Objective: To ascertain the role of HIV-1 gp120 env PNGs variations and sequence length polymorphism following transmission events as possible supporting forensic evidence to determine directionality of HIV transmissi...Objective: To ascertain the role of HIV-1 gp120 env PNGs variations and sequence length polymorphism following transmission events as possible supporting forensic evidence to determine directionality of HIV transmission. Method: An observational study of HIV-1 infected family members, where median and range values of the amino acid lengths and PNGs for the genotyped C2V5 region were calculated. Wilcoxon rank-sum test was used to determine differences in these parameters between different family members. Results: For heterosexual transmission, two mothers had longer C3 sequences relative to that of their spouses;p=0.006 and=0.025 whilst the opposite was observed for one mother, p = 0.028. No clear trends were observed for PNGs. Index children had longer C2V5 amino acid sequences compared to their mothers p = 0.013, 0.040, 0.043 for families 205, 375, 567 respectively. Second siblings “V4 and V5 sequences were generally shorter relative to the maternal ones p = 0.039 and 0.028, respectively. Adults had longer V3 amino acid sequences compared to children;p = 0.018. Similar trends were also observed regarding PNGs within the entire C2V5 region, C3 and V4 sub-regions;p= 0.0025, 0.005 and 0.008, respectively. First siblings’ C2V5 and C3 sequence lengths were significantly longer relative to those of the second siblings;p = 0.005 and 0.007, respectively. Conclusion: Our results are suggestive that HIV-1 env C2V5 amino acid length polymorphism and PNGs tend to increase with age and HIV disease progression. Though sensitive and should be cautiously handled, it is tempting to propose the direc-tionality of the HIV transmission events with respect to C3 sequence length polymorphisms. Correlating HIV-1 env C2V5 amino acid length polymorphism and age of infection may be the first step towards a possible valuable piece of forensic evidence which may be useful in criminalisation of willful HIV infections. However, bigger studies are war-ranted to substantiate the authenticity of this potentially useful application.展开更多
BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum leve...BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum level of glycated hemoglobin A1C(HbA1c) in critically ill patients to evaluate the effects of hyperglycemia on the prognosis of the patients.METHODS:A total of 826 critically ill patients,who had been treated at the Department of Emergency Medicine of Chaoyang Hospital during October 2006 and November 2007,were divided into a diabetes mellitus group(n=184) and a non-diabetes mellitus group(642) according to whether they had diabetes mellitus.Fasting glucose and HbA1 c were measured in all patients.Those in the diabetes mellitus group were further assigned to a drug therapy subgroup and a non-drug therapy subgroup;the serum level of HbA1 c and its relationship with short-term outcome were evaluated.RESULTS:Fasting glucose increased in 78.8% of the patients(88.6%in the diabetes mellitus group,and 75.9%in the non-diabetes mellitus group,P<0.05),and HbA1 c was elevated in 45.5% of the patients(78.3% in the diabetes mellitus group,and 36.1%in the non-diabetes mellitus group,P<0.01).Fasting glucose,HbA1 c and 28-day mortality were improved more significantly(P<0.01) in the drug therapy subgroup than in the non-drug therapy subgroup.The 28-day mortality was more significantly different in patients with fasting blood glucose >8.33 mmol/L than in those with fasting blood glucose <8.33 mmol/L.CONCLUSIONS:Hyperglycemia of critically ill patients could not totally attribute to stress response,especially in those who have no history of diabetes mellitus.Prognosis of hyperglycemia may vary among critically ill patients.展开更多
AIM： To evaluate the utility of the hemoglobin A1C （HbA1C） at the frst prenatal visit as a triaging tool in patients at high risk for gestational diabetes （GDM）.METHODS： The HbA1C was obtained at the frst prenat...AIM： To evaluate the utility of the hemoglobin A1C （HbA1C） at the frst prenatal visit as a triaging tool in patients at high risk for gestational diabetes （GDM）.METHODS： The HbA1C was obtained at the frst prenatal visit prior to 20 wk. Women with a HbA1C ≥ 6.5% （group one） were instructed on diet and daily self-monitoring of blood glucose. Women with a HbA1C between 5.7%-6.4% （group two） were offered testing or daily self-monitoring of blood glucose. Women with a HbA1C 〈 5.7% （group three） were tested at 24-28 wk. Patients were tested for GDM using the two step testing and Carpenter and Coustan values as cutoffs. Medication was started if patients failed to meet glycemic goals of fasting ≤ 95 mg/dL （5.3 mmol/L） and 2 h postprandial ≤ 120 mg/dL （6.7 mmol/L）.RESULTS： In group one （n = 16）, 15/16 （95%） re-quired medication to achieve euglycemia. The mean gestational age at which medication was required was early at 14 ± 6 wk. Postpartum, 14/16 patients （87%） remained diabetic. Group two contained 82 patients. Sixty-sixpatients （80%） were given a diagnosis of GDM and 52 patients （64%） required medication. The mean gestational age at which medication was started in group two was 20 ± 7.8 wk. There were 205 patients in group three, 18 patients （8.7%） were diagnosed with GDM and 13 patients （6%） required medication. In comparison to group three, patients in group one were 220 times more likely to require medication （95%CI： 26.9- 〉 999, P 〈 0.0001）. Patients in group two were 26 times more likely to require medication （95%CI： 12.5-54.3, P 〈 0.0001）.展开更多
The benchmark for assessing quality of long-term glycemic control and adjustment of therapy is currently glycated hemoglobin(Hb A1c). Despite its importance as an indicator for the development of diabeticcomplications...The benchmark for assessing quality of long-term glycemic control and adjustment of therapy is currently glycated hemoglobin(Hb A1c). Despite its importance as an indicator for the development of diabeticcomplications, recent studies have revealed that this metric has some limitations; it conveys a rather complex message, which has to be taken into consideration for diabetes screening and treatment. On the basis of recent clinical trials, the relationship between Hb A1 c and cardiovascular outcomes in long-standing diabetes has been called into question. It becomes obvious that other surrogate and biomarkers are needed to better predict cardiovascular diabetes complications and assess efficiency of therapy. Glycated albumin, fructosamin, and 1,5-anhydroglucitol have received growing interest as alternative markers of glycemic control. In addition to measures of hyperglycemia, advanced glucose monitoring methods became available. An indispensible adjunct to Hb A1 c in routine diabetes care is selfmonitoring of blood glucose. This monitoring method is now widely used, as it provides immediate feedback to patients on short-term changes, involving fasting, preprandial, and postprandial glucose levels. Beyond the traditional metrics, glycemic variability has been identified as a predictor of hypoglycemia, and it might also be implicated in the pathogenesis of vascular diabetes complications. Assessment of glycemic variability is thus important, but exact quantification requires frequently sampled glucose measurements. In order to optimize diabetes treatment, there is a need for both key metrics of glycemic control on a day-to-day basis and for more advanced, user-friendly monitoring methods. In addition to traditional discontinuous glucose testing, continuous glucose sensing has become a useful tool to reveal insufficient glycemic management. This new technology is particularly effective in patients with complicated diabetes and provides the opportunity to characterize glucose dynamics. Several continuous glucose monitoring(CGM) systems, which have shown usefulness in clinical practice, are presently on the market. They can broadly be divided into systems providing retrospective or real-time information on glucose patterns. The widespread clinical application of CGM is still hampered by the lack of generallyaccepted measures for assessment of glucose profiles and standardized reporting of glucose data. In this article, we will discuss advantages and limitations of various metrics for glycemic control as well as possibilities for evaluation of glucose data with the special focus on glycemic variability and application of CGM to improve individual diabetes management.展开更多
There is currently no effective treatment for the Ebola virus(EBOV)thus far.Most drugs and vaccines developed to date have not yet been approved for human trials.Two FDA-approved c-AbI1 tyrosine kinase inhibitors Glee...There is currently no effective treatment for the Ebola virus(EBOV)thus far.Most drugs and vaccines developed to date have not yet been approved for human trials.Two FDA-approved c-AbI1 tyrosine kinase inhibitors Gleevec and Tasigna block the release of viral particles;however,their clinical dosages are much lower than the dosages required for effective EBOV suppression.Anα-1,2-glucosidase inhibitor Miglustat has been shown to inhibit EBOV particle assembly and secretion.Additionally,the estrogen receptor modulators Clomiphene and Toremifene prevent membrane fusion of EBOV and 50-90%of treated mice survived after Clomiphene/Toremifene treatments.However,the uptake efficiency of Clomiphene by oral administration is very low.Thus,I propose a hypothetical treatment protocol to treat Ebola virus infection with a cumulative use of both Miglustat and Toremifene to inhibit the virus effectively and synergistically.EBOV infection induces massive apoptosis of peripheral lymphocytes.Also,cytolysis of endothelial cells triggers disseminated intravascular coagulation(DIC)and subsequent multiple organ failures.Therefore,blood transfusions and active treatments with FDA-approved drugs to treat DIC are also recommended.展开更多
Objective： To investigate the effects of health education based on integrative therapy of Chinese and Western medicine for type 2 diabetes mellitus（T2DM） from the aspects of knowledge, attitude and practice（KAP）,...Objective： To investigate the effects of health education based on integrative therapy of Chinese and Western medicine for type 2 diabetes mellitus（T2DM） from the aspects of knowledge, attitude and practice（KAP）, health-related quality of life（HRQo L）, body mass index（BMI） and glucose control. Methods： Patients were individually randomized into intervention group（receiving integrative education, n=120） and control group（receiving usual education, n=120）. The primary outcome was the changes in glycosylated hemoglobin A1c（HbA1c） levels after 3, 6, 9 and 12 months from baseline. Hierarchical linear models（HLMs） were used to assess within-group changes in outcomes over time and between-group differences in patterns of change. Secondary outcomes were KAP scores, HRQo L scores and BMI after 6 and 12 months, paired-sample t test was used to assess within-group changes in outcomes in 6 and 12 months, independent-sample t test was used to assess between-group differences in patterns of change. Results： HbA1c decreased statistically from baseline to 3 months, from 3 to 6 months, from 6 to 9 months and from 9 to 12 months in the intervention group（all P〈0.01）; and decreased significantly from baseline to 3 months, and from 3 to 6 months in the control group（P〈0.01）. There were significant between-group differences from baseline to 3 months（P=0.044）, from 6 to 9 months（P〈0.01） and from 9 to 12 months（P〈0.01）. Significant improvements in the intervention group along with significant between-group differences were found in KAP and HRQo L scores respectively（all P〈0.05）. The number in the intervention group of normal weight increased from 56 at baseline to 81（6 months）, 94（12 months）, the number in the control group were 63（baseline）, 69（6 months）, 70（12 months）, the χ~2 of hierarchical analysis of BMI were 6.93（P=0.075）, 10.31（P=0.016）, 15.53（P〈0.01）, respectively. Conclusion： Health education based on integrative therapy of Chinese and Western medicine is beneficial to the control of T2DM and should be recommended for T2DM.展开更多
文摘Objective: To ascertain the role of HIV-1 gp120 env PNGs variations and sequence length polymorphism following transmission events as possible supporting forensic evidence to determine directionality of HIV transmission. Method: An observational study of HIV-1 infected family members, where median and range values of the amino acid lengths and PNGs for the genotyped C2V5 region were calculated. Wilcoxon rank-sum test was used to determine differences in these parameters between different family members. Results: For heterosexual transmission, two mothers had longer C3 sequences relative to that of their spouses;p=0.006 and=0.025 whilst the opposite was observed for one mother, p = 0.028. No clear trends were observed for PNGs. Index children had longer C2V5 amino acid sequences compared to their mothers p = 0.013, 0.040, 0.043 for families 205, 375, 567 respectively. Second siblings “V4 and V5 sequences were generally shorter relative to the maternal ones p = 0.039 and 0.028, respectively. Adults had longer V3 amino acid sequences compared to children;p = 0.018. Similar trends were also observed regarding PNGs within the entire C2V5 region, C3 and V4 sub-regions;p= 0.0025, 0.005 and 0.008, respectively. First siblings’ C2V5 and C3 sequence lengths were significantly longer relative to those of the second siblings;p = 0.005 and 0.007, respectively. Conclusion: Our results are suggestive that HIV-1 env C2V5 amino acid length polymorphism and PNGs tend to increase with age and HIV disease progression. Though sensitive and should be cautiously handled, it is tempting to propose the direc-tionality of the HIV transmission events with respect to C3 sequence length polymorphisms. Correlating HIV-1 env C2V5 amino acid length polymorphism and age of infection may be the first step towards a possible valuable piece of forensic evidence which may be useful in criminalisation of willful HIV infections. However, bigger studies are war-ranted to substantiate the authenticity of this potentially useful application.
文摘BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum level of glycated hemoglobin A1C(HbA1c) in critically ill patients to evaluate the effects of hyperglycemia on the prognosis of the patients.METHODS:A total of 826 critically ill patients,who had been treated at the Department of Emergency Medicine of Chaoyang Hospital during October 2006 and November 2007,were divided into a diabetes mellitus group(n=184) and a non-diabetes mellitus group(642) according to whether they had diabetes mellitus.Fasting glucose and HbA1 c were measured in all patients.Those in the diabetes mellitus group were further assigned to a drug therapy subgroup and a non-drug therapy subgroup;the serum level of HbA1 c and its relationship with short-term outcome were evaluated.RESULTS:Fasting glucose increased in 78.8% of the patients(88.6%in the diabetes mellitus group,and 75.9%in the non-diabetes mellitus group,P<0.05),and HbA1 c was elevated in 45.5% of the patients(78.3% in the diabetes mellitus group,and 36.1%in the non-diabetes mellitus group,P<0.01).Fasting glucose,HbA1 c and 28-day mortality were improved more significantly(P<0.01) in the drug therapy subgroup than in the non-drug therapy subgroup.The 28-day mortality was more significantly different in patients with fasting blood glucose >8.33 mmol/L than in those with fasting blood glucose <8.33 mmol/L.CONCLUSIONS:Hyperglycemia of critically ill patients could not totally attribute to stress response,especially in those who have no history of diabetes mellitus.Prognosis of hyperglycemia may vary among critically ill patients.
文摘AIM： To evaluate the utility of the hemoglobin A1C （HbA1C） at the frst prenatal visit as a triaging tool in patients at high risk for gestational diabetes （GDM）.METHODS： The HbA1C was obtained at the frst prenatal visit prior to 20 wk. Women with a HbA1C ≥ 6.5% （group one） were instructed on diet and daily self-monitoring of blood glucose. Women with a HbA1C between 5.7%-6.4% （group two） were offered testing or daily self-monitoring of blood glucose. Women with a HbA1C 〈 5.7% （group three） were tested at 24-28 wk. Patients were tested for GDM using the two step testing and Carpenter and Coustan values as cutoffs. Medication was started if patients failed to meet glycemic goals of fasting ≤ 95 mg/dL （5.3 mmol/L） and 2 h postprandial ≤ 120 mg/dL （6.7 mmol/L）.RESULTS： In group one （n = 16）, 15/16 （95%） re-quired medication to achieve euglycemia. The mean gestational age at which medication was required was early at 14 ± 6 wk. Postpartum, 14/16 patients （87%） remained diabetic. Group two contained 82 patients. Sixty-sixpatients （80%） were given a diagnosis of GDM and 52 patients （64%） required medication. The mean gestational age at which medication was started in group two was 20 ± 7.8 wk. There were 205 patients in group three, 18 patients （8.7%） were diagnosed with GDM and 13 patients （6%） required medication. In comparison to group three, patients in group one were 220 times more likely to require medication （95%CI： 26.9- 〉 999, P 〈 0.0001）. Patients in group two were 26 times more likely to require medication （95%CI： 12.5-54.3, P 〈 0.0001）.
文摘The benchmark for assessing quality of long-term glycemic control and adjustment of therapy is currently glycated hemoglobin(Hb A1c). Despite its importance as an indicator for the development of diabeticcomplications, recent studies have revealed that this metric has some limitations; it conveys a rather complex message, which has to be taken into consideration for diabetes screening and treatment. On the basis of recent clinical trials, the relationship between Hb A1 c and cardiovascular outcomes in long-standing diabetes has been called into question. It becomes obvious that other surrogate and biomarkers are needed to better predict cardiovascular diabetes complications and assess efficiency of therapy. Glycated albumin, fructosamin, and 1,5-anhydroglucitol have received growing interest as alternative markers of glycemic control. In addition to measures of hyperglycemia, advanced glucose monitoring methods became available. An indispensible adjunct to Hb A1 c in routine diabetes care is selfmonitoring of blood glucose. This monitoring method is now widely used, as it provides immediate feedback to patients on short-term changes, involving fasting, preprandial, and postprandial glucose levels. Beyond the traditional metrics, glycemic variability has been identified as a predictor of hypoglycemia, and it might also be implicated in the pathogenesis of vascular diabetes complications. Assessment of glycemic variability is thus important, but exact quantification requires frequently sampled glucose measurements. In order to optimize diabetes treatment, there is a need for both key metrics of glycemic control on a day-to-day basis and for more advanced, user-friendly monitoring methods. In addition to traditional discontinuous glucose testing, continuous glucose sensing has become a useful tool to reveal insufficient glycemic management. This new technology is particularly effective in patients with complicated diabetes and provides the opportunity to characterize glucose dynamics. Several continuous glucose monitoring(CGM) systems, which have shown usefulness in clinical practice, are presently on the market. They can broadly be divided into systems providing retrospective or real-time information on glucose patterns. The widespread clinical application of CGM is still hampered by the lack of generallyaccepted measures for assessment of glucose profiles and standardized reporting of glucose data. In this article, we will discuss advantages and limitations of various metrics for glycemic control as well as possibilities for evaluation of glucose data with the special focus on glycemic variability and application of CGM to improve individual diabetes management.
基金We thank LetPub for its linguistic assistance during the preparation of this manuscriptThis work was supported by the National Natural Science Foundation of China(31300207)+1 种基金the Preeminent Youth Fund of Sichuan Province(2015JQO045)the Support Program of Sichuan Agricultural University(03570305).
文摘There is currently no effective treatment for the Ebola virus(EBOV)thus far.Most drugs and vaccines developed to date have not yet been approved for human trials.Two FDA-approved c-AbI1 tyrosine kinase inhibitors Gleevec and Tasigna block the release of viral particles;however,their clinical dosages are much lower than the dosages required for effective EBOV suppression.Anα-1,2-glucosidase inhibitor Miglustat has been shown to inhibit EBOV particle assembly and secretion.Additionally,the estrogen receptor modulators Clomiphene and Toremifene prevent membrane fusion of EBOV and 50-90%of treated mice survived after Clomiphene/Toremifene treatments.However,the uptake efficiency of Clomiphene by oral administration is very low.Thus,I propose a hypothetical treatment protocol to treat Ebola virus infection with a cumulative use of both Miglustat and Toremifene to inhibit the virus effectively and synergistically.EBOV infection induces massive apoptosis of peripheral lymphocytes.Also,cytolysis of endothelial cells triggers disseminated intravascular coagulation(DIC)and subsequent multiple organ failures.Therefore,blood transfusions and active treatments with FDA-approved drugs to treat DIC are also recommended.
基金Supported by the National Natural Science Foundation of China(No.30873256)
文摘Objective： To investigate the effects of health education based on integrative therapy of Chinese and Western medicine for type 2 diabetes mellitus（T2DM） from the aspects of knowledge, attitude and practice（KAP）, health-related quality of life（HRQo L）, body mass index（BMI） and glucose control. Methods： Patients were individually randomized into intervention group（receiving integrative education, n=120） and control group（receiving usual education, n=120）. The primary outcome was the changes in glycosylated hemoglobin A1c（HbA1c） levels after 3, 6, 9 and 12 months from baseline. Hierarchical linear models（HLMs） were used to assess within-group changes in outcomes over time and between-group differences in patterns of change. Secondary outcomes were KAP scores, HRQo L scores and BMI after 6 and 12 months, paired-sample t test was used to assess within-group changes in outcomes in 6 and 12 months, independent-sample t test was used to assess between-group differences in patterns of change. Results： HbA1c decreased statistically from baseline to 3 months, from 3 to 6 months, from 6 to 9 months and from 9 to 12 months in the intervention group（all P〈0.01）; and decreased significantly from baseline to 3 months, and from 3 to 6 months in the control group（P〈0.01）. There were significant between-group differences from baseline to 3 months（P=0.044）, from 6 to 9 months（P〈0.01） and from 9 to 12 months（P〈0.01）. Significant improvements in the intervention group along with significant between-group differences were found in KAP and HRQo L scores respectively（all P〈0.05）. The number in the intervention group of normal weight increased from 56 at baseline to 81（6 months）, 94（12 months）, the number in the control group were 63（baseline）, 69（6 months）, 70（12 months）, the χ~2 of hierarchical analysis of BMI were 6.93（P=0.075）, 10.31（P=0.016）, 15.53（P〈0.01）, respectively. Conclusion： Health education based on integrative therapy of Chinese and Western medicine is beneficial to the control of T2DM and should be recommended for T2DM.
