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Aim: To determine efficacy and tolerability of dutogliptin, a dipeptidyl peptidase 4 (DPP4) inhibitor, in patients with type 2 diabetes mellitus. Methods: This was a 12-week, multicentre, randomized, double-blind, placebo-controlled trial in 423 patients with type 2 diabetes with suboptimal metabolic control. Following a 2-week single-blind placebo run-in, patients aged 18–75 years with a body mass index of 25–48 kg/m2 and baseline HbA1c of 7.3–11.0% were randomized 2:2:1 to receive once-daily oral therapy with either dutogliptin (400 or 200 mg) or placebo on a background medication of either metformin alone, a thiazolidinedione (TZD) alone or a combination of metformin plus a TZD. Results: Average HbA1c at baseline was 8.4%. Administration of dutogliptin 400 and 200 mg for 12 weeks decreased HbA1c by −0.52% (p < 0.001) and −0.35% (p = 0.006), respectively (placebo-corrected values), with absolute changes in HbA1c for the 400 mg, 200 mg and placebo groups of −0.82, −0.64 and −0.3%, respectively. The proportion of patients achieving an HbA1c < 7% was 27, 21 and 12% at dutogliptin doses of 400 and 200 mg or placebo, respectively (p = 0.008 for comparison of 400 mg vs. placebo). Fasting plasma glucose (FPG) levels were significantly reduced in both active treatment groups compared to placebo: the placebo-corrected difference was −1.00 mmol/l (p < 0.001) for the 400 mg group and −0.88 mmol/l (p = 0.003) for the 200 mg group. Dutogliptin caused significantly greater reductions in postprandial glucose AUC 0–2h in both the 400 and 200 mg groups (placebo corrected values −2.58 mmol/l/h, p < 0.001 and −1.63 mmol/l/h, p = 0.032, respectively). In general, patients tolerated the study drug well. There were minor, not clinically meaningful differences in adverse events (AEs) between dutogliptin-treated patients and placebo controls, and 60% of all reported AEs were mild. Vital signs and body weight were stable, and routine safety laboratory parameters did not change compared with placebo. Trough ex vivo DPP4 inhibition at the end of the 12-week treatment period was 80 and 70%, at the 400 and 200 mg doses of dutogliptin, respectively. Conclusions: Dutogliptin treatment for 12 weeks improved glycaemic control in patients with type 2 diabetes who were on a background medication of metformin, a TZD or metformin plus a TZD. Tolerability was favourable for both doses tested. The 400 mg dose of dutogliptin resulted in larger changes of HbA1c and FPG and more subjects reached an HbA1c target of < 7% than the 200 mg dose. [ABSTRACT FROM AUTHOR]

An 18-year-old woman presented with a 6-month history of amenorrhoea and hyperandrogenism. Three months later she developed several episodes of fasting hypoglycaemia and was subsequently diagnosed with an insulinoma. Hyperinsulinaemia was observed in association with an elevated serum testosterone level. Surgical removal of the insulinoma resulted in resolution of the clinical and biochemical features of the polycystic ovarian syndrome (PCOS). Polycystic ovarian syndrome is unusual in a patient having an insulinoma. The rarity of this association may be the result of the late age of onset of this type of tumour, intermittent secretion of excessive insulin by the tumour, the degree of hyperinsulinism or other factors extrinsic to the insulin receptor that may facilitate insulin activity. However, we could not discover how our patient differs in having had PCOS from the majority of women with insulinoma who do not. If other patients with insulinoma are subsequently found to have hyperandrogenism, then this tumour might be added to the differential diagnosis of causes of anovulatory cycles and hyperandrogenaemia, although rare the association would be uncommon. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a major health problem in the world. Several clinical trials have shown that some of the major complications of diabetes mellitus can be partially prevented or delayed by intensive glycaemic control. However, there are benefits and risks in aiming for near normal blood glucose levels. Intensive glycaemic control delays the onset and progression of retinopathy, nephropathy and neuropathy. Epidemiological and observational studies have shown that cardiovascular events may be correlated with the severity and duration of diabetes mellitus, but major randomised trials have only shown weak and nonsignificant benefits of intensive glycaemic management in decreasing event rates. A modest improvement in lipid profile results from blood glucose control although, in the majority of cases, not enough to reach current targets. Detrimental effects of intensive glycaemic control include bodyweight gain and hypoglycaemia. Controversial issues in the management of patients with diabetes mellitus include the unproven increase in cardiovascular morbidity from sulphonylureas and hyperinsulinaemia, and the still unknown long term effects of newer oral antihyperglycaemic agents alone or in combination with traditional therapies (such as sulphonylureas and metformin). It is important to individualise management in setting glycaemic goals. Control of cardiovascular risk factors through blood pressure and lipid control and treatment with aspirin (acetylsalicylic acid) and ACE inhibitors have consistently shown benefits in the prevention of both macro- and microvascular complications in patients with diabetes mellitus; these measures deserve priority. [ABSTRACT FROM AUTHOR]

This article studies the case of a 72 year old Asian man was transferred to our institution for work-up of hyponatraemia and an intrasellar mass. The patient had been exposed to ill children and reported symptoms of upper respiratory tract infection a week before presentation. Lumbar puncture findings were normal. Computed tomography of the head done at that point showed a 2.1 cm sellar mass with suprasellar extension, elevating the optic chiasm. The neuro-ophthalamic evaluation revealed bitemporal visual field defects with no papilloedema.

In this paper we report a novel way of processing CsI powder into poly-crystalline transparent plate by vacuum hot pressing technique. The fabricated CsI plate is investigated for its microstructure and phase purity. Further we have measured the luminescence and scintillation characteristics of this plate. These measurements establish that the polycrystalline plate can have application in radiation detection. Further the efficacy of the transparent CsI plate is shown for industrial X-ray radiography applications. Our results show that this kind of CsI plate can be economically fabricated and can replace the use of CsI single crystals and thin films in specific applications like radiation detection and industrial radiography. [ABSTRACT FROM AUTHOR]

• Impurity in raw materials/quartz crucible affects the quality of grown crystals. • Crucible designs play a crucial role for nucleation and further crystal growth. • High purity raw materials/fused quartz crucibles are vital for SrI 2 crystal growth. We report a systematic study on the growth of pure and Eu doped SrI 2 single crystals by Bridgman technique. The effect of various parameters pertaining to the impurity in raw material as well as in crucibles on the quality of the grown crystal has been experimentally checked and documented. Further we have also studied that nucleation behavior changes with selection of crucibles design. We have established that high purity raw material and OH free high pure fused quartz crucible enables the growth of good quality single crystal of pure SrI 2 and lower concentration of Eu doped SrI 2 without putting much effort in designing of crucible or furnace. For higher concentration of Eu doped SrI 2 single crystal growth, modification in crucible design is required to grow good quality single crystals. We believe that this work will guide young researchers struggling in growth of good quality single crystals of similar alkali halide scintillators. [ABSTRACT FROM AUTHOR]

A yellow light-emitting SrZnO2:Mn2+ nanophosphor was synthesized through a combustion process using metal nitrates as precursors and urea as fuel. The nanocrystals have sizes ranging from 25 to 30 nm. X-ray diffraction, transmission electron microscopy, photoluminescence (PL) and cathodoluminescence spectra were utilized to characterize the present samples. Crystallographically the occupancy of cations in SrZnO2 has been explained. Under the UV and the electron-beam excitation, the SrZnO2:Mn2+ nanoparticle shows a yellow emission due to the characteristic transition of the Mn2+ (4T → 6A1). To study oxygen-related defects and the surface chemical composition, the X-ray photoelectron spectroscopy technique was used. Surface chemical study suggests that oxygen vacancies may be generated by surface shrinkage due to the size reduction. For post-combustion annealing at 900 °C, the PL intensity of the nanopowders was increased due to better crystallinity and improved activity of the recombination centers. [ABSTRACT FROM AUTHOR]

Aim This study was designed to assess the efficacy and safety of the dipeptidyl peptidase IV inhibitor gemigliptin ( LC15-0444) 50 mg versus placebo in patients with type 2 diabetes. Methods We conducted a 24-week, randomized, double-blind, placebo-controlled phase III trial in 182 patients (74 from Korea and 108 from India) with type 2 diabetes. After an initial 2 weeks of a diet and exercise programme followed by 2 weeks of a single-blind placebo run-in period, eligible patients were randomized to gemigliptin 50 mg or placebo, receiving the assigned treatment for 24 weeks. HbA1c and fasting plasma glucose ( FPG) were measured periodically, and oral glucose tolerance test was performed at baseline and weeks 12 and 24. Results At week 24, gemigliptin treatment led to significant reductions in HbA1c measurements compared to placebo (adjust mean after subtracting the placebo effect size: −0.71%, 95% confidence interval: −1.04 to −0.37%). A significantly greater proportion of patients achieved an HbA1c <7% with gemigliptin than with placebo. The placebo-subtracted FPG change from baseline at week 24 was −19.80 mg/ dl. The overall incidence rates for adverse events were similar in the gemigliptin and placebo groups. Conclusions This study showed the efficacy and safety of gemigliptin 50 mg administered once daily as a monotherapy for type 2 diabetes patients. [ABSTRACT FROM AUTHOR]

Objective: The Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus (VA CSDM) was a multicenter randomized prospective study of 153 male type 2 diabetic patients to assess the ability to sustain clinically significant glycemic separation between intensive and standard treatment arms. A trend toward an excess of combined cardiovascular events in the intensive treatment arm of this trial was reported earlier. The present analysis was done to evaluate the effect of 2 years of intensive glycemic control on the left ventricular (LV) function.Research Design and Methods: The patients were randomized to intensive step treatment with insulin alone or with sulfonylurea (intensive treatment arm [INT], n = 75) or to standard once-daily insulin injection (standard treatment arm [STD], n = 78) treatment. A total of 136 patients (standard treatment arm [STD], n = 70; INT, n = 66) had radionuclide ventriculography at entry and at 24 months for the assessment of LV function.Results: There was no difference in the mean LV ejection fraction (at entry: STD 57.1+/-9.51%; INT 58.1+/-8.7%; at 24 months: STD 57.3+/-10.8%, INT 59.5+/-10.7%), peak filling rate (at entry: STD 2.6+/-0.7 end diastolic volume per second, INT 2.4+/-0.8 end diastolic volume per second; at 24 months: STD 2.7+/-1.0 end diastolic volume per second, INT 2.5+/-0.7 end diastolic volume per second), or time to peak filling rate (at entry: STD 195.3+/-69.5 ms, INT 185.6 +/-62.4 ms; at 24 months: STD 182.6+/-64.8 ms, INT 179.2+/-61.2 ms) between the 2 treatment arms. A subgroup analysis of 104 patients (STD, n = 53; INT, n = 51) that omitted individuals with intervening cardiac events/revascularization or a change in cardioactive medications also showed no difference in the LV function at entry and at 24 months between the 2 groups. Abnormal LV ejection fraction at baseline predicted cardiac events (interval between cardiac beats [RR] = 2.5).Conclusions: Two years of intensive glycemic control does not affect the LV systolic or diastolic function in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]