Use and effectiveness of dapagliflozin in routine clinical practice. An Italian multicenter retrospective study

In randomized controlled trials (RCTs), sodium-glucose co-transporter-2 (SGLT2) inhibitors have been shown to confer glycaemic and extra-glycaemic benefits. The DARWIN-T2D (DApagliflozin Real World evIdeNce in Type 2 Diabetes) study was a multicentre retrospective study designed to evaluate the baseline characteristics of patients receiving dapagliflozin vs those receiving selected comparators (dipeptidyl peptidase-4 inhibitors, gliclazide, or glucagon-like peptide-1 receptor agonists), and drug effectiveness in routine clinical practice. From a population of 281 217, the analysis included 17 285 patients initiating dapagliflozin or comparator glucose-lowering medications (GLMs), 6751 of whom had a follow-up examination. At baseline, participants starting dapagliflozin were younger, had a longer disease duration, higher glycated haemoglobin (HbA1c) concentration, and a more complex history of previous GLM use, but the clinical profile of patients receiving dapagliflozin changed during the study period. Dapagliflozin reduced HbA1c by 0.7%, body weight by 2.7 kg, and systolic blood pressure by 3.0 mm Hg. Effects of comparator GLMs were also within the expected range, based on RCTs. This real-world study shows an initial channelling of dapagliflozin to difficult-to-treat patients. Nonetheless, dapagliflozin provided significant benefits with regard to glucose control, body weight and blood pressure that were in line with findings from RCTs

Comparison of endothelial progenitor cell function in type 2 diabetes with good and poor glycemic control

<p>Abstract</p> <p>Background</p> <p>Endothelial progenitor cells (EPCs) play an important role in vascular repair and a decrease in the number of EPCs is observed in type 2 diabetes. However, there is no report on the change of EPCs after glycemic control. This study therefore aimed to investigate the EPC number and function in patients with good and poor glycemic control.</p> <p>Methods</p> <p>The number of EPCs was studied using flow cytometry by co-expression of CD34 and VEGFR2. The EPCs were cultured and characterized by the expression of UEA-I, CD34, VEGFR2, vWF and Dil-Ac-LDL engulfment, as well as the ability to form capillary-like structures. An <it>in vitro </it>study on the effect of hyperglycemia on the proliferation and viability of the cultured EPCs was also performed.</p> <p>Results</p> <p>The number of EPCs in type 2 diabetes was significantly decreased compared with healthy controls and there was an inverse correlation between the EPC numbers and plasma glucose, as well as HbA1_C. The number and function of EPCs in patients with good glycemic control were recovered compared with those with poor glycemic control. When glucose was supplemented in the culture <it>in vitro</it>, there was a negative effect on the proliferation and viability of EPCs, in a dose-dependent manner, whereas the enhancement of apoptosis was observed.</p> <p>Conclusion</p> <p>There was EPC dysfunction in type 2 diabetes which might be improved by strict glycemic control. However, the circulating EPC number and proliferative function in patients with good glycemic control did not reach the level in healthy controls.</p

Combinações copa e porta-enxerto para citros ornamentais em vasos.

A seleção de genótipos de citros ornamentais vem sendo conduzida em Cruz das Almas-BA, pelo Programa de Melhoramento Genético de Citros - PMG Citros da Embrapa Mandioca e Fruticultura para fomentar essa atividade no agronegócio citrícola brasileiro. Aqui, são apresentados os resultados de dois experimentos que avaliaram o desempenho de combinações copa e porta-enxerto de citros para uso ornamental

Maize plants produce direct resistance elicited by Tetranychus urticae Koch (Acari: Tetranychidae).

Plants can be attacked by a wide variety of herbivores. Thus, developing protective mechanisms for resistance against these agents is an advantage for survival and reproduction. Over the course of evolution, many resistance mechanisms against herbivory have been developed by the plants. Induced direct and indirect resistance mechanisms can manifest in plants after herbivore attack. The two-spotted spider mite Tetranychus urticae is not a pest of maize crops (Zea mays), despite being reported infesting plants that may have resistances against this herbivore. We tested the hypothesis that maize plants would be able to induce direct resistance against T. urticae after, evaluating the effect of T. urticae infestation in maize plants on the development and reproduction of conspecifics. We tested induced direct resistance performing infestation and measuring biological parameters upon a second infestation. Maize plants, 40 days after sowing, were divided into two groups: 30 not infested by T. urticae (clean plants clean) and, 30 infested by the spider mite. Infestation of maize plants by T. urticae reduced the conspecific female adult survival. However, no change in the survival of immature or reproduction was observed. These results suggest the induction of induced direct resistances in maize by T. urticae. This is first report of direct resistance induction in Z. mays by the two-spotted spider mite T. urticae

Caracterização de germoplasma de citros para fins ornamentais.

As fruteiras ornamentais aparecem como uma possibilidade de inovação deste mercado, face à sua plasticidade de uso, dado que possuem inúmeros atrativos, podendo ser apreciadas em parques e jardins, como plantas de vaso e na condição de flores de corte, folhagens e minifrutos. A citricultura ornamental ainda é pouco significativa no contexto da floricultura brasileira, mas possui grande potencial para exploração e desenvolvimento de novos produtos para o setor

Stepwise Optimization of the Procedure for Assessment of Circulating Progenitor Cells in Patients with Myocardial Infarction

The number and functional activity of circulating progenitor cells (CPCs) is altered in diabetic patients. Furthermore, reduced CPC count has been shown to independently predict cardiovascular events. Validation of CPCs as a biomarker for cardiovascular risk stratification requires rigorous methodology. Before a standard operation protocol (SOP) can be designed for such a trial, a variety of technical issues have to be addressed fundamentally, which include the appropriate type of red blood cell lysis buffer, FMO or isotype controls to identify rare cell populations from background noise, optimal antibody dilutions and conditions of sample storage. We herein propose improvements in critical steps of CPC isolation, antigenic characterization and determination of functional competence for final application in a prospective investigation of CPCs as a biomarker of outcome following acute myocardial infarction.In this validation study, we refined the standard operating procedure (SOP) for flow cytometry characterisation and functional analysis of CPCs from the first 18 patients of the Progenitor Cell Response after Myocardial Infarction Study (ProMIS). ProMIS aims to verify the prognostic value of CPCs in patients with either ST elevation or non-ST elevation myocardial infarction with or without diabetes mellitus, using cardiac magnetic resonance imaging (MRI) for assessment of ventricular function as a primary endpoint. Results indicate crucial steps for SOP implementation, namely timely cell isolation after sampling, use of appropriate lysis buffer to separate blood cell types and minimize the acquisition events during flow cytometry, adoption of proper fluorophore combination and antibody titration for multiple antigenic detection and introduction of counting beads for precise quantification of functional CPC activity in migration assay.With systematic specification of factors influencing the enumeration of CPC by flow cytometry, the abundance and migration capacity of CPCs can be correctly assessed. Adoption of validated SOP is essential for refined comparison of patients with different comorbidities in the analysis of risk stratification

Preditores de comportamentos de autocuidado em indivíduos com insuficiência cardíaca no Brasil

Objetivo: Identificar preditores de comportamentos de autocuidado em indivíduos com insuficiência cardíaca no Brasil.Método: Estudo transversal com 405 pacientes com insuficiência cardíaca. Os comportamentos de autocuidado foram analisados através do Self-Careof Heart Failure Index (Índice de Autocuidado na Insuficiência Cardíaca). Características clínicas e sociodemográficas foram investigadas como preditores da manutenção do autocuidado, de sua administração, e da confiança, por meio de regressões logísticas. Resultados: Os preditores da manutenção do autocuidado foram o número de filhos (p&lt;0.01), a fração de ejeção do ventrículo esquerdo (p&lt;0.01), sentimentos positivos sobre a doença (p=0.03), obesidade (p=0.02), e doença renal dialítica crônica (p&lt;0.01). Os preditores de administração do autocuidado foram ter filhos casados (p&lt;0.01) e apneia (p&lt;0.01). Os preditores de confiança no autocuidado foram renda familiar (p&lt;0.01), número de internações nos 12 meses anteriores (p=0.01), número de doses de medicação diárias (p&lt;0.01), e sedentarismo (p&lt;0.01).Conclusão: Encontrou-se alguns preditores associados aos comportamentos de autocuidado, de modo que educação intensiva e auxílio social deveriam ser oferecidos aos pacientes com essas características.Descritores: Insuficiência cardíaca. Autocuidado. Autogestão. Comportamento relacionados com a saúde. Enfermage

Defesa direta elicitada por Tetranychus urticae Koch (Acari: Tetranychidae) em milho Bt.

Direct and indirect induced defense mechanisms against herbivores can be manifested in maize (Zea mays L.) plants. Furthermore, there are constitutive defenses in which plants continuously express resistance traces. In recent decades has increased the production of transgenic maize plants that constitutively express proteins with insecticide action (Bt maize). The increase of the use of transgenic maize cultivars with the Bt (Bacillus thuringiensis) gene demand studies that evaluate the impacts caused by this technology on plant defense mechanisms and their impact on non-targeted organisms, as the two-spotted spider mite Tetranychus urticae Koch (Acari: Tetranychidae). We tested the hypothesis that Bt maize plants (expressing Cry1F protein) would be capable of inducing direct defenses to T. urticae after being attacked by these mites. Thus, we used plants of a commercial maize hybrid (30F35 Hx - expressing Cry1F protein) and plants of its respective non-Bt isogenic line (control). We compared the survival and reproductive performances of T. urticae on plants of both lines that were previously infested with conspecifics and on plants that did not suffer pre-infestations. The previous infestation of maize plants by T. urticae did not impacted the survival and reproductive abilities of adult and immature forms of the conspecific in both genotypes. These results suggest that, Bt maize expressing the Cry1F insecticidal protein, does not interfere in the induction of direct defense by the T. urticae when compared with conventional maize plants