[Blood glucose control and cardiovascular risk factors in type 2 diabetic patients with cardiovascular disease in Spain, and its treatment pattern, according to gender: CODICE study]. / Control glucémico y de los factores de riesgo cardiovascular en los pacientes con diabetes tipo 2 con enfermedad cardiovascular en España, y su patrón de tratamiento, en función del género: Estudio CODICE.

INTRODUCTION AND OBJECTIVES: With the implementation of the Strategy of Health Promotion and Prevention in Spain, the scenario reflected in previous studies of low control of cardiovascular risk factors (CVRF) in patients with type 2 diabetes (DM2) and cardiovascular disease (CVD) can be modified. This study intends to determine the level of blood glucose control and other CVRF in patients with DM2 and CVD currently seen in clinics in Spain, as well as the pattern of antidiabetic treatment, and differences according to gender. MATERIALS AND METHODS: An epidemiological, observational, cross-sectional, nationwide study was conducted in patients of both genders diagnosed with DM2 and established CVD. RESULTS: The study included 3,143 patients with a mean age 69.0±10 years. The mean HbA1c was 7.4±1.1% in females vs 7.3±1.2% in males (P<.05) and systolic blood pressure was 137±15.0mmHg in females vs 135.6±14.7mmHg in males (P<.05). The mean LDL-cholesterol was 101.5±38.1mg/dl in females vs 91.1±37.5mg/dl in males; P<.001) and the mean body mass index (30.7±5.4kg/m2 in females vs 29.6±4.5kg/m2 in males; P<.001). The most used treatments were metformin (68.1%) and/or DPP4 inhibitors (53.7%), with no differences between genders. CONCLUSIONS: The level of blood glucose control of DM2 patients with CVD in Spain can be improved. The treatment profile does not conform to the recommendations of clinical practice guidelines in general. The differences in the control of CVRF are worse in women for lipids and obesity.

[ESCRYTO study. Diabetes without cardiovascular disease and level of control]. / Estudio ESCRYTO. Diabetes sin enfermedad cardiovascular y grado de control.

BACKGROUND AND OBJECTIVES: Diabetes is a significant risk factor for the development of cardiovascular disease, which is the main cause of death. The purpose of this study was to determine the level of glycaemic control in patients with type 2 diabetes without cardiovascular disease in Spain. The data used includes the most recent determination of glycosylated haemoglobin, as well as the pattern of antidiabetic treatment, the incidence of episodes of severe hypoglycaemia in the last 6 months, and the level of control of cardiovascular risk factors, and gender. PATIENTS AND METHODS: A national, multicentre, and cross-sectional epidemiological study in which 800 doctors associated with the GDPS network participated. RESULTS: Of the total of 1,059 patients, 57% male, with a mean age of 62.7 years in men vs. 65.2 in women (P<.001). The mean onset of diabetes was 9.4±7.5 years. The mean HbA1C was 7.0% in men vs. 7.1% in women (P=.039), with the control objective of <7% being observed in 47.2%. There were 65% patients on treatment with metformin, and 62.4% on DPP-4 inhibitors, and basal insulin: 14.2%. Incidence of severe hypoglycemias in the last 6 months was 1.9%. The women had worse glycaemic control, total cholesterol, LDL cholesterol, abdominal obesity, and glomerular filtration levels. CONCLUSIONS: The glycaemic control is worse in women even if adjusted for age and time of onset of diabetes (P=.043), and for the number of hypoglycaemic agents (P=.015). The level of control is also worse in women for dyslipidaemia, abdominal obesity, and glomerular filtration. A preventive strategy promoted from Primary care on healthy lifestyles and controlling all vascular risk factors is essential.

Glycaemic control of elderly patients with type 2 diabetes mellitus in Spain (2015) and its relationship with functional capacity and comorbidity. The Escadiane study. / Control glucémico de los pacientes ancianos con diabetes mellitus tipo 2 en España (2015) y su relación con la capacidad funcional y la comorbilidad. Estudio Escadiane.

OBJECTIVES: To understand the state of glycaemic control of elderly patients with type 2 diabetes mellitus in Spain and its relationship with functional capacity and comorbidity. METHODS: Cross-sectional, observational, multicentre national study on patients with diabetes mellitus aged 65 years or older. The study analysed demographic and anthropometric variables, cardiovascular risk factors, clinical and laboratory data, associated comorbidity and treatments. We analysed the functional capacity using the Barthel index and the comorbidity with Charlson index. RESULTS: The study included 939 patients with a mean age of 76.4±6.7 years. The mean glycated haemoglobin (HbA1c) level was 7.0%±1.2%, and the mean basal blood glucose level was 137±39.6mg/dL. The HbA1c level showed statistically significant differences depending on the degree of disability. In the patients who were totally, severely, moderately or slightly dependent or who were independent, the mean HbA1c levels were 7.0%, 7.9%, 7.4% and 7.0%, respectively (P<.028). HbA1c levels were 7.3%, 7.1% and 6.9% in the patients with very high, high and medium comorbidity, respectively (P<.001). CONCLUSIONS: Mean HbA1c levels in elderly patients with type 2 diabetes analysed in Spain are below those recommended by the main clinical practice guidelines. The levels are higher in patients who have more functional disability and a higher level of comorbidity.

Characterization of poly(2-hydroxyethyl methacrylate) (PHEMA) contact lens using the Langmuir monolayer technique.

The behavior of poly(2-hydroxyethyl methacrylate) (PHEMA) polymer monolayer spread on water was studied under various experimental conditions. The influence of subphase pH and temperature, compression speed, elapsed time from the deposit of the monolayer and the recording of the surface pressure-area (π-A) isotherms, as well as the number of polymer molecules deposited at the air/water surface (surface concentration) was studied. The obtained results show that PHEMA exhibits a very stable monolayer given that it is unaffected by modifications in the majority of these variables. Only the elapsed time between the spreading of the monolayer and the beginning of compression causes a small change in the π-A isotherms that consists in an increase in the area occupied by the film. This is attributed to the greater unfolding with time of the polymer's monomers at the air/water interface. The plateau that appears on π-A curves of the PHEMA monolayer is attributed to the reorientation of their hydroxyethyl polar groups through their C-O-C bonds, as well as to the reorientation of the ethylene (CH(2)) groups that link the monomers, which provokes a folding of the polymer's chains causing an accordion configuration. The existence of this structure is confirmed by the presence of numerous noise peaks in the relative thickness versus time curve corresponding to this region. In the same fashion, the images observed from Brewster angle microscopy (BAM) reveal the existence of light-dark "bands" relative to the different regions of this particular structure.

How to obtain a well-spread monolayer of lysozyme at the air/water interfaces.

The purpose of this study is to define the conditions required to obtain a complete spreading of the lysozyme monolayer at the A/W interface. To this end, using Trurnit's method, the influence of the ionic strength of the substrate, the elapsed time between the spreading of the monolayer and the beginning of its compression, and the number of lysozyme molecules spread at the interface was studied. The results obtained show that the lysozyme spreading is conditioned by the unfolding of amino acid chains which form part of its structure, so that such unfolding is hindered, either because of an excessive accumulation of lysozyme molecules on the substrate surface or because the waiting time necessary to get this unfolding is not long enough, regardless of the number of spread molecules. The complete unfolding of lysozyme, which involves the loss of tertiary and secondary structures, has been obtained in this work under certain conditions: (1) using a substrate with a high saline concentration (NaCl 3-3.5 M) and at a pH value close to the isoelectric point of lysozyme (pI=11) in order to reduce the solubility and the electrical potential of the protein, (2) increasing the elapsed time between the spreading of the protein and the beginning of its compression to 3h in order to get a complete unfolding of lysozyme, which is a very slow process, (3) using an initial spreading area of 2.1m(2)/mg or larger (equivalent to a protein surface concentration of less than 2×10(12) molec/cm(2)) to reduce the accumulation of protein molecules at the surface, thus facilitating their unfolding, and (4) using Trurnit's spreading method, although for the spreading of this protein was found to be insufficiently significant.

Interactions in monolayers: a study of the behavior of poly(methyl methacrylate)-lysozyme mixed films from surface pressure-area and ellipsometric measurements.

Mixed monolayers of PMMA-lysozyme show the existence of negative deviations from the additivity of the molecular areas (A(m)) when the composition of polymer mixtures is less than X(PMMA) 0.6, regardless of the surface pressure of the monolayers. The maximum deviation occurs in the mixed monolayer with composition X(PMMA) 0.25, which is attributed to the formation of a complex consisting of one polymer molecule and three protein molecules (1:3 stoichiometry), stabilized by hydrogen bonds between the NH groups of the protein and the CO groups of the polymer as well as by van der Waals attractive forces between the hydrocarbon chains of both components. When the relative proportion of the components in the mixed films significantly differs from the value corresponding to the stoichiometry of the complex (as in mixtures with X(PMMA) > 0.6), this complex cannot be formed, causing an immiscible system where the values of the experimental molecular areas coincide with those corresponding to ideal behavior. Measurements of monolayer thickness and BAM images allow confirmation on the microscopic level of the structural characteristics deduced from the π-A isotherms.

Approach to knowledge of the interaction between the constituents of contact lenses and ocular tears: mixed monolayers of poly(methyl methacrylate) and dipalmitoyl phosphatidyl choline.

Mixed monolayers of poly(methyl methacrylate) (PMMA), the main component of hard contact lenses, and dipalmitoyl phosphatidyl choline (DPPC), a characteristic phospholipidic constituent of ocular tear films, were selected as an in vitro model in order to observe the behavior of contact lenses on the eye. Using Langmuir monolayer and Brewster angle microscopy (BAM) techniques, the interaction between both components was analyzed from the data of surface pressure-area isotherms, compressional modulus-surface pressure, and relative film thickness versus time elapsed from the beginning of compression, together with BAM images. Regardless of the surface pressure at which the molecular/monomer areas (A(m)) were recorded, the A(m) mole fractions of PMMA (X(PMMA)) plots show that the experimental results match the theoretical values calculated from additivity rule A(m) = X(PMMA)A(PMMA) + X(DPPC)A(DPPC). The application of the Crisp phase rule to the phase diagram of the PMMA-DPPC system can explain the existence of a mixed monolayer made up of miscible components with ideal behavior at surface pressures below 25 mN/m. However, at very high surface pressures, when collapse is reached (at 60 mN/m), the single collapsed components are segregated into two independent phases. These results allows us to argue that PMMA hard contact lenses in the eye do not alter the structural characteristics of the phospholipid (DPPC) in tears.

Interactions between polymers and lipid monolayers at the air/water interface: surface behavior of poly(methyl methacrylate)-cholesterol mixed films.

The behavior of mixed monolayers of cholesterol and poly(methyl methacrylate) (PMMA) with molecular weights of M(w) = 120,000 g/mol and M(w) = 15,000 g/mol was investigated at the air/water interface using Langmuir and Brewster angle microscopy techniques. From the data of surface pressure (pi)-area (A) isotherms, compressional modulus-surface pressure (C(s)(-1)-pi) curves, and film thickness, complemented with Brewster angle microscopy images, the interaction between the components was analyzed. Regardless of the surface pressure (pi = 10, 20, or 30 mN/m) at which the mean molecular/monomer areas (Am) were calculated, the Am-mole fraction plots (corresponding to X(PMMA) = 0.1, 0.3, 0.5, 0.7, and 0.9) show that all the experimental points obtained are placed on the theoretical straight line calculated according to the additivity rule. This fact, together with the existence of two collapses in the mixed monolayers and with the fact that the surface pressure of the liquid-expanded LE-L'E phase transition of PMMA does not change with the monolayer composition, demonstrates the immiscibility of the film components at the interface. The application of the Crisp phase rule to the phase diagram of PMMA-cholesterol mixed monolayers helps to explain the existence of a biphasic system, regardless of their composition and surface pressure. Besides, Brewster angle microscopy (BAM) images showed the existence of heterogeneous cholesterol domains with high reflectivity immersed in a homogeneous polymer separate phase with low reflectivity.

Monolayer and Brewster angle microscopy studies of poly(methyl methacrylate)-monopalmitin mixed systems at the air-water interface.

Mixed monolayers of poly(methyl metacrylate) (PMMA) and monopalmitin (Mp) were used for the study of their interactions. A thorough analysis of surface pressure (pi)-area (A) isotherms with the Langmuir monolayer technique, complemented with Brewster angle microscopy (BAM) images was performed. Mixed films show two phase transitions at a surface pressure of 14.5 mN/m and at 20-21 mN/m, respectively. Moreover, mixed monolayers show two well-defined collapses: one, corresponding to the lipid (at surface pressures of 50-51 mN/m) and the another one, ascribed to the PMMA, at surface pressure values of 57-58 mN/m. When the mean molecular areas of the mixed films (A(1,2)) were plotted versus film composition (X(1) or X(2)), positive deviations from the ideal behavior were observed at surface pressures below 15 mN/m, which were mainly attributed to a change in the conformation of the PMMA molecules at the surface. However, at higher surface pressures, the areas per monomer unit of the mixed monolayers obey the additivity rule, attributed to the fact that the film components form an immiscible system in these conditions.

Discrete breathers for understanding reconstructive mineral processes at low temperatures.

Reconstructive transformations in layered silicates need a high temperature in order to be observed. However, very recently, some systems have been found where transformation can be studied at temperatures 600 degrees C below the lowest experimental results previously reported, including sol-gel methods. We explore the possible relation with the existence of intrinsic localized modes, known as discrete breathers. We construct a model for nonlinear vibrations within the cation layer, obtain their parameters, and calculate them numerically, obtaining their energies. Their statistics show that, although there are far less breathers than phonons, there are much more above the activation energy, making them good candidates to explain the reconstructive transformations at low temperatures.

¿La diabetes tipo 2 debería diagnosticarse y tratarse como una enfermedad cardiovascular? / Type 2 diabetes mellitus: should be diagnosed and treated as a cardiovascular disease?

Cada vez más estudios clínicos ponen de manifiesto que existe una asociación entre diabetes tipo 2 y enfermedad cardiovascular, y que la mayoría de los pacientes diabéticos fallecen debido a complicaciones macrovasculares. Estudios prospectivos recientes han demostrado que un buen control de la glucemia en ayunas y de la hemoglobina glucosilada, es capaz de prevenir la aparición de las complicaciones microvasculares en los diabéticos. Otros estudios epidemiológicos han resaltado la importancia de la hiperglucemia post-prandial y su papel como factor de riesgo independiente de morbi-mortalidad cardiovascular. Los individuos con el llamado síndrome metabólico (hipertensión arterial, dislipemia, obesidad central, insulin-resistencia e hiperinsulinismo) tienen un riesgo elevado de padecer una enfermedad cardiovascular, sin tener una diabetes manifiesta sino, solamente, una tolerancia alterada a la glucosa. Esto pone de manifiesto que el riesgo cardiovascular aumenta de forma paralela al incremento glucémico global (glucemia basal y post-prandial).Por ello, las opciones terapéuticas actuales, en caminadas a controlar las alteraciones metabólicas de la diabetes, deben tratar, también, de prevenir a largo plazo la aparición de las complicaciones macrovasculares de la enfermedad. La nateglinida, un estimulador de la secreción de insulina de acción rápida y de corta duración, que actúa reduciendo eficazmente los picos post-prandiales de glucosa, puede ofrecer una al ternativa terapéutica válida para el manejo global del paciente con diabetes tipo 2 (AU)