Search

Aim: We aimed to evaluate the clinical utility of blood ketone measurement and to test the performance of the diagnostic criteria for diabetic ketoacidosis (DKA) issued by the American Diabetes Association, the Joint British Diabetes Societies, and the American Association of Clinical Endocrinologists and the American College of Endocrinology. Methods: This retrospective analysis included 278 patients with suspected DKA who were hospitalized at 4 university hospitals and aged ≥16 years with a blood glucose level of >200 mg/dL and a blood ketone level of ≥1.0 mmol/L as well as other biochemical data. The patients were categorized into four subgroups (ketosis, typical DKA, atypical DKA, and DKA + lactic acidosis). Atypical DKA in each analysis was defined by our supplementary criteria if the biochemical data did not meet each set of diagnostic criteria from the aforementioned societies. Results: Blood ketone levels in patients with diabetic ketosis and those with DKA varied widely, 1.05–5.13 mmol/L and 1.02–15.9 mmol/L, respectively. Additionally, there were significant discrepancies between the guidelines in the diagnosis of DKA. Thus, the proportion of patients with atypical DKA ranged from 16.5% to 42.4%. Notably, the in-hospital mortality was comparable between patients with typical and atypical DKA, with a very high mortality in patients with DKA + lactic acidosis (blood lactate >5 mmol/L). Conclusions: Our results showed that considering variable presentations of DKA, blood ketone data need to be interpreted cautiously along with other biochemical data and suggested that a new system is required to better characterize DKA. [ABSTRACT FROM AUTHOR]

Abstract: Background & Aims: Several risk prediction models for hepatocellular carcinoma (HCC) development are available. We explored whether the use of risk prediction models can dynamically predict HCC development at different time points in chronic hepatitis B (CHB) patients. Methods: Between 2006 and 2014, 1397 CHB patients were recruited. All patients underwent serial transient elastography at intervals of >6 months. Results: The median age of this study population (931 males and 466 females) was 49.0 years. The median CU‐HCC, REACH‐B, LSM‐HCC and mREACH‐B score at enrolment were 4.0, 9.0, 10.0 and 8.0 respectively. During the follow‐up period (median, 68.0 months), 87 (6.2%) patients developed HCC. All risk prediction models were successful in predicting HCC development at both the first liver stiffness (LS) measurement (hazard ratio [HR] = 1.067‐1.467 in the subgroup without antiviral therapy [AVT] and 1.096‐1.458 in the subgroup with AVT) and second LS measurement (HR = 1.125‐1.448 in the subgroup without AVT and 1.087‐1.249 in the subgroup with AVT). In contrast, neither the absolute nor percentage change in the scores from the risk prediction models predicted HCC development (all P > .05). The mREACH‐B score performed similarly or significantly better than did the other scores (AUROCs at 5 years, 0.694‐0.862 vs 0.537‐0.875). Conclusions: Dynamic prediction of HCC development at different time points was achieved using four risk prediction models, but not using the changes in the absolute and percentage values between two time points. The mREACH‐B score was the most appropriate prediction model of HCC development among four prediction models. [ABSTRACT FROM AUTHOR]

Background: We evaluated the diagnostic usefulness of polymerase chain reaction (PCR) analysis for detecting varicella-zoster virus (VZV) infection and reactivation of VZV, using DNA extracted from saliva and plasma specimens obtained from subjects with suspected herpes zoster and from healthy volunteers during stressful and nonstressful conditions.Methods: There were 52 patients with a diagnosis of herpes zoster (group 1), 30 with a diagnosis of zoster-mimicking disease (group 2), and 27 healthy volunteers (group 3). Saliva and plasma samples were evaluated for VZV DNA by real-time PCR analysis.Results: Among patients with suspected herpes zoster (ie, patients in groups 1 and 2), the sensitivity of PCR analysis of salivary DNA for detecting VZV (88%; 95% confidence interval [CI], 74%-95%) was significantly higher than that of PCR analysis of plasma DNA (28%; 95% CI, 16%-44%; P < .001), whereas the specificity of PCR analysis of salivary DNA (100%; 95% CI, 88%-100%) was similar to that of PCR analysis of plasma DNA (100%; 95% CI, 78%-100%; P > .99). VZV DNA was not detected in saliva and plasma samples from group 3 (0%; 95% CI, 0%-14%).Conclusions: Real-time PCR analysis of salivary DNA is more sensitive than that of plasma DNA for detecting VZV among patients with suspected herpes zoster. We found no subclinical reactivation of VZV in group 3 following exposure to common stressful conditions. [ABSTRACT FROM AUTHOR]

Rapid, accurate detection of Mycobacterium tuberculosis is crucial in the diagnosis of tuberculosis (TB), but conventional diagnostic methods have limited sensitivity and specificity or are time consuming. A new highly sensitive nucleic acid amplification test, combined nested and real-time polymerase chain reaction (PCR) in a single tube (one-tube nested real-time PCR), was developed for detecting M . tuberculosis , which takes advantage of two PCR techniques, i.e., nested PCR and real-time PCR. One-tube nested real-time PCR was designed to have two sequential reactions with two sets of primers and dual probes for the insertion sequence (IS) 6110 sequence of M . tuberculosis in a single closed tube. The minimum limits of detection of IS 6110 real-time PCR and IS 6110 one-tube nested real-time PCR were 100 fg/μL and 1 fg/μL of M . tuberculosis DNA, respectively. AdvanSure TB/non-tuberculous mycobacteria (NTM) real-time PCR, IS 6110 real-time PCR, and two-tube nested real-time PCR showed 100% sensitivity and 100% specificity for clinical M . tuberculosis isolates and NTM isolates. In comparison, the sensitivities of AdvanSure TB/NTM real-time PCR, single IS 6110 real-time PCR, and one-tube nested real-time PCR were 91% (152/167), 94.6% (158/167), and 100% (167/167) for sputum specimens, respectively. In conclusion, IS 6110 one-tube nested real-time PCR is useful for detecting M . tuberculosis due to its high sensitivity and simple manipulation. [ABSTRACT FROM AUTHOR]

Abstract: We have investigated the clinical utility of antichromatin antibodies for the diagnosis of SLE and as a marker of disease activity in Korean SLE patients. Blood samples were collected from SLE patients, lupus syndrome patients having only two or three of ACR classification criteria for SLE and normal controls. The level of antichromatin antibody was measured by enzyme linked immunosorbent assay and expressed as arbitrary unit. The antichromatin antibody levels of the SLE and lupus syndrome patients were higher than NC. The antichromatin antibody levels were significant higher in SLE patients with arthritis. A significant correlation was found between the level of antichromatin antibodies and each of anti-dsDNA antibody, leukopenia, complement and SLEDAI. The change of antichromatin antibody levels showed a positive correlation with the change of SLEDAI in serial samples. These data suggest that the antichromatin antibodies appear to be a useful laboratory test that can help in the diagnosis and assessment of SLE. [Copyright &y& Elsevier]