Prevention of hypoglycemia by intermittent-scanning continuous glucose monitoring device combined with structured education in patients with type 1 diabetes mellitus : A randomized, crossover trial

Aims: We conducted a randomized, crossover trial to compare intermittent-scanning continuous glucose monitoring (isCGM) device with structured education (Intervention) to self-monitoring of blood glucose (SMBG) (Control) in the reduction of time below range. Methods: This crossover trial involved 104 adults with type 1 diabetes mellitus (T1DM) using multiple daily injections. Participants were randomly allocated to either sequence Intervention/Control or sequence Control/Intervention. During the Intervention period which lasted 84 days, participants used the first-generation FreeStyle Libre (Abbott Diabetes Care, Alameda, CA, USA) and received structured education on how to prevent hypoglycemia based on the trend arrow and by frequent sensor scanning (≥10 times a day). Confirmatory SMBG was conducted before dosing insulin. The Control period lasted 84 days. The primary endpoint was the decrease in the time below range (TBR; <70 mg/dL). Results: The time below range was significantly reduced in the Intervention arm compared to the Control arm (2.42 ± 1.68 h/day [10.1 %±7.0 %] vs 3.10 ± 2.28 h/day [12.9 %±9.5 %], P = 0.012). The ratio of high-risk participants with low blood glucose index >5 was significantly reduced (8.6 % vs 23.7 %, P < 0.001). Conclusions: The use of isCGM combined with structured education significantly reduced the time below range in patients with T1DM

Lzts1 controls both neuronal delamination and outer radial glial-like cell generation during mammalian cerebral development

発生期の大脳で分化細胞と未分化細胞の移動開始をもたらす共通の分子を解明 --「大脳のシワ」形成に貢献する外側放射状グリアはどのように誕生するか--. 京都大学プレスリリース. 2019-07-08.In the developing central nervous system, cell departure from the apical surface is the initial and fundamental step to form the 3D, organized architecture. Both delamination of differentiating cells and repositioning of progenitors to generate outer radial glial cells (oRGs) contribute to mammalian neocortical expansion; however, a comprehensive understanding of their mechanisms is lacking. Here, we demonstrate that Lzts1, a molecule associated with microtubule components, promotes both cell departure events. In neuronally committed cells, Lzts1 functions in apical delamination by altering apical junctional organization. In apical RGs (aRGs), Lzts1 expression is variable, depending on Hes1 expression levels. According to its differential levels, Lzts1 induces diverse RG behaviors: planar division, oblique divisions of aRGs that generate oRGs, and their mitotic somal translocation. Loss-of-function of lzts1 impairs all these cell departure processes. Thus, Lzts1 functions as a master modulator of cellular dynamics, contributing to increasing complexity of the cerebral architecture during evolution

3.5 mm compliant robotic surgical forceps with 4 DOF:design and performance evaluation

Minimally invasive surgery (MIS) is a viable alternative to general surgery with distinct advantages. Robotically assisted MIS, has been demonstrated to achieve higher accuracy and repeatability in comparison with those of manual procedures. Despite these advantages, owing to the nature of some surgical procedures in which dexterous tissue manipulations in deep narrow areas of the human body are necessary, there is a need for further miniaturized tools with smaller bending radii. To cater to this requirement, this study proposes a new compliant mechanism based surgical robotic forceps. It can generate four degrees of freedom at the tip of the forceps including two bending motions in two perpendicular axes, grasping and rotation. A better combination of the stress distribution through the elastic material, grasping force, and range of motion was determined based on a series of finite element analyses. In addition, the manufactured prototype underwent a series of laboratory experiments to evaluate its effectiveness. Details of the mechanism, finite element analysis, prototype implementation, and evaluations are presented in this paper.</p

Design and Prototyping of a Handheld 3-DOF Laparoscopic Ultrasound Manipulator for Liver Surgery

AbstractLaparoscopic ultrasound offers noninvasive, real-time, and low-cost intraoperative monitoring of the intra-abdominal organs. However, because of the lack of degrees of freedom in the positioning of the laparoscopic ultrasound probe, it is difficult to align an ultrasound imaging plane with the longitudinal section of a blood vessel in the liver. This paper proposes a handheld laparoscopic ultrasound manipulator with three degrees of freedom designed to manipulate a miniature laparoscopic ultrasound probe. First, an ideal range of motion, measured using sensors and quantified as the required minimum range of motion of the laparoscopic ultrasound probe, was demonstrated by a surgeon. Thereafter, a double-bevel-gear mechanism enabling a pitch motion of ±40° and a yaw motion of ±30° and a wire-driven mechanism enabling a roll motion of ±60° were designed and implemented to the laparoscopic ultrasound manipulator with three degrees of freedom. A mechanism for assembling the miniature laparoscopic ultrasound probe with the shaft of the manipulator under a laparoscopic view was also designed to minimize the number and size of incisions in the abdomen. A prototype of the manipulator with a drive unit was fabricated and tested on an ultrasound liver phantom. A successful assembly, as well as successful visualization of the longitudinal section of a blood vessel in the liver model was demonstrated in a simulated laparoscopic environment. In future, the design will be revised, and the handheld laparoscopic ultrasound manipulator with three degrees of freedom will be tested for in vivo experiments

Aortic Arch Atherosclerosis in Ischaemic Stroke of Unknown Origin Affects Prognosis

Background: Cerebral infarction of unknown origin at admission accounts for half of all cerebral infarction cases in some institutions. However, the factors associated with cerebral infarction prognosis have not been sufficiently examined. Here, we investigated whether aortic arch plaques (AAPs) on transoesophageal echocardiography (TOE) were associated with the prognosis of cerebral infarction of unknown origin at admission. Methods: Of 571 patients who were hospitalised between June 2009 and September 2011, 149 (age: 67 ± 14 years; 95 men) with cerebral infarctions of unknown origin at admission underwent TOE and were enrolled in this study. We examined their clinical characteristics, the incidence of intermittent atrial fibrillation detected on 24-hour electrocardiography, and the echographic findings of the carotid artery in the hospital. A poor prognostic outcome was defined as a modified Rankin Scale score of ≥3 after 90 days. Results: In all, 110 patients (74%) showed good prognoses and 39 patients (26%) showed poor outcomes. A National Institutes of Health Stroke Scale score of >6 on admission [odds ratio (OR) = 6.77; 95% confidence interval (CI): 2.59-18.8; p Conclusions: Thick AAPs could be a factor in the prediction of a poor prognosis of cerebral infarction of unknown origin at admission. The establishment of international standards for aortogenic brain embolisms is required. Future prospective studies should examine cerebral infarctions of unknown origin

Elasticity-based boosting of neuroepithelial nucleokinesis via indirect energy transfer from mother to daughter

<div><p>Neural progenitor cells (NPCs), which are apicobasally elongated and densely packed in the developing brain, systematically move their nuclei/somata in a cell cycle–dependent manner, called interkinetic nuclear migration (IKNM): apical during G2 and basal during G1. Although intracellular molecular mechanisms of individual IKNM have been explored, how heterogeneous IKNMs are collectively coordinated is unknown. Our quantitative cell-biological and in silico analyses revealed that tissue elasticity mechanically assists an initial step of basalward IKNM. When the soma of an M-phase progenitor cell rounds up using actomyosin within the subapical space, a microzone within 10 μm from the surface, which is compressed and elastic because of the apical surface’s contractility, laterally pushes the densely neighboring processes of non–M-phase cells. The pressed processes then recoil centripetally and basally to propel the nuclei/somata of the progenitor’s daughter cells. Thus, indirect neighbor-assisted transfer of mechanical energy from mother to daughter helps efficient brain development.</p></div

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