a specificity of 86.0%, a positive predictive value of 23.8%, and a negative predictive value of 100%.Conclusions: We have identified four predictors and a model of high neonatal serum magnesium concentrations that can guide maternal magnesium treatment.Our study will allow safer use of magnesium and better prognosis for neonates.

As technologic advances of ultrasound with high resolution, the importance and accuracy of identifying fetal structural abnormalities in first trimester has increased. We aimed to develop an artificial intelligence system called ViewAssist™ that automatically identifies and classifies the fetal structures in the first trimester and to evaluate its performance. Ultrasound images of over 8,000 first trimester fetuses were prospectively collected from Seoul St. Mary's Hospital, Eunpyeong St. Mary's Hospital, Uijeongbu St. Mary's Hospital, and Buchoen St. Mary's Hospital. The collected images were classified by anatomical areas including head, face, neck, chest, heart, abdomen, extremities, and spine, according to the International Society of Ultrasound in Obstetrics and Gynecology guideline. For effective classification of the anatomical areas, we used the Vision Transformer architecture and pre-processed the data by augmenting images while maintaining the aspect ratio. We randomly selected images from the original data, with 90% for the training set and 10% for the validation set. During the deep learning training stage, we used 100 epochs, with a batch size of 64 and a learning rate of 0.0005. We adjusted the hyperparameters at each epoch to minimise the loss function. The classification accuracy of the anatomical areas using ViewAssist™ was 96.75% overall, with the following category-specific accuracy: 100% for head, 98.9% for face, 93.8% for neck, 85.7% for chest, 100% for heart, 94.5% for abdomen, 97.5% for extremities, and 96.2% for spine. Through deep learning algorithms, ViewAssist™ was able to accurately classify the structures of first trimester fetuses. It is expected to be clinically useful in assisting with identifying fetal structures and diagnosing structural abnormalities in the first trimester.

Purpose: The aim of this study was to determine the relationship between polycystic ovarian morphology (PCOM), ovarian morphology, anti-Müllerian hormone (AMH), and testosterone levels in young nulliparous Korean women. Materials and Methods: A total of 139 PCOM patients were evaluated from 2013 to 2018. The relationships between serum AMH levels and androgenic hormones, clinical signs of polycystic ovarian syndrome (PCOS), and ovarian morphology were investigated. Results: Irregular menstruation was the most common symptom in women with PCOM. This study found that hyperandrogenism was present in 26.6% of nulliparous Korean women with PCOM. The present findings support the use of serum AMH as a useful marker to reflect PCOM in cases where accurate ultrasounds are not available. Conclusions: This study found that PCOM did not equate with PCOS, although PCOM is one of the diagnostic criteria for PCOS. AMH levels were positively correlated with ovarian volume and AMH levels were not reflected by hyperandrogenism. Content: The use of serum AMH as a useful marker to reflect PCOM in cases where accurate ultrasounds are not available.

Background The kidney is one of the most commonly involved major organ in systemic lupus erythematosus (SLE). It may occur as an initial presentation at the onset of SLE and it can also present later in the course of the disease. Objectives To compare clinical characteristics, management, and outcomes after 12 months in patients with early-onset lupus nephritis (LN) and late-onset LN and to assess the risk factors for late-onset LN. Methods Patients with lupus nephritis enrolled in the Hanyang BAE Lupus Cohort were retrospectively assessed. Patients who developed LN within one year of the diagnosis of SLE (early-onset) were compared with those who developed LN more than a year later from the diagnosis of SLE (late-onset). Clinical characteristics including the features of SLE, management, and outcomes including renal responses and SLE disease activity were assessed. Results From 1,294 SLE patients in the Hanyang BAE Lupus Cohort, 641 (49.5%) patients had LN. Early-onset LN was observed in 469 (73.2%) and late-onset LN in 172 (26.8%). Hypertension was more frequent in early-onset LN while malar rash, discoid rash, photosensitivity, oral ulcer, arthritis, leukopenia, anti-Sm Ab, and anti-RNP Ab were more frequent in late-onset LN. Late-onset LN patients also showed lower C3 and higher activity index in renal biopsy. There was no significant difference in ISN/RPS classification and in induction therapy. SLEDAI score at onset of LN and after 12 months was similar in the two groups. Complete and partial response rates at six months and twelve months were also similar and there were no differences in progression to end-stage renal disease or death between the two groups. Multivariate analysis identified younger age at onset, malar rash, arthritis, serositis, anti-dsDNA Ab, and anti-Sm Ab as independent risk factors for late-onset LN. Conclusions Late-onset LN patients showed more mucocutaneous symptoms, autoantibodies, and higher activity index in renal biopsy compared to early-onset. However, there were no differences in outcomes after 12 months. Younger age at onset, malar rash, arthritis, serositis, anti-dsDNA Ab, and anti-Sm Ab were risk factors for late-onset LN. Disclosure of Interest None declared

Objective The objective of this paper is to identify the prevalence, risk factors, and impact on mortality of neuropsychiatric systemic lupus erythematosus (NPSLE). Methods Patients from the Hanyang BAE lupus cohort were registered and followed from 1998 to 2015. NPSLE was defined using American College of Rheumatology (ACR) case definitions and Ainiala criteria. Demographics, autoantibodies, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and Systemic Lupus International Collaborating Clinic (SLICC)/ACR Damage Index were collected at baseline and then annually. Mortality data were derived by linking data from the Korean National Statistics Office. Multivariable logistic regression and Cox regression analysis were conducted in the inception cohort to assess the risk factors and mortality impact of NPSLE. Results Of 1121 registered patients, 429 (38.3%) had NPSLE manifestations according to ACR criteria and 216 (19.3%) by Ainiala criteria. In multivariable logistic regression analysis, higher SLEDAI (OR 1.08, CI 1.01–1.16, p = 0.02) and antiphospholipid antibody positivity (OR 1.72, CI 1.03–2.87, p = 0.04) at SLE diagnosis increased NPSLE risk, while elevated anti-dsDNA antibodies (OR 0.43, CI 0.24–0.78, p < 0.01) and greater education duration (OR 0.92, CI 0.85–1.00, p = 0.04) showed reduced risk of NPSLE. Cox proportional hazard models demonstrated that presence of NPSLE had a three-fold increased risk of mortality (HR 3.09, CI 1.03–9.21, p = 0.04), especially in patients with focal CNS NPSLE (HR = 7.83, CI 2.12–28.96, p < 0.01). Conclusion Higher SLEDAI, antiphospholipid antibody positivity, absence of anti-dsDNA antibody at SLE diagnosis, and fewer years of education are risk factors for development of NPSLE. Presence of NPSLE, especially focal CNS NPSLE, increased the risk of mortality in SLE patients.

Objectives Avascular necrosis (AVN) is one of the most common causes of organ damage in patients with systemic lupus erythematosus (SLE) and often causes serious physical disability. The aims of this study were to investigate clinical risk factors associated with symptomatic AVN and to analyze their synergistic effects in a large SLE cohort in Korea. Methods Patients with SLE were enrolled and followed from 1998 to 2014 in the Hanyang BAE Lupus cohort, and damage was measured annually according to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). AVN was confirmed by imaging study if patients had symptoms. To determine risk factors for AVN, clinical, laboratory and therapeutic variables were analyzed by logistic regression. Relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S) were calculated to measure interactions between significant variables. Results Among 1219 SLE patients, symptomatic AVN was the most common type of musculoskeletal damage (10.8%, n = 132). SLE patients with AVN showed an earlier onset age, demonstrated AVN more commonly in conjunction with certain other clinical manifestations such as renal and neuropsychiatric disorders, and received significantly higher total cumulative corticosteroid dose and immunosuppressive agents than did patients without AVN. However, in multivariable analysis, only two variables including use of a cumulative corticosteroid dose greater than 20 g (odds ratio (OR) 3.62, p = 0.015) and use of immunosuppressants including cyclophosphamide or mycophenolate mofetil (OR 4.51, p < 0.001) remained as significant risk factors for AVN. Patients with cumulative corticosteroid dose > 20 g and immunosuppressant use had a 15.44-fold increased risk for AVN, compared with patients without these risk factors ( p < 0.001). RERI, AP and S, which define the strength of interactions between two risk factors, were 9.01 (95% confidence interval (CI) 1.30-16.73), 0.58 (95% CI 0.36-0.81) and 2.66 (95% CI 1.42-4.99), respectively, supporting the presence of synergistic interactions in the development of symptomatic AVN in our Korean lupus cohort. Conclusions An individual risk assessment for AVN development should be made prior to and during treatment for SLE, especially in patients with high-dose corticosteroid and immunosuppressant use regardless of clinical manifestations and disease activity.

Objectives Outcomes of systemic lupus erythematosus (SLE) have significantly improved over the years. However, when there is major organ involvement, the outcomes can still be unfavorable. Outcomes of multitarget therapy using mycophenolate mofetil (MMF) and tacrolimus in patients with SLE who were refractory to standard therapy were assessed. Methods We retrospectively reviewed the Hanyang BAE lupus cohort to identify patients with biopsy-confirmed lupus nephritis (classes III, IV, or V) who failed to either achieve complete response with standard induction therapy or those who had a lupus flare after achieving a complete response with conventional induction therapy and subsequently were switched to multitarget combination therapy with MMF and tacrolimus. Outcomes, including renal response, proteinuria, glomerular filtration rate, serum albumin, anti-dsDNA antibody level, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and complements, were assessed at six and 12 months. Results Twenty-nine patients, including 12 who failed to achieve a complete response at 12 months after initial conventional induction therapy and 17 with lupus flare after achieving a complete response at 12 months and treated with multitarget therapy, were included in the analysis. At six months, 53.9% of the patients showed a response, with 15.4% of patients showing a complete response and 38.5% of patients showing a partial response. At 12 months, 55.5% of patients exhibited a response (with complete and partial response in 25.9% and 29.6%, respectively). The dosage of steroids was significantly decreased at six months compared with baseline and was maintained at 12 months. Proteinuria, anti-double-stranded DNA antibody positivity, as well as C3 and C4 levels improved after treatment and persisted until 12 months, but were not significant. SLEDAI also improved. Outcomes were significantly better in patients who had a complete response but later had a flare, resulting in the use of multitarget therapy and achieving a subsequent complete response. Conclusions Multitarget therapy with MMF and tacrolimus can be a reasonable option in refractory lupus nephritis patients who failed to show adequate response to conventional induction therapy or who had flares during maintenance therapy. This treatment can help patients achieve a renal response and reduce the use of steroids.

Background Neuropsychiatric involvement is one of the most serious involvement of SLE and generally associated with a worse prognosis. However, previous reports about the prevalence and risk factors of neuropsychiatric systemic lupuc erythematosus (NPSLE) have yielded inconsistent findings. Also, there are only few studies of the prognosis of NPSLE, especially in a large prospective cohort. Objectives To identify the prevalence, risk profiles, and impact on mortality of NPSLE. Methods Patients from the Hanyang BAE lupus cohort were registered and followed from 1998 to 2015. Demographics, autoantibodies, SLEDAI-2K and SLICC/ACR damage index were collected at baseline and then annually. Patients registered within 12 months of SLE development were grouped as the inception cohort and analysed separately to elucidate the clinical features at disease onset. NP manifestations were defined using the ACR 19 case definitions and Ainiala NPSLE that did not include minor NP events1. Mortality data were derived by linking data from the Korean National Statistics Office. Results The prevalence of NPSLE by ACR 19 case definition was 38.3%, and 19.3% by Ainiala criteria. Higher SLEDAI, APLA positivity, absence of anti-dsDNA antibody at SLE diagnosis and fewer years of education incresed NPSLE risk. Patients with any NPSLE manifestation had a three-fold increased risk of mortality (HR 3.09, p=0.04), and patients with focal CNS NPSLE showed nearly an eight-fold increased risk of mortality in SLE patients (HR=7.83, p<0.01). Among the 216 patients with Ainiala NPSLE, sixty-four (29.6%) had multiple events. The two most common symptom combinations were seizure with CVA (18 patients) and seizure with psychosis (8 patients). Conclusions Higher SLEDAI, APLA positivity, absence of anti-dsDNA antibody at SLE diagnosis and fewer years of education are risk factors for development of NPSLE. Presence of NPSLE, especially focal CNS NPSLE, increased the risk of mortality in SLE patients. Reference [1] Ainiala H, Hietaharju A, Loukkola J, et al. Validity of the new American College of Rheumatology criteria for neuropsychiatric lupus syndromes: a population-based evaluation. Arthritis Rheum. 2001;45:419–423. Disclosure of Interest None declared

Objectives This study aims to identify the factors associated with the development and mortality of pulmonary hypertension (PH) in systemic lupus erythematosus (SLE) patients. Methods We conducted a prospective study of SLE patients in a single tertiary center. PH was defined as a systolic pulmonary arterial pressure ≥30 mmHg on transthoracic echocardiography. We assessed potential associated factors contributing to the development and mortality of PH in SLE patients. Results Of 1110 patients with SLE, 48 patients were identified to have PH. Multivariable analysis indicated that pleuritis or pericarditis (odds ratio (OR) = 4.62), anti-RNP antibody (OR = 2.42), interstitial lung disease (ILD) (OR = 8.34) and cerebro-cardiovascular disease (OR = 13.37) were independently associated with the development of PH in SLE. Subgroup analysis among patients with PH demonstrated that there were no statistically significant factors associated with PH mortality in SLE. Conclusions The prevalence of PH was 4.3% in our cohort. There were significant associations with pleuritis or pericarditis, anti-RNP antibody, ILD, and cerebro-cardiovascular disease in SLE, which may contribute to the development of PH. However, there were no statistically significant factors associated with PH mortality in SLE.

Objective To identify the incidence, risk factors and prognosis for neuropsychiatric lupus (NPSLE) in Korea. Methods 1121 patients with SLE from Hanyang BAE lupus cohort were enrolled and followed from 1998 to 2015. NPSLE was defined using the ACR case definitions and Ainiala Criteria. Demographics and clinical information including ACR Classification criteria for SLE, autoantibodies, SLE Disease Activity Index, the SLICC/ACR damage index (DI) were collected at baseline and then annually. Symptoms of NPSLE were collected from patient interview and medical records. Mortality data were derived by linking with data from the Korean National Statistics Office (KNSO). Multivariable logistic regression and cox regression test were performed to assess the risk factor of NPSLE and predictors of mortality. Results Of 1121 SLE patients, 429 (38.2%) patients had NPSLE events according to ACR definitions and 216 (19.3%) by Ainiala criteria. In multivariable logistic regression analysis, year of education [Odds ratio (OR) 0.92, 95% confidence interval (CI) 0.87 to 0.96, p<0.01] and elevated anti-dsDNA antibodies (OR 0.52, CI: 0.37 to 0.76, p<0.01) decreased the risk of NPSLE. In multivariable cox regression analysis, SLEDAI without NP manifestations at enrollment increased the risk of mortality (OR 1.18, CI: 1.08 to 1.25, p<0.01) in NPSLE patients. Conclusion The 38.2% and 19.3% of SLE patients had NPSLE according to ACR and Ainiala definition of NPSLE. Year of education and elevated anti-dsDNA antibodies decreased the risk of occurrence of NPSLE. SLEDAI without NP manifestations at enrollment increased the risk of mortality in NPSLE patients.