Impact of HbA1c Measurement on Hospital Readmission Rates: Analysis of 70,000 Clinical Database Patient Records

Management of hyperglycemia in hospitalized patients has a significant bearing on outcome, in terms of both morbidity and mortality. However, there are few national assessments of diabetes care during hospitalization which could serve as a baseline for change. This analysis of a large clinical database (74 million unique encounters corresponding to 17 million unique patients) was undertaken to provide such an assessment and to find future directions which might lead to improvements in patient safety. Almost 70,000 inpatient diabetes encounters were identified with sufficient detail for analysis. Multivariable logistic regression was used to fit the relationship between the measurement of HbA1c and early readmission while controlling for covariates such as demographics, severity and type of the disease, and type of admission. Results show that the measurement of HbA1c was performed infrequently (18.4%) in the inpatient setting. The statistical model suggests that the relationship between the probability of readmission and the HbA1c measurement depends on the primary diagnosis. The data suggest further that the greater attention to diabetes reflected in HbA1c determination may improve patient outcomes and lower cost of inpatient care

A clinico-pathological and molecular analysis reveals differences between solitary (early and late-onset) and synchronous rectal cancer

Rectal cancer (RC) appears to behave differently compared with colon cancer. We aimed to analyze existence of different subtypes of RC depending on distinct features (age of onset and the presence of synchronous primary malignant neoplasms). We compared the clinicopathological, familial and molecular features of three different populations diagnosed with RC (early-onset RC [EORC], late-onset RC, and synchronous RC [SRC]). Eighty-five RCs were identified and were evaluated according to their microsatellite instability, CpG Island Methylator Phenotype (CIMP) and chromosomal instability, as assessed by Next Generation Sequencing and microarray-based comparative genomic hybridization approaches. The results were subjected to cluster analysis. SRCs displayed the most specific characteristics including a trend for the development of multiple malignant neoplasms, a greater proportion of CIMP-High tumors (75%) and more frequent genomic alterations. These findings were confirmed by a clustering analysis that stratified RCs according to their genomic alterations. We also found that EORCs exhibited their own features including an important familial cancer component and a remarkable rate of mutations in TP53 (53%). Together, heterogeneity in RC characteristics by age of disease-onset and SRC warrants further study to optimize tailored prevention, detection and intervention strategies—particularly among young adults.This work was funded by the Spanish Ministry of Health and Consumer Affairs and FEDER, Grant number PI16/01650 to José Perea, PI16/01920 to Rogelio González-Sarmiento, and PI14/00459 to Miguel Uriost

Comment on 'Distinct clinical outcomes of two CIMP-positive colorectal cancer subtypes based on a revised CIMP classification system'

This work was funded by Projects PI13/01741, PI13/01273, PI16/01920 and PI16/01650 from the Spanish Ministry of Health and Consumer Affairs and FEDER, and Mutua Madrileña Foundation (2012-0036), and was approved by the Ethics Committee of our Institution.Peer Reviewe

Effects of morphine self-administration on brain glucose metabolism in rats

Abstract of: AMI Annual Conference 2006, March 25-29Chronic exposure to opiates has been shown to influence neural activity in brain regions related to the rewarding process. It also induces neuroadaptations which lead to addiction. We have found in previous works that morphine self-administration produces neuroadaptative changes in brain areas of Fischer-344 rats. The aim of this study is to examine the effect of chronic self-administration of morphine on cerebral glucose metabolismPublicad

Chronic cannabinoid administration to periadolescent rats modulates the metabolic response to acute cocaine in the adult brain

Purpose: To analyze brain metabolic response to acute cocaine in male and female Wistar rats with or without a history of cannabinoid exposure during periadolescence. Procedures: The synthetic cannabinoid agonist CP 55,940 (CP) or its vehicle (VH), were administered to male and female rats during periadolescence. When these animals reached adulthood, saline and cocaine-induced changes in 2-deoxy-2-[18F]fluoro D glucose (FDG) uptake were studied by positron emission tomography. Results: The baseline (post-saline) metabolism in the septal nuclei was higher in CP-females than in VH-females, although septal metabolism was lower in CP-females after cocaine, reaching similar values to those of VH-females at baseline. Cocaine did not affect metabolism in VH-females. Periadolescent cannabinoid treatment did not influence baseline metabolism in males although cocaine reduced the FDG uptake in the dorsal striatum of males that received the VH but not CP. Conclusions: These results suggest that cannabinoids during periadolescence modify baseline and cocaine-evoked brain metabolism in a sex-dependent manner. In the case of CP-females, the involvement of septal metabolic alterations in their susceptibility to the rewarding effects of cocaine should be further investigated.This work was supported by grants from the Ministerio de Educación y Ciencia (Grants nº SAF2004-08148 and SAF2007-064890); Ministerio de Sanidad y Consumo (Grants RD06/ 00170029 of Instituto de Salud Carlos III, PNSD 2004 2007 and 2008 2010); Dirección General de Investigación de la Comunidad de Madrid (Grant S-SAL/0261/2006, I+D CANNAB-CM Consortium); and UNED (Plan de Promoción de la Investigación) to EA, and grants from the “Ministerio de Ciencia y Tecnología” (TEC2004-07052-C02-01/TCM), “Ministerio de Sanidad y Consumo” (CIBER CB06/01/0079, PNSD 2007 2010, FIS CP08/00017), “Ministerio de Industria” (CENIT program) and “Fundación de Investigación Médica Mutua Madrileña” (2007 2010 and 2008 2011) to MD.Publicad

Case report : De novo pathogenic variant in WFS1 causes Wolfram-like syndrome debuting with congenital bilateral deafness

Background: Congenital deafness could be the first manifestation of a syndrome such as in Usher, Pendred, and Wolfram syndromes. Therefore, a genetic study is crucial in this deficiency to significantly improve its diagnostic efficiency, to predict the prognosis, to select the most adequate treatment required, and to anticipate the development of other associated clinical manifestations. Case presentation: We describe a young girl with bilateral congenital profound deafness, who initially received a single cochlear implant. The genetic study of her DNA using a custom-designed next-generation sequencing (NGS) panel detected a de novo pathogenic heterozygous variant in the WFS1 gene related to Wolfram-like syndrome, which is characterized by the presence of other symptoms such as optic atrophy. Due to this diagnosis, a second implant was placed after the optic atrophy onset. The speech audiometric results obtained with both implants indicate that this work successfully allows the patient to develop normal speech. Deterioration of the auditory nerves has not been observed. Conclusion: The next-generation sequencing technique allows a precise molecular diagnosis of diseases with high genetic heterogeneity, such as hereditary deafness, while this was the only symptom presented by the patient at the time of analysis. The NGS panel, in which genes responsible for both syndromic and non-syndromic hereditary deafness were included, was essential to reach the diagnosis in such a young patient. Early detection of the pathogenic variant in the WFS1 gene allowed us to anticipate the natural evolution of the disease and offer the most appropriate management to the patient

Intermediate-onset colorectal cancer: A clinical and familial boundary between both early and late-onset colorectal cancer

Comparative studies of colorectal cancer (CRC) according to the age of onset have found differences between early-onset CRC (EOCRC) and late-onset CRC (LOCRC). Using this as a starting point, we wished to determine whether intermediate-onset CRC (IOCRC) might also be considered as an independent group within CRC. We performed a retrospective comparative study of the clinicopathological and familial features, as well as of the symptoms and their duration, of a total of 272 subjects diagnosed with CRC classified into three groups according to the age-of-onset (98 EOCRC, 83 IOCRC and 91 LOCRC). The results show that from a clinicopathological point of view, IOCRC shared certain features with EOCRC (gender, prognosis), and with LOCRC (multiple primary CRCs), whereas it also had characteristics that were specific for IOCRC (mean number of associated polyps). A gradual progression was observed from EOCRC to LOCRC from a greater family aggregation to sporadic cases, in parallel with a change of Lynch Syndrome cases to the sporadic microsatellite instability pathway, with the IOCRC being a boundary group that is more related to EOCRC. With respect to symptoms, duration and correlation with stages, IOCRC appeared more similar to EOCRC. Clinically, IOCRC behaves as a transitional group between EOCRC and LOCRC, with features in common with both groups, but also with IOCRC-specific features. Excluding cases with familial cancer history, the awareness for EOCRC diagnosis should be extended to IOCRC.Wethank the Tumor Registry of the Pathology Department of the 12 de Octubre University Hospita lfor providing the paraffinembedded tissues,and Ron Hartong for his help with the English revision of this manuscript.S

Discriminant Analysis of Geographical Origin of Cork Planks and Stoppers by Near Infrared Spectroscopy

The objective of this study was to assess the potential of visible and near infrared spectroscopy (VIS+NIRS) combined with multivariate analysis for identifying the geographical origin of cork. The study was carried out on cork planks and natural cork stoppers from the most representative cork-producing areas in the world. Two training sets of international and national cork planks were studied. The first set comprised a total of 479 samples from Morocco, Portugal, and Spain, while the second set comprised a total of 179 samples from the Spanish regions of Andalusia, Catalonia, and Extremadura. A training set of 90 cork stoppers from Andalusia and Catalonia was also studied. Original spectroscopic data were obtained for the transverse sections of the cork planks and for the body and top of the cork stoppers by means of a 6500 Foss-NIRSystems SY II spectrophotometer using a fiber optic probe. Remote reflectance was employed in the wavelength range of 400 to 2500 nm. After analyzing the spectroscopic data, discriminant models were obtained by means of partial least square (PLS) with 70% of the samples. The best models were then validated using 30% of the remaining samples. At least 98% of the international cork plank samples and 95% of the national samples were correctly classified in the calibration and validation stage. The best model for the cork stoppers was obtained for the top of the stoppers, with at least 90% of the samples being correctly classified. The results demonstrate the potential of VIS + NIRS technology as a rapid and accurate method for predicting the geographical origin of cork plank and stopper

Aplicación de analisis de imagen y tecnología NIRS a la evaluacion de la porosidad de planchas, láminas y tapones de corcho y su relacion con la calidad industrial

The quality of cork is one of the most important issues for the cork industry. It is a complex process that requires evaluating many factors and simultaneously handles continuous and discrete variables, sometimes with a high degree of subjectivity. There are two objectives, in first place to establish the relationship between the commercial quality of the cork and the porosity measured by image analysis at different stages of industrial processing (planks, sheets, and stoppers), and in second place, to evaluate the potential of NIRS technology as a method of assessing the porosity and, therefore, the industrial quality. For this, there has been used a sample group formed by 479 planks, 176 sheets and 90 one piece natural cork stoppers, classified industrially into 4, 2 and 3 quality classes, respectively. The coefficient of porosity was evaluated into two and three classes of color by using image analysis techniques. NIRS spectra were obtained in the transverse section (planks and stoppers), in the tangential section (sheets and stoppers) and in the radial section (stoppers), with a spectrophotometer Foss NIRSystems 6500 SY II, by remote reflectance mode. Statistical analysis of the relationship between quality and coefficient of porosity, measured by image analysis, discriminates two quality classes for planks and sheets, and three classes for stoppers. Classifying the image into a larger number of clusters improves the results. Best NIRS calibrations were obtained measuring the porosity into 3 classes of color, matching the results obtained by image analysis. This allow to discriminate two quality classes in planks (refuse and race), the two classes in sheets (R2 =0.83; r2 =0.78) and the three classes for stoppers (R2 =0.67; r2 =0.53). Due to the difficulties of automated image analysis in the early stages of industrial processing, NIRS technology could be an objective tool to evaluate the porosity and to differentiate two classes of quality in planks and sheets, and three classes in stoppers.La calidad del corcho es una de las cuestiones más relevantes para el sector corchero. Es un proceso complejo que requiere evaluar múltiples factores y manejar simultáneamente variables cuantitativas y cualitativas, en ocasiones, con un alto grado de subjetividad. Se presentan dos objetivos, en primer lugar establecer la relación entre la calidad comercial del corcho y la porosidad medida mediante análisis de imagen en diferentes etapas de la transformación industrial (planchas, láminas y tapones), y en segundo lugar, evaluar el potencial de la tecnología NIRS como método de caracterización de la porosidad y, por tanto, de la calidad industrial. Para ello se ha utilizado un colectivo muestral formado por 479 planchas, 176 láminas y 90 tapones de corcho natural de una pieza, clasificados industrialmente en 4, 2 y 3 clases de calidad, respectivamente. El coeficiente de porosidad se evaluó aplicando técnicas de análisis de imagen, en dos y tres clases de color. Los espectros NIRS se obtuvieron en la sección transversal (planchas y tapones), en la sección tangencial (láminas y tapones) y en la sección radial (tapones), con un espectrofotómetro Foss NIRSystems 6500 SY II, mediante la modalidad de reflectancia remota. El análisis estadístico de la relación entre calidad y coeficiente de porosidad, medido mediante análisis de imagen, permite discriminar dos clases de calidad para planchas y láminas y tres clases para tapones. La clasificación de la imagen en un mayor número de cluster mejora los resultados. Las mejores calibraciones NIRS se obtuvieron para la porosidad medida en 3 clases de color, coincidiendo con los resultados obtenidos mediante análisis de imagen y permiten discriminar dos clases de calidad en planchas (refugo y corcho taponable), las dos clases en láminas (R2 =0,83; r2 =0,78) y las tres clases en tapones (R2 =0,67; r2 =0,53). Debido a las dificultades de automatización del análisis de imagen en las primeras etapas de la transformación industrial, la tecnología NIRS podría ser una herramienta objetiva que permitiera evaluar la porosidad y diferenciar dos clases de calidad en planchas y láminas y tres clases en tapones