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The sensitivity to subject motion is one of the major challenges in functional MRI (fMRI) studies in which a precise alignment of images from different time points is required to allow reliable quantification of brain activation throughout the scan. Especially the long measurement times and laborious fMRI tasks add to the amount of subject motion found in typical fMRI measurements, even when head restraints are used. In case of moving subjects, prospective motion correction can maintain the relationship between spatial image information and subject anatomy by constantly adapting the image slice positioning to follow the subject in real time. Image-based prospective motion correction is well-established in fMRI studies and typically computes the motion estimates based on a volume-to-volume image registration, resulting in low temporal resolution. This study combines fMRI using simultaneous multislice imaging with multislice-to-volume-based image registration to allow sub-TR motion detection with subsequent real-time adaption of the imaging system. Simultaneous multislice imaging is widely used in fMRI studies and, together with multislice-to-volume-based image registration algorithms, enables computing suitable motion states after only a single readout by registering the simultaneously excited slices to a reference volume acquired at the start of the measurement. The technique is evaluated in three human BOLD fMRI studies (n = 1, 5, and 1) to explore different aspects of the method. It is compared to conventional, volume-to-volume-based prospective motion correction as well as retrospective motion correction methods. Results show a strong reduction in retrospectively computed residual motion parameters of up to 50% when comparing the two prospective motion correction techniques. An analysis of temporal signal-to-noise ratio as well as brain activation results shows high consistency between the results before and after additional retrospective motion correction when using the proposed technique, indicating successful prospective motion correction. The comparison of absolute tSNR values does not show an improvement compared to using retrospective motion correction alone. However, the improved temporal resolution may provide improved tSNR in the presence of more exaggerated intra-volume motion.

Cattle vaccination is an attractive approach in compliance with control and eradication programs against Bovine Tuberculosis (bTB). Today, there is no anti bTB vaccine licensed. Two vaccine candidates, MbΔmce2 and MbΔmce2-phoP previously designed were evaluated in BALB/c mice, including the parental M. bovis NCTC10772 and a M. bovis hypervirulent Mb04-303 strains as controls. Sentinel mice (non-inoculated) cohoused with subcutaneous inoculated mice. Persistence, visible tuberculosis lesions (VTL) in lungs and spleens and bacillary load were investigated subcutaneously delivered at 60 and 90 days after inoculation (dpi) as well as their potential transmission to naïve mice. While a 100% survival was observed at 90 dpi without VTL in all groups, transmission was not evidenced in the sentinels mice. Vaccine candidates and control strains were isolated from the spleen of all inoculated mice, while Mb04-303 was isolated from the lungs of one inoculated mouse. Vaccine candidate's attenuation considering survival, lung bacillary load and VTL was confirmed, administrated by the subcutaneous route. Future experiments are necessary to demonstrate whether the persistence of both mutants in the spleen, with low CFU, remains over time to increase the potential increasing risk of dissemination to organs and subsequent transmission to other animals by airborne or other routes.

The aim of this post hoc analysis was to assess the efficacy and safety of once-weekly dulaglutide in Hispanic/Latino patients with type 2 diabetes (T2D) in phase 3 AWARD trials 1 to 6.Hispanic/Latino data at Week 26 were pooled across studies for each dulaglutide dose to analyze the change from baseline in glycosylated hemoglobin (HbA1c), percent to HbA1c goal, and adverse events (AEs). Change from baseline in HbA1c, change from baseline in weight and hypoglycemia were analyzed by Hispanic/Latino and non-Hispanic/Latino subgroups for each study.Of the 3,136 patients randomized to dulaglutide 1.5 or 0.75 mg, 949 were reported as having Hispanic/Latino ethnicity. Baseline characteristics were similar for Hispanic/Latino and overall populations, except there were slightly more Hispanic/Latino females and weight was slightly lower for Hispanic/Latino patients. Hispanic/Latino patients receiving dulaglutide 1.5 mg had a reduction in HbA1c of 1.25% (95% confidence interval [CI]: -1.35, -1.15); dulaglutide 0.75 mg had a reduction of 1.07% (95% CI: -1.18, -0.96). Reductions in HbA1c and percent to goal HbA1c7% and ≤6.5% were similar between Hispanic/Latino patients and the overall population. Weight change and hypoglycemia were similar between Hispanic/Latino and non-Hispanic/Latino subgroups for all studies. Treatment-emergent AEs were consistent with the overall population.Dulaglutide improved glycemic control with the potential for weight loss in Hispanic/Latino patients with T2D. Dulaglutide was well tolerated and had a low risk of hypoglycemia when used without insulin secretagogues or insulin. In the Hispanic/Latino population, dulaglutide efficacy and safety was consistent with that of the overall population.AE = adverse event AWARD = Assessment of Weekly AdministRation of dulaglutide in Diabetes BID = twice daily CARMELA = The Cardiovascular Risk Factor Multiple Evaluation of Latin America CI = confidence interval GLP-1 RA = glucagon-like peptide-1 receptor agonist HbA1c = glycosylated hemoglobin T2D = type 2 diabetes.

A new expression for the fundamental solution is introduced, presenting three relevant characteristics: (i) it is explicit in terms of the Stroh’s eigenvalues, (ii) it remains well-defined when some Stroh’s eigenvalues are repeated, and (iii) it is exact. A fast and robust numerical scheme for the evaluation of the fundamental solution and its derivatives developed from double Fourier series representations is presented. The Fourier series representation is possible due to the periodic nature of the solution. The attractiveness of this series solution is that the information of the material properties is contained only in the Fourier coefficients, while the information of the dependence of the evaluation point is contained in simple trigonometric functions. This implies that any order derivatives can be determined by spatial differentiation of the trigonometric functions. Moreover, Fourier coefficients need to be obtained only once for a given material, leading to an efficient methodology. The robustness of the scheme arises from the properties (i) and (ii) of the new expression for the fundamental solution, which is used to compute the Fourier coefficients. The proposed approach combines the clean structure of the Stroh formalism with the simplicity of Fourier expansions, addressing the old drawbacks of anisotropic fundamental solutions.

Multiscale material design has made it possible to control the properties of a material through introducing structures at multiple length scales. This structuring brings about unusual material behaviour that is not seen in a continuum material. Here we introduce a multiscale design for the matrix components of a lead-free piezocomposite. This combines a microscale stiff polymeric structure embedded within a softer matrix to form a composite matrix. By controlling the microscale features of the embedded structure, we tune the mechanical behaviour of the matrix by rendering it either nonauxetic (hexagonal structure) or auxetic (inverted hexagonal structure). Further, the mechanical and electrical properties of the matrix are controlled at the nanoscale by addition of carbon nanotubes within the embedded polymeric structure. By engineering the matrix at the nano and the microscale, we firstly demonstrate that the auxetic matrix can result in three orders of magnitude higher piezoelectric response by amplifying the strains within the piezoelectric inclusions. We further demonstrate that by using the matrix with the nonauxetic embedded structure, it is possible to design piezoelectric composites with pronounced anisotropy in their longitudinal and transverse responses. This is an important requirement for designing materials with directional sensing ability. Our findings show that the multiscale material design proposed here has important implications for both energy harvesting and directional sensing. Further, the approach taken here yields considerable performance improvements while using limited quantities of nanomaterial. The multiscale matrix design is scalable and amenable to fabrication through emerging methods such as additive manufacturing.

This work introduces a set of analytical expressions that simplifies the procedure of obtaining closed-form formulas to estimate the effective piezoelectric properties of polycrystalline aggregates formed by crystals of all the 21 non-centrosymmetrical classes and with arbitrary textures. The expressions are derived from orientational averages of third-order piezoelectric tensors of the individual crystals that are weighted by orientational distribution functions. The averaging is done by using generalized spherical harmonic series expansions. Improvements with respect to previous works in the literature are twofold: all crystal symmetries are considered and no symmetry restrictions are imposed to texture. The versatility of the introduced expressions is demonstrated on an example of BaTiO3 polycrystals with uniaxial and biaxial textures characterized by single and double Gaussian distributions, respectively. The results for uniaxial texture are in perfect agreement with the results published in the literature. The biaxial texture is discussed in detail and analyzed for a set of limiting cases.

An explicit and unified boundary element formulation for the linear fracture analysis of three-dimensional bodies with general anisotropic multifield coupling is presented. The herein considered multifield media include, as particular cases, the purely elastic, piezo-electric and magneto-electro-elastic material models. The proposed formulation is based on the fundamental solutions for displacements and tractions recently introduced by Buroni and Saez (2010), which presents the remarkable features of being exact, explicit in terms of the Stroh’s eigenvalues and valid for mathematically degenerate as well as non-degenerate materials. Behaviour around the crack front is modeled with quarter-point elements for the extended displacements (elastic displacements, electric potential and magnetic potential) and singular quarter-point elements for the extended stresses (mechanical stresses, electric displacements and magnetic inductions) which allow for the direct extrapolation of the extended stress intensity factors (the mechanical stress intensity factors in the three classical modes KI, KII and KIII, the electric displacement intensity factor KIV and the magnetic induction intensity factor KV) from the computed nodal values at the singular quarter-point elements. Some benchmark examples are presented and discussed in order to validate this simple and robust approach for the assessment of multifield fracture parameters.

Objectives Time-of-flight (TOF) magnetic-resonance-angiography (MRA) identifies vessel pathology in cerebrovascular disease. At 7.0 T, the clinical performance of TOF-MRA is constrained owing to radio frequency power deposition. We studied the diagnostic value of whole-brain MPRAGE-based MRA as an alternative imaging technique in comparison to the clinical standard 3.0 T TOF-MRA. Methods Patients with stroke and/or moya-moya disease were included. TOF-MRA was performed at 3.0 T and MPRAGE-MRA at 7.0 T. Two radiologists rated the MRAs independently for overall quality and local arterial segment visualization. The identification of steno-occlusive pathology was reported for each protocol. Results In 18 patients (9 females; 6 patients with moya-moya) 7.0 T MPRAGE-MRA provided better overall image quality and better distinction of small structures compared to 3.0 T TOF-MRA. These findings were pronounced in the proximal segments of the anterior cerebral artery (A1), middle cerebral artery (M1, M2), posterior cerebral artery (P1) and the posterior communicating artery. Seven steno-occlusive findings were identified by both imaging protocols. Conclusions For clinical studies using ultrahigh field MRI, 7.0 T MPRAGE-MRA provides a suitable alternative to TOF-MRA imaging to identify brain vessel pathology and yields simultaneous structural brain imaging within clinically feasible acquisition times.

Improving the performance of lead-free piezocomposites to the levels of state-of-the-art lead-based composites has been an important challenge in composite research. Consequently, an important agenda of piezocomposite research has been to identify new coupled mechanisms that can enhance the piezoelectric response. One such method is to tap into the size-dependent flexoelectric phenomenon in geometrically anisotropic structures. Numerical models which can account for flexoelectricity and nonlinear effects such as electrostriction are not well-developed for piezocomposite design, and current designs are based on linear piezoelectric models. Here, we develop an advanced model with flexoelectric and electrostrictive contributions in geometrically tailored piezocomposites to obtain insights on aspects of enhanced response due to small-size effects. Here, based on design considerations, we numerically demonstrate that in epoxy-matrix-based piezocomposites which are structured as truncated pyramids, flexoelectricity can lead to significant enhancements in both the electric field and the electric flux generation at small length scales. Particularly, we show that at dilute inclusion concentrations, dramatic improvements nearing 150% in the piezoelectric response are possible. Further, the flexoelectric enhancement is sensitive to the packing of the inclusions within the composite structure with the best enhancements occurring when the inclusions are closer to the inclined edges of the pyramids. We also show that in composite structures with CNT-modified matrices, flexoelectricity produces similar enhancements as in the case of unmodified matrices, demonstrating that the effect operates almost independent of nanoscale elastic and dielectric modifications by the nanotubes. Finally, we also establish that for a large range of applied stresses, the nonlinear deviations in the response due to electrostriction are negligible and flexoelectricity is the predominant size-dependent enhancement mechanism in structured lead-free piezocomposites.

Lead-free piezocomposites are an ecofriendly route for sensing and harvesting energy from mechanical stimuli and it is important to develop accurate models which can capture essential physical processes underlying their performance. Current piezocomposite design heavily relies on the linear piezoelectric model which neglects nonlocal and nonlinear electro-elastic processes. Here we develop a more accurate modelling paradigm to determine the contributions from nonlocal flexoelectric and nonlinear electrostrictive effects towards the performance of lead-free piezocomposites. We find that in the case of microscale randomly shaped piezoelectric inclusions which represent a practical scenario, the flexoelectric effect does not contribute appreciably towards the piezoelectric response. However, the nonlinear electrostrictive effects impart significant strain-dependent responses. Further, in nano-modified composites, we find that the nonlinear electro-mechanical coupling can have different effects on the transverse and the longitudinal electro-elastic responses. In particular, the longitudinal electric field response, with the nonlinear contribution, is less sensitive to the polycrystalline structure of the piezoelectric inclusions. These observations clearly indicate that at larger strains, nonlinear effects cannot be neglected. In general, our results entail that it is important to include nonlocal and nonlinear processes for reliable and accurate modelling of piezocomposites.

Carbon nanotube (CNT)-reinforced composites exhibit a piezoresistive behavior that permits their use as sensors in novel structural health monitoring (SHM) applications, by measuring the electrical resistivity change of the CNT modified laminate. However, the presence of cracks in such composite materials may not only compromise their structural integrity, but may as well alter their capability to act as reliable piezoresistive sensors. In this paper, we conduct a numerical study aimed at quantifying how the presence of cracks in reinforced polymer composites does influence their electrical conductivity and, consequently, their sensor performance. To this end, the electromechanical constitutive properties of the composite are determined by a mixed micromechanics approach that allows characterizing both the elastic properties and the strain-induced alterations in the overall electrical conductivity of the CNT-reinforced composite. The strain response of the cracked composite domain is accurately determined by means of a dual Boundary Element (BE) approach. Electrical conductivity in the cracked composite follows from its computed strain state at each point in the domain. Subsequently, the resulting non-homogeneous electrical conductivity problem is solved using a finite differences scheme that also accounts for semipermeable crack-face electrical boundary conditions. Several parametric studies are conducted to illustrate the influence of various crack geometries in the piezoresistive behavior of CNT-reinforced composites at varying CNTs concentrations.

Graphene nano-additions to polymer matrices have demonstrated exceedingly better mechanical properties compared to carbon-nanotube modified matrices. Therefore, in the context of mechanically superior high-performance piezo-composites, graphene-modified composite architectures represent an important design direction. In this paper, we first develop an effective property model for graphene-modified piezoelectric matrices, taking into account the mechanical anisotropy of the matrix. We further evaluate the piezoelectric performance of the matrix architecture which incorporates lead-free BaTiO3 polycrystal inclusions. In order to obtain comparisons with well-established composites, we compare the electro-elastic response of two composite architectures in which the matrix is modified by multiwalled CNTs and graphene respectively. It is seen that, near percolation of the nano-additions, graphene-based systems exhibit an order of improvement in the piezoelectric response compared to the composite without nano modification. This improvement is comparable to CNT-based systems, but the matrix hardening is lesser than half the hardening observed in CNT-modified composites. This feature is due to a considerably smaller percolation threshold of graphene compared to CNTs which brings about percolative conditions at very small filler concentrations. We further investigate the dependence of the electric flux and fields in the graphene-modified piezocomposite on the polycrystallinity of the piezoelectric inclusions to identify the polycrystalline configurations that can lead to improved performance in such nanomodified piezocomposites.

Objective The improvement in Arterial Spin Labeling (ASL) perfusion quantification, especially for delayed bolus arrival times (BAT), with an acquisition redistribution scheme mitigating the T1 decay of the label in multi-TI ASL measurements is investigated. A multi inflow time (TI) 3D-GRASE sequence is presented which adapts the distribution of acquisitions accordingly, by keeping the scan time constant. Material and Methods The MR sequence increases the number of averages at long TIs and decreases their number at short TIs and thus compensating the T1 decay of the label. The improvement of perfusion quantification is evaluated in simulations as well as in-vivo in healthy volunteers and patients with prolonged BATs due to age or steno-occlusive disease. Results The improvement in perfusion quantification depends on BAT. At healthy BATs the differences are small, but become larger for longer BATs typically found in certain diseases. The relative error of perfusion is improved up to 30% at BATs > 1500 ms in comparison to the standard acquisition scheme. Conclusion This adapted acquisition scheme improves the perfusion measurement in comparison to standard multi-TI ASL implementations. It provides relevant benefit in clinical conditions that cause prolonged BATs and is therefore of high clinical relevance for neuroimaging of steno-occlusive diseases.

SummaryBacterial infections associated with methicillin-resistant Staphylococcus aureus (MRSA) are a major economic burden to hospitals, and confer high rates of morbidity and mortality among those infected. Exploitation of novel therapeutic targets is thus necessary to combat this dangerous pathogen. Here, we report on the identification and characterization, including crystal structures, of two nitric oxide synthase (NOS) inhibitors that function as antimicrobials against MRSA. These data provide the first evidence that bacterial NOS (bNOS) inhibitors can work synergistically with oxidative stress to enhance MRSA killing. Crystal structures show that each inhibitor contacts an active site Ile residue in bNOS that is Val in the mammalian NOS isoforms. Mutagenesis studies show that the additional nonpolar contacts provided by the Ile in bNOS contribute to tighter binding toward the bacterial enzyme.

A new complex-variable formalism for the analysis of three-dimensional (3D) steady-state heat transfer problems in homogeneous solids with general anisotropic behaviour is proposed in this paper. The derived method is based on the Radon transform, which is used in order to reduce the dimension of the problem to a two-dimensional (2D) Radon space where a solution can be easily handled via a complex-variable method. Subsequently, the 3D solution is obtained by applying the inverse Radon transform. Despite that the main goal of this work is to develop and illustrate the general methodology, the proposed formalism is further applied to derive new Green’s functions as application examples. Contributions include new forms for bimaterial and half-space Green’s functions for line, point, vortex and dipole heat sources. In particular Green’s functions due to heat vortex loop sources for infinite media, half-space and bimaterial systems are presented for the first time. The veracity and computability of the approach are demonstrated with some numerical examples.

Piezoelectric matrix-inclusion composites based on lead-free ceramics have attracted attention due to the possibility of manufacturing environmentally friendly devices using scalable emerging technologies such as 3D printing. However, lead-free materials lag lead-based piezo-composites in terms of performance, thus necessitating new design strategies to escalate piezoelectric response. Here, we build a modeling paradigm for improving the piezoelectric performance through improved matrices and optimal polycrystallinity in the piezoelectric inclusions. By incorporating carbon nanotubes in the matrix, we demonstrate 2–3 orders of improvement in the piezoelectric response, through simultaneous hardening of the matrix and improvement in its permittivity. By tuning the polycrystallinity of the piezoelectric inclusions, we show considerable improvements exceeding 50% in the piezo-response, compared to single crystal inclusions. We further analyze the influence of carbon nanotube agglomerations at supramolecular length scales, as well as vacancy defects in the nanotubes at the atomic level, on composite performance. Although nanomaterial agglomeration is conventionally considered undesirable, we show that, near nanotube percolation, clustering of nanotubes can lead to better matrix hardening and higher permittivities, leading to improvements exceeding 30% in the piezoelectric response compared to non-agglomerated architectures. We further demonstrate that although atomic vacancy defects in nanotubes effectively soften the matrix, this can be compensated by agglomeration of nanotubes at larger length-scales.

This work studies numerically the tribological behavior of fiber-reinforced plastics (FRP) under different frictional contact conditions, using a boundary element methodology. The formulation uses the Boundary Element Method (BEM) with an explicit approach for fundamental solutions evaluation, for computing the elastic influence coefficients. To enforce the contact constraints on the potential contact zone: Signorini’s contact conditions and an orthotropic law of friction, contact operators over the augmented Lagrangian are considered in the formulation. The methodology and the proposed algorithm are applied to study two types of glass FRP and two types of carbon FRP, with the same fiber volume fraction, under frictional contact. In these studies, it can be observed how the fiber orientation and sliding orientation affect the normal and tangential contact compliance, as well as the contact traction distribution. Furthermore, the formulation considers a micromechanics model for FRP that allows also to study the influence of fiber volume fraction on normal and tangential contact compliances.

Farmland expanded quickly at the expense of natural lands in Argentina since the mid-1950's without consideration of ecological costs. In order to analyze the implications of such changes we aimed to (i) develop a simple biophysical model to estimate the relative (0-100) provision of ecosystem services, (ii) calculate the economic value of food and fiber production derived from farming activities (economic services), and (iii) assess the tradeoffs between the provision of ecosystem and economic services. Land-use/land cover changes were studied through data from agricultural censuses in three historical periods (1956-1960, 1986-1990 and 2001-2005). The model uses biophysical data about biomass, water coverage, slope, soil infiltration capacity, temperature, precipitation and altitude. After testing the consistency of the model, its results were used to assess the relative ecological value of main regions across the country. On the other hand, the annual gross margin per hectare of farming activities was estimated in order to compare 1956-1960 and 2001-2005 periods that greatly differ in their regional farming model. Results showed that different regions respond differently to human intervention, both in economic and ecological terms, and any attempt to apply sole and centralized land-use strategies to different biomes may lead to undesirable outcomes. Economic and ecological criteria should be regionally balanced as a pre-requisite to the application of land-use policies. Fil: Carreño, Lorena Verónica. Instituto Nacional de Tecnología Agropecuaria. Centro Regional La Pampa-San Luis. Estación Experimental Agropecuaria Anguil; Argentina Fil: Frank, Federico Carlos. Instituto Nacional de Tecnología Agropecuaria. Centro Regional La Pampa-San Luis. Estación Experimental Agropecuaria Anguil; Argentina. Universidad Nacional de La Pampa. Facultad de Ciencias Exactas y Naturales; Argentina Fil: Viglizzo, Ernesto Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Ciencias de la Tierra y Ambientales de La Pampa. Universidad Nacional de La Pampa. Facultad de Ciencias Exactas y Naturales. Instituto de Ciencias de la Tierra y Ambientales de La Pampa; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro Regional La Pampa-San Luis. Estación Experimental Agropecuaria Anguil; Argentina. Universidad Nacional de La Pampa. Facultad de Ciencias Exactas y Naturales; Argentina

Given the increasing number of actors related to farming that make decisions at different scales (plot, farm, region, etc.), knowledge about patterns and processes that behave hierarchically is increasingly needed. This is necessary in countries like Argentina, where cultivation expanded at increasing pace during the last 50 years over an area of 1.47 million km^2. Relying on different sources of existing data, the purpose of this work was to assess the cross-scale dependence of patterns and processes related to the expansion of cultivation in Argentina. The study involved indicators of (i) carbon, nitrogen and phosphorous stocks, (ii) energy productivity, fossil energy consumption, C, N and P balances, water consumption and greenhouse gases fluxes, and (iii) impacts related to pesticide contamination, habitat intervention and soil erosion. Three scales involving (i) regions, (ii) macro-regions and (iii) the whole country were analyzed. Principal Components, Correlation and Regression Analysis were used to identify and quantify meaningful relationships between the different scales. The expansion of annual crops affected C-N-P stocks significantly at the regional scale, whereas it influenced energy and matter flows, and contamination across all scales. This finding explains conflictive responses to land use and management when different scales are considered and shows that scale dependency needs to be considered when their effects on the environment are explored and quantified. Fil: Viglizzo, Ernesto Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Ciencias de la Tierra y Ambientales de La Pampa. Universidad Nacional de La Pampa. Facultad de Ciencias Exactas y Naturales. Instituto de Ciencias de la Tierra y Ambientales de La Pampa; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro Regional La Pampa-San Luis. Estación Experimental Agropecuaria Anguil; Argentina. Universidad Nacional de La Pampa; Argentina Fil: Ricard, Maria Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Ciencias de la Tierra y Ambientales de La Pampa. Universidad Nacional de La Pampa. Facultad de Ciencias Exactas y Naturales. Instituto de Ciencias de la Tierra y Ambientales de La Pampa; Argentina Fil: Jobbagy Gampel, Esteban Gabriel. Universidad Nacional de San Luis; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis. Instituto de Matemática Aplicada de San Luis "Prof. Ezio Marchi". Universidad Nacional de San Luis. Facultad de Ciencias Físico, Matemáticas y Naturales. Instituto de Matemática Aplicada de San Luis "Prof. Ezio Marchi"; Argentina Fil: Frank, Federico Carlos. Instituto Nacional de Tecnología Agropecuaria. Centro Regional La Pampa-San Luis. Estación Experimental Agropecuaria Anguil; Argentina. Universidad Nacional de La Pampa; Argentina Fil: Carreño, Lorena Verónica. Instituto Nacional de Tecnología Agropecuaria. Centro Regional La Pampa-San Luis. Estación Experimental Agropecuaria Anguil; Argentina

Resumen Aunque la monitorizacion continua de glucosa a tiempo real (MCG-TR) esta disponible desde hace mas de 10 anos, su incorporacion a la practica clinica es aun escasa. El objetivo de este articulo es revisar la evidencia cientifica existente en torno a los actuales sistemas de MCG-TR incorporados a la atencion de los pacientes con diabetes que pudiera justificar su utilizacion en determinados perfiles clinicos. Tras una busqueda bibliografica seleccionando fundamentalmente estudios controlados aleatorizados que comparan los sistemas MCG-TR con la automonitorizacion de la glucemia, hay 12 estudios clinicos —dos con sistemas actualmente no comercializados y uno en DM2— y un reciente metaanalisis con 6 de ellos. Ademas de analizar sus principales ventajas e inconvenientes, se ha recogido informacion sobre su utilizacion en situaciones especiales -pacientes en UCI, gestacion- y revisado estudios de calidad de vida y de coste-efectividad. Tambien se describe la variable situacion administrativa en cuanto a financiacion por los sistemas de salud publicos en Europa y America, asi como las indicaciones clinicas actualmente reconocidas para su uso.