The Cost-Effectiveness of an Advanced Hybrid Closed-Loop System in People with Type 1 Diabetes: a Health Economic Analysis in Sweden.

INTRODUCTION: Swedish National Diabetes Registry data show a correlation of improved glycemic control in people with type 1 diabetes (T1D) with increased use of diabetes technologies over the past 25 years. However, novel technologies are often associated with a high initial outlay. The aim of the present study was to evaluate the long-term cost-effectiveness of the advanced hybrid closed-loop (AHCL) MiniMed 780G system versus intermittently scanned continuous glucose monitoring (isCGM) plus self-injection of multiple daily insulin (MDI) or continuous subcutaneous insulin infusion (CSII) in people with T1D in Sweden. METHODS: Outcomes were projected over patients' lifetimes using the IQVIA CORE Diabetes Model (v9.0). Clinical data, including changes in glycated hemoglobin (HbA1c) and hypoglycemia rates, were sourced from observational studies and a randomized crossover trial. Modeled patients were assumed to receive the treatments for their lifetimes, with HbA1c kept constant following the application of treatment effects. Costs were accounted from a societal perspective and expressed in Swedish krona (SEK). Utilities and days off work estimates were taken from published sources. RESULTS: The MiniMed 780G system was associated with an improvement in life expectancy of 0.16 years and an improvement in quality-adjusted life expectancy of 1.95 quality-adjusted life years (QALYs) versus isCGM plus MDI or CSII. These clinical benefits were due to a reduced incidence and a delayed time to onset of diabetes-related complications. Combined costs were estimated to be SEK 727,408 (EUR 72,741) higher with MiniMed 780G, with treatment costs partially offset by direct cost savings from the avoidance of diabetes-related complications and indirect cost savings from the avoidance of lost workplace productivity. The MiniMed 780G system was associated with an incremental cost-effectiveness ratio of SEK 373,700 per QALY gained. CONCLUSIONS: Based on a willingness-to-pay threshold of SEK 500,000 per QALY gained, the MiniMed 780G system was projected to be cost-effective versus isCGM plus MDI or CSII for the treatment of T1D in Sweden.

Oral semaglutide versus injectable glucagon-like peptide-1 receptor agonists: a cost of control analysis.

Aims: The efficacy and safety of oral semaglutide, the first glucagon-like peptide-1 (GLP-1) receptor agonist developed for oral administration for the treatment of type 2 diabetes, was evaluated in the PIONEER clinical trial program, and a recently published network meta-analysis allowed comparison with further injectable GLP-1 receptor agonists. The present study aimed to assess the short-term cost- effectiveness of oral semaglutide 14 mg versus subcutaneous once-weekly dulaglutide 1.5 mg, once-weekly exenatide 2 mg, twice-daily exenatide 10 µg, once-daily liraglutide 1.8 mg, once-daily lixisenatide 20 µg, and once-weekly semaglutide 1 mg, in terms of the cost per patient achieving glycated hemoglobin (HbA1c) targets (cost of control).Materials and methods: Cost of control was calculated by dividing the annual treatment costs associated with an intervention by the proportion of patients achieving the treatment target with an intervention, with outcomes calculated for targets of HbA1c ≤6.5% and HbA1c <7.0% for all included GLP-1 receptor agonists. Annual treatment costs were accounted in 2019 United States dollars (USD), based on 2019 wholesale acquisition cost.Results: For the treatment target of HbA1c ≤6.5%, once-weekly semaglutide 1 mg and oral semaglutide 14 mg were associated with the lowest costs of control, at USD 15,430 and USD 17,383 per patient achieving target, respectively. Similarly, the cost of control was lowest with once-weekly semaglutide 1 mg at USD 12,627 per patient achieving target, followed by oral semaglutide 14 mg at USD 13,493 per patient achieving target for the target of HbA1c <7.0%. All other interventions were associated with higher cost of control values for both targets.Conclusions: Oral semaglutide 14 mg is likely to be cost-effective versus dulaglutide, exenatide (once weekly and twice daily), liraglutide, and lixisenatide in terms of bringing people with type 2 diabetes to glycemic control targets of HbA1c ≤6.5% and HbA1c <7.0% in the US.

Statistical models suggest presence of two distinct subpopulations of miniature EPSCs in fast-spiking interneurons of rat prefrontal cortex.

Properties of excitatory synaptic responses in fast-spiking interneurons (FSIs) and pyramidal neurons (PNs) are different; however, the mechanisms and determinants of this diversity have not been fully investigated. In the present study, voltage-clamp recording of miniature excitatory post-synaptic currents (mEPSCs) was performed of layer 2-3 FSIs and PNs in the medial prefrontal cortex of rats aged 19-22days. The average mEPSCs in the FSIs exhibited amplitudes that were two times larger than those of the PNs and with much faster rise and decay. The mEPSC amplitude distributions in both cell types were asymmetric and in FSIs, the distributions were more skewed and had two-times larger coefficients of variation than in the PNs. In PNs but not in FSIs, the amplitude distributions were fitted well by different skewed unimodal functions that have been used previously for this purpose. In the FSIs, the distributions were well approximated only by a sum of two such functions, suggesting the presence of at least two subpopulations of events with different modal amplitudes. According to our estimates, two-thirds of the mEPSCs in FSIs belong to the high-amplitude subpopulation, and the modal amplitude in this subpopulation is approximately two times larger than that in the low-amplitude subpopulation. Using different statistical models, varying binning size, and data subsets, we confirmed the robustness and consistency of these findings.

Rapid redox signal transmission by "Cable Bacteria" beneath a photosynthetic biofilm.

Recently, long filamentous bacteria, belonging to the family Desulfobulbaceae, were shown to induce electrical currents over long distances in the surface layer of marine sediments. These "cable bacteria" are capable of harvesting electrons from free sulfide in deeper sediment horizons and transferring these electrons along their longitudinal axes to oxygen present near the sediment-water interface. In the present work, we investigated the relationship between cable bacteria and a photosynthetic algal biofilm. In a first experiment, we investigated sediment that hosted both cable bacteria and a photosynthetic biofilm and tested the effect of an imposed diel light-dark cycle by continuously monitoring sulfide at depth. Changes in photosynthesis at the sediment surface had an immediate and repeatable effect on sulfide concentrations at depth, indicating that cable bacteria can rapidly transmit a geochemical effect to centimeters of depth in response to changing conditions at the sediment surface. We also observed a secondary response of the free sulfide at depth manifest on the time scale of hours, suggesting that cable bacteria adjust to a moving oxygen front with a regulatory or a behavioral response, such as motility. Finally, we show that on the time scale of days, the presence of an oxygenic biofilm results in a deeper and more acidic suboxic zone, indicating that a greater oxygen supply can enable cable bacteria to harvest a greater quantity of electrons from marine sediments. Rapid acclimation strategies and highly efficient electron harvesting are likely key advantages of cable bacteria, enabling their success in high sulfide generating coastal sediments.

[Properties of spontaneous and miniature excitatory postsynaptic currents of rat prefrontal cortex neurons].

Quantum analysis of postsynaptic currents is important for fundamental and applied studies of synaptic transmission. In the present work, we investigated the possibility of using the characteristics of spontaneous excitatory postsynaptic currents (EPSCs) for estimation of quantum parameters of excitatory synaptic transmission in different types of neurons from rat prefrontal cortex slices. By blocking spontaneous spiking activity in slices by tetrodotoxin, we showed that spontaneous and miniature EPSCs in prefrontal cortex neurons did not differ by their properties. Thereby, both spontaneous and miniature responses can be used for estimation of quantum parameters of excitatory synaptic transmission in this preparation. We also revealed that excitatory spontaneous responses of pyramidal cells were 2 times lower by amplitude, had twice lower the coefficient of variation and exhibited much slower kinetics than responses of the fast-spiking and regular-spiking interneurons. Possible mechanisms of these differences are considered.

Light-induced carbon dioxide and oxygen uptake in plant leaves measured by the photoacoustic method.

Leaf discs, enclosed in a photoacoustic (PA) chamber, generate two types of PA gas-uptake signals under certain conditions. Type I is manifested by a severe signal decrease that develops slowly under very low-light intensity and often reaches negative values. It is partially reversed by low-intensity far-red light. Type II occurs transiently in modulated far-red light. It is manifested by a rapid and dramatic decrease of the PA signal, upon the addition of short-wave background light, which is subsequently reversed. It differs from type-I uptake in that it occurs at much higher total light intensities. A thorough study, including modulation frequency and atmospheric composition dependencies, indicates different mechanisms for the two types of uptakes. Type-I uptake results from CO2 accumulation in the PA cell by leaf respiration and reflects modulations in CO2 solubilization. Type-II uptake likely reflects oxygen photoreduction in photosystem I, occurring prior to the activation of photosynthesis (i.e. during photosynthesis induction). This is supported by the complete suppression of type-II uptake when O2 was removed. Also, type-II uptake was only mildly sensitive to CO2 elimination, whereas type-I uptake was totally dependent on the presence of CO2. Type-II uptake consists usually of two uptake waves. Fluorescence transients measured in parallel give further support to the reality and interpretation of these two uptake waves. PA could thus provide a unique opportunity to monitor oxygen photoreduction in vivo with high sensitivity and time resolution.

Thermal and structural changes of photosynthetic reaction centers characterized by photoacoustic detection with a broad frequency band hydrophone.

Photoacoustic measurements using a broad frequency band hydrophone were carried out in photosynthetic reaction centers (RC) isolated from Rhodobacter sphaeroides R-26 purple bacteria. Data were extracted on enthalpy and volume changes accompanying the primary steps after excitation in the range of 0-500 microseconds aimed at further characterizing the thermodynamic properties of the RC. Quinone titration showed that the volume contraction accompanying the electron transport is sensitive to the molecular species occupying the secondary quinone site. delta VM = 14.4, 7.7 and 4.3 cm3 molar volume contractions were calculated from the measured parameters for 1, 2 and 0.07 quinone/RC after light excitation. Comparing the enthalpy changes (delta H) to the Gibbs free energy data in the literature, a rather large (26%) entropic contribution to the free energy changes (delta G) is estimated for the P*QAQB-->P+QA-QB electron transport (where QA and QB represent primary and secondary quinones, respectively). This is in contrast to previous estimations that delta G = delta H in these processes. On the other hand, only a small (4%) entropic contribution to the delta G of the P*QAQB-->P+QAQB- process is estimated, in agreement with the literature data. Our results are in good agreement with the data obtained earlier (Edens et al. [2000] J. Am. Chem. Soc. 122, 1479-1485).

Oxygen uptake photosensitized by disorganized chlorophyll in model systems and thylakoids of greening barley.

Light-dependent oxygen uptake was observed and studied in thylakoids from early greening barley in comparison to oxygen uptake in chlorophyll solutions and in thylakoids from fully green leaves. Substantial oxygen uptake was observed in chlorophyll solutions supplemented with tryptophan, histidine, ascorbic acid or linoleic acid. This uptake was diminished by adding azide, beta-carotene and alpha-tocopherol, which are specific singlet-oxygen quenchers. Illuminated thylakoids from greening barley also exhibited marked oxygen uptake that, likewise, was strongly quenched by azide. In comparison, azide was found not to affect oxygen uptake that is associated with the methyl viologen-catalyzed Mehler reaction. It is reasoned that in the first two cases the oxygen uptake arises from chlorophyll-photosensitized activation of oxygen to the singlet state and its consumption by exogenous or endogenous substrates. In greening, we propose that disorganized chlorophyll photo-sensitizes the oxygen uptake.

Excitation energy transfer in aggregates of Photosystem I and Photosystem II of the cyanobacterium Synechocystis sp. PCC 6803: Can assembly of the pigment-protein complexes control the extent of spillover?

The fluorescence profile of Photosystem I/Photosystem II mixtures in different solvent systems shows that both non-hydrophobic and hydrophobic interactions govern their association and control energy transfer from Photosystem II to Photosystem I. The non-hydrophobic interactions lead to a highly efficient excitation energy transfer from Photosystem II to Photosystem I. In view of this, we propose that similar non-hydrophobic interactions, between the Photosystem II and Photosystem I peripheral proteins, also play a significant role in their association in thylakoids that control state transitions in cyanobacteria.

Differential responses to different light spectral ranges of violaxanthin de-epoxidation and accumulation of Cbr, an algal homologue of plant early light inducible proteins, in two strains of Dunaliella.

Unicellular green algae of the genus Dunaliella, similar to higher plants, respond to light stress by enhanced de-epoxidation of violaxanthin and accumulation of Cbr, a protein homologous to early light inducible proteins (Elips) in plants. These proteins belong to the superfamily of chlorophyll a/b binding proteins. Two Dunaliella strains, D. bardawil and D. salina, were compared for these two responses under light in the UVA, blue, green and red spectral ranges. In D. bardawil, the two stress responses were similarly induced under UVA, blue or red light and to a lesser extent under green light. In D. salina, a similar spectral range dependence was exhibited for violaxanthin de-epoxidation. However, Cbr accumulated only under UVA or blue light but not under green or red light. A strong synergistic effect of a low dose of blue light superimposed on red light resulted in Cbr accumulation. These results reveal strain-specific differences in spectral range requirements of the two light-stress responses. In the two strains, violaxanthin de-epoxidation is triggered under photosynthetically-active spectral ranges but at least in D. salina, Cbr accumulation appears to require a specific light signal additionally to a signal(s) generated by light stress.

Possible Role of Cbr, an Algal Early-Light-Induced Protein, in Nonphotochemical Quenching of Chlorophyll Fluorescence.

The unicellular green alga Dunaliella bardawil exhibits typical responses to excessive light when starved for sulfate under normal light (60 [mu]E m-2 s-1) but not under low light (14 [mu]E m-2 s-1). Algae were analyzed during several days of sulfate starvation for nonphotochemical quenching of chlorophyll fluorescence in the absence or presence of the uncouplers SF-6847 (SF) or carbonyl cyanide p- trifluoromethoxyphenyl hydrazone. Parallel analyses followed two light-stress responses: (a) violaxanthin conversion to zeaxanthin and (b) accumulation of Cbr, a protein analogous to plant early-light-induced proteins and implicated in zeaxanthin binding. In cells starved under normal light SF inhibited nonphotochemical quenching during the first 24 h, but not from 40 h onward. In cells starved under low light SF inhibited nonphotochemical quenching throughout the starvation period. Under normal light accumulation of zeaxanthin was nearly maximal by 24 h, but Cbr was fully induced only by 40h. Under low light zeaxanthin accumulated slowly but no Cbr was evident. These results suggest that during exposure to excessive light, the initial pH gradient-dependent, Cbr-independent mode of nonphotochemical quenching is modified to become less dependent on pH gradient and requires Cbr.

Bill Arnold and calorimetric measurements of the quantum requirement of photosynthesis-once again ahead of his time.

The approach of photocalorimetry to decide on the true quantum requirement of photosynthesis - one of the main issues of the research in the first half of the century and a source of a bitter debate - is described. Bill Arnold's original approach to get into the true answer is reflected from the point of view of present day calorimetric techniques.

The D-E region of the D1 protein is involved in multiple quinone and herbicide interactions in photosystem II.

The region between helices D and E (D-E region) of the D1 protein of photosystem II (PSII) is exposed at the stromal side of the photosynthetic membrane, contains the secondary plastoquinone (QB) binding niche, and is involved in processes at the reducing side of PSII. The role of the D-E region was studied in 27 site-directed mutants generated in the psbAII gene of the cyanobacterium Synechocystis sp. PCC 6803. The photochemical performance of the modified PSII reaction centers was assessed with respect to photoautotrophic growth, oxygen evolution, fluorescence induction, and herbicide inhibition. A few mutations, located at positions presumably involved in essential interactions in the QB binding niche, greatly interfered with PSII performance. On the other hand, mutations in the presumptive loop region between helices D and de resulted in relatively minor effects, indicating a flexible region not critical for photochemical function. Indeed, although more than 80% of the D-E region is phylogenetically invariant, the bulk of the mutations affected the measured parameters only moderately. The significance of the conserved residues appears to be in subtle interactions that optimize the thermodynamic balance between some of the redox components of PSII, as indicated by mild changes in the steady state fluorescence. Many mutations modified tolerances to PSII herbicides. The dispersion of these mutations throughout the D-E region indicates the complex nature of the interactions, direct and indirect, affecting herbicide binding in the QB niche. Mutation of codons Ser221 and Ser222 to Leu221 and Ala222 revealed a new location coordinating the herbicide diuron in the D1 protein.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship between millisecond luminescence and fluorescence in tobacco leaves during the induction period.

Millisecond luminescence and fluorescence, from an intact tobacco (Nicotiana tabacum) leaf, were measured simultaneously during the induction period, as a function of the time. This was accomplished using a luminescence apparatus which separated out the faster luminescence components by subtraction of the accumulated slow-decaying ones. An antiparallel correlation between the two was observed, but only during a part of the induction period starting with the first fluorescence peak where the fluorescence decreases to a quasi plateau level. During this induction phase, luminescence rose very prominently to a maximum while fluorescence decreased. This correlation fits a linear dependence of the luminescence on the extent of RCs openness, as monitored by the photochemical quenching of the fluorescence. It may be concluded that during this induction phase, all other factors, which modulate luminescence (e.g. membrane potential), have become already steady and that the millisecond delayed luminescence reflects the photochemical reaction in an open center (i.e. with QA oxidized). This is further supported by steady-state experiments in thylakoid membranes. No correlations between luminescence and either momentary (F) or maximum (Fm) fluorescence during later induction phases can be pinpointed with confidence, although a trend of a parallel decrease at certain time intervals can be seen occasionally. Likewise, there is no relationship between the two in the very initial induction phase, during the rise of fluorescence from Fo to Fm, as noted earlier. This lack of correlation is presumably due to the dependence of luminescence on other parameters, which vary during these induction phases. The implications of these observations are discussed.

The use of photothermal radiometry in assessing leaf photosynthesis: II. Correlation of energy storage to Photosystem II fluorescence parameters.

Following the first part of this work (Malkin et al. (1991) Photosynth Res 29: 87-96), where modulated photothermal radiometry (PTR) was used to measure energy storage (ES) in intact leaves as a function of P700 redox state, we report here on simultaneous ES and fluorescence measurements, which characterize the state of PS II. PTR monitors the conversion of modulated light into heat by measuring the modulated infra-red radiation emitted from the sample. The ratio [PTR+-PTR-]/PTR+, where PTR indicates the PTR signal and the subscripts +,- indicate the presence or absence of saturating background light, is used to quantitate ES. We searched carefully for the right conditions where the background light does not introduce a significant rise in the leaf temperature, which influences the PTR signal as such, otherwise the above ratio deviates from the true ES. Under such conditions, ES and the fluorescence parameters, F (momentary fluorescence level) Fm' (fluorescence of fully reduced PS II reaction centers) were measured during the induction phase of photosynthesis and in the steady state. ES and the parameter γ=(Fm'-F)/Fm', considered by Genty et al. ((1989) Biochim Biophys Acta 990: 87-92) to reflect the yield of PS II, had similar kinetics during the induction phase. Both reached a final maximum plateau after about 4-5 min. of illumination. In different experiments, where the measuring light intensities varied, γ was approximately linearly related to ES. This linear relationship was found in the same way also in steady-state measurements, where these parameters varied by using different background light intensities. Extrapolation to an ES value of zero indicates a finite non-zero value of γ. A possible explanation for this may be found in the existence an electron transport cycle around PS II which does not store energy in the range corresponding to the modulation frequency used (ca. 3.6 Hz).

Measurement of red blood cell-vitamin B12: a study of the correlation between intracellular B12 content and concentrations of plasma holotranscobalamin II.

We have recently reported a new and rapid assay to measure plasma holotranscobalamin II (holo TC II) as a means of exploring vitamin B12 status. In order to further evaluate the significance of plasma holoTC II in determining tissue cobalamin, we have chosen the red blood cell-vitamin B12 (RBC-B12) assay as a measure of tissue vitamin B12 content and studied the relationship between RBC-B12 and plasma holoTC II levels. Plasma holoTC II and RBC-B12 concentrations were concomitantly assayed in 20 hematologically normal controls and cancer patients. In our groups of controls, the mean value of RBC-B12 was determined as 241 +/- 51 pg/ml of packed erythrocytes (PE) with a range varying from 180 to 355 pg/ml PE. Preliminary results obtained in 32 cancer patients revealed lower holoTC II and RBC-B12 levels than the control group and a required threshold value of 70 pg/ml of holoTC II in order to maintain a normal RBC-B12 greater than 180 pg/ml PE.

Enhanced oxidative-stress defense in transgenic potato expressing tomato Cu,Zn superoxide dismutases.

The two cDNAs coding for the cytosolic (cyt) and the chloroplast-located (chl) Cu,Zn superoxide dismutases (SODs) of tomato (Perl-Treves et al. 1988) were cloned into respective binary vectors and mobilized into Agrobacterium strains. Potato tuber discs were infected with either of the two agrobacterial strains and cultured on selective medium containing kanaymcin. The integration of either of the cyt or the chl SOD transgenes was verified by Southern-blot hybridization. The enzymatic activity of the additional tomato chl Cu,Zn SOD could be distinguished from endogenous SOD activity since the latter isozyme migrated faster on SOD-activity gels. Several transgenic potato lines harboring either the cyt or the chl SOD genes of tomato showed elevated tolerance to the superoxide-generating herbicide paraquat (methyl viologen). After exposure of shoots to paraquat, tolerance was recorded either by scoring symptoms visually or by measurements of photosynthesis using the photoacoustic method. Root cultures from transgenic lines that harbored the additional cyt Cu,Zn SOD gene of tomato were tolerant to methyl viologen up to 10(-5) M; a lower tolerance was recorded in roots of transgenic lines that expressed the additional chl Cu,Zn SOD of tomato.

The degree of functional separation between the two photosystems in isolated thylakoid membranes deduced from inhibition studies of the imbalance in photoactivities.

In order to examine whether the two photosystems, PS I and PS II, are organized in specific electron transporting pairs, or randomly transport electrons from PS II to PS I, the photosystems imbalance of photoactivities (Emerson enhancement) was measured by modulated fluorimetry under different degrees of PS II inhibition in broken chloroplasts, where the granal structures were preserved by the presence of 5 mM MgCl. The results indicate a lack of any measurable specific functional pairing between individual PS I and PS II, in contrast to a previous research work in leaves (Malkin et al. 1986, Photosynth. Res. 10: 291-296). These results and this discrepancy are further discussed.

A new way to monitor by-pass restorations of electron transport in inhibited chloroplasts by cyclic electron flow cofactors--a study by modulated fluorimetry.

Inhibition of electron transport in broken chloroplasts by DBMIB, under light-limiting conditions, is shown to be bypassed by PMS in a manner similar to the known effects of the phenylenediamine derivatives TMPD and DAD. These bypasses were demonstrated and further studied by modulated fluorimetry, monitoring DBMIB inhibition by the shift of the steady-state fluorescence towards the Fm level and the release of inhibition by a reverse shift together with establishment of a quenching effect by background far-red light. Comparative studies were also made with electron transport blocked by DCMU or BNT. A weak bypass by TMPD and a weaker one by PMS of the block created by DCMU was observed by modulated fluorimetry. The block created by BNT is similarly shown to be bypassed by TMPD but hardly or not at all by PMS. Bypass effects persisted even in the presence of ascorbate. It appears that, following reduction of the different cofactors by ascorbate in the stroma side, illumination caused the accumulation of a pool of oxidized cofactor molecules in the lumen, which is able to mediate electron transport between reduced plastoquinone and plastocyanin or P-700. The existence and the size of this pool were found to depend largely on the internal pH at the lumen, presenting an artificial system in which electron flow is controlled by the lumenal pH. The bypassing electron transport in the presence of DBMIB presumably avoids the participation of the cytochrome b6f complex. During its occurrence, there is also a strong imbalance in the activities of the two photosystems for linear electron flow, in favor of PS II. These experiments may thus serve to establish an in vitro model system for a future investigation of effects related to changes in the imbalance between the two photosystems and its regulation. Furthermore, this experimental system may also be utilized to study the role of the internal lumenal pH in control of photosynthesis.