真实世界中不同ALT、AST水平慢性丙型肝炎患者对直接抗病毒药物治疗的病毒学应答及肝纤维化指标变化情况

目的探讨真实世界中不同ALT、AST水平的慢性丙型肝炎患者对直接抗病毒药物(DAA)治疗的病毒学应答,以及治疗后肝硬度测定(LSM)值、4项因素的肝纤维化指数(FIB-4)和AST/PLT比值指数(APRI)的变化情况。方法纳入2017年12月—2020年5月在北京大学第一医院感染疾病科门诊就诊的慢性丙型肝炎患者,计算患者治疗病毒学应答率。采用Wilcoxon秩和检验对比不同组间基线及治疗结束第12周LSM、FIB-4和APRI的变化;计数资料组间比较采用χ2检验。结果共纳入48例慢性丙型肝炎患者,其中基线ALT或AST出现异常的患者为33.3%。所有患者DAA治疗第4周病毒学应答率为85.4%,治疗结束时、治疗结束12、24、48周均为100%;治疗结束第12周较基线LSM[6.1(5.1~12.4)kPa vs 8.6(5.7~16.9)kPa,Z=-1.676,P=0.043]、APRI[0.24(0.19~0.48)vs 0.42(0.23~1.17),Z=-2.050,P=0.027]差异有统计学意义。ALT或AST异常的患者治疗结束12周与基线LSM[8.9(5.6~13.1)kPa vs 14.4(8.0~28.2)kPa,Z=-1.679,P=0.047]、APRI[0.44(0.25~0.50)vs 1.29(0.99~2.09),Z=-3.427,P=0.001]差异有统计学意义。结论慢性丙型肝炎患者DAA治疗后持续病毒学应答率高,基线ALT或AST有异常较无异常的患者在治疗后LSM及APRI改善更明显。     

直接作用抗病毒药物治疗丙型肝炎肝硬化和肝移植术后丙型肝炎复发的初步临床观察

目的观察直接作用抗病毒药物(direct-acting antiviral agents,DAAs)治疗丙型肝炎(丙肝)肝硬化和肝移植术后丙肝复发的安全性和临床效果。方法入组丙肝肝硬化7例(5例失代偿)和肝移植术后丙肝复发7例(移植后时间6~44个月,中位时间17个月),年龄26~69岁(中位年龄55岁),HCV RNA分型均为基因1b型,HCV RNA载量为6.90×104~4.34×107IU/ml。DAAs治疗方案为索菲布韦(sofosbuvir)+息米普韦(simeprevir)(3例)和harvoni(sofosbuvir+ledipasvir)(11例),疗程12周。治疗过程中观察HCV RNA、肝功能、安全性指标及不良反应。结果除1例肝移植术后患者4周时HCV RNA为5.60×10 IU/ml,其余患者均获快速病毒学应答,HCV RNA最快5 d低于检测值下限。所有患者均获得治疗结束时病毒学应答和持续病毒学应答,ALT和AST下降,ALB水平升高。移植术后患者他克莫司血药浓度未见明显变化。不良反应轻,主要为头痛(1例)、乏力(2例)和关节痛(1例)。结论 DAAs治疗丙肝肝硬化和肝移植术后丙肝复发安全性好,疗效肯定。对失代偿期丙肝肝硬化的远期疗效待观察。     

直接抗病毒药物治疗HIV/HCV合并感染患者长期疗效及肝纤维化改变

目的:探讨人类免疫缺陷病毒（HIV）/丙型肝炎病毒（HCV）合并感染患者接受直接抗病毒药物（DAAs）治疗后病毒学、免疫学及肝纤维化指标长期变化特征。方法:以2014年5月至2019年12月广州医科大学附属市八医院HIV/HCV合并感染患者为研究对象,观察DAAs结束治疗后144周随访期间病毒学应答率、外周血CD4 ...     

维持性血液透析合并丙型肝炎病毒感染患者随访研究

目的 :观察维持性血液透析(maintenance hemodialysis,MHD)合并丙型肝炎病毒(hepatitis C virus,HCV感染者的自然病程特点,了解患者生存和治疗情况。方法:收集我院及上海交通大学医学院附属第九人民医院北院2016年1月起所有MHD患者446例,随访2年。收集患者血常规、肝功能、肾功能、HCV抗体、HCV RNA等指标,计算天冬氨酸转氨酶(aspartate aminotransferase,AST)和血小板(platelet,PLT)比例指数(APRI)及基于4因子的纤维化(four-factor-based fibrosis,FIB-4)指数,比较随访初期和随访末期指标变化。检测患者HCV基因型,记录患者自行开展的直接抗病毒药物(direct-acting antiviral agents,DAA)治疗情况,并统计所有患者死亡情况。结果:446例患者初次筛查抗HCV阳性患者43例(9.6%),HCV RNA阳性患者31例(7.0%),随访期间无HCV RNA阳转。31例HCV RNA阳性患者为HCV感染者,其中1例未及检测基因型即死亡,其余30例患者HCV基因1b型27例(90.0%),2a型3例(10.0%)。6例患者自行购买和服用DAA,治疗方案均为基于索磷布韦(sofosbuvir,SOF)的抗病毒方案,疗程均为12周,治疗结束时HCV RNA均转阴,平均随访(12.5±3.4)个月后,6例患者HCV RNA仍为阴性。24个月随访期间,HCV RNA阴性组患者死亡50例,HCV RNA阳性组死亡3例,差异无统计学意义。在HCV RNA阳性组中,DAA治疗组治疗前后各项随访指标差异均无统计学意义;DAA未治疗组在随访期间血白细胞由(4.94±1.20)×109/L至(4.31±1.39)×109/L,FIB-4指数由(2.17±1.34)分增至(2.69±2.00)分,差异均有统计学意义(均P0.05)。结论:MHD患者是HCV感染高发区,1b型和2a型是MHD合并HCV感染患者中最主要的HCV病毒基因型。随访期间未接受DAA治疗者肝纤维化指标有显著进展,治疗组无显著差异。     

直接作用抗病毒药物治疗丙型肝炎病毒感染相关肝脏疾病的疗效分析

全世界目前约有3%的人群感染丙型肝炎病毒(HCV),每年因丙型肝炎肝硬化及肝细胞癌(HCC)死亡的患者可达35万。20世纪80年代治疗丙型肝炎的药物主要为干扰素,但其不良反应多、耐受性差,且仅有6%的病毒学应答率。近年来直接作用抗病毒药物(DAA)的应用大大提高了HCV相关肝脏疾病的疗效,有效率可达80%~90%。该文主要对DAA治疗HCV相关肝硬化及肝移植后病毒复发患者的疗效作一综述。     

直接抗病毒药物治疗慢性丙型肝炎的效果及对肝硬度、APRI的影响

目的探讨目前直接抗病毒药物(DAA)治疗方案下,慢性丙型肝炎患者真实世界病毒应答情况及对肝硬度值和天门冬氨酸/血小板比值指数(APRI)的影响。方法连续性纳入2018年4月1日-2018年11月30日在天津市第三中心医院接受DAA治疗的慢性丙型肝炎患者,应用无干扰素方案的DAA治疗12～24周,评估治疗结束后第12周病毒学应答情况,对比基线及治疗结束后12周肝硬度值和APRI的变化。计量资料两组间比较采用Wilcoxon秩和检验。结果共纳入212例慢性丙型肝炎患者,其中肝硬化患者占35. 4%,基因1b、2a、3a、6a型分别占75. 0%、18. 4%、4. 2%及2. 4%。174例患者完成了DAA治疗疗程及治疗后12周随访。在DAA治疗结束和治疗结束后12周获得持续病毒学应答(SVR)的比例分别为98. 3%及95. 4%。基因1b型、2a型、3a型及6a型患者的SVR12分别为96. 3%、93. 1%、80. 0%及100%。治疗结束后12周肝硬度值较基线[9. 8(6. 9～16. 3) kPa vs 11. 4(7. 7～19. 1) kPa,Z=-2. 5,P=0. 012]及APRI[0. 34(0. 25～0. 64) vs 0. 76(0. 56～2. 25),Z=-6. 6,P 0. 001]均明显下降。根据基线是否存在肝硬化进行分组,结果显示治疗结束12周非肝硬化组患者肝硬度值较基线显著降低[7. 6(6. 6～10. 7) k Pa vs 8. 8(7. 2～13. 0) kPa,Z=-2. 7,P=0. 007];而肝硬化组患者治疗前后肝硬度值无明显差异[17. 4(12. 7～22. 1) k Pa vs 19. 8(12. 8～24. 9) kPa,Z=-1. 4,P=0. 152]。肝硬化组和非肝硬化组患者APRI在治疗后12周较基线均明显下降[0. 73 (0. 52～1. 34) vs1. 37(0. 80～2. 11),Z=-3. 4,P 0. 001; 0. 29(0. 21～0. 36) vs 0. 54(0. 31～0. 95),Z=-6. 8,P 0. 001]。结论在该真实世界研究中,应用DAA治疗的慢性丙型肝炎患者总体病毒学应答率较高,治疗结束后12周肝硬度及APRI明显改善。     

直接抗病毒药物治疗慢性丙型肝炎48周临床观察

背景慢性丙型肝炎(chronic hepatitis C,CHC)是全球公共卫生问题,随着直接抗病毒药(direct antiviral therapy,DAA)在中国的应用,DAA药物成为目前国内慢性丙型肝炎抗病毒一线方案,但目前真实世界DAA治疗后长期疗效数据尚少.目的观察慢性丙型肝炎患者接受直接抗病毒药物抗病毒治疗后48 wk病毒学应答及临床疗效.方法连续收集2018-04-01/2020-04-30在天津市第三中心医院接受DAA治疗的初治CHC患者,评估治疗基线、治疗结束、治疗后12 wk及48 wk的病毒学应答及肝肾功能、肝硬度、APRI及临床结局.结果共收集291例应用DAA治疗的CHC患者,纳入145例完成抗病毒治疗及随访的CHC患者进入本研究.其中肝硬化患者占28.3%,基因型1b、2a、3a、6a分别占78.0%、17.2%、2.8%、2.0%.DAA治疗结束、治疗后12 wk及48 wk获得持续病毒学应答(sustained virological response,SVR)比例分别为100%、97.9%和97.2%,其中基因型1b、2a、3a、6a的SVR48分别为97.3%、96%、100%、100%.治疗结束后48 wk与基线相比较,丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素及白蛋白的复常率分别为93.2%、91.7%、73.3%及97.7%.治疗结束后48 wk肝硬度(liver stiffness measurement,LSM)及APRI与基线水平相比均明显下降(LSM 12.5 vs 10.2kpa P<0.01;APRI 0.34 vs 0.13 P<0.01),肝硬化组及非肝硬化组患者均有明显下降(P<0.05).48 wk随访期间,其中4例(2.8%)CHC患者进展为肝硬化,8例(5.6%)肝硬化患者进展为肝硬化失代偿,3例(2.1%)肝硬化患者发生新发肝细胞癌(hepatocellular carcinoma,HCC).结论本研究真实世界中慢性丙型肝炎患者应用DAA治疗后48 wk,总体病毒持续应答率较高,肝功能、肝硬度及APRI值均明显改善.2.1%患者出现新发HCC.     

肝移植术后丙型肝炎复发患者抗病毒治疗效果及其对肝纤维化的影响

目的通过对肝移植术后丙型肝炎复发患者进行抗病毒治疗,研究抗病毒治疗效果以及对肝纤维化进展的影响。方法对本院2005年6月至2012年12月收治的23例肝移植术后丙型肝炎复发患者进行干扰素联合利巴韦林抗病毒治疗,观察病毒学应答情况、不良反应以及治疗前后肝组织病理情况。计数资料以例数表示,不同抗病毒疗效组间肝纤维化情况比较采用等级资料秩和检验。结果 12例患者因不良反应终止治疗。23例患者共获得结束时病毒学应答(ETVR)18例,其中6例获得持续病毒学应答(SVR),12例出现反跳。19例患者完成前后肝组织病理检查,SVR组肝纤维化减轻3例、持平1例、进展0例;停药后反跳组肝纤维化减轻2例、持平3例、进展5例;无应答组肝纤维化减轻0例、持平1例、进展4例;3组间抗纤维化效果比较,差异有统计学意义(χ2=7.330,P=0.026)。结论肝移植术后丙型肝炎复发患者抗病毒治疗SVR率较低,有效的抗病毒治疗可延缓肝纤维化进展,取得SVR的患者肝纤维化改善效果最佳。     

慢性HCV感染DAA应答特点和长期预后观察研究

目的 本研究旨在观察不同疾病进展阶段的HCV感染者直接抗病毒药物(direct-acting antiviral agents,DAA)治疗的应答特点和长期预后.方法 纳入2016年7月—2017年3月就诊于我中心的慢性HCV感染者127例,其中慢性丙型肝炎(chronic hepatitis C,CHC)患者85例,代偿期肝硬化(compensated-liver cirrhosis,CLC)患者32例,失代偿期肝硬化(decompensated-liver cirrhosis,DLC)患者10例.DAA治疗12或24周.比较3组患者HCV RNA转阴时间、停药后12周持续病毒学应答(sustained virologic response 12,SVR12)率以及停药后2年的转归情况.结果 所有CHC、CLC、DLC患者均完成DAA治疗.CHC、CLC和DLC患者的SVR12率分别为98.82％(84/85)、96.88％(31/32)和100％(10/10);CHC患者HCV RNA转阴时间明显早于CLC和DLC患者(P均<0.05).在2年随访期间,1例CLC患者发生病毒学复发,2例DLC患者分别出现肝功能恶化和肝细胞癌.结论 目前常用的DAA治疗方案对CHC、CLC和DLC的患者均有高效的抑制病毒复制的作用,并且SVR12率在96％～100％之间,有很高治愈率.对于肝硬化患者停药后仍须监测肝癌的发生或个别病例HCV复发等情况.     

丙型肝炎肝硬化抗病毒治疗现状

目前干扰素联合利巴韦林是慢性HCV感染的主要抗病毒治疗方案,但丙型肝炎肝硬化患者对于抗病毒治疗耐受性差.目前研究报道对于丙型肝炎肝硬化患者进行抗病毒治疗,如能获得持续病毒学应答(SVR),有利于缓解肝纤维化进展,并减少肝移植术后HCV再感染的发生.因此,应对丙型肝炎肝硬化患者进行仔细评估,对于进行抗病毒治疗的患者可给予适当干预以维持抗病毒治疗的进行,并在治疗过程中密切监测不良反应的发生.     

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.