Blood Glucose Measurement with Dextrostix and New Reflectance Meter

A new instrument, Eyetone, has been produced for use with a Dextrostix reagent strip for estimating blood sugar levels. It differs from the Dextrostix Reflectance Meter in having only one meter scale, a two-point calibration, and a range of measurement limited to 10-400 mg/100 ml. Results with the manufacturers'' original calibration were unsatisfactory, but when recalibrated the performance of the instrument gave a regression equation line close to the ideal. The three Eyetone instruments tested were comparable in their accuracy and functional stability. Packed cell volumes in the blood samples in the range of 30-50% had a negligible effect on the results. The Dextrostix-Eyetone method represents a quick and reliable alternative to conventional laboratory methods for blood sugar estimation. It is especially useful for patients outside hospital.     

Dextrostix-Eyetone in the insulin hypoglycaemia test.

The Ames Dextrostix-Eyetone system was evaluated for monitoring the blood glucose concentration during insulin-induced hypoglycaemia. The results agreed well with laboratory values for plasma glucose, obtained by an orthotoluidine method, and the method was practicable as a bedside technique. In two cases quick results obtained with the Eyetone enabled the insulin tolerance test to be interrupted to prevent severe hypoglycaemia before the clinical indications were obvious. The extra time and effort required were minimal, and its value seems to far outweigh the disadvantage of the extra work entailed. Nevertheless, care in using the system was important, and the operator must familiarise himself with the system before the most reliable results can be obtained.     

妊娠期糖尿病孕妇血糖水平与新生儿体质量的相关性

目的:探究妊娠期糖尿病(GDM)孕妇产前血糖水平与新生儿质量的关系。方法:选取2012年6月至2014年6月我院分娩的GDM孕妇97例为研究对象,按照随机数字表法将患者随机分为严格组(50例)和宽松组(47例),选择同期血糖正常孕妇50例作为对照组;分析孕妇血糖水平与新生儿出生质量的关系。结果:对照组血糖水平、新生儿质量以及巨大儿的发生率均明显低于宽松组和严格组(P0.05);严格组的血糖水平、新生儿质量以及巨大儿的发生率均明显低于宽松组(P0.05);孕妇血糖水平与新生儿质量存在显著的正相关(r=0.72,P0.05)。结论:产前孕妇血糖水平与新生儿质量存在显著的正相关,对GDM患者产前进行严格的血糖控制有助于降低巨大儿的发生率,有利于母体和新生儿的健康。     

Evaluation of the quality of bedside monitoring of the blood glucose level in a teaching hospital.

We evaluated the precision and accuracy of monitoring of the blood glucose level in the laboratory and at the bedside with one of four glucose meters by an experienced operator and by 39 nurses in a teaching hospital. For precision studies aqueous quality control materials were used. A total of 85 blood samples were tested. The precision of the glucose meters (expressed as the coefficient of variation [CV]) in the hands of the experienced operator ranged from 6.7% to 11.1%. The correlation between the values obtained by the experienced operator and the reference values obtained in the laboratory was high (0.95 to 0.98). The precision of the values obtained by the nurses using the meters ranged from 13.7% on medical wards to 45.7% in the intensive care unit (ICU). The correlation between these values and those obtained in the central laboratory ranged from 0.72 to 0.82. Twenty-four percent of the glucose values determined on medical wards and 62% of those determined in the ICU deviated from the reference value by at least 20%. Of the 85 patients 12 (14%) would have received different insulin dosages had the reference value been available at the same time as the glucose meter reading: in 3 of the patients the discrepancy was 6 units of insulin or greater. Continuous quality control of bedside monitoring of the blood glucose level is needed. In addition, personnel who use glucose meters should receive adequate training.     

Glycostator: a Novel Technology to Summarize Blood Glucose Control in Patients with Diabetes Mellitus

BackgroundGlycostator is a diabetes management software package consisting of 3 indicators—“time-averaged glucose (TAG),” “virtual A1c (VA1c),” and “lability index”—all devised for statistical manipulation of capillary glucose data and assessment of overall glycemic control. The TAG approximates the average value of the function of blood glucose versus time, adding the element of time to the computation of the mean glucose value. It mitigates the major pitfall of the arithmetical averaging methods currently available in glucose-monitoring devices: bias toward glycemic extremes. With use of the TAG value and a linear function, Glycostator calculates VA1c, a statistical emulation of the laboratory hemoglobin A1c (HgbA1c).MethodsWe examined the relationship between Glycostator-calculated VA1c and laboratory-determined HgbA1c in 57 patients.ResultsGlycostator VA1c results were within 15% of concomitant laboratory HgbA1c values in 82% of the patients studied. Further analysis revealed that 60 to 90 days of testing and an average of 3 or more finger-stick glucose tests per day optimized the accuracy of the VA1c as a predictor of HgbA1c (91% of these patients’ VA1c values were within 15% of the concomitant HgbA1c laboratory value).ConclusionIn patients who test blood glucose frequently, VA1c complements HgbA1c as a measure of overall glucose control and has the advantage of being updated after each blood glucose test for patient and physician feedback. Glycostator parameters are calculated by using recurrence relation algorithms that can be easily implemented on currently available blood glucose monitors. (Endocr Pract. 2008;14:1115-1125)     

Evaluation of a serological test for tuberculosis.

The agglutination test of Nicholls was found to be ineffective in diagnosing active tuberculosis. A positive result (titre of 1/125 or more) was found in the serum of 74 (70%) out of 105 patients with newly diagnosed, smear-positive pulmonary tuberculosis; 61 (62%) out of 98 healthy family contacts; and 19 (63%) out of 30 patients with non-tuberculous conditions. These findings were not due to faulty technique since the results obtained at Hammersmith were similar to those obtained by Nicholls''s laboratory in the same serum samples. Twenty-seven of the tuberculous patients who had a negative result before treatment were retested two months after the start of chemotherapy but showed no evidence of a rising titre.     

抽动障碍患儿实验室检查及其诊断意义的分析

目的:统计抽动障碍住院患儿相关实验室检查,分析其对于抽动障碍诊断与鉴别诊断的意义。方法:抽取2013年1月至2014年9月在上海交通大学医学院附属新华医院中医科住院治疗的98例抽动障碍患儿各项主要实验室检查结果进行统计分析。结果:抗"O"异常率为17.35%,与对照组比较P0.05,铜蓝蛋白均值为0.2719±0.0477,与对照组比较P0.05,血沉异常率为4.08%,与对照组比较,P0.05。炎症因子均存在一定异常,异常率最高为IL-2r达14.29%,免疫球蛋白只有Ig M存在1例(1.02%),T细胞亚群各项均存在异常,其中CD4/CD8异常率达25.51%,CD3异常率为12.24%。肝肾功能、血尿常规各项异常率统计基本正常,仅仅少数存在少量异常;结论:抗"O"、血沉和铜蓝蛋白等对TD的诊断和鉴别诊断具有重要意义,同时也应该关注患儿的免疫情况。肝肾功能、血尿常规等项目的监测对选择用药具有指导意义。     

Does random blood glucose sampling outdate testing for glycosuria in the detection of diabetes during pregnancy?

A random blood glucose concentration was determined in 2403 pregnant women attending an antenatal clinic at between 28 and 32 weeks'' gestation. The calculated 99% cut off values were 6.1 mmol/l (110 mg/100 ml) within two hours after a meal and 5.6 mmol/l (101 mg/100 ml) more than two hours after a meal. Patients with a blood glucose concentration in excess of these values were referred for a 75 g oral glucose tolerance test. Of 59 referred, four were found to have previously unsuspected but unequivocal diabetes mellitus and another four to have impaired glucose tolerance on the basis of the World Health Organisation''s criteria. Screening all antenatal patients by randomly measuring blood glucose concentrations is not only cheap and efficient but also does not interfere with the routine of busy antenatal clinics.     

Contributions of the history,physical examination,and laboratory investigation in making medical diagnoses.

We report an attempt to quantitate the relative contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. In this prospective study of 80 medical outpatients with new or previously undiagnosed conditions, internists were asked to list their differential diagnoses and to estimate their confidence in each diagnostic possibility after the history, after the physical examination, and after the laboratory investigation. In 61 patients (76%), the history led to the final diagnosis. The physical examination led to the diagnosis in 10 patients (12%), and the laboratory investigation led to the diagnosis in 9 patients (11%). The internists'' confidence in the correct diagnosis increased from 7.1 on a scale of 1 to 10 after the history to 8.2 after the physical examination and 9.3 after the laboratory investigation. These data support the concept that most diagnoses are made from the medical history. The results of physical examination and the laboratory investigation led to fewer diagnoses, but they were instrumental in excluding certain diagnostic possibilities and in increasing the physicians'' confidence in their diagnoses.     

A guide to the pharmacology of placebos.

The placebo effect is capable of relieving pain in a substantial proportion of patients; affective disorders also respond to the administration of inert medication. Changes in objective measures, such as blood pressure and blood glucose levels, demonstrate the action of placebos. The underlying mechanisms are not yet known, but because the nature and strength of the placebo response are governed by the patient''s perceptions, both positive and negative results may be obtained. The complexity of human perception has made it extremely difficult to characterize the people who react. In clinical situations the placebo may be underused as a therapeutic agent, while in clinical trials the effect may be inadequately evaluated; the power and nature of the placebo effect truly warrant greater recognition.     

AKR1B10 is induced by hyperglycaemia and lipopolysaccharide in patients with diabetic nephropathy

Aldose reductase family member B10 (AKR1B10) belongs to the aldo–keto reductase gene superfamily and is closely related to aldose reductase (AKR1B1). It has been shown that AKR1B10 is present in many of the same human tissues as AKR1B1. The objective of this study was to investigate whether AKR1B10 has a role in diabetic nephropathy (DN) by investigating its response to high glucose and inflammation, both of which have been associated with the development and progression of DN. Expression levels of AKR1B10 were determined in peripheral blood mononuclear cells (PBMCs) obtained from 25 patients with type 1 diabetes and nephropathy, 25 without DN and 25 normal healthy controls that were exposed to high glucose (25 mM d-glucose) and also the inflammatory stressor lipopolysaccharide (LPS, 10 μm). Under high glucose and LPS conditions, there was a significant increase in the expression of AKR1B10 in the PBMCs from patients with DN compared to those without DN and the normal controls. In conclusion, these results suggest that AKR1B10 may have an important role in the development and progression of DN.     

Immunoresponsiveness in Ulcerative Colitis and Crohn's Disease—Effect of Colectomy and Suppression of Disease Activity

We evaluated the effect of medically induced symptomatic disease improvement on in vitro tests of cell-mediated immune responses in 33 patients with Crohn''s disease. When results obtained in 17 patients with ulcerative colitis were compared with those of 10 patients with ulcerative colitis who had undergone a colectomy, no significant correlation was detected between individual clinical and laboratory variables or the Crohn''s disease activity index and in vitro tests of cell-mediated immunity. A different pattern emerged from the longitudinal tests of cell-mediated immunity: when these test results were initially abnormal in patients with Crohn''s disease, clinical improvement as assessed by the Crohn''s disease activity index was associated with normalizing cell-mediated immunity. In contrast, when the test results were initially normal, clinical improvement was not associated with any change in the immune response. Following colectomy in patients with ulcerative colitis, some abnormalities of suppressed immune responses remained, although patients were cured of their disease. Factors other than clinical disease activity may be responsible for the suppressed immunoresponsiveness in some patients with inflammatory bowel disease, and variable changes in cell-mediated immunity occur after both surgical and medical treatment.     

Guar crispbread in the diabetic diet.

Nine diabetic patients who were receiving various treatments supplemented their normal home diets (two patients) or metabolic ward diets (seven patients) with guar crispbread for five days. Their mean urinary glucose excretion fell significantly by 38% during the last two days. A significant fall in fasting blood glucose concentration of 1.1 +/- 0.4 mmol/1 (19.8 +/- 7.2 mg/100 ml) was seen only in those who took guar after the control period. Over eight weeks'' treatment insulin dosage was reduced by 21% in five patients, and home testing showed that glycosuria was reduced by 68% in six patients. Guar crispbread is likely to be a useful adjunct to diabetic treatment irrespective of the type of treatment or insulin dosage used.     

Bench-scale bioethanol production from eucalyptus by high solid saccharification and glucose/xylose fermentation method

In the bioethanol production process, high solid saccharification and glucose/xylose co-fermentation are important technologies for obtaining increased ethanol concentrations; however, bench-scale studies using combinations of these methods are limited. In this study, we hydrolyzed high solid concentration of milled eucalyptus using commercial enzymes and obtained 138.4 g/L total monomeric sugar concentration. These sugars were fermented to 53.5 g/L of ethanol by a xylose-utilizing recombinant Saccharomyces cerevisiae strain, MA-R4. These experiments were performed in bench scale (using 50 L scale solid mixer and 70 L scale fermenter). The results obtained in this study were comparable to our previous results in laboratory scale, indicating that we successfully achieved an efficient high solid saccharification and glucose/xylose co-fermentation system in bench scale.     

西格列汀对2 型糖尿病患者微量白蛋白尿影响的研究

目的:研究西格列汀对2型糖尿病患者微量白蛋白尿的影响,分析其可能机制和临床应用价值。方法:选取160例伴微量白蛋白尿的2型糖尿病患者,随机分为西格列汀组和其他药物组,各80例。比较两组患者治疗前和治疗3个月后血糖水平、尿微量白蛋白、超敏C反应蛋白及血浆还原型谷胱甘肽水平。结果:经3个月治疗,两组患者空腹血糖、餐后2 h血糖、Hb A1c均较治疗前下降,但差异无明显统计学意义(P0.05);西格列汀治疗组患者尿微量白蛋白和血浆Hs-CRP水平明显下降,血浆还原型谷胱甘肽水平明显升高,与其他口服药物治疗组相比差异具有统计学意义(P0.05)。结论:西格列汀可能通过改善机体炎症状态,降低氧化和应激水平等机制降低2型糖尿病患者的尿微量白蛋白水平。     

Long-Acting Subcutaneously Administered Insulin for Glycemic Control Immediately After Cardiac Surgery

ObjectiveTo test the hypothesis that subcutaneous administration of basal insulin begun immediately after cardiac surgery can decrease the need for insulin infusion in patients without diabetes and save nursing time.MethodsAfter cardiac surgery, 36 adult patients without diabetes were randomly assigned to receive either standard treatment (control group) or insulin glargine once daily in addition to standard treatment (basal insulin group). Standard treatment included blood glucose measurements every 1 to 4 hours and intermittent insulin infusion to maintain blood glucose levels between 100 and 150 mg/dL. The study period lasted up to 72 hours.ResultsThere were no differences in demographics or baseline laboratory characteristics of the 2 study groups. Mean daily blood glucose levels were lower in the basal insulin group in comparison with the control group, but the difference was not statistically significant (129.3 ± 9.4 mg/ dL versus 132.6 ± 7.3 mg/dL; P = .25). The mean duration of insulin infusion was significantly shorter in the basal insulin group than in the control group (16.3 ± 10.7 hours versus 26.6 ± 17.3 hours; P = .04). Nurses tested blood glucose a mean of 8.3 ± 3.5 times per patient per day in the basal insulin group and 12.0 ± 4.7 times per patient per day in the control group (P = .01). There was no occurrence of hypoglycemia (blood glucose level < 60 mg/dL) in either group.ConclusionOnce-daily insulin glargine is safe and may decrease the duration of insulin infusion and reduce nursing time in patients without diabetes who have hyperglycemia after cardiac surgery. (Endocr Pract. 2011;17: 558-562)     

Effect of troxerutin on insulin signaling molecules in the gastrocnemius muscle of high fat and sucrose-induced type-2 diabetic adult male rat

Troxerutin is a trihydroxyethylated derivative of the flavonoid, rutin. It has been reported to possess the hepatoprotective, nephroprotective, antioxidant, anti-inflammatory, and antihyperlipidemic activities. Troxerutin treatment reduced the blood glucose and glycosylated hemoglobin levels in high-cholesterol-induced insulin-resistant mice and in type-2 diabetic patients. However, the mechanism by which it exhibits antidiabetic property was unknown. Therefore, the present study was designed to evaluate the effect of troxerutin on insulin signaling molecules in gastrocnemius muscle of high fat and sucrose-induced type-2 diabetic rats. Wistar male albino rats were selected and divided into five groups. Group I: Control. Group II: High fat and sucrose-induced type-2 diabetic rats. Group III: Type-2 diabetic rats treated with troxerutin (150 mg/kg body weight/day orally). Group IV: Type-2 diabetic rats treated with metformin (50 mg/kg body weight/day orally). Group V: Normal rats treated with troxerutin (150 mg/kg body weight/day orally). After 30 days of treatment, fasting blood glucose, oral glucose tolerance, serum lipid profile, and the levels of insulin signaling molecules, glycogen, glucose uptake, and oxidation in gastrocnemius muscle were assessed. Diabetic rats showed impairment in insulin signaling molecules (IR, p-IRS-1^Tyr632, p-Akt^Ser473, β-arrestin-2, c-Src, p-AS160^Thr642, and GLUT4 proteins), glycogen concentration, glucose uptake, and oxidation. Oral administration of troxerutin showed near normal levels of blood glucose, serum insulin, lipid profile, and insulin signaling molecules as well as GLUT4 proteins in type-2 diabetic rats. It is concluded from the present study that troxerutin may play a significant role in the management of type-2 diabetes mellitus, by improving the insulin signaling molecules and glucose utilization in the skeletal muscle.     

应激性高血糖与急性自发性脑出血患者术后并发症和早期预后的相关性研究

目的:探讨应激性高血糖与自发性脑出血患者术后并发症及早期预后的关系。方法:回顾性分析我院收治的自发性脑出血患者358例,根据入院时血糖水平、糖化血红蛋白(HbAlc)及既往有无糖尿病史分为血糖正常组(96例)、应激性高血糖组(107例)及糖尿病组(155例),记录和比较各组入院时的血糖、格拉斯哥昏迷评分(GCS)、平均出血量及入院后30 d时各组的术后并发症发生情况、格拉斯哥预后评分(GOS)的差异。结果:糖尿病组入院时血糖水平、平均出血量、重型患者所占比率、脑出血破入脑室、颅内再出血、颅内感染、肺部感染、尿路感染及上消化道出血发生率、GOS分级植物状态或死亡发生率均明显高于应激性高血糖组(P0.05),GOS分级良好率低于应激性高血糖组(P0.05);而应激性高血糖组入院时血糖水平、平均出血量、重型患者所占比率、脑出血破入脑室、颅内再出血发生率、GOS分级植物状态或死亡发生率均明显高于血糖正常组(P0.05)。结论:自发性脑出血患者入院时应激性高血糖与患者的病情显著相关,可加重急性脑出血的不良预后。     

Anti-IgA-mediated transfusion reactions in Canada.

During a 6-year period (1977 to 1982) blood samples from 152 Canadian patients were referred to the national reference laboratory of the Canadian Red Cross Society because the referring hospitals had not been able to determine the cause of the patients'' severe nonhemolytic transfusion reactions. Twenty-one patients were found to be IgA deficient, and 12 of them had strong class-specific anti-IgA antibodies, which were presumed to have been responsible for the reactions. The spectrum of symptoms that accompanied these violent reactions was documented for 10 of the patients. As a probable minimum, the incidence of anti-IgA-mediated reactions averaged 1.3 per million units of blood or blood products transfused during this period.     

Influence of incubation conditions on bacterial production estimates in an estuarine system

This study aimed to assess the influence of incubation conditions in the determination of bacterial production (BP). In order to achieve that goal, experimental setups were performed in situ and in the laboratory under both dark and light conditions. To test spatial and seasonal variations and the different natural light exposure of microorganisms, sampling was performed in two distinct zones of the estuary Ria de Aveiro (Portugal), typifying the marine and brackish water zones of the estuarine system. Denaturing gradient gel electrophoresis analysis of 16S rRNA gene fragments was used to monitor possible alterations in bacterial community composition induced by the incubation conditions. The results showed that BP determined in situ conditions significantly differed from in the laboratory. In the marine zone, a defined pattern of variation was detected, with consistent higher values of BP in laboratory dark conditions. This trend was not present in the brackish water zone. The seasonal and spatial variability of BP observed in field incubations was related to the physical–chemical proprieties of the water column, irradiance levels and the original community composition. The metabolic active profiles of bacteria were substantially different in the several incubation conditions, suggesting that methodological procedure influences the bacterial community composition, and the values of BP reported for aquatic ecosystems could be quite different from the real ones. In the light of these results, we suggest that BP determinations should be conducted under in situ conditions. However, due to execution limitations, BP needs to be frequently determined in the laboratory, and in this case, dark incubations provide more approximate values. This is the method routinely used, and although this incubation condition can cause stimulation of BP, the structure of the bacterial community is more similar to the one obtained with the in situ incubations.