Azathioprine versus mycophenolate mofetil for long-term immunosuppression in lupus nephritis: results from the MAINTAIN Nephritis Trial

Background: Long-term immunosuppressive treatment does not efficiently prevent relapses of lupus nephritis (LN). This investigator-initiated randomised trial tested whether mycophenolate mofetil (MMF) was superior to azathioprine (AZA) as maintenance treatment. Methods: A total of 105 patients with lupus with proliferative LN were included. All received three daily intravenous pulses of 750 mg methylprednisolone, followed by oral glucocorticoids and six fortnightly cyclophosphamide intravenous pulses of 500 mg. Based on randomisation performed at baseline, AZA (target dose: 2 mg/kg/day) or MMF (target dose: 2 g/day) was given at week 12. Analyses were by intent to treat. Time to renal flare was the primary end point. Mean (SD) follow-up of the intent-to-treat population was 48 (14) months. Results: The baseline clinical, biological and pathological characteristics of patients allocated to AZA or MMF did not differ. Renal flares were observed in 13 (25%) AZA-treated and 10 (19%) MMF-treated patients. Time to renal flare, to severe systemic flare, to benign flare and to renal remission did not statistically differ. Over a 3-year period, 24 h proteinuria, serum creatinine, serum albumin, serum C3, haemoglobin and global disease activity scores improved similarly in both groups. Doubling of serum creatinine occurred in four AZA-treated and three MMF-treated patients. Adverse events did not differ between the groups except for haematological cytopenias, which were statistically more frequent in the AZA group (p=0.03) but led only one patient to drop out. Conclusions: Fewer renal flares were observed in patients receiving MMF but the difference did not reach statistical significance.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

On the non-respect of the thermodynamic cycle of DsbA variants

International audienc

Comportamiento estático y modal del chasis de un ómnibus modernizado//Static and modal behavior of the chassis of a modernized bus

<p>El presente trabajo tiene como objetivo determinar el comportamiento estático y modal del chasis de un ómnibus modernizado debido a la modificación realizada a la estructura que se montará sobre el mismo.<br />La nueva estructura tendrá una mejor forma aerodinámica y apariencia exterior, alcanzará una mayor velocidad y cargará un mayor número de personas, por lo que es necesario recalcular el chasis para estas nuevas condiciones. Se presentan dos simulaciones numéricas mediante el Método de los Elementos Finitos: la primera de ellas se refiere al análisis estático del chasis para tres estados de carga. La segunda corresponde al análisis modal determinando las frecuencias naturales y los modos propios del chasis.<br />Basado en los resultados de los análisis de resistencia y de rigidez se concluye que el chasis puede ser empleado para las nuevas condiciones.<br /><br /><strong>Palabras claves:</strong> ómnibus, chasis, análisis estático, análisis modal, simulación numérica.<br /><br /><strong>Abstract</strong><br /><br />The static and modal behavior of the chassis of a modernized bus due to the modification made to the structure to be mounted on it is the objective of this paper. The new structure will have a better aerodynamic shape and external appearance, will reach a higher speed and will load a larger number of<br />people, so the chassis has to be re-analyzed to the new conditions. Two numerical simulations using the Finite Element Method are presented: The first one concerns the static analysis of the chassis for three load states. The second corresponds to the modal analysis by determining the natural frequencies and<br />natural modes of the chassis. Based on the results of strength and rigidity analyses it is concluded that the chassis can be used on the new conditions.</p><p><strong>Key words: </strong>bus, chassis, static analysis, modal analysis, numeric simulation.</p

Möglichkeiten empirischer Erfassung der Computernutzung von Schüler/innen im Unterricht

Der vorliegende Beitrag befasst sich mit den Möglichkeiten der empirischen Untersuchung des Umgangs von Schülerinnen und Schülern mit multi- und hypermedialen Lernsystemen. Ein Instrument zur Erfassung des Umgangs damit stellt die Aufzeichnung und Auswertung von Logfiles dar. Es wird erläutert, welche Aspekte bei der Aufzeichnung sowie der Auswertung beachtet werden müssen und welche rechtlichen Probleme sich ggf. ergeben können. Zur Erhärtung der These, dass Logfileuntersuchungen als ein nicht-reaktives Messverfahren einen wichtigen, wenn auch nicht allein ausreichenden Baustein, zur empirischen Erfassung der Computernutzung von Schülerinnen und Schülern darstellen, werden darüber hinaus exemplarisch einige Untersuchungsergebnisse vorgestellt

Etude préliminaire sur l'utilisation de "l'Aqui'S"comme anesthésique pour la manipulation et l'échantillonnage de truites arc-en-ciel (Oncorhynchus mykiss) et de truites fario (Salmo trutta)

National audienc

Cogan syndrome: Characteristics, outcome and treatment in a French nationwide retrospective study and literature review

International audienceBACKGROUND:Cogan syndrome is mainly treated with steroids. We aimed to determine the place of DMARDs and biologic-targeted treatments.PATIENTS AND METHODS:We conducted a French nationwide retrospective study of patients with Cogan syndrome (n=40) and a literature review of cases (n=22) and analyzed the efficacy of disease-modifying anti-rheumatic drugs (DMARDs) and tumor necrosis factor α (TNF-α) antagonists.RESULTS:We included 62 patients (31 females) (median age 37years [range 2-76]. At diagnosis, 61 patients (98%) had vestibulo-auditory symptoms, particularly bilateral hearing loss in 41% and deafness in 31%. Ocular signs were present in 57 patients (92%), with interstitial keratitis in 31 (51%). The first-line treatment consisted of steroids alone (n=43; 70%) or associated with other immunosuppressive drugs (n=18; 30%). Overall, 13/43 (30%) and 4/18 (22%) patients with steroids alone and with associated immunosuppressive drugs, respectively (p=0.8), showed vestibulo-auditory response; 32/39 (82%) and 15/19 (79%) ocular response; and 23/28 (82%) and 10/14 (71%) general response. Overall 61 patients had used a total of 126 lines of treatment, consisting of steroids alone (n=51 lines), steroids with DMARDs (n=65) and infliximab (n=10). Vestibulo-auditory response was significantly more frequent with infliximab than DMARDs or steroids alone (80% vs 39% and 35%, respectively), whereas ocular, systemic and acute-phase reactant response rates were similar. Infliximab was the only significant predictor of vestibulo-auditory improvement (odds ratio 20.7 [95% confidence interval 1.65; 260], p=0.019).CONCLUSION:Infliximab could lead to vestibulo-auditory response in DMARDS and steroid-refractory Cogan syndrome, but prospective studies are necessary

Non HCV-related infectious cryoglobulinemia vasculitis: Results from the French nationwide CryoVas survey and systematic review of the literature

International audienc

Rituximab versus Azathioprine for Maintenance in ANCA-Associated Vasculitis

International audienc

Long-term efficacy of remission-maintenance regimens for ANCA-associated vasculitides

International audienceObjective - To compare long-term efficacy of remission-maintenance regimens in patients with newly diagnosed or relapsing antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitides. Methods - The 28-month Maintenance of Remission using Rituximab in Systemic ANCA-associated Vasculitis trial compared rituximab with azathioprine to maintain remission in patients with newly diagnosed or relapsing granulomatosis with polyangiitis, microscopic polyangiitis or renal-limited ANCA-associated vasculitis. Thereafter, prospective patient follow-up lasted until month 60. The primary endpoint was the major-relapse rate at month 60. Relapse and serious adverse event-free survival were also assessed. Results - Among the 115 enrolled patients, only one was lost to follow-up at month 60. For the azathioprine and rituximab groups, respectively, at month 60, the major relapse-free survival rates were 49.4% (95% CI 38.0% to 64.3%) and 71.9% (95% CI 61.2% to 84.6%) (p=0.003); minor and major relapse-free survival rates were 37.2% (95% CI 26.5% to 52.2%) and 57.9% (95% CI 46.4% to 72.2%) (p=0.012); overall survival rates were 93.0% (95% CI 86.7% to 99.9%) and 100% (p=0.045) and cumulative glucocorticoid use was comparable. Quality-adjusted time without symptoms and toxicity analysis showed that rituximab-treated patients had 12.6 months more without relapse or toxicity than those given azathioprine (p<0.001). Antiproteinase-3-ANCA positivity and azathioprine arm were independently associated with higher risk of relapse. HRs of positive ANCA to predict relapse increased over time. Conclusion - The rate of sustained remission for ANCA-associated vasculitis patients, following rituximab-based or azathioprine-based maintenance regimens, remained superior over 60 months with rituximab, with better overall survival. Trial registration number - NCT00748644