Evaluation of hybrid closed-loop insulin delivery system in type 1 diabetes in real-world clinical practice:One-year observational study

BACKGROUND In 2016,the Food and Drug Administration approved the first hybrid closed-loop(HCL)insulin delivery system for adults with type 1 diabetes(T1D).There is limited information on the impact of using HCL systems on patient-reported outcomes(PROs)in patients with T1D in real-world clinical practice.In this independent study,we evaluated glycemic parameters and PROs over one year of continuous use of Medtronic’s 670G HCL in real-world clinical practice.AIM To assess the effects of hybrid closed loop system on glycemic control and quality of life in adults with T1D.METHODS We evaluated 71 patients with T1D(mean age:45.5±12.1 years;59%females;body weight:83.8±18.7 kg,body mass index:28.7±5.6 kg/m2,A1C:7.6%±0.8%)who were treated with HCL at Joslin Clinic from 2017 to 2019.We measured A1C and percent of glucose time-in-range(%TIR)at baseline and 12 months.We measured percent time in auto mode(%TiAM)for the last two weeks preceding the final visit and assessed PROs through several validated quality-of-life surveys related to general health and diabetes management.RESULTS At 12 mo,A1C decreased by 0.3%±0.1%(P=0.001)and%TIR increased by 8.1%±2.5%(P=0.002).The average%TiAM was only 64.3%±32.8%and was not associated with A1C,%TIR or PROs.PROs,provided at baseline and at the end of the study,showed that the physical functioning submodule of 36Item Short-Form Health Survey increased significantly by 22.9%(P<0.001).Hypoglycemia fear survey/worry scale decreased significantly by 24.9%(P<0.000);Problem Areas In Diabetes reduced significantly by-17.2%(P=0.002).The emotional burden submodules of dietary diversity score reduced significantly by-44.7%(P=0.001).Furthermore,analysis of Clarke questionnaire showed no increase in awareness of hypoglycemic episodes.WHO-5 showed no improvements in subject’s wellbeing among participants after starting the 670G HCL system.Finally,analysis of Pittsburgh Sleep Quality Index showed no difference in sleep quality,sleep latency,or duration of sleep from baseline to 12 mo.CONCLUSION The use of HCL in real-world clinical practice for one year was associated with significant improvements in A1C,%TIR,physical functioning,hypoglycemia fear,emotional distress,and emotional burden related to diabetes management.However,these changes were not associated with time in auto mode.

DASH and MMT and Their Applications in ATSC 3.0

Despite the success of MPEG?2 Transport Stream (TS) being used to deliver services in broadcast channels, the increase of on?demand viewing of multimedia content over IP with browser?centric media endpoints introduces a new requirement for more indi?vidualized and flexible access to content. This has resulted in alternatives to MPEG?2 TS. While the needs of interactive broad?cast services (such as personalized advertisement or selection of audio stream with a language suitable for a specific user) grow there is an active standardization work under going for the next generation broadcasting systems. To best enable a complete sys?tem of hybrid broadcast and broadband services, Advanced Television Systems Committee (ATSC) 3.0 has developed an enhanced broadcast transport method named Real?Time Object Delivery over Unidirectional Transport (ROUTE)/DASH for delivery of DASH?formatted content and non?real time (NRT) data. Additionally, for broadcasting, ATSC 3.0 has also adopted MPEG Media Trans?port (MMT) standard, which inherits major advantageous features of MPEG?2 TS and is very useful in real?time streaming delivery via a unidirectional delivery network.This paper mainly describes features and design considerations of ATSC 3.0, and discusses the applications of the transport protocols used for broadcasting, i.e., ROUTE/DASH and MMT, whose comparative introductions are also presented in details.

Redox-responsive polymer prodrug/AgNPs hybrid nanoparticles for drug delivery

A drug carrier system of the hybrid nanoparticles based on the redox-responsive P[（2-（（2-（（camptothecin）-oxy）ethyl）disulfanyl）ethylmethacrylate）-co-（2-（D-galactose）methylmethacryl-ate）]（P（MACPTS-co-MAGP）） and AgNPs is developed to deliver the anti-cancer drug camptothecin（CPT） and monitor the drug release by the recovery of the fluorescence of CPT. CPT is linked to the polymer sidechains via a redox-responsive disulfide bond, attaching on the surface of AgNPs and leading to the quenching of CPT fluorescence（ ＂off＂ state） due to the nanoparticle surface energy transfer（NSET） effect.Upon the exposure to glutathione（GSH）, the disulfide bond is cleaved to release CPT, resulting in the recovery of the fluorescence of CPT（＂on＂ state）. The system offers a platform to track the CPT delivery and releasing in real time