OBJECTIVE: To reveal the significance of continuous transcutaneous carbon dioxide (CO2) level monitoring through reviewing cases which showed a discrepancy in CO2 levels between arterial blood gas analysis (ABGA) and continuous transcutaneous blood gas monitoring. METHOD: Medical record review was conducted retrospectively of patients with neuromuscular diseases who had started home mechanical ventilation between June 2008 and May 2010. The 89 patients underwent ABGA at the 1st hospital day, and changes to their CO2 level were continuously monitored overnight with a transcutaneous blood gas analysis device. The number of patients who initially appeared to show normal PaCO2 through ABGA, yet displayed hypercapnea through overnight continuous monitoring, was counted. RESULTS: 36 patients (40.45%) presented inconsistent CO2 level results between ABGA and continuous overnight monitoring. The mean CO2 level of the 36 patients using ABGA was 37.23+/-5.11 mmHg. However, the maximum and mean CO2 levels from the continuous monitoring device were 52.25+/-6.87 mmHg and 46.16+/-6.08 mmHg, respectively. From the total monitoring period (357.28+/-150.12 minutes), CO2 retention over 45 mmHg was detected in 198.97 minutes (55.69%). CONCLUSION: Although ABGA only reflects ventilatory status at the puncturing moment, ABGA results are commonly used to monitor ventilatory status in most clinical settings. In order to decide the starting point of home mechanical ventilation in neuromuscular patients, continuous overnight monitoring should be considered to assess latent CO2 retention.
Blood Gas Analysis ; Blood Gas Monitoring, Transcutaneous ; Carbon Dioxide ; Humans ; Medical Records ; Neuromuscular Diseases ; Organothiophosphorus Compounds ; Respiration, Artificial ; Respiratory Insufficiency ; Retention (Psychology) ; Retrospective Studies ; Ventilators, Mechanical

BACKGROUND: The monitoring of end-tidal CO2 tension (PETCO2) during high frequency jet ventilation (HFJV) has been unsatisfactory because of a small tidal volume and slow response time of CO2 analyser, although several authors have reported strategies of successful PETCO2 measurement during HFJV. The aim of this study was to assess the validity of tracheal CO2 tension (PtCO2) as a PaCO2 during HFJV. METHODS: We studied 24 patients undergoing laryngomicrosurgery during HFJV (rates: 100/min; I:E= 0.2; driving pressure: 0.25-0.35 MPa) through a 12 Fr. polyethylene injector placed 6-7 cm below the vocal cord. A gas sampling line was placed longitudinally against the injector and they were wrapped with aluminum foil. Continuous capnography was recorded during 20 minutes of HFJV. Every 5 minutes of HFJV, PtCO2 was obtained from the plateau value of CO2 wave after the stopping of JV and arterial blood gas analysis was done at 20 minutes of HFJV comparing PaCO2 to PtCO2. A Pearson's product moment correlation and regression analysis between PtCO2 and PaCO2 and the agreement between the two methods using Bland-Altman method were assessed. RESULTS: A regression analysis (R2=0.928) and a Pearson's product moment correlation (r=0.965, P<0.001) indicated a strong correlation of PtCO2 and PaCO2 during HFJV. The difference against a mean scatter diagram showed a relative good agreement between the two method (mean difference: 1.58 (SD 2.22) mmHg; limit of agreement: 2.86 and -6.02). CONCLUSIONS: PtCO2 obtained from a plateau of CO2 wave on capnography after interruption of HFJV can accurately reflect PaCO2 during HFJV in relative.
Aluminum ; Blood Gas Analysis ; Blood Gas Monitoring, Transcutaneous ; Capnography ; High-Frequency Jet Ventilation* ; Humans ; Polyethylene ; Reaction Time ; Tidal Volume ; Vocal Cords

OBJECTIVETo study the anti-endotoxin of different concentration baicalin.

METHODS6.250 microg/mL, 3.125 microLg/mL, 1.562 microg/mL and 0.781 microg/mL baicalin solutions were mixed with I EU/mL endotoxin, respectively. The mixtures were put into water of (37+/-1) degrees C for 15 min, 30 min and 60 min. The degrading effects were determined by using limulus amebocyte lysate test (LAL test).

RESULTS1) The degrading effect of 6.250 microg/mL, 3.125 microg/mL and 1.562 microg/mL baicalin solution on I EU/mL endotoxin was degraded completely in 15 min, 30 min and 60 min, respectively. 2)The degrading effect of 3.125 microg/mL, 1.562 microg/mL and 0.781 microg/mL baicalin solution on 1 EU/mL endotoxin after these mixtures had been incubated for 15 min. Endotoxin values were (0.155 5 +/- 0.002 8) EU/mL, (0.212 1+/-0.004 9) EU/mL, (0.355 9+/-0.013 9) EU/mL, respectively. These differences among them were statistically significant (P<0.01). 3) The degrading effect of 1.562 microg/mL and 0.781 microg/mL baicalin solution on 1 EU/mL endotoxin after these mixtures had been incubated for 30 min. Endotoxin values were (0.1640+/-0.0025) EU/mL and (0.2094+/-0.004 4) EU/mL, respectively. These differences between them were statistically significant (P<0.01).

CONCLUSIONThe action of anti-endotoxin of baicalin is dose-dependent and time-dependent. The results show that baicalin has the stronger anti-endotoxin effect.

Endotoxins ; Flavonoids ; Limulus Test

Insulin resistance is one of the major aggravating factors for metabolic disease. There are many methods available for estimation of insulin resistance which range from complex techniques down to simple indices. For all methods of assessing insulin resistance, it is essential that their validity and reliability be established before using them in clinical investigations. The reference techniques of hyperinsulinemic euglycemic clamp and its alternative,the frequently sampled intravenous glucose tolerance test, are the most reliable methods available for estimating insulin resistance. However, there are many simple methods from which indices can be derived that have been assessed and validated, which include homeostasis model assessment (HOMA) and the quantitative insulin sensitivity check index (QUICKI). Given the increasing number of simple indices of insulin resistance, it may be difficult for clinicians and researchers to select the most appropriate index for their studies. In planning studies on insulin resistance and selecting a suitable index, a number of important factors need to be considered by investigators, the principle one being the nature of the study to be undertaken.
Glucose Clamp Technique ; Glucose Tolerance Test ; Homeostasis ; Humans ; Insulin Resistance* ; Metabolic Diseases ; Reproducibility of Results ; Research Personnel

OBJECTIVETo investigate the accuracy and potential error range of noninvasive estimation of CO2 pressure (PCO2), arterial O2 pressure (PaO2), and oxygenation index (OI) by measuring the end-tidal CO2 pressure (PETCO2) and pulse oxygen saturation (SpO2) in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure, and assess the feasibility of this method for dynamic monitoring of arterial CO2 pressure (PaCO2) and PaO2 in the primary care facilities where arterial blood gases analysis is not available.

METHODSAll the 30 patients with COPD and respiratory failure received routine clinical treatment including bronchodilators, mucolytics, glucocorticosteroid, antibiotics and oxygen therapy (titrated to keep SpO2 above 90%) for 5-7 days. A subgroup of the patients also received NIPPV treatment. All the patients were tested with both the eupnea method and prolonged expiratory method before and after the treatment to obtain the data of PCO2 and SpO2 were respectively performed before and after treatment.

RESULTSThe PETCO2 with eupnea (PETCO2(Q)) was 50.72-/+8.93 mmHg, significantly lower than PaCO2 (71.25-/+9.08 mmHg, Plt;0.01), but the PETCO2(P) (70.35-/+8.91 mmHg) was comparable with PaCO2 (P>0.05). Similar results were obtained after the treatment. The PETCO2(P) before treatment and after treatment was positively correlated to PaCO2 (r=0.96 and 0.97, respectively, P<0.01). The PaO2(Y) before the treatment derived from the oxygen dissociation curve based on SpO2 measurement was close to SpO2 (59.96-/+1.42 mmHg vs 59.07-/+2.22 mmHg, P>0.05). The OI derived from PaO2 and OI(Y) from PaO2 (Y) was also similar (215.70-/+22.77 vs 219.15-/+24.63, P>0.05). Linear regression analysis showed positive correlations between PaO2(Y) to PaO2 (r=0.81, P<0.01) and between OI(Y) and OI (r=0.95, P<0.01).

CONCLUSIONSIn patients with COPD (especially those with also type II respiratory failure), the modified monitoring method of PCO2 and maintenance of SpO2 above 90% can precisely estimate PaCO2 and PaO2. This method is feasible for clinical noninvasive and dynamic evaluation of respiratory failure in COPD patients, especially in primary care facilities where arterial blood gases analysis is not available.

Aged ; Aged, 80 and over ; Blood Gas Monitoring, Transcutaneous ; Capnography ; Humans ; Male ; Middle Aged ; Oximetry ; Pulmonary Disease, Chronic Obstructive ; blood ; complications ; physiopathology ; Respiratory Insufficiency ; blood ; etiology ; physiopathology ; Tidal Volume

The authors recommend reference values of blood gas, co-oximetry and acid-base balances in arterial blood of normal people (n=53) by using ABL-520 of radiometer Copenhagen.
Blood Gas Analysis ; Oximetry ; Blood

OBJECTIVES: Insulin resistance is a major pathophysiology in polycystic ovary syndrome (PCOS), and assessment of insulin sensitivity is important. Various insulin sensitivity indices from fasting state or oral glucose tolerance test (OGTT) have been compared with euglycemic hyperinsulinemic clamp. We aimed to evaluate the usefulness of these indices in young Korean women with PCOS. METHODS: Euglycemic hyperinsulinemic clamp test and 75 g OGTT were performed in 290 women with PCOS. Insulin mediated glucose uptake (IMGU), the insulin sensitivity index from clamp, was compared with various insulin sensitivity indices such as composite insulin sensitivity index (ISIcomp), estimated metabolic clearance rate (MCRest) of glucose and estimated insulin sensitivity index (ISIest), area under the curve of glucose and insulin ratio (AUC-GIR), OGTT-derived Belfiore index, and oral glucose insulin sensitivity index (OGSI) by Kazama. Fasting state indices such as glucose insulin ratio (GIR), homeostasis model assessment for insulin resistance (HOMA-IR), fasting Belfiore index, and quantitative insulin sensitivity check index (QUICKI) were also compared with IMGU. RESULTS: The correlation coefficients of ISIcomp, MCRest, ISIest, AUC-GIR, OGTT-Belfiore index, and OGSI with IMGU were all about 0.5 (Ps'<0.001) in PCOS women as a whole. The MCRest and ISIest were significantly correlated with IMGU in both obese (r=0.58 and 0.58, P<0.0001) and non-obese subjects (r=0.33 and 0.32, P<0.001). Fasting glucose and insulin-derived indices showed worse correlation with IMGU than OGTT-derived ones. CONCLUSION: The MCRest and ISIest from OGTT might be the best replacement for the insulin sensitivity index from hyperinsulinemic euglycemic clamp independent of obesity.
Fasting ; Female ; Glucose ; Glucose Clamp Technique ; Glucose Tolerance Test ; Homeostasis ; Humans ; Insulin ; Insulin Resistance ; Metabolic Clearance Rate ; Obesity ; Polycystic Ovary Syndrome

OBJECTIVETo evaluate the accuracy of continuous glucose monitoring system (CGMS) during oral glucose tolerance test (OGTT) in the detection of blood glucose changes in glucose stress condition.

METHODSForty-nine out-patients with fasting plasma glucose of 3.9-11.0 mmol/L underwent continuous blood glucose monitoring using CGMS for 3 days, and OGTT was conducted on the third day. The venous blood glucose was measured at 0, 30, 60, 90, and 120 min after oral glucose intake, and the accuracy of CGMS during OGTT was evaluated.

RESULTSThe correlation indices between CGMS values and the venous blood glucose values during the entire OGTT and in phases of stable, rapidly rising and falling glucose levels were 0.928, 0.901, 0.924 and 0.902, respectively (P<0.001). Clarke error-grid analysis showed that more than 95% of the measured results fell into the A and B zones.

CONCLUSIONCGMS values show good consistency with venous blood glucose values measured during OGTT. CGMS is accurate in detection of rapidly changing blood glucose during OGTT.

Adult ; Aged ; Blood Glucose ; analysis ; Blood Glucose Self-Monitoring ; methods ; Female ; Glucose Tolerance Test ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; methods ; Young Adult

BACKGROUND: Insulin resistance is a central feature of polycystic ovary syndrome (PCOS), and hyperinsulinemia contributes to anovulation, oligo or amenorrhea, hyperandrogenism and infertility in women with PCOS. The use of insulin sensitizers, such as metformin or thiazolidinedione, in PCOS is becoming increasingly accepted. The purpose of our study was to evaluate the therapeutic effects of metformin and rosiglitazone on the metabolic and reproductive derangement, and find parameters predicting their therapeutic efficacy in Korean PCOS women. METHODS: Sixty-two women with PCOS were recruited. The baseline characteristics, including BMI, glucose tolerance test, lipid profiles, sex hormones and hyperinsulinemic euglycemic clamp test, were assessed. After the administration of the insulin sensitizer (metformin 1.5g/day or rosiglitazone 4mg/day) for 3 months, the insulin sensitivity was reassessed. A drug response was defined as menstrual restoration or pregnancy. RESULTS: Of the 62 women with PCOS, 36 gained restored regular menstruation, and a further 5 conceived (a drug response rate of 66.7%). There were no significant clinical differences between responders and nonresponders. Twelve weeks after taking the drugs, the insulin sensitivity was significantly improved (M-value 4.7+/-0.2 vs. 5.5+/-0.4mg/kg/min, P<0.05), and the free testosterone levels(72.5+/-39.9 vs. 45.8 +/-3.8pmol/L, P<0.05) were significantly decreased, without significant weight reduction. CONCLUSION: Metformin and rosiglitazone restored menstruation in 66.1% of women with PCOS. Hyperandrogenemia and insulin sensitivity were significantly improved with the use of the two drugs. However, metabolic or hormonal markers for predicting the drug response could not be found.
Amenorrhea ; Anovulation ; Female ; Glucose Clamp Technique ; Glucose Tolerance Test ; Gonadal Steroid Hormones ; Humans ; Hyperandrogenism ; Hyperinsulinism ; Infertility ; Insulin ; Insulin Resistance ; Menstruation ; Metformin* ; Polycystic Ovary Syndrome* ; Pregnancy ; Testosterone ; Weight Loss

The Clinical Chemistry subcommittee of the Korean Association for Quality Assurance for Clinical Laboratory conducted external quality assessments in 2013. This included general chemistry and blood gas measurements as part of a scheme of six trials, comprising of three samples each. All control materials were sent at the same time. The overall response rates were 90.8% for general chemistry and 88.0% for blood gas. The parameters tested included sodium, potassium, chloride, blood urea nitrogen, glucose, calcium, phosphorus, uric acid, creatinine, bilirubin, total protein, albumin, total cholesterol, triglyceride, AST, ALT, alkaline phosphatase, lactate dehydrogenase, and gamma glutamyl transferase for general chemistry and pH, pCO2, and pO2 for blood gas assessment. Two types of reports were generated, namely, method summary reports including mean, standard deviation, and coefficient of variation, according to the test method as well as result summary reports of each participating laboratory, including mean, standard deviation and number of peer groups, and standard deviation index and variance index score of each laboratory. The overall quality performance in 2013 was similar to that of previous years, and as compared to results from 2012, the inter-laboratory variation had decreased. The requisite continual improvement in quality of clinical chemistry testing can be achieved through participation in similar proficiency testing programs.
Alkaline Phosphatase ; Bilirubin ; Blood Urea Nitrogen ; Calcium ; Chemistry ; Chemistry, Clinical* ; Cholesterol ; Clinical Chemistry Tests ; Creatinine ; Glucose ; Hydrogen-Ion Concentration ; Korea ; L-Lactate Dehydrogenase ; Laboratory Proficiency Testing ; Peer Group ; Phosphorus ; Potassium ; Research Report ; Sodium ; Transferases ; Triglycerides ; Uric Acid