Influence of the glycation gap on the diagnosis of type 2 diabetes.

AIMS: The results of using HbA1C-based criteria for diagnosis of type 2 diabetes and prediabetes have been reported to differ from those obtained using fasting plasma glucose (FPG) or an oral glucose tolerance test (OGTT). We aimed to determine whether these discrepancies might be due to the influence of the glycation gap. METHODS: For 430 patients without previously diagnosed diabetes for whom an OGTT had been requested in normal clinical practice, FPG, fructosamine and HbA1C were measured at the time of the test and again 1 month later. Glycaemia/diabetes status was classified as normoglycaemia, prediabetes or diabetes using both HbA1C-based and FPG/OGTT-based criteria, and their glycation gaps GG were calculated. RESULTS: The specificity of an HbA1C level of 6.5 % (48 mmol/mol) for diagnosis of FPG/OGTT-defined type 2 diabetes was 99 %, but its sensitivity was less than 37 %. HbA1C-diabetic patients had higher average blood glucose levels than FPG/OGTT-diabetic patients. With either set of criteria, high-GG patients were disproportionately numerous among those classified as diabetic and were disproportionately infrequent among those classified as normoglycaemic, but the effect was greater for the HbA1C criteria. CONCLUSIONS: The differences between HbA1C-based and FPG/OGTT-based diagnoses are largely due to the influence of the glycation gap, which may also influence the early stages of FPG/OGTT-defined diabetes.

Concordance among pathologists in the second Cardiac Allograft Rejection Gene Expression Observational Study (CARGO II).

BACKGROUND: There has been no large evaluation of the ISHLT 2004 acute cellular rejection grading scheme for heart graft endomyocardial biopsy specimens (EMBs). METHODS: We evaluated agreement within the CARGO II pathology panel and between the panel (acting by majority) and the collaborating centers (treated as a single entity), regarding the ISHLT grades of 937 EMBs (with all grades ≥2R merged because of small numbers). RESULTS: Overall all-grade agreement was almost 71% both within the panel and between the panel and the collaborating centers but, in both cases, was largely because of agreement on grade 0: for the average pair of pathologists, fewer than a third of the EMBs assigned grade ≥2R by at least one were assigned this grade by both. CONCLUSION: The 2004 revision has done little to improve agreement on the higher ISHLT grades. An EMB grade ≥2R is not by itself sufficient as a basis for clinical decisions or as a research criterion. Steps should be taken toward greater uniformity in EMB grading, and efforts should be made to replace the ISHLT classification with diagnostic criteria--EMB based or otherwise--that correspond better with the pathophysiology of the transplanted heart.

The influence of sampling site and assay method on lactate concentration in response to rock climbing.

The sport of rock climbing has increased in popularity and as a focus for research. Previous studies have examined the physiological determinants for successful performance. Variation is evident between studies over lactate sampling sites and assay methods. The aim of this study was to examine the limits of agreement between the YSI 2300 analyser and the Lactate Pro for finger and ear capillary blood samples in a climbing context. Forty-five (31 males and 14 females) participants volunteered to complete the climbing trial. Blood samples were collected simultaneously from finger and ear pre, post and 5 min post climb. The repeatability results indicated a good agreement across samples. Modelling analysis indicated the use of a -0.175 mmol l(-1) adjustment to move from Lactate Pro to YSI finger concentrations. To move from finger to ear concentrations, using the Lactate Pro, modelling analysis suggested a regression equation of Y = 0.827x + 0.769 adjustment for pre climb samples and Y = 0.955x + 0.566 for post climb concentrations. To better understand the physiological demands of climbing further research on natural rock is required. Results from this study suggest the Lactate Pro and blood sampling from the ear lobe could be of benefit to future rock climbing field studies.

Effects of Active Recovery on Lactate Concentration, Heart Rate and RPE in Climbing.

The performance advantage of active rather than passive recovery during subsequent trials for repeated high intensity short-term exercise is well documented. Research findings suggest that shorter periods of active recovery, than traditionally employed, can be prescribed and still retain performance benefits over passive recoveries in successive exercise trials. The aim of this study was to examine the benefits of a short duration active recovery for repeat climbing trials. Ten recreational climbers volunteered for the study. In this randomly assigned crossover study each climber completed five two-minute climbing trails before a two minute active or passive recovery. This was followed by a one and a half minute passive refocusing period for all climbers before the subsequent climbing trial. Heart rate was monitored continuously, RPE immediately post climbing and fingertip capillary blood samples collected during each refocusing phase. There was a non-significant difference between active and passive recoveries for heart rate during climbing. After the active phase climbers had higher heart rates than when following the passive recovery protocol, however, by the end of the refocusing phase the active recovery protocol led to lower heart rates than for the entirely passive recovery. There was a significant difference between active and passive recovery conditions in lactate concentration (F(1,9) = 18.79, p = 0.002) and RPE (F(1,9) = 6.51, p = 0.031). Lactate concentration and RPE were lower across all five climbing trials for the active recovery protocol. After active recovery climbers started the next trial with a lower arterial lactate concentration than for a passive recovery and indicated lower RPE scores at the end of each climb. The refocusing period following active recovery allowed climbers heart rates to return to a lower level at the start of the next climb than for the passive recovery condition. Key PointsThe three and half minute recovery strategy employed in this study did not allow sufficient time for complete recovery for either the active or passive conditions.The active condition appeared to allow for a more complete recovery after each climbing trial than did the passive recovery.Lactate concentrations and RPE were lower for the active recovery.The use of larger and or alternative muscle groups in the active recovery may benefit lactate clearance.The use of a refocusing passive phase at the end of the active recovery may provide a useful and more ecologically valid mechanism for recovery in an applied sporting context.