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Objective(s)To determine whether variation in cell-associated unspliced (CA-US) HIV RNA in HIV-infected individuals on antiretroviral therapy (ART) has a circadian basis.MethodsProspective observational study of HIV-infected individuals on ART. Blood was collected on three occasions and CA-US HIV RNA and mRNA of the circadian-locomotor-output-cycles-kaput (CLOCK)-associated genes quantified by real time PCR. CLOCK-associated proteins were over-expressed in a cell line stably transfected with an HIV long-terminal repeat (LTR) luciferase reporter.ResultsUsing a mixed effects model, there was a significant increase in log-CA-US RNA at the third visit compared with the first visit (effect size of 0.619 with standard error (SE) of 0.098, P

Objective: Gestational Diabetes Mellitus (GDM) increases the risk of type 2 diabetes. A register can be used to follow-up high risk women for early intervention to prevent progression to type 2 diabetes. We evaluate the performance of the world’s first national gestational diabetes register. Research design and methods: Observational study that used data linkage to merge: (1) pathology data from the Australian states of Victoria (VIC) and South Australia (SA); (2) birth records from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM, VIC) and the South Australian Perinatal Statistics Collection (SAPSC, SA); (3) GDM and type 2 diabetes register data from the National Gestational Diabetes Register (NGDR). All pregnancies registered on CCOPMM and SAPSC for 2012 and 2013 were included–other data back to 2008 were used to support the analyses. Rates of screening for GDM, rates of registration on the NGDR, and rates of follow-up laboratory screening for type 2 diabetes are reported. Results: Estimated GDM screening rates were 86% in SA and 97% in VIC. Rates of registration on the NGDR ranged from 73% in SA (2013) to 91% in VIC (2013). During the study period rates of screening at six weeks postpartum ranged from 43% in SA (2012) to 58% in VIC (2013). There was little evidence of recall letters resulting in screening 12 months follow-up. Conclusions: GDM Screening and NGDR registration was effective in Australia. Recall by mail-out to young mothers and their GP’s for type 2 diabetes follow-up testing proved ineffective. [ABSTRACT FROM AUTHOR]

The authors discuss changes in maternal physiology which cause changes in electrolyte and acid-base status of pregnant women and the factors to consider in adopting pregnancy-specific reference intervals. Topics discussed include the role of pregnancy reference intervals in clinical biochemistry, pregnancy dating and defining partitions, and vascular and renal physiology changes during pregnancy. It also discusses analytes such as sodium, potassium and chloride.

The concentration of prostate specific antigen in the blood can help in the assessment and management of early prostate cancer. However, it is important to understand the biology underlying the test. recent refinements have addressed some of the weaknesses of the test. These include age-related prostate specific antigen reference limits, the free to total prostate specific antigen ratio and prostate specific antigen rates of change including velocity or doubling time. Measuring prostate specific antigen without understanding the underlying biology or without applying these refinements may result in more harm than good. [ABSTRACT FROM AUTHOR]

Harmonisation of reference intervals for routine general chemistry analytes has been a goal for many years. Analytical bias may prevent this harmonisation. To determine if analytical bias is present when comparing methods, the use of commutable samples, or samples that have the same properties as the clinical samples routinely analysed, should be used as reference samples to eliminate the possibility of matrix effect. The use of commutable samples has improved the identification of unacceptable analytical performance in the Netherlands and Spain. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) has undertaken a pilot study using commutable samples in an attempt to determine not only country specific reference intervals but to make them comparable between countries. Australia and New Zealand, through the Australasian Association of Clinical Biochemists (AACB), have also undertaken an assessment of analytical bias using commutable samples and determined that of the 27 general chemistry analytes studied, 19 showed sufficiently small between method biases as to not prevent harmonisation of reference intervals. Application of evidence based approaches including the determination of analytical bias using commutable material is necessary when seeking to harmonise reference intervals.

Scientific evidence supports the use of common reference intervals (RIs) for many general chemistry analytes, in particular those with sound calibration and traceability in place. Already the Nordic countries and United Kingdom have largely achieved harmonised RIs. Following a series of workshops organised by the Australasian Association of Clinical Biochemists (AACB) between 2012 and 2014 at which an evidence-based approach for determination of common intervals was developed, pathology organisations in Australia and New Zealand have reached a scientific consensus on what adult and paediatric intervals we should use across Australasia. The aim of this report is to describe the processes that the AACB and the Royal College of Pathologists of Australasia have taken towards recommending the implementation of a first panel of common RIs for use in Australasia.

Obesity is essentially an excessive accumulation of triacylglycerols in fatty tissue that is the net result of excessive energy intake compared to energy usage. Severe forms of the disease are most likely to have a predominantly genetic basis and this is probably polygenic. The 'thrifty gene' hypothesis also describes the disturbance that a modern environment, including higher energy intake and decreased physical activity, has on otherwise advantageous genetic variations. While the physical consequences of obesity, such as arthritis, are debilitating and costly, the metabolic consequences are the drivers behind the modern epidemics of insulin resistance, diabetes, fatty liver disease, coronary artery disease, hypertension and polycystic ovary syndrome. The pathophysiological mechanisms behind these diseases are probably a combination of the toxic metabolic effects of free fatty acids and adipokines - the numerous messengers that adipose tissue has been discovered to produce.