The relationships between disability level, health-promoting lifestyle, and quality of life in outpatients with systemic lupus erythematosus.

[[abstract]]The purpose of this study was to explore the relationships between disability, health-promoting lifestyle and quality of life in SLE outpatients. Cross-sectional research design and purposive sampling were used in this study. One hundred and twenty-nine SLE outpatients from a medical center were sampled. Questionnaires, including the Visual Analogue Scale, Pittsburgh Sleep Quality Index, and The Hospital Anxiety and Depression Scale, were adopted in order to survey subject disabilities in terms of pain, fatigue, quality of sleep, anxiety, and depression. Health-promoting lifestyle was measured using the Health-Promoting Lifestyle Profile, while quality of life data were collected using Short-Form 36. Hierarchical regressions and a Sobel test were the major statistical procedures employed. Study results indicated that SLE patient self-reported pain and fatigue related to the SLE disease to be 27.7 +/- 26.2 and 37.4 +/- 26.6, respectively. Seventy-two percent of SLE patients were reported to be troubled by poor sleep quality, while 20%-32% suffered from severe anxiety and depression. The Health-Promoting Lifestyle Profile total score for SLE patients was 61.5 +/- 17.2. In terms of SLE patient quality of life (QOL), physical component summary (PCS) and mental component summary (MCS) scores were 45.3 +/- 9.1 and 43.8 +/- 9.7, respectively. Based on the hierarchical regressions and Sobel test, it was revealed that the health-promoting lifestyle has no significant effect on the physical component summary (p > .05). Fatigue was the mediator factor of health-promoting lifestyle to physical component summary of quality of life. Nevertheless, health-promoting lifestyle has a significant effect on the mental component summary (p <.05). Interestingly, the results showed facilitating health- promoting lifestyle in SLE patient could not enhance physical component summary of quality of life directly without an improvement in fatigue disability; however, facilitating health-promoting lifestyle had a direct and positive effect on the mental component summary of quality of life

Autoantibody and Biopsy Grading Are Associated with the Expression of ICAM-1, MMP3 and TRAIL in the Salivary Gland Mononuclear Cells of Chinese Patients with Sjogren’s Syndrome.

[[abstract]]OBJECTIVE: Sjögren's syndrome (SS) is an inflammatory autoimmune disease. We investigated important factors associated with the expression of inflammation-related molecules in minor salivary gland (MSG) mononuclear cells in patients with SS. METHODS: Thirty-four patients with SS with a MSG biopsy grading of either grade III (10 patients) or grade IV (24 patients) were enrolled. The age, sex, autoantibodies, cell infiltration, and intercellular adhesion molecule-1 (ICAM-1), matrix metalloproteinase-3 (MMP-3), tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), or CXCR3 expression were also analyzed. RESULTS: Ten of the 34 patients with SS were diagnosed with secondary SS; in these patients, the diagnosis of rheumatoid arthritis was confirmed in 8 and systemic lupus erythematosus in 2. TRAIL and ICAM-1 were overexpressed in patients with antinuclear antibodies (ANA) > 1:160, compared to those with titer OR= 20) was associated with higher TRAIL expression and CD20 cell infiltration in contrast to lower ESR (< 20; p < 0.05). ICAM-1, TRAIL, and MMP-3 were expressed more predominantly in anti-SSA-positive than in anti-SSA-negative patients with SS. There was a significant difference in CD20 cell infiltration and MMP-3 expression between primary SS and secondary SS. Biopsy of a grade IV showed a significantly increased expression of TRAIL (44.9 +/- 4.5 vs 40.8 +/- 3.6, p = 0.013) and MMP-3 (62.7 +/- 6.3 vs 54.4 +/- 7.3, p = 0.003) in mononuclear cells as compared to those of grade III. CONCLUSION: In our study, pathologic grading with a higher grade (grade IV) and the presence of SSA or a higher titer of ANA were significantly associated with the overexpression of TRAIL, MMP-3, or ICAM-1 in the salivary gland mononuclear cells in patients with SS

A Study of Staffs Satisfaction and Documentation Completeness on using a Nursing Information System.

[[abstract]]Due to the information technologies the fast development of many information devices were implemented to health care environments. There are many studies about documentation time spent, documentation completeness and nurses' attitude and satisfaction reported abroad. But there are few literatures about personal digital assistant applications and satisfaction about using the system. The purpose of this study is to explore staffs' satisfaction and documentation completeness after a nursing information system was implemented. Data were explored by use of descriptive and multivariate analysis. There were 389 nurses answered the questionnaire, 200 charts for documentation completeness were audited. The results of this study are as followed. Nurses who were older or worked in ICU, had lower satisfaction, and with N4 position had higher satisfaction. Overall, the completeness of documentations were not related to technology use. This study suggests that organizations have to provide the information equipments, the information personnel revise the system design and the user proposed the usage feedback, in order to solve the clinical usage problems

Hypertension was the major risk factor leading to the development of cardiovascular diseases among hyperuricemic men.

[[abstract]]OBJECTIVE: A 7-year followup study among men with hyperuricemia was conducted to study the longterm relationships between serum uric acid concentrations and cardiovascular diseases. Any interaction between uric acid levels and other risk factors (e.g., obesity, hypertension) on the development of cardiovascular diseases was also examined. METHODS: A total of 391 men with hyperuricemia aged 30 and over screened from the community-based Kinmen study in 1991-92 (the baseline study) were followed in 1997-98, with a 75% followup rate. Demographic, clinical, and biochemical data were collected in both baseline and followup periods. RESULTS: After followup for 7 years, the significant risk factors of coronary heart disease were age, increase of uric acid level at followup, baseline systolic blood pressure, and increase of systolic blood pressure at followup. Factors independently associated with left ventricular hypertrophy included baseline systolic blood pressure and increase of systolic blood pressure at followup. Gouty syndrome, age, baseline fasting plasma glucose level, and increase of systolic blood pressure followup were significantly related to cardiac arrhythmia. After adjusting for baseline serum uric acid level, we found that hyperuricemic men with hypertension, especially overt hypertension stage 2 and stage 3, would predict cardiovascular disease incidence synergistically with uric acid level. CONCLUSION: There is a positive and statistically significant relationship between gout and subsequent cardiac arrhythmia. Moreover, hypertension was the major risk factor leading to aggravation of development of atherosclerosis among hyperuricemic subjects. Gout and elevated uric acid level seemed not to be an independent risk factor for most cardiovascular diseases. Nevertheless, blood pressure level was predictive for cardiovascular disease incidence synergistically with serum uric acid level

Serum matrix metalloproteinases and tissue inhibitors of metalloproteinases in ankylosing spondylitis: MMP-3 is a reproducibly sensitive and specific biomarker of disease activity.

[[abstract]]OBJECTIVE: To submit serum levels of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) to statistical analyses to test their exact degrees of clinical usefulness as biomarkers for detecting high disease activity in ankylosing spondylitis (AS), comparing them with erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). METHODS: Serum levels of MMP-1, -3, -9 and TIMP-1 and -2 were measured in 42 AS patients and 20 healthy controls. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) provided the gold standard for measuring disease activity. Patients with BASDAI > or =4 were regarded as having high disease activity. The results were compared with results for a separate cohort of 41 AS patients. RESULTS: Only MMP-3 levels were significantly higher in AS patients than in healthy controls (P<0.001). Within AS patients, MMP-3 levels were also higher in patients with high disease activity compared with those with low disease activity, and correlated significantly with BASDAI (r = 0.366, P = 0.017) and functional indices (r = 0.344, P = 0.026). The correlation with BASDAI was stable in a 1-yr follow-up (r = 0.464, P = 0.095) and reproducible with two different enzyme-linked immunosorbent assays. For detecting high disease activity, the sensitivity and specificity of MMP-3 level was 69.2 and 68.8% respectively. Most importantly, using receiver operating characteristic plots to analyse the two cohorts, MMP-3 was more accurate than ESR and CRP in detecting AS patients with high disease activity (P = 0.01 and P = 0.009, respectively). CONCLUSION: Using several analytical approaches that have never been reported previously, we showed that MMP-3 is a more useful biomarker than ESR and CRP to detect high disease activity in AS

Study of undifferentiated spondyloarthropathy among first-degree relatives of ankylosing spondylitis probands.

[[abstract]]OBJECTIVE: To estimate in a Chinese population the prevalence of undifferentiated spondyloarthropathy (USpA) among first-degree relatives (FDRs) of ankylosing spondylitis (AS) probands, and to compare the clinical features of familial USpA with those of sporadic USpA. METHODS: The FDRs of two separate cohorts of consecutive AS probands were evaluated for the prevalence of USpA, using the Modified New York criteria and the European Spondylitis Study Group criteria for AS and SpA, respectively. Sporadic USpA and FDRs of non-SpA rheumatic patient probands served as separate controls. RESULTS: Among the 301 FDRs of 102 AS probands, 7.0% were USpA. This was 1000 times higher than the 147 FDRs of 40 non-SpA probands (P = 0.00230). Within the AS families, USpA was less male-dominated than AS (33.3 vs 72.5%) (P = 0.006). The only feature distinguishing familial from sporadic USpA was that the percentages of HLA B27 were 100 and 50%, respectively (P<0.001). CONCLUSION: USpA and AS coexist in the same Chinese families, both being predisposed by HLA B27. In these families, a female gender favours the development of USpA rather than AS. A significant subset of sporadic USpA (HLA B27-negative group) has a different genetic predisposition compared with familial USpA

Human Leukocyte Antigen and Clinical and Demographic Characteristics in Psoriatic Arthritis and Psoriasis in Chinese Patients

[[abstract]]OBJECTIVE: Psoriasis and psoriatic arthritis (PsA) are interrelated disorders. To date, no study has compared the differences of genes between patients with PsA and psoriasis and healthy controls in a Chinese population. We conducted a retrospective study to determine the human leukocyte antigen (HLA) -A, -B, -Cw, -DR, and -DQ alleles in Chinese patients with PsA and psoriasis. METHODS: HLA studies were performed using polymerase chain reaction sequence-specific oligonucleotide (PCR-SSO) genotyping methods in 91 patients with PsA and 80 with psoriasis and 75 controls. Age at disease onset, sex, disease duration, enthesitis, and uveitis were also analyzed. RESULTS: Among the patients with PsA and psoriasis, the frequency of HLA-B27 was significantly higher in PsA and HLA-A*30, -Cw*06, -DR*07 in psoriasis compared with controls. In contrast, HLA-B*58 was more common in controls than in PsA and psoriasis groups, and the prevalence of HLA-DR*17 was significantly higher in controls than in those with psoriasis. Comparing PsA and psoriasis, the prevalence of HLA-B*27 and HLA-Cw*12 were more common in PsA patients, while the prevalence of HLA-DR*07 was higher in those with psoriasis (p < 0.05). Among PsA patients, the association between HLA-B*27 and axial joint involvement and uveitis was significant (p < 0.05). CONCLUSION: Certain HLA alleles are found in Chinese patients with psoriasis (HLA-A*30, -Cw*06, -DR*07) and PsA (HLA-B*27). Psoriasis patients with the HLA-B*27 and/or -Cw*12 may have higher risk of developing PsA. Ours is the first study to assess the genetic role of HLA in patients with psoriasis and PsA in a Chinese population

Different progressions of hyperglycemia and diabetes among hyperuricemic men and women in the Kinmen study hyperglycemia and diabetes among hyperuricemic men and women in the Kinmen Study.

[[abstract]]OBJECTIVE: A 7-year followup study among hyperuricemic subjects was conducted to investigate the association between longterm hyperuricemia and subsequent hyperglycemia and diabetes mellitus. The possible sex difference was also investigated. METHODS: A total of 641 hyperuricemic subjects aged 30 years and over (391 men, 250 women) screened from the community-based Kinmen Study in 1991-92 (the baseline study) were followed in 1997-98, with 75% followup rate. Demographic, clinical, and biochemical data were collected in both baseline and followup periods. RESULTS: After followup for 7 years, the distribution of plasma glucose concentrations changed moderately among male hyperuricemic subjects, but increased markedly among female subjects. The increase of uric acid levels during the followup period was correlated with subsequent diabetes only among hyperuricemic women. Moreover, a relatively higher incidence of diabetes was found in postmenopausal hyperuricemic women after 7-year followup. CONCLUSION: Although the direct role and causality played by uric acid cannot be confirmed by this study, the findings, as applicable to a Chinese nondiabetic population, show that specific progressions of plasma glucose concentrations were significantly different between male and female hyperuricemic subjects. Hyperuricemia and persistent increase in uric acid levels among postmenopausal women should alert physicians to the possibility of subsequent hyperglycemia and diabetes

The effect of etanercept on anti-cyclic citrullinated peptide antibodies and rheumatoid factor in patients with rheumatoid arthritis

[[abstract]]OBJECTIVE: To evaluate the changes in anti-cyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor (RF) following etanercept treatment in patients with rheumatoid arthritis. METHODS: The study included 90 patients with rheumatoid arthritis who failed treatment with disease modifying antirheumatic drugs (DMARDs). All patients were allowed to continue treatment with DMARDs; 52 of them received etanercept as a twice weekly 25 mg subcutaneous injection for three months, and the others did not. Serum samples were collected at baseline and one month intervals during the treatment course. The serum levels of anti-CCP and RF were tested by enzyme linked immunosorbent assay and nephelometry, respectively. RESULTS: At baseline, 45 of the 52 etanercept treated patients (86.5%) and 32 of the 38 controls (84.2%) were positive for anti-CCP. Tests for RF were positive in 78.9% and 84.2% of patients with or without etanercept treatment, respectively. The serum levels of anti-CCP and RF decreased significantly after a three month etanercept treatment (p = 0.007 and p = 0.006, respectively). The average decrease from baseline calculated for each individual patient in the etanercept treated group was 31.3% for anti-CCP and 36% for RF. The variation in anti-CCP was positively correlated with the variation in disease activity, swollen and tender joint counts, RF, and C reactive protein. CONCLUSIONS: Etanercept combined with DMARDs leads to a much greater decrease than DMARDs alone in the serum levels of anti-CCP and RF in rheumatoid arthritis, compatible with a reduction in clinical disease activity