Effects of hybrid closed-loop system on glycemic control and psychological aspects in persons with type 1 diabetes treated with sensor-augmented pump: A prospective single-center observational study.

AIMS/INTRODUCTION: This study evaluated the effects of the Medtronic MiniMed 770G hybrid closed-loop system on glycemic control and psychological aspects in persons with type 1 diabetes mellitus. MATERIALS AND METHODS: This 3-month prospective observational study included 22 participants with type 1 diabetes mellitus who used the Medtronic MiniMed 640G predictive low-glucose suspend system and were switched to the 770G system. Time in the range of 70-180 mg/dL and glycated hemoglobin levels were evaluated; satisfaction, emotional distress and quality of life were assessed using self-reported questionnaires, including the Diabetes Treatment Satisfaction Questionnaire Status, Problem Area in Diabetes and Diabetes Therapy-Related Quality of Life. RESULTS: Time in the range of 70-180 mg/dL increased (63.5 ± 13.4 to 73.0 ± 10.9% [mean ± standard deviation], P = 0.0010), and time above the range of 181-250 mg/dL decreased (26.9 ± 8.9 to 19.6 ± 7.1%, P < 0.0005). Glycated hemoglobin levels decreased (7.7 ± 1.0 to 7.2 ± 0.8%, P = 0.0021). The percentage of participants with time below the range of 54-69 mg/dL <4% of readings increased from 91% to 100% (P < 0.0005). No significant changes were detected in the satisfaction, emotional distress and quality of life levels, but increased sensor calibration might be related to worsened emotional distress and quality of life. CONCLUSIONS: The hybrid closed-loop system decreased hyperglycemia and minimized hypoglycemia, but did not improve psychological aspects compared with the predictive low-glucose suspend system, probably because sensor calibration was increased.

3D image scanning of gravel soil using in-situ X-ray computed tomography.

A typical ground investigation for characterizing geotechnical properties of soil requires sampling soils to test in a laboratory. Laboratory X-ray computed tomography (CT) has been used to non-destructively observe soils and characterize their properties using image processing, numerical analysis, or three-dimensional (3D) printing techniques based on scanned images; however, if it becomes possible to scan the soils in the ground, it may enable the characterization without sampling them. In this study, an in-situ X-ray CT scanning system comprising a drilling machine with an integrated CT scanner was developed. A model test was conducted on gravel soil to verify if the equipment can drill and scan the soil underground. Moreover, image processing was performed on acquired 3D CT images to verify the image quality; the particle morphology (particle size and shape characteristics) was compared with the results obtained for projected particles captured in a two-dimensional (2D) manner by a digital camera. The equipment successfully drilled to a target depth of 800 mm, and the soil was scanned at depths of 700, 750, and 800 mm. Image processing results showed a reasonable agreement between the 3D and 2D particle morphology images, and confirmed the feasibility of the in-situ X-ray CT scanning system.

The first detection of avian haemosporidia from Culicoides biting midges in Japan, with notes on potential vector species and the transmission cycle.

BACKGROUND: Biting midges (Ceratopogonidae) are capable of transmitting a variety of pathogens including viruses, trypanosomes and haemosporidia. The majority of Haemoproteus parasites are transmitted by biting midges predominantly of the genus Culicoides and are known to cause significant physical and reproductive impacts on both wild and domestic birds. In Japan, Haemoproteus had been detected from various avian hosts, but not from arthropod vectors. In this study, we investigated the prevalence of avian haemosporidia at an educational forest in central Japan in attempt to reveal possible vector species of Haemoproteus, which would help to better understand the transmission cycle of Haemoproteus within Japan and to develop preventative measures for captive and domestic birds. METHODS: Biting midges were caught using UV light traps from 2016 to 2018. The collected samples were morphologically identified, and haemosporidian parasites were detected using PCR-based methods. The detected lineages were phylogenetically analyzed and compared with lineages previously detected from birds. Bloodmeal analyses were also carried out for part of the blood-fed individuals. RESULTS: Six Haemoproteus lineages were detected from 17 of 1042 female Culicoides (1.63%), including three species (C. sigaensis, C. arakawae, and C. pictimargo) in which Haemoproteus was detected for the first time. All detected lineages were placed in the subgenus Parahaemoproteus clade and were previously detected from crows of central Japan, strongly suggesting that parasites of these genetic lineages are transmitted between Culicoides and crows. Two Plasmodium lineages were also detected but are thought to be transmitted between Culex mosquitoes and birds of the educational forest based on previous detections. No amplifications were seen in bloodmeal analysis, possibly due to insufficient amount of blood, denaturation via digestion, or insufficient detectability of the used protocol. CONCLUSION: Haemoproteus DNA was detected from Culicoides for the first time in Japan, suggesting that transmission is possible within the country. These findings highlight the necessity to investigate Culicoides populations and Haemoproteus infections dynamics in Japan. However, vector competence could not be confirmed in this study and further studies are anticipated.

Prediction of Second Language Proficiency Based on Electroencephalographic Signals Measured While Listening to Natural Speech.

This study had two goals: to clarify the relationship between electroencephalographic (EEG) features estimated while non-native speakers listened to a second language (L2) and their proficiency in L2 determined by a conventional paper test and to provide a predictive model for L2 proficiency based on EEG features. We measured EEG signals from 205 native Japanese speakers, who varied widely in English proficiency while they listened to natural speech in English. Following the EEG measurement, they completed a conventional English listening test for Japanese speakers. We estimated multivariate temporal response functions separately for word class, speech rate, word position, and parts of speech. We found significant negative correlations between listening score and 17 EEG features, which included peak latency of early components (corresponding to N1 and P2) for both open and closed class words and peak latency and amplitude of a late component (corresponding to N400) for open class words. On the basis of the EEG features, we generated a predictive model for Japanese speakers' English listening proficiency. The correlation coefficient between the true and predicted listening scores was 0.51. Our results suggest that L2 or foreign language ability can be assessed using neural signatures measured while listening to natural speech, without the need of a conventional paper test.

Glucocorticoid-sensitive Paroxysmal Atrial Fibrillation, Sick Sinus Syndrome, and Mitral Regurgitation in a Patient with Malignant Rheumatoid Vasculitis.

An 80-year-old woman with rheumatoid arthritis presented with chest pain. Clinical examination revealed new-onset paroxysmal atrial fibrillation with symptomatic sinus pauses and worsening mitral regurgitation, which were both resistant to conventional therapies. Based on her skin lesions, an increase in pleural and pericardial effusion, possible myocardial involvement, and a positive finding for immune complex testing, rheumatoid vasculitis was diagnosed. Subsequent glucocorticoid therapy suppressed systemic inflammation, resulting in structural, functional, and electrical reverse remodeling of the left atrium with complete remission of atrial arrhythmias and also an improvement of mitral regurgitation. This case highlights the importance of evaluating the underlying disease activity in a case of de novo paroxysmal atrial fibrillation associated with systemic autoimmune disease.

Effects of the physical and social environment on flight response and habitat use in a solitary ungulate, the Japanese serow (Capricornis crispus).

Observations of the flight response of ungulates are commonly used to test behavioral responses to predation risk. In gregarious ungulates with sexual body-size dimorphism such responses are likely to be stronger in situations where individuals have perceptions of less security as well as among more-sensitive individuals, such as female groups or female groups with offspring which are understood to use safety habitats more often than males do. However, little is known about these behaviors in solitary ungulates with little sexual dimorphism. Therefore, we examined the flight response to human presence and the habitat use of Japanese serow (Capricornis crispus), a solitary ungulate with little sexual dimorphism, in relation to its physical and social environments, based on direct observations conducted over approximately four years. Based on a total of 335 sightings, serows took flight less often when in steep terrain, in closed habitat, or in low-visibility seasons, and they selectively used steep-closed habitat. These findings suggest that steep slopes and low-visibility conditions provide the species with greater security, and that serows select safer habitats to decrease predation risk. There were no significant differences in the flight responses and habitat use of solitary males and solitary females; the absence of differences is likely related to the serow's habit of monogamy and its underdeveloped sexual dimorphism. Females with kids more frequently fled than other group types; this difference is thought to be linked to females' priority to secure the survival of their offspring. This result shows the key role of offspring presence in affecting flight response in the serow. Conversely, there were no differences in habitat use between females with kids and other group types; here, the absence of such differences may be associated with intra-sexual territoriality of the serow, since all types of territory holders (including females with kids) need to continuously use the entire home range to maintain a territory.

Does the single-limb stance reflect chronic ankle instability in an athlete?

BACKGROUND: The single-limb stance with closed eyes has been widely used to evaluate chronic ankle instability as static balance; however, there was lack of consideration of whether difference in age, frequency of previous ankle sprain or physical ability influenced single-limb stance. RESEARCH QUESTION: We hypothesized that the single-limb stance might not reflect subjective ankle instability and function on physical activity in people who perform sports activities. METHODS: In total, 102 high school basketball players were recruited to evaluate their physical performance at the beginning of the season. Participants were divided into five groups based on the frequency of previous ankle sprain. Karlsson ankle function score (K score) was considered as a subjective ankle function score, that was divided into various components. Each component and the single-limb stance test with center of pressure (COP) analysis was observed between the frequency of ankle sprains with one-way ANOVA and compared using Spearman's rank correlation coefficient to verify the relationship between the K score and COP. RESULTS: For COP parameters, no difference was observed in the history of ankle sprains. The K score was lower in participants with three previous ankle sprains than in those with a different number of ankle sprains for instability, stiffness, running, work activities, support, and total K score for all parameters. There were weak negative correlations (r = -0.19∼-0.35) between K score and COP parameters among participants with no history of ankle sprain or only once. In contrast, there were strong positive correlations (r = 0.69∼0.87) among history of ankle sprain at third. SIGNIFICANCE: The single-limb stance might not accurately reflect an athlete's ankle instability and function on physical activity. Clinically, therapists should choose suitable evaluation tools depending on the athlete's activity level to check for chronic ankle instability.

EEG dipole source localization with information criteria for multiple particle filters.

Electroencephalography (EEG) is a non-invasive brain imaging technique that describes neural electrical activation with good temporal resolution. Source localization is required for clinical and functional interpretations of EEG signals, and most commonly is achieved via the dipole model; however, the number of dipoles in the brain should be determined for a reasonably accurate interpretation. In this paper, we propose a dipole source localization (DSL) method that adaptively estimates the dipole number by using a novel information criterion. Since the particle filtering process is nonparametric, it is not clear whether conventional information criteria such as Akaike's information criterion (AIC) and Bayesian information criterion (BIC) can be applied. In the proposed method, multiple particle filters run in parallel, each of which respectively estimates the dipole locations and moments, with the assumption that the dipole number is known and fixed; at every time step, the most predictive particle filter is selected by using an information criterion tailored for particle filters. We tested the proposed information criterion first through experiments on artificial datasets; these experiments supported the hypothesis that the proposed information criterion would outperform both AIC and BIC. We then analyzed real human EEG datasets collected during an auditory short-term memory task using the proposed method. We found that the alpha-band dipoles were localized to the right and left auditory areas during the auditory short-term memory task, which is consistent with previous physiological findings. These analyses suggest the proposed information criterion can work well in both model and real-world situations.

New concept to describe three-phase capillary pressure-degree of saturation relationship in porous media.

The Leverett concept is used conventionally to model the relationship between the capillary pressures and the degrees of saturation in the water-nonaqueous phase liquid (NAPL)-air three-phase system in porous media. In this paper, the limitation of the Leverett concept that the concept is not applicable in the case of nonspreading NAPLs is discussed through microscopic consideration. A new concept that can be applied in the case of nonspreading NAPLs as well as spreading NAPLs is then proposed. The validity of the proposed concept is confirmed by comparing with past experimental data and simulation results obtained using the conventional model based on the Leverett concept. It is confirmed that the proposed concept can correctly predict the observed distributions of NAPLs, including those of nonspreading ones.

Chiral lyotropic chromonic liquid crystals composed of disodium cromoglycate doped with water-soluble chiral additives.

We investigated the pitches of cholesteric liquid crystals prepared by mixing disodium cromoglycate (DSCG) in water with 5 different water-soluble chiral additives. The measurements are based on the Grandjean-Cano wedge cell method. Overall, the twisting effect is weak, and the shortest pitch of 2.9 ± 0.2 µm is obtained using trans-4-hydroxy-l-proline, by which the cholesteric sample is iridescent at certain viewing angles. Freeze-fracture transmission electron microscopy (FFTEM) was also performed for the first time on both the nematic and cholesteric phases, revealing that stacked chromonic aggregates are very long, up to a few hundred nm, which explains why cholesteric chromonic liquid crystals hardly have pitches in the visible wavelength region.

Prolonged Inflation Technique Using a Scoring Balloon for Severe Calcified Lesion.

Percutaneous coronary intervention for the treatment of a severe calcified lesion is still one of the most technically challenging areas of interventional cardiology. Calcified lesions are a cause of stent underexpansion, which significantly increases the subsequent risks of in-stent restenosis and thrombosis, even when drug-eluting stents are used. In this report, we describe the usefulness of prolonged inflations using a scoring balloon catheter (Scoreflex) for severe calcified lesions. Prolonged inflation using a scoring balloon enables an adequate dilation for treatment of a severe calcified plaque that was unresponsive to conventional technique with or without rotational atherectomy.

A left atrial appendage thrombus that developed during prophylactic low-dose dabigatran treatment resolved after switching to apixaban.

We describe a case of atrial fibrillation in which an intracardiac thrombus that could not be prevented with "low-dose" dabigatran treatment was resolved by switching to apixaban treatment. Thrombolysis using direct oral anticoagulants (DOACs) could be a therapeutic option for patients with intracardiac thrombi, although the efficacies of different DOACs seem to differ and need further examination.

Risk stratification of coronary artery disease in asymptomatic diabetic subjects using multidetector computed tomography.

BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) show a greater risk for coronary artery disease (CAD), but the risk stratification in asymptomatic CAD patients has not been established. This study investigated the prevalence and severity for asymptomatic CAD and predictors in T2DM patients. METHODS AND RESULTS: In a multiclinic group, diabetic patients (320 men, 186 women) without known symptoms suggestive of CAD were recruited for multidetector computed tomography (MDCT). Patients were categorized according to severity of coronary atherosclerosis: Grade 1 (normal findings), Grade 2 (mild atherosclerosis without significant stenosis), Grade 3 (moderate stenosis/atherosclerosis, 50-74% stenosis), Grade 4 (moderate stenosis/atherosclerosis, 75-89% stenosis), Grade 5 (severe stenosis/atherosclerosis, ≥90% stenosis). The trend for severity grade of CAD was slightly higher in men than women (P=0.054). For critical lesions (combined Grades 3-5), the prevalence was almost equal (men 44% vs. women 37%; P=0.113). Multivariate models showed that in men, HbA1c≥7.4%, dyslipidemia, duration of diabetes, retinopathy, and other type of cardiovascular diseases were predictors of critical lesions and in women, duration of diabetes and retinopathy were predictors. CONCLUSIONS: The prevalence and severity of asymptomatic CAD are comparably high in men and women with T2DM. Risk stratification by using MDCT might be useful to predict asymptomatic coronary lesions requiring coronary revascularization.

Differences in the roles of the two surface-exposed tyrosine residues, Y240 and Y481, of Serratia marcescens chitinase B during processive degradation of crystalline chitin.

Chitinase B from Serratia marcescens 2170 is one of the processive chitinases, and it has a linear path of aromatic amino acid residues on the surface and in the catalytic cleft. There are four surface-exposed residues lined-up towards the cleft, Y481, W479, W252, and Y240. The substitution of these residues with alanine causes a decrease in both the extent of the substrate binding and the hydrolytic activity (Katouno et al., 2004). Here, we examine the three mutants without losing the substrate-binding ability, Y240W, Y481W, and Y240W/Y481W. These mutants were prepared for a detailed analysis of the functions of Y240 and Y481, which showed a lower contribution to substrate binding than W479 and W252. The parameters for the binding of the three mutants to crystalline ß-chitin were similar to those for the wild type. The hydrolytic activity of Y240W and Y240W/Y481W against crystalline ß-chitin was significantly decreased. However, the hydrolytic activity of Y481W was similar to that of the wild type, indicating some differences in the roles of Y240 and Y481 during the processive degradation of crystalline ß-chitin. Taken together with the previous results, it was suggested that while Y240 and Y481 were required for the substrate binding, Y240 had additional roles in the processive degradation of crystalline ß-chitin, possibly in guiding a chitin chain into the catalytic cleft.

Black hole restenosis after drug-eluting stent implantation for in-stent restenosis: potential mechanism and optimal strategy.

In-stent restenosis (ISR) has long remained as the major limitation of coronary stenting. The use of drug-eluting stent (DES) reduces the risk of repeat revascularization without an increase of death and myocardial infarction, compared to the standard bare metal stents. DES has also demonstrated markedly to reduce ISR for complex lesions. However, ISR after DES implantation still occurs and optimal treatment for ISR after DES has not been established. Herein, we report 3 cases with black hole restenosis confirmed by intravascular ultrasound at the site of overlapped DES and discuss potential mechanism and optimal strategy for this phenomenon.

[Development of an automated patient recognition method for chest CT images using a template-matching technique].

If patient information, such as identification number or patient name, has been entered incorrectly in a picture archiving and communication system (PACS) environment, the image may be stored in the wrong place. To prevent such cases of misfiling, we have developed an automated patient recognition system for chest CT images. The image database consisted of 100 cases with present and previous chest CT images. A volume of interest (VOI) measuring 40 × 40 pixels was selected from the left lung region, bronchus region, and right lung region. Next, the overall lung region and these three regions in a current chest CT image were used as a template for determining the residual value with the corresponding four regions in previous chest CT images. To ensure separation between the same and different patients, we applied a combined analysis that employed the ruled-based plus artificial neural network (ANN) method. The overall performance of the method developed was examined in terms of receiver operating characteristic (ROC) curves. The performance of the rule-based plus ANN method using a combination of the four regions was higher than obtained using a rule-based method using these four regions separately. The automated patient recognition system using the rule-based plus ANN method achieved an area under the curve (AUC) value of 0.987. This automated patient recognition method for chest CT images is promising for helping to retrieve misfiled patient images, especially in a PACS environment.

Usefulness of the Corsair microcatheter for treatment of complex chronic total occlusion.

Percutaneous coronary intervention (PCI) for the treatment of chronic total occlusion (CTO) is one of the most technically challenging areas of interventional cardiology. When CTO is combined with angulation and tortuosity of the coronary artery, the technical complexity of PCI for CTO is magnified. In this report, we describe a case of successful revascularization of a CTO lesion in the complex circumflex anatomy using a novel microcatheter (the Corsair catheter) along with an antegrade approach to facilitate guidewire passage through a proximal steep angulation and to cross the circumflex CTO lesion that was unresponsive with conventional microcatheters.