We aimed to develop two models to estimate first AMI and stroke/TIA, respectively, in type 2 diabetes mellitus patients, by applying backward elimination to the following variables: age, sex, ...duration of diabetes, smoking, BMI, and use of antihyperglycemic drugs, statins, and aspirin. As time-varying covariates, we analyzed blood pressure, albuminuria, lipid profile, HbA1c, retinopathy, neuropathy, and atrial fibrillation (only in stroke/TIA model). Both models were stratified by antihypertensive drugs. We evaluated 2980 patients (52.8% women; 67.3 ± 11.2 years) with 24,159 person-years of follow-up. We recorded 114 cases of AMI and 185 cases of stroke/TIA. The factors that were independently associated with first AMI were age (≥ 75 years vs. < 75 years) (p = 0.019), higher HbA1c (> 64 mmol/mol vs. < 53 mmol/mol) (p = 0.003), HDL-cholesterol (0.90-1.81 mmol/L vs. < 0.90 mmol/L) (p = 0.002), and diastolic blood pressure (65-85 mmHg vs. < 65 mmHg) (p < 0.001). The factors that were independently associated with first stroke/TIA were age (≥ 75 years vs. < 60 years) (p < 0.001), atrial fibrillation (first year after the diagnosis vs. more than one year) (p = 0.001), glomerular filtration rate (per each 15 mL/min/1.73 m
decrease) (p < 0.001), total cholesterol (3.88-6.46 mmol/L vs. < 3.88 mmol/L) (p < 0.001), triglycerides (per each increment of 1.13 mmol/L) (p = 0.031), albuminuria (p < 0.001), neuropathy (p = 0.01), and retinopathy (p = 0.023).
The use of titanium diboride films as protective coatings was proposed for several applications because of its mechanical and tribological properties, as well as chemical and thermal stabilities. The ...aim of this work is to evaluate the effects of the deposition parameters on the microstructure and mechanical properties of titanium diboride films. All films were deposited on silicon substrates by dc-magnetron sputtering from a stoichiometric TiB2 target in argon atmospheres. The chemical composition was determined by Rutherford backscattering spectroscopy (RBS), while structural information was obtained by X-ray photoelectron spectroscopy (XPS) and X-ray diffraction (XRD). The intrinsic stress of the films was determined by measuring the change of the substrate curvature due to film deposition. Surface roughness was studied by Atomic Force Microscopy (AFM). The film hardness and elastic modulus were determined by nanoindentation measurements. The correlation between the mechanical properties with the film density is presented. The internal stress reduction occurs with substantial reduction of the film hardness, and it occurs for films with low mass density.
►TiB2 films deposited by dc-magnetron sputtering. ►XRD measurements indicate a strong TiB2 preferential (001) orientation. ►Compressive stress increases upon the increase of the film density. ►Correlation between stress, hardness and elastic modulus with film density.
Longer survival for orthotopic liver transplantation (OLT) patients over the last decade has focused emphasis on the metabolic complications that contribute to patient morbidity and mortality. The ...aim of our study was to analyze the prevalence of the metabolic syndrome (MS) and other risk factors after OLT among our patients at 1 year follow-up. From 2001 to 2008, we performed OLT in 210 patients with 62 exclusions leaving 148 patients for the study. We recorded age, gender, liver disease, smoking status, pre- and post-OLT body mass index, pre- and post-OLT arterial blood pressure, pre- and post-OLT fasting blood glucose, pre- and post-OLT high-density lipoproteins and triglycerides, family history of diabetes, hepatitis B and C virus status, immunosuppressive therapy, and corticosteroid bolus for rejection episodes. The MS was defined according to modified ATP III criteria. At month 12 after OLT, 29/148 patients (19.6%) developed the MS. The associated factors were obesity and hyperlipidemia pre-OLT, familial and personal history of diabetes as well as alcoholic cirrhosis. By multivariate analysis, pre-OLT body mass index (odds ratio, 3.7 1.3–10.5) and pre-OLT diabetes (odds ratio, 2.9 1.1–7.9) were independent risk factors.
Background and rationale
Thromboembolic complications are a serious, preventable and common event in cancer patients that contributes to increasing morbidity and mortality. Despite increasing ...knowledge on cancer-associated thrombosis (CAT), there are still several aspects of diagnosis, clinical management, treatment and prognosis with uncertainties that are under-represented in randomized clinical trials. For this reason, the Spanish Society of Medical Oncology (SEOM) launched in June 2018 a registry of CAT.
Methods/design
TESEO is an ongoing prospective, non-interventional, multicentric study in consecutive cancer patients with newly diagnosed of thromboembolic event (TEE). Eligibility criteria include being > 18 years with a histologically confirmed diagnosis of cancer and a symptomatic or incidental TEE confirmed with an imaging technique in the previous month or any time after the cancer diagnosis and signing of informed consent. The study consists of two types of integrated but independent prospective registries. Regular CAT sub-registry includes information on patient’s cancer´s characteristics, anticoagulant treatment provided and outcome data. Special CAT sub-registry includes variables related to special situations of CAT that comprise patients with severe kidney failure, thrombocytopenia, high risk of bleeding related to the cancer or with coexistence of bleeding and patients who receive new treatments such a targeted therapy, antiangiogenics agents and immunotherapy. The registry considers the status of the cancer and the time to assess how the prognosis is changed based on when the thrombus occurs. Some outcomes such as rethrombosis, major bleeding, tumor progression and survival will be valued in various time intervals including 1, 3, 6 and 12 months after the even in the first year; and then every 6 months until the patient’s death.
Results
After 18 months and with 35 centers and researchers, the registry has 1128 patients.
Conclusion
TESEO registry will provide clinical real-world evidence for prevention, treatment and complications of CAT in different scenarios that are under-represented in randomized clinical trials.
It is desirable for patients to play active roles in the choice of renal replacement therapy (RRT). Patient decision aid tools (PDAs) have been developed to allow the patients to choose the option ...best suited to their individual needs.
An observational, prospective registry was conducted in 26 Spanish hospitals between September 2010 and May 2012. The results of the patients' choice and the definitive RRT modality were registered through the progressive implementation of an Education Process (EP) with PDAs designed to help Chronic Kidney Disease (CKD) patients choose RRT.
Patients included in this study: 1044. Of these, 569 patients used PDAs and had made a definitive choice by the end of registration. A total of 88.4% of patients chose dialysis 43% hemodialysis (HD) and 45% peritoneal dialysis (PD) 3.2% preemptive living-donor transplant (TX), and 8.4% conservative treatment (CT). A total of 399 patients began RRT during this period. The distribution was 93.4% dialysis (53.6% HD; 40% PD), 1.3% preemptive TX and 5.3% CT. The patients who followed the EP changed their mind significantly less often kappa value of 0.91 (95% CI, 0.86-0.95) than those who did not follow it, despite starting unplanned treatment kappa value of 0.85 (95% CI, 0.75-0.95. A higher agreement between the final choice and a definitive treatment was achieved by the EP and planned patients kappa value of 0.93 (95% CI, 0.89-0.98). Those who did not go through the EP had a much lower index of choosing PD and changed their decision more frequently when starting definitive treatment kappa value of 0.73 (95% CI, 0.55-0.91).
Free choice, assisted by PDAs, leads to a 50/50 distribution of PD and HD choice and an increase in TX choice. The use of PDAs, even with an unplanned start, achieved a high level of concordance between the chosen and definitive modality.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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•We designed a nebulizer based on the flow focusing principle.•The nebulizer produces droplets much smaller than those obtained with flow focusing.•We analyze the stability and ...outcome of the nebulizer.
Flow focusing is providing new tools in Analytical Chemistry for its unique combination of simplicity, droplet size control just above the micrometer scale, and aerosol beam collimation. However, the most interesting droplet size range lies at the stability limit of the standard flow focusing operating mode. Nevertheless, that stability limit can be forced down to produce jets on the submicrometer scale by underpinning the cone-like meniscus at the tip of a hypodermic needle. Using a nebulizer design based on that concept, we show that the flow focusing steady jetting regime extends down to the limit imposed by the instability of jet itself, even for Reynolds numbers as low as 10−2. This stability enhancement leads to droplet sizes well below those previously obtained with flow focusing. In this work, we experimentally determine the influence on the jet's radius of the liquid flow rate and viscosity, as well as the focusing orifice. We analyze the instability mechanisms that impose the minimum values of the issued flow rate and jet's size. Finally, the jet's breakup and the size of the resulting micron-sized droplets are examined from high-speed optical imaging.
The validity of the one-dimensional (1D) (slenderness) approximation to describing the cone-jet mode of electrospraying is examined by comparing its results with those obtained from the ...two-dimensional (2D) leaky-dielectric model. This comparison shows that the 1D approach provides accurate predictions for the relevant quantities if the (dimensionless) electrical conductivity and/or the Ohnesorge number are sufficiently high. By using the procedure proposed in Gañán-Calvo, A.M. (1999b) (The surface charge in electrospraying: Its nature and its universal scaling laws. Journal of Aerosol Science, 30, 863–872), we show the suitability of the 1D model to precisely “measure” those quantities in an electrospray experiment. Our method combines a super-resolution image processing technique to detect the liquid free surface in the experimental images, and the numerical integration of the 1D model. In this way, the conduction and surface convection contributions to the current intensity, as well as the electric field over the jet’ surface, are determined in an experimental realization.
•We analyze the validity of the 1D approximation to describing the cone-jet mode of electrospray.•We compare the 1D results with those obtained from the 2D leaky-dielectric model.•The 1D approach is accurate for high enough conductivities and/or Ohnesorge numbers.•The 1D model is used to precisely measure the relevant quantities in an experiment.•The method combines a super-resolution image processing technique and the 1D approach.
Few studies have analyzed the relationship between glucose variability (GV) and adverse health outcomes in patients with differences in glycemic status. The present study tests the hypothesis that GV ...predicts all-cause mortality regardless of glycemic status after simple adjustment (age and sex) and full adjustment (age, sex, cardiovascular disease, hypertension, use of aspirin, statins, GLP-1 receptor agonists, SGLT-2 inhibitors and DPP-4 inhibitors, baseline FPG and average HbA1c). A total of 1,223 patients (657 men, 566 women) died after a median of 9.8 years of follow-up, with an all-cause mortality rate of 23.35/1,000 person-years. In prediabetes or T2DM patients, the fourth quartile of CV-FPG exerted a significant effect on all-cause mortality after simple and full adjustment. A sensitivity analysis excluding participants who died during the first year of follow-up revealed the following results for the highest quartile in the fully adjusted model: overall, HR (95%CI) = 1.54 (1.26-1.89); dysglycemia (prediabetes and T2DM), HR = 1.41 (1.15-1.73); T2DM, HR = 1.36 (1.10-1.67). We found CV-FPG to be useful for measurement of GV. It could also be used for the prognostic stratification of patients with dysglycemia.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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