Lactate measurement is important in the fields of sports and medicine. Lactate accumulation can seriously affect an athlete’s performance. The most common problem caused by lactate accumulation in athletes is muscle soreness due to excessive exercise. Moreover, from a medical viewpoint, lactate is one of the main prognostic factors of sepsis. Currently, blood sampling is the most common approach to lactate measurement for lactate sensing, and continuous measurement is not available. In this study, a low-cost continuous lactate monitoring system (CLMS) is developed based on a percutaneous microneedle array that uses a three-electrode lactate sensor. The working electrode has an area of 10 mm × 6 mm, including a 3 × 3 array of stainless-steel microneedles. The length, width, and thickness of each needle are 1 mm, 0.44 mm, and 0.03 mm, respectively. The working electrode is then plated with gold, polyaniline, lactate enzyme, Nafion, and Poly(2-hydroxyethyl methacrylate) (poly HEMA). The reference electrode is a 2 × 1 array covered with AgCl, and the counter electrode is a 2 × 1 array plated with gold. The sensor is incorporated into the CLMS and connected to a smartphone application and the cloud. The CLMS was tested on 40 human subjects who rode indoor bicycles, starting at 100 W and increasing in steps of 25 W at intervals of 5 min until exhaustion. The data acquired from the app connected to the CLMS were analyzed to determine the subjects’ lactate response to exercise and the feasibility of assessing exercise performance and training exercise intensity by using the proposed system.

A continuous blood glucose monitoring system (CGMS) which include a microneedle-array blood glucose sensor, a circuit module, and a transmission module placed in a wearable device is developed in this research. When in use, the wearable device is attached to the human body with the microneedle array inserted under the skin for continuous blood glucose sensing, and the measured signals are transmitted wirelessly to a mobile phone or computer for analysis. The purpose of this study is to replace the conventionally used method of puncture for blood collection and test strips are used to measure the blood glucose signals. The microneedle sensor of this CGMS uses a 1 mm length needle in a 3 mm × 3 mm microneedle array for percutaneous minimally invasive blood glucose measurement. This size of microneedle does not cause bleeding damage to the body when used. The microneedle sensor is placed under the skin and their solutions are discussed. The blood glucose sensor measured the in vitro simulant fluid with a glucose concentration range of 50~400 mg/dL. In addition, a micro-transfer method is developed to accurately deposit the enzyme onto the tip of the microneedle, after which cyclic voltammetry (CV) is used to measure the glucose simulation solution to verify whether the difference in the amount of enzyme on each microneedle is less than 10%. Finally, various experiments and analyses are carried out to reduce the size of the device, test effective durability (approximately 7 days), and the feasibility of minimally invasive CGMS is evaluated by tests on two persons.

Background: To evaluate the effectiveness and tolerability of add-on sitagliptin in elderly Taiwanese patients with Type 2 diabetes mellitus who have inadequate glycemic control to existing oral antidiabetic agents (OADs) combination regimens. Methods: Patients were randomized to receive the existing OAD combinations or add-on with sitagliptin (100 mg daily) for 24 weeks. We measured HbA1c, fasting plasma glucose, 2-hours postprandial plasma glucose, body mass index, and recorded the hypoglycemic episodes before and after 24 weeks of adding sitagliptin 100 mg once daily to existing maximal dose of OAD combination therapy for 24 weeks. Results: Compared with the change of 0.0% (95% confidence interval: −0.6% to 0.5%) from a baseline of 10.0% in the controlled arm, HbA1c change from a mean baseline of 9.5% was −1.14% ± 1.18 after add-on sitagliptin. Confirming significant differences (p < 0.0001), sitagliptin was generally well tolerated in all study patients. The between-groups difference in body mass index was not significant after 24 weeks of treatment. Conclusion: In elderly Taiwanese patients with Type 2 diabetes mellitus with inadequate glycemic control from OAD combination, the addition of sitagliptin provided significant HbA1c lowering the efficacy over 24 weeks.

Background: Incidental radiotherapy (RT) to the adrenal gland may have systemic effects. This study aimed to investigate the effects of adrenal RT on fatigue. Methods: BALB/c mice were surgically explored to identify the left adrenal gland and delivered intra-operative RT. The swimming endurance test was used for endurance assessment to represent fatigue. Plasma levels of stress hormones and histopathological features were examined. Three patients with inevitable RT to the adrenal gland were enrolled for the preliminary study. Serum levels of cortisol, aldosterone, and adrenocorticotropic hormone (ACTH) were measured before and after RT. Fatigue score by using the fatigue severity scale and RT dosimetric parameters were collected. Results: In the experimental mouse model, adrenal RT decreased baseline cortisol from 274.6 ± 37.8 to 193.6 ± 29.4 ng/mL (p = 0.007) and swimming endurance time from 3.7 ± 0.3 to 1.7 ± 0.6 min (p = 0.02). In histopathological assessment, the irradiated adrenal glands showed RT injury features in the adrenal cortex. In the enrolled patients, baseline cortisol significantly declined after RT. There were no significant differences in the levels of morning cortisol, aldosterone, and ACTH before and after RT. Conclusions: The RT dose distributed to the adrenal gland may correlate with unwanted adverse effects, including fatigue and adrenal hormone alterations.

Background: There is limited information regarding the immunohistochemistry stain and its prognostic role in adrenocortical carcinoma (ACC), and few studies focus on Asian patients. Our study aims to identify the correlation between immunohistochemistry staining and the prognosis of ACC in Asian patients. Methods: We searched the database of a single center in Taiwan for cases with a pathological diagnosis of ACC in the past 25 years. We collected patient data on age, sex, initial presentation, staging, metastatic site, and survival duration. Immunohistochemical studies using antibodies to CDK4, ATRX, beta-catenin, Ki-67, SSTR2, and p53 were performed. Survival analysis was performed using the log-rank test, the Cox proportional hazards model and bootstrapping with 5000 samplings. Results: Fourteen patients were identified, and the median age was 49.5 (range 1–70) years. There were eight male and six female patients. Four patients presented with Cushing’s syndrome, and half were diagnosed with stage IV ACC at presentation. Only three patients survived (21%). The median survival time was 15.5 (range 0.67–244) months. SSTR2 expression score > 50 (log-rank test: p = 0.009) and Ki-67 > 50% (log-rank test: p = 0.017) were associated with mortality. However, after adjusting for stage, the bootstrapping analysis demonstrated that Ki-67 [B 2.04, p = 0.004], Beta-catenin [B 2.19, p = 0.009], ATRX [B 1.48, p = 0.026], P53 [B 1.58, p = 0.027], SSTR2 [B 1.58, p = 0.015] and SSTR2 expression score [B 0.03, p < 0.001] were all significantly associated with mortality. Conclusions: After adjusting for stage, Ki-67 > 50%, Beta-catenin, ATRX, P53, SSTR2 and SSTR2 expression score > 50 were associated with mortality in Asian patients with ACC.

BackgroundBasal insulin is a common therapy for insulin initiation in patients with type 2 diabetes mellitus (T2DM) uncontrolled with oral antidiabetic drugs (OAD). There is limited data for initiating basal insulin therapy in the elderly population in clinical practice.MethodsThe aim of this study was to analyze 72 Taiwanese patients with T2DM on OAD with glycated hemoglobin (HbA1c) > 7% who received basal insulin therapy with insulin glargine for 24 weeks in clinical practice. The patients were divided into an older group (≥ 65 years, n = 32) and younger group (< 65 years, n = 40) for comparison purposes.ResultsAt baseline, the duration of diabetes was longer and the fasting plasma glucose (FPG) level was slightly lower in the older group versus the younger group. The number of OAD types was significantly reduced after initiation of basal insulin in both groups. After the 24-week treatment of insulin glargine, the HbA1c and the FPG were significantly reduced by 1.18% and 81.3 mg/dL, respectively, in the older group, and by 1.49% and 93.0 mg/dL, respectively, in the younger group, but did not differ statistically between the two groups. The mean daily insulin doses in both groups were similar. Body weight increased significantly but it was comparable in older and younger patients. The rate of hypoglycemic events was low and no difference was found between the two groups.ConclusionIn elderly people with T2DM in Taiwan who had inadequate glycemic control by OAD, initiation of basal insulin therapy with insulin glargine over 24 weeks provided effective glycemic control similar to the younger population.