Insulin Requirements in Patients With Type 2 Diabetes Undergoing Bariatric Surgery in the Inpatient Setting and Upon Discharge: A Single-Center Retrospective Analysis of Insulin Management Strategies

ObjectiveRapid improvement in blood glucose (BG) after weight-loss surgery (WLS) can make postoperative glucose management challenging in patients with type 2 diabetes mellitus (T2DM). Our study examined the safety and efficacy of insulin management strategies during hospitalization and after discharge following WLS.MethodsThis single-center retrospective cohort study included 160 adult patients with type 2 diabetes mellitus undergoing WLS. Patients with glycated hemoglobin A1C (HbA1C) level <7% (53 mmol/mol) and not on antihyperglycemic medications or metformin monotherapy were excluded. BG and insulin dosing during hospitalization and at 2-week follow-up, and impact of preoperative HbA1C level were analyzed.ResultsMean age was 46.3 years. Median preoperative HbA1C level was 8% (64 mmol/mol). Postoperatively, most patients received basal insulin plus sliding-scale insulin (SSI; 79/160, 49%) or SSI alone (77/160, 48%). The initial postoperative basal dose was 0.23 units/kg/day. The median basal insulin dose at discharge was 61% lower than preoperative dose. At 2-week follow-up, 34 of 44 patients (77%) had BG levels between 70-200 mg/dL and 1 of 44 (2.2%) had BG levels >200 mg/dL, with no hypoglycemia. Patients with HbA1C level >9% (75 mmol/mol) had higher BG on admission and during hospitalization, required higher insulin doses while hospitalized, and were more frequently discharged on insulin.ConclusionSSI is effective in managing BG in some patients immediately after WLS. However, about half of the patients may require basal insulin at doses similar to those required by other inpatients. Preoperative hyperglycemia may affect inpatient insulin needs and BG. Low-dose basal insulin appears safe and effective upon discharge for select patients.     

Dose and frequency in cancer therapy. Theoretical non-autonomous model of p53 network

A non-autonomous model for the regulation of apoptosis by p53 is proposed as a model for cancer chronotherapy. A perturbation is introduced that simulates damage caused to DNA in a periodic regime. To characterize the resulting system dynamics, the techniques used were stroboscopic analysis, Poincare section and power spectrum. The complexity of the time series was determined using the LZ index. Periodic and quasi-periodic dynamics were obtained as the control parameters were varied. The less complex states are those corresponding to higher values of the amplitude which indicates a strict control of the dose is required on periodic treatments.     

3D printed copper-plastic composite material for use as a radiotherapy bolus

The purpose of this work is to evaluate a commercially available copper-plastic composite material for use as a custom fit 3D printed bolus. Superficial dose under copper-plastic composite bolus was assessed for 0.4 mm, 0.6 mm, and 0.8 mm thicknesses. Superficial dose measurements were performed with an Attix parallel plate ionization chamber and radiochromic film. Additionally, a custom-fit bolus was designed for the temporal-frontal cranial region of an anthropomorphic phantom. A treatment plan with a tangential field arrangement was designed, and radiochromic film was used to measure the dose enhancement to the surface of the phantom from the bolus and compared to the calculated dose. It was shown that 3D printed copper-plastic composite bolus can provide the equivalent dose enhancement of thicker conventional bolus. Due to the limited thickness of the copper-plastic composite the bolus can remain flexible, which can aid in the placement of the bolus and improve patient comfort.     

The use of meta-analysis in food contact materials risk assessment

Abstract

As materials intended to be brought into contact with food, food contact materials (FCMs) – including plastics, paper or inks – can transfer their constituents to food under normal or foreseeable use, including direct or indirect food contact. The safety of FCMs in the EU is evaluated by the European Food Safety Authority (EFSA) using risk assessment rules. Results of independent, health-based chemical risk assessments are crucial for the decision-making process to authorize the use of substances in FCMs. However, the risk assessment approach used in the EU has several shortcomings that need to be improved in order to ensure consumer health protection from exposure arising from FCMs. This article presents the use of meta-analysis as a useful tool in chronic risk assessment for substances migrating from FCMs. Meta-analysis can be used for the review and summary of research of FCMs safety in order to provide a more accurate assessment of the impact of exposure with increased statistical power, thus providing more reliable data for risk assessment. The article explains a common methodology of conducting a meta-analysis based on meta-analysis of the dose-effect relationship of cadmium for benchmark dose evaluations performed by EFSA.     

Insulin Dosing and Glycemic Outcomes Among Steroid-treated Hospitalized Patients

ObjectiveTo determine the optimal insulin-to-steroid dose ratio for the attainment of glycemic control in hospitalized patients.MethodsWe retrospectively studied data collected from the electronic health records within an academic medical center from 18 599 patient-days where patients were treated concurrently with insulin and steroids. Multivariate logistic regression analyses, which included demographic and clinical variables, were performed to assess the relationships between the exposures of total and basal insulin-to-steroid ratios and the outcomes of glycemic control (all blood glucose readings on the following patient-day were >70 and ≤180 mg/dL) and hypoglycemia within 3 subgroups of steroid dosing: low (≤10-mg prednisone equivalent dose [PED]), medium (from >10-mg to ≤40-mg PED), and high (>40-mg PED).ResultsIncreased insulin-to-steroid ratio was associated with increased odds of both glycemic control and hypoglycemia. The optimal total insulin-to-steroid ratio for attaining glycemic control was 0.294 U/kg/10-mg PED in the low-dose subgroup, 0.257 U/kg/10-mg PED in the medium-dose subgroup, and 0.085 U/kg/10-mg PED in the high-dose subgroup. The optimal basal insulin-to-steroid ratio was 0.215 U/kg/10-mg PED in the low-dose subgroup, 0.126 U/kg/10-mg PED in the medium-dose subgroup, and 0.036 U/kg/10-mg PED in the high-dose subgroup.ConclusionIncreasing insulin-to-steroid ratios are positively associated with glycemic control and hypoglycemia. Our study suggests that approximately 0.3 U/kg/10-mg PED is an optimal dose for low- and medium-dose steroids, whereas approximately 0.1 U/kg/10-mg PED is an optimal dose for high-dose steroids. Further prospective studies are needed to identify insulin regimens that will optimize glycemic control in steroid-treated patients while minimizing the risk of hypoglycemia.     

Development of a stable low-dose aglycosylated antibody formulation to minimize protein loss during intravenous administration

The physical and chemical integrity of a biopharmaceutical must be maintained not only during long-term storage but also during administration. Specifically for the intravenous (i.v.) delivery of a protein drug, loss of stability can occur when the protein formulation is compounded with i.v. bag diluents, thus modifying the original composition of the drug product. Here we present the challenges associated with the delivery of a low-dose, highly potent monoclonal antibody (mAb) via the i.v. route. Through parallel in-use stability studies and conventional formulation development, a drug product was developed in which adsorptive losses and critical oxidative degradation pathways were effectively controlled. This development approach enabled the i.v. administration of clinical doses in the range of 0.1 to 0.5 mg total protein, while ensuring liquid drug product storage stability under refrigerated conditions.     

Some Mathematical Properties of Cumulative Damage Models Regarding Their Application in Cancer Epidemiology

In an earlier paper, cumulative damage models (CD models) were proposed for modelling the epidemiological aspects of carcinogenesis. In the present paper, further, mainly mathematical support is given for the adequacy of this approach. In the first place, this concerns the aspect that the cumulative damage process is a compound Poisson process. Secondly, it will be demonstrated that the CD models can be considered as a formal generalization of certain well-known special carcinogenesis models. A more intensive investigation of these models themselves makes it evident that, on account of their mathematical qualities, they will possibly place very efficient new measures at the disposal of epidemiology. A diffusion approximation, however, does, after first experiments, not appear to make the handling of the models any easier but, on the contrary, to lead to a loss of certain pleasant qualities.     

Oral consumption of α-glucosyl-hesperidin could prevent lens hardening,which causes presbyopia

Presbyopia is one of the most well-known diseases of the eye, predominantly affecting the adult population after 50 years’. Due to hardening of the lens and failure of accommodative change, patients lose the ability to focus on near objects. This eye symptom is reported to be an early symptom of age-related nuclear cataract, and we have previously reported that hesperetin treatment could delay the onset of nuclear cataractogenesis induced by sodium selenite. In this study, we examined whether oral intake of α-glucosyl-hesperidin (G-Hsd), which has greater water solubility than hesperetin, could delay the onset of presbyopia. G-Hsd treatment protected lens elasticity, upregulated the mRNA expression of anti-oxidative enzymes like glutathione reductase and thioredoxin reductase 1 in the plasma and lens, and prevented premature cataract symptoms in selenite-induced cataract rat lens. Thus, the anti-presbyopic effects of G-Hsd were attributed, at least in part, to its antioxidant effects. G-Hsd represents the first oral treatment agent with anti-presbyopia and/or anti-cataract properties.