Evaluation of the Characteristics of the Enzyme-Linked Immunospot Assay for Diagnosis of Active Tuberculosis in China

The purpose of this study was to evaluate the characteristics of the T-SPOT.TB test for the diagnosis of active tuberculosis (ATB) and to distinguish ATB from other diseases using a receiver operating characteristic (ROC) curve. A total of 535 patients with suspected active tuberculosis were enrolled in the study and divided into ATB and nonactive tuberculosis (NATB) groups, as well as pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) subgroups. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of the T-SPOT.TB test for the diagnosis of ATB were 84.95%, 85.12%, 82.94%, 86.93%, 5.71, and 0.18, respectively. The median number of spot-forming cells (SFCs) in the ATB group was higher than that in the NATB group (71 versus 1; P < 0.0001). The sensitivities in the PTB and EPTB subgroups were 92.31% and 81.77%. The areas under the curve (AUC) for the diagnosis of ATB using the T-SPOT.TB, early secreted antigenic target 6 (ESAT-6), and culture filtrate protein 10 (CFP-10) were 0.906, 0.884, and 0.877, respectively. A cutoff of 42.5 SFCs for ATB yielded a positive predictive value of 100%. Our study shows that the T-SPOT.TB test is useful for the diagnosis of ATB. Utilizing an ROC curve to select an appropriate cutoff made it possible to discriminate ATB from NATB.     

A Study of Patient Experience Using a Blood Glucose Meter With an In-Built Insulin Dose Calculator

Background:Accurate calculation and adjustment of insulin doses is integral to maintaining glycemic control in insulin treated patients. Difficulties with insulin dose calculations may lead to poor adherence to blood glucose monitoring and insulin treatment regimes, resulting in poor metabolic control. The main objective of this study was to evaluate ease of use and user preference of a high specification touch screen blood glucose meter, which has an in-built insulin calculator, compared to patients’ usual method of testing blood glucose and deciding insulin doses.Methods:Patients with diabetes on a multiple daily injection insulin regime used the Test Meter without the insulin calculator and 1 of 3 comparator meters, each for a 7-day period. They then used the Test Meter with the in-built calculator for 10 days. Patients completed an ease of use questionnaire after each 7-day period, a preference questionnaire after the second 7-day period, and a questionnaire comparing the Test Meter with their usual method after the final 10-day period.Results:Of 164 patients who completed the study, 76% stated a preference for the Test Meter as a diabetes management tool compared to their usual method. A small number of patients preferred familiar methods and/or calculating insulin doses themselves. The log book function of meters was important to most patients.Conclusions:The Test Meter system with in-built insulin calculator supports people to better manage their diabetes and increases their confidence. Patients have different needs and preferences which should be acknowledged and supported in a patient centered health service.     

Endobronchial ultrasound-guided transbronchial biopsy of peripheral pulmonary lesions: how many specimens are necessary?

Background: Although endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) has been shown to increase the diagnostic yield over conventional bronchoscopic techniques, an important issue regarding the optimal number of biopsy specimens required has not been thoroughly investigated. Objectives: We sought to examine whether the number of biopsy specimens taken was associated with the diagnostic yield of EBUS-guided TBB and, if this was the case, to determine the optimal number of specimens required for the maximum diagnostic yield in peripheral pulmonary lesions. Methods: The medical records of patients undergoing EBUS-guided TBB for the diagnosis of peripheral pulmonary lesions from 2008 to 2010 were retrospectively reviewed. The association of clinical and radiological features, including the number of biopsy specimens, with the diagnostic yield was analysed. Results: A total of 384 patients were included for analysis. The overall diagnostic yield of EBUS-guided TBB was 73%, and the only factor influencing the diagnostic yield was the position of the probe. Patients in which the EBUS probe was placed within the lesions had a significantly higher yield (85%) than those in which the probe was adjacent to or outside the lesions (38%; p < 0.001). When the number of biopsy specimens was determined based on their adequacy, it was an insignificant factor in predicting the diagnostic yield. Conclusions: Probe position independently predicts the diagnostic yield of EBUS-guided TBB. In real-world practice, the optimal number of biopsy specimens should be decided on a case-by-case basis.     

同型半胱氨酸和神经元特异性烯醇化酶在急性脑梗死患者中的检测意义

目的探讨同型半胱氨酸(Hcy)和神经元特异性烯醇化酶(NSE)在急性脑梗死(ACI)患者中的检测意义。方法选择我院急性脑梗死患者100例作为观察组,同期健康体检者100例作为对照组。检测观察组患者入院第2天和治疗14d后血清同型半胱氨酸水平和血清神经元特异性烯醇化酶水平,并与健康对照者进行比较。结果观察组治疗前同型半胱氨酸水平和神经元特异性烯醇化酶水平均高于对照组,差异有统计学意义(P<0.01);观察组治疗后同型半胱氨酸水平和神经元特异性烯醇化酶水平均低于治疗前,差异有统计学意义(P<0.01)。结论对急性脑梗死患者进行同型半胱氨酸与神经元特异性烯醇化酶监测有助于了解脑梗死病情严重程度和预后,具有一定的临床检测意义。     

γ-Aminobutyric Acid Regulates Both the Survival and Replication of Human β-Cells

γ-Aminobutyric acid (GABA) has been shown to inhibit apoptosis of rodent β-cells in vitro. In this study, we show that activation of GABA_A receptors (GABA_A-Rs) or GABA_B-Rs significantly inhibits oxidative stress–related β-cell apoptosis and preserves pancreatic β-cells in streptozotocin-rendered hyperglycemic mice. Moreover, treatment with GABA, or a GABA_A-R– or GABA_B-R–specific agonist, inhibited human β-cell apoptosis following islet transplantation into NOD/scid mice. Accordingly, activation of GABA_A-Rs and/or GABA_B-Rs may be a useful adjunct therapy for human islet transplantation. GABA-R agonists also promoted β-cell replication in hyperglycemic mice. While a number of agents can promote rodent β-cell replication, most fail to provide similar activities with human β-cells. In this study, we show that GABA administration promotes β-cell replication and functional recovery in human islets following implantation into NOD/scid mice. Human β-cell replication was induced by both GABA_A-R and GABA_B-R activation. Hence, GABA regulates both the survival and replication of human β-cells. These actions, together with the anti-inflammatory properties of GABA, suggest that modulation of peripheral GABA-Rs may represent a promising new therapeutic strategy for improving β-cell survival following human islet transplantation and increasing β-cells in patients with diabetes.A central focus of research in the type 1 diabetes (T1D) field is to develop ways to safely improve β-cell survival and function and promote their replication. The addition of γ-aminobutyric acid (GABA) or the GABA_B receptor (GABA_B-R)–specific agonist baclofen to culture media has been shown to inhibit β-cell apoptosis in cultured rodent cell lines and islets (1,2). It remains to be determined whether GABA treatment can inhibit mouse β-cell apoptosis in vivo or, more importantly, whether it can protect human β-cells from stress-induced apoptosis. If GABA can inhibit human β-cell apoptosis, elucidating whether this effect is mediated through the G-protein–coupled GABA_B-Rs, and/or the chloride channel GABA_A-Rs will enable more specific drug targeting.GABA can promote neurogenesis and neuronal proliferation and is a neuronal survival factor (3–8). GABA has also been shown to promote rodent β-cell replication (1,2). Those studies, however, differentially pointed to GABA_A-Rs or GABA_B-Rs as modulators of GABA’s effects, making it important to clarify whether one or both types of GABA receptors modulate rodent β-cell replication. While a number of mitogens and growth factors can promote rodent β-cell replication, most fail to promote human β-cell replication (reviewed in refs. 9,10). Therefore, a key question is whether GABA can promote human β-cell replication. Even a small amount of GABA-induced human β-cell replication may be clinically useful by lowering insulin requirements and reducing the risk for long-term complications in T1D patients (11).