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Ectopic production of somatostatin-like immuno- and bioactivity by cultured human pulmonary small cell carcinoma.

Eleven continuous cultures of human pulmonary small cell carcinoma cells were examined, and eight were shown to secrete quantities of somatostatin-like immunoreactivity (SRIF-LI) ranging from 0.07-27 ng/ml culture medium/4 days, SRIF-LI was also found in a 2-N acetic acid extract of one of three human pulmonary small cell carcinomas obtained at autopsy as well as in the extract of a solid tumor resulting from inoculation of nude, athymic mice with SRIF-LI-producing, cultured small cell carcinoma cells. The SRIF-LI produced by one continuous cell line, DMS 53, was characterized in terms of its immunological, chromatographic, and biological properties. SRIF-LI from DMS 53 culture media and lysed cells was heat stable and exhibited parallel displacement to synthetic SRIF standard in a double antibody RIA. DMS 53 SRIF-LI was quantitatively retained on an immunoaffinity column of sheep anti-SRIF-Sepharose 4B under neutral conditions and could be eluted with 2 N acetic acid. Gel filtration chromatography of immunoaffinity-purified SRIF-LI revealed multiple molecular weight forms, the largest of which had an apparent molecular weight of 10,000-12,000 daltons and may represent a precursor form. This high molecular weight SRIF-LI form was resistant to exposure to denaturing conditions (8 M urea or 4 M urea plus 0.5% mercaptoethanol), suggesting the absence of noncovalent and/or disulfide linkages. A low molecular weight form coeluted with synthetic SRIF. Additional evidence for the identity of this form with the tetradecapeptide was provided by highly specific reverse phase high performance liquid chromatography. The rate of degradation of high molecular weight SRIF-LI by the cultures was markedly reduced in comparison to that of the SRIF monomer, resulting in a preferential accumulation of high molecular weight SRIF-LI in 4-day culture medium. Bioactivity of DMS 53 SRIF-LI was assessed in 4-day primary monolayer cultures of rat adenohypophyseal cells where 10(-10)-10(-9) M synthetic SRIF elicited a linear log-dose suppression of 5 X 10(-4) M synthetic SRIF elicited a linear log-dose suppression of 5 X 10(-4) M dibutyryl cAMP-stimulated rat GH release. Immunoaffinity-purified SRIF-LI from DMS 53 lysed cells and 1-h serum-free incubation medium, which consisted predominantly of monomeric SRIF, was equipotent to synthetic SRIF, SRIF-LI from 4-day culture medium consisted mostly of the high molecular weight form and exhibited a reduced bioassay potency ratio relative to synthetic SRIF of 0.73 (95% confidence limits, 0.99-0.53). Chromatographically purified high molecular weight SRIF-LI had significant bioactivity with a bioassay to immunoassay ratio of 0.19 (95% confidence limits, 0.33-0.09). The demonstration of ectopic SRIF, production by human pulmonary small cell carcinoma is consistent with the proposed derivation of this tumor from a cell type in the amine precursor uptake and decarboxylation cell series.

Animals↗

Characterization of microorganism identification in the United States in 1996.

CONTEXT: The National Inventory of Clinical Laboratory Testing Services (NICLTS) was designed to give an unbiased estimate of all patient testing performed by laboratories registered under the Clinical Laboratory Improvement Amendments in 1996. OBJECTIVE: Survey data were used to develop a profile of laboratory testing primarily intended to identify microorganisms or antibodies to these microorganisms. DESIGN: Estimates of the extent of microorganism identification were derived from the NICLTS database by identifying associated tests and methods. The volumes for tests performed at locations that primarily prepared blood components for distribution were excluded. Organisms of public health importance were identified from the National Notifiable Disease list maintained by the Centers for Disease Control and Prevention. PARTICIPANTS: Laboratories that were enrolled in the 1996 Online Certification Survey and Reporting System, maintained by the US Health Care Finance Administration, and that performed laboratory testing in 1996. OUTCOME MEASURE: Estimated volumes and associated confidence limits by test, method, specimen type, public health importance, and testing location. RESULTS: Excluding testing of the blood supply, 315 million tests (95% confidence limits, 280-354 million tests) were performed in the United States for microorganism identification. Those tests for which public health consensus requires national reporting represented 38% of this total. Although hospitals performed 46% of all microorganism identification, they only performed 33% of the testing for microorganisms of public health importance. Independent and specialty laboratories performed 38% of all testing but 65% of the testing for microorganisms of public health importance. Direct methods (methods not involving culture) were used in 77% of the tests for microorganisms of public health importance and in 42% of all identification tests. CONCLUSIONS: The distribution of microorganism identification testing found using NICLTS data is consistent with plans to modernize the public health surveillance system in the United States.

Data Collection↗

Universal precautions to prevent HIV transmission to health care workers: an economic analysis.

The universal precautions recommended by the US Centers for Disease Control (CDC), Atlanta, for the prevention of HIV (human immunodeficiency virus) transmission to health care workers are widely accepted, despite little documentation of their effectiveness and efficiency. We reviewed the evidence on the risk of HIV transmission to hospital workers and the effectiveness of the universal precautions. We also evaluated the costs of implementing the recommendations in a 450-bed acute care teaching hospital in Hamilton, Ont. On the basis of aggregated results from six prospective studies the risk of HIV seroconversion among hospital workers after a needlestick injury involving a patient known to have AIDS (acquired immune deficiency syndrome) is 0.36% (upper 95% confidence limit 0.67%); the risk after skin and mucous membrane exposure to blood or other body fluids of AIDS patients is 0% (upper 95% confidence limit 0.38%). We estimated that 0.038 cases of HIV seroconversion would be prevented annually in the study hospital if the CDC recommendations were followed. The incremental cost of implementing the universal precautions was estimated to be about $315,000 per year, or over $8 million per case of HIV seroconversion prevented. If all HIV-infected workers were assumed to have AIDS within 10 years of infection the of the program would be about $565,000 per life-year saved. When less conservative, more probable assumptions were applied the best estimate of the implementation cost was $128,862,000 per case of HIV seroconversion prevented. The universal precautions implemented in the study hospital were not found to be efficacious or cost-effective. To minimize the already small risk of HIV transmission in hospitals the sources of risk of percutaneous injury should be better defined and the design of percutaneous lines, needles and surgical equipment as well as techniques improved. Preventive measures recommended on the basis of demonstrated efficacy and aimed at routes of exposure that represent true risk are needed.

Acquired Immunodeficiency Syndrome↗

Public Health Service study of Reye's syndrome and medications. Report of the main study.

Between January 1985 and May 1986, following completion of a pilot study, a main study concerning the possible association between Reye's syndrome and salicylates was conducted. Twenty-seven patients with stage II or deeper Reye's syndrome whose diagnoses were confirmed by an expert panel and who had appropriate antecedent illnesses (chickenpox, respiratory illness, or gastrointestinal illness) prior to the onset of Reye's syndrome were compared with 140 controls matched for age, race (black or not black), and type and timing of onset of antecedent illness. Controls were selected from the same hospital, emergency room, or school as case-patients or were identified by random-digit telephone dialing. As in the pilot study, a strong statistical association with ingestion of salicylates during the antecedent illness and prior to the onset of Reye's syndrome was observed (odds ratio, 40; lower 95% confidence limit, 5.8). Analysis of the independent risk of aspirin and nonaspirin salicylates revealed a significant association with aspirin (odds ratio, 26; lower 95% confidence limit, 6.4); the independent risk of nonaspirin salicylates could not be assessed because only two cases were not exposed to aspirin. Assessment of epidemiologic issues of concern, including case-control differences in the severity of the antecedent illness, did not explain the high odds ratios that were observed. The high percentage of patients with Reye's syndrome exposed to salicylates (greater than or equal to 90%) in this and prior studies suggests that, though the reported incidence of Reye's syndrome has declined in recent years, concomitant with a decline in salicylate use among children, a majority of Reye's syndrome cases may be attributable to salicylate use.

Adolescent↗

[Neonatal mortality, morbidity and late sequelae in infants with birth weight under 1.501 gr or gestational age under 31 weeks, primarily admitted to a central hospital].

The purpose of the study was during a three year period from 1990 to 1992 to describe the neonatal mortality, morbidity and the late complications of 75 very low birth weight infants primarily treated in the neonatal department of a County Hospital. The study was performed retrospectively. The mean birth weight was 1292 g in (range 755-2046 g) and the mean gestational age 29.9 weeks (range 25-37 weeks). The primary choice of treatment was nasal continuous positive airway pressure (nasal-CPAP) and "minimal handling" regime. When needed surfactant administration and/or mechanical ventilation was used. Twenty neonates (27%) received mechanical ventilation, and 14 (19%) were treated with surfactant (Curosurf). The mortality (8%) (95% confidence limits 2.9%-16.6%) and morbidity is low. Late complications such as cerebral palsy or mental retardation were seen in eight infants (12.1%) (95% confidence limits 5.4-22.5%). The results of our treatment seem acceptable, and confirm an increasing survival among very low birth weight infants.

Cerebral Palsy↗

[beta2-Microglobulin and pulmonary tuberculosis (author's transl)].

Serum beta2-microglobulin levels, determined in 29 healthy adults were found to be 1,3 mg/l with an upper confidence limit (95%) of 2,0 mg/ml. In contrast, serum values in 101 patients with pulmonary tuberculosis were 2,1 mg/l with an upper confidence limit of 3,2 mg/l. The latter value is therefore to be taken into consideration if serum beta2m is to be used for discriminating between lung carcinoma and other pulmonary diseases.

Beta-Globulins↗

Surgical management of pulmonary stenosis in tetralogy of Fallot.

Fifty-five consecutive patients with the tetralogy of Fallot underwent intracardiac repair in a 12 month period. A standardized protocol for outflow tract enlargement was used. When the measured diameter of the pulmonary valve ring was at least the "minimum acceptable pulmonary valve ring diameter," primary patch-graft enlargement across the valve ring was not done (Group I, 34 patients); when it was less, primary patch-graft enlargement was done (Group II, 21 patients). The right ventricular-left ventricular systolic pressure ratio (PRV/LV) after repair without patch-graft enlargement across the ring was related to the size of the ring. Sixteen (94 percent) of 17 such patients with normal-sized or large pulmonary valve rings (according to the criteria of Rowlatt, Rimoldi, and Lev) had PRV/LV equal to or less than 0.65; four (80 percent) of five patients with smaller rings but within the 50 percent confidence limits had PRV/LV equal to or less than 0.65; five (56 percent) of nine with still smaller rings but within the 72.5 percent confidence limits had PRV/LV equal to or less than 0.65. In Group II, 15 patients had abnormally small rings, but after patch-graft enlargement the mean PRV/LV was 0.44 +/- 0.140. A surgical protocol based on these data has been developed.

Humans↗

Antibodies to human papillomavirus 16 and subsequent in situ or invasive cancer of the cervix.

Our objective was to examine whether past infection with human papillomavirus (HPV)-16, as determined by an antibody assay, is a risk factor for subsequent cervical cancer. Incident cases of in situ or invasive cervical cancer occurring between 1975 and 1990 in a cohort of over 11,000 healthy women in Washington County, MD, were identified. The baseline sera of cases and of matched controls, collected in 1974, were examined for IgG antibodies reactive with virus-like particles of HPV-16, a cancer-associated HPV, and HPV-6, a low-risk HPV. Postdiagnosis sera of 11 cases were also assessed similarly. Fourteen cases of invasive and 28 cases of in situ cervical cancer and 83 matched controls were evaluated. The main outcome measure was the risk of cervical cancer in women who had HPV-16 or HPV-6 antibodies in prediagnostic sera. Antibodies to HPV-16 but not to HPV-6 were a marker for subsequent occurrence of cervical cancer. Case sera were reactive more often and more strongly with HPV-16 virus-like particles than were sera of matched controls. The presence of antibodies to HPV-16 was significantly associated with an increased risk of cervical cancer (odds ratio, 3.9; 95% confidence limits, 1.4, 10.7); high antibody levels to HPV-16 were associated with an even greater risk of cervical cancer (odds ratio = 7.5, 95% confidence limits 1.5, 36.3). The association with cervical cancer was strengthened after adjustment for smoking and years of education. In tests of 11 pairs of pre- and postdiagnostic sera, HPV-16 antibodies did not decline markedly over a 7-13-year time period, and seroconversion to HPV-16 appeared to have occurred in 2 cases. The serological data indicate that HPV-16 infection is associated with future risk of cervical cancer and strengthen the evidence for the etiological role of HPVs in cervical cancer.

Adult↗

Growth rate and growth probability of Listeria monocytogenes in dairy, meat and seafood products in suboptimal conditions.

AIMS: To evaluate the performances of models predicting the growth rate or the growth probability of Listeria monocytogenes in food. METHODS AND RESULTS: Cardinal and square root type models including or not interactions between environmental factors and probability models were evaluated for their ability to describe the behaviour of L. monocytogenes in liquid dairy products, cheese, meat and seafood products. Models excluding interactions seemed sufficient to predict the growth rate of L. monocytogenes. However, the accurate prediction of growth/no-growth limits needed to take interactions into account. A complete and a simplified form (preservatives deducted) of a new cardinal model including interactions and parameter values were suggested to predict confidence limits for the growth rate of L. monocytogenes in food. This model could also be used for the growth probability prediction. CONCLUSIONS: The new cardinal model including interactions was efficient to predict confidence limits for the growth rate of L. monocytogenes and its growth probability in liquid dairy products, meat and seafood products. In cheese, the model was efficient to predict the absence of growth of the pathogen. SIGNIFICANCE AND IMPACT OF THE STUDY: The suggested model can be used for risk assessment and risk management concerning L. monocytogenes in dairy, meat and seafood products.

Animals↗

Teenaged girls, carbonated beverage consumption, and bone fractures.

OBJECTIVE: To determine the possible association between carbonated beverage consumption and bone fractures among teenaged girls given the awareness of the concern about the impact of carbonated beverage consumption on children's health. SETTING: An urban high school. METHODS: A cross-sectional (retrospective) study. Four hundred sixty 9th- and 10th-grade girls attending the high school participated in this study by completing a self-administered questionnaire relating to their physical activities and personal and behavioral practices. The school system and the Harvard School of Public Health Institutional Review Boards approved the study. The girls' self-reports on physical activity, carbonated beverage consumption, and bone fractures are analyzed. RESULTS: In the total sample, carbonated beverage consumption and bone fractures are associated: odds ratio = 3.14 (95% confidence limit, 1.45, 6.78), P = .004. Among physically active girls, the cola beverages, in particular, are highly associated with bone fractures: odds ratio = 4.94 (95% confidence limit, 1.79, 13.62), P = .002. CONCLUSIONS: The results reported confirm previous findings, but the mechanism by which cola drinks are associated with bone fractures in physically active girls has neither been fully explored nor determined. Nevertheless, national concern and alarm about the health impact of carbonated beverage consumption on teenaged girls is supported by the findings of this study. The results have policy implications for improving the dietary practices and health of children.

Adolescent↗

Polyamine metabolism III: urinary acetyl polyamines in human cancer.

Polyamine levels were determined by high-pressure liquid chromatography in the unhydrolyzed 24-hr urine obtained from 15 cancer patients and nine normal subjects. N1-Acetylspermine, N4-acetylspermine, N4-acetylspermidine, and N-(3-aminopropyl)acetamide were not detected in any samples. N1-Acetylspermidine, N8-acetylspermidine, acetylputrescine, and acetylcadaverine were present in all samples. Furthermore, acetylspermidine and acetylputrescine were excreted in much greater quantities than the respective amines in the urine of both cancer patients and normal subjects. The levels of N1-acetylspermidine were considerably higher than the levels of N8-acetylspermidine in the 24-hr urine of cancer patients, resulting in a ratio of N1- to N8-acetylspermidine in the urine of cancer patients significantly higher than that in normal subjects. The urinary levels of acetylputrescine were also significantly higher in cancer patients. The urinary polyamines in 13 of the 15 cancer patients were outside the 95% confidence limits of the normal mean for the ratio of N1- to N8-acetylspermidine and acetylputrescine. All cancer patients showed values outside the 95% confidence limits of the mean for either of these two parameters. Diurnal variation was observed in the urinary excretion of the acetyl polyamines but not for the free amines in two normal subjects.

Acetylation↗

Intravesical bacillus Calmette-Guerin in the treatment of superficial transitional cell carcinoma of the bladder.

Pasteur strain bacillus Calmette-Guerin was used to treat 145 patients with superficial transitional cell carcinoma of the bladder: 47 had established residual disease (therapeutic group) and 130 received prophylactic/adjuvant therapy (including 32 who had a complete response in the therapeutic group and then were placed into the prophylactic group). Among the patients in the therapeutic group a complete response rate of 68 per cent (32 of 47 patients, 95 per cent confidence limits 55 to 81 per cent) was achieved. Of those in the prophylactic/adjuvant group 85 per cent (111 of 130 patients, 95 per cent confidence limits 73 to 91 per cent) remain free of disease. The median followup for the therapeutic group was 17 months (range 3 to 49 months). In the prophylactic/adjuvant therapy group the followup was greater than 3 years in 7 per cent, 2 to 3 years in 23 per cent, 1 to 2 years in 29 per cent and up to 1 year in 41 per cent (median 18 months). Our study confirms that Pasteur strain bacillus Calmette-Guerin is safe and efficacious in the treatment and prevention of recurrent superficial bladder carcinoma.

Administration, Intravesical↗

Case-control study of serum immunoglobulin-E antibodies reactive with soybean in epidemic asthma.

Since 1981, twenty-six asthma outbreaks have been identified in Barcelona, all coinciding with the unloading of soybean in the harbour. Serum from patients with epidemic asthma and individually matched controls with non-epidemic asthma was assayed for immunoglobulin-E (IgE) antibodies against soybean antigens by means of a radioallergosorbent test. In 64 of 86 cases (74.4%) there was a reaction with commercial soybean antigen extracts, compared with only 4 of the 86 controls (4.6%) (odds ratio = 61; lower 95% confidence limit = 8.1). The statistical significance was greater for reactions with extracts of soybean dust taken from Barcelona harbour (odds ratio, unquantifiably high; lower 95% confidence limit = 11.7). No other serological covariate (total serum IgE levels or specific IgE levels against the commonest airborne allergens or legumes) confounded the association between serum anti-soybean IgE antibodies and epidemic asthma. These results support a causal relation between the release of dust during unloading of soybean at the harbour and the occurrence of asthma outbreaks, suggesting an underlying allergic mechanism.

Antibodies↗

Bioimpedance vector pattern in cancer patients without disease versus locally advanced or disseminated disease.

OBJECTIVE: Bioelectrical impedance vector analysis allows non-invasive evaluation of soft tissue hydration and mass through pattern analysis of vector plots as height, normalized resistance, and reactance measurements. METHODS: Whole-body impedance measurements were made with a single frequency (50 kHz) analyzer (BIA-101, Akern/RJL Systems) in 148 adult, white, male subjects 45 to 85 y old: 56 healthy control subjects, 31 cancer patients after surgical procedure (without disease), and 61 patients with locally advanced (30 patients) or disseminated (31 patients) disease with the same body mass index and age. All patients were free from antineoplastic treatment and active nutritional intervention. RESULTS: Mean vectors of cancer groups without disease and locally advance disease versus the control group were characterized by a comparable normalized resistance component with a reduced reactance component (separate 95% confidence limits, P < 0.05), indicating a comparable ionic conduction (hydration) with loss of dielectric mass (cell membranes and tissue interfaces) of soft tissues. Overlapping 95% confidence limits of their mean vectors indicated comparable electrical tissue properties in less versus more advanced disease. CONCLUSION: Monitoring vector displacement trajectory toward the reference target vector position may represent useful feedback in support therapy planning of individual patients.

Aged↗

A new radioimmunoassay of thioridazine and its comparison with a high performance liquid chromatographic method and another radioimmunoassay.

A new radioimmunoassay (RIA) procedure for the determination of thioridazine in plasma is described. Antiserum was produced in rabbits immunized with N-(2-carboxyethyl)desmethylthioridazine-protein conjugate. The developed RIA procedure can measure as low as 80 pg of thioridazine in a 200-microliter human plasma sample with a coefficient of variation of less than 5%. This RIA procedure was compared with previously reported RIA and high performance liquid chromatographic (HPLC) methods by determining plasma concentrations of thioridazine in samples from human volunteers over 72 h after administration of single 50-mg oral doses of thioridazine hydrochloride. There was a good correlation between the assay values (n = 55) determined by the new RIA and HPLC methods (r2 = 0.916), and the slope of the regression line was not significantly different from 1.0 (p greater than 0.60, 95% confidence limits 0.981 +/- 0.081 when RIA values were plotted on the y axis, and HPLC values on the x axis; p greater than 0.10, 95% confidence limits 0.934 +/- 0.080 when HPLC values were plotted on the y axis and RIA values on the x axis). Also, the plot of the differences between these two assay values against the average of the assay values showed that the differences were independent of the concentration range studied. Similar favorable statistical comparisons were obtained when the assay values (n = 44) determined for thioridazine by the two RIA procedures were compared with one another.

Analysis of Variance↗

Reproductive factors and melanoma of the skin among women.

A higher risk of reproductive system disorders, (which include benign tumors, endometriosis, dilation and curettage, hysterectomy, and other disorders requiring gynecologic biopsies) exist among women with cutaneous melanoma as compared to women with skin cancers: The odds ratio (OR) is 3.2, 95% confidence limits (1.0, 10.1), p = 0.049; as compared to a random sample of women with no melanoma or skin cancers, the OR is 3.9, 95% confidence limits (1.2, 12.4), p = 0.021. Confirming the observations of others, the authors found that melanoma was associated with red hair. The data also confirmed the finding that melanoma is associated with significantly fewer pregnancies. The mean numbers of pregnancies in the melanoma group is 1.83 +/- 1.6 (mean and standard deviation) compared to 2.99 +/- 1.9 in the skin cancer group and 2.93 +/- 1.9 in the random sample (p less than or equal to 0.05).

Analysis of Variance↗

Incidence, prevalence, and gene frequency studies of chronic childhood spinal muscular atrophy.

A total population study of chronic childhood spinal muscular atrophy (arrested Werdnig-Hoffmann disease, Kugelberg-Welander disease, SMA type II and III) was undertaken in north-east England to establish gene and carrier frequencies, incidence, and prevalence. The incidence of this disease was 1 in 24 100 live births. Prevalence was 1.20 per 100,000 of the general population. A technique for estimating an autosomal recessive gene frequency in the known presence of dominant new mutations (or phenocopies), using data from a segregation analysis, is described. Gene frequency was in the range (0.00451 to 0.00659 (95% confidence limits), with a working estimate of 0.0055. Carrier rates for the autosomal recessive gene concerned were 1 in 76 to 1 in 111 (95%) confidence limits), with a working estimate of 1 in 90 for genetic counselling purposes.

Child, Preschool↗

A comparison of three pulmonary artery oximetry catheters in intensive care unit patients.

OBJECTIVE: To compare the clinical performance of three pulmonary artery oximetry catheters (Oximetrix 3, SAT-2, and HEMOPRO2) in intensive care unit (ICU) patients. DESIGN: Unblinded comparison of performance over 24 h using an IL-282 CO-oximeter as a criterion standard. SETTING: Multispecialty adult ICU at a university teaching hospital. PATIENTS: Thirty critically ill patients selected from those requiring hemodynamic monitoring for medical management. MEASUREMENTS AND MAIN RESULTS: By all measures, performance of the Oximetrix 3 and SAT-2 systems were comparable; bias +/- precision were -1.98 +/- 3.07 and +1.80 +/- 3.49, respectively, vs -2.28 +/- 5.24 for the HEMOPRO2. The Oximetrix 3 and SAT-2 systems demonstrated consistent performance over the range of saturations tested, though Oximetrix 3 tended to underestimate and SAT-2 tended to overestimate the CO-oximeter value. The HEMOPRO2 underestimated the CO-oximetry-derived saturation, although this was not constant across the range of values tested. The 95 percent confidence limits based on intrasubject variability were similar (+/- 4.59, +/- 5.66, and +/- 6.56 for the Oximetrix 3, SAT-2, and HEMOPRO2, respectively); however, the 95 percent confidence limits based on total variability, while similar for Oximetrix 3 (+/- 6.03) and SAT-2 (+/- 6.86), were larger for the HEMOPRO2 (+/- 10.30). The expected SD was similar for the three systems (2.03, 2.50, and 2.90 for the Oximetrix 3, SAT-2, and HEMOPRO2 systems, respectively). None of the systems equaled or exceeded (p greater than 0.05) the manufacturers' published specifications, which, in all cases, are listed as +/- 2 percent (saturation; 1 SD) when compared with bench oximetry. CONCLUSIONS: Although each system measures mixed venous oxygen saturation, the Oximetrix 3 and SAT-2 systems demonstrate closer agreement with CO-oximetry. However, none of these catheters provided statistically significant evidence that they would perform within +/- 2 percent of CO-oximetry. As a continuous monitor used to detect changes or trends, any of the three may be acceptable.

Calibration↗