Double-blind, randomized, multicentre, and active comparator controlled investigation of the effect of Pioglitazone, Metformin, and the combination of both on cardiovascular risk in patients with type 2 diabetes receiving stable basal insulin therapy: the PIOCOMB study

<p>Abstract</p> <p>Background</p> <p>We analyzed specific effects of an add-on therapy with pioglitazone compared to metformin and their combination in patients with basal insulin treatment on biomarkers of CV risk.</p> <p>Methods</p> <p>In this double-blind, randomized, multicentre, active comparator controlled trial, 121 patients with type 2 diabetes were enrolled. Inclusions: treatment with basal insulin, HbA_1C6.5% - 8.5%, age 30 - 75 years. After glargine therapy over 2 weeks for titration towards FBG ≤ 7.8 mmol/L, patients received either (A) bid 850 mg metformin (n = 42), (B) bid 15 mg pioglitazone (n = 40), or (C) 30 mg pioglitazone plus 1.7 g metformin (n = 39) over 6 months. Matrix Metal Proteinase 9 (MMP-9) was primary objective, together with biomarkers of CV risk.</p> <p>Results</p> <p>Pioglitazone (B) reduced MMP-9 versus baseline by 54.1 + 187.1 ng/mL, with metformin (A) it was increased by 49.6 + 336.2 ng/mL (p = 0.0345; B vs. A), and with the combination of both (C) it was decreased by 67.8 + 231.4 ng/mL (A vs. C: p = 0.0416; B vs. C: p = 0.8695). After logarithmic transformation due to high variances the exploratory results showed significance for A vs. B (p = 0.0043) and for A vs. C (p = 0.0289).</p> <p>Insulin dosage was reduced by 7.3 units in group B (p < 0.0001), by 6.0 units in C (p = 0.0004), but was increased by 2.5 units (p = 0.1539) in A at follow up. Reduction in hs-CRP was significant within treatment groups for B (p = 0.0098) and C (p < 0.0001), and between the groups for A vs. C (p = 0.0124). All three single regimens reduced PAI-1. Adiponectin was significantly elevated in B and C (p < 0.0001) and between-groups. HbA_1Cwas only significantly decreased in the combination group. No significant effects were observed for NFkB and PGFα. peripheral edema were seen in 11.9% vs. 40.0% vs. 20.5%, and weight change was -0.7 kg vs. +4.3 kg vs. +2.7 kg (A vs. B vs. C).</p> <p>Conclusions</p> <p>Addition of pioglitazone but not of metformin reduces MMP-9, hs-CRP and increased insulin sensitivity and adiponectin in this study. The combination of both had no additional effect on inflammation. Pioglitazone is suggested to be a rational add-on therapy to basal insulin in patients with high CV risk.</p

CFD Simulation and Grid Study of a Cavitating Orifice Flow

A cavitating flow through an orifice is investigated by the use of computational fluid dynamics (CFD) with an ANSYS CFX solver. Turbulence is described by the Menter shear stress transport (SST) model, mass transfer due to cavitation by the Rayleigh - Plesset based default cavitation model. A grid study following the best practice guidelines known from literature has shown as not sufficient enough for the simulation of a cavitating flow. When refining the grid monitor values e. g. the mass flow rate reached convergence at a certain amount of elements, whereas the cavitation zones itself changed in shape and location until a significantly high resolution is reached. The SST turbulence model calculates the boundary layer with a wall function approach at high YPLUS values and resolves it at small YPLUS values. The accuracy of the simulation was increased by avoiding the use of the wall function approach

Online matching on a line

We prove a lower bound ρ ≥ 9.001 for the competitive ratio of the so-called online matching problem on a line. As a consequence, the online matching problem is revealed to be strictly more difficult than the "cow problem". \u

Betriebswirtschaftliche Grundlagen im Krankenhaus

In diesem Lehrbuch werden die theoretischen Grundlagen für eine Betriebswirtschaftslehre in Gesundheitseinrichtungen gelegt, praktisch aufbereitet und mit vielen Aufgaben und Fallbeispielen vertieft. Die Autoren setzen sich dabei insbesondere mit dem Leistungsgeschehen in Krankenhäusern im Spannungsfeld von ökonomischer Verantwortung und sozialem Handeln auseinander und treten einer Kundensicht entgegen, die den Patienten in ein ökonomisches Objekt transferiert. Prof. Dr. Winfried Zapp vertritt das Lehrgebiet Controlling in Gesundheitseinrichtungen an der Hochschule Osnabrück. Dr. Julia Oswald leitet das Konzerncontrolling der Paracelsus-Kliniken. Prof. Dr. Uwe Bettig lehrt an der Alice Salomon Hochschule (Berlin) Management und Betriebswirtschaft in gesundheitlichen und sozialen Einrichtungen. Dr. Christine Fuchs ist Ärztin für Chirurgie und leitet das Projektmanagement der Mühlenkreiskliniken AöR