Prediction of fatty acids composition in the rainbow trout Oncorhynchus mykiss by using Raman micro-spectroscopy.

The importance of poly-unsaturated fatty acids (PUFAs) in food is crucial for the animal and human development and health. As a complementary strategy to nutrition approaches, genetic selection has been suggested to improve fatty acids (FAs) composition in farmed fish. Gas chromatography (GC) is used as a reference method for the quantification of FAs; nevertheless, the high cost prevents large scale phenotyping as needed in breeding programs. Therefore, a calibration by means of Raman scattering spectrometry has been established in order to predict FA composition of visceral adipose tissue in rainbow trout Onchorhynchus mykiss. FA composition was analyzed by both GC and Raman micro-spectrometry techniques on 268 individuals fed with three different feeds, which have different FA compositions. Among the possible regression methods, the ridge regression method, was found to be efficient to establish calibration models from the GC and spectral data. The best cross-validated R2 values were obtained for total PUFAs, omega-6 (Ω-6) and omega-3 (Ω-3) PUFA (0.79, 0.83 and 0.66, respectively). For individual Ω-3 PUFAs, α-linolenic acid (ALA, C18:3), eicosapentaenoic acid (EPA, C20:5) and docosahexenoic acid (DHA, C22:6) were found to have the best R2 values (0.82, 0.76 and 0.81, respectively). This study demonstrates that Raman spectroscopy could be used to predict PUFAs with good correlation coefficients on adipocytes, for future on adipocytes physiology or for large scale and high throughput phenotyping in rainbow trout.

Disease-related malnutrition in hospitalized chronic patients with complex needs.

BACKGROUND AND AIMS: Disease-related malnutrition is a prevalent condition that can be associated with multimorbidity. The purposes of this study were to assess the prevalence of disease-related malnutrition in a cohort of chronic patients with complex needs (CPCN) admitted to two University hospitals, and to evaluate the impact of malnutrition in their hospitalization outcomes. METHODS: All CPCN admitted on a previously agreed day in non-critical services of two University hospitals in Catalonia were included. Nutritional risk was evaluated with Mini-Nutritional Assessment Tool and Nutritional Risk Screening 2002. Hospitalization outcome data were evaluated, including length of the hospital stay, mortality during admission and placement when discharged. After five months, a new evaluation was performed to assess mortality and readmissions. RESULTS: A total of 101 patients were included, 83% of which were at nutritional risk when screened with NRS-2002; when using MNA, 86% of them were found to be either at nutritional risk or malnourished. Malnourished patients had a greater need for home care/intermediate care hospital at discharge (41.8% vs 22.9%, p < 0.01), and a higher mortality rate during admission (16.7% vs 1.6%, p < 0.01). Mortality at 5 months was also higher in the malnourished group (30.5% vs 9.8%, p < 0.01). Factors associated with malnutrition were BMI and gender (malnutrition was more prevalent in women). In our cohort, malnutrition was the sole independent predictor of mortality at 5 months. CONCLUSIONS: The prevalence of both malnutrition and risk of malnutrition is very high in hospital-admitted CPCN, and has a profound impact on placement at discharge and mortality. This high prevalence is not explained by the multimorbidity pattern. Other factors need to be evaluated in this group of high-need, high-cost patients.

Identifying patients with advanced chronic conditions for a progressive palliative care approach: a cross-sectional study of prognostic indicators related to end-of-life trajectories.

OBJECTIVES: 2 innovative concepts have lately been developed to radically improve the care of patients with advanced chronic conditions (PACC): early identification of palliative care (PC) needs and the 3 end-of-life trajectories in chronic illnesses (acute, intermittent and gradual dwindling). It is not clear (1) what indicators work best for this early identification and (2) if specific clinical indicators exist for each of these trajectories. The objectives of this study are to explore these 2 issues. SETTING: 3 primary care services, an acute care hospital, an intermediate care centre and 4 nursing homes in a mixed urban-rural district in Barcelona, Spain. PARTICIPANTS: 782 patients (61.5% women) with a positive NECPAL CCOMS-ICO test, indicating they might benefit from a PC approach. OUTCOME MEASURES: The characteristics and distribution of the indicators of the NECPAL CCOMS-ICO tool are analysed with respect to the 3 trajectories and have been arranged by domain (functional, nutritional and cognitive status, emotional problems, geriatric syndromes, social vulnerability and others) and according to their static (severity) and dynamic (progression) properties. RESULTS: The common indicators associated with early end-of-life identification are functional (44.3%) and nutritional (30.7%) progression, emotional distress (21.9%) and geriatric syndromes (15.7% delirium, 11.2% falls). The rest of the indicators showed differences in the associations per illness trajectories (p<0.05). 48.2% of the total cohort was identified as advanced frailty patients with no advanced disease criteria. CONCLUSIONS: Dynamic indicators are present in the 3 trajectories and are especially useful to identify PACC for a progressive PC approach purpose. Most of the other indicators are typically associated with a specific trajectory. These findings can help clinicians improve the identification of patients for a palliative approach.

Advanced soft-tissue sarcoma in elderly patients: patterns of care and survival.

BACKGROUND: There are no data regarding the management of advanced soft-tissue sarcoma (STS) in elderly patients. PATIENTS AND METHODS: We retrospectively reviewed the charts of patients ≥75 years old diagnosed with metastatic or unresectable STS between 1991 and 2011 in 11 French and American centers. RESULTS: The study included 361 patients. Of these, 223 patients (62%) received systemic therapy, whereas 123 patients (34%) were managed with best supportive care (BSC) only. Patients who received BSC were more likely to be ≥80 years, with performance status (PS) ≥ 2, Charlson comorbidity score ≥ 10, and metastatic disease. The median progression-free survival of patients treated with systemic therapy was 4 months (95% CI: 2.9-5.1). Thirty-six patients (16%) stopped chemotherapy because of toxicity. Median overall survival (OS) of patients managed with specific therapy was 10.9 months (95% CI: 8.3-13.5) versus 5.3 months (95% CI: 3.6-7.1) for patients managed with BSC (P = 0.001). On multivariate analysis, age ≥ 80 years, PS ≥ 2, and number of metastatic sites were the only independent factors associated with OS. CONCLUSION: A high proportion of elderly patients with advanced STS were denied chemotherapy. Further efforts are needed to define better the optimal care for fit and unfit elderly patients with STS.

[Medical information and patients' choices. Influences on term singleton breech deliveries]. / Information médicale et choix des patientes. Influences sur la pratique de l'accouchement du siège à terme par voie basse.

OBJECTIVE: The mode of delivery of term singleton breech presentation has been argued for decades. Many elements are responsible for the current increase in the rate of elective cesarean delivery. Among these elements, the influence of medical information and patients' choices are unknown. PATIENTS AND METHODS: We studied retrospectively, between January 1996 and December 2005, the mode of term breech delivery in a French maternity. RESULTS: Medical information relates primarily to the complications of vaginal birth. Patient's request for an elective Cesarean has been in constant increase since 1996. DISCUSSION AND CONCLUSION: Medical information and patients' choices strongly influence the practice of breech delivery.

[Repeated thromboembolism during pregnancy with constitutional antithrombin deficiency]. / Thromboses récidivantes gravidiques et déficit en antithrombine.

We report the case of a twenty-three-year old woman with constitutional antithrombin deficiency, who had oral anticoagulation since she was four years old. During her first pregnancy, after the introduction of unfractionated heparin prophylactic therapy, she presented a first venous thromboembolism at nine weeks, and a second one with low-molecular-weight heparin therapy at nineteen weeks. Because of a severe antithombin deficiency, regular infusions of antithrombin concentrates were necessary until delivery to ensure effective anticoagulation by heparin. Patients with antithrombin deficiency have a very high risk of venous thromboses during the pregnancy and post-partum. We discuss the significant points of management for this period.

Los límites de la evaluación clínica objetiva y estructurada (ECOE) / The limits of the ECOE

No disponible

[Cost analysis and degree of hypercholesterolemia control in type 2 diabetic patients according to different groups and scientific societies]. / Análisis de costes y grado de control de la hipercolesterolemia en los pacientes diabéticos tipo 2 según distintos grupos y sociedades científicas.

OBJECTIVES: To analyse the cost and describe the degree of control of the hypercholesterolaemia of type-2 diabetic (DM2) patients according to different groups and scientific societies. DESIGN: Retrospective cross-sectional study. SETTING: Rural health area. PATIENTS: All DM2 patients monitored in the health area (n = 338). MEASUREMENTS AND MAIN RESULTS: Gathering of data on clinical histories, determination of cardiovascular risk, LDL-C concentration and total/HDL cholesterol index. DM2 prevalence was 3.08%; annual incidence, 2.55/1000; 45.2% presented hypercholesterolaemia; 16.9% received lipid-lowering treatment; and 20.1% (n = 68) had DM2 with cardiovascular disease. According to the criteria of the GEDAPS-99, European Consensus-98 (Framingham table), Sheffield Group (objectives of the European Consensus-98) and PAPPS-99 for primary prevention, 59.3%, 58.4%, 24.5% and 17.7%, respectively, of hypercholesterolaemic patients were poorly controlled. The percentages of hypercholesterolaemic patients who in each case should receive treatment were: 64.9%, 66.1%, 36.4% and 29.6%. Expenditure in thousands of pesetas every 28 days to achieve proper control of these patients was 282, 423, 274 and 117. The criteria on secondary prevention of the GEDAPS-99 and European Consensus-98 gave figures of 81% and 72.4%, respectively, of poor control of Hypercholesterolaemia. 82.7% and 77.5% of these patients should receive treatment. Expenditure in thousands of pesetas every 28 days to achieve proper control of these patients was 342 and 210. CONCLUSIONS: The degree of control and the costs of hypercholesterolaemia in both primary and secondary prevention vary enormously, depending on the criterion used by the group or scientific society.

Análisis de costes y grado de control de la hipercolesterolemia en los pacientes diabéticos tipo 2 según distintos grupos y sociedades científicas / Analysis of costs and hypercholesterolaemia control in type-2 diabetic patients, according to different groups and scientific societies

Objetivo. Analizar el coste y describir el grado de control de la hipercolesterolemia de los pacientes diabéticos tipo 2 (DM2) según los distintos grupos y sociedades científicas. Diseño. Estudio transversal, retrospectivo. Emplazamiento. Área Básica de Salud (ABS) rural. Pacientes. Totalidad de los pacientes DM2 controlados en el ABS (n = 338). Mediciones y resultados principales. Recogida de datos de las historias clínicas, determinación del riesgo cardiovascular, la concentración del cLDL y el índice colesterol total/cHDL. Prevalencia de DM2, 3,08 por ciento; incidencia anual, 2,55‰; presentan hipercolesterolemia, 45,2 por ciento, y reciben tratamiento hipolipemiante, 16,9 por ciento. DM2 con enfermedad cardiovascular (n = 68; 20,1 por ciento). Según los criterios del GEDAPS-99, Consenso Europeo-98 (tabla de Framingham), Grupo de Sheffield (objetivos del Consenso Europeo-98) y PAPPS-99 para prevención primaria, el porcentaje de pacientes hipercolesterolémicos mal controlados es del 59,3, 58,4, 24,5 y 17,7, respectivamente. El porcentaje de pacientes hipercolesterolémicos que en cada caso deberían recibir tratamiento es del 64,9, 66,1, 36,4 y 29,6. El gasto en miles de pts./28 días para conseguir el correcto control de estos mismos pacientes sería 282, 423, 274 y 117. Según los criterios del GEDAPS-99 y el Consenso Europeo-98 para prevención secundaria, el mal control de la hipercolesterolemia es del 81 y 72,4 por ciento, respectivamente. El porcentaje de pacientes hipercolesterolémicos que en cada caso deberían recibir tratamiento es del 82,7 y 77,5. El gasto en miles de pts./28 días para conseguir el correcto control de estos mismos pacientes sería 342 y 210. Conclusiones. El grado de control y los costes de la hipercolesterolemia, tanto en prevención primaria como secundaria, varía considerablemente según el criterio del grupo o sociedad científica utilizado (AU)

[Dementias in the primary care setting]. / Las demencias en el ámbito de la atención primaria.

OBJECTIVE: To study the epidemiological, demographic, social and family, and clinical variables of the population suffering dementia in our health district. DESIGN: A retrospective evaluation of medical records. SETTING: A rural health district. PATIENTS: All those patients with a diagnosis of dementia in 1995. MEASUREMENTS AND RESULTS: The evaluation was based on primary care medical records. The prevalence of dementia in the over-65s ranged, according to the population group, between 1.29 and 5.19 per 100 inhabitants. 90.2% of patients with dementia remained living at home. Their average age was 79.8 (SD, 7.4). 57% had Alzheimer's disease. 40% were in advanced stages of the disease (stage III and IV). Only 26% of the patients were referred to Neurology in 1995. 35% of the patients took no medication for their dementia. 45.6% were included in a home care programme. The main carer was the son or daughter in 47.8% of cases. Expectation of life from when dementia was diagnosed was 5.53 (SD 4.64) years. Patients with dementia died in their own homes in 47% of cases, the main cause of death being infection. CONCLUSIONS: In our rural environment most patients with dementia remained with their families. In most cases the aetiological diagnosis of dementia could be made from primary care.