Insulin lispro is as effective as regular insulin in optimising metabolic control and preserving beta-cell function at onset of type 1 diabetes mellitus

The aim of the study was to examine the effects of intensive insulin therapy using lispro on metabolic control, immunogenicity and β-cell function of newly diagnosed type 1 diabetic subjects in comparison with intensive insulin therapy using regular insulin. An open study was conducted in 45 newly diagnosed type 1 diabetic subjects. Patients were randomly assigned to intensive insulin therapy using insulin lispro (lispro) (lispro, n=22; 22.8 years) or intensive insulin therapy using regular insulin (regular) (regular, n=23; 24.4 years): three to five injections of subcutaneous rapid-acting insulin before meals and Neutral Protamine Hagedorn (NPH) before dinner/bed-time. GAD, IA2, insulin antibodies, basal and stimulated plasma C-peptide and HbA_1c were measured initially and at months 1, 4, 8 and 12. Daily blood glucose profiles tended to be lower in the lispro group, particularly values after breakfast, without reaching statistical significance. There were no differences in terms of HbA_1c throughout the study. The proportion of subjects achieving an HbA_1c<6% at the end of the study was similar in both groups (regular 73.9%, lispro 68.0%). The number of mild hypoglycemic episodes tended to be lower with lispro, but not significantly. β-Cell function was not significantly different in both groups. During follow-up there were no differences in antibodies, including IAAb. In summary, insulin lispro used in intensive insulin therapy is as effective as regular insulin in optimizing metabolic control and preserving β-cell function at diagnosis of type 1 diabetes.     

Incidence of newly diagnosed epileptic seizures in a French South Indian Ocean Island, La Réunion (EPIREUN)

Purpose:   To assess the incidence of newly diagnosed epileptic seizures in the population of La Réunion.
Methods:   From July 1, 2004 to June 30, 2005, we conducted a prospective, observational, and multicenter epidemiologic study to identify patients with newly diagnosed epileptic seizures. Febrile and neonatal seizures were excluded.
Results:   Seven hundred sixty-six patients were included. The standardized (2000 U.S. population) incidence rate of all suspected cases of newly diagnosed (provoked and unprovoked) epileptic seizures was 115.4/100.000 person-years [95% confidence interval (CI) 106.7–124.0]. We observed a bimodal distribution: The crude incidence was 99.5/100,000 in the group aged 0–14 years and 330.8/100,000 in those older than 65 years. One hundred thirty-five cases were classified as provoked seizures (17.6%; incidence 17.7/100,000). Alcohol consumption, cranial trauma, and cerebrovascular disease were the most frequent causes (27.4%, 11.1%, and 10.4%, respectively). Six hundred twenty cases were classified as unprovoked seizures (single and recurrent) (80.9%; incidence, 81.2/100,000). Two hundred sixty cases of seizures were due to stable neurologic conditions (incidence, 34.1/100,000) and the most common causes were cerebrovascular disease (46.2%), alcoholism (20.4%), and cranial trauma (5.4%). Evolutive neurologic conditions contributed to 23 cases (incidence, 3.0/100,000). Lastly, unprovoked seizures with unknown etiology were 337 (incidence, 44.2/100,000).
Conclusions:   The global incidence rate of newly diagnosed epileptic seizures in La Réunion was clearly higher than those observed in industrialized countries and similar to those observed in developing countries. The major risk factors were represented by cerebrovascular disease, alcohol consumption, and cranial trauma. Surprisingly, there were few infections.     

Olaparib plus bevacizumab as maintenance therapy in patients with newly diagnosed,advanced ovarian cancer: Japan subset from the PAOLA-1/ENGOT-ov25 trial

ObjectiveThe addition of maintenance olaparib to bevacizumab demonstrated a significant progression-free survival (PFS) benefit in patients with newly diagnosed, advanced ovarian cancer in the PAOLA-1/ENGOT-ov25 trial ({"type":"clinical-trial","attrs":{"text":"NCT02477644","term_id":"NCT02477644"}}NCT02477644). We evaluated maintenance olaparib plus bevacizumab in the Japan subset of PAOLA-1.MethodsPAOLA-1 was a randomized, double-blind, phase III trial. Patients received maintenance olaparib tablets 300 mg twice daily or placebo twice daily for up to 24 months, plus bevacizumab 15 mg/kg every 3 weeks for up to 15 months in total. This prespecified subgroup analysis evaluated investigator-assessed PFS (primary endpoint).ResultsOf 24 randomized Japanese patients, 15 were assigned to olaparib and 9 to placebo. After a median follow-up for PFS of 27.7 months for olaparib plus bevacizumab and 24.0 months for placebo plus bevacizumab, median PFS was 27.4 versus 19.4 months, respectively (hazard ratio [HR]=0.34; 95% confidence interval [CI]=0.11–1.00). In patients with tumors positive for homologous recombination deficiency, the HR for PFS was 0.57 (95% CI=0.16–2.09). Adverse events in the Japan subset were generally consistent with those of the PAOLA-1 overall population and with the established safety and tolerability profiles of olaparib and bevacizumab.ConclusionResults in the Japan subset of PAOLA-1 support the overall conclusion of the PAOLA-1 trial demonstrating that the addition of maintenance olaparib to bevacizumab provides a PFS benefit in patients with newly diagnosed, advanced ovarian cancer.Trial RegistrationClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT02477644","term_id":"NCT02477644"}}NCT02477644     

短期胰岛素泵强化治疗对初发2型糖尿病的疗效观察

目的了解短期胰岛素泵强化治疗对初发2型糖尿病的临床疗效及其影响因素。方法34例初发的2型糖尿病经胰岛素泵强化治疗2周,治疗前后行空腹血糖、餐后血糖、糖化血红蛋白、血尿C肽、体重指数等测定,以评价治疗效果。结果2周的强化胰岛素泵治疗能有效及平稳地降低血糖,与治疗成功组相比,病程越短,胰岛素用量越少,达标时间越短,其临床缓解率的越高。结论短期的胰岛素泵强化治疗能使初诊的2型糖尿病患者血糖达到有效控制,部分患者不用药物,仅通过饮食控制就可获得良好的血糖控制。     

Patients with epilepsy: Cognitively compromised before the start of antiepileptic drug treatment?

Purpose:   To compare the cognitive profile of newly diagnosed untreated epilepsy patients with healthy volunteers using a comprehensive neuropsychological test battery.
Methods:   A total of 155 untreated patients with newly diagnosed epilepsy, and no known brain pathology, were assessed before the start of treatment with antiepileptic medication. Their scores across the neuropsychological measures were compared with 87 healthy volunteers from the general population equated for age and sex.
Results:   After adjusting for age, sex, and education, patients with epilepsy performed significantly worse than healthy volunteers on 6 of 14 cognitive measures, particularly in the domains of memory and psychomotor speed. Cognitive performance was not related to the number of seizures, type of epilepsy, or mood. When an impairment index was calculated, 53.5% patients had a least one abnormal score [>2 standard deviations (SD) below the control mean] on the test battery compared with 20.7% of healthy volunteers.
Discussion:   Newly diagnosed untreated patients with epilepsy are cognitively compromised before the start of antiepileptic drug medication. The domains most affected are memory and psychomotor speed. More than one-half of the patients had at least one abnormal test score across the test battery. There were no differences in epilepsy-related or mood variables between those who demonstrated dysfunction and those that did not.     

天津市2011～2015年HIV/AIDS晚发现病例特征及影响因素分析

目的:了解天津市2011~2015年新报告HIV/AIDS病例的晚发现比例,分析晚发现的影响因素。方法:通过艾滋病综合防治信息系统收集天津市2011~2015年新报告HIV/AIDS病例的数据信息,对病例信息进行分析,计算晚发现的比例并分析其影响因素。结果:2011~2015年天津市累计新发现的HIV/AIDS病例数为2922例,晚发现比例为31.3%。多因素分析表明25~34岁病例(adjusted OR=1.722,95%CI:1.346~2.334)、35~49岁病例(adjusted OR=2.934,95%CI:2.125~4.051)、50岁及以上病例(adjusted OR=3.859,95%CI:2.625~5.673)晚发现比例高于25岁以下病例;STD就诊者发现病例(adjusted OR=0.293,95%CI:0.209~0.413)、VCT发现病例(adjusted OR=0.278,95%CI:0.213~0.364)、专题调查发现病例(adjusted OR=0.254,95%CI:0.198~0.326)晚发现比例低于医疗机构检测发现病例;本市户籍病例(adjusted OR=1.266,95%CI:1.043~1.538)晚发现比例高于非本市户籍病例。结论:天津市新发现HIV/AIDS病例存在一定比例的晚发现现象,年龄、户籍、病例来源为影响病例晚发现的主要因素,应采取有效措施及早发现病例。     

初诊急性髓系白血病患者十种常见突变基因的突变组分析

目的 探讨初诊急性髓系白血病(AML)患者中最常见的10种突变基因的突变组合规律.方法 选取AML患者129例,基因测序法检测初诊时骨髓样本中ASXL1、CEBPA、DNMT3A、FLT3、IDH1/2、KIT、NPM1、PHF6和TET2基因突变.结果 68.99％(89/129)患者上述基因突变阳性,30.23％(39/129)同时有多种基因突变.激酶类基因FLT3和KIT突变互斥,不同时出现.FLT多与其他基因伴随突变,而KIT突变多单独出现.转录因子基因CEBPA、NPM1和PHF6可相互伴随突变.表观遗传调控基因ASXL1、DNMT3A、IDH1/2和TET2的突变多与上述两组基因突变同时出现,但该组基因之间较少伴随突变.结论 首次对初诊AML中的突变组按基因的功能和分类进行谱型分析,显示基因突变的组合具有一定的规律,与基因的功能和分类相关.     

新发麻风712例临床分析

目的：分析近年来江西省新发麻风病例临床特征,提高临床诊断和治疗麻风病水平。方法根据2000～2012年江西省新发麻风资料进行回顾性分析。结果新发麻风病患者712例,男女比2.72∶1,农民占87.36%,有家族史者占32.44%。发现方式以皮肤科门诊为主,占71.63%;平均病程（延迟期）（31.12±8.14）个月。误诊情况：首诊确诊者318例（44.66%）,误诊次数平均达（5.34±3.19）次。临床表现上仅有皮损者15.87%,仅有神经损害者13.62%,两者兼有者64.47%。临床分型TT10.39%,BT17.98%,BB8.57%,BL30.17%,LL31.46,I1.4%;不同类型查菌阳性率有较大差别;大都具有麻风病的特征病理表现。患者均给予联合化疗,出现麻风反应162例次,神经炎186例次;临床判愈698例,非治疗死亡11例,治疗死亡3例,残疾比为25.98%。结论江西省麻风病处低流行状态。确诊麻风需要以皮肤科临床为主,结合查菌和病理结果。治疗中需注意药物的副作用及麻风反应和神经炎等并发症。     

阶段性护理干预在初发2型糖尿病双C治疗中的应用与研究

目的 探讨阶段性、个体化护理干预在初发T2DM患者双C治疗中的应用价值.方法 对60例初诊的T2DM患者采用CSⅡ和CGMS联合治疗(双C治疗)法,给予阶段性、个体化的护理干预,干预治疗前、后进行血糖及糖尿病知识测试得分、依从性等比较.结果 干预治疗后患者的血糖水平较治疗前明显改善,血压下降,糖尿病知识测试及格率显著增加,病人依从性明显提高.结论 阶段性、个体化的护理干预是提高初诊T2DM患者依从性的重要措施,有助于双C治疗的顺利实施.同时能减轻糖毒性,提高患者的自我管理能力,改善患者的生活质量.