Characterization of the hypertriglyceridemic waist phenotype in patients with type2 diabetes mellitus in Spain: An epidemiological study

BACKGROUND AND OBJECTIVES

In patients with type2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW.

METHODS

We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥94cm for men and ≥80cm for women) with the presence of triglyceride levels ≥150mg/dl. We compared demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype.

RESULTS

Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14±4.88 vs. 29.2±4.82kg/m2; P<.001) and glycated hemoglobin levels (7.38±1.2% vs. 7±1.07%; P<.001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; P<.001), exercise (44.6 vs. 58.2%; P<.001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; P<.001).

CONCLUSIONS

The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.

Multimodal semantic revision during inferential processing: The role of inhibitory control in text and picture comprehension

Although language comprehension usually requires multimodal information, no study to date has investigated how comprehenders deal with the revision of a text's interpretation when different modalities are involved. Twenty-four young adults listened to a story prompting an inference (e.g., polar bear), and then saw a picture that was either consistent (polar bear) or inconsistent but still plausible (penguin). Larger negativity (N400) in the inconsistent picture indicated successful inferential monitoring. Subsequently, a sentence carried the disambiguating word which was either expected ("bear") or unexpected ("penguin") in relation to the auditory-verbal information. Larger negativity in the unexpected word coming from the consistent picture suggested that comprehenders had difficulties selecting the unexpected concept when previous information was contradictory. More importantly, this effect was modulated by inhibitory control, where a higher resistance to distractor interference (flanker task) was associated with a better ability to suppress pictorial information, therefore preventing semantic competition. Similarly, accuracy measured in a final comprehension question demonstrated that higher inhibitory control was related to a more efficient ability to revise the situation model across modalities. Our findings speak to a relationship between story comprehension and mental flexibility during multimodal processing.

TLI in pediatric patients

PURPOSE

Hematopoietic progenitor cell transplantation (HSCT) is a procedure used in different hematological diseases as part of the curative treatment, so the investigators propose a system of conditioning of reduced intensity based on total lymphoid irradiation (TLI) as an alternative to the classic total body irradiation (TBI) followed by haploidentical transplantation in patients compatible with a single HLA haplotype, as an alternative to patients who do not have an HLA compatible donor.

MATERIALS AND METHODS

A cohort of 25 patients with hematological disease underwent haploidentical HSCT from February 2015 to May 2018, conditioned with TLI from day - 10 (2-4 days of treatment) followed by thiotepa (5 mg/kg/12 h) and melphalan (70 mg/m²/day) prior to HSCT and prophylaxis with ciclosporin (1.5 mg/kg/12 h). 2 Gy/fraction was administered to complete 8 Gy with IMRT and VMAT technique.

RESULTS

12% rejection of the transplant was obtained with acute GVHD < II (48%) and chronic GVHD 12%. No acute toxicity was recorded in irradiated patients and 56% survival of patients at the end of follow-up.

CONCLUSION

Conditioning the haploidentical transplant with TLI, IMRT, and VMAT techniques compared with TBI and RT3D-C techniques is a feasible technique that helps inducing the necessary immunosuppression in patients with a high risk of graft rejection, minimal adverse effects, low incidence of GVHD, and high survival rate.

Goal-directed fluid therapy on laparoscopic colorectal surgery within enhanced recovery after surgery program

INTRODUCTION

Enhanced recovery after surgery protocols (ERAS) are used in peri-operative care to reduce the stress response to surgical aggression. As fluid overload has been associated with increased morbidity and delayed hospital discharge, a major aspect of this is fluid management. Intra-operative goal-directed fluid protocols have been shown to reduce post-operative complications, particularly in high risk patients.?.

OBJECTIVE

To compare 2fluid therapy models (zero-balance versus goal-directed fluid therapy) in patients who were scheduled for laparoscopic colorectal surgery within an ERAS program, recording the rate of complications such as surgical site infection, ileus, post-operative náusea and vomiting, and variability of the estimated glomerular filtration rate (eGFR).

MATERIALS AND METHODS

An observational, retrospective study was conducted including adults who were scheduled for elective laparoscopic colorectal surgery within an ERAS program, and to investigate the postoperative complication rate.

RESULTS

A total of 128 patients were included in this study; 43 (33.6%) in the zero-balance group and 85 (66.4%) in the goal-directed fluid therapy group. The total fluids administered was lower in the goal-directed fluid therapy group, as well as the incidence of post-operative complications (surgical site infection, anastomotic leak, ileus, and postoperative náusea and vomiting). No significant differences were found for length of stay, intra-operative urine output, and variability of the eGFR.?.

CONCLUSION

The results of this study show that by using a goal-directed fluid therapy algorithm, the total amount of fluids administered can be reduced, as well as obtaining a lower incidence of post-operative complications.

Cross-Sectional Characterization of Albumin Glycation State in Cerebrospinal Fluid and Plasma from Alzheimer's Disease Patients

We determined albumin post-translational modifications (PTMs) by mass spectrometry (MS) in plasma and cerebrospinal fluid (CSF) from 31 Alzheimer's disease (AD) patients (with 27 samples of paired plasma-CSF from the same patients). Results were cross-sectionally compared with healthy controls. For percentage of relative intensity of glycated isoforms, plasma albumin was globally more glycated in AD patients than in healthy controls (P<0.01). MS results in plasma were confirmed by a quantitative enzymatic assay (Lucica GA-L) for albumin early-glycation detection. In CSF there were no global glycation differences detected by MS, although a different pattern of glycated isoforms was observed. Oxidized+glycated and cysteinylated+glycated isoforms were increased in both plasma and CSF of AD patients in comparison with healthy controls (P<0.001). Furthermore, AD patients showed higher glycation in plasma than in CSF (P<0.01). Our data support the role of glycation and oxidative stress in AD.

Optimization of the sugar hydrothermal extraction process from olive cake using neuro-fuzzy models

The optimization of the hydrothermal extraction step in the biorefinery scheme in order to obtain sugars and antioxidants from olive cake was carried out. This process using water and low temperatures for the olive cake has not been previously studied by other authors. Central Composite Design of experiments was carried out. Four variables and three levels for each variable were tested: temperature (50, 70 and 90 °C) time (60, 120, 180 min), average particle diameter (0.42, 0.96 and 1.5 mm) and solid/liquid ratio (0.15, 0.20, 0.25). The main aim was to understand the relationship between the process variables and the yield of extraction of glucose, xylose, polyphenols and oligomers. The variables which most influenced the process were particle diameter and solid/liquid ratio. The experimental values were adjusted to a classical polynomial model and to a neuro-fuzzy system. The neuro-fuzzy demonstrated to be much more accurate when predicting the experimental values.

Kinetic study of thermal degradation of olive cake based on a scheme of fractionation and its behavior impregnated of metals

This research aims to provide a better knowledge of the thermal decomposition of the olive cake as well as this lignocellulosic material loaded, in a previous stage of biosorption, with heavy metals for its use in processes of energy recovery. Firstly, isolation of constituents of the olive cake was carried out. Then, experiments were performed by thermogravimetric analysis (TGA) and differential thermogravimetry (DTG) under inert and oxidative atmosphere at a heating rate of 15 K/min for each isolated fraction. Next, adequate reactions schemes were proposed to find kinetic parameters. Validation of these schemes were verified by the goodness of fitting between experimental and simulated data. Also, some important combustion characteristics such as ignition and burnout temperatures were determined. With regard to the effect of metals, cadmium, copper, chromium, nickel and lead present in metal-loaded olive cake did not modify values of kinetic parameters which described the thermal decomposition processes.

Indicator performance after the implementation of the Spanish Consensus Document for the control of hyperglycemia in the hospital and at discharge

BACKGROUND AND AIMS

Information for the adequate management of diabetic patients at hospital discharge is limited. We aimed to evaluate the impact of implementation of recommendations of the Spanish consensus for the management hospital discharge in patients with type 2 diabetes or hyperglycaemia during hospitalization.

METHODS

Observational multicentric study with a prospective and a retrospective colection of patients with type 2 diabetes /hyperglycaemia (>140mg/dl) during hospitalization from 19 Spanish hospitals. Quality indicators in discharge report, antidiabetic therapy, HbA_1c and adverse events were gathered at hospital admission, hospital discharge and 3 month post-discharge.

RESULTS

199 and 75 subjects in the prospective and retrospective group respectively were included. The indicators of quality in the hospital discharge reports was higher in the prospective group (P<.001). The proportion of patients with insulin, oral antidiabetic drugs (OADs), and insulin+OADs was modified at discharge in patients with HbA_1c<7.5% (P<.005) and ≥7.5% (P<.001) in the prospective group and in patients with HbA 1c ≥7.5% (P<.001) in the retrospective group. At 3 month post-discharge HbA_1c levels decreased from 8.2±1.9% to 7.3±1.2% (P<.001) in the prospective group, and from 8.3±1.5% to 7.2±1.2% (P<.001) in the retrospective group. Hypoglycaemic and hyperglycaemic episodes and hospital readmissions were similar in both groups.

CONCLUSIONS

Implementation of Spanish consensus recommendations for the management of hospital discharge in patients with diabetes type 2 or hyperglycaemia considerably improved the registration of quality indicators in the discharge report. Reconciliation of antidiabetic medication at the time of hospital discharge, improves glycaemic control after hospital discharge.

Intestinal-Type Adenocarcinoma of the Nasal Cavity and Paranasal Sinuses. A Clinicopathologic Study of 6 Cases

The clinical and pathologic features of 6 cases of intestinal-type adenocarcinoma of the sinonasal region are presented. These cases were collected in a 17 year period (1972-1988) and account for less than 4% of malignancies of this region in our records for this period. All of the patients were men aged 48 to 82 years (mean, 54 years). Previous exposure to wood dust was reported in 1 case. Radiographic studies, especially computerized tomography, were of critical importance to delineate the extent of tumors. Nasal obstruction was the most common compliant. Duration of symptoms prior to diagnosis is available in 5 cases and ranged from 5 to 36 months (mean 18 months). Surgical treatment was performed in 4 patients (of palliative type in 2) followed by radiotherapy in 3. Histo-pathology revealed tubulo-papillary (5 cases) and mucinous (1 case) patterns. Follow-up is available in all patients (range 0 to 108 months), 50% of whom are still alive. In our series, only 1 patient has survived more than 5 years. Data pooled from the literature reveal that 53% of patients have experienced local recurrences following therapy, and 60% have died of their disease. Of these deaths, 80% occurred within 5 years of diagnosis.

Neural fuzzy modelization of copper removal from water by biosorption in fixed-bed columns using olive stone and pinion shell

Continuous copper biosorption in fixed-bed column by olive stone and pinion shell was studied. The effect of three operational parameters was analyzed: feed flow rate (2-6 ml/min), inlet copper concentration (40-100 mg/L) and bed-height (4.4-13.4 cm). Artificial Neural-Fuzzy Inference System (ANFIS) was used in order to optimize the percentage of copper removal and the retention capacity in the column. The highest percentage of copper retained was achieved at 2 ml/min, 40 mg/L and 4.4 cm. However, the optimum biosorption capacity was obtained at 6 ml/min, 100 mg/L and 13.4 cm. Finally, breakthrough curves were simulated with mathematical traditional models and ANFIS model. The calculated results obtained with each model were compared with experimental data. The best results were given by ANFIS modelling that predicted copper biosorption with high accuracy. Breakthrough curves surfaces, which enable the visualization of the behavior of the system in different process conditions, were represented.

Kinetic analysis of pyrolysis and combustion of the olive tree pruning by chemical fractionation

This paper presents a kinetic analysis of thermal decomposition of olive tree pruning from its basic compounds in pyrolysis and combustion reactions. Experiments were performed by TGA under inert and oxidant conditions and results indicated that the decomposition of the olive tree pruning was related to the material composition. Pseudo-mechanistic models were proposed estimating the yield of pyrolysis on its basic compounds (hemicelluloses, cellulose and lignin). Validity and reliability of the proposed kinetic models were verified by the good fitting between the simulated and experimental curves (with values of R² higher than 0.99 in most cases). Moreover, during the fractionation process, an acid fraction was obtained with great fuel properties, a high calorific value and a low residue after its combustion.

Spanish version validation of the Marihuana Motives Measure in a drug-consuming adolescent sample

INTRODUCTION

Cannabis is the illicit drug mostly widely consumed by adolescents in Spain. The understanding of consumption motives is an important factor for intervention. In Spain, there are no available instruments for their evaluation, hence, the goal of this paper is to study the psychometric properties of the Marihuana Motives Measure (MMM) in a sample of adolescent consumers.

MATERIAL AND METHOD

Firstly, translation and back-translation was performed. A total of 228 adolescent consumers of cannabis were evaluated. Factorial analysis was conducted, and the reliability of the total scores and of each scale of the questionnaire was studied through Cronbach's alpha. Test-retest reliability was analyzed through interclass correlations. Validity evidence of the MMM was examined through correlations between current cannabis use, subjective consumption effects measured with the Addiction Research Center Inventory (ARCI), and personality measured with the Millon Adolescent Clinical Inventory (MACI).

RESULTS

High reliability was observed in total score of the MMM (Cronbach α = .86), and high and moderate reliability for each of the five factors obtained in the factorial analysis of the MMM, Social = .82, Enhancement = .72, Coping = .83, Expansion = .74, and Conformity = .64. Significant correlations were also observed between cannabis consumption motives and subjective effects, and between consumption motives and personality.

CONCLUSION

The Spanish version of the MMM shows a similar factorial structure as the one obtained by the original author, and its measures are reliable and valid for the study of cannabis consumption motives in adolescent consumer population.

Carbon accumulation and storage capacity in mangrove sediments three decades after deforestation within a eutrophic bay

A dated sediment core from an eutrophic mangrove area presented non-significant differences in carbon accumulation rates before (55.7±10.2gm^-2yr^-1) and after three decades of deforestation (59.7±7.2gm^-2yr^-1). Although eutrophication effects appear to compensate the loss of mangrove organic matter input, the results in this work show a threefold lower carbon accumulation than the global averages estimated for mangrove sediments. The effects of increasing eutrophication and enhanced sediment dry bulk density observed after deforestation (~30% higher) did not result in higher carbon stocks. Moreover, the lower TOC:OP (<400) and C:N (~20) molar ratios, as well as increased nutrient accumulation, reflect the dominance of phytoplankton-derived organic matter after deforestation, resulting in less-efficient sedimentary carbon sinks. These results indicate that the organic material deposited from eutrophication may not compensate mangrove deforestation losses on carbon accumulation in mangrove ecosystems.