Performance of Subcutaneous Continuous Glucose Monitoring in Adult Critically Ill Patients Receiving Vasopressor Therapy.

Background: Subcutaneous continuous glucose monitoring (CGM) may facilitate glucose control in the ICU. We aimed to assess the accuracy of CGM (Dexcom G6) against arterial blood glucose (ABG) in adult critically ill patients receiving intravenous insulin infusion and vasopressor therapy. We also aimed to assess feasibility and tolerability of CGM in this setting. Methods: We included ICU patients receiving mechanical ventilation, insulin, and vasopressor therapy. Numerical accuracy was assessed by the mean absolute relative difference (MARD), overall, across arterial glucose strata, over different noradrenaline equivalent infusion rates, and over time since CGM start. MARD <14% was considered acceptable. Clinical accuracy was assessed using Clarke Error Grid (CEG) analysis. Feasibility outcome included number and duration of interrupted sensor readings due to signal loss. Tolerability outcome included skin reactions related to sensor insertion or sensor adhesives. Results: We obtained 2946 paired samples from 40 patients (18 with type 2 diabetes) receiving a median (IQR) maximum noradrenaline equivalent infusion rate of 0.18 (0.08-0.33) µg/kg/min during CGM. Overall, MARD was 12.7% (95% CI 10.7-15.3), and 99.8% of CGM readings were within CEG zones A and B. MARD values ≥14% were observed when ABG was outside target range (6-10 mmol/L [108-180 mg/dL]) and with noradrenaline equivalent infusion rates above 0.10 µg/kg/min. Accuracy improved with time after CGM start, reaching MARD values <14% after 36 h. We observed four episodes of interrupted sensor readings due to signal loss, ranging from 5 to 20 min. We observed no skin reaction related to sensor insertion or sensor adhesives. Conclusions: In our ICU cohort of patients receiving vasopressor infusion, subcutaneous CGM demonstrated acceptable overall numerical and clinical accuracy. However, suboptimal accuracy may occur outside glucose ranges of 6-10 mmol/L (108-180 mg/dL), during higher dose vasopressor infusion, and during the first 36 h after CGM start.

Days at home alive after major surgery in patients with and without diabetes: an observational cohort study.

OBJECTIVE: We hypothesized that days at home alive up to 30 days after surgery (DAH30), a novel patient-centered outcome metric, as well as long-term mortality, would be impaired in patients with type 1 or 2 diabetes mellitus (DM) undergoing major surgery. METHODS: This cohort study investigated patients > 18 years with and without DM presenting for major non-cardiovascular, non-ambulatory surgical procedures at 23 hospitals in Sweden between 2007 and 2014. We identified 290,306 patients. Data were matched with various quality registers. The primary outcome was the composite score, DAH30. The secondary outcome was mortality from 31 to 365 days. Using multivariable logistic regression, significant independent risk factors influencing the primary and secondary outcomes were identified, and their adjusted odds ratios were calculated. RESULTS: Patients with DM type 1 and 2 had significantly lower DAH30 as compared to non-diabetics. Patients with DM were older, had higher co-morbid burden, and needed more emergency surgery. After adjustment for illness severity and age, the odds of having a DAH30 less than 15, indicating death and/or complications, were significantly increased for both type 1 and type 2 diabetes. In the year after surgery, DM patients had a higher mortality as compared to those without diabetes. CONCLUSIONS: The results of this large cohort study are likely broadly generalizable. To optimize patient and societal outcomes, specific perioperative care pathways for patients with diabetes should be evaluated.

Correction: Jaik et al. Photomotion of Hydrogels with Covalently Attached Azo Dye Moieties-Thermoresponsive and Non-Thermoresponsive Gels. Gels 2022, 8, 541.

In the original publication [...].

Photomotion of Hydrogels with Covalently Attached Azo Dye Moieties-Thermoresponsive and Non-Thermoresponsive Gels.

The unique photomotion of azo materials under irradiation has been in the focus of research for decades and has been expanded to different classes of solids such as polymeric glasses, liquid crystalline materials, and elastomers. In this communication, azo dye-containing gels are obtained by photocrosslinking of non-thermoresponsive and lower critical solution temperature type thermoresponsive copolymers. These are analysed with light microscopy regarding their actuation behaviour under laser irradiation. The influences of the cloud-point temperature and of the laser power are investigated in a series of comparative experiments. The thermoresponsive hydrogels show more intense photoactuation when the cloud-point temperature of the non-crosslinked polymer is above, but closer to, room temperature, while higher laser powers lead to stronger motion, indicating a photothermal mechanism. In non-thermoresponsive gels, considerably weaker photoactuation occurs, signifying a secondary mechanism that is a direct consequence of the optical field-azo dye interaction.

Biosensing with a scanning planar Yagi-Uda antenna.

We investigate a model bioassay in a liquid environment using a z-scanning planar Yagi-Uda antenna, focusing on the fluorescence collection enhancement of ATTO-647N dye conjugated to DNA (deoxyribonucleic acid) molecules. The antenna changes the excitation and the decay rates and, more importantly, the emission pattern of ATTO-647N, resulting in a narrow emission angle (41°) and improved collection efficiency. We efficiently detect immobilized fluorescently-labeled DNA molecules, originating from solutions with DNA concentrations down to 1 nM. In practice, this corresponds to an ensemble of fewer than 10 ATTO-647N labeled DNA molecules in the focal area. Even though we use only one type of biomolecule and one immobilization technique to establish the procedure, our method is versatile and applicable to any immobilized, dye-labeled biomolecule in a transparent solid, air, or liquid environment.

Focused Gaussian beam in the paraxial approximation.

A focused Gaussian beam represents a case of highly practical importance in many areas of optics and photonics. We derive analytical expressions for a focused Gaussian beam in the paraxial approximation, considering an arbitrary lens filling factor. We discuss the role of higher-order Bessel functions of the first kind in defining the electric field in the focal region.

Planar antenna designs for efficient coupling between a single emitter and an optical fiber.

Fluorescence detection is a well-established readout method for sensing, especially for in-vitro diagnostics (IVD). A practical way to guide the emitted signal to a detector is by means of an optical fiber. However, coupling fluorescence into a fiber is challenging and commonly lacks single-molecule sensitivity. In this work, we investigate specific fiber geometries, materials and coatings that in combination with a planar Yagi-Uda antenna reach efficient excitation and collection. The simulation of a practical setting determines more than 70% coupling efficiency for a horizontally oriented dipole, with respect to the planar antenna, emitting at 700 nm and embedded in polyvinyl alcohol (PVA). Moreover, the coupling efficiency would only scale by a factor of 2/3 for emitters with random orientation, as a result of the antenna geometry. These findings are relevant for single-molecule detection with fiber optics and have implications for other applications involving the coupling of light with nano-scale sources and detectors. Scanning the surface of a sample with such fibers could also be advantageous for imaging techniques to provide a low background noise and a high resolution.

BCG-induced cytokine release in bladder cancer cells is regulated by Ca2+ signaling.

Bacillus Calmette-Guérin (BCG) is widely used in the clinic to effectively treat superficial urinary bladder cancer. However, a significant proportion of patients who fail to respond to BCG risk cystectomy or death. Though more than 3 million cancer treatments with BCG occur annually, surprisingly little is known about the initial signaling cascades activated by BCG. Here, we report that BCG induces a rapid intracellular Ca2+ (calcium ion) signal in bladder cancer cells that is essential for activating the transcription factor nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and for synthesizing and secreting proinflammatory cytokines, including interleukin 8 (IL-8). A similar Ca2+ response was observed when cells were exposed to the supernatant of BCG. Studying cellular molecular mechanisms involved in the BCG signaling event, we found pivotal roles for phospholipase C and the Toll-like receptor 4. Further assessment revealed that this signaling pathway induces synthesis of IL-8, whereas exocytosis appeared to be controlled by global Ca2+ signaling. These results shed new light on the molecular mechanisms underlying BCG treatment of bladder cancer, which can help in improving therapeutic efficacy and reducing adverse side effects.