基于SAT技术分析不同年龄段儿童肺炎支原体感染的临床分析

目的基于RNA实时荧光恒温扩增技术(SAT)分析不同年龄段儿童肺炎支原体(MP)感染的临床特征。 方法回顾性分析我院2018年5月至2019年7月经SAT诊断为MP感染的285例社区获得性肺炎(CAP)患儿的临床资料,并根据年龄将其分为婴幼儿组(≤3岁)、学龄前组(>3～6岁)和学龄组(>6岁)。比较不同年龄组儿童临床症状、肺部体征、实验室指标、胸部X线表现及肺外并发症等方面的差异。 结果三组患儿临床表现比较差异有统计学意义(P<0.05)。婴幼儿组喘息症状相对明显,平均热程短,肺外表现以消化系统症状为主;学龄组发热多见,平均热程较婴幼儿组长,肺外并发症多见,以血液及心血管系统损害为主;学龄前组患儿临床表现介于两者之间。三组在咳嗽症状及肺部体征上差异无统计学意义(P>0.05);MP感染患儿胸部X线表现多种多样,婴幼儿组及学龄前组小叶实质浸润及间质浸润明显多于学龄组;学龄组肺段实质浸润明显多于婴幼儿组及学龄前组(P<0.01);婴幼儿组LDH水平高于学龄组,学龄组CRP水平高于婴幼儿组(P<0.01),学龄前组介于两者之间。 结论不同年龄段儿童MP感染在临床症状、肺部体征、实验室指标、胸部X线表现及肺外并发症等方面存在一定差异,临床工作中应该予以重视。     

不同年龄段儿童肺炎支原体感染临床特点观察

目的分析不同年龄段肺炎支原体感染患儿的临床特点,并总结合理有效的治疗方案。方法回顾性分析诊断为肺炎支原体感染的110例患儿的临床资料,收集记录每例患儿的年龄、性别、发病季节、临床表现(发热、咳嗽、喘息)、除呼吸系统外其他系统受累情况、住院时间等,并根据年龄将其分为三组(婴幼儿组、学龄前组、学龄期组),对其行相关统计学分析。结果 110例患儿中,男79例(71.8%),女41例(37.2%),不同季节MP感染例数分别为:春20例(18.2%),夏18例(16.4%),秋32例(29.1%),冬40例(36.4%);0-3岁(婴幼儿组)25例:男17例,女8例,平均年龄:(1.5±0.5)岁,发热10例,咳嗽7例,喘息8例,肺部啰音23例,其他系统损害19例(消化系统损害3例,心血管系统损害10例,泌尿系损害3例,神经系统损害2例,皮肤损害1例),平均住院天数(5.6±1.2)天;4-6岁(学龄前组)27例:男18例,女9例,平均年龄:(5.1±0.3)岁,发热15例,咳嗽22例,喘息15例,肺部啰音10例,其他系统损害10例(消化系统损害3例,心血管系统损害1例,皮疹1例,泌尿系损害,3例,神经系统损害1例,浆膜腔积液1例),平均住院天数(4.7±2.3)天;7-14岁(学龄期组)58例:男34例,女24例,平均年龄(11±0.6)岁,发热40例,咳嗽50例,喘息42例,肺部啰音18例,其他系统损害10例(消化系统损害5例,泌尿系损害3例,神经系统损害2例,平均住院天数(4.9±3.1)天;分析三组数据:冬季及学龄期组MP感染占总例数百分比最高。婴幼儿肺部啰音及肺外损伤所占比例最高,而表现为咳嗽症状比例最低,与其余两组比较有统计学差异(P0.05),婴幼儿组肺外损害以心血管系统受累所占比例最高,学龄前及学龄组以消化系统所占比例最高;学龄组发热、喘息所占比例最高,与其余两组相比有统计学差异(P0.05),三组患儿感染MP后住院治疗天数无明显统计学差异(P0.05)。结论不同年龄段MP感染后临床表现、肺外损害发生率及形式各不相同,根据不同年龄段制定有效合理的治疗措施。     

基于SAT技术分析浦江镇地区儿童肺炎支原体感染的流行病学特点

目的基于RNA实时荧光恒温扩增技术(SAT)分析浦江镇地区因社区获得性肺炎(CAP)住院儿童的肺炎支原体感染现状与流行病学特点,为临床早期诊断和合理治疗提供理论依据。 方法选取2018年7月至2019年6月于上海交通大学医学院附属仁济医院南院住院治疗的967例CAP患儿为研究对象,采用SAT技术检测MP-RNA,统计分析不同性别、年龄以及发病季节患儿间MP感染阳性率的差异。 结果967例患儿中,MP-RNA检出阳性252例(26.06%),男性患儿MP感染阳性率为24.20%,女性患儿为28.34%,差异无统计学意义(χ²＝2.126,P>0.05)。MP感染见于各年龄组住院儿童,不同年龄组MP感染阳性率分别为：婴幼儿组(0～3岁)9.56%,学龄前期组(>3～6岁)28.61%,学龄期组(>6岁) 64.97%,各年龄组间差异有统计学意义(χ²＝185.266,P<0.05),MP阳性率随着年龄的增大逐渐升高。MP感染全年可见,春(3～5月)、夏(6～8月)、秋(9～11月)、冬(12～2月)四季MP感染阳性率分别为31.82%、31.96%、22.94%和21.28%,不同季节间MP感染阳性率差异有统计学意义(χ²＝11.825,P<0.05)。春夏季MP阳性率显著高于秋冬季(χ²＝11.620,P<0.05)。 结论上海浦江镇地区因CAP住院儿童MP感染与患病年龄及发病季节有关,不同性别之间无显著差异。MP感染可发生于各个年龄段的儿童,以学龄前及学龄儿童多见,MP感染阳性率随着年龄的增大逐渐升高。MP感染全年可见,以春季、夏季为高发季节。     

安徽省第二人民医院近4年急性胰腺炎患者的临床特点

目的:探讨安徽省第二人民医院近4年急性胰腺炎患者的临床特点,为其临床研究提供可参考依据.方法:选择2010-01/2014-10 235例急性胰腺炎患者作为研究对象,详细记录患者临床信息,分析急性胰腺炎的病因及临床特点变化.结果:235例急性胰腺炎患者中,年龄60岁(中青年组)155例,年龄≥60岁(老年组)80例;重症胰腺炎55例,非重症胰腺炎180例.中青年组与老年组急性胰腺炎均以胆源性、暴饮暴食及高脂血症最常见;中青年组胆源性、酒精源性、暴饮暴食比例及C-反应蛋白水平明显高于老年组,而老年组高脂血症性急性胰腺炎比例高于中青年组,差异有统计学意义(P0.05).非重症组以胆源性急性胰腺炎发生率最高,而重症以高脂血症急性胰腺炎发生率最高;重症组胆源性、酒精源性、高脂血症、腹痛、恶心呕吐比例及C-反应蛋白、血淀粉酶、降钙素原水平明显高于非重症组,差异有统计学意义(P0.05).结论:近4年急性胰腺炎发病仍以胆源性为主,不同年龄段急性胰腺炎病因有差异,高脂血症更容易发生重症急性胰腺炎.     

长期未转阴新型冠状病毒肺炎患者儿童传染性单核细胞增多症临床特征及合并肝脏损害的危险因素分析

[摘要]?目的?分析儿童传染性单核细胞增多症（infectious mononucleosis, IM）临床特征及合并肝脏损害的危险因素，为临床早期诊断及治疗提供重要依据。方法?选取2015年1月—2020年12月我院收治的86例IM儿童作为研究对象，回顾性收集并分析其性别、年龄等人口学特征及发病季节、临床表现、实验室检查结果等临床资料。根据ALT水平将IM儿童分为肝脏损害组（ALT＞40 U/L，46例）和非肝脏损害组（ALT≤40 U/L，40例），评估影响儿童IM合并肝脏损害的危险因素。结果?86例IM儿童中，男性略多于女性（55.81% vs. 44.19%），发病年龄以3～7岁居多（52.33%），发病季节以秋季（31.40%）及春季（26.74%）居多，临床表现以发热（95.35%）、颈部淋巴结肿大（91.86%）、咽峡炎（63.95%）为主。白细胞增多36例（41.86%），异型淋巴细胞增多27例（31.40%），血小板减少7例（8.14%），CRP升高39例（45.35%），CK-MB升高11例（12.79%），ALT、AST升高分别为46例（53.49%）和44例（51.16%），EBV DNA为5.00×104 copies/ml～500.00×104 copies/ml的儿童37例（43.02%）。热程＞7 d、白细胞增多、EBV DNA＞500.00×104 copies/ml均为影响IM合并肝脏损害的危险因素（P均＜0.05）。结论?秋季与春季是儿童IM高发季节，学龄前期为好发年龄，发热、颈部淋巴结肿大、咽峡炎为其主要临床表现，患儿常伴多种实验室检查指标异常。热程较长、白细胞增多、EBV DNA载量较高的IM患儿应警惕肝脏损害，临床应予以重视。     

不同年龄段人群发生急性胰腺炎的临床特点回顾分析

背景急性胰腺炎(acute pancreatitis, AP)是临床常见的急腹症之一,以往认为AP患者以青壮年居多,然而,近年来随着我国人口的增长及社会老龄化的形成,老年及儿童AP的发病率也呈上升趋势.不同年龄段人群因其生理学特性从而导致AP发病时的临床表现略有差异.老年及儿童患者临床表现不典型,极易造成误诊、漏诊.本文通过回顾性分析不同年龄段AP患者的临床特点,旨在总结临床经验,为临床诊治提供参考.目的探讨不同年龄段人群发生AP的临床特点.方法回顾性分析2003-01/2016-061758例AP的临床资料,根据年龄进行分组:未成年组(18岁);中青年组(18-60岁);老年组(≥60岁).总结不同年龄段人群发病的一般资料、病因、严重程度、并发症、临床经过及预后以及相关实验室指标的特点.结果未成年组AP男性发病率稍高于女性;轻度AP(mild acutepancreatitis,MAP)比例(78.5%)较另外两组高;并发症的发生率、病死率较其他两组低(P0.05).中青年组AP男性构成比(71.0%)较高,酒精性、高脂血症性胰腺炎发病率(13.4%、21.5%)较其他两组高(P 0.05);中青年AP胰腺坏死的发生率(23.4%)最高,发生胰周渗出、胸腔积液、急性呼吸窘迫综合征、急性肾功能不全的比例也高于未成年组(P0.05).老年组AP男性发病率稍高于女性,发生恶心症状的比例(58.2%)最高(P0.05).老年AP病因中胆源性所占比例(61.2%)最高(P0.05);老年AP发生中度重症AP的比例(43.5%)较其他两组高(P0.05).未成年组AP住院时间(17.97±12.14 d)最长,老年组AP入住重症监护病房的比例(4.1%)及病死率(13.1%)最高(P0.05),不同年龄段AP患者在住院费用方面差异不明显(P0.05).实验室指标结果对比显示,三组外周血白细胞计数差异无统计学意义(P0.05);未成年组C反应蛋白均值较其他两组低,老年组血清淀粉酶较中青年组高;老年组脂肪酶(lipase, LPS)较其他两组高(P0.05),LPS均值在未成年组及中青年组中的差异无统计学意义(P0.05).结论中青年较其他年龄段人群的酒精性、高脂血症性胰腺炎的发病率高;老年AP患者发病时最容易出现恶心,且病死率最高;当未成年患者出现不明原因的呕吐、腹胀时,应警惕AP可能.     

小汤山地区儿童微量元素分析

目的了解北京市小汤山地区儿童微量元素水平,为防治儿童缺乏微量元素提供参考依据。方法采用原子吸收光谱仪对2013年在北京市小汤山辖区内1538名儿童末梢血的钙、铜、锌、铁、镁5种微量元素进行检测,受检儿童均为小汤山常住人口,将其分为4个年龄组:婴儿组(1~12个月,391名),幼儿组(1~2岁,278名),学龄前组(3~6岁,200名),学龄期组(7~11岁,669名),每组按性别又分成男、女2组,对不同年龄段和不同性别间儿童5种微量元素分布情况进行分析。结果小汤山地区儿童末梢血微量元素代谢紊乱,同时低于北京市平均水平。结论小汤山地区儿童微量元素与正常地区存在差异,提示积极改水对于儿童健康发展具有重要意义。     

某院学龄前儿童腹泻诊治368例

目的:了解浙江省长兴县人民医院学龄前儿童腹泻的患病情况,探讨重型腹泻发生的危险因素.方法:选取2014-01/2015-12于浙江省长兴县人民医院门诊或住院治疗的368例腹泻儿童为研究对象,根据Vesikari Scale评分分为重型组(≥11分,n=50)和轻型组(11分,n=318),比较两组的性别、年龄、户籍、户口来源、住址、发病季节、发病至就诊的时间等基线资料及病毒感染状况,采用多因素Logistics回归分析筛选出患儿发生重型腹泻的影响因素.结果:无论是男性还是女性,两组的年龄分布比较,差异无统计学意义(P0.05).重型组的农业户籍、外地户口、住在郊区、冬春季节发病、发病至就诊时间≤24 h、轮状病毒感染的比例显著高于轻型组,差异均有统计学意义(P0.05).多因素Logistics回归分析表明农业户籍、冬春季节发病、发病至就诊时间≤24 h、轮状病毒感染是患者出现重度腹泻的独立危险因素(P0.05).结论:学龄前儿童是重型腹泻的高发人群,尤其是对于农业户籍、冬春季节发病、发病至就诊时间≤24 h、轮状病毒感染者要给予针对性的防治.     

3368例武汉市儿童幽门螺杆菌感染的临床分析

目的了解武汉市有消化道症状的儿童幽门螺杆菌感染状况、分布特征及影响因素。方法选取我院及武汉市医院2010年8月～2011年7月3 368例有消化道症状的儿童,以性别和年龄进行分组,通过14 C-尿素呼气试验检测幽门螺杆菌感染情况,并对其结果进行统计学分析,同时对这些儿童的生活方式进行问卷调查分析。结果 3 368例受检儿童H.pylori总感染率为29.2%,其中男女儿童H.pylori感染阳性率分别为29.2%和29.1%,男女儿童H.pylori感染阳性率差异无统计学意义(P>0.05);学龄前、学龄期及青春期儿童H.pylori感染阳性率分别为27.1%、28.7%和39.1%,学龄前期与学龄期H.pylori感染阳性率差异无统计学意义(P>0.05),学龄前期、学龄期与青春期H.pylori感染阳性率差异有统计学意义(P<0.01);年龄与H.pylori感染阳性率相关(P=0.001);同年龄组男女儿童H.pylori感染阳性率差异无统计学意义(P>0.05);父母幽门螺杆菌阳性患儿幽门螺杆菌阳性率57.5%。结论武汉市有消化道症状的儿童幽门螺杆菌感染率高,随年龄增长感染率递增,但与性别无关,父母幽门螺杆菌阳性患儿幽门螺杆菌阳性率高,年龄、家庭聚集性、父母H.pylori感染与儿童H.pylori感染相关。     

儿童保健对婴幼儿生长发育的影响分析和护理对策

目的分析通过开展儿童保健对于促进婴幼儿生长发育的临床价值以及有效的护理措施。方法抽取贵州省六盘水市妇幼保健院2017年1月—2018年2月接受儿童健康保健的200例婴幼儿为回顾分析对象,数字法分组为观察组、对照组,每组100例。对照组婴幼儿采取常规的儿童保健护理方式,观察组婴幼儿在此常规基础上采取强化儿童保健护理。比较两组的发育情况和营养性疾病发生率。结果观察组婴幼儿在10个月时身高和体重两项体格发育指标均明显高于对照组婴幼儿(P0.05);观察组婴幼儿在10个月时适应性评分和精细运动评分均显著高于对照组婴幼儿(P0.05);观察组婴幼儿在保健期内营养性疾病发病率为1.00%,显著低于同期对照组的7.00%(P0.05)。结论通过开展儿童保健并配合强化保健护理,有助于促进婴幼儿的良好生长和发育,可降低婴幼儿营养性疾病的发生率。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.