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Introduction: This retrospective study on patients with biopsy-proven lupus nephritis (LN) aimed to assess the probability of sustained clinical remission (sCR) and to investigate sCR effects on disease flares and impaired kidney function (IKF). Methods: sCR was defined as clinical-Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) = 0 and estimated glomerular filtration rate (eGFR) >60 ml/min per 1.73 m2 lasting ≥1 year; IKF: eGFR <60 ml/min per 1.73 m2 for >3 months. We analyzed the probability of achieving and maintaining sCR, and the yearly risk of flare. Cox models were used to identify predictors of sCR and IKF with variables analyzed as time-dependent covariates when appropriate. Results: Of 303 patients followed-up with for 14.8 (interquartile range: 9.8–22) years, 257 (84.8%) achieved sCR. The probability of achieving sCR progressively increased over time reaching 90% at 15 years. Baseline age (hazard ratio [HR]: 1.017; 95% confidence interval [CI]: 0.005–1.029; P = 0.004), hydroxychloroquine intake (HR: 1.385; 95% CI: 1.051–1.825; P = 0.021), and absence of arterial hypertension (HR: 0.699; 95% CI: 0.532–0.921; P = 0.011) were independent predictors of sCR. Among patients who achieved sCR, 142 (55.3%) developed a lupus flare after a median time of 3.6 (2.3–5.9) years. In the remaining 115 patients, sCR persisted for 9.5 (5.8–14.5) years. The probability of sCR to persist at 15 years was 38%. SLE flare risk decreased to 10%, 5%, and 2% in patients with sCR lasting <5, 5 to 10, and >10 years, respectively. At the last observation, 57 patients (18.81%) had IKF. sCR achievement (HR: 0.18, P < 0.001) and its duration (HR: 0.83, P < 0.001) were protective against IKF. Conclusion: sCR is an achievable target in LN management and protects against IKF. The longer the sCR, the higher the chance of its persistence and the lower the risk of SLE flares.

Objectives: To analyse the effectiveness, safety and steroid-sparing effect of AZA and MTX as induction of remission and maintenance treatment in eosinophilic granulomatosis with polyangiitis. Methods: We retrospectively collected data from 57 patients divided into four groups according to treatment: MTX/AZA as first-line agents (MTX1/AZA1) in non-severe disease or as second-line maintenance therapy (MTX2/AZA2) in severe disease previously treated with CYC/rituximab. During the first 5 years of treatment with AZA/MTX we compared the groups according to: remission rate [defined as R1: BVAS 1⁄4 0; R2: BVAS 1⁄4 0 with prednisone ≤5 mg/day; R3 (MIRRA definition): BVAS 1⁄4 0 with prednisone ≤3.75 mg/day], persistence on therapy, cumulative glucocorticoid (GC) dose, relapse and adverse events (AEs). Results: There were no significant differences in remission rates (R1) in each group (63% in MTX1 vs 75% in AZA1, P 1⁄4 0.53; 91% in MTX2 vs 71% in AZA2, P 1⁄4 0.23). MTX1 allowed R2 more frequently in the first 6 months compared with AZA1 (54% vs 12%, P 1⁄4 0.04); no patients receiving AZA1 achieved R3 up to the first 18 months (vs 35% in MTX1, P 1⁄4 0.07). The cumulative GC dose was lower for MTX2 vs AZA2 (6 g vs 10.7 g at 5 years, P 1⁄4 0.03). MTX caused more AEs compared with AZA (66% vs 30%, P 1⁄4 0.004), without affecting the suspension rate. No differences emerged in time-to-first relapse, although fewer patients treated with AZA2 had asthma/ENT relapses (23% vs 64%, P 1⁄4 0.04). Conclusion: A significant proportion of patients achieved remission with both MTX and AZA. MTX1 had an earlier remission on a lower GC dose but MTX2 had a better steroid-sparing effect.

Within the NONCADO project, which aims at preventing falls in the elderly living alone at home, we performed a literature search for models that provide an estimate of the subject's risk of falling. Our goal is to combine the scores produced by multiple models to derive an overall risk score. In this work we described nine predictive models and we tested their concordance in assessing the risk of falling of two patient populations, namely a simulated patient population and an Italian real-world patient population. Using the real-world population, we also measured the performance of a subset of these models, by comparing their predictions with the outcome (in terms of occurred falls) collected in a 9-months follow-up study. Our experiments showed poor model concordance and dependence of the results on the population. Furthermore, the predictive performance measured the Italian population were limited. Therefore, attempts to combine the risk predictions of multiple models should be cautious.

Falls in the elderly are a known problem, leading to hospitalization, impaired life quality, and social costs. Falls are associated to multiple risk factors, related to the subject’s health, lifestyle, and living environment. Living alone makes it difficult to detect a patient’s decline, which increases the fall risk. In this paper, we present NONCADO, a project funded by the Lombardy Region (Italy), aimed at developing a system for preventing falls in the elderly living alone, by integrating data from a network of sensors (both wearable and environmental). The collected data are analyzed by a decision support system (DSS) that exploits advanced temporal data analysis techniques to detect behaviors known to increase the individual risk (e.g. moving within the house with inadequate lighting, or performing not enough physical activity). A daily report listing the detected risky behaviors is produced and delivered through a mobile app. Since we address long-term monitoring, it’s important to detect as well the changes in a subject’s habits that may increase fall risk. Such changes are summarized in a weekly report. A preliminary feasibility evaluation of the system was performed during a 2-weeks pilot study involving 16 patients treated at the Casa di Cura Privata del Policlinico hospital, in Milan, Italy. Patients were asked to perform 5 activities, and the system’s ability to correctly detect them was assessed. The study results were encouraging, as the system reached an overall accuracy of 90%.

Objectives Short-term predictive endpoints of chronic kidney disease (CKD) are needed in lupus nephritis (LN). We tested response to therapy at 1 year. Methods We considered patients with LN who underwent renal biopsy followed by induction therapy between January 1970 and December 2016. LN was assessed using the International Society of Nephrology/Renal Pathology Society (2003) criteria and the National Institute of Health (NIH) activity and chronicity index. The renal outcome was CKD. Response was defined according to EULAR/European League Against Rheumatism/European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations: complete: proteinuria <0.5 g/24 hours, (near) normal estimated glomerular filtration rate (eGFR); partial: ≥50% proteinuria reduction to subnephrotic levels, (near) normal eGFR; and no response: all the other cases. Logistic regression analysis was employed for 12-month response and Cox regression for CKD prediction. Results We studied 381 patients (90.5% Caucasians). After 12-month therapy, 58%, 26% and 16% of patients achieved complete, partial and no response, respectively, according to EULAR/ERA-EDTA. During a median follow-up of 10.7 (IQR: 4.97-18.80) years, 53 patients developed CKD. At 15 years, CKD-free survival rate was 95.2%, 87.6% and 55.4% in patients with complete, partial and no response at 12 months, respectively (p<0.0001). CKD-free survival rates did not differ between complete and partial responders (p=0.067). Serum creatinine (HR: 1.485, 95% CI 1.276 to 1.625), eGFR (HR 0.967, 95% CI 0.957 to 0.977) and proteinuria at 12 months (HR 1.234, 95% CI 1.111 to 1.379) were associated with CKD, yet no reliable cut-offs were identified on the receiver operating characteristic curve. In multivariable analysis, no EULAR/ERA-EDTA response at 12 months (HR 5.165, 95% CI 2.770 to 7.628), low C4 (HR 1.053, 95% CI 1.019 to 1.089) and persistent arterial hypertension (HR 3.154, 95% CI 1.500 to 4.547) inde