Maximal Walking Distance in Persons with a Lower Limb Amputation.

The distance one can walk at a time could be considered an important functional outcome in people with a lower limb amputation. In clinical practice, walking distance in daily life is based on self-report (SIGAM mobility grade (Special Interest Group in Amputee Medicine)), which is known to overestimate physical activity. The aim of this study was to assess the number of consecutive steps and walking bouts in persons with a lower limb amputation, using an accelerometer sensor. The number of consecutive steps was related to their SIGAM mobility grade and to the consecutive steps of age-matched controls in daily life. Twenty subjects with a lower limb amputation and ten age-matched controls participated in the experiment for two consecutive days, in their own environment. Maximal number of consecutive steps and walking bouts were obtained by two accelerometers in the left and right trouser pocket, and one accelerometer on the sternum. In addition, the SIGAM mobility grade was determined and the 10 m walking test (10 MWT) was performed. The maximal number of consecutive steps and walking bouts were significantly smaller in persons with a lower limb amputation, compared to the control group (p < 0.001). Only 4 of the 20 persons with a lower limb amputation had a maximal number of consecutive steps in the range of the control group. Although the maximal covered distance was moderately correlated with the SIGAM mobility grade in participants with an amputation (r = 0.61), for 6 of them, the SIGAM mobility grade did not match with the maximal covered distance. The current study indicated that mobility was highly affected in most persons with an amputation and that the SIGAM mobility grade did not reflect what persons with a lower limb amputation actually do in daily life. Therefore, objective assessment of the maximal number of consecutive steps of maximal covered distance is recommended for clinical treatment.

Feasibility study by a single-blind randomized controlled trial of self-management of mobility with a gait-speed feedback device by older persons at risk for falling.

This single-blind randomized pilot study explored feasibility and safety of a self-management fall prevention program, hypothesizing that older persons can comply with this program, while it does not result in more (injurious) falls, or a decrease in mental wellbeing as an adverse effect of being focused on falls prevention. Eighty-six persons, community-dwelling or home for the aged (mean age 80.3 years [SD: 6.3], 56 women (65.1%)) participated. The intervention group measured their gait speed by using the Mobility Feedback Device (MFD) weekly for 6 months. The control group was monitored for the outcomes without an intervention. Change scores involving health perception and mental wellbeing (Medical Outcomes Study 20-item short form (MOS-20)) were compared between groups. Feasibility was assessed by drop-out rate and compliance to measure gait speed. Safety was assessed by fall incidence during follow-up. MOS-20 decreased significantly in the control group (p = 0.024) but remained stable in the intervention group. Drop-out rate was low (9.3%), and compliance was good. Fall incidence was the same for both groups (p = 0.155). The self-management fall prevention program is feasible and safe in a community-dwelling and home for the aged population, making it worthwhile to further explore self-management fall-prevention studies.

Clopidogrel may decrease the risk of post-stroke infection after ischaemic stroke.

BACKGROUND AND PURPOSE: The P2Y12 receptor, a well-known factor in the platelet activation pathway, plays a role in thrombosis as well as systemic inflammation. Clopidogrel, a prototype P2Y12 receptor antagonist, reportedly decreases inflammation and systemic infection. The aim of this study was to evaluate whether clopidogrel use decreases the risk of post-stroke infection following ischaemic stroke. METHODS: A total of 1643 patients with acute ischaemic stroke (within 7 days after onset) were included for analysis between March 2010 and December 2015. Patients were categorized into two groups (clopidogrel users versus clopidogrel non-users), and clinical characteristics and risks of post-stroke infection were compared between the two groups. The inverse probability of treatment weighting using propensity scores for baseline imbalance adjustments was applied. RESULTS: Of the included patients (mean age 67.7 years; men 60.6%), 670 (40.8%) patients were clopidogrel users and 164 (10.0%) patients had post-stroke infection. The proportion of patients with post-stroke infection was significantly lower in clopidogrel users compared to clopidogrel non-users (6.7% vs. 12.2%, P ≤ 0.001). Moreover, clopidogrel users were less likely to be admitted to the intensive care unit (13.3% vs. 35.3%, P = 0.006). A multivariate analysis with inverse probability of treatment weighting revealed that clopidogrel users exhibited a lower risk of post-stroke infection (odds ratio 0.56, 95% confidence interval 0.42-0.75) and intensive care unit admission (odds ratio 0.34, 95% confidence interval 0.22-0.53). CONCLUSIONS: The study suggested that clopidogrel users exhibit a lower risk of infection and develop less severe infections after ischaemic stroke. Further prospective studies are needed.

Self-management tasks to improve mobility and reduce fall risk are not leading to lower research participation in older adults.

PURPOSE OF STUDY: The first aim is to evaluate, in a sub-study, the recruitment process of the Senior Step Study, which was an intervention study on the self-management of mobility and fall risk; the second aim is to explore the reasons mentioned by older people, from three different settings, for (not) participating. METHODS: Subjects were community-dwelling older persons, residents of homes for the elderly, and older persons regularly visiting community centres. The effectiveness of different recruitment procedures was analysed for each setting separately. We also analysed reasons for accepting and declining participation between the settings. RESULTS: The total inclusion rate was 27.9%. A personal initial approach (i.e., first contact was face-to-face or in a group meeting) did not improve the inclusion rate. More subjects consented to participate after an introductory meeting (which was planned after the first face-to-face contact) compared to persons not having one (p < 0.01). At different settings, subjects gave different reasons for participation. No differences were found in the reasons for refusing participation. Especially in homes for the elderly, people refused to participate because the research was too burdensome. CONCLUSIONS: The inclusion rates in this study are comparable to other self-management studies with older people. An introductory meeting during which the study design and benefits of participating are explained and formal interim evaluations of the recruitment process may benefit recruitment. Recruiting older persons for self-management tasks is possible with the appropriate recruitment process, enabling more research on this increasingly important research topic.

Bronchial angles are associated with nodular bronchiectatic non-tuberculous mycobacteria lung disease.

BACKGROUND: The nodular bronchiectatic (NB) form of non-tuberculous mycobacteria (NTM) lung disease usually involves the right middle lobe (RML) and the left upper lobe lingular segment. However, the reason underlying this preference is not known. METHODS: Fifty patients with NB NTM lung disease who had both positive NTM culture(s) and NB lesions in the RML or lingular segment on computed tomography (CT) of the chest, and 100 healthy subjects matched for sex, age, height and body weight with normal chest CT, were randomly selected. Using reconstructed curved multiplanar reformation (MPR) images, the lengths, diameters and angles of the RML and lingular bronchi were measured. RESULTS: Of the 150 individuals, 64% were female; the mean age was 55 years. The angles of the bronchi were significantly more acute in patients than in healthy subjects, both in the RML (patients, mean 46.75° ± standard deviation 8.87° vs. healthy subjects, mean 51.73° ± 7.76°; P = 0.001) and in the lingular segments (patients, mean 26.94° ± 8.16° vs. healthy subjects, mean 34.65° ± 9.75°; P < 0.001). In addition, the angles of the bronchi in the involved segments were more acute than those in the non-involved segments, both in the RML and the lingular segments. There were no differences in the lengths and bronchi diameters between groups. CONCLUSIONS: An acute angle (obtuse slope) of RML/lingular bronchi could be an anatomical risk factor for NB NTM lung disease.

Risk factors to predict the development of chronic kidney disease in patients with lupus nephritis.

Objectives We analyzed the clinical follow-up results of 88 lupus nephritis patients to find prognostic factors for the development of chronic kidney disease in ethnically homogeneous Korean patients with biopsy-proven lupus nephritis. Methods Sociodemographic, clinical, laboratory, and treatment-related data at the time of kidney biopsy and during follow-up were obtained. Renal biopsy specimens were reclassified according to the International Society of Pathology/Renal Pathology Society classification, separately, by two renal pathologists blinded to the previous classification. Univariate and multivariate analyses were performed using the Cox proportional hazard regression model to identify independent risk factors for chronic kidney disease in lupus nephritis patients. Results Eighteen of 88 patients (20.5%) developed chronic kidney disease during a mean follow-up of 47.6 months (range: 12-96 months). Patients who developed chronic kidney disease were older at onset of lupus nephritis, had less education, and were more likely to have hypertension; they had lower serum albumin levels, lower platelet levels, higher serum creatinine levels, lower estimated glomerular filtration rate, higher chronicity index, and lower frequency of anti-ribosomal P antibodies, and they were less likely to be in complete remission in the first year. In stepwise multivariable analyses, hypertension, lower glomerular filtration rate, and failure to achieve complete remission in the first year of treatment were significant predictors of the development of chronic kidney disease in lupus nephritis patients. Conclusions These findings suggest that patients with hypertension and decreased kidney function at the onset of lupus nephritis and showing a poor response to immunosuppressive drugs in the first year should be monitored carefully and managed aggressively to avoid deterioration of kidney function.

Causation or selection - examining the relation between education and overweight/obesity in prospective observational studies: a meta-analysis.

Numerous studies have investigated the association between education and overweight/obesity. Yet less is known about the relative importance of causation (i.e. the influence of education on risks of overweight/obesity) and selection (i.e. the influence of overweight/obesity on the likelihood to attain education) hypotheses. A systematic review was performed to assess the linkage between education and overweight/obesity in prospective studies in general populations. Studies were searched within five databases, and study quality was appraised with the Newcastle-Ottawa scale. In total, 31 studies were considered for meta-analysis. Regarding causation (24 studies), the lower educated had a higher likelihood (odds ratio: 1.33, 1.21-1.47) and greater risk (risk ratio: 1.34, 1.08-1.66) for overweight/obesity, when compared with the higher educated. However, these associations were no longer statistically significant when accounting for publication bias. Concerning selection (seven studies), overweight/obese individuals had a greater likelihood of lower education (odds ratio: 1.57, 1.10-2.25), when contrasted with the non-overweight or non-obese. Subgroup analyses were performed by stratifying meta-analyses upon different factors. Relationships between education and overweight/obesity were affected by study region, age groups, gender and observation period. In conclusion, it is necessary to consider both causation and selection processes in order to tackle educational inequalities in obesity appropriately.

miR-10b-5p is a novel Th17 regulator present in Th17 cells from ankylosing spondylitis.

OBJECTIVE: To determine the microRNA (miR) signature in ankylosing spondylitis (AS) T helper (Th)17 cells. METHODS: Interleukin (IL)-17A-producing CD4+ T cells from patients with AS and healthy controls were FACS-sorted for miR sequencing and qPCR validation. miR-10b function was determined by miR mimic expression followed by cytokine measurement, transcriptome analysis, qPCR and luciferase assays. RESULTS: AS Th17 cells exhibited a miR signature characterised by upregulation of miR-155-5p, miR-210-3p and miR-10b. miR-10b has not been described previously in Th17 cells and was selected for further characterisation. miR-10b is transiently induced in in vitro differentiated Th17 cells. Transcriptome, qPCR and luciferase assays suggest that MAP3K7 is targeted by miR-10b. Both miR-10b overexpression and MAP3K7 silencing inhibited production of IL-17A by both total CD4 and differentiating Th17 cells. CONCLUSIONS: AS Th17 cells have a specific miR signature and upregulate miR-10b in vitro. Our data suggest that miR-10b is upregulated by proinflammatory cytokines and may act as a feedback loop to suppress IL-17A by targeting MAP3K7. miR-10b is a potential therapeutic candidate to suppress pathogenic Th17 cell function in patients with AS.

D-dimer as a predictor of early neurologic deterioration in cryptogenic stroke with active cancer.

BACKGROUND AND PURPOSE: The occurrence of stroke in cancer patients is caused by conventional vascular risk factors and cancer-specific mechanisms. However, cryptogenic stroke in patients with cancer was considered to be more related to cancer-specific hypercoagulability. In this study, we investigated the potential of the D-dimer level to serve as a predictor of early neurologic deterioration (END) in cryptogenic stroke patients with active cancer. METHODS: We recruited 109 cryptogenic stroke patients with active cancer within 72 h of symptom onset. We defined END as an increase of ≥1 point in the motor National Institutes of Health Stroke Scale (NIHSS) score or ≥2 points in the total NIHSS score within 72 h of admission. After adjusting for potential confounding factors in the multivariate analysis, we calculated the odds ratios (ORs) and confidence intervals (CIs) of D-dimer in the prediction of END. RESULTS: Among 109 patients, END events were identified in 34 (31%) patients within 72 h. END was significantly associated with systemic metastasis, multiple vascular territory lesions on the initial magnetic resonance imaging (MRI), initial NIHSS score and D-dimer levels. In the multivariate analysis, the D-dimer level (adjusted OR, 1.11; 95% CI, 1.04-1.17; P < 0.01) and initial NIHSS score (adjusted OR, 1.08; 95% CI, 1.01-1.15; P = 0.03) predicted END after adjusting for potential confounding factors. In the subgroup analysis of 72 follow-up MRIs, D-dimer level was also correlated with new territory lesions on the follow-up MRI in a dose-dependent manner. CONCLUSION: Ischemic stroke patients with active cancer and elevated D-dimer levels appear to be at increased risk for END recurrent thromboembolic stroke.

Measuring impairments of functioning and health in patients with axial spondyloarthritis by using the ASAS Health Index and the Environmental Item Set: translation and cross-cultural adaptation into 15 languages.

INTRODUCTION: The Assessments of SpondyloArthritis international society Health Index (ASAS HI) measures functioning and health in patients with spondyloarthritis (SpA) across 17 aspects of health and 9 environmental factors (EF). The objective was to translate and adapt the original English version of the ASAS HI, including the EF Item Set, cross-culturally into 15 languages. METHODS: Translation and cross-cultural adaptation has been carried out following the forward-backward procedure. In the cognitive debriefing, 10 patients/country across a broad spectrum of sociodemographic background, were included. RESULTS: The ASAS HI and the EF Item Set were translated into Arabic, Chinese, Croatian, Dutch, French, German, Greek, Hungarian, Italian, Korean, Portuguese, Russian, Spanish, Thai and Turkish. Some difficulties were experienced with translation of the contextual factors indicating that these concepts may be more culturally-dependent. A total of 215 patients with axial SpA across 23 countries (62.3% men, mean (SD) age 42.4 (13.9) years) participated in the field test. Cognitive debriefing showed that items of the ASAS HI and EF Item Set are clear, relevant and comprehensive. All versions were accepted with minor modifications with respect to item wording and response option. The wording of three items had to be adapted to improve clarity. As a result of cognitive debriefing, a new response option 'not applicable' was added to two items of the ASAS HI to improve appropriateness. DISCUSSION: This study showed that the items of the ASAS HI including the EFs were readily adaptable throughout all countries, indicating that the concepts covered were comprehensive, clear and meaningful in different cultures.

Feasibility of repeated self-measurements of maximum step length and gait speed by community-dwelling older persons.

OBJECTIVES: Self-management of mobility and fall risk can be important in fall prevention; however, it remains unstudied. Therefore, the current study assessed whether community-dwelling older persons were able to repeatedly self-assess maximum step length (MSL) and gait speed (GS) in their own home for a 6-month period, how these tests changed during this period and if these changes were related to falling. DESIGN: This is a prospective study. SETTING: This study was conducted at home. PARTICIPANTS: A total of 56 community-dwelling older adults (24 women (43%), mean age 76.2 (SD 3.9) years) entered the study; of which, 45 completed the study. METHODS: Participants performed MSL and GS once a week in their own home during a 6-month period. PRIMARY AND SECONDARY OUTCOMES: Repeated MSL and GS measurements were the primary outcomes. Falls, self-management and mobility were the secondary outcomes. RESULTS: Self-assessment of MSL and GS by older persons is feasible. Compliance of repeatedly self-measuring MSL and GS was good; the median number of weekly measurements was 23.0 (88%) and 21.0 (81%) for MSL and GS, respectively. Drop-outs showed less self-management abilities compared to the participants who completed the study (p=0.049). Linear mixed models showed a small significant improvement in MSL and GS over time (p<0.001), without an influence on falling. CONCLUSIONS: Most community-dwelling older persons are able and willing to repeatedly assess their MSL and GS. Self-managing mobility and fall risk did not increase fall occurrence. The fact that older persons can be actively involved in their own healthcare is clinically relevant. Further studies are needed to examine the (cost-)effectiveness of self-management in fall prevention interventions.

The rate of and risk factors for frequent hospitalization in systemic lupus erythematosus: results from the Korean lupus network registry.

Objectives The survival rate of patients with systemic lupus erythematosus has improved in the last few decades, but the rate of hospitalization and health care costs for these patients remain higher than in the general population. Thus, we evaluated the rate of hospitalization and associated risk factors in an inception cohort of Korean patients with lupus. Methods Of the 507 patients with systemic lupus erythematosus enrolled in the KORean lupus NETwork, we investigated an inception cohort consisting of 196 patients with systemic lupus erythematosus presenting within 6 months of diagnosis based on the American College of Rheumatology classification criteria. We evaluated the causes of hospitalization, demographic characteristics, and laboratory and clinical data at the time of systemic lupus erythematosus diagnosis of hospitalized patients and during a follow-up period. We calculated the hospitalization rate as the number of total hospitalizations divided by the disease duration, and defined "frequent hospitalization" as hospitalization more than once per year. Results Of the 196 patients, 117 (59.6%) were admitted to hospital a total of 257 times during the 8-year follow-up period. Moreover, 22 (11.2%) patients were hospitalized frequently. The most common reasons for hospitalization included disease flares, infection, and pregnancy-related morbidity. In the univariate regression analysis, malar rash, arthritis, pericarditis, renal involvement, fever, systemic lupus erythematosus disease activity index > 12, hemoglobin level < 10 mg/dl, albumin level < 3.5 mg/dl, and anti-Sjögren's syndrome A positivity were associated with frequent hospitalization. Finally, multivariate analysis showed that arthritis, pericarditis, and anti-Sjögren's syndrome A antibody positivity at the time of diagnosis were risk factors for frequent hospitalization. Conclusions Our results showed that frequent hospitalization occurred in 11.2% of hospitalized patients and arthritis, pericarditis, and anti-Sjögren's syndrome A antibody positivity at the time of diagnosis were risk factors for frequent hospitalization.

Prolonged sleep increases the risk of intracerebral haemorrhage: a nationwide case-control study.

BACKGROUND AND PURPOSE: Although abnormal sleep duration is positively associated with increased risk for cardiovascular disease and mortality, the specific impact on intracerebral haemorrhage (ICH) risk remains unclear. The relationship between sleep duration and the risk of ICH was investigated in our study. METHODS: A nationwide, multicentre matched case-control study was performed to investigate the risk factors for haemorrhagic stroke, using patients from 33 hospitals in Korea. In all, 490 patients with ICH and 980 age- and sex-matched controls were enrolled. Detailed information regarding sleep, sociodemographic factors, lifestyle and medical history before ICH onset was obtained using qualified structured questionnaires. Sleep duration was categorized and the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a conditional logistic regression with 7 h as the reference duration. RESULTS: The number of subjects with long sleep duration, more than 8 h, was significantly greater in the ICH group than in the control group (≥8 h, 30.4% vs. 22.6%, P = 0.002). After controlling for relevant confounding factors, longer sleep duration was found to be independently associated with the risk of ICH in a dose-response manner (8 h, OR 1.57, 95% CI 1.00-2.47; ≥9 h, OR 5.00, 95% CI 2.18-11.47). CONCLUSIONS: Our study suggested that long sleep duration is positively associated with an increased ICH risk in a dose-dependent manner. Further studies on the relationship linking long sleep duration with increased risk of ICH are required.

The effect of feeding native warm season grasses in the stocker phase on the carcass quality, meat quality, and sensory attributes of beef loin steaks from grain-finished steers.

The objective of this study was to evaluate the effect of feeding native warm season grass (NWSG) to beef cattle during the stocker phase (110days) on carcass and meat quality. Treatments included Bermudagrass (BER), Indiangrass monoculture (IND), and a mixture of NWSG including Big Bluestem, Little Bluestem, and Indiangrass (MIX). Cattle were finished on grain (180days) in a commercial feedlot and carcass data were collected after harvest. The percentages of 'choice' carcasses were 100, 95.8, and 87 within MIX, BER, and IND treatments, respectively. Steaks from BER had greater (P<0.05) fat content, and lower (P<0.05) protein and moisture percentages when compared to steaks from IND and MIX treatments. However, steaks from the MIX and IND treatments had less (P<0.05) lipid oxidation than steaks from BER after 6days of refrigerated storage. Results indicate that NWSG could be effectively incorporated into forage systems for stocker cattle without compromising carcass and meat quality.

Effect of roflumilast on airway remodelling in a murine model of chronic asthma.

BACKGROUND: Airway remodelling is associated with irreversible, or partially reversible, airflow obstruction and ultimately unresponsiveness to asthma therapies such as corticosteroids. Roflumilast is a selective phosphodiesterase-4 inhibitor that has an anti-inflammatory effect in chronic obstructive pulmonary disease (COPD). OBJECTIVE: The objective of this study was to study the effect of roflumilast on airway inflammation and remodelling in a murine model of chronic asthma. METHODS: BALB/c mice sensitized to ovalbumin (OVA) were chronically exposed to intranasal OVA administration twice a week for additional 3 months. Roflumilast was administered orally during the intranasal OVA challenge. A lung fibroblast cell line was used in the proliferation assay. RESULTS: Compared with control mice, mice chronically exposed to OVA developed eosinophilic airway inflammation, airway hyper-responsiveness (AHR), and exhibited features of airway remodelling. Administration of roflumilast significantly inhibited airway inflammation and AHR. Roflumilast also significantly decreased goblet cell hyperplasia and pulmonary fibrosis, which are parameters of airway remodelling. The levels of interleukin (IL)-4, IL-5, and IL-13 in the bronchoalveolar lavage (BAL) fluids were significantly lower in the roflumilast group. In vitro, roflumilast significantly inhibited stem cell factor (SCF)-induced cell proliferation of fibroblasts. The SCF concentration and mRNA expression in a murine model also significantly decreased with roflumilast treatment. CONCLUSIONS: These results suggest that the administration of roflumilast regulates airway inflammation, AHR, and airway remodelling in a model of chronic asthma. The beneficial effects from roflumilast may be related to the SCF/c-kit pathway.

Novel echocardiographic indicator for potential cardioembolic stroke.

BACKGROUND AND PURPOSE: In many cardioembolic strokes (CSs), the specific embolic source is uncertain. Despite the high mortality of CS, not enough attention is paid to its potential source. Although atrial fibrillation (AF) is the most common source of embolism, more complex and dynamic multiplicities may influence CS. The aim of this study was to evaluate novel indicators of transthoracic echocardiography (TTE) that have additional value for detecting CS. METHODS: In total, 1878 patients with acute ischaemic stroke who had TTE during admission were identified. Of the patients with undetermined etiology, 93 patients with incomplete evaluations were excluded. Thereafter, two stroke neurologists reviewed all of the magnetic resonance images to assess cardioembolic lesion patterns. The patients were classified into two groups: potential cardioembolic stroke (PCS) and non-PCS. RESULTS: Amongst a total of 1601 patients, 518 (32.4%) had PCS. About half of the patients with PCS had AF. Patients with PCS were more likely to have larger left ventricular (LV) end-diastolic diameters, larger LV end-systolic diameters, larger left atrial sizes, increased E/A ratios and reduced LV ejection fractions. After adjusting for multiple clinical and TTE variables including AF, an E/A ratio ≥1.5 had a significant predictive value for PCS (odds ratio 2.89, 95% confidence interval 1.57-5.31, P < 0.01). CONCLUSION: An E/A ratio ≥1.5 is independently associated with PCS after adjusting for multiple covariates including AF and provides incremental prognostic information for detecting PCS.

Perceived job insecurity, unemployment and depressive symptoms: a systematic review and meta-analysis of prospective observational studies.

PURPOSE: It was shown that both job insecurity and unemployment are strongly and consistently associated with depressive symptoms. It is, however, less clear whether perceived job insecurity and unemployment constitute a comparable risk for the onset of depressive symptoms. A meta-analysis was conducted to explore this issue. METHODS: In December 2014, relevant records were identified through the databases MEDLINE, Embase and PsychINFO. Articles were included if they had been published in the last 10 years and contained a quantitative analysis on the prospective link between job insecurity and unemployment with depressive symptoms. RESULTS: In 20 cohort studies within 15 articles, job insecurity and unemployment were significantly related to a higher risk of depressive symptoms, with the odds ratio (OR) being modestly higher for job insecurity (1.29, 95% CI 1.06-1.57) than for unemployment (1.19, 95% CI 1.11-1.28). Sensitivity analyses revealed that the effects were strongest in studies that examined younger respondents (<40 years) and used an unadjusted statistical model. By considering the length of the observational period, it was shown that unemployment ORs were higher in shorter time lags (under 1 year), while ORs for job insecurity were increased in longer exposure-outcome intervals (3-4 years). Specifically for unemployment, ORs were highest in studies that did not control for potential health selection effects and that ascertained enduring unemployment. A statistically significant publication bias was found for studies on unemployment, but not for job insecurity. CONCLUSIONS: The analyses revealed that both perceived job insecurity and unemployment constitute significant risks of increased depressive symptoms in prospective observational studies. By comparing both stressors, job insecurity can pose a comparable (and even modestly increased) risk of subsequent depressive symptoms.

Isolation and characterization of human intestinal Enterococcus avium EFEL009 converting rutin to quercetin.

UNLABELLED: Quercetin is a flavonol believed to have beneficial effects on human health. Rutin, found in many plants, fruits and vegetables, is metabolized by human intestinal bacteria and converted to quercetin, where it is absorbed through the intestinal epithelium. This study aimed to isolate and characterize human intestinal bacteria capable of converting rutin to quercetin. A bacterium that can metabolize rutin was isolated from human faecal samples and identified by 16S rRNA gene sequencing. The whole-cell enzymatic activities on flavonoid glycoside and the conversion profiles of the isolate were also analysed. The bacterium was identified as Enterococcus avium EFEL009 and was shown to convert rutin to isoquercetin and then to quercetin under anaerobic conditions. Microscopic analysis revealed short chains of cocci with diameters of approx. 1 µm. ß-Glucosidase was shown to be constitutively expressed in Ent. avium, while α-rhamnosidase was expressed following induction by rutin. Both enzymes were mainly localized to the cell surface. This study is the first report on the isolation of a quercetin-producing Ent. avium FEEL009, which could be a potential industrial starter bacterium. SIGNIFICANCE AND IMPACT OF THE STUDY: Quercetin is a member of the flavonoids family reported to have better cytoprotective abilities, stronger inhibition of lipopolysaccharide-induced nitric oxide production, and better chemoprevention than rutin. This is the first report on the isolation and characterization of Enterococcus avium EFEL009 from the human intestine which is capable of converting rutin to quercetin.

Comparison of clinical and serological differences among juvenile-, adult-, and late-onset systemic lupus erythematosus in Korean patients.

OBJECTIVES: We investigated whether systemic lupus erythematosus (SLE) patients could be distinguished based on the time of disease onset and, if so, whether the groups differed in their clinical and laboratory features in ethnically homogeneous Korean patients. METHODS: We enrolled 201 SLE patients with available clinical data at the time of onset of SLE from the lupus cohort at Chonnam National University Hospital. Sociodemographic, clinical, and laboratory data, including autoantibodies, and concomitant diseases were found at the time of diagnosis of SLE by reviewing patient charts. We divided SLE patients according to age at SLE diagnosis into three groups: juvenile-onset SLE (JSLE, diagnosed at ≤ 18 years), adult-onset SLE (ASLE, diagnosed at 19-50 years), and late-onset SLE (LSLE, diagnosed at >50 years), and compared baseline demographic, clinical, and relevant laboratory findings. RESULTS: Of the 201 patients, 27 (14.4%), 149 (74.1%), and 25 (12.4%) were JSLE, ASLE, and LSLE patients, respectively. Fever, oral ulcers, nephritis, anemia, and thrombocytopenia were more common in JSLE patients than ASLE or LSLE patients (p < 0.05, < 0.05, 0.001, < 0.05, and < 0.05, respectively). However, Sjögren's syndrome was more frequent in LSLE patients than JSLE or ASLE patients (p < 0.05). Disease activity was significantly higher in JSLE patients than in ASLE or LSLE patients (p < 0.001). Anti-dsDNA and anti-nucleosome antibodies were found more frequently in JSLE patients and less frequently in LSLE patients (p < 0.05 and 0.005, respectively) and decreased complement levels were more common in JSLE patients and less common in LSLE patients (p < 0.001, 0.001, and < 0.05, respectively). CONCLUSIONS: Our results indicate that SLE patients present with different clinical and serological manifestations according to age at disease onset. JSLE patients have more severe disease activity and more frequent renal involvement and LSLE patients have milder disease activity, more commonly accompanied by Sjögren's syndrome, at disease onset.