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1.
Pediatr Rheumatol Online J ; 18(1): 9, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31973755

RESUMO

BACKGROUNDS: In order to provide juvenile idiopathic arthritis (JIA) patients with better pre-conceptional and prenatal counselling, we investigated the obstetrical and neonatal outcomes among women with Asian descent. METHODS: Through the linkage of Taiwan National Health Insurance database and National Birth Registry, we established a population-based birth cohort in Taiwan between 2004 and 2014. In a case control study design, first children born to mothers with JIA are identified and matched with 5 non-JIA controls by maternal age and birth year. Conditional logistic regression was used to calculate odds ratios for maternal and neonatal outcomes crude and with adjustment. RESULTS: Of the 2,100,143 newborn, 778 (0.037%) were born to JIA mothers. Among them, 549 first-born children were included in this research. Our result suggested that babies born to mothers with JIA were more likely to have low birth body weight, with an adjusted OR of 1.35(95% CI: 1.02 to 1.79) when compared to babies born to mothers without. No differences were observed in other perinatal complications between women with and without JIA including stillbirth, prematurity, or small for gestational age. The rate of adverse obstetrical outcomes such as caesarean delivery, preeclampsia, gestational diabetes, postpartum hemorrhage and mortality were also similar between the two. CONCLUSIONS: Adverse obstetrical and neonatal outcomes were limited among Asian mothers with JIA. Intensive care may not be necessary for JIA mothers and their newborns.

2.
Gerontologist ; 60(1): e52-e65, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31002312

RESUMO

BACKGROUND AND OBJECTIVES: Minimizing disability is critical to reduce the costly health care associated with disability and maintain quality of life into old age. We examined the effect sizes of nonpharmacological intervention studies in reducing disability and explored the active ingredients of interventions. RESEARCH DESIGN AND METHODS: A scoping review was conducted via PubMed, PsycINFO, and CINAHL databases. Thirty-one randomized controlled trials were included. Eight active ingredients were identified by three experts (exercise, problem-solving, cognitive behavioral therapy, environmental modification, education, goal setting, comprehensive geriatric assessment, and cognitive training). RESULTS: The range of Cohen's d was -0.85 to 1.76 across 31 studies (included 33 interventions); 67% studies (n = 22) obtained small-to-negative effect sizes (d = -0.85 to 0.18), accounting for 83% participants across studies. Interventions that incorporated exercise, problem-solving, cognitive behavior therapy, and environmental modification were associated with stronger effect sizes. Interventions that incorporated comprehensive geriatric assessment obtained small effect sizes. DISCUSSION AND IMPLICATIONS: Majority of intervention studies found little or no effect in reducing disability for older adults. To optimize the effects of nonpharmacological interventions, we recommend researchers to (i) develop a screening tool for "risk of disability" to inform those who are early on the disability progression, yet not experience any difficulties in activities of daily living and instrumental activities of daily living; (ii) specify the active ingredients embedded in complex interventions to facilitate change in disability; and (iii) select sensitive tools to capture the progression of disability in late life.

3.
Pediatr Rheumatol Online J ; 17(1): 69, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651352

RESUMO

BACKGROUND/PURPOSE: Endothelium is a key element in the regulation of vascular homeostasis and its alteration can lead to the development of vascular diseases. Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with potential extensive vascular lesions, involving skin vessels, renal glomeruli, cardiovascular system, brain, lung alveoli, gastrointestinal tract vessels and more. We aimed to assess endothelial dysregulation related biomarkers in pediatric-onset SLE (pSLE) patient serum and elucidate its correlation with their clinical features, laboratory parameters, and the overall disease activity. METHODS: Disease activities were evaluated by SLE disease activity index (SLEDAI). Patient characteristics were obtained by retrospective chart review. Six biomarkers associated with endothelial dysregulation, including Angiopoietin-1 (Ang-1), Angiopoietin-2 (Ang-2), Tie2, Vascular endothelial growth factor (VEGF), thrombomodulin, and a disintegrin-like and metalloprotease with thrombospondin type 1 motif (ADAMTS13) were tested through enzyme-linked immunosorbent assay (ELISA) measurement. RESULTS: This study comprised 118 pSLE patients. Data from 40 age-matched healthy controls were also obtained. The mean diagnostic age was 13 ± 4.12 years-old and 90.7% are females. Serum levels of VEGF, Tie2, thrombomodulin were significantly higher while serum ADAMTS13 was lower in active pSLE patients when compared to those with inactive diseases (all p < 0.05). In organ specific association, serum thrombomodulin level was higher in pSLE patient with renal involvement, and serum ADAMTS13 levels was negatively associated with neurological involvement (p < 0.05). A cutoff of thrombomodulin at 3333.6 pg/ml best correlated renal involvement. (AUC = 0.752, p < 0.01). CONCLUSION: Endothelial dysregulation associating proteins seems to be potent biomarkers for pSLE activity as well as organ involvement in pSLE patients. These biomarkers may be beneficial in understanding of the vascular pathogenesis and disease monitoring.

4.
Clin Pharmacol Ther ; 2019 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-31628864

RESUMO

Hyperuricemia has been associated with chronic kidney disease (CKD) progression. The antihyperuricemic febuxostat's potential renoprotective effect has been demonstrated in stage 1-3 CKD. Large-scale studies comparing the renoprotective potential of febuxostat and allopurinol in advanced CKD are lacking. We exclusively selected 6,057 eligible patients with predialysis stage 5 CKD prescribed either febuxostat or allopurinol using the National Health Insurance Research Database in Taiwan during 2012-2015. There were 69.57% of allopurinol users and 42.01% febuxostat users who required long-term dialysis (P < 0.0001). The adjusted hazard ratio (HR) of 0.65 (95% confidence interval (CI) 0.60-0.70) indicated near 35% lower hazards of long-term dialysis with febuxostat use. The renal benefit of febuxostat was consistent across most patient subgroups and/or using the propensity score-matched cohort. The adjusted HR was 0.66 (95% CI, 0.61-0.70) for long-term dialysis or death. In conclusion, lower risk of progression to dialysis was observed in predialysis stage 5 CKD febuxostat users without compromising survival.

5.
Int J Biol Macromol ; 141: 41-50, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31476391

RESUMO

In this study, the reaction conditions of sulfur trioxide-pyridine (SO3-Pyr) method for the modification of Qingke ß-glucans (THB) were optimized by response surface methodology, and effects of different degrees of substitution (low, medium, and high) on the physicochemical properties, antioxidant activities, and in vitro hypolipidemic activities of THB were investigated. The optimal reaction conditions to obtain the high degree of substitution of sulfated ß-glucans were as follows: ratio of SO3-Pyr to THB of 16.88 g/g, reaction time of 2.03 h, and reaction temperature of 57.54 °C. Results showed that sulfated modification significantly affected the water solubilities, apparent viscosities, molecular weights, and molar ratios of constituent monosaccharides of THB. Besides, the sulfated THB exhibited much better antioxidant activities (DPPH and nitric oxide radical scavenging activities, and reducing powers), in vitro binding properties (fat, cholesterol, and bile-acid binding capacities), and pancreatic lipase inhibition activities than that of THB. Indeed, the sulfated THB with higher degree of substitution has stronger antioxidant activities and in vitro hypolipidemic activities. Results suggested that the sulfated modification could be an efficient approach for the improvement of functional properties of THB, and sulfated THB could be further explored as functional food ingredients for industrial applications.

6.
BMC Nephrol ; 20(1): 323, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419960

RESUMO

BACKGROUND: Patients with end-stage renal disease (ESRD) under hemodialysis (HD) are at greater risks of infectious spondylitis (IS), but there is no reliable predictor that facilitate early detection of this relatively rare and insidious disease. METHODS: A retrospective review of the medical records from patients with ESRD under HD over a 12-year period was performed at a tertiary teaching hospital, and those with a first-time diagnosis of IS were identified. A 1:4 propensity score-matched case-control study was carried out, and baseline characteristics, underlying diseases, and laboratory data were compared between the study group and the control group, one month before the date of diagnosis or the index date respectively. RESULTS: A total of 16 patients with IS were compared with 64 controls. After adjustment, recent access operation (odds ratio [OR], 13.27; 95% confidence interval [CI], 3.53 to 49.91; p <  0.001), degenerative spinal disease (OR, 12.87; 95% CI, 1.89 to 87.41; p = 0.009), HD through a tunneled cuffed catheter (OR, 6.75; 95% CI, 1.74 to 26.14; p = 0.006), low serum levels of hemoglobin, albumin, as well as high levels of red blood cell volume distribution width (RDW), alkaline phosphatase (ALP), and high sensitivity C-reactive protein were significant predictors for a IS diagnosis one month later. Receiver operating characteristic curves for hemoglobin, RDW, ALP, and albumin all showed good discrimination. The further multivariate models identified both high serum ALP levels and low serum RDW levels following a recent access intervention in patients with relatively short HD vintages may be indicative of the development of IS. CONCLUSION: Patients under HD with relatively short HD vintages showing either elevated ALP levels or low RDW levels following a recent access intervention should prompt clinical awareness about IS for timely diagnosis.

7.
Int J Mol Sci ; 20(13)2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31261684

RESUMO

Urothelial carcinoma of the bladder (UCB) and upper tracts (UTUC) used to share management with similar principles. However, their genetic and epigenetic differences along with different responses to immunotherapy were recently identified, which are reminiscent of their distinct etiologies. Different from the variety of environmental factors relating to UCB, UTUC is best known for its close relationship with exposure to aristolochic acid (AA). AA is believed to cause its carcinogenicity through forming DNA adducts of deoxyadenosine-aristolactam, as well as A:T → T:A transversions in the TP53 tumor suppressor gene. Since recent findings suggested that cancers with higher somatic mutations are associated with better treatment responses upon immune checkpoint blockade, UTUC and AA-related biomarkers reasonably serve as good candidates, as well as a potential prognostic predictor for the flourishing immunotherapy. This review covers the current state of the literature on the clinical response of UTUC and UCB receiving immunotherapy and points out directions for refinement regarding patient selection.


Assuntos
Ácidos Aristolóquicos/toxicidade , Carcinógenos/toxicidade , Carcinoma/terapia , Imunoterapia/métodos , Neoplasias da Bexiga Urinária/terapia , Animais , Carcinoma/etiologia , Humanos , Neoplasias da Bexiga Urinária/etiologia , Urotélio/efeitos dos fármacos , Urotélio/metabolismo , Urotélio/patologia
8.
Polymers (Basel) ; 11(2)2019 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-30960199

RESUMO

In order to explore snow chrysanthemum polysaccharides (SCPs) as functional food ingredients and natural antioxidants for industrial applications, both microwave-assisted extraction (MAE) and ultrasonic-assisted extraction (UAE) were firstly optimized for the extraction of SCPs. Furthermore, the effects of conventional hot water extraction, UAE, and MAE on the chemical structures and antioxidant activities of SCPs were investigated. The maximum extraction yields of SCPs extracted by UAE (4.13 ± 0.24%) and MAE (4.26 ± 0.21%) were achieved at the optimized extraction parameters as follows: ultrasound amplitude (68%) and microwave power (500 W), ultrasound extraction time (21 min) and microwave extraction time (6.5 min), and ratio of liquid to raw material (42.0 mL/g for UAE and 59.0 mL/g for MAE). In addition, different extraction methods significantly affected the contents of uronic acids, the molecular weights, the molar ratio of constituent monosaccharides, and the degree of esterification of SCPs. SCPs exhibited remarkable DPPH (IC50 ≤ 1.702 mg/mL), ABTS (IC50 ≤ 1.121 mg/mL), and nitric oxide (IC50 ≤ 0.277 mg/mL) radical scavenging activities, as well as reducing power (≥ 80.17 ± 4.8 µg Trolox/mg), which suggested that SCPs might be one of the major contributors toward the antioxidant activities of snow chrysanthemum tea. The high antioxidant activities (DPPH, IC50 = 0.693 mg/mL; ABTS, IC50 = 0.299 mg/mL; nitric oxide, IC50 = 0.105 mg/mL; and reducing power, 127.79 ± 2.57 µg Trolox/mg) observed in SCP-M extracted by the MAE method might be partially attributed to its low molecular weight and high content of unmethylated galacturonic acids. Results suggested that the MAE method could be an efficient technique for the extraction of SCPs with high antioxidant activity, and SCPs could be further explored as natural antioxidants for industrial application.

9.
PM R ; 11(6): 597-603, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30844137

RESUMO

BACKGROUND: Caregiver burden is commonly experienced in caregivers of adults with cognitive impairment after stroke. This burden can be associated with caregiver-centered factors, including caregiver-perceived relationship quality. OBJECTIVE: To examine the role of caregiver-perceived relationship quality on caregiver burden at 6 months following stroke. DESIGN: Prospective observational study. SETTING: Community settings. PARTICIPANTS: Adults enrolled in two randomized controlled trials after stroke (n = 60) and their caregivers (n = 60). METHODS: Three constructs of relationship quality (relationship consensus, cohesion, and satisfaction) were examined as predictors of caregiver burden (the Abbreviated Dyadic Adjustment Scale). A hierarchical logistic regression and a Poisson regression with robust standard errors were used to examine the effect of relationship quality on caregiver burden while controlling for characteristics of stroke survivors and caregivers. MAIN OUTCOME MEASUREMENTS: Caregiver burden was measured with the abridged version of the Zarit Burden Interview. RESULTS: Poor relationship consensus (odds ratio [OR] = 1.48; 95% confidence interval [CI] = 1.06-2.07; P = .02) increased the odds of high caregiver burden after controlling for characteristics of stroke survivors (age, comorbidity, cognitive fluency) and caregivers (gender, self-reported health). Relationship cohesion (OR = 1.03; 95% CI = .84-1.25; P = .81) and relationship satisfaction (OR = 1.53; 95% CI = .75-3.10; P = .24) did not predict caregiver burden. CONCLUSION: Meaningful and agreeable goals and expectations between dyads are essential to reduce caregiver burden after stroke. Collaborative goal-setting between stroke survivors and their caregivers may be a promising intervention strategy to increase relationship consensus and reduce caregiver burden. LEVEL OF EVIDENCE: III.

10.
J Formos Med Assoc ; 118(1 Pt 1): 2-6, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29857952

RESUMO

MicroRNAs (MiR, MiRNA) are small single-stranded non-coding RNAs that play an important role in the regulation of gene expression. MircoRNAs exert their effect by binding to complementary nucleotide sequences of the targeted messenger RNA, thus forming an RNA-induced silencing complex. The mircoRNA-17-92 cluster encoded by the miR-17-92 host gene is first found in malignant B-cell lymphoma. Recent research identifies the miR-17-92 cluster as a crucial player in the development of the immune system, the heart, the lung, and oncogenic events. In light of the miR-17-92 cluster's increasing role in regulating the immune system, our review will discuss the latest knowledge regarding its involvement in cells of both innate and adaptive immunity, including B cells, subsets of T cells such as Th1, Th2, T follicular helper cells, regulatory T cells, monocytes/macrophages, NK cells, and dendritic cells, and the possible targets that are regulated by its members.


Assuntos
Linfócitos/imunologia , MicroRNAs/genética , MicroRNAs/imunologia , Imunidade Adaptativa , Regulação da Expressão Gênica , Humanos , Imunidade Inata
11.
J Head Trauma Rehabil ; 34(4): E32-E41, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30499925

RESUMO

OBJECTIVE: The purpose of this scoping review was to identify predictors of community integration for adults with traumatic brain injury. DATA SOURCES: We searched the PubMed and PsycINFO databases and reviewed references of included studies. We selected studies exploring multiple components of community integration, including instrumental activities of daily living, leisure activities, and social activities. A total of 53 studies were included. DATA EXTRACTION: We extracted data on sample size and sample characteristics (stage of injury and recovery, severity) and examined predictor variables, outcome measures for community integration, and significant findings, reported as correlations. DATA SYNTHESIS: We found that the predictors of community integration fell into 4 categories: demographics, injury characteristics, disability and impairments, and environmental factors. There was large variability in reported relationships for demographics (r = 0.01-0.43), injury characteristics (r = 0.01-0.58), disability/functional impairments (r = 0.003-0.98) and environmental factors (r = 0.11-0.58). Cognition, disability, mobility/physical functioning, mood, social support, and length of posttraumatic amnesia had the strongest relationships with community integration outcomes. CONCLUSIONS: Strategies for the management of cognitive, physical, and emotional functioning, and building and training a strong support system, may facilitate community integration outcomes. Additional work is warranted to further explore the discrepancies found among studies.

12.
J Formos Med Assoc ; 117(12): 1058-1064, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30293929

RESUMO

BACKGROUND: Heart rate variability (HRV), a non-invasive measurement of the sympathetic-vagal balance, has been demonstrated as a predictor of long-term survival in various patient populations. However, its predictive value in patients with end-stage renal disease (ESRD) has not been evaluated in a long-term follow-up study. METHODS: Prospective data collected for 41 patients with chronic hemodialysis (age 59 ± 10 years, men 51.3%, diabetes mellitus 31%, and duration of dialysis 64 ± 50 months) who underwent a 5-minute electrocardiogram (ECG) recording as a baseline for frequency domain HRV analysis. RESULTS: During a median follow-up of 150.2 months from 2003 to 2014, 15 (35.7%) patients died (3 due to cardiac causes and 12 due to non-cardiac causes). The Cox proportional hazards model suggested that the low frequency versus high frequency signal (LF/HF) of a high ratio for the HRV and diabetes mellitus were two independent predictors of mortality (hazard ratios 3.028 and 3.494; p = 0.033 and 0.022, respectively). Less reduction in MAP during dialysis showed borderline significance of long-term survival than those with larger drop (p = 0.058). CONCLUSION: A short ECG recording and an analysis of the frequency domain of the HRV is clinically predictive of the long-term survival of patients with chronic hemodialysis.


Assuntos
Frequência Cardíaca , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Diálise Renal/mortalidade , Idoso , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Taiwan/epidemiologia
13.
Diabetes Care ; 41(10): 2072-2078, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30072401

RESUMO

OBJECTIVE: We examined whether the trajectory of disability differed between older adults with and without elevated depressive symptoms before and after the onset of diabetes mellitus (DM) over 10 years (2004-2014) and explored difficulties in basic and instrumental activities of daily living between the two groups. RESEARCH DESIGN AND METHODS: A generalized linear mixed-model analysis was conducted using five waves (8th-12th) of Health and Retirement Study (HRS) data. We included 419 older adults who self-reported new DM diagnosis within the previous 2 years and used the Center of Epidemiologic Studies Depression Scale to measure elevated depressive symptoms. Disability was measured by 10 items defined in the HRS data set. RESULTS: The trajectory of disability differed between older adults with and without elevated depressive symptoms after newly diagnosed DM over time. Significant and clinically meaningful between-group differences were found in disability after the onset of DM (waves 10 and 11) but not before the onset of DM (waves 8 and 9). Among older adults with elevated depressive symptoms, disability at pre-DM waves (8 and 9) was significantly less than post-DM waves (10-12). Difficulties with shopping, walking, and dressing were mostly reported by older adults with elevated depressive symptoms. CONCLUSIONS: Older adults with newly diagnosed DM and elevated depressive symptoms have a clinically meaningful and faster disablement trajectory than those without elevated depressive symptoms. Future interventions may take an indicated approach to disability prevention in older adults with newly diagnosed DM, especially in those with a change in depression severity.


Assuntos
Atividades Cotidianas , Depressão/epidemiologia , Diabetes Mellitus/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Atividades Cotidianas/psicologia , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Depressão/complicações , Transtorno Depressivo/complicações , Transtorno Depressivo/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/psicologia , Pessoas com Deficiência/psicologia , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Aposentadoria
14.
Pediatr Nephrol ; 33(7): 1189-1198, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29511890

RESUMO

BACKGROUND: Lupus nephritis (LN) is a major risk factor for systemic lupus erythematous (SLE)-related morbidity and mortality. With the aim of bypassing renal biopsy, we analyzed urinary biomarkers for their ability to predict renal histopathologic features and end-stage kidney disease (ESKD). METHODS: Urinary albumin, ß2-microglobulin (B2M), cystatin C, kidney injury molecule-1 (KIM-1), monocyte chemoattractant protein 1 (MCP-1), clusterin, calbindin, interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL), trefoil factor 3 (TFF3), osteopontin, and glutathione S-transferase π (GST-π) levels were measured at time of renal biopsy. Renal histopathologies were carefully reviewed. RESULTS: Urine from 60 pediatric SLE cases with LN, 29 without and 22 healthy controls were collected. Median age at SLE diagnosis was 12.92 years (range = 4.27-17.30 years) and 10 cases progressed to ESKD during a period of 4.12 ± 2.17 years. Urinary albumin and clusterin were significantly elevated (p = 0.035 and 0.048, respectively) in patients with tubulointerstitial renal lesions. Urinary clusterin among all urinary markers, performed best at predicting ESKD with cutoff of 0.61 × 10-4 (AUC = 0.804; p = 0.002). Interestingly, elevation of urinary clusterin likely resulted from local over-expression in tubulointerstitial tissue since the level of serum clusterin was not concomitantly higher (p = 0.424). CONCLUSION: Urinary biomarkers are emerging as non-invasive indicators for lupus-related renal histopathology and renal outcome prediction in pediatric SLE patients. Urinary clusterin, a newly identified biomarker, is an indicator that shows an association with tubulointerstitial renal lesions and demonstrates the best ability to predict ESKD.


Assuntos
Clusterina/urina , Falência Renal Crônica/diagnóstico , Túbulos Renais/patologia , Nefrite Lúpica/complicações , Nefrite Intersticial/urina , Adolescente , Biomarcadores/urina , Biópsia , Criança , Pré-Escolar , Clusterina/sangue , Clusterina/metabolismo , Progressão da Doença , Feminino , Seguimentos , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/patologia , Túbulos Renais/metabolismo , Nefrite Lúpica/sangue , Nefrite Lúpica/urina , Masculino , Nefrite Intersticial/sangue , Nefrite Intersticial/etiologia , Nefrite Intersticial/patologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos
15.
Oncotarget ; 9(9): 8502-8511, 2018 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-29492211

RESUMO

Although aberrant complement activation is involved in the pathogenesis of systemic lupus erythematosus (SLE), the role of complement regulatory proteins in disease activity of SLE remains limited. We enrolled the pediatric-onset SLE patients from our cohort study over 10 years. The clinical and laboratory data including SLEDAI disease activity score, and serum complement factor H (CFH), CFI, CD46, C5a, and C5b-9 in the active and remission phases were determined. Glomerular C5b-9 deposition as a complement activity marker was also examined. Forty patients (35 female and 5 male, aged 13.9 ± 3.8 years) met the criteria of investigation were assessed. Fever and kidney were the most common symptom and organ involved, respectively. Mean SLEDAI in the active and remission phases were 12.6 vs 1.7, respectively. All patients exhibited lower serum C3, C4, CFH and CFI and higher serum anti-dsDNA and CD46 in the active pahse. There was a significant difference in serum CFH, CFI and CD46 between active and remissive phases. Serum CFI but not CFH and CD46 level was negatively correlated with SLEDAI score in active phase. Compared to classical activity markers, serum CFI was superior to C4 and anti-dsDNA in reflecting disease activity and also significantly correlated with white blood count and hemoglobin. Glomerular C5b-9 depositions were detected in patients with nephritis during active phase but not in disease controls. Serum CFI level may not only be a promising biomarker for disease activity of SLE, but also reflects the hematological features of SLE.

16.
Artigo em Inglês | MEDLINE | ID: mdl-30630711

RESUMO

BACKGROUND: This clinical study investigates the role of 5-methoxytryptophan (5-MTP) in pediatric systemic lupus erythematosus (SLE), with a particular interest in lupus nephritis (LN). PATIENTS AND METHODS: One hundred ten children with SLE were enrolled in the cohort study. Among the patients, seventy-seven (70%) had active LN and thirty-three (30%) were not present with LN during their first visit to the clinic. The diagnoses of LN were biopsy-proven. Serum samples were collected before and after administration of immunosuppressive medications to evaluate 5-MTP levels and regular laboratory data. Data were analyzed longitudinally. RESULTS: Before any treatment started, patients with active LN had significantly higher 5-MTP levels as compared to patients with no LN (1.021 ± 0.709 vs. 0.719 ± 0.606, P = 0.0456). Also, in patient with active LN, 5-MTP level was significant decreased after treatment, compared with the levels before treatment (1.021 ± 0.709 vs. 0.802 ± 0.597, P = 0.0484). Patients who reached complete remission also had significantly higher initial serum 5-MTP levels than that in patients with no remission (1.244 ± 0.784 vs. 0.846 ± 0.556, P = 0.0488). There was an overall reduction in 5-MTP levels after six months of immunosuppressive treatment, regardless of the disease outcome. Subgroup analysis further revealed a significantly higher 5-MTP level during the active stage of LN (1.127 ± 0.149 vs. 0.742 ± 0.092, P = 0.0384). CONCLUSION: We demonstrated that serum 5-MTP level is positively correlated to the disease activity, prognosis, and remission status of pediatric LN in vivo.

17.
Hong Kong J Occup Ther ; 31(2): 115-124, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30643499

RESUMO

Background/objectives: Patient-reported outcome measures have been found to be an effective method of reflecting client perspectives on their personal health condition. The primary aim of this study was to determine the reliability and validity of the self-reported Activities of Daily Living Scale (sf-ADLS) using Rasch analysis in Taiwan. Methods: A total of 455 people were included in this study; 224 were persons with mental illness and 231 were healthy adults. We applied Rasch analysis as the means of testing the psychometrics of the scale. Results: The final version of the sf-ADLS used in this study included 14 items, with no differential item functioning being discernible on the gender variable. The scale was found to be of use in classifying the subjects into four levels of independence. Conclusions: The revised sf-ADLS conforms to the Rasch measurement model in the formulation of a unidimensional scale. The scale can be used to measure the level of independence with acceptable reliability (internal consistency as 0.9) and validity.

18.
Artigo em Inglês | MEDLINE | ID: mdl-29289551

RESUMO

BACKGROUND: Raising evidence suggested a prognostic utility of tubulointerstitial lesions in lupus nephritis (LN). The exact prevalence of tubulointerstitial abnormalities and its predictive value among pediatric onset systemic lupus erythematous (pSLE) cases, however, remained unknown. METHODS: Sixty-seven pSLE subjects diagnosed with LN with initial renal samples available were enrolled and followed for an average of 6.49 ± 3.06 years. Renal histology was evaluated according to the International Society of Nephrology/Renal Pathology Society classification, National Institute of Health classification and tubulointerstitial activity index (TIAI). RESULTS: Tubulointerstitial injuries were observed in 38.81% of all LN cases, including 13.33% with non-proliferative lupus nephritis (nPLN) and 46.15% of with proliferative lupus nephritis (PLN). Tubulointerstitial injuries occurred solitarily in cases with nPLN(13.33%), but always associated glomerular changes and significantly impacted renal survival (p = 0.032) among those with PLN. TIAI associated glomerular abnormalities (p = 0.031) but did not correlate renal performance or subsequent outcome (p = 0.445). Among the chronicity index, it was the chronic tubulointerstitial lesions that provided prognostic information (p = 0.012). None of the individual tubulointerstitial factors, however, reached statistical significance in end-stage renal disease prediction. Finally, considering tubulointerstitial injuries in PLN further discriminated subsequent renal outcome (p = 0.006). CONCLUSION: Tubulointerstitial abnormalities were found in nearly one-third of all pediatric LN cases. With its importance in early identifying those at risk of renal failure, histologic classification considering tubulointerstitial lesions may potentially assist outcome prediction.

19.
Medicine (Baltimore) ; 95(40): e5037, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27749566

RESUMO

An urge of biomarker identification is needed to better monitor lupus nephritis (LN) disease activity, guide clinical treatment, and predict patient's long-term outcome. With the proinflammatory effect and its association with inflammasomes, the significance of interleukin-18 (IL-18) among pediatric-onset systemic lupus erythematous (pSLE) patient, especially, its importance in predicting long-term renal outcome was investigated.In a pSLE cohort of 96 patients with an average follow-up period of 10.39 ±â€Š3.31 years, clinical data and laboratory workups including serum IL-18 were collected at time of disease onset and 6 months after treatment despite their initial renal status. Through Cox regression analysis, the parameters at baseline and at 6 months posttreatment were carefully analyzed.Average age of all cases was 12.74 ±â€Š3.01 years old and 65 of them underwent renal biopsy at the time of diagnosis. Nine subjects (9.38%) progressed to end-stage renal disease (ESRD) and 2 cases (2.08%) died during follow-up. Through multivariate analysis, serum IL-18 level 6 months posttreatment was found to be the most unfavorable factor associating poor clinical outcome despite patient's initial renal status. In addition, the presentation of serum IL-18 in its correlation with SLE global disease activity as well as the presence and severity of LN were all significant (P < 0.001, P = 0.03, and P = 0.02, respectively). The histological classification of LN, however, was not associated with the level of IL-18 among the pSLE patients (P = 0.64).The role of serum IL-18 as biomarker representing global disease activity and status of renal flares among pSLE population was shown for the first time. Additionally, we have identified IL-18 at 6 months posttreatment a novel marker for long-term renal outcome prediction.


Assuntos
Previsões , Interleucina-18/metabolismo , Falência Renal Crônica/metabolismo , Lúpus Eritematoso Sistêmico/metabolismo , Adolescente , Biomarcadores/sangue , Biomarcadores/urina , Biópsia , Criança , Pré-Escolar , Progressão da Doença , Feminino , Seguimentos , Humanos , Rim/patologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/etiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Masculino , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
20.
Immunity ; 45(1): 83-93, 2016 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-27438767

RESUMO

Regulatory T (Treg) cells are important in maintaining self-tolerance and immune homeostasis. The Treg cell transcription factor Foxp3 works in concert with other co-regulatory molecules, including Eos, to determine the transcriptional signature and characteristic suppressive phenotype of Treg cells. Here, we report that the inflammatory cytokine interleukin-6 (IL-6) actively repressed Eos expression through microRNA-17 (miR-17). miR-17 expression increased in Treg cells in the presence of IL-6, and its expression negatively correlated with that of Eos. Treg cell suppressive activity was diminished upon overexpression of miR-17 in vitro and in vivo, which was mitigated upon co-expression of an Eos mutant lacking miR-17 target sites. Also, RNAi of miR-17 resulted in enhanced suppressive activity. Ectopic expression of miR-17 imparted effector-T-cell-like characteristics to Treg cells via the de-repression of genes encoding effector cytokines. Thus, miR-17 provides a potent layer of Treg cell control through targeting Eos and additional Foxp3 co-regulators.


Assuntos
Proteínas de Transporte/metabolismo , Colite/imunologia , Interleucina-6/metabolismo , MicroRNAs/metabolismo , Proteínas do Tecido Nervoso/metabolismo , Linfócitos T Reguladores/imunologia , Animais , Proteínas de Transporte/genética , Células Cultivadas , Proteínas de Ligação a DNA , Modelos Animais de Doenças , Fatores de Transcrição Forkhead/metabolismo , Humanos , Subunidade alfa de Receptor de Interleucina-2/metabolismo , Interleucina-6/genética , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , MicroRNAs/genética , Proteínas do Tecido Nervoso/genética , Tolerância a Antígenos Próprios
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