A Wearable Cellulose Acetate-Coated Mouthguard Biosensor for In Vivo Salivary Glucose Measurement.

In this study, a cellulose acetate (CA) membrane is formed as an interference rejection membrane on a glucose sensor to measure glucose in saliva. Glucose in saliva is successfully measured in vivo without any pretreatment of human saliva. A mouthguard (MG) glucose sensor is developed to monitor salivary glucose, which is reported to be correlated with the blood glucose level. Salivary components of ascorbic acid (AA) and uric acid (UA) hinder the accurate measurement of the glucose concentration of human saliva. CA-coated electrodes are prepared to investigate the interference rejection membrane. To measure hydrogen peroxide, which is a reaction product of glucose oxidase, effects of AA and UA are examined. Characteristics of the fabricated biosensor are examined on the basis of artificial saliva. The as-developed MG sensor can quantify the glucose concentration in the range of 1.75-10 000 µmol/L, which includes a salivary sugar concentration of 20-200 µmol/L. For the measurement of saliva samples collected from healthy subjects, the output corresponding to the concentration is confirmed; this suggests the possibility of glucose measurement. This MG glucose sensor can provide a useful method for the unrestricted and noninvasive monitoring of saliva glucose for the management of diabetes patients.

Adhesive Approach Using Internal Coping for Vertical Root Fractured Teeth with Flared Root Canals.

Vertical root fractures are often observed in teeth with endodontic treatment and post space preparation. Frequently, because such teeth have flared root canals with thin dentin walls, conventional treatments are disadvantageous in terms of adhesiveness, sealability and risk of refracture. Here we devised an intentional replantation method that uses internal resin coping, with a reinforcing effect on thin root canal dentin. In two patients treated with this method, satisfactory conditions have been maintained. This report suggests that an intentional replantation method in which an internal resin coping is employed may be a useful therapy for fractured teeth with flared root canals.

[Expandable metallic stent treatment for obstructive colorectal cancer patients].

UNLABELLED: The expandable metallic stent (EMS) have been used to treat obstructive colorectal cancer. We used EMS in 13 out of 14 cases of obstructive colorectal carcinoma patients (insertion rate 93%). Of these 13 cases, 6 cases were male patients, and 7 cases were female patients. The average age was 69.1-years-old (44-87). The placement of insertion part in rectum and sigmoid colon was 8 cases and 5 cases, respectively. We detained Ultraflex non-covered type for all patients. Seven patients were able to have an operation after stenting. After the stent treatment, 11 patients were able to eat, and 7 patients were discharged from hospital. COMPLICATIONS: perforation and stent migration were occurred in one case. These results suggested that EMS might be an effective treatment for obstructive colorectal carcinoma.

Mouthguard biosensor with telemetry system for monitoring of saliva glucose: A novel cavitas sensor.

We develop detachable "Cavitas sensors" to apply to the human oral cavity for non-invasive monitoring of saliva glucose. A salivary biosensor incorporating Pt and Ag/AgCl electrodes on a mouthguard support with an enzyme membrane is developed and tested. Electrodes are formed on the polyethylene terephthalate glycol (PETG) surface of the mouthguard. The Pt working electrode is coated with a glucose oxidase (GOD) membrane. The biosensor seamlessly is integrated with a glucose sensor and a wireless measurement system. When investigating in-vitro performance, the biosensor exhibits a robust relationship between output current and glucose concentration. In artificial saliva composed of salts and proteins, the glucose sensor is capable of highly sensitive detection over a range of 5-1000µmol/L of glucose, which encompasses the range of glucose concentrations found in human saliva. We demonstrate the ability of the sensor and wireless communication module to monitor saliva glucose in a phantom jaw imitating the structure of the human oral cavity. Stable and long-term real-time monitoring (exceeding 5h) with the telemetry system is achieved. The mouthguard biosensor will be useful as a novel method for real-time non-invasive saliva glucose monitoring for better management of dental patients.

Intraluminal low-dose-rate 192Ir brachytherapy combined with external beam radiotherapy and biliary stenting for unresectable extrahepatic bile duct carcinoma.

PURPOSE: To evaluate the results of combined-modality therapy, including external beam radiotherapy, intraluminal (192)Ir, and biliary stenting for extrahepatic bile duct carcinoma. MATERIALS AND METHODS: Between 1988 and 1998, 93 patients with unresectable extrahepatic bile duct carcinoma underwent definitive radiotherapy. The dose of external beam radiotherapy was 50 Gy in 25 fractions. Low-dose-rate (192)Ir was delivered at a dose of 27-50 Gy (mean 39.2) at 0.5 cm from the source. An expandable metallic endoprosthesis was used to establish an internal bile passage. RESULTS: The median survival was 12 months, with a 1-, 3-, and 5-year actuarial survival rate of 50%, 10%, and 4%, respectively. Tumor length, hepatic invasion, and distant metastasis significantly affected survival. Ninety-six percent of patients could successfully remove external drainage catheters. The actuarial biliary patency rate for these patients at 1, 3, and 5 years was 52%, 29%, and 18%, respectively. Tumor length, tumor diameter and T stage were significantly associated with the patency rate. Mild-to-severe gastroduodenal complications were observed in 32 patients and were significantly associated with the active length of (192)Ir and linear source activity. Eight patients had treatment-related biliary fistula. CONCLUSIONS: Our combined-modality therapy provided reasonable local control and improved the quality of life of patients with extrahepatic bile duct carcinoma. Because none of the treatment characteristics had any impact on survival or biliary patency, lower dose levels and/or a localized target volume are recommended to minimize morbidity.

The prognosis of dysphagia patients over 100 years old.

Several reports have recently been published regarding dysphagia in very elderly patients, and centenarian dysphagia patients have become more common in Japan. The aim of this study was to assess the prognosis of dysphagia in very elderly patients. Participants were 24 centenarian dysphagia patients. For each patient, we collected information on age, care level, past medical history, and changes in oral intake according to the Functional Oral Intake Scale (FOIS). Patients were divided into two groups based on the mode of food intake at the time of transfer or discharge: the per oral-only group (the PO-only group, i.e., oral intake alone) and the tube feeding-dependent group (the TF-dependent group, i.e., combination of oral intake and tube feeding, or tube feeding alone). In both groups, the FOIS score decreased significantly from pre-hospitalization to the time of transfer or discharge (p=0.006 for both). The FOIS score at initial assessment was higher in the PO-only group with the TF-dependent group (p=0.0004). Furthermore, the frequency of a FOIS score of 4 at initial assessment was significantly higher in the PO-only group, and the frequency of a FOIS score of 1 was significantly higher in the TF-dependent group (p=0.0006). These findings collectively suggest that oral intake can be recovered if the FOIS score is ≥ 4 at initial assessment, is difficult if the score is 1, and may be possible with a FOIS score of 2.

An optic pharyngeal manometric sensor for deglutition analysis.

A micro optic pharyngeal manometric sensor for deglutition analysis was constructed. The optical manometric sensor was composed of a fluid-sensitive and air-sensitive fiber-optic pressure sensor (extrinsic Fabry-Perot interferometric type) and a lateral pressure-sensitive attachment. The manometric sensor was circumferential type, and had a very small diameter (distal: 2.08 mm, mesial: 0.99 mm). The output current of the sensor was linearly related to the output of a conventional catheter-type solid-state pressure sensor over a range of -3.0 x 10(4) to 3.0 x 10(4) N/m(2). The time constants of responsiveness were 12.2 +/- 2.7 ms during rapid decompression and 32.1 +/- 1.6 ms after a rapid return to ambient pressure. The optical pharyngeal manometric sensor had similar response time characteristics as the naked optical sensor and the conventional solid-state sensor. During in vivo measurement, the waveform of the optical pharyngeal manometer output was almost similar to the waveform of the output of the conventional sensor. The optical manometer could sufficiently detect the lateral pressure and the suction pressure for bolus transit generated in the P-E segment.

Enhanced virtual bronchoscopy using the pulmonary artery: improvement in route mapping for ultraselective transbronchial lung biopsy.

OBJECTIVE: We evaluated a new simulation method for ultraselective transbronchial lung biopsy using the pulmonary artery. MATERIALS AND METHODS: A new method for enhanced virtual bronchoscopy using the pulmonary artery was developed for ultraselective transbronchial lung biopsy. In a volunteer study of healthy adults, three radiologists with different levels of experience independently reconstructed conventional virtual bronchoscopy and enhanced virtual bronchoscopy using the pulmonary artery until reaching the farthest point of the bronchus and pulmonary artery. The bronchovascular branch order and the minimum luminal diameter (e.g., for bronchus and artery) for reconstruction were compared. In a clinical study, virtual bronchoscopy and enhanced virtual bronchoscopy using the pulmonary artery were compared with regard to accessibility to target lesions in 40 patients with small pulmonary nodules or ground-glass opacities. A comparison between the simulated bronchial route reconstructions and actual bronchoscopic routes on biopsy was made to determine the efficacy of each reconstruction method. RESULTS: In the volunteer study, quality of enhanced virtual bronchoscopy using the pulmonary artery was not significantly affected by the experience levels of the radiologists. In the clinical study, bronchial reconstruction was successful in guiding to a bronchoscopic tumor in 35 (87.5%) of 40 cases. The maximum bronchial order on reconstruction was the sixth for the virtual bronchoscopy group and the eighth for the group with enhanced virtual bronchoscopy using the pulmonary artery (p < 0.001, Wilcoxon's signed rank test). The bronchial route reconstructed on enhanced virtual bronchoscopy using the pulmonary artery agreed with the actual biopsy routes in 30 cases (85.7%), but those reconstructed on virtual bronchoscopy alone agreed in only eight cases (22.9%) (p < 0.001, chi-square test). CONCLUSION: Enhanced virtual bronchoscopy using the pulmonary artery is feasible and helpful for ultraselective transbronchial lung biopsy of small nodules in the lung.