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Background We aimed to analyze the association of estimated glomerular filtration rate (eGFR) levels of hospitalized patients with treatment decisions and clinical outcomes in Chinese patients with acute coronary syndrome (ACS). Methods This was a secondary analysis study from CPACS-2 Program which was a trial of a quality improvement intervention in China and recruited 15,141 patients from 75 hospitals between October 2007 and August 2010. All patients were divided into three groups by the eGFR level on admission. The primary outcomes were several key performance indicators (KPIs) reflecting the management of ACS and the secondary outcomes were clinical outcomes. Results A total of 14,437 ACS patients were enrolled in this analysis. Among patients with reduced eGFR levels, fewer patients received appropriate medical therapy (p for trend Conclusion Among Chinese ACS patients, those with renal insufficiency have a lower percentage of adherence to guideline-recommended treatments and worse clinical prognosis. Renal insufficiency is an important factor affecting guideline implementation in Chinese ACS patients. Clinical trial registration http://www.anzctr.org.au/default.aspx . Unique identifier: ACTRN12609000491268.

We report that the load transfer in carbon nanotube (CNT) networks is determined by the cross-link density

Centimetres-long carbon nanotube (CNT) bundles with tensile strength over 80 GPa have been fabricated and tested recently [Nat. Nanotechnol. 13, 589–595 (2018)], but it is still a tremendous challenge to predict their nonlinear mechanical behaviors by full-atom molecular dynamics (MD) due to the huge computational cost, particularly for carbon nanotube networks. We completely established here the explicit expressions of the chirality-dependent higher-order nonlinear coarse-grained stretching and bending potentials based on the full-atom Reactive Empirical Bond-Order interatomic potential of second generation (REBO potential). In particular, the coarse-grained non-bonded potentials are improved by using the 18–24 Lennard-Jones potential. By comparison with available experimental results and full-atom MD simulations as well as our analytical results, the present nonlinear coarse-grained potentials have high accuracy. The obtained nonlinear coarse-grained potentials can be used to efficiently characterize the nonlinear mechanical behaviors and understand the failure mechanism of the CNT bundles and networks with 2∼5 orders of magnitude reduction in computing time, which should be of great help for designing and assembling CNT-based flexible microdevices.

Aims: To assess predictors of glycemic control after patients with type 2 diabetes mellitus (T2DM), inadequately controlled with oral antidiabetic drugs (OADs), were initiated basal insuli...

Background. Though many randomized control trials had examined the effectiveness and safety of taking insulin therapy with or without metformin, there are limited real-world data, especially among Chinese type 2 diabetes patients initiating basal insulin (BI) with uncontrolled hyperglycemia by oral agents. This study was designed to assess the effectiveness and safety of BI therapy combined with or without metformin in a real-world national cohort study. Methods. Patients with type 2 diabetes mellitus who initiated BI treatment due to uncontrolled hyperglycemia (HbA1c ≥ 7%) by oral antidiabetic drugs (OADs) were recruited in Chinese real-world settings between 2011 and 2013. A total of 12,358 patients initiated BI without bolus insulin and completed a 6-month follow-up were selected as the study population and divided into BI with metformin or BI without metformin group based on whether metformin was simultaneously prescribed or not at baseline. Propensity score adjustment was used to balance baseline covariates between two groups. A sub-analysis was also conducted among 8,086 patients who kept baseline treatment regimen during the follow-up. Outcomes were HbA1c, hypoglycemia, weight gain and insulin dose in two groups. Results. 53.6% (6,621 out of 12,358) patients initiated BI therapy concomitant with metformin. After propensity score adjustment, multivariate regression analysis controlled with number of OADs, total insulin dose, physical activity and diet consumption showed that BI with metformin group had a slightly higher control rate of HbA1c

Previous studies have shown an inverse relationship between education and clinical outcomes in coronary heart disease. Whether a similar association exists in patients presenting with suspected acute coronary syndromes (ACS) in China is unknown.Clinical Pathways for Acute Coronary Syndromes - Phase 2 (CPACS-2) was a study to evaluate a quality improvement for ACS management in China which implemented in 75 hospitals between October 2007 and August 2010. All patients was divided into 6 groups by education level. We evaluated clinical managements and outcomes according to level of education.A total of 14350 patients were enrolled in current analysis. Patients with less education were older, had greater female representation and had a higher Killip class at admission. Compared to patients with lower education levels, more educated patients had a longer length of hospitalization (p for trend0.001), greater likelihood of receiving appropriate coronary angiography (p for trend0.001) and appropriate reperfusion therapy for ST-segment elevated myocardial infarction (STEMI) (p for trend0.001) even after adjustment for differences in patient characteristics and comorbidities at presentation. Patients with less education were at higher risk of death, cardiac death and major adverse cardiovascular events but none of these differences remained statistically significant after adjustment for baseline characteristics.In China, less educated patients with ACS were less likely to receive appropriate coronary angiography and reperfusion therapy. Less educated patients were at higher risk for adverse clinical events; however this was explained by differences in baseline characteristics.

Background: To explore the proportion and characteristics of patients with Type 2 diabetes mellitus (T2DM) uncontrolled by oral antidiabetic drugs (OADs) who initiated basal insulin (BI) therapy using a basal-bolus regimen. Methods: This multicenter, observational, prospective study included a representative sample of 18,995 Chinese insulin-naïve T2DM patients who initiated BI therapy due to uncontrolled hyperglycemia by OADs. The type and dose of BI as well as other treatment regimens depended on physician’s discretion and patient’s willingness. Proportion of patients initiating basal-bolus insulin and associated factors were analyzed. Results: Basal-bolus accounted for 24.6% of patients initiating BI, of whom 97.8% initiated a full basal-bolus regimen. In the multivariate logistic regression, factors significantly associated with initiating basal-bolus regimen were tertiary hospital, in-patients, younger age, higher BMI, longer diabetes duration, more complications, higher HbA1c level, low self-monitoring of blood glucose (SMBG) frequency before, one OAD used before, no concomitant OAD, and initiating Neutral Protamine Hagedorn (NPH). About half of patients initiating basal-bolus persisted on the same insulin regimen at 3-month. Glycemic control rates (HbA1c

Aims: To compare glucose control and safety of different basal insulin therapies (BI, including Insulin NPH, glargine and detemir) in real-world clinical settings based on a large-scale registry study.Methods: In this multi-center 6-month prospective observational study, patients with type 2 diabetes (HbA1c >= 7%) who were uncontrolled by oral anti-diabetic drugs (OADs) and were willing to initiate BI therapy were enrolled from 209 hospitals within 8 regions of China. Type and dose of BI were at the physician's discretion and the patients' willingness. Interviews were conducted at 0 months (visit 1), 3 months (visit 2) and 6 months (visit 3). Outcomes included change in HbA1c, hypoglycemia rate and body weight from baseline at 6 months.Results: A total of 16 341 and 9002 subjects were involved in Intention-To-Treat (ITT) and per-protocol (PP) analysis, respectively. After PS regression adjustment, ITT analysis showed that reduction in HbA1c in glargine (2.2% +/- 2.1%) and detemir groups (2.2% +/- 2.1%) was higher than that in the NPH group (2.0% +/- 2.2%) (P < .01). The detemir group had the lowest weight gain (-0.1 +/- 2.9 kg) compared with the glargine (+0.1 +/- 3.0 kg) and NPH (+0.3 +/- 3.1 kg) groups (P < .05). The glargine group had the lowest rate of minor hypoglycaemia, while there was no difference in severe hypoglycaemia among the 3 groups. The results observed in PP analyses were consistent with those in ITT analysis.Conclusion: In a real-world clinical setting in China, treatment with long-acting insulin analogues was associated with better glycaemic control, as well as less hypoglycaemia and weight gain than treatment with NPH insulin in type 2 diabetes patients. However, the clinical relevance of these observations must be interpreted with caution.

To examine treatment patterns following basal insulin (BI) introduction in type 2 diabetes mellitus (T2DM) patients under real-world conditions across China.Overall, 18 995 patients inadequately controlled (HbA1c ≥ 53 mmol/mol [7%]) with oral antihyperglycaemic drugs (OADs) and willing to receive BI treatment were registered at 209 hospitals and followed at baseline (visit 1), 3 months (visit 2) and 6 months (visit 3). Type of BI was initiated at physicians' discretion.Retention with BI therapy at 6 months was 75.6%. Use of long-acting BI predominated, with insulin glargine accounting for 71%, detemir 13% and Neutral Protamine Hagedorn (NPH) insulin 16%. Over 70% of long-acting users maintained the same initial BI at visit 3, while 40% of NPH users switched treatment and 24.4% of participants initiated BI with prandial insulin. The initial mean (± SD) dose of BI and total insulin was 0.18 ± 0.07 and 0.25 ± 0.19 IU/kg, respectively, with a mean increase of daily dose by 0.03 and 0.02 IU/kg after 6 months, respectively. Only 56.6% of insulin users reported dose titration at visit 3. Mean HbA1c was 81 mmol/mol (9.6%) at baseline and 57 mmol/mol (7.4%) at 6 months. The frequency of hypoglycaemia was 1.61 and 2.07 episodes/patient-year at baseline and 6 months, respectively.In real-world clinical settings, add-on BI therapy in T2DM patients is associated with significant improvement in glycaemic control without overtly compromising safety related to hypoglycaemia and weight gain. Evolution of insulin treatment regimens varied among patients, but dose titration was suboptimal. More active BI dose titration might further improve glycaemic outcome in patients receiving BI therapy.A free Video Abstract to accompany this article is available at https://vimeo.com/212655959.

Objectives: To evaluate the changes in diet, physical activity level and smoking status in insulin naive patients with type 2 diabetes uncontrolled by oral antidiabetic drugs (OADs) after initiating basal insulins (BIs) for 6 months. Methods: Observational Registry of Basal Insulin Treatment (ORBIT) program is a 6-month, prospective study in China. Patients with type 2 diabetes uncontrolled on OADs (HbA1c ?7%, 53 mmol/mol) and willing to initiate BI treatment were enrolled. Type and dose of BI were at the physician’s discretion and patients’ willingness. Interviews were conducted at baseline, month 3 and month 6. Daily diet consumption, frequency of physical activity and smoking status in past 7 days were collected. Patients who kept using BI during the 6 months were included for analysis. Results: Totally, 12 353 patients were included. Compared with the proportions at baseline, the proportion of patients with staple food of 0.4kg/day and above declined by 3%-4% at 6th -month, whist the proportion of patients with moderate consumption (0.3kg/day) increased by 9.3%. The proportion of patients with 0.4kg/day vegetables increased by 4.2% and those with 0.2kg/day declined by 3.4% at 6th -month. Proportion of patients with 0.2kg/day fruit and meat increased by 12.5% and 7.6% respectively at 6th -month. Also, at 6 th -month, patients spent more days participating physical activities weekly (5.8 vs. 5.3days), and both proportion of patients with smoking (20.0% vs. 22.9%) and number of cigarettes smoked per day (14.7 vs. 17.4) declined. Conclusions: Adding-on BIs therapy is associated with positive lifestyle change including healthier diet consumption, more physical activities and less smoking behaviours in patients with type 2 diabetes.

Hip fracture becomes a major public health issue with the growing aging population. This study evaluated a multidisciplinary co-management program for older hip fracture patients and found it significantly improved the best practice indicators. It provided preliminary evidence to support the use of such intervention in hip fracture management. Hip fracture leads to high morbidity and mortality in older people. A previous study found a significant disparity in hip fracture management in Beijing Jishuitan Hospital (JSTH) compared to best practice care in the United Kingdom (UK). Following this audit, JSTH launched a multidisciplinary co-management care plan for older hip fracture patients. This study aims to evaluate the effect of this program on the six standards recommended in the UK hip fracture best practice guidelines. In this retrospective study, electronic medical record data were collected before and after the intervention. Eligible patients were aged ≥ 65 years, had X-ray confirmed hip fracture, and were admitted to JSTH within 30 days of injury. Patient demographic information, time from emergency department presentation to admission, time from admission to surgery, pressure ulcers, osteoporosis assessment, and falls prevention were collected. Multivariable logistic and median regression models were used for binary and continuous outcomes respectively. Segment regression was also performed for time-related outcomes. A total of 3540 eligible patients were identified. After the intervention, half of the patients who received co-management received surgery within 48 h of ward admission compared to 6.4% previously, 0.3% (vs 1.4%) developed pressure ulcers, and 76% (vs 19%) received osteoporosis assessment. No significant differences were observed in fall assessment rates. However, there was a higher rate of ward admission within 4 h of arrival in emergency for patients admitted pre-intervention (61% vs 34%). The introduction of the co-management model significantly reduced the time from admission to surgery and improved other practice outcomes. A multicenter randomized controlled trial is needed to evaluate the impact of this model on patient health outcomes.

Helical nanostructures, like nanosprings, made from carbon-based materials have broad promising applications in mechanical nanodevices and energy-absorbing materials. However, it is a big challenge to reveal the mechanism of their excellent mechanical properties due to the lack of theoretical models. Here we report the huge stretchability and reversibility of helical graphenes (HGs) using molecular dynamics (MD) simulations. Simplified theoretical models based on interlayer van der Waals (vdW) interactions are developed to predict the tensile properties of different-size HGs in three elastic stages including the initial deformation, stable delamination and elastic deformation. During the tensile process, the vdW interactions between adjacent free coils play a key role in the initial deformation and delamination stages, while the tensile behavior is dominated by the stretching of carbon-carbon bonds in the elastic deformation stage. The obtained theoretical results agree well with those from present MD simulations. Meanwhile, both the critical force in the initial deformation stage and the critical elastic force in the elastic deformation stage decrease with increasing temperature. In particular, the mechanical behavior of HGs under cyclic loading shows obvious hysteresis loops, which produce large energy dissipation due to the recovery of interlayer vdW interactions. These findings should be of great help towards understanding the stability and reliability of these helical structures, and giving an insight to design a new generation of nanodevices.

Introduction: This study evaluates an insulin dose titration model and factors that impact insulin dose adjustment in Chinese adults with type-2 diabetes, who receive basal insulin in real-world settings. Material and methods: A total of 19,894 patients from the ORBIT study were included. These patients were divided into four groups, according to the type of insulin dose adjustment: no insulin titration (group A), self-titration (group B), physician-led insulin titration (group C), and combined physician and patient-led insulin titration (group D). Data were collected and compared at baseline and after six months of treatment. Results: A total of 12,865 patients completed the visits and were included in the analysis. Among these patients, 3187 (24.8%), 1971 (15.3%), 5165 (40.1%), and 2542 (19.8%) patients were included in groups A, B, C, and D, respectively. The multivariate logistic regression analysis revealed that the duration of diabetes, body mass index, microvascular complications, inpatient days, HbA1C level, and self-monitoring of blood glucose (SMBG) were positively correlated with insulin titration in group B, C, and D, compared with group A. The number of inpatient days and outpatient visits were positively correlated with dose adjustment for physician-led titration, while this was negatively correlated for self-titration. Self-titration encouraged by physicians and home blood glucose monitoring were positively correlated with self-titration and the combined physician and patient-led titration. Conclusions: High HbA1C level, SMBG, long disease duration, microvascular complications, and the encouragement of physicians while initiating insulin use prompt patients to perform dose adjustments in real-world settings.

The Observational Registry of Basal Insulin Treatment (ORBIT) study evaluated the safety of basal insulin (BI) in real-world settings in China.We analyzed 9002 patients with type 2 diabetes (T2D) inadequately controlled with oral hypoglycemic agents from 8 geographic regions and 2 hospital tiers in China who initiated and maintained BI treatment. Body weight and hypoglycemic episodes were recorded at baseline and 3 and 6 months. Serious adverse events (SAEs) were recorded at 3 and 6 months.Age, gender, inpatient/outpatient status, body mass index, glycated hemoglobin (HbA1c) at baseline and at the end of study, T2D duration, microvascular complications, BI type, combination with insulin secretagogues, self-monitoring of blood glucose frequency, and insulin dosage, all predicted hypoglycemia. BI use generally did not induce significant weight gain (0.02 kg); weight gain with insulin detemir (-0.30 kg) was less than that with neutral protamine Hagedorn (NPH) insulin (0.20 kg) or insulin glargine (0.05 kg). Overall, general hypoglycemia incidence (5.6% vs. 7.7%) and annual event rate (1.6 vs. 1.8) were similar before and after BI initiation, whereas a slight decrease was noted in severe hypoglycemia incidence (0.6%-0.3%) and frequency (0.05-0.03 events/patient-year). The general hypoglycemia rate was lowest with insulin glargine, whereas there was no significant difference in severe hypoglycemia among the three BI groups. Overall, 3.5% of patients had at least one SAE during the study. Most SAEs were found to be unrelated to BI treatment.Real-world BI use, particularly insulin detemir and glargine, was associated with only slight weight gain and low hypoglycemia risk in patients with T2D in China.

We aimed to determine the clinical characteristics of type 2 diabetes patients on basal insulin therapy with inadequate glucose control due to discordance between glycated haemoglobin (HbAThis was a retrospective analysis of data from the ORBIT study in China. Clinical characteristics of patients with discordance between HbAOverall, of 6721 patients initiated on basal insulin, 853 achieved HbAPatients treated with insulin analogues (glargine or detemir), instead of neutral protamine Hagedorn, and with more frequent SMBG are more likely to exhibit concordance between HbA

This study aims to examine short-term treatment cost changes after initiating basal insulin in insulin naive patients with type 2 diabetes for 6 months in routine clinical practice. Observational Registry of Basal Insulin Treatment (ORBIT) program is a 6-month, prospective study in China. Patients with type 2 diabetes inadequately controlled (HbA1C≥7%) by oral antidiabetic drugs (OADs) and willing to initiate basal insulin treatment were enrolled from 209 hospitals of eight geographic regions of China. Type and dose of BI were at the physician’s discretion and patients’ willingness. Interviews were conducted at baseline, month 3 and month 6. Daily treatment cost (including cost of OAD medication, insulin therapy, self-monitoring of blood glucose and dealing with minor hypoglycemia) of per person before and after adding BIs was evaluated. After adding on Basal insulin, the weighted mean ± standard deviation (SD) daily treatment cost for insulin-naive patients with type 2 diabetes increased from $1.25 ± $0.74 (baseline) to $2.57 ± $0.68 at month 6, a median (Q1, Q3) increase of 1.51 (0.38, 4.11) times over 6 months. The daily treatment cost increased with growing baseline HbA1c level and prolonged diabetes duration. The reduction in HbA1c was 2.2%, with minor hypoglycemia increased by 0.68 times/person/year. Insulin cost accounted for the highest proportion (47.9%) of costs. Our findings suggest adding-on BI therapy may increase the daily treatment cost by 1.5 times at 6 months. Early initiation of BI therapy may provide an opportunity to achieve treatment goals with low cost and low risk of hypoglycemia.

Background We aimed to determine the clinical characteristics of type 2 diabetes patients on basal insulin therapy with inadequate glucose control due to discordance between glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) in the real world. Methods This was a retrospective analysis of data from the ORBIT study in China. Clinical characteristics of patients with discordance between HbA1c and FPG at baseline and at the end of 6 months of follow‐up were analysed using multinomial logistic regression in 4 study groups divided by HbA1c and FPG. Results Overall, of 6721 patients initiated on basal insulin, 853 achieved HbA1c < 7% but FPG ≥ 7 mmol/L (group 2), while 997 had FPG < 7 mmol/L but HbA1c ≥ 7% (group 3) at the end of follow‐up. Patients in group 3 had a longer duration of type 2 diabetes compared with those in group 2 (7.22 ± 5.30 vs 6.00 ± 4.80 y, P < .05). Patients on glargine (32.90%) or detemir (36.88%) treatment accounted for a higher proportion of patients with both HbA1c and FPG controlled than those on neutral protamine Hagedorn therapy (23.45%; P < .05). Per the multinomial logistic analysis, higher frequency of self‐monitoring of blood glucose (SMBG) and use of glargine or detemir therapy were significantly inversely associated with risk of discordance between HbA1c and FPG, while dose of insulin was a risk factor for discordance at the end of follow‐up (all P < .05). Conclusions Patients treated with insulin analogues (glargine or detemir), instead of neutral protamine Hagedorn, and with more frequent SMBG are more likely to exhibit concordance between HbA1c and FPG.

Background— In rural areas in China and India, the cardiovascular disease burden is high but economic and healthcare resources are limited. This study (the Simplified Cardiovascular Management Study [SimCard]) aims to develop and evaluate a simplified cardiovascular management program delivered by community health workers with the aid of a smartphone-based electronic decision support system. Methods and Results— The SimCard study was a yearlong cluster-randomized, controlled trial conducted in 47 villages (27 in China and 20 in India). Recruited for the study were 2086 individuals with high cardiovascular risk (aged ≥40 years with self-reported history of coronary heart disease, stroke, diabetes mellitus, and/or measured systolic blood pressure ≥160 mm Hg). Participants in the intervention villages were managed by community health workers through an Android-powered app on a monthly basis focusing on 2 medication use and 2 lifestyle modifications. In comparison with the control group, the intervention group had a 25.5% ( P P P =0.04). However, no significant changes were observed in the lifestyle factors. The intervention was culturally tailored, and country-specific results revealed important differences between the regions. Conclusions— The results indicate that the simplified cardiovascular management program improved quality of primary care and clinical outcomes in resource-poor settings in China and India. Larger trials in more places are needed to ascertain the potential impacts on mortality and morbidity outcomes. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01503814.

Background The three most commonly used basal insulins in patients with type 2 diabetes are neutral protamine Hagedorn (NPH) insulin and the long-acting insulin analogues glargine and detemir. Although randomised controlled trials have shown equivalent efficacy of these three insulins, inconsistencies in safety exist. We aimed to assess the safety and efficacy of these three basal insulins in real-world clinical setting in the ORBIT (Observational Registry for Basal Insulin Treatment) study. Methods In this multicentre, 6 month, prospective, registry study, patients were recruited between Nov 25, 2011, and Sept 1, 2014, who were aged 18–80 years, with type 2 diabetes that was inadequately controlled (HbA 1C ≥7%, 53 mmol/mol) with oral antidiabetic drugs and who were willing to start treatment with basal insulin were enrolled from 209 hospitals in eight regions of China. Patients who were prescribed any type of insulin in the past 2 years, with clinically significant acute major organ or systemic disease or other condition judged by the investigator that would create difficulty for the 6 month follow-up, or current or planned pregnancy or lactating women were excluded. Type and dose of basal insulin were at the physician's discretion and at the patients' willingness. Assessments were done at baseline (0 month—visit 1), mid-term (3 months—visit 2), and at the end of the study (6 months—visit 3) by investigators during routine practice. During analysis, patients were separated into NPH, glargine, and detemir insulin groups according to their initial prescription of basal insulin. Outcomes included the change in concentration of HbA 1c , hypoglycaemia rate, and bodyweight change in the three groups from baseline to 6 months. Propensity scores with regression adjustment were used to balance the baseline differences among the three groups. Intention-to-treat analysis was used to assess the outcomes. Findings Our findings show that treatment with long-acting insulin analogues is associated with better glycaemic control and less hypoglycaemia and weight gain than treatment with NPH insulin in patients with type 2 diabetes. Interpretation 16 341 patients were analysed in the intention-to-treat group and 9002 were analysed in the per-protocol group. In the intention-to-treat population, there were 11 290 (69%) patients treated with glargine, 2135 (13%) patients treated with detemir, and 18% (2916) patients treated with NPH insulin. After controlling for the baseline and process variables in the propensity score regression, the intention-to-treat analysis showed that the reductions in HbA 1c in the glargine (2%, SD 2·1, p=0·0014) and detemir (2%, 2·1, p=0·0065) groups were higher than that in the NPH group (2%, 2·2). The detemir group had lower weight gain (−0·1 kg, SD 2·9) than the glargine group (0·1 kg, 3·0; p=0·032) and the NPH group (0·3 kg, 3·1; p Funder Sanofi (Shanghai, China).