Efficacy and safety of vildagliptin in clinical practice-results of the PROVIL-study

AIM:To investigate efficacy and safety of vildagliptin compared to other oral antidiabetics in clinical practice in Germany.METHODS:In this prospective,open,observational study,patients with type 2 diabetes mellitus(T2DM) previously on oral monotherapy were selected by their treating physician to receive either vildagliptin addon to metformin(cohort 1),vildagliptin+metformin single-pill combination(SPC)(cohort 2)or another dual combination therapy with oral antidiabetic drugs(OADs)(cohort 3).According to routine clinical practice,interim examinations occurred every 3 mo:at baseline,after approximately 3 mo and after approximately 6 mo.Parameters documented in the study included demographic and diagnostic data,history of T2DM,data on diabetes control,vital signs,relevant prior and concomitant medication and disease history.Efficacy was assessed by changes in HbA1c and fasting plasma glucose(FPG)3 mo and 6 mo after initiation of dual combination therapy.Safety was assessed by adverseevent reporting and measurement of specific laboratory values(serum creatinine,total bilirubin,alanine aminotransferase,aspartate aminotransferase,creatine kinase).RESULTS:Between October 2009 and January 2011,a total of 3881 patients were enrolled in this study.Since 47 patients were withdrawn due to protocol violations,3834 patients were included in the statistical analysis.There were no relevant differences between the three cohorts concerning age,body weight and body mass index.Average diabetes duration was approximately 6 years and mean HbA1c was between 7.6%and 7.9% at baseline.Antidiabetic treatment was recorded in 3648 patients.Patients were treated with vildagliptin add-on to metformin(n=603),vildagliptin+metformin(SPC)(n =2198),and other oral OADs including combinations of metformin with sulfonylurea(n=370),with glitazones(n =123),other dipeptidyl peptidase-4 inhibitors(n=99).After 6 mo of treatment,the absolute decrease in HbA1c(mean±SE)was significantly more pronounced in patients receiving vildagliptin add-on to metformin(-0.9% ±0.04%)and vildagliptin+metformin(SPC)(-0.9%± 0.03%)than in patients receiving other OADs(-0.6% ±0.04%;P<0.0001).In addition,significant cohort differences were observed for the improvement in FPG after 6 mo treatment(vildagliptin add-on to metformin:-291 mg/L±18.3 mg/L;vildagliptin+metformin(SPC):-305 mg/L±9.6 mg/L;other antidiabetic drugs:-209 mg/L±14.0 mg/L for(P<0.0001).Moderate decreases in body weight(absolute difference between last control and baseline:mean±SE)were observed for patients in all cohorts(vildagliptin add-on to metformin:-1.4 kg ±0.17 kg;vildagliptin+metformin(SPC):-1.7 kg± 0.09 kg;other OADs:?0.8 kg±0.13 kg).No significant differences in adverse events(AEs)and other safety measures were observed between the cohorts.When performing an additional analysis by age(patients<65 years vs patients≥65 years),there was no relevant difference in the most common AEs between the two age groups and the AE profile was similar to that of the overall patient population.CONCLUSION:Clinical practice confirms that vildagliptin is an effective and well-tolerated treatment in combination with metformin in T2DM patients.

The eligibility criteria,training content,and scope of practice for prescriptive authority for midwives:a modified Delphi study

Objective:To investigate the necessary eligibility criteria for prescriptive authority for midwives,gather suggestions from experts on training content for prescriptive authority for midwives,and explore the scope of practice of their prescriptive authority in certain circumstances.The results of this study could serve as a reference for the development of policies on prescriptive authority for midwives.Methods:Based on a literature search and semistructured interviews,a modified Delphi method was first used to conduct 2 rounds of expert consultation on eligibility criteria and training content for prescriptive authority for midwives.This stage included nursing experts(20)and medical experts(16)engaged in midwifery in many tertiary Grade A hospitals in China.Subsequently,consultation on the scope of practice of prescriptive authority for midwives was conducted with nursing experts(18)and medical experts(14)engaged in midwifery in many tertiary Grade A hospitals in China.The suggestions from the experts were analyzed using statistical methods to confirm the eligibility criteria for prescriptive authority,training content,circumstances,scope of practice for prescriptive authority,and the prescription forms.Results:Among the consulted experts,70.59%(the highest acceptance rate)considered an undergraduate degree to be the minimum educational requirement for midwives to be eligible for prescriptive authority,85.29%(the highest acceptance rate)considered the supervisor nurse to be the minimum technical position experience necessary for midwives to be eligible for having prescriptive authority,and 50%(the highest acceptance rate)considered 5 years to be the minimum number of years of experience in the specialty for midwives to be eligible for prescriptive authority.The applicants should at least be practicing at Grade C hospitals,which was the consensus among 91.18%of the consulted experts.Among the consulted experts,100%,100%,97.06%,94.12%,and 94.12%agreed that the applicants should have knowledge in pharmacology,laws and ethics,nursing,diagnostics,and midwifery,respectively.The consulted experts confirmed 22 related course topics and identified 6 specific circumstances in which the midwives could partially practice prescriptive authority,including uterine atony,excessive uterine contraction,postpartum hemorrhage,premature rupture of fetal membranes,normal labor,and neonatal asphyxia.Under these 6 circumstances,the consulted experts commonly agreed that there were 20 medication prescriptions and 13 auxiliary examination prescriptions that could be prescribed by midwives.Of these prescriptions,51.5%were independent prescriptions,30.3%were protocol prescriptions,and the remaining 18.2%were both independent and protocol prescriptions.Conclusions:Midwives who have an undergraduate degree,supervisor nurse position,and 5 years of practice in Grade C hospitals are considered eligible to apply for prescriptive authority.Partial prescriptive authority could be granted after regulated training in fundamental theories and practices,which could improve the independence and professionalism of midwifery.

Knowledge,attitude,and practice of patients living with inflammatory bowel disease:A cross-sectional study

BACKGROUND Patients with inflammatory bowel diseases(IBDs)generally have poor knowledge,attitude,and practice of their disease,while the data from China are lacking.AIM To address this knowledge disparity among Chinese patients with IBD.METHODS This web-based,cross-sectional study was conducted on a cohort of IBD patients who visited the Second Affiliated Hospital of Wenzhou Medical University between December 2022 and February 2023.Their socio-demographic information and the knowledge,attitude,and practice scores were collected and estimated using a self-designed questionnaire.Pearson’s correlation analysis was used to determine the pairwise correlations among knowledge,attitude,and practice scores.A multivariate logistic regression analysis was further performed to determine the independent factors associated with their knowledge,attitude,and practice scores.RESULTS A total of 353 patients(224 males)with IBD completed the questionnaires.The mean knowledge,attitude,and practice scores were 10.05±3.46(possible range:0-14),41.58±5.23(possible range:0-56),44.20±7.39(possible range:0-56),respectively,indicating good knowledge,positive attitude,and proactive practice toward IBD.Pearson’s correlation analysis showed that the knowledge score had significant positive correlations with the attitude score(r=0.371,P<0.001)and practice score(r=0.100,P<0.001).The attitude score had a significant positive correlation with the practice score(r=0.452,P<0.001).Moreover,multivariate logistic regression analysis showed that aged 30-40 years[odds ratio(OR)=4.06,95%confidence interval(CI):1.04-15.82,P=0.043],middle school education(OR=3.98,95%CI:1.29-12.33,P=0.017),high school/technical secondary school education(OR=14.06,95%CI:3.92-50.38,P<0.001),and junior college/bachelor’s degree and above education(OR=15.20,95%CI:4.15-55.650,P<0.001)were independently associated with good knowledge.The higher knowledge score was independently associated with a positive attitude(OR=1.23,95%CI:1.11-1.36,P<0.001).The higher attitude score was independently associated with proactive practice(OR=1.20,95%CI:1.11-1.30,P<0.001).CONCLUSION Chinese patients with IBD might have good knowledge,a positive attitude,and proactive practice toward their disease.However,a small number of specific items require education.

Feelings and Spiritual Practices of Patients with Mastectomy: A Qualitative Study from Turkey

Purpose: This study was conducted to describe feelings and spiritual practices of patients with mastectomy. Method: The study was employed a qualitative design at a private university hospital oncology unit in Ankara, Turkey. Interviews were performed with 20 mastectomized women. Results: The findings indicated that commonly used in several spiritual practices;prayer was used by 96%, of the patients, and 94% requested that others pray for their health, the practice to positive reframing (76%), the practice to planning for family-friends activities (74%), visiting mos-que-shrine (73%), and the practice to reading Quran (71%). The categorization of the data led to identification of three thematic units. The first we described as “Experiencing the consequences of illness as a disorder”. The second was “Restoring a sense of order to life”, and the third was “Living with the new condition”. Conclusion: We concluded that a having mastectomy was difficult for the subjects. In this respect, nurses’ role is vital to help women with breast cancer in such a difficult and modifying process as breast removal.

Clinical study of combination therapy of tamsulosin and solifenacin for benign prostatic hyperplasia with overactive bladder

Objective To evaluate the efficacy and safety of combination therapy of tamsulosin and solifenacin for benign prostatic hyperplasia ( BPH) with overactive bladder ( OAB) . Methods 82 patients with OAB and coexisting BPH were randomly divided into tamsulosin group ( n

Literature Review of the Prevalence of Hypertension at Gulu University, Gulu City, Acholi Subregion, Northern Uganda

Hypertension is a big problem worldwide. The purpose of this study is to examine the prevalence, knowledge, attitude, and practice about hypertension at Gulu University, Gulu city, Gulu district, Acholi subregion, Northern Uganda. A literature search on hypertension was done. It showed that, in Uganda, a representative number of 17,777 adult patients’ data were analyzed from January 2014 to February 2024. The epidemiological data on awareness of hypertension was found to be at 8%. Of this, 18.3% of the people with hypertension had it under control. The results of the findings were promising. Hypertension is an important public health challenge in Uganda particularly in Northern Uganda where Gulu University falls. In comparison with the two regions of Central Uganda and Northern Uganda, there was a significant number of populations that were not aware of their condition. Those diagnosed were on treatment but the treatment was not adhered to due to stock outs of medicines. Therefore, Measures are required to prevent hypertension, improve awareness, treatment and control within the community, especially at Gulu University where research has never been done.

Experimental Study on Bubble Pulse Features Under the Combined Action of Horizontal and Vertical Walls

The pulse features of a bubble have a close connection with the boundary condition. When a bubble moves near a rigid wall, it will be attracted by the Bjerknes force of the wall, and a jet pointing at the wall will be generated. In real application, the bubble may move under the combined action of walls in different directions when it forms at the corner of a pipe or at the bottom of a dam. The motion of the bubble shows complex and nonlinear characteristics under these conditions. In order to investigate the bubble pulse features near complex walls, a horizontal wall and a vertical wall are put into the experimental water tank synchronously, and an electric circuit with 200 voltages is designed to generate discharge bubbles, and then experimental study on the bubble pulse features under the combined action of horizontal and vertical walls is carried out. The influences of the combined action of two walls on the bubble shape, pulse period, moving trace and inside jet are obtained by changing the distances from bubble center to the two walls. It aims at providing references for the relevant theoretical and numerical research.

Combined Effect of Smoking and Obesity on Coronary Heart Disease Mortality in Male Veterans:A 30-year Cohort Study

Objective Evidence is lacking regarding the combined effects of smoking and obesity on mortality from coronary heart disease in male veterans.This study aimed to explore the combined effect of smoking and obesity on coronary heart disease mortality in male veterans in China.Methods A cohort of 1,268 male veterans from 22 veteran centers in Xi’an(Shaanxi Province,China)were followed up once every 2 years from February 1,1987 to October 30,2016.The endpoint was death from any cause.The hazard ratio(HR)of each risk factor and the 95%confidence interval(CI)were calculated using a multivariate Cox proportional hazard model.Results The total follow-up was 24394.21 person-years;each subject was followed up for a mean duration of 19.24 years.By the end of the study,of the 1,268 veterans,889 had died,363 were alive,and 16 were lost to follow-up.Cox regression analysis results revealed that current smoking(HR:1.552,95%CI:1.074–2.243),obesity(HR:1.625,95%CI:1.024–2.581),and the combined effect of the two factors(HR:2.828,95%CI:1.520–5.262)were associated with coronary heart disease mortality.Conclusion Our results suggest that obese veterans who smoke might be an important target population for coronary heart disease mortality control.

Combined Influence of Insulin Resistance and Inflammatory Biomarkers on Type 2 Diabetes:A Population-based Prospective Cohort Study of Inner Mongolians in China

This prospective study was designed to examine the combined influence of insulin resistance（IR）and inflammatory biomarker levels on type 2 diabetes mellitus（T2DM）among 1,903Inner Mongolians.

A Biochemical Study on Combined Treatment of Experimental Silicosis with Tetradrine-PVNO and Tetradrine-QOHP in Rats

A better understanding is needed to explain the mechanism of therapeutic effect of combined use of tetradrine-PVNO and tetradrine-QOHP which play very important roles in treatment of silicosis. Blood prolidase (PLD), monoamine oxidase (MAO) and plasminogen (PLG) in silicotic rats after treatment with tetradrine-PVNO or tetradrine-QOHP were measured. The values obtained were compared with the untreated silicotic rats. It was found that the silicotic rats that received tetradrine-PVNO showed significant increase in PLD and decrease in PLG, but no significant change in MAO. The PLD in plasma of silicotic rats that received tetradrine-QOHP were elevated significantly, but PLG and MAO did not change appreciably. These findings suggest that the combined use of tetradrine-PVNO and tetradrine-QOHP can accelerate the degradation of collagen in silicotic rats

A PRELIMINARY STUDY OF THE EFFECTS OF CHEMOTHERAPEUTICAGENTS IN COMBINATION WITH CHINESE HERBAL COMPOUNDS AS IMMUNOMODULATORS IN MOUSE S_(180)

The effect of the Chinese herbal compound (CHC) on solid sarcoma 180 (S180) in Swiss mice was studied either alone or in combination with 5-fluorouracil (5FU), cyclophosphamide (CYT) or mitomycin C (MMC). The preliminary results indicated that combination treatment seemed to possess better antitumor activity than chemotherapy alone. The treatment with CHC alone however had neither an obvious antitumor effect in tumor bearing mice nor toxicity in normal mice. These results show that CHC may stimulate organs of the immune system such as the spleen to be im-munomodulators and enhance the antitumor activity of some chemotherapeutic agents.

Comparative Study of Traditional Chinese Medicine and Western Medicine in the Treatment of Coronavirus

Taking the process of treating coronavirus disease 2019(COVID-19)with Western medicine and traditional Chinese medicine(TCM)as the research object,this article compares the characteristics of Western medicine and TCM from the perspectives of aetiology,pathogenesis,diagnosis,and treatment.Western medicine and TCM each has its own theoretical system.Each has its own exposition in explaining the etiology and pathogenesis of the disease,and each has its own characteristics and advantages in diagnosis and treatment.Integrating TCM and Western medicine can improve the effect of treatment by forming a coordinated traditional Chinese and Western medicine treatment method.

A Clinical and Experimental Study on the Protective Effects of Jiangzhi Tongmai Fang on Endothelial Injury

31 cases of atherosclerosis (AS) were treated with Jiang Zhi Tong Mai Fang ([symbol: see text], formula of JZTMF), and its effect was compared with 30 cases treated with lovastatin in the control group. Clinically, the JZTMF formula showed an effect of regulating blood lipids, and therefore it was antiatherosclerotic. The mechanism is, probably, restoration of the function of endothelial cells (EC) by increasing the synthesis of 6-keto-PGF1 alpha and decreasing the release of endothelin (ET) as evidenced in the experimental study.

A comparative study of pancreatic endocrine function and related metabolism after long-term survival between the patients with combined kidneypancreas transplantation vs those with combined en bloc ' liver-pancreas transplantation

Objective To compare the effects of combined en bloc liver - pancreas transplantation ( LPT) with portal vein drainage and simultaneous combined kidney - pancreas transplantation ( KPT) with systemic venous drainage on the pancreatic endocrine function and related me-

Factors influencing the diagnosis and treatment of chronic prostatitis among urologists in China

Aim. To identify the factors influencing diagnosis and treatment of chronic prostatitis （CP） among Chinese urologists. Methods： A sample of 656 urologists from 29 provinces of China were asked to complete a questionnaire that explored attitudes towards CP as well as diagnosis and treatment patterns in the management of CP. Both univariate and multivariate logistic regression analysis schemes were used to determine the factors that influence the diagnosis and treatment of CP. Results： A total of 656 questionnaires were given out. All were returned and 410 of those were included in the final univariate and multivariate analysis. Multivariate logistic regression analysis indicated that belief of bacterial infection in the etiology of CP （odds ratio [OR], 2.544; 95% confidence interval [CI], 1.650-3.923; P 〈 0.001） was the most significant factor influencing the routine performance of bacterial culture test. Using the same model, the type of hospital （OR, 2.799; 95% CI, 1.719-4.559; P 〈 0.001） and the routine use of the 4- or the 2-glass test （OR, 3.194; 95% CI, 2.069-4.931; P 〈 0.001） were determined to be significant factors influencing the use of the National Institutes of Health （NIH） new classification system. According to the same model, belief of bacterial infection in the etiology of CP （OR, 3.415; 95% CI, 2.024-5.762; P 〈 0.001） and the routine use of bacterial culture test （OR, 2.261; 95% CI, 1.364-3.749; P 〈 0.01） were important factors influencing the routine prescription of antibiotics. Conclusion： Our findings suggest that attitudes towards CP, and the characteristics of individual urologists＇ practices may influence the diagnosis and treatment of CP among Chinese urologists.

Experimental Study on Tensile Properties of Steel Plate Bonded by CFRP

The tensile properties of five groups of composite specimens, which consist of steel plate bonded by CFRP,were experimentally researched. The failure types, performing characteristics and failure mechanism of the composite specimens were investigated in detail. The influence of different ratio of CFRP on bearing capacity, loading-strain curves, compound modulus, rigidity and ductility of the composite specimens was analyzed. The experimental results indicate that the composite specimen can work harmonically and the steel plate does not break in tension. Comparing with steel plate, the bearing capacity and the rigidity of the composite specimens increase and ductility decreases. The bearing capacity increases sharply with the increase in the number of layers of CFRP. With the increase in CFRP, the yield strength increases slightly and ductility decreases. The experimental researches can provide a theoretical basis for engineering application of combination strengthening.

Evaluation of the Impact of Presence Lighting and Digital Speed Limit Trailers on Interstate Speeds in Indiana Work Zones

Work zone safety continues to be one of the important focus areas for transportation agencies. Previous studies have identified that vehicle speed and lighting conditions are significant risk factors impacting work zone safety. This study evaluated the impact of the use of presence lighting and digital speed limit trailers on nighttime motorist speeds using commercially available connected vehicle speed data. Geospatial analysis was conducted on over 500,000 connected vehicle records to linear reference nearly 18,000 records from 195 unique trajectories to study section during the study period of 2 days. Results showed that median speeds reduced by 4 to 13 mph from 11PM to 7AM during the deployment of presence lighting and speed limit trailers compared to base conditions. A Kolmogorov-Smirnov (KS) statistical test comparing 105 vehicles traveling through the construction zone with presence lighting and speed limit trailers with a group of 90 vehicles during base condition indicated the speeds during the deployment of presence lighting and speed limit trailers were lower than the base condition. Also, increased compliance with the 55 mph speed limit was observed when the presence lighting and digital speed limit trailers were deployed. However, there were two hours (3AM to 5AM) where speeds increased by 0 - 4 mph, perhaps due to the low volume at that hour. The encouraging results support the further deployment of presence lighting and speed limit trailers in nighttime construction zones for reducing vehicle speeds. Those future deployments should be monitored with connected vehicle speeds to collect additional data to broaden the evaluation of these speed mitigation techniques over a diverse set of construction zone activities.

Enzyme-linked immunosorbent assay of 3 Screen Islet Cell Autoantibody in patients with autoimmune thyroid disease

BACKGROUND In recent years,the emergence of multiplex technology that can simultaneously measure multiple anti-islet autoantibodies has become particularly valuable for the staging and early diagnosis of immune-mediated type 1 diabetes(T1D).While it has been established that 20%-30%of T1D patients suffer from autoimmune thyroid disease(AITD),there is limited available data regarding the presence of anti-islet autoantibodies in AITD patients.Among commercially available anti-islet autoantibodies,glutamic acid decarboxylase 65 autoantibodies(GADAs)are often the first marker measured in general clinical practice.AIM To investigate the frequency of anti-islet autoantibodies in AITD patients.METHODS Our study involved four hundred ninety-five AITD patients,categorized into three distinct groups:AITD with T1D(n=18),AITD with phenotypic type 2 diabetes(T2D)(n=81),and AITD without diabetes(n=396),and the enzyme-linked immunosorbent assay(ELISA)was employed to determine the frequencies of 3 Screen Islet Cell Autoantibody(3 Screen ICA),GADA,insulinoma-associated antigen-2 autoantibodies(IA-2As),and zinc transporter 8 autoantibodies(ZnT8As)within these groups.RESULTS The frequency of 3 Screen ICA in AITD patients with T1D,T2D,and those without diabetes were 88.9%,6.2%,and 5.1%,respectively,with no significant difference seen between the latter two groups.Notably,the frequency of 3 Screen ICA was 11.1%higher in AITD patients with T1D,1.3%higher in AITD patients with T2D,and 1.1%higher in AITD patients without diabetes compared to GADA,respectively.Furthermore,12.5%,20.0%,and 20.0%of the 3 Screen ICA-positive patients were negative for GADA.Additionally,1.3%of the AITD patients who tested negative for 3 Screen ICA in both the AITD with T2D and non-diabetic AITD groups were found to be positive for individual autoantibodies.Among the 3 Screen ICA-positive patients,there was a significantly higher proportion of individuals with multiple autoantibodies in AITD patients with T1D compared to those without diabetes(37.5%vs 5.0%,P<0.05).However,this proportion was similar to that in AITD patients with T2D(20.0%).Nevertheless,there was no significant difference in 3 Screen ICA titers between AITD patients with T1D and those without diabetes(436.8±66.4 vs 308.1±66.4 index).Additionally,no significant difference in 3 Screen ICA titers was observed between Graves’disease and Hashimoto’s thyroiditis in any of the groups.CONCLUSION Our findings reveal that some AITD patients without diabetes exhibit 3 Screen ICA titers comparable to those in AITD patients with T1D.Thus,3 Screen ICA outperforms GADA in identifying latent anti-islet autoantibody-positive individuals among AITD patients.

Real world effectiveness of PCSK-9 inhibitors combined with statins versus statins-based therapy among patients with very high risk of atherosclerotic cardiovascular disease in China(RWE-PCSK study)

BACKGROUND The efficacy and safety of proprotein convertase subtilisin/kexin type 9(PCSK-9) inhibitors were confirmed by several clinical trials, but its effectiveness in routine clinical practice in China has not been evaluated. This study aims to describe the real world effectiveness of PCSK-9 inhibitors combined with statins compared with statins-based therapy among patients with very high risk of atherosclerotic cardiovascular disease(ASCVD).METHODS This is a multi-center observational study, enrolled patients from 32 hospitals who underwent percutaneous coronary intervention(PCI) from January to June in 2019. There are 453 patients treated with PCSK-9 inhibitors combined with statins in PCSK-9 inhibitor group and 2,610 patients treated with statins-based lipid lowering therapies in statins-based group. The lipid control rate and incidence of major adverse cardiovascular events(MACE) over six months were compared between two groups.A propensity score-matched(PSM) analysis was used to balance two groups on confounding factors. Survival analysis using Kaplan-Meier methods was applied for MACE.RESULTS In a total of 3,063 patients, 89.91% of patients had received moderate or high-intensity statins-based therapy before PCI, but only 9.47% of patients had low-density lipoprotein cholesterol(LDL-C) levels below 1.4 mmol/L at baseline. In the PSM selected patients, LDL-C level was reduced by 42.57% in PCSK-9 inhibitor group and 30.81%(P < 0.001) in statins-based group after six months. The proportion of LDL-C ≤ 1.0 mmol/L increased from 5.29% to 29.26% in PCSK-9 inhibitor group and 0.23% to 6.11% in statins-based group, and the proportion of LDL-C ≤ 1.4 mmol/L increased from 10.36% to 47.69% in PCSK-9 inhibitor group and 2.99% to 18.43% in statins-based group(P < 0.001 for both). There was no significant difference between PCSK-9 inhibitor and statins-based treatment in reducing the risk of MACE(hazard ratio = 2.52, 95% CI: 0.49-12.97, P = 0.250).CONCLUSIONS In the real world, PCSK-9 inhibitors combined with statins could significantly reduce LDL-C levels among patients with very high risk of ASCVD in China. The long-term clinical benefits for patients received PCSK-9 inhibitor to reduce the risk of MACE is still unclear and requires further study.