Obstructive sleep apnea syndrome is a reduction of the airflow during sleep which not only produces a reduction in sleep quality but also has major health consequences. The prevalence in the obese pediatric population can surpass 50%, and polysomnography is the current gold standard method for its diagnosis. Unfortunately, it is expensive, disturbing and time-consuming for experienced professionals. The objective is to develop a patient-friendly screening tool for the obese pediatric population to identify those children at higher risk of suffering from this syndrome. Three supervised learning classifier algorithms (i.e., logistic regression, support vector machine and AdaBoost) common in the field of machine learning were trained and tested on two very different datasets where oxygen saturation raw signal was recorded. The first dataset was the Childhood Adenotonsillectomy Trial (CHAT) consisting of 453 individuals, with ages between 5 and 9 years old and one-third of the patients being obese. Cross-validation was performed on the second dataset from an obesity assessment consult at the Pediatric Department of the Hospital General Universitario of Valencia. A total of 27 patients were recruited between 5 and 17 years old; 42% were girls and 63% were obese. The performance of each algorithm was evaluated based on key performance indicators (e.g., area under the curve, accuracy, recall, specificity and positive predicted value). The logistic regression algorithm outperformed (accuracy = 0.79, specificity = 0.96, area under the curve = 0.9, recall = 0.62 and positive predictive value = 0.94) the support vector machine and the AdaBoost algorithm when trained with the CHAT datasets. Cross-validation tests, using the Hospital General de Valencia (HG) dataset, confirmed the higher performance of the logistic regression algorithm in comparison with the others. In addition, only a minor loss of performance (accuracy = 0.75, specificity = 0.88, area under the curve = 0.85, recall = 0.62 and positive predictive value = 0.83) was observed despite the differences between the datasets. The proposed minimally invasive screening tool has shown promising performance when it comes to identifying children at risk of suffering obstructive sleep apnea syndrome. Moreover, it is ideal to be implemented in an outpatient consult in primary and secondary care.
Introduction:In type 2 diabetes (T2D), key barriers to optimal glycaemic control include lack of persistence with treatment, reduced medication adherence and therapeutic inertia. This study aimed to assess the impact of these barriers in obese adults with type 2 diabetes treated with a GLP-1 receptor agonist (GLP-1RA) and compare them against other glucose-lowering agents in a real-world setting. Methods: A retrospective study was conducted using electronic medical records from 2014 to 2019 for adults with T2D at the Valencia Clı ´nico-Malvarrosa Department of Health (Valencia, Spain). Four study groups were established: all GLP-1RA users, SGLT2i users, insulin users and other glucose-lowering agent users (miscellany group). To account for imbalance between groups, propensity score matching (PSM) including age, gender and preexisting cardiovascular disease was performed. Chi-square tests were used for comparisons between groups. Time to first intensification was calculated using competing risk analysis. Results: Among the 26,944 adults with T2D, 7392 individuals were selected following PSM,
GATA4 and GATA6 are transcription factors involved in the differentiation and development of PDAC. GATA6 expression is related to the classic molecular subtype, while its absence is related to the basal-like molecular subtype. The aim was to determine the clinical utility of IHC determination of GATA4 and GATA6 in a series of patients with resected PDAC. GATA4 and GATA6 expression was studied by IHC in TMA samples of normal tissue, PanIN, tumor tissue and lymph node metastases from a series of 89 patients with resected PDAC. Its relationship with clinicopathologic variables and the outcome was investigated. Seventy-two (81%) tumors were GATA6+ and 37 (42%) were GATA4+. While GATA4 expression was reduced during tumor progression, GATA6 expression remained highly conserved, except in lymph node metastases. All patients with early stages and well-differentiated tumors were GATA6+. The absence of GATA4 expression was related to smoking. Patients with GATA4+ or GATA6+ tumors had significantly lower Ca 19.9 levels. The expression of GATA4 and GATA6 was related to DFS, being more favorable in the GATA4+/GATA6+ group. The determination of the expression of GATA4 and GATA6 by IHC is feasible and provides complementary clinical and prognostic information that can help improve the stratification of patients with PDAC.
AimsTo assess the impact of anticoagulant treatment on risk for stroke and all-cause mortality of patients with atrial fibrillation using real-world data (RWD).MethodsPatients with prevalent or incident atrial fibrillation were selected throughout a study period of 5 years. Stroke, transitory ischemic attack, hemorrhagic stroke, and all-cause mortality were identified in the claims of the electronic health records (EHRs). Subjects were classified according to the anticoagulant treatment in four groups: untreated, vitamin K antagonists (VKAs), New Oral Anticoagulants (NOACs), and antiplatelet (AP). Risk of events and protection with anticoagulant therapy were calculated by Cox proportional hazard models adjusted by potential confounders.ResultsFrom a total population of 3,799,884 patients older than 18,123,227 patients with incident or prevalent atrial fibrillation (AF) were identified (mean age 75.2 ± 11.5 years old; 51.9% women). In a follow-up average of 3.2 years, 17,113 patients suffered from an ischemic stroke and transitory ischemic attack (TIA), 780 hemorrhagic stroke, and 42,558 all-cause death (incidence of 46, 8, 2, and 120 per 1,000 patients/year, respectively). Among CHA2DS2, VASc Score equal or >2, 11.7% of patients did not receive any anticoagulant therapy, and a large proportion of patients, 47%, shifted from one treatment to another. Although all kinds of anticoagulant treatments were significantly protective against the events and mortality, NOAC treatment offered significantly better protection compared to the other groups.ConclusionIn the real world, the use of anticoagulant treatments is far from guidelines recommendations and is characterized by variability in their use. NOACs offered better protection compared with VKAs.
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