Self-monitoring of blood glucose using capillary glucose testing (C) has a number of shortcomings compared to continuous glucose monitoring (CGM). We aimed to compare these two methods and used blood ...glucose measurements in venous blood (IV) as a reference. Postprandial blood glucose levels were measured after 50 g oral glucose load and after the consumption of a portion of different foods containing 50 g of carbohydrates. We also evaluated the associations between postprandial glucose responses and the clinical characteristics of the participants at the beginning of the study.
12 healthy volunteers (age: 36 ± 17 years, BMI: 24.9 ± 3.5 kg/m²) ate white bread (WB) and whole grain (WG) bread and drank a 50 g glucose drink as reference. Postprandial glucose responses were evaluated by CGM, IV and C blood glucose measurements. Incremental area under the curve (AUC
) of postprandial blood glucose was calculated for 1 h (AUC
) and 2 h (AUC
).
After the consumption of white bread and whole grain bread, the AUC
did not differ between CGM and IV or C. AUC
of CGM showed no difference compared to C. Correlation analyses revealed a positive association of age with glucose AUC
(
= 0.768;
= 0.004) and WG AUC
(
= 0.758;
= 0.004); fasting blood glucose correlated with WG AUC
(
= 0.838;
< 0.001).
Despite considerable inter-individual variability of postprandial glycemic responses, CGM evaluated postprandial glycemic excursions which had comparable results compared to standard blood glucose measurements under real-life conditions. Associations of AUC
and AUC
postprandial glucose response with age or fasting blood glucose could be shown.
Left atrial appendage closure is a non-pharmacological alternative for stroke prevention in high-risk patients with non-valvular atrial fibrillation. The objective of the multicentre EWOLUTION ...registry was to obtain clinical data on procedural success and complications, and long-term patient outcomes, including bleeding and incidence of stroke/transient ischaemic attack (TIA). Here, we report on the peri-procedural outcomes of up to 30 days.
Baseline/implant data are available for 1021 subjects. Subjects in the study were at high risk of stroke (average CHADS2 score: 2.8 ± 1.3, CHA2DS2-VASc: 4.5 ± 1.6) and moderate-to-high risk of bleeding (average HAS-BLED score: 2.3 ± 1.2). Almost half of the subjects (45.4%) had a history of TIA, ischaemic stroke, or haemorrhagic stroke; 62% of patients were deemed unsuitable for novel oral anticoagulant by their physician. The device was successfully deployed in 98.5% of patients with no flow or minimal residual flow achieved in 99.3% of implanted patients. Twenty-eight subjects experienced 31 serious adverse events (SAEs) within 1 day of the procedure. The overall 30-day mortality rate was 0.7%. The most common SAE occurring within 30 days of the procedure was major bleeding requiring transfusion. Incidence of SAEs within 30 days was significantly lower for subjects deemed to be ineligible for oral anticoagulation therapy (OAT) compared with those eligible for OAT (6.5 vs. 10.2%, P = 0.042).
Left atrial appendage closure with the WATCHMAN device has a high success rate in complete LAAC with low peri-procedural risk, even in a population with a higher risk of stroke and bleeding, and multiple co-morbidities. Improvement in implantation techniques has led to a reduction of peri-procedural complications previously limiting the net clinical benefit of the procedure.
H. H. Klein, B. Kowalewski, M. Drenckhan and H. L. Fehm
Department of Internal Medicine, Medical University of Lubeck, Germany.
The degree of insulin receptor kinase activation by in situ stimulation ...was
studied in isolated human adipocytes. Although maximal in situ stimulation
increased the kinase activity approximately 10-fold, this activity could
again be doubled by subsequent activation in a cell-free system. To
investigate how in situ stimulation resulted in incomplete activation,
receptors binding or not binding to anti-phosphotyrosine antibody
(alpha-PY) were studied separately. Even after maximal insulin stimulation
of the cells, approximately 50% of the receptors did not bind to alpha-PY
and had low kinase activity. In the cell-free system, however, these
receptors reached activity levels similar to the other receptors,
suggesting that they were intact and that factors in their cellular
environment had prevented their activation. The activity of the
alpha-PY-binding receptors could only be slightly increased in the
cell-free system, suggesting that almost complete activation had been
attained in situ. In situ stimulation with increasing insulin
concentrations increased the number of activated receptors rather than
their individual activity. We conclude that factors in the in situ
environment prevent insulin activation of approximately 50% of the insulin
receptors in human adipocytes and might therefore be important regulators
of insulin signaling.
A motorkerékpár hősei Werner Krehbiel, hangmérnök; Walli Gürschke, vágó; Horst Kaiser, trükk ...
1965
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