Diagnóstico de niños con TDAH mediante el análisis Wavelet

El trastorno por déficit de atención con hiperactividad (TDAH) es un padecimiento crónico que se caracteriza por síntomas de inatención, hiperactividad e impulsividad. Este afecta el funcionamiento académico, familiar, social y laboral de quien lo padece. Este no es un trastorno exclusivo de la época actual, ya que existen referencia de su existencia desde el s. XVII. Sin embargo, conforme ha pasado el tiempo, se ha convertido en el desorden neuropsicológico más frecuente en la consulta psiquiátrica de niños y adolescentes. Se estima que su prevalencia a nivel mundial es del 5 %, por lo cual en México existen al menos un millón y medio de niños que padecen el trastorno. Además, existe la posibilidad de que haya un sobrediagnóstico, debido al aumento cada vez mayor de casos diagnosticados, además del hecho de que no existe una prueba diagnóstica específica y solo se utilizan herramientas de valoración clínica; por otro lado, debido a la alta comorbilidad con otras psicopatologías, se diculta su correcto diagnóstico. Es por ello que existe la necesidad de desarrollar nuevas herramientas que ayuden a diagnosticar con mayor certeza este trastorno, para poder elegir de ser necesario el tratamiento más adecuado y oportuno para el paciente, mejorando entonces su calidad de vida. El principal objetivo del trabajo de tesis consistió en el estudio de un método de diagnóstico para niños con TDAH basado en la caracterización de sus señales dependientes del nivel de oxigenación en sangre (o señales BOLD por sus siglas en inglés), obtenidas mediante resonancia magnética funcional en estado de reposo. Los voluntarios empleados en el trabajo fueron niños varones, diestros, sin otros padecimientos crónicos reportados y con edades entre 7 y 13 años. Los datos se obtuvieron de la base de datos llamada The ADHD-200 Sample

Brain MRI study for glioma segmentation using convolutional neural networks and original post-processing techniques with low computational demand

Gliomas are brain tumors composed of different highly heterogeneous histological subregions. Image analysis techniques to identify relevant tumor substructures have high potential for improving patient diagnosis, treatment and prognosis. However, due to the high heterogeneity of gliomas, the segmentation task is currently a major challenge in the field of medical image analysis. In the present work, the database of the Brain Tumor Segmentation (BraTS) Challenge 2018, composed of multimodal MRI scans of gliomas, was studied. A segmentation methodology based on the design and application of convolutional neural networks (CNNs) combined with original post-processing techniques with low computational demand was proposed. The post-processing techniques were the main responsible for the results obtained in the segmentations. The segmented regions were the whole tumor, the tumor core, and the enhancing tumor core, obtaining averaged Dice coefficients equal to 0.8934, 0.8376, and 0.8113, respectively. These results reached the state of the art in glioma segmentation determined by the winners of the challenge.Comment: 34 pages, 12 tables, 23 figure

Automatic quantification of abdominal subcutaneous and visceral adipose tissue in children, through MRI study, using total intensity maps and Convolutional Neural Networks

Childhood overweight and obesity is one of the main health problems in the world since it is related to the early appearance of different diseases, in addition to being a risk factor for later developing obesity in adulthood with its health and economic consequences. Visceral abdominal tissue (VAT) is strongly related to the development of metabolic and cardiovascular diseases compared to abdominal subcutaneous adipose tissue (ASAT). Therefore, precise and automatic VAT and ASAT quantification methods would allow better diagnosis, monitoring and prevention of diseases caused by obesity at any stage of life. Currently, magnetic resonance imaging is the standard for fat quantification, with Dixon sequences being the most useful. Different semiautomatic and automatic ASAT and VAT quantification methodologies have been proposed. In particular, the semi-automated quantification methodology used commercially through the cloud-based service AMRA R Researcher stands out due to its extensive validation in different studies. In the present work, a database made up of Dixon MRI sequences, obtained from children between 7 and 9 years of age, was studied. Applying a preprocessing to obtain what we call total intensity maps, a convolutional neural network (CNN) was proposed for the automatic quantification of ASAT and VAT. The quantifications obtained from the proposed methodology were compared with quantifications previously made through AMRA R Researcher. For the comparison, correlation analysis, Bland-Altman graphs and non-parametric statistical tests were used. The results indicated a high correlation and similar precisions between the quantifications of this work and those of AMRA R Researcher. The final objective is that the proposed methodology can serve as an accessible and free tool for the diagnosis, monitoring and prevention of diseases related to childhood obesity.Comment: 14 pages, 9 figures, 3 table

Sharp increase of Saharan dust intrusions over the Western Mediterranean and Euro-Atlantic region in winters 2020–2022 and associated atmospheric circulation [Discussion paper]

During the winters of the 2020–2022 period, several intense North African dust intrusions affected Europe. Some of them displayed a duration never recorded before. They were referred to as exceptional by several international operational and research institutions considering that wintertime is the season with minimum dust activity in the Mediterranean and Europe. These anomalous winter events with origin in North Africa largely affected western Mediterranean. The main objective of the present work is to analyse the atmospheric drivers (synoptic and large-scale environments) of wintertime (from January to March) dust events over the region covering North Africa, the Western Mediterranean and the Euro-Atlantic during the period 2003–2022. Overall, our results indicate large interannual variability over the study period. A dust catalogue of dust events identified by aerosols retrievals from satellite and aerosol reanalysis products shows a very irregular record and large differences between winter months. The analyses demonstrate a positive anomaly in dust concentration and maximum altitude during the dust events of 2020–2022 in comparison with those of previous years (2003–2019). Winter dust events over western Mediterranean are associated with enhanced blocking activity over the Euro-Atlantic sector, which favours the obstruction of the westerlies and the occurrence of cut-off lows at subtropical latitudes. However, these high-pressure systems can exhibit a large variety of configurations, including meridional dipole blocking patterns with poleward shifted jets or Mediterranean subtropical ridges with an intensified mid-latitude jet. The former was more frequent during the reference 2003–2019 period, whereas the latter was relatively common during the anomalous 2020–2022 period

The avoidance of G-CSF and the addition of prophylactic corticosteroids after autologous stem cell transplantation for multiple myeloma patients appeal for the at-home setting to reduce readmission for neutropenic fever

Autologous stem cell transplantation (ASCT) remains the standard of care for young multiple myeloma (MM) patients; indeed, at-home ASCT has been positioned as an appropriate therapeutic strategy. However, despite the use of prophylactic antibiotics, neutropenic fever (NF) and hospital readmissions continue to pose as the most important limitations in the outpatient setting. It is possible that the febrile episodes may have a non-infectious etiology, and engraftment syndrome could play a more significant role. The aim of this study was to analyze the impact of both G-CSF withdrawal and the addition of primary prophylaxis with corticosteroids after ASCT. Between January 2002 and August 2018, 111 MM patients conditioned with melphalan were managed at-home beginning +1 day after ASCT. Three groups were established: Group A (n = 33) received standard G-CSF post-ASCT; group B (n = 32) avoided G-CSF post-ASCT; group C (n = 46) avoided G-CSF yet added corticosteroid prophylaxis post-ASCT. The incidence of NF among the groups was reduced (64%, 44%, and 24%; P2 (OR 6.1; P = 0.002) and G-CSF avoidance plus corticosteroids (OR 0.1; P<0.001); and for hospital readmission: age �60 years (OR 14.6; P = 0.04) and G-CSF avoidance plus corticosteroids (OR 0.07; P = 0.05. G-CSF avoidance and corticosteroid prophylaxis post ASCT minimize the incidence of NF in MM patients undergoing at-home ASCT. This approach should be explored in a prospective randomized clinical trial

Results of a survey on peri-operative nutritional support in pancreatic and biliary surgery in Spain

Introduction: a survey on peri-operative nutritional support in pancreatic and biliary surgery among Spanish hospitals in 2007 showed that few surgical groups followed the 2006 ESPEN guidelines. Ten years later we sent a questionnaire to check the current situation. Methods: a questionnaire with 21 items sent to 38 centers, related to fasting time before and after surgery, nutritional screening use and type, time and type of peri-operative nutritional support, and number of procedures. Results: thirty-four institutions responded. The median number of pancreatic resections (head/total) was 29.5 (95 % CI: 23.0-35; range, 5-68) (total, 1002); of surgeries for biliary malignancies (non-pancreatic), 9.8 (95 % CI: 7.3-12.4; range, 2-30); and of main biliary resections for benign conditions, 10.4 (95 % CI: 7.6-13.3; range, 2-33). Before surgery, only 41.2 % of the sites used nutritional support (< 50 % used any nutritional screening procedure). The mean duration of preoperative fasting for solid foods was 9.3 h (range, 6-24 h); it was 6.6 h for liquids (range, 2-12). Following pancreatic surgery, 29.4 % tried to use early oral feeding, but 88.2 % of the surveyed teams used some nutritional support; 26.5 % of respondents used TPN in 100 % of cases. Different percentages of TPN and EN were used in the other centers. In malignant biliary surgery, 22.6 % used TPN always, and EN in 19.3 % of cases. Conclusions: TPN is the commonest nutrition approach after pancreatic head surgery. Only 29.4 % of the units used early oral feeding, and 32.3 % used EN; 22.6 % used TPN regularly after surgery for malignant biliary tumours. The 2006 ESPEN guideline recommendations are not regularly followed 12 years after their publication in our country

Anexo II. Fichas de los ítems

El presente documento contiene uno de los anexos a la publicación impresa titulada "Recuperando la ciudad. Estrategia para el diseño y la evaluación de planes y programas de regeneración urbana integrada" —ISBN: 978-84-9728-5585-1— libro que es uno de los resultados obtenidos del proyecto financiado por el Plan Nacional I+D+i para el periodo 2013-2015, titulado "Estrategia para el diseño y evaluación de planes y programas de regeneración urbana integrada. La intervención en las periferias españolas a través de las áreas de rehabilitación integral y el programa URBAN" (BIA2012-31905). Dicho proyecto se ha realizado en el Departamento de Urbanística y Ordenación del Territorio de la Escuela Técnica Superior de Arquitectura de Madrid, mediante la financiación del Ministerio de Economía y Competitividad, a través del Plan Nacional de I+D+i 2008-2011 (Subprograma de Proyectos de Investigación Fundamental no Orientada). En este segundo anexo se realiza una caracterización y descripción de cada uno de los ítems que forman parte cada una de las categorías pertenecientes a las cuatro áreas principales, facilitando así el uso de la herramienta en los casos en los que se requiera de un mayor nivel de detalle

Recuperando la ciudad. Estrategia para el diseño y la evaluación de planes programas de regeneración urbana integrada

El presente documento es uno de los resultados obtenidos del proyecto financiado por el Plan Nacional I+D+i para el periodo 2013-2015, titulado Estrategia para el diseño y evaluación de planes y programas de regeneración urbana integrada. La intervención en las periferias españolas a través de las áreas de rehabilitación integral y el programa URBAN (BIA2012-31905), realizado en el Departamento de Urbanística y Ordenación del Territorio de la Escuela Técnica Superior de Arquitectura de Madrid. El objetivo del proyecto fue desarrollar una “herramienta de evaluación” de los planes y programas de Rehabilitación Urbana Integrada y se materializa en un árbol de conceptos que deberían ser analizados tanto antes como después del plan o proyecto. Su intención es facilitar la comunicación entre los distintos actores de la rehabilitación: vecinos, técnicos y administración, que al disponer de un modelo de análisis común (que deberá ser ratificado de forma consensuada desde las fases previas de la operación) puedan llegar a consensos sobre cuáles son los elementos fundamentales y los secundarios de la operación, lo que permitiría determinar (en un marco de recursos limitados), el porqué y las consecuencias de la elección de alguno de los elementos del modelo en detrimento de otros. El modelo se construye en una doble dimensión. La espacial en la que se reflexiona sobre los distintos niveles de integración, desde el área urbana en la que se enclava, al espacio público del barrio sobre el que se pretende actuar, para llegar a la edificación y la vivienda, incluyendo a los propios habitantes. Pero esta estructura tiene la capacidad de garantizar la segunda dimensión, la integralidad de las operaciones, diferenciándose ésta en tres niveles: áreas, categorías e ítems. Se definen cuatro áreas, Marco Urbano y Territorial, Diseño urbano y Medio ambiente local, Edificación y Socio-Económica, que establecen el marco básico de la calidad urbana. Las categorías, en las que se divide cada área, representan un marco conceptual consistente que establece los temas que tienen que ser considerados y analizados en el proceso si queremos garantizar la integralidad de la actuación. Las categorías se dividen en ítems que son los elementos que en cada caso se utilizarán para garantizar la calidad final del plan o programa. Se han considerado los ítems como contextuales porque se conformarán en detalle y con matices diferenciados en función de cada proyecto o acción concreta, por lo que podrán coincidir con los ítems elaborados durante el desarrollo de esta herramienta o ser diferentes por necesidades específicas. El presente documento se completa con dos anexos: Anexo I: Informe de la encuesta sobre experiencias de rehabilitación urbana en las ciudades españolas. Resultados. URL: http://oa.upm.es/43244/ Anexo II: Fichas de los ítems. URL: http://oa.upm.es/43247

Seed storage conditions change the germination pattern of clonal growth plants in Mediterranean salt marshes.

8 páginas, 4 tablas, 8 figuras.The effect of salinity level and extended exposure to different salinity and flooding conditions on germination patterns of three saltmarsh clonal growth plants (Juncus subulatus, Scirpus litoralis, and S. maritimus) was studied. Seed exposure to extended flooding and saline conditions significantly affected the outcome of the germination process in a different, though predictable, way for each species, after favorable conditions for germination were restored. Tolerance of the germination process was related to the average salinity level measured during the growth/germination season at sites where established individuals of each species dominated the species cover. No relationship was found between salinity tolerance of the germination process and seed response to extended exposure to flooding and salinity conditions. The salinity response was significantly related to the conditions prevailing in the habitats of the respective species during the unfavorable (nongrowth/nongermination) season. Our results indicate that changes in salinity and hydrology while seeds are dormant affect the outcome of the seed-bank response, even when conditions at germination are identical. Because these environmental-history-dependent responses differentially affect seed germination, seedling density, and probably sexual recruitment in the studied and related species, these influences should be considered for wetland restoration and managementFinancial support from the Spanish Ministry of the Environment (MMA, project 05/99) and the Junta de Andalucía (research group 4086)enabled us to carry out the present work.Peer reviewe

Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID)

Background: Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. Methods: Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. Results: The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). Conclusions: Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival. (C) 2021 The Authors. Published by Elsevier Ltd