Sensor-augmented pump therapy lowers HbA(1c) in suboptimally controlled Type?1 diabetes; a randomized controlled trial

To investigate the efficacy of sensor-augmented pump therapy vs. multiple daily injection therapy in patients with suboptimally controlled Type 1 diabetes.

SMARTDIAB: a communication and information technology approach for the intelligent monitoring, management and follow-up of type 1 diabetes patients

SMARTDIAB is a platform designed to support the monitoring, management, and treatment of patients with type 1 diabetes mellitus (T1DM), by combining state-of-the-art approaches in the fields of database (DB) technologies, communications, simulation algorithms, and data mining. SMARTDIAB consists mainly of two units: 1) the patient unit (PU); and 2) the patient management unit (PMU), which communicate with each other for data exchange. The PMU can be accessed by the PU through the internet using devices, such as PCs/laptops with direct internet access or mobile phones via a Wi-Fi/General Packet Radio Service access network. The PU consists of an insulin pump for subcutaneous insulin infusion to the patient and a continuous glucose measurement system. The aforementioned devices running a user-friendly application gather patient's related information and transmit it to the PMU. The PMU consists of a diabetes data management system (DDMS), a decision support system (DSS) that provides risk assessment for long-term diabetes complications, and an insulin infusion advisory system (IIAS), which reside on a Web server. The DDMS can be accessed from both medical personnel and patients, with appropriate security access rights and front-end interfaces. The DDMS, apart from being used for data storage/retrieval, provides also advanced tools for the intelligent processing of the patient's data, supporting the physician in decision making, regarding the patient's treatment. The IIAS is used to close the loop between the insulin pump and the continuous glucose monitoring system, by providing the pump with the appropriate insulin infusion rate in order to keep the patient's glucose levels within predefined limits. The pilot version of the SMARTDIAB has already been implemented, while the platform's evaluation in clinical environment is being in progress.

Macrocephaly in neurofibromatosis type 1: a sign post for optic pathway gliomas?

Optic pathway gliomas, which occur in 15-20% of paediatric patients with neurofibromatosis type 1, are the most common central nervous system tumour associated with this neurocutaneous disorder. The detection of optic pathway gliomas is essential for further management but is often delayed in infancy due to oligosymptomatic progression and difficulties in clinical detection. Therefore, the aim of our study was to find a clinical indicator for the presence of optic pathway gliomas in children with neurofibromatosis type 1 in order to facilitate early diagnosis and initiate further ophthalmological and neuroimaging investigations.

Influence of time point of calibration on accuracy of continuous glucose monitoring in individuals with type 1 diabetes

Abstract Background and Aims: Data on the influence of calibration on accuracy of continuous glucose monitoring (CGM) are scarce. The aim of the present study was to investigate whether the time point of calibration has an influence on sensor accuracy and whether this effect differs according to glycemic level. Subjects and Methods: Two CGM sensors were inserted simultaneously in the abdomen on either side of 20 individuals with type 1 diabetes. One sensor was calibrated predominantly using preprandial glucose (calibration(PRE)). The other sensor was calibrated predominantly using postprandial glucose (calibration(POST)). At minimum three additional glucose values per day were obtained for analysis of accuracy. Sensor readings were divided into four categories according to the glycemic range of the reference values (low, ≤4 mmol/L; euglycemic, 4.1-7 mmol/L; hyperglycemic I, 7.1-14 mmol/L; and hyperglycemic II, >14 mmol/L). Results: The overall mean±SEM absolute relative difference (MARD) between capillary reference values and sensor readings was 18.3±0.8% for calibration(PRE) and 21.9±1.2% for calibration(POST) (P<0.001). MARD according to glycemic range was 47.4±6.5% (low), 17.4±1.3% (euglycemic), 15.0±0.8% (hyperglycemic I), and 17.7±1.9% (hyperglycemic II) for calibration(PRE) and 67.5±9.5% (low), 24.2±1.8% (euglycemic), 15.5±0.9% (hyperglycemic I), and 15.3±1.9% (hyperglycemic II) for calibration(POST). In the low and euglycemic ranges MARD was significantly lower in calibration(PRE) compared with calibration(POST) (P=0.007 and P<0.001, respectively). Conclusions: Sensor calibration predominantly based on preprandial glucose resulted in a significantly higher overall sensor accuracy compared with a predominantly postprandial calibration. The difference was most pronounced in the hypo- and euglycemic reference range, whereas both calibration patterns were comparable in the hyperglycemic range.

An Actor-Critic based controller for glucose regulation in type 1 diabetes

A novel adaptive approach for glucose control in individuals with type 1 diabetes under sensor-augmented pump therapy is proposed. The controller, is based on Actor-Critic (AC) learning and is inspired by the principles of reinforcement learning and optimal control theory. The main characteristics of the proposed controller are (i) simultaneous adjustment of both the insulin basal rate and the bolus dose, (ii) initialization based on clinical procedures, and (iii) real-time personalization. The effectiveness of the proposed algorithm in terms of glycemic control has been investigated in silico in adults, adolescents and children under open-loop and closed-loop approaches, using announced meals with uncertainties in the order of ±25% in the estimation of carbohydrates. The results show that glucose regulation is efficient in all three groups of patients, even with uncertainties in the level of carbohydrates in the meal. The percentages in the A+B zones of the Control Variability Grid Analysis (CVGA) were 100% for adults, and 93% for both adolescents and children. The AC based controller seems to be a promising approach for the automatic adjustment of insulin infusion in order to improve glycemic control. After optimization of the algorithm, the controller will be tested in a clinical trial.

Real-time adaptive models for the personalized prediction of glycemic profile in type 1 diabetes patients

Prediction of glycemic profile is an important task for both early recognition of hypoglycemia and enhancement of the control algorithms for optimization of insulin infusion rate. Adaptive models for glucose prediction and recognition of hypoglycemia based on statistical and artificial intelligence techniques are presented.

2,3-Dichloro-1,4-hydroquinone 2,3-dichloro-1,4-benzoquinone monohydrate: a quinhydrone-type 1:1 donor-acceptor [D-A] charge-transfer complex

In the crystal structure of the title compound (systematic name: 2,3-dichlorobenzene-1,4-diol 2,3-dichlorocyclohexa-2,5-diene-1,4-dione monohydrate), C(6)H(4)Cl(2)O(2)center dot C(6)H(2)Cl(2)O(2)center dot H(2)O, the 2,3-dichloro-1,4-hydroquinone donor (D) and the 2,3-dichloro-1,4-benzoquinone acceptor (A) molecules form alternating stacks along [100]. Their molecular planes [maximum deviations for non-H atoms: 0.0133 (14) (D) and 0.0763 (14) angstrom (A)] are inclined to one another by 1.45 (3)degrees and are thus almost parallel. There are pi-pi interactions involving the D and A molecules, with centroid-centroid distances of 3.5043 (9) and 3.9548 (9) angstrom. Intermolecular O-H center dot center dot center dot O hydrogen bonds involving the water molecule and the hydroxy and ketone groups lead to the formation of two-dimensional networks lying parallel to (001). These networks are linked by C-H center dot center dot center dot O interactions, forming a three-dimensional structure.

Central and peripheral components of exercise-related fatigability in myotonic dystrophy type 1

Fatigue frequently occurs in myotonic dystrophy type 1 (DM1), but its pathophysiology remains unclear. This study assessed central and peripheral components of exercise-related fatigability in patients with DM1, compared to controls.

Evaluation des effets de l’extrait aqueux des fleurs de Nymphaea lotus Linn. (Nymphéacées) sur la fonction de reproduction des rats normoglycémique et diabétique de type 1

In traditional medicine of Cameroon, Nymphaea lotus Linn. (Nympheaceae) is used for treatment of male sexual disorders. The aim of this study was to evaluate the effects of the N. lotus flowers aqueous extracts on general mating behavior, fertility and some androgenic parameters of normoglycemic and diabetic adult male rats. Mating behavior assessment was carried out with primiparous and with oestrus female rats. Male rats were divided into 5 groups and subjected once in a day to the following treatment: distilled water (10 mL/kg), Sildenafil citrate (5mg/kg), Testosterone enanthate (5mg/kg) and plant extract (75 mg/kg and 150 mg/kg). Treatment lasted for 8 and 55 days before sacrifice. Organ weight, epididymal sperm counts, motility, viability, histomorphometric analysis, muscular strength, seminal fructose, cholesterol level, epididymal and serum proteins testicular were determined. Results showed a dose- dependant influence of the treatment in sperm count and motility which significantly increases compared to the distilled water-administered control. An increase in some sexual performance parameters (mount and intromission frequencies) was observed in both diabetic and normal rats compared to respective controls. The latencies of mount and intromission were significantly reduced. Computed frequencies of penile licking, index of libido and sexual motivation were higher in normal and diabetic extract-treated animals; which suggest an enhancement of motivational parameters. The treatment also caused significant increases in the weight of the testis, prostate, epididymis, in serum cholesterol and epididymal protein level in normal rats compared to the distilled water-administered control. These results indicate an androgenic pro-sexual potential of N. lotus in male rats and justify the empirical use of N. lotus in the management of erectile dysfunction and fertility disorders in males. Key-words: Nymphaea lotus, prosexual, androgenic, fertility, diabetic, male rat. //Selon les tradipraticiens de l’Ouest-Cameroun, Nymphaea lotus Linn. (N. lotus), de la famille des Nymphéacées, est utilisé pour le traitement des dysfonctionnements sexuels chez les hommes. Dans cette étude, l’effet de l’extrait aqueux des fleurs de N. lotus sur la fonction de reproduction des rats mâles adultes normaux et diabétiques a été évalué. Dans le but d’évaluer les effets de l’extrait aqueux des fleurs de N. lotus sur les paramètres généraux de copulation, d’androgénicité et de fertilité, les rats normoglycémiques et diabétiques ont été divisé en 3 groupes contrôle [Groupe I- recevant de l’eau distillée, Groupe II et III recevant respectivement du citrate de sildénafil (5 mg/kg) et l’énanthate de testostérone (5 mg/kg)] et deux groupes expérimentaux traités à l’extrait aux doses 75 mg/kg (Groupe IV) et 150 mg/kg (Groupe V). L’eau distillée, l’extrait et la substance de référence était administré per os une fois par jour. Pour analyser le comportement sexuel et la fertilité, des femelles primipares et en oestrus étaient utilisées. Le traitement a duré 8 et 55 jours avant le sacrifice. Le poids relatif des organes, le nombre de spermatozoïde, la motilité, les analyses morphométriques, la force musculaire, le taux de cholestérol, le taux de protéines sériques et épididymaires étaient déterminé. Le temps de latence de monte et d’intromission a diminué significativement alors que la fréquence d’éjaculation a augmenté. L’index de libido, la fréquence de monte, d’intromission, d’éjaculation, d’orientation des mâles vis-à-vis d’eux même et l’index de motivation sexuelle a augmenté chez les animaux traités l’extrait comparés à ceux ayant reçu de l’eau distillée aussi bien chez les normaux que chez le diabétiques qui n’enregistrent d’ailleurs aucune éjaculation. Le traitement a augmenté significativement (P < 0,01) le poids des testicules, de la prostate et de l’épididyme. Il est observé une augmentation dose-dépendante du nombre et de la motilité des spermatozoïdes (P < 0,05), ainsi qu’une augmentation significative (P < 0,001) temps-dépendant du taux de cholestérol sérique et de protéines épididymaires. Ces résultats indiquent un potentiel androgénique pro-érectile de N. lotus chez les rats mâles et justifient l’utilisation empirique des fleurs de N. lotus dans le traitement des dysfonctions érectiles et des problèmes de fertilité chez les hommes. Mots-clés: Nymphaea lotus, pro-érectile, androgénique, fertilité, diabétiques, rat male

Influence of cristalline structure of two minerals clays of type 1/1 on their pozzolanic power

Two clayey materials, one provided by a patner in mineral sector and the other coming from Balengou (West Region Cameroon) were subject of a comparative study in order to evaluate the influence of their crystalline structure on their pozzolanic property. These two natural materials were preliminary enriched in clay minerals by wet sieving and the fractions obtained are denoted K and H respectively. K and H were calcinated at 700 °C, with a heating rate of 5 °C/min and 10 hours dwell at the peak temperature, the products obtained were named MK and MH. Samples K, H, MK and MH were physicochemically characterized by the chemical (ICP), thermal(TGA/DTA) and mineralogical (DRX and Spectrometry IR) analyses together with the measurement of specific surface (BET), crystallinity and the pouzzolanicity test. The results confirmed K as a kaolinitic and H halloysic clay. The kaolinite and the halloysite respectively presented in these clayey materials exhibited a poor crystallinity, but the degree of disorder is higher in K than in H. These results were largely affected by the significant fraction of gibbsite in kaolinitic clay K. At the crude state, the pozzolanic activity of the material H is weak compared with that of K, but the heat treatment makes largely improve this property for both samples.

Liver kidney microsomal type 1 antibodies reduce the CYP2D6 activity in patients with chronic hepatitis C virus infection

Liver kidney microsomal type 1 (LKM-1) antibodies have been shown to decrease the CYP2D6 activity in vitro and are present in a minority of patients with chronic hepatitis C infection. We investigated whether LKM-1 antibodies might reduce the CYP2D6 activity in vivo. All patients enrolled in the Swiss Hepatitis C Cohort Study and tested for LKM-1 antibodies were assessed (n = 1723): 10 eligible patients were matched with patients without LKM-1 antibodies. Patients were genotyped for CYP2D6 variants to exclude individuals with a poor metabolizer genotype. CYP2D6 activity was measured by a specific substrate using the dextromethorphan/dextrorphan metabolic ratio to classify patients into four activity phenotypes. All patients had a CYP2D6 extensive metabolizer genotype. The observed phenotype was concordant with the CYP2D6 genotype in most LKM-negative patients, whereas only three LKM-1 positive patients had a concordant phenotype (six presented an intermediate and one a poor metabolizer phenotype). The median DEM/DOR ratio was sixfold higher in LKM-1 positive than in LKM-1 negative patients (0.096 vs. 0.016, P = 0.004), indicating that CYP2D6 metabolic function was significantly reduced in the presence of LKM-1 antibodies. In chronic hepatitis C patients with LKM-1 antibodies, the CYP2D6 metabolic activity was on average reduced by 80%. The impact of LKM-1 antibodies on CYP2D6-mediated drug metabolism pathways warrants further translational studies.

Uninephrectomy reduces 11β-hydroxysteroid dehydrogenase type 1 and type 2 concomitantly with an increase in blood pressure in rats

Renal allograft donors are at risk of developing hypertension. Here, we hypothesized that this risk is at least in part explained by an enhanced intracellular availability of 11β-hydroxyglucocorticoids due to an increased 11β-hydroxysteroid dehydrogenase type 1 enzyme (11β-HSD1), an intracellular prereceptor activator of biologically inactive 11-ketocorticosteroids in the liver, and/or a diminished 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2), an inactivator of 11β-hydroxyglucocorticoids in the kidney. To test this hypothesis, uninephrectomized (UNX) (n=9) and sham-operated (n=10) adult Sprague-Dawley rats were investigated. Mean arterial blood pressure and heart rate were measured continuously by telemetry for 6 days in week 5 after UNX. The mRNA of 11β-Hsd1 and 11β-Hsd2 in liver and kidney tissues were assessed by RT-PCR and the 11β-HSD activities were directly quantified in their corresponding tissues by determining the ratios of (tetrahydrocorticosterone+5α-tetrahydrocorticosterone)/tetrahydrodehydrocorticosterone ((THB+5α-THB)/THA) and of corticosterone/dehydrocorticosterone (B/A) by gas chromatography-mass spectrometry. The apparent total body activities of 11β-HSD1 and 11β-HSD2 were estimated using the urinary and plasma ratios of (THB+5α-THB)/THA and B/A. Mean arterial blood pressure was increased after UNX when compared with sham operation. Hepatic mRNA content of 11β-Hsd1 and hepatic, plasma, and urinary ratios of (THB+5α-THB)/THA were decreased after UNX, indicating diminished access of glucocorticoids to its receptors. In renal tissue, 11β-Hsd2 mRNA was reduced and B/A ratios measured in kidney, plasma, and urine were increased, indicating reduced 11β-HSD2 activity and enhanced access of glucocorticoids to mineralocorticoid receptors. Both 11β-HSD1 and 11β-HSD2 are downregulated after UNX in rats, a constellation considered to induce hypertension.

Pontocerebellar hypoplasia type 1: clinical spectrum and relevance of EXOSC3 mutations

Pontocerebellar hypoplasia with spinal muscular atrophy, also known as PCH1, is a group of autosomal recessive disorders characterized by generalized muscle weakness and global developmental delay commonly resulting in early death. Gene defects had been discovered only in single patients until the recent identification of EXOSC3 mutations in several families with relatively mild course of PCH1. We aim to genetically stratify subjects in a large and well-defined cohort to define the clinical spectrum and genotype-phenotype correlation.