Randomized trial of a dual-hormone artificial pancreas with dosing adjustment during exercise compared with no adjustment and sensor-augmented pump therapy

AIMS

To test whether adjusting insulin and glucagon in response to exercise within a dual-hormone artificial pancreas (AP) reduces exercise-related hypoglycaemia.

MATERIALS AND METHODS

In random order, 21 adults with type 1 diabetes (T1D) underwent three 22-hour experimental sessions: AP with exercise dosing adjustment (APX); AP with no exercise dosing adjustment (APN); and sensor-augmented pump (SAP) therapy. After an overnight stay and 2 hours after breakfast, participants exercised for 45 minutes at 60% of their maximum heart rate, with no snack given before exercise. During APX, insulin was decreased and glucagon was increased at exercise onset, while during SAP therapy, subjects could adjust dosing before exercise. The two primary outcomes were percentage of time spent in hypoglycaemia (<3.9 mmol/L) and percentage of time spent in euglycaemia (3.9-10 mmol/L) from the start of exercise to the end of the study.

RESULTS

The mean (95% confidence interval) times spent in hypoglycaemia (<3.9 mmol/L) after the start of exercise were 0.3% (-0.1, 0.7) for APX, 3.1% (0.8, 5.3) for APN, and 0.8% (0.1, 1.4) for SAP therapy. There was an absolute difference of 2.8% less time spent in hypoglycaemia for APX versus APN (p = .001) and 0.5% less time spent in hypoglycaemia for APX versus SAP therapy (p = .16). Mean time spent in euglycaemia was similar across the different sessions.

CONCLUSIONS

Adjusting insulin and glucagon delivery at exercise onset within a dual-hormone AP significantly reduces hypoglycaemia compared with no adjustment and performs similarly to SAP therapy when insulin is adjusted before exercise.

Analgesic efficacy and safety of the diclofenac epolamine topical patch 1.3% (DETP) in minor soft tissue injury

The diclofenac epolamine topical patch 1.3% was designed to deliver analgesic concentrations of diclofenac to an underlying soft tissue injury site, while limiting systemic exposure to diclofenac. This randomized, double-blind, placebo-controlled study evaluated the safety and efficacy of the diclofenac epolamine topical patch for the treatment of acute pain due to minor soft tissue injury. Patients (18-65 years, inclusive) with clinically significant minor soft tissue injuries (mild or moderate sprain, strain, or contusion) incurred within 7 days of study entry and having pain scores ≥ 5 on a Visual Analog Scale of 0-10 were enrolled. Patients were randomized to receive the diclofenac epolamine topical patch (n=207) or placebo patch (n=211) application twice daily for 14 days or until pain resolution. Patients recorded pain scores every 12 h at the time of patch removal using the Visual Analog Scale. Investigator-assessed global response to therapy was also evaluated. Safety data were collected throughout the study. Twice-daily treatment with diclofenac epolamine topical patch produced a statistically significant reduction in mean pain score relative to baseline by an additional 18.2% in the diclofenac epolamine topical patch group (0.435 ± 0.268) compared with the placebo group (0.532 ± 0.293) (p=0.002; overall) beginning after application of the second patch. Consistent with this treatment effect, median time to pain resolution was shortened by 2 days in the diclofenac epolamine topical patch group relative to the placebo group (p=0.007). These results were reinforced independently by investigators who reported treatment as good or excellent for 58% of diclofenac epolamine topical patch-treated patients compared with 49% in the placebo patch group (p=0.008). The most common adverse events were treatment site related (n=16, 7.9% diclofenac epolamine topical patch; n=12, 5.8% placebo patch). Most (80%) patients reported tolerability as excellent or good. In conclusion, the diclofenac epolamine topical patch provides effective, rapid pain relief for the treatment of acute pain from minor soft tissue injury and appears generally safe and well tolerated.

Rapid postmortem invasion of cecal mucosa of macaques by nonpathogenic Entamoeba chattoni

Although Entamoeba histolytica is the third leading parasitic cause of death in the world, most infections in humans are asymptomatic and restricted to the intestinal lumen. Entamoeba histolytica infections have also been reported in most species of captive nonhuman primates, with New World monkeys being particularly susceptible to fatal invasive amebiasis. In contrast, Old World monkeys appear to be resistant to the disease, although tissue invasion in asymptomatic monkeys has been reported. Our initial objectives were to determine the incidence, the predisposing factors, and the light microscopic and ultrastructural features of invasive amebiasis in Macaca mulatta (rhesus) and and M. fasicularis (cynomolgus) macaques. Our findings indicate that nonpathogenic E. chattoni in macaques can invade cecal mucosa rapidly (within 1 hr) after death. Therefore, the presence of invasive Entamoeba trophozoites in routinely collected necropsy materials should be interpreted with caution, particularly in cases where tissue fixation is delayed.

Nucleocapsid- and virus-like particles assemble in cells infected with recombinant baculoviruses or vaccinia viruses expressing the M and the S segments of Hantaan virus

The formation of Hantaan (HTN) virus nucleocapsid-like structures (NLS) or virus-like particles (VLP) from expressed gene products was investigated in two eukaryotic systems. Baculovirus expression of the HTN virus small segment (S), which encodes the viral nucleocapsid protein, resulted in assembly of NLS inside infected insect cells. The NLS and authentic ribonucleocapsids, prepared by detergent disruption of HTN virions, had similar sedimentation characteristics and morphologies, and were recognized by HTN virus N-specific antibodies. Co-expression of S and the medium segment (M), which encodes the two viral envelope glycoproteins (G1 and G2), did not efficiently generate VLP in the baculovirus-insect cell system, but VLP were observed in lysates and supernatants of cells infected with a recombinant vaccinia virus co-expressing HTN virus M and S. The VLP sedimented in sucrose to densities consistent with HTN virions, and some of them bore a striking resemblance to Hantaan virions when examined by immunoelectron microscopy.

CPR in children

CPR has not been well studied in children and little is known about factors predictive of outcome. We conducted a study with three goals: longitudinal determination of demographic and laboratory data characterizing pediatric arrest victims; identification of factor(s) predictive of outcome; and determination of the prevalence of ionized hypocalcemia in pediatric arrest victims. All resuscitation efforts were documented during a one-year period in a 240-bed tertiary care children's hospital. Patients were classified into two groups--respiratory arrest (RA, requiring only assisted ventilation), and cardiac arrest (CA, absence of palpable cardiac activity requiring closed-chest CPR). Collected data and laboratory tests were analyzed using a step-wise discriminant analysis to determine which factors were predictive of outcome. There were 113 arrests in 93 children; 53 were CA victims and 40 were RA victims. CA had a high in-hospital mortality (90.6%) compared to RA (32.5%). The population was young (55% less than 1 year old) and 87% had at least one chronic underlying disease. No laboratory or demographic value was significantly associated with eventual outcome. The number of doses of epinephrine in CA victims, or bicarbonate in RA victims, was associated with eventual outcome. None of 31 CA victims receiving more than two doses of epinephrine survived to discharge. Low ionized calcium concentrations (less than 3.5 mg/dL) were identified in ten patients; septic shock was present in seven, and chronic renal failure in two.(ABSTRACT TRUNCATED AT 250 WORDS)