the planned gestational age should be carefully identified to determine the optimal timing.

初诊SLE患者抗CTLA-4抗体水平及其临床意义

目的探讨初诊系统性红斑狼疮(SLE)患者血清中抗CTLA-4抗体水平及其临床意义。方法选取2022年1月至2023年6月在苏州大学附属第一医院风湿免疫科就诊的初诊SLE患者56例作为病例组,同时选取我院体检中心52例体检者作为对照组。采用酶联免疫吸附试验(ELISA)检测两组血清中IgG和IgM型抗CTLA-4抗体。比较不同临床特征(包括皮疹、口腔溃疡、浆膜炎等等)初诊SLE患者组间抗CTLA-4抗体水平差异。采用Pearson相关分析评估初诊SLE患者抗CTLA-4抗体与疾病活动指标[包括SLE疾病活动指数2000版(SLEDAI-2K)、抗ds-DNA以及C反应蛋白(CRP)]的关系。结果病例组IgG和IgM型抗CTLA-4水平均高于对照组(t=4.657、5.014,P均<0.05);IgG和IgM型抗CTLA-4抗体水平在SLE合并浆膜炎的患者中高于未合并浆膜炎患者(t=1.849、2.013;P=0.046、0.032);Pearson相关分析显示,IgM型抗CTLA-4抗体与SLEDAI-2K(r=0.425,P=0.029)及补体C3(r=-0.494,P=0.029)呈正相关;IgG和IgM型抗CTLA-4抗体与CRP(r=0.301、0.404;P=0.041、0.022)和抗ds-DNA抗体(r=0.644、0.363;P=0.002、0.036)呈正相关。结论初诊SLE患者血清抗CTLA-4抗体呈高表达,且该抗体与浆膜炎、疾病活动度相关。

Sepsis Prediction Using CNNBDLSTM and Temporal Derivatives Feature Extraction in the IoT Medical Environment

Background:Sepsis,a potentially fatal inflammatory disease triggered by infection,carries significant healthimplications worldwide.Timely detection is crucial as sepsis can rapidly escalate if left undetected.Recentadvancements in deep learning(DL)offer powerful tools to address this challenge.Aim:Thus,this study proposeda hybrid CNNBDLSTM,a combination of a convolutional neural network(CNN)with a bi-directional long shorttermmemory(BDLSTM)model to predict sepsis onset.Implementing the proposed model provides a robustframework that capitalizes on the complementary strengths of both architectures,resulting in more accurate andtimelier predictions.Method:The sepsis prediction method proposed here utilizes temporal feature extraction todelineate six distinct time frames before the onset of sepsis.These time frames adhere to the sepsis-3 standardrequirement,which incorporates 12-h observation windows preceding sepsis onset.All models were trained usingthe Medical Information Mart for Intensive Care III(MIMIC-III)dataset,which sourced 61,522 patients with 40clinical variables obtained from the IoT medical environment.The confusion matrix,the area under the receiveroperating characteristic curve(AUCROC)curve,the accuracy,the precision,the F1-score,and the recall weredeployed to evaluate themodels.Result:The CNNBDLSTMmodel demonstrated superior performance comparedto the benchmark and other models,achieving an AUCROC of 99.74%and an accuracy of 99.15%one hour beforesepsis onset.These results indicate that the CNNBDLSTM model is highly effective in predicting sepsis onset,particularly within a close proximity of one hour.Implication:The results could assist practitioners in increasingthe potential survival of the patient one hour before sepsis onset.

Prognostic value of C-reactive protein levels within 6 hours after the onset of acute anterior myocardial infarction with primary PCI

Background Increased levels of inflammatory markers have been documented in various settings of coronary artery disease. The vulnerability of coronary lesions in acute myocardial infarction(AMI) at the time of onset may be related to serum levels of C reactive protein(CRP) on admission, before CRP levels are affected by myocardial damage.Objective This study assessed the predictive value of CRP levels within six hours after the onset of acute anterior myocardial infarction with primary percutaneous coronary intervention(PCI).Methods The plasma CRP of 76 patients with first acute anterior myocardial infarction was measured within 6 hours after onset. They were divided into 2 groups: group 1( n =20) with elevated CRP( ≥0.3mg/dl ) on admission within 6 hours after onset and group 2( n =56) with normal CRP( <0.3mg/dl ) within 6 hours after onset. All patients were treated by primary PCI. The primary combined end points, including death due to cardiac causes, re MI related to the infarction artery(RIA) and repeat intervention of the RIA, and the restenosis rate were assessed in relation to CRP levels within 6 hours after onset. Left ventricular end diastolic volume index(EDVI),end systolic volume index(ESVI),and ejection fraction(EF) on admission and 6 month after the onset were assessed by left ventriculography. Changes in EDVI(ΔEDVI),ESVI(ΔESVI), and EF(ΔEF) were obtained by subtracting respective on admission values from corresponding 6 month follow up values. Results There were no significant differences in baseline characteristics between the two groups. The primary combined end points were significantly more frequent in group 1(20%) than those in group 2( 1.79% , P <0.01 ).In addition, restenosis rates were significantly higher in group 1 than in group 2(41.18% vs 16.07%, P<0.05). Group 1 showed greater increases in left ventricular volume and less improvement in EF compared with group 2(ΔEDVI 6.31 ±2.17 vs 3.29 ±9.46ml/m 2 , ΔESVI 5.92 ±2.31 vs 3.86 ±1.08ml/m 2 , ΔEF 1.92 ±0.47 vs 4.79 ±1.73% , P <0.05 , respectively).Conclusions CRP levels within 6 hours after the onset of AMI might predict adverse outcome after primary PCI and progressive ventricular remodeling within 6 month of AMI.

A Family of GCK-MODY, About 02 Cases and Review of the Literature

Positive diagnosis of diabetes is currently easy, but typing diagnosis of diabetes still remains a challenge for every clinician. It is currently accepted that types of diabetes apart from T1D and T2D can expand and include several forms of diabetes mellitus;From gestational diabetes, to all forms of secondary diabetes mellitus due to medications, intercurrent disease but also infections, and finally monogenic diabetes, whose diagnosis is not always easy to establish. The aim is to reveal the difficulties that clinicians may face in the process of etiological diagnosis regarding the suspicion of this type of monogenic diabetes, through the study of 2 cases, in which MODY type diabetes was suspected. Today we recognize 17 different genetic mutations that can all lead to MODY diabetes, the most common mutation of which is GCK coding for the glucokinase, the real sensor of pancreatic Beta-cell. The truly stable glycemic profile, with an A1C ranging between 7% and 7.5%, confirmed with a TIR always above 70% and a good MAGE, but also the rarity of degenerative complications and pharmacological therapeutic abstention which can last for years, these would be the most striking clinical characteristics of a GCK MODY.