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• Discrete unidirectional sliding-modes is feasible for a hybrid artificial pancreas. • Discrete Adaptive Luenberger observer estimates unknown variables of diabetic patients. • The personalization fits the controller to patients according to their glucose dynamic. • The scenarios imitate the real-life meal habits with variations and transgressions. This paper presents an artificial pancreas algorithm implemented with a discrete-time sliding-mode method combined with a nonlinear block controllable form using a unidirectional control law and a discrete adaptive observer. The algorithm is both unidirectional, using insulin as unique input, and hybrid with a percentage of the pre-meal bolus administered in advance to complement the control action. Personalisation combines patient clustering and individual gain calculation after analysing glucose time-in-range. The stability of the complete closed-loop system involving the observer bounds is tested using the Lyapunov methodology. The performance of the algorithm is evaluated with 256 patients, simulated using Hovorka's model. The evaluation defines two scenarios (closed-loop and open loop with continuous subcutaneous insulin infusion, CSII), divided into three 1-week intervals, to respectively compare the impact of glucose control under the expected meal plan as a result of changes in carbohydrates quantities and meal schedule, and in response to more extreme events. The performance of time-in-range in each period obtained with CSII is improved by hybrid closed-loop in all cases, i.e., with the expected meals (weekdays 74.9 vs 78.4; weekends 71.5 vs 73.4), with meal variability (weekdays 74.3 vs 77.6; weekend 71.6 vs 72.7), and in the presence of transgressions (forgetting meal announcement: 50.1 vs 63.4; meal omission: 78.2 vs 82.03; copious meal: 60.1 vs 63.4). Compared to CSII, the personalised nonlinear block controller was able to increase the time-in-range without glucose presence in time below range level 2 for 98 % of the cohort for expected meals, meal variability, and transgressions. [ABSTRACT FROM AUTHOR]

Objective: It is estimated that in one year between 50-60% of patients treated with osteoporosis drugs are non-compliant. There are different indirect methods of assessing compliance. Our objective is to test a single determination of the carboxyterminal telopeptide of type I collagen (CTX) to assess compliance in patients treated with bisphosphonates, either on its own or together with the Morinsky-Green questionnaire. Material and method: A diagnostic assessment study was carried out in 10 centers in Catalonia. Through consecutive sampling, postmenopausal women with osteoporosis were selected and treated with the same antiresorptive drug in the last year. Those treated with a drug other than bisphosphonate, with cognitive impairment, terminal illness, advanced renal failure or fracture in the previous year, were excluded. Data were collected on the diagnosis of osteoporosis and type of treatment. Analysis was requested with CTX determination. As a gold standard, the medication possession rate (MPR) was used. Using the ROC curve methodology, the theoretical CTX cut-off point was established. Sensitivity, specificity and positive predictive values were calculated to estimate therapeutic compliance. Results: 100 patients were included, of which more than half were being treated with alendronate. According to the MPR, 70% were compliant. The mean CTX value was 0.193±0.146 ng/ml. It was lower in the compliant patients. A value of 0.196 ng/ml was established as a cut-off point to assess compliance. The joint assessment of the CTX together with the Morinsky-Green questionnaire showed greater discriminatory capacity. Conclusions: Carrying out a single determination of CTX (<0.196 ng/ml) along with the Morinsky-Green questionnaire allows us to more accurately assess the therapeutic compliance in patients treated with bisphosphonates. [ABSTRACT FROM AUTHOR]

Clinical management of breast cancer, making a prognosis and deciding on treatment, currently depend on defining prognostic factors, especially hormone receptors (HR). In addition to confirming the heterogeneity of the disease, these biological parameters are indispensable tools for designing personalized treatment. In this study, 1509 tumors from Cuban women diagnosed with breast cancer were examined. Hormone receptor (HR) expression was determined and correlated with a group of prognostic factors, such as age, tumor size, histological type, nuclear grade, histological grade, number of metastatic axillary lymph nodes, and clinical stage. Estrogen receptor (ER) expression was associated with low nuclear grade and histological grade, and with smaller tumor size (p<0.05). Analysis of age at the time of diagnosis showed that ER expression was greater in patients in the group aged >50 years (p<0.05). In general, ER expression was greater in patients in earlier clinical stages (p<0.05). With regard to HR expression, 53% of tumors in this sample were ER+ and 49% were PR+. In 38% of cases, both receptors were positive and in 28% both receptors proved negative. The ER+/PR- combination was observed in 23% of cases while only 11% exhibited the ER-/PR+ combination. These findings indicate that approximately 72% of the tumors studied expressed some level of hormone dependency. This is the first report of HR expression in Cuba using immunohistochemical techniques and a representative sample of breast tumors diagnosed in different provinces around the country. [ABSTRACT FROM AUTHOR]

Purpose: Electronic medical records databases use pre-specified lists of diagnostic codes to identify fractures. These codes, however, are not specific enough to disentangle traumatic from fragility-related fractures. We report on the proportion of fragility fractures identified in a random sample of coded fractures in SIDIAP., Methods: Patients≥50 years old with any fracture recorded in 2012 (as per pre-specified ICD-10 codes) and alive at the time of recruitment were eligible for this retrospective observational study in 6 primary care centres contributing to the SIDIAP database (www.sidiap.org). Those with previous fracture/s, non-responders, and those with dementia or a serious psychiatric disease were excluded. Data on fracture type (traumatic vs fragility), skeletal site, and basic patient characteristics were collected., Results: Of 491/616 (79.7%) patients with a registered fracture in 2012 who were contacted, 331 (349 fractures) were included. The most common fractures were forearm (82), ribs (38), and humerus (32), and 225/349 (64.5%) were fragility fractures, with higher proportions for classic osteoporotic sites: hip, 91.7%; spine, 87.7%; and major fractures, 80.5%. This proportion was higher in women, the elderly, and patients with a previously coded diagnosis of osteoporosis., Conclusions: More than 4 in 5 major fractures recorded in SIDIAP are due to fragility (non-traumatic), with higher proportions for hip (92%) and vertebral (88%) fracture, and a lower proportion for fractures other than major ones. Our data support the validity of SIDIAP for the study of the epidemiology of osteoporotic fractures., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)