Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE) ABSTRACT ObjeCtive To compare the effectiveness of insulin pumps with multiple daily injections for adults with type 1 diabetes, with both groups receiving equivalent training in flexible insulin treatment. PartiCiPantsAdults with type 1 diabetes who were willing to undertake intensive insulin treatment, with no preference for pumps or multiple daily injections. Participants were allocated a place on established group training courses that taught flexible intensive insulin treatment ("dose adjustment for normal eating," DAFNE). The course groups (the clusters) were then randomly allocated in pairs to either pump or multiple daily injections.interventiOns Participants attended training in flexible insulin treatment (using insulin analogues) structured around the use of pump or injections, followed for two years. Main OutCOMe MeasuresThe primary outcomes were a change in glycated haemoglobin (HbA1c) values (%) at two years in participants with baseline HbA1c value of ≥7.5% (58 mmol/mol), and the proportion of participants achieving an HbA1c value of <7.5%. Secondary outcomes included body weight, insulin dose, and episodes of moderate and severe hypoglycaemia. Ancillary outcomes included quality of life and treatment satisfaction. results 317 participants (46 courses) were randomised (156 pump and 161 injections). 267 attended courses and 260 were included in the intention to treat analysis, of which 235 (119 pump and 116 injection) had baseline HbA1c values of ≥7.5%. Glycaemic control and rates of severe hypoglycaemia improved in both groups. The mean change in HbA1c at two years was −0.85% with pump treatment and −0.42% with multiple daily injections. Adjusting for course, centre, age, sex, and accounting for missing values, the difference was −0.24% (−2.7 mmol/mol) in favour of pump users (95% confidence interval −0.53 to 0.05, P=0.10). Most psychosocial measures showed no difference, but pump users showed greater improvement in treatment satisfaction and some quality of life domains (dietary freedom and daily hassle) at 12 and 24 months. COnClusiOnsBoth groups showed clinically relevant and long lasting decreases in HbA1c, rates of severe hypoglycaemia, and improved psychological measures, although few participants achieved glucose levels currently recommended by national and international guidelines. Adding pump treatment to structured training in flexible intensive insulin treatment did not substantially enhance educational benefits on glycaemic control, hypoglycaemia, or psychosocial outcomes in adults with type 1 diabetes. These results do not support a policy of providing insulin pumps to adults with poor glycaemic control until the effects of training on participants' level of engagement in intensive self management have been determined. trial registratiOn Current Controlled Trials ISRCTN61215213.
Three phenolic compounds cosmosiin, caffeic acid, and p-coumaric acid were isolated for the first time from the leaves of Cupressus sempervirens L., together with cupressuflavone, amentoflavone, rutin, quercitrin, quercetin, myricitrin. The isolated compounds were identified using (1)H- and (13)C-NMR spectra. The hepatoprotective activity of the MeOH extract was carried out in liver homogenate of normal and CCl(4)-treated rats; a significant decrease in glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, cholesterol level, and triglycerides, while a significant increase in the total protein level, was observed after the oral administration of MeOH extract. The free radical scavenging activity against stable 2,2-diphenyl-2-picrylhydrazyl (DPPH*) was measured for MeOH extract and some of the isolated phenolic compounds in comparison with alpha-tocopherol and butylated hydroxy toluene as standard antioxidants using ESR technique, showed high antioxidant activity for quercetin, rutin, caffeic acid, and p-coumaric acid.
The high propensity of influenza viruses to develop resistance to antiviral drugs necessitates the continuing search for new therapeutics. Peanut skins, which are low-value byproducts of the peanut industry, are known to contain high levels of polyphenols. In this study, we investigated the antiviral activity of ethanol extracts of peanut skins against various influenza viruses using cell-based assays. Extracts with a higher polyphenol content exhibited higher antiviral activities, suggesting that the active components are the polyphenols. An extract prepared from roasted peanut skins effectively inhibited the replication of influenza virus A/WSN/33 with a half maximal inhibitory concentration of 1.3 μg/mL. Plaque assay results suggested that the extract inhibits the early replication stages of the influenza virus. It demonstrated activity against both influenza type A and type B viruses. Notably, the extract exhibited a potent activity against a clinical isolate of the 2009 H1N1 pandemic, which had reduced sensitivity to oseltamivir. Moreover, a combination of peanut skin extract with the anti-influenza drugs, oseltamivir and amantadine, synergistically increased their antiviral activity. These data demonstrate the potential application of peanut skin extract in the development of new therapeutic options for influenza management.
The essential oil obtained by hydro-distillation of Aegle marmelos (L.) Correa leaves were analyzed by GC/MS yield (0.9% v/w). Twenty seven components were identified representing 97.76% of the total oil composition. The major components were α-phellenderene (20.97%), α-pinene (17.76%) and δ-carene (16.37%) and other abundant components asγ-cadinene (8.01%), trans-2-hydroxycinnmic acid (6.85%) and β-myrcene (4.32%). The essential oil exhibited significant antibacterial activity against Gram-positive bacteria as Streptococcus faecalis with inhibition zone (30 mm) and Gram-negative bacteria as Pseudomonas aeruginosa (28 mm). Moreover, moderate activity was observed against Bacillus subtilis (23mm), Staphylococcus aureus (23mm), Sarcina lutea (20mm), Arthrobacter citreus (20 mm) and Escherichia coli (25mm) in comparison with antibiotics. The antifungal activity against Aspergillus niger (30 mm) and Candida albicans (30 mm) was higher than the antifungal antibiotics. Moreover, the oil inhibited the germination of Aspergillus niger and Fusarium oxysporum spores at different concentrations.
The present study discusses the isolation of ursolic acid from the chloroform extract of Paulownia tomentosa (Thunb) Steud fruits and its cytotoxic effect has been assessed in-vitro was performed in different cells lines (A-549, MCF-7, HepG2) and in-vivo using N-diethylnitrosamine. The obtained results revealed that ursolic acid showed significant cytotoxic activity on MCF-7 and HepG2 cell lines in comparison to Doxorubicin as a reference drug. Moreover, we have assessed the inhibitory effects of Paulownia tomentosa fruit chloroform extract and the isolated ursolic acid on hepatocarcinogenesis was carried out for the first time using N-diethylnitrosamine, where the group treated with ursolic acid given orally after 8 weeks of cancer induction showed the most significant results in comparison to the chloroform extract. The effect of ursolic acid on intoxicated rats caused significant restoration of most of the normal hepatocytes architecture with regular dark nuclei and the group treated with Paulownia tomentosa fruits showed remarkable results with improvement in biochemical analysis.
One new dihydrochalcone diglycoside has been isolated from the EtOAc fraction of the Egyptian seagrass Thalassodendrin ciliatum (Forsk.) den Hartog, and was identified as 6'-O-rhamnosyl-(1‴ → 6″)-glucopyranosyl asebogenin for which a trivial name Thalassodendrone was established. Furthermore, five known phenolics were isolated and identified as asebotin, quercetin 3,7-diglucoside, protocatechuic acid, ferulic acid and p-hydroxybenzoic acid. The structures of all the isolated compounds were established based on 1D and 2D NMR spectroscopy and high-resolution-mass spectrometer. High-resolution electrospray ionization mass spectra (HR-ESI-MS) were obtained using a JEOL JMS-T100TD spectrometer (JEOL Ltd., Tokyo, Japan). The anti-influenza A virus activity of the isolated new compound and asebotin was evaluated, and the obtained results revealed that the inhibition dose concentration of asebotin was more than that of Thalassodendrone with IC50 = 2.00 and 1.96 μg/mL, respectively, and with cytotoxic concentration (CC50) of 3.36 and 3.14 μg/mL, respectively.
547.913The essential oil of the leaves of Cupressus sempervirens L. was isolated by hydrodistillation and tested against gram positive and gram negative bacteria, showing remarkable antimicrobial activity against Bacillus subtilis with minimum inhibitory concentration (MIC) 75%. The antiviral activity of the essential oil was tested against Herpes simplex virus type 1 (HSV-1), showing antiviral activity with virucidal percentages of 68.0% and 53.2% at concentrations of 1:32 and 1:64, respectively. We firstly reported the isolation of two epi-betulin esters of fatty acids from the CHCl 3 fraction of Cupressus sempervirens L. leaves, which were isolated and purified using HPLC, and identified using PMR and MS. The CHCl 3 fraction showed significant cytotoxicity against HeLa cells.
The cytotoxic activity of petroleum ether extract of the leaves of Cassia roxburghii Linn. against HCT-116 and MCF-7 cell lines resulted with IC50=34.9 and 38.04 μg/ml, respectively, while against HepG-2 showed no activity. A bioassay guided-fractionation approach was conducted to isolate and identify the active cytotoxic principles. Further chromatographic separation and purification of the petroleum ether extract resulted in the isolation of two anthraquinones identified as aloe-emodin acetate and aloe-emodin, along with stigmasterol, β-sitosterol and palmitic acid. The structure elucidation of isolated compounds was performend using 1D, 2D-NMR and HR-MS. Furthermore, the cytotoxicity of aloe-emodin acetate and aloe-emodin were evaluated and resulted with IC50=153.30 and 70.02 μg/ml against HCT-116 and with 93.20 and 53.20 μg/ml against MCF-7, respectively, while against HepG-2 showed no activity. Moreover, the antiviral activity of the two isolated anthraquinones was tested against influenza virus-A, and resulted with IC50=10.23 as well as 2.00 and with CC50=1.32 and 0.47 μg/ml, respectively.
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