Impact of structured self-monitoring of blood glucose on the quality of life of insulin-treated Chinese patients with type 2 diabetes mellitus: Results from the COMPASS study

AIMS

To evaluate the effect of structured self-monitoring of blood glucose (SMBG) regimen on quality of life (QoL) in poorly controlled insulin-treated patients with type 2 diabetes.

METHODS

Phase II of the COMPASS trial was a 6-month, multicenter, prospective, single-arm, interventional study. This study recruited 820 outpatients from 19 clinical sites in China who met the following inclusion criteria: type 2 diabetes, insulin treatment for ≥ 3 months, and age 18-65 years, an HbA1c >8.0% (64 mmol/mol), and willingness to perform SMBG. Subjects were advised to follow a structured SMBG regimen specific to their insulin regimen, and were trained to respond to SMBG readings via lifestyle changes and insulin dose self-adjustment. QoL assessments (SF-36) were performed at baseline and 6 months.

RESULTS

Patients with a mean age of 55.13 ± 9.77 years had an average diabetes duration of 9.83 ± 7.05 years and had been receiving insulin therapy for a mean of 45.4 ± 46.79 months. All QoL parameters were significantly improved following structured SMBG after 6 months, most notably the physical role functioning (p<0.0001) and emotional role functioning (p<0.0001) component scores. Overall, 40.6% of patients rated their overall QoL as 'a bit' or a lot better' after structured SMBG compared with 16.5% prior to the intervention (p<0.0001). SMBG also improved overall feelings of wellbeing, with 39.13% of patients believing that their health was deteriorating prior to SMBG compared with only 14.4% of patients after the intervention (p<0.0001).

CONCLUSIONS

The structured SMBG program in insulin-treated Chinese outpatients with type 2 diabetes significantly improved QoL outcomes. Physical and emotional role functioning are the 2 QoL scales that demonstrate the largest improvement with SMBG.

Feasibility of prophylactic laparoscopic appendectomy in obese patients

PURPOSE

To investigate the feasibility of prophylactic laparoscopic appendectomy in obese patients.

MATERIALS AND METHODS

A retrospective study was performed in obese patients undergoing total laparoscopic hysterectomy (TLH) along (66 patients, TLH group) or in combination (55 patients, THL+LA group) with laparoscopic appendectomy (LA) between 2007 and 2012. Operation time, intraoperative bleeding volume, postoperative exhaust time, analgesic use, and the incidence of major complications, hospital stay and cost of hospitalization were compared.

RESULTS

The operation time was longer in THL+LA group than in TLH group (p < 0.05), while the intraoperative bleeding volume, postoperative exhaust time, postoperative morbidity, the incidence of major postoperative complications, and hospitalization time were not significantly different between the two groups.

CONCLUSION

It is safe and feasible for obese patients to undergo simultaneous LA and prophylactic appendectomy, and the combined procedure does not increase the risk of infection of hysterectomy and avoids reoperation of patients due to the recurrence of appendicitis.

How much is too much? Outcomes in patients using high-dose insulin glargine

BACKGROUND AND OBJECTIVES

Many patients with type 2 diabetes mellitus (T2DM) do not achieve glycaemic control targets on basal insulin regimens. This analysis investigated characteristics, clinical outcomes and impact of concomitant oral antidiabetes drugs (OADs) in patients with T2DM treated with high-dose insulin glargine.

METHODS

Patient-level data were pooled from 15 randomised, treat-to-target trials in patients with T2DM treated with insulin glargine ± OADs for ≥ 24 weeks. Data were stratified according to whether patients exceeded three insulin dose cut-off levels (> 0.5, > 0.7 and > 1.0 IU/kg). End-points included glycated haemoglobin A1c (A1C), fasting plasma glucose, body weight, and overall, nocturnal and severe hypoglycaemia.

RESULTS

Data from 2837 insulin-naïve patients were analysed. Patients with insulin titrated beyond the three doses investigated had significantly higher baseline A1C levels and were younger, with shorter diabetes duration than those at/below cut-offs (p < 0.05 for all cut-offs); they also had greater weight gain (p < 0.001 for the > 0.5 and > 0.7 IU/kg cut-offs) than those who did not exceed the cut-offs, regardless of concomitant OAD. Patients on concomitant metformin alone had higher insulin doses at Week 24, but achieved greater reductions in A1C, less weight gain and lower hypoglycaemia rates than patients on a concomitant sulfonylurea or metformin plus a sulfonylurea, regardless of whether cut-offs were exceeded.

CONCLUSION

In patients with T2DM, increasing basal insulin doses above 0.5 IU/kg may not improve glycaemic control; treatment strategies targeting postprandial glucose control should be considered for such patients.

Methylation-sensitive amplified polymorphism-based genome-wide analysis of cytosine methylation profiles in Nicotiana tabacum cultivars

This study aimed to investigate cytosine methylation profiles in different tobacco (Nicotiana tabacum) cultivars grown in China. Methylation-sensitive amplified polymorphism was used to analyze genome-wide global methylation profiles in four tobacco cultivars (Yunyan 85, NC89, K326, and Yunyan 87). Amplicons with methylated C motifs were cloned by reamplified polymerase chain reaction, sequenced, and analyzed. The results show that geographical location had a greater effect on methylation patterns in the tobacco genome than did sampling time. Analysis of the CG dinucleotide distribution in methylation-sensitive polymorphic restriction fragments suggested that a CpG dinucleotide cluster-enriched area is a possible site of cytosine methylation in the tobacco genome. The sequence alignments of the Nia1 gene (that encodes nitrate reductase) in Yunyan 87 in different regions indicate that a C-T transition might be responsible for the tobacco phenotype. T-C nucleotide replacement might also be responsible for the tobacco phenotype and may be influenced by geographical location.

Computed tomography parameters can be used as predictive markers for the improvement of renal function in patients with retroperitoneal fibrosis

OBJECTIVES

To discover the relationship between computed tomography (CT) parameters of retroperitoneal soft tissue of untreated retroperitoneal fibrosis patients and the variation of renal function after treatment.

METHODS

Data were collected retrospectively from 42 patients with established diagnosis of retroperitoneal fibrosis, at the Department of Rheumatology in Peking University First Hospital from May 2009 to April 2015. The demographic information, clinical characteristics, laboratory data, treatment and general therapeutic response were collected. The CT parameters such as radial lines, Hounsfield unit values, radiographic classification at baseline before the initiation of therapy were measured. Then the correlations between baseline CT parameters and clinical data were analysed.

RESULTS

The Hounsfield unit values of venous phase and delayed phase at baseline were negatively correlated with the change of estimated glomerular filtration rate (eGFR) at the 12th month after the initiation of medications. The baseline transverse diameters of the retroperitoneal soft tissue were larger in the group of eGFR <60 ml/min/1.73 m² compared with the group of eGFR ≥ 60 ml/min/1.73 m² at the 12th month, while the vertical diameters and maximum cross-section thickness were not. The baseline transverse diameters were also significantly correlated with the duration of intubation.

CONCLUSIONS

The baseline Hounsfield unit values and baseline transverse diameters of soft tissue of untreated retroperitoneal fibrosis patients may be used to predict the renal function after 12 months of therapy.

Low expression of microRNA-21 contributes to LPS-induced osteoblast cell apoptosis through up-regulation of OAS1

Lipopolysaccharide (LPS) is a critical component of the outer membrane of Gram&mdash;negative bacteria. Many cellular signals that are activated by Gram&mdash;negative bacteria are initiated by LPS. LPS triggers not only inflammatory responses, but also activates pro&mdash;apoptotic signals in a series of human cell types. However, there is relatively minimal data on the microRNA&mdash;dependent mechanism(s) of LPS&mdash;induced functional activity in osteoblast cells. CCK&mdash;8 assay and flow cytometry were used to measure cell viability and apoptosis, respectively. RT&mdash;PCR and western blot were performed to determine the mRNA and protein expression in osteoblast cells. In this study, we found that LPS triggered apoptosis in osteoblastic hFOB1.19 cells and induced a low expression of the miRNA&mdash;21. Furthermore, through the gene microarray technique, OAS1 was screened and later confirmed to be the target gene which was up&mdash;regulated in response to the low expression of miRNA&mdash;21. Knockdown of OAS1 by specific siRNAs significantly rescued the LPS&mdash;induced hFOB1.19 cell apoptosis. Our data suggest that LPS induces low expression of miRNA&mdash;21which consequently causes the up&mdash;regulation of the downstream gene OAS1 and eventually triggers apoptosis in hFOB1.19 cells. Knockdown of OAS1 rescues LPS&mdash;induced cell death and thus may be a promising therapeutic strategy for orthopedic diseases.

Efficacy and Safety of Bromocriptine-QR in Type 2 Diabetes: A Systematic Review and Meta-Analysis

Bromocriptine-QR (quick release) is a novel treatment for type 2 diabetes. The objective of this study is to assess the efficacy and safety of bromocriptine-QR in adults with type 2 diabetes mellitus based on randomized controlled trials published in peer-reviewed journals or as abstracts. We performed a comprehensive literature search of MEDLINE, Pubmed, Web of Science, EMBASE, and the Cochrane Library up to May 2015. Randomized controlled trials of bromocriptine-QR therapy in type 2 diabetes mellitus were eligible. Two reviewers independently assessed the eligibility of trials based on predefined inclusion criteria. Information was collected concerning basic study data, patient characteristics, efficacy and safety outcomes, and methodological quality. Bromocriptine-QR add-on therapy lowered hemoglobin A1c compared with placebo (weighted mean difference, - 6.52 mmol/mol; 95% CI, - 8.07 to - 4.97 mmol/mol). Bromocriptine-QR exhibited an increase in achieving an HbA1c level ≤ 53 mmol/mol (≤ 7.0%) (32.0 vs. 9.5%; odds ratio, 4.57; 95% CI, 2.42-8.62). Fasting plasma glucose was reduced with bromocriptine-QR compared with placebo (weighted mean difference,-1.04 mmol/l; 95% CI,-1.49 to-0.59 mmol/l). Moreover, bromocriptine-QR had neutral effects on postprandial glycemia, Body Mass Index (BMI), and lipid profile. Bromocriptine-QR had more gastrointestinal side effects of nausea and vomiting. Bromocriptine-QR had no increased risk of hypoglycemia, hypotension, or cardiovascular effects. Bromocriptine-QR therapy offers an alternative option to currently available antidiabetic agents for type 2 diabetes mellitus adults. Neither hypoglycemia nor other metabolic changes occur with this drug. More data for long-term efficacy and safety are needed for further observation.

bFGF in the CSF and serum of sALS patients

OBJECTIVES

Amyotrophic lateral sclerosis is a fatal neurodegenerative disease characterized by selective motor neuron loss in the brain and spinal cord. The cause of this selective death of motor neurons is still unclear, but among several pathomechanisms that have been discussed, the loss of neurotrophic factors is one hypothesis. Basic fibroblast growth factor 2 (bFGF) may be a potential neurotrophic factor for slowing various neurodegenerative diseases, but its potential role in the prognosis of ALS is not known.

METHODS

To explore the role of bFGF in ALS, we investigated changes in bFGF in the CSF and serum from patients with sALS and from the control group. Furthermore, we analyzed the correlations between bFGF, disease duration, disease progression rate, ALSFRS-r score and survival.

RESULTS

The level of bFGF increased in both the CSF and serum in sALS patients. It was higher in patients with longer durations. It was negatively correlated with disease progression rates, especially in the later stages of sALS, but showed no linear correlation with ALSFRS-r. In an analysis of the relationship between bFGF and survival, we found that sALS patients with high levels of bFGF had significantly higher cumulative survival rates than patients with low levels of bFGF.

DISCUSSION AND CONCLUSION

In conclusion, endogenous bFGF increased both in the CSF and serum of sALS patients and it may be a useful biomarker that could predict disease progression and survival.

Activation of the SIRT1/p66shc antiapoptosis pathway via carnosic acid-induced inhibition of miR-34a protects rats against nonalcoholic fatty liver disease

Recent studies have demonstrated that miR-34a expression is significantly upregulated and associated with apoptosis in nonalcoholic fatty liver disease (NAFLD). Carnosic acid (CA) is a novel antioxidant and a potential inhibitor of apoptosis in organ injury, including liver injury. This study aimed to investigate the signaling mechanisms underlying miR-34a expression and the antiapoptotic effect of CA in NAFLD. CA treatment significantly reduced the high-fat diet (HFD)-induced elevations in aminotransferase activity as well as in serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and malondialdehyde (MDA) levels but increased serum high-density lipoprotein cholesterol (HDL-C) and hepatic superoxide dismutase (SOD) levels. Moreover, CA treatment ameliorated the increase in cleaved caspase-3 caused by HFD exposure and completely reversed the HFD-induced decreases in manganese superoxide dismutase (MnSOD) and B-cell lymphoma-extra large expression. CA also counteracted the HFD- or palmitic acid (PA)-induced increases in caspase-3 and caspase-9 activity. Mechanistically, CA reversed the HFD- or PA-induced upregulation of miR-34a, which is the best-characterized regulator of SIRT1. Importantly, the decrease in miR-34a expression was closely associated with the activation of the SIRT1/p66shc pathway, which attenuates hepatocyte apoptosis in liver ischemia/reperfusion injury. A dual luciferase assay in L02 cells validated the modulation of SIRT1 by CA, which occurs at least partly via miR-34a. In addition, miR-34a overexpression was significantly counteracted by CA, which prevented the miR-34a-dependent repression of the SIRT1/p66shc pathway and apoptosis. Collectively, our results support a link between liver cell apoptosis and the miR-34a/SIRT1/p66shc pathway, which can be modulated by CA in NAFLD.

Binding Force Dynamics of Streptococcus mutans-glucosyltransferase B to Candida albicans

Candida albicans cells are often detected with Streptococcus mutans in plaque biofilms from children affected with early childhood caries. The coadhesion between these 2 organisms appears to be largely mediated by the S. mutans-derived exoenzyme glucosyltransferase B (GtfB); GtfB readily binds to C. albicans cells in an active form, producing glucans locally that provide enhanced binding sites for S. mutans. However, knowledge is limited about the mechanisms by which the bacterial exoenzyme binds to and functions on the fungal surface to promote this unique cross-kingdom interaction. In this study, we use atomic force microscopy to understand the strength and binding dynamics modulating GtfB-C. albicans adhesive interactions in situ. Single-molecule force spectroscopy with GtfB-functionalized atomic force microscopy tips demonstrated that the enzyme binds with remarkable strength to the C. albicans cell surface (~2 nN) and showed a low dissociation rate, suggesting a highly stable bond. Strikingly, the binding strength of GtfB to the C. albicans surface was ~2.5-fold higher and the binding stability, ~20 times higher, as compared with the enzyme adhesion to S. mutans. Furthermore, adhesion force maps showed an intriguing pattern of GtfB binding. GtfB adhered heterogeneously on the surface of C. albicans, showing a higher frequency of adhesion failure but large sections of remarkably strong binding forces, suggesting the presence of GtfB binding domains unevenly distributed on the fungal surface. In contrast, GtfB bound uniformly across the S. mutans cell surface with less adhesion failure and a narrower range of binding forces (vs. the C. albicans surface). The data provide the first insights into the mechanisms underlying the adhesive and mechanical properties governing GtfB interactions with C. albicans. The strong and highly stable GtfB binding to C. albicans could explain, at least in part, why this bacterially derived exoenzyme effectively modulates this virulent cross-kingdom interaction.

A point mutation of zebrafish c-cbl gene in the ring finger domain produces a phenotype mimicking human myeloproliferative disease

Controlled self-renewal and differentiation of hematopoietic stem/progenitor cells (HSPCs) are critical for vertebrate development and survival. These processes are tightly regulated by the transcription factors, signaling molecules and epigenetic factors. Impaired regulations of their function could result in hematological malignancies. Using a large-scale zebrafish N-ethyl-N-nitrosourea mutagenesis screening, we identified a line named LDD731, which presented significantly increased HSPCs in hematopoietic organs. Further analysis revealed that the cells of erythroid/myeloid lineages in definitive hematopoiesis were increased while the primitive hematopoiesis was not affected. The homozygous mutation was lethal with a median survival time around 14-15 days post fertilization. The causal mutation was located by positional cloning in the c-cbl gene, the human ortholog of which, c-CBL, is found frequently mutated in myeloproliferative neoplasms (MPN) or acute leukemia. Sequence analysis showed the mutation in LDD731 caused a histidine-to-tyrosine substitution of the amino acid codon 382 within the RING finger domain of c-Cbl. Moreover, the myeloproliferative phenotype in zebrafish seemed dependent on the Flt3 (fms-like tyrosine kinase 3) signaling, consistent with that observed in both mice and humans. Our study may shed new light on the pathogenesis of MPN and provide a useful in vivo vertebrate model of this syndrome for screening drugs.

Phase I study of every 2- or 3-week dosing of ramucirumab, a human immunoglobulin G1 monoclonal antibody targeting the vascular endothelial growth factor receptor-2 in patients with advanced solid tumors

BACKGROUND

Ramucirumab is a fully human immunoglobulin G1 monoclonal antibody receptor antagonist designed to block the ligand-binding site of vascular endothelial growth factor receptor-2 (VEGFR-2). An initial phase I study evaluated ramucirumab administered weekly in advanced cancer patients. This phase I study of ramucirumab [administered every 2 or 3 weeks (Q2W or Q3W)] examined safety, maximum tolerated dose, pharmacokinetics, immunogenicity, antitumor activity, and pharmacodynamics.

PATIENTS AND METHODS

Patients with advanced solid malignancies were treated with escalating doses of ramucirumab i.v. over 1 h. Blood was sampled for pharmacokinetics studies throughout treatment; levels of circulating vascular endothelial growth factor-A (VEGF-A) and soluble VEGF receptors (R)-1 and -2 were assessed.

RESULTS

Twenty-five patients were treated with ramucirumab: 13 with 6, 8, or 10 mg/kg Q2W, and 12 with 15 or 20 mg/kg Q3W. The median treatment duration was 12 weeks (range 2-81). No dose-limiting toxicities were observed. The most frequently reported adverse events (AEs) included proteinuria and hypertension (n = 6 each), and diarrhea, fatigue and headache (n = 4 each). Treatment-related grade 3/4 AEs were: two grade 3 hypertension (10 and 20 mg/kg), one each grade 3 vomiting, fatigue (20 mg/kg), atrial flutter (15 mg/kg), and one each grade 4 duodenal ulcer hemorrhage (6 mg/kg) and grade 4 pneumothorax (20 mg/kg). Pharmacokinetic analysis revealed low clearance and half-life of ∼110-160 h. Analysis of serum biomarkers indicated considerable patient-to-patient variability, but trends toward elevated VEGF-A and a transient decline in soluble VEGFR-2. Fifteen patients (60%) had best response of stable disease, with a median duration of 13 months (range 2-18 months) in tumor types including colorectal, renal, liver, and neuroendocrine cancers.

CONCLUSION

Ramucirumab was well tolerated. Study results led to recommended phase II doses of 8 mg/kg Q2W and 10 mg/kg Q3W. Prolonged stable disease was observed, suggesting ramucirumab efficacy in various solid tumors.

CLINICALTRIALSGOV

NCT00786383.

Precision mapping of laser-driven magnetic fields and their evolution in high-energy-density plasmas

The magnetic fields generated at the surface of a laser-irradiated planar solid target are mapped using ultrafast proton radiography. Thick (50  μm) plastic foils are irradiated with 4-kJ, 2.5-ns laser pulses focused to an intensity of 4×10^{14}  W/cm^{2}. The data show magnetic fields concentrated at the edge of the laser-focal region, well within the expanding coronal plasma. The magnetic-field spatial distribution is tracked and shows good agreement with 2D resistive magnetohydrodynamic simulations using the code draco when the Biermann battery source, fluid and Nernst advection, resistive magnetic diffusion, and Righi-Leduc heat flow are included.

Antiboding and bonding lasing modes with low gain threshold in nonlocal metallic nanoshell

Based on a full-wave nonlocal Mie theory, we establish the spaser generation condition for compact plasmonic nanolasers in the long-wavelength limit for dielectric-metal core-shell nanoparticles. We found that there exist two lasing states arising from the hybridized antibonding and bonding modes for this coated nanolaser. By varying the surrounding medium and the gain materials, we can achieve low gain threshold for each mode with flexible radii ratios on the purpose of realistic easy fabrication. Numerical results show that nonlocal effects have different influences on the required gain threshold and gain refractive index of these two lasing modes, which may be of great importance in the design of such kind of ultrasmall nanoparticle lasers.

Screening Isolates of Soybean mosaic virus for Infectivity in a Model Plant, Nicotiana benthamiana

Soybean mosaic virus (SMV), belonging to the genus Potyvirus of the family Potyviridae, has a relatively narrow host range almost exclusively confined to leguminous hosts. While disease management through genetic transformation can be an effective approach, soybean remains recalcitrant to routine genetic transformation. In this context, it is important to identify new hosts for SMV that can be used to develop effective transgenic resistance strategies. Transformation in Nicotiana benthamiana is simple and highly efficient; hence, here we demonstrate the infectivity of SMV strain SC7 in N. benthamiana plants. To identify an SMV strain infectious in N. benthamiana, we mechanically inoculated N. benthamiana plants with 37 isolates from 21 (SC1 to SC21) SMV strains. Plants inoculated with isolates of strain SC7 produced mosaic symptoms on leaves. However, N. benthamiana plants inoculated with the 20 other SMV strains showed no visible symptoms. Furthermore, soybean cv. Nannong 1138-2 inoculated with sap prepared from symptomatic N. benthamiana leaves showed typical SMV mosaic symptoms 2 weeks after inoculation. In addition, SMV was detected in symptomatic N. benthamiana and soybean leaves by RT-PCR, DAS-ELISA, and further identified by sequencing. Together, the results indicate that N. benthamiana plants could support multiplication of SMV strain SC7. The findings of this study would be useful for the investigation of SMV resistance using the model plant N. benthamiana.