Thermal body patterns for healthy Brazilian adults (male and female)

The aim of this study was to establish the skin temperature (T_sk) thermal profile for the Brazilian population and to compare the differences between female and male Brazilian adults. A total of 117 female and 103 male were examined with a thermographic camera. The T_sk of 24 body regions of interest (ROI) were recorded and analyzed. Male T_sk results were compared to female and 10 ROI were evaluated with respect to the opposite side of the body (right vs. left) to identify the existence of significant contralateral T_sk differences (ΔT_sk). When compared right to left, the largest contralateral ΔT_sk was 0.3 °C. The female vs. male analysis yielded significant differences (p<0.05) in 13 of the 24 ROI. Thigh regions, both ventral and dorsal, had the highest ΔT_sk by sex (≈1.0 °C). T_sk percentile below P₅ or P₁₀ and over P₉₀ or P₉₅ may be used to characterize hypothermia and hyperthermia states, respectively. Thermal patterns and T_sk tables were established for Brazilian adult men and women for each ROI. There is a low T_sk variation between sides of the body and gender differences were only significant for some ROIs.     

A study on multidimensional time series model of individual age’s measurement in Castanopsis kawakamii population

Studies on disclosing characteristics and endangered mechanisms of Castanopsis kawakamii population ecology have already become an urgent task of protecting C. kawakamii population. The establishment of the standard life table is one of an important work study on C. kawakamii population ecology, and determining individual ages of the plant is necessary for studying age structures and population dynamics of C. kawakamii. There are three main methods of determining individual age of forest population: (1) by annual ring of tree, (2) by individual growth phase, and (3) by DBH and height of tree. However, the three methods have their shortcomings, such as low precision, worse serviceability, high difficulty for operation and so on. In this paper, a new method for determining plant individual ages more accurately is presented on the basis of the method aboU_t “annual ring–time series”. Based on the stem analysis, the multidimensional time series model of diameter growth at breast height in C. kawakamii population was established by U_tilizing the analY_tical method of multidimensional time series: Y_t = 1.325034Y_t-1 ? 0.4711007Y_t-2 ? 284.5648U_t + 569.4783U_t?1 ? 284.8745U_t?2, where Y_t, Y_t-1, Y_t-2 represent diameter growth in C. kawakamii population at t, t ? 10 and t ? 20 years respectively, and U_t, U_t?1, U_t?2 represent individual age in C. kawakamii population at t, t ? 10 and t ? 20 years respectively, the model coefficient correlation is 0.9994. Based on this model CAR(2), the total increment of individual DBH in C. kawakamii population are simulated and regressively verified at different ages. The mean simulating precision of this model was 98.84%, the maximum relative error was 2.56%, bU_t the next was 2.47% and the minimum relative error was 0.07%, showing that this model was suitable for estimating breast-height diameter of C. kawakamii plant. Using the multidimensional time series model, diameter growth of C. kawakamii population for longer time series was estimated in order to gain data for establishing the relationship model of individual age, diameter growth and to increase its precision in determining individual age is by tree ring analysis. A combination method of determining individual age of C. kawakamii population by integrating annual ring data with its diameter using multidimensional time series model, which can improve precision of individual ages in C. kawakami, was produced: A = 9.966671944 + 1.146011591D + 0.041059628D² ? 0.000211907D³, where A and D represent individual age and diameter at breast height respectively in C. kawakamii population, the model coefficient correlation is 0.9998. The combination model, which shows that the regression relationship is significant and the model can exactly predict the individual age of population, is a valuable tool for determining individual ages in endangered plants.     

Plants as bioindicator for temperature interpolation purposes: Analyzing spatial correlation between botany based index of thermophily and integrated temperature characteristics

The success of interpolation techniques relies heavily on the density and regularity of field reference data points. For instance temperature interpolations in the Arctic are hampered by few and scattered meteorological stations. The major objective of this study is to analyze the spatial relationship between plants, defined in terms of an index of thermophily (I_t) and temperature distribution. The study area is located in Kongsfjorden, northwest Spitsbergen (Svalbard). A systematic recording of floristic data covering the study area was made within quadrates of 1 km × 1 km (93 units). For each of them, the I_t was calculated. I_t provides a synthetic measure by which plants are taken as temperature indicators at a long time scale. Temperature values were recorded by means of 39 temperature loggers during the summer 2000. The model for spatial interpolation of temperature was developed using multiple regression of remote sensed data (Landsat TM) and topographical features derived from a digital elevation model (DEM). Continuous temperature layers were calculated at a spatial resolution of 50 m × 50 m, and aggregated to a resolution of 1 km × 1 km in order to correspond with the observed botanical units. Different maps were produced showing spatial distribution of the modelled temperature and I_t. Correlations between the I_t and temperature values derived from the modelled temperature layers were systematically explored. Correlation between the I_t and temperatures works well as standard deviation of residues is 0.7 °C only. Highest correlations (r) of I_t and the spatial distribution of temperature were obtained for: (a) maximum average temperature for August, excluding all areas higher than 100 m above sea level (0.75), (b) average daily maximum temperature for July–October (0.67), (c) average temperature for July and August (0.64, 0.65), and (d) when temperature range is >8 °C (0.55). Areas with low correlations between I_t and temperature were mainly attributed to the fact that these measurements represent (a) different time scales and (b) different spatial scales. However, results from this study have shown that calculating I_t provide a mean for restoring selected temperature parameters and thus can contribute to fill in and extend the network of field data points for temperature interpolation purposes.     

Effects of geometrical design on hydrodynamic and mass transfer characteristics of a rectangular-column airlift bioreactor

Gas holdup and gas–liquid mass transfer coefficients were measured in a 21-L rectangular-column airlift bioreactor with aspect ratio of 10 and working volumes ranging from 10 to 16 L. The effect of the bottom and top clearances was investigated using water and mineralized CMC solutions and covering a range of effective viscosity from 0.02 to 0.5 Pa s and surface tension from 0.065 to 0.085 N m⁻¹. The gas holdup and mass transfer results were successfully correlated using expressions derived via dimensional analysis. The separator gas holdup was found to be similar to the total gas holdup in the airlift bioreactor. The downcomer gas holdup (ɛ_d) increased two-fold when the bottom clearance (h_b) was increased from 0.014 to 0.094 m while the top clearance (h_t) had no effect. Increasing h_b decreased the mass transfer by 50% compared to 31% when the top clearance (h_t/D_hr) was increased. It was found that the gas–liquid separator diameter ratio (D_hs/D_hc) exerted the maximal influence of over 65% on mass transfer as compared to both clearances.     

Differential changes of neuroactive amino acids in samples obtained from discrete rat brain regions after systemic administration of saxitoxin

Aspartic acid, glutamic acid, γ-amino-n-butyric acid (GABA) and 2-aminoethanesulfonic acid are neuroactive amino acids. They are found in the central rat nervous system. Here, we have studied if a relationship exists between the presence of saxitoxin (STX) a paralytic poisoning shellfish (PSP) and the neuroactive amino acids. Samples of striatum (S), hypothalamus (H), mid brain (MB), frontal cortex (FC), brain stem (BS), right hemisphere (RH) and left hemisphere (LH) of rat brain were collected and analyzed for neuroactive amino acids (AAn_t) by Aswad method (1984). Experiments, consisting of intraperitoneal injection of SXT (5 and 10 μg kg^?1 body weight) to young male rats, evoked significant changes in AAn_t above basal values. Aspartic and glutamic acid significantly increased for RH and LH (after 30 min the increased was 116% and 210%, P ≤ 0.001 over basal values, respectively). On the other hand, aspartic, glutamic, taurine and GABA significantly decreased for S (after 30 min the decreased was 77.4%; 84%; 93.8% and 95.3%, P ≤ 0.001 over basal values, respectively). These results suggest that STX alters AAn_t. It is produced at least in part, because STX blocks voltage-gated sodium channels and this blockade could decrease AAn_t release by exocytotic dependent mechanism of depolarization.     

Association of urinary 15-F2t-isoprostane level with oxygen desaturation and carotid intima–media thickness in nonobese sleep apnea patients

Obstructive sleep apnea (OSA) is characterized by recurrent apnea during sleep that may unbalance oxidative stress, increasing atherosclerosis. Among oxidative stress markers, 15-F_2t-isoprostane is considered one of the most sensitive and specific metabolites of lipid peroxidation. To explore the relationship between urinary 15-F_2t-isoprostane with sleep apnea severity and carotid modifications in nonobese OSA patients, 31 nonobese sleep apnea patients were studied, along with 10 lean subjects without OSA. Patients were assessed by polysomnography, blood pressure measurement, and ultrasonography to determine the carotid intima–media thickness (IMT). Urinary 15-F_2t-isoprostanes were measured by liquid chromatography–tandem mass spectrometry. Urinary 15-F_2t-isoprostane concentrations were increased in severe OSA patients compared to control subjects (20.2 ± 7.3 vs 12.3 ± 2.8 ng/mmol creatinine; P = 0.020). Mean carotid IMT was correlated with 15-F_2t-isoprostane (r = 0.532; P < 0.001) and with the apnea–hypopnea index (r = 0.345; P = 0.029). 15-F_2t-Isoprostane level was related to the night time spent at SaO₂ < 90% (r = 0.478; P = 0.002), the apnea–hypopnea index (r = 0.465; P = 0.003), and the mean nocturnal SaO₂ (r = ? 0.424; P = 0.007). These results showed a relationship between lipid peroxidation, carotid intima–media thickness, and intermittent hypoxia in nonobese OSA patients, thus reinforcing the hypothesis that oxidative stress could be involved in the early atherosclerotic process.     

Synthesis and evaluation of copper-64 labeled benzofuran derivatives targeting β-amyloid aggregates

In vivo imaging of β-amyloid (Aβ) aggregates consisting of Aβ(1–40) and Aβ(1–42) peptides by positron emission tomography (PET) contributes to the diagnosis and therapy for Alzheimer’s disease (AD). Because ⁶⁴Cu (t_1/2 = 12.7 h) is a radionuclide for PET with a longer physical half-life than ¹¹C (t_1/2 = 20 min) and ¹⁸F (t_1/2 = 110 min), it is an attractive radionuclide for the development of Aβ imaging probes that are suitable for routine use. In the present study, we designed and synthesized two novel ⁶⁴Cu labeled benzofuran derivatives and evaluated their utility as PET imaging probes for Aβ aggregates. In an in vitro binding assay, 6 and 8 showed binding affinity for Aβ(1–42) aggregates with a K_i value of 33 and 243 nM, respectively. In addition, these probes bound to Aβ plaques deposited in the brain of an AD model mouse in vitro. In a biodistribution experiment using normal mice, these probes showed low brain uptake (0.33% and 0.36% ID/g) at 2 min post-injection. Although refinement to enhance brain uptake is needed, [⁶⁴Cu]6 and [⁶⁴Cu]8 demonstrated the feasibility of developing novel PET probes for imaging Aβ aggregates.     

Continued optimization of the M5 NAM ML375: Discovery of VU6008667, an M5 NAM with high CNS penetration and a desired short half-life in rat for addiction studies

This letter describes the continued optimization of M₅ NAM ML375 (VU0483253). While a valuable in vivo tool compound, ML375 has an excessively long elimination half-life in rat (t_1/2 = 80 h), which can be problematic in certain rodent addiction paradigms (e.g., reinstatement). Thus, we required an M₅ NAM of comparable potency to ML375, but with a rat t_1/2 of less than 4 h. Steep SAR plagued this chemotype, and here we detail aniline replacements that offered some improvements over ML375, but failed to advance. Ultimately, incorporation of a single methyl group to the 9b-phenyl ring acted as a metabolic shunt, providing (S)-11 (VU6008667), an equipotent M₅ NAM, with high CNS penetration, excellent selectivity versus M_1–4 and the desired short half-life (t_1/2 = 2.3 h) in rat.     

Graft polymers of eucalyptus lignosulfonate calcium with acrylic acid: Synthesis and characterization

The graft copolymerization of eucalyptus lignosulfonate calcium (HLS-Ca) from hardwood and acrylic acid (AA) was investigated by using Fenton agent as a coinitiator. The influences of reaction conditions on grafting parameters i.e. product yield (Y%), AA conversion (C%), grafting ratio (G%) and grafting efficiency (GE%) were carefully studied. The effects of the phenolic hydroxyl (Ph-OH) group on the polymerization of AA and grafting reaction were researched. Graft copolymers were identified by the new absorption at 1727 cm^?1, more homogenized morphology and higher decomposition temperature after grafted with AA, as illustrated in FTIR, SEM and TG spectra. The optimum synthesis conditions are as follows: H₂O₂ = 25.2 mol/L, FeCl₂ = 63.0 mol/L, T = 50 °C and t = 2 h and the optimum percentages of Y, C, G and GE are 97.61%, 95.23%, 71.29% and 78.85%, respectively. The Ph-OH group of HLS-Ca cannot inhibit the polymerization of AA and is involved in the grafting reaction as an active center.     

Efficacy and Safety of Linagliptin in Black/African American Patients with Type 2 Diabetes: A 6-Month,Randomized, Double-Blind,Placebo-Controlled Study

ObjectiveAlthough black/African American individuals are disproportionately affected by type 2 diabetes, there is scant clinical trial information available on antidiabetes therapies in this group. We compared linagliptin with placebo in black/African American adults who were treatment-naïve or receiving one oral antidiabetes drug.MethodsOf 226 patients randomized to 24 weeks’ linagliptin 5 mg/day or placebo, 208 had baseline and at least one on-treatment glycated hemoglobin (HbA_1c) measurement. Mean baseline HbA_1c was 8.6% in the linagliptin group (n = 98) and 8.68% in the placebo group (n = 110). The primary outcome was change in HbA_1c from baseline to week 24.ResultsBy week 24, mean HbA_1c changes were − 0.84% with linagliptin and − 0.25% with placebo (treatment difference, − 0.58%; P < .001), and more patients in the linagliptin group achieved HbA_1c < 7.0% (26.8% vs. 8.3%; P = .001) or an HbA_1c reduction ≥ 0.5% (54.1% vs. 30.0%; P < .001). Mean weight loss was − 1.1 kg in both groups. During the treatment period, 8 of 98 linagliptingroup patients and 17 of 110 placebo-group patients required rescue therapy (odds ratio, 0.5; P = .14). For postprandial glucose, values were available for few patients (11 placebo, 10 linagliptin), and thus the between-group difference was associated with wide confidence intervals (CIs) (difference, − 1.97 mg/dL; 95% CI, − 53.80 to 49.86; P = .94). In the overall study population, a similar proportion of patients in both groups had adverse events (58.5% vs. 61.7%); most events were mild or moderate and considered unrelated to study drug. Investigator-defined hypoglycemia was rare (3 linagliptin-group patients and 1 placebogroup patient), with no severe events (requiring external assistance).ConclusionThis study confirms that linagliptin is efficacious and well tolerated in black/African American patients with type 2 diabetes. (Endocr Pract. 2014;20: 412-420)     

Algorithmic detection of the beginning and end of bipolar electrograms: Implications for novel methods to assess local activation time during atrial tachycardia

Activation mapping is required to effectively ablate atrial tachycardia (AT). Conventional tools to assess local activation time (LAT) are based upon the peak of the bipolar electrogram (B-EGM, LAT_Peak) and the maximal negative slope of the unipolar electrogram (U-EGM, LAT_Slope). Bipolar electrograms are influenced by wavefront direction, bipole orientation, and inter-electrode spacing causing ambiguity in peak detection, whereas unipolar electrograms are disturbed by the presence of far-field signals. We developed a new algorithm to detect the beginning and end of bipolar electrograms (t_begin and t_end). Then, we introduced new LAT methods related to the onset of B-EGMs (LAT_Onset), the center of mass of B-EGMs (LAT_CoM), and the slope of U-EGMs within a pre-defined window (LAT_Slope-hybrid).In total 3752 recordings from 31 AT patients were retrospectively analyzed. The signal-to-noise ratio (SNR) for B-EGMs was calculated to differentiate algorithmically high from low quality electrograms (HQ and LQ). In a subset of 328 B-EGMs, five experts validated the t_begin as determined by the algorithm by visual rating. The newly developed LAT methods were compared to the conventional LAT methods and to one another (Bland–Altman plots) in both HQ (n = 3003) and LQ EGMs (n = 749).The t_begin algorithm was accurate (deviation < ±10 ms) in 96 ± 4% of HQ and 91 ± 8% of LQ B-EGMs. BA plots revealed the following difference (bias) and variation in HQ and LQ EGMs respectively: (1) LAT_Onset vs. LAT_Peak: 27 ± 30 ms and 24 ± 62 ms; (2) LAT_CoM vs. LAT_Peak: 0 ± 16 ms and 2 ± 38 ms; (3) LAT_Slope-hybrid vs. LAT_Slope: 1 ± 32 ms and 15 ± 110 ms; (4) LAT_Onset vs. LAT_CoM: 22 ± 24 ms and 18 ± 22 ms; (5) LAT_Onset vs. LAT_Slope-hybrid: 16 ± 18 ms and 13 ± 22 ms; and (6) LAT_CoM vs. LAT_Slope-hybrid: 5 ± 20 ms and 4 ± 18 ms.In the present study, we introduced three new methods to assess local activation time in AT, based upon an algorithm detecting accurately the beginning and end of the B-EGM complex. BA analysis of the new methods showed similar variation in high and low quality EGMs, suggesting that they introduce less ambiguity than the conventional peak method. LAT_Onset consistently yielded an earlier activation moment. LAT_Slope-hybrid – by blanking far-field potentials – seems to be the optimal method for detection of the maximal negative slope in U-EGMs. Interestingly, LAT_CoM in B-EGMs coincided with the maximal negative slope in U-EGMs, suggesting its physiological sense and future use. The new LAT methods can be implemented in real-time mapping applications.     

Determination of mildronate by LC–MS/MS and its application to a pharmacokinetic study in healthy Chinese volunteers

A simple, rapid and accurate liquid chromatography–tandem mass spectrometry (LC–MS/MS) method has been developed and validated for the determination of mildronate in human plasma. Following a simple protein precipitation with methanol, the analyte was separated on a C₁₈ column by isocratic elution with methanol and 10 mM ammonium acetate (55:45; v/v), and then analyzed by mass spectrometry in the positive ion MRM mode. Good linearity was achieved over a wide range of 0.01–20 μg/mL. The intra- and inter-batch precisions (as RSD, %) were less than 7.1%. The average extraction recovery was 87.5%. The method described above has been used, for the first time, to reveal the pharmacokinetics of mildronate injection in healthy subjects. After single intravenously administration of 250, 500 and 1000 mg mildronate, the elimination half-life (t_1/2) were (5.56 ± 1.55), (6.46 ± 1.07) and (6.55 ± 1.17) h, respectively. The Student–Newman–Keuls test results showed that peak plasma concentration (C_max) and the area under the plasma concentration versus time curve from time 0 to 24 h (AUC_0–24) were both linearly related to dose. The pharmacokinetics of mildronate fitted the linear dynamic feature over the dose range studied. The essential pharmacokinetic parameters of multidoses administration intravenously (500 mg, b.i.d) were as follows: t_1/2 was (15.34 ± 3.14) h; C_max was (25.50 ± 3.63) μg/mL; AUC_0–24 was (58.56 ± 5.57) mg h/L. The t_1/2 and AUC of multidoses administration intravenously were different from those of single-dose administration significantly. These findings suggested that accumulation of mildronate in plasma occurred.     

Reprint of “Multiphase mixing characteristics in a microcarrier-based stirred tank bioreactor suitable for human mesenchymal stem cell expansion”

Large-scale human mesenchymal stem cell expansion calls for a bioreaction system, that provides a sufficient growth surface. An alternative to static cultivations systems like cell factories are disposable stirred tank reactors. Here, microcarriers provide the required growth surface, but these make it difficult to achieve a complete homogenization in the bioreactor, while avoiding shear stress. To gain insight into this process, we investigated the impact of different power inputs (0.02–2.6 W m⁻³) on the mixing time (t_m). Whereas t_m was inversely proportional to agitation in a one-phase-system, aeration resulted in a constant mixing time at 30–70 rpm. A high microcarrier concentration (30 g L⁻¹) and low stirrer speed (30 rpm) in the liquid-solid system caused a 50-fold increase in t_m and the formation of a discrete non-mixed upper zone. The effect of the microcarrier concentration on t_m became negligible at higher stirrer speeds. In the three-phase system, microcarrier settling was prevented by aeration and a minimal specific power input of 0.6 W m⁻³ was sufficient for complete homogenization. We confirmed that a low power input during stem cell expansion leads to inhomogeneity, which has not been investigated in the three-phase system up to date.     

Synthesis and characterization of a pH-sensitive conjugate of isoniazid with Fe3O4@SiO2 magnetic nanoparticles

The Letter describes the preparation and characterization of a conjugate of isoniazid (INH) with magnetic nanoparticles Fe₃O₄@SiO₂ 115 ± 60 nm in size. The INH molecules were attached to the surface of nanoparticles by a covalent pH-sensitive amidine bond. The conjugate was characterized by X-ray diffraction, SEM, dynamic light scattering, IR spectroscopy and microanalysis. The conjugate released isoniazid under in vitro conditions (pH = 4; 37 °C; t_1/2 ≈ 115 s). In addition, the cytotoxicity of the Fe₃O₄@SiO₂–INH conjugate was evaluated in SK-BR-3 cells using the xCELLigence system.     

Exenatide-loaded PLGA microspheres with improved glycemic control: In vitro bioactivity and in vivo pharmacokinetic profiles after subcutaneous administration to SD rats

A subcutaneous exenatide delivery system was developed and characterized in vitro and in vivo. The results clearly showed that the exenatide loaded PLGA microspheres prepared by using a non-aqueous processing medium had low burst release and high drug encapsulation efficiency. Exenatide loaded in the microspheres preserved its bioactivity. The pharmacokinetics parameters were determined after subcutaneous administration of microspheres to SD rats. The plasma concentration of the single dose of the sustained-release microspheres attained C_max of 108.19 ± 14.92 ng/ml at t_max of 1.33 ± 0.58 h and the t_1/2 was 120.65 ± 44.18 h. There was a linear correlation between the in vitro and in vivo release behavior (R² = 0.888). Exenatide loaded microspheres may prove to have great potential for clinical use.     

Production of human milk fat substitutes enriched in omega-3 polyunsaturated fatty acids using immobilized commercial lipases and Candida parapsilosis lipase/acyltransferase

In human milk fat (HMF), palmitic acid (20–30%), the major saturated fatty acid, is mostly esterified at the sn-2 position of triacylglycerols, while unsaturated fatty acids are at the sn-1,3 positions, conversely to that occurring in vegetable oils.This study aims at the production of HMF substitutes by enzyme-catalyzed interesterification of tripalmitin with (i) oleic acid (system I) or (ii) omega-3 polyunsaturated fatty acids (omega-3 PUFA) (system II) in solvent-free media. Interesterification activity and batch operational stability of commercial immobilized lipases from Rhizomucor miehei (Lipozyme RM IM), Thermomyces lanuginosa (Lipozyme TL IM) and Candida antarctica (Novozym 435) from Novozymes, DK, and Candida parapsilosis lipase/acyltransferase immobilized on Accurel MP 1000 were evaluated. After 24-h reaction at 60 °C, molar incorporation of oleic acid was about 27% for all the commercial lipases tested and 9% with C. parapsilosis enzyme. Concerning omega-3 PUFA, the highest incorporations were observed with Novozym 435 (21.6%) and Lipozyme RM IM (20%), in contrast with C. parapsilosis enzyme (8.5%) and Lipozyme TL IM (8.2%). In system I, Lipozyme RM IM maintained its activity for 10 repeated 23-h batches while for Lipozyme TL IM, Novozym 435 and C. parapsilosis enzyme, linear (half-life time, t_1/2 = 154 h), series-type (t_1/2 = 253 h) and first-order (t_1/2 = 34.5 h) deactivations were respectively observed. In system II, Lipozyme RM IM showed linear deactivation (t_1/2 = 276 h), while Novozym 435 (t_1/2 = 322 h) and C. parapsilosis enzyme (t_1/2 = 127 h), presented series-type deactivation. Both activity and stability of the biocatalysts depended on the acyl donor used.     

Preadmission Glycemic Control and Changes to Diabetes Mellitus Treatment Regimen After Hospitalization

ObjectiveTo evaluate treatment patterns associated with diabetes medication regimen changes after hospitalization on the basis on preadmission hemoglobin A_1c levels.MethodsIn this retrospective database analysis, patients with a diabetes diagnosis, hospitalization, and documented hemoglobin A_1c level within the 90 days leading up to hospital admission were identified in an administrative claims database. Treatment regimens were assessed before and after hospitalization. The proportion of patients who had progression, reduction, or no change in therapy was compared across hemoglobin A_1c subgroups: hemoglobin A_1c < 7.0%, hemoglobin A_1c 7.0%-7.9%, and hemoglobin A_1c ≥ 8.0%.ResultsFour hundred patients were included (192 in hemoglobin A_1c < 7.0% group, 94 in hemoglobin A_1c 7.0% 7.9% group, and 114 in hemoglobin A_1c ≥ 8.0% group). Demographically, hemoglobin A_1c subgroups did not differ significantly (mean age, 57 years; 47.5% male). With respect to therapeutic regimen overall, 28%, 24%, and 48% of patients experienced progression, reduction, and no change, respectively. Across hemoglobin A_1c subgroups, 37.7% of patients in the hemoglobin A_1c ≥ 8.0% subgroup had therapy progression compared with 26% and 20.2% in the hemoglobin A_1c < 7.0% and hemoglobin A_1c 7.0%-7.9% subgroups, respectively (P = .032 and P = .006, respectively). Within the progression category, progression via insulin initiation was significantly higher in the hemoglobin A_1c ≥ 8.0% subgroup (55.8%) than in the hemoglobin A_1c < 7.0% subgroup (16%, P < .001), but not significantly higher than in the hemoglobin A_1c 7.0%-7.9% subgroup (36.8%, P = .084). In the hemoglobin A_1c ≥ 8.0% subgroup, a lower percentage of patients, 35.1%, experienced no therapy change than in both the hemoglobin A_1c < 7.0% subgroup (52.6%) and the hemoglobin A_1c 7.0%-7.9% subgroup (54.3%) (P = .003 and P = .006, respectively). There was no difference between subgroups in reduction of therapy.ConclusionsA higher proportion of patients with a hemoglobin A_1c level ≥ 8.0% had progression of their antidiabetes therapy after hospitalization and fewer patients had no change in therapy than those in lower hemoglobin A_1c subgroups. These data suggest that clinicians may be using hemoglobin A_1c measurements to guide discharge planning treatment decisions. (Endocr Pract. 2012;18:371-375)     

Patient-Led Versus Physician-Led Titration of Insulin Glargine in Patients with Uncontrolled Type 2 Diabetes: A Randomized Multinational Atlas Study

ObjectiveSelf-adjustment of insulin dose is commonly practiced in Western patients with type 2 diabetes but is usually not performed in Asian patients. This multinational, 24-week, randomized study compared patient-led with physician-led titration of once-daily insulin glargine in Asian patients with uncontrolled type 2 diabetes who were on 2 oral glucose-lowering agents.MethodsPatient-led (n = 275) or physician-led (n = 277) subjects followed the same dose-titration algorithm guided by self-monitored fasting blood glucose (FBG; target, 110 mg/dL [6.1 mmol/L]). The primary endpoint was change in mean glycated hemoglobin (HbA_1c) at week 24 in the patient-led versus physician-led titration groups.ResultsPatient-led titration resulted in a significantly higher drop in HbA_1c value at 24 weeks when compared with physician-led titration (− 1.40% vs. − 1.25%; mean difference, − 0.15; 95% confidence interval, − 0.29 to 0.00; P = .043). Mean decrease in FBG was greatest in the patient-led group (− 2.85 mmol/L vs. − 2.48 mmol/L; P = .001). The improvements in HbA_1c and FBG were consistent across countries, with similar improvements in treatment satisfaction in both groups. Mean daily insulin dose was higher in the patient-led group (28.9 units vs. 22.2 units; P < .001). Target HbA_1c of < 7.0% without severe hypoglycemia was achieved in 40.0% and 32.9% in the patient-led and physician-led groups, respectively (P = .086). Severe hypoglycemia was not different in the 2 groups (0.7%), with an increase in nocturnal and symptomatic hypoglycemia in the patient-led arm.ConclusionPatient-led insulin glargine titration achieved near-target blood glucose levels in Asian patients with uncontrolled type 2 diabetes who were on 2 oral glucose-lowering drugs, demonstrating that Asian patients can self-uptitrate insulin dose effectively when guided. (Endocr Pract. 2015;21:143-157)     

Production of Ga-68 with a General Electric PETtrace cyclotron by liquid target

PurposeIn recent years the use of ⁶⁸Ga (t_1/2 = 67.84 min, β⁺: 88.88%) for the labelling of different PET radiopharmaceuticals has significantly increased. This work aims to evaluate the feasibility of the production of ⁶⁸Ga via the ⁶⁸Zn(p,n)⁶⁸Ga reaction by proton irradiation of an enriched zinc solution, using a biomedical cyclotron, in order to satisfy its increasing demand.MethodsIrradiations of 1.7 M solution of ⁶⁸Zn(NO₃)₂ in 0.2 N HNO₃ were conducted with a GE PETtrace cyclotron using a slightly modified version of the liquid target used for the production of fluorine-18. The proton beam energy was degraded to 12 MeV, in order to minimize the production of ⁶⁷Ga through the ⁶⁸Zn(p,2n)⁶⁷Ga reaction. The product’s activity was measured using a calibrated activity meter and a High Purity Germanium gamma-ray detector.ResultsThe saturation yield of ⁶⁸Ga amounts to (330 ± 20) MBq/µA, corresponding to a produced activity of ⁶⁸Ga at the EOB of (4.3 ± 0.3) GBq in a typical production run at 46 µA for 32 min. The radionuclidic purity of the ⁶⁸Ga in the final product, after the separation, is within the limits of the European Pharmacopoeia (>99.9%) up to 3 h after the EOB. Radiochemical separation up to a yield not lower than 75% was obtained using an automated purification module. The enriched material recovery efficiency resulted higher than 80–90%.ConclusionsIn summary, this approach provides clinically relevant amounts of ⁶⁸Ga by cyclotron irradiation of a liquid target, as a competitive alternative to the current production through the ⁶⁸Ge/⁶⁸Ga generators.