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Author(s): M. González-Rodríguez [sup.1] , R. Villar-Taibo [sup.1] , A. Fernández-Pombo [sup.1] , M. Pazos-Couselo [sup.1] [sup.2] , M. A. Sifontes-Dubón [sup.1] , S. Ferreiro-Fariña [sup.1] , A. Cantón-Blanco [sup.1] [...], Background/Objectives Radiotherapy (RT) is a component of therapy for head and neck cancer (HNC) with a negative nutritional impact. Our aim was to compare an early versus a conventional nutritional intervention. Subjects and methods Retrospective study of HNC patients undergoing RT. Evolution before and after the establishment of a fast-track circuit was evaluated. A conventional group (CG) made up of patients submitted to the nutrition unit during RT after nutritional deterioration, was compared to an early group (EG) represented by patients included in a fast-track circuit, starting nutritional follow-up before the beginning of RT. Only patients with preserved oral intake were involved. Demographic, nutritional and clinical variables were analyzed. Data of hospitalizations and deaths were collected up to three months after RT. Results 135 subjects constituted the EG and 39 the CG. At baseline, the prevalence of malnutrition was lower in the EG (31.9% vs 69.5%, p = 0.0001), as was the need for nutritional supplements (40% vs 79.5%, p = 0.0001) or nasogastric tube (0% vs 12.8%, p = 0.0001) in comparison to the CG. Three months after RT, there were less patients with oral nutritional support in the EG (79.1% vs 96.9%, p = 0.018), and the number of emergency visits (0.75 vs 1.1 episodes per patient, p = 0.021) and hospitalizations was also lower in this group (29% vs 59%, p = 0.044). Conclusions The fast-track approach made early intervention possible. Therefore, patients maintained a better nutritional status, needed less nutritional support and their evolution improved, with a significant decrease in hospitalizations.

Bone Marrow Transplantation (2002) 30, S31–S34. doi:10.1038/sj.bmt.1703746 [ABSTRACT FROM AUTHOR]

Purpose: To assess the diagnostic performance of hemoglobin concentration for Meckel's diverticulum (MD) and evaluate if hemoglobin levels could be useful in the surgical decision-making process of children with lower gastrointestinal bleeding (LGIB)., Methods: Retrospective cohort study of children with LGIB attending the emergency department between 2011 and 2021. Episodes of LGIB were divided into two groups: MeckD (MD diagnosed by surgery) and non-MeckD. Demographic and clinical variables were recorded. Comparisons between groups were made using the χ2 and the Mann-Whitney U tests. The diagnostic performance of hemoglobin for MD was studied using ROC curves., Results: Eight hundred and nineteen episodes of LGIB were considered. Blood samples were obtained in 233 cases (31 with MD). There were differences between MeckD and non-MeckD in hemoglobin concentration (8.7 vs. 12.6; U = 592; p < 0.01), hematochezia (83.9% vs. 50.5%; χ2 = 12.1; p < 0.01), absence of other symptoms (61.3% vs. 39.6%; χ2 = 5.2; p < 0.02) and blood transfusions (41.9% vs. 9.9%; χ2 = 74.8; p < 0.01). Hemoglobin levels ≤ 8.3 g/dL obtained a specificity ≥ 99.01% and a positive likelihood ratio ≥ 35.8 for MD. The area under the curve was 0.91 (95% CI 0.86-0.94)., Conclusion: Hemoglobin showed a good diagnostic performance for MD. Low hemoglobin levels could guide surgical indications in the management of children with LGIB., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Limited data exist on educational programs for people using insulin pump (IP) therapy or those considering its initiation, and the influence of individual characteristics on their educational pathway remains unclear. Our aim was to analyze the characteristics of people with type 1 diabetes (T1D) referred for IP therapy and how these characteristics may influence their educational process. A retrospective descriptive observational study was carried out on people with T1D referred for participation in a structured pre-IP educational program in a hospital setting. Educational, sociodemographic and clinical variables were collected and analyzed. Participants were followed up 5 years after IP placement. Seventy-one people finalized the educational program, of whom 10 experienced major barriers to completing it. People with lower educational level required more sessions and weeks to complete it compared to those with higher educational levels. People referred due to suboptimal metabolic control and hypoglycemia also required more time to complete the process. It is essential for diabetes educators to recognize the diversity of characteristics, needs and challenges among the participants in an educational program. Based on this, they must adapt strategies to provide more effective, person-centered diabetes education and support, fostering positive and sustained outcomes and engagement for participants., (© The Author(s) 2024. Published by Oxford University Press.)

Background and Aim: Few real-life studies have analyzed the glycemic response to nutrients in individuals without diabetes. We investigated the glycemic response to evening meals in relation to individual characteristics, nutrient components, and preprandial and postprandial routines., Methods: A cross-sectional study of 489 individuals without diabetes from a randomly selected general adult population (310 women, median age 46 years, range 18-84 years) was conducted using a continuous glucose monitoring device for 7 days. The study recorded the participants' glycemic profile at 6 h after dinner, the food consumed at dinner, the fasting duration before dinner, and the duration between the end of dinner and going to bed. Principal component analysis and multilevel functional data analysis were used to interpret the data., Results: On average, a postprandial glycemic peak was observed at 45 min, followed by a decline to baseline levels from 90 min onwards. Older age, higher body mass index, and large meals (especially those high in starch and dairy products) were all significantly associated with higher glucose levels throughout the 6 h after dinner. The fruit component was associated with a higher initial glycemic peak, followed by a lowering glycemic effect thereafter (p < 0.001). The alcohol component was associated with an initial hypoglycemic effect (p = 0.006). The participants who fasted longer before dinner had higher postprandial glycemic peaks (p = 0.001), and those who went to bed later had higher postprandial glucose levels than those who went to bed earlier (p = 0.003)., Conclusions: The participants' characteristics, nutrient components, and pre- and post-dinner routines have divergent effects on post-dinner glycemic response., Competing Interests: Conflict of interest The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: Advanced hybrid closed-loop systems (AHCL) have been shown to improve glycemic control and patient-reported outcomes in type 1 diabetes. The aim was to analyze the outcomes of two commercially available AHCL in real life., Research Design and Methods: A prospective study was performed, including adolescents and adults with type 1 diabetes, AHCL naïve, from 14 centers, who initiated the use of MM780G with SmartGuard or Tandem t:slimX2 with Control-IQ. Baseline and 3-month evaluations were performed, assessing HbA1c, time in different glycemic ranges, and patient-reported outcomes. The primary outcome was the between-group time in range 70-180 mg/dL difference from beginning to end of follow-up., Results: One hundred fifty participants were included, with 75 initiating each system (age: 39.9 ± 11.4 years [16-72]; 64% female; diabetes duration: 21.6 ± 11.9 years). Time in range increased from 61.53 ± 14.01% to 76.17 ± 9.48% (P < 0.001), with no between-group differences (P = 0.591). HbA1c decreased by 0.56% (95% CI 0.44%, 0.68%) (6 mmol/mol, 95% CI 5, 7) (P < 0.001), from 7.43 ± 1.07% to 6.88 ± 0.60% (58 ± 12 to 52 ± 7 mmol/mol) in the MM780G group, and from 7.14 ± 0.70% to 6.56 ± 0.53% (55 ± 8 to 48 ± 6 mmol/mol) in the Control-IQ group (both P < 0.001 to baseline, P = 0.819 between groups). No superiority of one AHCL over the other regarding fear of hypoglycemia or quality of life was found. Improvement in diabetes-related distress was higher in Control-IQ users (P = 0.012). Sleep quality was improved (PSQI: from 6.94 ± 4.06 to 6.06 ± 4.05, P = 0.004), without differences between systems. Experience with AHCL, evaluated by the INSPIRE measures, exceeded the expectations., Conclusions: The two AHCL provide significant improvement in glucose control and satisfaction, with no superiority of one AHCL over the other., (© 2024 by the American Diabetes Association.)

Continuous glucose monitoring systems (CGM) are a very useful tool to understand the behaviour of glucose in different situations and populations. Despite the widespread use of CGM systems in both clinical practice and research, our understanding of the reproducibility of CGM data remains limited. The present work examines the reproducibility of the results provided by a CGM system in a random sample of a free-living adult population, from a functional data analysis approach. Functional intraclass correlation coefficients (ICCs) and their 95% confidence intervals (CI) were calculated to assess the reproducibility of CGM results in 581 individuals. 62% were females 581 participants (62% women) mean age 48 years (range 18-87) were included, 12% had previously been diagnosed with diabetes. The inter-day reproducibility of the CGM results was greater for subjects with diabetes (ICC 0.46 [CI 0.39-0.55]) than for normoglycaemic subjects (ICC 0.30 [CI 0.27-0.33]); the value for prediabetic subjects was intermediate (ICC 0.37 [CI 0.31-0.42]). For normoglycaemic subjects, inter-day reproducibility was poorer among the younger (ICC 0.26 [CI 0.21-0.30]) than the older subjects (ICC 0.39 [CI 0.32-0.45]). Inter-day reproducibility was poorest among normoglycaemic subjects, especially younger normoglycaemic subjects, suggesting the need to monitor some patient groups more often than others., (© 2023. Springer Nature Limited.)

Aim: To investigate the prognostic value of time range metrics, as measured by continuous glucose monitoring, with respect to the development of type 2 diabetes (T2D)., Research Design and Methods: A total of 499 persons without diabetes from the general population were followed-up for 5 years. Time range metrics were measured at the start and medical records were checked over the period study., Results: Twenty-two subjects (8.3 per 1,000 person-years) developed T2D. After adjusting for age, gender, family history of diabetes, body mass index and glycated hemoglobin concentration, multivariate analysis revealed 'time above range' (TAR, i.e., with a plasma glucose concentration of >140 mg/dL) to be significantly associated with a greater risk (OR = 1.06, CI 1.01-1.11) of developing diabetes (AUC = 0.94, Brier = 0.035)., Conclusions: Time above range provides additional information to that offered by glycated hemoglobin to identify patients at a higher risk of developing type 2 diabetes in a population-based study., Competing Interests: MP-C, JM-F, and FG reports consultant fees from Medtronic. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Marco, Pazos-Couselo, Moreno-Fernandez, Díez-Fernández, Alonso-Sampedro, Fernández-Merino, Gonzalez-Quintela and Gude.)

Background: Recent investigations highlight how important it is to identify the key factors involved in the design of strategies to promote blood donation among undergraduates as a public health concern. The study aims to investigate attitudes and knowledge towards blood donation in university students with health education roles and examine the way sociodemographic and educational characteristics play a part in it., Materials and Methods: A cross-sectional and multi-center design was used. A structured questionnaire was answered by 1128 Spanish university students (Schools of Health Sciences and Education Sciences)., Results: The knowledge test indicated a low score (M = 4.2 out of 10), being Me = 3.00 in the case of Education Sciences and Me = 5.00 in Health Sciences students. The greatest degree of importance is found in the "external incentives" dimension (M = 3.7 out of 5). Health science students and participants with relatives who needed a donation showed fewer "fears" (p ≤ 0.001) and "pretexts" (p ≤ 0.01)., Conclusions: The low knowledge score stresses the need to develop valuable health education-related strategies in the curriculum of studies related with health education; showing room for improvement particularly in Education Science students. Health education interventions aimed at increasing donors in the university environment should be designed while considering differences among undergraduates. Based on their better attitudes, health science students might play a relevant role in promoting blood donation., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aims: This systematic review aimed to assess the effectiveness of educational interventions in type 2 diabetes specifically designed for community-dwelling older adults., Methods: In accordance with PRISMA guidelines, a systematic search of studies published between 2010 and 2021 was conducted across five electronic databases and manual sources. The study protocol was previously registered in PROSPERO (CRD42021288236)., Results: Twelve papers matched the inclusion criteria and were appraised using MERSQI. The features of the educational programs were heterogeneous, and none complied with the ten suggested standards for diabetes self-management education and support. Comprehensive gerontological assessment was not considered. Outcomes included biomedical, psychosocial, behavioral, and knowledge measures. HbA1c and knowledge showed improvements with a high certainty level according to GRADE., Conclusions: Structured DSME programs aimed at older adults have great potential, however there is still room to improve. Applying the principles of a comprehensive gerontological approach and the standards for DSME as continuous monitoring and support could increase their benefits., Competing Interests: Competing interests The authors declare no conflicts of interest., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Aims: This study aimed to determine the effect of aging on glucose profiles in a population without diabetes., Methods: We investigated the evolution of glucose profiles in an adult population without diabetes using continuous glucose monitoring (CGM) in two periods separated by 5 years. Anthropometrics, laboratory tests (HbA1c, fasting blood glucose) and CGM data (mean glycemia level, coefficient of variation, time in range) were measured in both periods to study the change in values over time., Results: 125 participants (68% women) mean age 43.1 ± 12.4 years and classified as normoglycemic at baseline were included. Of the total population 15.2% had worsened glycemic status after 5 years, age and baseline glucose values (HbA1c and percentage of values above 175 mg/dL) were the variables related with this change. Related to CGM, we found that after 5 years there was a decrease in the percentage of values between 70 and 99 mg/dl (45.0% to 38.7%, p = 0.002) and an increase in the 100-139 mg/dL range (52.9% to 57.5% p = 0.016)., Conclusions: Our results indicate that in an adult population without diabetes there are changes in glucose profiles with aging highlighting the reduction of blood glucose values below 100 mg/dL., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Due to the high prevalence of nodular thyroid disease in the general population and the need to rule out malignant tumours, a clinical pathway for nodular thyroid disease was created at our tertiary-level hospital. Our study aimed to quantify timings and delays in diagnosis and treatment in this clinical pathway, specifically for patients who were diagnosed with thyroid cancer., Methods: A retrospective review was conducted of patients who were newly diagnosed with thyroid cancer and who had been previously evaluated in the clinical pathway for nodular thyroid disease at our institution during 2015-2017. Patient demographics, previous diagnostic studies, cytological results, tumour details and key dates were analysed to identify wait times in diagnosis and treatment., Results: Forty patients with thyroid cancer were included. The diagnostic delay had a median time of 60 days, and the treatment delay was dependent on cytopathological results. The main cause for delay in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. In the treatment phase, patients with a cytological result of Bethesda III, V or VI underwent surgery at the suggested time, while those in the Bethesda II or IV category did not., Conclusions: The major delay found in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. We are not suggesting that this step must be eliminated, though the implementation of routine ultrasonography in a thyroid clinic can help identify patients who need more urgent evaluation for fine needle aspiration cytology. In our hospital, decision for surgery is based mainly on the cytopathological report. Imaging studies and/or molecular testing could be considered to reduce treatment delays.

Background: Blood donors are key in meeting the ever-increasing blood requirements worldwide. The Spanish and Portuguese donation systems are based on altruism and voluntariness. However, nursing students may not be fully aware of the importance of this social responsibility and their professional skills in this field., Objectives: This study aimed to identify differences regarding attitudes towards and knowledge about blood donation among Spanish and Portuguese undergraduate Nursing students (1st to 8th semester), as well as to analyse how different variables account for them., Design: A multicentre cross-sectional study was carried out., Participants/settings: The participants of the study were 1038 nursing students from four Schools of Nursing in two countries, Spain and Portugal., Methods: The web-based CADS-19 questionnaire to measure attitudes and knowledge was used during the academic years 2018-2019 and 2019-2020. Additionally, sociodemographic data were collected., Results: The mean knowledge score was 3.079 out of 10 (SD = 1.429). The level of knowledge differed significantly by gender, where females scored higher, along with older students and previous donors. The highest mean attitude score corresponded to the "external incentives" dimension, significant differences were found between countries. In barriers and incentives, some differences were found depending on gender or sexual orientation, among others, with slightly better attitudes in Spanish participants., Conclusions: The level of knowledge was lower than expected, considering participants were nursing students. The attitude's comparative analysis between both countries showed significant differences, especially in the pretext dimension. As for greater donation rates found in Spanish students, nurse-led international partnerships could be designed to enhance health literacy and sensitivity among nursing undergraduates. Interventions should focus on specific theoretical and practical training programs and educative actions should contribute to a greater awareness, motivation, and sensitise students to blood donation., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To validate the clinical score of Valdivieso et al. in the management of patients with suspected foreign body aspiration in a tertiary hospital. This score raises different scenarios according to the result: bronchoscopy, CT, observation or discharge., Material and Methods: Retrospective study of patients who underwent a bronchoscopy due to suspected tracheobronchial foreign body between November-2015 and November-2018. The variables proposed by the score were collected (choking, stridor, wheezing, unilateral hypoventilation, altered chest X-ray and high-risk foreign body) and the score was calculated for each patient, analyzing the performance of the test using the ROC (Receiver Operating Characteristic) curve., Results: Bronchoscopy was performed in 81 patients with a mean age of 2.1 years (7 months-11 years), finding foreign body in 33.3%. The area under the ROC curve of the score was 0.803 (0.695-0.911). In 6 (22.2%) patients with confirmed foreign body the score initially indicated observation in 5 cases and discharge in 1. Excluding the 49 patients with unilateral altered auscultation or when there was a nut suspected, which in our environment are clear indications for bronchoscopy, the score correctly classified the remaining 32 patients, which would have reduced the rate of normal bronchoscopies from 66% to 45%., Conclusions: The score in our sample presents a high diagnostic power but a non-negligible false negative rate. It has a special utility in patients who do not have unilateral altered auscultation and/or choking with nuts, allowing to reduce the rate of normal bronchoscopies.

Aims: To investigate, in a sample of nondiabetic adults from a Spanish community, the differences between prediabetes as defined by HbA 1c ("H-prediabetes") and by fasting plasma glucose (FPG) ("F-prediabetes") in regard to prevalence and the influence of potential risk factors, adjusting the latter for confounders., Methods: A total of 1328 nondiabetic participants aged ≥ 18 years were classified as normoglycemic, H-prediabetic [HbA 1c 5.7-6.4% (39-47 mmol/mol)] or F-prediabetic (FPG 5.6-6.9 mmol/L). Multivariable analyses were used to compare the impacts of risk factors on the prevalence of H-prediabetes, F-prediabetes and their conjunctive and disjunctive combinations ("HaF-prediabetes" and "HoF-prediabetes," respectively)., Results: Some 29.9% of participants were HoF-prediabetic, 21.7% H-prediabetic, 16.3% F-prediabetic and only 8.1% HaF-prediabetic. Whatever the definition of prediabetes, increasing age, fasting insulin and LDL cholesterol were each a risk factor after adjustment for all other variables. Increasing BMI and decreasing mean corpuscular hemoglobin (MCH) were additional risk factors for H-prediabetes; male sex and increasing uric acid for F-prediabetes and increasing BMI for HaF-prediabetes. The participants satisfying the compound condition "hypertension or hyperlipidemia or obesity or hyperuricemia" (59.9% of the whole study group) included 83.1% of all subjects with HoF-prediabetes., Conclusions: In this population, the most sensitive risk factor for detection of prediabetes was age, followed by fasting insulin, LDL cholesterol, BMI, MCH, male sex and uric acid, with differences depending on the definition of prediabetes. MCH, an indirect measure of erythrocyte survival, significantly influences the prevalence of HbA 1c -defined prediabetes. This study suggests that screening of individuals with selected risk factors may identify a high proportion of prediabetic persons.

Background: There is a growing interest in the pathopysiological consequences of postprandial hyperglycemia. It is well known that in diabetic patients 2 h plasma glucose is a better risk predictor for coronary heart disease than fasting plasma glucose. Data on the glycemic response in healthy people are scarce., Objective: To evaluate the effect of macronutrients (carbohydrates, fats, and proteins) and fiber on postprandial glycemic response in an observational study of a non-diabetic adult population., Design: Cross-sectional study. 150 non-diabetic adults performed continuous glucose monitoring for 6 days. During this period they recorded food and beverage intake. The participants were instructed not to make changes in their usual diet and physical exercise.Variables analyzed included clinical parameters (age, sex, body weight, height, body mass index, blood pressure, and waist measurement), meal composition (calories, carbohydrates, fats, proteins, and fiber) and glycemic postprandial responses separated by sexes.The study period was defined from the start of dinner to 6 h later., Results: A total of 148 (51% women) subjects completed all study procedures. Dinner intake was higher in males than in females (824 vs 531 kcal). Macronutrient distribution was similar in both sexes. No significant differences were found in fiber intake between men and women (5.5 g vs 4.5 g).In both sexes, the higher intake of carbohydrates corresponded to a significantly higher glycemic response ( p  = 0.0001 in women, p  = 0.022 in men). Moreover, in women, as fat intake was higher, a flattening of the postprandial glycemic curve was observed ( p  = 0.003). With respect to fiber, a significantly lower glycemic response was observed in the group of women whose fiber intake at dinner was higher ( p  = 0.034)., Conclusions: Continuous glucose monitoring provides important information about glucose levels after meals. In this study, the postprandial glycemic response in women was different from that of men, and carbohydrates were the main determinant of elevated postprandial glucose levels., Competing Interests: Competing interestsThe authors declare that they have no competing interests.

Aim: To analyze the clinical impact of the Flash glucose monitoring system in patients with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII)., Methods: A 24-week retrospective cohort study in CSII-treated T1DM patients exposed (1:1) to the Flash glucose monitoring system vs. self-monitoring of capillary blood glucose (SMBG). The primary outcome was the difference in hemoglobin A1c (HbA1c) levels between both groups at the end of the study., Results: Thirty-six patients with a mean age of 38.2 years (range 22-55) and a mean T1DM duration of 20.9±7.8 years, treated with CSII for 7.1±5.4 years, were enrolled into the study. At the end of the study, mean HbA1c levels improved in patients in the Flash group (7.1±0.7 vs. 7.8±1.0, p=0.04). Only the Flash group showed a significant decrease in HbA1c levels of -0.4% (95% CI, -0.6, -0.2; p=0.004) during follow-up. Flash patients captured 93.9% of data through 17.8±9.9 scans daily. In fact, the Flash cohort showed a three-fold increase in daily self-monitoring of glucose, while daily frequency of SMBG decreased during the study (-1.8 tests/24h (95% CI -3, -0.7; p=0.01). No safety issues related to Flash use were recorded., Conclusions: The Flash glucose monitoring system is a novel approach to improve blood glucose control in CSII-treated T1DM patients. Randomized controlled trials are needed to assess the effectiveness of this system in CSII-treated T1DM patients., (Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: In patients with hemolytic disorders (HD) splenectomy is recommended between 6-12 years. A higher risk of biliary complications (BC) has been described in those with associated Gilbert's disease (GD), but the ideal surgical age has not been stablished yet. Our aim is to quantify the risk of BC in patients with HD and GD to assess the benefit of early splenectomy., Material and Methods: Retrospective study of splenectomies performed in patients with HD between 2000-2017. The incidence of BC, its clinical consequences (admission or invasive treatment) and time of onset were analyzed. Two groups were considered: patients with GD and without GD. Survival curves were obtained and compared with log-rank test., Results: Fourty-four patients underwent splenectomy, 15 of them (34.1%) with HD+GD. The median age at surgery was 10.3 years (range 5.4-14.8). Twenty-nine (65.9%) had BC. Half of the patients with GD had BC before 8 years vs. 10,5 years in the cases without GD (log-rank 3.9, p= 0.05). Patients with GD had more BC (86.7% vs. 55.2%; Chi 2 = 4.37, p= 0.037). In the HD+GD group, 8 cases (53%) required admission vs.8 patients (31%) in the group HD without GD (Chi 2 = 2, p= 0.1). Invasive treatment was performed in 2 patients (13%) in the HD+GD group and 2 others (7.6%) in the group HD without GD (Chi 2 = 0.3, p= 0.6)., Conclusions: In our series, the BC incidence was higher in patients with HD and GD. There was a trend towards an earlier presentation of BC in this group, but neither this data nor its clinical consequences allow us to recommend early splenectomy.

Aims: To investigate whether continuous glucose monitoring (CGM) reveals patterns of glycaemic behaviour, the detection of which might improve early diagnosis of dysglycaemia., Methods: A total 1521 complete days of valid CGM data were recorded under real-life conditions from a healthy sample of a Spanish community, as were matching FPG and HbA1 C data. No participant was pregnant, had a history of kidney or liver disease, or was taking drugs known to affect glycaemia., Results: CGM and fingerstick measurements showed a mean relative absolute difference of 6.9 ± 2.2%. All subjects were normoglycaemic according to FPG and HbA 1C except 21% who were prediabetic. The normoglycaemic subjects had a 24-hour mean blood glucose concentration (MBG) of 5.7 ± 0.4 mmol/L, spending a median of 97% of their time within the target range (3.9-7.8 mmol/L). 73% of them experienced episodes with blood glucose levels above the threshold for impaired glucose tolerance, and 5% levels above the threshold for diabetes. These normoglycaemic participants with episodes of high glycaemia had glycaemic variabilities similar to those of prediabetic subjects with episodes of similar intensity or combined duration., Conclusions: CGM is a better indicator of possible early dysglycaemia than either FPG or HbA1c., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: The role of surgery in stage IIIA-N2 non-small cell lung cancer (NSCLC) is an actively debated in oncology. To evaluate the value of surgery in this patient population, we conducted a multi-institutional retrospective study comparing neoadjuvant chemoradiotherapy or chemotherapy plus surgery (CRTS) to definitive chemoradiotherapy (dCRT)., Material and Methods: A total of 247 patients with potentially resectable stage T1-T3N2M0 NSCLC treated with either CRTS or dCRT between January 2005 and December 2014 at 15 hospitals in Spain were identified. A centralized review was performed to ensure resectability. A propensity score matched analysis was carried out to balance patient and tumor characteristics (n = 78 per group)., Results: Of the 247 patients, 118 were treated with CRTS and 129 with dCRT. In the CRTS group, 62 patients (52.5%) received neoadjuvant CRT and 56 (47.4%) neoadjuvant chemotherapy. Surgery consisted of either lobectomy (97 patients; 82.2%) or pneumonectomy (21 patients; 17.8%). In the matched samples, median overall survival (OS; 56 vs 29 months, log-rank p = .002) and progression-free survival (PFS; 46 vs 15 months, log-rank p < 0.001) were significantly higher in the CRTS group. This survival advantage for CRTS was maintained in the subset comparison between the lobectomy subgroup versus dCRT (OS: 57 vs 29 months, p < 0.001; PFS: 46 vs 15 months, p < 0.001), but not in the comparison between the pneumonectomy subgroup and dCRT., Conclusion: The findings reported here indicate that neoadjuvant chemotherapy or chemoradiotherapy followed by surgery (preferably lobectomy) yields better OS and PFS than definitive chemoradiotherapy in patients with resectable stage IIIA-N2 NSCLC., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: The objective was to investigate glycemic variability indices in relation to demographic factors and common environmental lifestyles in a general adult population., Methods: The A Estrada Glycation and Inflammation Study is a cross-sectional study covering 1516 participants selected by sampling of the population aged 18 years and over. A subsample of 622 individuals participated in the Glycation project, which included continuous glucose monitoring procedures. Five glycemic variability indices were analyzed, that is, SD, MAGE, MAG, CONGA1, and MODD., Results: Participants had a mean age of 48 years, 62% were females, and 12% had been previously diagnosed with diabetes. In the population without diabetes, index distributions were not normal but skewed to the right. Distributional regression models that adjusted for age, gender, BMI, alcohol intake, smoking status, and physical activity confirmed that all indices were positively and independently associated with fasting glucose levels and negatively with heavy drinking. SD, MAGE, and CONGA1 were positively associated with aging, and MAG was negatively associated with BMI. None of the GVI studied were influenced by physical activity. Age-group-specific reference values are given for the indices., Conclusions: This study yielded age-specific reference values for glucose variability indices in a general adult population. Significant increases were observed with aging. Heavy drinking of more than 140 g/week was associated with significant decreases in variability indices. No differences were found between males and females. These normative ranges provide a guide for clinical care, and may offer an alternative treatment target among persons with diabetes.

Introduction  Low values of esophageal impedance baseline (EIB) have been related to esophagitis. The aim of this study was to evaluate the diagnostic performance of EIB for erosive esophagitis (ErE) and histological esophagitis (HiE) in children studied for gastroesophageal reflux. Material and Methods  Children who underwent esophageal multichannel intraluminal impedance-pH monitoring (MII-pH) and upper-endoscopy with esophageal biopsies were studied retrospectively. EIB values were obtained by MII-pH. ErE was assessed by endoscopy following the Hetzel-Dent classification; HiE was defined by basal zone hyperplasia, papillary lengthening, or inflammatory infiltration. EIB was compared between groups. Receiver operating characteristic (ROC) curves were obtained to calculate the global diagnostic performance of EIB and to find cut-off values for sensitivity and specificity. Logistic regression was used for age adjustment. Results  Fifty-one patients were studied: 11 had ErE and 23 had HiE. EIB median values were 1,159 in ErE versus 2,583 in non-ErE (U = 80, p  < 0.01). The adjusted ROC curve analysis for ErE was 0.85 (95% CI = 0.74-0.96); the EIB cut-off value = 2,379 determined sensitivity = 100% and specificity = 52.6% in children < 4 years old. and sensitivity = 100% and specificity = 63.2% in children > 4 years old. EIB median values were 1,666 in HiE versus 2,669 in non-HiE ( U  = 80, p  < 0.01). The adjusted ROC curve analysis for HiE was 0.75 (95% CI = 0.59-0.90); the EIB cut-off value = 2,296 determined sensitivity = 71.2% and specificity = 83.1% in children < 4 years old, and sensitivity = 75.1% and specificity = 80.1% in children > 4 years old. Conclusion  EIB provides statistically significant diagnostic performances for ErE and HiE. It could become a useful tool, especially to discriminate between ErE and non-ErE, avoiding other invasive tests., (Georg Thieme Verlag KG Stuttgart · New York.)