Methods for the measurement of insulin resistance. Hyperinsulinemic euglycemic clamp

Insulin resistance is defined as the decrease of the biological action of insulin, and it mainly presents as an hyperinsulinaemia. The clinical investigation of the states of insulin resistance requires expertise in sophisticated in vivo and in vitro methods. The hyperinsulinaemic euglycemic clamp is the reference method for quantifying insulin resistance. The clamp technique consists in infusing insulin at constant rate and, to prevent any decrease in the plasma glucose level, by infusing dextrose. The rate of dextrose infused to maintain euglycaemia is an estimate of the amount of glucose which is taken up by the tissues under the effect of a defined plasma insulin concentration. Using several rates of insulin infusion allows to establish the relationship between the whole body glucose disposal and plasma insulin levels, and to discriminate between the states of decreased insulin sensitivity and/or altered maximal capacity to dispose of glucose. The measurement of glucose fluxes, using the constant infusion of stable isotope labelled glucose, allows to differentiate the hepatic and the peripheral components of insulin resistance. Insulin sensitivity may be estimated using other methods, such as the minimal model which consists in a mathematical analysis of the intravenous glucose tolerance test. In vitro studies include the search for anti-insulin antibodies and anti-insulin-receptor antibodies, the study of insulin receptors (insulin binding, tyrosine-kinase activity and gene structure) and of the post-receptor glucose metabolism. Genetic syndromes of extreme insulin resistance, the pathophysiology of which is poorly known, are the main applications of these investigations. However, insulin resistance plays an important role in non-insulin-dependent diabetes mellitus, and also in insulin-dependent diabetes and various pathological or physiological endocrine disorders.     

Assessing insulin sensitivity in the cat: evaluation of the hyperinsulinemic euglycemic clamp and the minimal model analysis

A case of self-inflicted bite injuries of the fingers with an episode of small intracerebral haemorrhages is presented. There were many injuries on the right fingers. The tip of the right forefinger was bitten off, and some small pieces of the finger had been aspirated and swallowed. This unusual case seemed to be an emotional response to pain from cerebral episode.     

The utility of external performance measurement tools in program evaluation

We describe the use of unfrozen tissue lenses in 42 cases of epikeratophakia in children aged 2-14 years. Fourteen operations were performed in an aphakic eye, 28 in combination with congenital or traumatic cataract extraction. The tissue lenses, made from unfrozen donor cornea according to an original design, healed in 91.5% of cases. The tissue lens was removed when epithelial growth was inadequate on its surface. A five-year follow-up showed that correction within 3.0 D of emmetropia was achieved in 73.7% of the eyes. Preoperatively, mean keratometry readings were 43.5+/-0.2 D, increasing postoperatively to 53.6+/-0.8 D. Mean spherical equivalent at the spectacle plane increased by 9.6+/-0.9 D. Our investigations show the efficacy and safety of non-freeze epikeratophakia in the correction of pediatric aphakia.     

分析测试中的测量不确定度及评定 第二部分 测量不确定度评定的基本方法

本文叙述了测量不确定度评定的基本程序,A类和B类标准不确定度、合成标准不确定度和扩展不确定度评定的基本方法。     

分析测试中的测量不确定度及评定第二部分测量不确定评定的基本方法

本文叙述了测量不确定度评定的基本程序,A类和B类标准不确定度、合成标准不确定度和扩展不确定度评定的基本方法.     

Cardiac sympathetic nerve stimulation enhances cardiovascular performance during hyperkalaemia in the anaesthetized pig

A total of 74 patients with poor risk AML (median age 36.7 years, range 4.5-60.6) received a single course of a regimen including mitoxantrone (6 mg/m2 intravenous bolus daily, days 1 to 6), etoposide (80 mg/m2 intravenous over 1 h, daily, days 1 to 6) and intermediate-dose Ara-C (1 g/m2 over 6 h, daily days 1 to 6). 28 patients had failed initial remission induction with daunorubicin and conventional doses of Ara-C, 16 patients had secondary AML and 30 patients had relapsed from initial remission (five within six months, 15 over six months and ten after autologous or allogeneic bone marrow transplantation). Overall 41/74 patients (55%) achieved complete remission, 26 (35%) had resistant disease and seven (10%) died of infection during marrow hypoplasia. A 4-day course of the same regimen was given as consolidation to patients in complete remission. Subsequent antileukemic therapy was individualized. Profound myelosuppression and pancytopenia were universal resulting in fever or documented infections in almost 100% of patient; major hemorrhagic complications occurred in 39% of patients. Extrahematologic toxicity was mild to moderate consisting mostly of nausea and vomiting, oral mucositis and transient liver and cardiac dysfunction. We conclude that the MEC combination chemotherapy program seems to be an effective antileukemic regimen for secondary and advanced AML, with acceptable toxicity.     

Physiological changes in insulin resistance in human pregnancy: longitudinal study with the hyperinsulinaemic euglycaemic clamp technique

Twenty-six patients with rheumatoid disease affecting the cervical spine underwent surgical treatment for neck pain, neurological deficit, or both. Atlantoaxial subluxation (n=13), subaxial subluxation (n=7) and vertical migration of the odontoid (n=6) were treated. Arthrodesis with autologous bone was augmented with wire, Ransford loop, Hartshill rectangle or Magerl technique. Pain relief occurred in 92% of patients. Neurological deficit improved in 89% and was unchanged in the remainder. Radiographic stability was achieved in all but one patient. Posterior surgery effectively relieved pain and neurological deficit, and the complications encountered did not jeopardize the outcome.     

Predicting body cell mass with bioimpedance by using theoretical methods: a technological review

The body cell mass (BCM), defined as intracellular water (ICW), was estimated in 73 healthy men and women by total body potassium (TBK) and by bioimpedance spectroscopy (BIS). In 14 other subjects, extracellular water (ECW) and total body water (TBW) were measured by bromide dilution and deuterium oxide dilution, respectively. For all subjects, impedance spectral data were fit to the Cole model, and ECW and ICW volumes were predicted by using model electrical resistance terms RE and Rt in an equation derived from Hanai mixture theory, respectively. The BIS ECW prediction bromide dilution was r = 0.91, standard error of the estimate (SEE) 0.90 liter. The BIS TBW prediction of deuterium space was r = 0.95, SEE 1.33 liters. The BIS ICW prediction of the dilution-determined ICW was r = 0.87, SEE 1.69 liters. The BIS ICW prediction of the TBK-determined ICW for the 73 subjects was r = 0.85, SEE = 2.22 liters. These results add further support to the validity of the Hanai theory, the equation used, and the conclusion that ECW and ICW volume can be predicted by an approach based solely on fundamental principles.     

Mercury contamination during pH measurement and its effect on creatine kinase activity

Inhibition of activity of the enzyme creatine kinase occurs when small volumes of assay mixtures have their pH measured using a combination pH electrode prior to addition of the enzyme. This inhibition can be attributed to diffusion of ionic mercury from the calomel reference electrode through the saturated potassium chloride salt bridge and the ground glass-liquid junction to the test solution. The concentration of mercury accumulating in a solution by this process can be sufficient to affect the activity of an enzyme, and EDTA cannot be used successfully to scavenge mercury ion and avoid the inhibition.     

Cardiac evaluation of liver transplant recipients: QT dispersion in electrocardiogram

Increased QT dispersion, the interlead variability of the QT interval length in the 12-lead electrocardiogram, reflects uneven ventricular repolarization as a sign of cardiomyopathy. We analyzed QT dispersion in the preoperative electrocardiogram of 100 adult liver transplant recipients and 20 healthy control subjects. In 12% of the liver recipients, QT dispersion was increased above 65 ms (mean + 3SD). Six of these patients had a liver storage disease (haemochromatosis, Wilson's disease or amyloidosis). Five had a history of cardiac disease. Severe intraoperative cardiac complications occurred in three patients with markedly increased QT dispersion (> or = 99 ms). In conclusion, in liver storage diseases the heart may be affected, leading to increased risk of cardiac complications, which might be predicted from increased QT dispersion. Analysis of QT dispersion, a noninvasive inexpensive technique, can be recommended to be included in the cardiac screening of liver transplant candidates.     

分析测试中测量不确定度及评定 第五部分 测量不确定度评定中要注意的一些问题

对A类和B类不确定度评定的概念、合成标准不确定度的评定方法、温度对溶液体积的影响等几个容易混淆和在评定中要注意的问题进一步讨论,提出一些新的认识,有助于对测量不确定度评定概念的理解,并对评定中的具体问题作出正确、合理的判断。     

Control, means-ends, and agency beliefs: A new conceptualization and its measurement during childhood.

We presented a new conceptualization of perceived control in which three conceptually independent sets of beliefs are distinguished: control beliefs, expectations about the extent to which agents (e.g., the self) can obtain desired outcomes; means-ends beliefs, expectations about the extent to which certain potential causes produce outcomes; and agency beliefs, expectations about the extent to which agents possess potential means. In a study of 155 children from Grades 2, 4, and 6, we demonstrated that children's questionnaire responses reflected the distinction between these beliefs. Factor analyses of the items for each known cause separately revealed the predicted three factors, marked by control, means-ends, and agency items, respectively. Likewise, factor analysis of the scale scores resulted in control and agency beliefs factors as well as three factors for means-ends beliefs. Initial evidence on the usefulness of the new scheme indicates that control, means-ends, and agency beliefs show differential developmental trajectories as well as differential relations with cognitive performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pressure measurement evaluation and accuracy validation: the Gabarith test

OBJECTIVE: The dynamic distortion introduced by manometric systems has been known for many years, with several methods developed to describe and quantify the degree of distortion. We developed the Gabarith as a technique to describe more accurately, and yet more simply, the dynamic accuracy of the chain of monitoring. SETTING: A pressure monitoring system transforms some input signal, i.e. the actual pressure waveform present in the artery, into some other shape of waveform, i.e. the waveform displayed on the patient monitor. This transformation is characterized by the transfer function of the total system. A complete technique to define the transfer function is to measure the response directly at many different frequencies and combine them to produce the dynamic response plot. METHOD: We described the dynamic response of a monitoring chain and we simplified the communication of this dynamic response to users by developing the Gabarith, as a tolerance envelope based on the frequency content of typical pressure waveforms. If a given monitoring chain's dynamic response (including a catheter, a pressure kit and a monitor) can be shown to fall within that tolerance envelope, the chain will provide adequate dynamic accuracy. CONCLUSION: "Gabarith tested" means that a pressure kit, in combination with a catheter and a monitor, has had its frequency response function measured and that the function falls within a tolerance band for dynamic accuracy. Passing a Gabarith means that a given level of accuracy will be reached when using the sets which have passed the corresponding test.     

The performance measurement matrix: a framework to optimize decision making

Patient care executives and performance improvement specialists continually are challenged to make decisions that have far-reaching effects on cost, productivity, and the quality of patient care. With multiple stakeholders to serve, minimal time to consider options, and an overabundance of data, new approaches to assessing and monitoring quality are needed. This article describes a framework and process to assist health care leaders in making informed and timely decisions. Six dimensions of health care--patients, caregivers, the organization, quality, efficiency, and cost--are assessed within the organization's context for overall impact on performance.     

Medical-surgical nursing: a new teaching approach and its evaluation by the student

This issue is about a teaching methodology developed by the Medical-Surgical subject of Nursing on Graduate Course at Universidade Estadual de Londrina. The teachers used the student-centered teaching process based on interpersonal relationship and problem solving method. The aim was to evaluate the last period of nursing students perception about developing of cognitive, affective and psychomotor abilities when compared with others subjects of nursing course since 1985 until 1990. This method of teaching supplied more integration among theory and practice, more ability in developing library search and oral exposition, besides more active student participation on his apprenticeship process.