Head-to-head comparison of two continuous glucose monitoring systems on a cardio-surgical ICU.

In critical illness hypo-and hyperglycemia have a negative influence on patient outcome. Continuous glucose monitoring (CGM) could help in early detection of hypo-and hyperglycemia. A requirement for these new methods is an acceptable accuracy and precision in clinical practice. In this pilot study we prospectively evaluated the accuracy and precision of two CGM sensors (subcutaneous sensor: Sentrino®, Medtronic and intravasal sensor: Glucoclear®, Edwards) in 20 patients on a cardio-surgical ICU in a head to head comparison. CGM data were recorded for up to 48 h and values were compared with blood-gas-analysis (BGA) values, analysed with Bland-Altman-plots and color-coded surveillance error-grids. Shown are means ± standard deviations. In total 270/255 intravasal/subcutaneous pairs with BGA-values were analysed. The average runtime of the sensors was 28.4 ± 6.4 h. Correlation with BGA values yielded a correlation coefficient of 0.76 (subcutaneous sensor) and 0.92 (intravasal sensor). The Bland Altman Plots revealed an accuracy of 2.5 mg/dl, and a precision of + 43.0 mg/dl to - 38.0 mg/dl (subcutaneous sensor) and an accuracy of - 6.0 mg/dl, and a precision of + 12.4 mg/dl to - 24.4 mg/dl (intravasal sensor). No severe hypoglycemic event, defined as BG level below 40 mg/dl, occurred during treatment. Both sensors showed good accuracy in comparison to the BGA values, however they differ regarding precision, which in case of the subcutaneous sensor is considerable high.

Continuous glucose monitoring on the ICU using a subcutaneous sensor.

INTRODUCTION: Hypoglycemia is a frequent and feared complication of insulin therapy on the intensive care unit (ICU). Sedated patients in particular are at risk for hypoglycemia due to the absence of clinical symptoms. Furthermore, recent studies point to a correlation between the variability of blood glucose and mortality. Therefore, continuous glucose monitoring has the potential to influence outcome due to a better control of blood glucose in critically ill patients. MATERIALS AND METHODS: We evaluated the efficacy, accuracy and safety of a new commercially available subcutaneous continuous glucose monitoring system (sCGM; Sentrino®, Medtronic) in a pilot study in critically ill adult patients. sCGM data were recorded for up to 72 h and values were compared with blood glucose values measured by cassette-based blood gas analyzer (BGA). RESULTS: A total of 14 patients (eight male, six female), with a mean age of 62.1 ± 9.8 years, referred to the ICU after major abdominal surgery were studied. The average simplified acute physiology score (SAPS II) was 35 ± 9. Three patients had known type II diabetes. The average runtime of sensors was 44.1 ± 22.1 h. In comparison to BGA, measurement of blood glucose by sCGM revealed an accuracy of 1.5 mg/dl, and a precision of +34.2 mg/dl to -31.2 mg/dl. Linn's concordance correlation coefficient yielded 0.74 with a 95% confidence interval of 0.68-0.78. No hypoglycemic events, defined as a blood glucose level below 70 mg/dl, occurred during treatment. CONCLUSIONS: sCGM monitoring via a subcutaneous sensor demonstrated high accuracy and considerable variability compared to blood gas samples, even in critically ill patients.

Globin's structure and function in vesicomyid bivalves from the Gulf of Guinea cold seeps as an adaptation to life in reduced sediments.

Vesicomyid bivalves form dense clam beds in both deep-sea cold seeps and hydrothermal vents. The species diversity within this family raises questions about niche separation and specific adaptations. To compare their abilities to withstand hypoxia, we have studied the structure and function of erythrocyte hemoglobin (Hb) and foot myoglobin (Mb) from two vesicomyid species, Christineconcha regab and Laubiericoncha chuni, collected from the Regab pockmark in the Gulf of Guinea at a depth of 3,000 m. Laubiericoncha chuni possesses three monomeric globins, G1 (15,361 Da), G2 (15,668 Da), and G3 (15,682 Da) in circulating erythrocytes (Hb), and also three globins, G1, G3, and G4 (14,786 Da) in foot muscle (Mb). Therefore, globins G2 and G4 appear to be specific for erythrocytes and muscle, respectively, but globins G1 and G3 are common. In contrast, C. regab lacks erythrocyte Hb completely and possesses only globin monomers G1' (14,941 Da), G2' (15,169 Da), and G3' (15,683 Da) in foot muscle. Thus, these two vesicomyid species, C. regab and L. chuni, show a remarkable diversity in globin expression when examined by electrospray ionization mass spectrometry. Oxygen-binding affinities reveal extremely high oxygen affinities (P50 < 1 Torr, from 5° to 15°C at pH 7.5), in particular L. chuni globins, which might be an advantage allowing L. chuni to dig deeply for sulfides and remain buried for long periods in reduced sediments.

Clinical outcome of advanced squamous cell carcinoma of the conjunctiva.

BACKGROUND: To evaluate the outcome of surgical management of advanced squamous cell carcinoma (SCC) of the conjunctiva (American Joint Committee Cancer-classification >III) and the rate of recurrences after treatment during follow-up. Second, to investigate the incidence of orbital exenteration during follow-up. METHODS: Thirty-eight cases with SCC >grade T3 AJCC were retrospectively analysed at a University Eye Hospital Munich. Tumour stage, type of treatment, follow-up time, risk factors and--if present--recurrence were documented. RESULTS: The mean follow-up was 24.2 months (22.3-71 months). The most frequent surgical procedure was local tumour excision (n=25 patients, 71%). Orbital exenteration was performed in 10 patients (28%). Twenty patients (57%) did not show a progressive disease during follow-up. Of the patients with primary local excision, 13 (52%) had recurrence. Average time to recurrence for all treated patients was 24 months in the mean (minimum 4 months, maximum 68 months, SD, 22). Patients following orbital exenteration had recurrence of disease in 20% (n=2). None of the patients with primarily local tumour excision required an orbital exenteration. CONCLUSION: Advanced-stage SCC can be treated surgically. An extensive surgical approach is sometimes inevitable. Patients with surgical excision of advanced-stage disease should be reviewed closely as recurrences may occur and even after more than 5 years. However, on early detection, most of these recurrences can be handled by local excision.

Enzyme replacement therapy for mucopolysaccharidosis VI: long-term cardiac effects of galsulfase (Naglazyme®) therapy.

Characteristic cardiac valve abnormalities and left ventricular hypertrophy are present in untreated patients with mucopolysaccharidosis type VI (MPS VI). Cardiac ultrasound was performed to investigate these findings in subjects during long-term enzyme replacement therapy (ERT) with recombinant human arylsulfatase B (rhASB, rhN-acetylgalactosamine 4-sulfatase, galsulfase, Naglazyme®). Studies were conducted in 54 subjects before ERT was begun and at specific intervals for up to 96 weeks of weekly infusions of rhASB at 1 mg/kg during phase 1/2, phase 2, and phase 3 trials of rhASB. At baseline, mitral and aortic valve obstruction was present and was significantly greater in those ≥12 years of age. Mild mitral and trace aortic regurgitation were present, the former being significantly greater in those <12 years. Left ventricular hypertrophy, with averaged z-scores ranging from 1.6-1.9 SD greater than normal, was present for ages both <12 and ≥12 years. After 96 weeks of ERT, ventricular septal hypertrophy regressed in those <12 years. For those ≥12 years, septal hypertrophy was unchanged, and aortic regurgitation increased statistically but not physiologically. Obstructive gradients across mitral and aortic valves remained unchanged. The results suggest that long-term ERT is effective in reducing intraventricular septal hypertrophy and preventing progression of cardiac valve abnormalities when administered to those <12 years of age.

[Invasive squamous cell carcinoma of the conjunctiva]. / Invasives Plattenepithelkarzinom der Bindehaut.

We report the case of a 71-year-old male who was first diagnosed with conjunctival squamous cell carcinoma in September 2010. The lesion was excised twice and cryotherapy of the margins was performed. On histology the margins were not tumor-free but this was not followed up by further excision. After 5 months the patient was referred to this department with a growing tumor mass which had infiltrated into the anterior chamber and partly destroyed the iris. Because of this advanced finding extended enucleation was performed. The histological examination showed a well differentiated squamous cell carcinoma and no evidence of metastasis in lymph nodes or elsewhere could be found by conventional computed tomography (CT) and positron emission CT (PET-CT).

Children's emotional adaptation to parental BMT.

Few studies have examined the effect of parental BMT on the family and less is known regarding the impact on children. The purpose of this prospective study was to increase understanding of children's adaptation to the stress of parental BMT across a 12-month trajectory. Data were obtained from 61 children ages 10-18 before parental transplant, during parental hospitalization, 1, 4 , 8 and 12 months post BMT. Mixed linear modeling was used to analyze longitudinal data from children nested within families. Analyses examined change in child emotional adaptation, points of greatest vulnerability throughout the BMT trajectory and the impact of theoretically relevant variables on their adaptation. Children's emotional adaptation became significantly more positive over time, although their level of distress remained above the norm. Pre-transplant was the period of greatest emotional distress. Negative self-esteem, disruption within the family structure, use of disengagement coping and the mother as transplant recipient were associated with more negative adaptation. Further research is needed to fully understand the effects of parental BMT on children. However, these findings point to the importance of considering the adaptation of children and its implications for the development of preventive family interventions for this vulnerable population.

Longitudinal assessment of cardiac diastolic function in HIV-infected patients.

Asymptomatic isolated diastolic dysfunction (DD), with normal left ventricular systolic function, may be the first indication of underlying cardiac disease in HIV-negative populations. We previously reported a high prevalence (37%) of DD among asymptomatic HIV-infected patients at low risk for AIDS and cardiovascular disease (CVD). We performed a longitudinal assessment of interval echocardiographic changes in this cohort over a four-year period. Repeat transthoracic echocardiograms (TTEs) utilized standard techniques. Sixty (of the original 91) HIV-infected patients, predominately men, underwent repeat TTE (median follow-up 3.7 years, interquartile range [IQR] 3.5, 4.0). Cohort characteristics (median; IQR) include age 42.0 (36.5, 46.0) years, HIV duration 16.4 years (8.1, 18.9), current CD4 count 572.0 cells/mm(3) (436.5, 839.0), antiretroviral therapy (ART) duration 8.1 years (4.8, 13.4) and Framingham risk score 1.0 (0.0, 2.0). DD was observed in 28/60 patients on re-evaluation (47%, 95% confidence interval [CI] 34%, 60%); 31% (11/36) of patients had new onset DD for an overall incidence of 8.2/100 person-years. On follow-up, subjects with DD were older, had a trend towards higher body mass index, hypertension and longer duration of HIV infection compared with subjects without DD. We confirmed a high prevalence of DD (47%) in asymptomatic HIV-infected patients at low risk for AIDS and CVD.

Brain connectivity and postural control in young traumatic brain injury patients: A diffusion MRI based network analysis.

Our previous research on traumatic brain injury (TBI) patients has shown a strong relationship between specific white matter (WM) diffusion properties and motor deficits. The potential impact of TBI-related changes in network organization of the associated WM structural network on motor performance, however, remains largely unknown. Here, we used diffusion tensor imaging (DTI) based fiber tractography to reconstruct the human brain WM networks of 12 TBI and 17 control participants, followed by a graph theoretical analysis. A force platform was used to measure changes in body posture under conditions of compromised proprioceptive and/or visual feedback. Findings revealed that compared with controls, TBI patients showed higher betweenness centrality and normalized path length, and lower values of local efficiency, implying altered network organization. These results were not merely a consequence of differences in number of connections. In particular, TBI patients displayed reduced structural connectivity in frontal, parieto-premotor, visual, subcortical, and temporal areas. In addition, the decreased connectivity degree was significantly associated with poorer balance performance. We conclude that analyzing the structural brain networks with a graph theoretical approach provides new insights into motor control deficits following brain injury.

[An unusual case of non-traumatic enophthalmos]. / Ungewöhnlicher Fall eines atraumatischen Enophthalmus.

An extensive spectrum of differential diagnoses has to be considered when a patient presents with enophthalmos. The most common causes of this presentation include orbital trauma or contraction and atrophy of the orbital contents secondary to scleroderma or radiotherapy. However radiologists also have to consider less common causes of enophthalmos, such as the imploding antrum syndrome or the ethmoid silent sinus syndrome. The latter involves the ethmoidal cells and results in medial orbital wall implosion. Along with the case presentation the pathogenesis, incidence and differential diagnoses of ethmoid silent sinus syndrome are elucidated. In particular the differentiation from normal anatomical variants, such as dehiscent lamina papyracea is discussed.

The Miethke dual switch valve: experience in 169 adult patients with different kinds of hydrocephalus: an open field study.

OBJECT: In spite of the development of approximately 200 different shunt systems within the last 50 years, overdrainage and valve obstructions are still major problems in the current treatment of hydrocephalus. In 1994, a new gravitational valve with different opening pressures (depending upon the patient's posture) and a big contact area to CSF was introduced by Miethke and co-workers (DSV). We report about a single institution's experience in the treatment of 169 adult patients with different kinds of hydrocephalus with this valve. METHODS: We retrospectively reviewed the clinical and radiological data of all patients who were treated with a DSV between 1998 and 2005 at our institution. A telephone interview was perfomed at the end of the study, to determine the overall shunt survival. We analysed the outcome and the shunt-related complications. RESULTS: Among 169 patients with DSV, we had 70 patients with normal pressure hydrocephalus (NPH), 40 patients with communicating hydrocephalus due to SAH, 31 patients with communicating hydrocephalus not due to SAH and 28 patients with occlusive hydrocephalus. We had a rate of shunt responders of 93.2%, an overdrainage rate of 3.2% and no valve obstruction in the whole series. The overall shunt survival was 81% after 82 months (mean follow-up: 47.6 months). All implantations were performed by the whole staff, as well as by residents of the neurosurgical department. DISCUSSION: Among the currently available shunt systems, this series is one with the lowest complication rates due to overdrainage and valve obstructions. In patients with NPH, where low opening pressures are essential, the DSV seems to bear an advantage because of a high drainage rate and, in spite of this, a low rate of overdrainage. Even in patients with relatively high CSF protein content, we did not observe any valve obstruction. This study was an open field analysis providing data about the current complication rates of hydrocephalus treatment with this shunt system, outside of a specialized hydrocephalus team or a prospective study trial. However, this study is a retrospective analysis and a prospective randomized controlled trial is required for the comparison of these valves with other shunt systems, such as programmable and flow-controlled ones is required for the future.

Thoracoscopic talc pleurodesis for the treatment of spontaneous pneumothorax.

BACKGROUND: During the Belgian Surgical Week in May 2004 some controversy existed on the optimal treatment of spontaneous pneumothorax. Doubts raised about the safety of talc in performing pleurodesis because of reported complications. METHODS: A retrospective analysis of a consecutive series of thoracoscopic pleurodesis with talc was performed. Patients operated for spontaneous pneumothorax were analysed focusing on complications and freedom of recurrence. A literature search was performed on complications from the use of talc to treat pleural disease. RESULTS: From September 1999 till August 2004 forty-one patients had a thoracoscopic pleurodesis with talc. In 21 patients this was performed for recurrent malignant pleural effusion and in 20 for spontaneous pneumothorax. In 5 of these 20 patients we faced a secondary spontaneous pneumothorax. In seven patients an apical pulmonary wedge resection of bullae was performed. No intra-operative or serious postoperative complications were seen in these patients. All drains were removed after 4 to 6 days. No episodes of respiratory insufficiency occurred. No recurrence was encountered during a mean follow-up of 22.7 months. CONCLUSION: Thoracoscopic talc pleurodesis for spontaneous pneumothorax was effective and safe in our experience. In the literature no convincing evidence against the use of talc to treat pleural disease was found. Although some cases of ARDS are attributed to the pleural administration of talc, the incidence of complications after talc poudrage appears to be low.

Prospectively randomized trial using perioperative low dose octreotide to prevent organ related and general complications following pancreatic surgery and pancreatico-jejunostomy.

BACKGROUND: The aim of the study was to evaluate the influence of low dose perioperative Octreotide on the prevention of complications (pancreatic fistula and general complications) in patients undergoing pancreatic surgery followed by pancreatico-jejunostomy. MATERIAL AND METHODS: 105 patients were randomized to receive either Octreotide 0.1 mg subcutaneously 3 times/day for a total of 7 days or no Octreotide. The primary endpoints were the occurrence of a pancreatic fistula and/or general complications including the length of hospital stay. There were 25 surgical draining procedures performed and 80 duodeno-pancreatectomies with or without preservation of the pylorus. Twenty-six (24.8%) of the patients were treated for chronic pancreatitis, 8 (7.6%) for benign tumoral disease and 71 (67.6%) for carcinoma. All patients underwent pancreatico-jejunostomy. RESULTS: 56 patients received Octreotide and 49 did not. The incidence of fistula formation in the Octreotide group was 8.9% (n=5) and in the control group 8.2% (n=4) for a total incidence of 8.5%. The difference between the two groups was not statistically significant. There was one death in the Octreotide group and none in the control group for an overall mortality of 0.9%. The morbidity, except fistulas, was 10.7% in the Octreotide group and 12.2% in the control group. The length of hospital stay was 23.1 +/- 15.1 days in the group receiving Octreotide vs 20.4 +/- 8.1 days in the control group (p = 0.808). Stratifying the data for duodenopancreatectomy and for draining procedures there was no difference between the groups either. CONCLUSION: In patients undergoing pancreatic surgery and pancreatico-jejunostomy, the perioperative use of 3 x 0.1 mg Octreotide for 7 days does not reduce general complications nor fistula formation.

[Image quality and exposure dose in digital projection radiography]. / Bildqualität und Dosis in der Digitalen Projektionsradiographie.

PURPOSE: Comparison of the imaging capabilities of storage phosphor (computed) radiography and flat plate radiography with conventional film-screen radiography to find new strategies for quality and dose management, i. e., optimizing imaging quality and dose depending on the imaging method and clinical situation. MATERIALS AND METHODS: Images of a CDRAD-phantom, hand-phantom, abdomen-phantom and chest-phantom obtained with different exposure voltages (50 kV, 73 kV, 109 kV) and different speeds (200, 400, 800, 1600) were processed with various digital systems (flat plate detector: Digital Diagnost [Philips]; storage phosphors: ADC-70 [Agfa], ADC-Solo [Agfa], FCR XG 1 [Fuji]) and a conventional film-screen system (HT100G/ Ortho Regular [Agfa]). RESULTS: The evaluation of CDRAD images found the flat plate detector system to have the highest contrast detectability for all dose levels, followed by the FCR XG 1, ADC-Solo and ADC-70 systems. Comparison of the organ-phantom images found the flat plate detector system to be equal to film-screen radiography and especially to storage phosphor systems even for low exposure doses. CONCLUSIONS: Flat plate radiography systems demonstrate the highest potential for high image quality when reducing the exposure dose. Depending on the system generation, the storage phosphor systems also show an improved image quality, but the possibility of a dose reduction is limited in comparison with the flat plate detector system.

Molecular imaging of perfusion disturbances in glaucoma.

Ocular ischemia resulting from perfusion disturbances may play a major role in initiation of glaucoma. Possibly secondary to ischemia autoimmunogenic events are activated in glaucoma patients with increased prevalence of systemic autoimmune diseases. The determination of potential molecular markers in blood leukocytes could be useful for early noninvasive diagnostics of glaucoma. Our study using subtractive hybridization showed altered gene expression in leukocytes of glaucoma patients in comparison to age and sex matched healthy subjects. Subtracted genes encoding lymphocyte IgE receptor (Fc epsilon RII/CD23), T cell-specific tyrosine kinase, thromboxan A2 receptor, alkaline phosphatase and Na(+)/K(+)-ATPase are differentially expressed in circulating leukocytes of glaucoma patients. These genes show expression profiles characteristic for adherent leukocytes which could be an important contributor to blood-brain barrier breakdown which has been found in glaucoma patients.

Coherent coupling of two quantum dots embedded in an Aharonov-Bohm interferometer.

We define two laterally gated small quantum dots with less than 15 electrons in an Aharonov-Bohm geometry in which the coupling between the two dots can be changed. We measure Aharonov-Bohm oscillations for weakly coupled quantum dots. In an intermediate coupling regime we study molecular states of the double dot and extract the magnetic field dependence of the coherently coupled states.

The target of rapamycin signaling pathway regulates mRNA turnover in the yeast Saccharomyces cerevisiae.

The target of rapamycin (TOR) signaling pathway is an important mechanism by which cell growth is regulated by nutrient availability in eukaryotes. We provide evidence that the TOR signaling pathway controls mRNA turnover in Saccharomyces cerevisiae. During nutrient limitation (diauxic shift) or after treatment with rapamycin (a specific inhibitor of TOR), multiple mRNAs were destabilized, whereas the decay of other mRNAs was unaffected. Our findings suggest that the regulation of mRNA decay by the TOR pathway may play a significant role in controlling gene expression in response to nutrient depletion. The inhibition of the TOR pathway accelerated the major mRNA decay mechanism in yeast, the deadenylation-dependent decapping pathway. Of the destabilized mRNAs, two different responses to rapamycin were observed. Some mRNAs were destabilized rapidly, while others were affected only after prolonged exposure. Our data suggest that the mRNAs that respond rapidly are destabilized because they have short poly(A) tails prematurely either as a result of rapid deadenylation or reduced polyadenylation. In contrast, the mRNAs that respond slowly are destabilized by rapid decapping. In summary, the control of mRNA turnover by the TOR pathway is complex in that it specifically regulates the decay of some mRNAs and not others and that it appears to control decay by multiple mechanisms.

New twists in understanding the fate of antisense oligodeoxynucleotide mRNA targets.

In this issue of Molecular Cell, Thoma et al. show that after a target mRNA is cleaved, upon treatment with an antisense oligodeoxynucleotide, the 3' cleavage product persists and is translated to produce an N-terminally truncated version of the protein encoded by the target mRNA.

Alosetron controls bowel urgency and provides global symptom improvement in women with diarrhea-predominant irritable bowel syndrome.

OBJECTIVES: Bowel urgency is one of the most bothersome symptoms for nonconstipated IBS patients. The efficacy of alosetron in control of bowel urgency and Global Improvement of IBS symptoms were evaluated in a multicenter double-blind, randomized, placebo-controlled study. METHODS: Female IBS patients with lack of satisfactory control of bowel urgency were randomized 2:1 to alosetron 1 mg twice daily or placebo treatment groups. The primary endpoint was the proportion of days with satisfactory control of bowel urgency during the 12-wk treatment period and 2-wk follow-up period. Secondary endpoints included IBS Global Improvement (responder defined as patient-reported moderate or substantial improvement in IBS symptoms) and improvements in bowel function (stool frequency, consistency, and sensation of incomplete evacuation). RESULTS: A total of 801 women were randomized to the alosetron (n = 532) or placebo groups (n = 269). Physicians classified 98% of patients with diarrhea-predominant IBS. Patients treated with alosetron had a significantly greater proportion of days with satisfactory control of urgency compared to placebo for the treatment period (73% vs 57%, p < 0.001). A significantly greater number of patients treated with alosetron were IBS Global Improvement responders compared to placebo at week 12 (76% vs 44%, p < 0.001). IBS Global Improvement responders had more days with satisfactory control of urgency at week 12 (88% vs 48%) as well as firmer stools, fewer stools/day, and fewer days with incomplete evacuation compared with nonresponders. Alosetron-treated patients showed improvements in bowel functions compared to placebo-treated patients. Constipation was the most commonly reported adverse event.

The Psychology Graduate Applicant's Portal (www.psychgrad.org).

Applying to graduate school in psychology can be an intimidating process. Many obstacles must be overcome, such as applying to a program appropriate to the specific applicant, getting good GRE scores, submitting a clear and well-written statement of purpose, and obtaining letters of recommendation, to name just a few. Much information is available to assist applicants in these tasks, but finding this information can cause problems even for experienced Internet users. The goal of this project is to create an easily accessible Web clearing house of information on applying to graduate school in psychology. This Web site, called the Psychology Graduate Applicant's Portal (or PsychGrad.org), contains targeted links to other Web pages with valuable information, book recommendations on the applications process, polls to measure issues important to the graduate applicants, site-unique advice on graduate programs, a message board to exchange information and experiences, and other information relevant to the application process.