窄带成像内镜下NICE分型对结直肠肿瘤的诊断价值

目的探讨采用非放大内镜的简化的窄带成像技术（NBI）内镜下分型系统（NICE分型）在内镜诊断结直肠肿瘤中的应用价值。方法对结肠镜检查发现的181处结直肠新生性病变进行NBI内镜检查,观察病变的颜色、微血管结构及表面结构,依据NICE分型标准预测病变性质,并与内镜下或外科手术切除后标本的病理结果进行对比分析。结果NBI内镜下NICE总体分型诊断结直肠肿瘤的总体敏感度、总体特异度、总体阳性预测值、总体阴性预测值和总体准确率分别为95．8％（114／119）、91．9％（57／62）、95．8％（114／119）、91．9％（57／62）和94．5％（171／181）;对微小息肉（≤0．5cm）、小息肉（〉0．5—0．9em）和大息肉（〉0．9Cm）诊断的准确率分别为90．0％（72／80）、95．9％（47／49）和98．1％（51／52）,差异无统计学意义（P=0．175）;诊断直乙结肠微小肿瘤的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为87．5％（14／16）、95．2％（20／21）、93．3％（14／15）、90．9％（20／22）和91．9％（34／37）。结论依据NICE分型标准使用高分辨率NBI能够较好区分结直肠肿瘤性和非肿瘤性病变,基本可以满足临床需要。     

深度学习技术在提升结直肠息肉性质鉴别准确率中的应用

目的探讨采用深度学习技术提升内镜医师在窄带光成像（narrow band imaging,NBI）下判断结直肠息肉性质准确率的价值。方法收集武汉大学人民医院消化内镜中心结直肠息肉的NBI非放大图片并分为3个数据集,数据集1（2018年1月—2020年10月,1 846张非腺瘤性与2 699张腺瘤性息肉的NBI非放大图片）用来训练和验证结直肠息肉性质鉴别系统;数据集2（2018年1月—2020年10月,210张非腺瘤性息肉和288张腺瘤性息肉的NBI非放大图片）用来比较内镜医师及该系统息肉分型的准确性,同时比较4名消化内镜初学者在该系统的辅助下判断息肉性质的准确性是否有提升;数据集3（2020年11月—2021年1月,141张非腺瘤性息肉和203张腺瘤性息肉的NBI非放大图片）用来前瞻性测试该系统。结果该系统在数据集2中判断结直肠息肉的准确率为90.16%（449/498）,优于内镜医师。消化内镜初学者在有该系统的辅助下,息肉分型准确率显著提升。在前瞻性研究中,该系统的准确率为89.53%（308/344）。结论本研究开发的基于深度学习的结直肠息肉性质鉴别系统能够显著提升内镜医师初学者的息肉分型准确率。     

内镜下结肠息肉巴黎分型与NICE分型的诊断价值

目的探讨息肉大小、形态(巴黎分型)、表面结构等(NICE分型)对结直肠腺瘤性息肉的诊断价值。方法收集497例患者在内镜下的结直肠息肉图像,以病理检查结果为金标准评估白光内镜(white light endoscopy, WLE)下巴黎分型与窄带成像(narrow-band imaging, NBI)下NICE分型对不同大小息肉的诊断效果。结果直径5 mm对腺瘤的预测值为55.3%;直径5～10 mm对腺瘤的预测值为79.2%,两组比较,差异有统计学意义(P0.05)。巴黎Ⅰsp型、Ⅰp型对腺瘤的预测值高,分别为88.5%、88.2%,Ⅰs型对腺瘤预测值为73.2%。当息肉直径5 mm时,巴黎分型的灵敏度为50.7%、特异度为69.9%,NICE分型的灵敏度为90.7%、特异度为95.6%;当息肉直径≥5 mm时,巴黎分型的灵敏度为95.7%、特异度为27.0%,NICE分型的灵敏度为98.6%、特异度为70.3%;差异有统计学意义(P0.05)。当息肉直径5 mm时,在NICE分型的基础上联合巴黎分型的诊断结果差异无统计学意义(P0.05);当息肉直径≥5 mm时,NICE 1型+巴黎Ⅰsp/Ⅰp型对非腺瘤的预测值显著低于NICE 1型+巴黎Ⅰs型、Ⅱa型(P=0.040);NICE 2型+巴黎Ⅱa型对腺瘤性息肉的预测值显著低于NICE 2型+巴黎Ⅰs型、Ⅰsp/Ⅰp型(P=0.012)。结论单独应用NICE分型的诊断效果明显优于单独应用巴黎分型;对于直径5 mm的息肉,可以单独应用NICE分型,而对于直径≥5 mm的息肉,联合应用NICE分型和巴黎分型可以进一步提高对息肉性质的预测效果;对于直径≥5 mm的NICE 1型+巴黎Ⅰsp/Ⅰp型的息肉以及NICE 2型+巴黎Ⅱa型的息肉,病理检查仍是必要的。     

国产分光内镜对结直肠微小息肉诊断价值的研究

背景:结肠镜检出的结肠息肉中微小息肉所占的比例最高,国产分光内镜复合分光染色(CBI)内镜与窄带成像(NBI)技术同样具有分光染色功能。目的:探讨国产CBI内镜应用NICE分型诊断结直肠微小息肉的价值以及不同资质的内镜医师应用CBI技术的稳定性。方法:纳入2014年6月—2015年4月上海交通大学医学院附属仁济医院735例患者的707枚结直肠微小息肉,将患者随机分配至不同资质的内镜医师(NBI使用年限分别为5年、3年、2年)行CBI检查。根据病变的色泽、血管结构、表面结构判断NICE分型,并与病理结果进行比较,分析CBI内镜诊断结直肠微小息肉的价值以及不同资质的内镜医师应用CBI技术的稳定性。结果:国产CBI内镜诊断结直肠微小肿瘤性息肉的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为83.6%、79.3%、86.7%、81.5%和85.1%;不同资质的内镜医师应用CBI技术诊断结直肠微小息肉的准确性无明显差异(P=0.07)。结论:国产CBI内镜对结直肠微小息肉的实时诊断具有良好的应用价值,且操作过程易于掌握。     

NICE分型对结直肠息肉及早癌诊治准确性的研究

目的探讨国产非放大高清晰度分光染色（CBI）内镜应用NICE分型对结直肠息肉及早癌诊治的准确性,并为临床诊疗工作提供借鉴。 方法选取2015年12月至2017年10月行结肠镜检查发现结直肠息肉样病变的患者96例,应用非放大或放大CBI内镜对病变进行内镜下实时分型,并行相应治疗或取病理,最终与病理结果相对照,进行比较分析。 结果非放大CBI内镜应用NICE分型诊断肿瘤性病变的准确性、特异性、敏感性、阳性及阴性预测值分别为95.2%、72.73%、100%、94.4%、100%,2型和3型的病变与其对应的病理诊断进行一致性分析,kappa值为0.795（≥0.75）,说明具有理想的一致性,且一致性有统计学意义（P<0.01）。NICE分型与Sano分型对结直肠良性肿瘤性息肉和m-sm1癌与sm2-3癌相鉴别的一致性分析得到,kappa值为0.795,说明具有理想的一致性,且一致性有统计学意义（P<0.01）。 结论国产非放大CBI内镜应用NICE对结直肠息肉及早癌的诊治有良好的准确性,有助于结直肠息肉及早癌的鉴别诊断,避免不必要的治疗,节省医疗资源。     

JNET分型在结直肠肿瘤性病变诊断中的价值

目的 评估窄带成像放大内镜（ME-NBI）下应用JNET分型诊断结直肠肿瘤性病变的临床价值。 方法 在ME-NBI模式下对结肠镜检查发现的110处结直肠新生性病变进行观察，分析病变的血管形态及表面结构变化，根据ME-NBI分型系统（JNET分型、Kudo分型）初步判断病变的性质，并与切除标本的病理结果进行对比分析。 结果 ME-NBI下JNET分型总体分型诊断结直肠肿瘤性病变的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为96.2%（75/78）、93.8%（30/32）、97.4%（75/77）、90.9%（30/33）和95.5%（105/110），Kudo分型总体分型的上述指标结果分别为92.3%（72/78）、81.3%（26/32）、92.3%（72/78）、81.3%（26/32）和89.1%（98/110），两者在诊断准确率上差异无统计学意义（P=0.077）。JNET分型总体分型诊断微小息肉（≤0.5 cm）、小息肉（＞0.5～1.0 cm）、大息肉（＞1.0 cm）肿瘤性的准确率分别为92.3%（36/39）、93.8%（15/16）和98.2%（54/55），三者间差异无统计学意义（P=0.379）。 结论 ME-NBI下JNET分型在鉴别结直肠病变肿瘤性与非肿瘤性方面具有较可靠的诊断价值。     

非放大内镜下结直肠病变的国际NICE分型判断结直肠息肉的应用及学习曲线

目的 研究非放大内镜下结直肠病变的国际分型(NICE)在结直肠息肉判断准确性方面的应用价值,明确不同经验的内镜医师对NICE分型应用的学习曲线.方法 收集2019年12月至2020年4月经中山大学附属第六医院行肠镜检查105例患者的1 674张结直肠息肉图片,分别由3位初级医师和1位高级医师进行NICE分型,以病理诊断...     

利用窄带成像技术观察毛细血管形态在结直肠息肉样病变鉴别诊断中的价值

目的:探讨利用窄带成像技术(narrow bandimaging,NBI)观察毛细血管形态(capillarypatterns,CP)对结直肠息肉样病变鉴别诊断的价值.方法:75例患者接受NBI结肠镜检查共发现病变部位116处.根据Yoshiki的分型方法,将结直肠病变的CP分为6种:蜂窝状结构型、模糊结构型、网状结构型、密度增高型、不规则结构型、稀疏结构型.利用NBI下观察到的CP进行鉴别诊断,并与病理结果对照判定其敏感性、特异性及准确率.结果:在116例结直肠病变中增生性息肉毛细血管形态多表现为模糊结构型,而腺瘤性息肉的毛细血管形态表现为网状结构型和密度增高型,癌症的毛细血管形态多表现为不规则型和稀疏结构型.利用此分型方法鉴别肿瘤性病变和非肿瘤性病变的敏感性和特异性分别是94.6%和78.6%,准确性88.8%,阳性预测值(positive predictive value,PPV)88.6%,阴性预测值(negative predictivevalue,NPV)89.2%(P<0.01).同样,对于腺瘤性息肉和癌症的鉴别诊断的敏感性和特异性分别是100.0%和87.5%,准确性91.4%(P<0.01).将直径<10 mm的小息肉按毛细血管的有无进行鉴别诊断的敏感性和特异性分别是89.7%和80.5%,PPV81.4%,NPV89.2%,准确性85.0%(P<0.01).结论:NBI结肠镜观察结直肠病变CP对于鉴别肿瘤性病变与非肿瘤性病变,以及腺瘤性息肉与癌症具有可靠的诊断价值.对于直径<10 m m小息肉的肿瘤性及非肿瘤性的鉴别诊断方面NBI结肠镜也具有很好作用.     

窄带成像放大内镜鉴别大肠肿瘤性与非肿瘤性病变的价值

目的 探讨窄带成像放大内镜（NBI—ME）鉴别大肠肿瘤性与非肿瘤性病变表面网状微血管结构改变的临床价值。方法选择常规内镜检出大肠肿瘤性、非肿瘤性病变144处（102例）,记录NBI—ME观察病变表面微血管结构（CP）形态和染色放大内镜观察病变黏膜表面腺管开口（pit）形态。分析pit周围CP形态变化,比较两者形态间的关系。所有病变经内镜或手术治疗后行组织病理学检查。结果常规内镜鉴别病变是否为肿瘤性的准确率75．7％、敏感性85．1％、特异性40．0％,明显低于NBI—ME和染色放大内镜（P〈0．005）,NBI—ME和染色放大内镜间则未见差异。CP分型与pit分型对照,CP—Ⅰ型、Ⅱ型、Ⅳ型、Ⅵa型分别与pitⅠ型、Ⅱ型、Ⅳ型、Ⅴ1型间一致性达100％。144处病变中,内镜治疗129处,手术治疗15处。组织病理学检查：非肿瘤性30处（增生性息肉17处、炎症性息肉13处）;肿瘤性114处（腺瘤95处、腺癌19处）。结论初步显示NBI—ME和染色放大内镜之间具有正相关性,两种检查方法互补可作为当前鉴别大肠病变是否为肿瘤性的重要手段。     

醋酸联合窄带成像放大内镜在结直肠小息肉诊断中的价值

目的 探讨醋酸联合窄带成像放大内镜（NBI-ME）在结直肠小息肉诊断中的价值。 方法 对行内镜治疗的122例261个肠息肉依次采用放大内镜（ME）、NBI-ME和醋酸联合NBI-ME模式观察病灶,保留图像。分别由3位有放大内镜诊断经验的内镜医师（专家）及3位无放大内镜诊断经验的内镜医师（非专家）独立观察图像,图像评估依据工藤腺管开口形态分型诊断标准。以组织病理诊断为金标准,评价不同放大内镜模式对结直肠小息肉诊断的准确性,并对各种放大模式下图像的清晰度及观察者间的一致性进行对比分析。 结果 专家组ME、NBI-ME、醋酸联合NBI-ME模式诊断结直肠肿瘤性小息肉的准确率分别为65.5％（171／261）、90.0％（235／261）、94.6％（247／261）,非专家组分别为57.1％（149／261）、83.1％（217／261）、89.3％（233／261）。专家组、非专家组醋酸联合NBI-ME模式诊断结直肠肿瘤性小息肉的准确率明显高于NBI-ME（P均＜0.05）和ME模式（P均＜0.001）。专家组、非专家组醋酸联合NBI-ME模式清晰度评分均明显大于NBI-ME、ME模式（P均＜0.001）。观察者间一致性评价显示,专家组ME、NBI-ME及醋酸联合NBI-ME模式诊断结直肠肿瘤性小息肉的Kappa值（95％CI）分别为0.578 （0.508～0.648）、0.669 （0.599～0.739）、0.940 （0.870～1.010）,非专家组分别为0.476 （0.406～0.546）、 0.534 （0.464～0.604）、 0.830 （0.760～0.900）;醋酸联合NBI-ME模式一致性好。 结论 醋酸联合NBI-ME对结直肠小息肉性质的诊断准确性和可重复性较高。     

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.     

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.     

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.     

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。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

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.