2型糖尿病患者无症状心肌缺血缓解的研究

糖尿病患者无症状心肌缺血检测(DIAD)研究重点是评估2型糖尿病患者无症状心肌缺血的患病率和5年心血管事件的发生率.2型糖尿病是冠心病(CHD)发生发展的主要危险因素,本研究假设糖尿病患者无症状心肌缺血是随时间延长而进展的.     

Deferred modification of antiretroviral regimen following documented treatment failure in Asia: results from the TREAT Asia HIV Observational Database (TAHOD)

Objective The aim of the study was to examine the rates and predictors of treatment modification following combination antiretroviral therapy (cART) failure in Asian patients with HIV enrolled in the TREAT Asia HIV Observational Database (TAHOD).
Methods Treatment failure (immunological, virological and clinical) was defined by World Health Organization criteria. Countries were categorized as high or low income by World Bank criteria.
Results Among 2446 patients who initiated cART, 447 were documented to have developed treatment failure over 5697 person-years (7.8 per 100 person-years). A total of 253 patients changed at least one drug after failure (51.6 per 100 person-years). There was no difference between patients from high- and low-income countries [adjusted hazard ratio (HR) 1.02; P =0.891]. Advanced disease stage [Centers for Disease Control and Prevention (CDC) category C vs . A; adjusted HR 1.38, P =0.040], a lower CD4 count (≥51 cells/μL vs . ≤50 cells/μL; adjusted HR 0.61, P =0.022) and a higher HIV viral load (≥400 HIV-1 RNA copies/mL vs . <400 copies/mL; adjusted HR 2.69, P <0.001) were associated with a higher rate of treatment modification after failure. Compared with patients from low-income countries, patients from high-income countries were more likely to change two or more drugs (67% vs . 49%; P =0.009) and to change to a protease-inhibitor-containing regimen (48% vs . 16%; P <0.001).
Conclusions In a cohort of Asian patients with HIV infection, nearly half remained on the failing regimen in the first year following documented treatment failure. This deferred modification is likely to have negative implications for accumulation of drug resistance and response to second-line treatment. There is a need to scale up the availability of second-line regimens and virological monitoring in this region.     

Measures of site resourcing predict virologic suppression,immunologic response and HIV disease progression following highly active antiretroviral therapy (HAART) in the TREAT Asia HIV Observational Database (TAHOD)

Objectives

Surrogate markers of HIV disease progression are HIV RNA in plasma viral load (VL) and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource‐limited settings. Therefore, the objective was to assess effects of economic and diagnostic resourcing on patient treatment outcomes.

Methods

Analyses were based on 2333 patients initiating highly active antiretroviral therapy (HAART) from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of VL (≥3, 1–2 or <1) or CD4 (≥3 or <3) testing. Endpoints were time to AIDS/death and change in CD4 cell count and VL suppression (<400 HIV‐1 RNA copies/mL) at 12 months. Demographics, Centers for Disease Control and Prevention (CDC) classification, baseline VL/CD4 cell counts, hepatitis B/C coinfections and HAART regimen were covariates. Time to AIDS/death was analysed by proportional hazards models. CD4 and VL endpoints were analysed using linear and logistic regression, respectively.

Results

Increased disease progression was associated with site‐reported VL testing less than once per year [hazard ratio (HR)=1.4; P=0.032], severely symptomatic HIV infection (HR=1.4; P=0.003) and hepatitis C virus coinfection (HR=1.8; P=0.011). A total of 1120 patients (48.2%) had change in CD4 cell count data. Smaller increases were associated with older age (P<0.001) and ‘Other’ HIV source exposures, including injecting drug use and blood products (P=0.043). A total of 785 patients (33.7%) contributed to the VL suppression analyses. Patients from sites with VL testing less than once per year [odds ratio (OR)=0.30; P<0.001] and reporting ‘Other’ HIV exposures experienced reduced suppression (OR=0.28; P<0.001).

Conclusion

Low measures of site resourcing were associated with less favourable patient outcomes, including a 35% increase in disease progression in patients from sites with VL testing less than once per year.     

Dying from cancer or other chronic diseases in the Netherlands: ten-year trends derived from death certificate data

Background  

For the further development of palliative care, it is relevant to gain insight into trends in non-acute mortality. The aim of this article is twofold: (a) to provide insight into ten-year trends in the characteristics of patients who died from cancer or other chronic diseases in the Netherlands; (b) to show how national death statistics, derived from physicians' death certificates, can be used in this type of investigations.     

自闭症儿童语言初期训练的案例报告

目的:通过对1例自闭症儿童语言初期训练的案例分析,介绍初期训练的过程和效果。方法:运用观察法、分析法、游戏法、离散单元法、多重刺激强化的方法、多情景训练法对自闭症儿童进行能力训练、发音训练、口型训练和词的发音训练。结果:自闭症儿童在目光接触、听从指令、模仿能力和表达要求方面得到改善。结论:从现有能力入手,采取针对性的训练,进行全面综合性干预,对促进自闭症儿童的能力发展能取到较好效果。     

Role of PPAR alpha in the mechanism of action of the nongenotoxic carcinogen and peroxisome proliferator Wy-14,643

Chronic administration of peroxisome proliferators to mice and rats results in hepatomegaly and ultimately carcinogenesis. The mechanism underlying the carcinogenic effect of nongenotoxic peroxisome proliferators is not well understood. To determine whether nongenotoxic carcinogenesis is receptor mediated, we evaluated the effect of the prototypical peroxisome proliferator Wy-14,643 on replicative DNA synthesis and carcinogenesis in the PPAR alpha-null mouse line. Male mice (F4, Sv/129 ter) of both genotypes (+/+) and (-/-) were fed either a control diet or one containing 0.1% Wy-14,643 for either 1 week, 5 weeks, or 11 months. Wild-type mice fed the Wy-14,643 diet for 1 or 5 weeks showed increased hepatic labeling by bromodeoxyuridine (BrDU) compared to untreated controls. In contrast, there was no increase in hepatic BrDU labeling index in (-/-) mice fed the Wy-14,643 diet for the same time periods compared to controls. After 11 months, 100% of the (+/+) mice fed the Wy-14,643 diet had multiple hepatocellular neoplasms, including adenomas and carcinomas, while the (-/-) mice fed the Wy-14,643 diet were unaffected. This work demonstrates that the effects of Wy-14,643 on replicative DNA synthesis and hepatocarcinogenesis are mediated by PPAR alpha.