非诺贝特与过氧化体增殖物激活型受体α对人肝瘤细胞1型纤溶酶原激活物抑制剂表达的影响

目的探讨非诺贝特对人肝瘤细胞株(HepG2)细胞1型纤维酶原激活物抑制剂(PAI-1)表达的影响及机制。方法用不同浓度非诺贝特刺激HepG2细胞,采用半定量逆转录聚合酶链反应(RT-PCR)法检测PAI-1mRNA水平,发色底物法检测PAI-1的活性变化。构建4个荧光素酶报告基因质粒,分别由PAI-1启动子序列从-804至+17间不同长度片段驱动,体外转染HepG2细胞,检测荧光素酶的活性。结果非诺贝特能使HepG2细胞PAI-1mRNA表达及蛋白活性显著降低,且呈一定剂量依赖性;还可使PAI-1转录活性显著降低;当转染质粒含有PAI-1启动子序列-636~+17、-449~+17-、276~+17 bp 3个片段时,荧光素酶活性显著增高;共转染过氧化体增殖物激活型受体α(PPARα)表达质粒(PPAR-αpSG5)的细胞在非诺贝特诱导下PAI-1转录活性显著降低。结论非诺贝特可以抑制HepG2细胞PAI-1mRNA表达及其活性,调节PAI-1的基因转录,PPARα参与非诺贝特对PAI-1基因的表达调控。     

PPARα激活物影响HepG-2细胞PAI-1表达机制初探

目的探讨不同的过氧化体增殖物激活型受体α(PPARα)激活物对HepG-2细胞纤溶酶原激活物抑制剂-1(PAI-1)活性和mRNA表达的影响及其可能的机制。方法分别以亚油酸和非诺贝特刺激HepG-2细胞,检测PAI-1活性和mRNA表达。基因瞬时转染含不同片段缺失的PAI-1启动子序列控制表达的报告基因质粒,测定亚油酸和非诺贝特诱导后的转录活性。结果亚油酸使HepG-2细胞PAI-1 mRNA表达及蛋白活性显著增加,而非诺贝特使其著降低。转染HepG-2细胞由PAI-1启动子全长控制的表达质粒,亚油酸诱导PAI-1转录活性显著增加,非诺贝特显著抑制其转录活性;转染PAI-1启动子序列核转录因子KB(NF-KB)反应元件缺失的质粒时,亚油酸和非诺贝特仍显著增加PAI-1转录活性;而转染PAI-1启动子序列极低密度脂蛋白(VLDL)／脂肪酸反应元件缺失的质粒时,亚油酸对PAI-1转录活性无诱导作用,非诺贝特可下调其转录活性。结论PPARα可能是亚油酸增强PAI-1表达所涉及的转录因子之一;非诺贝特下调PAI-1表达可能涉及对NF-κB信号转导途径的抑制作用。     

过氧化物酶体增殖物辅助激活因子1 α基因多态性对糖异生基因转录的影响

目的 研究过氧化物酶体增殖物辅助激活因子1α（PGC-1α）基因482号密码子甘氨酸-丝氨酸突变（Gly482Ser）多态性对糖异生关键基因磷酸烯醇式丙酮酸羧基酶（PEPCK）转录的影响.方法 （1）应用寡核苷酸诱导的定点突变和PCR技术构建PGC-1α 1444位点基因多态性表达质粒,并用普通PCR和酶切方法构建连接荧光素酶报告基因的人PEPCK启动子报告质粒PGL3-hPCK-luc.分别将PGC-1α基因482号密码子为甘氨酸的野生型表达质粒pcDNA3.1-PGC-1α（G）或482号密码子为丝氨酸的突变型表达质粒pcDNA3.1-PGC-1α（S）,与转录因子肝细胞核因子4α（HNF4α）表达质粒pcDNA3.0-HNF4α共转染进培养的人肝癌细胞及人正常肝细胞株.（2）转染48 h后检测细胞株内PGC-1α及PEPCK的mRNA水平及蛋白水平.进一步按不同组合联合转染PGL3-hPCK-luc及内参质粒PRL-SV40,培养48 h后用双荧光素酶检测试剂盒检测细胞荧光素酶的相对活性.多组间比较用单因素方差分析,2组组间比较用独立样本t检验.结果 成功构建PGC-1α 1444位点突变质粒及PGL3-hPCK-luc荧光素酶报告质粒.瞬时转染进HepG2细胞中,PGC-1α（G）与PGC-1α（S）质粒转染组PGC-1α mRNA及蛋白表达水平均明显增加,但2组间无明显差异（P＞0.05）;联合转染PGC-1α和HNF4α组的PEPCK的mRNA及蛋白表达水平较单转染PGC-1α明显增高（分别为10.40±0.70、4.50±0.50和0.86±0.18、0.99±0.09,均P＜0.05）;转染PGC-1α（G）＋HNF4α组较PGC-1α（S）＋HNF4α组PEPCK的mRNA及蛋白表达水平分别增高1.83倍和1.4倍（分别为10.40±0.70、5.35±0.23和4.50±0.50、3.00±0.40,均P＜0.05）.转染PGC-1α＋HNF4α组可显著促进PEPCK启动子活性（与单转染PGL3-hPCK-luc组比较）（分别为28.0±5.0和2.4±0.4,F=23.41,P＜0.05）;在HepG2中联合转染HNF4α时,PGC-1α（G）组较PGC-1α（S）可使PEPCK启动子相对活性增高2倍（分别为83±10和41±5,F=23.41,P＜0.001）;在L02细胞中联合转染HNF4α时,PGC-1α（G）组较PGC-1α（S）可使PEPCK启动子相对活性增高2.25倍（分别为28.0±5.0和12.6±1.5,F=60.75,P＜0.001）.结论PGC-1α可辅助激活HNF4α对PEPCK转录的促进作用,而PGC-1α基因Gly482 较Ser482对HNF4α的蛋白辅助激活作用更强,这可能为基因多态性引起蛋白表达后不同构型影响蛋白-蛋白相互作用有关.     

脂肪酸影响血管内皮细胞纤溶酶原激活物抑制剂-1表达的机制初探

目的 探讨脂肪酸影响血管内皮细胞纤溶酶原激活物抑制剂－1 机制。方法 以PAI－1启动子控制表达氯霉素转移乙酰酶（CAT）报告基因的重组质粒－PAI－pCAT转染人血管内皮细胞株ECV304，并且部分共转染不同量的过氧化增殖物激活型肥体（PPAR）α或PPARγ表达载体。分别以亚麻酸，亚油酸，油酸，硬脂酸诱导转染细胞，酶联免疫吸附CAT表达量显示启动子片面转录活性。结果 亚麻酸，亚油酸，油酸诱导以及增加PPARα表达可提高PAI－1启动子转录活性，硬脂酸诱导和增加PPARγ表达无影响。结论 不饱和脂肪酸可通过提高PAI－1转录活性诱导其在血管内皮细胞的表达，此作用涉及PPARγα对PAI-1基因转录的诱导调节。     

肿瘤坏死因子α对人脂联素3T3-L1细胞PPARγ2 mRNA表达的影响

目的探讨肿瘤坏死因子α（TNF-α）对稳定表达人脂联素3T3-L1细胞过氧化物酶体增殖物激活受体（PPAR）γ2 mRNA表达的影响，为进一步研究脂联素功能提供了实验基础。方法重组脂联素真核表达质粒（pcDNA3．1^＋-hADPN）脂质体法稳定转染3T3-L1细胞。用TNF-α（100ng／m1）处理未转染、转染空载载体、转染pcDNA3．1^＋-hADPN的3T3-L1细胞，RT-PCR检测PPARγ2 mRNA的表达量。结果（1）稳定转染了pcDNA3．1^＋-hADPN的未分化和已分化3T3-L1细胞中，PPARγ2表达量较未转染组明显增加（P〈0.01）。（2）TNF-α可明显抑制PPARγ2 mRNA的表达（P〈0.05）。（3）稳定转染pcDNA3．1^＋-hADPN可改善TNF-α抑制作用（P〈0.05）。结论稳定转染pcDNA3．1^＋-hADPN可明显增加未分化和已分化的3T3-L1细胞PPARγ2 mRNA表达。TNF-α抑制PPAR-γ2 mRNA表达，而转染pcDNA3．1^＋-hADPN可改善TNF-α抑制作用。     

约氏疟原虫环子孢子蛋白对TNF-α刺激人肝癌细胞株核转录因子活化的抑制作用

目的 观察约氏疟原虫环子孢子蛋白（CSP）对肿瘤坏死因子α（TNF-α）刺激人肝癌细胞株HepG2核转录因子-κB （NF-κB）活化的影响。 方法 以约氏疟原虫BY265株子孢子总RNA为模板,用RT-PCR扩增CSP基因的编码区序列并克隆至pFLAG-CMV8载体,构建重组质粒pFLAG-CMV8-CSP。以兔抗CSP多克隆抗体间接免疫荧光法观察pFLAG-CMV8-CSP能否在HepG2细胞中正确表达,及其在细胞中的分布。实验分为3组,A组（阴性对照组）为转染质粒pFLAG-CMV8的HepG2细胞,B组以100 ng/ml TNF-α刺激转染质粒pFLAG-CMV8的HepG2细胞,C组以100 ng/ml TNF-α刺激转染质粒pFLAG-CMV8-CSP的HepG2细胞。采用双荧光素酶试验和凝胶迁移试验（EMSA）检测NF-κB 的核转位及其活化,观察pFLAG-CMV8?鄄CSP对于TNF-α刺激HepG2细胞活化NF-κB是否具有抑制作用。 结果 　质粒pFLAG-CMV8-CSP主要在HepG2细胞胞浆中表达。 检测HepG2细胞浆中NF-κB活性,C组萤火虫荧光素酶活性与海肾荧光素酶活性比值为0.228±0.029,明显低于B组（0.571±0.030）和A组（0.438±0.085）（P＜0.05）。EMSA结果显示,C组的条带明显弱于B组。　结论 位于细胞浆中的疟原虫CSP蛋白通过抑制NF-κB核转位, 从而抑制TNF-α刺激HepG2细胞活化NF-κB。     

血管紧张素受体1阻断剂替米沙坦、厄贝沙坦具有激活PPARα的作用

目的 通过观察替米沙坦、厄贝沙坦对PPARa转录活性的影响以探讨其改善糖脂代谢的机制.方法 将构建的PPARa表达质粒、PPAR反应元件(PPRE)调控的荧光素酶表达质粒与pRL表达载体以脂质体(SuperFect)瞬时共转染COS-7细胞后,分别加入不同浓度的替米沙坦及厄贝沙坦,继续培养细胞不同时间,用双荧光索酶基因报告系统检测荧光素酶活性以反映PPARa转录活性.不同浓度的厄贝沙坦及替米沙坦孵育3T3-L1脂肪细胞,分别应用RT-PCR和Western印迹测定细胞的PPARα mRNA和蛋白表达水平.结果 (1)替米沙坦和厄贝沙坦均呈剂量和时间依赖性地增加COS-7细胞的PPARα转录活性,在60 h作用均达高峰,两者在100μmol/L浓度时PPRE调控的荧光素酶活性较对照组增高3.8倍和2.6倍(均P<0.01);(2)替米沙坦及厄贝沙坦激活PPARα的作用不能被PPARγ脚特异性抑制剂GW9662抑制;(3)替米沙坦和厄贝沙坦呈剂量依赖性增加3T3-L1脂肪细胞PPARα mRNA和蛋白表达水平.结论 血管紧张素受体阻断剂替米沙坦和厄贝沙坦增加PPARα转录活性,可能通过此途径改善糖脂代谢.     

丙型肝炎病毒1b基因型核心蛋白对HepG2细胞Bax与Bcl-2基因表达的影响

目的研究丙型肝炎病毒（HCV）1b基因型核心蛋白（C）对HepG2细胞B细胞淋巴瘤-2基因（Bcl-2）与Bcl-2相关X蛋白（Bax）表达的影响,以探索1b型HCV C蛋白与HepG2细胞凋亡的关系。方法利用RT-PCR扩增出HCV-1b-C基因,经双酶切后连接pcDNA3.1（-）,成功构建真核表达载体pcDNA3.1（-）/HCV-1b-C。利用脂质体转染HepG2细胞,RT-PCR及Western Blot检测其mRNA及蛋白的表达,RT-PCR及Western Blot检测转染成功后HCV-1b-C对HepG2细胞Bax与Bcl-2表达的影响,并设转染空质粒组及未处理组作对照。结果成功构建真核表达载体pcDNA3.1（-）/HCV-1b-C;瞬时转染HepG2细胞,成功表达HCV C mRNA及蛋白;转染C基因组的Bax的mRNA及蛋白相对表达量减少,与转染空质粒组及未处理组比较差异均有统计学意义（P〈0.01）;转染C基因组的Bcl-2的mRNA及蛋白相对表达量增多,与转染空质粒组及未处理组比较差异均有统计学意义（P〈0.01）。结论 1b基因型HCV C蛋白转染HepG2细胞会导致Bax表达减少及Bcl-2表达增多,降低Bax/Bcl-2比值,可能是抑制HepG2细胞凋亡的机制之一。     

胰岛素通过激活P13K／mTOR通路诱导人肾小球系膜细胞血管内皮细胞生长因子转录

目的探讨胰岛素诱导人肾小球系膜细胞（HMC）血管内皮细胞生长因子（VEGF）基因转录机制。方法（1）用VEGF报告质粒或低氧诱导因子1（HIF-1）结合位点畸变的VEGF mut报告质粒转染HMC,荧光素酶分析法检测其转录活性;（2）应用Real—time PCR、Western blot法分别检测HIF-1α mRNA和蛋白表达。结果（1）胰岛素呈剂量依赖性增加VEGF基因转录,在100nmol／L时达高峰,为未刺激组的2．14±0．17倍（P〈0．01）,但对转染VEGF mut报告质粒的HMC VEGF基因转录无影响;（2）Ly294002和雷帕霉素均可抑制胰岛素诱导的VEGF基因转录（P〈0．01）;（3）胰岛素呈时间依赖性上凋HIF-1α蛋白表达,4h达高峰,为对照组的2．35±0．35倍（P〈0．01）,但对其mRNA表达无影响。结论胰岛素通过激活P13K／mTOR通路和上调HIF-1α蛋白表达诱导HMC VEGF基因转录。     

HIF-1α对乳腺癌MCF-7细胞增殖的影响及其机制探讨

目的 观察缺氧诱导因子1α（HIF-1α）基因对乳腺癌MCF-7细胞增殖的影响,并探讨其可能的机制.方法 构建并筛选HIF-1 α基因的RNAi表达质粒,以脂质体LipofectamineTM 2000介导转染MCF-7细胞.转染后48h,采用实时定量RT-PCR技术检测转染细胞中HIF-1α mRNA的转录水平,筛选有效的HIF-1 αRNAi质粒;CCK-8法比较转染前后乳腺癌细胞增殖变化,实时定量RT-PCR检测顺滑蛋白（SMO）mRNA表达.结果 成功构建含HIF-1α短发夹状RNA（shRNA）1～4的RNAi表达质粒,其中HIF-1 αshRNA-4干扰抑制效率为74％,干扰效果最强（P均＜0.05）.HIF-1 αshRNA-4干扰48、72、96 h后,MCF-7细胞的生长抑制率明显升高（P均＜0.05）.HIF-1αshRNA-4转染后MCF-7细胞SMO mRNA的相对表达量为0.56 ±0.06,低于转染前的1.07 ±0.16（P ＜0.05）.结论 HIF-1α表达可促进乳腺癌细胞增殖,可能与其参与调控SMO的表达有关.     

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。     

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。     

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。     

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.