Calving prediction with continuous measurement of subcutaneous tissue glucose concentration in pregnant cows.

To reduce losses of dams and calves due to unfortunate events, such as dystocia and freezing to death, identifying the onset of calving and providing necessary assistance are crucial. Prepartum increase in blood glucose concentration is a known indicator to detect labor in pregnant cows. However, some issues, including the need for frequent blood sampling and stress on cows, must be resolved before establishing a method for anticipating calving using changes in blood glucose concentrations. Herein, instead of measuring the blood glucose concentrations, subcutaneous tissue glucose concentration (tGLU) was measured in peripartum primiparous (n = 6) and multiparous (n = 8) cows at 15 min intervals using a wearable sensor. A transient increase in tGLU was observed in the peripartum period, with peak individual concentrations occurring between 2.8 h before and 3.5 h after calving. tGLU in primiparous cows was significantly higher than that in multiparous cows. To account for individual variations in basal tGLU, the maximum relative increase in the 3-h moving average of tGLU (Max MA) was used to predict calving. Cutoff points for Max MA were established by parity, with receiver operating characteristic analysis predicting calving within 24, 18, 12, and 6 h. Except for one multiparous cow that showed an increase in tGLU just before calving, all cows reached at least two cutoff points and calving was predicted successfully. The time interval between reaching the tGLU cutoff points that predicted calving within 12 h and actual calving was 12.3 ± 5.6 h. In conclusion, this study demonstrated the potential role of tGLU as a predictive indicator of calving in cows. Advancements in machine learning-based prediction algorithms and bovine-optimized sensors will help in increasing the accuracy of calving prediction using tGLU.

Successful perioperative management of a pediatric patient with medium-chain acyl-CoA dehydrogenase deficiency using a continuous tissue glucose monitoring device: A case report.

Medium-chain acyl-CoA dehydrogenase deficiency can cause symptoms resulting from ß-oxidation disorder during preoperative fasting. Tight perioperative glucose monitoring is needed to avoid these symptoms. We report the first pediatric case using continuous tissue glucose monitoring devices. The patient was a 9-year-old boy with medium-chain acyl-CoA dehydrogenase deficiency for whom femoral osteotomy and selective muscle release of the hip and knee was planned to treat hip dislocation and joint contracture. To monitor tissue glucose levels continuously during preoperative fasting, a percutaneous sensor was attached to the right upper extremity, 2 days before the operation. Anesthetic management using Ringer's acetate containing 5% glucose, an inhalational agent, and epidural anesthesia without a muscle relaxant or propofol was performed without complications. The device achieved tight perioperative glucose monitoring. Continuous tissue glucose monitoring devices helped perioperative glucose monitoring of the pediatric patient with medium-chain acyl-CoA dehydrogenase deficiency.

Device and Method for Noninvasive Glucose Assessment.

BACKGROUND: Intensive monitoring of blood glucose levels is crucial in diabetes management. This article presents a new device, the TensorTip Combo Glucometer (CoG), developed by Cnoga Medical Ltd, which enables to predict capillary tissue glucose concentration noninvasively. METHODS: Noninvasive glucose readings usually provide irregular or disordered mathematical manifold over the measurement space. To establish a transfer function, which correctly correlates the noninvasive raw data and the actual invasive glucose level, we suggest a mathematical concept that employs a personal calibration procedure to associate glucose pattern and multiple optical signals derived from tissue response to light emission in the range of visible to IR. The traversed light is detected by a color image sensor to predict the tissue glucose concentration at the fingertip. This article presents the mathematical concept underlying the technology and the requirements for device operation. RESULTS: The device was clinically evaluated and compared to standard invasive blood glucose monitoring devices in few medical centers and by home users. Based on consensus error grid analysis, more than 98% of the measurements of each study were in zones A (more than 81%) and B (more than 11%). Postmarketing evaluations showed high correlations comparing the CoG to other invasive reference devices. CONCLUSIONS: The CoG device employs a unique mathematical approach to predict glucose concentrations based on multiple optical signals. The first clinical results indicate that the device may show appropriate agreement with reference methods to be used for pain-free glucose assessment in daily routine.

Monitoring free flap venous congestion using continuous tissue glucose monitoring: A case report.

Blood glucose levels (BGLs) are a good indicator of postoperative venous congestion caused by a thrombus at the anastomotic site of a free flap. Tissue glucose levels (TGLs) are believed to be superior to BGLs for two reasons: TGLs are thought to represent a tissue's congestive status more directly than BGLs and are able to be measured by a continuous tissue glucose monitoring device (CTGMD), whereas BGLs must be measured manually by sampling the flap, hindering the patient's sleep and increasing the nurse's workload. A case is described in which a postoperative thrombus developed in a free flap vein three times. TGL in the flap was monitored by a CTGMD (Free Style Libre®, Abbott, U.S.A.), and BGL was monitored in parallel by conventional sampling of the flap. When venous congestion developed at the anastomotic site, TGLs decreased faster than BGLs; after the congestion was ameliorated by exsanguination, BGLs increased faster than TGLs, indicating that TGLs are a better indicator of venous thrombosis at the anastomotic site than BGLs.

Exploration of the hypoglycemic effect of Anoectochilus roxburghii alcohol extracts on diabetic zebrafish models / 中国比较医学杂志

Objective The aim of this study is to explore the hypoglycemic effect of active components of Anoectochilus roxburghii on zebrafish models. Methods Anoectochilus roxburghii components were extracted and separated into three groups: the alcohol extraction group, macromolecular polysaccharide group (≥ 5 ×103) and small molecular polysaccharide group (＜5×103). Zebrafish embryos were exposed to 2% glucose solution (2% Glu) at 24 h to imitate acute hyperglycemia phenotype, and then treated with the three Anoectochilus roxburghii components. Based on this high-glucose model, the zebrafish embryos at 72 h were collected to detect the whole tissue glucose value. Furthermore, semi-quantitative PCR and whole mount in situ hybridization were performed to detect the expression of mRNA levels of glycometabolism-related genes. Results An acute diabetic zebrafish model was induced by high glucose stress. In this model, some key factors during glycometabolism such as insulin, pck-1 and pdx-1 were significantly affected, while the alcohol extracts of Anoectochilus roxburghii obviously reversed these abnormalities induced by high glucose stress, even to normal levels. Conclusions The alcohol extracts of Anoectochilus roxburghii has obvious hypoglycemic effect on diabetic zebrafish model. Our result suggest that Anoectochilus roxburghii has a potential application in the hypoglycemic drug screening.

Neuroglucopenia and Metabolic Distress in Two Patients with Viral Meningoencephalitis: A Microdialysis Study.

INTRODUCTION: Viral encephalitis is an emerging disease requiring intensive care management in severe cases. Underlying pathophysiologic mechanisms are incompletely understood and may be elucidated using invasive multimodal neuromonitoring techniques in humans. METHODS: Two otherwise healthy patients were admitted to our neurological intensive care unit with altered level of consciousness necessitating mechanical ventilation. Brain imaging and laboratory workup suggested viral encephalitis in both patients. Invasive neuromonitoring was initiated when head computed tomography revealed generalized brain edema, including monitoring of intracranial pressure, brain metabolism (cerebral microdialysis; CMD), brain tissue oxygen tension (in one patient), and cerebral blood flow (in one patient). RESULTS: Brain metabolism revealed episodes of severe neuroglucopenia (brain glucose <0.7 mM/l) in both patients, which were not attributable to decreased cerebral perfusion or hypoglycemia. CMD-glucose levels changed depending on variations in insulin therapy, nutrition, and systemic glucose administration. The metabolic profile, moreover, showed a pattern of non-ischemic metabolic distress suggestive for mitochondrial dysfunction. Both patients had a prolonged but favorable clinical course and improved to a modified Rankin Scale Score of 1 and 0 three months later. CONCLUSION: Invasive multimodal neuromonitoring is feasible in poor-grade patients with viral meningoencephalitis and may help understand pathophysiologic mechanisms associated with secondary brain injury. The detection of neuroglucopenia and mitochondrial dysfunction may serve as treatment targets in the future.

Continuous tissue glucose monitoring correlates with measurement of intermittent capillary glucose in patients with distributive shock.

BACKGROUND: Intermittent glycemic measurements in patients admitted to the intensive care unit (ICU) can result in episodes of severe hypoglycemia or in a poor control of glycemia range. We designed a study to assess accuracy and reliability of continuous monitoring of tissue glucose for patients with distributive shock. METHODS: Consecutive patients admitted to the ICU with a diagnosis of distributive shock and the need of insulin infusion for glycemic control were included in the study. These patients were implanted a Continuous Glucose Control Monitoring System (CGMS) with the sensor inserted subcutaneously into the abdominal wall. CGMS values were recorded every 5min. Capillary glucose (CG) was monitored for adjusting insulin perfusion according to the ICU protocol. Correlation between both methods was assessed. RESULTS: A total of 11,673 CGMS and 348 CG values were recorded. In five patients, CGMS failed to detect tissue glucose. A glucose value <3.33mmol/l (<60mg/dl) was observed in 3.6% of CGMS and in 0.29% CG values. 295 pairs of measurements were included in the statistical analysis for correlation assessment. The intraclass correlation coefficient was 0.706. The Pearson correlation coefficient was 0.71 (p<0.0001, 95% CI 0.65-0.76). The mean of differences between both measurement methods was 0.22mmol/l (3.98mg/dl) (95% CI 0.66-7.31). CONCLUSIONS: When the Continuous Glucose Control Monitoring System (CGMS) is able to obtain data (75% of the patients), there is correlation between the values obtained by this method and capillary blood glucose in patients with distributive shock. CGMS can detect more episodes of glycemic excursions outside the normal range than intermittent capillary glucose monitoring. Variables that may impair glucose metabolism and peripheral soft tissues perfusion could impair CGMS measurements.