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Objectives (a) to evaluate and compare the psychological treatment needs of patients with cancer and non-cancer, who are going to undergo scheduled thoracic surgery, and (b) evaluate and compare the diagnostic accuracy of the screening tests of psychological treatment needs for cancer and non-cancer patients. Method The need for psychological treatment was evaluated in a total of 169 patients prior to thoracic surgery, through a clinical interview. The screening tests used were: the physician's judgment (yes/no), the Hospital Anxiety and Depression Scale (HADS) and, the single-item interview to assess depression “Do you feel depressed?” (DEPQ). Results The number of patients who needed psychological treatment in the total sample was 47 (27.81%), in non-cancer-patients: 22 (30.99%) and in cancer patients: 25 (25.51%). The participants with treatment needs were more often young women with primary education levels, with more fears and concerns regarding their disease. With respect to the screening tests, the HADS-T (cut-off point ≥13) obtained a sensitivity (SE) of 0.75 and Specificity (SP) of 0.81 in the total sample. In patients with cancer, the HADS total score (cut-off point ≥10) obtained an SE = 0.84 and SP = 0.80, and, in non-cancer patients, the HADS total score (cut-off point ≥13) showed an SE = 0.59 and SP = 0.84. The DEPQ and the physician's judgment did not achieve adequate levels of precision. Conclusions A high percentage of patients have psychological treatment needs before performing thoracic surgery, which are similar for cancer and non-cancer patients. Preoperative detection of patients who need psychological intervention is feasible with a simple screening test: HADS, which achieves greater precision in cancer patients.

Introduction and objectives Quantification of cardiovascular risk has been based on scores such as Framingham, Framingham-REGICOR, SCORE or Life's Simple 7 (LS7). In vitro, animal, and randomized clinical studies have shown that polyphenols may provide benefits to the vascular system and reduce the inflammatory response. However, some clinical-epidemiological studies have yielded inconsistent results. Our aim was to assess the possible association between intake of the various polyphenol classes and established cardiovascular scores. Methods This cross-sectional analysis involved 6633 PREDIMED-Plus study participants. Food polyphenol content was estimated by a semiquantitative food frequency questionnaire , adjusted for total energy intake according to the residual method. The association between polyphenol intake and cardiovascular risk was tested using linear regression analyses. Results Total polyphenol and flavonoid intake were directly and significantly associated only with the LS7 scale. Intake of lignans was directly and significantly associated with SCORE and LS7 scales, stilbene intake with SCORE, and phenolic acid intake with Framingham and Framingham-REGICOR scores. Other polyphenol classes were associated in a protective and significant manner in Framingham, SCORE and LS7 scores. In women, intake of all the polyphenol classes, except phenolic acids, showed a protective trend in the results of the Framingham, Framingham-REGICOR scores and LS7 scale. Conclusions An inverse association was found between consumption of the ‘other polyphenols’ class and, especially among women, with estimated cardiovascular risk. The results were similar to those of Framingham, Framingham-REGICOR and LS7 (after eliminating the diet component) and differed from those of SCORE, but the predictors included were limited in the latter case.

[Background & aims]: The Portfolio and Dietary Approaches to Stop Hypertension (DASH) diets have been shown to lower cardiometabolic risk factors in randomized controlled trials (RCTs). However, the Portfolio diet has only been assessed in RCTs of hyperlipidemic patients. Therefore, to assess the Portfolio diet in a population with metabolic syndrome (MetS), we conducted a longitudinal analysis of one-year data of changes in the Portfolio and DASH diet scores and their association with cardiometabolic risk factors in Prevención con Dieta Mediterránea (PREDIMED)-Plus trial. [Methods]: PREDIMED-Plus is an ongoing clinical trial (Trial registration: ISRCTN89898) conducted in Spain that includes 6874 older participants (mean age 65 y, 48% women) with overweight/obesity fulfilling at least three criteria for MetS. Data for this analysis were collected at baseline, six months and one year. Adherence to the Portfolio and DASH diet scores were derived from a validated 143-item food frequency questionnaire. We used linear mixed models to examine the associations of 1-SD increase and quartile changes in the diet scores with concomitant changes in cardiometabolic risk factors. [Results]: After adjusting for several potential confounders, a 1-SD increase in the Portfolio diet score was significantly associated with lower HbA1c (β [95% CI]: −0.02% [−0.02, −0.01], P < 0.001), fasting glucose (−0.47 mg/dL [−0.83, −0.11], P = 0.01), triglycerides (−1.29 mg/dL [−2.31, −0.28], P = 0.01), waist circumference (WC) (−0.51 cm [−0.59, −0.43], P < 0.001), and body mass index (BMI) (−0.17 kg/m2 [−0.19, −0.15], P < 0.001). A 1-SD increase in the DASH diet score was significantly associated with lower HbA1c (−0.03% [−0.04, −0.02], P < 0.001), glucose (−0.84 mg/dL [−1.18, −0.51], P < 0.001), triglycerides (−3.38 mg/dL [−4.37, −2.38], P < 0.001), non-HDL-cholesterol (−0.47 mg/dL [−0.91, −0.04], P = 0.03), WC (−0.69 cm [−0.76, −0.60 cm], P < 0.001), BMI (−0.25 kg/m2 [−0.28, −0.26 kg/m2], P < 0.001), systolic blood pressure (−0.57 mmHg [−0.81, −0.32 mmHg], P < 0.001), diastolic blood pressure (−0.15 mmHg [−0.29, −0.01 mmHg], P = 0.03), and with higher HDL-cholesterol (0.21 mg/dL [0.09, 0.34 mg/dL, P = 0.001]). Similar associations were seen when both diet scores were assessed as quartiles, comparing extreme categories of adherence. [Conclusions]: Among older adults at high cardiovascular risk with MetS, greater adherence to the Portfolio and DASH diets showed significant favourable prospective associations with several clinically relevant cardiometabolic risk factors. Both diets are likely beneficial for cardiometabolic risk reduction., The PREDIMED-Plus trial was supported by the Spanish government's official funding agency for biomedical research, ISCIII, through the Fondo de Investigación para la Salud (FIS) and co-funded by European Union ERDF/ESF, “A way to make Europe”/“Investing in your future” (five coordinated FIS projects led by JS-S and JVid, including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183,PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, and PI19/01332), the Special Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to JS-S, the European Research Council (Advanced Research Grant 2014–2019, 340918) to MÁM-G, the Recercaixa Grant to JS-S (2013ACUP00194), grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, and PI0137/2018), a grant from the Generalitat Valenciana (PROMETEO/2017/017), a SEMERGEN grant, and funds from the European Regional Development Fund (CB06/03). This research was also partially funded by EU-H2020 Grant (EAT2BENICE/H2020-SFS-2016-2; Ref 728018). Study resulting from the SLT006/17/00246 grant, funded by the Department of Health of the Generalitat de Catalunya by the call “Acció instrumental de programes de recerca orientats en l'àmbit de la recerca i la innovació en salut”. We thank CERCA Programme/Generalitat de Catalunya for institutional support. This work is partially supported by ICREA under the ICREA Academia programme. IP-G receives a grant from the Spanish Ministry of Education, Culture and Sports (FPU 17/01925). MRBL was supported by “Miguel Servet Type I” program (CP15/00028) from the ISCIII-Madrid (Spain), cofinanced by the Fondo Europeo de Desarrollo Regional-FEDER. AJG was supported by the Nora Martin Fellowship in Nutritional Sciences, the Banting & Best Diabetes Centre Tamarack Graduate Award in Diabetes Research, the Peterborough K.M. Hunter Charitable Foundation Graduate Award and an Ontario Graduate Scholarship. PH-A was supported by a postdoctoral fellowship (Juan de la Cierva-Formación), FJCI-2017–32205, funded by the Ministry of Science and Innovation. RE group has been supported by the ‘Ajut 2017-2021 SGR 1717 from the Generalitat de Catalunya. DJAJ was funded by the Government of Canada through the Canada Research Chair Endowment. JK was supported by the ‘FOLIUM’ programme within the FUTURMed project from the Fundación Instituto de Investigación Sanitaria Illes Balears (financed by 2017 annual plan of the sustainable tourism tax and at 50% with charge to the ESF Operational Program 2014–2020 of the Balearic Islands). JLS was funded by a Diabetes Canada Clinician Scientist Award.

AM Gómez,1– 3 DC Henao-Carillo,1– 3 L Taboada,1,3 O Fuentes,1,3 O Lucero,2,3 A Sanko,3 MA Robledo,3 O Muñoz,2,3 M Rondón,4 M García-Jaramillo,5 F León-Vargas6 1Endocrinology Unit, Hospital Universitario San Ignacio, Bogotá, Colombia; 2Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia; 3Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia; 4Department of Clinical Epidemiology, Pontificia Universidad Javeriana, Bogotá, Colombia; 5Faculty of Engineering, Universidad EAN, Bogotá, Colombia; 6Faculty of Engineering, Universidad Antonio Nariño, Bogotá, ColombiaCorrespondence: AM GómezEndocrinology Unit, Hospital Universitario San Ignacio, Carrera 7 No. 40-62, Bogotá, ColombiaEmail amgomezm5@gmail.comBackground: High glycemic Variability (HGV) has become a stronger predictor of hypoglycemia. However, clinical factors associate with HGV still are unknown.Objective: To determine clinical variables that were associated with a coefficient of variation (CV) above 36% evaluated by continuous glucose monitoring (CGM) in a group of patients with diabetes mellitus.Methods: A cohort of patients with type 2 diabetes (T2D) was evaluated. Demographic variables, HbA1c, glomerular filtration rate (GFR) and treatment regimen were assessed. A bivariate analysis was performed, to evaluate the association between the outcome variable (CV> 36%) and each of the independent variables. A multivariate model was constructed to evaluate associations after controlling for confounding variables.Results: CGM data from 274 patients were analyzed. CV> 36% was present in 56 patients (20.4%). In the bivariate analysis, demographic and clinical variables were included, such as time since diagnosis, hypoglycemia history, A1c, GFR and treatment established. In the multivariate analysis, GFR < 45 mL/min (OR 2.81; CI 1.27,6.23; p:0.01), A1c > 9% (OR 2.81; CI 1.05,7.51; p:0.04) and hypoglycemia history (OR 2.09; CI 1.02,4.32; p:0.04) were associated with HGV. Treatment with iDPP4 (OR 0.39; CI 0.19,0.82; p:0.01) and AGLP1 (OR 0.08; CI 0.01,0.68; p:0.02) was inversely associated with GV.Conclusion: Clinical variables such as GFR < 45 mL/min, HbA1C> 9% and a history of hypoglycemia are associated with a high GV. Our data suggest that the use of technology and treatments able to reduce glycemic variability could be useful in this population to reduce the risk of hypoglycemia and to improve glycemic control.Keywords: glycemic variability, variation coefficient, continuous glucose monitoring, diabetes mellitus

Resumen Objetivos Conocer la prevalencia de enfermedad renal cronica (ERC) y determinar los factores asociados al deterioro de la funcion renal en poblacion asistida en atencion primaria. Pacientes y metodo Estudio transversal y multicentrico realizado en los pacientes basales del estudio IBERICAN (identificacion de la poblacion espanola de riesgo cardiovascular y renal). Se considero ERC a un filtrado glomerular estimado (FGe) Resultados Se incluyeron 7.895 pacientes (edad media 57,9 ± 14,8 anos; 54,5% mujeres). El 14,4% (IC 95%: 13,6-15,1) presentaba ERC; en hombres un 16,1% (IC 95%: 14,9-17,3) y en mujeres un 12,9% (IC 95%: 11,9-14,0). Se observo un aumento continuo de la prevalencia con la edad (24,8% ≥ 65 anos) y con la agregacion de FRCV. Las variables que mas se asociaron a la probabilidad de padecer ERC fueron hipertrofia ventricular izquierda (OR: 1,95; p Conclusiones Catorce de cada 100 pacientes incluidos en el estudio IBERICAN presenta ERC. La prevalencia de ERC afecta a la cuarta parte de pacientes ≥ 65 anos y aumenta exponencialmente con la agregacion de FRCV.

Background and aims In Colombia, the government established mandatory isolation after the first case of COVID-19 was reported. As a diabetes care center specialized in technology, we developed a virtual training program for patients with type 1 diabetes (T1D) who were upgrading to hybrid closed loop (HCL) system. The aim of this study is to describe the efficacy and safety outcomes of the virtual training program. Method ology: A prospective observational cohort study was performed, including patients with diagnosis of T1D previously treated with multiple doses of insulin (MDI) or sensor augmented pump therapy (SAP) who were updating to HCL system, from March to July 2020. Virtual training and follow-up were done through the Zoom video conferencing application and Medtronic Carelink System version 3.1 software. CGM data were analyzed to compare the time in range (TIR), time below range (TBR) and glycemic variability, during the first two weeks corresponding to manual mode with the final two weeks of follow-up in automatic mode. Results 91 patients were included. Mean TIR achieved with manual mode was 77.3 ± 11.3, increasing to 81.6% ± 7.6 (p, Highlights • Hybrid closed-loop (HCL) systems allows type 1 diabetes (T1D) patients to improve Time in Range (TIR). • HCL training has been delivered in person. However, during COVID-19 pandemic we had to switch to a virtual modality. • Subjects with virtual training had an increase in TIR regardless of initial therapy after two weeks of automatic use. • This is the largest prospective non-sponsored study including adults treated with HCL trained through a virtual platform.

The aim of this article is to review the emerging research on entrepreneurial ecosystems and knowledge spillovers in general, and in the sport field in particular through bibliometric and content a...

Background Gut microbiota could be involved in the metabolic improvement after surgery. Objective The aim of the present study was to evaluate the short-term evolution of the gut microbiome after different bariatric surgery procedures and their functionality and relate it with obesity resolution. Setting University hospital, Spain. Methods We studied 28 patients with severe obesity; 14 underwent a Roux-en-Y gastric bypass (RYGB) and 14 underwent laparoscopic sleeve gastrectomy (SG). All patients were examined before and 3 months after the correspondent bariatric surgery. Gut microbiome profile was assessed by the sequencing of amplicons from the 16S rDNA gene by next-generation sequencing. Results Gut microbiota profiles significantly differed between surgical procedures. RYGB suffered the largest changes in the microbiota population. SG and RYGB differed in their profiles with higher levels of Akkermansia, Eubacterium, Haemophilus, and Blautia for SG, while Veillonella, Slackia, Granucatiella, and Acidaminococcus occurred with greater levels in RYGB. RYGB microbiota changes were reflected also at the level of functionality, especially in pathways related to environmental adaptation. A biomarker discovery analysis revealed the genus Blautia as characteristic in SG, while Veillonella was of RYGB. Conclusion Our study shows a shift of the gut microbiome after a bariatric surgery in a procedure-related manner. Gut microbiome changes are related to the adaptation to the changing gut environment and could be related to the pH fluctuations.

Background Bariatric surgery is the most effective treatment for obesity. During long-term follow-up, weight loss (WL) is variable between subjects. The aim of this study is to assess the change in percentage of total weight loss (%TWL) and excess weight loss (%EWL) and to describe the factors associated with greater or lesser WL over time. Methods Longitudinal study including patients treated with laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (LSG) and followed at Hospital Universitario San Ignacio, Bogotá (Colombia). Baseline data was recorded before surgery. Follow-up was performed at 3 (n=192), 6 (n=190), 9 (n=188), 12 (n=186), 24 (n=99) and 36 (n=30) months. Generalized Estimating Equation (GEE) analysis was used to assess the change in %TWL and %EWL over time. Results 196 patients were included (82.4% female, BMI 41.3±5.2 kg/m2). The tendency to increase on %TWL (31.6±6.6) and %EWL (80.2 RIQ 70.7-97.3) was evident in the first year, stabilizing after that. Nutritionist follow-up, baseline BMI>40 kg/m2 and WL≥10kg before surgery were associated with an average higher increase of %TWL (2.39% p=0.014, 0.41% p30 minutes/day after surgery reduced %TWL in 0.74% (p=0.009). Similar findings were described on %EWL. Conclusion Follow-up during the first year after bariatric surgery is critical to achieving %TWL and %EWL goals. This study suggests that modifiable factors such as nutritional follow-up, WL before surgery and time of physical activity are associated with a significant change in %TWL and %EWL during follow-up by a multidisciplinary team.

In the last decades, the global prevalence of non-alcoholic fatty liver disease (NAFLD) has reached pandemic proportions with derived major health and socioeconomic consequences; this tendency is expected to be further aggravated in the coming years. Obesity, insulin resistance/type 2 diabetes mellitus, sedentary lifestyle, increased caloric intake and genetic predisposition constitute the main risk factors associated with the development and progression of the disease. Importantly, the interaction between the inherited genetic background and some unhealthy dietary patterns has been postulated to have an essential role in the pathogenesis of NAFLD. Weight loss through lifestyle modifications is considered the cornerstone of the treatment for NAFLD and the inter-individual variability in the response to some dietary approaches may be conditioned by the presence of different single nucleotide polymorphisms. In this review, we summarize the current evidence on the influence of the association between genetic susceptibility and dietary habits in NAFLD pathophysiology, as well as the role of gene polymorphism in the response to lifestyle interventions and the potential interaction between nutritional genomics and other emerging therapies for NAFLD, such as bariatric surgery and several pharmacologic agents.

The burden of depression is increasing worldwide, specifically in older adults. Unhealthy dietary patterns may partly explain this phenomenon. In the Spanish PREDIMED-Plus study, we explored (1) the cross-sectional association between the adherence to the Prime Diet Quality Score (PDQS), an a priori-defined high-quality food pattern, and the prevalence of depressive symptoms at baseline (cross-sectional analysis) and (2) the prospective association of baseline PDQS with changes in depressive symptomatology after 2 years of follow-up. After exclusions, we assessed 6612 participants in the cross-sectional analysis and 5523 participants in the prospective analysis. An energy-adjusted high-quality dietary score (PDQS) was assessed using a validated FFQ. The cross-sectional association between PDQS and the prevalence of depression or presence of depressive symptoms and the prospective changes in depressive symptoms were evaluated through multivariable regression models (logistic and linear models and mixed linear-effects models). PDQS was inversely associated with depressive status in the cross-sectional analysis. Participants in the highest quintile of PDQS (Q5) showed a significantly reduced odds of depression prevalence as compared to participants in the lowest quartile of PDQS (Q1) (OR (95 %) CI = 0·82 (0·68, 0·98))). The baseline prevalence of depression decreased across PDQS quintiles (Pfor trend = 0·015). A statistically significant association between PDQS and changes in depressive symptoms after 2-years follow-up was found (β (95 %) CI = −0·67 z-score (–1·17, −0·18). A higher PDQS was cross-sectionally related to a lower depressive status. Nevertheless, the null finding in our prospective analysis raises the possibility of reverse causality. Further prospective investigation is required to ascertain the association between PDQS and changes in depressive symptoms along time.

There is pressing urgency to identify drugs that allow treating COVID-19 patients effectively. Respiratory failure is the leading cause of death in patients with severe COVID-19, and the host inflammatory response at the lungs remains poorly understood. Therefore, we retrieved data from postmortem lungs from COVID-19 patients and performed in-depth in silico analyses of single-nucleus RNA sequencing data, inflammatory protein interactome network, functional enrichment, and shortest pathways to cancer hallmark phenotypes to reveal potential therapeutic targets and drugs in advanced-stage COVID-19 clinical trials. Herein, we analyzed transcriptomics data of 719 inflammatory response genes across 19 cell types (116,313 nuclei) from lung autopsies. The functional enrichment analysis of the 233 significantly expressed genes showed that the most relevant biological annotations were: inflammatory response, innate immune response, cytokine production, interferon production, macrophage activation, thymic stromal lymphopoietin, blood coagulation, IL-1 and megakaryocytes in obesity, NLRP3 inflammasome complex, and the TLR, JAK-STAT, NF-κB, TNF, oncostatin M, AGE-RAGE signaling pathways. Subsequently, we identified 34 essential inflammatory proteins with both high-confidence protein interactions and shortest pathways to inflammation, cell death, glycolysis, and angiogenesis. Lastly, we propose five small molecules involved in advanced-stage COVID-19 clinical trials: baricitinib, pacritinib, and ruxolitinib are tyrosine-protein kinase JAK2 inhibitors, losmapimod is a MAP kinase p38 alpha inhibitor, and eritoran is a TLR4/MD-2 antagonist. After being thoroughly analyzed in COVID-19 clinical trials, these drugs can be considered for treating severe COVID-19 patients.

LThis work was supported by the official Spanish Institutions for funding scientific biomedical research, CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN) and Instituto de Salud Carlos III (ISCIII), through the Fondo de Investigacion para la Salud (FIS), which is co-funded by the European Regional Development Fund (six coordinated FIS projects leaded by JS-S and JVi, including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01332, PI20/01802, PI20/00138, PI20/01532, PI20/00456, PI20/00339, PI20/00557, PI20/00886, PI20/01158); the Especial Action Project entitled: Implementacion y evaluacion de una intervencion intensiva sobre la actividad fisica Cohorte PREDIMED-Plus grant to JS-S; the European Research Council (Advanced Research Grant 2014-2019; agreement #340918) granted to MAM-G.; the Recercaixa (number 2013ACUP00194) grant to JS-S; grants from the Consejeria de Salud de la Junta de Andalucia (PI0458/2013, PS0358/2016, PI0137/2018); the PROMETEO/2017/017 grant from the Generalitat Valenciana; the SEMERGEN grant; None of the funding sources took part in the design, collection, analysis, interpretation of the data, or writing the report, or in the decision to submit the manuscript for publication., Purpose We explored the cross-sectional association between the adherence to three different provegetarian (PVG) food patterns defined as general (gPVG), healthful (hPVG) and unhealthful (uPVG), and the cardiometabolic risk in adults with metabolic syndrome (MetS) of the PREDIMED-Plus randomized intervention study. Methods We performed a cross-sectional analysis of baseline data from 6439 participants of the PREDIMED-Plus randomized intervention study. The gPVG food pattern was built by positively scoring plant foods (vegetables/fruits/legumes/ grains/potatoes/nuts/olive oil) and negatively scoring, animal foods (meat and meat products/animal fats/eggs/fish and seafood/dairy products). The hPVG and uPVG were generated from the gPVG by adding four new food groups (tea and coffee/ fruit juices/sugar-sweetened beverages/sweets and desserts), splitting grains and potatoes and scoring them differently. Multivariable-adjusted robust linear regression using MM-type estimator was used to assess the association between PVG food patterns and the standardized Metabolic Syndrome score (MetS z-score), a composed index that has been previously used to ascertain the cardiometabolic risk, adjusting for potential confounders. Results A higher adherence to the gPVG and hPVG was associated with lower cardiometabolic risk in multivariable models. The regression coefficients for 5th vs. 1st quintile were − 0.16 (95% CI: − 0.33 to 0.01) for gPVG (p trend: 0.015), and − 0.23 (95% CI: − 0.41 to − 0.05) for hPVG (p trend: 0.016). In contrast, a higher adherence to the uPVG was associated with higher cardiometabolic risk, 0.21 (95% CI: 0.04 to 0.38) (p trend: 0.019). Conclusion Higher adherence to gPVG and hPVG food patterns was generally associated with lower cardiovascular risk, whereas higher adherence to uPVG was associated to higher cardiovascular risk., official Spanish Institutions, CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III (ISCIII), through the Fondo de Investigacion para la Salud (FIS), European Commission PI13/00673 PI13/00492 PI13/00272 PI13/01123 PI13/00462 PI13/00233 PI13/02184 PI13/00728 PI13/01090 PI13/01056 PI14/01722 PI14/00636 PI14/00618 PI14/00696 PI14/01206 PI14/01919 PI14/00853 PI14/01374, The European Regional Development Fund PI14/00972 PI14/00728 PI14/01471 PI16/00473 PI16/00662 PI16/01873 PI16/01094 PI16/00501 PI16/00533 PI16/00381 PI16/00366 PI16/01522 PI16/01120 PI17/00764 PI17/01183 PI17/00855 PI17/01347 PI17/00525 PI17/01827 PI17/00532 PI17/00215, European Commission PI17/01441 PI17/00508 PI17/01732 PI17/00926 PI19/00957 PI19/00386 PI19/00309 PI19/01032 PI19/00576 PI19/00017 PI19/01226 PI19/00781 PI19/01560 PI19/01332 PI20/01802 PI20/00138 PI20/01532 PI20/00456 PI20/00339 PI20/00557 PI20/00886 PI20/01158, Especial Action Project entitled: Implementacion y evaluacion de una intervencion intensiva sobre la actividad fisica Cohorte PREDIMED-Plus grant, European Research Council (ERC), European Commission 340918, La Caixa Foundation 2013ACUP00194, Junta de Andalucia PI0458/2013 PS0358/2016 PI0137/2018, Generalitat Valenciana European Commission PROMETEO/2017/017, SEMERGEN grant

Introduction The aim of the present study was to examine the diagnostic accuracy of screening tests in detecting cases requiring psychological intervention among patients referred for thoracic surgery. Methods Emotional distress was evaluated in 105 patients referred for thoracic surgery by means of a diagnostic psychological interview (criterion variable). The screening ability of the following methods was analyzed: the physician's opinion (Yes/No), Hospital Anxiety and Depression Scale (HADS), single-item interview: “Are you depressed?” (Depression Question, ADEP) (1–5) and the single-item interview: “Are you anxious?” (Anxiety Question, ANXQ) (1–5). Results According to the clinical interview, 34% of the patients were clinical cases requiring psychological intervention. The total HADS (cut-off point of 10) showed a sensitivity=0.89, specificity=0.75 and AUC=0.883; the ADEP scale (>1) showed a sensitivity=0.79, specificity=0.74 and AUC=0.795; the ANXQ scale (>1) showed a sensitivity=0.78, specificity=0.41 and AUC=0.690; and the physician's opinion showed a sensitivity=0.47 and specificity=0.86. Conclusions A high percentage of patients referred for thoracic surgery required psychological intervention. The best instrument to identify those patients requiring psychological care, taking a psychological interview as the criterion variable, was the total HADS score. This test is brief, simple and well accepted by patients; it is easy to implement within a thoracic surgery service and has a good diagnostic accuracy.

Resumen Introduccion El objetivo del presente estudio es examinar la precision diagnostica de los test de cribado utilizados para detectar la necesidad de atencion psicologica en pacientes remitidos para cirugia toracica. Metodos Se evaluo la presencia de malestar emocional en un total de 105 pacientes remitidos para cirugia toracica por medio de la entrevista clinica psicologica (variable criterio). Los metodos de cribado utilizados fueron: el juicio del medico (si/no), la Escala Hospitalaria de Ansiedad y Depresion (HADS), la pregunta unica para evaluar depresion «?se siente usted deprimido?» (ADEP) (1-5) y la pregunta unica para medir ansiedad «?se siente ansioso?» (AANA) (1-5). Resultados De acuerdo con la entrevista entrevista clinica psicologica, el 34% de los pacientes fueron casos clinicos que requerian intervencion psicologica. La puntuacion total de la escala HADS (punto de corte 10) mostro una sensibilidad del 0,89, especificidad del 0,75 y un ABC de 0,883; la ADEP (punto de corte 1) mostro una sensibilidad del 0,79, especificidad del 0,74 y ABC del 0,795; la AANS (>1) obtuvo una sensibilidad del 0,78, especificidad del 0,41 y ABC de 0,69 y el juicio del medico mostro una sensibilidad del 0,47 y especificidad del 0,86. Conclusiones Un alto porcentaje de pacientes remitidos para cirugia toracica requirieron intervencion psicologica. El mejor instrumento para identificar a aquellos pacientes con necesidades psicologicas, tomando la entrevista psicologica como variable criterio, fue la puntuacion total del HADS. Este instrumento es simple y breve, bien aceptado por los pacientes, de facil aplicacion en un servicio de cirugia toracica y tiene buena capacidad diagnostica.

Introduction: Continuous glucose monitoring (CGM) is a better tool to detect hyper and hypoglycemia than capillary point of care in insulin-treated patients during hospitalization. We evaluated the incidence of hypoglycemia in patients with type 2 diabetes (T2D) treated with basal bolus insulin regimen using CGM and factors associated with hypoglycemia. Methods: Post hoc analysis of a prospective cohort study. Hypoglycemia was documented in terms of incidence rate and percentage of time Results: A total of 34 hospitalized patients with T2D in general ward were included, with admission A1c of 9.26 ± 2.62% (76.8 ± 13 mmol/mol) and mean blood glucose of 254 ± 153 mg/dL. There were two events of hypoglycemia below 54 mg/dL (3.0 mmol/L) and 11 events below 70 mg/dL (3.9 mmol/L) with an incidence of hypoglycemic events of 0.059 and 0.323 per patient, respectively. From second to fifth day of treatment the percentage of time in range (140-180 mg/dL, 7.8-10.0 mmol/L) increased from 72.1% to 89.4%. Factors related to hypoglycemic events Conclusions: Basal bolus insulin regimen is effective and the overall incidence of hypoglycemia detected by CGM is low in hospitalized patients with T2D. Increased glycemic variability as well as the decrease in mean glucose were associated with events

An inadequate glycemic control in cardiovascular postoperative is a predictor of mortality, postoperative infections and a prolonged hospital stay. This study evaluates the incidence of hypoglycemia in the first 72 h of postoperative and its association with different factors, such as tissue perfusion parameters, and the administration of medicines that induct hypoglycemia during surgery, in patients that undergo cardiovascular surgery in a 4th level hospital in Bogota, Colombia.A nested cases and controls study was developed, taking as cases the patients that presented hypoglycemia episodes (70 mg/dl) and the controls were the patients without this outcome. A systematic record of the glycemic control in the first 72 h of postoperative was registered. An univariate and multivariate analysis was conducted to determine the factor associated with hypoglycemia.327 patients were evaluated (35% with coronary bypass and 27% with valvular replacement). 7.65% of the patients presented at least one episode of hypoglycemia70 mg/dL (25 episodes). The multivariate analysis showed an association with chronic kidney failure in dialysis (OR6,21; IC:0,97-43.27,p:0.05), administration of preoperative steroids (OR4,41; IC:1,27-15,20,p:0.02), intraoperative insulin (OR2,61; IC:1.09-6,22, p:0.03), and postoperative hydrocortisone (OR 7,15; IC 1,46-34,9 p:0.01).Hypoglycemia is frequent in patients that undergo a cardiovascular surgery. The associated factors were chronic kidney failure in dialysis, administration of preoperative steroids, intraoperative insulin and hydrocortisone during postoperative. Other factors such as tissue perfusion, administration of vasoactive or beta blockers substances, showed no association with hypoglycemia.

An accident as old as humanity, shipwreck involves a wide range of metaphors that fuse familiarity and exoticism, allegory and specificity, providence and godless catastrophe. In exploring Cervantes’s approach to this topos, this study identifies how the metaphor conveys an incisive political commentary in Don Quixote, a literary and spiritual reflection in Persiles, and a troubling self-projection in Journey to Parnassus. Unveiling the continuities of Cervantes’s use of this motif provides intriguing insights into the experiential fractures and literary exploits of the author as he embarked on the difficult journeys of his last works and years (1614–1616).

Despite bariatric surgery being the most effective treatment for obesity, some individuals do not respond adequately, especially in the long term. Identifying the predictors of correct weight maintenance in the medium (from 1 to 3 years after surgery) and long term (from 3 years and above) is of vital importance to reduce failure after bariatric surgery; therefore, we summarize the evidence about certain factors, among which we highlight surgical technique, psychological factors, physical activity, adherence to diet, gastrointestinal hormones or neurological factors related to appetite control. We conducted a search in PubMed focused on the last five years (2015–2021). Main findings are as follows: despite Roux-en-Y gastric bypass being more effective in the long term, sleeve gastrectomy shows a more beneficial effectiveness–complications balance; pre-surgical psychological and behavioral evaluation along with post-surgical treatment improve long-term surgical outcomes; physical activity programs after bariatric surgery, in addition to continuous and comprehensive care interventions regarding diet habits, improve weight loss maintenance, but it is necessary to improve adherence; the impact of bariatric surgery on the gut–brain axis seems to influence weight maintenance. In conclusion, although interesting findings exist, the evidence is contradictory in some places, and long-term clinical trials are necessary to draw more robust conclusions.

Background There are several medical devices used in Colombia for diabetes management, most of which have an associated telemedicine platform to access the data. In this work, we present the results of a pilot study evaluating the use of the Tidepool telemedicine platform for providing remote diabetes health services in Colombia across multiple devices. Method Individuals with Type 1 and Type 2 diabetes using multiple diabetes devices were recruited to evaluate the user experience with Tidepool over three months. Two endocrinologists used the Tidepool software to maintain a weekly communication with participants reviewing the devices data remotely. Demographic, clinical, psychological and usability data were collected at several stages of the study. Results Six participants, from ten at the baseline (five MDI and five CSII), completed this pilot study. Three different diabetes devices were employed by the participants: a glucose meter (Abbot), an intermittently-scanned glucose monitor (Abbot), and an insulin pump (Medtronic). A score of 81.3 in the system usability scale revealed that overall, most participants found the system easy to use, especially the web interface. The system also compared highly favourably against the proprietary platforms. The ability to upload and share data and communicate remotely with the clinicians was raised consistently by participants. Clinicians cited the lockdown imposed by the Covid-19 pandemic as a valuable test for this platform. Inability to upload data from mobile devices was identified as one of the main limitations. Conclusion Tidepool has the potential to be used as a tool to facilitate remote diabetes care in Colombia. Users, both participants and clinicians, agreed to recommend the use of platforms like Tidepool to achieve better disease management and communication with the health care team. Some improvements were identified to enhance the user experience.

Background and aims Few studies have reported on the use of continuous glucose monitoring (CGM) during the Covid-19 pandemic. We aimed to examine glycemic control metrics using flash glucose monitoring during insulin treatment and the clinical outcome in hospitalized patients with COVID-19. Methods Prospective, single-center cohort of adult patients diagnosed with type 2 diabetes or hyperglycemia and COVID-19 infection treated with basal bolus insulin regimen. Glycemic control was assessed with the use of intermittent Freestyle Libre flash glucose monitoring during the hospital stay. Outcome of interest were time in range [TIR], time above [TAR] and below [TBR] range, glycemic variability [coefficient of variation [% CV]), and differences in a composite of complications including ICU admission, acute respiratory distress syndrome (ARDS) and acute kidney injury. Results A total of 60 patients were included (44 known diabetes and 16 new onset hyperglycemia). In total 190,080 data points of CGM were available, of which 72.5% of values were within the target area [TIR (70–180 mg/dL)], 22% TAR (>180 mg/dL), and 3% were TBR (180 mg/dl had higher rates of a composite of complications (22.5% vs 16%, p = 0.04). Conclusions Basal bolus insulin regimen was safe and effective in achieving inpatient glycemic control in most patients with COVID-19. The association between TAR and complications indicates the need for improved inpatient glycemic control in hospitalized patients with COVID-19.

Goals To explore affective and cognitive status, later in life, in individuals with and without previous history of eating disorder (ED), and also its association with higher risk for metabolic syndrome (MetS) symptomatology. Methods A cross-sectional analysis of 6756 adults, aged 55-75 years with overweight/obesity and MetS participating in the Predimed-Plus study was conducted. Participants completed self-reported questionnaires to examine lifetime history of ED, according to DSM-5 criteria, and other psychopathological and neurocognitive factors. Anthropometric and metabolic measurements were also collected. Results Of the whole sample, 24 individuals (0.35%) reported a previous history of ED. In this subsample, there were more women and singles compared to their counterparts, but they also presented higher levels of depressive symptoms and higher cognitive impairment, but also higher body mass index (BMI) and severe obesity, than those without lifetime ED. Conclusions This is one of the first studies to analyse the cognitive and metabolic impact of a previous history of ED. The results showed that previous ED was associated with greater affective and cognitive impairment, but also with higher BMI, later in life. No other MetS risk factors were found, after controlling for relevant variables.

Background and aims: Previous studies, mainly focused on quantity rather than variety, have shown beneficial associations between the amount of fruit and vegetable consumed, diet quality and healthy lifestyle. The aim is to evaluate the association between fruit and vegetable consumption, diet quality and lifestyle in an elderly Mediterranean population, considering both variety and the combination of quantity and variety (QV). Methods: A cross-sectional analysis of 6647 participants (51.6% of males) was conducted in the framework of the PREDIMED-Plus study. A variety score was created as the sum of vegetables and/or fruits consumed at least once per month using food frequency questionnaires. Dietary Reference Intakes (EAR and IA values) were used to estimate the prevalence of inadequate intake of dietary fiber and micro nutrients. Logistic regression models were performed to examine the association between fruit and vegetable consumption and not meeting the DRIs, by tertiles of fruit and vegetable variety and QV categories. Results: Participants with higher fruit and vegetable variety score reported a significant higher intake of fiber, vitamins, minerals and flavonoids and were significantly more likely to be physically active and non-smoker. Besides, higher variety in fruit and vegetable consumption was associated with lower prevalence of having an inadequate intake of fiber [(0.13 (0.11-0.16)], two or more [(0.17 (0.14-0.21)], three or more [(0.15 (0.13-0.18)] and four or more [(0.11 (0.10-0.14)] micronutrients in our participants. Higher quantity and variety in fruit and vegetable consumption was associated with lower prevalence of having an inadequate intake of fiber [(0.05 (0.04-0.06)], two or more [(0.08 (0.06-0.10)], three or more [(0.08 (0.06-0.09)] and four or more [(0.06 (0.05-0.07)] micronutrients. Conclusion: Greater variety in fruit and vegetable intake was associated with better nutrient adequacy, diet quality and healthier lifestyle in an elderly Mediterranean population. (c) 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

In this research, we demonstrate that business sustainability can be a model to foster in order to reach real development, as it is shown that business sustainability has both an ethical and economic logic. Even though, from an ethical point of view, sustainability can be well-founded on human rights and civic ethics, our goal in this paper has been to sustain and enrich business sustainability based on the Social Doctrine of the Catholic Church, which can be shared in its advises by many non-Catholic people, as it is a rich source of wisdom. We have also studied its economic logic, analyzing why it is justified for sustainable companies to obtain good results, formulating the model to alleviate the agency problem (which allows it to overcome the traditional stakeholder model), studying empirical analyses that demonstrate the good financial performance of sustainable companies, and making a new analysis that confirms the above.

The COVID-19 pandemic is posing a great challenge worldwide. Its rapid progression has caused thousands of deaths worldwide. Although multiple aspects remain to be clarified, some risk factors associated with a worse prognosis have been identified. These include obesity and some of its main complications, such as diabetes and high blood pressure. Furthermore, although the possible long-term complications and psychological effects that may appear in survivors of COVID-19 are not well known yet, there is a concern that those complications may be greater in obese patients. In this manuscript, we review some of the data published so far and the main points that remain to be elucidated are emphasized.

Despite using sensor-augmented pump therapy (SAPT) with predictive low-glucose management (PLGM), hypoglycemia is still an issue in patients with type 1 Diabetes (T1D). Our aim was to determine factors associated with clinically significant hypoglycemia (54 mg/dl) in persons with T1D treated with PLGM-SAPT.ology: This is a multicentric prospective real-life study performed in Colombia, Chile and Spain. Patients with T1D treated with PLGM-SAPT, using sensor ≥70% of time, were included. Data regarding pump and sensor use patterns and carbohydrate intake from 28 consecutive days were collected. A bivariate and multivariate Poisson regression analysis was carried out, to evaluate the association between the number of events of54 mg/dl with the clinical variables and patterns of sensor and pump use.188 subjects were included (41 ± 13.8 years-old, 23 ± 12 years disease duration, A1c 7.2% ± 0.9). The median of events54 mg/dl was four events/patient/month (IQR 1-10), 77% of these events occurred during day time. Multivariate analysis showed that the number of events of hypoglycemia were higher in patients with previous severe hypoglycemia (IRR1.38; 95% CI 1.19-1.61; p 0.001), high glycemic variability defined as Coefficient of Variation (CV%) 36% (IRR 2.09; 95%CI 1.79-2.45; p 0.001) and hypoglycemia unawareness. A protector effect was identified for adequate sensor calibration (IRR 0.77; 95%CI 0.66-0.90; p:0.001), and the use of bolus wizard60% (IRR 0.74; 95%CI 0.58-0.95; p:0.017).In spite of using advanced SAPT, clinically significant hypoglycemia is still a non-negligible risk. Only the identification and intervention of modifiable factors could help to prevent and reduce hypoglycemia in clinical practice.

Dietary polyphenol intake is associated with improvement of metabolic disturbances. The aims of the present study are to describe dietary polyphenol intake in a population with metabolic syndrome (MetS) and to examine the association between polyphenol intake and the components of MetS. This cross-sectional analysis involved 6633 men and women included in the PREDIMED (PREvenci&oacute, n con DIeta MEDiterranea-Plus) study. The polyphenol content of foods was estimated from the Phenol-Explorer 3.6 database. The mean of total polyphenol intake was 846 &plusmn, 318 mg/day. Except for stilbenes, women had higher polyphenol intake than men. Total polyphenol intake was higher in older participants (&gt, 70 years of age) compared to their younger counterparts. Participants with body mass index (BMI) &gt, 35 kg/m2 reported lower total polyphenol, flavonoid, and stilbene intake than those with lower BMI. Total polyphenol intake was not associated with a better profile concerning MetS components, except for high-density lipoprotein cholesterol (HDL-c), although stilbenes, lignans, and other polyphenols showed an inverse association with blood pressure, fasting plasma glucose, and triglycerides. A direct association with HDL-c was found for all subclasses except lignans and phenolic acids. To conclude, in participants with MetS, higher intake of several polyphenol subclasses was associated with a better profile of MetS components, especially HDL-c.

(1) Background&mdash, low-dose radioiodine ablation is an accepted strategy for the treatment of low- and intermediate-risk thyroid carcinomas, although there is no international consensus. The aim of this study is to describe the clinical experience with low-dose radioiodine ablation in patients with low- and intermediate-risk thyroid cancer compared to high-dose ablation. (2) Methods&mdash, 174 patients with low- and intermediate-risk thyroid cancer, 90 treated with low-dose ablation and 84 treated with high-dose ablation, were included. The primary endpoint was response to treatment one year after ablation, defined by stimulated thyroglobulin, whole body scan and ultrasound imaging. (3) Results&mdash, an excellent response rate of 79.8% in the low-dose group and 85.7% in the high-dose group was observed (p = 0.049). Stimulated thyroglobulin at the moment of ablation (p = 0.032) and positive antithyroglobulin antibodies (p &lt, 0.001) were independent predictive factors for nonexcellent response. Young age (p = 0.023), intermediate initial recurrence risk (p &lt, 0.001) and low-dose ablation (p = 0.004) were independent predictive factors for recurrence. (4) Conclusion&mdash, low-dose ablation seemed to be less effective than high-dose ablation, especially in those patients with positive antithyroglobulin antibodies or higher stimulated thyroglobulin levels at the moment of ablation. Low dose was associated with higher recurrence rates, and lower age and intermediate initial recurrence risk were independent risk factors for recurrence in our sample.

The authors especially thank the PREDIMED-Plus participants for their enthusiastic collaboration, the PREDIMED-Plus personnel for outstanding support, and the personnel of all associated primary care centres for their exceptional effort. CIBEROBN, CIBERESP and CIBERDEM are initiatives of Instituto de Salud Carlos III, Spain. We thank the PREDIMED-Plus Biobank Network, part of the National Biobank Platform of Instituto de Salud Carlos III for storing and managing biological samples., Healthy lifestyle factors, such as physical activity (PA) and Mediterranean diet (MD), decrease the likelihood of developing metabolic syndrome (MetS). The aim of this study was to report main lifestyle components and related factors according to the MetS severity. Cross-sectional analysis was done of baseline lifestyle factors from 5739 participants with overweight/obesity and MetS features (aged 55–75 years) included in the PREDIMED-PLUS primary cardiovascular prevention randomized trial. Participants were categorized in tertiles according to a validated MetS severity score (MetSSS). Anthropometrics, visceral adiposity index, dietary nutrient intake, biochemical marker levels, as well as a Dietary Inflammatory Index and depression symptoms (Beck Depression Inventory-II) were measured. Diet quality was assessed using a 17-item energy-restricted MD questionnaire. Duration and intensity of PA was self-reported using the Minnesota-REGICOR Short Physical Activity Questionnaire. Sedentary behaviours were measured using the Spanish version of the Nurses’ Health Study questionnaire. The 30 s chair stand test was also assessed. Participants with highest MetSSS showed higher values of cardiovascular risk factors (except for total cholesterol and LDL cholesterol), depression risk, sedentary and TV viewing time, and lower moderate and vigorous leisure-time physical activity (LTPA). Highest MetSSS participants tended to a pro-inflammatory dietary pattern and tended to lower MD adherence. In addition, they showed lower carbohydrate and nut intake and higher intake of protein, saturated and trans fatty acids, cholesterol, iodine, sodium, red and processed meat products, other oils different from olive oil and spirit alcoholic drinks. The highest MetS severity score was associated with lower moderate and vigorous LTPA and higher sedentary time and depression risk, as they tended to a pro-inflammatory dietary pattern and lower MD adherence., The PREDIMED-Plus trial was supported by the official funding agency for biomedical research of the Spanish government, ISCIII, through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund [five coordinated FIS projects led by Jordi Salas-Salvadó and Josep Vidal, including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, and PI19/01332], the Especial Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to Jordi Salas-Salvadó, the European Research Council (Advanced Research Grant 2014–2019, 340918) to Dr. Miguel A. Martínez-González, the Recercaixa Grant to Jordi Salas-Salvadó (2013ACUP00194), Grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, and PI0137/2018), a Grant from the Generalitat Valenciana (PROMETEO/2017/017), a SEMERGEN Grant, EU-COST Action CA16112, a Grant of support to research groups no. 35/2011 from the Balearic Islands Government, Grants from Balearic Islands Health Research Institute IDISBA [FOLIUM, PRIMUS, SYNERGIA, and LIBERI], funds from the European Regional Development Fund (CIBEROBN CB06/03 and CB12/03) and from the European Commission (EAT2BENICE_H2020_SFS2016). Fundació La Marató TV3 (projects no. PI044003 and 201630.10). Laura Gallardo-Alfaro and Catalina M. Mascaró received FPU PhD Grants from the Spanish Ministry of Education. The funding sponsors had no role in the design of the study, in the collection, analyses, or interpretation of the data; in the writing of the manuscript, and in the decision to publish the results.

Brewers' spent grain (BSG) is the most abundant by-product obtained from beer production. However, it contains some bioactive compounds such as phenolic compounds, therefore, the valorization of BSG is important to recovery these compounds and reused them as functional ingredients in food industry. Therefore, in this work, pulsed electric field (PEF) has been used as extraction pre-treatment. PEF parameters such as electric field strength E (0.5, 1.5, 2.5 kV/cm), frequency (50, 100, 150 Hz) and total time of treatment (5, 10, 15 s) were optimized in order to maximize the content of flavan-3-ols, flavonoids, phenolic acid derivates and total free phenolic compounds. Optimal conditions to the maximum value of total free phenolic compounds were the following: 2.5 kV/cm, 50 Hz and 14.5 s. Concentrations of total free and bound phenolic compounds from BSG under these PEF optimum conditions were 2.7 and 1.7 times, respectively, higher than in case of the extraction without PEF pre-treatment, indicating an improvement in the phenolic recovery with the use of PEF as a pre-treatment in brewers spent grain samples.

Many studies have showed the beneficial effects of the olive (Olea europaea) leaf extract (OLE) in experimental models of metabolic syndrome, which have been ascribed to the presence of phenolic compounds, like oleuropeoside. This study evaluated the effects of a chemically characterized OLE in high fat diet (HFD)-induced obesity in mice, describing the underlying mechanisms involved in the beneficial effects, with special attention to vascular dysfunction and gut microbiota composition. C57BL/6J mice were distributed in different groups: control, control-treated, obese and obese-treated with OLE (1, 10 and 25 mg/kg/day). Control mice received a standard diet, whereas obese mice were fed HFD. The treatment was followed for 5 weeks, and animal body weight periodically assessed. At the end of the treatment, metabolic plasma analysis (including lipid profile) as well as glucose and insulin levels were performed. The HFD-induced inflammatory status was studied in liver and fat, by determining the RNA expression of different inflammatory mediators by qPCR; also, different markers of intestinal epithelial barrier function were determined in colonic tissue by qPCR. Additionally, flow cytometry of immune cells from adipose tissue, endothelial dysfunction in aortic rings as well as gut microbiota composition were evaluated. Faecal microbiota transplantation (FMT) to antibiotic-treated mice fed with HFD was performed. OLE administration reduced body weight gain, basal glycaemia and insulin resistance, and showed improvement in plasma lipid profile when compared with HFD-fed mice. The extract significantly ameliorated the HFD-induced altered expression of key adipogenic genes, like PPARs, adiponectin and leptin receptor, in adipose tissue. Furthermore, the extract reduced the RNA expression of Tnf-α, Il-1β, Il-6 in liver and adipose tissue, thus improving the tissue inflammatory status associated to obesity. The flow cytometry analysis in adipose tissue corroborated these observations. Additionally, the characterization of the colonic microbiota by sequencing showed that OLE administration was able to counteract the dysbiosis associated to obesity. The extract reversed the endothelial dysfunction observed in the aortic rings of obese mice. FMT from donors HFD-OLE to recipient mice fed an HFD prevented the development of obesity, glucose intolerance, insulin resistance and endothelial dysfunction. OLE exerts beneficial effects in HFD-induced obesity in mice, which was associated to an improvement in plasma and tissue metabolic profile, inflammatory status, gut microbiota composition and vascular dysfunction. his work was supported by the Junta de Andalucía (CTS 164) and by the Spanish Ministry of Economy and Competitiveness (AGL2015-67995-C3-3-R) with funds from the European Union. A. Rodriguez-Nogalesis a postdoctoral fellow of Instituto de Salud Carlos III (Sara Borrell Program);J. Garrido-Mesa and F. Algieri are postdoctoral fellows of University of Granada; T. Vezza is a postdoctoral fellow from Instituto de Investigación Biosanitaria de Granada. The CIBER-EHD and the “Red de Investigación en SIDA”are funded by the Instituto de Salud Carlos III Sí

El monitoreo continuo de glucosa (MCG) es una herramienta que permite evaluar el control glucémico, la variabilidad glucémica y la detección de episodios de hipoglucemia asintomática y nocturna. Actualmente disponemos de dispositivos de última generación que son más precisos y sensibles para la detección de hipoglucemia, lo cual ha permitido el desarrollo de algoritmos predictores con el fin de prevenir dichos eventos, ya sea utilizando alarmas para que el paciente intervenga o suspendiendo la infusión de insulina. Esta tecnología se encuentra disponible en Colombia y ha demostrado ser una alternativa segura y efectiva en el tratamiento de pacientes diabéticos con alto riesgo de hipoglucemia severa y otras poblaciones especiales como niños y mujeres embarazadas. El objetivo de esta revisión es resumir la evidencia clínica relevante, ventajas y desventajas de esta terapia, así como el impacto clínico del uso del MCG en tiempo real (MCG-TR) en pacientes en tratamiento con múltiples dosis o sistemas de infusión subcutánea de insulina.

Resumen En los ultimos anos, el numero de pacientes anticoagulados y antiagregados esta aumentando significativamente. Al ser un tratamiento cronico, es de esperar que a lo largo de su vida necesiten un procedimiento quirurgico o intervencionista que pueda requerir la interrupcion del farmaco antitrombotico. La decision de retirar o mantener dicho tratamiento estara determinada, por un lado, por el riesgo trombotico y, por otro, por el hemorragico. De la interaccion entre estos 2 factores dependera la actitud ante la anticoagulacion y la antiagregacion. El objetivo de este documento de consenso, coordinado desde el Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Espanola de Cardiologia y certificado por un amplio numero de sociedades cientificas que participan en el proceso asistencial del paciente durante el periodo perioperatorio o periprocedimiento, consiste en proponer una serie de recomendaciones practicas y sencillas con el fin de homogeneizar la practica clinica diaria.

Summary Introduction Degludec (IDeg) is an ultralong-acting insulin, with stable pharmacodynamic profile which leads to lower fluctuations in glucose levels. The effect of IDeg has not been specifically assessed in patients with unstable diabetes, defined as increased glycemic variability (GV). Methods A prospective before-after pilot study was conducted, including patients managed at Hospital Universitario San Ignacio in Bogotá, Colombia. The impact of the switch from a Glargine or Detemir insulin to a basal insulin regimen with IDeg for 12 weeks on GV measured by continuous glucose monitoring, on A1c levels, and on the incidence of episodes of global and nocturnal hypoglycemia was assessed in a group of patients with (coefficient of variation >34%) or without increased basal GV using a Generalised Estimating Equation (GEE) analysis. Results 60 patients with basal bolus therapy and history of hypoglycemia were included. 18 patients had High GV (HGV). In this group a significant reduction of 11.1% of CV (95% CI: 6.3, 15.9, p = 0.01) was found. GEE analysis confirmed a higher impact over time on patients with HGV (p

Introduction: Recent publications frequently introduce new indexes to measure glycemic variability (GV), quality of glycemic control, or glycemic risk; however, there is a lack of evidence supporting the use of one particular parameter, especially in clinical practice. Methods: A cohort of type 2 diabetes mellitus (T2DM) patients in ambulatory care were followed using continuous glucose monitoring sensors (CGM). Mean glucose (MG), standard deviation, coefficient of variation (CV), interquartile range, CONGA1, 2, and 4, MAGE, M value, J index, high blood glucose index, and low blood glucose index (LBGI) were estimated. Hypoglycemia incidence (Results: CGM data for 657 days from 140 T2DM patients (4.69 average days per patient) were analyzed. Hypoglycemia was present in 50 patients with 144 hypoglycemic events in total (incidence rate of 0.22 events per patient/day). In the multivariate analysis, both CV (OR 1.20, 95% CI 1.12-1.28, P < .001) and LBGI (OR 4.83, 95% CI 2.41-9.71, P < .001) were shown to have a statistically significant association with hypoglycemia. The highest AUC were for CV (0.84; 95% CI 0.77-0.91) and LBGI (0.95; 95% CI 0.92-0.98). The optimal cutoff threshold for CV as IRH was 34%, and 3.4 for LBGI. Conclusion: This analysis shows that CV can be recommended as the preferred parameter of GV to be used in clinical practice for T2DM patients. LBGI is the preferred IRH between glycemic risk indexes.

This paper presents the results of an experimental study on the behavior of the cold- formed steel shear wall panel (CFSSWP) with fibrocement panels as sheathing, when it is subjected in-plane shear deformations and flexural deformation under perpendicular monotonically increasing horizontal loads on the longest plane. A full-scale housing section was built with three walls and a ceiling using commonly used construction details in El Salvador. The strength and stiffness of the experimental specimen tested overcame significantly critical demand imposed by the technical design standards in this country. Additionally, a simplified finite element model was defined with the objective to analyze stresses in the components. The results of the numerical model were similar to the experimental model tested.

The analytical method for the calculation of the properties of a bolted joint established by the structural Eurocodes proposes the T-stub as a component for the characterization of the tension and compression zones in moment joints. In this article, a review of the state of the art on the T-stub component is developed, where the works developed since it was initially defined, and from the perspectives of formulation, experimentation and numerical simulation are summarized and discussed. Additionally, possible future lines of work are proposed.

Heart failure (HF) has been a hot topic in diabetology in the last few years, mainly due to the central role of sodium-glucose cotransporter 2 inhibitors (iSGLT2) in the prevention and treatment of cardiovascular disease and heart failure. It is well known that HF is a common complication in diabetes. However, most of the knowledge about it and the evidence of cardiovascular safety trials with antidiabetic drugs refer to type 2 diabetes (T2D). The epidemiology, etiology, and pathophysiology of HF in type 1 diabetes (T1D) is still not well studied, though there are emerging data about it since life expectancy for T1D has increased in the last decades and there are more elderly patients with T1D. The association of T1D and HF confers a worse prognosis than in T2D, thus it is important to investigate the characteristics, risk factors, and pathophysiology of this disease in order to effectively design prevention strategies and therapeutic tools.

Clinical interventional studies in diabetes mellitus usually exclude patients undergoing peritoneal dialysis (PD). This study evaluates the impact of an educational program and a basal-bolus insulin regimen on the blood glucose level control and risk of hypoglycemia in this population.A before-and-after study was conducted in type 1 and type 2 DM patients undergoing PD at the Renal Therapy Services (RTS) clinic network, Bogota, Colombia. An intervention was instituted consisting of a three-month educational program and a basal-bolus detemir (Levemir, NovoNordisk) and aspart (Novorapid, NovoNordisk) insulin regimen. Prior to the intervention and at the end of treatment were conducted measures of HbA1c levels and continuous glucose monitoring (CGM).Forty-seven patients were recruited. Mean HbA1c level decreased from 8.41% ± 0.83 to 7.68% ± 1.32 (mean difference -0.739, 95% CI -0.419, -1.059; P.0001). Of subjects, 52% achieved HbA1c levels7.5% at the end of study. Mean blood glucose level reduced from 194.0 ± 42.5 to 172.9 ± 31.8 mg/dl ( P = .0015) measured by CGM. Significant differences were not observed in incidence of overall ( P = .7739), diurnal ( P = .3701), or nocturnal ( P = .5724) hypoglycemia episodes nor in area under the curve (AUC)54 mg/dl ( P = .9528), but a reduction in AUC180 ( P.01) and AUC250 ( P = .01) was evidenced for total, diurnal, and nocturnal episodes.An intervention consisting of an educational program and a basal-bolus insulin regimen in type 1 and type 2 diabetes mellitus patients undergoing PD caused a decrease in HbA1c levels, and mean blood glucose levels as measured from CGM with no significant increases in hypoglycemia episodes.

Continuous glucose monitoring (CGM) is a tool that allows constant evaluation of glycemic control, providing data such as the trend and fluctuation of interstitial glucose levels over time. In clinical practice, there are two modalities: the professional or retrospective and the personal or real-time CGM (RT-CGM). The latest-generation sensors are more accurate and sensitive for hypoglycemia, improving adherence to self-monitoring, which has allowed optimizing glycemic control. The development of algorithms that allow the suspension of the infusion of insulin during hypoglycemia gave rise to the integrated therapy or sensor-augmented insulin pump therapy with low glucose suspend, which has proven to be an effective and safe alternative in the treatment of diabetic patients with high risk of hypoglycemia. The objective of this review is to present the evidence of the advantages of RT-CGM, the clinical impact of integrated therapy, and cost-effectiveness of its implementation in the treatment of patients with diabetes mellitus.

Introducción: Los bloqueos del nervio pudendo poseen un amplio rango de utilidades clínicas en el manejo agudo de dolor POP en cirugía urológica, ginecológica, en coloproctología así como en Medicina del dolor en diagnóstico diferencial y manejo de las neuropatías del nervio pudendo. Sin embargo su aplicación es relativamente infrecuente a pesar de los beneficios. Objetivo: Realizar una descripción detallada de las técnicas más recientes guiadas por ultrasonografía con el objeto de motivar su aprendizaje de una manera segura y reproducible. Materiales y métodos: Se realizó una revisión amplia, no sistemática de la literatura a través de Medline, Embase y Science Direct desde 1985 hasta 2016, evaluando los artículos más relevantes, utilizando las palabras clave: anatomía del nervio pudendo, nervio pudendo, bloqueos del nervio pudendo, ultrasonido del nervio pudendo, neuralgia del pudendo, atrapamiento nervioso, dolor crónico, canal de Alcock y dolor pélvico. La búsqueda se limitó a artículos publicados en español, inglés y francés. Resultados: Se encontraron recientes descripciones de una gran cantidad de variantes anatómica, que se describen en detalle y muestran en documentos gráficos con el propósito de facilitar la correlación sonoanatómica de la localización del nervio como guía para la realización de bloqueos de nervio pudendo a través de los diferentes abordajes. Conclusiones: El conocimiento profundo y detallado de la anatomía del nervio pudendo y sus variaciones es esencial para la realización de técnicas de anestesia regional guiada por imágenes. Estas técnicas promisorias deben continuar evaluándose con estudios clínicos. © 2017 Sociedad Colombiana de Anestesiología y Reanimación. Introduction Pudendal nerve blocks have a wide range of clinical applications for the management of acute post-operative pain in urologic and gynaecologic surgery, in coloproctology, as well as in pain medicine for differential diagnosis, and for the management of pudendal neuropathies. However, despite its benefits, it is infrequently used. Objective To perform a detailed description of the most recent ultrasound-guided techniques with the aim of encouraging safe and reproducible learning. Materials and methods We have performed a broad, non-systematic review of the literature through Medline, Embase and Science Direct between 1985 and 2016, to evaluate the most relevant articles, using the following key words: pudendal nerve anatomy; pudendal nerve; pudendal nerve blocks; pudendal nerve ultrasound; pudendal neuralgia; nerve entrapment; chronic pain; Alcock canal; and pelvic pain. The search was limited to articles published in Spanish; English and French. Results Recent descriptions were found of a large number of anatomic variants, which are described in detail and shown in graphic documents in order to facilitate the sonoanatomic correlation of nerve location as a guide for the performance of the pudendal nerve block through the different approaches. Conclusions The deep and detailed knowledge of the anatomy of the pudendal nerve and its variations is essential for the realization of Regional Anesthesia techniques guided by images. These promising techniques should continue to be evaluated with clinical studies. © 2017 Sociedad Colombiana de Anestesiología y Reanimación

Pregnancy in women with type 1 diabetes (T1D) is associated with increased risk of maternal complications and neonatal morbidity and mortality. Optimizing glycemic control improves these outcomes.To describe the experience of using sensor-augmented insulin pump therapy (SAPT) and SAPT + low-glucose suspension (LGS) on pregnant women with T1D, including neonatal and maternal outcomes.A prospective observational study was conducted in women with T1D who started SAPT and SAPT + LGS before or during pregnancy at the San Ignacio University Hospital Diabetes Center in Bogotá, Colombia. The main indication was severe hypoglycemia (SH) and poor glycemic control. Glycated hemoglobin (A1c), hypoglycemia, and maternal and fetal outcomes were assessed.Thirty-four pregnant women with T1D on SAPT and SAPT + LGS were included. Sixteen patients started therapy during pregnancy at a mean gestational age of 17.6 ± 8.3 weeks. Mean preconceptional A1c was 8.24% ± 2.02%. Absolute reduction of A1c level from prepregnancy to third trimester was -1.63% (P 0.0001), with a significant clinical and statistical reduction in both groups, women who initiated SAPT before or during pregnancy. 52.9% of patients in second trimester and 66.6% in third trimester achieved A1c6.5%, respectively. 91.1% underwent cesarean section. The main reasons were iterative cesarean (30%), fetal distress (20%), and preeclampsia (16%). The median gestational age at delivery was 37 weeks and 15 pregnancies resulted in preterm delivery. There was neither maternal-fetal mortality nor severe hypoglycemic episodes. Two patients had diabetic ketoacidosis.In pregnant patients with T1D and high risk of hypoglycemia, SAPT and SAPT + LGS should be considered as a therapeutic alternative for A1c reduction with a low risk of SH. However, additional studies are required to evaluate the efficacy and safety of this therapy during pregnancy.

After the evacuation from Africa to Western hospitals of several international workers with the Ebola virus disease, the first case of contagion outside Africa occurred in Madrid, Spain. A nursing care assistant who had attended a missionary repatriated from Sierra Leone contracted the disease. On October 7th 2014, the patient arrived at the University Hospital La Paz-Carlos III in Madrid. She remained in the hospital for 30 days, 25 of which were in strict isolation in a negative pressure room with air lock anteroom; personal protective equipment was required. During the last five days, the patient was moved to a standard room. Protection measures were used in accordance with the Hospital Occupational Health Department. According to its evolution, we differentiate three phases with specific care demands which were conditioned by the risk of transmission, forcing extreme measures of prevention. The largest numbers of direct interventions fall within the realm of the nursing profession. It is essential that specialized units with regular training be created for highly contagious diseases. In addition, this and other cases should be analyzed from the point of view of nursing, to allow standardized care. We also recognize the importance of managing communication to prevent social unrest and stigmatization of staff.

Objective To assess the long-term clinical and economic impact of integrated pump/CGM technology therapy as compared to multiple daily injections (MDI), for the treatment of type 1 diabetes (T1D) in Colombia. Methods The CORE Diabetes Model was used to simulate a hypothetical cohort of patients with T1D. Mean baseline characteristics were taken from a clinical study conducted in Colombia and a healthcare payer perspective was adopted, with a 5% annual discount rate applied to both costs and outcomes. Results The integrated pump/CGM improved mean life expectancy by 3.51 years compared with MDI. A similar increase occurred in mean quality-adjusted life expectancy with an additional 3.81 quality-adjusted life years (QALYs). Onset of diabetes-related complications was also delayed as compared to MDI, and mean survival time free of complication increased by 1.74 years with integrated pump/CGM. Although this increased treatment costs of diabetes as compared to MDI, savings were achieved thanks to reduced expenditure on diabetes-related complications. The estimated incremental cost-effectiveness ratio (ICER) for SAP was Colombian Pesos (COP) 44,893,950 (approximately USD$23,200) per QALY gained. Conclusions Improved blood glucose control associated to integrated pump/CGM results in a decreased incidence of diabetes-related complications and improves life expectancy as compared to MDI. Using recommended thresholds from the World Health Organization and previous coverage decisions about health technologies in Colombia, it is a cost-effective alternative to MDI for the treatment of type 1 diabetes in Colombia.

Brewing spent grains (BSGs) are the main by-product from breweries and they are rich of proanthocyanidins, among other phenolic compounds. However, literature on these compounds in BSGs is scarce. Thus, this research focuses on the establishment of ultrasound-assisted extraction of proanthocyanidin compounds in brewing spent grains using a sonotrode. To set the sonotrode extraction up, response surface methodology (RSM) was used to study the effects of three factors, namely, solvent composition, time of extraction, and ultrasound power. Qualitative and quantitative analyses of proanthocyanidin compounds were performed using HPLC coupled to fluorometric and mass spectrometer detectors. The highest content of proanthocyanidins was obtained using 80/20 acetone/water (v/v), 55 min, and 400W. The established method allows the extraction of 1.01 mg/g dry weight (d.w.) of pronthocyanidins from BSGs; this value is more than two times higher than conventional extraction., This project was supported by the University of Granada (project PPJI2017.16).

Patients with long-term, treated, rheumatoid arthritis (RA) show abnormalities in their circulating CD4+ T-lymphocytes, but whether this occurs in recently diagnosed na&iuml, ve patients to disease-modifying drugs (DMARDs) is under discussion. These patients show heterogeneous clinical response to methotrexate (MTX) treatment. We have examined the count of circulating CD4+ T-lymphocytes, and their na&iuml, ve (TN), central memory (TCM), effector memory (TEM) and effector (TE) subsets, CD28 expression and V&beta, TCR repertoire distribution by polychromatic flow cytometry in a population of 68 DMARD-na&iuml, ve recently diagnosed RA patients, before and after 3 and 6 months of MTX treatment. At pre-treatment baseline, patients showed an expansion of the counts of CD4+ TN, TEM, TE and TCM lymphocyte subsets, and of total CD4+CD28&minus, cells and of the TE subset with a different pattern of numbers in MTX responder and non-responders. The expansion of CD4+TEM lymphocytes showed a predictive value of MTX non-response. MTX treatment was associated to different modifications in the counts of the CD4+ subsets and of the V&beta, TCR repertoire family distribution and in the level of CD28 expression in responders and non-responders. In conclusion, the disturbance of CD4+ lymphocytes is already found in DMARD-na&iuml, ve RA patients with different patterns of alterations in MTX responders and non-responders.

Introduction: Thyroid nodule (TN) is a common reason for consultation in daily practice. The purpose of this study was to evaluate the diagnosis and treatment of TNs in our environment and to assess the current status regarding the existence and structure of high-resolution TN clinics. Material and methods: Members of the Spanish Society of Endocrinology and Nutrition were invited in 2018 to participate in an online survey on the diagnostic and therapeutic processes of TN. Results: A total of 211 valid surveys were received. Of all respondents, 30.8% stated that there were high-resolution TN clinics in their environment, with the endocrinologist being the main person responsible for performing ultrasonography (87.7%) and fine needle aspiration (FNA) (69.2%). For ultrasound classification of TNs, 32.7% used the ATA criteria, 32.2% the TI-RADS criteria, and 22.7% no classification. In situ verification of sample suitability was performed in 35.5% of the cases, and molecular analysis in 8.1%. With regard to clinical discharge, 65.4% would consider it after 5 years of follow-up and with a benign FNA. In the event of a Bethesda III result, 50.2% of respondents would repeat FNA and 35.5% would opt for surgery; if a Bethesda IV result was found, 95.8% would opt for surgery. Conclusions: High-resolution TN clinics are structures increasingly implemented in our environment where the endocrinologist is the main person responsible for performing ultrasonography and FNA. The standard clinical practice in our specialty is consistent with most recommendations concerning clinical practice guidelines for TNs. (c) 2019 SEEN y SED. Published by Elsevier Espana, S.L.U. All rights reserved.