Perinatal mortality in lambs of ewes exposed to cultures of Diplodia maydis (= Stenocarpella maydis) during gestation. A study of the central-nervous-system lesions

Previously published results of dosing trials, involving 82 ewes, revealed that 66% of the offspring of dams exposed to cultures of Diplodia maydis in the second trimester of pregnancy and 87% of lambs of ewes exposed in the third trimester, were born dead or died soon afterwards. Spongiform degeneration of myelin of varying degree was present in the brains of all the stillborn and non-viable lambs in these trials. Myelin lamellae were separated at the intraperiod line. The spongiform degeneration occurred throughout the central nervous system in severely affected animals, whereas in mildly affected lambs the lesions had a predilection for the white matter, particularly of the cerebellum and cerebrum. In 28 lambs the spongiform degeneration progressed to lytic necrosis, and hydrocephalus was recorded in two animals.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat XI Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.mn201

Perinatal mortality in lambs of ewes exposed to cultures of Diplodia maydis (= Stenocarpella maydis) during gestation.

Previously published results of dosing trials, involving 82 ewes, revealed that 66 % of the offspring of dams exposed to cultures of Diplodia maydis in the second trimester of pregnancy and 87 % of lambs of ewes exposed in the third trimester, were born dead or died soon afterwards. Spongiform degeneration of myelin of varying degree was present in the brains of all the stillborn and non-viable lambs in these trials. Myelin lamellae were separated at the intraperiod line. The spongiform degeneration occurred throughout the central nervous system in severely affected animals, whereas in mildly affected lambs the lesions had a predilection for the white matter, particularly of the cerebellum and cerebrum. In 28 lambs the spongiform degeneration progressed to lytic necrosis, and hydrocephalus was recorded in two animals

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke