BG Level Research Articles

Diagnostic Performance of the (1→3)‐β‐d‐Glucan Assay for Invasive Fungal Disease

Diagnosis of invasive fungal disease (IFD) is challenging, and it remains a significant cause of morbidity and mortality in immunocompromised patients. The (1-->3)-beta-D-glucan (BG) assay may be a useful adjunct, but its diagnostic performance is not well characterized. We retrospectively assessed the diagnostic indices of the BG assay in patients at risk of IFD who had a compatible clinical syndrome for the diagnosis of IFD a week after initial BG testing and at the end of the hospitalization associated with the first BG value. Patients with IFD were classified according to current European Organization for Research and Treatment of Cancer-Mycoses Study Group criteria, independent of BG results. A total of 1308 BG assays were performed for 871 patients. One hundred twelve proven or probable IFD cases were diagnosed within 1 week after initial testing, and 116 cases were diagnosed by the end of hospitalization. Sensitivity of an initial BG level 80 pg/mL for IFD at 1 week was 0.64 (95% confidence interval [CI], 0.55-0.73), specificity was 0.84 (95% CI, 0.81-0.86), the positive likelihood ratio was 3.93 (95% CI, 2.94-5.26), and the negative likelihood ratio was 0.43 (95% CI, 0.31-0.59). Albumin, intravenous immunoglobulin, and hemodialysis were associated with elevated BG levels in patients without IFD (odds ratio, 4.78; 95% CI, 2.59-8.80). After excluding patients with these factors, specificity and the positive likelihood ratio of an initial BG level 80 pg/mL increased slightly. Empirical systemic antifungal treatment did not reduce overall BG sensitivity. Sensitivity was slightly lower among patients with hematologic malignancy or stem cell transplantation. Consideration of BG results would have increased the diagnostic certainty to probable in 54% of possible IFD cases. BG level appears to be a fair diagnostic adjunct for IFD in patients with appropriate pretest probability and a suggestive clinical syndrome, especially when checked serially in patients not receiving factors associated with an elevated BG level in the absence of IFD.

A pilot study to stabilize normoglycemia during an educational camp for children and adolescents with type 1 diabetes mellitus

Background: Children and adolescents with type 1 diabetes mellitus (DM) who participate in diabetes camps do not often achieve stable, normoglycemic control, largely because changes in the campers' activity levels and food options necessitate adjustments to their insulin use and nutritional therapies. It would seem logical, with the abundance of diabetes education and professional consultation freely available at these camps, that the glycemic levels of these young campers could approach normal values. Objective: This informal study was designed to explore the feasibility of safely achieving stable, short-term normo-glycemic control in children and adolescents with recent-onset type 1 DM attending a diabetes camp. Methods: A multidisciplinary team worked with children and adolescents 6 to 18 years of age during a residential 3-day/2-night diabetes camp. Demographic data were compiled from the application forms completed by the campers and signed by the campers and their parents. The staff functioned in 2 distinct roles: as managers (securing time, task, technique, and territory boundaries) and as consultants (addressing participants' educational, social, and emotional needs). The staff supported the campers in their attempts to quickly and safely achieve tight normoglycemic control (ie, 71–99 mg/dL) and stability (ie, an estimated mean amplitude of glycemic excursion [eMAGE] score ≤95) through their firsthand experience with self-directed learning methods, basal-bolus insulin analogue therapy, and a diet low in concentrated carbohydrates (CHOs). Campers chose foods from meal buffets, calculated preprandial and complementary doses of ultra-rapid insulin, and participated in physical exercise and self-monitoring of blood glucose (SMBG) at will. SMBG values retained in each camper's combined glucose/ketone monitor furnished statistical data. Initial and final glycosylated hemoglobin values were not measured because 3 days of glycemic control—at any BG level—would not be expected and have not been reported to produce significant changes. No follow-up of the campers was planned or possible. Results: Six boys and 3 girls (aged 8–17 years; mean [SD] age, 11.8 [2.6] years; mean duration of diabetes, 1.62 [0.88] years) agreed to participate in the study. All but 1 of the campers were preadolescents. Mean BG levels on arrival and departure were 209 (101.5) and 81 (12.8) mg/dL, respectively ( P < 0.003). The mean 3-day BG level was 95 (21.2) mg/dL. The 3-day mean eMAGE score (66.5 [28.1]) indicated stable glycemic control. Seven of the 9 campers (78%) returned to the camp the following year (2007). Conclusions: Combining self-directed educational methods for learning diabetes self-management with insulin analogues in a basal-bolus therapy regimen, ad libitum physical activity and SMBG, and a diet low in concentrated CHOs, campers rapidly established routinely normal daily mean BG levels and glycemic stability.

Solar neutrino measurements with Super-Kamiokande III

The third phase of Super-Kamiokande experiment (SK-III) has been running since 12th July, 2006. The SK-III detector is achieved 40% photo-cathode coverage with 11,129 20-inch PMTs. One of the physics goals in SK-III is observing the transition of solar neutrino oscillations between vacuum and matter oscillation around 4MeV. From 24th January, 2007 to 2nd March, 2008, we obtained data of live-time 288.9 days with energy threshold 6.5MeV (Full Final sample: FF sample). For data with a lower energy threshold 5.0MeV, we needed remove high radon contaminated period from the FF sample, then we obtained another data sample (Radon reduced sample: RR sample) with live-time 191.7 days. The current measurements show that SK-III has already achieved a similar signal to noise ratio as SK-I for energy range from 5.0 to 20.0MeV, and the solar angle distribution of FF sample shows that the solar neutrino event rate also looks consistent with SK-I for energy range from 6.5 to 20.0MeV. As for the RR sample, although the vertex distribution of low energy events is not uniform in the detector and there are more BG events in the edge of fiducial volume, it is clear that SK-III BG level is smaller than that of SK-I in the central region of the detector. Finally, the future plan for lowering the energy threshold shows a 2a discovery potential of the energy spectrum upturn with 3 years of observation after both software and hardware improvements.

Clinical significance of (1→3)-β- d-glucan in a patient with invasive sino-orbital aspergillosis

Objectives The usefulness of BG as a marker has been reported in patients with pulmonary aspergillosis. However, no data have demonstrated the behavior of BG in sino-orbital IA. We encountered a case of sino-orbital IA and demonstrated changes in the BG level, radiological images, and pathological features. Method and results A 63-year-old Japanese woman suffered from invasive sino-orbital aspergillosis. The serum BG level measured immediately before surgery was 37.2 pg/mL (normal value <3.4 pg/mL). Endoscopic sinus surgery revealed some necrotic tissue extending from the ethmoid sinus to the orbit. The infiltrating Aspergillus was revealed in the pathological examination. The BG level decreased to the normal value. However, CT revealed a high-density area; this may indicate that an aspergillosis lesion remained slightly in the orbit. Conclusion (1→3)-β- d-Glucan (BG) is a useful marker for diagnosing Aspergillus and evaluating the therapeutic effect of the treatment administered.

Mealtime 50/50 basal + prandial insulin analogue mixture with a basal insulin analogue, both plus metformin, in the achievement of target HbA 1c and pre- and postprandial blood glucose levels in patients with type 2 diabetes: A multinational, 24-week, randomized, open-label, parallel-group comparison

Background: In people without diabetes, ∼50% of daily insulin secretion is basal and the remainder is postprandial. Hence, it would be expected that insulin replacement therapy in a 50/50 ratio with each meal would mimic physiologic insulin secretion better than treatment with once-daily basal insulin in patients with diabetes mellitus. Using lispro mix (LM) 50/50 before meals may be a logical approach to achieving glycemic targets (glycosylated hemoglobin [HbA lc] and pre- and postprandial blood glucose [BG] concentrations) in these patients. Objective: The aim of this study was to test the hypothesis that treatment with a premixed insulin analogue containing 50/50 basal + prandial insulins administered before each meal would achieve lower overall and mealtime glycemic control than once-daily basal insulin analogue, both plus metformin (Met), in patients with type 2 diabetes mellitus. Methods: This 24-week, randomized, open-label, parallel-group trial was conducted at 38 sites across Australia, Greece, India, The Netherlands, Poland, Puerto Rico, and the United States. Male and female patients aged 35 to 75 years with type 2 diabetes mellitus and an HbA 1c level of 6.5% to 11.0%, who were receiving metformin and/or a sulfonylurea with a stable dose of 0 to 2 daily insulin injections over the previous 3 months were eligible. Patients were randomly assigned to receive LM50/50 (50% insulin lispro protamine suspension [ILPS] and 50% lispro) TID plus metformin (to a maximally tolerated daily dosage of 500-1000 mg BID) (LM50/50 + Met) or insulin glar-gine QD at bedtime plus metformin (500-1000 mg BID) (G + Met) for 24 weeks. With LM50/50 + Met, the insulin dose was titrated to target a fasting BG (FBG) level of <6.7 mmol/L (<120 mg/dL) and a 2-hour post-prandial BG (PPBG) level of <8.0 mmol/L (<144 mg/dL)

81 RESPONSE OF ENDOGENOUS GLUCOSE PRODUCTION (EGPR) TO A CHANGE IN BLOOD GLUCOSE (BG) LEVEL IN LOW BIRTH WEIGHT (LBW) INFANTS ON THE FIRST DAY OF LIFE

In a previous study we found a large inter-individual variability between the BG level and EGPR. In the present study we have measured the response of EGPR to a change in BG level in individual LBW infants.Patients: Four infants were studied solar. Gestational age ranged from 30 to 39 weeks, and birthweight from 1.5 to 2.1 kg. Increase of BG level was obtained by increasing the glucose infusion rate from 3.4 to 6.7 mg/kg/min, prior to the increase a small bolus of glucose was given. Studies were done prior to oral feeding. EGPR was measured with the prime dose, constant rate infusion technique, using 66, [2H2] glucose as a tracer.Results: Before the change in BG level, BG was 3.5 mmol/l (mean), glucose turnover was 5.6 ±0.5 mg/kg/min. EGPR was 2.2 ± 0.2 mg/kg/min. After the change of BG. BG level was 5.7 mmol/l (mean), glucose turnover increased to 7.7± 1.0 mg/kg/min. The decrease of EGPR ranged from 13 to 100 %. This decrease was not related to the BG level, but was correlated to.the relative increase of BG (r=0.99, p=0.006)Hypothesis: An increase of BG level induces a decrease ol EGPR, the degree ol decrease is related to the relative change of BG.

葛花の薬理学的研究(第2報)アルコール誘発性の代謝異常並びに実験的肝障害に対する葛花の影響

The present study was designed to examine the effects of methanolic extract (PE-ME), isoflavonoid fraction (PF-IF), triterpenoid saponin fraction (PF-SP) and N-acyl-N1-glucosyl-tryptophan (PF-P) isolated from puerariae flos on alcohol-induced unusual metabolism (as for glucose (BG), triglyceride (TG), and urea nitrogen (BUN) level in blood) and experimental liver injury (model: CCl4- and high fatty food induced) in mice. These alcohol-induced increasing responses were inhibited by the extracted and refined substances from puerariae flos. In short, PF-ME (4500 mg/kg) and PF-P (400 mg/kg) inhibited an increase in BG level induced by alcohol, whereas PF-IF (1000 mg/kg) and PF-SP (1000 mg/kg) did not. Similary, PF-ME and PF-SP inhibited an increase in TG induced by alcohol, whereas PF-IF did not. In addition, PF-IF and PF-SP inhibited increasing BUN level. Still more, PF-IF and PF-SP significantly inhibited an increase in gulutamate oxalacetate transaminase or gulutamate pyruvate transaminase level induced by high-fatty food and CCl4 in control animals. Especially PF-IF (250 mg/kg) administration showed a remarkable effect (inhibition: 76.3%) in control animals. These results suggested that puerariae flos or its combination drugs may be a useful drug as a traditional medicinal system for counteraction to drinking.

NOCTURNAL SUBCUTANEOUS INSULIN INFUSION IN CHILDREN - EFFICACY AND ACCEPTABILITY

Many younger children consider 24 hour Continuous Subcutaneous Insulin Infusion (CSII) unacceptably intrusive. We have attempted to test an alternative infusion system using a Nocturnal Subcutaneous Insulin Infusion (NSII) which is removed before breakfast at which time an intermediate-acting insulin is injected to cover daytime requirements. Ten children took part in a cross-over trial of 8 weeks on either conventional insulin treatment (CIT) or NSII. Six previously well-controlled children (average age 13 years) completed the study. BG profiles showed a significant improvement in the post-breakfast BG level (10.4 mmol/l on CIT vs. 8.1 on NSII) but a higher BG before the evening meal (7.5 on CIT vs. 10.3 on NSII). This deterioration in the afternoon profile improved as the trial progressed. Overnight control was good both on CIT and NSII. Acceptance of NSII was less favourable - only three children elected to stay on an insulin infusion and 12 months after the trial only one child remains on NSII, and another uses it intermittently. NSII in young children would appear to be effective but more impractical than CIT.

Chemstrip glucose test strips

Estimations of blood glucose in the range 0-80 mg/dl were performed using the Chemstrip bG and StatTek Glucose Low Level test strips. Estimations of glucose levels closely approximated values obtained by a quantitative, enzymatic reference method; both appear to be excellent screening tests for hypoglycemia. There were no false-negatives, the tests were 100% sensitive and predicted the absence of hypoglycemia, as defined by a plasma glucose value of less than 30 mg/dl, in every case. Therefore, significant hypoglycemia should not be missed. Both give some false positives; in the usual neonatal intensive care population, about 4 of 10 Chemstrip readings of less than 40 mg/dl would lead to an unnecessary blood glucose determination, an acceptable rate for this type of test. The Chemstrip bG technique, a simple and useful test, should be valuable for blood glucose screening in the nursery.