Assessing the relationship between markers of glycemic control through flexible copula regression models.

Glycated haemoglobin (HbA1c) is a sensitive marker of blood glucose in patients with diabetes. However, levels can vary considerably, even amongst individuals with similar mean blood glucose concentrations. Other glycated proteins, such as fructosamine, can also act as blood sugar markers, but estimating HbA1c and fructosamine via independent models may lead to errors of interpretation regarding disease severity. From a clinical standpoint, it would be of great interest to know the factors that affect the mean concentration of both HbA1c and fructosamine, which influence the variability in the concentrations of these glycated markers and cause HbA1c/fructosamine discordance. Flexible models are required to illustrate the behaviour of these variables as well as the association between them. This work reviews existing models that might serve in this regard. Flexible copula regression models using splines were used to provide a better understanding of the behaviour of both glycated proteins and the relationship between them under the possible influence of different covariates. This work shows the usefulness of this type of models in practise and provides a basis for their clinical interpretation by means of an understandable case study. Ultimately, to better understand the effects of each continuous covariate, they are represented at the true scale of the response variables.

The 3D structure of the human urinary bladder mucosa: a scanning electron microscopy study.

We performed a scanning electron microscopy study on the human urinary bladder tunica mucosa. Specimens from bladder biopsies were treated with OsO4 maceration and 1N NaOH maceration methods prior to SEM observation to disclose the three-dimensional organization of the lamina propria, basal lamina and urothelium. The lamina propria housed a well developed capillary plexus just below the basal lamina; the urothelium presented a typical three-layered organization with basal, intermediate and superficial cells. The intermediate cells appeared essentially similar to basal cells in their external features and stretched from the basal lamina up to the superficial layer. The most superficial cells appeared consistently flattened and interconnected by extensive junctional complexes. They showed a peculiar specialization, their apical plasmalemma being thickened with distinctive, stiff plaques, in contrast with the underlying globular or spindle-shaped cells whose plasmalemma was only covered by short microvillosities.