A screening algorithm for HIV‐associated neurocognitive disorders

Background

HIV physicians have limited time for cognitive screening. Here we developed an extra‐brief, clinically based tool for predicting HIV‐associated neurocognitive impairment (HAND) in order to determine which HIV‐positive individuals require a more comprehensive neurological/neuropsychological (NP) assessment.

Methods

Ninety‐seven HIV‐positive individuals with advanced disease recruited in an HIV out‐patient clinic received standard NP testing. A screening algorithm was developed using support vector machines, an optimized prediction procedure for classifying individuals into two groups (here NP‐impaired and NP‐normal) based on a set of predictors.

Results

The final algorithm utilized age, current CD4 cell count, past central nervous system HIV‐related diseases and current treatment duration and required approximately 3 min to complete, with a good overall prediction accuracy of 78% (against the gold standard; NP‐impairment status derived from standard NP testing) and a good specificity of 70%.

Conclusion

This noncognitive‐based algorithm should prove useful to identify HIV‐infected patients with advanced disease at high risk of HAND who require more formal assessment. We propose staged guidelines, using the algorithm, for improved HAND therapeutic management. Future larger, international studies are planned to test the predictive effect of nadir CD4 cell count, hepatitis C virus infection, gender, ethnicity and HIV viral clade. We recommend the use of this first version for HIV‐infected Caucasian men with advanced disease.     

Analysis and enumeration of T cells,B cells and NK cells using the monoclonal antibody fluorescence capability of a routine haematology analyser (Cell‐Dyn CD4000)

This communication details a method for the quantitative and qualitative analysis of blood T‐, B‐ and NK‐cell populations using the Abbott Cell‐Dyn CD4000 haematology analyser. A series of 66 ethylenediaminetetraacetic acid (EDTA)‐anticoagulated samples with lymphocyte counts between 0.2 and 33.3 × 10⁹/l were selected and analysed with CD3, CD19, Ia and CD56 monoclonal reagents. The flow cytometry reference method utilized a lymphocyte gate defined by optical scatter, with phenotypic analyses referencing to this gate and the absolute lymphocyte count. The CD4000 method analysed all leucocyte events, set primary gates for specific immunophenotypic fractions, and then determined population counts by reference to the white blood cell (WBC) count. Comparisons of CD3⁺ T‐cell and CD19⁺ B‐cell numbers showed high coefficients of correlation (R² > 0.95) and agreement (y = 1.01x) between the CD4000 and flow cytometry reference methods. Lower coefficients of correlation were obtained for CD3^?CD56⁺ (R² = 0.52) and CD3⁺CD56⁺ (R² = 0.83) components. No major discrepancies were observed, and the CD4000 procedures additionally provided qualitative insights into the possibility of T‐cell activation. The potential to undertake immediate analysis of EDTA‐anticoagulated blood samples to determine the nature of abnormal lymphocyte morphology or numbers represents a considerable advance in the capability of haematology laboratories.     

Seven years of regional malaria control collaboration--Mozambique, South Africa, and Swaziland

The Lubombo Spatial Development Initiative is a joint development program between the governments of Mozambique, Swaziland, and South Africa, which includes malaria control as a core component of the initiative. Vector control through indoor residual spraying (IRS) was incrementally introduced in southern Mozambique between November 2000 and February 2004. Surveillance to monitor its impact was conducted by annual cross-sectional surveys to assess the prevalence of Plasmodium falciparum infection, entomologic monitoring, and malaria case notification in neighboring South Africa and Swaziland. In southern Mozambique, there was a significant reduction in P. falciparum prevalence after the implementation of IRS, with an overall relative risk of 0.74 for each intervention year (P < 0.001), ranging from 0.66 after the first year to 0.93 after the fifth intervention year. Substantial reductions in notified malaria cases were reported in South Africa and Swaziland over the same period. The success of the program in reducing malaria transmission throughout the target area provides a strong argument for investment in regional malaria control.     

聚乙二醇干扰素α-2b单药或聚乙二醇干扰素α-2b联合拉米夫定治疗HBeAg阳性慢性乙型肝炎的多中心、随机、双盲、对照试验

与干扰素非应答者相比,应答的慢性乙型肝炎(乙肝)患者发生肝硬化、肝衰竭及肝细胞癌的可能性明显下降[1,2].然而,大部分慢性乙肝患者不能获得应答.在已经获得批准治疗慢性乙肝的药物中,最常用的是干扰素和核苷类似物,如拉米夫定或阿德福韦.     

2007年青海省碘缺乏病高危地区育龄妇女尿碘调查

Objective To investigate the iodine nourishment in women of child-beating age in high risk region of iodine deficiency disorders (IDD) in Qinghai Province. Methods According to The Notice to Launch a Reinforced Survey on IDD in High Risk Region issued by The Ministry of Public Health, 17 counties in 6 districts were selected as investigated area in Qinghai Province in 2007, using two stage cluster sampling and combining The National IDD Preliminary Surveillance Scheme, 30 women aged from 18 to 40 years were selected in each village, 1 or 2 villages in each town, 3 to 5 towns in each county, who were divided into newly wedding, pregnant, lactation and other women of child-bearing age. Iodine concentration in urine was detected by the method of As3+-Ce4+catalytic spectrophotometry. Results One thousand six hundreds and four urine iodine samples were analyzed. The median was 93.3 μg/L,52.1%(836/1604),31.8%(510/1604) and 12.4%(199/1604) was lower than 100,50 and 20 μg/L, respectively. It was 70.5%(527/747) and 43.0%(128/298) of women in Yushu and Haixi that had urinary iodine lower than 100 μg/L, respectively, while it was 50% of women in the 6 districts, to be specific, 88.3%(91/103) in Nangqian, 83.8% (62/74) in Zaduo and 70.7%(118/167) in Zhiduo Counties respectively. The median of urinary iodine in women who were not lactating and not pregnant was only 88.6 μg/L, of whom 53.9% (763/1415) lower than 100 μg/L. Conclusions The women of reproductive age in high risk region of IDD are deficient of iodine in Qinghai Province.     

Surgery and anesthesia in sickle cell disease. Cooperative Study of Sickle Cell Diseases

From 1978 to 1988, The Cooperative Study of Sickle Cell Disease observed 3,765 patients with a mean follow-up of 5.3 +/- 2.0 years. One thousand seventy-nine surgical procedures were conducted on 717 patients (77% sickle cell anemia [SS], 14% sickle hemoglobin C disease [SC], 5.7% S beta zero thalassemia, 3% S beta zero + thalassemia). Sixty-nine percent had a single procedure, 21% had two procedures, and the remaining 11% had more than two procedures during the study follow- up. The most frequent procedure was abdominal surgery for cholecystectomy or splenectomy (24% of all surgical procedures, N = 258). Of these, 93% received blood transfusion, and there was no association between preoperative hemoglobin A level and complication rates (except reduction in pain crisis). Overall mortality within 30 days of a surgical procedure was 1.1% (12 deaths after 1,079 surgical procedures). Three deaths were considered to be related to the surgical procedure and/or anesthesia (0.3%). No deaths were reported in patients younger than 14 years of age. Sickle cell diseases (SCD)-related complications after surgery were more frequent in SS patients who received regional compared with general anesthesia (adjusted for risk level of the surgical procedure, patient age, and preoperative transfusion status, P = .058). Non-SCD-related postoperative complications were higher in both SS and SC patients who received regional compared with those who received general anesthesia (P =.095). Perioperative transfusion was associated with a lower rate of SCD- related postoperative complications for SS patients undergoing low-risk procedures (P = .006, adjusted for age and type of anesthesia), with crude rated of 12.9% without transfusion compared with 4.8% with transfusion. In SC patients, preoperative transfusion was beneficial for all surgical risk levels (P = .009). Thus, surgical procedures can be performed safely in patients with SCD.     

CD34+ endothelial cell lines derived from murine yolk sac induce the proliferation and differentiation of yolk sac CD34+ hematopoietic progenitors

Embryonic hematopoiesis is initiated in part in the blood islands of the yolk sac. Previous confocal microscopic analysis has shown that the CD34 antigen, a mucin-like cell surface glycoprotein that is expressed by hematopoietic progenitors and all endothelial cells of the adult and embryo, is also found on a subset of luminal hematopoietic-like cells in the yolk sac blood islands as well as on the vascular endothelium lining these early hematopoietic locations. We show here that, as in all other hematopoietic sites thus far examined, immunoaffinity- purified CD34+ nonadherent cells from murine yolk sacs contain the vast majority of erythroid and myeloid progenitor cell colony forming activity. To examine the developmental interactions between these CD34+ hematopoietic progenitor cells of the yolk sac and the CD34+ yolk sac endothelium, we have immunaffinity-purified adherent endothelial cells from day 10.5 yolk sacs using CD34 antiserum and produced cell lines by transformation with a retrovirus expressing the polyoma middle T antigen. Analysis of these cell lines for CD34, von Willebrand's factor, FLK 1 and FLT 1 expression, and capillary growth in Matrigel indicates that they appear to be endothelial cells, consistent with their original phenotype in vivo. Coculture of yolk sac CD34+ hematopoietic cells on these endothelial cell lines results in up to a 60-fold increase in total hematopoietic cell number after approximately 8 days. Analysis of these expanded hematopoietic cells showed that the majority were of the monocyte/macrophage lineage. In addition, examination of the cultures showed the rapid formation of numerous cobblestone areas, a previously described morphologic entity thought to be representative of early pluripotential stem cells. Scrutiny of the ability of these endothelial cell lines to expand committed progenitor cells showed up to a sixfold increase in erythroid and myeloid colony- forming cells after 3 to 6 days in culture, consistent with the notion that these embryonic endothelial cells mediate the expansion of these precursor cells. Polymerase chain reaction analyses showed that most of the cell lines produce FLK-2/FLT-3 ligand, stem cell factor, macrophage colony-stimulating factor, leukemia-inhibitory factor, and interleukin- 6 (IL-6), whereas there is a generally low or not measurable production of granulocyte colony-stimulating factor, granulocyte-macrophage colony- stimulating factor, IL-1, IL-3, transforming growth factor beta-1, erythropoietin, or thrombopoietin. The output of mature hematopoietic cells from these cocultures can be modified to include an erythroid population by the addition of exogenous erythropoietin. These data suggest that endothelial cell lines derived form the yolk sac provide an appropriate hematopoietic environment for the expansion and differentiation of yolk sac progenitor cells into at least the myeloid and erythroid lineages.     

INNER EAR INVOLVEMENT IN MIXED CRYOGLOBULINAEMIA PATIENTS

In order to evaluate the nature and prevalence of audiovestibulardisturbances in mixed cryoglobulinaemia (MC), 32 consecutiveMC patients were studied by a wide audiological and vestibularexamination. Pure tone audiometry, impedance audiometry, brainstemresponse audiometry and vestibular function were performed.Patients with a previous history of ear damag due to other well-knownagents were excluded from the study. In MC patients we founda rather frequent audiovestibular involvement (34.3%). Bilateralsensorineural hearing loss was found in seven MC patients (22%)and altered vestibular function test values in other seven subjects(22%). Moreover, anamnestic and clinical data revealed a highincidence of benign positional paroxysmal vertigo in our MCseries. We can suppose that immune complex-mediated microvascularinvolvement of the labyrinthine vessels may be responsible forinner ear damage in MC. Thus, audiovestibular disturbances maybe included among various organ involvement of the MC. KEY WORDS: Mixed cryoglobulinaemia, Hepatitis C virus, Audiovestibular disturbances, Cupulolithiasis     

2007年青海省碘缺乏病高危地区育龄妇女尿碘调查

目的 调查青海省碘缺乏病高危地区育龄妇女尿碘水平,了解当地育龄妇女的碘营养状况.方法 2007年按照<卫生部办公厅关于开展我国碘缺乏病高危地区重点调查的通知>要求,确定青海省6个地区(州)17个县作为调查地区,采用二阶段整群抽样法结合<全国碘缺乏病监测方案(试行)>在每个被调查县选择3～5个乡,每个乡选择1或2个村,每个村选择30名18～40岁育龄妇女作为调查对象,并将其分为新婚妇女、孕妇、哺乳期妇女和其他育龄妇女4组.采集调查对象尿样,砷铈催化分光光度法检测尿碘.结果 共检测了1604份育龄妇女尿样,尿碘中位数为93.3 μg/L,低于100、50、20μg/L的比例分别占52.1%(836/1604)、31.8%(510/1604)和12.4%(199/1604);玉树州和海西州育龄妇女尿碘低于100μg/L的比例分别为70.5%(527/747)和43.0%(128/298);6个县育龄妇女尿碘低于100μg/L的比例>50%,其中囊谦县、杂多县和治多县低于100μg/L的比例分别为88.3%(91/103)、88.3%(91/103)、70.7%(118/167).4种类型中其他育龄妇女尿碘中位数为88.6μg/L,低于100μg/L的比例为53.9%(763/1415).结论 青海省碘缺乏病高危地区育龄妇女存在碘营养不足.