OBJECTIVE -To evaluate whether treatment with insulin is advantageous compared with oral antidiabetes agents in newly diagnosed type 2 diabetes with severe hyperglycemia after short-term intensive insulin therapy.RESEARCH DESIGN AND METHODS -Newly diagnosed type 2 diabetic patients with severe hyperglycemia were hospitalized and treated with intensive insulin injections for 10 -14 days. The oral glucose tolerance test (OGTT) was performed after intensive insulin treatment. After discharge, the patients were randomized to receive either insulin injections or oral antidiabetes drugs (OADs) for further management. The OGTT was repeated 6 months later, and ␤-cell function and insulin sensitivity were evaluated again. These subjects were continually followed up for another 6 months to evaluate their long-term glycemic control.RESULTS -At the 6th month of the study, the A1C level was significantly lower in the insulin group than in the OAD group (6.33 Ϯ 0.70% vs. 7.50 Ϯ 1.50%; P ϭ 0.002). During the follow-up visit, the A1C level was still better in the insulin group (6.78 Ϯ 1.21% vs. 7.84 Ϯ 1.74%; P ϭ 0.009). All parameters regarding ␤-cell function measured in the OGTT were improved significantly in both groups after 6 months of treatment. Compared with the OAD group, the homeostasis model assessment of ␤-cell function index, insulin area under the curve, and insulinogenic index were better in the insulin group. CONCLUSIONS -A 6-month course of insulin therapy, compared with OAD treatment, could more effectively achieve adequate glycemic control and significant improvement of ␤-cell function in new-onset type 2 diabetic patients with severe hyperglycemia.

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Background: Globally, chronic hepatitis B (CHB) is a major public health concern. Timely and effective management can prevent disease progression to cirrhosis and reduce the risk of hepatocellular carcinoma (HCC). Currently, there is no consensus on the clinical management of CHB in East Asia. Aim: To establish an East Asia expert opinion on treatment initiation for CHB based on alanine aminotransferase (ALT) level, hepatitis B virus (HBV) deoxyribonucleic acid (DNA) level, cirrhosis and HCC risk scores. Methods: A meeting was held online with a panel of 10 experts from East Asia to discuss ALT, HBV DNA, cirrhosis and HCC risk scores. Indications for CHB treatment in the latest international guidelines were reviewed. Consensus was summarised to provide recommendations on the initiation of treatment for CHB. Results: Anti-viral therapy is recommended for CHB patients with (a) HBV DNA ≥ 2000 IU/mL and ALT ≥ 1× upper limit of normal (ULN); (b) HBV DNA ≥ 2000 IU/ mL, ALT < 1× ULN and ≥ F2 fibrosis and/or ≥ A2 necroinflammation occurs; (c) cirrhosis and detectable HBV DNA; or (d) HBV DNA ≥ 2000 IU/mL, ALT < 1× ULN and a family history of cirrhosis or HCC, extrahepatic manifestations or age > 40 years. Patients with cirrhosis and/or HCC should be treated regardless of ALT levels if HBV DNA level is detectable. Initiating anti-viral therapy or close monitoring at 3-month intervals is recommended for CHB patients with at least two HCC risk factors. Conclusions: These expert recommendations will contribute to a new standard of daily clinical practice in East Asia.

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A landfill siting analysis typically requires evaluating various rules, factors, constraints, and numerous spatial data. A modern geographical information system, although capable of rapidly processing a massive amount of spatial data, lacks the ability to locate an optimal site when compactness and other factors are simultaneously evaluated. A previously developed grid-based model could not be applied to resolve this inability for irregularly shaped spatial data. Therefore, an enhanced spatial siting model is proposed herein for general spatial data. A compactness index is applied to ensure the integrity of selected sites. Two case studies are presented to demonstrate the applicability of the proposed model. The proposed model and two models developed previously are compared in the first case study based on the single factor of land cost. A single factor model is perhaps quite unacceptable with respect to other factors. The second case study is thus presented to demonstrate the flexibility of the model for considering additional factors, land slope, and road network accessibility. Moreover, results obtained from various models and siting factors are compared and discussed.