El Fast Track en cistectomía radical: evolución de resultados a lo largo del tiempo en nuestro Servicio

Los protocolos Fast Track se basan en el cumplimiento de una serie de ítems para optimizar la preparación, el acto quirúrgico y el postoperatorio de los pacientes intervenidos. Se implantaron inicialmente en cirugía colorrectal, pero aún no ha sido ampliamente implementado en Urología y la evidencia para intervenciones específicas es limitada o no está disponible. La experiencia en otras áreas quirúrgicas y sus buenos resultados provocó que se estableciera un protocolo específico para la cistectomía radical. (1) En nuestro Servicio de Urología se aplica un protocolo Fast Track específico para cistectomía radical desde 2011 y el objetivo de este análisis es describir y evaluar la evolución de un protocolo Fast Track en cistectomía radical. Se incluyeron en el estudio los pacientes intervenidos de cistectomía radical en el Hospital Clínico Lozano Blesa de Zaragoza de enero de 2012 a junio de 2017. Se estratificó a los pacientes en tres periodos de estudio coincidiendo con la incorporación en el servicio de nuevos ítems del protocolo FT y por lo tanto nuevos protocolos. Se realizó un estudio descriptivo de la muestra y un estudio de regresión para evaluar la estancia hospitalaria, las complicaciones totales, la tasa de sangrado y de reingreso, comparando los tres periodos de tiempo. Contamos con 164 pacientes intervenidos, el 89,6% son hombres y la edad media es de 67,1±9,1 años. Un 46,3% de los pacientes (76/164) pertenecen al periodo 1, un 25,6% al periodo 2 (42/164) y un 28,0% al periodo 3 (46/164). No se observan diferencias relevantes entre los tres grupos para variables demográficas, antecedentes personales, antecedentes clínicos o estadio tumoral. De forma estadísticamente significativa disminuye la estancia hospitalaria media, la tasa de complicaciones totales, la necesidad de transfusión. La evolución en la tasa de reingreso también es positiva clínicamente pero no muestra diferencias significativas. En conclusión se demuestra una evolución muy positiva en la aplicación del protocolo FT en las intervenciones de cistectomía radical.<br /

Multi-frequency point source detection with fully convolutional networks: Performance in realistic microwave sky simulations

Context. Point source (PS) detection is an important issue for future cosmic microwave background (CMB) experiments since they are one of the main contaminants to the recovery of CMB signal on small scales. Improving its multi-frequency detection would allow us to take into account valuable information otherwise neglected when extracting PS using a channel-by-channel approach. Aims. We aim to develop an artificial intelligence method based on fully convolutional neural networks to detect PS in multi-frequency realistic simulations and compare its performance against one of the most popular multi-frequency PS detection methods, the matrix filters. The frequencies used in our analysis are 143, 217, and 353 GHz, and we imposed a Galactic cut of 30°. Methods. We produced multi-frequency realistic simulations of the sky by adding contaminating signals to the PS maps as the CMB, the cosmic infrared background, the Galactic thermal emission, the thermal Sunyaev-Zel’dovich effect, and the instrumental and PS shot noises. These simulations were used to train two neural networks called flat and spectral MultiPoSeIDoNs. The first one considers PS with a flat spectrum, and the second one is more realistic and general because it takes into account the spectral behaviour of the PS. Then, we compared the performance on reliability, completeness, and flux density estimation accuracy for both MultiPoSeIDoNs and the matrix filters. Results. Using a flux detection limit of 60 mJy, MultiPoSeIDoN successfully recovered PS reaching the 90% completeness level at 58 mJy for the flat case, and at 79, 71, and 60 mJy for the spectral case at 143, 217, and 353 GHz, respectively. The matrix filters reach the 90% completeness level at 84, 79, and 123 mJy. To reduce the number of spurious sources, we used a safer 4σ flux density detection limit for the matrix filters, the same as was used in the Planck catalogues, obtaining the 90% of completeness level at 113, 92, and 398 mJy. In all cases, MultiPoSeIDoN obtains a much lower number of spurious sources with respect to the filtering method. The recovering of the flux density of the detections, attending to the results on photometry, is better for the neural networks, which have a relative error of 10% above 100 mJy for the three frequencies, while the filter obtains a 10% relative error above 150 mJy for 143 and 217 GHz, and above 200 mJy for 353 GHz. Conclusions. Based on the results, neural networks are the perfect candidates to substitute filtering methods to detect multi-frequency PS in future CMB experiments. Moreover, we show that a multi-frequency approach can detect sources with higher accuracy than single-frequency approaches also based on neural networks.We warmly thank the anonymous referee for the very useful comments on the original manuscript. J.M.C., J.G.N., L.B., M.M.C. and D.C. acknowledge financial support from the PGC 2018 project PGC2018-101948-B-I00 (MICINN, FEDER). DH acknowledges the Spanish MINECO and the Spanish Ministerio de Ciencia, Innovación y Universidades for partial financial support under project PGC2018-101814-B-I00. M.M.C. acknowledges PAPI-20-PF-23 (Universidad de Oviedo). J.D.C.J., M.L.S., S.L.S.G., J.D.S. and F.S.L. acknowledge financial support from the I+D 2017 project AYA2017-89121-P and support from the European Union’s Horizon 2020 research and innovation programme under the H2020-INFRAIA-2018-2020 grant agreement No 210489629. This research has made use of the python packages ipython (Pérez & Granger 2007), matplotlib (Hunter 2007), TensorFlow (Abadi et al. 2015), Numpy (Oliphant 2006) and Scipy (Jones et al. 2001), also the HEALPix (Górski et al. 2005) and healpy (Zonca et al. 2019) packages

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Multiple Scenario Generation of Subsurface Models:Consistent Integration of Information from Geophysical and Geological Data throuh Combination of Probabilistic Inverse Problem Theory and Geostatistics

Neutrinos with energies above 1017 eV are detectable with the Surface Detector Array of the Pierre Auger Observatory. The identification is efficiently performed for neutrinos of all flavors interacting in the atmosphere at large zenith angles, as well as for Earth-skimming \u3c4 neutrinos with nearly tangential trajectories relative to the Earth. No neutrino candidates were found in 3c 14.7 years of data taken up to 31 August 2018. This leads to restrictive upper bounds on their flux. The 90% C.L. single-flavor limit to the diffuse flux of ultra-high-energy neutrinos with an E\u3bd-2 spectrum in the energy range 1.0 7 1017 eV -2.5 7 1019 eV is E2 dN\u3bd/dE\u3bd &lt; 4.4 7 10-9 GeV cm-2 s-1 sr-1, placing strong constraints on several models of neutrino production at EeV energies and on the properties of the sources of ultra-high-energy cosmic rays

Subjective probability in use: reasoning about a chess game

International audienceSubjective probability is often left aside in elementary school curricula, despite it is often used in daily-life. In this paper, we expose a didactic experiment with 5 th grade students (10-11 years old) in which they were asked to handle subjective probability. Findings show how students were able to make probability judgements even without a numerical support, they changed their initial judgements when more quality information was provided, and they refrained from state a founded judgement when they considered available information was not enough. Results endorse the importance of introducing this type of probabilistic reasoning in elementary school

Psychosocial Intervention Cultural Adaptation for Latinx Patients and Caregivers Coping with Advanced Cancer

Latinx advanced cancer patients and caregivers are less likely to have adequate access to culturally congruent psychosocial interventions. Culturally relevant and adapted interventions are more effective within minority groups. We obtained patients&rsquo; and caregivers&rsquo; initial evaluations of the Caregivers&ndash;Patients Support to Latinx coping with advanced-cancer (CASA) protocol. A qualitative study was conducted, and an acceptance questionnaire and semi-structured interviews were conducted to culturally adapt the psychosocial intervention for Latinx coping with cancer. The semi-structured interview described and demonstrated intervention components and elicited feedback about each one. Latinx advanced cancer patients (Stage III and IV) and caregivers (n = 14 each) completed the acceptance survey, and N = 7 each completed semi-structured interviews. A total of 12 of the 14 patients and caregivers (85.7%) reported high acceptance of the goals and purposes of the intervention protocol. They also reported willingness to daily use of the content of the intervention components: Communication Skills, the Willingness of Meaning, Life has Meaning, Freedom of Will, Identity, Creative Sources of Meaning, and Homework. Most of the participants reported high acceptance (n = 9) of integrating family caregivers into therapy and the high acceptance (n = 10) of the length of the 4-session intervention

Maltrato Infantil : guía de actuación para los centros educativos de Asturias

Resumen basado en la publicaciónDeterminados modelos y prácticas educativas, crisis de convivencia y otros factores asociados hacen en ocasiones de las familias estructuras generadoras de maltrato infantil. Cada vez son más frecuentes los casos detectados de maltrato infantil en sus diferentes modalidades, en los que niños, niñas y adolescentes se convierten en víctimas indefensas. Las consejerías de Vivienda y Bienestar Social y Educación y Ciencia del Principado de Asturias, ante un hecho tan relevante impulsan la elaboración de un marco de actuación conjunto que permita buscar soluciones integrales y eficaces en la prevención, detección y actuación ante situaciones de malos tratos en la infancia. Esta guía del maltrato infantil intenta integrar y unificar las actuaciones de las instituciones que tienen competencia en materia de atención a la infancia y a la vez sea un instrumento que facilite la detección de los posibles casos de maltrato infantil desde el ámbito escolar y que facilite la comunicación, la coordinación y la colaboración entre los profesionales. Es sabido que los centros escolares son espacios donde el personal docente tiene una buena oportunidad para observar cualquier tipo de indicador de maltrato infantil y esta guía tiene precisamente el objetivo de facilitar la comunicación de estos casos al órgano competente en materia de protección de menores para que tome las medidas oportunas. La utilización de este instrumento hace posible la actuación coordinada del personal de los centros docentes con el de los Servicios Sociales para llevar a cabo una actuación rápida y efectiva.AsturiasConsejería de Vivienda y Bienestar Social. Instituto Asturiano de Atención Social a la Infanci, Familia y Adolescencia;ES

Inserción de prótesis pancreáticas tras la canulación involuntaria con guía del Wirsung en la CPRE

RESUMEN Introducción: en los intentos de canulación del colédoco durante la colangiopancreatografía retrógrada endoscópica (CPRE) la guía puede entrar en el conducto pancreático. No está definido qué maniobra es más eficaz para canular la vía biliar y prevenir la pancreatitis tras pasar la guía al Wirsung. Objetivo: estudiar la tasa de canulación coledociana y de pancreatitis post-CPRE cuando en la primera ocasión en que la guía pasó al conducto pancreático de forma involuntaria se insertó una prótesis pancreática. Material y métodos: análisis retrospectivo de pacientes a los que se realizó una CPRE para drenaje biliar e incluidos de forma prospectiva en una base de datos. Tras la inserción involuntaria de una guía en el conducto pancreático se insertó una prótesis plástica recta de 5 Fr y 4 cm de longitud, sin topes internos para facilitar su expulsión. El colédoco se intentó canular por encima de la prótesis. En los pacientes mayores de 60 años se realizó una esfinterotomía pancreática antes de insertar la prótesis. Resultados: en un grupo de 154 CPRE se insertaron 46 prótesis pancreáticas (29,8%) y en estos casos el colédoco se canuló en el 95,6% (44/46) de las ocasiones. Se realizaron 21/46 (45,6%) esfinterotomías pancreáticas. Hubo 1/46 (2,17%) pancreatitis leves. La mayoría de las prótesis se expulsaron de forma espontánea. Conclusiones: en este estudio, la inserción de una prótesis pancreática plástica cuando la guía ha pasado al conducto pancreático de forma involuntaria en los intentos de canulación del colédoco ayudó a canular la vía biliar en la mayoría de las ocasiones, sin que la inserción de las prótesis produjera efectos adversos