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IntroductionThe shape of the glucose curve during an oral glucose tolerance test (OGTT) reflects β-cell function in populations without diabetes but has not been as well studied in those with diabetes. A monophasic shape has been associated with higher risk of diabetes, while a biphasic pattern has been associated with lower risk. We sought to determine if phenotypic or metabolic characteristics were associated with glucose response curve shape in adults with type 2 diabetes treated with metformin alone.Research design and methodsThis is a cross-sectional analysis of 3108 metformin-treated adults with type 2 diabetes diagnosed ResultsThe monophasic profile was the most common (67.8% monophasic, 5.5% biphasic, 26.7% continuous rise). The monophasic subgroup was younger, more likely male and white, and had higher body mass index (BMI), while the continuous rise subgroup was more likely female and African American/black. HOMA2-S and fasting glucose did not differ among the subgroups. The biphasic subgroup had the highest early, late, and total insulin and C peptide responses (all pConclusionsBased on the large multiethnic GRADE cohort, sex, race, age, and BMI were found to be important determinants of the shape of the glucose response curve. A pattern of a continuously rising glucose at 2 hours reflected reduced β-cell function and may portend increased glycemic failure rates.Trial registration numberNCT01794143.

ML18147 evaluated continued bevacizumab with second-line chemotherapy for patients with metastatic colorectal cancer (mCRC) progressing after the standard first-line bevacizumab-containing therapy.Evaluating outcomes according to tumor Kirsten rat sarcoma virus oncogene (KRAS) status was an exploratory analysis. KRAS data were collected from local laboratories (using their established methods) and/or from a central laboratory (mutation-specific Scorpion amplification-refractory mutation system). No adjustment was made for multiplicity; analyses were not powered to detect statistically significant differences.Of 820 patients, 616 (75%) had unambiguous KRAS data; 316 (51%) had KRAS wild-type tumors and 300 (49%) had mutant KRAS tumors. The median progression-free survival (PFS) was 6.4 months for bevacizumab plus chemotherapy and 4.5 months for chemotherapy [P0.0001; HR = 0.61; 95% confidence interval (CI): 0.49-0.77] for wild-type KRAS and 5.5 and 4.1 months, respectively (P = 0.0027; HR = 0.70; 95% CI: 0.56-0.89) for mutant KRAS. The median overall survival (OS) was 15.4 and 11.1 months, respectively (P = 0.0052; HR = 0.69; 95% CI: 0.53-0.90) for wild-type KRAS and 10.4 versus 10.0 months, respectively (P = 0.4969; HR = 0.92; 95% CI: 0.71-1.18) for mutant KRAS. In both analyses, no treatment interaction by KRAS status was observed (PFS, P = 0.4436; OS, P = 0.1266).Bevacizumab beyond first progression represents an option for patients with mCRC treated with bevacizumab plus standard first-line chemotherapy, independent of KRAS status.

There is limited research about tobacco-related behaviours and attitudes among rural populations in the Eastern Mediterranean Region. The aim of this study was to determine smoking behaviours and attitudes among the nomadic Bedouin in rural southern Jordan. Patients visiting a village clinic over 2 months of 2009 were invited by the attending physician to participate in the survey, which was adapted from the California Tobacco Survey. The smoking prevalence among the 92 participants was 46.7%. Most smokers were men who smoked heavily (1 pack/day) (90.7%). There was general low self-efficacy to quit among smokers, yet 81.4% acknowledged that smoking was harming their health. Although 79.1% of smokers and 89.1% of non-smokers believed second-hand smoke was harmful to non-smokers, most of them had no restrictions on smoking for residents and guests (66.3%) and most had children at home (73.9%). These data demonstrate contradictions between attitudes and behaviours about smoking of this rural population.السلوكيات والمواقف المتعلقة بالتدخين لدى البدو في أرياف الأردنجيمن إيكارت، وائل خلف الدليميقليلةٌ هي البحوث حول المعتقدات والمواقف المتعلقة بالتدخين لدى سكان الأرياف في إقليم شرق المتوسط. وتهدف هذه الدراسة للتعرُّف على السلوكيات والمواقف بين البدو الرحّل في الأرياف جنوبيّ الأردن. وقد قام الطبيب المسؤول بدعوة المرضى الذين يزورون عيادة قروية على مدى شهرين في عام 2009 للمشاركة في هذا المسح الذي تم اقتباسُه من مسح كاليفورنيا للتبغ. واتضح للباحثين أن معدل انتشار التدخين لدى 92 مشاركاً في المسح هو 46.7% وأن معظم المدخنين هم من الرجال الذين يدخنون بشراهة (أكثر من علبة سجائر يومياً) (90.7%). وكانت الكفاءة الذاتية للإقلاع عن التدخين منخفضة بشكل عام بين المدخنين، إلا أن 81.4% منهم اعترفوا بأن التدخين ضار بصحتهم. وعلى الرغم من أن 79.1% من المدخنين و 89.1% من غير المدخنين كانوا يعتقدون أن الدخان السلبي ضار لغير المدخنين، فلم يكن لدى معظمهم (66.3%) أيَّة قيود يفرضها على تدخين الساكنين أو الضيوف مع أن معظمهم (73.9%) كان لديهم أطفال في المنزل، وتشير هذه المعطيات إلى التناقض بين المعتقدات والسلوكيات حول التدخين لدى سكان الأرياف.Comportements et attitudes en matière de tabagisme dans une population bédouine en Jordanie rurale.Les travaux de recherche sur les comportements et les attitudes concernant le tabac sont limités dans les populations rurales de la Région de la Méditerranée orientale. La présente étude visait à déterminer les comportements et les attitudes en matière de tabagisme chez les Bédouins nomades du sud rural de la Jordanie. Pendant deux mois en 2009, les patients en consultation dans un centre de santé de village ont été invités par le médecin traitant à participer à l'étude, adaptée du California Tobacco Survey. La prévalence du tabagisme chez les 92 participants était de 46,7 %. La plupart des fumeurs (90,7 %) étaient des hommes ayant une forte consommation de tabac (1 paquet/jour). Le sentiment d'auto-efficacité pour le sevrage tabagique était généralement faible chez les fumeurs, tandis que 81,4 % reconnaissaient que le tabagisme était nocif pour leur santé. Si 79,1 % des fumeurs et 89,1 % des non-fumeurs étaient convaincus que le tabagisme passif était nocif pour les non-fumeurs, la majorité d'entre eux n'avait aucune restriction sur la consommation de tabac à leur domicile pour les membres du foyer comme pour les invités (66,3 %) alors que la plupart avaient des enfants à la maison (73,9 %). Ces données mettent en évidence des contradictions entre les attitudes et les comportements au sujet du tabagisme dans cette population rurale.

We present for the first time a full three-dimensional (3-D) reconstruction of absorption images of breast from continuous-wave (cw) measurements performed on a premenopausal woman. Our 3-D optical images clearly reveal a large primary tumor as well as a small secondary tumor in a separate location of the breast. The multiple tumors identified by our 3-D optical imaging have been confirmed by the subsequent biopsy examination of the breast. Quantitative information of the optical images obtained is provided in terms of the location, size, and absorption coefficient of the tumors.

There is still controversy as to what constitutes the optimal therapy for acute and delayed chemotherapy-induced emesis and nausea. We conducted a three-armed randomized multi-centre study in 193 chemotherapy-naive patients receiving highly emetogenic chemotherapy inducing both acute and delayed symptoms (cisplatinor = 50 mg/m2, carboplatinor = 300 mg/m2, cyclophosphamideor = 750 mg/m2, ifosfamideor = 1.5 g/m2 on day 1). Group A: 1 x 5 mg tropisetron i.v. on day 1 + 2, then 10 mg p.o. (oral dose now recommended: 5 mg); group B: tropisetron as for A+dexamethasone, 20 mg i.v., on days 1 + 2, then 4 mg i.v./p.o.; group C: tropisetron as for A+metoclopramide, 20 mg i.v. +2 x 10 mg p.o. on day 1, then 3 x 10 mg p.o. Treatment was continued for at least 2 days after the end of chemotherapy. Tropisetron+dexamethasone was significantly superior to tropisetron alone both for acute (P = 0.0064) and delayed (P = 0.0053) emesis. Complete control of acute and delayed emesis (nausea) was achieved in 80% (75%) and 53% (46%) in group A, 97% (90%) and 80% (58%) in group B, and 86% (80%) and 49% (45%) in group C. Patients completely asymptomatic during the whole cycle accounted for 26% of those in group A, 49% in group B and 28% in group C. The most frequent adverse events were constipation (16.6%), headache (7.3%) and tiredness (7.3%). Once-daily tropisetron+dexamethasone over several days is well tolerated and is a simple means of achieving further significant improvement in the efficacy of tropisetron against acute and delayed symptoms.

We report an open, three-armed, multicenter study being carried out to assess the optimum treatment for acute and delayed emesis and nausea in patients undergoing highly emetogenic chemotherapy. Eighty-seven patients were randomized to receive tropisetron (Navoban; Sandoz Pharma Ltd, Basel, Switzerland), tropisetron plus dexamethasone, or tropisetron plus metoclopramide during chemotherapy. Tropisetron in combination with dexamethasone produced the best control of both acute and delayed emesis. Acute vomiting was prevented in 69% of patients by tropisetron monotherapy, and the addition of dexamethasone significantly increased the total control of vomiting to 92% (P.01). Similarly for delayed vomiting, total control of emesis was seen in approximately 70% of patients on tropisetron alone during days 2 and 3; this control rate increased to almost 90% with combined tropisetron/ dexamethasone treatment. In all patients receiving cisplatin, the tropisetron/dexamethasone combination produced total control of acute emesis. The tropisetron and dexamethasone combination also provided the best control of acute and delayed nausea. Tropisetron produced total control of acute nausea in 69% of patients. The addition of dexamethasone increased this control rate to 81%. Similarly for delayed nausea, on days 2 and 3 of treatment, dexamethasone plus tropisetron provided total control of nausea in more than 80% of patients compared with a control rate of more than 60% achieved using tropisetron. The combination of tropisetron and metoclopramide did not improve significantly on the control of nausea and vomiting achieved using tropisetron alone. Evaluation of quality of life events by patients indicated no appreciable change in their mental or physical condition during chemotherapy, irrespective of antiemetic therapy. In the tropisetron and tropisetron plus metoclopramide treatment groups, a decreased food intake was observed due to delayed nausea while the addition of dexamethasone prevented loss of appetite. The antiemetic treatments were similarly well tolerated. The most common adverse events were constipation (15%) and tiredness (7%).

Monocyte antibody-dependent cell-mediated cytotoxicity (ADCC) was compared to intrinsic cyclic-adenosine-monophosphate (cAMP) levels in 14 patients with systemic sclerosis. Depressed monocyte cytotoxicity was observed. Elevated cAMP levels (2-5 times) in resting monocytes were found in 5 patients; the rest had normal cAMP values. Monocyte ADCC was inversely correlated to cellular cAMP content (r = -0.6659, P less than 0.02). Scleroderma patients with high basal cAMP levels showed impaired responses to beta-adrenergic stimulation but not to prostaglandin E (PGE1) and histamine. Patients with normal basal cAMP levels showed no defect in beta-adrenergic responses. No close correlation between monocyte abnormality and clinical state was found.

In 7 penicillamine-treated patients with generalized scleroderma zinc in serum, erythrocytes and granulocytes, alkaline phosphatase activity in serum and granulocytes, carbonic anhydrase activity in erythrocytes were examined. No significant difference was found between patient and control values, but granulocyte zinc strongly tended to be decreased (0.1 greater than p greater than 0.05). It is our hypothesis that penicillamine may produce a zinc depletion at a cellular level.

This study compares prostaglandin E2 (PGE2) gel and oxytocin for the initiation of labor in term pregnancies with a moderately favorable cervix (Bishop score 5-8). Compared with a matched group, 48 cases treated with PGE2 gel (2.5 mg intravaginally) required significantly less or no oxytocin, had shorter first stages of active labor, and had no increased risk of uterine hyperstimulation or cesarean section. Initiation of labor with low dose PGE2 when the cervix is moderately favorable is less labor intensive and meets with more patient satisfaction.