Systematic review and meta-analysis of randomized clinical trials comparing efficacy and safety outcomes of insulin glargine with NPH insulin, premixed insulin preparations or with insulin detemir in type 2 diabetes mellitus

AIMS: A variety of basal insulin preparations are used to treat patients with type 2 diabetes mellitus (T2DM). We aimed to summarize scientific evidence on relative efficacy and safety of insulin glargine (IGlar) and other insulins in T2DM. METHODS: A systematic review was carried out in major medical databases up to December 2012. Relevant studies compared efficacy and safety of IGlar, added to oral drugs (OAD) or/and in combination with bolus insulin, with protamine insulin (NPH) or premixed insulin (MIX) in the same regimen, as well as with insulin detemir (IDet), in T2DM. Target HbA1c level without hypoglycemic events was considered the primary endpoint. RESULTS: Twenty eight RCTs involving 12,669 T2DM patients followed for 12–52 weeks were included in quantitative analysis. IGlar + OAD use was associated with higher probability of reaching target HbA1c level without hypoglycemia as compared to NPH + OAD (RR = 1.32 [1.09, 1.59]) or MIX without OAD (RR = 1.61 [1.22, 2.13]) and similar effect as IDet + OAD (RR = 1.07 [0.87, 1.33]) and MIX + OAD (RR = 1.09 [0.86, 1.38]). IGlar + OAD demonstrated significantly lower risk of symptomatic hypoglycemia as compared to NPH + OAD (RR = 0.89 [0.83, 0.96]), MIX + OAD (RR = 0.75 [0.68, 0.83]) and MIX without OAD(RR = 0.75 [0.68, 0.83]), but not with IDet + OAD (RR = 0.99 [0.90, 1.08]). In basal-bolus regimens, IGlar demonstrated similar proportion of T2DM patients achieving target HbA1c as compared to NPH (RR = 1.14 [0.91, 1.44]) but higher than MIX (RR = 1.26 [1.12, 1.42) or IDet (RR = 1.38 [1.11, 1.72]). The risk of severe hypoglycemia was lower in IGlar than in NPH (RR = 0.77 [0.63, 0.94]), with no differences in comparison with MIX (RR = 0.74 [0.46, 1.20]) and IDet (RR = 1.10 [0.54, 2.25]). IGlar + OAD has comparable safety profile to NPH, with less frequent adverse events leading to treatment discontinuation than MIX + OAD (RR = 0.41 [0.22, 0.76]) and IDet + OAD (RR = 0.40 [0.24, 0.69]). Also severe adverse reactions were less common for IGlar + OAD when compared to MIX + OAD (RR = 0.71 [0.52; 0.98]). CONCLUSION: For the majority of examined efficacy and safety outcomes, IGlar use in T2DM patients was superior or non-inferior to the alternative insulin treatment options. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00592-014-0698-4) contains supplementary material, which is available to authorized users

Digit ratio (2D:4D), laryngeal cancer and vocal fold leukoplakia

Background - To date, there are no studies that have analyzed the possible influence of exposure to prenatal sex hormones on the risk of laryngeal cancer (LC) and premalignant laryngeal lesion—vocal fold leukoplakia (VFL). Digit ratio (2D:4D) is suggested to be a proxy of prenatal sex hormone exposure. Objective - To examine 2D:4D in patients with LC and clarify if it could add to the verified risk factors in estimating the overall risk of LC. Methods - 511 subjects participated in the study. The study group included 269 patients: with LC (N = 114, 64 men) and VFL (N = 155, 116 men). Controls included 242 healthy individuals (66.40 ± 4.50 years (106 men)). Results - Predictive models estimating the risk of VFL and LC in women, based solely on predictors like smoking and alcohol consumption had a lower area under the ROC curve (AUC) than the model with left 2D:4D. AUC for the model estimating the likelihood of VFL increased from 0.83 to 0.85, and for LC from 0.76 to 0.79. Conclusions - Low left 2D:4D may be associated with an increased risk of developing leukoplakia and laryngeal cancer in women. In the case of laryngeal cancer, left 2D:4D may serve as additional variable (to other known risk factors, such as smoking and/or alcohol consumption), which can improve cancer risk prediction

Running performance at high running velocities is impaired but V'O_{2max} and peripheral endothelial function are preserved in IL-6^{−/−} mice

It has been reported that IL-6 knockout mice (IL-6^{−/−}) possess lower endurance capacity than wild type mice (WT), however the underlying mechanism is poorly understood. The aim of the present work was to examine whether reduced endurance running capacity in IL-6^{−/−} mice is linked to impaired maximal oxygen uptake (V′O_{2max}), decreased glucose tolerance, endothelial dysfunction or other mechanisms. Maximal running velocity during incremental running to exhaustion was significantly lower in IL-6−/− mice than in WT mice (13.00±0.97 m.min^{-1} vs. 16.89±1.15 m.min^{-1}, P<0.02, respectively). Moreover, the time to exhaustion during running at 12 m.min^{-1} in IL-6^{−/−} mice was significantly shorter (P<0.05) than in WT mice. V′O_{2max} in IL-6^{−/−} (n = 20) amounting to 108.3±2.8 ml.kg^{-1}.min^{-1} was similar as in WT mice (n = 22) amounting to 113.0±1.8 ml.kg^{-1}.min^{-1}, (P = 0.16). No difference in maximal COX activity between the IL-6^{−/−} and WT mice in m. soleus and m. gastrocnemius was found. Moreover, no impairment of peripheral endothelial function or glucose tolerance was found in IL-6^{−/−} mice. Surprisingly, plasma lactate concentration during running at 8 m.min−1 as well at maximal running velocity in IL-6^{−/−} mice was significantly lower (P<0.01) than in WT mice. Interestingly, IL-6^{−/−} mice displayed important adaptive mechanisms including significantly lower oxygen cost of running at a given speed accompanied by lower expression of sarcoplasmic reticulum Ca^{2+}-ATPase and lower plasma lactate concentrations during running at submaximal and maximal running velocities. In conclusion, impaired endurance running capacity in IL-6^{−/−} mice could not be explained by reduced V′O_{2max}, endothelial dysfunction or impaired muscle oxidative capacity. Therefore, our results indicate that IL-6 cannot be regarded as a major regulator of exercise capacity but rather as a modulator of endurance performance. Furthermore, we identified important compensatory mechanism limiting reduced exercise performance in IL-6^{−/−} mice

High efficacy and safety of VTD as an induction protocol in patients with newly diagnosed multiple myeloma eligible for high dose therapy and autologous stem cell transplantation : a report of the Polish Myeloma Study Group

The present retrospective analysis evaluated the efficacy and safety of the VTD (bortezomib, thalidomide, dexamethasone) regimen in 205 newly‑diagnosed patients with multiple myeloma (MM) eligible for high dose therapy and autologous stem cell transplantation (HDT/ASCT) in routine clinical practice. With a median of 6 cycles (range, 1‑8), at least partial response was achieved in 94.6% and at least very good partial response (VGPR) was achieved in 67.8% of patients. Peripheral neuropathy (PN) grade 2‑4 was observed in 28.7% of patients. In 72% of patients undergoing stem cell mobilization one apheresis allowed the number of stem cells sufficient for transplantation to be obtained. Following HDT/ASCT the sCR rate increased from 4.9 to 14.4% and CR from 27.8 to 35.6%. The results demonstrated that VTD as an induction regimen was highly efficient in transplant eligible patients with MM with increased at least VGPR rate following prolonged treatment (≥6 cycles). Therapy exhibited no negative impact on stem cell collection, neutrophils and platelets engraftment following ASCT. Therapy was generally well tolerated and PN was the most common reason of dose reduction or treatment discontinuation

Zalecenia Polskiej Grupy Szpiczakowej dotyczące rozpoznawania i leczenia szpiczaka plazmocytowego oraz innych dyskrazji plazmocytowych na rok 2018/2019

Liczba chorych na szpiczaka plazmocytowego zwiększa się, co jest skutkiem zarówno skuteczniejszej diagnostyki, jak również istotnego przedłużania przeżycia chorych. Zawdzięczamy to dostępności nowych leków w pierwszej i kolejnych liniach leczenia, zmianie koncepcji leczenia i przedłużaniu czasu trwania leczenia, stosując leczenie konsolidujące oraz podtrzymujące do progresji choroby. Poza zmianą koncepcji leczenia, zmienia się obecnie również kryterium czasu rozpoczęcia terapii uwzględniające biomarkery aktywności choroby oraz dużą uwagę przywiązuje się optymalizacji leczenia w oparciu o dowody pochodzące z badań klinicznych. W artykule tym przedstawiono także zalecenia dotyczące rozpoznania i leczenia makroglobulinemii Waldenströma i innych dyskrazji plazmocytowych

Współczesne zagadnienia zarządzania: przedsiębiorstwo - biznes - region

Praca recenzowana / peer-reviewed pape

Zalecenia Polskiej Grupy Szpiczakowej dotyczące rozpoznawania i leczenia szpiczaka plazmocytowego oraz innych dyskrazji plazmocytowych na rok 2017

New drugs introduced in recent years to the therapy of multiple myeloma patients resulted in better responses and prolongation of overall survival. While therapeutic regimens based on bortezomib and thalidomide are recommended to most patients in first line therapy, lenalidomide represents the cornerstone for treatment of relapsed/refractory myeloma patients. Most patients profit from prolonged treatment composed of consolidation and maintenance treatment till progression. Besides the concept of longer treatment, it is recommended to start therapy in some patients earlier, taking into consideration biomarkers of active disease. In this article, we described therapeutic recommendation also for Waldenström macroglobulinemia and other plasmacytic dyscrasias

Recommendations of Polish Myeloma Group concerning diagnosis and therapy of multiple myeloma and other plasmacytic dyscrasias for 2016

New drugs introduced in recent years for the therapy of multiple myeloma patients resulted in better responses and prolongation of overall survival. While therapeutic regimens based on bortezomib and thalidomide are recommended to most patients in first-line therapy, lenalidomide represents a cornerstone for treatment of relapsed/refractory myeloma patients. Most patients profit from prolonged treatment composed of consolidation and maintenance or treatment till progression. Beside concept of longer treatment, it is recommended to start therapy in some patients earlier, taking into consideration biomarkers of active disease. In this article, we described also therapeutic recommendation for Waldenström macroglobulinemia and other plasmocytic dyscrasias

Otępienie czołowo-skroniowe : ujęcie interdyscyplinarne

Publikacja recenzowana / Peer-reviewed publicationZe wstępu: Oddajemy do rąk Czytelników monografię Otępienie czołowo-skroniowe: ujęcie interdyscyplinarne, która stanowi oryginalny zbiór odpowiednio dobranych rozdziałów, opracowanych przez autorów z różnych specjalności medycznych i paramedycznych zajmujących się diagnozą i rehabilitacją osób z otępieniem. Otępienie czołowo-skroniowe stanowi nadzwyczaj ważki i trudny temat dla współczesnej neuronauki. Temat jest ważki przede wszystkim dlatego, że problemy związane z otępieniem w starszych latach dotyczą wciąż wzrastającej liczby osób, co stanowi nieunikniony, choć dość paradoksalny skutek przedłużenia się życia przeciętnego człowieka, bez proporcjonalnej poprawy jego kondycji fizycznej i psychicznej. Oznacza to m.in., że najprawdopodobniej mało kto z nas (tj. sami autorzy wraz z Czytelnikami) uniknie tego problemu w przyszłości, a ten dość przykry fakt czasami utrudnia proces utrzymywania należytego dystansu naukowego do tematu. Wiele rozdziałów publikowanych w tej książce jest owocem 13. Międzynarodowego Kongresu Polskiego Towarzystwa Neuropsychologicznego, zorganizowanego przez Krakowską Akademię im. Andrzeja Frycza Modrzewskiego w dniach 22 do 24 lutego 2010 roku. Uczestnicy kongresu podjęli panelową dyskusję, mającą na celu syntezę przyczyn i objawów otępienia czołowo-skroniowego. Główne tezy z tej dyskusji wykorzystano również w przygotowywaniu rozdziałów tej monografii

Studia z Dziejów Państwa i Prawa Polskiego T. XXI Badania nad rozwojem instytucji politycznych i prawnych

Tytuł finansowany przez: Krakowską Akademię im. Andrzeja Frycza Modrzewskiego, Uniwersytet im. Marii Curie-Skłodowskiej w Lublinie, Uniwersytet Gdański, Uniwersytet Warszawsk