The effects of aging and frailty on inpatient glycemic control by continuous glucose monitoring in patients with type 2 diabetes.

BACKGROUND: Older adults with diabetes in the hospital are generally managed similarly to younger adults, however, it is unknown if the degree of frailty can affect glucose control among hospitalized patients. METHODS: We examined glycemic parameters derived from continuous glucose monitoring (CGM) in older adults with type 2 diabetes and frailty who were hospitalized in non-acute settings. Data was pooled from 3 prospective studies using CGM including 97 patients wearing Libre CGM sensors and 166 patients wearing Dexcom G6 CGM. Glycemic parameters (time in range (TIR) 70-180; time below range (TBR) <70 and 54 mg/dl) by CGM were compared between 103 older adults ≥60 years and 168 younger adults <60 years. Frailty was assessed using validated laboratory and vital signs frailty index FI-LAB (n = 85), and its effect on hypoglycemia risk was studied. RESULTS: Older adults, as compared to younger adults, had significantly lower admission HbA1c (8.76% ± 1.82 vs. 10.25% ± 2.29, p < 0.001), blood glucose (203.89 ± 88.65 vs. 247.86 ± 124.17 mg/dl, p = 0.003), mean daily BG (173.9 ± 41.3 vs. 183.6 ± 45.0 mg/dl, p = 0.07) and higher percent TIR 70-180 mg/dl (59.0 ± 25.6% vs. 51.0 ± 26.1%, p = 0.02) during hospital stay. There was no difference in hypoglycemia occurrence between older and younger adults. Higher FI-LAB score was associated with higher % CGM < 70 mg/dl (0.204) and % CGM < 54 mg/dl (0.217). CONCLUSION: Older adults with type 2 diabetes have better glycemic control prior to admission and during hospital stay compared to younger adults. Frailty is associated with longer presence of hypoglycemia in non-acute hospital settings.

Evolutionary dynamics of autopolyploids in natural populations: the case of Turnera sidoides complex / Dinámica evolutiva de autopoliploides en poblaciones naturales: el caso del complejo Turnera sidoides

ABSTRACT Turnera sidoides (x=7) is one of the few well-studied South American autopolyploid complexes. Since polyploidy has played a prominent role within this complex, ongoing studies in T. sidoides focus on understanding the mechanisms involved in the origin and the establishment of polyploids using integrative approaches. This paper synthesises the results of more than 20 years of research on this topic. Cytogenetics analysis provided evidences for the production of unreduced male and female gametes, supporting the hypothesis of bilateral sexual polyploidization as the mechanism of origin of polyploids in T. sidoides. The finding of viable triploids suggested that unilateral sexual polyploidization could also be an important mechanism for the origin of tetraploids in T. sidoides. The occurrence of plants continuously forming many unreduced gametes would play a key role in the establishment of neopolyploids in natural populations. Also, the higher number of propagules that tetraploids contribute to subsequent generations, the ability to multiply asexually by rhizomes, and the occurrence of occasional cases of self-compatibility and successful illegitimate crosses in polyploids increase the likelihood that a low frequency of neopolyploids can be maintained in natural populations of T. sidoides. In addition, integration of cytogeographic and genetic divergence data together with past niche modelling provided further insights supporting the hypothesis that historical climatic and geomorphological events provided favourable conditions for the establishment of autopolyploids, with the wider distribution of tetraploids of T. sidoides being the result of their range expansion.

RESUMEN Turnera sidoides (x=7) es uno de los pocos complejos autopoliploides sudamericanos bien estudiados. Como la poliploidía ha tenido un papel destacado en el complejo, los estudios en curso en T. sidoides se centraron en la comprensión de los mecanismos implicados en el origen y el establecimiento de los poliploides mediante diferentes enfoques. En este trabajo se sintetizan los resultados de más de 20 años de investigación sobre este tema. El análisis citogenético proporcionó evidencias de la producción de gametos masculinos y femeninos no reducidos, sustentando la hipótesis de la poliploidización sexual bilateral como mecanismo de origen de los poliploides en T. sidoides. Sin embargo, el hallazgo de triploides fértiles sugirió que la poliploidización sexual unilateral también sería un mecanismo importante de origen de tetraploides en T. sidoides. La ocurrencia de plantas que forman continuamente gametos no reducidos desempeñaría un papel clave en el establecimiento de neopoliploides. Además, el mayor número de propágulos que los tetraploides aportan a las siguientes generaciones, la capacidad de multiplicación asexual por rizomas y los casos ocasionales de autocompatibilidad y cruzamientos ilegítimos exitosos aumentarían la probabilidad de que se mantenga una baja frecuencia de neopoliploides en las poblaciones naturales de T. sidoides. Asimismo, la integración de datos citogeográficos y de divergencia genética junto con el modelado de nicho en el pasado aportó información que sustenta la hipótesis de que los eventos climáticos y geomorfológicos históricos proporcionaron las condiciones favorables para el establecimiento y expansión de los tetraploides de T. sidoides.

[Risk of refracture according to the FRAX score in patients older than 50 years who suffer a fracture by a low-impact mechanism]. / Riesgo de refractura según el FRAX score en pacientes mayores de 50 años que sufren una fractura por un mecanismo de bajo impacto.

INTRODUCTION: as the population pyramid inverts, we'll see more old patients suffering a fracture secondary to a low impact mechanism and not all hospitals have a densitometer to make a definitive diagnosis. Nevertheless, we have clinical tools that can help us to start an early treatment. OBJECTIVE: to recognize the risk of re-fracture of patients older than 50 years in our population. MATERIAL AND METHODS: we included all patients older than 50 that suffered a low impact fracture in the Ángeles Mocel Hospital. We used Mexico FRAX score tool to determine de risk of suffering a fracture. The sample was divided in two groups. Utilizing p < 0.05 and a CI of 95%. RESULTS: 69 patients where included. 47.8% had past fractures and only 10% of those had preventive osteoporotic treatment. 50.7% of the patients have a high risk of suffering a mayor osteoporotic fracture in 10 years and 75% of suffering a hip fracture in 10 years. None of the patients received a treatment, either lifestyle modifiers or specific osteoporosis pharmacotherapy at hospital discharge. CONCLUSION: there is a deficiency in the early preventive management of osteoporosis in patients suffering a low impact fracture by orthopedic surgeons.

INTRODUCCIÓN: a medida que se invierte la pirámide poblacional vamos a ver más pacientes que sufren fracturas por mecanismos de bajo impacto y no todos los hospitales cuentan con un densitómetro para hacer el diagnóstico definitivo. Sin embargo, se cuenta con herramientas clínicas que nos apoyan para iniciar con un tratamiento oportuno. OBJETIVO: reconocer el riesgo de refractura que existe en pacientes mayores de 50 años dentro de nuestra población. MATERIAL Y MÉTODOS: se incluyeron a pacientes > 50 años que sufrieron de una fractura de bajo impacto en el Hospital Ángeles Mocel. Usando el FRAX score México para medir el riesgo de sufrir una fractura. Se dividió la muestra en dos grupos, utilizando una p < 0.05 para considerar estadísticamente significativa con un IC de 95%. RESULTADOS: se incluyeron 69 pacientes, 47.8% ya habían sufrido de alguna fractura previa, 10% de ellos tienen tratamiento para la osteopenia. El riesgo de sufrir una fractura mayor osteoporótica en 10 años se observó en 50.7% de los pacientes. El riesgo de sufrir una fractura de cadera en 10 años se encontró en 75% de los pacientes. A ningún paciente se le dio tratamiento, ya sea modificadores del estilo de vida o tratamiento farmacológico para osteopenia/osteoporosis a su egreso hospitalario. CONCLUSIÓN: hay una deficiencia en el manejo inmediato de los cirujanos ortopedistas para prevenir en pacientes futuras refracturas de bajo impacto.

[Computer-assisted total bilateral knee arthroplasty in one surgical time]. / Artroplastía total de rodilla bilateral en un tiempo quirúrgico asistida por computadora.

INTRODUCTION: Total navigated knee replacement uses a computer-guided system, which provides immediate information on pre-cut trans-operative conditions of the knee, in relation to pelvic limb alignment. MATERIAL AND METHODS: Observational, descriptive study conducted from March 2003 to February 2019. Total bilateral knee replacement was performed at the same time surgically by a surgeon, evaluating function and pain on the WOMAC, EVA, and range of motion scores of both knees. Two groups of patients were studied: the first represents presurgical and the second post-surgical. Student's t-test and 2 were applied for statistical analysis. RESULTS: 31 patients (62 prostheses), 83.9% of the female sex and 16.1% male, average age 67.32 years, average follow-up 6.55 years (± 3.8) were studied. It was identified that 100% of the patients in both knees have a deviation between 0o and 2o measured in the mechanical axis. The WOMAC scale showed an average of 22.71 ± 3.34 presurgical and 4.16 ± 1.84) post-surgical, with statistically significant differences. The average analog visual scale was 9.06 ± 0.814 presurgical and 2.35 ± 1.427 post-surgical. CONCLUSIONS: This technique is reliable, safe and satisfactory. Excellent clinical and radiographic results were evident regarding the positioning of prosthetic components.

INTRODUCCIÓN: La artroplastía total de rodilla navegada utiliza un sistema guiado por computadora que proporciona información inmediata de condiciones transoperatorias precorte de la rodilla, con relación a la alineación del miembro pélvico. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo, efectuado de Marzo de 2003 a Febrero de 2019. Se realizó artroplastía total de rodilla bilateral navegada en un mismo tiempo quirúrgico por un cirujano, evaluando función y dolor según las escalas WOMAC, EVA y arcos de movilidad de ambas rodillas. Se estudiaron dos grupos de pacientes: el primero representa prequirúrgicos y el segundo postquirúrgicos. Se aplicó prueba t de Student y 2 para el análisis estadístico. RESULTADOS: Se estudiaron 31 pacientes (62 prótesis), 83.9% del sexo femenino y 16.1% del masculino, edad media 67.32 años, media de seguimiento 6.55 años (± 3.8). Se identificó que 100% de los pacientes intervenidos en ambas rodillas tienen una desviación entre 0o y 2o medida en el eje mecánico. La escala WOMAC mostró una media de 22.71 ± 3.34 prequirúrgica y 4.16 ± 1.84 postquirúrgica, con diferencias estadísticamente significativas. La escala visual análoga media fue de 9.06 ± 0.814 prequirúrgico y 2.35 ± 1.427 postquirúrgico. CONCLUSIONES: Esta técnica es confiable, segura y satisfactoria. Se evidenciaron excelentes resultados clínicos y radiográficos respecto al posicionamiento de los componentes protésicos.

Evidence of the occurrence of structural chromosome changes at the initial diploid diversification of the autopolyploid Turnera sidoides L. (Passifloraceae) complex.

Turnera sidoides is an autopolyploid complex of obligate outcrossing perennial herbs. It includes five subspecies and five morphotypes in which diploid to octoploid cytotypes were found. Based on phenetic analyses of the complex and karyotype data of polyploid cytotypes, it has been hypothesized that morphological and chromosome differentiation of T. sidoides occurred at the diploid level. To test this hypothesis, we present the first detailed chromosome analysis of diploid populations of three subspecies and four morphotypes. CMA(+)/DAPI(-) bands were restricted to secondary constrictions (except in the andino morphotype) and varied in number and position among taxa. By contrast, DAPI staining was uniform in all the materials investigated. The number and position of 45S rDNA loci were coincident with the CMA(+)/DAPI(-) bands associated with secondary constrictions. Only one pair of 5S rDNA loci was detected in all the taxa (except in subsp. holosericea), but its position was variable. The identified chromosome markers varied among the three subspecies analyzed, but they were more conserved among the morphotypes of subsp. pinnatifida. Cluster analysis of these chromosome markers supports the current taxonomic arrangement of diploids and demonstrates that structural chromosome changes would have led or accompanied the initial differentiation of T. sidoides at the diploid level.

Effects of transient, mild mood states on semantic memory organization and use: an event-related potential investigation in humans.

The effects of transient mood states on semantic memory organization and use were investigated using event-related potentials. Participants read sentence pairs ending with (1) the most expected word, (2) an unexpected word from the expected semantic category, or (3) an unexpected word from a different (related) category; half the pairs were read under neutral mood and half under positive mood. Under neutral mood, N400 amplitudes were smallest for expected items and smaller for unexpected items when these came from the expected category. In contrast, under positive mood, N400 amplitudes to the two types of unexpected items did not differ. Positive mood seemed to specifically facilitate the processing of distantly-related, unexpected items. The results suggest that transient mood states are associated with dynamic changes in how semantic memory is used on-line.