Response to insulin glargine 100 U/mL treatment in newly-defined subgroups of type 2 diabetes: Post hoc pooled analysis of insulin-naïve participants from nine randomised clinical trials

AimsTo assess insulin glargine 100 U/mL (IGlar-100) treatment outcomes according to newly-defined subgroups of type 2 diabetes mellitus (T2DM).MethodsInsulin-naïve T2DM participants (n = 2684) from nine randomised clinical trials initiating IGlar-100 were pooled and assigned to subgroups “Mild Age-Related Diabetes (MARD)”, “Mild Obesity Diabetes (MOD)”, “Severe Insulin Resistant Diabetes (SIRD)”, and “Severe Insulin Deficient Diabetes (SIDD)”, according to age at onset of diabetes, baseline HbA1c, BMI, and fasting C-peptide using sex-specific nearest centroid approach. HbA1c, FPG, hypoglycemia, insulin dose, and body weight were analysed at baseline and 24 weeks.ResultsSubgroup distribution was MARD 15.3 % (n = 411), MOD 39.8 % (n = 1067), SIRD 10.5 % (n = 283), SIDD 34.4 % (n = 923). From baseline HbA1c 8.0–9.6% adjusted least square mean reductions after 24 weeks were similar between subgroups (1.4–1.5 %). SIDD was less likely to achieve HbA1c < 7.0 % (OR: 0.40 [0.29, 0.55]) than MARD. While the final IGlar-100 dose (0.36 U/kg) in MARD was lower than in other subgroups (0.46–0.50 U/kg), it had the highest hypoglycemia risk. SIRD had lowest hypoglycemia risk and SIDD exhibited greatest body weight gain.ConclusionsIGlar-100 lowered hyperglycemia similarly in all T2DM subgroups, but level of glycemic control, insulin dose, and hypoglycemia risk differed between subgroups.     

酒黄连HPLC特征图谱的建立及聚类分析和主成分分析＊

目的 建立酒黄连的HPLC特征图谱，并对其进行聚类分析和主成分分析，为酒黄连饮片质量评价提供方法和依据。方法 采用XtimateC₁₈色谱柱；以碳酸氢铵水溶液-乙腈为流动相（梯度洗脱）；流速1 mL·min^-1；检测波长270 nm；柱温30 ℃；进样量10 μL，在此条件下记录20批酒黄连色谱图，将其导入“中药色谱指纹图谱相似度评价系统”，选取分离度、峰形较好的13个峰为共有峰，得到20批酒黄连饮片的特征图谱。以特征图谱13个共有峰的峰面积标准化后作为变量，应用SPSS 19.0软件对其进行聚类分析和主成分分析。结果 20批酒黄连饮片特征图谱有13个共有峰，相似度为0.999-1.000，说明20批酒黄连饮片质量稳定；欧氏距离（Euclidean distance）为18时，聚类分析将产地为重庆的S1-S3酒黄连聚为一类，产地为四川的S4-S13酒黄连聚为一类，产地为湖北的S14-S20酒黄连聚为一类，表明酒黄连饮片中生物碱含量差异与其产地来源相关；主成分分析选取3个主成分，累积方差贡献率在90%以上，其结果与聚类分析结果一致。结论 将聚类分析和主成分分析与特征图谱相结合可为酒黄连饮片质量评价提供参考。     

中风后痉挛性瘫痪明清时期文献用药规律分析

收集整理明清时期中风后痉挛性瘫痪的方药,采用SPSS 20.0对所采集的数据进行频数分析、因子分析、聚类分析等数理统计分析。结果显示明清时期医家治疗中风后痉挛性瘫痪最常用的药物是发散风寒药、祛风寒湿药、温里药、祛风湿热药、补血药、活血化瘀药、补气药等,常用治法有祛风散寒,养血祛风,温阳养血,养血活血,化痰活血等。对于中风后痉挛性瘫痪的病机认识并没有像中风病那样形成由“外风”向“内风”学说的演变,而是由“外风”学说逐渐演变为“外风兼血虚”的认识,为中风后痉挛性瘫痪的临床治疗提供了文献参考。     

集束化中医护理措施对脓毒症胃肠功能障碍的改善作用

目的观察集束化中医护理措施对脓毒症继发胃肠功能障碍的临床效果。方法脓毒症继发胃肠功能障碍患者120例,根据纳入、排除和脱落标准共入组95例,按照随机数字表法分为对照组(46例)与观察组(49例)。对照组给予常规护理,观察组在对照组基础上加用集束化中医护理措施,包括辨证施治的中药灌胃和灌肠、芒硝敷脐、新斯的明足三里穴位注射、耳穴压豆,比较两组的胃肠功能障碍的改善情况及临床预后。结果干预后第7天,观察组胃肠功能障碍评分(GIF)、腹内压、腹围、急性生理与慢性健康状况I评分(APACHEI)比对照组降低、肠呜音增加(均P<0.05)。且观察组首次排便时间和住ICU时间短于对照组、28 d病死率降低,差异均有统计学意义(P<0.05)。结论集束化中医护理措施能促进脓毒症患者胃肠功能障碍的恢复,改善临床预后。     

Spinal Cord Stimulation–Naïve Patients vs Patients With Failed Previous Experiences With Standard Spinal Cord Stimulation: Two Distinct Entities or One Population?

IntroductionNowadays, the success of spinal cord stimulation (SCS) is evaluated separately in patients who have previous experiences with standard SCS and in SCS-naïve patients. Nevertheless, it is yet to be evaluated whether both patient groups are effectively distinct patient groups. Therefore, the aims of this study are twofold: 1) Are there clusters in the data to distinguish between both patient groups? 2) Can we discriminate both patient groups based on routinely collected clinical parameters?Materials and MethodsBaseline data from the Discover study were used, in which 263 patients with persistent spinal pain syndrome type 2 were included (185 neurostimulation-naïve patients and 78 patients with previous SCS experience). Pain intensity scores for low back and leg pain, functional disability, medication use, and health-related quality of life utility scores were used in the analysis. Model-based clustering was performed on standardized data. Discriminant analysis was performed with linear and quadratic discriminant analysis, with leave-one-out cross-validation to evaluate model performance.ResultsModel-based clustering revealed two different clusters in the data. None of the clusters clearly separated SCS-naïve patients from patients with previous SCS experience. Linear discriminant analysis resulted in a leave-one-out cross-validation error rate of 30.0% to discriminate between both patient groups, based on routinely collected clinical parameters.ConclusionsClustering analysis did not result in clusters that separate SCS-naïve patients from patients with previous SCS experience. This may suggest that both patient groups should not be considered as two different patient groups when comparing them on routine clinical parameters, with potentially profound implications for research and clinical settings.Clinical Trial RegistrationThe Clinicaltrials.gov registration number for the Discover study is NCT02787265.     

Brain excitability and connectivity of neuronal assemblies in Alzheimer's disease: From animal models to human findings

The human brain contains about 100 billion neurons forming an intricate network of innumerable connections, which continuously adapt and rewire themselves following inputs from external and internal environments as well as the physiological synaptic, dendritic and axonal sculpture during brain maturation and throughout the life span.