3P association (3PAs): Pituitary adenoma and pheochromocytoma/paraganglioma. A heterogeneous clinical syndrome associated with different gene mutations.

BACKGROUND: Pituitary adenomas (PA) associated with pheochromocytomas/paragangliomas (Pheo/PGL), also known as "the three P association" or "3PAs" could be the results of coincidence, but new evidence supports a common pathogenic mechanism in some patients. Our aim is to report the clinical data, surgical outcome, genetic findings of a large case series and review the current knowledge on this topic. METHODS AND RESULTS: In a retrospective multicentre study, we compiled 10 patients with PAs (6 new unreported cases). Six patients were female with mean age of 51.6 ±â€¯18.0 years. PA were: 6 acromegaly, 3 prolactinoma and 1 non-functioning PA (NFPA). Among the Pheo/PGL, 7 patients had a single tumour (4 Pheo and 3 PGL) and 3 patients had multiple or bilateral disease (2 PGL and 1 Pheo). Patients with GH-secreting PA and NFPA underwent surgery, while patients with prolactinoma received medical treatment (one patient required surgery). Unilateral adrenalectomy was carried out in all single Pheo and a bilateral procedure was performed in the patient with bilateral tumour. A single tumour was resected in two patients with multiple PGL. We found 3 germline pathogenic mutations: 2 in SDHB (c.166-170delCCTCA and a gross deletion involving exon 1) and 1 SDHD (p.P81L exon 3). Two variants of uncertain significance: 1 in MEN1 (c.1618C > T; p.Pro540Ser) and 1 in RET (c.2556C > G, p.Ile852Met), and finally a RETM918T somatic mutation in a Pheo tissue. CONCLUSION: We actively suggest considering the possibility of hereditary disease in all cases with 3PA and performing a complete genetic study.

Improved Omnidirectional Odometry for a View-Based Mapping Approach.

This work presents an improved visual odometry using omnidirectional images. The main purpose is to generate a reliable prior input which enhances the SLAM (Simultaneous Localization and Mapping) estimation tasks within the framework of navigation in mobile robotics, in detriment of the internal odometry data. Generally, standard SLAM approaches extensively use data such as the main prior input to localize the robot. They also tend to consider sensory data acquired with GPSs, lasers or digital cameras, as the more commonly acknowledged to re-estimate the solution. Nonetheless, the modeling of the main prior is crucial, and sometimes especially challenging when it comes to non-systematic terms, such as those associated with the internal odometer, which ultimately turn to be considerably injurious and compromise the convergence of the system. This omnidirectional odometry relies on an adaptive feature point matching through the propagation of the current uncertainty of the system. Ultimately, it is fused as the main prior input in an EKF (Extended Kalman Filter) view-based SLAM system, together with the adaption of the epipolar constraint to the omnidirectional geometry. Several improvements have been added to the initial visual odometry proposal so as to produce better performance. We present real data experiments to test the validity of the proposal and to demonstrate its benefits, in contrast to the internal odometry. Furthermore, SLAM results are included to assess its robustness and accuracy when using the proposed prior omnidirectional odometry.

Adenoma hipofisario asociado a feocromocitoma/paraganglioma: una nueva forma de neoplasia endocrina múltiple / Pituitary adenoma associated with pheochromocytoma/paraganglioma: a new form of multiple endocrine neoplasia

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Estado actual de los sistemas de infusión subcutánea continua de insulina y monitorización continua de glucosa en la Comunidad de Madrid / Current status of continuous subcutaneous insulin infusion and continuous glucose monitoring systems in the Community of Madrid

OBJETIVO: Analizar la información disponible sobre el estado de los sistemas de infusión subcutánea continua de insulina (ISCI) y de monitorización continua de glucosa (MCG) en la red pública sanitaria de la Comunidad Autónoma de Madrid (CAM). MATERIAL Y MÉTODOS: Se remitió una encuesta a los 28 servicios de endocrinología de los hospitales públicos de la CAM con 31 preguntas sobre los sistemas ISCI y MCG, que incluían registros de pacientes y aspectos asistenciales, administrativos y logísticos. Entre marzo y mayo de 2014 se recibieron respuestas de los centros y se recabó la información de los 20 servicios que realizaban este tipo de procedimientos en nuestra comunidad. Los datos sobre pacientes pediátricos se recibieron mayoritariamente a través de los servicios de adultos, con la excepción de 2 servicios de pediatría de los que la información se recibió directamente. RESULTADOS: En la CAM hay contabilizados un total de 1.256 sistemas ISCI en la población diabética. Los usuarios son mayoritariamente adultos (1.089 pacientes), mientras que 167 corresponden a pacientes pediátricos. Durante 2013 se instauraron 151 nuevos tratamientos (12% del total) mientras que se retiraron un total de 14 bombas. La disponibilidad de recursos asistenciales y la proporción de facultativos de plantilla encargados de estos tratamientos son muy desiguales entre distintos centros. Un 85% de los hospitales incluye entre sus prestaciones sistemas MCG retrospectivos, y un 40% los utiliza habitualmente al inicio de los tratamientos ISCI. Trece centros (65%) utilizan MCG a tiempo real (MCG-TR) a largo plazo en casos seleccionados, contabilizándose un registro acumulado de 67 pacientes. CONCLUSIONES: La implantación de las tecnologías en diabetes en la CAM es desigual en los distintos centros madrileños, y continúa siendo inferior a otros países de nuestro entorno, aunque parece observarse una discreta tendencia a recortar esas diferencias

OBJECTIVE: To analyze the available information about continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems in the public health care system of the Community of Madrid. MATERIAL AND METHODS: A survey consisting of 31 items was sent to the 28 endocrinology department of the Madrid public hospitals. Items focused on CSII and CGM and included patients' registrations, as well as data regarding healthcare, administrative, and logistic aspects. Responses from a total of 20 hospitals where these procedures are used were received from March 2013 to May 2014. Data about pediatric patients were obtained from adult endocrinology departments, except for two hospitals which directly reported the information. RESULTS: A total of 1256 CSII pumps were recorded in the Madrid region, of which 1089 were used by adults, and the remaining 167 by pediatric patients. During 2013, 151 new CSII systems were implanted (12% of the total), while 14 pumps were withdrawn. Availability of human resources (medical assistance) and the number of staff practitioners experienced in management of these systems widely varied between hospitals. Eighty-five percent of hospitals used retrospective CGM systems, and 40% routinely placed them before starting an insulin pump. Thirteen hospitals (65%) used long-term, real-time CGM systems in selected cases (a total of 67 patients). CONCLUSIONS: Use of these technologies in diabetes is unequal between public health care hospitals in Madrid, and is still significantly lower as compared to other countries with similar incomes. However, there appears to be a trend to an increase in their use

[Current status of continuous subcutaneous insulin infusion and continuous glucose monitoring systems in the Community of Madrid]. / Estado actual de los sistemas de infusión subcutánea continua de insulina y monitorización continua de glucosa en la Comunidad de Madrid.

OBJECTIVE: To analyze the available information about continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems in the public health care system of the Community of Madrid. MATERIAL AND METHODS: A survey consisting of 31 items was sent to the 28 endocrinology department of the Madrid public hospitals. Items focused on CSII and CGM and included patients' registrations, as well as data regarding healthcare, administrative, and logistic aspects. Responses from a total of 20 hospitals where these procedures are used were received from March 2013 to May 2014. Data about pediatric patients were obtained from adult endocrinology departments, except for two hospitals which directly reported the information. RESULTS: A total of 1256 CSII pumps were recorded in the Madrid region, of which 1089 were used by adults, and the remaining 167 by pediatric patients. During 2013, 151 new CSII systems were implanted (12% of the total), while 14 pumps were withdrawn. Availability of human resources (medical assistance) and the number of staff practitioners experienced in management of these systems widely varied between hospitals. Eighty-five percent of hospitals used retrospective CGM systems, and 40% routinely placed them before starting an insulin pump. Thirteen hospitals (65%) used long-term, real-time CGM systems in selected cases (a total of 67 patients). CONCLUSIONS: Use of these technologies in diabetes is unequal between public health care hospitals in Madrid, and is still significantly lower as compared to other countries with similar incomes. However, there appears to be a trend to an increase in their use.

Searching dynamic agents with a team of mobile robots.

This paper presents a new algorithm that allows a team of robots to cooperatively search for a set of moving targets. An estimation of the areas of the environment that are more likely to hold a target agent is obtained using a grid-based Bayesian filter. The robot sensor readings and the maximum speed of the moving targets are used in order to update the grid. This representation is used in a search algorithm that commands the robots to those areas that are more likely to present target agents. This algorithm splits the environment in a tree of connected regions using dynamic programming. This tree is used in order to decide the destination for each robot in a coordinated manner. The algorithm has been successfully tested in known and unknown environments showing the validity of the approach.

Alimentación en zona de operaciones y riesgo cardiovascular / No disponible

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Control glucémico de los pacientes con diabetes tipo 1 y 2 tratados mediante procedimientos de cardiología intervencionista / Glycaemic management in type 1 and 2 diabetes patients undergoing interventional cardiology procedures

A pesar del creciente número tanto de alternativas terapéuticas disponibles para el tratamiento de la diabetes como de revisiones y guías de práctica clínica generales, en el caso de contextos específicos como la cardiología intervencionista se encuentra una ausencia de pautas terapéuticas claras e inequívocas. En esta guía de actuación clínica se propone un algoritmo consensuado, basado tanto en la revisión crítica de la evidencia de ensayos clínicos recientes como en criterios subjetivos derivados de la experiencia clínica y conocimiento colectivos, para orientar en la elección de las alternativas más adecuadas en esta situación clínica del manejo del control glucémico de pacientes con diabetes tipo 1 y 2 que van a ser sometidos a procedimientos de cardiología intervencionista en el laboratorio de hemodinámica (AU)

Despite the growing number of therapeutic alternatives available as well as general reviews and treatment guidelines for the treatment of diabetes, physicians are often left without a clear pathway of therapy to follow in specific clinical contexts such as interventional cardiology. The present document proposes a consensus treatment algorithm, based both on a critical appraisal of evidence from recent clinical trials and on value judgements supported by the authors’ collective clinical knowledge and experience, in an attempt to guide practitioners when choosing the most appropriate alternatives in the context of glycemic management in type 1 and 2 diabetic patients scheduled to undergo interventional cardiology procedures in a haemodynamic laboratory (AU)

[Glycaemic management in type 1 and 2 diabetes patients undergoing interventional cardiology procedures. Heart and Diabetes Working Group. Sociedad Espan˜ola de Cardiologi´a. Sociedad Espan˜ola de Diabetes]. / Control glucémico de los pacientes con diabetes tipo 1 y 2 tratados mediante procedimientos de cardiología intervencionista.

Despite the growing number of therapeutic alternatives available as well as general reviews and treatment guidelines for the treatment of diabetes, physicians are often left without a clear pathway of therapy to follow in specific clinical contexts such as interventional cardiology. The present document proposes a consensus treatment algorithm, based both on a critical appraisal of evidence from recent clinical trials and on value judgements supported by the authors' collective clinical knowledge and experience, in an attempt to guide practitioners when choosing the most appropriate alternatives in the context of glycemic management in type 1 and 2 diabetic patients scheduled to undergo interventional cardiology procedures in a haemodynamic laboratory.

One-year prevalence of migraine in Spain: a nationwide population-based survey.

AIM: The purpose of the study was to estimate the one-year prevalence of migraine among a population-based sample of Spanish adults. METHOD: Men and women aged 18-65 years were selected at random according to quotas for age, sex, size of habitat (<10,000 inhabitants, 10,001-50,000 inhabitants, 50,001-200,000 inhabitants and >200,000 inhabitants) and residence proportional to the population size of the geographical location. A random-digit-dial, computer-assisted telephone interview (CATI) survey was conducted between April and July 2006. The 2004 International Headache Society operational diagnostic criteria were applied. RESULTS: From a total of 70,692 telephone calls and 26,255 (31.7%) valid contacts, 5,668 (21.6%) respondents completed the CATI survey. A total of 476 subjects (8.4%, 95% confidence interval [CI] 7.7-9.1%) with strict migraine and 236 with probable migraine (4.2%, 95% CI 3.7-4.7%) were recorded. The 1-year prevalence of total migraine (N = 712) was 12.6% (95% CI 11.6-13.6) (17.2% in females, 8.0% in males). The prevalence rates showed significant geographic variations, from 7.6% in Navarra to 18% in the Canary Islands. One-half of the subjects had migraine with aura. One-third of subjects were never diagnosed for migraine. CONCLUSIONS: The one-year prevalence of migraine in Spain is 12.6%, with a prevalence of migraine with and without aura of 8.4% and probable migraine of 4.2%. These findings add data to the current understanding of migraine.

Development of the stapedius muscle canal and its possible clinical consequences.

OBJECTIVE: To study the development of the stapedius muscle canal in human embryos and foetuses. MATERIALS AND METHODS: 46 temporal bones with ages between 9mm and new-borns were studied. The preparations were dyed using Martins' trichrome technique. RESULTS: Two areas of different embryological origin form the stapedius muscle canal, which contains this muscle and the facial nerve. On the otic capsule, at 11 weeks an extension starts to grow from its caudal part, which moves outwards and near to Reichert's cartilage, forming the footplate and internal wall. The pyramidal eminence comes from the mesenchyme that surrounds the muscle, forming a partition to separate it from the laterohyale portion of Reichert's cartilage. Extensive connections are observed in its development between bone marrow and mesenchyme. At 35 weeks the muscle and nerve start to separate by means of a bony partition. If this partition does not form, there is going to be a dehiscence that could cause peripheral nerve pathology due to the repeated contraction of the muscle, or the dissemination of infections from middle ear. CONCLUSION: During the development of the stapedius muscle canal the presence of dehiscences between the facial nerve and the muscle may have clinical repercussions.

Tratamiento hipoglucemiante en pacientes con diabetes mellitus tipo 2 con insuficiencia cardiaca estable o cardiopatía isquémica sin insuficiencia cardiaca / Treatment guidelines for hyperglycaemia in type 2 diabetes patients with stable chronic heart failure or ischemic cardiomyopathy without heart failure

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Consenso para la elaboración del informe de alta hospitalaria en especialidades médicas / Consensus for hospital discharge reports in medical specialities

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Estimation of visual maps with a robot network equipped with vision sensors.

In this paper we present an approach to the Simultaneous Localization and Mapping (SLAM) problem using a team of autonomous vehicles equipped with vision sensors. The SLAM problem considers the case in which a mobile robot is equipped with a particular sensor, moves along the environment, obtains measurements with its sensors and uses them to construct a model of the space where it evolves. In this paper we focus on the case where several robots, each equipped with its own sensor, are distributed in a network and view the space from different vantage points. In particular, each robot is equipped with a stereo camera that allow the robots to extract visual landmarks and obtain relative measurements to them. We propose an algorithm that uses the measurements obtained by the robots to build a single accurate map of the environment. The map is represented by the three-dimensional position of the visual landmarks. In addition, we consider that each landmark is accompanied by a visual descriptor that encodes its visual appearance. The solution is based on a Rao-Blackwellized particle filter that estimates the paths of the robots and the position of the visual landmarks. The validity of our proposal is demonstrated by means of experiments with a team of real robots in a office-like indoor environment.

Map building and monte carlo localization using global appearance of omnidirectional images.

In this paper we deal with the problem of map building and localization of a mobile robot in an environment using the information provided by an omnidirectional vision sensor that is mounted on the robot. Our main objective consists of studying the feasibility of the techniques based in the global appearance of a set of omnidirectional images captured by this vision sensor to solve this problem. First, we study how to describe globally the visual information so that it represents correctly locations and the geometrical relationships between these locations. Then, we integrate this information using an approach based on a spring-mass-damper model, to create a topological map of the environment. Once the map is built, we propose the use of a Monte Carlo localization approach to estimate the most probable pose of the vision system and its trajectory within the map. We perform a comparison in terms of computational cost and error in localization. The experimental results we present have been obtained with real indoor omnidirectional images.

Papel de las nuevas insulinas en el tratamiento de la diabetes / Rol of new insulin son thetreatment of diabetes mellitus

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