Diabetes and chronic heart failure: from diabetic cardiomyopathy to therapeutic approach.

Diabetes and chronic heart failure are interrelated conditions with major medical and economic impact that have to be treated as a distinct entity. Several pathological mechanisms have been investigated and proposed to explain the structural and functional changes associated with diabetic cardiomyopathy. These mechanisms are likely to act synergically and may potentiate one the other. This review outlines recent advances in the pathophysiological mechanisms implicated in the development and progression of diabetic cardiomyopathy and in current therapeutic strategies.

Are behavioural approaches feasible and effective in the treatment of type 2 diabetes? A propensity score analysis vs. prescriptive diet.

BACKGROUND AND AIMS: Lifestyle changes are considered first line treatment in type 2 diabetes, but very few data are available in the "real world" of diabetes units. We aimed to measure the effectiveness of moderate and high intensity interventions on weight loss, metabolic control and insulin use. We report a prospective cohort study, carried out in 822 consecutive subjects with type 2 diabetes, first seen in a 4-year period in a diabetes unit of an academy hospital. METHODS AND RESULTS: Subjects were treated with either a sole prescriptive diet (Diet), or received an additional short-course Elementary Nutritional Education (4 group sessions-ENE) or an intensive Cognitive Behavioural Therapy (12-15 group sessions-CBT). The results were adjusted for the propensity score to be assigned different treatments, derived from logistic regression on the basis of age, gender, BMI, HbA1c, diabetes duration and insulin use at baseline. Main outcome measures were weight loss and weight loss maintenance, metabolic control, and secondary failure to insulin use. Both structured programmes produced a larger weight loss, and the adjusted probability of achieving the 7% weight loss target was increased. Similarly, both programmes favoured metabolic control, irrespective of insulin use. After adjustment for propensity score, both ENE (hazard ratio, 0.48; 95% CI, 0.27-0.84) and CBT (hazard ratio, 0.36; 95% CI, 0.16-0.83) were associated with a reduced risk of de novo insulin treatment. CONCLUSION: Structured behavioural programmes aimed at lifestyle changes are feasible and effective in the "real world" setting of a diabetes unit for the treatment of type 2 diabetes.

Vaccination trials of sea bass (Dicentrarchus labrax) against pasteurellosis using oral, intraperitoneal and immersion methods.

Photobacterium damsela subsp. piscicida (Phdp) is the aetiological agent of fish pasteurellosis, causing heavy losses in intensive mariculture plants. The present work compares the protective efficacy of five different vaccine formulation: oral, intraperitoneal, immersion, bivalent immersion (Vibrio anguillarum) and immersion associated with immunostimulants. Each of these vaccine formulations containing whole cells of Phdp formalin inactivated (FKC), was administered to 100 sea bass weighing approximately 2 g; 100 non-vaccinated sea bass were used as controls. Protection against pasteurellosis was tested for 40 days after vaccination by intraperitoneal challenge: each fish was inoculated with Phdp cells at a concentration of 2.75 x 10(4) cfu/ml. Mortality was recorded over the following 14 days, vaccine protection was evaluated using a relative percentage survival (RPS) index. The intraperitoneal formulation gave excellent protection (RPS 82.4%). The most effective immersion form was that followed by simple immersion (RPS 23.1%) followed by the group vaccinated with bivalent vaccine (RPS 18.7%). Protection conferred orally (RPS 28.6%) is of interest for practical purposes.