Cross-sectional evaluation of the association between greenness and cognitive performance in Mexican pre-pubertal boys.

BACKGROUND: Evidence shows that greenspace exposure benefits children's health and cognitive development. However, evidence assessing this association in young children in low- and middle-income economies is scarce. OBJECTIVE: To assess the association between exposure to greenness and cognitive performance in pre-pubertal boys living in Mexico City. METHODS: Cross-sectional study using data from 144 boys aged 6-11 years living in Mexico City in 2017 and enrolled in the "MetCog" study. Cognitive performance was evaluated through selected Wechsler Scale for Intelligence in Children Fourth Edition (WISC-IV) and Neuropsychological Assessment of Children (Evaluación Neuropsicológica Infantil, ENI) tests. Exposure to greenness was assessed through Normalised Difference Vegetation Index (NDVI) at 300, 500, 1500, 2000, and 3000 m buffer zones from children's residences. Multiple linear regression analysis was undertaken to assess associations between cognitive performance and greenness (aß) with 95% confidence intervals (CI) and adjusted for potential confounding variables. Significance was set at q < 0.05 after False Discovery Rate (FDR) correction. RESULTS: A positive association was found between the NDVI Interquartile Range (IQR) at 2000 m and the WISC-IV block design test score (aß 2000 = 1.18, 95% CI = 0.31, 2.06; q < 0.05), which assesses perceptual reasoning. Positive associations were found with NDVI IQR at 1500 m and WISC-IV block design (aß1500 = 1.00, 95% CI = 0.14, 1.86) and matrix reasoning (aß1500 = 0.83, 95% CI = 0.06, 1.61) scores, but neither survived FDR correction. No significant associations were found between NDVI IQR at any buffer size with other WISC-IV and ENI task scores. CONCLUSIONS: Greater exposure to greenness was associated with higher perceptual reasoning skills in 144 pre-pubertal boys living in Mexico City. Thus, urban planning should consider increasing vegetation in megacities, especially in neighbourhoods with high percentages of young children.

Compassionate use of Quantum Magnetic Resonance Therapy for treatment of children with Diffuse Brainstem Glioma in Mexico City: a single institutional experience.

PURPOSE: Diffuse Brainstem Glioma (DBG) is a catastrophic brain tumor with a survival rate of less than 10% two years after diagnosis despite the existence of different treatment protocols. Among the devices that use magnetic fields generated by Magnetic Resonance Imaging is Quantum Magnetic Resonance Therapy (QMRT). METHODS: Five children diagnosed with DBG in our institution in Mexico City underwent treatment of compassionate use with QMRT between December 2018 and July 2019. A survival analysis was performed with previously reported historical data (n = 15). RESULTS: Two patients (40%) survived after three years of follow-up; the log-rank test showed a statistically significant difference in overall survival between both groups (p = 0.032). All patients tolerated the treatment adequately without reporting any severe clinical or neuroradiological adverse effects. Of the patients included, all showed a decrease in the tumor one month after the end of the treatment, although there was great variability in the response and the difference was not statistically significant (p = 0.06). CONCLUSIONS: Although future investigations are needed to confirm the findings reported in the present study, the improvement in survival is promising for a group of patients whose prognosis has been catastrophic over the years. Trial registration NCT03577600.

Effects of fatty liver on the size and composition of high-density lipoprotein cholesterol subpopulations in adolescents with type 2 diabetes mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is an emerging disease in the pediatric population. The association between T2DM and non-alcoholic fatty liver disease (NAFLD) has been described. Recent evidence suggests that sizes and composition of high-density lipoprotein (HDL) may be more important that HDL-C levels in predicting coronary heart disease. There is not data regarding the HDL subclasses distribution and composition in T2DM youths with NAFLD. METHODS: This cross-sectional study included 47 adolescents with T2DM and 23 non-diabetic controls of both sexes aged 10 to 18 years. The presence of NAFLD was determined estimated proton density fat fraction (PDFF) by magnetic resonance by spectroscopy. We compared the HDL subclasses distribution (HDL2b, HDL2a, HDL3a HDL3b and HDL3c) and the HDL chemical composition (total protein, triglyceride, phospholipid, cholesteryl esters, and free cholesterol) between the groups of adolescents with T2DM and the control group. RESULTS: Patients with T2DM and NAFLD had a significantly lower proportion HDL2b (P = .040) and a higher proportion of HDL3c (P = .035); higher proportion of TG (P = .032) and a lower CE (P = .002) and FC (P < .001). A negative association was observed between PDFF and the percentages of HDL2b (r2 = -0.341, P = .004) and the average particle size (r2 = -0.327, P = .05), and a positive association with HDL3c subpopulations (r2 = 0.327, P = .015); about composition inside HDL particle, a positive association with PDFF and the TG (r2 = 0.299, P = .013) and negative with CE (r2 = -0.265, P = .030). CONCLUSIONS: In adolescents diagnosed with T2DM, the presence of NAFLD is associated with abnormalities in the distribution of HDL subpopulations and the lipid composition of HDL particles.

BOLD Activation During the Application of MOXO-CPT in School Patients With and Without Attention Deficit Hyperactivity Disorder.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 3% of children in the world. OBJECTIVE: In this work, we seek to compare the different brain activations of pediatric patients with and without ADHD. METHODS: A functional resonance examination with BOLD contrast was applied using the MOXO-CPT test (Continuous Performance test with single and double visual-auditory distractors). RESULTS: Differences in BOLD activation were observed indicating that control children regularly presented negative BOLD activations that were not found in children with ADHD. Inhibitory activity in audiovisual association zones in control patients was greater than in patients with ADHD. The inhibition in the frontal and motor regions in the controls contrasted with the overactivation of the motor areas in patients with ADHD, this, together with the detection of cerebellar activation which attempted to modulate the responses of the different areas that lead to executive failure in patients with ADHD. CONCLUSIONS: In view of these results, it can be argued that the lack of inhibition of ADHD patients in their executive functions led to a disorganization of the different brain systems.

Guía mexicana para el diagnóstico y el tratamiento del hemangioma infantil.

Infantile hemangioma is a benign vascular tumor, the most common in childhood, whose natural evolution is the disappearance of the lesion in the pediatric age and which has effective and safe treatments that limit its growth and favor its disappearance at younger ages. Infantile hemangioma continues to be a reason for attention to complications, due to erroneous diagnoses, lack of knowledge of the condition, late referral or fear of the effects of the medications used for its treatment. Furthermore, its presence is normalized without taking into account that it can cause uncertainty, anxiety, feelings of guilt and, as a consequence, a significant impact on the quality of life, mainly in the parents or caregivers of the child. The need for a clinical practice guideline in our country arises from the high presentation of late-remitted complications in infantile hemangioma even with the availability of adequate treatments, the continuous evolution of medicine and the appearance of new evidence. Throughout the guide you will find recommendations regarding the diagnosis, treatment and follow-up of patients with infantile hemangioma, taking into account the paraclinical tests that can be performed, topical or systemic management options, as well as adjuvant therapies. For the first time, objective tools for patient follow-up are included in a guide for the management of infantile hemangioma, as well as to help the first contact doctor in timely referral.

El hemangioma infantil es un tumor vascular benigno, el más frecuente de la infancia, cuya evolución natural favorece la desaparición de la lesión en la misma edad pediátrica y que cuenta con tratamientos eficaces y seguros que limitan su crecimiento y favorecen su desaparición a edades más tempranas. Continúa siendo motivo de atención de complicaciones, debido a diagnósticos erróneos, desconocimiento del padecimiento, referencia tardía o temor de los efectos de los fármacos utilizados para su tratamiento. Además, se normaliza su presencia sin tomar en cuenta que puede llegar a causar incertidumbre, ansiedad, sentimientos de culpa y, como consecuencia, importante afectación de la calidad de vida, principalmente en los padres o cuidadores del niño. La necesidad de una guía de práctica clínica en nuestro país surge ante la alta presentación de complicaciones del hemangioma infantil referidas de manera tardía aun con la disponibilidad de tratamientos adecuados, la evolución continua de la medicina y la aparición de nueva evidencia. A lo largo de la guía se encontrarán recomendaciones en relación con el diagnóstico, el tratamiento y el seguimiento de los pacientes con hemangioma infantil, tomando en cuenta los paraclínicos que pueden realizarse, las opciones de manejo tópico o sistémico, y las terapias adyuvantes. Por primera vez se incluyen en una guía para el manejo del hemangioma infantil herramientas objetivas para el seguimiento de los pacientes, así como para ayudar al médico de primer contacto en su referencia oportuna.

Fabrication of a multifunctional magnetic-fluorescent material for medical applications.

Multifunctional biocompatible materials have evoked considerable interest in the field of medical applications. Here we report the thermal decomposition preparation of homogeneous fluorescent-magnetic particles with a composite structure containing CoFe2O4 nanoparticles as nucleation seeds for fluorescent Gd2-xO3:Eux. The composite exhibited a wide range of fluorescence transitions in the whole visible spectrum, displaying 18 different emission peaks when excited at a 250 nm wavelength. Moreover, at low temperature the peaks of the composite were wider than the peaks of the fluorescent material, which may be attributed to a set of new energy levels due to a combination of Stark splitting with the magnetic field of CoFe2O4. Because this material is intended to be used for biomedical applications, the potential toxicity of the composite was tested using an invertebrate hemocyte cell model. The cells showed slight morphological and biochemical changes upon exposure to the composite; however, there was no increase in cell death at concentrations of up to 40 ppm. In addition, the material could be tracked by its fluorescence inside the cells, when excited at a more bio-friendly and less energetic wavelength of 405 nm. Furthermore, MRI showed T1 and T2 dual contrast with relaxivity values in the range of most reported materials.

Resolution of fatty liver disease after growth hormone replacement in a pediatric survivor of thyroid cancer.

Background: A rare case of primary papillary thyroid cancer (PTC) and growth hormone (GH) deficiency in a pediatric patient is described. In addition, the patient developed fatty liver disease attributed to GH deficiency. Case report: A 10-year-old male with a history of PTC with extension to the cervical nodes detected at 5 years of age was referred to the endocrinology consultation due to a low growth rate. On examination, GH deficiency was detected (height -3.51 standard deviations and low insulin-like growth factor-1 levels). This hormonal deficiency was not associated with thyroid cancer or treatment. Furthermore, elevated transaminases (~300 IU/ml), lipids, and fally liver disease by ultrasound were detected. These data suggested fatty liver disease, which was attributed to GH deficiency. Regardless of the risk of recurrence, somatotropin was administered due to liver dysfunction and very short stature of the patient. A considerable improvement in growth, transaminases, and lipid profile was observed. At present, at 14 years of age, resolution of hepatic steatosis and a considerable increase in his growth rate without recurrence of thyroid cancer 9 years after its diagnosis and 4 years after the initiation of GH treatment are confirmed. Conclusions: GH therapy could be a good therapeutic option for pediatric cancer survivors to address impaired growth and fatty liver disease. However, additional medical evidence based on clinical trials is necessary to determine the benefits.

Introducción: Se presenta el caso de un paciente pediátrico con una asociación de cáncer papilar de tiroides (CPT) y deficiencia de hormona de crecimiento (HC) que no ha sido descrita previamente. Además, presenta enfermedad hepática grasa atribuida a la deficiencia hormonal. Caso clínico: Paciente de sexo masculino con antecedente de CPT con extensión a los ganglios cervicales diagnosticado a los 5 años de edad. Es referido a los 10 años por talla baja, sin datos de recurrencia del CPT. En el abordaje diagnóstico se detecta deficiencia de HC basándose en una estatura 3.51 desviaciones estándar por debajo de la media y niveles bajos de factor de crecimiento insulínico tipo 1. Adicionalmente, se detectó elevación de transaminasas (~300 IU/ml), dislipidemia y esteatosis hepática en el ultrasonido. Después de los estudios de extensión, la enfermedad hepática grasa se atribuyó a la deficiencia de HC. A pesar del riesgo de recurrencia del cáncer de tiroides, se decidió dar tratamiento con HC debido a la afectación hepática y de crecimiento. El paciente presentó una evolución satisfactoria y actualmente, a la edad de 14 años, la esteatosis hepática está resuelta, presenta una mejoría considerable en su estatura y no ha tenido recurrencia del cáncer de tiroides 9 años después del diagnóstico y 4 años después del inicio del tratamiento con HC. Conclusiones: El tratamiento con HC puede ser una adecuada opción terapéutica para sobrevivientes de cáncer en la edad pediátrica con afectación en el crecimiento y esteatosis hepática. Sin embargo, se requieren estudios con mayor evidencia científica y seguimiento a largo plazo para apoyar esta afirmación.

Different Food Odors Control Brain Connectivity in Impulsive Children.

BACKGROUND: Impulsivity is a complex multi-dimensional combination of behaviors which include: ineffective impulse control, premature decision-making and inability to delay gratification. OBJECTIVE: The aim of this work was to explore how food odor perception and its emotional value is affected in impulsive children. METHODS: Here we compared two cohorts of impulsive and control children with ages between 10 and 16 years. Both groups underwent a functional magnetic resonance imaging experiment, in which foodrelated odor-cues were presented to all of them. RESULTS: Differences in regions of blood oxygen level dependent activation, as well as connectivity, were calculated. Activations were significant for all odors in the impulsive group in the temporal lobe, cerebellum, supplementary motor area, frontal cortex, medial cingulate cortex, insula, precuneus, precentral, para-hippocampal and calcarine cortices. CONCLUSION: Connectivity results showed that the expected emotional reward, based on odor perceived and processed in temporal lobes, was the main cue driving responses of impulsive children. This was followed by self-consciousness, the sensation of interaction with the surroundings and feelings of comfort and happiness, modulated by the precuneus together with somatosensory cortex and cingulum. Furthermore, reduced connectivity to frontal areas as well as to other sensory integration areas (piriform cortex), combined to show different sensory processing strategies for olfactory emotional cues in impulsive children. Finally, we hypothesize that the cerebellum plays a pivotal role in modulating decision-making for impulsive children.

Strategies for tonal and atonal musical interpretation in blind and normally sighted children: an fMRI study.

INTRODUCTION: Early childhood is known to be a period when cortical plasticity phenomena are at a maximum. Music is a stimulus known to modulate these mechanisms. On the other hand, neurological impairments like blindness are also known to affect cortical plasticity. Here, we address how tonal and atonal musical stimuli are processed in control and blind young children. We aimed to understand the differences between the two groups when processing this physiological information. RESULTS: Atonal stimuli produced larger activations in cerebellum, fusiform, and temporal lobe structures than tonal. In contrast, tonal stimuli induced larger frontal lobe representations than atonal. Control participants presented large activations in cerebellum, fusiform, and temporal lobe. A correlation/connectivity study showed that the blind group incorporated larger amounts of perceptual information (somatosensory and motor) into tonal processing through the function of the anterior prefrontal cortex (APC). They also used the visual cortex in conjunction with the Wernicke's area to process this information. In contrast, controls processed sound with perceptual stimuli from auditory cortex structures (including Wernicke's area). In this case, information was processed through the dorsal posterior cingulate cortex and not the APC. The orbitofrontal cortex also played a key role for atonal interpretation in this group. DISCUSSION: Wernicke's area, known to be involved in speech, was heavily involved for both groups and all stimuli. The two groups presented clear differences in strategies for music processing, with very different recruitment of brain regions.

A multi-methodological MR resting state network analysis to assess the changes in brain physiology of children with ADHD.

The purpose of this work was to highlight the neurological differences between the MR resting state networks of a group of children with ADHD (pre-treatment) and an age-matched healthy group. Results were obtained using different image analysis techniques. A sample of n = 46 children with ages between 6 and 12 years were included in this study (23 per cohort). Resting state image analysis was performed using ReHo, ALFF and ICA techniques. ReHo and ICA represent connectivity analyses calculated with different mathematical approaches. ALFF represents an indirect measurement of brain activity. The ReHo and ICA analyses suggested differences between the two groups, while the ALFF analysis did not. The ReHo and ALFF analyses presented differences with respect to the results previously reported in the literature. ICA analysis showed that the same resting state networks that appear in healthy volunteers of adult age were obtained for both groups. In contrast, these networks were not identical when comparing the healthy and ADHD groups. These differences affected areas for all the networks except the Right Memory Function network. All techniques employed in this study were used to monitor different cerebral regions which participate in the phenomenological characterization of ADHD patients when compared to healthy controls. Results from our three analyses indicated that the cerebellum and mid-frontal lobe bilaterally for ReHo, the executive function regions in ICA, and the precuneus, cuneus and the clacarine fissure for ALFF, were the "hubs" in which the main inter-group differences were found. These results do not just help to explain the physiology underlying the disorder but open the door to future uses of these methodologies to monitor and evaluate patients with ADHD.

Resolution of fatty liver disease after growth hormone replacement in a pediatric survivor of thyroid cancer / Resolución de enfermedad hepática grasa posterior al reemplazo con hormona de crecimiento en un paciente pediátrico sobreviviente a cáncer de tiroides

Abstract Background A rare case of primary papillary thyroid cancer (PTC) and growth hormone (GH) deficiency in a pediatric patient is described. In addition, the patient developed fatty liver disease attributed to GH deficiency. Case report A 10-year-old male with a history of PTC with extension to the cervical nodes detected at 5 years of age was referred to the endocrinology consultation due to a low growth rate. On examination, GH deficiency was detected (height −3.51 standard deviations and low insulin-like growth factor-1 levels). This hormonal deficiency was not associated with thyroid cancer or treatment. Furthermore, elevated transaminases (~300 IU/ml), lipids, and fally liver disease by ultrasound were detected. These data suggested fatty liver disease, which was attributed to GH deficiency. Regardless of the risk of recurrence, somatotropin was administered due to liver dysfunction and very short stature of the patient. A considerable improvement in growth, transaminases, and lipid profile was observed. At present, at 14 years of age, resolution of hepatic steatosis and a considerable increase in his growth rate without recurrence of thyroid cancer 9 years after its diagnosis and 4 years after the initiation of GH treatment are confirmed. Conclusions GH therapy could be a good therapeutic option for pediatric cancer survivors to address impaired growth and fatty liver disease. However, additional medical evidence based on clinical trials is necessary to determine the benefits.

Resumen Introducción Se presenta el caso de un paciente pediátrico con una asociación de cáncer papilar de tiroides (CPT) y deficiencia de hormona de crecimiento (HC) que no ha sido descrita previamente. Además, presenta enfermedad hepática grasa atribuida a la deficiencia hormonal. Caso clínico Paciente de sexo masculino con antecedente de CPT con extensión a los ganglios cervicales diagnosticado a los 5 años de edad. Es referido a los 10 años por talla baja, sin datos de recurrencia del CPT. En el abordaje diagnóstico se detecta deficiencia de HC basándose en una estatura 3.51 desviaciones estándar por debajo de la media y niveles bajos de factor de crecimiento insulínico tipo 1. Adicionalmente, se detectó elevación de transaminasas (~300 IU/ml), dislipidemia y esteatosis hepática en el ultrasonido. Después de los estudios de extensión, la enfermedad hepática grasa se atribuyó a la deficiencia de HC. A pesar del riesgo de recurrencia del cáncer de tiroides, se decidió dar tratamiento con HC debido a la afectación hepática y de crecimiento. El paciente presentó una evolución satisfactoria y actualmente, a la edad de 14 años, la esteatosis hepática está resuelta, presenta una mejoría considerable en su estatura y no ha tenido recurrencia del cáncer de tiroides 9 años después del diagnóstico y 4 años después del inicio del tratamiento con HC. Conclusiones El tratamiento con HC puede ser una adecuada opción terapéutica para sobrevivientes de cáncer en la edad pediátrica con afectación en el crecimiento y esteatosis hepática. Sin embargo, se requieren estudios con mayor evidencia científica y seguimiento a largo plazo para apoyar esta afirmación.

Comparación de las medidas obtenidas por resonancia magnética con reconstrucción tridimensional y las obtenidas por angiografía digital para el diagnóstico de coartación de aorta / Comparison between the measurements obtained by magnetic resonance and digital angiography in patients with aortic coarctation

Introducción. La angiografía digital (AD) transcateterismo es el estándar de oro en el diagnóstico de la coartación de aorta (CoAo) aunque la resonancia magnética (RM) ha mostrado utilidad en la evaluación del sistema cardiovascular. La medición de los segmentos del arco aórtico facilita la selección de los candidatos para angioplastia transcateterismo evitando una cirugía torácica. No hay reportes de estudios comparativos de las medidas de los diferentes segmentos aórticos, obtenidas por RM y AD. Material y métodos. Se estudiaron 49 pacientes con RM y AD que ingresaron con CoAo entre enero de 2002 y diciembre de 2003. Se determinó el tipo de CoAo. Se midieron los segmentos aórticos por RM y AD y se compararon por medio de correlación lineal (Pearson). En 43 pacientes se realizó angioplastia con globo. Resultados. La variabilidad en la medición de los diferentes segmentos entre ambos métodos fueron: aorta ascendente 1.99-2.10 mm (desviación estándar (DE) 2.7-2.8), arco aórtico 1.79-2 mm (DE 2.55-2.99), istmo 1.53-1.56 mm (DE 2-2.17), aorta descendente 1.75-1.78 mm (DE 2.54-2.55). Las medidas comparadas por correlación lineal muestran r entre 0.80 y 0.999, excepto en arco aórtico por RM que obtuvo r de 0.57. Conclusión. La evaluación con RM de niños con CoAo puede sustituir a la realizada mediante AD ya que una variación de 1.5 a 2.1 mm en las medidas obtenidas por ambos métodos no interfiere con la decisión terapéutica. Sólo debe realizarse la medición del arco aórtico en 2 proyecciones.

Introduction. Quantitative aortic arch analysis may improve the selection of candidates for angioplasty who are most likely to benefit from the procedure. Digital angiography (DA) has traditionally been the definitive preoperative diagnostic procedure for aortic coarctation (AoCo), but magnetic resonance (MR) imaging affords good spatial resolution and excellent contrast between blood vessels and soft tissues and offers great potential for delineating thoracic cardiovascular structures. Material and methods. Forty nine patients with AoCo were examined with MR and DA between June 2002 and December 2003. The site and type of AoCo were determined and the measurements of aortic arch segments were obtained. We realized balloon angioplasty in 43 patients. Results. We compared the measurements using Pearson's linear correlation. The variability of the measurements was: ascending aorta 1.99-2.1 mm (standard deviation [SD] 2.7-2.8), aortic arch 1.79-2 mm (SD 2.55-2.99), aortic isthmus 1.53-1.56 mm (SD 2-2.17), and descending aorta 1.75-1.78 mm (SD 2.54-2.55). The lineal correlation of Pearson for measurements were; r =0.80-0.999 but the aortic arch was r =0.57 by MR. Conclusion. We conclude that quantitative MR measurements of aorta may be used to diagnose of AoCo and avoid using DA. To obtain precise measurements of aortic arch in patients with AoCo, MR should include 2 projections.