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Aim: To determine whether de‐escalating from advanced insulin therapy (AIT) to the combined use of metformin, an SGLT2 inhibitor, a GLP1 receptor agonist and basal insulin is the better option than multiple daily insulin injections (MDI) in obese patients with poorly controlled T2DM. Methods: This was a 16‐week, prospective, randomized, controlled trial. Twenty‐two obese patients with T2DM on AIT were randomized to intervention (step‐down) or control (MDI) group. In the intervention group, all prandial insulin injections were discontinued, but the patient remained on basal insulin and metformin, to which an SGLT2i and a GLP1 RA were added. In the control group, the patient remained on MDI. Results: Compared to control group (n = 8), A1c was significantly lower at week 4 (9.54% vs 8.25%; p =.0088) and week 16 (9.7% vs 7.31%; p <.001) in intervention group (n = 10). In intervention group, compared to baseline, there was a significant decrease in weight (−16.38 pounds; p =.003), BMI (−3.06; p <.001), LDL cholesterol (−15.7 mg/dl; p =.0378), total cholesterol (−18.5 mg/dl; p =.0386), total daily insulin dose (−57.3 units; p <.001) and a significant improvement in DM‐SAT patient satisfaction 0‐100 scores: total score (+45.3; p <.001) and subscale scores (Convenience + 35.28, p =.019; Lifestyle + 35.8, p =.0052; Medical control + 51.3, p <.001; Wellbeing + 47.2, p =.0091) at week 16. Conclusion: De‐escalating from AIT to the combined use of metformin, SGLT2i, GLP1 RA and basal insulin in obese patients with poorly controlled T2DM on MDI resulted in significant improvement in glycaemic control, weight loss and significantly higher patient satisfaction. This stepping‐down approach may be the better option than continuing MDI in these patients. [ABSTRACT FROM AUTHOR]

Located at the southern edge of the eastern Himalayan syntaxis, the Central Myanmar Basin ( CMB) is divided into several Tertiary sub-basins that have been almost continuously filled since the Indo-Asia collision. They are currently drained by the Irrawaddy River, which flows down the eastern Tibetan Plateau and the Sino-Burman Ranges. Tracing sediment provenance from the CMB is thus critical for reconstructing the past denudation of the Himalayan-Tibetan orogen; it is especially relevant since a popular drainage scenario involves the capture of the Tsangpo drainage system in Tibet by a precursor to the Irrawaddy River. Here, we document the provenance of sediment samples from the Minbu Sub-Basin at the southern edge of the CMB, which is traversed by the modern stream of the Irrawaddy River. Samples ranging in age from middle Eocene to Pleistocene were investigated using Nd isotopes, trace element geochemistry and sandstone modal compositions. Our data provide no evidence of a dramatic provenance shift; however, sandstone petrography, trace element ratios and isotopic values display long-term trends indicating a gradual decrease of the volcanic input and its replacement by a dominant supply from the Burmese basement. These trends are interpreted to reflect the progressive denudation of the Andean-type volcanic arc that extended onto the Burmese margin, along the flank of the modern Sino-Burman Ranges, where most of the post-collisional deformation of central Myanmar is located. Though our results do not exclude an ephemeral or diluted contribution from a past Tsangpo-Irrawaddy connection, sedimentation rates suggest that this hypothesis is unlikely before the development of a stable Tsangpo-Brahmaputra River in the Miocene. These results thus suggest that the central Myanmar drainage basin has remained restricted to the Sino-Burman Ranges since the beginning of the India-Asia collision. [ABSTRACT FROM AUTHOR]

The phylogenetic affinities of the primates of the late middle Eocene Pondaung Formation of Myanmar have long been disputed. The discovery of the NMMP 39 talus (Marivaux et al.: Proc Natl Acad Sci USA 100 (2003) 13173-13178) provided the first clear evidence from the postcranium that a relatively large-bodied haplorhine primate is represented in the Pondaung fauna. Another talus (NMMP 82; Marivaux et al., 2010). Talar morphology, phylogenetic affinities and locomotor adaptation of a large-bodied amphipithecid primate from the late middle Eocene of Myanmar, Am J Phys Anthropol DOI: 10.1002/ajpa.21307) has been recently recovered which also pertains to Haplorhini. The metric and nonmetric features supporting the hypothesis of anthropoid affinities for NMMP 39 have been criticized by Gunnell and Ciochon (Gunnell GF, Ciochon RL. 2008. Revisiting primate postcrania from the Pondaung Formation of Myanmar. In: Fleagle JG, Gilbert CC, editors. Elwyn Simons: a search for origins. New York: Springer. p 211-228). Their analysis, however, was based on a very limited choice of variables, taxa, and individuals. Based on an extended sample, we are able to produce both principal components and discriminant functions that yield a rather clear separation of extant haplorhine and strepsirhine tali. Both principal components and discriminant function scores of the Pondaung tali fall with those of haplorhine primates. In addition, the Pondaung tali lack all the derived nonmetric features characteristic of strepsirhine primates, but exhibit all the features characteristic of haplorhine primates. We dispute the features Gunnell and Ciochon (2008) claim are uniquely shared by the Pondaung tali and adapiforms. Their rejection of the phylogenetic significance of the features shared by these tali and haplorhines is unwarranted by the evidence. Based on both metric and nonmetric features, the Pondaung tali are structurally most similar to the tali of haplorhines, particularly anthropoids. [ABSTRACT FROM AUTHOR]

A well-preserved fossil talus [National Museum of Myanmar Primates (NMMP) 82] of a large-bodied primate is described from the late middle Eocene Pondaung Formation of central Myanmar. The specimen was collected at Thandaung Kyitchaung, a well-known amphipithecid primate-bearing locality near the village of Mogaung. NMMP 82 adds to a meager but growing sample of postcranial remains documenting the large-bodied primates of the Pondaung Formation. This new talus exhibits a suite of features that resemble conditions found in living and fossil haplorhine primates, notably anthropoids. As such, the phylogenetic signal deriving from the morphology of NMMP 82 conflicts with that provided by NMMP 20, a partial skeleton (including a fragmentary calcaneus) of a second large-bodied Pondaung primate showing undoubted adapiform affinities. Analysis subtalar joint compatibility in a hypothetical NMMP 82/NMMP 20 combination (talus/calcaneus) reveals a substantial degree of functional mismatch between these two tarsal bones. The functional incongruence in subtalar joint morphology between NMMP 20 and NMMP 82 is consistent with the seemingly divergent phylogenetic affinities of these specimens, indicating that two higher level taxa of relatively large-bodied primates are documented in the Pondaung Formation. On the basis of its size and morphology, we refer the NMMP 82 talus to the large-bodied amphipithecid Pondaungia. The occurrence of anthropoid-like tali in the Pondaung Formation obviates the need to invoke homoplasy to explain the shared, derived dental characters that are common to amphipithecids and undoubted anthropoids. Functionally, the NMMP 82 talus appears to have pertained to a primate that is engaged in active quadrupedalism in an arboreal environment along broad and subhorizontal branches. The primate taxon represented by NMMP 82 was capable of climbing and leaping, although it was not particularly specialized for either of these activities. [ABSTRACT FROM AUTHOR]

The postcranial anatomy of the Asian sivaladapid adapiforms is still virtually undocumented, whereas dental remains of these primates have been known for several decades. Little is known about their positional behavior as a result. In this article, we describe a partial left femur of a medium-sized primate preserving its entire proximal portion and a significant length of its shaft. This fossil was recently recovered from the fossiliferous locality of Thamingyauk in the late middle Eocene Pondaung Formation (central Myanmar). This femur is considered to pertain to the same individual as two tarsal elements (fragmentary talus and calcaneus) from the same locality (same location), and attributed to a medium-sized sivaladapid adapiform primate (Kyitchaungia takaii). This new postcranial element provides the first documentation of femoral anatomy among Sivaladapidae from Asia. The mechanical implications deriving from the musculoskeletal interpretation of this bone indicate an animal that probably engaged in a kind of active arboreal quadrupedalism with some degree of proficiency in leaping. Even though many musculoskeletal aspects suggest that branch walking and running were important parts of its locomotor repertoire, in other details it appears that relatively complex movements at the hip joint were actually possible and probably associated with climbing or some hindlimb suspensory activities. [ABSTRACT FROM AUTHOR]