三氧化二砷协同肿瘤坏死因子相关细胞凋亡诱导配体抗胃癌细胞的作用及其机制

目的研究三氧化二砷（As2O3）联合肿瘤坏死因子相关细胞凋亡诱导配体（TRAIL）对胃癌细胞生长和凋亡的影响及其机制。方法人胃腺癌细胞株SGC7901以As2O3、rsTRAIL及两者联用处理；用MTT法检测细胞生长；用双染色流式细胞仪检测细胞凋亡；用间接免疫荧光染色结合流式细胞技术检测细胞表面TRAIL R1／DR4和TRAIL R2／DR5分子表达；RT—PCR方法检测TRAIL R1／DR4和TRAIL R2／DR5 mRNA表达。结果As2O3和rsTRAIL在单用或联用时均可以抑制胃癌细胞SGC7901生长，并在一定范围内呈时间、剂量依赖性；联合用药组抑制率显著高于单用As2O3或rsTRAIL组（P〈0．01），金正均方法分析提示两药联用有协同抑制细胞生长效应。As2O3和rsTRAIL在单用或联用时均可以诱导胃癌细胞SGC7901凋亡，联合用药组细胞凋亡率显著高于单用As2O3或rsTRAIL组（P〈0．01）。As2O3单独或联合rsTRAIL作用于SGC7901细胞24h后，死亡受体TRAIL R1／DR4和TRAIL R2／DR5在细胞表面的表达明显上调（P〈0．01），其mRNA表达水平亦相应增加（P〈0．01）。结论As2O3联合rsTRAIL可以协同抑制胃癌细胞SGC7901生长并显著增强两药诱导胃癌细胞凋亡的作用，其机制可能是As2O3增加细胞TRAIL R1／DR4和TRAIL R2／DR5 mRNA表达、上调细胞表面TRAIL死亡受体从而增加胃癌细胞SGC7901对rsTRAIL的敏感性。     

紫杉醇对TRAIL诱导胃癌SGC7901细胞凋亡的影响

目的探讨紫杉醇对TRAIL诱导的胃癌SGC7901细胞凋亡的影响。方法采用MTT法测定细胞活力、采用流式细胞仪检测细胞凋亡、Western blot检测蛋白表达。结果在胃癌SGC7901细胞中,100 ng/ml的TRAIL导致轻度的增殖抑制和细胞凋亡,TRAIL（100 ng/ml）联合紫杉醇（7.19μg/ml,24 h的IC50剂量）引起明显的细胞增殖抑制和诱导凋亡作用（P〈0.05）。TRAIL单药没有改变死亡受体5（DR5）的蛋白表达,而7.19μg/ml紫杉醇作用于胃癌SGC7901细胞后明显上调了DR5的蛋白表达。TRAIL和紫杉醇联合作用后,也有DR5蛋白的明显上调。结论紫杉醇通过上调DR5的蛋白表达增强了TRAIL诱导的胃癌SGC7901细胞凋亡。     

肿瘤坏死因子相关凋亡诱导配体诱导胃癌细胞凋亡机制的研究

背景：肿瘤坏死因子相关凋亡诱导配体（TRAIL）可诱导不同胃癌细胞株的凋亡，但凋亡的途径尚不清楚。目的：通过研究TRAIL诱导胃癌细胞凋亡的作用机制，为TRAIL的临床应用提供理论依据。方法：应用逆转录聚合酶链反应（RT—PCR）法检测SGC-7901胃癌细胞TRAIL受体（TRAILR），包括死亡受体TRAILR1、TRAILR2和诱惑受体TRAILR3、TRAILR4的表达；应用免疫组化法检测SGC-7901胃癌细胞Bcl-2和caspase-3的表达．并观察两者在不同浓度（50ng／ml和500ng／ml）的TRAIL处理后的变化。结果：SGC-7901胃癌细胞仅表达TRAILR1和TRAILR2，不表达TRAILR3、TRAILR4。TRAIL可引起SGC-7901胃癌细胞Bcl-2阳性表达，不同浓度的TRAIL作用12h、24h、48h其表达无影响；与对照组比较，不同浓度的TRAIL作用24h后SGC-7901胃癌细胞caspase-3表达均有显著增加（P〈0．01）。结论：TRAIL诱导胃癌细胞凋亡是因胃癌细胞仅表达TRAILR1、TRAILR2，不表达TRAILR3、TRAILR4。TRAIL是通过TRAILR1、TRAILR2增加细胞内caspase-3的表达而导致胃癌细胞凋亡，其诱导胃癌细胞凋亡的作用不受Bcl-2的影响。     

凋亡相关蛋白在胃癌细胞凋亡中的作用研究

目的　研究核转录因子 (NF) κB、生存素 (survivin)、Bcl 2和Caspase3在肿瘤坏死因子相关凋亡诱导配体 (TRAIL)诱导的胃癌细胞凋亡中的作用。方法　应用细胞培养和流式细胞仪检测的方法 ,观察胃癌细胞SGC 790 1、MKN2 8、AGS、MKN45经TRAIL作用后的细胞凋亡率 ,Westernblot方法分析 4种胃癌细胞中NF κB、生存素、Bcl 2和Caspase3的表达。结果　TRAIL 50ng/ml作用于胃癌细胞 2 4h后 ,MKN2 8、MKN 45、AGS和SGC 790 1细胞的凋亡率分别为 2 4.0 5% ,7.83 % ,8.0 5%和3 .17%。TRAIL 3 0 0ng/ml作用于胃癌细胞 2 4h后 ,MKN2 8、MKN 45、AGS和SGC 790 1细胞的凋亡率分别为 3 6.0 5% ,2 0 .2 7% ,16.50 %和 11.80 %。Westernblot结果显示 ,SGC 790 1细胞NF κB、生存素的表达高于MKN2 8细胞 (P <0 .0 5) ,与Bcl 2的表达无明显差异。MKN2 8细胞Caspase3的表达高于SGC 790 1细胞 (P <0 .0 5)。结论　TRAIL具有选择性诱导肿瘤细胞凋亡的特性 ,肿瘤细胞对TRAIL的耐药现象可能与凋亡抑制因子生存素和NF κB的表达增强以及Caspase3 的表达抑制有关     

食管癌、胃癌细胞对氧化砷促凋亡的敏感性与固有活性氧水平有关

目的 探讨食管癌，胃癌细胞的固有活性氧（reactive oxygen species,ROS)水平与细胞对三氧化二砷（As2O3)促凋亡敏感性之间的关系。方法 用小剂量（2μmol/L)As2O3作用于人胃癌细胞和食管癌细胞株各一对（SGC7901、MKN45和EC/CUHK1、EC1867），证实As2O3促凋亡敏感性在SGC7901和MKN45之间及EC/CUHK1和EC1867之间均有差异。然后在不加As2O3的情况下，用活性氧捕获剂双氢罗丹明123（DHR123）卵育细胞（DHR123在细胞内被ROS氧化为发出荧光的罗丹明123），通过流式细胞仪检测细胞内罗丹明123的荧光而测得细胞内固有ROS水平。结果 对As2O3敏感的SGC7901细胞的固有活性氧水平比As2O3不敏感的MKN45细胞高，对As2O3敏感的EC/CUHK1细胞的固有活性氧水平比As2O3不敏感的EC1867细胞高。结论 食管癌，胃癌细胞固有ROS水平的差异与细胞对As2O3诱导凋亡的敏感性差异有关。     

三氧化二砷诱导胃癌细胞凋亡及其对C-myc和TGF-β1表达的影响

目的 探讨三氧化二砷（As2O3）对体外培养的人胃癌细胞SGC-7901生长的抑制和诱导细胞凋亡的作用。方法 用MTT法检测药物效应，透射电镜及流式细胞仪观察As2O3处理SGC-7901细胞后细胞周期细胞凋亡。细胞免疫化学观察As2O3处理后SGC-7901细胞TGF-β1及C-myc表达的变化。结果 ①MTT法证实As2O3对SGC-7901细胞生长有抑制作用，并呈剂量．效应关系。②流式细胞仪分析As2O3处理SGC-7901细胞后细胞滞留于G2／M期，并可见凋亡峰。③透射电镜可见SGC-7901细胞出现典型的细胞凋亡及坏死形态学改变。④As2O3导致C—myc表达的波动，下调TGF-β1，表达。结论As203对人胃癌细胞SGC-7901有抑制作用，其抑制作用可能通过导致C—myc基因表达波动，诱导胃癌细胞凋亡和坏死、阻抑细胞周期进程，抑制SGC-7901细胞增殖。同时通过下调TGF-β1表达阻止胃癌的恶性进程。     

As2O3对TRAIL抑制人肺癌A549细胞增殖及调节DR4 mRNA、DR5 mRNA表达作用的影响

目的观察三氧化二砷（As2O3）对人肿瘤坏死因子相关凋亡诱导配体（TRAIL）抑制人肺癌A549细胞增殖作用的影响及机制。方法体外培养A549细胞至对数生长期后随机分为As2O3组、TRAIL组、联合组及对照组,As2O3组分别加入1、10μmol／LAs2O3,TRAIL组加入100μg／LTRAIL,联合组分别加入1μmol／LAs2O3＋100μg/LTRAIL、10μmol／LAs2O3＋100μg／LTRAIL,对照组加入DMEM培养液。四组均继续培养24、48、72h,采用四甲基偶氮唑蓝（MTT）比色法检测细胞生长情况,计算细胞增殖抑制率（IR）;用RT-PCR法检测死亡受体4（DR4）mRNA、死亡受体5（DR5）mRNA表达变化。结果 联合组IR显著高于As2O3,组及TRAIL组,尤以作用48h和72h为著（P均〈0．05）;联合组DR4 mRNA和DR5 mRNA表达均明显强于As2O3组及TRAIL组（P均〈0.05）。结论 As2O3,可增强TRAIL对A549细胞增殖的抑制作用,机制可能为上调DR4m RNA和DR5 mRNA表达;此为肺癌的临床靶向治疗根供了依据．     

As2O3与Aspirin联合应用对人胃癌SGC-7901细胞凋亡的影响

目的:观察As2O3与Aspirin联合应用对人胃癌SGC-7901细胞凋亡的影响并探讨其可能机制.方法:As2O3和Aspirin处理SGC-7901细胞,实验分为:阴性对照组、2 mmol/L Aspirin组、1 mmol/L Aspirin组、4 pmoI/L As2O3组、2μmol/L As2O3组和2 Bmol/L As2O3组 1 mmol/LAspirin组,流式细胞术检测As2O3和Aspirin单独及联合应用对SGC-7901细胞凋亡的作用,免疫细胞化学法检测Bcl-2和Bax蛋白的表达.结果:2 μmol/L As2O3 1 mmol/L Aspirin联合应用组与4 μmol/L As2O3组、2 mmol/L Aspirin 组SGC-7901细胞在细胞周期G1期前均出现明显的亚二倍体凋亡峰,差异无明显统计学意义,与阴性对照组细胞、2 μmol/L As2O3及1 mmol/L Aspirin单药组相比,差异均有统计学意义(均P＜0.05).As2O3与Aspirin联合应用组使Bcl-2表达下降,Bax表达增高,与阴性对照组、2 μmol/L As2O3及1 mmol/L Aspirin单药组相比,差异均具统计学意义(50.21%±5.94% VS 91.65%±11.51%,88.66%±10.53%,89.27%±9.84%;40.72%±9.54% VS 21.03%±4.32%,23.07%±6.23%,22.67%±3.1 6%,均P＜0.05).结论:As2O3和Aspirin可能通过改变Bcl-2和Bax表达诱导SGC-7901细胞凋亡,两者联合应用具有协同作用.     

奥曲肽联合汉防己甲素对人胃癌细胞增殖的影响

目的:观察奥曲肽、汉防己甲素单独及联合应用对体外培养人胃癌细胞株增殖的影响,并初步探讨其可能的作用机制．方法:以MTT比色法观察奥曲肽(善宁)、汉防己甲素 (Tet)单独及联合应用对体外培养人胃癌细胞株SGC 7901和MKN 45增殖的影响,并用Fura-2／AM荧光标记法测定了其对胃癌细胞内游Ca2 浓度的影响．结果:2．4×10-5 mol／L、2．4×10-6 mol／L高浓度奥曲肽、10-160 μmol／L浓度范围的Tet对体外培养人胃癌细胞株SGC 7901和MKN 45均有显著的抑制作用,其增殖抑制率(IR)分别为,对SGC 7901:40．76％、 23．2％和30．5-70．0％;对MKN 45:24．9％、21．7％和 20．4-79．01％(P<0．05或P<0．01);奥曲肽2．4×10-6、2．4 ×10-9、2．4×10-12 mol／L分别与Tet 10 μmol／L联合应用,可将其对SGC7901和MKN 45的IR分别由32．8％和 27．0％提高至50．5％和60．3％、55．0％和47．7％、67．8％和63．0％(vs Tet组P<0．05或P<0．01)．10 μmol／L Tet作用于SGC 7901和MKN 45,其细胞内游离Ca2 浓度较对照组显著降低(394．2±18．4 nmol／L vs 505．0±15．8 nmol／L, 412．1±20．8 nmol／L vs 512．0±16．0 nmol／L,P<0．01);2．4 ×10-6 mol／L奥曲肽亦可显著降低胃癌细胞内的钙离子浓度(SGC 7901 450．8±20．1 nmol／L,P<0．01;MKN45 413．1±10．4 nmol／L,P<0．01)．但奥曲肽联合Tet并不能进一步降低胃癌细胞内钙离子浓度．结论:Tet对体外培养人胃癌细胞有剂量依赖性的抑制作用,其机制可能是通过降低细胞内游离Ca2 浓度发挥其抗增殖作用．高浓度奥曲肽的抗增殖作用亦可能与其抗钙作用有关;各浓度奥曲肽可显著提高小剂量 Tet对胃癌细胞的抑制作用,但与其抗钙作用无关．     

肿瘤坏死因子相关配体与阿司匹林合用对肝癌SMMC-7721细胞凋亡的影响

目的 观察肿瘤坏死因子相关的凋亡诱导配体(TRAIL)与阿司匹林合用对肝癌SMMC-772l细胞的作用。方法 氨甲喋呤法检测SMMC-772l细胞存活分数；流式细胞仪检测SMMC-772l细胞的凋亡率和细胞周期；WesternBlot法检测凋亡相关基因的表达。结果 单用300ng／ml TRAIL、3、10mmol／L阿司匹林SMMC-772l细胞存活分数分别为82．76％、81．34％和71．29％，合用的存活分数分别为43．5％、37．8％。3、l0mmol／L阿司匹林与300ng／ml TRAIL合用诱导的细胞凋亡率明显大于单用两药诱导的细胞凋亡率之和(单用300ng／ml TRAIL、3mmol／L和10mmol／L阿司匹林凋亡率分别为21．25％、1．89％和6．08％，合用的凋亡率分别34．76％，38．56％)并使G0/Gl期细胞增加l3、10mmol／L的阿司匹林使SMMC-772l细胞Bcl-2的表达明显减弱，但对Bax的表达无影响。结论 TRAlL与阿司匹林合用对肝癌SMMC-772l细胞有明显的协同杀伤作用，其机制可能与阿司匹林抑制Bcl-2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.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。