Fluid Glucose Levels Research Articles

Glucose predictability, blood capillary permeability, and glucose utilization rate in subcutaneous, skeletal muscle, and visceral fat tissues

This study suggests an approach for the comparison and evaluation of particular compartments with modest experimental setup costs. A glucose level prediction model was used to evaluate the compartment's glucose transport rate across the blood capillary membrane and the glucose utilization rate by the cells. The glucose levels of the blood, subcutaneous tissue, skeletal muscle tissue, and visceral fat were obtained in experiments conducted on hereditary hypertriglyceridemic rats. After the blood glucose level had undergone a rapid change, the experimenter attempted to reach a steady blood glucose level by manually correcting the glucose infusion rate and maintaining a constant insulin infusion rate. The interstitial fluid glucose levels of subcutaneous tissue, skeletal muscle tissue, and visceral fat were evaluated to determine the reaction delay compared with the change in the blood glucose level, the interstitial fluid glucose level predictability, the blood capillary permeability, the effect of the concentration gradient, and the glucose utilization rate. Based on these data, the glucose transport rate across the capillary membrane and the utilization rate in a particular tissue were determined. The rates obtained were successfully verified against positron emission tomography experiments. The subcutaneous tissue exhibits the lowest and the most predictable glucose utilization rate, whereas the skeletal muscle tissue has the greatest glucose utilization rate. In contrast, the visceral fat is the least predictable and has the shortest reaction delay compared with the change in the blood glucose level. The reaction delays obtained for the subcutaneous tissue and skeletal muscle tissue were found to be approximately equal using a metric based on the time required to reach half of the increase in the interstitial fluid glucose level.

Effects of Coexisting Pneumonia and End-stage Renal Disease on Pleural Fluid Analysis in Patients With Hydrostatic Pleural Effusion

BackgroundIn individual patients, especially those who are hospitalized, several conditions often coexist that may be responsible for the development of a pleural effusion and may affect the pleural fluid analysis (PFA). The objective of this study was to investigate the effects of end-stage renal disease and pneumonia on PFA in patients with hydrostatic pleural effusion. MethodsIn a retrospective analysis of 1,064 consecutive patients who underwent thoracentesis at a university hospital, cell counts and pleural fluid protein, lactate dehydrogenase, pH, and glucose levels were examined in those (n = 300) with clinical evidence of hydrostatic pleural effusion. ResultsThe 300 patients (28.1%) with pleural effusions had congestive heart failure (CHF), circulatory overload (CO), or both. Expert consensus was achieved in 66 (22%) for CHF as the sole diagnosis (SCHF), 30 (10%) for CHF and coexisting pneumonia (PCHF), and 26 (8.7%) for end-stage renal disease (ESRD) with coexisting CO or CHF. The remaining 178 patients were excluded because of complicating conditions. There were minor, but statistically significant differences in pleural fluid/serum protein ratios in patients with ESRD with coexisting CO or CHF compared with SCHF. Compared with SCHF, there were statistically significant tendencies for higher protein and lactate dehydrogenase concentrations and lower pH levels in those with PCHF. The total nucleated cell count and the absolute neutrophil count were significantly higher in PCHF. ConclusionsESRD in patients with hydrostatic pleural effusions has a minimal effect on the PFA. Coexisting pneumonia most often results in an exudative effusion in patients with CHF.

Independent Validation of an Existing Model Enables Prediction of Hearing Loss after Childhood Bacterial Meningitis

ObjectiveThis study aimed external validation of a formerly developed prediction model identifying children at risk for hearing loss after bacterial meningitis (BM). Independent risk factors included in the model are: duration of symptoms prior to admission, petechiae, cerebral spinal fluid (CSF) glucose level, Streptococcus pneumoniae and ataxia. Validation helps to evaluate whether the model has potential in clinical practice.Study design116 Dutch school-age BM survivors were included in the validation cohort and screened for sensorineural hearing loss (>25 dB). Risk factors were obtained from medical records. The model was applied to the validation cohort and its performance was compared with the development cohort. Validation was performed by application of the model on the validation cohort and by assessment of discrimination and goodness of fit. Calibration was evaluated by testing deviations in intercept and slope. Multiple imputation techniques were used to deal with missing values.ResultsRisk factors were distributed equally between both cohorts. Discriminative ability (Area Under the Curve, AUC) of the model was 0.84 in the development and 0.78 in the validation cohort. Hosmer-Lemeshow test for goodness of fit was not significant in the validation cohort, implying good fit concerning the similarity of expected and observed cases. There were no significant differences in calibration slope and intercept. Sensitivity and negative predicted value were high, while specificity and positive predicted value were low which is comparable with findings in the development cohort.ConclusionsPerformance of the model remained good in the validation cohort. This prediction model might be used as a screening tool and can help to identify those children that need special attention and a long follow-up period or more frequent auditory testing.

Glycosylated Hemoglobin and Albumin-Corrected Fructosamine Are Good Indicators for Glycemic Control in Peritoneal Dialysis Patients

PurposeDiabetes mellitus (DM) is the most common cause of end-stage renal disease and is an important risk factor for morbidity and mortality after dialysis. However, glycemic control among such patients is difficult to assess. The present study examined glycemic control parameters and observed glucose variation after refilling different kinds of fresh dialysate in peritoneal dialysis (PD) patients.MethodsA total of 25 DM PD patients were recruited, and continuous glucose monitoring system (CGMS) was applied to measure interstitial fluid (ISF) glucose levels at 5-min intervals for 3 days. Patients filled out diet and PD fluid exchange diaries. The records measured with CGMS were analyzed and correlated with other glycemic control parameters such as fructosamine, albumin-corrected fructosamine (AlbF), glycosylated hemoglobin (HbA1c), and glycated albumin levels.ResultsThere were significant correlations between mean ISF glucose and fructosamine (r = 0.45, P<0.05), AlbF (r = 0.54, P<0.01), and HbA1c (r = 0.51, P<0.01). The ISF glucose levels in glucose-containing dialysate increased from approximately 7–8 mg/dL within 1 hour of exchange in contrast to icodextrin dialysate which kept ISF glucose levels unchanged.ConclusionHbA1c and AlbF significantly correlated with the mean ISF glucose levels, indicating that they are reliable indices of glycemic control in DM PD patients. Icodextrin dialysate seems to have a favorable glycemic control effect when compared to the other glucose-containing dialysates.

Pleural and pericardial empyema in a patient with continuous ambulatory peritoneal dialysis peritonitis

To the Editor, Pleural empyema is usually complicated with pneumonia but may develop from hematogenous spreading from an extrapulmonary focus [1]. We report a case with pleural and pericardial empyema with cardiac tamponade complicating continuous ambulatory peritoneal dialysis (CAPD) peritonitis. A 47-year-old man with end-stage renal disease had been on CAPD for the previous 3 months. He was admitted with abdominal pain, turbid peritoneal dialysate f luid, and exertional dyspnea for 2 days. The total leukocyte count in the peritoneal fluid was 340/mm3 (neutrophil count 29%) and methicillin-sensitive Staphylococcus aureus (MSSA) was identified from a culture of the peritoneal dialysate. MSSA was also identif ied in blood culture. He was diagnosed with CAPD peritonitis and treated with intraperitoneal cefazolin. Simultaneously, a large amount of right pleural effusion was seen with cardiomegaly, but without pneumonic consolidation (Fig. 1). The pleural fluid proved to be exudate effusion and MSSA was identified from a culture. This empyema was treated with percutaneous drainage and antibiotics. Figure 1 Chest computed tomography scan shows right pleural effusion (white arrow) and pericardial effusion (black arrow). On the 8th day, his dyspnea worsened, accompanied by dizziness. His blood pressure dropped to 70/40 mmHg. Echocardiography and chest computed tomography showed markedly increased pericardial effusion with cardiac tamponade (Fig. 2). Pericardiocentesis and a pericardial window operation were performed. Figure 2 Chest computed tomography scan shows markedly increased pericardial effusion with cardiac tamponade (arrow). Two weeks later, the peritoneal f luid became clear and the leukocyte count in the dialysate fluid normalized. At 8 weeks after surgery, he was discharged with complete resolution of the pleural and pericardial empyema. In this case, the pleural empyema was assumed to have developed from hematogenous spreading rather than pleuro-peritoneal communication, because the same microorganism (MSSA) was identified from the cultures of blood, peritoneal dialysate, and pleural fluid. The glucose level in pleural fluid is much less than that of peritoneal dialysate. Our case demonstrates that CAPD peritonitis can be an extrapulmonary cause of pleural empyema. Interestingly, pericardial empyema with cardiac tamponade was also a complication in our patient. This case suggests that CAPD peritonitis can be a cause of pleural empyema and pericardial empyema, which may progress to cardiac tamponade.

In Vivo Noninvasive Monitoring of Glucose Concentration in Human Epidermis by Mid-Infrared Pulsed Photoacoustic Spectroscopy

The noninvasive determination of glucose in the interstitial layer of the human skin by mid-infrared spectroscopy is reported. The sensitivity for this measurement was obtained by combining the high pulse energy from an external cavity quantum cascade laser (EC-QCL) tunable in the infrared glucose fingerprint region (1000-1220 cm(-1)) focused on the skin, with a detection of the absorbance process by photoacoustic spectroscopy in the ultrasound region performed by a gas cell coupled to the skin. This combination facilitates a quantitative measurement for concentrations of skin glucose in the range from <50 mg/dL to >300 mg/dL, which is the relevant range for the glucose monitoring in diabetes patients. Since the interstitial fluid glucose level is representative of the blood glucose level and follows it without significant delay (<10 min), this method could be applied to establish a noninvasive, painless glucose measurement procedure that is urgently awaited by diabetes patients. We report here the design of the photoacoustic experiments, the spectroscopy of glucose in vivo, and the calibration method for the quantitative determination of glucose in skin. Finally, a preliminary test with healthy volunteers and volunteers suffering from diabetes mellitus demonstrates the viability of a noninvasive glucose monitoring for patients based on the combination of infrared QCL and photoacoustic detection.

The Hitchhiker's Guide to the Role of (Transient) Hypoglycemia in Refractory Seizures and Epilepsy

Hypoglycemia and hypoglycorrhachia, although they are uncommon causes of refractory seizures and epilepsy, should always be considered because they are potentially treatable conditions. A high index of suspicion and low threshold for testing recurrent blood and at least one cerebrospinal fluid glucose level are required. Jeavons syndrome and other refractory cryptogenic/idiopathic epilepsies may involve symptomatic etiologies, including hyperinsulinism, GLUT1 deficiency, and other metabolic disorders.

A fatal course of neonatal meningo-encephalitis

Case presentationA pregnant woman (36 weeks gestation) underwent cesareansection and laparotomy because of fever and peritoneal signs. Anormal appendix and no signs of intra-abdominal infection wereseen. A girl was born in good condition.On the fourth day of life, the neonate became lethargic withcyanotic spells, requiring admission to the neonatal intensive careunit and antibiotic therapy was started. Cerebrospinal fluid (CSF)cell count, protein and glucose level and urine microscopy werenormal.Five days after birth, respiratory and circulatory failuredeveloped. CSF showed 26×10

Pneumococcal Serotype–specific Unresponsiveness in Vaccinated Child with Cochlear Implant

Pneumococcal Serotype–specific Unresponsiveness in Vaccinated Child with Cochlear Implant

Horses, hormones and habits

Feeding frequency and density are two of the most important factors that directly affect the growth and physiology of sea cucumber Apostichopus japonicus. In the present study, a 60-day experiment was conducted to evaluate the effects of feeding frequency (1 time, 2 times and 3 times per day) and stocking density (D10, D20, D40 and D60) on growth performance, feed utilization, endocrine response and energy budget of sea cucumber. The results revealed that there was no significant interaction between feeding frequency and stocking density on final weight and specific growth rate (SGR). The maximum SGR occurred at treatment of stocking density D10 with feeding thrice per day. Stepwise multiple regression analysis showed that SGRW and SGRE increased with increasing feeding frequency, and decreased with the increase of stocking density. Density had significant influence on coefficient of variation (CV) for the sea cucumber body weight. For D10 and D20, no significant difference in CV was found between different feeding frequencies. Feed intake, energy intake and feces production rate were significantly affected by feeding frequency, stocking density and their interaction. Density also had significant influence on food conversion efficiency and protein efficiency ratio. Apparent digestibility coefficients of crude protein and crude lipid exhibited remarkable descending trends as stocking density increased. The energy for growth decreased and energy required for metabolism increased with the increase of stocking density, suggesting that crowding stress modified their energy allocation by inhibiting the accumulation of growth energy and accelerating energy consumption of sea cucumber. Cortisol level in coelomic fluid of sea cucumber significantly increased with the increase of stocking density, which could generate energy to satisfy the increasing demand of stress-related energy. Lactate level significantly elevated, and glucose level in coelomic fluid and glycogen in muscle showed remarkable descending trends from D10 to D60, implying long-term energy consumption under high stocking density. Feeding frequency had significant influence on glucose, glycogen and cortisol levels. To some extent, increasing feeding frequency could effectively reduce coefficient of variation of sea cucumber, especially under high stocking density.•In the present study, a 60-day experiment was conducted to evaluate the effects of feeding frequency (1 time, 2 times and 3 times per day) and stocking density (D10, D20, D40 and D60) on growth performance, feed utilization, endocrine response and energy budget of sea cucumber.•Increasing feeding frequency could effectively reduce coefficient of variation of sea cucumber.•The present study provided valuable information for the intensive culture of A. japonicus.

Proinflammatory and Antiinflammatory Cytokine Levels in Complicated and Noncomplicated Parapneumonic Pleural Effusions

This study aimed to evaluate a panel of proinflammatory and antiinflammatory cytokines in noncomplicated and complicated parapneumonic pleural effusions and to correlate their levels with pleural fluid biochemical parameters. Serum and pleural effusion were collected from 60 patients with noncomplicated (n = 26) or complicated (n = 34) parapneumonic effusions and assayed for cytologic, biochemical, and proinflammatory and antiinflammatory cytokines. Student t test was used to compare serum and pleural fluid values, Spearman correlation to analyze the relationship between pleural fluid cytokines and biochemical parameters, and accuracy of pleural fluid cytokine levels to determine the optimal cutoff value for identification of complicated effusions. Corrections for multiple comparisons were applied and a P value < .05 was accepted as significant. Serum and pleural fluid cytokine levels of IL-8, vascular endothelial growth factor (VEGF), IL-10, and tumor necrosis factor (TNF) soluble receptor (sR) II were similar between groups. In contrast, complicated effusions had higher levels of pleural fluid IL-1β, IL-1 receptor antagonist (ra), and TNF sRI. Negative correlations were found between pleural fluid glucose with IL-1β and TNF sRI and positive correlations between lactic dehydrogenate (LDH) with IL-1β, IL-8, and VEGF. Pleural fluid levels of IL-1β, IL-1ra, and TNF sRI were more accurate than IL-8, VEGF, IL-10, and TNF sRII in discriminating complicated effusions. Both proinflammatory and antiinflammatory cytokine levels in pleural fluid are elevated in complicated in comparison with noncomplicated parapneumonic pleural effusions, and they correlate with both pleural fluid glucose and LDH levels. IL-1β, IL-1ra, and TNF sRI had higher sensitivity and specificity than IL-8, VEGF, IL-10, and TNF sRII in discriminating complicated effusions.

Prediction of Interstitial Glucose Level

Glucose is an important source of energy for cells. In clinical practice, we measure glucose level in blood and interstitial fluid. Each method has its pros and cons, and both levels correlate with each other. As the body tries to maintain the glucose level within a particular range to avoid adverse effects, it is desirable to predict future glucose levels in order to aid provided health care. We can see this desire in research, e.g., research on glucose transporters of cells. As yet another example, we can see it with diabetic patients, patients in a metabolic intensive care unit, particularly. In this paper, a glucose level prediction method is proposed.

Feasibility of Continuous Glucose Monitoring in Critically Ill Emergency Department Patients

BackgroundGlucose control is important in the management of critically ill patients. However, strict glucose control requires a large amount of nursing resources, especially in overcrowded emergency departments (EDs). ObjectivesA continuous glucose monitoring system (CGMS) may be beneficial for glucose control in the ED. The objective of this study was to determine the test characteristics of CGMS in critically ill ED patients. MethodsA prospective observational study of critically ill ED patients was conducted. During a patient’s visit to the ED, a CGMS sensor measured their interstitial fluid glucose levels continuously. Capillary glucose was measured every hour and used for glucose control and as a reference value. CGMS values were recorded in real time and compared with capillary glucose values. ResultsA total of 122 pairs of capillary and CGMS glucose values in 12 patients were analyzed. The correlation coefficient was 0.87, and Bland-Altman analysis showed that 117 pairs (95.9%) were within a 95% confidence interval. A Clarke Error Grid Analysis indicated an overall accuracy of 96.8% (Zones A and B). However, the mean absolute relative difference (MARD) was significantly higher in the hypoglycemic range than in a normo- or hyperglycemic range (p = 0.001). The sensitivity and positive predictive value of CGMS for detecting hypoglycemia were 33.3% and 16.7%, respectively. The CGMS specificity and negative predictive value were 95.8% and 98.3%, respectively. There was no linear correlation between MARD and body mass index, axillary temperature, inotrope score, and base deficit (all p-value >0.05). ConclusionCGMS demonstrated good clinical accuracy by Clarke Error Grid Analysis. There also was high agreement between CGMS and capillary glucose levels. However, CGMS demonstrated only limited real-time hypoglycemia detection ability in critically ill ED patients.

Low pleural fluid-to-serum glucose gradient indicates pleuroperitoneal communication in peritoneal dialysis patients: presentation of two cases and a review of the literature

Transudative pleural effusions due to pleuroperitoneal communication occur in 1.6-10% of patients receiving peritoneal dialysis (PD) and usually have overtly elevated glucose concentrations. We report two cases of verified pleuroperitoneal communication with minimally elevated pleural fluid glucose levels. We reviewed the literature of all PD patients with pleuroperitoneal communication that reported pleural glucose levels to assess their clinical and laboratory features and pleural fluid-to-serum glucose gradients. We evaluated a total of 47 reported patients on PD with diagnosed pleuroperitoneal communication. Onset of the transudative pleural effusion after initiating PD was <3 months in only 48%. Shortness of breath was reported in 96%. Pleural effusions were right sided in 87%. Pleural fluid-to-serum glucose gradients varied from 2 to 1885 mg/dL, with 20% ≤50 mg/dL, 13% being 51-100 and 67% >100 mg/dL. All pleural fluid-to-serum glucose ratios were >1. With a transudative pleural effusion in patients receiving PD, a pleural fluid-to-serum glucose ratio >1 is consistent with a pleuroperitoneal communication. In questionable cases, independent verification is necessary.

Parameters relating to the development of residual pleural thickening in tuberculous pleurisy

To identify predictive parameters for the development of residual pleural thickening in tuberculous pleurisy, we investigated 58 tuberculous pleurisy patients retrospectively who could be followed up until their chest roentgenogram no longer changed. The patients were divided into the following three groups according to the final configuration of pleural space: group I costphrenic angle (C-P angle) of the affected side was completely or almost completely recovered (20 cases), group II C-P angle became dull (20 cases), group III pleural thickening of > 2 mm remained in the lateral chest wall above the diaphragmatic dome level (18 cases). Differences of the clinical, chest roentgenographic and laboratory data were compared between these three groups. There were no differences between groups I and II in all of the parameters compared, while there were some differences between groups I and/or II and group III. The mean age of group III (51.1 +/- 18.1 y.o.) was significantly higher than that of group I (40.7 +/- 18.6 y.o.) and group II (34.7 +/- 14.7 y.o.) (p < 0.05 and p < 0.005 respectively). Glucose level in pleural fluid of group III (32 +/- 31 mg/dl) was lower than that of group I (96 +/- 13 mg/dl) and group II (86 +/- 21 mg/dl) (p < 0.001, respectively), while the levels of LDH, TP and ADA in pleural fluid were not different significantly among three groups. BSR (blood sedimentation rate) and CRP (C-reactive protein) were higher in group III (77 +/- 30 mm/hr and 8.5 +/- 4.3 mg/dl) than those in group I (45 +/- 23 mm/hr and 4.1 +/- 5.4 mg/dl) (p < 0.01 and p < 0.05, respectively). The level of albumin in serum was lower and that of globulin was higher, and consequently that of A/G ratio in group III (0.78 +/- 0.17) was lower than that of group I (1.15 +/- 0.16) and group II (1.10 +/- 0.22) (p < 0.001, respectively). It should be emphasized that the level of gamma-globulin was higher in group III irrespective of the presence or absence of accompanying pulmonary tuberculosis. Most patients more than 40 years old with serum A/G ratio less than 0.95 belonged to group III (13/15 (87%)) while most of those with serum A/G ratio more than 0.95 belonged to group I or II (10/11 (91%)). Thus hyper (gamma-) globulinemia and the intensity of inflammatory reaction in the whole body and in the pleural space are the predictive factors for the development of residual pleural thickening in tuberculous pleurisy.

LGI1 related limbic encephalitis and response to immunosuppressive therapy

Limbic encephalitis (LE) is characterized by a subacute onset of episodic memory impairment, disorientation, agitation, seizures and histological evidence of mesial temporal lobe inflammation. It is usually considered to have a paraneoplastic origin and is associated with specific autoantibodies in various cancers [1]. The non-paraneoplastic form has similar clinical and neuroradiological presentation. In these cases antibodies usually target voltage-gated potassium channels (VGKC) or glutamic acid decarboxylase and are, therefore, accepted as immunotherapyresponsive syndromes. Potassium channel antibodies were reported in two patients with reversible LE for the first time in 2001 [2]. Very recently, however, Dalmau et al. showed that the autoantigen associated with LE previously attributed to VGKC is, in fact, leucine-rich, glioma inactivated 1 (LGI1), a neuronal secreted protein [3]. Since this is a relatively rare condition, there have been very few publications on the clinical findings, treatment and follow-up results in this group of patients [3–6] and the optimum treatment regimen is still unknown. In this case report we present a young male patient who did not respond to plasma exchange therapy, but improved rapidly and significantly after IV pulse steroid infusion. A 31-year-old man was admitted for confusional state that had started 1 month ago. He had fever, vomiting and headache at the onset. His past medical history was unremarkable. Physical and neurologic examinations were normal apart from confusion and short-term memory deficits. Cranial MRI revealed hyperintense signals in bilateral hippocampi and the amygdaloid nuclei with little contrast enhancement (Fig. 1). At the onset of his complaints he was admitted to another hospital where he was diagnosed with herpes encephalitis and was given acyclovir without any benefit. In our clinic, blood studies including complete blood count, liver and renal function tests, tumor markers and paraneoplastic antibody analysis (anti-Hu, -Yo, -Ri, -Ma, -CV2) were all normal. Serum electrolyte analysis revealed mild hyponatremia (132 mEq/L). Cerebrospinal fluid (CSF) protein and glucose levels were normal. Analysis of CSF cytology showed increased mononuclear cells. Herpes PCR was negative. Thorax– abdomen CT scans, scrotal-pelvic ultrasonography and whole body fluorodeoxyglucose-positron emission tomography were negative for malignancy. He had two temporal lobe seizures during his follow up. Electroencephalography revealed bilateral generalized mild slow wave paroxysms, without epileptiform discharges. The patient was put on oxcarbazepine (OXC), and did not have any further seizures. In order to investigate the presence of nonparaneoplastic LE, serum and CSF samples were sent to Dr. J. Dalmau’s laboratory where antibodies for NMDA receptors and VGKC antibodies were studied. Meanwhile, the patient had six exchanges of 1.5 plasma volumes on alternate days. We could not give intravenous immunoglobulin (IVIg) because his IgA levels were very low. No clinical response was obtained in the first week after treatment with plasmapheresis and the patient was discharged from hospital. One month later we were informed that he had antibodies against LGI1. The patient was hospitalized again for IV pulse steroid treatment. At that time, his orientation in time and space had partially improved; however, he still had severe memory deficits. He had difficulty in remembering some recent events. After the B. Kaymakamzade T. Kansu E. Tan N. Dericioglu (&) Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey e-mail: noroloji2011@gmail.com

Involvement of macroautophagy and chaperone‐mediated autophagy in the irreversible process of posterior silk gland histolysis during metamorphosis of Bombyx mori

As an approach to clarify the physiological condition and events occurring during the silk gland histolysis, western blot analysis were performed in addition to measuring the glucose level in body fluid and the lysosomal cathepsin activity at different stages, i.e. 6th day after entering 5th instar (V6), prior to spinning (PS), during spinning (S), after cocoon formation (C). The levels of glucose in the body fluid and the phosphorylated p70S6Kinase, which were high at the V6 stage, decreased dramatically after entering metamorphosis at the PS stage, reached the lowest level at the S stage and increased slightly at the C stage. The phosphorylated form of AMPKalpha became detectable at the S stages and increased remarkably at the C stage. The atg8 protein was detected at the stages of V6, PS and S, indicating that macroautophagy occurred before entering the metamorphosis stage and ended before completion of cocoon formation. The lysosomal cathepsin B/L activity showed a dramatic increase at the C stage; it was low at the stages of V6, PS and S. Regarding the ubiqutinated proteins level, it increased remarkably at the stages of S and C. These results suggest that chaperon‐mediated autophagy is involved in the silk gland degradation as well. In conclusion, our results reveal that the shift of the physiological condition at the PS stage allows the catabolic process to be promoted irreversibly.

Analysis of the risk of shunt failure or infection related to cerebrospinal fluid cell count, protein level, and glucose levels in low-birth-weight premature infants with posthemorrhagic hydrocephalus

Premature, low-birth-weight infants with posthemorrhagic hydrocephalus have a high risk of shunt obstruction and infection. Established risk factors for shunt failure include grade of the hemorrhage and age at shunt insertion. There is anecdotal evidence that the amount of red blood cells or protein levels in the CSF may affect shunt performance. However, this has not been analyzed specifically for this cohort of high-risk patients. Therefore, the authors performed this study to examine whether any statistical relationship exists between the CSF constituents and the rate of shunt malfunction or infection in this population. A retrospective cohort study was performed on premature infants born at Riley Hospital for Children from 2000 to 2009. Inclusion criteria were a CSF sample analyzed within 2 weeks prior to shunt insertion, low birth weight (< 1500 grams), prematurity (birth prior to 37 weeks estimated gestational age), and shunt insertion for posthemorrhagic hydrocephalus. Data points included the gestational age at birth and shunt insertion, weight at birth and shunt insertion, history of CNS infection prior to shunt insertion, shunt failure, shunt infection, and the levels of red blood cells, white blood cells, protein, and glucose in the CSF. Statistical analysis was performed to determine any association between shunt outcome and the CSF parameters. Fifty-eight patients met the study entry criteria. Ten patients (17.2%) had primary shunt failure within 3 months of insertion. Nine patients (15.5%) had shunt infection within 3 months. A previous CNS infection prior to shunt insertion was a statistical risk factor for shunt failure (p = 0.0290) but not for shunt infection. There was no statistical relationship between shunt malfunction or infection and the CSF levels of red blood cells, white blood cells, protein, or glucose before shunt insertion. Low-birth-weight premature infants with posthemorrhagic hydrocephalus have a high rate of shunt failure and infection. The authors did not find any association of shunt failure or infection with CSF cell count, protein level, or glucose level. Therefore, it may not be useful to base the timing of shunt insertion on CSF parameters.

Analysis of the risk of shunt failure or infection related to cerebrospinal fluid cell count, protein level, and glucose levels in low-birth-weight premature infants with posthemorrhagic hydrocephalus

Analysis of the risk of shunt failure or infection related to cerebrospinal fluid cell count, protein level, and glucose levels in low-birth-weight premature infants with posthemorrhagic hydrocephalus

1082 Continuous Glucose Monitoring in Morbidly Obese Children with Normal Fasting Bg and Normal Ogtt

This study has been undertaken to assess the glucose metabolism disorder by CGMS in morbidly obese children (BMI > 28) who have normal fasting glucose level and normal oral glucose tolerance. Methods: Ten morbidly obese children were studied. Interstitial fluid (ISF) glucose levels were measured by CGMS for 72 hours as well as by self-monitored blood glucose (SMBG) (3-4 times per day). The circulating fasting glucose, insulin, c-peptide, free T4, TSH, and HbA1C concentrations were measured. Results: The glucose levels in ISF measured by CGMS were highly correlated with those in capillary samples (r=0.742, P 7.6 mmol/L 2 h after food intake) and one had a diabetic curve (T2DM) (BG > 11.2 mmol/L 2 h after food intake). None of the children had elevated HbA1C level. Hyperinsulinemia and/or high C-peptide was recorded in 9 out of the 10 children. Conclusions: Our data suggest that glucose metabolism disorder including impaired postprandial glycemia and type 2 DM can be early diagnosed in morbidly obese children using CGMS when fasting BG and HbA1C levels are still normal. Further studies are required to improve the criteria of early diagnosis of glycemic abnormalities using CGMS.