Safety and accuracy of a new long-term subconjunctival glucose sensor

Background: A new biosensor has been developed by EyeSense (Großostheim, Germany) that is placed into the conjunctiva of one eye to measure the glucose concentration of the surrounding tissue in a non‐invasive manner. In the present study we investigated the correlation between glucose concentrations measured by the EyeSense implant and those determined by finger prick testing, as well as the tolerability and safety of the implant over a 16‐week period. Methods: The study was performed in 28 diabetic patients. The biosensor was inserted under local anesthesia and sterile conditions. Correlations between capillary glucose measured by laboratory methods and interstitial glucose determined by the biosensor were investigated by inducing increases and decreases in glucose values between 60 and 300 mg/dL. Results: Most patients experienced a mild subconjunctival hemorrhage postoperatively. Except for the minor sensation of the presence of foreign body, the implants were well tolerated. Three patients lost the ocular mini insert spontaneously, whereas there was a function failure of the insert in four patients. Error grid analysis showed that the percentage of data pairs in the acceptable ranges (zone A and B) was very high (>96%). However, there was a shift from zone A to zone B during observation. This was due primarily to an increase in the lag time between capillary and interstitial measured glucose. Conclusion: The present study demonstrates good tolerability and measurement performance of the biosensor. The reasons for an increase in the lag time are still unknown; local reactions may be involved.     

Effects of Residential Indoor Air Quality and Household Ventilation on Preterm Birth and Term Low Birth Weight in Los Angeles County,California

Objectives. The purpose of our study was to examine the effects of indoor residential air quality on preterm birth and term low birth weight (LBW).Methods. We evaluated 1761 nonsmoking women from a case-control survey of mothers who delivered a baby in 2003 in Los Angeles County, California. In multinomial logistic regression models adjusted for maternal age, education, race/ethnicity, parity and birthplace, we evaluated the effects of living with smokers or using personal or household products that may contain volatile organic compounds and examined the influence of household ventilation.Results. Compared with unexposed mothers, women exposed to secondhand smoke (SHS) at home had increased odds of term LBW (adjusted odds ratio [OR] = 1.36; 95% confidence interval [CI] =  0.85, 2.18) and preterm birth (adjusted OR = 1.27; 95% CI = 0.95, 1.70), although 95% CIs included the null. No increase in risk was observed for SHS-exposed mothers reporting moderate or high window ventilation. Associations were also observed for product usage, but only for women reporting low or no window ventilation.Conclusions. Residential window ventilation may mitigate the effects of indoor air pollution among pregnant women in Los Angeles County, California.Although numerous studies have examined the effects of outdoor air pollution on birth outcomes, less information is available on the effects of residential indoor air quality in high resource countries, even though pregnant women spend on average more than 15 hours per day at or near their home, and 7 hours per day at work or other indoor locations.1,2 Indoor air quality is influenced not only by the intrusion of outdoor pollutants, but also by the indoor sources such as tobacco smoke, and off-gassing of chemical agents from personal and household products or furniture may also be important contributors.3 Although studies have reported increased risk of preterm birth and low birth weight (LBW) with maternal smoking and secondhand smoke (SHS) exposures,4–10 no pregnancy outcome study to date has evaluated the effects of other agents affecting indoor air quality in high resource countries, nor the potential protective effect of home ventilation. The majority of pregnancy outcome studies addressing indoor air pollution beyond SHS were conducted in occupational settings,11–18 or in low or medium resource countries focusing on smoke from biomass fuels.19–23Volatile organic compounds (VOCs) are present in organic solvents used in many personal products, cleaners, adhesives, and residential-use insecticides.3,24–26 Most epidemiologic studies of organic solvents examined only occupational exposures, and reported increased risks of spontaneous abortion, small for gestational age (SGA), preterm birth, birth defects, and reductions in birth weight.11–15,17,18,27,28 Only 2 studies in high resource countries examined residential indoor air exposures from VOC-emitting household products, and neither examined whether ventilation mitigated the effects of exposure.29,30In this study, we describe how SHS, personal and household product usage, as well as household ventilation together influence the risk of preterm birth and term LBW for women in Los Angeles County, California.     

Multidisciplinary long‐term care and modern surgical treatment of congenital melanocytic nevi – recommendations by the CMN surgery network

In recent years, our knowledge of congenital melanocytic nevi (CMN) has greatly expanded. This has led to a paradigm shift. The present article represents a commentary by an interdisciplinary group of physicians from German‐speaking countries with extensive experience in long‐term care and surgical treatment of children and adults with CMN (CMN surgery network, “Netzwerk Nävuschirurgie”, NNC). The authors address aspects such as the indication for treatment as well as treatment planning and implementation under these new premises. Adequate counseling of parents on conservative and/or surgical management requires an interdisciplinary exchange among physicians and individualized planning of the intervention, which frequently involves a multi‐stage procedure. Today, the long‐term aesthetic outcome is at the center of any therapeutic endeavor, whereas melanoma prevention plays only a minor role. The premise of “removal at any cost” no longer holds. Potential treatment‐related adverse effects (hospitalization, wound healing disorders, and others) must be carefully weighed against the prospects of a beneficial outcome. In this context, the use of dermabrasion in particular must be critically evaluated. At a meeting of the NNC in September 2018, its members agreed on a consensus‐based position on dermabrasion, stating that the procedure frequently leads to impaired wound healing and cosmetically unfavorable or hypertrophic scarring. Moreover, dermabrasion is considered to be commonly associated with considerable repigmentation that usually occurs a number of years after the procedure. In addition, the NNC members saw no benefit in terms of melanoma prevention. In the future, physicians should therefore thoroughly caution about the potential risks and often limited cosmetic benefits of dermabrasion.     

Serum serotonin levels in patients with epileptic seizures

Profound cardiovascular and/or respiratory dysfunction is part of the terminal cascade in sudden unexpected death in epilepsy (SUDEP). Central control of ventilation is mediated by brainstem rhythm generators, which are influenced by a variety of inputs, many of which use the modulatory neurotransmitter serotonin to mediate important inputs for breathing. The aim of this study was to investigate epileptic seizure–induced changes in serum serotonin levels and whether there are potential implications for SUDEP. Forty‐one epileptic patients were pooled into 2 groups based on seizure type as (1) generalized tonic–clonic seizures (GTCS) of genetic generalized epilepsy and focal to bilateral tonic–clonic seizures (FBTCS; n = 19) and (2) focal seizures (n = 26) based on clinical signs using surface video‐electroencephalography. Postictal serotonin levels were statistically significantly higher after GTCS and FBTCS compared to interictal levels (P = .002) but not focal seizures (P = .941). The change in serotonin (postictal‐interictal) was inversely associated with a shorter duration of tonic phase of generalized seizures. The interictal serotonin level was inversely associated with a shorter period of postictal generalized electroencephalographic suppression. These data suggest that peripheral serum serotonin levels may play a role in seizure features and earlier postseizure recovery; these findings merit further study.     

Induction of false beliefs and false memories in laboratory studies—A systematic review

Psychological interventions often use guided discovery and other techniques for diagnostic exploration and intervention planning. This way, memories may arise in the person, which may be true or false. False memories of earlier events can be harmful and result in real suffering, similar to actual traumatic memories. Based on cognitive psychological and psycho-traumatological findings, there is pronounced dissent in the academic disciplines regarding the conceptualization, relevance and research of false memories. This review contributes to the basic question of how often false beliefs and false memories may be induced within the frame of different interactional techniques. A systematic review has been conducted of 59 articles from (quasi-)experimental studies and two qualitative sources from 30 data bases. Three main methods of memory induction provide the basis for reporting: imagination inflation, false feedback, and memory implantation. Due to the conceptual and methodological diversity of the studies, the results appear to be heterogeneous. Free and guided imagery, as well as suggestive statements, could induce false beliefs or false memories in, on average, 20%–50% of the participants who underwent experimental manipulation concerning false past events. A false belief induction may occur after dream interpretation or hypnosis in more than 50% of participants. Personalized suggestion is more effective in inducing memory than the general plausibility of the suggested events. Further research questions are which therapeutic actions seem appropriate in cases of harmful false memories. This depends not only on whether there are veridical elements in the false memory but also on the quality and meaning of the memory for the person's life and ability to cope with burdens.     

Childhood overgrowth in patients with common NF1 microdeletions

While growth retardation and short stature are well-known features of patients with classical neurofibromatosis type 1 (NF1), we found advanced height growth and accelerated carpal bone age in patients with an NF1 microdeletion. Our analysis is based on growth data of 21 patients with common 1.4/1.2 Mb microdeletions, including three patients with a Weaver-like appearance. Overgrowth was most evident in preschool children (2-6 years, n=10, P=0.02). We conclude that childhood overgrowth is part of the phenotypic spectrum in patients with the common 1.4/1.2 Mb NF1 microdeletions and assume that the chromosomal region comprised by the microdeletions contains a gene whose haploinsufficiency causes overgrowth.     

Differences in T‐cell responses between Mycobacterium tuberculosis and Mycobacterium africanum‐infected patients

In The Gambia, Mycobacterium tuberculosis (Mtb) and Mycobacterium africanum (Maf) are major causes of tuberculosis (TB). Maf is more likely to cause TB in immune suppressed individuals, implying differences in virulence. Despite this, few studies have assessed the underlying immunity to the two pathogens in human. In this study, we analyzed T‐cell responses from 19 Maf‐ and 29 Mtb‐infected HIV‐negative patients before and after TB chemotherapy following overnight stimulation of whole blood with TB‐specific antigens. Before treatment, percentages of early secreted antigenic target‐6(ESAT‐6)/culture filtrate protein‐10(CFP‐10) and purified protein derivative‐specific single‐TNF‐α‐producing CD4⁺ and CD8⁺ T cells were significantly higher while single‐IL‐2‐producing T cells were significantly lower in Maf‐ compared with Mtb‐infected patients. Purified protein derivative‐specific polyfunctional CD4⁺ T cells frequencies were significantly higher before than after treatment, but there was no difference between the groups at both time points. Furthermore, the proportion of CD3⁺CD11b⁺ T cells was similar in both groups pretreatment, but was significantly lower with higher TNF‐α, IL‐2, and IFN‐γ production in Mtb‐ compared with that of Maf‐infected patients posttreatment. Our data provide evidence of differences in T‐cell responses to two mycobacterial strains with differing virulence, providing some insight into TB pathogenesis with different Mtb strains that could be prospectively explored as biomarkers for TB protection or susceptibility.