Patient preferences for anti-hyperglycaemic medication for type 2 diabetes mellitus in China: findings from a national survey.

OBJECTIVE: This study aimed to investigate the preferences regarding risks, benefits and other treatment attributes of patients with type 2 diabetes mellitus (T2DM) in China when selecting a second-line anti-hyperglycaemic medicine. METHODS: A discrete choice experiment with hypothetical anti-hyperglycaemic medication profiles was performed using a face-to-face survey administered to patients with T2DM. The medication profile was described using seven attributes: treatment efficacy, hypoglycaemia risk, cardiovascular benefits, gastrointestinal (GI) adverse events, weight change, mode of administration and out-of-pocket cost. Participants chose between medication profiles by comparing attributes. Data were analysed using a mixed logit model with marginal willingness to pay (mWTP) and maximum acceptable risk (MAR) calculated. The preference heterogeneity within the sample was explored using a latent class model (LCM). RESULTS: A total of 3327 respondents from five major geographical regions completed the survey. Treatment efficacy, hypoglycaemia risk, cardiovascular benefits and GI adverse events were major concerns among the seven attributes measured. Weight change and mode of administration were of lesser concern. Regarding mWTP, respondents would pay ¥236.1 (US$36.6) for an anti-hyperglycaemic medication with an efficacy of 2.5% points reduction in HbA1c, while they were willing to accept a weight gain of 3 kg only if they received a compensation of ¥56.7 (US$8.8). Respondents were willing to accept a relatively large increase in hypoglycaemia risk (MAR=15.9%) to improve treatment efficacy from intermediate (1.0% points) to high (1.5% points). LCM identified the following four unobserved subgroups: trypanophobia, cardiovascular-benefits-focused, safety-focused and efficacy-focused and cost-sensitive. CONCLUSION: Patients with T2DM prioritised free out-of-pocket costs, highest efficacy, no hypoglycaemia risk and cardiovascular benefits over weight change and mode of administration. There exists great preference heterogeneity among patients, which should be taken into account in healthcare decision-making processes.

What Is Valued Most by Patients With Type 2 Diabetes Mellitus When Selecting Second-Line Antihyperglycemic Medications in China.

Objective: To estimate patient preferences for second-line antihyperglycemic medications in China. Methods: A face to face survey with the best-worst scaling (BWS) choices was administered in patients with diagnosed type 2 diabetes mellitus (T2DM). Study participants were asked to indicate which attribute they valued most and which attribute they valued least in 11 choice sets, each of which consisted of five alternatives out of 11 antihyperglycemic medication-specific attributes (treatment efficacy, weight change, hypoglycemic events, gastrointestinal side effects, cardiovascular health, urinary tract infection and genital infection side effects, edema, mode of administration, bone fracture, dosing frequency and out-of-pocket cost). A counting approach, a conditional logit model, and K-means clustering were used to estimate the relative importance of items and preference heterogeneity. Results: A total of 362 participants were included with a mean age of 63.6 (standard deviation: 11.8) years. There were 56.4% of participants were women, and 56.3% being diagnosed with diabetes for at least 5 years. Efficacy, cardiovascular health and hypoglycemic events were valued most, while dosing frequency, mode of administration and bone fracture were valued least. The K-means clustering further showed preference heterogeneity in out-of-pocket cost across the participants. Conclusion: Our study suggests that treatment efficacy, cardiovascular health and hypoglycemic events are valued most by Chinese patients with T2DM when selecting second-line antihyperglycemic medications. The study improves the understanding of patients' preferences for second-line antihyperglycemic medications in China.

Coil-stretch-like transition of elastic sheets in extensional flows.

The conformation of a long linear polymer dissolved in fluid and exposed to an extensional flow is well-known to exhibit a "coil-stretch" transition, which for sufficiently long chains can lead to bistability. The present work reports computations indicating that an analogous "compact-stretched" transition arises in the dynamics of a thin elastic sheet. Sheets of nominally circular, square or rectangular shape are simulated in planar and biaxial flows using a finite element method for the sheet conformations and a regularized Stokeslet method for the fluid flow. If a neo-Hookean constitutive model is used for the sheet elasticity, the sheets will stretch without bound once a critical extension rate, as characterized nondimensionally by a capillary number, is exceeded. Nonlinear elasticity, represented with the Yeoh model, arrests the stretching, leading to a highly-stretched steady state once the critical capillary number is exceeded. For all shapes and in both planar and biaxial extension, a parameter regime exists in which both weakly stretched (compact) and strongly stretched states can be found, depending on initial conditions. I.e. this parameter regime displays bistability. As in the long-chain polymer case, the bistable behavior arises from the hydrodynamic interaction between distant elements of the sheet, and vanishes if these interactions are artificially screened by use of a Brinkman model for the fluid motion. While the sheets can transiently display wrinkled shapes, all final shapes in planar and biaxial extension are planar.

Balanced Effects of Surface Reactivity and Self-Association of Bifunctional Polyaspartamide on Stem Cell Adhesion.

Extensive efforts have been made to regulate surface wettability using bivalent polymers composed of hydrophobic surface-reactive groups and hydrophilic groups. To further enhance the controllability, this study demonstrates that the balance between the surface reactivity and self-aggregation of bivalent poly(hydroxyethyl-co-methacryloxyethyl aspartamide) (PHMAA) is crucial in controlling the wettability of methacrylated glass and thus the adhesion of stem cells. In particular, the wettability of the glass and the subsequent cell spreading became maximal with PHMAA that led to the largest and most uniform coverage of hydroxyl groups. In summary, this study would be useful in advancing various molecules used for surface engineering.

[Food-borne Parasitic Infection in Intermediate Hosts in Ninghai County of Zhejiang Province].

To understand the status of food-borne parasitic infection in intermediate hosts in Ninghai County of Zhejiang Province, freshwater crabs were collected from 4 towns of the County to detect the infection with metacercariae of Paragonimus, and frogs were collected from 8 towns to examine the infection with plerocercoid of Spirometra mansoni from May to September, 2015. Among the 339 freshwater crabs collected, the infection rate was 9.1%（31/339）, with each crab containing 6.7 metacercariae of Paragonimus on average. Among the 348 frogs collected, the infection rate was 11.5%（40/348）, with each frog containing 2.2 plerocercoids on average. In conclusion, there is a high rate of food-borne parasitic infection in intermediate hosts in Ninghai County. Comprehensive prevention and control measures are needed.

[Chemical constituents from Perovskia atriplicifolia].

An investigation on the chemical constituents of the 90% EtOH extract of Perovskia atriplicifolia led to the isolation of fifteen compounds from the EtOAc fraction. Based on the detailed spectral analysis (MS, 1D and 2D NMR), as well as comparison with the literatures, the structures of compounds 1-15 were determined as cirsimaritin (1), salvigenin (2), syringaldehyde (3), vinyl caffeate (4), 2α, 3α-dihydroxyolean-12-en-28-oicacid (5), 2α, 3α-dihydroxyurs-12-en-28-oicacid (6), niga-ichigoside F1 (2α, 3ß, 19α, 23- tetrahydroxyurs - 12-en-28-oicacid- O-ß-D- glucopyranoside, 7), sericoside (8), 4-epi-niga-ichigoside F1 (2α, 3ß, 19α, 24-tetrahydroxyurs-12-en-28-oicacid O-ß-D-glucopyranoside, 9), 2α, 3ß, 24-trihydroxyolean-12-en-28-oicacid O-ß-D-glucopyranosyl-(1 --> 2) - ß-D-glucopyranoside (10), pruvuloside A (11), asteryunnanoside A [2α, 3ß, 23-trihydroxyolean-12-en-28-oicacid O-ß-D-glucopyranosyl-(1 --> 2)-ß- D- glucopyranoside,12], rosmarinic acid methyl ester (13), ß-sitosterol (14), and daucosterol (15), respectively. Compounds 1-13 were isolated from the Perovskia genus for the first time. All the compounds were obtained from P. atriplicifolia for the first time.

Icetexane diterpenoids from Perovskia atriplicifolia.

Five new icetexane diterpenoids, namely, perovskatones B-D (1, 3, 4), 1α-hydroxybrussonol (2), and 1α-hydroxypisiferanol (5), were isolated from Perovskia atriplicifolia, together with a new natural product (6) and two known compounds, przewalskin E (7) and brussonol (8). The structures of the new compounds were elucidated by detailed analyses of their MS, IR, 1D, and 2D NMR data. Compounds 1-8 were assayed for their inhibitory hepatitis B virus activities in the HepG 2.2.15 cell line. The results suggested that compounds 1 and 2 possessed noticeable anti-hepatitis B virus activity in vitro, suppressing the replication of hepatitis B virus DNA with selectivity index values of 154.3 and 137.7, respectively.