Fewer than half of patients with systemic sclerosis demonstrate modified Rodnan skin score improvement during mycophenolate mofetil (MMF) treatment. To understand the molecular basis for this observation, we extended our prior studies and characterized molecular and cellular changes in skin biopsies from subjects with systemic sclerosis treated with MMF. Eleven subjects completed ≥24 months of MMF therapy. Two distinct skin gene expression trajectories were observed across six of these subjects. Three of the six subjects showed attenuation of the inflammatory signature by 24 months, paralleling reductions in CCL2 mRNA expression in skin and reduced numbers of macrophages and myeloid dendritic cells in skin biopsies. MMF cessation at 24 months resulted in an increased inflammatory score, increased CCL2 mRNA and protein levels, modified Rodnan skin score rebound, and increased numbers of skin myeloid cells in these subjects. In contrast, three other subjects remained on MMF >24 months and showed a persistent decrease in inflammatory score, decreasing or stable modified Rodnan skin score, CCL2 mRNA reductions, sera CCL2 protein levels trending downward, reduction in monocyte migration, and no increase in skin myeloid cell numbers. These data summarize molecular changes during MMF therapy that suggest reduction of innate immune cell numbers, possibly by attenuating expression of chemokines, including CCL2.

Cord blood IGF-1 is strongly associated with all measures of neonatal adiposity suggesting that IGF-1 may be an important contributor to in utero neonatal fat accumulation.

Background Sedentary behavior is associated with increased risk of functional decline and disability. Individuals with rheumatoid arthritis (RA) spend more time sedentary than healthy adults. Self-reported assessment of sedentary behavior has not been well-developed in this patient population. Methods 172 adults with RA wore an accelerometer for 7 days and completed a modified version of the Yale Physical Activity Survey (YPAS). YPAS-derived sedentary estimates included 1) daily sitting categories (<3, 3 to 6, 6 to 8, >8 hours/day), 2) continuous daily sedentary time calculated by subtracting hours spent sleeping or in physical activity from a 24-hour day, and 3) rank order of YPAS-derived continuous daily sedentary time. Each estimate was compared with objective accelerometer-derived sedentary time using linear regression and Bland-Altman analysis. Results A significant relationship was observed between accelerometer-derived sedentary time and all 3 estimates. Bland-Altman plot demonstrated systematic bias, however Bland-Altman plot of rank-order demonstrated that the ranked YPAS-derived continuous estimate was an unbiased predictor of ranked accelerometer sedentary time though limits of agreement were wide. Conclusions This patient-reported approach using the YPAS shows promise to be a useful tool to identify the most sedentary patients. Providing a practical and accurate tool may increase the frequency sedentary behavior is assessed by clinicians.

BACKGROUND: Patient-physician continuity is difficult to achieve in hospital settings because of the need to provide care continuously. The impact of hospital physician discontinuity on patient safety is unknown.

Residents' self-reported and actual use of CBCs and chemistry panels is significantly higher than that of hospitalists in the same hospital. Our results reveal an opportunity for greater supervision and improved instruction of cost-conscious ordering practices.