A Control-Theoretical Approach to Model-Based Medicine

Abstract This paper discusses the notion of model-based medicine which is expected to give a solution to various difficulties in clinical medical systems based upon the familiar methodology of control science. The model-based medicine relies essentially on an integrated model of the visceral system of human body that includes various functional subsystems such as respiration, circulation, thermal, digestion, urinary, endocrine/neuronal systems as its component. We introduce an example of such integrated models of human body developed in our laboratory. Some novel results which enhance the effect of therapy are presented concerning brain hypothermia treatments based on the model. In the latter half of the paper, we propose a new hypothesis on the cause of diabetes based on the integrated model, as well as clinical evidence. We think the real cause of elevation of blood glucose is the homeostasis of glucose concentrations in the brain. In other words, the elevation of blood sugar itself is not as harm as people think, because it is an outcome of control of the brain sugar. Long-term effect of psychological stress is shown to cause diabetes based on our model.

[1]  J. Avery Critical review. , 2006, The Journal of the Arkansas Medical Society.

[2]  J. Michenfelder Blood–Brain Barrier in Physiology and Medicine , 1977 .

[3]  S. Vannucci,et al.  Blood—Brain Barrier Glucose Transporter , 1999, Journal of neurochemistry.

[4]  B. Thorens,et al.  Brain glucose sensing, counterregulation, and energy homeostasis. , 2007, Physiology.

[5]  R. Seeley,et al.  The integrative role of CNS fuel-sensing mechanisms in energy balance and glucose regulation. , 2008, Annual review of physiology.

[6]  A Boutayeb,et al.  A critical review of mathematical models and data used in diabetology , 2006, Biomedical engineering online.

[7]  S. Woods,et al.  Central nervous system control of food intake , 2000, Nature.

[8]  V. Routh,et al.  Glucose-sensing neurons Are they physiologically relevant? , 2002, Physiology & Behavior.

[9]  Hidenori Kimura,et al.  A Mathematical Model of Respiratory and Biothermal Dynamics in Brain Hypothermia Treatment , 2008, IEEE Transactions on Biomedical Engineering.

[10]  A. Geerts,et al.  Neural connections between the hypothalamus and the liver. , 2004, The anatomical record. Part A, Discoveries in molecular, cellular, and evolutionary biology.

[11]  K. Polderman Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part 1: Indications and evidence , 2004, Intensive Care Medicine.

[12]  W. Vandertop,et al.  Effects of therapeutic hypothermia on intracranial pressure and outcome in patients with severe head injury , 2002, Intensive Care Medicine.

[13]  R. Gruetter,et al.  Brain glucose concentrations in poorly controlled diabetes mellitus as measured by high-field magnetic resonance spectroscopy. , 2005, Metabolism: clinical and experimental.

[14]  R. Gruetter,et al.  Effect of chronic hypoglycaemia on glucose concentration and glycogen content in rat brain: a localized 13C NMR study , 2006, Journal of neurochemistry.

[15]  H. Kimura,et al.  Simulation of propofol anaesthesia for intracranial decompression using brain hypothermia treatment , 2007, Theoretical biology & medical modelling.

[16]  Yang Kuang,et al.  Mathematical models and software tools for the glucose-insulin regulatory system and diabetes: an overview , 2006 .

[17]  Bei B. Zhang,et al.  Glucagon and regulation of glucose metabolism. , 2003, American journal of physiology. Endocrinology and metabolism.

[18]  Dalton W. Dietrich,et al.  Brain Hypothermia Treatment , 2004, Springer Japan.

[19]  A. Gjedde,et al.  Blood-brain glucose transfer: repression in chronic hyperglycemia. , 1981, Science.

[20]  R. Gruetter,et al.  Brain glucose concentrations in healthy humans subjected to recurrent hypoglycemia , 2005, Journal of neuroscience research.

[21]  Lu Gaohua,et al.  An integrated model of thermodynamic-hemodynamic-pharmacokinetic system and its application on decoupling control of intracranial temperature and pressure in brain hypothermia treatment. , 2006, Journal of theoretical biology.

[22]  N. Sanders,et al.  Role of Neuronal Glucosensing in the Regulation of Energy Homeostasis , 2006, Diabetes.

[23]  Hidenori Kimura,et al.  A mathematical model of intracranial pressure dynamics for brain hypothermia treatment. , 2006, Journal of theoretical biology.

[24]  M. Feinglos,et al.  Stress and Diabetes Mellitus , 1992, Diabetes Care.