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Background: Continuous subcutaneous insulin infusion (CSII) therapy is a valuable option especially for people with type 1 diabetes. Although insulin infusion sets (IIS) are essential components of most insulin pump systems, only few studies have been conducted on their performance and safety. In this study 2 IIS with soft cannulas were compared. Methods: In an open-label, randomized, crossover, multicenter 8-week study 80 type 1 diabetic subjects on CSII (20-74 years, mean 46.5 ± 12.9 years, 58.8% male) were enrolled to evaluate the use of 2 IIS. The Accu-Chek® FlexLink Plus (FL Plus) and the Accu-Chek® FlexLink infusion set (FL) were used 4 weeks each under real-life conditions at home. All patients had to record details about every IIS change in a diary. Insertion-related pain was assessed by means of a visual analogue scale (VAS). Results: The mean pain noted during insertion was similar for both IIS (VAS 6.1 ± 6.4 mm for the FL Plus and 5.8 ± 6.3 mm for the FL, P = .92). 20.0% of the 895 IIS changes with FL Plus and 16.0% of the 854 with FL were unplanned. During the 4243 patient days of the study, 13 patients had adverse events. Among these, 2 serious adverse events occurred. Both serious events and 1 nonserious adverse event were considered as related to the IIS. Of the patients, 18.7% had kinked cannulas. Most patients were satisfied with both IIS. Conclusion: Both IIS are safe and effective. The 2 IIS did not differ from each other with respect to pain observed during insertion.

To evaluate the efficacy and tolerability of candesartan cilexetil 32 mg in combination with hydrochlorothiazide (HCT) 12.5 mg or 25 mg in hypertensive patients not optimally controlled with candesartan monotherapy.A total of 3521 patients with treated or untreated hypertension and sitting diastolic blood pressure (DBP) 90-114 mmHg, entered a single-blind run-in phase with candesartan (16 mg for 2 weeks, followed by 32 mg for 6 weeks). At the end of the run-in phase, 1975 patients who still had DBP 90-114 mmHg were randomized to 8 weeks' double-blind treatment with either candesartan 32 mg (n=654), or candesartan-HCT 32/12.5 mg (n=656), or candesartan-HCT 32/ 25 mg (n=665).At randomization, the mean blood pressure was similar in the three treatment groups (approximately 153/97 mmHg). It was reduced during the double-blind treatment phase by 6.1/5.6 mmHg in the candesartan 32 mg group, by 13.0/8.8 mmHg in the candesartan-HCT 32/12.5 mg group, and by 15.5/10.0 mmHg in the candesartan-HCT 32/25 mg group (p0.01 for all between treatment comparisons). All study treatments were generally well tolerated.Candesartan-HCT 32/12.5 mg and candesartan-HCT 32/25 mg are highly effective and provide improved blood pressure reduction and blood pressure control relative to candesartan 32 mg monotherapy, with maintained tolerability, in hypertensive patients whose blood pressure is not optimally controlled with candesartan monotherapy. Furthermore, candesartan-HCT 32/25 mg is more effective than candesartan-HCT 32/12.5 mg in this population.

The addition of a single injection of insulin to the oral drugs (basal supported oral therapy; BOT) has been shown to greatly reduce blood glucose levels. The intermediate-acting NPH insulin (NPH) and the long-acting insulin glargine (Lantus(®)) have been compared for use in BOT in numerous clinical trials; however, their efficacy and safety in a real-life setting have not been described.TIP (therapeutic benefits of patients on insulin glargine vs. NPH insulin being poorly controlled on prior short-time basal-insulin supported therapy with NPH insulin or insulin glargine) is a non-interventional, multicentre, observational study over 24 weeks. A total of 2629 patients were enrolled and 1931 were fully evaluable (1614 insulin glargine, 303 NPH insulin). Propensity scoring (PSM) was used to match 570 patients into 2 similar cohorts of 285 patients.In the PSM cohort, a slightly greater reduction in FBG and HbA1c levels was seen in the insulin glargine group compared to the NPH group. A weight loss, which was slightly more pronounced in insulin glargine patients despite receiving a lower insulin dose relative to the NPH group, was seen in both the groups. Additionally, hypoglycaemia, including nocturnal and severe events, was more prevalent in the patients receiving BOT with NPH. The occurrence of new micro- or macro-vascular complications and adverse events was low for both groups. A large proportion of patients changed from NPH therapy to insulin glargine therapy during the study, which was mainly attributable to insufficient glucose modulation. Improvements in quality of life and treatment satisfaction were found for both types of insulin.This observational study provides evidence from a real-life setting that BOT with insulin glargine provides slightly greater reductions in weight, FBG and HbA1c levels, with a lower risk of hypoglycaemia than patients receiving NPH. This conclusion indicates that insulin glargine may be preferable to NPH insulin for BOT.

BACKGROUND This study was undertaken to determine whether use of the direct renin inhibitor aliskiren would reduce cardiovascular and renal events in patients with type 2 diabetes and chronic kidney disease, cardiovascular disease, or both. METHODS In a double-blind fashion, we randomly assigned 8561 patients to aliskiren (300 mg daily) or placebo as an adjunct to an angiotensin-converting-enzyme inhibitor or an angiotensin-receptor blocker. The primary end point was a composite of the time to cardiovascular death or a first occurrence of cardiac arrest with resuscitation; nonfatal myocardial infarction; nonfatal stroke; unplanned hospitalization for heart failure; end-stage renal disease, death attributable to kidney failure, or the need for renal-replacement therapy with no dialysis or transplantation available or initiated; or doubling of the baseline serum creatinine level. RESULTS The trial was stopped prematurely after the second interim efficacy analysis. After a median follow-up of 32.9 months, the primary end point had occurred in 783 patients (18.3%) assigned to aliskiren as compared with 732 (17.1%) assigned to placebo (hazard ratio, 1.08; 95% confidence interval [CI], 0.98 to 1.20; P = 0.12). Effects on secondary renal end points were similar. Systolic and diastolic blood pressures were lower with aliskiren (between-group differences, 1.3 and 0.6 mm Hg, respectively) and the mean reduction in the urinary albumin-to-creatinine ratio was greater (between-group difference, 14 percentage points; 95% CI, 11 to 17). The proportion of patients with hyperkalemia (serum potassium level, = 6 mmol per liter) was significantly higher in the aliskiren group than in the placebo group (11.2% vs. 7.2%), as was the proportion with reported hypotension (12.1% vs. 8.3%) (P CONCLUSIONS The addition of aliskiren to standard therapy with renin-angiotensin system blockade in patients with type 2 diabetes who are at high risk for cardiovascular and renal events is not supported by these data and may even be harmful. (Funded by Novartis; ALTITUDE ClinicalTrials.gov number, NCT00549757.)

Insect-damaged rice plants emit a complex mixture of volatiles that are highly attractive to parasitic wasps. Indole is one constituent of insect-induced rice volatiles, and is produced in plants by the enzyme indole-3-glycerol phosphate lyase (IGL). The alpha-subunit of tryptophan synthase (TSA) is the IGL that catalyses the conversion of indole-3-glycerol phosphate to indole in the alpha-reaction of tryptophan synthesis; however, TSA is only active in the complex with the beta-subunit of tryptophan synthase and is not capable of producing free indole. In maize a TSA homolog, ZmIgl, is the structural gene responsible for volatile indole biosynthesis. Bioinformatic analysis based on the ZmIgl-sequence indicated that the rice genome contains five homologous genes. Three homologs Os03g58260, Os03g58300 and Os07g08430, have detectable transcript levels in seedling tissue and were expressed in both insect-damaged and control rice plants. Only Os03g58300, however, was up-regulated by insect feeding. Recombinant proteins of the three rice genes were tested for IGL activity. Os03g58300 had a low K(m) for indole-3-glycerol phosphate and a high k(cat), and hence can efficiently produce indole. Os07g08430 exhibited biochemical properties resembling characterized TSAs. In contrast, Os03g58260 was inactive as a monomer. Analysis of Os03g58300 expression and indole emission provides further support that Os03g58300 is the bona fide rice IGL for biosynthesis of indole, in analogy to maize, this gene is termed OsIgl. Phylogenetic analysis showed that the rice genes are localized in two distinct clades together with the maize genes ZmIgl and ZmBx1 (Os03g58300) and ZmTSA (Os03g58260 and Os07g08430). The genes in the two clades have distinct enzyme activities and gene structures in terms of intron/exon organization. These results suggest that OsIgl evolved after the split of monocot and dicot lineages and before the diversification of the Poaceae.

Benzoxazinoids are secondary metabolites that are effective in defence and allelopathy. They are synthesised in two subfamilies of the Poaceae and sporadically found in single species of the dicots. The biosynthesis is fully elucidated in maize; here the genes encoding the enzymes of the pathway are in physical proximity. This "biosynthetic cluster" might facilitate coordinated gene regulation. Data from Zea mays, Triticum aestivum and Hordeum lechleri suggest that the pathway is of monophyletic origin in the Poaceae. The branchpoint from the primary metabolism (Bx1 gene) can be traced back to duplication and functionalisation of the alpha-subunit of tryptophan synthase (TSA). Modification of the intermediates by consecutive hydroxylation is catalysed by members of a cytochrome P450 enzyme subfamily (Bx2-Bx5). Glucosylation by an UDP-glucosyltransferase (UGT, Bx8, Bx9) is essential for the reduction of autotoxicity of the benzoxazinoids. In some species 2,4-dihydroxy-1,4-benzoxazin-3-one-glucoside (DIBOA-glc) is further modified by the 2-oxoglutarate-dependent dioxygenase BX6 and the O-methyltransferase BX7. In the dicots Aphelandra squarrosa, Consolida orientalis, and Lamium galeobdolon, benzoxazinoid biosynthesis is analogously organised: The branchpoint is established by a homolog of TSA, P450 enzymes catalyse hydroxylations and at least the first hydroxylation reaction is identical in dicots and Poaceae, the toxic aglucon is glucosylated by an UGT. Functionally, TSA and BX1 are indole-glycerolphosphate lyases (IGLs). Igl genes seem to be generally duplicated in angiosperms. Modelling and biochemical characterisation of IGLs reveal that the catalytic properties of the enzyme can easily be modified by mutation. Independent evolution can be assumed for the BX1 function in dicots and Poaceae.

Benzoxazinoids were identified in the early 1960s as secondary metabolites of the grasses that function as natural pesticides and exhibit allelopathic properties. Benzoxazinoids are synthesized in seedlings and stored as glucosides (glcs); the main aglucone moieties are 2,4-dihydroxy-2H-1,4-benzoxazin-3(4H)-one (DIBOA) and 2,4-dihydroxy-7-methoxy-2H-1,4-benzoxazin-3(4H)-one (DIMBOA). The genes of DIBOA-glc biosynthesis have previously been isolated and the enzymatic functions characterized. Here, the enzymes for conversion of DIBOA-glc to DIMBOA-glc are identified. DIBOA-glc is the substrate of the dioxygenase BENZOXAZINLESS6 (BX6) and the produced 2,4,7-trihydroxy-2H-1,4-benzoxazin-3-(4H)-one-glc is metabolized by the methyltransferase BX7 to yield DIMBOA-glc. Both enzymes exhibit moderate K m values (below 0.4 mm) and k cat values of 2.10 s−1 and 0.25 s−1, respectively. Although BX6 uses a glucosylated substrate, our localization studies indicate a cytoplasmic localization of the dioxygenase. Bx6 and Bx7 are highest expressed in seedling tissue, a feature shared with the other Bx genes. At present, Bx6 and Bx7 have no close relatives among the members of their respective gene families. Bx6 and Bx7 map to the cluster of Bx genes on the short arm of chromosome 4.

Aus Acetessigester und Thioglykolsaureester erhalt man in der Kalte mit katalytischen Mengen alkoholischer Salzsaure eine „halbmercaptolartige” Verbindung, den β-Oxy-β-[carbathoxy-methylthio]-buttersaureester und in der Hitze eine „mercaptolartige”, den β.β-Bis-[carbathoxy-methylthio]-buttersaure-athylester. Bei der Dieckmannschen Esterkondensation liefert die erste Verbindung 3-Oxy-5-methyl-thiophen-carbonsaure-(2)-ester, letztere durch doppelten Ringschlus ein Derivat des Dihydrothiophthens. Mit Benzoylessigester konnten ahnliche Umsetzungen durchgefuhrt werden.

Durch Einwirkung von Phosphorpentachlorid oder Thionylchlorid auf Acetale des Glyoxals konnte in einfacher Weise eine Reihe von 1.2-Dichlor-1.2-dialkoxy-athanen hergestellt werden. Durch Umsetzung mit Phenylmagnesiumbromid entstanden Hydrobenzoinather, mit Kaliumacetat wurden 1.2-Dialkoxy-glykol-diacetate erhalten, mit Natriumalkoholaten entstanden gemischte Acetale des Glyoxals.

Die aus β-Ketosaureestern und Thioglykolsaure und anschliesender Veresterung entstehenden Mercaptole gehen mit alkohol. Kalilauge in der Kalte in 3-Hydroxy- thiophen-carbonsaure-(2)-ester uber.

Durch Einwirkung von Brom auf das dimere Methylendesoxybenzoin werden Tetrahydropyranderivate erhalten, die sich in 1.4-Diphenyl-1.4-dibenzoyl-butadien-(1.3) uberfuhren lassen. Durch Einwirkung von Brom geht dieses in eine von H. Kleinfeller auf anderem Weg erhaltene gelbe Verbindung vom Schmp. 212° uber, fur welche die Konstitution eines Indenderivates vorgeschlagen wird.

β-Aroyl-propionsauren kondensieren mit Ammoniumacetat unter Dimerisierung und Bildung von Pyrrolon-(2)-Derivaten.

Die Konstitution der durch doppelte Anlagerung von Thioglykolsaure-athylester an Acetylendicarbonsaure-diathylester mittels Piperidins erhaltenen Verbindung konnte durch unabhangige Synthese aus Oxalessigester als die eines α,α-Bis-[carbathoxy-methylmercapto]- bernsteinsaure-diathylesters festgelegt werden.

Es wurde die Darstellung von Glyoxal-tetraacetalen, ausgehend vom leicht zuganglichen Glyoxalsulfat und Alkoholen, genauer untersucht. Hierbei erwies sich ein Zusatz von Zinkoxyd als zweckmasig. Durch Umacetalisierung von Glyoxal-tetramethylacetal mit hoher siedenden Alkoholen konnten verschiedene Acetale neu gewonnen werden, wie Tetrabenzyl-, Tetracyclohexyl- und Dimethyl-dicyclohexyl-acetal. Durch Umsetzung der Tetraacetale mit Acetanhydrid entstanden Dialkoxy-athandiol-diacetate.

Methylendesoxybenzoine dimerisieren sich beim Stehenlassen, schneller beim Erhitzen, nach Art der Diensynthese zu Derivaten des 2.3-Dihydro-pyrans. Im Falle des Methylendesoxybenzoins und 4-Methoxy-methylendesoxybenzoins konnte die Konstitution der Dimeren durch oxydativen Abbau einwandfrei bewiesen werden. Eine Reihe anderer Dimerer wird beschrieben.

Durch Kondensation von Desoxybenzoinen mit Formaldehyd und Piperidin werden Methylendesoxybenzoine erhalten. Als α,β-ungesattigte Ketone addieren sie Grignard-Verbindungen in 1.4-Stellung unter Bildung von α-substituierten Desoxybenzoinen. Sie gehen leicht Michael-Addition ein und reagieren mit Acrylnitril und Vinylathern als Diene unter Bildung von Dihydropyranderivaten.