Diabetic gastroparesis: Therapeutic options

Gastroparesis is a condition characterized by delayed gastric emptying and the most common known underlying cause is diabetes mellitus. Symptoms include nausea, vomiting, abdominal fullness, and early satiety, which impact to varying degrees on the patient’s quality of life. Symptoms and deficits do not necessarily relate to each other, hence despite significant abnormalities in gastric emptying, some individuals have only minimal symptoms and, conversely, severe symptoms do not always relate to measures of gastric emptying. Prokinetic agents such as metoclopramide, domperidone, and erythromycin enhance gastric motility and have remained the mainstay of treatment for several decades, despite unwanted side effects and numerous drug interactions. Mechanical therapies such as endoscopic pyloric botulinum toxin injection, gastric electrical stimulation, and gastrostomy or jejunostomy are used in intractable diabetic gastroparesis (DG), refractory to prokinetic therapies. Mitemcinal and TZP-101 are novel investigational motilin receptor and ghrelin agonists, respectively, and show promise in the treatment of DG. The aim of this review is to provide an update on prokinetic and mechanical therapies in the treatment of DG

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Novel modulated Hexatic Phases in Symmetric Liquid Crystal Dimers

Homologues of the dimeric $\alpha,\omega$-bis(4-$n$-alkylanilinebenzylidene-4'-oxy)alkanes ($m.$O$n$O$.m$) have been synthesised with spacer lengths $n$ ranging from 9 to 12 methylene units and with terminal alkyl chain lengths $m$ of 10, 12 and 14. Characterisation of these materials has been carried out by X-ray diffraction, differential scanning calorimetry and optical microscopy. In six of these compounds a novel modulated tilted hexatic phase, denoted S$_1$, has been identified, in which the smectic layers have a periodic modulation in their structure, analogous to the S$_{\tilde {\rm C}}$ ribbon phase. This modulated hexatic phase is only observed for dimers with an odd parity spacer, suggesting that the average modelular shape, believed to be bent for the odd spacer dimers but linear for the even ones, is responsible for its formation. The compound 10.O9O.10 exhibits a second modulated hexatic phase denoted S$_2$, which is monotropic, and which cannot be distinguished from the S$_1$ phase by polarizing microscopy or by calorimetry. These long chain dimeric liquid crystals have been found to have a strong tendency to form tilted hexatic phases; indeed two of the compounds studied here are the first dimers to undergo a transition directly from a tilted hexatic phase to the isotropic liquid

A Structure Preserving Database Encryption Scheme

Abstract. A new simple and efficient database encryption scheme is presented. The new scheme enables encrypting the entire content of the database without changing its structure. In addition, the scheme suggests how to convert the conventional database index to a secure index on the encrypted database so that the time complexity of all queries is maintained. No one with access to the encrypted database can learn anything about its content without having the encryption key.