Short-term Intensive Treatment Research Articles

Stress exposure in at-risk, depressed, and suicidal adolescents.

Stress exposure contributes to the onset, maintenance, and recurrence of major depressive disorder (MDD) in adolescents. However, the precise stress facets (e.g. chronicity, domain) most strongly linked to outcomes at different stages along the depression severity continuum remain unclear. Across two studies, chronic and episodic stressors were comprehensively assessed among: (a) healthy youth with (High-Risk [HR]) and without (Low-Risk [LR]) a maternal history of MDD and (b) adolescents with current MDD and suicide ideation and healthy controls (HC). Study 1 included LR (n = 65) and HR (n = 22) 12- to 14-year-olds (49 females; 56.32%) with no lifetime history of mental disorders. Study 2 enrolled 87 mid-to-late adolescents (64 females; 73.56%), including 57 MDD youth from a short-term intensive treatment service and 30 HCs from the community. All depressed youth reported recent suicide ideation; some had no lifetime history suicide attempts (SI; n = 31) and others reported at least one past year attempt (SA; n = 26). The Life Events and Difficulties Schedule was used to capture stressor severity in both studies. We used multiple linear regression models that adjusted for demographic and clinical covariates. Being in the HR versus LR group was associated with more severe chronic (β = .22, CI95 = 0.01-0.42, p = .041), independent (β = .34, CI95 = 0.12-0.56, p = .003), and interpersonal (β = .23, CI95 = 0.004-0.45, p = .047) stress severity. By contrast, the MDD group reported significantly more severe chronic (β = .62, CI95 = 0.45-0.79, p < .001) and dependent (β = .41, CI95 = 0.21-0.61, p < .001) stress than the HC group, but not independent (p = .083) stress. Stress severity did not differ between recent attempters versus youth who reported suicide ideation alone (SA vs. SI contrast). However, the SA group reported a higher rate of targeted rejection events (RR = 3.53, CI95 = 1.17-10.70, p = .026). Our findings clarify the stressor features that may most strongly contribute to adolescent depression and its clinical correlates at two important points along depression's clinical course.

IDF21-0179 Efficacy and Safety of Gla-100 vs premix insulin after SIT in Chinese T2D: BEYOND V sub-analysis by Screening HbA1c

Background: The randomized, open-label, parallel-group BEYOND V (NCT03359837) study demonstrated that compared with insulin aspart 70/30 (Asp 30), insulin glargine 100 U/ml (Gla-100) demonstrated similar glycemic control at a lower hypoglycemia risk in Chinese type 2 Diabetes (T2D) individuals who had undergone short-term intensive insulin treatment (SIT).

Frontline High-Dose Therapy (HDT) for Adults with Disseminated Aggressive Lymphoma (NHL): Analysis of 327 Patients Included in 3 Prospective Trials (GOELAMS 071, 072, 074) over 12 Years.

We have demonstrated in a randomised prospective trial (GOELAMS 072) that front line HDT including an autologous stem cell transplantation improved significantly the EFS and OS as compared to standard CHOP regimen in adults with aggressive NHL and a high-intermediate age-adjusted-IPI (NEJM 2004). In order to further precise the benefit and risks as well as the prognostic factors with that type of treatment we decided to analyse the patients who entered the high-dose arm of successive prospective GOELAMS' trials designed for patients 15 to 60 y.o. with non previously treated aggressive NHL (excluding mantle cell, Burkitt, Lymphoblastic and transformation of known low grade) Ann.Arbor. stage II with abdominal bulk (> 7cm), III and IV, HIV neg and having given an informed consent (GOELAMS 071 BJH 2000; GOELAMS 072; GOELAMS 074 Blood 2004- ASH). Over a 12 years period 327 pts entered the high-dose arm of these trials. The median age was 44 yo, 60% male, 91% stage III/IV, 65% LDH>N, 33% PS≥2, 30% aa-IPI interm-low, 50% aa-IPI interm-high, 20% aa-IPI high. Histology was Diffuse large cell in 237, anaplastic in 29 and peripheral T cell in 16. Overall 75% of the pts received the planned treatment with autologous transplant. The median FU for surviving patients is 57 m (2 to 148m). The KM 5y and 10y survival is 63% and 55% respectively. Overall 114 pts died a median of 13 m after inclusion (1–130m). The main cause of death was lymphoma relapse or progression (86 pts-75% of the deaths); 12 pts died from TRM; 4 from second cancer (3 solid, 1 MDS). In UV analysis prognostic factors for OS were: PS=4, LDH>4xN, Peripheral T cell LNH. The median, KM 5y and 10y EFS are 77m, 51% and 49% respectively. In UV analysis prognostic factors for EFS were LDN>4xN and Peripheral T cell LNH.Survival and EFS according to aa-IPISurvivalEFSMedian (m)5 y10 ymedian (m)5 y10 yaa-IPI interm-lowNR65%53%12454%53%aa-IPI interm-highNR67%63%12853%53%aa_IPI high8556%44%1743%39%NR: not reachedThese results confirm that intensive short term treatment is able to produce long term survival for a high number of patients with intermediate or poor prognosis without long term toxicity at least in term of second cancer. For T cells LNH and very high LDH levels other treatments are needed.

677-P: Remission of Type 2 Diabetes following Intensive Treatment with Insulin Glargine, Lixisenatide, Metformin, and Lifestyle Approaches: Results of a Multicenter Randomized Controlled Trial

Background: Diabetes remission due to non-surgical approaches has not been well studied. We investigated induction of diabetes remission following a short-term treatment with insulin glargine, lixisenatide and metformin and changes in exercise and dietary behaviours. Methods: We randomized 160 individuals with type 2 diabetes to (i) 12-week intensive treatment with insulin glargine, lixisenatide, metformin and lifestyle approaches or (ii) standard glycemic management. At 12 weeks, diabetes medications were stopped in patients with HbA1C&amp;lt;7.3%, and participants were followed for diabetes relapse over the subsequent 52 weeks. Diabetes relapse was defined as either the use of diabetes medications, ≥50% of capillary glucose levels ≥10 mmol/L over 1 week, or HbA1C≥6.5% at 24, 36, 48 or 64 weeks and analyzed as time to event. Treatment groups were compared using a Cox Proportional Hazards model with adjustment for duration of diabetes and baseline HbA1C (primary analysis). Key secondary outcomes included the proportion of participants in remission at 24, 36, 48 and 64 weeks. Results: The intervention significantly reduced the hazard of diabetes relapse (HR 0.57, 95% CI 0.40-0.81; p=0.002). The proportion of participants with diabetes remission was significantly higher in the intervention group compared to the control group at 24 weeks (38% vs. 20%; relative risk RR 1.92 (1.14-3.24)) and at 36 weeks (32% vs. 17%; RR 1.83 (1.03-3.26)), but not at 48 and 64 weeks (RR 1.88 (1.00-3.53) and 2.05 (0.98-4.29), respectively). Conclusion: Short-term intensive treatment targeting normoglycemia and weight loss with insulin glargine, lixisenatide, metformin and lifestyle changes can induce sustained remission of type 2 diabetes. Disclosure N. Mcinnes: Other Relationship; Self; Merck &amp; Co., Inc., Novo Nordisk, Sanofi. J. Yale: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Novo Nordisk Canada Inc., Sanofi, Research Support; Self; Bayer Inc., Speaker’s Bureau; Self; Dexcom, Inc., Medtronic, Merck &amp; Co., Inc., Omnipod. F. Sultan: Employee; Self; Abbott Diabetes. A. C. Smith: None. R. E. Otto: None. D. Sherifali: None. Y. Liu: None. H. C. Gerstein: Advisory Panel; Self; Novo Nordisk Inc., Pfizer Inc., Sanofi, Consultant; Self; Abbott, Covance Inc., Eli Lilly and Company, Kowa Company, Ltd., Sanofi, Other Relationship; Self; Boehringer Ingelheim (Canada) Ltd., DKSH, Eli Lilly and Company, Sanofi, Zuellig, Research Support; Self; AstraZeneca, Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk Inc., Sanofi. Remit-iglarlixi collaborative group: n/a. S. Hall: None. H. A. Lochnan: Research Support; Self; Novo Nordisk Inc., Sanofi. S. B. Harris: Advisory Panel; Self; Abbott Diabetes, Abvance Therapeutics, HLS Therapeutics Inc., Lilly Diabetes, Novo Nordisk A/S, Consultant; Self; Boehringer Ingelheim (Canada) Ltd., mdBriefCase, Other Relationship; Self; American Diabetes Association, AstraZeneca, Novo Nordisk Canada Inc., Sanofi. Z. Punthakee: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi, Research Support; Self; AstraZeneca, Lexicon Pharmaceuticals, Inc., Novo Nordisk. R. J. Sigal: Advisory Panel; Self; Novo Nordisk, Research Support; Self; Lexicon Pharmaceuticals, Inc., Novo Nordisk. I. Hramiak: Advisory Panel; Self; AstraZeneca, Bayer Inc., BI-Lilly Joint Venture (Boehringer Ingelheim and Eli Lilly), Dexcom, Inc., Insulet Corporation, Medtronic, Research Support; Self; Eli Lilly and Company, Novo Nordisk, Sanofi. M. Azharuddin: Consultant; Self; Novo Nordisk Canada Inc. J. F. Liutkus: Advisory Panel; Self; Novo Nordisk Canada Inc., Research Support; Self; Bayer Inc., Boehringer Ingelheim (Canada) Ltd., IQVIA, Kowa Research Institute, Inc., Novo Nordisk Canada Inc., Sanofi, Speaker’s Bureau; Self; Novo Nordisk Canada Inc., Stock/Shareholder; Self; Bayer Inc., Novo Nordisk, Pfizer Inc., Stock/Shareholder; Spouse/Partner; Bayer Inc., Eisai Inc., Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk Canada Inc., Pfizer Inc. Funding Sanofi

Factors affecting the efficacy of repetitive transcranial magnetic stimulation for patients with Alzheimer's disease.

Repetitive transcranial magnetic stimulation (rTMS) is a safe and non-invasive technique. In recent years, many studies have demonstrated that rTMS can improve cognitive function in Alzheimer's disease (AD) patients and has potential as a therapeutic method for AD. However, the efficacy varies greatly with different rTMS treatment regimens, which is related to the frequency, type, location, duration, intensity and focusing power of stimulation. Recent studies have shown that high-frequency stimulation is superior to low-frequency stimulation; efficacy of intermittent theta burst stimulation (iTBS) is similar to that of conventional rTMS, but iTBS treatment session is shorter and might be more acceptable for AD patients; rTMS stimulation sites targeting AD-damaged brain regions or associated networks would be more effective; short-term intensive treatment combined with long-term maintenance treatment can gain long-term efficacy; dynamic adjustment of stimulus intensity combined with the degree of cognitive impairment can enhance the efficacy; functional connection based on functional magnetic resonance imaging may improve the focusing power of rTMS. In this article, we review the factors related to the efficacy of rTMS, to provide reference for feasible rTMS therapeutic regimens of AD.

Patient experiences with group behavioural activation in a partial hospital program.

Behavioural activation (BA) is an evidence-based treatment for depression that has been primarily delivered in individual out-patient treatment. Prior research supports a positive participant experience in individual therapy; however, less is known about the patient experience in group therapy, which is common in acute psychiatric settings. The present study examined the patient experience of Brief Behavioral Activation Treatment for Depression (BATD) delivered in group acute psychiatric treatment. We used thematic analysis to extract themes from feedback surveys administered as part of quality improvement practice at a partial hospital program. Survey questions explored what patients learned, liked, disliked and thought could be improved in the BATD groups. Three individuals independently coded survey responses and collaboratively developed categories and themes. Themes included several helpful content areas (e.g. value-driven activities, increasing motivation, goal setting, activity scheduling, cognitive behavioural model, self-monitoring) and learning methods (e.g. group format, experiential exercises, worksheets). Patients also identified unhelpful content (e.g. specific focus on depression and listing activities by mood). There was mixed feedback regarding the repetition of material and balance of lecture versus group participation. Overall, these findings suggest a mostly positive patient experience of group-delivered BATD and support the acceptability of group-delivered BATD as a component of short-term intensive treatment.

1047-P: The Change of HOMA-IR Predicted the Remission Time in Patients with Newly Diagnosed Type 2 Diabetes after Intensive Insulin Therapy

Objectives: Insulin resistance is one of strong predictions on the remission in patients with newly diagnosed type 2 diabetes (T2DM) after short-term insulin intensive therapy (SIIT). Therefore, the purpose of this study is to explore if the short-term change of insulin resistance can predict the long-time remission. Methods: This study enrolled 160 patients with newly diagnosed type 2 diabetes mellitus (103 male, aged 49.8±10.4 yrs,HbA1c11±2.1%). All of them have been treated by 2-week continuous subcutaneous insulin infusion as SIIT when new diagnosed. HOMA-IR was compared just at the termination of SIIT and later then follow up every 3 months regularly for 5 years. Results: After short-term intensive treatment, up to 84.4%, 81.3% and 26.9% of patients achieved disease remission with T2DM at the termination of CSII, the 3rd month and 5th year follow up without use of medication. The average remission time were 27+/-615 months. The average changes of HOMA-IR in the first 3 months after SIIT were 30%+/-52%. This short-term change percent of HOMA-IR was positive related to the statue of remission at 5th-year follow-up (r = 0.778, p &amp;lt;0.0001). The ROC curve analysis showed below. Conclusions: Maintaining the improving insulin resistance after short-term insulin intensive therapy is essential for the long-time remission from T2DM. Lifestyle interventions might be helpful. Disclosure W. Xuesi: None. Z. Huang: None. L. Liu: None. Y. Li: None. Funding National Key Research and Development Program of China (2018YFC1314100)

Efficacy of short-term intensive treatment with insulin pump to improve islet β-cell function in newly diagnosed type 2 diabetes via inhibition of oxidative stress.

The present study (Chinese Trial Registry GTB7027) assessed the effects of short-term intensive treatment with insulin pump on islet cell function in patients with newly diagnosed type 2 diabetes and the possible mechanism. A total of 100 patients newly diagnosed with type 2 diabetes and hospitalized between January 2016 and December 2017 were divided into a control and an experimental group (n=50 in each group). The subjects of the control group were administered multiple insulin injections for intensive treatment, while the experimental group received short-term intensive treatment with an insulin pump. Analysis of blood parameters, including lipids and glucose, as well as islet β-cell function were performed. The level of reactive oxygen species (ROS) in the peripheral blood mononuclear cells (PBMCs) from the patients was also measured. Oxidative stress indicators, including serum malondialdehyde (MDA) and superoxide dismutase (SOD), were also examined to explore the possible mechanism. The mRNA expression of heme oxygenase 1 (HO-1) and nuclear factor erythroid 2-related factor 2 (Nrf2) in PBMCs were analyzed by reverse transcription-quantitative PCR. The results indicated that the blood lipid levels were significantly improved in the two groups at two weeks, while the experimental group had significantly lower levels of total cholesterol and triglyceride, as well as low- and high-density lipoprotein cholesterol. The function of islet β-cells was significantly improved in the two groups. The insulin secretion index [homeostasis model assessment (HOMA) of β-cell function] in the experimental group was higher, while the insulin resistance (IR) index (HOMA of IR) was significantly lower than that in the control group. The serum MDA level in the experimental group was significantly lower and the SOD level was significantly higher compared with that in the control group. Following treatment, the level of ROS in diabetic PBMCs was significantly reduced, and the transcription level of HO-1 and Nrf2 were also significantly reduced (P<0.05). These results demonstrated that short-term intensive treatment with an insulin pump significantly improved lipid and blood glucose metabolism to protect islet function as well as significantly reducing the level of oxidative stress in patients with newly diagnosed type 2 diabetes.

268-OR: Insulin Resistance in the Liver, but Not Muscle or Adipose, Is Essential for Remission from Newly Diagnosed Type 2 Diabetes by Short-Term Insulin Intensive Therapy

To clarify the effects of insulin resistance from different tissues on the remission from newly diagnosed type 2 diabetes (T2DM) following short-term insulin intensive therapy (SIIT). This study enrolled 37 healthy controls and 160 patients with newly diagnosed type 2 diabetes mellitus (n=160, HbA1c11±2.1%). They were randomly divided to four groups, CSII alone for 2 weeks, or combination with an insulin sensitizer (CSII + metformin or CSII + rosiglitazone), or an antioxidant (CSII + α-lipoic acid). HOMA-IR, Adipo-IR and intramyocellular lipid (IMCL), were compared before and after termination of CSII. After short-term intensive treatment, 77.5% patients achieved normal HOMA-IR but little change in the Adipo-IR. The IMCL were nearly normalized except for those in metformin group, impacted by the lower insulin dose. The improvement of HOMA-IR and FFA, not IMCL or Adipo-IR, statistically related to the percentage declines of FPG (r=0.317 and 0.275), while only the HOMR-IR was associated with ΔPPG% (r=0.284). And 40.6% patients achieved sustained normal HOMA-IR in the first 3 months after CSII and attained 50% remission rate at the 5-year, far beyond 8.9% in the other patients (HR = 2.82 95% CI is1.813-4.388, p&amp;lt;0.001). Besides, slight superiority has occurred with HOMA-IR, Adipo-IR and IMCL in the CSII+ rosiglitazone group. In brief, short-term CSII therapy, with or without insulin sensitizers, is extremely effective in improving insulin resistance, even normalizing the HOMA-IR and IMCL. Sustained normal hepatic insulin resistance is essential for remission from T2DM. Insulin reversed ectopic fat in muscle with dose effect and the combination therapy with rosiglitazone is superior. Disclosure X. Wan: None. Z. Huang: None. Y. Li: None.

Predictors of Long-Term Glycemic Remission After 2-Week Intensive Insulin Treatment in Newly Diagnosed Type 2 Diabetes.

Although several studies suggest that improved β-cell function is a key determinant of glycemic remission in type 2 diabetes, other predictors remain unclear. The aim of this clamp-based study was to identify predictors of 2-year glycemic remission after short-term intensive insulin treatment. A 2-year follow-up was planned in 124 drug-naive patients with type 2 diabetes who received continuous subcutaneous insulin infusion (CSII) for 2 weeks. Euglycemic-hyperinsulinemic clamps and IV glucose tolerance tests were performed to assess the insulin sensitivity [glucose infusion rate (GIR)] and acute insulin response (AIR) before and after CSII. First-phase insulin secretion was restored, and the GIR was significantly improved (P < 0.0001) after the 2-week CSII. Glycemic remission rates were 47.6% and 30.7% after 12 and 24 months of follow-up, respectively. Cox analysis revealed that a higher post-CSII glucose level [hazard ratio (HR), 1.38; 95% CI, 1.15 to 1.66; P = 0.0005] and older age at diabetes diagnosis (HR, 1.34; 95% CI, 1.05 to 1.72; P = 0.02) accounted for an increased risk of hyperglycemic relapse. A 1 SD increase in the AIR (HR, 0.75; 95% CI, 0.57 to 0.99; P = 0.04), GIR (HR, 0.67; 95% CI, 0.48 to 0.93; P = 0.016) after CSII, and baseline GIR (HR, 0.71; 95% CI, 0.51 to 0.99; P = 0.047) was inversely associated with this risk. Younger age at diabetes diagnosis, higher baseline insulin sensitivity, and lower glucose levels after insulin treatment significantly favored a 2-year glycemic remission. This long-term remission was attributed to both improved insulin sensitivity and enhanced β-cell function after short-term intensive insulin treatment.

The Impact of Different Initial Insulin Dose Regimens in Short-Term Intensive Insulin Therapy

Objective: To compare the effects of different initial insulin dose regimens during the short-term insulin intensive treatment in newly diagnosed type 2 diabetes patients, in order to investigate the rational of formula based initiation regimen. Methods: Fifty six patients with newly diagnosed type 2 diabetes, 33 males and 23 females, aged 27-65 years old, BMI 25.43 ± 2.90 kg/m2, were randomly assigned into 2 groups: the formula group (whose insulin dose was initiated according to the formula recommended in our previous study, 28 cases) and the empirical group (according to current guidelines, 28 cases). Short-term intensive insulin therapy was performed, and the glycemic goal was gradually achieved. The time to glycemic goal(TGG), TDD-1, the frequency of hypoglycemia and the glycemic variability were compared. Results: The average TGG in the formula group(2.68 ± 1.44 days) is shorter than that in the empirical group (3.61 ± 1.60 days, P &amp;lt;0.05). There is no significant difference in the initial insulin dose (44.28 ± 9.10 IU, P&amp;gt; 0.05) of the formula group compared with the TDD-1 (46.91 ± 13.26 IU), whereas the initial insulin dose (34.09 ± 5.21 IU, P &amp;lt;0.05)of the empirical group is less than TDD-1. Compared with the TDD-1, while 70% of the estimate TDD-1(eTDD-1),which is calculated according to the formula as the initial insulin regimen,may not meet the requirements (P &amp;lt;0.001), 100% of the eTDD-1 is also too much for them (P &amp;lt;0.001).All the indicators for glycemic variability such as mean MBG, MGSD, M value, MAGE and LAGE during the initial three days are not significantly different between the two groups (P&amp;gt; 0.05). There is also no significant difference between 2 groups in the incidence of hypoglycemia(P&amp;gt; 0.05). Conclusion: Formula based initial insulin regimen is helpful in shortening TGG without increasing within-day glycemic variability or hypoglycemia events.It is recommended that 80% of the eTDD-1 can be used as the initial insulin regimen for the intensive treatment in most newly diagnosed T2DM patients. Disclosure H. Xinwei: None.

A Case Report on the Effect of a Short-Term Intensive Obesity Treatment on an Obese Patient

A Case Report on the Effect of a Short-Term Intensive Obesity Treatment on an Obese Patient

SHORT-TERM REHABILITATION FOR LINGUISTIC IMPAIRMENTS IN PRIMARY PROGRESSIVE APHASIA: A CASE SERIES

Language rehabilitation has been a valid strategy in order to slow the progression of symptoms and to increase quality of life for patients with primary progressive aphasia (PPA). The objective is to report the results of intensive short-term treatment administered to a case series of patients with non-fluent PPA (PPA-NF), semantic PPA (PPA-S), logopenic PPA (PPA-L) and unclassified PPA (PPA- NC), focusing on sentence production, lexical retrieval and working memory. Thirteen patients (5 PPA-S, 3 PPA-NF, 3 PPA-L and 2 PPA-NC) were submitted to a standardized training either targetting naming deficits (PPA-S and PPA-NC), sentence production or production of multisyllabic words (PPA-NF) and naming deficits or working memory (PPA-L and PPA-NC), based on principles of errorless learning. Thirty-minute rehabilitation sessions were offered twice a week, with daily workouts at home. The trained items (pre and post-treatment) and untrained items (pre and post-treatment) were compared. Generalization to other language tasks and functional communication was also informed. Follow-up results are reported for three patients. The sample comprised 5 women and 8 men. Mean age was 65 years and mean schooling was 13.7 years. A significant improvement for treated items was seen for all patients. Nine patients also improved in untreated items. In addition, seven generalized for other tasks. Three patients were evaluated one month after the end of the treatment and demonstrated maintenance of treatment results. Even being a progressive syndrome, patients were able to relearn target vocabulary and strategies to improve sentence construction during the active phase of treatment. These preliminary results suggest that linguistic-based treatment strategies may constitute an effective approach in the clinical management of PPA patients.

Influence of short-term intensive insulin therapy on plasma concentration of lipoprotein-associated phospholipase A(2) and secretory phospholipase A(2) in newly diagnosed type 2 diabetic patients

The aim of the study was to explore the effect and its clinical relevance of short-term intensive insulin treatment on plasma concentrations of lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) and secretory phospholipase A(2) (sPLA(2)) in newly diagnosed type 2 diabetes mellitus (T2DM). Ninety newly diagnosed T2DM patients were recruited and received continuous subcutaneous insulin infusion (CSII) for about 2 weeks. After CSII, sPLA(2) levels [173.78 (80.95, 278.09) μg/L] were significantly decreased compared with the levels before [219.33 (130.03, 337.30) μg/L], P<0.01, while no statistic significant changes could be viewed in Lp-PLA(2) levels. Correlation analysis showed that the changes of Lp-PLA(2) and sPLA(2) were both positively correlated with the changes of homeostasis model assessment of insulin resistance(HOMA-IR)after CSII (r=0.537, 0.493 respectively, all P<0.05). The Lp-PLA(2) and sPLA(2) level reduction after CSII might help to protect the patients from diabetic macroangiopathy. Trial registration Chinese Clinical Trial Registry, ChiCTR-TRC-10001618.

A Case Report on the Effect of Short-term Intensive Fat Treatment on an Obese Patient with Metabolic Syndrome

Objectives This case study reports on a case of rhabdomyolysis that occurred after spinning exercise. Methods A patient diagnosed with rhabdomyolysis received Korean medical treatment and Western medical treatment for 6 days. We observed the patient for 13 days. Clinical symptoms were evaluated with the Numerical Rating Scale (NRS) and laboratory tests that included Liver Function Test, Renal Function Test, creatinine phosphokinase (CPK), myoglobin, and urine. Results The clinical symptoms improved after treatment. In this case, acute renal failure has not occurred. The Laboratory results, including AST, ALT, CPK, and LDH, improved. Conclusions Rhabdomyolysis can be treated with Korean medical and Western medical cooperative treatment. Keywords: obesity, abdominal fat, Radix of Euphorbia kansui, Wuelbigachul-tang, case report

Intensive Treatment with Ultrasound Visual Feedback for Speech Sound Errors in Childhood Apraxia.

Ultrasound imaging is an adjunct to traditional speech therapy that has shown to be beneficial in the remediation of speech sound errors. Ultrasound biofeedback can be utilized during therapy to provide clients with additional knowledge about their tongue shapes when attempting to produce sounds that are erroneous. The additional feedback may assist children with childhood apraxia of speech (CAS) in stabilizing motor patterns, thereby facilitating more consistent and accurate productions of sounds and syllables. However, due to its specialized nature, ultrasound visual feedback is a technology that is not widely available to clients. Short-term intensive treatment programs are one option that can be utilized to expand access to ultrasound biofeedback. Schema-based motor learning theory suggests that short-term intensive treatment programs (massed practice) may assist children in acquiring more accurate motor patterns. In this case series, three participants ages 10–14 years diagnosed with CAS attended 16 h of speech therapy over a 2-week period to address residual speech sound errors. Two participants had distortions on rhotic sounds, while the third participant demonstrated lateralization of sibilant sounds. During therapy, cues were provided to assist participants in obtaining a tongue shape that facilitated a correct production of the erred sound. Additional practice without ultrasound was also included. Results suggested that all participants showed signs of acquisition of sounds in error. Generalization and retention results were mixed. One participant showed generalization and retention of sounds that were treated; one showed generalization but limited retention; and the third showed no evidence of generalization or retention. Individual characteristics that may facilitate generalization are discussed. Short-term intensive treatment programs using ultrasound biofeedback may result in the acquisition of more accurate motor patterns and improved articulation of sounds previously in error, with varying levels of generalization and retention.

Early Effects of Intensive Lipid-Lowering Treatment on Plaque Characteristics Assessed by Virtual Histology Intravascular Ultrasound.

PurposeThe effects of short-term intensive lipid-lowering treatment on coronary plaque composition have not yet been sufficiently evaluated. We investigated the influence of short-term intensive lipid-lowering treatment on quantitative and qualitative changes in plaque components of non-culprit lesions in patients with acute coronary syndrome.Materials and MethodsThis was a prospective, randomized, open-label, single-center trial. Seventy patients who underwent both baseline and three-month follow-up virtual histology intravascular ultrasound were randomly assigned to either an intensive lipid-lowering treatment group (ezetimibe/simvastatin 10/40 mg, n=34) or a control statin treatment group (pravastatin 20 mg, n=36). Using virtual histology intravascular ultrasound, plaque was characterized as fibrous, fibro-fatty, dense calcium, or necrotic core. Changes in plaque components during the three-month lipid-lowering treatment were compared between the two groups.ResultsCompared with the control statin treatment group, there was a significant reduction in low-density lipoprotein cholesterol in the intensive lipid-lowering treatment group (-20.4±17.1 mg/dL vs. -36.8±17.4 mg/dL, respectively; p<0.001). There were no statistically significant differences in baseline, three-month follow-up, or serial changes of gray-scale intravascular ultrasound parameters between the two groups. The absolute volume of fibro-fatty plaque was significantly reduced in the intensive lipid-lowering treatment group compared with the control group (-1.5±3.4 mm3 vs. 0.8±4.7 mm3, respectively; p=0.024). A linear correlation was found between changes in low-density lipoprotein cholesterol levels and changes in the absolute volumes of fibro-fatty plaque (p<0.001, R2=0.209).ConclusionModification of coronary plaque may be attainable after only three months of intensive lipid-lowering treatment.

Commentary on "Short-term intensive neurodevelopmental treatment program experiences of parents and their children with disabilities".

Commentary on "Short-term intensive neurodevelopmental treatment program experiences of parents and their children with disabilities".

Treatment-Induced Neuroplasticity Following Intensive Speech Therapy and a Home Practice Program in Fifteen Cases of Chronic Aphasia

Treatment-Induced Neuroplasticity Following Intensive Speech Therapy and a Home Practice Program in Fifteen Cases of Chronic Aphasia

Research in brief

In the first of a pair of randomised, double-blind, placebo-controlled trials published in The Lancet, investigators of the TESLA Part B study assessed the efficacy of the PCSK9 antibody, evolocumab, for homozygous familial hypercholesterolaemia. Patients received monthly evolocumab (n=33) or placebo (n=16) for 12 weeks. The percentage change in ultracentrifugation LDL cholesterol from baseline to week 12 was −23·1% (95% CI −30·7 to −15·4) in the intervention group compared with 7·9% (−2·7 to 18·5) in the placebo group (treatment difference −30·9%, −43·9 to −18·0; adjusted p<0·0001). In the second study, the RUTHERFORD-2 trialists allocated patients with heterozygous familial hypercholesterolaemia to evolocumab (n=110) or placebo (n=54) once every 2 weeks, or monthly evolocumab (n=110) or placebo (n=55), for 12 weeks. Both doses of the study drug led to reductions in LDL cholesterol from baseline to week 12 compared with placebo (treatment difference for once every 2 weeks dose −59·2% [95% CI −65·1 to −53·4] and for the monthly dose −61·3% [–69·0 to −53·6]; p<0·0001 for both). Treatment was generally well tolerated. The CALORIES trial investigators have attempted to resolve the uncertainty regarding the delivery route for early nutritional support in critical care. Their pragmatic, open, multicentre, randomised trial included patients with an unplanned admission to ICU who required early nutritional support. Parenteral or enteral nutrition was administered for up to 5 days. 30 day mortality was 33% (393/1188) in patients allocated to parenteral nutrition and 34% (409/1195) in patients allocated to enteral nutrition; the difference between the groups was not statistically significant (absolute difference between groups 1·15, 95% CI −2·65 to 4·94). Incidence of hypoglycaemia and vomiting was lower in the parenteral group than in the enteral group. A phase 2 randomised dose-ranging trial of mirogabalin has yielded some promising results for people with diabetes and painful peripheral neuropathy. Investigators allocated 452 patients with type 1 or type 2 diabetes and painful peripheral neuropathy to placebo, five different doses of mirogabalin, or pregabalin (active comparator) for 5 weeks. Higher mirogabalin doses (15 mg/day, 20 mg/day, and 30 mg/day) were associated with significantly greater reductions in mean daily pain score from baseline to week 5 compared with placebo (least squares mean difference −0·94, −0·88, and −1·01, respectively; p<0·05). The most common adverse events associated with mirogabalin treatment were dizziness and somnolence. The ADVANCE-ON collaborators report the post-trial observational follow-up of 8494 patients with type 2 diabetes who had participated in the ADVANCE factorial trial. In the ADVANCE trial, although the combination of perindopril and indapamide for blood pressure lowering over 4·5 years was associated with a reduction in mortality, intensive glycaemic control over 5 years was not. In ADVANCE-ON, after 5·9 years post-trial follow-up, reductions in cardiovascular mortality (hazard ratio 0·88, 95% CI 0·77 to 0·99) and all-cause mortality (0·91, 0·84 to 0·99) persisted for the active blood pressure lowering treatment group. There were no differences in cardiovascular mortality or all-cause mortality between the intensive glycaemic control or standard care cohorts after 5·4 years of post-trial follow-up. Liraglutide treatment could have effects beyond glycaemic control alone, suggest the investigators of the LIBRA placebo-controlled trial. Researchers randomly assigned patients with type 2 diabetes to 48 weeks of daily placebo injection (n=25) or subcutaneous liraglutide (n=26). In advance of receiving treatment, all patients had 4 weeks of short-term intensive insulin treatment to improve glucotoxicity caused by diabetes. At 48 weeks, patients in the liraglutide cohort had better pancreatic β-cell function than those in the placebo group, as assessed by the Insulin Secretion-Sensitivity Index-2 (mean [SE] baseline adjusted values: 339·8 [27·8] and 229·3 [28·4], respectively; p=0·008). However, the beneficial effect on β cells was not maintained following termination of liraglutide treatment. Results from a single-centre randomised controlled trial cast the spotlight on the role of vitamin D in intensive care. Investigators for the VITdAL-ICU trial allocated critically ill patients with vitamin D deficiency to receive a loading dose of vitamin D3 (540 000 IU) or placebo, and then five, monthly, maintenance doses. The primary outcome did not differ between groups assigned to vitamin D3 (n=237) or placebo (n=238), with patients receiving vitamin D3 staying in hospital for a median of 20·1 days (IQR 11·1–33·3), and placebo patients for 19·3 days (11·1–34·9; p=0·98). Length of ICU stay, in-hospital death, and death at 6 months did not significantly differ between the two groups.