Incretins stimulated by oral meals are claimed to be protective for the pancreatic beta cells, to increase insulin secretion, to inhibit glucagon release, slow gastric emptying (glucagon-like ...peptide-1) and suppress appetite. Recently it has however been suggested that glucagon-like peptide-1 (GLP-1) is putative early biomarker of metabolic consequences of the obesity associated proinflammatory state. The study was aimed to compare the release of incretins and some of early markers of inflammation at the fasting and postprandial period induced by functional oral glucose as well as lipid load in healthy controls and patients with metabolic syndrome (MS) to see if functional tests may be helpful in searching for the inflammatory status of patients. Fifty patients with MS and 20 healthy volunteers (C) participated in this study. The 3-hour oral glucose (OGTT) and the 8-hour oral lipid (OLTT) tolerance tests were performed. At fasting leptin and adiponectin, as well as every 30 minutes of OGTT and every 2 hours of OLTT blood concentration of GLP-1, glucose-dependent insulinotropic polypeptide (GIP), glucose, insulin, triglycerides, free fatty acids, glutathione peroxidase, interleukin-6, sE-selectin, monocyte chemoattractant protein-1 (MCP1) and visfatin were measured. At fasting and during both OGTT and OLTT the level of incretins did not differ between the MS and the C group. Both glucose and lipids reach food activated incretins secretion. Glucose was the main GLP-1 release activator, while the lipid load activated evidently GIP secretion. A significantly larger AUC-GIP after the lipid-rich meal over the carbohydrate meal was observed, while statistically bigger value of AUC-GLP-1 was noticed in OGTT than in OLTT (P < 0.001) within each of the investigated groups. In patients with the highest fasting plasma GIP concentration (3(rd) tertile), IL-6, MCP-1, sE-selectin and visfatin blood levels were increased and correlated with glutathione peroxydase, leptin/adiponectin ratio, higher visfatin and interleukin-6 levels. The fat containing meals stimulate the long-lasting release of incretins, mainly GIP, parallel to the increase of the markers of low grade inflammation associating obesity in metabolic syndrome. The possibility of use of the postprandial (OLTT) GIP release measurement for the low grade inflammation progress in MS patients is suggested.
New nontoxic and biocompatible ferroelectric materials are a subject undergoing intense study. One of the most promising research branches is focused on H-bonded organic or hybrid ferroelectrics. The ...engineering of these materials is based on mimicking the phase transition mechanisms of the well-known inorganic ferroelectrics. In our study, a coupled experimental and theoretical methodology was used for a precise investigation of the ferroelectric phase transition mechanism in ammonium sulfate (AS). A series of single-crystal X-ray diffraction measurements were performed in the temperature range between 273 and 163 K. The detailed inspection of the obtained static structural data, in the above-mentioned temperature range, allowed us to reveal dynamical effects at the ferroelectric phase transition. Accurate analysis of all geometrical features within the obtained crystal structures was carried out. The results were discussed in the view of previously discovered physical properties. X-ray studies were complemented by the use of quantum theory of atoms in molecules calculations and Hirshfeld surface analysis. Valence shell charge concentration analysis allowed us to find the subtle changes between charge density distribution within SO
in para- and ferroelectric phases. H-bond interactions, geometrically classified in both AS phases, were all confirmed by the appropriate critical points. The interaction energies were estimated for the structures at 273, 233, 213, 183, and 163 K. Correlation between the geometrical approach and the results of theoretical calculations enabled us to discover the differences in interaction equilibrium between the AS phases. The mechanism of the phase transition originates from the disruption of the vibrational lattice mode between sulfate anions. Our studies resolved the problem, which was under discussion for more than 60 years.
Carfax (2018) estimates that 20% of U.S. vehicles that are on the road have outstanding recalls: they have a known defective part or design. Recalled vehicles represent future costs to manufacturers ...and pose safety risks to the public. Only two prior studies examine the determinants of recall completion rates—the percent of recalled vehicles that are repaired—and both use cross-sectional data from the 1980s. This paper uses panel data on 677 U.S. vehicle recall campaigns from 2006 to 2015 to identify the correlates of completion rates for the Detroit 3 and the three largest foreign vehicle manufacturers. In addition to using more recent data, we include variables that were not previously examined: multiple recalls, vehicle type, and reporting period. The analysis confirms the earlier finding that domestic manufacturers’ completion rates exceed those of the foreign producers. We also observe higher completion rates on recalls for severe defects, on vehicles under multiple recalls, and on luxury vehicles. In contrast, older vehicles and trucks exhibit lower recall completion rates. The observed patterns in recall completion rates suggest that refinements in how manufacturers estimate recall costs in the litigation process and in strategies to improve completion rates are possible.
Introduction
Von Willebrand disease (VWD) is the most common inherited bleeding disorder. The bleeding phenotype is variable, and some individuals have persistent symptoms post‐diagnosis.
Aim
To ...characterize bleeding patterns in patients with VWD before and after diagnosis.
Methods
De‐identified claims data for commercially insured patients in the IQVIA PharMetrics® Plus US database (Jan‐2006 to Jun‐2015) were extracted. Eligible patients had ≥2 claims for VWD (ICD‐9 code 286.4), and continuous health‐plan enrolment for ≥2 years before and after diagnosis. Bleeding event, treatment and treating‐physician type were analysed for 18 months before and 7‐24 months after diagnosis, according to pre‐diagnosis bleeding phenotype (claims from one vs multiple bleed sites) and post‐diagnosis bleeding status (resolved no post‐diagnosis bleed claims vs continued ≥1 claim).
Results
Data for 3756 eligible patients (72.6% female; 71.0% aged ≥18 years at diagnosis) were analysed. Overall, 642 (17.1%) and 805 (21.4%) patients had single‐ and multiple‐site bleed claims pre‐diagnosis, respectively, and 1263 (33.6%) patients (38.5% of women, 20.8% of men) continued to bleed post‐diagnosis. Multiple‐site bleeding was associated with pre‐diagnosis heavy menstrual bleeding (HMB), oral contraceptive (OC) use and nasal cauterization. Continued bleeding post‐diagnosis was associated with pre‐diagnosis gastrointestinal bleeding, HMB and epistaxis; pre‐diagnosis use of OCs, aminocaproic acid and nasal cauterization; and younger age at diagnosis. Few patients consulted a haematologist for bleed management.
Conclusion
Many patients with VWD have persistent bleeding from multiple sites and continue to bleed post‐diagnosis. Our findings suggest a need to optimize management to reduce the symptomatic burden of VWD following diagnosis.
Background
Extended half‐life (EHL) factor VIII (FVIII) and IX (FIX) products are intended to decrease the burden of prophylaxis for patients with haemophilia A or B. Whether these newer concentrates ...have led to meaningful clinical practice change remains vague.
Aim
To characterize the longitudinal use of standard (SHL) and EHL factor concentrates at haemophilia treatment centres (HTCs), using the ATHNdataset, a US database of 138 ATHN‐affiliated HTCs.
Methods
Factor concentrate use among moderate and severe haemophilia A and B patients without inhibitors was analysed at three time points over 18 months.
Results
Use of EHL concentrates rose from 10% of patients to 22% during this study. EHL FVIII prophylaxis is prescribed to the minority of patients, 28%; EHL FIX now predominates for prophylaxis, 52%. Rates of prescribed EHL products varied significantly by age group and HTC region. Median prescribed prophylaxis for SHL compared to EHL products was FVIII 6240 and 5200 and FIX 6968 and FIX 3900 IU/kg/y, respectively. On‐demand EHL use has grown but has minimal contribution to overall usage (2%).
Conclusion
Haemophilia treatment centre region and patient age impact the rate of adoption of EHL products; however, EHL prescribing continues to rise nationally, particularly for EHL FIX. Careful attention to annual cost of prophylaxis is imperative as the decrease in median EHL prophylaxis consumption is not offset by the higher unit cost of these products. It is unclear how further growth in use of EHLs will be impacted by emerging non‐factor replacement and gene therapies.
With licensure of extended half‐life (EHL) factor products and the changing landscape of available hemophilia products, patients and providers have options for less treatment‐intense prophylaxis. The ...impact of these products in clinical practice to date remains understudied.
We aimed to quantify the use of EHL products in prophylaxis in the US using the ATHN‐dataset, a database of 145 ATHN‐affiliated hemophilia treatment centers (HTCs). Further, we aimed to quantify the impact of EHL on key hemophilia indicators including annualized bleed rates (ABRs), hemophilia joint health scores (HJHS) and quality of life (QOL) metrics. The use of EHL vs standard half‐life (SHL) products in severe hemophilia was compared between June 2018 and March 2019 using the ATHN‐dataset. A cohort of patients was also recruited from seven participating HTCs in order to compare ABR, HJHS and QOL between product classes.
By March 2019 the number of individuals with severe Hemophilia A (SHA) receiving EHLs remained relatively stable (28.4%), whereas the number of prescribed non‐factor products increased to 7.1%, with a diminishing majority of patients (64.0%) continuing to receive SHLs. The majority of patients with severe hemophilia B (SHB) received treatment with EHLs including 57.5% by March 2019. There was a trend toward lower ABR with use of EHLs in SHA and SHB, although this did not result in improved HJHS nor QOL.
EHL use in the United States in severe hemophilia continues to increase, although at a slower rate in SHA with the availability of non‐factor therapy. The impact of the EHL therapies in clinical practice should continue to be examined prospectively.
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