Efficacy and safety of saxagliptin added to metformin in Asian people with type 2 diabetes mellitus: a randomized controlled trial

Aim

To assess efficacy and safety of saxagliptin added to metformin versus placebo plus metformin in Asian patients with type 2 diabetes mellitus (T2DM) and inadequate glycemic control on metformin alone.

Methods

Adults (HbA_1c 7.0-10.0%, on stable metformin ≥1500 mg/day) were randomized 1:1 to saxagliptin 5 mg daily plus metformin (n = 283) or placebo plus metformin (n = 287). The primary end point was HbA_1c change from baseline to Week 24.

Results

Saxagliptin plus metformin provided significant adjusted mean decreases versus placebo plus metformin (p ≤ 0.0052) in HbA_1c (−0.78% versus −0.37%), fasting plasma glucose (−1.14 mmol/L versus −0.58 mmol/L), and postprandial glucose area under the curve from 0 to 180 min (−315 mmol min/L versus −160 mmol min/L). Significantly more saxagliptin-treated patients achieved a therapeutic glycemic response (HbA_1c < 7.0%) (46.5% versus 30.5%; p = 0.0001). The proportion of patients experiencing adverse events (excluding hypoglycemia) was similar for saxagliptin plus metformin (42.8%) versus placebo plus metformin (40.8%). Hypoglycemic events were reported in 1.4% of patients in each group.

Conclusion

Saxagliptin added to metformin significantly improved glycemic control and was well tolerated in Asian patients with T2DM who had inadequate glycemic control with metformin and diet and lifestyle modification.     

优化翼状胬肉切除术联合角膜缘干细胞移植术的临床研究

目的:研究优化的翼状胬肉切除术联合角膜缘干细胞移植术的临床疗效方法:选择59例59眼初发的翼状胬肉患者,随机分为实验组(优化的翼状胬肉切除术+角膜缘干细胞移植术组)32例32眼和对照组(翼状胬肉切除术+角膜缘干细胞移植术组)27例27眼,分别采用相应的手术方式治疗,比较术后角膜上皮愈合时间、结膜瓣愈合时间、手术操作时间、复发率、术后患者舒适度等并做统计分析。结果:实验组和对照组的术后角膜上皮愈合时间分别为2.16±0.37,2.87±0.31d;手术操作时间分别为30.03±1.98,36.63±2.42min;结膜瓣愈合时间分别为8.06±0.75,10.02±1.01d;术后患者不适感评分分别为0.91±0.69,1.63±0.74。差异均有统计学意义(P<0.01),两组均未见复发病例。结论:采用优化的翼状胬肉切除术联合角膜缘干细胞移植术,术后角膜上皮、结膜瓣愈合时间缩短和手术操作时间明显缩短,术后患者舒适度高。     

调制传递函数和对比敏感度函数评价LASIK术后早期视觉质量的研究

目的:应用调制传递函数(modulation transfer function,MTF)检查和对比敏感度函数(contrast sensitivity function,CSF)检查评价近视患者准分子激光原位角膜磨镶术(Laser in situ keratomileusis,LASIK)术后视觉质量的变化。方法:前瞻性研究。47例92眼行LASIK手术的患者按照术前验光度数分为低度近视组(A组)、中度近视组(B组)、高度近视组(C组)。术前等效球镜值分别为-2.28±0.48D,-4.54±0.97D,-6.86±1.17D。分别于术前,术后1wk;1,3mo检查裸眼视力(the uncorrected visual acuity,UCVA)、最佳矫正视力(best-corrected visual acuity,BCVA)、屈光度、波前像差、3mm和5mm瞳孔下的MTF和昼视及夜视视远状态下的CSF。利用德国Zeiss公司WASCAAnalyer波阵面像差仪检查三组患者在3mm和5mm瞳孔下去掉高阶像差后的MTF曲线,将图像扫描并载入至Engauge Digitizer4.1数字化软件,得出一定空间频率下的MTF值;利用Optical6500对比敏感度测试灯箱(美国STEREO OPTICAL公司)测量患者在昼视及夜视视远状态下的CSF值。对数据进行配对t检验。结果:(1)术后1wk,CSF值与术前相比有明显下降。术后3mo,只有明环境下低空间频率和暗环境下低中度近视组的低空间频率的CSF值可以恢复至术前。近视度数越高,中高空间频率的CSF值越不容易恢复至术前。(2)3mm瞳孔条件下低度近视组100L/mm,150L/mm,300L/mm空间频率的子午曲线和中度近视组50L/mm空间频率的子午曲线的MTF值,在术后7d与术前相比已经无统计学差异。3mm瞳孔条件下中度近视组150L/mm,200L/mm,300L/mm空间频率的弧矢曲线、高度近视组250L/mm空间频率下的子午曲线的MTF值和5mm瞳孔条件下低度近视组100L/mm,300L/mm,400L/mm空间频率下的子午曲线、中度近视组400L/mm,500L/mm空间频率下的弧矢曲线,200L/mm,400L/mm空间频率下的子午曲线,高度近视组全部空间频率下的弧矢曲线,100L/mm,200L/mm,300L/mm空间频率下的子午曲线的MTF值术后3mo可恢复到术前水平。其余所有空间频率下的MTF值均能在术后1mo恢复至术前水平。结论:(1)MTF值比CSF值恢复更早,只有部分低空间频率的CSF值可以恢复至术前,而所有的MTF值均能恢复至术前水平。(2)MTF值在术后早期可以更早更全面和客观的反映出视觉质量的提高。(3)利用Carl Zeiss公司WASCA Analyer波阵面像差仪检测患者MTF可以更立体全面客观的反映术后人眼光学系统的改变。     

Reconstruction of a nonfunctional trabeculectomy bleb using an amniotic membrane-wrapped silicone sponge to treat refractory glaucoma

Background

This study was conducted to verify the usefulness of nonfunctional trabeculectomy bleb reconstruction using a silicone sponge wrapped with amniotic membrane. Its purpose was to allow aqueous humor to flow from the flap to the posterior orbital space.

Methods

Seven consecutive patients who had undergone two or more surgeries in one eye for refractory glaucoma followed by our operation were included in this study. Conjunctival adhesion to the sclera was detached with a limbus-based conjunctival incision, followed by reopening the former trabeculectomy flap. A 1.5?×?12 mm silicone sponge used for retinal detachment surgery was wrapped three to four times with amniotic membrane, placed longitudinally on the sclera, and fixed with 10–0 nylon sutures. The anterior end of the amniotic membrane was fixed underneath the scleral flap with sutures, and the conjunctival wound was closed. We periodically checked the intraocular pressure (IOP) and for complications. Follow-up periods ranged from 15 to 30 months (average 19.4 months). Surgical success was defined as a final IOP of ≤ 21 mmHg with or without additional treatment. We defined failure as an IOP of > 21 mmHg on the second of two consecutive visits after the first 4 weeks, or the need for additional glaucoma surgery.

Results

Surgery was successful in five of the seven eyes, although bleb needling was performed in two eyes and amniotic membrane patch covering for early aqueous leakage was needed in one eye. In four of the five successful eyes, IOP was well controlled for longer than the period between the previous and present surgeries. One of the unsuccessful eyes, with neovascular glaucoma, had high IOP with hyphema followed by phthisis of the eyeball. The other, with aqueous leakage via the conjunctival wound, required trabeculectomy in a different area. There were no other complications.

Conclusions

Reconstruction of the nonfunctional trabeculectomy bleb using a silicone sponge wrapped with amniotic membrane can be a useful strategy for treating refractory glaucoma.     

Performance of rapid-test kits for the detection of the pandemic influenza A/H1N1 virus

The early detection of pandemic influenza strains is a key factor for clinicians in treatment decisions and infection control practices. The aims of this study were to determine the analytical sensitivity and clinical performance of the commercially available influenza rapid tests in Taiwan. Four rapid tests for influenza virus (BinaxNow test, QuickVue test, TRU test, and Formosa Rapid test) were evaluated for their detection limit against four influenza viruses (the 2009 pandemic influenza A virus H1N1, seasonal influenza virus H1N1, H3N2, and influenza B virus) circulating in Taiwan. The viral load of these isolates were quantified by rtRT-PCR and then diluted 2-fold serially for the comparison. The lowest detectable viral load of the pandemic influenza A virus H1N1 by the Formosa Rapid test, QuickVue test, TRU test, and Binax Now test was 5.3 × 10⁴, 1.0 × 10⁵, 1.0 × 10⁵, and 4.2 × 10⁵ copies/μL, respectively. Of these four tests, the two most sensitive tests (the QuickVue test and the Formosa Rapid test) were chosen to evaluate 62 nasopharyngeal specimens from patients who were suspected of infection with pandemic influenza A virus H1N1. The positive rate for the Formosa Rapid test and the QuickVue test were 53.2% (33/62) and 45.2% (28/62) (McNemar's test, P = 0.125), respectively. In conclusion, the Formosa Rapid test was the most sensitive test in the present study for the detection of influenza antigens and its clinical performance was similar to that of the QuickVue test (Kappa = 0.776). This suggests that the Formosa Rapid test could be used to aid clinical decision making in primary health care settings during outbreaks of influenza.     

脉络膜黑色素瘤中survivin的表达及其与微血管密度的关系

目的观察凋亡抑制蛋白survivin在脉络膜黑色素瘤中的表达及其与微血管密度(microvessel density,MVD)的关系,探讨survivin对脉络膜黑色素瘤血管生成的作用及意义。方法采用免疫组化SP法检测51例脉络膜黑色素瘤患者组织中survivin、CD34的表达,以CD34标记肿瘤微血管,并在显微镜下计数微血管密度。结果瘤旁组织中无survivin表达,survivin在脉络膜黑色素瘤表达阳性率为66.67%,其表达与脉络膜黑色素瘤病理分型、巩膜是否受侵相关(P<0.05),而与肿瘤位置、肿瘤最大基底直径无关;sur-vivin的表达与MVD呈正相关,survivin阳性表达组中MVD明显高于survivin阴性表达组(P<0.05)。结论survivin在脉络膜黑色素瘤的形成与发展中可能通过抑制凋亡和参与血管形成起着重要的作用,并且与患者预后关系密切。     

Comparative analysis of the gut microbiota of wild adult rats from nine district areas in Hainan,China

BACKGROUND Wild rats have the potential to hold zoonotic infectious agents that can spread to humans and cause disease.AIM To better understand the composition of gut bacterial communities in rats is essential for preventing and treating such diseases. As a tropical island located in the south of China, Hainan province has abundant rat species. Here, we examined the gut bacterial composition in wild adult rats from Hainan province.METHODS Fresh fecal samples were collected from 162 wild adult ra...