Toward Defining the Threshold Between Low and High Glucose Variability in Diabetes

International audienceOBJECTIVE:To define the threshold for excess glucose variability (GV), one of the main features of dysglycemia in diabetes.RESEARCH DESIGN AND METHODS:A total of 376 persons with diabetes investigated at the University Hospital of Montpellier (Montpellier, France) underwent continuous glucose monitoring. Participants with type 2 diabetes were divided into several groups-groups 1, 2a, 2b, and 3 (n = 82, 28, 65, and 79, respectively)-according to treatment: 1) diet and/or insulin sensitizers alone; 2) oral therapy including an insulinotropic agent, dipeptidyl peptidase 4 inhibitors (group 2a) or sulfonylureas (group 2b); or 3) insulin. Group 4 included 122 persons with type 1 diabetes. Percentage coefficient of variation for glucose (%CV = [(SD of glucose)/(mean glucose)] × 100) and frequencies of hypoglycemia (interstitial glucose 36% were compared with those with %CV ≤36%.CONCLUSIONS:A %CV of 36% appears to be a suitable threshold to distinguish between stable and unstable glycemia in diabetes because beyond this limit, the frequency of hypoglycemia is significantly increased, especially in insulin-treated subjects

Assessment of trace element contamination and effects on Paracentrotus lividus using several approaches: Pollution indices, accumulation factors and biochemical tools.

peer reviewedAmong the most common contaminants in marine ecosystems, trace elements are recognized as serious pollutants. In Corsica (NW Mediterranean Sea), near the old asbestos mine at Canari, trace elements from the leaching of mine residues have been discharged into the sea for several decades. The aim of this study was to assess the levels of contamination in this area and the potential effects on Paracentrotus lividus (Lamarck, 1816) using pollution indices, accumulation factors and biochemical tools. For this purpose, the concentration of 24 trace elements was measured in sea urchins (gonads and gut content), macroalgae, seawater column and sediment collected at 12 stations nearby the old asbestos mine and at a reference site. The bioaccumulation of trace elements occurs as follows: macroalgae > gut > gonads. TEPI contribute to highlight contamination gradients which are mainly due to the dominant marine currents allowing the migration of mining waste along the coastline. This hypothesis was supported by TESVI, which identified characteristic trace elements in the southern area of the mine. High hydrogen peroxide content, associated with elevated catalase and glutathione-S-transferase enzyme activities, were also identified at these sites and at the reference site. Trace elements contamination as well as several abiotic factors could explain these results (e.g. microbiological contamination, hydrodynamic events, etc.). The results obtained in this study suggest that oxidative stress induced by contamination does not affect the health of Paracentrotus lividus. This work has provided a useful dataset allowing better use of sea urchins and various tools for assessing trace element contamination in coastal ecosystems.STARECAPMED project (STAtion of Reference and rEsearch on Change of local and global Anthropogenic Pressures on Mediterranean Ecosystems Drifts

Nouvelles données sur l’agglomération antique d’<i>Epomanduodurum</i> (Mandeure et Mathay, Doubs)

International audienceDem antiken Mandeure-Mathay (Epomanduodurum), dem aufgrund seiner Größe und seiner bedeutenden Monumentalbauten im Sequanerland der zweite Platz nach dem Civitas-Hauptort Besançon zukommt, ist seit 2001 ein pluridisziplinäres Forschungsprojekt gewidmet. Im Anschluß an einen im Jahrgang 2007 dieser Zeitschrift vorgelegten Beitrag berichtet das vorliegende Dossier über die Forschungen der Jahre 2005 bis 2011. Parallel zur Weiterführung und Vertiefung der im Bereich der Kult- und Monumentalbauten begonnenen Arbeiten, trieb das Forschungsteam während dieses zweiten Projektabschnittes verschiedene Studien zur gesamten antiken Stadtanlage und der sie umgebenden Mikroregion voran. Diese Untersuchungen liefern neue Einsichten zur Entstehung, Entwicklung und zum Niedergang von Epomanduodurum und tragen zu einem vertieften Verständnis der Gestalt dieser Stadt und ihrer religiösen, ökonomischen und sozialen Organisation im Zeitraum vom Ende der Eisenzeit bis zum Frühmittelalter bei.A collective research program is studying since 2001 the ancient agglomeration of Mandeure-Mathay (Epomanduodurum), considered as second one after the chief town Besançon, in the Sequani territory, by its size and its impressive monumental buildings. This article, following a previous paper published in Gallia in 2007, draws up a report of the researches completed between 2005 and 2011. In this second stage, alongside the ongoing in-depth investigations on cult and monumental area, the PCR (Collective Program Research) team intensified its different studies and researches on the ancient agglomeration and its microregional environment. These studies lead to a better understanding of the appearance, development and decline of Epomanduodurum ; a better knowledge of its morphology, and its religious, economic and social organization between the end of the Iron Age and the Early Middle Ages.L’agglomération antique de Mandeure-Mathay (Epomanduodurum), considérée comme la seconde du pays séquane par ses dimensions et l’ampleur de sa parure monumentale, derrière la capitale de cité, Besançon, fait l’objet d’un programme collectif de recherche (PCR), pluridisciplinaire, depuis 2001. Le présent dossier, qui fait suite à un précédent article paru dans Gallia en 2007, dresse un bilan des recherches réalisées entre 2005 et 2011. Dans cette seconde étape, parallèlement à la poursuite et à l’approfondissement des actions engagées sur le secteur cultuel et monumental, l’équipe du PCR a accentué les études et investigations de diverses natures portant sur l’ensemble de l’agglomération antique et sur l’espace microrégional dans lequel celle-ci s’insère. Ces recherches aboutissent à une meilleure compréhension des modalités d’émergence, de développement et de déclin de la ville d’Epomanduodurum, et à une connaissance plus approfondie de sa morphologie et de son organisation religieuse, économique et sociale, entre la fin de l’âge du Fer et le haut Moyen Âge

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570