Conventional noise reduction algorithms have been used in image processing for a very long time, but recently, deep learning-based algorithms have been shown to significantly reduce the noise in CT ...images. In this paper, a comparison of CT noise reduction of a deep learning-based, a conventional, and their combined denoising algorithms is presented. A conventional adaptive 3D bilateral filter and a 2D deep learning-based noise reduction algorithm and a combination of these are compared. For comparison, we used the noise power spectrum and the task transfer function which were measured on original CT images and the effective dose saving factors were also calculated. The noise reduction effect, the noise power spectrum and the task-transfer function are studied using Catphan 600 phantom and 26 clinical cases with more than 100,000 images. We also show that the effect of noise reduction of a 2D deep learning-based algorithm can be further enhanced by using conventional 3D spatial noise reduction algorithms.
Background: Currently no data are available on the real-world effectiveness of the fixed ratio combination of insulin glargine 100 U/ml and lixisenatide (iGlarLixi). This non-interventional study (it ...was conducted in Hungary) aimed to evaluate its effects on glycaemic control and hypoglycaemia in real-world practice.
Methods: The single-arm, 6-month (with follow-up visits at 3 and 6 months) study included uncontrolled adults with type 2 diabetes (HbA1c>7,5%) treated by oral antidiabetics (OAD) +/- basal insulin. iGlarLixi treatment was started at the time of inclusion.
Results: Of the included 442 participants, 353 were involved in the efficacy analyses. 282 (79.9%) subjects were treated with OADs, while the remaining 71 (20.1%) with basal insulin and OAD(s) before inclusion. The proportion of participants achieving at least 1.0% HbA1c reduction during the observation period was 60.9% (primary endpoint). All glycaemic variables (mean±SD) improved significantly (p<0,001) during follow-up (HbA1c from 8.9±1.3% to 7.4 ±1.0%, fasting blood glucose from 9.0±2.2 mmol/L to 6.9±1.2 mmol/L, and postprandial blood glucose from 11.3±2.3 mmol/L to 8.5±1.5 mmol/L). All changes were clinically and statistically significant. Body weight was also decreased from 90.5±18.0 kg to 88.2±17.8 kg. Only 37 subjects (10.5%) self-reported at least one symptomatic hypoglycaemic episode during the study. There was no severe hypoglycaemic episode being reported. Frequency of gastrointestinal adverse events was low (5 patients, 1.4%).
Conclusion: The first prospective, non-interventional study confirmed several results from the LIXILAN programme in a real-life setting. iGlarLixi significantly improved glycaemic control with low frequency of hypoglycaemia and gastrointestinal adverse events in a heterogenous population of people with type 2 diabetes. Results confirm similar efficacy and safety in routine clinical care than in randomized controlled trials.
Disclosure
J. T. Kis: None. G. Nagy: Employee; Self; Sanofi-Aventis. P. Stella: Employee; Self; Sanofi-Aventis.
Funding
Sanofi
Little is known in real life clinical practice about the effectiveness and safety of iGlarLixi in insulin naïve compared to insulin treated people with T2D. In the European REALI pooled database, we ...analyzed patient-level data of 1317 people with T2D initiating a 24-week iGlarLixi treatment: 718 were insulin naïve (55%) and 598 insulin treated (45%), with a median treatment duration of 2.5 years. Demographics were similar among groups with an overall mean±SD age of 61±9 years and BMI 32.2±5.5 kg/m². Median T2D duration was 8 years in the naïve group and 10 years in the treated group. At Baseline, mean HbA1c was 9.39% in the naïve and 8.76% in the treated (p<0.001). The least square (LS) mean HbA1c change from Baseline to Week 24 (using MMRM) was -1.57% in the naïve and -1.29% in the treated (Fig 1); the LS mean 95% CI fasting plasma glucose change was -52.5 -54.9; -50.1 and -50.4 -53.4; -47.5 mg/dL, respectively. Mean±SD body weight decreased by 1.8±4.6 kg at Week 24, with no difference between groups. Mean iGlarLixi daily dose at Baseline was 14.3U in the naïve and 24.4U in the treated, and reached 30.7U and 36.4U, respectively, at Week 24. Symptomatic hypoglycemia reports and gastrointestinal side effects were low in both groups. This analysis demonstrated effectiveness and safety of iGlarLixi in both insulin naïve and insulin treated people with T2D in clinical practice.
Disclosure
J.Seufert: Advisory Panel; Abbott Diabetes, Boehringer Ingelheim Pharma GmbH&Co.KG, Sanofi-Aventis Deutschland GmbH, Speaker's Bureau; Abbott Diabetes, Bayer Inc., Boehringer Ingelheim Pharma GmbH&Co.KG, Merck Sharp & Dohme Corp., Sanofi-Aventis Deutschland GmbH, Novartis, Novo Nordisk. N.Freemantle: Advisory Panel; AstraZeneca, Research Support; Galderma, ALK-Abelló A/S, Ipsen Biopharmaceuticals, Inc., Vertex Pharmaceuticals Incorporated, Thea, Speaker's Bureau; Abbott Singapore, ALK Shanghai. C.Guja: Advisory Panel; AstraZeneca, Boehringer-Ingelheim, Eli Lilly and Company, Novo Nordisk A/S, Sanofi, Speaker's Bureau; AstraZeneca, Boehringer-Ingelheim, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Servier Laboratories, Viatris Inc. M.Haluzik: Advisory Panel; Novo Nordisk, Lilly Diabetes, Boehringer-Ingelheim, Research Support; Sanofi, Speaker's Bureau; Abbott, AstraZeneca. G.Bigot: None. M.Tournay: None. M.Bonnemaire: Employee; Sanofi, Stock/Shareholder; Sanofi. J.T.Kis: None.
Funding
Sanofi
Pre-Breakfast iGlarLixi efficacy and safety were demonstrated in several randomized controlled trials. Whether time of administration could impact effectiveness in real life clinical practice is ...unknown. In the European REALI pooled database, we analyzed patient-level data of 1303 people with type 2 diabetes (T2D) treated with iGlarLixi for 24 weeks. Of these, 33% had the injection pre-Breakfast, 20% pre-Lunch, 31% pre-Dinner, while 16% switched time of injection. Overall, baseline characteristics were similar among groups with mean±SD age of 61±9.0 years, BMI 32.2±5.5 kg/m2, and median diabetes duration of 9 years. People with T2D previously used 1 oral glucose-lowering agent (57%) or ≥2 (43%) . A total of 590 people (45%) were insulin pretreated for a median duration of 2.5 years. Mean±SD HbA1c improved from 9.1±1.4% at Baseline to 7.7±1.2% at Week 24, with a least square mean decrease of 1.4% 95% CI: -1.50;-1.36, and most notable reduction in the pre-Breakfast group as shown in Figure 1. Mean±SD fasting plasma glucose decreased by 50.0±54.2 mg/dL and body weight by 1.8±6.6 kg at Week 24 with no difference between groups. Hypoglycemia reports were low in all groups.This analysis confirms the effectiveness of iGlarLixi at all administration times; pre-Breakfast may be preferable when there is a choice.
Disclosure
M.Haluzik: Advisory Panel; Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi, Speaker's Bureau; Abbott Diabetes, AstraZeneca, Lilly Diabetes, Novartis AG. J.Seufert: Advisory Panel; Abbott, Sanofi-Aventis Deutschland GmbH, Research Support; Boehringer Ingelheim International GmbH, Speaker's Bureau; Abbott Diabetes, AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Lilly, Novo Nordisk, Sanofi-Aventis Deutschland GmbH. C.Guja: Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Servier Laboratories. M.Bonnemaire: Employee; Sanofi. G.Bigot: None. M.Tournay: None. J.T.Kis: Speaker's Bureau; 77 Elektronika Kft., AstraZeneca, Boehringer Ingelheim International GmbH, EGIS Pharmaceuticals, Lilly Diabetes, Novo Nordisk, Sanofi. N.Freemantle: Consultant; Novo Nordisk, Research Support; Aimmune, ALK-Abelló A/S, Allergan, AstraZeneca, Ipsen Biopharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Sanofi, Vertex Pharmaceuticals Incorporated, Speaker's Bureau; Abbott.
Funding
Sanofi
Resource availability largely determines the distribution and behaviour of organisms. In plant–pollinator communities, availability of floral resources may change so rapidly that pollinator ...individuals can benefit from switching between multiple resources, i.e. different flowering plant species. Insect pollinator individuals of a given generation often occur in different time windows during the reproductive season. This temporal variation in individual occurrences, together with the rapidly changing resource availability, may lead individuals of the same population to encounter and use different resources, resulting in an apparent individual specialisation. We hypothesized, that 1) individual pollinators change their resource use (flower visitation) during their lifetime according to the changing availability of floral resources, and that 2) temporal variation in individual occurrences of pollinators and in resource availability will partly explain individual specialisation. To test these hypotheses, we observed flower visitations of individually marked clouded Apollo butterflies Parnassius mnemosyne during one reproductive season. We found temporal changes in lifetime individual resource use that followed the changes in resource availability, indicating that butterflies can adjust foraging to varying resource availability. Individuals differed considerably in their resource use. This variation was partly explained by temporal variation in both floral resource availability and temporal occurrence of individual butterflies. We suggest the butterfly as a sequential specialist, i.e. short‐term specialist and long‐term generalist. This foraging plasticity can be essential for short‐living insect pollinators in rapidly changing environments. Although flowering dynamics do not fully explain the variability in foraging, our results highlight the importance of temporal dimension in resource use studies. Ultimately, the relative pace of environmental change compared to individual lifespan may be a key factor in resource use plasticity.
This paper systematises the works of György Márkus into two or possibly three periods. These emphasise the underlying consistency of purpose and interpreting theoretical interests throughout the ...oeuvre. despite the changing and socio-political forms and language games, all three share common features. These stages move from this initial critique of Orthodox Marxism employing the intellectual rigor of analytical and a philosophical anthropology to an investigation of the internal contradictions in Marx’s mature economic writings. to a final post-marxist phase after he left Hungary dominated by continual philosophical themes and a social democratic political perspective.
Aim
To evaluate the effectiveness and safety in routine clinical practice of insulin glargine/lixisenatide (iGlarLixi) in people with type 2 diabetes (T2D) according to age.
Methods
Patient‐level ...data were pooled from 1316 adults with T2D inadequately controlled on oral antidiabetic drugs with or without basal insulin who initiated iGlarLixi for 24 weeks. Participants were classified into age subgroups of younger than 65 years (N = 806) and 65 years or older (N = 510).
Results
Compared with participants aged younger than 65 years, those aged 65 years or older had a numerically lower mean body mass index (31.6 vs. 32.6 kg/m2), a longer median diabetes duration (11.0 vs. 8.0 years), were more likely to receive prior basal insulin (48.4% vs. 43.5%) and had a lower mean HbA1c (8.93% 74.10 mmol/mol vs. 9.22% 77.28 mmol/mol). Similar and clinically relevant reductions in HbA1c and fasting plasma glucose from baseline to week 24 of iGlarLixi therapy were observed regardless of age. At 24 weeks, least‐squares adjusted mean (95% confidence interval CI) change in HbA1c from baseline was –1.55% (–1.65% to –1.44%) in those aged 65 years or older and –1.42% (–1.50% to –1.33%) in those aged younger than 65 years (95% CI: –0.26% to 0.00%; P = .058 between subgroups). Low incidences of gastrointestinal adverse events and hypoglycaemic episodes were reported in both age subgroups. iGlarLixi decreased mean body weight from baseline to week 24 in both subgroups (–1.6 kg in those aged ≥ 65 years and –2.0 kg in those aged < 65 years).
Conclusions
iGlarLixi is effective and well tolerated in both younger and older people with uncontrolled T2D.
