Identification of phase angle and Triglyceride-Glucose index as biomarkers for prediction and management of diabetic foot disease.

Introduction: Approximately 25 % of diabetic patients develop diabetic foot ulcers (DFUs), significantly increasing morbidity, mortality, and healthcare costs. Effective control and prevention are crucial. Objective: This study aims to identify easily measurable parameters for predicting DFU risk by assessing the correlation between Phase Angle (PA) and the Triglyceride-Glucose (TyG) index with DFU risk. Materials and methods: A comparative case-control study was conducted at the General Hospital of Elche from March to June 2023 with 70 participants (33 with diabetes, 37 without). Cases had diabetes for over five years and a diabetic foot risk grade of 0, 1, or 2 (IWGDF 2019). Exclusion criteria included inability to walk, prior use of orthoses, and severe complications like edema or wounds. Predictive variables were PA, TyG index, body composition, and biochemical markers. Statistical analyses included Pearson/Spearman tests for correlations, Student's t-test/Mann-Whitney test for group comparisons, and ANOVA/Kruskal-Wallis tests for normally and non-normally distributed variables. Results: PAand TyG index were strongly linked to diabetic foot risk, supporting their potential as biomarkers. Significant relationships with other relevant biomarkers were also confirmed. Conclusion: PA and TyG index are valuable, easily measurable biomarkers for assessing diabetic foot risk, and can be monitored in primary care settings. Implementing these biomarkers in routine practice could enhance the management of diabetic complications, particularly in resource-limited settings, by enabling early detection and intervention, thus improving patient outcomes and reducing the burden of advanced complications.

Human sperm motility, capacitation and acrosome reaction are impaired by 2-arachidonoylglycerol endocannabinoid.

The endocannabinoids are cannabinoids synthesized by mammalian tissues. These compounds are closely related to the regulation of the male reproductive system. However, little is known about the effects produced by 2-arachidonoylglycerol (2AG) on in vitro human sperm functions. This study was undertaken to determine the effects produced by 2AG on fresh human sperm and in the capacitation technique. Semen samples from healthy young men were exposed to different concentrations of 2AG before and during capacitation technique. In this work, we have demonstrated that 2AG induces the spontaneous acrosome reaction and reduces progressive motility in fresh human sperm. During the capacitation technique, sperm becomes more sensitive to low concentrations of 2AG, triggering the acrosome reaction and inhibiting protein phosphorylation. In summary, 2AG affects the in vitro functionality of human sperm by reducing motility, inhibiting capacitation and triggering the acrosome reaction.

[Eponyms in musculoskeletal radiology: stories of bones, persons, and civilizations]. / Epónimos en radiología del esqueleto: cuentos de huesos, hombres y civilizaciones.

Eponyms reflect the history of medicine, of disease, and of physicians, but eponyms also reflect the history of the societies in which these physicians lived. Both loved and hated, eponyms are at the center of an interminable debate about whether they should continue to be used or whether they should disappear, and this debate has become more intense since some scientific societies have purged their terminologies of eponyms related to Nazism. Eponyms abound in conventional musculoskeletal radiology. In this article, rather than attempt an exhaustive review of all these eponyms, we take a few representative examples to illustrate the contributions of eponyms to medicine and the history of medicine.

Variables associated with the use of coercive measures on psychiatric patients in Spanish penitentiary centers.

We have studied the use of coercive medical measures (forced medication, isolation, and mechanical restraint) in mentally ill inmates within two secure psychiatric hospitals (SPH) and three regular prisons (RP) in Spain. Variables related to adopted coercive measures were analyzed, such as type of measure, causes of indication, opinion of patient inmate, opinion of medical staff, and more frequent morbidity. A total of 209 patients (108 from SPH and 101 from RP) were studied. Isolation (41.35%) was the most frequent coercive measure, followed by mechanical restraint (33.17%) and forced medication (25.48%). The type of center has some influence; specifically in RP there is less risk of isolation and restraint than in SPH. Not having had any previous imprisonment reduces isolation and restraint risk while increases the risk of forced medication, as well as previous admissions to psychiatric inpatient units does. Finally, the fact of having lived with a partner before imprisonment reduces the risk of forced medication and communication with the family decreases the risk of isolation. Patients subjected to a coercive measure exhibited a pronounced psychopathology and most of them had been subjected to such measures on previous occasions. The mere fact of external assessment of compliance with human rights slows down the incidence of coercive measures.

Predictive factors of achieving therapeutic goals of hypertriglyceridemia.

OBJECTIVES: The aim of this study was to ascertain the factors associated with non-achievement of triglyceride (TG) goals in a cohort of hypertriglyceridemic patients attending the lipid clinics of the Spanish Arteriosclerosis Society (LC-SAS). METHODS: Patients with high TG levels (>2.2 mmol/L; 200 mg/dL) were included in this multicenter, prospective, observational study and followed up for 1 year. The TG goal was ≤2.2 mmol/L (200 mg/dL). Main limitations of this study are that etiologic diagnosis of hypertriglyceridemia was not done under unified criteria and drug compliance was not evaluated. RESULTS: From 1394 patients initially included in the study, 929 (age range: 50 ± 12 years, 26% women) were followed up for 1 year; 523 patients (56%) failed to reach the TG target. These patients were younger, had a higher body mass index (BMI), were more frequently smokers, hypertensive and diabetic and had more severe dyslipidemia. They were also more sedentary, their diet was of poorer quality and they had higher alcohol consumption. The independent predictors of treatment failure were hypertriglyceridemia severity, low high density lipoprotein cholesterol (HDL-C), and high non-HDL-C, alcohol consumption and a raised BMI, while drug treatment had no predictive power. CONCLUSION: Independent predictors of failure to achieve hypertriglyceridemia treatment goals are inappropriate lifestyle, evidenced by insufficient weight loss, alcohol consumption and dyslipidemia severity.

Capacitation and acrosome reaction changes α-tubulin immunodistribution in human spermatozoa.

Tubulin is a protein constituent of cytoskeletal microtubules, closely related to sperm motility. However, the changes in tubulin distribution following capacitation and acrosome reaction are poorly understood. This study immunolocalized and quantified the expression of α-tubulin in fresh, capacitated and acrosome-reacted samples. Immunocytochemical data showed that in capacitated and acrosome-reacted spermatozoa, α-tubulin is labelled throughout most of the flagellum (⩾66.66%). However, the mean α-tubulin-labelled area in these samples was significantly lower than in fresh samples (P<0.05). Thus, there are different sperm clusters distinguished by their α-tubulin immunoreactivity and this could be directly linked to structural changes following capacitation and acrosome reaction.

[Intravenous infusion of adult adipose tissue stem cells for repairing spinal cord ischaemic lesions. An experimental study on animals]. / Infusión intravenosa de células madre adultas procedentes del tejido adiposo para la reparación de lesiones medulares isquémicas. Estudio experimental en conejos.

OBJECTIVE: To assess if a peripheral intravenous infusion of adipose tissue stem cells (ATSC), after an ischemic spinal cord injury can promote selective cell migration and cell survival in the damaged neural tissue. ANIMALS AND METHOD: An ischaemic spinal cord injury was provoked by trapping the abdominal aorta for 20 minutes in 11 male New Zealand rabbits (2.5±0.5kg). They were randomised into two groups: one group (n=5) received an intravenous transfusion of 10±2×10(6) ATSC at 24 hours from the injury, and the control group (n=6) were only given the vehicle. The functional status was assessed, using the Tarlov scale at 24h, and 7 and 14 days. The animals were sacrificed at 14 days and a histological and immunohistochemical study was performed. RESULTS: Complete paraplegia was achieved in both groups. There were no significant differences as regards neurological recovery, which was nil in both cases. In the histological and immunohistochemical study, it was tested to see if there was any bromodeoxyuridine-marked ATSC in the area of the lesion, but there was only a small amount. CONCLUSION: ATSC are able to migrate and survive in the injured spinal cord after aortic ischaemia after they have been administered intravenously. Intravenous infusion is a harmless procedure with no side effect. No neurological recovery was achieved.

Mitochondrial DNA variability of the pipefish Syngnathus abaster.

This study provides data on the genetic structuring of the pipefish Syngnathus abaster in the western Mediterranean and Adriatic Seas. A total of 109 specimens were collected in brackish-water biotopes. The control region and three other regions of the mitochondrial genome were analysed. The most relevant result was the high genetic structuring found by Bayesian inference (BI), maximum likelihood (ML) and network analyses, which were consistent in showing three well-separated clusters of S. abaster populations. Furthermore, BI and ML did not support the monophyly of the taxon S. abaster. These results suggest the occurrence of a species complex in the study area, whose differentiation may have occurred since the Pleistocene. The results also show a very high genetic variability at the inter-population level, with no shared haplotypes among sites. Evolutionary forces due to the fragmented nature of the brackish-water habitats may account for the high genetic divergence found among the groups and populations. Finally, although dispersal by rafting over long distances may occasionally occur, this study suggests linear stepping-stone model of colonization to be most likely. The complexity of the results obtained suggests that further studies are needed to elucidate the phylogeny of S. abaster.

Characterization of the lectin binding pattern in human spermatozoa after swim-up selection.

Capacitation is characterized by a hyperactivated pattern of sperm motility. The acquisition of highly motility is present in the early stages of capacitation. Sperm progressive motility is one of the most important parameters for determining the suitability of semen for processing. However, previous studies have shown that some sperm showing good motility have membrane damage. The aim of our study was to characterize the lectin staining pattern on the sperm plasma membrane of unselected and selected human sperm of normozoospermic donors. Sperm selection was performed by the swim-up technique. Fourteen samples from healthy consenting donors classified as normozoospermic according to the World Health Organization were used. We observed changes in the distribution of the carbohydrate residues after the swim-up selection. With Triticum vulgaris, the most abundant pattern was dotted labeling all over the head plasma membrane in the unselected sperm. However, this lectin was distributed homogenously over the acrosomal region after selection. With Arachis hypogaea, the most abundant pattern in fresh sperm was a highly stained acrosomal region. In the highly motility sperm population, the most frequent pattern was dotted fluorescence on the acrosomal region and a highly stained equatorial segment. Meanwhile, with the Aleuria aurantia and Canavalia ensiformis lectins, the most representative patterns were the same before and after the swim-up selection. Our data indicate that modifications which occur in carbohydrate residues during swim-up selection could be important for the regulation of progressive motility and prepare the sperm for capacitation.

[Reasons for not initating HCV treatment in prison: a subanalysis of the EPIBAND study]. / Causas de no inicios al tratamiento de la hepatitis C en el medio penitenciario: subanálisis del estudio EPIBAND.

OBJECTIVE: This sub-analysis was designed within the framework of the EPIBAND study to establish the reasons why prison patients do not initiate HCV treatment. METHODS: Epidemiological, prospective, multicentre study conducted in 26 centres. We present the results from those patients included in the EPIBAND study who did not initiate HCV treatment for different reasons. RESULTS: A total of 195 patients were evaluated (average age 39 ± 6.6 years, 86.7% male and 96.9% Spanish nationality). The reasons why this population did not initiate HCV treatment were secondary ones relating to the patient (41%), medical reasons (30.8%), and the prison environment (3.6%). 47.5% of patients reported lack of awareness and motivation, and 18.8% did not initiate treatment as a result of adverse events. Immunological status (35%). as well as psychiatric and neurological disorders (28.3%) were the main medical reasons for contraindication. Aspects associated to prison environment such as impending release or change of prison (64.4%) were among the various reasons that influenced treatment initiation. CONCLUSIONS: Lack of motivation and awareness in patients as well as adverse events were the main reasons for not initiating therapy. These factors are subjective, modifiable aspects that depend on patient education and adequate medical care.

Modelling the effect of the physical and chemical characteristics of the materials used as casing layers on the production parameters of Agaricus bisporus.

The aim of this research was to show the mathematical data obtained through the correlations found between the physical and chemical characteristics of casing layers and the final mushrooms' properties. For this purpose, 8 casing layers were used: soil, soil + peat moss, soil + black peat, soil + composted pine bark, soil + coconut fibre pith, soil + wood fibre, soil + composted vine shoots and, finally, the casing of La Rioja subjected to the ruffling practice. The conclusion that interplays in the fructification process with only the physical and chemical characteristics of casing are complicated was drawn. The mathematical data obtained in earliness could be explained in non-ruffled cultivation. The variability observed for the mushroom weight and the mushroom diameter variables could be explained in both ruffled and non-ruffled cultivations. Finally, the properties of the final quality of mushrooms were established by regression analysis.

Combined method for reduction of high frequency interferences in surface electroenterogram (EEnG).

Surface electroenterogram (EEnG) recording is a novel technique for monitoring intestinal motility non-invasively. However, surface EEnG recordings are contaminated by cardiac activity, the respiratory artefact, movement artefacts and other types of interference. The goal of this work is to remove electrocardiogram (ECG) interference and movement artefacts from surface EEnG by means of a combined method of empirical mode decomposition and independent component analysis. For this purpose, 11 recording sessions were conducted on animal models. In order to quantify the effectiveness of the proposed method, several parameters were calculated from each session: signal-to-ECG interference ratio (S/I), energy over 2 Hz (EF2) which quantifies the intestinal motility index of external EEnG recording and the variation of EF2. The proposed method removes both ECG interference and movement artefacts from surface EEnG, obtaining a significantly higher S/I ratio and considerably reducing the non-physiological variation of EF2. Furthermore, after applying the combined method, the correlation coefficient between internal recording EF2 and surface recording EF2 rises significantly. The proposed method could therefore be a useful tool to reduce high frequency interference in EEnG recording and to provide more robust non-invasive intestinal motility indexes.

The detection of intestinal spike activity on surface electroenterograms.

Myoelectrical recording could provide an alternative technique for assessing intestinal motility, which is a topic of great interest in gastroenterology since many gastrointestinal disorders are associated with intestinal dysmotility. The pacemaker activity (slow wave, SW) of the electroenterogram (EEnG) has been detected in abdominal surface recordings, although the activity related to bowel contractions (spike bursts, SB) has to date only been detected in experimental models with artificially favored electrical conductivity. The aim of the present work was to assess the possibility of detecting SB activity in abdominal surface recordings under physiological conditions. For this purpose, 11 recording sessions of simultaneous internal and external myolectrical signals were conducted on conscious dogs. Signal analysis was carried out in the spectral domain. The results show that in periods of intestinal contractile activity, high-frequency components of EEnG signals can be detected on the abdominal surface in addition to SW activity. The energy between 2 and 20 Hz of the surface myoelectrical recording presented good correlation with the internal intestinal motility index (0.64 +/- 0.10 for channel 1 and 0.57 +/- 0.11 for channel 2). This suggests that SB activity can also be detected in canine surface EEnG recording.

Characterization of the sensitivity of a TCB laplacian sensor for surface EEnG recordings.

The improvement of the quality of electroenterogram (EEnG) recordings on abdominal surface could lead to a non-invasive technique to diagnose intestinal motility dysfunctions. In this context, the use of coaxial active electrodes, which permit to record the laplacian potential, can help to achieve such signal enhancement. In this paper, we present a methodology to obtain the maps of sensitivity of this kind of electrodes to pick up the activity of electric dipoles of different orientations. The proposed methodology employs mathematical models, as well as experimental studies (phantoms) to check the theoretical results. The mathematical model of the electrode, and of the human abdomen is developed by means of ANSYS. A simplified physical model is formed by real ring electrodes, a methacrylate tank of size 50 x 50 x 50 cm filled with a saltwater mixture of 2.5 g/l concentration, and moving electric dipoles made by wires of 0.3 mm in diameter. Sensitivity of the sensor is obtained for different depths and different axial distances of vertical and horizontal dipoles. Preliminary results of tripolar ring electrodes in bipolar configuration (TCB) are shown. The obtained results prove the agreement between mathematical and experimental results. The validated model will allow us to study the behavior of laplacian ring electrodes of different dimensions and materials to record the EEnG activity and to analyze the influence of the abdominal layers.

Enhancement of the non-invasive electroenterogram to identify intestinal pacemaker activity.

Surface recording of electroenterogram (EEnG) is a non-invasive method for monitoring intestinal myoelectrical activity. However, surface EEnG is seriously affected by a variety of interferences: cardiac activity, respiration, very low frequency components and movement artefacts. The aim of this study is to eliminate respiratory interference and very low frequency components from external EEnG recording by means of empirical mode decomposition (EMD), so as to obtain more robust indicators of intestinal pacemaker activity from the external EEnG signal. For this purpose, 11 recording sessions were performed in an animal model under fasting conditions and in each individual session the myoelectrical signal was recorded simultaneously in the intestinal serosa and the external abdominal surface in physiological states. Various parameters have been proposed for evaluating the efficacy of the method in reducing interferences: the signal-to-interference ratio (S/I ratio), attenuation of the target and interference signals, the normal slow wave percentage and the stability of the dominant frequency (DF) of the signal. The results show that the S/I ratio of the processed signals is significantly greater than the original values (9.66 +/- 4.44 dB versus 1.23 +/- 5.13 dB), while the target signal was barely attenuated (-0.63 +/- 1.02 dB). The application of the EMD method also increased the percentage of the normal slow wave to 100% in each individual session and enabled the stability of the DF of the external signal to be increased considerably. Furthermore, the variation coefficient of the DF derived from the external processed signals is comparable to the coefficient obtained using internal recordings. Therefore, the EMD method could be a very useful tool to improve the quality of external EEnG recording in the low frequency range and therefore to obtain more robust indicators of the intestinal pacemaker activity from non-invasive EEnG recordings.

[Importance of early diagnosis and treatment in the prognosis of type I Glutaric Acidaemia]. / Importancia del diagnóstico precoz y el tratamiento temprano en el pronóstico de la aciduria glutárica tipo I.

INTRODUCTION: Glutaric Acidaemia type I (GA-I) is an autosomal recessive progressive neurodegenerative inborn error of metabolism caused by deficient activity of the enzyme glutaryl-CoA dehydrogenase (GCDH). In most cases, the diagnosis is established biochemically by the detection of glutaric acid and 3-hydroxy glutaric acid in urine and glutarylcarnitine in plasma. Patients excreting small amounts of glutaric acid may be overlooked. OBJECTIVE: To investigate the value of expanded newborn screening by adding the measurement of urine glutarylcarnitine to conventional chromatography-mass spectrometry (GC-MS) in the diagnosis of GA-1. MATERIAL AND METHODS: We report clinical and biochemical data in 5 GA-I patients diagnosed in our Hospital. Details regarding biochemical diagnosis are emphasised and the absence or presence of symptoms was correlated with neuroimaging findings, age at diagnosis and treatment. RESULTS: Two patients showed high glutarylcarnitine levels in plasma and were identified by routine newborn GC-MS screening. Following early appropriate treatment they are asymptomatic 6 years later. Two patients with delayed diagnosis displayed neurological sequels in spite of treatment. The remaining patient, who presented with encephalopathic episode at age 8 months showed normal glutarylcarnitine levels in routine plasma GC-MS but high urine glutarylcarnitine levels in a retrospectively screened urine sample from the newborn period. CONCLUSIONS: Early treatment seems to positively influence the clinical evolution of GA-I patients. Thus, improving the identification of GA-I represents an important diagnostic challenge. The urinary excretion of glutarylcarnitine is a specific biochemical marker of GA-I and allows the identification of patients without glutaric aciduria and with normal plasma acylcarnitine profiles.

Quantification of combined method for interferences reduction in multichannel surface electroenterogram.

Surface electroenterogram (EEnG) is a non-invasive method for monitoring the intestinal motility. However, surface EEnG signals are contaminated by strong physiological interferences. The main interferences which affect high-frequency components of surface EEnG are cardiac activity and movement artifacts. The aim of this work is to quantify the effectiveness of a combined method based on empirical mode decomposition and independent component analysis to remove these interferences from multichannel surface EEnG. In order to do so, several parameters were calculated from five recording sessions: Signal-to-ECG interference ratio (S/I) and variation of energy over 2 Hz (EF2). The results show that the S/I of processed signals was significantly higher than that of original signals, moreover the improvement of the S/I ratio is due to the attenuation of energy associated to interference. The proposed method also allows cancelling movement artifacts from surface EEnG, reducing considerably the non-physiological variation of EF2. Furthermore after the application of the combined method, correlation coefficient between EF2 of internal recording with EF2 of surface recording is greatly higher. Therefore, the proposed method could be helpful to reduce high-frequency interferences in EEnG recording and to provide more robust non-invasive intestinal motility indicators.

Combined method for artifact reduction in surface electroenterogram.

Surface electroenterogram (EEnG) is a non-invasive method for monitoring the intestinal motility. However, surface EEnG recordings are contaminated by movement artifact, cardiac activity, respiratory artifact and other interferences. The aim of this work is to remove movement artifacts by means of a combined method of empirical mode decomposition (EMD) and independent component analysis (ICA). Four recording sessions were conducted on canine model. Surface signals from 4 different channels are decomposed using EMD. Resulting intrinsic mode functions are the inputs of ICA analysis which permits to separate and identify the activities of different origin. Signal components associated to movement artifacts are removed and the original signals are reconstructed by means of an inverse procedure. The results show that the proposed method allows extracting and cancelling movement artifacts from surface EEnG, avoiding the presence of irregular peaks in external intestinal motility indexes. Therefore, the proposed method could be useful to reduce artifacts in EEnG recording and to provide more robust non-invasive intestinal motility indicators.

[Advances in the diagnosis and treatment of maple syrup urine disease: experience in Galicia (Spain)]. / Avances en el diagnóstico y tratamiento de la enfermedad de jarabe de arce, experiencia en Galicia.

INTRODUCTION: Maple syrup urine disease (MSUD) is a rare autosomal recessive disorder caused by an inherited deficiency of branched chain alpha-ketoacid dehydrogenase activity. Accumulation of the amino acids leucine, isoleucine, valine and alloisoleucine and their metabolic products in cells and biological fluids results in severe brain dysfunction. PATIENTS AND METHODS: We present three cases of MSUD diagnosed in Galicia since 2000, the year in which the Extended Newborn Screening Program by tandem mass spectrometry was started in this region. One of the patients was diagnosed on the basis of early clinical presentation and the others by neonatal screening. Enzymatic and molecular studies confirmed two classic cases of MSUD and an intermediate variant. We describe the clinical and biochemical details at confirmation of diagnosis and the long-term outcome of the three patients. Throughout follow-up, all the patients maintained adequate leucine levels, which were near the normal range (mean levels: 220, 177 and 252 micromol/L, respectively). Several moderate metabolic decompensations were observed but leucine levels only occasionally exceeded 1000 micromol/L (one day in two patients). IQ tests were performed in all patients and scores were within the normal range. In view of our results, we believe the following measures are essential to improve the prognosis of MSUD: inclusion of this disease in Expanded Neonatal Screening Programs with early samples (at 2-3 days of life); aggressive treatment in the initial phase and during acute decompensations; strict metabolic control to prevent crises, monitoring of branched-chain amino acids (dried blood spot sample), and maintenance of long term plasma leucine levels below 300 micromol/L.