Desarrollo de una metodología para la determinación automática de alteraciones estructurales y funcionales en el cerebro mediante el procesamiento de imágenes de resonancia magnética

[ES] El objetivo que se persigue es determinar de manera automática las propiedades estructurales y la conectividad funcional en estado de reposo en el cerebro. Para ello, se propone una metodología basada en el estudio de la morfometría cerebral y de la conectividad funcional a partir del análisis de imágenes de Resonancia Magnética (RM). Para el estudio de la morfometría, se utilizará el método Voxel Based Morphometry (VBM), en el que se normaliza la imagen anatómica del sujeto respecto a una plantilla para analizar la presencia de alteraciones morfológicas locales. En este método, primero se realiza un pre-procesado que trate de eliminar las posibles heterogeneidades presentes en la señal de RM, así como extraer de las imágenes aquellas estructuras de tejido cerebral que puedan influir negativamente en los siguientes procesos (cráneo, vasos, cuero cabelludo, ojos, grasa y músculos). Posteriormente, se llevan a cabo diversos procesos de estandarización y tipificación buscando posicionar todas las imágenes anatómicas que queremos evaluar en un mismo espacio para permitir su análisis estadístico. Estos procesos son la normalización a este espacio común, la segmentación en los diferentes tejidos de interés (sustancia gris, sustancia blanca y líquido cefalorraquídeo) y el suavizado. Una vez realizados estos pasos, se emplea el Modelo Lineal General (MLG) para construir mapas estadísticos paramétricos (SPMs) que permitan el análisis morfológico de las imágenes. Aquellas zonas cerebrales resultantes de este análisis se etiquetarán mediante el atlas Harvard-Oxford (sustancia gris). La segunda parte de la metodología, consistente en el estudio de la conectividad funcional, está basada en la correlación entre las señales BOLD de uno o más vóxels separados anatómicamente. De forma análoga al método anterior, es necesario realizar un pre-procesado previo de las imágenes anatómicas y funcionales antes de comenzar el análisis estadístico: realineamiento, corregistro, normalización y suavizado. Tras completar los pasos anteriores, se generarán SPMs para delimitar aquellas áreas cerebrales activas y se establecen relaciones funcionales entre ellas mediante un análisis ROI to ROI. Los resultados se encuentran etiquetados mediante el atlas Harvard-Oxford. Toda la metodología mostrada se llevará a cabo mediante un software de elaboración propia escrito en lenguaje MATLAB. Este algoritmo empleará paquetes especializados de esta herramienta como SPM12 (Statistical Parametric Mapping) y CONN (functional connectivity toolbox).[EN] The objective is to automatically determine the structural properties and functional connectivity during the resting state. To this end, a methodology based on the study of brain morphometry and functional connectivity from the analysis of magnetic resonance imaging (MRI) is proposed. For the morphometry study, the Voxel Based Morphometry (VBM) method will be used, in which the anatomical image of the subject is normalized with respect to a template in order to analyze the presence of local morphological alterations. In this method, a pre-processing is first performed to eliminate the possible heterogeneities present in the MRI signal, as well as to extract from the images those structures of brain tissue that may negatively influence the following processes (skull, vessels, scalp, eyes, fat and muscles). Subsequently, several standardization and typification processes are carried out in order to position all the anatomical images that we want to evaluate in the same space to allow their statistical analysis. These processes are the normalization to this common space, the segmentation in the different tissues of interest (grey matter, white matter and cerebrospinal fluid) and the smoothing. Once these steps are completed, the General Linear Model (GLM) is used to build parametric statistical maps (SPMs) that allow the morphological analysis of the images. Those brain areas resulting from this analysis will be labelled using the Harvard-Oxford (grey matter) and Jülich / Susumu Mori (white matter) atlases. The second part of the methodology, consisting of the study of functional connectivity, is based on the correlation between the BOLD signals of one or more anatomically separated voxels. Similar to the previous method, it is necessary to pre-process the anatomical and functional images before starting the statistical analysis: realignment, co-registration, normalization and smoothing. After finishing the above steps, SPMs are generated to delimit those active brain areas and functional relationships are established between them through a ROI to ROI analysis. Results are labelled using the Harvard-Oxford atlas. All the methodology shown will be carried out by means of an own elaboration software written in MATLAB language. This algorithm will use specialized packages of this tool such as SPM12 (Statistical Parametric Mapping) and CONN (functional connectivity toolbox).Camacho Ramos, EJ. (2018). Desarrollo de una metodología para la determinación automática de alteraciones estructurales y funcionales en el cerebro mediante el procesamiento de imágenes de resonancia magnética. http://hdl.handle.net/10251/110764TFG

The successful containment of a hospital outbreak caused by NDM-1-producing Klebsiella pneumoniae ST307 using active surveillance

The worldwide dissemination of high-risk carbapenemase-producing Klebsiella pneumoniae clones has become a major threat to healthcare facilities. This study describes the successful containment of a hospital outbreak caused by NDM-1-producing K. pneumoniae Sequence Type (ST) 307 using active surveillance. The outbreak began when a patient was transferred from a local hospital. After 48 hours in our hospital, a tracheal aspirate was positive for a meropenem resistant and carbapenemase-producing K. pneumoniae. All patients in the medical intensive care unit (ICU) and the neurology wards were subject to contact precautions. The hospital surfaces and devices, healthcare workers, and patients from these wards were screened by cultures. Fecal swabs were placed into broth and PCR for blaKPC, blaOXA-48, blaIMP, blaVIM, and blaNDM, which were performed directly from the broth after 12 hours. PCRs were also performed on DNA extracted from carbapenemase-producing species from subcultured broths. Five and nine days later, two more patients’ rectal swabs tested positive. Molecular assays identified K. pneumoniae blaNDM-1 onto a 130-kb conjugative plasmid (IncY, IncFIIs, and IncFIIY), ST307. After the three patients were discharged, monitoring continued, and after three weeks with negative results, rectal swabbing ended. In conclusion, it was possible to contain a hospital outbreak caused by NDM-1-producing K. pneumoniae ST307 through epidemiological and microbiological surveillance. With the methodology used, the detection of NDM-type genes in fecal samples was obtained in approximately 15 hours after obtaining the fecal sample

Aspergilosis invasiva neuropulmonar

This is a 68 year old male patient, white, with a history of bronchial asthma , hypothyroidism, benign prostatic hyperplasia, chronic liver  and chronic renal disease monitoring by Nephrology Specialist . Presented various income for respiratory diagnosed with bronchopneumonia plus low hemoglobin, the proteinuria was found in nephrotic range and the possibility of renal biopsy was assessed. Immunological studies and microbiological hemochemical and included  tests, with blood cultures positive for Staphylococcus aureus. It evolved unfavorably with acid-base imbalance and marked general malaise to extreme bradycardia and death. At autopsy the presence of membranoproliferative glomerulonephritis secondary to hepatotropic viruses with chronic liver damage leading to immunosuppression and the resulting Aspergillus infestation with meningoencephalic invasion and lung was found . Invasive aspergillosis is a major cause of morbidity and mortality in immunocompromised patients.Se trata de un paciente de 68 años, masculino, blanco, con antecedentes de asma bronquial, hipotiroidismo, hiperplasia benigna de próstata, hepatopatía crónica y enfermedad renal crónica con seguimiento por el Especialista en Nefrología. Presentó varios ingresos por cuadro respiratorio con diagnóstico de bronconeumonía además de cifras bajas de hemoglobina, se constató proteinuria en rango nefrótico y se valoró la posibilidad de realizar biopsia renal. Se incluyen en los exámenes estudios inmunológicos y hemoquímicos así como microbiológicos, con hemocultivos positivos para estafilococo aureus. Evolucionó desfavorablemente con desequilibrio ácido básico y marcada toma del estado general hasta la bradicardia extrema y la muerte. En la autopsia se encontró la presencia de una glomerulonefritis membranoproliferativa secundaria a virus hepatotropos con daño hepático crónico que llevó a la consiguiente inmunosupresión y a la infestación por aspergilus, con invasión meningoencefálica y pulmonar. La aspergilosis invasora es una causa importante de morbilidad y mortalidad en enfermos inmunosuprimidos

Efficacy of nimotuzumab according to inflammatory indices in patients with advanced non-small cell lung cancer

Introduction: The response to therapies in advanced lung cancer could be related to certain prognostic factors such as inflammatory indices. Objective: To evaluate the efficacy of the humanized monoclonal antibody nimotuzumab in patients with advanced non-small cell lung cancer according to inflammatory indices. Method: A retrospective longitudinal evaluation study was carried out in a universe of 498 patients older than 18 years, with a cytohistological diagnosis of non-small cell lung cancer, in advanced stages, after the first line of oncological therapy, including in multicenter clinical trials promoted by the Center for Molecular Immunology from 2002 to 2018. Descriptive statistics were applied, the x-tile 3.6.1 software was used for the Kaplan Meier test, significant differences were considered when p< 0,05. Results: In the patients analyzed, nimotuzumab showed therapeutic benefit in the group of patients who did not progress to the first line of treatment with chemotherapy or chemoradiotherapy, when they had a lower neutrophil-lymphocyte index (p= 0,017 and p= 0,027) and a lower platelet-lymphocyte index (p= 0,030 and p= 0,009). Conclusion: Selecting a patient with a lower inflammatory index benefits the efficacy of treatment with the humanized mAb nimotuzumab in advanced non-small cell lung cancer, which becomes a predictive tool for response to treatment

A Latin American Perspective to Agricultural Ethics

The mixture of political, social, cultural and economic environments in Latin America, together with the enormous diversity in climates, natural habitats and biological resources the continent offers, make the ethical assessment of agricultural policies extremely difficult. Yet the experience gained while addressing the contemporary challenges the region faces, such as rapid urbanization, loss of culinary and crop diversity, extreme inequality, disappearing farming styles, water and land grabs, malnutrition and the restoration of the rule of law and social peace, can be of great value to other regions in similar latitudes, development processes and social problems. This chapter will provide a brief overview of these challenges from the perspective of a continent that is exposed to the consequences of extreme inequality in multiple dimensions and conclude by arguing for the need to have a continuous South-South dialogue on the challenges of establishing socially and environmentally sustainable food systems

Revista de Vertebrados de la Estación Biológica de Doñana

Página 298 con error de impresiónEstudio cariológico en dos especies de Serránidos del Mediterráneo (Peces: PerciformesRelaciones morfométricas de Atherina boyeri Risso (Pisces: Atherinidae) de la laguna de Zoñar (Córdoba, España)Contribución al conocimiento de la biometríay osteología de Barbus barbus bocagei, Steindachner, 1866 (Pisces: CyprinidaeLa actividad de la salamandra, Salamandra salamandra (L.), en Galicia.Estudios sobre el sapo corredor (Bufo calamita) en el Sur de España.1. BiometríaEstudios sobre el sapo corredor (Bufo calamita) en el Sur de España. II. AlimentaciónBiología de la reproducción de Rana iberica Boulenger 1879 en zonas simpátridas con Rana temporaria Linneo, 1758Nuevos datos sobre la distribución geográfica de Lacerta monticola cantabrica Mertens, 1929. (Sauria, lacertidae).Datos sobre Lacerta monticola Boulenger, 1905 (Saurio: lacertidae)en el oeste del Sistema Central.Nueva especie de Anolis (lacertilia, Iguanidae) para CubaEtograma cuantificado del cortejo en Falco naumannOntogénesis del comportamiento predador en Falco naumanniContaminación xenobiótica del Parque Nacional de Doñana. 1. Residuos de insecticidas organoclorados, bifenilos policlorados y mercurio en anseriformes y gruiformesReproducción del críalo (Clamator glandarius) en Sierra Morena CentraNidificación de Picus viridis en taludes de arcilla en Ramblas de Guadix (Granada)Comportamiento del calamón Porphyrio porphyrio (Linnaeus, 1758) en Doñana, Marismas del GuadalquiviBiología y ecología de la malvasía (Oxyura leucocephala) en Andalucía.On the differential diet of Carnivora in islands:a method for analysing it and a particular case.Notas sobre la distribución pasada y actual del meloncillo Herpestes ichneumon (L.) en la Península IbéricaEstructuración de las interacciones en una camada de lobos (Canís lupus)Nuevos datos sobre la distribución del Cottus gobio L. (pisces, cottidae) en EspañaSobre la alimentación de Callopistes maculatus (Reptilia,teiidaeObservación de Lacerta lepida depredando un nido de Alectoris rufaNueva cita del galápago leproso Mauremys leprosa (Scheigger, 1812) en los pirineosPrimera cita de Psammodromus hispanicus (Fitzinger) para GaliciaSobre la presencia de Gallotia (=Lacerta) atlantica (Peters y Doria, 1882) en Gran CanariaNota sobre las Lacerta monticola Boulenger, 1905 de las zonas del norte de GaliciaPrimeras notas herpetológicas de la provincia de Soria.Datos sobre selección de hábitat y ecología alimenticia del porrón pardo (Aythya nyroca)Probable nueva área de cría del pechiazul (Luscinia svecica cyanecula) en el sistema central. PerisPredación de Falco peregrinus y Falco subbuteo sobre quirópterosResultados de la producción de Oxyura leucocephala en el año 1981 en las lagunas de Zóñar y el rincónAnálisis de la dieta de Tyto alba en un medio árido antropógeno de los alrededores de Almería¿Son Eudocimus ruber y E. albus distintas especies?EL Estornino pinto (Sturnus vulgaris) en Canarias: nueva especie nidifiante en el archipiélagoDatos sobre la alimentación otoñal del cárabo (Strix aluco) en la sierra de CádizObservación primaveral de rapaces y otras aves en el páramo del estado de Mérida (Venezuela).Murciélago hematófago (Desmodus rotundus) parasitando a un chigüire (Hidrochoerus hydrochaeris)Observaciones sobre la reproducción del zacatuche o teporinho Romerolagus diazi (Mammalia: lagomorpha)Estudio electroforético de hemoglobinas y esterasas sanguíneas en Rhinolophus ferrumequinum (Chiroptera: rhinolophidae) y de hemoglobinas en Tadaria taeniotis (chiroptera: molossidae)Peer reviewe

Guía clínica para el diagnóstico y seguimiento de la distrofia miotónica tipo 1, DM1 o enfermedad de Steinert

La enfermedad de Steinert o distrofia miotónica tipo 1 (DM1), (OMIM 160900) es la miopatía más prevalente en el adulto. Es una enfermedad multisistémica con alteración de prácticamente todos los órganos y tejidos y una variabilidad fenotípica muy amplia, lo que implica que deba ser atendida por diferentes especialistas que dominen las alteraciones más importantes. En los últimos anos ˜ se ha avanzado de manera exponencial en el conocimiento de la enfermedad y en su manejo. El objetivo de la guía es establecer recomendaciones para el diagnóstico, el pronóstico, el seguimiento y el tratamiento de las diferentes alteraciones de la DM1. Esta guía de consenso se ha realizado de manera multidisciplinar. Se ha contado con neurólogos, neumólogos, cardiólogos, endocrinólogos, neuropediatras y genetistas que han realizado una revisión sistemática de la literatura. Se recomienda realizar un diagnóstico genético con cuantificación precisa de tripletes CTG. Los pacientes con DM1 deben seguir control cardiológico y neumológico de por vida. Antes de cualquier cirugía con anestesia general debe realizarse una evaluación respiratoria. Debe monitorizarse la presencia de síntomas de disfagia periódicamente. Debe ofrecerse consejo genético a los pacientes con DM1 y a sus familiares. La DM1 es una enfermedad multisistémica que requiere un seguimiento en unidades especializadas multidisciplinares

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research