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Background and Objective Low vitamin D levels correlate with measures of insulin resistance and prevalence of diabetes mellitus, but there are limited and conflicting data on changes in insulin resistance after vitamin D replacement. The objective of the current study was to examine whether vitamin D replacement improves insulin sensitivity. Methods In this randomized double-blind placebo-controlled study, 12 healthy subjects with plasma 25-hydroxy vitamin D (25[OH]D) levels of less than 20 ng/mL were treated with ergocalciferol, 50,000 units, orally once a week for 8 weeks or matching placebo. The main outcome measure was insulin-stimulated glucose infusion rate during the last 20 minutes of a hyperinsulinemic-euglycemic glucose clamp study. Results At baseline, plasma 25(OH)D levels were similar between the ergocalciferol and placebo groups (13.3 ± 3.8 and 15.7 ± 2.4 ng/mL, respectively; P = 0.3) but were higher in the ergocalciferol group at 8 weeks (18.8 ± 5 vs 12.5 ± 2.2 ng/mL; P = 0.02). Glucose infusion rate was similar between the 2 groups both at baseline and after 8 weeks of treatment. Changes in plasma 25(OH)D levels did not correlate with change in glucose infusion rate. Conclusion Administration of ergocalciferol, 50,000 units, weekly for 8 weeks in subjects with low vitamin D levels improves 25(OH)D levels but does not improve insulin sensitivity.

Objective The objective was to examine age- and sex-specific cancer prevention and screening practices among 1820 Asian Indian (AI) adults in the United States using items from the 2000 National Health Interview Survey Cancer Control Topical Module. Methods A cross-sectional study of 1820 randomly selected AIs living in 7 US cities. Data were collected via telephone interviews by trained multilingual AI staff; the response rate was 62%. The primary outcome variables were age- and sex-specific cancer screening behaviors. Results Most of the AIs are men, married, educated, and with some form of health insurance. One fifth reported a family history of cancer. Adherence to mammography, Papanicolaou test, and clinical breast examination was higher in contrast to low rates of breast self-examination in women. Similarly, men reported low clinical testicular examination and fecal occult blood test, although prostate-specific antigen screening was higher than the reported rates among Asian Americans. Men were more likely to get a colonoscopy than women. The length of time in the United States had a relatively weak effect, and a family history of cancer had a moderate effect on screening behavior. Education and access to health care increased the odds (2-6 times) of cancer screening in AI men and women. Conclusions Cancer screening varies by educational level, years lived in the United States, and access to health care, among AIs living in the United States. Differences in sociodemographic factors should be considered to predict adherence to cancer screening guidelines and also be factored into patient education in this ethnic subgroup.

Our recent study defined the chemokine-induced human monocyte signaling under normoglycemic condition. To explore the hyperglycemia-induced monocyte signaling, we performed adhesion, migration, and transmigration assays on human monocytes obtained from THP-1 cell line in the presence of normal (5 mM) and high (10 and 20 mM) glucose concentrations without chemokines. We observed augmented ( P < 0.01) monocyte adhesion to human umbilical vein endothelial cell monolayer at 10 than 5 mM glucose with no further increase at 20-mM glucose concentration ( P < 0.07 vs 10 mM; P < 0.01 vs 5 mM). But incremental increases in monocyte migration ( P < 0.01), transmigration ( P < 0.01), and stress fiber response ( P < 0.01) were observed at 10- and 20-mM glucose concentrations in comparison to 5-mM glucose concentrations. We found gradational increase ( P < 0.01) in phosphorylation of Akt S473 and glycogen synthase kinase (GSK3β S9 ) in hyperglycemia (10 and 20 mM) when compared with 5 mM glucose. Furthermore, hyperglycemia (both 10 and 20 mM)-treated monocyte showed up-regulated phosphorylation of p101 and p110γ subunits of PI-3 kinase in comparison to 5 mM glucose. Hyperglycemia-induced monocyte migration was restored to basal levels in the presence of PI-3 kinase inhibitor, LY. These observations imply that modest hyperglycemia per se, as is commonly observed in diabetic individuals, is a potent stimulator of monocyte activity even without chemokines.

Objective Inadequate vascular remodeling is contributory to increased cardiovascular events in people with type 2 diabetes mellitus (DM) and impaired fasting glucose (IFG). Vascular endothelial growth factor (VEGF) and its regulatory molecule soluble Flt-1(sFlt-1) play important roles in atherogenesis. Research Design We measured fasting plasma concentrations of VEGF and sFlt-1 in 11 nondiabetic (ND) (aged 46.1 ± 2.1 years; body mass index [BMI], 26.1 ± 0.9 kg/m 2 ; glucose, 5.0 ± 0.1 mM), 15 IFG (aged 52.9 ± 1.8 years; BMI, 32.7 ± 1.3 kg/m 2 ; glucose, 6.4 ± 0.1 mM), and 8 DM (aged 55.8 ± 3.2 years; BMI, 30.0 ± 1.0 kg/m 2 ; glucose, 9.3 ± 0.5 mM) subjects. Results Plasma VEGF (42.1 ± 4.0 vs 24.2 ± 0.9 vs 29.4 ± 3.8 pg/mL, respectively) and sFlt-1 (119.4 ± 4.9 vs 58.9 ± 3.2 vs 56.7 ± 1.2 pg/mL, respectively) concentrations were higher ( P < 0.04) in DM than IFG and ND subjects. Whereas VEGF concentrations were significantly lower ( P < 0.05) in IFG than in ND subjects, sFlt-1 concentrations did not differ between the IFG and ND subjects. Conclusions Although plasma VEGF concentrations were higher (35%) in DM than in ND subjects, VEGF action on vascular remodeling was likely attenuated by higher sFlt-1 concentrations in DM. In contrast, IFG subjects did not have major perturbations in either VEGF or sFlt-1 levels. Further studies defining the roles of these mediators in DM and IFG are necessary to extend these observations.

Designer natriuretic peptides (NPs) are novel hybrid peptides that are engineered from the native NPs through addition, deletion, or substitution of amino acid(s) with a goal toward optimization of pharmacological actions while minimizing undesirable effects. In this article, selected peptides that were designed in our laboratory are reviewed, and future directions for research and development of designer NPs are discussed.

Objective The objective of this study was to provide recommendations for provision of training for sponsor and investigators at Academic Health Centers. Background A subgroup of the Investigational New Drug/Investigational Device Exemption (IND/IDE) Task Force of the Clinical and Translational Science Award (CTSA) program Regulatory Knowledge Key Function Committee was assembled to specifically address how clinical investigators who hold an IND/IDE and thus assume the role of sponsor-investigators are adequately trained to meet the additional regulatory requirements of this role. Methods The participants who developed the recommendations were representatives of institutions with IND/IDE support programs. Through an informal survey, the task force determined that a variety and mix of models are used to provide support for IND/IDE holders within CTSA institutions. In addition, a CTSA consortium-wide resources survey was used. The participants worked from the models and survey results to develop consensus recommendations to address institutional support, training content, and implementation. Recommendations The CTSA IND/IDE Task Force recommendations are as follows: (1) Institutions should assess the scope of Food and Drug Administration–regulated research, perform a needs analysis, and provide resources to implement a suitable training program; (2) The model of training program should be tailored to each institution; (3) The training should specifically address the unique role of sponsor-investigators, and the effectiveness of training should be evaluated regularly by methods that fit the model adopted by the institution; and (4) Institutional leadership should mandate sponsor-investigator training and effectively communicate the necessity and availability of training.

AbstractAnti‐cytotoxic T lymphocyte‐associated antigen‐4 (CTLA‐4) and anti‐programmed cell death‐1 (PD‐1) inhibitors have been shown to significantly improve survival in patients with metastatic cutaneous melanoma. However, there was some heterogeneity as well as some variation in the degree of benefit across studies. We reviewed randomized trials and performed a meta‐analysis to determine the efficacy and safety of immune checkpoint inhibitors in comparison with conventional regimens. Eligible studies were limited to randomized controlled trials comparing anti‐CTLA‐4 or anti‐PD‐1 inhibitors to chemotherapy or vaccination treatment in adult patients with unresectable cutaneous metastatic melanoma. Progression‐free survival (PFS) rate at 6 months was 28.5% versus 17.7% (RR: 0.84, 95% CI: 0.76–0.93), overall survival (OS) rate at 1 year was 51.2% versus 38.8% (RR: 0.72, 95% CI: 0.59–0.88), and overall response rate (ORR) at 6 months was 29.6% versus 17.7% (RR: 0.85, 95% CI: 0.76–0.95) favoring immune check point inhibitors over chemotherapies or vaccination. Immune check point inhibitors were associated with more frequent immune‐related adverse events at 13.7% versus 2.4% of treated patients (RR: 6.74, 95% CI: 4.65–9.75). Subgroup analyses demonstrated significant PFS (RR: 0.92 vs. 0.74, P < 0.00001) and ORR (RR: 0.95 vs. 0.76, P = 0.0004) improvement with anti‐PD‐1 treatment compared to anti‐CTLA‐4 when each of them was compared to control treatments. Collectively, these results demonstrate that immune checkpoint inhibitors have superior outcomes compared to conventional chemotherapies or vaccination, and support the results of recent randomized trials that showed superior outcomes with anti‐PD‐1 agents over ipilimumab in unresectable metastatic cutaneous melanoma patients.