Deep learning for fully automatic detection, segmentation, and Gleason grade estimation of prostate cancer in multiparametric magnetic resonance images.

Although the emergence of multi-parametric magnetic resonance imaging (mpMRI) has had a profound impact on the diagnosis of prostate cancers (PCa), analyzing these images remains still complex even for experts. This paper proposes a fully automatic system based on Deep Learning that performs localization, segmentation and Gleason grade group (GGG) estimation of PCa lesions from prostate mpMRIs. It uses 490 mpMRIs for training/validation and 75 for testing from two different datasets: ProstateX and Valencian Oncology Institute Foundation. In the test set, it achieves an excellent lesion-level AUC/sensitivity/specificity for the GGG[Formula: see text]2 significance criterion of 0.96/1.00/0.79 for the ProstateX dataset, and 0.95/1.00/0.80 for the IVO dataset. At a patient level, the results are 0.87/1.00/0.375 in ProstateX, and 0.91/1.00/0.762 in IVO. Furthermore, on the online ProstateX grand challenge, the model obtained an AUC of 0.85 (0.87 when trained only on the ProstateX data, tying up with the original winner of the challenge). For expert comparison, IVO radiologist's PI-RADS 4 sensitivity/specificity were 0.88/0.56 at a lesion level, and 0.85/0.58 at a patient level. The full code for the ProstateX-trained model is openly available at https://github.com/OscarPellicer/prostate_lesion_detection . We hope that this will represent a landmark for future research to use, compare and improve upon.

[Catch-up growth and associated factors in very low birth weight infants]. / Crecimiento recuperador y factores asociados en niños de muy bajo peso al nacer.

INTRODUCTION: The characteristics of catch-up growth in very low birth weight infants (VLBW) have not been clearly established. The aim of this study was to analyse the height catch-up and some associated factors in a cohort of VLBW (birth weight<1,500g) from birth to age 14 years. METHODS: We obtained retrospective data on weight and height at birth and ages one, 2, 3, 4, 6, 8, 10, 12 and 14 years in a cohort of 170 VLBW. We compared these anthropometric values with those documented in a control group. RESULTS: Thirty-seven children (21.8%) were born with an extremely low birth weight and 32 (18.8%) extremely preterm. At 10 years of age, 7% of VLBW (1,000-1,500g) and 35% of extremely low birth weight (<1,500g) children had short stature (P=.001). Almost all VLBW children who had a normal height at ages 2, 4 and 10 years had exhibited adequate weight catch-up in previous evaluations. We found that extremely low birth weight and extremely preterm were independent predictors for inadequate height catch-up. CONCLUSION: The growth pattern of VLBW children has specific characteristics. The catch-up in weight seems to be an important factor for catch-up in height, and therefore a thorough nutritional follow-up is recommended in these children.

Prevalence of malnutrition in hospitalised children: retrospective study in a Spanish tertiary-level hospital.

OBJECTIVE: To analyse the prevalence of malnutrition among paediatric patients at the time of hospital admission throughout a calendar year in a tertiary-level hospital and to identify those patients and/or groups of pathologies with a higher risk of malnutrition. DESIGN: Observational (retrospective evaluation of nutrition status). SETTING: Navarra Hospital Complex, Pamplona, Spain. PARTICIPANTS: A total of 852 patients hospitalised in 2013 in a Spanish tertiary-level paediatric hospital (462 males and 390 females). MAIN OUTCOME MEASURES: Sex, age, body mass index at the moment of admission and days of hospitalisation and diagnosis codified according to the International Classification of Diseases were registered. RESULTS: The prevalence of malnutrition patients registered at the moment of admission was 8.2%. Diseases of the nervous system (22.9%), together with diseases of the respiratory system (22.9%), infectious diseases (18.6%), congenital malformations (11.4%) and diseases of the genitourinary system (8.6%) account for 84.4% of the cases with malnutrition. CONCLUSIONS: The overall prevalence rate for malnutrition in paediatric patients at the moment of admission in our hospital was 8.2%, being a figure similar to those published in occidental countries. It should be mandatory to accomplish an initial screening and follow-up during hospitalisation of younger patients and those suffering from diseases of the nervous and/or respiratory system and, especially, from congenital diseases.

[Nutritional status at the time of admission among patients admitted to a tertiary-care paediatric hospital]. / SITUACIÓN NUTRICIONAL EN EL MOMENTO DEL INGRESO EN UN HOSPITAL PEDIÁTRICO TERCIARIO.

OBJECTIVE: To analyze the nutrition status of the pediatric patients at the time of hospital admission throughout a calendar year in a tertiary level hospital and to identify those patients and/or groups of pathologies with a higher risk of malnutrition. MATERIAL AND METHODS: Retrospective evaluation of nutrition status of 852 patients hospitalized in 2013 in a pediatric hospital (462 males and 390 females). Sex, age, body mass index at the moment of admission and days of hospitalization and diagnosis codified according to the International Classification of Diseases were registered. RESULTS: The prevalence of malnutrition patients registered at the moment of admission was 8.2%. Excess body weight (overweight and obesity) was detected in 18% of the patients. The diseases of the nervous system (22.9%), together with the diseases of the respiratory system, the infectious diseases (18.6%), the congenital malformations (11.4%) and the diseases of the genitorurinary system (8.6%) account for 84.4% of the cases with malnutrition. CONCLUSIONS: The overall prevalence rate for malnutrition in pediatric patients at the moment of admission in our hospital was 8.2%, being this figure similar to those published in occidental countries. It should be mandatory to accomplish an initial screening and follow up during hospitalization of younger patients and those suffering from diseases of the nervous and/or respiratory system and, especially, from congenital diseases.

Objetivo: analizar la situación nutricional de los pacientes en el momento del ingreso hospitalario a lo largo de un año natural e identificar a aquellos pacientes y/o grupos de enfermedades con mayor riesgo de malnutrición. Material y métodos: valoración retrospectiva de la situación nutricional de 852 pacientes hospitalizados durante el año 2013 en un hospital pediátrico (462 varones y 390 mujeres). De cada paciente se registraron el sexo, edad, peso y talla, índice de masa corporal (IMC), estancia hospitalaria y diagnóstico según la Clasificación Internacional de las Enfermedades (CIE-10). Resultados: la prevalencia de malnutrición al ingreso era del 8,2%, y la de sobrepeso/obesidad del 18%. Las enfermedades neurológicas (22,9%), junto con las respiratorias (22,9%), infecciosas (18,6%), malformaciones congénitas (11,4%) y genitourinarias (8,6%) representaban el 84,4% de los casos de malnutrición. Conclusiones: la tasa de prevalencia de malnutrición en los pacientes pediátricos al ingreso era del 8,2%; siendo esta cifra prácticamente similar a las publicadas en los países occidentales. Los pacientes con menor edad y afectos de enfermedades neurológicas y/o respiratorias y, especialmente, con enfermedades congénitas tenían un mayor riesgo de presentar malnutrición, siendo preceptivo realizar un cribado nutricional inicial y un seguimiento durante su hospitalización.

[Recurring post-traumatic growing skull fracture]. / Fractura craneal evolutiva postraumática recidivada.

INTRODUCTION: Growing skull fracture, also known as post-traumatic bone absorption or leptomeningeal cyst, is a rare complication of traumatic brain injuries and occurs almost exclusively in children under 3 years of age. CASE REPORT: We report the case of a 6-month-old child who presented, two months after an apparently unimportant traumatic skull injury, persistence of left temporoparietooccipital cephalohaematoma with no other signs. A transfontanellar ultrasonography scan revealed a bone defect with brain herniation, and computerised tomography and magnetic resonance imaging also confirmed the existence of a growing fracture. Excision of the leptomeningeal cyst, dural closure and repair of the bone defect with plates and lactate material were performed. Three months after the operation, the patient still presented collection of fluid and recurrence of the growing fracture was confirmed. Following the second operation, a baby helmet was fitted in order to prevent renewed recurrences. One year after the traumatic injury occurred, the patient remains asymptomatic. CONCLUSIONS: Any child under 3 years of age with a post-traumatic cephalohaematoma should be checked periodically until the full resolution of the collection of fluid, especially if they present a fractured skull. The presence of a cephalohaematoma that remains more than two weeks after traumatic brain injury must make us suspect a growing fracture and reparation of the dura mater and a cranioplasty will be needed to treat it. The use of resorbable material allows it to be remodelled as the patient's skull grows, but its fragility increases the risk of recurrence. The use of a baby helmet after the operation could prevent complications.

TITLE: Fractura craneal evolutiva postraumatica recidivada.Introduccion. La fractura craneal evolutiva, tambien llamada absorcion osea postraumatica o quiste leptomeningeo, es una rara complicacion de los traumatismos craneoencefalicos y ocurre de forma casi exclusiva en ninos menores de 3 anos. Caso clinico. Nino de 6 meses que presentaba, dos meses despues de un traumatismo craneal aparentemente banal, persistencia de cefalohematoma temporooccipital izquierdo sin otros signos. El estudio de ecografia transfontanelar revelo un defecto oseo con herniacion cerebral, y la tomografia computarizada y la resonancia magnetica confirmaron, ademas, una fractura evolutiva. Se realizo reseccion del quiste encefalomeningeo, cierre dural y reparacion del defecto oseo con placas y material de lactato. Tres meses despues de la intervencion, presentaba persistencia de coleccion liquida y se confirmo recidiva de la fractura evolutiva. Tras la reintervencion, se coloco casco ortesico para evitar nuevas recidivas. Un ano despues del traumatismo, el paciente continua asintomatico. Conclusiones. Todo nino menor de 3 anos con cefalohematoma postraumatico deberia ser revisado de forma periodica hasta comprobar la resolucion de la coleccion, en particular si presenta fractura craneal. La presencia de un cefalohematoma persistente mas de dos semanas despues de un traumatismo craneoencefalico debe hacernos sospechar un proceso de fractura creciente, y son necesarias la reparacion de la duramadre y una craneoplastia para su tratamiento. La colocacion de material reabsorbible permite su remodelacion con el crecimiento craneal del paciente, pero su fragilidad conlleva riesgo de recidiva. La colocacion de un casco ortesico tras la intervencion podria prevenir complicaciones.

[Longitudinal study of the evolution (from birth to 8 years of age) of anthropometric variables in a cohort of very low birth weight infants]. / Estudio evolutivo longitudinal (desde el nacimiento hasta los 8 años) de las variables antropométricas en una cohorte de recién nacidos de muy bajo peso.

OBJECTIVE: Descriptive anthropometric survey in a cohort of very low birth weight infants (VLBWI) newborns from birth to age 8 years, analyzing the growth characteristics in these patients. MATERIAL AND METHODS: Retrospective registration of weight and height at birth and age 0.5, 1, 1.5, 2, 3, 4, 6 and 8 years in a cohort of 170 VLBWI (< 1500 g). Patients were separated into appropriate for gestational age (AGA, n=101) and low birth weight or small for gestational age (SGA, n=69) according to the charts from Carrascosa et al. Anthropometric variables were compared with those from a control group. RESULTS: Gestational age was 30.4±3.1 weeks. Weight and height at birth were 1182.1± 228.4 g and 38.2± 3.2 cm, respectively. Weight, height and body mass index in both sexes and every considered age were higher (p<0.05) within the control group with respect to VLBWI (AGA and SGA). At age 2, 81.2% and 71% of AGA and SGA (p<0.05) respectively, presented with normal height. At age 8, the height of 8.95% of AGA and 17.4% of SGA infants did not exceed the 2 SD below the average of the control group. CONCLUSIONS: VLBWI have a catch-up growth which allows the acquisition of normal height in 87.1% and 78.3% of patients in groups AGA and SGA, respectively, at age 4. Only 8.9% of patients in group AGA did not present catch-up growth at age 8, being the possibility of treatment with growing hormone (GH) not included.

Objetivo: Estudio descriptivo antropométrico en una cohorte de recién nacidos de muy bajo peso (RNMBP) desde el nacimiento hasta los 8 años de edad, analizándose las características del crecimiento en estos pacientes. Material y Métodos: Registro retrospectivo del peso y talla al nacimiento y a los 0.5, 1, 1.5, 2, 3, 4, 6 y 8 años de edad de una cohorte de 170 RNMBP (

Accuracy of helical computed tomography and [18F] fluorodeoxyglucose positron emission tomography for identifying lymph node mediastinal metastases in potentially resectable non-small-cell lung cancer.

PURPOSE: Computed tomography (CT) and [18F] Fluorodeoxyglucose positron emission tomography (FDG-PET) are considered suitable methods for the noninvasive staging of the mediastinum. Our study was intended to estimate the efficacy of contrast-enhanced helical CT (hCT) and FDG-PET, alone and combined, in the diagnosis of lymph node mediastinal metastases. METHODS: This study was a prospective and blind comparison of the efficacy of hCT and FDG-PET with two alternative reference standards, mediastinoscopy, and mediastinoscopy plus thoracotomy plus a 6-month follow-up to diagnose lymph node mediastinal metastases in 132 consecutive patients with potentially resectable non-small-cell lung cancer (NSCLC). The metastatic disease was assessed histopathologically. Further clinical information was obtained postoperatively after a median follow-up of 42 months. RESULTS: The prevalence of cN2,3 is 0.28. For hCT the sensitivity and specificity are 0.86 (95% CI, 0.70 to 0.93) and 0.67 (95% CI, 0.56 to 0.75), for PET 0.94 (95% CI, 0.81 to 0.98) and 0.59 (95% CI, 0.49 to 0.68), and for hCT and PET combined in-parallel 0.97 (95% CI, 0.84 to 0.99) and 0.44 (95% CI, 0.34 to 0.53), which translate into a negative predicted probability of 0.98 (95% CI, 0.88 to 1.00). The crude diagnostic odds ratio of PET in the total sample studied is 13.1, in the subgroup hCT+ 11.04 (3.0 to 40 0.1), and in the hCT- 3.5 (0.5 to 21.5). Similar results were obtained for hCT stratified by PET. CONCLUSION: hCT and PET perform similarly in the mediastinal staging of NSCLC, both tests are conditionally dependent and provide complementary information, and their diagnostic value mainly resides on the negative results.