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T o date, there have been few comparison studies between rosiglitazone and pioglitazone (1,2) and none of the two thiazolidinediones (TZDs) as a third agent in triple oral therapy. In February 2003, pioglitazone replaced rosiglitazone as the TZD on the pharmacy formulary at our hospital. This gave us the opportunity to compare the effectiveness of rosiglitazone and pioglitazone added to type 2 diabetic patients already on maximum (tolerated) doses of metformin and a sulfonylurea agent whose HbA 1c (A1C) levels did not meet the American Diabetes Association goal of Ͻ7.0%.RESEARCH DESIGN AND METHODS -Our diabetes clinic treatment algorithm mandates starting small doses of either a sulfonylurea agent or metformin and increasing the dose every 2 weeks until either a fasting plasma glucose (FPG) concentration of Ͻ130 mg/dl is attained or a maximal (tolerated in the case of metformin) dose is reached. If the FPG concentration remains Ͼ130 mg/dl, the alternate drug is added and also increased every 2 weeks. When the FPG goal is achieved, further therapeutic decisions are based on A1C levels measured 2-3 months later. Only when both agents are maximized and either the FPG concentration 2 weeks after the last increase remains Ͼ130 mg/dl or an A1C level is Ն7.0% 2-3 months after the FPG goal is reached, or at any time thereafter, is a maximal dose of a TZD added. The maximal dose is used because it can take up to 4 months to see a maximal response. If lower TZD doses are used initially and titrated upward, the patient can remain out of control for up to a year before insulin is started.Four months after adding the TZD, we decided whether triple oral therapy had been successful. We chose an A1C level of Յ7.5% to designate success and not start insulin (which necessitates significant lifestyle changes) because there was only a slight increase in the development or progression of retinopathy and/or nephropathy in patients with mean A1C levels between 7 and 8% (3-7). Only when A1C levels exceeded 7.5% (measured 4 months after starting the TZD or subsequently) was bedtime insulin started.The study design was a retrospective chart review of 104 adult type 2 diabetic patients followed in our diabetes clinic. The criterion for inclusion was taking a TZD for at least 4 months in patients who had failed maximal (tolerated) doses of metformin and a sulfonylurea agent. Comparisons were made in patients at 4 months, and those with successful outcomes (A1C Յ7.5%) were followed for 8 more months. The responses of 56 consecutively treated patients, in whom 45 mg pioglitazone was added, were compared with 48 patients receiving 8 mg rosiglitazone, as reported previously (8).RESULTS -Fifty-six patients on pioglitazone (24 men and 32 women, aged 54.1 Ϯ 7.7 years [mean Ϯ SD], diabetes duration 8.3 Ϯ 5.9 years, and BMI 33.2 Ϯ 7.4 kg/m 2 ) were studied. There were 42 Latinos, 11 African Americans, 2 Caucasians, and 1 Asian Pacific Islander. At baseline, 55 patients were taking maximal doses of glyburide (20 mg) or glipizide (40 mg), with 1 pati...

A 53-year-old man with no past medical history was admitted with complaints of hematuria, flank and abdominal pain of one week duration. He also complained of an enlarging new neck mass one month before presentation. The laboratory assessment showed a calcium level of 17.3 mg/dL (normal 8.5-10.5 mg/dL), serum albumin 2.9 g/dL (normal 3.0-5.0 g/dL), serum creatinine 3.4 mg/dL (normal 0.5-1.2 mg/dL). A neck ultrasound showed a complicated left neck mass. He was hydrated for one week with improvement in his labs, showing a decrease in serum calcium to 9.3 mg/dL and a serum creatinine of1.8 mg/dL. He underwent a total thyroidectomy and parathyroidectomy. The pathology showed multiglandular parathyroid carcinoma. It is important for the physician and surgeon dealing with primary hyperparathyroidism to look for parathyroid carcinoma. A better knowledge and understanding of this condition would aid in early diagnosis and possibly increase the survival rate.

This study explores the mechanisms of racial discrimination in U.S. independent filmmaking. To answer this question, I combine the theoretical toolkits on Hollywood discrimination and Bourdieu’s theory of cultural production. I employ in‐depth, semi‐structured interviews with 30 U.S.‐based independent filmmakers of color, and observations of public discussions at film festivals in the greater Los Angeles area. I find that despite independent film’s inclusive and non‐commercial discourses, many of the mechanisms of racial exclusion that underlie Hollywood’s lack of diversity also exist in independent film: the economic uncertainty of creative labor, racialized market logics, the economic stigmatization of artists of color, and the reliance on closed social networks for career advancement. Furthermore, I also find that non‐commercial factors in the field of independent film also constrain the ability for filmmakers of color to make art reflective of their experiences, form mutually beneficial collaborations with other artists of color, or invest their time in projects that are culturally innovative. These findings suggest that even at the margins of mainstream cultural production, mechanisms of racialization can still operate where racial prejudice and racialized economics outweigh artistic independence.

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