Device and Method for Noninvasive Glucose Assessment

BACKGROUND

Intensive monitoring of blood glucose levels is crucial in diabetes management. This article presents a new device, the TensorTip Combo Glucometer (CoG), developed by Cnoga Medical Ltd, which enables to predict capillary tissue glucose concentration noninvasively.

METHODS

Noninvasive glucose readings usually provide irregular or disordered mathematical manifold over the measurement space. To establish a transfer function, which correctly correlates the noninvasive raw data and the actual invasive glucose level, we suggest a mathematical concept that employs a personal calibration procedure to associate glucose pattern and multiple optical signals derived from tissue response to light emission in the range of visible to IR. The traversed light is detected by a color image sensor to predict the tissue glucose concentration at the fingertip. This article presents the mathematical concept underlying the technology and the requirements for device operation.

RESULTS

The device was clinically evaluated and compared to standard invasive blood glucose monitoring devices in few medical centers and by home users. Based on consensus error grid analysis, more than 98% of the measurements of each study were in zones A (more than 81%) and B (more than 11%). Postmarketing evaluations showed high correlations comparing the CoG to other invasive reference devices.

CONCLUSIONS

The CoG device employs a unique mathematical approach to predict glucose concentrations based on multiple optical signals. The first clinical results indicate that the device may show appropriate agreement with reference methods to be used for pain-free glucose assessment in daily routine.

Auditory tracts identified with combined fMRI and diffusion tractography

The auditory tracts in the human brain connect the inferior colliculus (IC) and medial geniculate body (MGB) to various components of the auditory cortex (AC). While in non-human primates and in humans, the auditory system is differentiated in core, belt and parabelt areas, the correspondence between these areas and anatomical landmarks on the human superior temporal gyri is not straightforward, and at present not completely understood. However it is not controversial that there is a hierarchical organization of auditory stimuli processing in the auditory system. The aims of this study were to demonstrate that it is possible to non-invasively and robustly identify auditory projections between the auditory thalamus/brainstem and different functional levels of auditory analysis in the cortex of human subjects in vivo combining functional magnetic resonance imaging (fMRI) with diffusion MRI, and to investigate the possibility of differentiating between different components of the auditory pathways (e.g. projections to areas responsible for sound, pitch and melody processing). We hypothesized that the major limitation in the identification of the auditory pathways is the known problem of crossing fibres and addressed this issue acquiring DTI with b-values higher than commonly used and adopting a multi-fibre ball-and-stick analysis model combined with probabilistic tractography. Fourteen healthy subjects were studied. Auditory areas were localized functionally using an established hierarchical pitch processing fMRI paradigm. Together fMRI and diffusion MRI allowed the successful identification of tracts connecting IC with AC in 64 to 86% of hemispheres and left sound areas with homologous areas in the right hemisphere in 86% of hemispheres. The identified tracts corresponded closely with a three-dimensional stereotaxic atlas based on postmortem data. The findings have both neuroscientific and clinical implications for delineation of the human auditory system in vivo.

C-terminal methylation of truncated neuropeptides: an enzyme-assisted extraction artifact involving methanol

Neuropeptides are the largest class of signaling molecules used by nervous systems. Today, neuropeptide discovery commonly involves chemical extraction from a tissue source followed by mass spectrometric characterization. Ideally, the extraction procedure accurately preserves the sequence and any inherent modifications of the native peptides. Here, we present data showing that this is not always true. Specifically, we present evidence showing that, in the lobster Homarus americanus, the orcokinin family members, NFDEIDRSGFG-OMe and SSEDMDRLGFG-OMe, are non-native peptides generated from full-length orcokinin precursors as the result of a highly selective peptide modification (peptide truncation with C-terminal methylation) that occurs during extraction. These peptides were observed by MALDI-FTMS and LC-Q-TOFMS analyses when eyestalk ganglia were extracted in a methanolic solvent, but not when tissues were dissected, co-crystallized with matrix, and analyzed directly with methanol excluded from the sample preparation. The identity of NFDEIDRSGFG-OMe was established using MALDI-FTMS/SORI-CID, LC-Q-TOFMS/MS, and comparison with a peptide standard. Extraction substituting deuterated methanol for methanol confirmed that the latter is the source of the C-terminal methyl group, and MS/MS confirmed the C-terminal localization of the added CD3. Surprisingly, NFDEIDRSGFG-OMe is not produced via a chemical acid-catalyzed esterification. Instead, the methylated peptide appears to result from proteolytic truncation in the presence of methanol, as evidenced by a reduction in conversion with the addition of a protease-inhibitor cocktail; heat effectively eliminated the conversion. This unusual and highly specific extraction-derived peptide conversion exemplifies the need to consider both chemical and biochemical processes that may modify the structure of endogenous neuropeptides.

Long-term TENS treatment decreases cortical motor representation in multiple sclerosis

This study investigated the effects of a long-term transcutaneous electrical nerve stimulation (TENS) treatment on cortical motor representation in patients with multiple sclerosis (MS). In this double-blind crossover design, patients received either TENS or sham stimulation for 3 weeks (1h per day) on the median nerve region of the most impaired hand, followed by the other stimulation condition after a washout period of 6 months. Cortical motor representation was mapped using transcranial magnetic stimulation (TMS) at the baseline and after the 3-week stimulation protocol. Our results revealed that 3 weeks of daily stimulation with TENS significantly decreased the cortical motor representation of the stimulated muscle in MS patients. Although the mechanisms underlying this decrease remain unclear, our findings indicate that TENS has the ability to induce long-term reorganization in the motor cortex of MS patients.