Standards for rate accuracy may differ if CGMs are intended only to warn clinicians that blood glucose is trending out of range and changes in management are not made until the CGM reading is confirmed by a reference blood glucose measurement. Greater accuracy is required if the CGM readings are to be used to guide therapy, in EMD 1214063 particular the administration of insulin, without confirmation from a reference blood glucose measurement. CGMs must also demonstrate a lack of interference from substances other than glucose, and a lack of sample contamination by adjacent infusions.The set-up and calibration of the CGM should be easy to perform in the clinical setting using methods that provide an accurate reference blood glucose measurement; and the CGM should withhold data and alert the clinician when accuracy becomes questionable.
The current glucose concentration and trend data should be displayed at the bedside, with visual and audible alerts and alarms for hypoglycemia, hyperglycemia, and rapid rates of change. The CGM data should be sufficiently frequent, reliable, and accurate for alarm algorithms to detect and/or predict hypoglycemia and hyperglycemia with high sensitivity and specificity.All systems (needle-type CGM sensors inserted into the subcutaneous tissue that provide an interstitial fluid glucose measurement, optical fiber and dialysis catheter CGM sensors inserted directly into the bloodstream, and external CGM sensors attached to a vascular catheter) should ideally provide a glucose measurement that agrees closely with the true blood glucose concentration when recalibrated les
Sepsis represents a systemic response of the immune system to infection that leads to high mortality and costs [1,2].
The pathophysiologic mechanisms of sepsis are not well known and a better understanding of these processes may allow unmasking of other mortality risk factors.Matrix metalloproteinases (MMPs) are a family of zinc-containing endoproteinases implicated in the degradation and remodelling of the extracellular matrix. The regulation of MMP activity is carried out by tissue inhibitors of matrix metalloproteinases (TIMPs). MMPs have a role in normal physiological functions such as the menstrual cycle, morphogenesis, tissue remodelling and angiogenesis, and in diseases with abnormal extracellular matrix turnover, such as arthritis, tumour invasion, aneurysm formation and atherosclerosis [3].
The role of MMPs/TIMPs in sepsis remains unclear; however, the results of some studies indicate that MMPs facilitate the recruitment of leukocytes from the bloodstream to the site of infection for eradication of the pathogen by proteolysis of the basement membrane [4], and Drug_discovery modulate inflammatory [4] and prothrombotic responses [5,6].Higher circulating levels of TIMP-1 have been reported in nonsurviving septic patients than in surviving septic patients [7-9].