A comparison of biphasic insulin aspart and insulin glargine administered with oral antidiabetic drugs in type 2 diabetes mellitus--a systematic review and meta-analysis.

OBJECTIVE: It is uncertain whether the addition of biphasic insulin analogues to oral antidiabetic drugs (OADs) is as effective and safe as basal insulin in patients with type 2 diabetes mellitus (T2DM). We performed a systematic review to compare glycaemic control and selected clinical outcomes in T2DM patients inadequately controlled with OADs whose treatment was intensified by adding biphasic insulin aspart (BIAsp 30) or insulin glargine (IGlar). METHODS: The analysis included randomised controlled trials (RCTs) identified by a systematic literature search in medical databases (MEDLINE, EMBASE, The Cochrane Library and other sources) up to March 2013. Studies met the inclusion criteria if they compared BIAsp 30 vs. IGlar added to at least one OAD in T2DM patients. Trials applying different OADs in both treatment arms were also included. Results were presented as weighted mean difference (WMD) or odds ratio (OR) with a 95% confidence interval (CI). RESULTS: Five trials, including a total number of 1758 patients followed up from 24 to 28 weeks, were identified. Quantitative synthesis demonstrated that BIAsp 30 reduced HbA1c level more efficiently than IGlar [5 RCTs; WMD (95% CI): -0.21% (-0.35%, -0.08%)]. Differences were observed in favour of BIAsp for lower mean prandial glucose increment [3 RCTs; WMD (95% CI): -14.70 mg/dl (-20.09, -9.31)]; no difference was observed for fasting plasma glucose [3 RCTs; WMD (95% CI): 7.09 mg/dl (-15.76, 29.94)]. We found no evidence for higher risk of overall [2 RCTs; 63% vs. 51%; OR = 1.77 (0.91; 3.44)] and severe hypoglycaemic episodes [4 RCTs; 0.98% vs. 1.12%; OR (95% CI) = 0.88 (0.31, 2.53)] in the BIAsp 30 group as compared with IGlar group. Twice-daily administration of BIAsp 30 resulted in larger weight gain [2 RCTs; WMD (95% CI) = 1.78 kg (1.04; 2.52)]. CONCLUSIONS: BIAsp 30 added to OAD therapy results in a better glycaemic control as compared with IGlar in T2DM patients. BIAsp 30 use is associated with slightly larger weight gain but no rise in risk of severe hypoglycaemic episodes.

The serotonergic inhibition of slowly bursting cells in the intergeniculate leaflet of the rat.

Electrophysiological studies combined with local neurotoxic lesions were conducted on anaesthetized rats in order to determine whether the dorsal raphe nucleus (DRN) inhibits the intergeniculate leaflet (IGL) of the lateral geniculate nucleus by means of innervation by serotonin-containing fibres. In the control animals, electrical stimulation of the DRN induced the long-latency and long-lasting inhibition of the neuronal firing of the IGL cells that are characterized by rhythmic, slow-bursting activity in light conditions. The electrical destruction of the DRN resulted in an increase in the firing rate of the recorded IGL cells, whilst at the same time not affecting the rhythmic, bursting pattern of the activity. In the second group of animals, local neurotoxic lesion of serotonergic fibres was performed by injection of the toxin 5,7-dihydroxytryptamine into the IGL. After 10 days of postoperative recovery, electrophysiological experiments were performed on the toxin-treated rats. In these animals, electrical stimulation as well as electrical lesion of the DRN did not induce any change in the firing of the slowly bursting cells in the 5,7-dihydroxytryptamine-injected IGL. The results obtained provide evidence that inhibition of the IGL slowly bursting cells, by innervation from the dorsal raphe, is mediated by the release of serotonin. Furthermore, the observed serotonergic inhibition of the light-dependent activity of slowly bursting cells can contribute to the neuronal mechanism gating the information that flows through this nucleus to the vestibular, visuomotor, circadian and sleep/arousal systems, with which the IGL is strongly interconnected.

Polymyositis caused by a new genus of nematode.

We report two patients who presented with increasing malaise and myalgia, and had biopsy-proven polymyositis. Their conditions deteriorated after corticosteroid treatment, and repeat muscle biopsies showed adult and larval nematodes. Anthelminthic treatment was completely successful in both cases. The infecting nematode appears to belong to a new genus and is, to our knowledge, the first known muspiceoid nematode to infect humans. Its life cycle and the route of infection are unknown.

Age-dependent decline in motor evoked potential (MEP) amplitude: with a comment on changes in Parkinson's disease.

Peak-to-peak measurement of the maximum amplitude motor evoked potential (MAXMEP) elicited by 20 consecutive transcranial magnetic stimuli recorded from the contracting thenar and hypothenar muscles measured 9.8 +/- 2.0 mV and 7.25 +/- 2.9 mV respectively (P less than 0.01). The ratio of MAXMEP/CMAP measured 92.6 +/- 25.8% and 54.8 +/- 12.3% respectively (P less than 0.001). Repeat studies showed good individual reproducibility. Amplitudes declined linearly with age (r = -0.836 for thenar MAXMEP P less than 0.001). It is argued that MAXMEP related to age is more meaningful than the MEP/CMAP wave ratio and is proportional to the number of fast conducting cortical motor neurons excited. In 7/18 patients with Parkinson's disease (PD) MAXMEP was increased; in 2 other patients MAXMEP was decreased for their age.

Absence of septum pellucidum and polymicrogyria: a forme fruste of the porencephalic syndrome.

Two cases are presented of absence of the septum pellucidum associated with bilateral polymicrogyria. In one case a circumscribed, completely enclosed cavity was present in the white matter of one cerebral hemisphere, different in structure from typical prenatal porencephaly. It is suggested that these cases represent a "forme fruste" of the syndrome of absent septum, bilateral porencephaly, polymicrogyria and heterotopia and may be ascribed to a similar, if less severe, encephaloclastic process of debatable etiology, operating around the midterm of pregnancy.

Dystonia and intracerebral calcification: pseudohypoparathyroidism presenting in an eleven-year-old girl.

Pseudohypoparathyroidism is an uncommon cause of movement disorders. We describe the case of an otherwise well 11-year-old girl, who presented with dystonia and was subsequently shown to have the classical metabolic abnormalities of pseudohypoparathyroidism. Cranial computerised tomographic scanning (CT scanning) showed intracerebral calcification of the basal ganglia and frontal lobes.