尿酸对老年冠心病心力衰竭患者预后的影响

目的：分析老年冠心病心力衰竭患者的尿酸水平对预后的影响.方法：选择2005年1月～2007年12月入住心内科的老年冠心病合并慢性心衰患者783例.按尿酸水平的四分位间距分为低水平组（195例）、较低水平组（195例）、较高水平组（195例）和高水平组（198例）,比较各组的病死率.按随访期是否死亡分为死亡组（199例）和生存组（584例）,采用多因素Cox回归分析尿酸对冠心病合并心衰患者预后的影响.结果：尿酸各组的病死率有显著差异（P＜0.01）,高水平组最高,达43.4％,显著高于其他三组（P均＜0.05）.与生存组比较,死亡组患者年龄较大[（70.03±9.67）岁比（73.31±8.69）岁],尿酸[（353.28±122.58） μmol/L比（423.71±189.84） μmol/L]水平显著升高,合并贫血（17.6％比24.1％）、房颤（17.5％比31.2％）、肾衰竭（22.1％比34.7％）的比例显著增加,左室射血分数[（56.49±11.14）％比（49.43±12.19）％]显著下降（P＜0.05或＜0.01）.Cox回归分析显示,高水平的尿酸（≥437 μmol/L）、年龄、NYHAⅢ～Ⅳ级及房颤是老年冠心病心衰预后不良的独立危险因素（HR 0.596～1.547,P均＜0.05）.结论：血尿酸作为老年冠心病心衰患者心源性死亡的预后指标,其作用独立于影响心衰患者生存的其他因素,具有一定的临床预后判断价值.     

尿酸对慢性心力衰竭合并心房颤动的老年患者心功能及远期预后的相关关系

目的 探讨尿酸对慢性心力衰竭(心衰)合并心房颤动(房颤)的老年患者心功能及远期预后的相关关系。方法 采用回顾性队列研究,连续纳入2018年8月至2020年8月在河北省人民医院心血管内科住院的老年慢性心衰合并房颤患者324例,根据尿酸水平,将患者分为高尿酸组150例和正常尿酸组174例。收集各组临床资料、实验室检查及超声心电图指标,出院后随访3年,研究终点为主要不良心血管事件。结果 单因素方差分析显示,纽约心功能分级Ⅳ级的患者尿酸水平显著高于心功能Ⅱ级、Ⅲ级[(445.39±184.54)μmol/L vs(378.86±122.64)μmol/L、(403.50±142.15)μmol/L,P<0.05)]。多因素Cox分析显示,年龄(95%CI:1.012～1.075,P=0.007)、尿酸水平(95%CI:1.000～1.004,P=0.048)、他汀类药物(95%CI:0.215～0.721,P=0.003)与心脏性死亡风险显著相关。结论 尿酸与慢性心衰合并房颤的老年患者长期预后有关,对远期发生心脏性死亡有一定预测价值。     

老年男性糖耐量减低患者血清尿酸水平与全因或心血管疾病病死率的相关性分析

目的探讨基线血清尿酸水平与老年男性糖耐量减低(impaired glucose tolerance,IGT)患者全因或心血管疾病(cardiovascular disease,CVD)病死率的关系。方法纳入2006年4月1日～2015年8月31日于解放军总医院第二医学中心接受口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)、血清尿酸监测和健康体检中传统CVD危险因素评估的老年男性IGT患者334例,根据血清尿酸水平三分位法分为322.13μmol/L组(A组)111例,322.13～387.70μmol/L组(B组)112例,387.70μmol/L组(C组)111例,平均随访时间(5.82±3.31)年。采用Cox比例危险模型分析血清尿酸水平与全因病死率或CVD病死率或非CVD病死率的独立相关性。结果本研究高尿酸血症患者39例(11.68%)。A组、B组、C组体质量指数、TG、尿酸及肌酐水平逐渐升高(P0.05,P0.01),肾小球滤过率逐渐降低[64.68(52.71,74.32)ml/(min·1.73 m~2)vs 63.66(49.50,73.00)ml/(min·1.73 m~2)vs 57.77(45.81,64.73)ml/(min·1.73 m~2),P=0.026]。随访期间,全因死亡61例(18.26%),其中12例(19.67%)死于心脑血管事件。最常见的死亡原因是癌症21例(34.43%)和肺炎21例(34.43%)。Kaplan-Meier生存分析显示,基线血清尿酸与CVD病死率不相关(P_(log-rank)=0.230)。Cox比例危险模型显示,年龄、BMI和TC是CVD病死率危险因素(P0.05),年龄(HR=1.177,95%CI:1.123～1.234,P=0.000)及既往心脑血管事件(HR=2.462,95%CI:1.348～4.498,P=0.003)是全因病死率危险因素。结论老年男性IGT患者中,血清尿酸水平与CVD死亡或全因死亡风险增加可能无关。     

急性心肌梗死患者血浆二甲基甘氨酸水平对死亡风险的预测价值

目的:探究血浆二甲基甘氨酸(DMG)水平与急性心肌梗死(AMI)患者死亡风险的关系,及其对死亡风险的预测价值。方法:本院2010年至2014年间的AMI患者2406例,根据随访3年的存活情况,被分为死亡组(319例)和存活组(2087例),选择同期本院体检的健康志愿者2000例为健康对照组。测量研究对象的血浆DMG水平,分析血浆DMG水平对AMI患者死亡风险的预测价值。结果:AMI组血浆DMG水平显著高于健康对照组[(4.16±1.06)μmol/L比(2.93±0.47)μmol/L],死亡组血浆DMG水平显著高于存活组[(4.81±1.05)μmol/L比(4.06±1.08)μmol/L],P均=0.001。ROC曲线分析显示,血浆DMG水平预测患者死亡的曲线下面积(AUC)为0.756,最佳截断值为4.76μmol/L,敏感度和特异度分别为76.7%和69.2%。根据此截断值,AMI组被分为低水平组(DMG≤4.76μmol/L,1103例)和高水平组(DMG4.76μmol/L,1303例)。与低水平组比较,高水平组BMI、吸烟、高血压、糖尿病、三支病变比例、TC、LDL-C、载脂蛋白(Apo)B、Apo A1水平显著升高,单支病变比例和HDL-C水平显著降低,P0.05或0.01。Kaplan-Meier生存分析高水平组3年总体生存率显著低于低水平组(84.19%比89.76%,P=0.001)。COX比例风险回归的多因素分析显示,冠脉病变程度和血浆DMG水平是影响AMI患者预后的独立危险因素(HR=1.746,1.823,P均=0.001)。结论:血浆DMG水平是预测AMI患者死亡的独立危险因素之一。     

间断重复静脉应用左西孟旦治疗老年扩张型心肌病患者的有效性研究

目的观察间断重复静脉使用左西孟旦治疗老年扩张型心肌病患者的有效性。方法选择2016年1月~2018年3月在四川省人民医院心力衰竭中心住院的老年扩张型心肌病患者43例,随机分为左西孟旦组21例和对照组22例。对比分析应用左西孟旦治疗前后的B型钠尿肽(BNP)、LVEF等相关临床指标。结果左西孟旦组治疗后LVEF、体质量较治疗前明显升高[(35.75±9.17)%vs(27.96±4.69)%,P=0.000;(62.05±9.16)kg vs(61.24±9.94)kg,P=0.025],心率、收缩压、舒张压、BNP、尿酸较治疗前明显降低[(81.48±8.79)次/min vs(92.10±11.48)次/min,P=0.000;(116.62±11.45)mm Hg vs(126.71±14.89)mm Hg,P=0.000;(72.48±7.23)mm Hg vs(77.52±8.13)mm Hg,P=0.000;(785.85±1107.76)ng/L vs(2296.43±1305.11)ng/L,P=0.001;(437.52±87.13)μmol/L vs(517.67±113.88)μmol/L,P=0.019]。对照组治疗后LVEF较治疗前明显升高,心率、体质量、BNP较治疗前明显降低,差异有统计学意义(P0.01)。左西孟旦组再次住院间隔时间为130(120,147)d,对照组再次住院间隔时间为32(22,69)d。2组生存曲线比较,差异有统计学意义(HR=0.3601,95%CI:0.1842~0.7038,P=0.000)。结论老年扩张型心肌病患者间断重复静脉滴注左西孟旦,可显著改善心功能,减少住院率。     

血清尿酸检验在老年冠心病患者诊断中的临床价值

目的探讨血清尿酸检验在老年冠心病患者诊断中的应用价值。方法选取2014年1月~2015年1月我院收治的老年冠心病患者60例作为观察组,选取同期在我院进行体检的健康体检者60例作为对照组。两组研究对象均进行血清检验,并着重检查血清尿酸。比较不同血清尿酸值引发的心力衰竭情况。结果观察组患者的各类血清胆红素检测值均明显低于对照组健康体检者,而血清尿酸检测值明显高于对照组健康体检者,差异有统计学意义(P0.05)。不同血清尿酸检测值患者的心力衰竭发生情况:血清尿酸检测值为500μmol/L以上的患者其心力衰竭的发生率明显高于尿酸检测值为300~400μmol/L、400~500μmol/L的患者,尿酸水平与心力衰竭呈正相关。结论老年冠心病患者的血清尿酸检测值明显高于健康人群,因而它可以作为冠心病的一个诊断依据;同时,血清尿酸水平越高,则心力衰竭的发生率越高,对冠心病的治疗及预后具有重要的意义。     

血清尿酸水平与自发性脑出血患者的近期临床转归:前瞻性病例系列研究

目的 探讨血清尿酸水平与自发性脑出血患者近期临床转归的关系.方法 前瞻性连续纳入发病24 h内入院的自发性脑出血患者.入院次日检测血清尿酸水平;发病30天时应用改良Rankin量表(modified Rankin Scale,mRS)评估临床转归.将患者分为转归良好组(mRS评分≤2分)与转归不良组(mRS评分≥3分).结果 共纳入92例自发性脑出血患者,其中46例(50％)为男性,平均年龄(63±12)岁,基线格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分为11分(9～12分).在发病后30天时进行的随访中,22例患者(23.9％)转归良好,70例患者(76.1％)转归不良.单变量分析显示,转归良好组GCS评分显著高于转归不良组[(13.85±2.80)分对(11.21±2.51)分;t=4.186,P=0.000],而血肿体积[(25.65 ±5.33)cm3对(34.60±8.97)cm3;t =4.430,P=0.000]和血清尿酸水平[(324.90±86.02) μmol/L对(458.63±72.77) μmol/L;t=7.193,P=0.000]显著低于转归不良组.多变量logistic回归分析显示,基线GCS评分低[优势比(odds ratio,OR)1.810,95％可信区间(confidence interval,CI) 1.382 ～2.382;P =0.001]、血肿体积较大(OR 1.156,95％ CI 1.045 ～ 1.280;P =0.005)和血清尿酸水平增高(OR2.127,95％ CI 1.055 ～4.287;P=0.035)是自发性脑出血患者近期临床转归不良的独立预测因素.结论 血清尿酸水平增高能预测自发性脑出血患者的近期临床转归不良.     

红细胞分布宽度与老年心力衰竭合并心房颤动患者预后关系的研究

目的探讨红细胞分布宽度(RDW)与老年心力衰竭合并心房颤动患者不良预后的关系。方法选取2017年6月～2019年12月郑州大学第一附属医院心内科住院的老年心力衰竭合并心房颤动患者831例,根据RDW最佳截断值分为低RDW组596例(RDW14.39%),高RDW组235例(RDW≥14.39%)。平均电话随访(2.25±0.64)个月,观察并记录主要终点事件发生情况,包括全因死亡、心源性死亡和因心力衰竭再入院。结果随访期间,2组因心力衰竭再入院比例比较,无统计学差异(P0.05);高RDW组全因死亡、心源性死亡比例明显高于低RDW组(27.2%vs 8.1%,19.1%vs 5.2%,P0.01)。多因素Cox回归分析显示,RDW水平与全因死亡、心源性死亡发生风险呈正相关(HR=1.634,95%CI:1.267～1.979,P0.01;HR=1.323,95%CI:1.173～1.672,P0.01)。结论升高的RDW与老年心力衰竭合并心房颤动患者不良预后密切相关,是其独立预测因素。     

冠状动脉斑块负荷对老年稳定性冠心病患者并发心力衰竭的预测价值

目的 探讨冠状动脉斑块负荷对老年稳定性冠心病患者并发心力衰竭的预测价值。方法 收集2018年1月至2020年6月重庆市大足区人民医院心血管内科接诊的稳定性冠心病患者206例,随访3年,根据术后是否发生心力衰竭分为心力衰竭组56例和对照组150例。收集所有患者一般临床资料、总斑块负荷、钙化斑块负荷、非钙化斑块负荷、左心室射血分数等。所有患者行冠状动脉CT血管造影测量冠状动脉斑块负荷,并分析其对老年稳定性冠心病患者并发心力衰竭的预测价值。结果 与对照组比较,心力衰竭组高血压、总斑块负荷、非钙化斑块负荷明显增高[73.2%vs 52.7%,P=0.008;(55.23±10.26)%vs(48.26±9.82)%,P=0.000;(26.93±7.98)%vs(21.46±7.62)%,P=0.000],左心室射血分数明显降低[(52.97±7.85)%vs(58.02±7.91)%,P=0.000]。ROC曲线分析显示,总斑块负荷和非钙化斑块负荷对老年稳定性冠心病患者3年内并发心力衰竭具有一定预测价值,曲线下面积分别为0.752(95%CI:0.682～0.822,P=0.000)和0.7...     

尿酸与急性缺血性脑卒中患者病情严重程度和预后的相关性研究

目的探讨血尿酸水平与急性缺血性脑卒中患者入院时病情严重程度和短期预后的关系。方法选择急性缺血性脑卒中患者496例,根据血尿酸水平分为高尿酸组119例,正常尿酸组377例。收集人口统计学信息、生活方式、疾病史、入院时尿酸水平等,评估患者入院时及出院时临床神经功能。以尿酸274、338和411mmol/L为截取点比较不同血尿酸水平患者短期预后的差异。结果高尿酸组尿酸、神经功能好转率明显高于正常尿酸组[(438.30±80.24)mmol/L vs(274.50±84.82)mmol/L,P=0.000;(62.00±22.00)%vs(57.00±15.00)%,P=0.005],出院时美国国立卫生研究院卒中量表评分明显低于正常尿酸组[(4.80±2.21)分vs(5.60±3.58)分,P=0.022]。与尿酸≥412μmol/L患者比较,尿酸≤274μmol/L患者预后不良明显升高(45.2%vs 29.6%,P<0.05)。结论血尿酸水平与急性缺血性脑卒中患者入院时病情严重程度无相关性,血尿酸水平升高有助于缺血性脑卒中早期神经功能恢复,提示高尿酸水平对急性缺血性脑卒中具有一定的保护作用。     

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.