脓毒症患者出现肺损伤与微量白蛋白尿的相关性研究

目的探讨脓毒症患者出现肺损伤与微量白蛋白尿的相关性。方法研究98例脓毒症患者并于6 h内检测和计算其体内的尿白蛋白肌酐比值(urinealbumin ereatinine ratio.UACR)、肺血管通透性指数(Pulmonary vascular permeability index,PVPI);使用Picc0(pulse indicated cardiac output,Pi CC0)系统监测血管外肺水指数(Extravascular lung water index,EVLWI)和PVPI。(1)根据EVLWI是否增高,把患者分为EVLWI正常组与增高组,分别比较PVPI、氧合指数(oxygenation index,0I)和UACR的差异;(2)另外,根据是否需要机械通气把患者分为机械通气组和非机械通气组,分别比较EVLWI、PVPI和UACR之间的差异。(3)分析UACR与EVLWI、PVPI和0I的相关性。结果增高组的UACR(t=4.690,P0.001)、PVPI(t=26.512,P0.001)均高于正常组,OI(t=5.397,P0.001)低于正常组,而且他们差异均有统计学意义(P0.05)。其中UACR与EVLWI(r=0.809,t=14.48,P0.001)、PVPI(r=0.901,t=20.35,P0.001)呈现正相关的关系,但是与OI(r=-0.663,t=8.68,P0.001)呈现负相关的关系(P0.05)。需要机械通气患者的EVLWI(t=7.114,P0.001)、PVPI(t=15.378,P0.001)、UACR(t=5.018,P0.001)均高于非机械通气患者,并且差异均有统计学意义(P0.05)。结论对于部分脓毒症患者,可用尿白蛋白肌酐比值来预测肺水肿的形成和评估肺损伤的严重程度。     

脓毒症患者N-末端B型利钠肽原与连续心排血量监测指标及预后的相关性

目的探究脓毒症患者N-末端B型利钠肽(NT-pro BNP)以及脉搏指数连续心排血量(Pi COO)监测指标与预后的相关性。方法选择脓毒症患者113例。经过1个月的治疗74例存活,39例死亡。对比存活组与死亡组患者临床资料以及不同阶段NT-pro BNP水平、治疗前的Pi CCO各指标,最后进行相关性分析。结果存活组APACHEⅡ评分显著低于死亡组,并且出现严重感染以及并发症的患者比例也显著低于死亡组;两组在第1天NT-pro BNP水平比较无差异,存活组在第3、5、7天NT-pro BNP水平均显著低于死亡组;两组胸腔内血容量指数(ITBVI)、体外循环阻力指数(SVRI)无显著差异,但存活组心脏指数(CI)高于死亡组,而血管外肺水指数(EVLWI)、肺毛细血管通透性指数(PVPI)低于死亡组(均P<0.05)。通过相关性分析得到:NT-pro BNP、EVLWI、PVPI与死亡率存在明显正相关(r=0.741,P=0.000;r=0.731,P=0.000;r=0.814,P=0.000),CI与死亡率存在明显负相关(r=-0.261,P=0.000)。结论脓毒症患者血浆中NT-pro BNP水平随着病情加重而逐渐升高,结合APACHEⅡ评分两者越高预后越差。Pi COO监测指标也与预后存在显著相关性,对临床治疗及预后评估具有非常高的指导价值。     

C反应蛋白、白蛋白比值与多评分系统对脓毒症严重程度和预后的评估价值比较

目的:分析C反应蛋白(CRP)、白蛋白(ALB)比值与多评分系统对脓毒症严重程度和预后的评估价值。方法:选取脓毒症患者117例,根据脓毒症严重程度分为脓毒症组与重脓毒症组,均在入院后24h内检测CRP、ALB水平,计算CRP/ALB比值,并进行序贯器官衰竭评分(SOFA)、急性生理与慢性健康状况评估(APACHEⅡ)评分、急诊脓毒症死亡风险评分(MEDS)、简化急性生理学评分(SAPSⅡ)、快速急诊内科评分(REMS)、改良早期预警评分(MEWS),分析CRP/ALB值与各评分系统对脓毒症严重程度和预后的评估价值,采用Pearson多重线性分析计算CRP/ALB值与脓毒症严重程度和预后的相关性。结果:存活患者入院24h CRP/ALB比值低于死亡患者,脓毒症组入院24h CRP/ALB比值低于重脓毒症组(均P 0.05)。存活患者SOFA评分、APACHEⅡ评分、MEDS评分、SAPSⅡ评分、REMS评分、MEWS评分均低于死亡组,脓毒症组SOFA评分、APACHEⅡ评分、MEDS评分、SAPSⅡ评分、MEWS评分均低于重脓毒症组(均P 0.05)。死亡患者患糖尿病的构成比高于存活组(18.8%vs 5.9%,P 0.05)。CRP/ALB值与脓毒症患者严重程度呈正相关(r=0.672),与预后呈正相关(r=0.596)。结论:CRP/ALB值对脓毒症病情和预后有较高的评估价值,而各项评分在一定程度上均可反映脓毒症患者病情,部分指标对预后有一定的预测价值。     

血小板计数动态变化在脓毒症中的临床意义

目的:探讨血小板计数动态变化在脓毒症中的临床意义。方法:检测159例脓毒症患者入院后第1、2天血小板计数,记录APACHEⅡ评分。按照第28天生存状况分为生存组或死亡组,比较2组患者第1天、第2天血小板计数、血小板变化率、APACHEⅡ评分的差异计数。按APACHEⅡ评分分组,比较3组第1天,第2天血小板计数和血小板变化率的差异。结果:生存组和死亡组第1天、第2天血小板计数、APACHEⅡ评分比较差异无统计学意义(P0.05)。血小板变化率比较差异有显著统计学意义(P0.01)。按APACHEⅡ评分分组,APACHEⅡ15分为A组;APACHEⅡ15~20分为B组;APACHEⅡ20为C组,3组第1天、第2天血小板计数比较差异有统计学意义(P0.05),血小板变化率比较差异无统计学意义(P0.05)。血小板变化率与预后具有显著负相关(r=-0.274,P0.001);第1天、第2天血小板计数,APACHEⅡ评分与预后无相关性(r=-0.051,-0.154,0.128,P=0.524,0.053,0.108)。ROC下面积分别为0.681、0.431。血小板变化率的截断值为-0.14。结论:动态监测血小板计数的变化对脓毒症严重程度的判断有一定的临床意义。     

ICU危重病患者预后与APACHEⅡ评分变化率的关系

目的:分析ICU危重病患者预后与APACHEⅡ评分变化率的关系。方法:采用前瞻性研究方法,选取ICU的危重病患者634例,按28 d生存率分成生存组(493例)与死亡组(141例),比较2组第1天APACHEⅡ(APACHEⅡ1),第2天APACHEⅡ(APACHEⅡ2)及APACHEⅡ变化率的差异。结果:2组APACHEⅡ1、APACHEⅡ2、APACHEⅡ变化率差异有显著统计学意义(P0.01)。APACHEⅡ1与APACHEⅡ变化率显著正相关(r=0.104,P=0.009),与预后显著正相关(r=0.296,P=0.000),APACHEⅡ变化率与预后显著负相关(r=-0.352,P=0.000)。APACHEⅡ1和APACHEⅡ变化率ROC下面积分别为0.303、0.742。APACHEⅡ变化率的截断点为0.19(敏感性99%,特异性92%)。结论:APACHEⅡ变化率对ICU危重病患者的预后判断有一定的临床价值。     

血管外肺水指数和肺血管通透性指数对脓毒性休克患者病情及预后的评估价值研究

目的分析血管外肺水指数(EVLWI)和肺血管通透性指数(PVPI)对脓毒性休克患者病情及预后的评估价值。方法选取2011年3月—2015年12月佛山市禅城区中心医院和广东医学院附属医院重症医学科收治的脓毒性休克患者57例,根据入院28 d预后情况分为生存组41例和死亡组16例。比较两组患者入住ICU第1、2、3天EVLWI和PVPI,分析EVLWI和PVPI与脓毒性休克患者急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、感染相关器官衰竭评分系统(SOFA)评分的相关性,并使用受试者工作特征(ROC)曲线评价EVLWI和PVPI对脓毒性休克患者预后的评估价值。结果入住ICU第1天两组患者EVLWI比较,差异无统计学意义(P0.05);入住ICU第2、3天死亡组患者EVLWI均高于生存组,入住ICU第1、2、3天死亡组患者PVPI均高于生存组(P0.05)。生存组患者入住ICU第2、3天EVLWI和PVPI低于第1天,入住ICU第3天EVLWI和PVPI低于第2天(P0.05);死亡组患者入住ICU第1、2、3天EVLWI和PVPI比较,差异无统计学意义(P0.05)。Spearman秩相关性分析结果显示,EVLWI与脓毒性休克患者APACHEⅡ评分、SOFA评分呈正相关(rs值分别为0.531、0.625,P0.05);PVPI与脓毒性休克患者APACHEⅡ评分、SOFA评分呈正相关(r_s值分别为0.658、0.610,P0.05)。绘制入住ICU第1、2、3天EVLWI和PVPI评估脓毒性休克患者预后的ROC曲线,以入住ICU第3天EVLWI11.65作为判断预后的最佳临界值,其灵敏度为74.3%、特异度为71.6%;以入住ICU第2天PVPI4.95作为判断预后的最佳临界值,其灵敏度为72.5%、特异度为84.7%。结论 EVLWI和PVPI能评估脓毒性休克患者的病情严重程度,且入住ICU第2天PVPI、入住ICU第3天EVLWI可作为评估脓毒性休克患者入院28 d预后的指标。     

老年营养风险指数联合降钙素原清除率和中性粒细胞/淋巴细胞比值对老年脓毒症病人短期预后的预测价值

目的 探讨老年营养风险指数(GNRI)、降钙素原清除率(PCTc)、中性粒细胞/淋巴细胞比值(NLR)对老年脓毒症病人短期预后的预测价值。方法 选择2018年10月至2021年11月本院收治的97例脓毒症病人作为观察对象,根据28 d病人生存情况将病人分为死亡组(42例)和存活组(55例)。收集病人基本临床资料,比较2组GNRI、PCTc、NLR水平;采用Spearman法分析GNRI、PCTc、NLR与APACHEⅡ评分的相关性,采用ROC曲线分析GNRI、PCTc、NLR对脓毒症病人短期内死亡的预测价值。结果 死亡组病人GNRI及PCTc显著低于存活组(P<0.05),NLR、APACHEⅡ评分显著高于存活组病人(P<0.05)。相关性分析显示,GNRI、PCTc与APACHEⅡ评分呈负相关(r=-0.357、-0.401,P<0.001),NLR与APACHEⅡ评分呈正相关(r=0.367,P<0.001);ROC曲线显示GNRI联合PCTc、NLR预测脓毒症病人短期内死亡的AUC为0.850(95%CI:0.763～0.914,P<0.001),敏...     

原发性高血压患者血清vaspin水平与血压及UACR关系的研究

目的:观察原发性高血压患者血清内脏脂肪特异性丝氨酸蛋白酶抑制剂(visceral adipose tissue-derived serine protease inhibitor,vaspin)水平及尿微量白蛋白/尿肌酐(urine protein to creatine ratio,UACR),探讨血清vaspin与血压及UACR之间的关系。方法:选取就诊于湘雅医院并未行治疗的原发性高血压患者125例,其中原发性高血压UACR正常组67例(高血压组),原发性高血压UACR升高组58例(UACR组)。另选健康体检者53例为对照组。测定各组血清vaspin水平、尿微量白蛋白、尿肌酐值,计算比值。观察各组间血清vaspin水平、UACR值的差异,vaspin与血压及UACR的相关性。结果:高血压组血清vaspin水平低于对照组(P0.05),UACR组血清vaspin水平低于高血压组(P0.05)。相关分析显示vaspin水平与SBP、DBP、UACR呈负相关关系(r=-0.294,r=-0.589,r=-0.381;均P0.01);UACR与SBP、DBP、LDL-C、Hs-CRP呈正相关关系(r=0.503,r=0.628,r=0.208,r=0.301;均P0.01)。多元逐步回归显示vaspin为收缩压、舒张压、UACR的独立影响因素(偏相关系数β分别为-1.782,-1.874,-0.063;P值分别为0.000,0.000,0.030)。DBP为UACR的独立影响因素(偏相关系数β=0.065,P=0.000)。结论:原发性高血压患者血清vaspin水平与SBP、DBP、UACR显著负相关关系。vaspin水平可能是原发性高血压血压升高程度的一个评价指标及原发性高血压尿微量白蛋白的一个预测指标。     

PCT、BNP、D-D二聚体及APACHEⅡ评分预测脓毒症患者预后的研究

目的探讨PCT、BNP、D-D二聚体水平及APACHEⅡ评分预测脓毒血症患者预后的作用。方法比较分析死亡组与生存组脓毒症患者第1、3、7天检测PCT、BNP、D-D二聚体水平及APACHEⅡ评分,采用受试者工作曲线(ROC)评估上述指标与预后的关系。结果与生存组患者相比,死亡组住院第1、3、7天PCT、BNP及APACHEⅡ评分显著增高(P0.05),死亡组和生存组的D-D二聚体水平差异无统计学意义(P0.05)。PCT、BNP、APACHEⅡ评分住院第1、3、7天ROC曲线下面积(AUC)均70%。结论高PCT、BNP及APACHEⅡ评分可作为脓毒症患者不良预后的指标。     

乳酸/白蛋白比值对老年脓毒症并发多器官功能障碍综合征患者的预后评估价值

目的探讨乳酸/白蛋白比值(Lac/Alb)对老年脓毒症并发多器官功能障碍综合征(MODS)患者的预后评估价值。方法回顾性研究2015年1月至2017年6月海南省人民医院急诊科和ICU收治的老年脓毒症并发MODS患者162例,根据MODS患者入院后14 d的生存情况,将其分为2组:存活组(n=56)和死亡组(n=106)。检测2组患者治疗后0、24、48 h的乳酸(Lac)、白蛋白(Alb)及Lac/Alb,并记录入院时急性生理学与慢性健康状况量表系统Ⅱ(APACHEⅡ)、序贯器官衰竭评估(SOFA)评分情况。采用SPSS 19.0软件进行数据处理。应用受试者工作特征(ROC)曲线分析Lac、Alb及Lac/Alb对MODS患者的预后评估价值。相关性分析采用Pearson相关分析。结果死亡组0、24、48 h的Lac[(7.84±2.65)vs(4.58±1.52)mmol/L,(9.23±4.16)vs(3.60±1.18)mmol/L,(10.58±4.72)vs(2.14±0.85)mmol/L]及Lac/Alb[(0.38±0.17)vs(0.19±0.12),(0.51±0.20)vs(0.14±0.08),(0.67±0.23)vs(0.08±0.03)]均显著高于存活组(P0.05),而Alb[(22.26±4.35)vs(25.38±4.72)g/L,(19.15±4.07)vs(27.14±5.20)g/L,(16.30±3.52)vs(31.73±6.82)g/L]显著低于存活组(P0.05)。ROC曲线显示,Lac/Alb48h的最佳截断点为0.45时,预测MODS患者预后的敏感度(93.6%)和特异度(86.5%)最好。Lac/Alb48h与APACHEⅡ(r=0.725)和SOFA(r=0.806)评分呈显著正相关(P0.01)。结论 Lac/Alb与MODS患者的病情严重程度及预后密切相关,Lac/Alb48h预测MODS患者预后的价值较高。     

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.