The artificial pancreas: two alternative approaches to achieve a fully closed-loop system with optimal glucose control.

INTRODUCTION: Diabetes mellitus type 1 is a chronic disease that implies mandatory external insulin delivery. The patients must monitor their blood glucose levels and administer appropriate insulin boluses to keep their blood glucose within the desired range. It requires a lot of time and endeavour, and many patients struggle with suboptimal glucose control despite all their efforts. MATERIALS AND METHODS: This narrative review combines existing knowledge with new discoveries from animal experiments. DISCUSSION: In the last decade, artificial pancreas (AP) devices have been developed to improve glucose control and relieve patients of the constant burden of managing their disease. However, a feasible and fully automated AP is yet to be developed. The main challenges preventing the development of a true, subcutaneous (SC) AP system are the slow dynamics of SC glucose sensing and particularly the delay in effect on glucose levels after SC insulin infusions. We have previously published studies on using the intraperitoneal space for an AP; however, we further propose a novel and potentially disruptive way to utilize the vasodilative properties of glucagon in SC AP systems. CONCLUSION: This narrative review presents two lesser-explored viable solutions for AP systems and discusses the potential for improvement toward a fully automated system: A) using the intraperitoneal approach for more rapid insulin absorption, and B) besides using glucagon to treat and prevent hypoglycemia, also administering micro-boluses of glucagon to increase the local SC blood flow, thereby accelerating SC insulin absorption and SC glucose sensor site dynamics.

Status epilepticus in pregnancy. A case report.

Status epilepticus is a serious emergency that rarely complicates the management of the pregnant patient with seizure disorders. Because of concerns regarding the safety of anticonvulsion medications, this condition may appear with increasing frequency. Our management of such a case resulted in a healthy mother and infant.

A multi-modal approach for hand motion classification using surface EMG and accelerometers.

For decades, electromyography (EMG) has been used for diagnostics, upper-limb prosthesis control, and recently even for more general human-machine interfaces. Current commercial upper limb prostheses usually have only two electrode sites due to cost and space limitations, while researchers often experiment with multiple sites. Micro-machined inertial sensors are gaining popularity in many commercial and research applications where knowledge of the postures and movements of the body is desired. In the present study, we have investigated whether accelerometers, which are relatively cheap, small, robust to noise, and easily integrated in a prosthetic socket; can reduce the need for adding more electrode sites to the prosthesis control system. This was done by adding accelerometers to a multifunction system and also to a simplified system more similar to current commercially available prosthesis controllers, and assessing the resulting changes in classification accuracy. The accelerometer does not provide information on muscle force like EMG electrodes, but the results show that it provides useful supplementary information. Specifically, if one wants to improve a two-site EMG system, one should add an accelerometer affixed to the forearm rather than a third electrode.

Examining the adverse effects of limb position on pattern recognition based myoelectric control.

Pattern recognition of myoelectric signals for the control of prosthetic devices has been widely reported and debated. A large portion of the literature focuses on offline classification accuracy of pre-recorded signals. Historically, however, there has been a semantic gap between research findings and a clinically viable implementation. Recently, renewed focus on prosthetics research has pushed the field to provide more clinically relevant outcomes. One way to work towards this goal is to examine the differences between research and clinical results. The constrained nature in which offline training and test data is often collected compared to the dynamic nature of prosthetic use is just one example. In this work, we demonstrate that variations in limb position after training can have a substantial impact on the robustness of myoelectric pattern recognition.

Parovarian cystadenocarcinoma of low-malignant potential.

In the world's literature, only 16 patients with parovarian malignancies have been described, five of which have been of low-malignant potential. All but one of these low-malignant potential lesions have been serous tumors. This is the second low-malignant potential parovarian tumor to be described with mucinous and serous components as well as hobnail cells. These tumors occur almost exclusively in young women, yet they are so rare that no treatment plan has been developed. We propose that until more data becomes available, these low-malignant potential lesions be treated as are their ovarian counterparts with staging laparotomy and surgery which conserves reproductive functioning being appropriate for women who meet the rigid clinical and histologic criteria for a very early potentially nonaggressive tumor, and complete extirpative surgery for those who do not.

Fetal cells in maternal blood: determination of purity and yield by quantitative polymerase chain reaction.

OBJECTIVE: The detection of fetal aneuploidy and gene mutations by analysis of fetal cells in maternal blood has demonstrated the feasibility of noninvasive prenatal diagnosis. Fetal cells are rare in the maternal circulation; all current methods used for their isolation also yield maternal cells. We developed a method that permits a quantitative assessment of the relative numbers of fetal and maternal cells. STUDY DESIGN: Samples from 40 pregnant women were flow sorted with different monoclonal antibodies. Deoxyribonucleic acid was subsequently purified from candidate fetal cells; polymerase chain reaction was performed with synthetic primers specific for sequences on chromosomes Y and 7. RESULTS: The maximum number of fetal cells detected was 52 in 1080 maternal cells. Fetal cell purity ranged from 0.001% to 4.8%. Fetal cells were detected with antibodies to CD71, CD36, and glycophorin A. CONCLUSION: Quantitative polymerase chain reaction enables the determination of the purity and yield of fetal cells remaining after isolation from maternal blood, facilitating rapid comparisons between different cell separation techniques.