Regional differences in the degree of glycaemic diabetes control in Spain and associated factors. IBERICAN study

BACKGROUND AND OBJECTIVE

The prevalence of type 2 diabetes (T2D) is high, it is increasing and its degree of control seems to be improvable with important social and health consequences. The objective of this study is to determine the regional differences in the degree of glycaemic control of T2D in Spain and its associated factors.

MATERIAL AND METHODS

Cross-sectional, multicentre, observational study in patients with T2D between 18 and 85 years of age selected by consecutive sampling between 2014 and 2018. The population was divided into four regions: north, centre, Mediterranean and south-east. The main variable was the value of glycated haemoglobin (HbA1c). Sociodemographic and clinical variables, presence or absence of other risk factors and treatment were recorded.

RESULTS

A total of 1587 patients with T2D were analysed, with a mean age of 65.93 years (standard deviation [SD] 10.14); 54.5% were men; the mean duration of T2D was 8.63 years (SD 6.64) and the mean HbA1c value was 7.05%. Of the total, 59.8% had an HbA1c value ≤ 7% (north 59.5%, centre 59.5%, Mediterranean 60.6% and south-east 59.8%; P=.99). The factors for poor control were: in the north, duration of T2D and being sedentary; in the centre, duration of T2D and having a low income; in the Mediterranean, duration of T2D; and in the south-east, duration of T2D and having a low level of education or income. Overall, 76.2% of the subjects had hypertension, 75.1% dyslipidaemia, and 51.7% obesity, with significant differences between regions only being observed in the case of dyslipidaemia (P<.001).

CONCLUSIONS

No differences were observed in the degree of diabetes control in the different regions, with the percentage of patients needing intensification in their control being high in all of them. The factors associated with poor control were the duration of the disease, a low level of education or income, and a sedentary lifestyle.

Two-Year Changes in Physical Activity and Concurrent Changes in Cognitive Function in a Cohort of Adults with Metabolic Syndrome

BACKGROUND

It has been proposed that physical activity (PA) could prevent cognitive decline.

OBJECTIVE

To evaluate the association between changes in PA and changes in cognitive function in a cohort of adults with metabolic syndrome.

METHODS

Longitudinal observational study including 5,500 adults (mean age 65 years, SD = 5; women = 49.3% ) with metabolic syndrome. Participants underwent physical activity measurements and cognitive evaluation at baseline and at two-years of follow-up. PA was quantified using the Minnesota questionnaire-shortened version. Cognitive function was evaluated using a battery of tests: Mini-Mental Test Examination, Clock Drawing Test, Trail Making Test A and B, Verbal Fluency Test, and Digit Span. The primary outcome was two-year change in cognition, measured through the Global Composite Score (GCS) of all neuropsychological tests. Multivariable-adjusted linear regression models were fitted with baseline PA and their changes as the main exposures and changes in cognitive function as the outcome.

RESULTS

No significant association was found between PA levels (or their changes) in the GCS of cognitive function. A greater increase in PA levels was associated with a more favorable two-year change in the Trail Making Test A (Q4 versus Q1: b = - 2.24s, 95% CI -4.36 to -0.12s; p-trend = 0.020). No significant association was found for other neuropsychological test.

CONCLUSION

Our results do not support an association between increases in PA and the evolution of the global cognitive function at two-year in an intervention trial which included PA promotion in one of its two randomized arms, but they suggested a possible beneficial effect of PA on attentional function in older adults.

Abstract P6-05-02: Intrinsic subtype and gene expression changes between primary and metastatic breast cancer

Background: A better understanding of the biological changes occurring during metastatic progression of breast cancer is needed to identify new biomarkers, targets and novel treatment strategies. Here, we compared the intrinsic subtype and the expression of a gene panel across a large dataset of paired primary and metastatic tissues.

Methods: Expression profiling of 105 breast cancer-related genes was performed on 254 (127 pairs) formalin-fixed paraffin-embedded tumor tissues using the nCounter platform. Tumor samples were obtained from 3 independent sources (ConvertHER trial [BCRT 2014] and two in-house datasets). Tumors were classified into each intrinsic subtype using the research-based PAM50 classifier (Parker et al. J Clin Oncol 2009). Chi-square tests were performed to determine the differences in the distribution of variables. Paired two-class Significance of Microarrays (SAM) was performed to determine the genes differentially expressed between paired primary and metastatic tissues. In vitro stable transfection of FGFR4-GFP was performed on Luminal B MCF7 cell line. RNA was purified on control vs. transfected cell lines. 7-AAD cell viability was performed following estrogen deprivation for 6 days.

Results: Subtype distribution in primary vs. metastatic disease was 39.0% vs. 26.8% for Luminal A (p=0.012), 26.0% vs. 35.0% for Luminal B (p=0.322), 11.4% vs. 20.3% for HER2-enriched (p=0.115) and 10.6% vs. 13.0% for Basal-like tumors (p=0.843). The rate of subtype conversion was 7.7% in Basal-like, 23.1% in HER2-enriched, 30.0% in Luminal B and 54.3% in Luminal A disease. The majority of subtype conversions in Luminal A disease were to Luminal B (72.0%) and HER2-enriched (24.0%). Overall, 13.2% of primary Luminal A/B tumors progressed to a HER2-E subtype despite 70% of them being clinically HER2-negative. In a paired analysis using all samples, 10- and 12- genes were found up- and down- regulated in metastatic tissues (False Discovery Rate [FDR] &lt;5%). The up-regulated gene list in metastatic disease was composed of FGFR4 (top gene) and proliferation genes (CDC6, CCNB1, CEP55). The down-regulated gene list in metastatic disease was enriched for luminal-related genes (ESR1, PGR, NAT1 and MAPT). A similar paired analysis within Luminal A, Luminal B, HER2-enriched and Basal-like disease revealed 22, 8, 7 and 0 differentially expressed genes (FDR&lt;5%), respectively. Finally, MCF7 cell line transfected with FGFR4 showed a relative increase in the HER2-enriched profile compared with transfected control. In vitro, MCF7-FGFR4 cells showed estrogen independent growth compared to transfected controls.

Conclusions: Metastatic tissues are relatively more proliferative and less luminal compared to primary tumors. This is especially relevant in primary Luminal A disease. In contrast, metastatic tissues from Basal-like primary disease remain largely unchanged. In luminal disease, a significant increase in the HER2-enriched profile is observed in metastatic disease despite most tumors being clinically HER2-negative. A potential driver of the HER2-enriched profile and estrogen independence in clinically HER2-negative metastatic tissues might be FGFR4.

Citation Format: Prat A, Martínez de Dueñas E, Galván P, Garcia S, Burgués O, Paré L, Antolín S, Martinello R, Blancas I, Adamo B, Guerrero Á, Muñoz M, Nuciforo P, Vidal M, Pérez RM, Chacón JI, Caballero R, Gascón P, Carrasco E, Rojo F, Perou CM, Cortés J, Adamo V, Albanell J, Lluch A. Intrinsic subtype and gene expression changes between primary and metastatic breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-05-02.

Combined strategy for the precipitation of heavy metals and biodegradation of petroleum in industrial wastewaters

The precipitation of chromium(III), copper(II), manganese(II) and zinc(II) by biogenic hydrogen sulfide generated by sulfate-reducing bacteria, Desulfovibrio sp., and the degradation of total petroleum hydrocarbons (TPH) in the presence of heavy metal by Pseudomonas aeruginosa AT18 have been carried out. An anaerobic stirred tank reactor was used to generate hydrogen sulfide with Desulfovibrio sp. culture and the precipitation of more than 95% of each metal was achieved in 24 h (metal solutions contained: 60, 49, 50 and 80 mg L(-1) of chromium, copper, manganese and zinc sulfates). A stirred tank reactor with P. aeruginosa AT18, in the presence of the heavy metal solution and 2% (v/v) of petroleum, led to the degradation of 60% of the total petroleum hydrocarbons and the removal of Cr(III) 99%, Cu(II) 93%, Zn(II) 46% and Mn(II) 88% in the medium through biosorption phenomena. These results enabled the development of an integrated system in which the two processes were combined. The overall aim of the study was achieved, with 84% of TPH degraded and all of the metals completely removed. Work is currently underway aimed at improving this system (decrease in operation time, culture of P. aeruginosa in anaerobic conditions) in an effort to apply this process in the bioremediation of natural media contaminated with heavy metals and petroleum.

[Utility of 3D computed tomography for the surgical planning of pelvic fractures]

BACKGROUND

To determine the utility of 3D computed tomography for the preoperative planning of pelvic rim fractures assessing possible changes in fracture classification as well as in the surgical indication itself.

METHODS

We retrospectively reviewed patients who had undergone surgery for complex pelvic fractures during a 15-month period. The mechanism of injury was recorded and the availability of a multi-slice spiral volumetric CT scan was requested as a preoperative study.

RESULTS

Ten cases (58%) were pelvic rim fractures and 7 were acetabular fractures. The mean ISS was 23.82 (9-50), and 82.3% of cases were severe traumas (ISS > 16). After the CT scan was obtained, the initial classification of the fracture was changed in four cases (23.5%), without any changes in the surgical indication. An artifact was detected in the volumetric reconstruction but it did not limit the surgeon's interpretation.

CONCLUSION

Tridimensional CT-based modeling is very helpful in the surgical planning of pelvic fractures and is a complement of the plain X-rays.

[Biodistribution of 99mTC-HMPAO in healthy rats and B16 melanoma carriers]

Scintigraphic studies carried out in melanoma patients have demonstrated that the 99mTc-HMPAO complex makes it possible to locate the lesion. A biodistribution and pharmacokinetic study of the 99mTc-HMPAO complex was carried out in B16-melanoma tumor healthy and carrier mice after an intravenous injection. Radioactivity was measured in the liver, kidneys, spleen, stomach, brain, blood and tumor. It was seen that at 15 minutes of the injections, 40% of the total activity distributed in the animal body was recorded in the tumor. An interesting effect observed is an increase in the tissue distribution curves in both experimental groups at 1-2 hours post-injection. According to the seriated imaging study results with 99mTc-HMPAO in B16 melanoma bearing mice, the best image is obtained 10-30 minutes after the injection.

Hygiene behaviour in rural Nicaragua in relation to diarrhoea

BACKGROUND

Childhood diarrhoea is a leading cause of morbidity and mortality in Nicaragua. Amongst the risk factors for its transmission are 'poor' hygiene practices. We investigated the effect of a large number of hygiene practices on diarrhoeal disease in children aged <2 years and validated the technique of direct observation of hygiene behaviour.

METHODS

A prospective follow-up study was carried out in a rural zone of Nicaragua. From the database of a previously conducted case-control study on water and sanitation 172 families were recruited, half of which had experienced a higher than expected rate of diarrhoea in their children and the other half a lower rate. Hygiene behaviour was observed over two mornings and diarrhoea incidence was recorded with a calendar, filled out by the mother, and collected every week for 5 months.

RESULTS

Of 46 'good' practices studied, 39 were associated with a lower risk of diarrhoea, five were unrelated and only for two a higher risk was observed. Washing of hands, domestic cleanliness (kitchen, living room, yard) and the use of a diaper/underclothes by the child had the strongest protective effect. Schooling (>3 years of primary school) and better economic position (possession of a radio) had a positive influence on general hygiene behaviour, education having a slightly stronger effect when a radio was present. Individual hygiene behaviour appeared to be highly variable in contrast with the consistent behaviour of the community as a whole. Feasible and appropriate indicators of hygiene behaviour were found to be domestic cleanliness and the use of a diaper or underclothes by the child.

CONCLUSION

A consistent relationship between almost all hygiene practices and diarrhoea was detected, more schooling producing better hygiene behaviour. The high variability of hygiene behaviour at the individual level requires repeated observations (at least two) before and after the hygiene education in the event one wants to measure the impact of the campaign on the individual.

Corticosterone induces hypoactivity of prolactin-immunoreactive cells

In order to determine whether corticosterone regulates activity of rat lactotrophs by acting directly at the pituitary level, immunohistochemical studies were carried out in adrenalectomized rats, subjected or not to treatment with corticosterone or colchicine, and in monolayer cultures after incubation with corticosterone. Adrenalectomy increased cellular and nuclear areas (p<0.01) of prolactin-immunoreactive cells without affecting their cytoplasmic area. Similar results were found in adrenalectomized and colchicine-treated animals. Corticosterone reversed the effects of adrenalectomy, although normal values were partially reversed. In cultured pituitary cells, exposure to corticosterone reduced numerical density and cellular, cytoplasmic and nuclear areas with respect to control dishes. Morphological differences in shape, arrangement and nuclear features were observed after treatment with corticosterone. These results demonstrate an inhibitory effect of corticosterone on the activity of rat pituitary prolactin cells and suggest that corticosterone induces hypoactivity by acting on the pituitary prolactin cells of male rats.

Antidiarrhoeal activity of Waltheria americana, Commelina coelestis and Alternanthera repens

The antidiarrhoeal activity of the hexane, chloroform, methanol and aqueous extracts of Waltheria americana, Commelina coelestis and Alternathera repens, was tested on mice with diarrhoea induced by castor oil and MgSO4. The methanol extract of C. coelestis and A. repens and aqueous extract of A. repens, presented antidiarrhoeal effect, monitored by number of liquid feces defecated and intestinal transit of a suspension of graphite with castor oil in Wistar rats.

Cryopreservation and storage of embryogenic callus cultures of several Citrus species and cultivars

Nucellus-derived embryogenic callus cultures of Salustiana sweet orange were subjected to cryoconservation assays. Cryoprotection with 10%(vol/vol) dimethylsulfoxide, freezing by slow cooling and thawing by fast warming was suitable to recover viable growing cultures and whole plants through embryogenesis. Evaluation of liquid phase R ₁ and solid phase R ₂ cooling rates using a programmable freezing unit indicated that 100% of embryogenic cultures survived when frozen using a range of cooling rates (R ₁ not above 0.5°C min^-1 and R ₂ not above 1°C min ¹) and thawed by fast warming. Storage up to 2 years in liquid nitrogen did not affect the growth of the cryopreserved cultures and the recovery of whole plants. Cultures of four cultivars of sweet orange (C. sinensis Osb.), three cultivars of grapefruit (C. paradisi Macf.), and one cultivar each of lemon [C. limon (L.) Burm. f.], Cleopatra mandarin (C. reshni Hort. ex Tan.), sour orange (C. aurantium L.) and Mexican lime [C. aurantifolia (Christm.) Swing.] have been successfully cryopreserved. Problems using a viability assessment using fluorescein diacetate staining are discussed.

In vitro effects of estradiol on pituitary GH-immunoreactive cells

In order to determine whether estradiol modulates the proliferation and activity of somatotrophic cells in vitro, a study of GH-immunoreactive cells was carried out in pituitary monolayer cultures obtained from male adult rats treated with 10(-6)M estradiol for 3 hours. Cellular activity was evaluated in a morphometric study of GH-immunoreactive cells. The proliferation rate was determined by double immunostaining for GH and PCNA (proliferating cellular nuclear antigen). The results were compared to those obtained from control dishes. Estradiol was seen to increase the cellular (p < 0.05), nuclear (p < 0.01) and cytoplasmic areas (p < 0.05). Estradiol decreased the percentage of proliferating GH-immunoreactive cells (p < 0.05) and the nuclear density of somatotrophs (p < 0.05) when all cells present in the dishes were considered. However, when only GH-immunoreactive cells were considered, estradiol increased the proliferation rate of these cells (p < 0.05). Overall, our results suggest that, in vitro, estradiol stimulates the cellular activity and proliferation of GH-immunoreactive cells in the rat.

Coyolosa, a new hypoglycemic from Acrocomia mexicana

From the methanol extract of the Arocomia mexicana root a new tetrahydropyrane compound was isolated. Its skeletal structure and relative stereochemistry were established by spectral analysis. Substituent effects have been determined with the hope of providing information about steric interactions and conformation of tetrahydropyran derivatives and carbohydrates. The extract showed a significant blood sugar lowering effect on normal and alloxan-diabetic mice when administered at 2.5 to 40 mg/kg i.p. doses, and exhibited a dose-dependent response in the mice models.

Decreases in the size and proliferation rate of VIP-immunoreactive cells induced in vitro by testosterone are associated with decreases in VIP release

As in vitro study was carried out to determine whether testosterone directly inhibits the secretion of pituitary vasoactive intestinal peptide (VIP). A study was also conducted to elucidate the repercussions of treatment with 10(-6) M testosterone of monolayer cultures in the size and proliferation rate of pituitary VIP-immunoreactive cells, using double immunocytochemical labelling for proliferating cell nuclear antigen (PCNA) and VIP. Testosterone decreased the in vitro release of VIP from pituitary cells. It also decreased the percentage of pituitary VIP-immunoreactive and PCNA- and VIP-immunoreactive cells and decreased the size of the cellular and nuclear areas of these cells. Our results suggest that the inhibition of pituitary VIP secretion induced by testosterone could be exerted at pituitary level and that testosterone could act as a modulator of the proliferation rate of rat pituitary VIP-immunoreactive cells.

[Childhood diarrhea in rural Nicaragua: beliefs and traditional health practices]

In Nicaragua, the principal cause of infant mortality is diarrhea, which is responsible for 40% of these deaths annually. This statistic reflects the low usage of health services and oral rehydration therapy (ORT). In an effort to improve the situation, several studies were carried out in Villa Carlos Fonseca municipio. This report describes two of those studies, one ethnographic and the other epidemiologic (conducted in 1989 and 1990, respectively), to find out beliefs and traditional health practices and their influence on the way in which mothers responded to their children's diarrheal illness. The ethnographic study involved interviewing 70 mothers with an average age of 28 years who had children under 2 years of age. The children represented two groups: one at high risk for diarrhea and the other at low risk. The objectives were to learn the traditional names for diarrhea, the perception of risk, and the treatments that were used. The epidemiologic study included 391 mothers over 14 years of age with one or more children under age 5 years, of whom 215 had had diarrhea in the two weeks preceding the survey. The objectives were to describe local beliefs and health practices and to determine the incidence of diarrheas according to the diagnosis made by the mothers. At least 12 types of diarrhea were identified, for which terms such as "empacho" and "sol de vista" were used. In most cases, the mothers had more confidence in folkloric treatments that they themselves or the traditional healers (curanderos) applied than in the services offered at health centers. This attitude limited their use of health services and ORT, although it was observed that in certain cases traditional treatments were used in combination with those of western medicine. There was a direct but nonsignificant correlation between the level of schooling of the mothers and the frequency with which they visited the health center. The authors suggest the effects of massages, herbal baths, and other traditional treatments should be studied to evaluate their effectiveness and adapt them, to the extent possible, to "modern" medicine. Health services providers should become familiar with traditional nomenclature and beliefs in order to be able to communicate better with mothers and steer them away from harmful practices toward improved results in infant diarrheal disease prevention programs.

Inhibitory activity of 3-methylenhydroxy-5-methoxy-2,4-dihydroxy tetrahydrofurane isolated from Selaginella lepidophyla on smooth muscle of Wistar rat

A new compound, 3-methylenhydroxy-5-methoxy-2,4-dihydroxy tetrahydrofurane, has been isolated from a methanol extract of Selaginella lepidophyla. The structure is based on 1H-NMR, 13C-NMR and MS analysis. The compound was tested on uterus (oestrus), ileum and duodenum of Wistar rats. It proved to have a slight inhibitory effect on the contraction response of the uterus, but it did not have any effect on the two other muscles.

A study of the hypoglycemic effect of some Mexican plants

Diabetes mellitus is a disease that annually causes many deaths, and to date no really efficient remedy has been found. We studied a number of plants traditionally used in Mexico against diabetes, some of them since prehispanic times. Specimens of each species were collected and extracts from them were tested on CD1 strain mice with alloxan-induced diabetes. Hypoglycemic activity was determined by the O-toluidine and the Dextrostix tape methods. Several of the plants showed a marked hypoglycemic effect.