Podcasts about dpp4

Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. Welcome to diabetes core update where every month we go over the most important articles to come out in the field of diabetes. Articles that are important for practicing clinicians to understand to stay up with the rapid changes in the field.  This issue will review: 1.     Large Language Model GPT-4 Compared to Endocrinologist Responses on Initial Choice of Antidiabetic Medication   2.     Long term health outcomes in people with diabetes 12 months after hospitalization with COVID-19 in the UK: a prospective cohort study 3.     Risk of nephrolithiasis associated with SGLT2 inhibitors versus DPP4 inhibitors among patients with type 2 diabetes: a target trial emulation study 4.     Early Screening for Latent Autoimmune Diabetes in Adults to Improve Care—Beyond the Routine 5.     Project ECHO Diabetes Trial Improves Outcomes for Medically Underserved People   For more information about each of ADA's science and medical journals, please visit Diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health

In this podcast, a study from Ontario revealed that SGLT2 inhibitors, when combined with statins, were associated with a 25% lower risk of rhabdomyolysis compared to DPP4 inhibitors. A phase I trial at Washington University demonstrated promising outcomes for a neoantigen DNA vaccine aimed at preventing recurrence in triple-negative breast cancer (TNBC). Finally, intensive systolic blood pressure control in Chinese patients with type 2 diabetes and elevated cardiovascular risk significantly reduced major cardiovascular events compared to standard care.

It's In the News.. a look at the top headlines and stories in the diabetes community. This week's top stories: World Diabetes Day roundup, existing drugs examined for T1D prevention, Blue Circle Health expands its novel T1D care model, Mounjaro studied further, Canada approves a new pumps system, and tragedy in the diabetes community.  Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Learn more about Gvoke Glucagon Gvoke HypoPen® (glucagon injection): Glucagon Injection For Very Low Blood Sugar (gvokeglucagon.com) Omnipod - Simplify Life Learn about Dexcom  Edgepark Medical Supplies Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode transcription with links:   Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and every other Friday I bring you a short episode with the top diabetes stories and headlines happening now. XX Of course, World Diabetes Day was yesterday. November 14 marks the birthday of Sir Frederick Banting. who discovered insulin along with Charles Best in 1922. Lots of the tech companies are taking action.. I'm going to link up a great article highlighting what many of them are doing…. from Medtronics Blue Balloon challenge to Dexcom's Nick Jonas video and a lot more. https://www.drugdeliverybusiness.com/world-diabetes-day-2024/ XX A new triple combo therapy could restore insulin production in people with type 1 using existing medications. Levicure's triple-combo oral therapy is already considered very safe, because it involves two drugs approved by the U.S. Food and Drug Administration (FDA) and a well-known supplement. The therapy is a combination of: DPP4-inhibitors, a common type 2 diabetes medication Proton pump inhibitors (PPIs), a drug for severe acid reflux A proprietary version of gamma-aminobutyric acid (GABA), a supplement often used to treat anxiety Levicure says the combined effect can block beta cell destruction, suppress autoimmunity, and restore beta cell function. So far, Levicure's triple therapy has gone through only one retrospective chart review; it has not been put to the test in a randomized controlled trial https://www.diabetesdaily.com/blog/can-this-triple-combo-oral-therapy-restore-insulin-production-733261/   XX Blue Circle Health is expanding it's unique approach to type 1 care. Already active in Florida, Maine & Vermont, it will now be in Delaware and Ohio. Blue Circle Health is free and develops a personalized care plan for each participant, tailored to their unique needs, and offers comprehensive multidisciplinary support over a six-month period. It's paid for by the Helmsley Charitable Trust. The program is available to people 18 years of age and older that speak Spanish or English, regardless of insurance coverage or citizen status. We've got an upcoming podcast episode all about Blue Circle coming up soon. https://www.prnewswire.com/news-releases/blue-circle-health-expands-to-delaware-and-ohio-to-address-health-system-barriers-to-type-1-diabetes-care-and-education-302304170.html XX An international team of experts has created the world's first evidence-based guide for eating lower and low carb. The group says until now, people with type 1 diabetes and their healthcare providers have lacked comprehensive resources to help implement this approach safely and effectively. The guide provides essential information for dietitians and nutritionists and empowers them to work collaboratively with individuals and families who are interested in reducing carbohydrates. It's free and we've got the download link in the show notes. https://www.newswire.ca/news-releases/international-team-launches-first-guide-for-carbohydrate-reduction-in-type-1-diabetes-883729104.html XX A new pump system is available in Canada. mylife YpsoPump insulin pump and CamAPS FX hybrid closed-loop algorithm by Health Canada. mylife Loop consists of the mylife YpsoPump, a lightweight intuitive insulin pump, integrated with the CamAPS FX hybrid closed-loop, a mobile phone-based algorithm, and the Dexcom G6 Continuous Glucose Monitoring (CGM) System. Working together, these components provide an innovative, automated insulin delivery (AID) system designed to simplify insulin therapy and improve glycemic control for Canadians living with diabetes.   "The approval of the mylife YpsoPump and CamAPS FX marks an important milestone as we bring these advanced technologies to the Canadian market," said Sébastien Delarive, Chief Business Officer of Ypsomed Diabetes Care. "Although Ypsomed is relatively new in Canada, our established leadership in diabetes care throughout Europe provides a solid foundation for delivering innovative solutions to Canadians living with type 1 diabetes."   "We are excited to see both mylife YpsoPump and CamAPS FX approved," said Karina Schneider, General Manager at Ypsomed Canada. "This step brings us closer to offering an integrated solution that will help simplify diabetes management for Canadian patients, empowering them to take more control of their health." https://finance.yahoo.com/news/ypsomed-camdiab-receive-health-canada-205500840.html XX The FDA updates the labels for all GLP-1 receptor agonists with a warning about pulmonary aspiration during general anesthesia or deep sedation. The affected drugs are semaglutide (Ozempic, Rybelsus, Wegovy); liraglutide (Saxenda, Victoza); and the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 tirzepatide (Mounjaro, Zepbound). the Medication Guide section of the label also has new additions. Patients are counseled to tell their healthcare provider if they are scheduled to have surgery or other procedures that use anesthesia or deep sleepiness (deep sedation). They are alerted that the GLP-1 RAs they are taking may cause serious side effects, including food or liquid getting into the lungs during surgery or other procedures that use anesthesia or deep sedation. Patients are advised to tell all their healthcare providers that they are taking a GLP-1 RA before they are scheduled to have surgery or other procedures. https://www.medscape.com/viewarticle/fda-updates-glp-1-label-pulmonary-aspiration-warning-2024a1000k84?form=fpf XX Following an impressive data drop this summer highlighting the potential for Eli Lilly's tirzepatide to stave off progression to Type 2 diabetes in prediabetic patients, the Indianapolis-based drugmaker is laying out full results from its longest completed study of the dual GIP/GLP-1 receptor agonist to date. In the three-year SURMOUNT-1 trial, tirzepatide curbed the risk of disease progression to Type 2 diabetes by 94% versus placebo in adult prediabetes patients who were obese or overweight, Lilly said in a release Wednesday. The number represents a pooled result from three tirzepatide doses (5 mg, 10 mg and 15 mg) studied in the trial.   Putting those results into perspective, one new case of diabetes could be prevented for every nine patients treated with tirzepatide, which is marketed in the U.S. as Mounjaro for Type 2 diabetes and as Zepbound for obesity, Lilly said. https://www.fiercepharma.com/pharma/lilly-unwraps-detailed-data-showing-tirzepatide-kept-nearly-99-pre-diabetic-patients XX Edgparke commeical? XX https://www.bloomberg.com/news/articles/2024-10-25/apple-secretly-tests-blood-sugar-app-in-sign-of-health-ambitions XX XX And finally, many of you have likely already heard but we had some incredibly tragic news in the diabetes community, especially for the Breakthrough T1D ride community. I'm going to read from the Breakthrough T1D website: The leadership, staff, and volunteers of Breakthrough T1D mourn the tragic, sudden loss of five T1D Champions on Friday, Nov. 1, 2024.  Jeff and Michelle Bauer, Josh and Tammy Stahl and Barry Sievers were all killed in a singe car crash. The group included two married couples and one single individual—all very close friends and veteran Breakthrough T1D Ride participants. Of this incredibly impactful group, I knew Michelle Bauer personally, I met her as Michelle Alswager – you may know her as Jesse's mom. Her son, Jesse died from complications of type 1 in 2010. And that year, mile 23 on the JDRF ride was created as a mile of silence in memory of Jesse.  Now all riders are asked to ride in silence for that mile not only in memory of Jesse, but all those lost to type 1 diabetes. Michelle wrote her book, Jesse Was Here and created a program that's part of Beyond Type 1 to this day, all to help other families going through grief. She called me a few years ago when she was thinking of writing her book and I'm so grateful for our conversations and that our conversations may have helped her get it out there into a world where it's so needed. But we need Michelle here to talk about grief. More about talking to Michelle about the book).   Please, write the book, ride the bike, do the ironman, follow your heart and your dreams.  All of these incredible people gone too soon. https://www.breakthrought1d.org/news-and-updates/breakthrough-t1d-mourns-tragic-sudden-loss-of-five-ride-champions/   Thanks for joining me..

This episode is sponsored by Freed – Freed is an amazing time saver for busy healthcare professionals! It listens, transcribes, and writes medical notes for you! Go check them out and support our sponsor! Robitussin (Guaifenesin) is a medication that is used as a cough suppressant. It is often combined with numerous other medications so patients need to pay attention Valium (diazepam) is a benzodiazepine used to treat anxiety or seizures. Falls, dizziness, confusion, and sedation are common adverse effects. Viagra (sildenafil) makes the list at number 73. This medication is a PDE-5 inhibitor that can be used for erectile dysfunction. Bactroban (mupirocin) is a topical antibiotic that can be used for superficial skin infections. Januvia (Sitagliptin) is a DPP4 inhibitor used for treating hyperglycemia in type 2 diabetes. It doesn't reduce A1C quite as much as other diabetes medications like SGLT2 inhibitors and GLP-1 agonists.

What does the body of evidence say on Ozempic and its impact on diabetes and obesity? Plus: can you trade in your antidepressant for a jog, and Chris returns to the hot seat to diagnose a teenage boy who fell during a baseball game! Block 1: (2:22) Ozempic/Wegovy: GLP-1 receptor agonists; the difference between them; Mounjaro; Trulicity; diabetes biology; glucagon-like peptides 1 and 2; the problem with GLP-1; DPP4 inhibitors Block 2: (12:33) Ozempic/Wegovy: The venom of the Gila monster; how semaglutide became a blockbuster drug; weight loss; the numerous clinical trials; the impact on the stock prices of dialysis companies; downsides; the Internet craze Block 3: (27:03) Is running as beneficial for depression as medication? Block 4: (36:42) The case of the baseball player's heart   * Jingle by Joseph Hackl * Theme music: “Fall of the Ocean Queen“ by Joseph Hackl * Assistant researcher: Aigul Zaripova   To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/. To make a one-time donation to our show, you can now use PayPal! https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE Patrons get a bonus show on Patreon called “Digressions”! Check it out!   References: 1) History of GLP-1 receptor agonists: https://www.statnews.com/2023/09/30/weight-loss-ozempic-nobel-prize-science/ 2) Liraglutide vs. exenatide: https://doi.org/10.1016/S0140-6736(12)61267-7 3) Meta-analysis of GLP-1 receptor agonists: https://doi.org/10.1111/dom.12849 4) A brief summary of the SUSTAIN studies, all 11 of them, which demonstrated the efficacy of semaglutide and its cardiovascular benefit: https://diabetes.medicinematters.com/semaglutide/type-2-diabetes/a-quick-guide-to-the-sustain-trials/12206922 5) A brief summary of the STEP trials, all 10 of them, which tested semaglutide as a weight loss medications even in non-diabetics: https://diabetes.medicinematters.com/semaglutide/obesity/quick-guide-step-trials/18854832 6) Announcement that the FLOW trial is being stopped prematurely: https://www.novonordisk.com/news-and-media/news-and-ir-materials/news-details.html?id=166327 & https://www.investors.com/news/technology/novo-nordisk-stock-pops-after-hinting-weight-loss-drug-treats-kidney-disease/ 7) GI side effects of GLP-1 receptor agonists: https://doi.org/10.1001/jama.2023.19574 8) Gid M-K's Slate article: https://slate.com/technology/2023/10/exercise-depression-anxiety-treatment-effectiveness-ssris-research.html 9) Study on running to treat depression: https://www.sciencedirect.com/science/article/pii/S0165032723002239?via%3Dihub#s0065:~:text=https%3A//doi.org/10.1016/j.jad.2023.02.064 10) Details on the DEA-Quebec app to find an AED near you: https://www.jacquesdechamplain.com/en/major-update-to-the-dea-quebec-application/ 11) Government of Canada's definition of a pesticide: https://www.canada.ca/en/health-canada/services/environmental-workplace-health/reports-publications/environmental-contaminants/human-biomonitoring-resources/glyphosate-in-people.html   It's Not Twitter, But It'll Do: 1) Jonathan's article on how natural health products and dietary supplements are regulated: https://www.mcgill.ca/oss/article/critical-thinking-health-and-nutrition/false-reassurance-dietary-supplement-regulation 2) Jonathan's article on fentanyl: https://www.mcgill.ca/oss/article/medical-critical-thinking/you-wont-die-touching-fentanyl 3) Chris' article in Medscape about the COSMOS study: https://www.medscape.com/viewarticle/996926 4) Chris' Gazette article on coated vs. uncoated aspirin: https://montrealgazette.com/opinion/columnists/christopher-labos-the-bare-facts-about-coated-aspirin

BUFFALO, NY- September 20, 2023 – A new editorial paper was published in Oncotarget's Volume 14 on September 15, 2023, entitled, “Potential repurposing of DPP4 inhibitors for target therapy resistance in renal cell carcinoma.” In their new editorial, researchers Kuniko Horie and Satoshi Inoue from Saitama Medical University and Tokyo Metropolitan Institute for Geriatrics and Gerontology discuss renal cell carcinoma (RCC) — a major adult kidney cancer, which is often incidentally discovered as an asymptomatic disease on imaging in the developed countries. RCC has the most fatal disease among urological cancers, as a recent 5-year relative survival rate in the U.S. (2009–2015) is less than 80%. While RCC is known as a cancer resistant to chemo- and radio-therapies, the prognosis of RCC has been remarkably improved after the clinical application of tyrosine kinase inhibitors (TKIs) and immunotherapy. The rationale for the efficacy of TKIs in RCC is mainly based on the angiogenetic status, particularly in clear cell RCC (ccRCC) that is the most common type of RCC (70–75% of RCC), in which the loss of function mutation of Von Hippel-Lindau (VHL) tumor suppressor gene activates hypoxia inducible factor (HIF) and vascular endothelial growth factor (VEGF) pathways. The first-line TKIs that predominantly target VEGF receptor (VEGFR) and platelet-derived growth factor receptor (PDGFR) (e.g., sunitinib and sorafenib) have been clinically used since late 2000s, and the second-line TKIs such as cabozantinib, which targets more receptor tyrosine kinases including MET and TAM kinases as well as VEGFR, have been further applied to the treatment of advanced RCC since early 2010s in which the first-line TKIs are ineffective. “In our recent study, we established a panel of patient-derived ccRCC spheroid cultures with the enhancement of cancer stemness gene signature including DPP4 [9]. Focusing on TKI sunitinib sensitivity, we demonstrated that DPP4 inhibition increased sunitinib efficacy in DPP4-high RCC spheroids and DPP4 was upregulated in sunitinib-resistant RCC cells.” DOI - https://doi.org/10.18632/oncotarget.28463 Correspondence to - Satoshi Inoue - sinoue07@gmail.com Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28463 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords - cancer, renal cell carcinoma (RCC), tyrosine kinase inhibitor (TKI), Dipeptidyl peptidase IV (DPP4), drug resistance, drug repurposing About Oncotarget Oncotarget (a primarily oncology-focused, peer-reviewed, open access journal) aims to maximize research impact through insightful peer-review; eliminate borders between specialties by linking different fields of oncology, cancer research and biomedical sciences; and foster application of basic and clinical science. To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: SoundCloud - https://soundcloud.com/oncotarget Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Media Contact MEDIA@IMPACTJOURNALS.COM 18009220957

Are you looking to shed a few pounds? Learn how certain medications can actually help with weight loss! By curbing your hunger and reducing your food intake, these drugs can be a game-changer on your weight loss journey. Say hello to a healthier, happier you!   In this episode, I take a closer look at the function of these drugs and how they can help alleviate some of the symptoms associated with menopause. From reducing hunger to aiding weight loss, these medications can have a significant impact on our overall well-being.   I also take some time to address your burning questions and concerns, offering a more comprehensive understanding of the function of the drugs we discuss. It's brain candy at its finest! I truly believe that knowledge is power, and by exploring the science behind menopause, we can empower ourselves to create the most exceptional life on our own terms.   At Menopause Mastery, my mission is to empower women during this transformative season of life. This episode is dedicated to helping you tap into your deepest desires, harness your physical and mental health, and explore your true passions. I believe that by peeling back the layers, you can uncover exactly what you want out of life and create the most exceptional life on your terms.   Menopause is not just about physical changes, it's also about tapping into your deepest desires, exploring your passions, and creating the life you truly want. In this episode, I also delve into how you can harness your physical and mental health, and peel back the layers to uncover your truest desires. Get ready to make this season the best ever!   *Check out episode 26: https://menopausemasterypodcast.com/should-you-try-semiglutide-with-dr-amie-hornaman/     Key Takeaways: [00:00:27] Appetite suppressants and weight loss. [00:06:39] Weight loss and appetite suppressors. [00:07:14] Weight loss and diabetes drugs. [00:12:05] Estrogen and glucose balance. [00:17:01] DPP4 enzyme and celiac disease. [00:19:12] Genetic variability in DPP4 enzyme. [00:24:06] Muscle loss and weight loss. [00:25:37] Muscle loss and weight regain. [00:29:21] Drug-induced obesity and mental health. [00:33:00] DPP4 drugs require caution and monitoring. [00:35:22] Microbiome and weight gain. [00:36:58] Menopause mastery podcast.     Memorable Quotes "Weight loss and fat loss are two separate things. Weight loss is just a number changing on the scale. You went from 150 to 135. Fat loss is the loss of body fat because five pounds of fat and five pounds of muscle weigh the same, but five pounds of fat takes up a lot more space on the body, so it's more voluminous, it's less dense than muscle." – Betty Murray   "The other thing that I think is really important is we have to look at when you do things hormonally that radically change these hunger hormones like glucagon and ghrelin. What we often see is patterns of eating that are now what we would call disordered." – Betty Murray     Website Living Well Dallas Hormone Reset Betty Murray   Socials  Facebook Instagram

Are you looking to shed a few pounds? Learn how certain medications can actually help with weight loss! By curbing your hunger and reducing your food intake, these drugs can be a game-changer on your weight loss journey. Say hello to a healthier, happier you!   In this episode, I take a closer look at the function of these drugs and how they can help alleviate some of the symptoms associated with menopause. From reducing hunger to aiding weight loss, these medications can have a significant impact on our overall well-being.   I also take some time to address your burning questions and concerns, offering a more comprehensive understanding of the function of the drugs we discuss. It's brain candy at its finest! I truly believe that knowledge is power, and by exploring the science behind menopause, we can empower ourselves to create the most exceptional life on our own terms.   At Menopause Mastery, my mission is to empower women during this transformative season of life. This episode is dedicated to helping you tap into your deepest desires, harness your physical and mental health, and explore your true passions. I believe that by peeling back the layers, you can uncover exactly what you want out of life and create the most exceptional life on your terms.   Menopause is not just about physical changes, it's also about tapping into your deepest desires, exploring your passions, and creating the life you truly want. In this episode, I also delve into how you can harness your physical and mental health, and peel back the layers to uncover your truest desires. Get ready to make this season the best ever!   *Check out episode 26: https://menopausemasterypodcast.com/should-you-try-semiglutide-with-dr-amie-hornaman/     Key Takeaways: [00:00:27] Appetite suppressants and weight loss. [00:06:39] Weight loss and appetite suppressors. [00:07:14] Weight loss and diabetes drugs. [00:12:05] Estrogen and glucose balance. [00:17:01] DPP4 enzyme and celiac disease. [00:19:12] Genetic variability in DPP4 enzyme. [00:24:06] Muscle loss and weight loss. [00:25:37] Muscle loss and weight regain. [00:29:21] Drug-induced obesity and mental health. [00:33:00] DPP4 drugs require caution and monitoring. [00:35:22] Microbiome and weight gain. [00:36:58] Menopause mastery podcast.     Memorable Quotes "Weight loss and fat loss are two separate things. Weight loss is just a number changing on the scale. You went from 150 to 135. Fat loss is the loss of body fat because five pounds of fat and five pounds of muscle weigh the same, but five pounds of fat takes up a lot more space on the body, so it's more voluminous, it's less dense than muscle." – Betty Murray   "The other thing that I think is really important is we have to look at when you do things hormonally that radically change these hunger hormones like glucagon and ghrelin. What we often see is patterns of eating that are now what we would call disordered." – Betty Murray     Website Living Well Dallas Hormone Reset Betty Murray   Socials  Facebook Instagram

It's In the News, a look at the top stories and headlines from the diabetes community happening now. Top stories this week: The US Senate grills insulin makers about keeping the price where it is, two studies look at the impact of faster-acting insulins, a new study looks out temperature and insulin storage, researchers examine CGM access and health outcomes, and more Check out Moms' Night Out with three new dates on the calendar! Please visit our Sponsors & Partners - they help make the show possible! Take Control with Afrezza  Omnipod - Simplify Life Learn about Dexcom  Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com   Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and these are the top diabetes stories and headlines happening now XX In the news is brought to you by Moms Night Out - Treat yourself to some time away with other moms who get it. Our next stops this fall in Providence, RI and Frisco TX. XX Our top story this week, big Senate hearing on insulin.. The three insulin makers recently cut their list prices by around 70%. The Senate Committee on Health, Education, Labor and Pensions pressed industry leaders and all three – Lilly, Novo Nordisk and Sanofi - committed to “keeping their drugs affordable,” But asked whether the companies would no longer raise prices on their existing insulins, only Lilly sai yes. The Sanofi and Novo Nordisk chiefs did not. Sen. Markwayne Mullin, R-Oklahoma, called PBMs “the fox guarding the henhouse,” going after the executives for essentially “rebating themselves." He said the situation “isn't working for America.” “This committee is going to stay on this issue," Senator Bernie Sanders said Wednesday. "We need profound change in the industry and in PBMs." https://www.fiercepharma.com/pharma/bernie-sanders-led-senate-committee-holds-pharma-chiefs-and-pbm-execs-feet-fire-insulin XX Not a big difference between fast-acting insulin aspart and standard insulin. New study using hybrid closed-loop insulin delivery system found that faster acting Fiasp did not offer any additional glycemic benefits compared with standard insulin aspart – Novolog - and participants had more cases of hyperglycemia with ketosis with the Fiasp. The study cohort had a baseline HbA1c of 7.2% and a time in range of 63.9% at the start of the trial. Of the cohort, 76% was using a hybrid closed-loop insulin delivery system at enrollment. There were no cases of severe hypoglycemia or DKA during either intervention. https://www.healio.com/news/endocrinology/20230508/time-in-range-similar-with-fastacting-vs-standard-insulin-for-young-kids-with-diabetes XX On the other hand, people with type 2 diabetes saw more time in range with faster acting insulin. These were adults with type 2 on basal bolus MDI along with CGM. The insulins here with Lyumjev and humalog. https://link.springer.com/article/10.1007/s13300-023-01400-w XX New study confirming that insulin doesn't have to be refrigerated as strictly at package instructions. These researchers took 6 different bands and types of insulins and stored them – quote - unopened for 1–4 months in non-refrigerated conditions in a real-world setting during the summer in India, all compared with control samples of each insulin, which remained refrigerated. Insulin vials were stored in watertight bags. Bags were placed in either an open plastic container stored on a high shelf or in a cupboard, or in clay pots with a separate water compartment. All storage containers were placed in shaded areas The temperature was measured every 15 min by electronic data loggers. The mean maximum temperatures were between 86 and 94 degrees. Most of the insulin stayed fine for two months and much of it for four months. Every study I talk about is linked up at this episode's homepage at d-c dot com with more specifics. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(23)00028-1/fulltext?fbclid=IwAR1J2Y2JLZNHTvlPwtCo7t-wA60zhFMRvx2DEc7sujaFOX1pKc_-RbjhnL0 XX Not so shocking conclusion that increasing access to CGMs – regardless of ethnicity and insurance status – can improve outcomes. Despite higher rates of complications among T1D youths from lower-income backgrounds, diabetes technology is 50% lower among this group. Youths with public insurance have frequent interruptions to CGM access, which are associated with worsening HbA1C trends. Implicit biases and willingness to recommend diabetes technology to youths from underrepresented backgrounds are likely additional contributors to these disparities, according to authors. Authors concluded the results demonstrated in the study suggest equitable access to CGM soon after T1D diagnosis could be a first step to improve HbA1C for all youths, but acknowledge this access alone is, “unlikely to eliminate disparities entirely.” The authors add broader societal strategies to address structural drivers of disparities in diabetes care are required. https://www.contemporarypediatrics.com/view/equitable-access-to-glucose-monitoring-improves-hba1c-levels XX Interesting reminder that the seemingly obvious answer isn't always the right one comes from cataract research.. Cataracts—the clouding of the lens of the eye—are the number one cause of blindness worldwide and are a common complication of type 2 diabetes. The current hypothesis behind diabetic cataract development is coined “the sugar hypothesis” and suggests that high blood sugar—a hallmark of diabetes—precedes cataract development. The working assumptions underlying the sugar hypothesis describe higher levels of glucose in the lenses of people with diabetes convert to a sugar alcohol molecule called sorbitol, which induces structural changes to the lens of the eye that precede cataract development. While unproven, researchers rarely investigate this theory further due to cataracts' treatable nature. Now, after some animal studies, it looks like the damage actually starts before blood glucose rises above normal. The reseahres say it's still too early to tell what's going on but they hope ore study will bring the medical community a step closer to understanding the cellular mechanisms underlying the origins of diabetic complications during the pre-diabetic stage of the disease. Then, they say, they can search for ways to better prevent them. https://scitechdaily.com/sweet-deception-sugar-hypothesis-of-diabetic-cataract-development-gets-an-eye-opening-reality-check/ XX Very large study shows that GLP1 receptor agonists—a class of diabetes medications that include Trulicy and Ozempic —are associated with fewer major adverse cardiovascular events than another type of diabetes drug older veterans with no prior heart disease. The second drug type is DPP4 inhibitors with brand names like Januvia and Nesina. Apparently, the clinical trials showing cardiovascular benefits for these drugs were conducted in people who already had heart disease, so these researchers wanted to see if it would help those who did not. 100-thousand US veterans were included in this study. The median patient age was 67 years, and the median diabetes duration was 8.5 years. The researchers included variables such as age, sex, race, body mass index, blood pressure, laboratory values like hemoglobin A1c, and history of prior illnesses in the statistical analysis. https://medicalxpress.com/news/2023-05-diabetes-drugs-adverse-cardiac-events.html XX Ascensia expands it's Eversense PASS, a Payment Assistance and Simple Savings program designed to enhance affordability and access to the Eversense E3 CGM System. Under the new and improved program, more people with diabetes will be eligible for assistance paying for the system, which now includes increased savings for eligible first time users. Eligibility for the program has now been extended to all commercially insured people with diabetes across the country, including those who do not have coverage for the Eversense E3 system from their insurance provider. Eversense is an implanted CGM that lasts six months and has a removable smart transmitter. https://www.prnewswire.com/news-releases/ascensia-diabetes-care-expands-payment-assistance-and-simple-savings-program-for-eversense-e3-cgm-system-301818639.html XX Right back to the news, but first, I want to tell you about Moms Night Out! In the 16+ years since my son was diagnosed with type 1, I have attended dozens of diabetes conferences and events. Now I've taken the best elements from those events and created a brand new experience. We're going to have lots of diabetes technology for you to see and learn about, stress-relieving social time where you can meet other moms just like you, and speakers who will leave you feeling energized and ready to face the challenges of parenting a child with T1D. We had the first of these in January – I didn't realize it was the first I actually expect it to be a one and done – but it went to so well and the reaction was so good from moms around the country that I deided to keep going. Our next stops are Frisco TX and Providence RI, back to Charlotte in Feb and more cities to come in 2024. Join us – check out the very top of diabetes-connections dot com or click on the event tab. XX XX Garmin today announced expanded region availability of the Dexcom Connect IQ apps. Available for a wide range of Garmin smartwatches, the Dexcom Connect IQ app3 provides people with diabetes with a secondary way to view their glucose levels, right from their wrist. Connect IQ is the app platform for Garmin wearables, bike computers, and outdoor handhelds https://www.garmin.com/en-US/newsroom/press-release/wearables-health/people-with-diabetes-can-now-view-dexcom-cgm-data-on-their-garmin-smartwatch-or-cycling-computer/ XX XX On the podcast next week.. Neil Greathouse is a familiar face on social media – posting every day as “The Betes.” I'll catch up with Neil to talk about what motivated this every day connection – he has a real job not in diabetes – and more. Last week I spoke with The Marvelous Mrs Maisel's Austin Basis about managing T1D on set and off. That's In the News for this week.. if you like it, please share it! Thanks for joining me! See you back here soon.

TWiV reviews eukaryotic viruses recovered from ancient permafrost, a mistake made by scientists on Omicron origins, and close relatives of MERS-CoV from bats that bind ACE2 for entry into cells. Hosts: Vincent Racaniello, Dickson Despommier, Alan Dove, Rich Condit, and Brianne Barker Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Support MicrobeTV with a Spike t-shirt (Vaccinated.us) with promo code MicrobeTV Positions with the Mosquito and Vector Control Division in Harris County Public Health (one and two) Ancient eukaryotic viruses from permafrost (bioRxiv) We made a mistake (Science) Bat MERS-like CoV bind ACE2 (Nature) Letters read on TWiV 968 Timestamps by Jolene. Thanks! Weekly Picks Dickson – Alto Saxophone: Paul Desmond/Cannonball Adderley/Charlie Parker/Randal Despommier: Paul Desmond: Signature album: Paul Desmond:The Complete RCA Victor Recordings (1961-1965). Signature song: Take Five (Dave Brubeck Quartet). Cannonball Adderley: Signature album: The Cannonball Adderley Quintet: Mercy, Mercy, Mercy. Signature song: Mercy, Mercy, Mercy. Charlie Parker (Bird): played in many groups: Signature album: Dizzy Gillespie and His Allstars. Signature song: A Night In Tunisia; Randal Despommier: Signature album: A Midsummer Odyssey. Signature song: I Hope It's Spring For You. Brianne – How a See-Through Frog Hides its Red Blood from Predators (also covered in The Atlantic) Rich – Mindfulness in Plain English by Ven. Henepola Gunaratana Vincent – Unveiling skin macrophage dynamics explains both tattoo persistence and strenuous removal Listener Picks Rona – WKCR, FM 89.9 Columbia‘s radio station Alan – XKCD Proxy Variable Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv

Sitagliptin is a DPP4 inhibitor. I discuss the pharmacology of this medication on the podcast. Which diabetes medication works similarly to sitagliptin? I discuss that further on this episode of the Real Life Pharmacology podcast. Renal elimination plays a significant role with sitagliptin. I discuss how this impacts the appropriate dosing. Cost is a significant issue with sitagliptin at this time. In addition, it's A1C-lowering effects aren't anything to write home about. I discuss how much it will lower A1C in this podcast episode.

God Warns of Worse Pestilence (2)  (Audio) David Eells - 4/6/22 Pestilence Food and Energy Many things promised are happening now but dont expect to hear about it on MSM. Although they are having to report on the Biden laptop to avoid the expense of losing all credibility. It appears DS is throwing the Biden crime family under the bus.   What we are hearing from various sources is that very soon we will see a (planned) global economic collapse. This will be a world wide shutdown to change over from the worthless dollar to asset backed currencies and the new QFS economic system of the Alliance.   Solar storms may be blamed for the electrical and internet collapse.  Back up your computers and anything online. Also food and fuel and industrial supplies lines will likely collapse. A large portion of this is due to China's actions of which include price controls which could well tip us over the edge bringing down many companies around the world and shipping. Almost the whole world depends on China for food, industrial supplies, electronics, chips, computer parts, etc.  Many banks could shut down at least for a few days to switch over to QFS. Get some cash out as even ATM's may go down. Insiders from early on have warned to have at least 2-3 weeks worth of food, cash, water, fuel, and essentials. Tell your friends who dont know God to be their Jehovah Jireh provider. The military will be standing by to help also. The rest of you trust in Jesus who said in Mat 6:25-26  Therefore I say unto you, Be not anxious for your life, what ye shall eat, or what ye shall drink; nor yet for your body, what ye shall put on. Is not the life more than the food, and the body than the raiment?  26  Behold the birds of the heaven, that they sow not, neither do they reap, nor gather into barns; and your heavenly Father feedeth them. Are not ye of much more value than they? Mat 6:30-34  But if God doth so clothe the grass of the field, which to-day is, and to-morrow is cast into the oven, shall he not much more clothe you, O ye of little faith?  31  Be not therefore anxious, saying, What shall we eat? or, What shall we drink? or, Wherewithal shall we be clothed?  32  For after all these things do the Gentiles seek; for your heavenly Father knoweth that ye have need of all these things.  33  But seek ye first his kingdom, and his righteousness; and all these things shall be added unto you.  34  Be not therefore anxious for the morrow: for the morrow will be anxious for itself. Sufficient unto the day is the evil thereof. Mat 7:7-12  Ask, and it shall be given you; seek, and ye shall find; knock, and it shall be opened unto you:  8  for every one that asketh receiveth; and he that seeketh findeth; and to him that knocketh it shall be opened.  9  Or what man is there of you, who, if his son shall ask him for a loaf, will give him a stone;  10  or if he shall ask for a fish, will give him a serpent?  11  If ye then, being evil, know how to give good gifts unto your children, how much more shall your Father who is in heaven give good things to them that ask him?  12  All things therefore whatsoever ye would that men should do unto you, even so do ye also unto them: for this is the law and the prophets. The Emergency Broadcast System with its declass of D.S. crimes, and the Starlink Quantum Internet are said to be very near along with Project Odin. The switchover will include Tesla Free Energy which has been tested and is still running in some areas of the US.  The wild card of course is the D.S. who desperately wants all of this to stop. We are told that soon there will be only military intelligence which would cut out a lot of crime but could eventually phase into world crime since neither beast knows God.  Dr Sherry Tenpenny has said that every fully death jabbed (vaccinated) person over 30 years of age will have Aids by the end of this year. How is that for a plague for those who trust in man and not God? Also China is in lockdown with a more deadly man made strain of Covid. Pfizer Documents prove that inhalation and skin contact with vaccinated people can infect the unvaccinated with the vaccine. https://thetruedefender.com/bomb-stay-away-from-the-vaccinated/   It is time for everyone to heed the warnings in God's Vaccine Book the 7 simple steps to be immune from plagues/pestilences.   Famine in “Food City" Marie Kelton - 3/26/22 (David's notes in red)   The Lord gave me an open vision, while I was at work in Food City. (Representing the larger food supply system.) I was cutting cheese on the cheese slicer and I looked up at where we keep the menu for the food. It was all gray (Representing a spirit of death from starvation.); there were no lights on (Representing energy and electricity shortages.) and the sun light was shining through the windows but it was gray too. I looked around me and saw that everything looked gray. No one was in the store and I saw that weeds and grass had grown up all in Food City. (This is a warning that without prayer and faith we will see a desperate situation. I asked the Lord if this was something that can be changed by prayer and faith and got a Yes. But He told me He would only change it in measure.)   Then today on 3/29/22, I was cutting meat for a customer, and I was facing the area where we keep bread and pies etc. I had an open vision of it being gray again and desolate and weeds and vines had grown in Food City. There were no lights on and no food on the shelves. Then I heard the Lord say, “Your house is left unto you desolate”. I wasn't sure if I was hearing correctly so he spoke it again, “Your house left unto you desolate."  That was the end of the vision. Mat 23:37-39 O Jerusalem, Jerusalem, that killeth the prophets, and stoneth them that are sent unto her! How often would I have gathered thy children together, even as a hen gathereth her chickens under her wings, and ye would not! 38 Behold, your house is left unto you desolate. 39 For I say unto you, Ye shall not see me henceforth, till ye shall say, Blessed is he that cometh in the name of the Lord. (The Lord is coming again in His Man-child corporate body in the midst of desolation to save His elect and gather together all the members of the Body of Christ.) Beast Engineered Energy and Food Shortages Vanessa Weeks - 9/29/21 (David's notes in red) I dreamed I was standing on the sidewalk in front of an Atlantic and Pacific (A&P) grocery store . (Representing that this dream is occurring all over the U.S. from the Atlantic to the Pacific.) In the dream I was thinking about Kathy, (meaning pure) Lakesha's mom, telling me she used to work at an A&P in Texas (meaning: friends). (This is signifying a pure message given to the friends of God.) The outside of the store was box shaped like Kentucky Fried Chicken, (The fast food stores are going down too.) and it was all orange and brown except for the white letters of A&P and a white picture of Colonel Sanders on the sign. (Orange and brown are fall colors.) (Fall is a play on words, we are watching the FALL of the D.S. now. Factions are falling along with the Economy, the rigged election, Forced Va/cc/inat/ions, News Media, Internet, DS Satellites, Electricity. God is giving us a short time to prepare the Church for the Great Tribulation when liberal communists will once again gain control to bring the Church to her cross. All the great things coming now will ultimately be given over to the last Beast.) I wondered if the store was open, and I looked into a front window and saw small tables and chairs like a restaurant. All the lights were out. It was the middle of the day and I realized it was closed.  (They are being closed from the Atlantic to the Pacific. The DS has been destroying all the food sources to break the supply chain. The restaurant being closed represents the shut down of the economy and the food shortage. All of this evil is being realized, even by the liberals and will fall. Communism, Liberalism, the Democratic Party, are falling for a short time to give us time to rebuild the Kingdom.)  But I opened the front door and went in anyway. It was very dim there and I saw cobwebs everywhere.(Cobwebs represent that the supply chain is currently breaking down.) Then I knew that this store had gone out of business because they could not pay their debts. (This is what actually happened to A&P, but I did not know that till after I had this dream.) (The easy money printing policies of the Federal Reserve has caused a massive debt bubble that will eventually bankrupt the world and cause a global reset. Many small businesses and individuals will be the hardest hit casualties of the planned financial collapse. The GCR will infuse tons of money to turn this around as Trump goes back officially in office. (But the truth is that he's not coming back because he never left.) There were stairs in the middle of the restaurant and I walked up the stairs and saw empty cardboard boxes, like this was their supply room. (This represents shipping and receiving failed and supply lines failed. The supply chain shortages are breaking the backs of business and industry all over the world.) As I walked back down the stairs I saw many cobwebs. (The warning is they were not brought back quickly as suspected and that there could be a delay. We are being shown to pray against this delay.) Back at the lower level, which looked like a restaurant, I saw that people had left things behind, very suddenly. (Representing that these events are taking place very quickly and suddenly before most people, who are not awake, have time to prepare.)  I also saw a few original Edison light bulbs hanging from the ceiling, and knew that this store was only getting electricity 2 or 3 hours a day. (Many countries around the world are experiencing an engineered energy crisis and are having to ration electricity which will soon fail.)  (After I woke up, I thought that maybe this has to do with the electric energy being switched over to Tesla energy.) (The stores closed when electricity was failing and before it was changed to Tesla Free Energy. The system failed for lack of electricity and supply lines. Vehicles need the gas and diesel electric pumps at the stations to run. I asked the Lord if we should pray that the electrical switchover and supply lines would be restored quickly and got a YES. This dream is a warning that if Christians do not pray, this switch over to the new economy will fail.) I asked Him about the Edison light bulb and received by faith at random Zep. 3:10. (In context 7-13)  I said, 'Surely you will fear me; you will accept correction. Then your dwelling would not be cut off according to all that I have appointed against you.' (Christians must repent of their wandering from the Word and cling to the ancient light given to the Apostolic forefathers.) But all the more they were eager to make all their deeds corrupt. (They turn against the Word to be taken into beast captivity)  8 "Therefore wait for me," declares the LORD, "for the day when I rise up to seize the prey. (Judgment shall fall also upon the global community.) For my decision is to gather nations, to assemble kingdoms, to pour out upon them my indignation, all my burning anger; for in the fire of my jealousy all the earth shall be consumed. 9 "For at that time I will change the speech of the peoples to a pure speech, (i.e. many will come to repentance through these judgments.) that all of them may call upon the name of the LORD and serve him with one accord.  10 From beyond the rivers of Cush my worshipers, the daughter of my dispersed ones, shall bring my offering. (Christians must confess their sins and claim the blood of the Lamb for their sacrifice; calling upon the Lord.) 11 "On that day you shall not be put to shame because of the deeds by which you have rebelled against me; for then I will remove from your midst your proudly exultant ones, and you shall no longer be haughty in my holy mountain. 12 But I will leave in your midst a people humble and lowly. They shall seek refuge in the name of the LORD, 13 those who are left in Israel; they shall do no injustice and speak no lies, nor shall there be found in their mouth a deceitful tongue. For they shall graze and lie down, and none shall make them afraid.” (Let us cast down the delays by the DS and push them to the Red Sea so that the people can have revival on the other side and be ready for the wilderness tribulation.) Faith Tested for Provision  Eve Brast - 2/10/22 (David's notes in red) I dreamed that I was in a small room with David and Michael and several other local UBM brethren. This room had white walls and blue indoor/outdoor carpet. (The white walls represent sanctification from the world. Blue on the floor represents a heavenly walk.) I and another sister each brought a package of 8 flour tortillas, totaling 16, to distribute to the brethren in the room. Everyone in the dream was hungry and these 2 packages of tortillas was all we had to feed everyone with. I knew in the dream that there was extreme lack and shortages of food all around the country. (Aside from the obvious, literal problem we can see that spiritually speaking, there is a famine of the Word also. Tortillas are unleavened bread meaning the pure Word and 8 is the number of Jesus who is the bread of life.)  We started to pass them out but realized that there wasn't going to physically be enough to go around, because the young men and the older men would need more to keep up their strength. (The evangelists and teachers should be the first to receive the message so they can distribute it. Literally, Christians are going to be tested as to whether they can believe the Word of God. Mat. 6:26  Behold the birds of the heaven, that they sow not, neither do they reap, nor gather into barns; and your heavenly Father feedeth them. Are not ye of much more value than they?) So we gave the men a larger portion and the women and children got a little; just enough to sustain them. (We should remember that Jesus multiplied the fishes and the loaves and He is the same yesterday, today, and forever, so He will do it in our day as we have seen.) David and I realized that there wouldn't even be enough this way, so we decided to fast and give our portions to the men and just pray that the Lord would supernaturally multiply the food for us all. (Many will wake up in this desperate situation to learn from Jesus to multiply the food.)  Then I woke up. Psa. 132:13-15, For Jehovah hath chosen Zion; He hath desired it for his habitation. 14 This is my resting-place for ever: Here will I dwell; for I have desired it. 15 I will abundantly bless her provision: I will satisfy her poor with bread.  And 2 Co. 9:7-13  Let each man do according as he hath purposed in his heart: not grudgingly, or of necessity: for God loveth a cheerful giver. 8 And God is able to make all grace abound unto you; that ye, having always all sufficiency in everything, may abound unto every good work: 9 as it is written, He hath scattered abroad, he hath given to the poor; His righteousness abideth for ever. (Those who give will receive. Those who hoard will not.) 10 And he that supplieth seed to the sower and bread for food, shall supply and multiply your seed for sowing, and increase the fruits of your righteousness: 11 ye being enriched in everything unto all liberality, which worketh through us thanksgiving to God. 12 For the ministration of this service not only filleth up the measure of the wants of the saints, but aboundeth also through many thanksgivings unto God; 13 seeing that through the proving of you by this ministration they glorify God for the obedience of your confession unto the gospel of Christ, and for the liberality of your contribution unto them and unto all. (In the natural, One of the testimonies for provision for my family after we ran out of all our food and were tested with a fast for one day was, my wife asked, “What will we do?” And I said, “Set the table." Then the 7 of us sat down and I prayed a simple prayer, “Father, you sent us here so we ask you to fill these plates or fill our stomachs.” Then my children, one by one, said, “Dad my stomach is full.” Then they began to get up from the table. Then I realized my stomach was full also. Php. 4:19, And my God shall supply every need of yours according to his riches in glory in Christ Jesus. And this fits the natural and the spiritual. Another time, we ran out of food except for one pot of spaghetti. We blessed it and ate half of it and then put the rest in the refrigerator. In the morning, we took it out and the pot was full again. Like the Israelites you can't get anywhere in your wilderness where God can't supply your needs, physical and spiritual.)   Another Pestilence is Coming   Mena Lee Jones - Faithful Walk Healing Ministries - 3/29/22 (David's notes in red)   I would like to share a vision the Lord gave me in the wee hours of this morning... I saw a list appear in front of me. The list was held up and it looked as if it was on a scroll. There were numbers listed; from one to four. However, they were in descending order, like a countdown. (4,3,2,1) The numbers four through two each had a single word written next to them, however I could only make out what the word next to number four was: Cooperation. (There is a cooperation between all the countries to usher in a new world order. The D.S. plans to accomplish this is through famine and human suffering. If they control the food and access to healthcare then you control the people.) As my eyes scanned to number one, I noticed there wasn't a word next to it.  All of a sudden, I saw a creature begin to emerge out of the paper next to the number one. It was pitch black with long claws and it had a wing that resembled...a Raven's. (Ravens often symbolize harbingers of doom and death. They're associated with the occult and psychic powers, and are frequently portrayed as the companions of witches and wizards.) I turned my head before it completely emerged, but I quickly asked the Lord, “What it was He was showing me." The Lord answered swiftly. "Another pandemic is coming,”.  My vision then ended. (Famine and pestilence go together. Jer. 32:24  Behold, the mounds, they are come unto the city to take it; and the city is given into the hand of the Chaldeans that fight against it, because of the sword, and of the famine, and of the pestilence; and what thou hast spoken is come to pass; and, behold, thou seest it.) As many of you know, I was shown the current pandemic first in June 2016. Then I was told again in August 2017, and finally in July 2018 that a pestilence would sweep across the planet.  I found myself a little distraught this morning and sort of dazed, but the Lord had already told me two months prior that we would have a small window to get things done. (This meaning ministry.) He had spoken this to me as far as making plans for conferences and travel this year. The Lord said we "would have a small window where it would be safe to travel, but soon that door will close again." At the time, He didn't reference as to why, or what was going to take place that would close that window.  Saints, we are in the birth pangs. And if you understand labor, as the time for birth draws nigh, the contractions become stronger and closer together. I remember when I was in labor with my firstborn, it got to the point where my contractions were only sixty-five seconds apart. This is how things that are unfolding on earth are starting to feel, and yet, there are so many in the church that have been lulled to sleep by a satanic lullaby because they believe things are going to get better. (The New Agers are trying to convince everyone that the book of Revelation is wrong and our thousand years of peace has come.) As with all things, take this to prayer.  Covid Mutates  Isaac Payne - 2/6/22 (David's notes in red) In this dream I saw a glimpse of a news reporter on the TV. I couldn't hear the news reporter as there was no audio on the TV. It was basically a brief picture that I witnessed in this dream.    The reporter was a man in a buisness suit. The headline that appeared on the news said "Covid Mutates; 1 Million People Die." I knew in this dream that this mutation killed 1 million people within days. Then I woke up. (I repeat, Dr Sherry Tenpenny has said that every fully death jabbed (vaccinated) person over 30 years of age will have Aids by the end of this year. How is that for a plague for those who trust in man and not God? Aids is a destruction of your immune system so that anything can take you down.)   D.S. Releases a Worse Plague William Steenland - 7/6/20 (David's notes in red)   Prepare for a second Plague not like the first. I told you that Covid 19 did not fulfill all that the Lord told us three years ago that He would do with the plague to bring down the factions and apostates and that I expected more plague. Then we received this: On Jul 6, 2020, William Steenland had this dream. He said, In this dream the Lord allowed me to follow these satanists into a very rich high rise private apartment condo in NY. I knew that they had infiltrated the CDC and WHO and were executing a plan for their satanic New World Order.  The dream changed and I was still in the same condo at a small medical facility where people were dropping like flies from some unknown pathogen or contagion. There were three women and two men who were so sick they were unable to function. I tried to grab the one woman closest to me while she was falling. In the dream I knew the elite were experimenting with the next Plandemic. I said, “Ma'am! Ma'am what's wrong? Get up!" again and again, but she was dead.  I went over to the nurse who was in a back room. I could tell she knew something and was divided about it. She was very sad and on her knees. I knew it was partially because she was totally helpless to assist or medicate the sick that were there. I picked her up off the ground and somewhat screamed at her, ”What is happening to these people?” She told me, “Don't ask me that question” as she cried in fear and sadness. I yelled again for her to tell me everything you know,  what's happening to these people?! She again told me not to ask that question. She knew they were victims of a trial run for the next pandemic. In the dream I just knew it. That's the info that kept coming to me in the dream, next plandemic and trial run experiment.  Clips from Operation Disclosure:   Chinese scientists have developed a deadly Coronavirus called “NeoCoV” capable of giving a mortality rate of 34% compared to 1.6% for Covid-19. It was described in a scientific article dated January 25, 2022, published by Chinese scientists from Wuhan University. https://www.jpost.com/health-and-wellness/coronavirus/article-694885   So, NeoCoV is a member of a group of Coronaviruses, one of which caused an outbreak of Middle East respiratory syndrome (MERS) in 2012, which killed 34% of the approximately 2,500 people infected with it. According to the Chinese authors, NeoCoV binds not only to the bat DPP4 receptor found in most MERS Coronaviruses, but also weakly binds to ACE2, which is a human receptor for the highly transmissive Covid-19 virus. Similar to the laboratory creation of Covid-19, Chinese scientists have again taken a Coronavirus found in nature and artificially manipulated its structure to infect people, but now with a virus capable of giving a mortality rate of 34% compared to 1.6% for Covid-19. It is becoming obvious that China is using the threat of new viral diseases as a cover for its biological warfare program. The recent (January 2021) is alarming and indicative for the development of biological weapons the interest shown by Chinese scientists in the furin cleavage site NeoCoV…. https://www.sciencedirect.com/science/article/pii/S1873506120304165 (If you are in fear and driven toward the next vaccine suicide, try God instead. Jesus is still the same and heals all who come to him by repentance and faith. Heb 13:8  Jesus Christ is the same yesterday and to-day, (yea) and for ever. If you do not believe this you are an apostate and are in danger. Read Revelations; a large portion of the earth will die from these things. Rom 1:17  For therein is revealed a righteousness of God from faith unto faith: as it is written, But the righteous shall live by faith. Jesus bore your sin and its curse. 1Pe 2:24  who his own self bare our sins in his body upon the tree, that we, having died unto sins, might live unto righteousness; by whose stripes ye were healed. Don't be an apostate, Learn of your Biblical provision for health in God's Vaccine Book.)  

Preserved from the Beast (26) (Audio) David Eells - 2/2/22   History Has to Repeat According to God David Eells - 2/1/22   Ecc 1:9-10  That which hath been is that which shall be; and that which hath been done is that which shall be done: and there is no new thing under the sun.  10  Is there a thing whereof it may be said, See, this is new? it hath been long ago, in the ages which were before us. We are now in a repeat of history.  Zedekiah and his apostate leadership and people were in lockdown by Babylon (DS) and Jerusalem was in famine. (These lockdowns now include those for C-19, those losing their jobs for refusing the suicide jabs, those in self quarantines because they were told they had tested positive for C-19 and martial law coming because of the man made famine and shutdown of the economy), The Babylonians broke into the city and when Zedekiah and the leadership with the men of war saw this they fled the city and were captured. This equates to the apostate leadership of Christianity in our day. 1Co 10:11  Now these things happened unto them (the Jews) by way of example (Greek here is type or shadow); and they were written for our admonition, upon whom the ends of the ages are come. (So what happened to the Jews speaks to us at the end of this age in types and shadows.) Jer 39:4  And it came to pass that, when Zedekiah the king of Judah and all the men of war saw them, then they fled, and went forth out of the city by night, by the way of the king's garden, through the gate betwixt the two walls; and he went out toward the Arabah. 5. But the army of the Chaldeans pursued after them, and overtook Zedekiah in the plains of Jericho: and when they had taken him, they brought him up to Nebuchadrezzar king of Babylon to Riblah in the land of Hamath; and he gave judgment upon him.  6  Then the king of Babylon slew the sons of Zedekiah in Riblah before his eyes: also the king of Babylon slew all the nobles of Judah. (So we see the apostate leadership of Christianity is being judged by Babylon DS. They sent their people to take the vac/cine who are now sickly and dying from it. So what about the famine?) Those left in the city who had gone through the pestilence, sword, and famine were given over to the King of Babylon (DS). Jer 21:7  And afterward, saith Jehovah, I will deliver Zedekiah king of Judah, and his servants, and the people, even such as are left in this city from the pestilence, from the sword, and from the famine, into the hand of Nebuchadrezzar king of Babylon, and into the hand of their enemies, and into the hand of those that seek their life: and he shall smite them with the edge of the sword; he shall not spare them, neither have pity, nor have mercy. (It's no secret that the satanist leadership of Babylon DS has a fierce hatred for Christianity and especially their leadership.) Apostate Israel as a type of the Apostate Church was taken down by pestilence, sword, and famine by their own DS Babylon. Jer 21:7  And afterward, saith Jehovah, I will deliver Zedekiah king of Judah, and his servants, and the people, even such as are left in this city from the pestilence, from the sword, and from the famine, into the hand of Nebuchadrezzar king of Babylon, and into the hand of their enemies, and into the hand of those that seek their life: and he shall smite them with the edge of the sword; he shall not spare them, neither have pity, nor have mercy. (You will notice that God is saying this has to happen and it is because Christian leadership has departed from the Word of God as we shall see.) Jer 32:24  Behold, the mounds, they are come unto the city to take it (This city Jerusalem represented the leadership of God's apostate people.); and the city is given into the hand of the Chaldeans (or Babylonians) that fight against it, because of the sword, and of the famine, and of the pestilence; and what thou hast spoken is come to pass; and, behold, thou seest it. It is coming to pass before our eyes... Jer 42:17  So shall it be with all the men that set their faces to go into Egypt to sojourn there: (This represents the apostates trusting in the flesh and the world to save them from the DS like they did with the vaccine suicide to save them from the DS pestilence. The Church swamp is being drained, as God told us it would 5 years ago.) they shall die by the sword, by the famine, and by the pestilence; and none of them shall remain or escape from the evil that I will bring upon them. (Apostate Israel, representing the apostate Church, was taken down by famine, pestilence, sword, and fire as we are seeing happen.) Insiders are saying 3-4 weeks of food is needed for provision during this time but the supply lines are destroyed and they don't come back easily when the enemy is intent on depopulation.  The truckers are in lockdown and the farmland is bought up and destroyed by Gates and his kind. Watch the Linked video here. Bill Gates Announces Plans To Spray "Chemical Clouds" Into The Atmosphere - https://banned.video/watch?id=61f8030baabf5c2d0ceeeb35 (So we can see clearly from this that they are poisoning the soil for trees and crops to fail and poison us.) The DS has used weather warfare on the farmers and burned the granaries and silos. None of which you will hear in the DS news. No shipping is coming in by the ports, big businesses like Walmart are bringing it in by air and when the refineries or pipelines go down we won't have trucking or air shipping. U.N. reports that since the lockdowns over the last couple of years 40 Million have Died of Starvation on top of the other 25 million who starve to death every year - https://gettr.com/streaming/prl20x8139  Start at the 41 min mark and go for about 3 min.    Farming Insider Warns The Coming Food Shortages Are Going To Be Far Worse Than We're Being Told:    Zero Hedge by Tyler Durden - 1/31/22  Authored by Michael Snyder via TheMostImportantNews.com,  The information that I am about to share with you is extremely alarming, but I have always endeavored to never sugarcoat things for my readers.  Right now, there are shortages of certain items in grocery stores across the United States, and food supplies have gotten very tight all over the globe.  I have repeatedly warned that this is just the beginning, but I didn't realize how dire things have already gotten until I received an email from a farming insider that I have corresponded with over the years.  I asked him if I could publicly share some of the information that he was sharing with me, and he said that would be okay as long as I kept his name out of it.  According to this farming insider, dramatically increased costs for fertilizer will make it impossible for many farmers to profitably plant corn this year.  The following is an excerpt from an email that he recently sent me… “Things for 2022 are interesting (and scary). Input costs for things like fertilizer, liquid nitrogen and seeds are like triple and quadruple the old prices. It will not be profitable to plant this year. Let me repeat, the economics will NOT work. Our plan, is to drop about 700 acres of corn off and convert to soybeans (they use less fertilizer, and we also have chicken manure from that operation). Guess what? We are not the only ones with those plans. Already there is a shortage of soybean seeds, so we will see how that will work out. The way I see it, there will be a major grain shortage later in the year, especially with corn. I mean, we are small with that. What about these people in the midwest who have like 10,000 acres of corn? This will not be good.” Once I received that message, I wrote him back with some questions that I had. In response, he expanded on his comments in a subsequent email… "As for the farming, I see it getting bad.  Things like fertilizer and liquid nitrogen have tripled and quadrupled in price.  Yes commodity prices are up, but that certainly wont cover the new increased input costs.  We are in NC, so while certainly not like the midwest, we still grow grain.  The midwest of course will have these same higher input costs as well. Corn for example, typically takes about 600 pounds of fertilizer per acre, plus 50 gallons of liquid nitrogen.  Times that by many acres and thats a lot of money.  Soybeans take much less.  The plan for us, and most others around here, is to drastically cut corn acres and switch to soybeans.  Problem is, there is apparently a soybean seed shortage because others have this plan as well.  We were lucky enough to pre buy enough to do it.  However, most people, especially younger farmers, or farmers where that is all they do, probably don't have the money to front like that. The way I see it, a corn shortage will come.  I guess there could possibly be a glut of soybeans, but remember that could depend on the seed being available.  I guess there are other alternatives, maybe milo, oats, or barley.  Of course the corn market is much larger.  Think animal feed and ethanol.  I mean for animals, soybeans are used too, but its a mix. What happens to the animal producers who depend on reasonably priced corn?  I just don't see how it can end well.  I mean, even if we end up with plenty of soybeans, even a glut, then you have a busted market for that.  I don't know.  There just isn't much history to base any of this on.  I just see it hurting both grain farmers, and animal farmers, and also translating to more shortages and price increases for consumers who buy the end products.” I was stunned when I first read that. Corn is one of the foundational pillars of our food supply. If you go to the grocery store and start reading through the ingredients of various products, you will quickly discover that corn is in just about everything in one form or another. So what is our country going to look like if a severe corn shortage actually happens? I don't even want to think about that. Of course fertilizer prices are not just going through the roof here in the United States. In South America, high fertilizer prices are going to dramatically affect coffee production… Christina Ribeiro do Valle, who comes from a long line of coffee growers in Brazil, is this year paying three times what she paid last year for the fertilizer she needs. Coupled with a recent drought that hit her crop hard, it means Ms. do Valle, 75, will produce a fraction of her Ribeiro do Valle brand of coffee, some of which is exported. There is also a shortage of fertilizer. “This year, you pay, then put your name on a waiting list, and the supplier delivers it when he has it,” she said. If you love to drink coffee in the morning, you will soon be paying much more for that privilege. Over in Africa, fertilizer prices could result in “30 million metric tons less food produced”… Fertilizer demand in sub-Saharan Africa could fall 30% in 2022, according to the International Fertilizer Development Center, a global nonprofit organization. That would translate to 30 million metric tons less food produced, which the center says is equivalent to the food needs of 100 million people. “Lower fertilizer use will inevitably weigh on food production and quality, affecting food availability, rural incomes and the livelihoods of the poor,” said Josef Schmidhuber, deputy director of the United Nations Food and Agriculture Organization's trade and markets division. Where in the world are we going to get enough food to replace “the food needs of 100 million people”? This is beyond serious. Basically, the stage is being set for the sort of historic global crisis that I have been relentlessly warning about. Many Americans had assumed that even if the rest of the world was suffering that we would be immune. But now there are widespread shortages all over the nation, and the Wall Street Journal just published a major article entitled “U.S. Food Supply Is Under Pressure, From Plants To Store Shelves”. This is really happening. In Washington D.C., residents are being instructed to “just buy what you need and leave some for others”…“If you're hitting the grocery store to prepare for winter weather, please just buy what you need and leave some for others! You may have noticed empty shelves in some stores due to national supply chain issues, but there is no need to buy more than you normally would.” What would have been unimaginable just a few years ago is now making headlines on a daily basis. Of course it isn't just our food supply that is under threat.  As Victor Davis Hansen has aptly noted, our country is now in the process of undergoing a “systems collapse”… In modern times, as in ancient Rome, several nations have suffered a “systems collapse.” The term describes the sudden inability of once-prosperous populations to continue with what had ensured the good life as they knew it. Abruptly, the population cannot buy, or even find, once plentiful necessities. They feel their streets are unsafe. Laws go unenforced or are enforced inequitably. Every day things stop working. The government turns from reliable to capricious if not hostile. A lot of people are going to be caught off guard by the pace of change. Things are shifting so rapidly that it really is hard to keep up with it all unless you are paying very close attention. Now that you have been exposed to the information in this article, please don't go back to sleep. This is not a drill. We really are heading into a nightmare scenario, and I strongly urge you to act accordingly.   (If you understand what is going on confess your sins and go to God by faith and believe His Word. Php 4:19  And my God shall supply every need of yours according to his riches in glory in Christ Jesus. Mar 11:24  Therefore I say unto you, All things whatsoever ye pray and ask for, believe that ye receive them, and ye shall have them. If you have been taught not to believe such words, you and your teacher are apostates, meaning fallen away from God's Word.  Repent and believe.)   Provision for The Faithful David Eells - 2-2-22 The Bride, who are beautiful to God because they are faithful to His Word, are not among the Apostates and will escape. We just got these verses in our morning meeting. Isa 61:6  But ye shall be named the priests of Jehovah; men shall call you the ministers of our God: ye shall eat the wealth of the nations, and in their glory shall ye boast yourselves. 7 Instead of your shame ye shall have double; and instead of dishonor they shall rejoice in their portion: therefore in their land they shall possess double. (In their promised land represents standing on the promises, where all provision is supplied.); everlasting joy shall be unto them. 8 For I, Jehovah, love justice, I hate robbery with iniquity; and I will give them their recompense in truth, and I will make an everlasting covenant with them.    Psa 132:13-15  For Jehovah hath chosen Zion; He hath desired it for his habitation.  14  This is my resting-place for ever: Here will I dwell; for I have desired it.  15  I will abundantly bless her provision: I will satisfy her poor with bread.  (One of the cures for famine is here and it applies whether you are in feast or famine.) 2Co 9:7-13  Let each man do according as he hath purposed in his heart: not grudgingly, or of necessity: for God loveth a cheerful giver.  8  And God is able to make all grace abound unto you; that ye, having always all sufficiency in everything, may abound unto every good work:  9  as it is written, He hath scattered abroad, he hath given to the poor; His righteousness abideth for ever. 10 And he that supplieth seed to the sower and bread for food, shall supply and multiply your seed for sowing, and increase the fruits of your righteousness:  11  ye being enriched in everything unto all liberality, which worketh through us thanksgiving to God.  12  For the ministration of this service not only filleth up the measure of the wants of the saints, but aboundeth also through many thanksgivings unto God;  13  seeing that through the proving of you by this ministration they glorify God for the obedience of your confession unto the gospel of Christ, and for the liberality of your contribution unto them and unto all. As we saw Babylon destroyed the apostates "by the famine, and by the pestilence.” So now we'll update our knowledge of pestilence. Clips from Operation Disclosure: Chinese scientists have developed a deadly Coronavirus called “NeoCoV” capable of giving a mortality rate of 34% compared to 1.6% for Covid-19. It was described in a scientific article dated January 25, 2022, published by Chinese scientists from Wuhan University. https://www.jpost.com/health-and-wellness/coronavirus/article-694885 So, NeoCoV is a member of a group of Coronaviruses, one of which caused an outbreak of Middle East respiratory syndrome (MERS) in 2012, which killed 34% of the approximately 2,500 people infected with it. According to the Chinese authors, NeoCoV binds not only to the bat DPP4 receptor found in most MERS Coronaviruses, but also weakly binds to ACE2, which is a human receptor for the highly transmissive Covid-19 virus. Similar to the laboratory creation of Covid-19, Chinese scientists have again taken a Coronavirus found in nature and artificially manipulated its structure to infect people, but now with a virus capable of giving a mortality rate of 34% compared to 1.6% for Covid-19. It is becoming obvious that China is using the threat of new viral diseases as a cover for its biological warfare program. The recent (January 2021) is alarming and indicative for the development of biological weapons the interest shown by Chinese scientists in the furin cleavage site NeoCoV…. https://www.sciencedirect.com/science/article/pii/S1873506120304165 (If you are in fear and driven toward the next vaccine suicide, try God instead. Jesus is still the same and heals all who come to him by repentance and faith. Heb 13:8  Jesus Christ is the same yesterday and to-day, (yea) and for ever. If you do not believe this you are an apostate and are in danger. Read revelations; a large portion of the earth will die from these things. Rom 1:17  For therein is revealed a righteousness of God from faith unto faith: as it is written, But the righteous shall live by faith. Jesus bore your sin and its curse. 1Pe 2:24  who his own self bare our sins in his body upon the tree, that we, having died unto sins, might live unto righteousness; by whose stripes ye were healed. Don't be an apostate, Learn of your Biblical provision for health in God's Vaccine Book.)   Monkeys Loosed in Pennsylvania Truck Crash were DISEASED; Being Brought to CDC-Approved Quarantine NATION NEWSDESK - 23 JANUARY 2022       (This scenario could have easily been used to release diseases in the midst of our nation. However, it is at least a warning from the DS to the Alliance that it would be an easy thing to do, 'so back off.' The Alliance is collecting and jailing and executing some of these mass murderers now.)  A truck crash in Pennsylvania last week made new when some of its cargo - Monkeys - got loose after the crash   Now we find out the monkeys were DISEASED, and being brought to a CDC-approved Quarantine facility when they got loose. The last of the escaped monkeys from the crash of a truck towing a trailer load of 100 of the animals was accounted for by late Saturday, a day after the pickup collided with a dump truck on a Pennsylvania highway, authorities said.       Several monkeys had escaped following Friday's collision, Pennsylvania State Police said. But only one had remained unaccounted for as of Saturday morning, prompting the Pennsylvania Game Commission and other agencies to launch a search for it amid frigid weather.   Kristen Nordlund, a spokesperson with the Centers for Disease Control and Prevention, said in an email Saturday evening that all 100 of the cynomolgus macaque monkeys had since been accounted for. Three were dead after being euthanized. The email did not elaborate on why the three were euthanized or how all came to be accounted for. But Nordlund said those euthanized were done so humanely according to American Veterinary Medical Association guidelines. The shipment of monkeys was en route to a CDC-approved quarantine facility after arriving Friday morning at New York's Kennedy Airport from Mauritius, an Indian Ocean island nation, police said. The Atlanta-based CDC said the agency was providing “technical assistance” to state police in Pennsylvania. The collision occurred Friday on a state highway near an Interstate 80 exit in Pennsylvania's Montour County, Trooper Andrea Pelachick told The Daily Item newspaper of Sunbury.  The location of the quarantine facility and the type of research for which the monkeys were apparently destined weren't clear, but cynomolgus monkeys are often used in medical studies. A 2015 paper posted on the website of the National Center for Biotechnology Information referred to them as the most widely used primate in preclinical toxicology studies. Hal Turner Commentary So now what? What other animals did those monkeys interact with while they were loose?  What disease(s) were they being quarantined for and what did they spread while they were out? Is this the start of a new outbreak of yet ANOTHER disease the world will have to battle?   Didn't they make a horror move "12 monkeys" about a similar thing?   If you start to hear about an outbreak of some new disease in Pennsylvania that has scientists and Doctors "baffled" you'll know where it came from.  What none of us know - yet - is what diseases these monkeys had that they were going to Quarantine.  God help us all if it was something like Ebola. (Locals are being told to watch for cold symptoms.)    Ebola has already been found in China. This 'loose monkey business' can provide a cover story accident for the deliberate release of a smallpox or hemorrhagic fever in the USA as some accident.  Gordon Bornman sent this to us: Here is the trailer for the movie, “Outbreak”. It's definitely a psy-op and predictive programming for escaped lab monkeys that start a worldwide human plague: https://www.imdb.com/title/tt0114069/ Remember when Bill Gates said on TV that the next pandemic would get people's attention?       Next Pandemic Will Get Attention: Video Clip of 'Smirking' Bill and Melinda Gates Draws Ire Online By Parwinder Sandhu - 7/10/20 A video clip showing Microsoft co-founder Bill Gates and Melinda Gates smirking while talking about a second wave of the pandemic has gone viral on Twitter. The clip shared widely by those opposing Gates has given rise to yet another set of conspiracy theories related to the power couple. Since the outbreak of the global pandemic, both Bill and Melinda have been constantly targeted by anti-vaxxers and conspiracy theorists regarding their association with vaccine programs.   Bill Gates and Melinda Gates     What Caused the Uproar? The couple, who are also the founders of Bill and Melinda Gates Foundation, appeared during the special edition of Part Forward series by the US Chamber of Commerce Foundation. Gates, who is quite vocal about vaccination against COVID-19 and failure of the government in handling the pandemic, said that this will not be the last pandemic that we face. Stating that there was a reason to be prepared, Gates said: "We didn't actually do the simulation to think about nursing homes, getting factories ready, the testing regime. In fact, the testing was ramped up very quickly in a few countries that have almost avoided the epidemic entirely like Taiwan, New Zealand, and Australia. They took their experience, prepared, and moved a lot faster.” (a clear deception) It was then that Gates looked at Melinda and smiled saying: "We'll have to prepare for the next one. That will get attention this time." The couple broke into a smile that was soon given a tint of a conspiracy by citizens…. Bill & Melinda Gates Giggle & Smirk Over 2nd Wave of Pandemic     Woman who Came into Contact with Escaped Lab Monkey Showing Potential Signs of Infection  by: Cassie B - 1/25/22 (Natural News) When a truck that was carrying 100 lab monkeys crashed in Pennsylvania, the public was warned not to approach any of the missing primates, who were being transported to a quarantine facility after arriving in the country from Mauritius. However, one woman who may not have heard the warning and stopped to help has developed symptoms such as a cough and pinkeye after one of the monkeys hissed in her face. Michelle Fallon had been driving directly behind the vehicle when the crash took place at the intersections of State Route 54 and Interstate 80 near Danville. Animal crates were thrown all over the highway, and some of them were smashed. Four of the monkeys escaped and went on the run, with one of them remaining missing well into the next day. Troopers were seen searching for the monkeys with rifles, while firefighters used thermal imaging to help locate the animals. While the monkey was missing, state police sent out a warning saying that anyone who sees or locates the missing monkey should not approach it, come into contact with it, or attempt to catch it and should instead call 911 right away. However, the danger wasn't immediately obvious in the moments following the accident when Fallon stopped to help. She has now developed symptoms of pinkeye and a cough and is concerned because she was close to the monkeys, touching their crates and walking through their feces. She got out of her car to help the driver and the animals, which she at first believed were cats. When she approached one and placed her hand on the cage, the macaque hissed at her. She also had an open cut at the time.  Fallon has been given the first of four rabies injections as well as antiviral drugs and is monitoring for symptoms of rabies and monkey herpes virus B. Although monkey herpes virus B is rare, it can lead to severe brain damage and even death if it is not treated immediately. Infection can occur when a person is bitten or scratched by an infected macaque monkey or has close contact with the monkey's nose, mouth or eyes…. Banned.tv:  Did the CDC Start a new Pandemic in PA? (I believe this was at least a warning from the DS to the Alliance who seemed to have backed away from immediate plans we were told of.  We also have a dream warning of Bill Gates spiritually being in our midst with his Graphene Oxide. This warns us to pray this down for the Saints and loved ones..)     Bill Gates Trying to Rape God's Elect?  Winnie Osegueda - 1/24/22 (David's notes in red) I had recently prayed for a dream of something that would help the body that we can pray about and this is what the Father gave me: I dreamt that I was at a local house … It was then time for our meeting to start and Bill Gates was there. (Bill Gates represents the evil plans of the Beast against the saints of God through injectable computing systems in the vaccines as well as using 5G and cell phones and other devices to distract and control people.) This was so real, I could see him as clear as day. He was sitting on the couch where Chuc and I normally sit, but all the way at the other end next to the end table, which is next to where Michael sits on Wednesdays. (The end table is a play on words and indicates not only the end game that the DS elites are playing out but also the Lord's end game that He has ultimate sovereignty over.) As Chuc and I went to sit down, we were wondering why Bill Gates was sitting there, but we sat down anyway and it was kinda tight and we were uncomfortable. I think there were a couple of other UBM people on the couch with us. (The DS agenda and vaccine mandates and passports have been putting the 'Squeeze' on many and causing them to make destructive choices in order to stay and participate in 'Babylon and Egypt.') We all looked at each other and said, “Don't tell him we didn't get vaccinated.” (Unfortunately ‘he' already knows.) I then noticed he had two small metallic stones that resembled magnets in his hand that he put down on a table that suddenly appeared in front of him. (When I told a friend about this dream sent me a picture of what Graphene Oxide stones look like, and it was what Bill Gates was holding in his hands, color and all, except in my dream they looked more magnetic. Link: Live Call: Graphene And Graphene Oxide Basics | Holistic Health Online ) At some point as I was sitting on the same couch opposite of Bill Gates, I looked to my left and I saw a young sister walk in with a little toddler girl that was her daughter. In the dream I knew that the young lady was generally a good mother, but I could see that she was very distracted. She sat the little girl down and then she reclined and began to watch some videos on her phone. (The distractions of the enemy and their devices will cause us to neglect these warnings and neglect our spiritual fruit; the new man of Christ in us our hope of glory.) I then got up from my seat and I had two very tiny aborted or miscarried babies in my hands. One of the babies was no longer alive and I was trying to bring it back to life. Then I woke up. (In the natural Babies are clearly being aborted by these vaccines. Spiritually our fruit will be aborted and lost if we don't succeed in overcoming the temptations to give in to our flesh nature.) When I woke up, I asked the Lord if I'm supposed to share this dream and I received by faith at random: Pro 30:16 (15-16 for context)  The horseleach hath two daughters, crying, Give, give. There are three things that are never satisfied, Yea, four that say not, Enough: 16 Sheol; and the barren womb; The earth that is not satisfied with water; And the fire that saith not, Enough. (The flesh is never satisfied and will never have enough. If we keep giving it what it wants, it will always demand more and more until we have lost the battle and many eternal rewards that we could have had for our obedience. Our positions could be given to others and we will lose our crowns.) My eyes were also drawn to the book "Destructive Demon Doctrines" and so I opened it by faith and landed on the following sentences on page 123: "Abraham didn't waver through unbelief. Instead, he waxed strong in his faith, giving glory to God. He believed God was able to do this because God promised it. God has made these same awesome promises to us. He's able to do it. We are not able to do it."  I then knew I had to share this dream so that we can pray against this, being that they have been spraying to make people sick, among other things. I don't really ever think about Bill Gates or follow much regarding the vaccines anymore in terms of side effects and what's in it, etc. so I know the Lord is saying something to His people in this dream. I asked for a verse by faith at random and received Leviticus 26:43 (40-45 in context)  And they shall confess their iniquity, and the iniquity of their fathers, in their trespass which they trespassed against me, and also that, because they walked contrary unto me, 41 I also walked contrary unto them, and brought them into the land of their enemies: if then their uncircumcised heart be humbled, and they then accept of the punishment of their iniquity; 42 then will I remember my covenant with Jacob; and also my covenant with Isaac, and also my covenant with Abraham will I remember; and I will remember the land. 43 The land also shall be left by them, and shall enjoy its sabbaths, while it lieth desolate without them: and they shall accept of the punishment of their iniquity; because, even because they rejected mine ordinances, and their soul abhorred my statutes. 44 And yet for all that, when they are in the land of their enemies, I will not reject them, neither will I abhor them, to destroy them utterly, and to break my covenant with them; for I am Jehovah their God; 45 but I will for their sakes remember the covenant of their ancestors, whom I brought forth out of the land of Egypt in the sight of the nations, that I might be their God: I am Jehovah. I read the entire chapter of Leviticus 26, and I thought this could be a warning to remain in Him and be repentant of anything the Lord is showing us so that we would not be overtaken by the enemy in any form.   Luke 8:9-10 And his disciples asked him what this parable might be. 10 And he said, Unto you it is given to know the mysteries of the kingdom of God: but to the rest in parables; that seeing they may not see, and hearing they may not understand.    Select LanguageAfrikaansAlbanianAmharicArabicArmenianAzerbaijaniBasqueBelarusianBengaliBosnianBulgarianCatalanCebuanoChichewaChinese (Simplified)Chinese (Traditional)CorsicanCroatianCzechDanishDutchEsperantoEstonianFilipinoFinnishFrenchFrisianGalicianGeorgianGermanGreekGujaratiHaitian CreoleHausaHawaiianHebrewHindiHmongHungarianIcelandicIgboIndonesianIrishItalianJapaneseJavaneseKannadaKazakhKhmerKinyarwandaKoreanKurdish (Kurmanji)KyrgyzLaoLatinLatvianLithuanianLuxembourgishMacedonianMalagasyMalayMalayalamMalteseMaoriMarathiMongolianMyanmar (Burmese)NepaliNorwegianOdia (Oriya)PashtoPersianPolishPortuguesePunjabiRomanianRussianSamoanScots GaelicSerbianSesothoShonaSindhiSinhalaSlovakSlovenianSomaliSpanishSundaneseSwahiliSwedishTajikTamilTatarTeluguThaiTurkishTurkmenUkrainianUrduUyghurUzbekVietnameseWelshXhosaYiddishYorubaZulu Powered by Translate Printer-friendly version

This week we have more congress highlights from the 2021 annual meeting of the European Association for the Study of Diabetes (EASD), held online from the 28th September to the 1st October. Listen for commentary from Prof. Steve Bain on highlights including: - Results from the TriMaster study - Cardiovascular events with semaglutide with and without metformin (post-hoc analysis of SUSTAIN 6 and PIONEER 6) - More results from the SURPASS program - Intra-organ fat content during weight loss-induced remission of type 2 diabetes in people with normal or raised BMI (data from ReTUNE and DiRECT) For more free education, visit the DKIP website, follow us on Twitter (@dkipractice) or connect on LinkedIn. Disclosures: Professor Stephen Bain declares no relevant financial relationships within the past 12 months. References: Angwin C, et al. TriMaster: randomised double-blind crossover study of a DPP4 inhibitor, SGLT2 inhibitor and thiazolidinedione as second-line or third-line therapy in patients with type 2 diabetes who have suboptimal glycaemic control on metformin treatment with or without a sulfonylurea-a MASTERMIND study protocol. BMJ Open. 2020 Dec 21;10(12):e042784. Husain M., et al. Semaglutide reduced cardiovascular events regardless of metformin use: a post hoc exploratory subgroup analysis of SUSTAIN 6 and PIONEER 6. Abstract 21 presented at the 57th Annual Meeting of the European Association for the Study of Diabetes, 27 September – 1 October 2021, virtual. Diabetologia 64, 1–380 (2021). Taylor R, et al. Intra-organ fat content during weight loss-induced remission of type 2 diabetes in people with normal or raised BMI. Abstract 110 presented at the 57th Annual Meeting of the European Association for the Study of Diabetes, 27 September – 1 October 2021, virtual. Diabetologia 64, 1–380 (2021). This independent educational activity is supported by an educational grant from Novo Nordisk A/S. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Novo Nordisk A/S has had no influence on the content of this education.

This episode is also available as a blog post: https://mdforlives.blog/2021/04/19/glp1-receptor-dpp4-inhibitors/ --- Send in a voice message: https://anchor.fm/mdforlives/message

در این اپیزود گفتگو می کنیم با دکتر سعیده فارس پور، متخصص پزشکی خانواده، در مورد بیماری دیابت، انواع و درمان های آن --- « سوالات مطرح شده » علت بروز بیماری دیابت چیست علائم بالینی تیپ ۲ دیابت چیست علاوه بر تست قند خون، چه تست دیگری برای تشخیص و پیگیری دیابت وجود دارد چه درمانهایی برای بیماری دیابت وجود دارد چرا سولفونیل اوره ها در درمان دیابت تیپ ۲ دیگر جایگاهی ندارند داروهای جدید در زمینه درمان دارویی دیابت نقش انسولین در درمان دیابت چیست --- « کلمات کلیدی » HbA1C, Metformin, Glimepirid, SGL2, Jardiance, GLP-1, Victoza, Ozempic, DPP-4 inhibitors, Januvia, DPP4. --- مجری: میترا نادعلی تدوین: امیر ختایی انتخاب موسیقی: کتایون صابری ---

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.09.09.289488v1?rss=1 Authors: Kotani, N., Nakano, T. Abstract: COVID-19 represents a real threat to the global population, and understanding the biological features of the causative virus (SARS-CoV-2) is imperative to aid in mitigating this threat. Analyses of proteins such as primary receptors and co-receptors (co-factors) that are involved in SARS-CoV-2 entry into host cells will provide important clues to help control the virus. Here, we identified host cell membrane protein candidates that were present in proximity to the attachment sites of SARS-CoV-2 spike proteins through the use of proximity labeling and proteomics analysis. The identified proteins represent candidate key factors that may be required for viral entry. Our results indicated that a number of membrane proteins, including DPP4, Cadherin-17, and CD133, were identified to co-localize with cell membrane-bound SARS-CoV-2 spike proteins in Caco-2 cells that were used to expand the SARS-CoV-2 virion. We anticipate that the information regarding these protein candidates will be utilized for the future development of vaccines and antiviral agents against SARS-CoV-2. Copy rights belong to original authors. Visit the link for more info

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.09.06.285023v1?rss=1 Authors: Garg, A., Kumar, G., Sinha, S. Abstract: nCOVID-19 virus makes cellular entry using its spike protein protruding out on its surface. Angiotensin converting enzyme 2 receptor has been identified as a receptor that mediates the viral entry by binding with the receptor binding motif of spike protein. In the present study, we elucidate the significance of N-terminal domain of spike protein in spike-receptor interactions. Recent clinical reports indicate a link between nCOVID-19 infections with patient comorbidities. The underlying reason behind this relationship is not clear. Using molecular docking, we study the affinity of the nCOVID-19 spike protein with cell receptors overexpressed under disease conditions. Our results suggest that certain cell receptors such as DC/L-SIGN, DPP4, IL22R and ephrin receptors could act as potential receptors for the spike protein. The receptor binding domain of nCOVID-19 is more flexible than that of SARS-COV and has a high propensity to undergo phase separation. Higher flexibility of nCOVID-19 receptor binding domain might enable it to bind multiple receptor partners. Further experimental work on the association of these receptors with spike protein may help us to explain the severity of nCOVID-19 infection in patients with comorbidities. Copy rights belong to original authors. Visit the link for more info

  Dr. Carolyn Lam: Welcome to Circulation On The Run, your weekly podcast summary and backstage pass to the Journal and its editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: I'm Greg Hundley, associate editor from the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, you know I'm vegetarian and any paper on plant-based diet will always interest me, and of course, we have one as a featured paper this week, very interestingly talking about changes in plant-based diet quality, meaning that there could be good plant-based diets and not so good plant-based diets. I mean we all know that potato chips, for example, are still plant-based. But, anyways, so this feature paper discusses the changes in these plant-based diet quality and association with total and cost-specific mortality. Neat, huh? Dr. Greg Hundley: Yeah. I can't wait to hear about that one. I know that's a favorite topic of yours. How about if we have a sip of coffee and jump into our other articles? Dr. Carolyn Lam: Sure. I'm sipping away, and have already picked my first paper. This talks about mutations in plakophilin 2, which are the most common cause of gene-positive familial arrhythmogenic right ventricular cardiomyopathy. Dr. Greg Hundley: No quizzes for me on plakophilin 2, please. Dr. Carolyn Lam: All right, well, let me tell you all about it. Plakophilin 2 is classically defined as a protein of the desmosome, which is an intracellular adhesion structure. Studies though have suggested that plakophilin 2 also translates information at the initiation. Recent studies have also shown that plakophilin 2 translates information initiated at the site of cell to cell contact into intracellular signals that maintain structural and electrical homeostasis. Now, the important thing is that mutations in plakophilin 2 associated with most cases of gene-positive arrhythmogenic right ventricular cardiomyopathy or ARVC. However, the molecular and cellular mechanisms responsible for arrhythmias in ARVC remain unclear. Dr. Carolyn Lam: In today's paper, Doctors Delmar and Cerrone from New York University School of Medicine and their colleagues studied the role of cardiomyocyte plakophilin-2 expression in cardiac function. To do that, they utilized a cardiomyocyte-specific, tamoxifen-activated, plakophilin-2 knockout murine line. They found that loss of plakophilin-2 expression caused, as an early event and predominantly in the right ventricle, a non-transcriptional and likely arrhythmogenic, connexin-43-dependent disruption of calcium homeostasis. Dr. Carolyn Lam: The phenotype included accumulation of calcium in three intracellular compartments, the junctional sarcoplasmic reticulum, the cytoplasm, and the mitochondria. Right ventricular myocytes also showed increased eagerness of ryanodine-receptor-2 channels to release calcium from the sarcoplasmic reticulum. Intrinsic ryanodine-receptor-2 properties were also modified further contributing to the pro-arrhythmogenic state. In summary, the authors postulated that disruption of calcium homeostasis in the right ventricle is a major arrhythmia trigger in patients with ARVC. The data identified both the ryanodine-receptor-2 channel and the connexin-43 hemichannel as targets for antiarrhythmic therapy in this population. Dr. Greg Hundley: Very interesting that ARVC is such a worrisome concern, and gathering this mechanistic information is just so helpful. Dr. Carolyn Lam: Exactly. Dr. Greg Hundley: I have a basic science paper, but it was actually interesting because of the conduct was in many, many human subjects. It emanates from the large Million Veteran Program. There are a whole list of coauthors that are recognized as equal contributors, but Scott Damrauer actually serves as the corresponding author from the VA Medical Center. What it's addressing, about 13% of African American individuals carry two copies of the APOL1 risk alleles, G1 or G2, that are associated with a one and a half to two and a half fold increase in the risk of chronic kidney disease. Dr. Greg Hundley: There've been conflicting reports as to whether an association exists between these APOL1 risk alleles and cardiovascular disease independent of the effects of the APOL1 on kidney disease. Here, the investigators thought to test the association of these G1 and G2 alleles with coronary artery disease, peripheral arterial disease, and stroke among African American individuals in the Million Veterans Program. Dr. Carolyn Lam: Seems like a great study population and designed to look at this. What did they find? Dr. Greg Hundley: Among 30,903 African American Million Veterans Program participants, 3,941 or about 13% carried the two APOL1 risk allele, high-risk genotype. Individuals with normal kidney function at baseline with the two risk alleles had a slightly higher risk of developing coronary artery disease compared to those with no risk alleles. Similarly, modest associations were identified with incident stroke and peripheral arterial disease. However, when modeling both cardiovascular and renal outcomes, APOL1 was strongly associated with incident renal disease while no significant association with the cardiovascular disease endpoints could be detected. In conclusion, what the authors are indicating is that the APOL1 risk variants display a modest association with cardiovascular disease, and this association is likely mediated by the already previously known association of APOL1 with chronic kidney disease. Dr. Carolyn Lam: Interesting. Dr. Carolyn Lam: My next paper also has to do with chronic kidney disease and this time looking at metformin use and clinical outcomes in patients with diabetes with or without heart failure or kidney dysfunction. We know that metformin is the first-line therapy for type 2 diabetes, although its effects on the cardiovascular system are actually, not fully proven. In this next paper, the authors examine metformin use in the SAVOR-TIMI 53 Trial. Dr. Greg Hundley: Tell us a little bit about that SAVOR-TIMI 53 Trial. How is that organized? Dr. Carolyn Lam: Just as a reminder, the SAVOR-TIMI 53 trial was a multinational, randomized, controlled cardiovascular outcomes trial that compared the dipeptidyl peptidase-4 or DPP4 inhibitor, Saxagliptin, with placebo, enrolling almost 16,500 patients with type 2 diabetes and cardiovascular disease or elevated cardiovascular risk. Dr. Carolyn Lam: Now, in the current paper led by Dr. Bergmark from TIMI study group in Brigham and Women's Hospital and Harvard Medical School, the authors performed the post hoc analysis and looked at patients in SAVOR-TIMI 53 with baseline biomarker samples of whom there were more than 12,000 patients and classified these patients as ever versus never taking metformin during the trial period. The associations between metformin exposure and outcomes were estimated using inverse probability of treatment weighting, Cox modeling. Dr. Carolyn Lam: They found that among patients with type 2 diabetes and high cardiovascular risk in the SAVOR-TIMI 53 trial, metformin use was associated with lower rates of all-cause mortality including after adjustment for clinical variables and biomarkers, however not lower rates of the composite endpoint of cardiovascular death, MI or stroke. This association was most apparent in patients without prior heart failure or moderate to severe chronic kidney disease. Dr. Greg Hundley: Excellent. Dr. Greg Hundley: I'm going to transition to another clinical trial and this one is looking at ezetimibe in elderly patients and looking at efficacy for preventing cardiovascular-related events. The paper comes from Yasuyoshi Ouchi from Toranomon Hospital in Japan. Evidence regarding the primary prevention of coronary artery disease events by LDL-C/lipid-lowering therapy in order individuals that are above the age of 75 years, is somewhat incomplete. This trial tested whether LDL-C lowering with ezetimibe is useful for the primary prevention of cardiovascular events in older patients. They implemented a multicenter, prospective, randomized but open-label, blinded, endpoint, however, evaluation design conducted among 363 medical institutions in Japan. Dr. Greg Hundley: In the study, there're 3,796 patients that are aged greater than 75 years with elevated LDLC without a history of coronary artery disease that already were receiving dietary counseling. They're randomly assigned one-to-one to receive as ezetimibe 10 milligrams once daily versus usual care with their randomization stratified in a block design on age, sex, and baseline LDL-C. The primary outcome is the composite of sudden cardiac death, myocardial infarction, coronary revascularization, and stroke. Dr. Carolyn Lam: Ooh, so tell us the results. Dr. Greg Hundley: There were several patients that had to be excluded, so what ended up happening, there's 1,716 and then 1,695 that are included in each of the two respective arms for the primary analysis. What they found is that as ezetimibe reduced the incidents of the primary outcome. Then, regarding some secondary outcomes, the incidents of composite cardiovascular events and coronary revascularization were lower in the ezetimibe group than in the control group. But, there was no difference in the incidents of stroke, all-cause mortality, or adverse events in the two different groups. Dr. Carolyn Lam: Can you sum it up for us, Greg? What should we take home regarding ezetimibe and what further do we need to do? Dr. Greg Hundley: Good point, Carolyn. I think what we can take away from this study is that LDL-C lowering therapy with ezetimibe prevented cardiovascular events, suggesting the importance of LDL-C lowering for primary prevention in individuals greater than 75 years of age with an elevated LDL-C. However, remember, it was open label, so I think a placebo, controlled, randomized clinical trial will be required to validate the data that were obtained in this study. I think another study is probably going to be needed. Dr. Carolyn Lam: Thanks, Greg. Well, let's move on to our feature discussion, shall we? Dr. Carolyn Lam: Today's feature paper is of personal interest to me and I'm sure of widespread interest to everybody. Why? It's on plant-based diet. We've heard a lot about it. I'm vegetarian and very, very loudly self-confessed, but does the quality of a plant-based diet actually matter? Such an important question. Dr. Carolyn Lam: I'm so pleased to have the authors of this very remarkable paper, Dr. Megu Baden as well as Dr. Shilpa Bhupathiraju, both from the Harvard T.H. Chan School of Public Health; and our associate editor, Dr. Mercedes Carnethon from Northwestern University Feinberg School of Medicine. Welcome, ladies. What a nice chat we're going to have on this very personal topic to me as well. Dr. Carolyn Lam: First of all, maybe, could I ask, Shilpa, do we need another study on plant-based diet? Could you tell us the rationale for what you did this time? Dr. Shilpa Bhupathiraju: Like you said, when we talk about plant-based diets and what people usually think is, well, it's vegetarian or not. But, I think there's much more to a vegetarian diet. It's the quality that matters. Previous studies really then differentiate the quality of a vegetarian diet. To this extent, we developed plant-based diet indices, which actually capture the quality of a plant-based diet, so we have an overall plant-based diet index which captures the amount of plant-based foods; a healthy plant-based diet index, which captures the quantity of healthy plant-based foods; and again, the unhealthy plant-based diet index, which captures the quantity of unhealthy, plant-based foods. Dr. Carolyn Lam: Thanks. Meg, if you don't mind, I know everybody is asking this as they're listening. Could you give us some examples of what an unhealthy plant-based diet index would consist of compared to healthy? Then, perhaps, tell us a little bit about your study and what you found. Dr. Megu Baden: First of all, let me explain again. In this study, we use three versions of plant-based diet indices that can assess the quality of plant foods in general population. The first index is an overall plant-based diet index, PDI for short. A second one is a healthful plant-based diet index, HPDI. The third one is an unhealthful plant-based diet index, UPDI. In order to create these indices, we divide all food groups into three larger categories. One is the healthy plant foods, which contains whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea, and coffee; less healthy plant foods such as fruits juice, refined grains, potatoes, sugar-sweetened beverages, and sweets or desserts; and animal foods, which is animal food, dairy, eggs, fish, meat, miscellaneous animals-based food. Dr. Megu Baden: We investigated the association between preceding trailblazing changes in these indices and subsequent total and cause basic mortality in two large US cohorts. We found that compared with participants whose diet remained stable, the hazard ratio for total mortality, among those risks, the greatest increase in PDI was 0.95; for the greatest increase in HPDI, the healthful versions of the PDI was 0.90; and the greatest increasing in unhealthful PDI was 1.12. In contrast, the hazard ratio among participants with the greatest difficulty is in PDI, was 1.09; the greatest decrease in healthful PDI was 1.10; and the greatest decreasing in unhealthful PDI was 0.93. For CVD mortality, the risk was 7% lower for our 10 point increase in PDI, and 9% lower for HPDI and 8% higher for UPDI. Dr. Megu Baden: In summary, we found that improving plant-based diet quality over a 12-year period was associated with a lower risk of total and CVD mortality, whereas increased consumption of unhealthful plant-based diet was associated with a higher risk of total and CVD mortality. Dr. Carolyn Lam: Could I ask, Shilpa, to maybe add a line of ... have you applied this information in any way yourself or with patients, or is there an overwhelming take-home message you'd like people to remember? Dr. Shilpa Bhupathiraju: Yeah, I'm not a clinician myself, but I'm a public health researcher. I'm in India currently and I'm giving a talk to South Asians and the emphasis on vegetarianism. But, again, the quality of the vegetarianism is important. Being a vegetarian is not enough, but what goes into it is really important. If it's a white rice and sugar-sweetened beverages, it's not good, so really the emphasis should be on whole grains, consuming more nuts and legumes. I think that's important. Dr. Carolyn Lam: Oh, that's great. Mercedes, we've discussed this paper as associate editors, so proud to be publishing this in circulation. Could you share some of your thoughts on the implications of these findings? Dr. Mercedes Carnethon: The authorship team has done an outstanding job of clarifying a very complicated issue. I think what we really like about this and the ways in which it really adds to the literature, what you point out, that every vegetarian diet isn't the same. I was very impressed with the thought that went into classifying vegetarian foods as healthy or unhealthy. I would be interested in hearing more from the authors, particularly, since I feel they did a good job of how they dealt with complicated foods or mixed foods. I think one example given was a pizza, which has tomato sauce, but it also has other things, so I would love to hear from the authors how they classified complicated foods. Dr. Shilpa Bhupathiraju: The decision to classify pizza as an animal food was somewhat, I would say, arbitrary. I do agree that there's lots of tomato sauce, but again, I think the decision that went to it, it does have a ton of cheese, processed cheese, I think that's why we classified that as an animal food. The other complicated foods are mixed dishes that we struggled with were cream soups. We thought about what the base was or what the general preparation of that would be. Given that heavy cream is a major ingredient, so those were again, classified as animal foods. Dr. Mercedes Carnethon: I think there's a lot of logic in that and I really like the thought and care that you put into that. The other questions I have, I feel that you did a really nice job of, are even portion sizes. Tell me how you handled portions. Dr. Megu Baden: We basically take the information from our food frequency questionnaire. All of them are per the serving sizes, so we considered how participants reported how often on average they had consumed each food of our standard portion size in the past year. I know it's difficult to indicate the portion size. Shilpa, would you add something for the portion size for that? Dr. Shilpa Bhupathiraju: Yes. Like Megu said, we use standardized portioning sizes, so a cup of fruit, a cup of vegetables, an eight-ounce, or a cup of tea or coffee, so that's how we use what people use in general. The portion sizes are all specified on the food frequency questionnaire, so the nurses or the health professionals, they understand exactly what they're reporting. Is it a glass of fruit juice or half a glass? Then, we can word those frequencies into standardized serving sizes onto servings per day. Dr. Carolyn Lam: Great. Shilpa, could I follow up from Mercedes very important question? How does the index account for portion size too, as an is too much of even a good thing become a bad thing? You know what I mean? Dr. Shilpa Bhupathiraju: The index itself is a score. The way we capture it, as you know, everything is converted from frequencies into servings per day for each participant. Then, what we did was we divided the participants based on the distribution of the data into quintiles. Those in the highest category of the healthy plant foods received the highest points. The scoring varied a little bit based on which index we were calculating. But, in general, what we did was we divided everybody into five groups or quintiles. Then, the scoring varied depending on what we were calculating. For the HPDI, which is the healthy plant-based diet index, those in the fifth group or the highest intake received the maximum number of points, which was five. For the unhealthy plant-based diet index, those people received the reverse scoring, so they received zero points. Essentially, the participants were divided into quintiles and the scoring was done accordingly. Dr. Carolyn Lam: Maybe I could ask you a question on a different track, and I'm not sure if you have some answers here, but I noticed that your study population was impressive, almost 49,500 women from the Nurses' Health Study, almost 26,000 men from the Health Professionals Follow-up Study. Did you find any sex differences? Dr. Shilpa Bhupathiraju: We didn't find any sex differences. We did some sensitivity analysis by cohort and we didn't find a statistically significant interaction, which is I think good to note because we would expect the effects to be similar in men and women. Dr. Carolyn Lam: I think both men and women need to hear that. None of us are excused from, I suppose, trying to gear towards a healthy plant-based diet. I think that's what I'm hearing. Mercedes, do you have more thoughts to add? Dr. Mercedes Carnethon: I do. One thing I really like about this particular paper is the way the you acknowledge some of the limitations that we face when interpreting findings from observational studies, particularly observational studies of a health behavior when we know that health behaviors often cluster or correlate with other health behaviors. Can you tell us a little bit about some of the cautions and interpretation that you certainly acknowledged and presented very well? Dr. Shilpa Bhupathiraju: Sure. Our primary analysis was looking at changes, so long-term changes. When people change a diet or their lifestyle, they change something else. As you can see from our paper, those who improve the plant-based diet quality, we're also, in general, tended to be healthier. This being an observational study, we tried to control for those as to the greatest extent possible, but again, they could be residual confounding. We maybe failed to measure for certain things that we were unaware of or that we did not measure. I think we really can't get at causality, but I think the consistency of the evidence from our previous papers and from this paper point to a suggestion that improving plant-based diet quality is definitely associated with better health outcomes and a lower risk of death. But, again, it is important to know that this is observational and there could be changes in other health behaviors that we did not measure that could explain this association. But, we did as well of a job as we could in trying to control for these changes and other behaviors, lifestyles or even health conditions. Dr. Mercedes Carnethon: Thank you. Dr. Carolyn Lam: Thank you so much, Meg and Shilpa. You've been listening to Circulation on the Run. Don't forget to tune in again next week. Dr. Carolyn Lam: This program is copyright American Heart Association 2019

I've been getting a lot of questions lately about the mysterious molecule I consume before I eat bread and pasta - a compound that allows me to digest gluten without any of the "bathroom decommissioning" that so notoriously occurs after a hefty bout of gluten consumption. After all, I don't want to not eat bread or pasta for the rest of my life. I find them enjoyable. But due to glyphosate exposure from pesticides and herbicides, stress, a leaky gut and other modern assailants that make gluten a bigger issue than it ever has been in human history, I use a bit of better living through science to make gluten digestible. In today's podcast, I interview the inventors of Gluten Guardian - Matt Gallant and Wade Lightheart - the guys who first appeared in the podcast "" and later in my article "". Matt Gallant is an entrepreneur, a poker champion, an ex-rock guitarist, a serial entrepreneur (who's built 13 companies in the last 20 years) strength and conditioning coach with a degree in kinesiology, the CEO and co-founder of a company called BiOptimizers. Wade T. Lightheart, host of the AWESOME Health Podcast, 3-time All Natural National Bodybuilding Champion, advisor to the American Anti-Cancer Institute and Cofounder of BiOptimizers. He is also the author of several books including the best-selling books, “Staying Alive in a Toxic World” and “The Wealthy Backpacker.” MARGE LINK TO WADE'S BOOKS During our discussion, you'll discover: -Why Matt eats between 6-10,000 calories every Sunday...7.36 For the calorie spike. One meal per day for 6 days. A combo of healthy and regular food. Matt feels great afterwards. He takes the day off from training. -Why we should be cognizant of our gluten intake, even if we don't have celiac disease...10:30  New England Journal of Medicine listed 55 diseases that can be caused by eating gluten. Many times we're not aware of these diseases; can be immune, neurological and psychiatric. Differences between wheat germ in the gluten and gluten itself. Different type of protein. Both are resistant to digestion. Can make the gut more permeable. (Leaky gut) Amylase/trypsin inhibitors come packaged with gluten - specifically wheat. What about other factors to leaky gut such as stress and glyphosate. 4x increase in celiac disease; traced to glyphosate interrupting the digestive process. Will continue to increase due to the exposure to glyphosate.  -The use of enzymes in the preparation of food to increase its palatability...18:10 In a perfect world, you'd be eating pre-digested food primarily. You use enzymes to assist with breaking food down. -Do Matt and Wade recommend any panels for evaluating gluten sensitivity or gluten cross reactivity?...20:30 Anti-tissue trans glutaminase or endomysial antibody. Recommend Cyrex. Helps you know if other foods such as coffee or quinoa are exacerbating your level of gluten intolerance. Also testing gliad and peptide antibodies. How does gluten negatively affect the brain?...24:00 Inflames the brain by causing an auto-immune response. Antibodies intended to protect your body actually attack your body. During the digestive process, gluten can be broken down into proteins similar to psychedelic drugs. Has an addictive quality. Overloads the brain with glutamate. Irritates and damages brain cells. Negative impact on your social life. -What Wade REALLY thinks about Monsanto...29:50 They were written into protection against lawsuits by federal law during the previous administration. Demonstrable evidence of their products causing damage to the body. Has been bought out by Bayer. Food has essentially been mutated, much to our detriment. Destroy livelihoods of small farmers. -The product Matt uses to pre-digest gluten before you even eat it...37:00 Dipeptidyl peptidase 4, also DPP-4. Dissolves bread placed in water in 15 minutes (watch the video below) You take it while you eat. Does DPP-4 actually mitigate symptoms of gluten intolerance? Depends on the dosage. Can be taken as late as the day after eating. Citrusy foods have been found to inhibit DPP-4 Breaks down various hormones in the body such as insulin. -Does DPP-4 have any effect on foods not containing gluten?...45:00 Milk proteins, but not milk sugars like lactose. Good idea to add DPP-4 if you have a plant-based diet. Just mix and match until you find the right combination for you, and for the right meals. Safe for children to ingest. -More on Matt and Wade's diet and workout regimen...49:50 -How do HCL and hydrochloric acid work with Gluten Guardian?...54:55 Plays a supportive role Stomach acid decreases after the age of 35 Simulates the effects of apple cider vinegar P3-OM  Optimal time to take is before bed or first thing in the morning, rather than meal time. -Matt plays "myth busters" with colonizing properties of probiotics...58:41 -Special offer from Matt and Wade...1:04:15 Get 10% off your order of Gluten Guardian when you use code "greenfield" at 365 day unconditional money-back guarantee Brand new offer: "we'll fix your digestion guarantee" Resource from this episode: -Masszymes -Cyrex blood panel for gluten allergy -Book: Grain Brain Episode Sponsors: - utilizes sound waves to optimize sexual performance and reverse the effects of ED. Purchase 6 treatments, and get the 7th treatment for FREE. - Discover Omax3, the 93.9% pure omega-3 supplement developed by Yale-affiliated scientists. Use my link and you can try an entire box for FREE, plus get 60% off your first month's supply. - Organic brands you love, for less. Get your favorite Organic & Non-GMO brands delivered to your door! Get 25% off your first order when you use my link. - Make the cold your secret weapon with next-level cold gear. Enter code "ben" at checkout and receive 15% off your order! Do you have questions, thoughts or feedback for Matt, Wade or me? Leave your comments at http://bengreenfieldfitness.com/glutenpodcast and one of us will reply!

Cards Against Humanity/Apples to Apples Resources: http://www.techsavvyed.net/archives/3811 https://insidetheclassroomoutsidethebox.wordpress.com/2016/06/19/apples-to-apples-edu-style/ What: • Word association games • Shared goal by all players to complete a phrase by matching the dealer’s card to a card in their hand to earn points • Everyone has a unique set of cards in their hand, and thus the phrases can vary wildly, depending on the preference of the player. How: • Learners are divided into teams that can range from 4 students per team to 10 or more. • In each round, one player (the ‘judge’) turns over the top prompt card and the others, who each have a hand of 8-10 cards, anonymously throw down a single card in response.  • Two sets of cards— a “judge” lays a category word or phrase and participants have to secretly lay a card from their hand that they believe best represents the word/phrase. The judge selects which card was the closest/funniest/most interesting/best. The card that the judge chooses earns a point. Who: • Small or large groups, though smaller teams may be more engaged • Classroom likely most conducive What topics: • Almost any content, usually as a review • Any topic that has clear subcategories/topics • So, for pharmacotherapy of diabetes, the topic card could be “DPP4’s, insulin, GLP-1’s, etc” and then students would have to use adjective/descriptor cards “hypoglycemia, weight gain, nausea, etc” and the best card wins • For heart failure, could use each drug class as a topic card and the descriptor cards could be “hypokalemia, mortality benefit, etc” When/Why: • Goal of this strategy is to provide an immersive active learning strategy for review and association/correlation of complex topics. • Though would take time to set up and print, could be used over and over • Estimated classroom time: 15-20 minutes Other: • This active learning strategy, like many, requires the instructor to be comfortable with a small amount of chaos. Learners typically enjoy this game and become competitive. • To add descriptor cards, could use “NOT cards”-so “NOT hypoglycemia” as a descriptor • Templates available online (see links in show notes)-probably want to print on cardstock for longer-lasting cards

Keep current with this monthly journal club covering landmark articles through May 2018, plus rapid fire hot takes from the medical literature and health news. We rate each article according to a highly scientific ‘Hotcakes’ scale to highlight what practice-changing knowledge we’ll take to work this month. Topics: Hypertension, blood pressure monitoring, prostate cancer screening, Intimate Partner Violence screening, alcohol is killing you, new diabetes drugs and mortality, DPP-4 inhibitors and IBD risk, NT-proBNP-guided therapy vs usual care, effect of teaching status on mortality, and more! If you’re a listener and have something interesting for us to discuss, please send it our way. Join our mailing list to receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders. Credits: Written and produced by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD Editor: Matthew Watto MD Time Stamps:  00:00 The Curbsiders need a web master 00:50 Disclaimer 01:25 Intro to the format 03:25 Ambulatory BP monitoring and mortality 09:08 Blood pressure treatment strategies: CVD risk score vs systolic BP targets 14:14 Repeated BP measurements important at office visits and future directions of BP management 21:25 Hot takes in order of appearance: Prostate cancer screening, intimate partner violence, alcohol, DPP4 inhibitors mortality and IBD, teaching status and mortality in US hospitals, 5 lifestyle factors that may add to life expectancy, NT pro-BNP, BNP and mortality 38:12 Outro

Get cozy with these new drugs for diabetes. Don’t be scared, they won’t bite. On this episode,  we interview Endocrinologist and current president of AACE, Dr. Jonathan D. Leffert, MD, FACP, FACE, ECNU about how to utilize the myriad of new diabetes drugs on the marketplace including SGLT2 inhibitors, DPP4 inhibitors, GLP1 agonists, and new ultra long acting insulins. Plus, we’ll teach you how to choose between agents, common side effects, A1C goals, and the cardiovascular benefits of these newer agents. Full show notes available at http://thecurbsiders.com/podcast Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Case: Case from Kashlak Memorial Hospital: 49 yo M with HTN, BMI 29, hyperlipidemia, family history of premature CAD (dad age 45yo), and DM2 with A1C increase from 6.4% to 9% while on metformin monotherapy. Time Stamps 00:00 Intro 04:33 Getting to know our guest 09:50 Clinical case of diabetes 12:40 Latent autoimmune diabetes 15:16 Life expectancy and A1C goal 16:47 Anemia’s effect on A1C 18:40 Back to our case, choice of agent 20:57 Lifestyle changes effect on A1C 22:55 Starting an SGLT2 inhibitor, what to look for 26:45 SGLT2 inhibitor use in patient already on diuretic 27:53 Discussion of CV risk reduction and newer DM meds 33:27 Euglycemic DKA 34:30 Choice of agent GLP1 vs SGLT2 37:10 Use of DPP4 inhibitors 38:55 Back to the case 39:37 Degludec, long acting insulin 41:34 Clinical case conclusion 43:03 Take home points 45:15 Outro Tags: diabetes, medications, glucose, insulin, oral, therapy, drug, hypoglycemia, a1c, blood, cardiac, risk, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Dr. Carolyn Lam:               Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carlolyn Lam, associate editor from the National Heart Center, and Duke National University of Singapore. What's the link between DPP4 and aortic valve calcification? Well, to find out, keep listening because we'll be discussing this and an important new paper right after these summaries.                                 The first original paper in this issue tells us that high sensitivity Troponin I, may have a role in personalizing preventive strategies in patients with Type II Diabetes. Dr. Cavender and colleagues from University of North Carolina, Chapel Hill, sought to describe the relationship between changes in high sensitivity Troponin I and cardiovascular outcomes in the EXAMINE phase 3B trial, which was designed to evaluate the cardiovascular safety of alogliptin. The current analysis was restricted to patients, randomized 30 days or more after the qualifying acute coronary syndrome event, and high sensitivity Troponin I was measured using the Abbot Architect Assay at baseline and six months.                                 The authors found that high sensitivity Troponin I was detectable in the vast majority - 93% of patients with Type II Diabetes, stabilized within 30 days after acute coronary syndrome. One in six of these patients had high sensitivity Troponin I levels above the 99th percentile upper reference limit. High sensitivity Troponin I had a strong graded relationship with the incidence of subsequent major cardiovascular events.                                 Changes in high sensitivity Troponin I as small as two to six nanograms per liter over six months, were associated with a heightened risk of adverse outcomes. Particularly cardiovascular death and heart failure. Alogliptin neither increased nor decreased the risk of cardiovascular events in a high risk cohort of patients with elevated high sensitivity Troponin I levels. These findings therefore imply that serial measurements of high sensitivity Troponin may have a role in preventive strategies, either by intensifying or prolonging therapies in patients at high risk or reducing or shortening therapies in patients at low risk of cardiovascular events.                                 The next paper describes the effects of Pioglitazone on cardiac outcomes after ischemic stroke or transient ischemic attack in patients with insulin resistance without diabetes in the IRIS trial, which stands for Insulin Resistance Intervention after Stroke. As a reminder, the IRIS trial compared the effects of Pioglitazone with placebo on major cardiovascular events after stroke or transient ischemic attack, in patients without diabetes but who had evidence of insulin resistance. And it showed that Pioglitazone improved insulin resistance, prevented diabetes, improved CRP and reduced fatal and non-fatal stroke or myocardial infarction.                                 In the current paper, by Dr. Young and colleagues from Yale Cardiovascular Research Center in New Haven, Connecticut, the authors performed a secondary analysis of IRIS and examined the effect of Pioglitazone on acute coronary syndromes, mainly myocardial infarction or unstable angina. They found that Pioglitazone reduced the risk of these events by 29%, with benefit emerging after two years of treatment. Furthermore, Pioglitazone reduced the incidence of Type I myocardial infarction with a neutral effect on Type II myocardial infarction. In summary, among patients with insulin resistance without diabetes, Pioglitazone reduced the risk of acute coronary syndromes after a recent cerebrovascular event, and may serve as a useful secondary prevention therapy in addition to statins, aspirin, and other established treatments.                                 The next study tells us that immune complexes may be an important biomarker in the risk stratification of Antiphospholipid Syndrome. Now recall that Antiphospholipid Syndrome is characterized by recurrent thrombosis in patients with Antiphospholipid predictive antibodies. However, the predictive value of the presence of Antiphospholipid auto antibodies is low. And new markers are needed to identify carriers at higher risk.                                 In the current study by Dr. Serrano and colleagues from Madrid, Spain, the authors performed a historical cohort follow up study based on the Magnum 12 plus 12 cohort, that included all patients who had received a kidney transplant in their hospital in a 12 year period from 2000 to 2011. Sera used for the analysis were collected in the 24 hours before the kidney transplant surgery, and used to measure circulating immune complexes of immunoglobulin A bound to beta II glycoprotein I.                                 The authors then investigated the possible association of these immune complexes with thrombosis, graft thrombosis and graft loss in the six months following kidney transplant. They found that in patients with the immunoglobulin A isotope antiphospholipid antibodies, the presence of circulating immune complexes of immunoglobulin A bound to beta II glycoprotein I, pre transplant, was associated with acute thrombotic events. Patients positive for the immune complexes had a much higher risk of developing post transplant thrombotic events, and higher risk of graft thrombosis mediated graft loss. On the other hand, complex negative patients had the same thrombosis risk as the control population. These findings imply that treatment to prevent thrombosis should focus mainly on the immune complex positive patients in this setting.                                 The final paper addresses the issue that public reporting of PCI Outcomes may create disincentives for physicians to provide care for critically ill patients, particularly at institutions with worse clinical outcomes. In this study from first author, Dr. Waldo from the VA Eastern Colorado Health Care System in Denver, Colorado, corresponding author, Dr. Yeh from Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues. The authors used state reports to identify 31 out of 86 hospitals that were recognized as negative PCI outliers in two states: Massachusetts and New York, from 2002 to 2012.                                 They sought to evaluate the procedural management and in hospital outcomes of patients treated for acute myocardial infarction before and after a hospital had been publicly identified as the negative outlier. They found that outlier facilities were larger, treating more acute myocardial infarction patients, and performed more PCI's than non outlier hospital. The rates of percutaneous revascularization increased similarly at outlier and non outlier institutions after report of the outlier status. After outlier designation, the in hospital mortality declined at the outlier institutions to a greater extent than was observed at the non outlier facilities. Thus, public reporting of outlier status may prompt outlier facilities to improve case selection, and employ systems improvements that optimize patient care, and improve in hospital mortality among patients with myocardial infarctions.                                 We are going to have such a fun discussion in today's feature paper. Have you ever wondered what does dipeptidyl peptidase-4, or DPP4 have to do with aortic valve calcification? Well, you're about to learn, because in today's paper we actually learn that DPP4 inhibitors, which you might recognize from diabetes, you know drugs such as sitagliptin, could serve a potential therapeutic target in aortic valve disease. To tell us about it and discuss it, we have corresponding author, Dr. Jae-Kwan Song] from Asan Medical Center in Seoul, South Korea, as well as Dr. Thomas Eschenhagen, Associate Editor from University Hospital Hamburg Eppendorf in Germany. Welcome, gentlemen. Dr. Jae-Kwan Song:         Hi. Dr. Thomas Eschenhagen:            Hi. Dr. Carolyn Lam:               Fascinating paper. I have to congratulate you first and foremost, but please tell us, what inspired you to look at DPP4 in aortic valve disease. Dr. Jae-Kwan Song:         Yeah, actually as a clinician, I think there is two issues. One is the prevalence of calcific aortic valve disease is increasing rapidly in the developed and also developing countries. The second important issue is that we do not have effective medical treatment option. So I will say that the medical treatment of calcific aortic valve disease is a typical example of unmet clinical needs to serve this kind of troubled scientific issues, our team have focused on the reciprocal interaction between endothelial cells and interstitial cells. Because this potential mechanism was well reported by other investigators that the interaction between two cells are very critical for maintaining aortic valve tissues. So first we started with Enos knockout mouse, to go over what's going on in the aortic valve in the models. In the human tissues in patient with calcific aortic valve disease, we have found that DPP4 is specifically activated. That's the beginning of our study. Dr. Carolyn Lam:               Could you please explain to those of us who don't do basic science research everyday, I mean, your study involves tissues both from humans and mirroring models. Could you explain it very simply what you did and what you found? Dr. Jae-Kwan Song:         Yes, in the Enos Knockout mouse, we have found that those mouse showed very strong calcification process compared to the live animals. What is the mechanism of this enhanced calcification in this mouse? And we found that the loss of endothelial  function is critical, and then we found that DPP4 is actively involved in the calcification process. The first test we have done is the isolation of developed interstitial cells. And then we focused on osteogenic transformation over this valvular interstitial cell both in the Enos Knockout mouse, and the human developing interstitial cells. So we have found that the endothelial dysfunction activates the DPP4 activity in these tissues, which resulted in the increase osteogenic transformation of developed interstitial cell. So that's the beginning of our observation. Dr. Carolyn Lam:               And could you describe what you did subsequently to prove the whole mechanism? Dr. Jae-Kwan Song:         As you know the DPP4 has many substrates including many peptides involved in glucose metabolism, so the hardest part of our study is what is the molecule target, or associated with DPP4 in the pathologic process of calcification in developing interstitial cells. We tested many different substrates known to the potential targets of DPP4, and we have found specifically insulin-like growth factor-1 (IGF-1) is the key proponent of all this process. With further study, we found that the DPP4 cleaves or inactivates or decrease IGF1 activity in the valvular interstitial cell, and in the normal status IGF1 is a very critical to protect osteoblastic transformation of valvular interstitial cell. We have found that the DP4 and IGF1 exercises key therapeutic target, and the key molecules involved in valvular calcification. As you know we do have a DP4 inhibitors, which were successfully clinically to reduce the diabetes control. So it's very easy to test the DP4 inhibitors in animal models. Both in the Enos Knockout mouse, and we also developed in the calcific aortic valve disease using some treatment, including Vitamin D and hypercholesterol and diet the in vivo experiment showed that [inaudible 00:13:58] inhibitors effectively prevented the development of calcification and prevented the development of calcification and prevented the developement of calcific aortic disease. This the main finding of our study. Dr. Carolyn Lam:               That is so fascinating, and really especially what you just said, that sitagliptin in this rabbit model prevented calcific aortic valve disease with the concurrent increase in plasma IGF1 levels in line with the DPP4 inhibition. That is just such a beautiful piece of work, congratulations. And congratulations Thomas on managing such a nice paper. Take us under the hood about the discussions that happened with the editors. Surely you recognized the translational impact. What do you think? Is it time to reposition DPP4 inhibitors? Dr. Thomas Eschenhagen:            We and the reviewers like the paper because first of all it describes a new, interesting biological mechanism. If we are done, and we like that it uses human samples, but also this treatment in two different animal models. This together, really makes it a strong paper, we've found perfectly suitable for Circulation. As you said Carolyn, the translation perspective is fascinating. Obviously it's very early days. There is no specific evidence yet from patients. But that could, in patients, take actually very very long. Even the big studies already been done with sitagliptin and other DPP4 inhibitors, that don't show a signal in this direction yet, but I would say that could still happen, and maybe in the long term, all of the cardiologists putting all this stuff in German it's call TAVS, in America it's called TAVR does not work anymore, obviously. That's just the speculation.                                 But it gives a very interesting signal, and this study certainly should stimulate research in humans and do some prospective studies in patients. Dr. Carolyn Lam:               Yes indeed. If I may ask, Jae-Kwan, do you have plans for further steps? Dr. Jae-Kwan Song:         Yeah, we are expecting some [inaudible 00:16:06]. The first process with proof of concept study as you know is DP4 inhibitors have been actually been used for the diabetic controls, so we may have a patient cohort who also underwent [inaudible 00:16:22] echocardiogram [inaudible 00:16:23] while without medication. The analysis of those later can be used for proof of concept study. But we are challenging issues that although many drugs are classified as a DP4 inhibitors, we should really focus on the tissue distribution on these drugs, specifically on the cardiac issues. It may be possible that the different drugs have a different tissue distribution even after all our medication. The second critical issue is what is the actual dose of these drugs to prevent calcific aortic valve disease. Usually these drugs are used for diabetes control. We may need different lab results of these drugs for different critical indications. So that's the two important issues to be solved. Dr. Carolyn Lam:               That's wonderfully put, and I couldn't agree more. Thomas, could we switch tracks a little bit. Because now that I have you online, and you're the first time joining us on the show too, tell us a little bit more about what it's like as an associate editor really looking at these pre clinical data, being able to parse out what you think has translational value, and especially for circulation. We have a very strong emphasis now on clinical translation. Share some of your thoughts there on how it's been for us. Dr. Thomas Eschenhagen:            It's been a great experience. I do have some experience with other journals as an associate editor, or being on an editorial board. But I have to say circulation is really quite unique. I think it's a very strong group of people. I'm amazed by the level of knowledge and also the level of engagement of the other editors and associate editors, in every single paper. What's also really rewarding is the overall quality of papers being submitted to circulation, it's really great. A lot of papers are not only presenting some beautiful, basic science, but also this translational perspective, that's actually what we are looking for. So very solid, exciting scientific work in cells, animals, but always some link, either some materials from humans or a good link to a translation perspective. That's the perfect paper for circulation and I have to say we get quite a bit of them, and it's sometimes even difficult to pick the ones we really like. But it's great, it's really been a lot of fun.  Dr. Carolyn Lam:              This is actually one of the purposes of this podcast. It's hoping to share with our readers, with our listeners, what happens at these editor discussions because it's so interesting, I just wish everyone could listen to all the science and the clinical translation that we discuss. Thank you very much for sharing your thoughts today, both Thomas, and Jake Won, beautiful work. We're very proud to be publishing this work in circulation.                                 Thank you listeners for joining us this week. Don't forget, tell all your friends about this podcast, and tune in again next week.

Interview with Darren McGuire, MD, author of Association Between Sitagliptin Use and Heart Failure Hospitalization and Related Outcomes in Type 2 Diabetes Mellitus, and Benjamin Scirica, MD, author of The Safety of Dipeptidyl Peptidase 4 Inhibitors and the Risk for Heart Failure

We reviewed the CDA 2013 guidelines on antihyperglycemic therapy for type 2 diabetes (http://guidelines.diabetes.ca/executivesummary/ch13), and explored the pharmacological properties of each of the major classes: Biguanides: Metformin Sulfonylureas: chlorpropamide, gliclazide, glimepiride, glyburide, and tolbutamide Thiazolidinediones: pioglitazone and rosiglitazone Meglitinides: Nateglinide and repaglinide Alpha-glucosidase inhibitors: Acarbose Dipeptidyl Peptidase-4 inhibitors (DPP4 inhibitors): Saxagliptin and sitagliptin Glucagon Like Peptide-1 […] The post Diabetes 2: antihyperglycemics appeared first on Family Pharm Podcast.

Hosts: Vincent Racaniello, Alan Dove, and Kathy Spindler Vincent, Alan, Kathy, and Dickson discuss identification of a cell receptor for the coronavirus-EMC, and the role of interferon-epsilon in protecting the female reproductive tract. Links for this episode: Dipeptidyl peptidase 4 is CoV-EMC receptor (Nature) Receptor for new coronavirus (Nature) Broad reception for coronavirus (Nature) SARS 10th anniversary (Science) Interferon-epsilon protects female reproductive tract (Science) Families fighting flu (YouTube) Monitoring infections with online data (TWiM 41) Natalie Portman was a scientist (NY Times) Letters read on TWiV 223 Weekly Science Picks Kathy - 2013 Intel Science Talent Search awardsAlan - Krebs Cycle Rap (CDC)Vincent -  Jetpens (favorite one and two)D ickson - Rabies death in organ recipients (CDC) Listener Pick of the Week Justin - The DNA StoreJim - Massive Open Online ClassroomsChris - Feedly Send your virology questions and comments (email or mp3 file) to twiv@twiv.tv