Quality control assessment of human immunodeficiency virus type 2 (HIV-2) viral load quantification assays: results from an international collaboration on HIV-2 infection in 2006

Human immunodeficiency virus type 2 (HIV-2) RNA quantification assays used in nine laboratories of the ACHI(E)V(2E) (A Collaboration on HIV-2 Infection) study group were evaluated. In a blinded experimental design, laboratories quantified three series of aliquots of an HIV-2 subtype A strain, each at a different theoretical viral load. Quantification varied between laboratories, and international standardization of quantification assays is strongly needed.     

郑州市社区老年冠心病患者衰弱现状及影响因素分析

目的 了解郑州市社区老年冠心病患者衰弱现状及主要影响因素。方法 采用一般资料调查表、Tilburg衰弱量表等工具,对郑州市2个社区821例老年冠心病患者衰弱现状进行调查,采用多因素logistic回归分析筛查影响因素。结果 老年冠心病患者衰弱发生率为24.0%;logistic回归分析显示,年龄(60～69)岁(OR = 0.348, 95%CI: 0.159～0.764)、不服药(OR = 0.247, 95%CI:0.134～0.456)、认知正常(OR = 0.511,95%CI:0.283～0.923)、不抑郁(OR = 0.177,95%CI:0.096～0.327)、高握力(OR = 0.686,95%CI:0.634～0.742)、高BMI(OR = 0.830,95%CI:0.765～0.900)是社区老年冠心病患者衰弱的保护因素(P＜0.05),缺乏运动(OR = 3.392,95%CI: 1.948～5.904)、空腹血糖(OR = 2.293,95%CI:1.745～3.015)、心率(OR = 1.035,95%CI: 1.012～1.060)、甘油三酯(OR = 1.418, 95%CI:1.096～1.834)、低密度脂蛋白胆固醇(OR = 3.447,95%CI:2.268～5.238)是社区老年冠心病患者衰弱的危险因素(P＜0.05)。结论 郑州市社区老年冠心病患者衰弱发生率高,并且受多种可控因素的影响,应予以重视。     

Performance of HbA1c as an Early Diagnostic Indicator of Type 1 Diabetes in Children and Youth

OBJECTIVE The aim of this study was to evaluate HbA(1c) as an alternative criterion for impaired glucose tolerance (IGT) or type 1 diabetes (T1D) in high-risk subjects <21 years of age. RESEARCH DESIGN AND METHODS Subjects <21 years of age who participated in the prospective DPT-1, TEDDY, TRIGR, and Type 1 Diabetes TrialNet Natural History (TrialNet) studies and had an HbA(1c) within 90 days of an OGTT with a 2-h plasma glucose (2-hPG) measure were included. An OGTT of 140-199 mg/dL defined IGT, and an OGTT with 2-hPG ≥200 mg/dL or fasting plasma glucose ≥126 mg/dL defined diabetes. HbA(1c) ≥5.7% defined IGT, and HbA(1c) ≥ 6.5% defined diabetes. Receiver-operating characteristic curve analysis was used to assess diagnostic accuracy of HbA(1c) compared with OGTT. RESULTS There were 587 subjects from DPT-1, 884 from TrialNet, 91 from TEDDY, and 420 from TRIGR. As an indicator for IGT, HbA(1c) sensitivity was very low across the studies (8-42%), and specificity was variable (64-95%). With HbA(1c) ≥6.5% threshold used for T1D diagnosis, the sensitivity was very low and specificity was high (sensitivity and specificity: DPT-1 24 and 98%, TrialNet 28 and 99%, TEDDY 34 and 98%, and TRIGR 33 and 99%, respectively). The positive predictive value of HbA(1c) ≥6.5% for the development of T1D was variable (50-94%) across the four studies. CONCLUSIONS HbA(1c) ≥6.5% is a specific but not sensitive early indicator for T1D in high-risk subjects <21 years of age diagnosed by OGTT or asymptomatic hyperglycemia. Redefining the HbA(1c) threshold is recommended if used as an alternative criterion in diagnosing T1D.     

The application of the diabetes prevention trial-type 1 risk score for identifying a preclinical state of type 1 diabetes

OBJECTIVE

We assessed the utility of the Diabetes Prevention Trial–Type 1 Risk Score (DPTRS) for identifying individuals who are highly likely to progress to type 1 diabetes (T1D) within 2 years.

RESEARCH DESIGN AND METHODS

The DPTRS was previously developed from Diabetes Prevention Trial–Type 1 (DPT-1) data and was subsequently validated in the TrialNet Natural History Study (TNNHS). DPTRS components included C-peptide and glucose indexes from oral glucose tolerance testing, along with age and BMI. The cumulative incidence of T1D was determined after DPTRS thresholds were first exceeded and after the first occurrences of glucose abnormalities.

RESULTS

The 2-year risks after the 9.00 DPTRS threshold was exceeded were 0.88 and 0.77 in DPT-1 (n = 90) and the TNNHS (n = 69), respectively. In DPT-1, the 2-year risks were much lower after dysglycemia first occurred (0.37; n = 306) and after a 2-h glucose value between 190 and 199 mg/dL was first reached (0.64; n = 59). Among those who developed T1D in DPT-1, the 9.00 threshold was exceeded 0.81 ± 0.53 years prior to the conventional diagnosis. Postchallenge C-peptide levels were substantially higher (P = 0.001 for 30 min; P < 0.001 for other time points) when the 9.00 threshold was first exceeded compared with the levels at diagnosis.

CONCLUSIONS

A DPTRS threshold of 9.00 identifies individuals who are very highly likely to progress to the conventional diagnosis of T1D within 2 years and, thus, are essentially in a preclinical diabetic state. The 9.00 threshold is exceeded well before diagnosis, when stimulated C-peptide levels are substantially higher.Current diagnostic glucose thresholds for clinical type 1 diabetes (T1D) are based on the levels at which diabetes complications begin to occur; moreover, they are the same for type 2 diabetes (1). Yet it is known that the pathogenetic development of T1D begins well before those thresholds are reached. Pancreatic autoantibodies are commonly present a number of years before diagnosis (2–4). In addition, glucose, insulin, and C-peptide abnormalities are commonly present years before diagnosis (5–8). However, as yet, there has not been a means to identify individuals who will almost certainly be diagnosed within a few years.A risk score (DPTRS) for T1D has been developed from Diabetes Prevention Trial–Type 1 (DPT-1) participants, all islet cell autoantibody positive, which utilizes oral glucose tolerance test (OGTT) glucose and C-peptide values, age, and BMI (9). The DPTRS was subsequently validated in the TrialNet Natural History Study (TNNHS), a separate cohort of biochemical autoantibody-positive individuals (10).The strong prediction accuracy of the DPTRS suggested the possibility that it could be used to detect a preclinical state prior to the diagnosis of T1D. Thus, in both the DPT-1 and TNNHS cohorts, we have sought to detect a DPTRS threshold that might identify individuals at a sufficiently high 2-year risk for T1D to warrant the characterization of their being in a preclinical state. In addition, we have assessed the metabolic status of those individuals when such a threshold was exceeded.     

温阳益气解毒法联合核苷类似物治疗慢性乙型肝炎的研究述评

目的:探讨温阳益气解毒法联合核苷类似物治疗慢性乙型肝炎的应用情况.方法:对近10年来有关温阳益气解毒法联合核苷类似物治疗慢性乙型肝炎的应用的文献资料进行整理、分析、归纳.结果:核苷类似物通过直接抑制病毒复制,改善肝组织病变,延缓乙型肝炎病情进展,是目前临床上治疗慢性乙型肝炎的重要抗病毒药物.但核苷类似物之容易发生病毒变...     

对老年护理职业教育多元化的思考

随着人口老龄化的快速进展和高龄老人对护理需求的不同,养老服务日益差异化、多样化,服务岗位和从业人员包括老年人自身、子女、保姆、护工、老年护理员、社区护士、注册护士和社区卫生服务机构和养老机构的管理人员.差异化养老对老年护理教育提出了严重的挑战,应对的主要措施应该是多元化的职业教育,包括全民的健康教育、养老机构护工的职业教育、临床护士的转岗培训和高校老年护理专业及课程设置,既要培养全民的养老、防老意识,又要造就一支强大的有老年护理专业技能的养老队伍,同时要加速高级老年护理与管理人员的培养.