Comparison of mumps-IgM ELISAs in acute infection.

BACKGROUND: In Scotland there has been an outbreak of mumps with over 4000 confirmed cases in the last 2 years. As laboratory diagnosis is usually requested on patients with symptoms, a prompt diagnosis early in the illness is required. OBJECTIVES: To assess the performance of the five different commercial IgM-ELISAs used in Scottish Virus laboratories. STUDY DESIGN: The Specialist Virology Laboratory (SVC) Edinburgh distributed a serum panel to all Scottish laboratories that diagnose mumps by IgM-ELISA. The panel consisted of 45 sera from patients with confirmed mumps (date of onset known for 44/45) and 11 sera from patients with alternative diagnoses. Each laboratory performed their own commercial IgM-ELISAs blindly and reported results to the SVC Edinburgh. RESULTS: Sensitivity ranged from 24% to 51%. Assays performed better on samples taken later than 10 days after onset of symptoms. Specificity was about 82% for most assays. CONCLUSION: The sensitivity of commercial mumps IgM-ELISAs varied greatly. The Microimmune mumps-IgM ELISA had the best overall sensitivity in acute serum specimens. Diagnostic laboratories should be developing the means to perform direct detection of mumps virus for acute presentation and requesting convalescent bloods, if acute blood samples have no detectable IgM.     

Clustering of cardiovascular risk factors with diabetes in Chinese patients: the effects of sex and hyperinsulinaemia

SUMMARY
Objective   This study was designed to investigate factors which affect the clustering of cardiovascular risk factors with diabetes in Chinese patients.
Research Design and Methods: Six hundred and fifty-four patients with diabetes were assessed comprehensively for diabetes complications and cardiovascular risk factors in a metropolitan hospital in Beijing, China. Insulin resistance and secretion were also evaluated by measurement of glucose and insulin levels before and after a meal tolerance test. Results were analysed according to patient groups stratified by the number of cardiovascular risk factors coexisting with diabetes.
Results   Cardiovascular risk factors were common in Chinese diabetic patients. The clustering of three or more of these factors with diabetes occurred more often than by chance alone and was associated with postprandial hyperinsulinaemia. Patients with a high number of risk factors were more prone to macrovascular events but did not have higher albuminuria. Using the commonly adopted lower threshold for diagnosing obesity and central obesity in women, there were more women with multiple risk factors. However, this disappeared if the same criteria were used for men and women. Even in the presence of diabetes, cardiovascular risk factors were inadequately controlled in most patients.
Conclusions   The concurrence of diabetes and other cardiovascular risk factors which constitute the metabolic syndrome is a common phenomenon in urban Chinese diabetic patients. It is associated with hyperinsulinaemia and possibly the female sex. This study emphasises the importance of public health measures to control cardiovascular risk factors in patients with diabetes.     

A blinded clinical study using a subepidermal moisture biocapacitance measurement device for early detection of pressure injuries

This study aimed to evaluate the sensitivity and specificity of subepidermal moisture (SEM), a biomarker employed for early detection of pressure injuries (PI), compared to the “Gold Standard” of clinical skin and tissue assessment (STA), and to characterize the timing of SEM changes relative to the diagnosis of a PI. This blinded, longitudinal, prospective clinical study enrolled 189 patients (n = 182 in intent‐to‐treat [ITT]) at acute and post‐acute sites (9 USA, 3 UK). Data were collected from patients' heels and sacrums using a biocapacitance measurement device beginning at admission and continuing for a minimum of 6 days to: (a) the patient developing a PI, (b) discharge from care, or (c) a maximum of 21 days. Standard of care clinical interventions prevailed, uninterrupted. Principal investigators oversaw the study at each site. Blinded Generalists gathered SEM data, and blinded Specialists diagnosed the presence or absence of PIs. Of the ITT population, 26.4% developed a PI during the study; 66.7% classified as Stage 1 injuries, 23% deep tissue injuries, the remaining being Stage 2 or Unstageable. Sensitivity was 87.5% (95% CI: 74.8%‐95.3%) and specificity was 32.9% (95% CI: 28.3%‐37.8%). Area under the receiver operating characteristic curve (AUC) was 0.6713 (95% CI 0.5969‐0.7457, P < .001). SEM changes were observed 4.7 (± 2.4 days) earlier than diagnosis of a PI via STA alone. Latency between the SEM biomarker and later onset of a PI, in combination with standard of care interventions administered to at‐risk patients, may have confounded specificity. Aggregate SEM sensitivity and specificity and 67.13% AUC exceeded that of clinical judgment alone. While acknowledging specificity limitations, these data suggest that SEM biocapacitance measures can complement STAs, facilitate earlier identification of the risk of specific anatomies developing PIs, and inform earlier anatomy‐specific intervention decisions than STAs alone. Future work should include cost‐consequence analyses of SEM informed interventions.     

Use of genomic analysis of varicella-zoster virus to investigate suspected varicella-zoster transmission within a renal unit.

BACKGROUND: The source of hospital-acquired chickenpox infection may be presumed from a known exposure, but has not been previously proven using genomic analysis. OBJECTIVE: Investigation of suspected VZV transmission was done using single nucleotide polymorphism genomic analysis. STUDY DESIGN: Comparison was made of viral isolates from two patients with chickenpox on the same ward who were not known to have had direct contact. RESULTS: An identical genotype in the variable R1 region of the VZV was isolated from the two patients. CONCLUSION: Inapparent hospital-acquired transmission was the most likely route of infection.     

Macrophages: A review of their role in wound healing and their therapeutic use

Macrophages are mononuclear phagocytes established during embryogenesis and derived from the yolk sac or the fetal liver but also recruited from the blood and bone marrow under proliferative inflammatory conditions (such as tissue repair). Most importantly, they take on distinct phenotypes and functions crucial to healing upon localization in the wound. The objective of this review is to summarize recent findings in regard to the cellular mechanisms of macrophages and chronic wounds. Advances in the potential use of macrophage therapy have arisen based, in part, on the fact that early recruitment of macrophages is critical to wound healing. Higher quality evidence is needed to support the use of macrophage therapy for chronic wound types, as is a better understanding of the signaling related to macrophage polarization, activation of macrophages, and their effect of mechanisms of repair. An evaluation of the currently available research on mechanism of action may lead to a better understanding of the signaling processes of the many macrophage phenotypes, as well as their roles and outcomes in wound healing, which could then guide the development and eventual widespread use of macrophage therapies.     

Endothelial and neural regulation of skin microvascular blood flow in patients with diabetic peripheral neuropathy: effect of treatment with the isoform-specific protein kinase C beta inhibitor, ruboxistaurin

PURPOSE: This article aims to study the effects of ruboxistaurin (RBX) on skin microvascular blood flow (SkBF) and evaluate the relationship between endothelial and neural control of SkBF in patients with diabetic peripheral neuropathy (DPN). METHODS: We studied 11 placebo- and 9 RBX (32 mg/day)-treated patients who participated in a 1-year, double-masked, randomized, Phase 3 study of RBX for treatment of DPN sensory symptoms. Patients had type 1 or type 2 diabetes, a detectable sural sensory nerve action potential, and Neuropathy Total Symptom Score-6 (NTSS-6) >6 points. SkBF was measured by laser Doppler velocimetry, combined with iontophoresis of acetylcholine and sodium nitroprusside, at baseline, 3 months, and 1 year. Sensory symptoms and electrophysiology were also evaluated during the study. The relationship between endothelial and neural control of SkBF at baseline was assessed using linear regression. RESULTS: No significant differences (RBX vs. placebo) were demonstrable for post-iontophoresis SkBF [fold increase from basal state (1 year): endothelium-dependent, 3.6 vs. 8.6; endothelium-independent, 3.7 vs. 2.0; C fiber-mediated, 1.7 vs. 2.0; P>.05] or sensory symptoms [NTSS-6 total score (1 year): 7.7 vs. 6.0 points; P=.4]. There were also no significant between-group differences in nerve conduction parameters, except for placebo peroneal nerve conduction velocity, which demonstrated a statistically significant improvement of unknown clinical importance (Z=2.1; P=.034). At baseline, C fiber-mediated vasodilatation correlated well with endothelium-dependent vasodilation (r=.7, P<.01) but not with endothelium-independent vasodilatation (r=-.1, P=.7). CONCLUSIONS: RBX demonstrated no effect on SkBF or sensory symptoms after 1 year in this cohort. The correlation between C fiber-mediated and endothelium-dependent SkBF at baseline suggests that improving endothelial function could affect the microcirculation not only locally but also via the neurovascular arcade.     

Glycemic Control and Blood Glucose Monitoring Over Time in a Sample of Young Australians With Type 1 Diabetes: The role of personality

OBJECTIVE

To determine whether personality traits (conscientiousness, agreeableness, emotional regulation, extraversion, and openness to experience) are associated with glycemic control and blood glucose monitoring behavior, and change or stability of these outcomes over time, in young people with type 1 diabetes.

RESEARCH DESIGN AND METHODS

A 3-year longitudinal study was conducted using data from 142 individuals with type 1 diabetes, 8–19 years of age. Personality was assessed at baseline using the Five-Factor Personality Inventory for Children. Data relating to glycemic control (HbA_1c) and frequency of blood glucose monitoring (based on meter memory) were collected annually. Relationships between personality traits and HbA_1c and monitoring frequency were examined using regression models and mixed-design ANOVA.

RESULTS

Three of the Five-Factor domains were independently associated with glycemic control. Individuals high in conscientiousness and agreeableness had a lower and more stable HbA_1c across the 3-year study period. In contrast, the HbA_1c of individuals scoring low on these traits was either consistently worse or deteriorated over time. Low or high emotional regulation scores were also associated with worse glycemic control. By the third year, these domains, together with initial HbA_1c, accounted for 39% of HbA_1c variance. Conscientiousness was the only personality factor associated with blood glucose monitoring behavior.

CONCLUSIONS

Results of this study underline the importance of personality in contributing to diabetes outcomes. Attention to a young person’s personality, and appropriate tailoring of diabetes management to ensure an individualized approach, may help to optimize diabetes outcomes.In Australia, and many other countries, a large proportion of young people with diabetes are not reaching glycemic targets (1–6). This is likely to have life-long consequences. Indeed, those subjects who were randomized to the conventional treatment arm of the Diabetes Control and Complications Trial (7) and who had an average HbA_1c of 9.1% during the course of the study continued to develop significantly more micro- and macrovascular complications compared with the intensive group when followed up in the Epidemiology of Diabetes Interventions and Complications study. This occurred despite the rapid convergence of mean HbA_1c between the groups at the end of the active study phase (8).While there are many factors that contribute to suboptimal control, there is mounting evidence that an individual’s personality may play an important role. Several studies in the late 1980s showed that personality traits could account for substantial variability in glycemic control in school-aged children (9,10). However, there has been increasing complexity in treatment regimens since that time. For example, current treatment now involves multiple daily injections or insulin pump therapy. Today, therefore, young people and their families are required to make more complex medical decisions on a daily basis.The role of personality in these new treatment contexts is not well-understood. Personality can be understood in terms of the Five-Factor model. The Five-Factor model states that there are five broad, independent, and stable dimensions that make up an individual’s personality (11). These factors are termed conscientiousness, agreeableness, emotional regulation, extraversion, and openness to experience. Conscientiousness refers to an individual’s tendency to be reliable, perseverant, and self-disciplined. Agreeableness refers to one’s tendency to be empathetic, considerate, friendly, and helpful. Emotional regulation refers to a person’s capability to regulate their emotional responses to their environment and others. Extraversion refers to an individual’s tendency to be gregarious, assertive, and seek out social situations. Openness refers to one’s tendency to be imaginative, sensitive, and have intellectual curiosity.Recent work by Vollrath et al. (12) suggests that personality, as measured using the Five-Factor model, influences glycemic control in the first 2 years following diagnosis of type 1 diabetes. In particular, higher levels of conscientiousness and agreeableness appear to have a positive influence on management of blood glucose values, while moderate levels of emotional regulation also appear to be protective (12). Further studies are needed to confirm these relationships between personality and glycemic control and to determine whether this is ameliorated by duration of diabetes. Studies are also needed to examine the role of personality in terms of self-care behavior.Accordingly, this study was designed to answer two research questions. 1) Are Five-Factor model personality traits associated with a young person’s glycemic control, as measured by HbA_1c, and their frequency of self-monitoring of blood glucose (SMBG)? 2) Are these traits associated with change or stability in HbA_1c and SMBG over time?