Photoconductive focal plane array based on HgTe quantum dots for fast and cost-effective short-wave infrared imaging.

HgTe nanocrystals, thanks to quantum confinement, present a broadly tunable band gap all over the infrared spectral range. In addition, significant efforts have been dedicated to the design of infrared sensors with an absorbing layer made of nanocrystals. However, most efforts have been focused on single pixel sensors. Nanocrystals offer an appealing alternative to epitaxially grown semiconductors for infrared imaging by reducing the material growth cost and easing the coupling to the readout circuit. Here we propose a strategy to design an infrared focal plane array from a single fabrication step. The focal plane array (FPA) relies on a specifically designed readout circuit enabling in plane electric field application and operation in photoconductive mode. We demonstrate a VGA format focal plane array with a 15 µm pixel pitch presenting an external quantum efficiency of 4-5% (15% internal quantum efficiency) for a cut-off around 1.8 µm and operation using Peltier cooling only. The FPA is compatible with 200 fps imaging full frame and imaging up to 340 fps is demonstrated by driving a reduced area of the FPA. In the last part of the paper, we discuss the cost of such sensors and show that the latter is only driven by labor costs while we estimate the cost of the NC film to be in the 10-20 € range.

The complex optical index of PbS nanocrystal thin films and their use for short wave infrared sensor design.

As nanocrystals (NCs) gain maturity, they become central building blocks for optoelectronics in devices such as solar cells and, more recently, infrared focal plane arrays. Now that the proof of concept of these devices has been established, their optimization requires a deeper understanding of their electronic and optical features to engineer their optoelectronic properties accurately. Though PbS NCs have been extensively investigated, the complex optical index of PbS NC thin films remains mostly unknown. Some previous works have unveiled the optical index for this type of material optimized for solar cells (excitonic peak at 940 nm), but longer wavelengths remain scarce and surface chemistry effects, which are known to be of central importance for layer doping, are simply unexplored. Here, we conduct a systematic investigation of the complex optical index of PbS NC thin films using broadband spectrally resolved ellipsometry. The obtained results are then compared with simulations combining tight-binding (TB) modeling at the NC level and the Bruggeman model to expand the results to the film scale. While TB calculation gives the NC optical indices, we extract the key NC film parameters such as the NC volume fraction and ligand indices by fitting the Bruggeman formula to ellipsometry measurements. We also bring evidence that this joint modeling method can be conducted without the need for ellipsometry data while preserving the main feature of the experimental results. Finally, the unveiled optical indices are used to model the absorption of short-wave infrared diode stacks based on PbS NCs and are relevant for state-of-the-art devices. Our electromagnetic modeling shows that the absorption within the contact is now a major limitation of the current device operated at the telecom wavelength.

Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain.

INTRODUCTION: Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE: Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS: We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS: The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS: The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

Insulin Withdrawal in Diabetic Kidney Disease: What Are We Waiting for?

The prevalence of type 2 diabetes mellitus worldwide stands at nearly 9.3% and it is estimated that 20-40% of these patients will develop diabetic kidney disease (DKD). DKD is the leading cause of chronic kidney disease (CKD), and these patients often present high morbidity and mortality rates, particularly in those patients with poorly controlled risk factors. Furthermore, many are overweight or obese, due primarily to insulin compensation resulting from insulin resistance. In the last decade, treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) have been shown to be beneficial in renal and cardiovascular targets; however, in patients with CKD, the previous guidelines recommended the use of drugs such as repaglinide or dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors), plus insulin therapy. However, new guidelines have paved the way for new treatments, such as SGLT2i or GLP1-RA in patients with CKD. Currently, the new evidence supports the use of GLP1-RA in patients with an estimated glomerular filtration rate (eGFR) of up to 15 mL/min/1.73 m2 and an SGLT2i should be started with an eGFR > 60 mL/min/1.73 m2. Regarding those patients in advanced stages of CKD, the usual approach is to switch to insulin. Thus, the add-on of GLP1-RA and/or SGLT2i to insulin therapy can reduce the dose of insulin, or even allow for its withdrawal, as well as achieve a good glycaemic control with no weight gain and reduced risk of hypoglycaemia, with the added advantage of cardiorenal benefits.

Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain. / Antecedentes de comportamientos autolesivos y autolíticos en población adolescente y adulta joven transexual, atendida en una unidad especializada en identidad de género en España.

INTRODUCTION: Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE: Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS: We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS: The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS: The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

Transexualidad: transiciones, detransiciones y arrepentimientos en España / Transsexuality: Transitions, detransitions, and regrets in Spain

INTRODUCCIÓN: La demanda de atención sanitaria a personas transexuales o con incongruencia de género ha aumentado en los últimos años, sobre todo a expensas de jóvenes y adolescentes. También en paralelo ha aumentado el número de personas que refieren una pérdida o modificación en el sentimiento de género inicialmente expresado. Aunque siguen siendo minoría, nos enfrentamos cada vez más a casos complejos de personas transexuales que solicitan detransicionar y revertir los cambios conseguidos por arrepentimientos. OBJETIVO: Relatar nuestra experiencia con un grupo de personas transexuales en fase de detransición. Analizar su experiencia personal y los conflictos generados y reflexionar sobre estos procesos nunca antes descritos en España. MATERIAL Y MÉTODOS: Cohorte de 796 personas con incongruencia de género atendidas desde enero de 2008 hasta diciembre de 2018 en la Unidad de Identidad de Género del departamento Valencia Doctor Peset. De los 8 casos documentados de detransición y/o desistencia se relatan los 4 más representativos y que consideramos más ilustrativos de esta realidad. RESULTADOS: Las causas observadas que motivaron su detransición fueron la desistencia identitaria, las variantes de género no binarias, la psicomorbilidad asociada y la confusión entre identidad y orientación sexual. CONCLUSIÓN: La detransición es un fenómeno de presentación creciente que conlleva problemas clínicos, psicológicos y sociales. Una incorrecta evaluación y recurrir a la medicalización como única vía de mejora de la disforia en algunos jóvenes puede conducir a posteriores detransiciones. Es fundamental una atención integral dentro de un equipo multidisciplinar con experiencia. A falta de más estudios que determinen posibles factores predictivos de detransición, es recomendable proceder con prudencia en casos de historias identitarias atípicas

INTRODUCTION: Health care demand by transsexual people has recently increased, mostly at the expense of young and adolescents. The number of people who report a loss of or change in the former identity feeling (identity desistance) has also increased. While these are still a minority, we face more and more cases of transsexual people who ask for detransition and reversal of the changes achieved due to regret. OBJECTIVE: To report our experience with a group of transsexual people in detransition phase, and to analyze their personal experience and their associated conflicts. MATERIAL AND METHODS: A cohort of 796 people with gender incongruence attending the Identity Gender Unit of Doctor Peset University Hospital from January 2008 to December 2018 was studied. Four of the eight documented cases of detransition and/or regret are reported as the most representative. RESULTS: Causes of detransition included identity desistance, non-binary gender variants, associated psicomorbidities, and confusion between sexual identity and sexual orientation. CONCLUSION: Detransition is a growing phenomenon that implies clinical, psychological, and social issues. Inadequate evaluation and use of medicalization as the only means to improve gender dysphoria may lead to later detransition in some teenagers. Comprehensive care by a multidisciplinary and experienced team is essential. As there are no studies reporting the factors predictive of detransition, caution is recommended in cases of atypical identity courses

Tendencia de la población española de búsqueda en internet sobre información relacionada con diferentes dietas / Spanish population trends in Internet searches for information on different diets

OBJETIVO: Explorar a través Google Trends las tendencias del interés de la población española sobre información relacionada con diferentes tipos de dietas, focalizadas en las más populares y con estudios de evidencia, a lo largo de los últimos 10 años. MATERIAL Y MÉTODO: Se analizaron las tendencias de búsqueda de los términos «dieta mediterránea», «dieta cetogénica», «dieta baja en grasas», «ayuno intermitente» y «dieta vegana». El volumen relativo de búsqueda (VRB) de cada término fue comparado. La dirección de la tendencia se estudió mediante la correlación de Spearman (CS). RESULTADOS: El término «dieta mediterránea» fue el más buscado, con una mediana de VRB de 16 (rango intercuartil [RI] 6; rango 8-100), aunque siguió una tendencia cronológica decreciente (CS = -0,216). Le siguieron «dieta cetogénica», con VRB de 8 (RI 9; rango 1-57); «dieta vegana», con VRB de 4 (RI 5; rango 0-16); «ayuno intermitente», con VRB de 2 (RI 5; rango 0-27), y «dieta baja en grasas», con VRB de 1,16 (RI 0; rango 0-2). El término con mejor correlación a lo largo del tiempo fue «ayuno intermitente» (CS = 0,96), seguido de «dieta cetogénica» (CS = 0,91) y «dieta vegana» (CS = 0,85). CONCLUSIÓN: En España, el interés de la población sobre la información acerca de la dieta mediterránea es mayor que para otras dietas. Sin embargo, en los últimos años se ha producido un incremento progresivo en el interés, medido como VRB, en otras dietas, como la dieta cetogénica, la dieta vegana o el ayuno intermitente, y se ha producido una reducción en el interés por la dieta mediterránea. La dieta baja en grasas no genera interés en la población española

OBJECTIVE: To use Google Trends to explore the trends of interest of the Spanish population regarding information related to different types of diets, focused on those that are popular and with evidence-based studies, over the last 10 years. MATERIAL AND METHODS: The search trends referred to the terms «Mediterranean diet», «ketogenic diet», «low fat diet», «intermittent fasting» and «vegan diet» were analyzed. The relative search volumes (RSV) of the terms were compared. The direction of the trend was studied using the Spearman's correlation coefficient (SC). RESULTS: «Mediterranean diet» was the most widely searched term, with a median RSV of 16 (interquartile range [IQR] 6; range 8-100), though it exhibited a decreasing chronological trend (SC = -0.216). It was followed by «ketogenic diet», with an RSV of 8 (IQR 9; range 1-57); «vegan diet», with an RSV of 4 (IQR 5; range 0-16); «intermittent fasting», with an RSV of 2 (IQR 5; range 0-27), and «low fat diet», with an RSV of 1.16 (IQR 0; range 0-2). The term with the best correlation over time was «intermittent fasting» (SC = 0.96), followed by «ketogenic diet» (SC = 0.91) and «vegan diet» (SC = 0.85). CONCLUSIONS: In Spain, the interest of the population in information about the Mediterranean diet is greater than for other diets. However, in recent years there has been a progressive increase in interest (measured as RSV) in other diets such as the ketogenic diet, vegan diet or intermittent fasting, and there has been a decrease in interest in the Mediterranean diet. The low fat diet does not generate interest in the Spanish population

Transsexuality: Transitions, detransitions, and regrets in Spain. / Transexualidad: transiciones, detransiciones y arrepentimientos en España.

INTRODUCTION: Health care demand by transsexual people has recently increased, mostly at the expense of young and adolescents. The number of people who report a loss of or change in the former identity feeling (identity desistance) has also increased. While these are still a minority, we face more and more cases of transsexual people who ask for detransition and reversal of the changes achieved due to regret. OBJECTIVE: To report our experience with a group of transsexual people in detransition phase, and to analyze their personal experience and their associated conflicts. MATERIAL AND METHODS: A cohort of 796 people with gender incongruence attending the Identity Gender Unit of Doctor Peset University Hospital from January 2008 to December 2018 was studied. Four of the eight documented cases of detransition and/or regret are reported as the most representative. RESULTS: Causes of detransition included identity desistance, non-binary gender variants, associated psicomorbidities, and confusion between sexual identity and sexual orientation. CONCLUSION: Detransition is a growing phenomenon that implies clinical, psychological, and social issues. Inadequate evaluation and use of medicalization as the only means to improve gender dysphoria may lead to later detransition in some teenagers. Comprehensive care by a multidisciplinary and experienced team is essential. As there are no studies reporting the factors predictive of detransition, caution is recommended in cases of atypical identity courses.

Spanish population trends in Internet searches for information on different diets. / Tendencia de la población española de búsqueda en internet sobre información relacionada con diferentes dietas.

OBJECTIVE: To use Google Trends to explore the trends of interest of the Spanish population regarding information related to different types of diets, focused on those that are popular and with evidence-based studies, over the last 10years. MATERIAL AND METHODS: The search trends referred to the terms «Mediterranean diet¼, «ketogenic diet¼, «low fat diet¼, «intermittent fasting¼ and «vegan diet¼ were analyzed. The relative search volumes (RSV) of the terms were compared. The direction of the trend was studied using the Spearman's correlation coefficient (SC). RESULTS: «Mediterranean diet¼ was the most widely searched term, with a median RSV of 16 (interquartile range [IQR] 6; range 8-100), though it exhibited a decreasing chronological trend (SC=-0.216). It was followed by «ketogenic diet¼, with an RSV of 8 (IQR 9; range 1-57); «vegan diet¼, with an RSV of 4 (IQR 5; range 0-16); «intermittent fasting¼, with an RSV of 2 (IQR 5; range 0-27), and «low fat diet¼, with an RSV of 1.16 (IQR 0; range 0-2). The term with the best correlation over time was «intermittent fasting¼ (SC=0.96), followed by «ketogenic diet¼ (SC=0.91) and «vegan diet¼ (SC=0.85). CONCLUSIONS: In Spain, the interest of the population in information about the Mediterranean diet is greater than for other diets. However, in recent years there has been a progressive increase in interest (measured as RSV) in other diets such as the ketogenic diet, vegan diet or intermittent fasting, and there has been a decrease in interest in the Mediterranean diet. The low fat diet does not generate interest in the Spanish population.

Impact of dimensionality and confinement on the electronic properties of mercury chalcogenide nanocrystals.

We demonstrate the growth of 2D nanoplatelets (NPLs) made of a HgTe/CdS heterostructure, with an optical absorption reaching the shortwave infrared range. The material is an interesting platform to investigate the effect of dimensionality (0D vs. 2D) and confinement on the electronic spectrum and carrier dynamics in colloidal materials. We bring consistent evidence for the p-type nature of this material from transport and photoemission measurements. The majority carrier dynamics probed using pump-probe photoemission is found to be mostly dependent on the presence of a confinement barrier at the surface rather than on the material dimensionality. The minority carrier, on the other hand, is strongly affected by the material shape showing a longer lived minority carrier in 2D NPLs compared to their 0D equivalent with a similar band gap. Finally, we test the potential of this material for photodetection in the short-wave infrared range (SWIR) and show that fast photoresponse and detectivity reaching 109 Jones at room temperature can be achieved.

Doping as a Strategy to Tune Color of 2D Colloidal Nanoplatelets.

Among colloidal nanocrystals, 2D nanoplatelets (NPLs) made of II-VI compounds appear as a special class of emitters with an especially narrow photoluminescence signal. However, the PL signal in the case of NPLs is only tunable by a discrete step. Here, we demonstrate that doping is a viable path to finely tune the color of these NPLs from green to red, making them extremely interesting as phosphors for wide-gamut display. In addition, using a combination of luminescence spectroscopy, tight-binding simulation, transport, and photoemission, we provide a consistent picture for the Ag+-doped CdSe NPLs. The Ag-activated state is strongly bound and located 340 meV above the valence band of the bulk material. The Ag dopant induces a relative shift of the Fermi level toward the valence band by up to 400 meV but preserves the n-type nature of the material.

Charge Dynamics and Optolectronic Properties in HgTe Colloidal Quantum Wells.

We investigate the electronic and transport properties of HgTe 2D colloidal quantum wells. We demonstrate that the material can be made p- or n-type depending on the capping ligands. In addition to the control of majority carrier type, the surface chemistry also strongly affects the photoconductivity of the material. These transport measurements are correlated with the electronic structure determined by high resolution X-ray photoemission. We attribute the change of majority carriers to the strong hybridization of an n-doped HgS layer resulting from capping the HgTe nanoplatelets by S2- ions. We further investigate the gate and temperature dependence of the photoresponse and its dynamics. We show that the photocurrent rise and fall times can be tuned from 100 µs to 1 ms using the gate bias. Finally, we use time-resolved photoemission spectroscopy as a probe of the transport relaxation to determine if the observed dynamics are limited by a fundamental process such as trapping. These pump probe surface photovoltage measurements show an even faster relaxation in the 100-500 ns range, which suggests that the current performances are rather limited by geometrical factors.

Strongly Confined HgTe 2D Nanoplatelets as Narrow Near-Infrared Emitters.

Two-dimensional colloidal nanoplatelets (NPLs), owing to the atomic-level control of their confined direction (i.e., no inhomogeneous broadening), have demonstrated improved photoluminescence (PL) line widths for cadmium chalcogenide-based nanocrystals. Here we use cation exchange to synthesize mercury chalcogenide NPLs. Appropriate control of reaction kinetics enables the 2D morphology of the NPLs to be maintained during the cation exchange. HgTe and HgSe NPLs have significantly improved optical features compared to existing materials with similar band gaps. The PL line width of HgTe NPLs (40 nm full width at half-maximum, centered at 880 nm) is a factor of 2 smaller than typical PbS nanocrystals (NCs) emitting at the same wavelength. The PL has a lifetime of 50 ns, almost 2 orders of magnitude shorter than small PbS colloidal quantum dots (CQDs), and a quantum yield of ∼10%, almost 2 orders of magnitude shorter than small PbS colloidal quantum dots (CQDs). These materials are promising for a large variety of applications spanning from telecommunications to the design of colloidal topological insulators.

¿De qué nos sirve evaluar las tendencias del perfil glucémico ambulatorio? / Is it worth evaluating home blood glucose patterns?

El perfil glucémico ambulatorio es un instrumento utilizado para detectar tendencias glucémicas a partir de datos de un paciente determinado, registrados mediante análisis de glucemia capilar o bien, de forma más habitual, mediante monitorización continua de glucosa. Este instrumento analiza las variaciones de las glucemias obtenidas a lo largo de un número determinado de días, y las expresa en función de la hora del día con ayuda de la mediana y los percentiles 10, 25, 75 y 90. Es de gran utilidad para identificar tendencias glucémicas en diferentes momentos del día, para cuantificar variabilidad glucémica y para estratificar el riesgo de hipoglucemias en función de las horas. Debe complementarse con el análisis del registro individual de glucemias, ingestas y ejercicio para de esta manera detectar posibles causas de variabilidad y corregirlas

The ambulatory glucose profile is an instrument used to detect blood glucose patterns from patient results by recording blood glucose results or, more usually, by continuous glucose monitoring. This instrument analyzes the changes in glucose levels obtained over a number of days, and expresses the data, depending on the time of the day, using the median and the 10th, 25th, 75th and 90th percentiles. It is very useful for identifying glycemic patterns over the day, to quantify blood glucose variability, and to classify hypoglycemia risk according to time. This should be complemented with the analysis of individual blood glucose data, diet, and exercise, to detect potential causes of variability and correct them

Influencia de la educación para el control del fósforo sérico realizada por enfermería a pacientes y a sus cuidadores principales / Influence of education provided by nurses to patients and their primary caregivers in monitoring serum phosphorus

Debido a la avanzada edad de la población, esta necesita, cada vez más, la figura de un cuidador principal que controle y se responsabilice de sus cuidados. Nuestro objetivo es evaluar la efectividad de la educación sanitaria a los pacientes y sus cuidadores principales en la disminución de fósforo sérico. Se realiza un estudio de 20 meses de duración con una muestra de 70 pacientes divididos en dos grupos; un grupo control que no recibe educación adicional y un grupo estudio que recibe la educación específica para el control del fósforo y su dieta; en este grupo se identifican los pacientes dependientes que requerirán de un cuidador principal, quien también recibirá educación. Para la identificación del grado de dependencia del paciente se utiliza el Test Delta. El 52.9% de nuestros pacientes son independientes; el 48.2%, presentan dependencia leve, y el 4.3%, una dependencia moderada. El análisis de los resultados pone de manifiesto una disminución significativa del nivel de fósforo sérico en el grupo estudio, consiguiendo que, el 21% de estos pacientes cuyo nivel de fósforo se encontraba por encima de 5.5 mg/dl, lo redujera hasta los niveles normales recomendados (3 - 5.5 mg/dl). Concluimos que la implicación del personal de enfermería tanto en la educación continua del paciente y de sus cuidadores es necesaria y fundamental para conseguir unos resultados clínicos adecuados (AU)

Due to the advanced age of the population, the figure of the primary caregiver to monitor and take responsibility for their care is most needed. The aim of study is to evaluate the effectiveness of health education to patients and their primary caregivers in decreasing serum phosphorus. A study of 20 months duration was carried out with a sample of 70 patients divided into two groups; a control group which received no additional education and a study group which receives specific education for phosphorus control and diet; in the latter group, dependent patients who required a primary caregiver were identified. These primary caregivers also received health education. Delta Test was used to identify the degree of dependency. Our study found that 52.9% of our patients were independent; 48.2% had mild dependence, and 4.3%, moderate dependence. The analysis of the results revealed a significant decrease in serum phosphorus level in the study group; obtaining that 21% of these patients whose phosphorus levels were above 5.5 mg / dl were reduced to the recommended normal levels (3 - 5.5 mg / dl). We can conclude that the involvement of nurses in patient education and their primary caregivers is necessary and fundamental to achieve adequate clinical outcomes (AU)

Cobalt-catalyzed diastereoselective synthesis of C-furanosides. Total synthesis of (-)-isoaltholactone.

An array of C-aryl and C-vinyl furanosides were prepared in good yields and diastereoselectivities from C-halogeno furanosides either with aryl Grignard or with vinyl Grignard using the convenient Co(acac)3/TMEDA catalytic system. This method is illustrated by the total synthesis of the (-)-isoaltholactone.

Human leukocyte/endothelial cell interactions and mitochondrial dysfunction in type 2 diabetic patients and their association with silent myocardial ischemia.

OBJECTIVE: Diabetes is associated with oxidative stress and increased mortality, but a possible correlation between leukocyte-endothelium interactions, oxidative stress, and silent myocardial ischemia (SMI) is yet to be confirmed. RESEARCH DESIGN AND METHODS: Mitochondrial dysfunction and interactions between leukocytes and human umbilical vein endothelial cells were evaluated in 200 type 2 diabetic patients (25 with SMI) and 60 body composition- and age-matched control subjects. A possible correlation between these parameters and the onset of SMI was explored, and anthropometric and metabolic parameters were also analyzed. RESULTS: Waist, levels of triglycerides, proinflammatory cytokines (interleukin-6 and tumor necrosis factor-α), HbA1c, high-sensitivity C-reactive protein (hs-CRP), glucose, and insulin, and homeostasis model assessment of insulin resistance were higher in diabetic patients than in control subjects. However, no statistical differences in hs-CRP and insulin levels were detected when the data were adjusted for waist. None of these parameters varied between SMI and non-SMI patients. Mitochondrial function was impaired and leukocyte-endothelium interactions were more frequent among diabetic patients, which was evident in the lower mitochondrial O2 consumption, membrane potential, polymorphonuclear cell rolling velocity, and GSH/GSSG ratio, and in the higher mitochondrial reactive oxygen species production and rolling flux, adhesion, and vascular cell adhesion molecule-1 (VCAM-1) and E-selectin molecules observed in these subjects. Moreover, these differences correlated with SMI. Statistical differences were maintained after adjusting the data for BMI and waist, with the exception of VCAM-1 levels when adjusted for waist. CONCLUSIONS: Oxidative stress, mitochondrial dysfunction, and endothelium-inducing leukocyte-endothelium interactions are features of type 2 diabetes and correlate with SMI.