PURPOSE The objective of this study was to determine the impact of lupus nephritis disease activity on maternal and fetal outcomes in pregnant patients with systemic lupus erythematosus (SLE). METHODS Medical records of all pregnant patients with SLE treated at our institution between 1976 and 2007 were reviewed. All patients met American College of Rheumatology classification criteria for SLE. Demographic data, history of lupus nephritis, nephritis disease activity, and maternal and fetal outcomes of pregnancy were abstracted. Active lupus nephritis was defined as the presence of proteinuria > 0.5 g/day and/or active urinary sediment with or without an elevation in serum creatinine (Cr). Quiescent lupus nephritis was confirmed in the presence of proteinuria < 0.5 mg/day and inactive urinary sediment. RESULTS We identified fifty-eight patients with ninety pregnancies. Compared to pregnancies in SLE patients without renal involvement (n=47), pregnancies in patients with active lupus nephritis (n=23) were associated with a higher incidence of maternal complications (57% vs. 11%, p<0.001), whereas those with quiescent lupus nephritis (n=20) were not (35% vs. 11%, p=0.10). Women with active lupus nephritis were more likely to deliver preterm than women without lupus nephritis, median of 34 weeks vs. 40 gestational weeks, respectively (p=0.002), and were more likely to suffer fetal loss (35% vs 9%, p=0.031). CONCLUSION Active, but not quiescent, lupus nephritis during pregnancy is associated with a higher incidence of maternal and fetal complications compared to pregnancies in SLE patients without renal involvement.

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In the current study, the sensitivity and specificity of methods of HER2 status detection were studied in 55 patients presenting with gastric/gastroesophageal junction carcinoma (30 intestinal and 25 diffuse), in small biopsy (endoscopy; n=33) and resection specimens (n=22). The primary objective of the present study was to compare various methods for the assessment of HER2 status, with regards to the sensitivity and specificity of each method, as well as their concordance. In all cases, the status of HER2 was determined using immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), silver in situ hybridization (SISH), and quantitative polymerase chain reaction (qPCR). The concordance rate between IHC and ISH was 100% for IHC 0 and 3+. The concordance rate for IHC 1+ was 100% between IHC and SISH, and 92.9% between IHC and FISH. The concordance rate among different FISH methods was 100%, between FISH and SISH it was 96.2%, and between qPCR and ISH methods it was 88.5%. Thus, the results demonstrate that different in situ hybridization methods are comparable and that none were superior. Furthermore, the IHC and FISH methods were found to be comparable and the concordance rate was particularly good. qPCR analysis correlated well with the other methods and appears to be a possible alternative tool for detection of the HER2 status. However, the concordance rate of qPCR with other methods was identified to be lower in the diffuse carcinoma group of endoscopy biopsy specimens; therefore investigation of further cases is required.

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