http://hdl.handle.net/10498/6798 2026-11-06T11:38:18Z http://hdl.handle.net/10498/40510 Anxiety Symptoms in Preschool Children Born Very Preterm: Associations with Cognition and Neonatal Striatal Volumes Rodríguez Barrios, Carmen; Jiménez Luque, Natalia; Marín Almagro, Yolanda; Gutierrez Rosa, Irene; Lubián Gutiérrez, Manuel; Jafrasteh, Bahram; Benavente Fernández, Isabel; Lubián López, Simón Pedro Background/Objectives: Children born very preterm (VP) are at increased risk of later emotional and cognitive difficulties, including anxiety symptoms during childhood. Altered early brain development, particularly within subcortical circuits involved in emotional regulation, may contribute to this vulnerability. This study aimed to assess anxiety symptoms in preschool-aged children born VP, examine their relationship with cognitive performance, and determine whether neonatal brain volumes at term-equivalent age (TEA) were associated with later anxiety symptoms. We also explored whether cognition mediated the association between neonatal striatal volumes and anxiety. Methods: We conducted a longitudinal cohort study of infants born at ≤32 weeks of gestation and/or with a birth weight ≤1500 g admitted to a tertiary neonatal intensive care unit between 2018 and 2021. At 4–6 years of age, anxiety symptoms were assessed using the Child Behavior Checklist (CBCL) Anxiety Problems subscale, and cognitive performance was evaluated with the Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV). Neonatal magnetic resonance imaging performed at TEA was used to obtain regional brain volumetric measures. Associations were analyzed using adjusted linear regression, interaction-based volumetric modeling, path analysis, and receiver operating characteristic analysis. Results: Ninety-five children were included, and 24 (25.3%) showed clinically relevant anxiety symptoms according to the CBCL Anxiety Problems subscale. Higher WPPSI-IV scores were associated with lower anxiety scores (β = −0.183; p = 0.042). The best-fitting MRI model included caudate volume, putamen volume, and their interaction, with a significant association between the putamen–caudate interaction and anxiety symptoms (β = −17.807; p < 0.001). In the path model, both cognition and the putamen–caudate interaction were directly associated with anxiety, whereas the indirect effect through cognition was not significant. The final MRI model showed acceptable discrimination for clinically relevant anxiety (AUC = 0.796). Conclusions: Anxiety symptoms were frequent in preschool-aged children born VP and were associated with lower cognitive performance. Neonatal striatal volumetric organization, particularly the interaction between the putamen and caudate volumes, was independently associated with later anxiety symptoms, suggesting that cognitive and early neural factors may contribute to anxiety risk through parallel rather than mediated pathways. 2026-05-19T00:00:00Z http://hdl.handle.net/10498/40498 Multicompartmental prolapse: A comparative study between clinical examination and ultrasound García-Mejido, José Antonio; Salas Álvarez, Olaya; Bugatto González, Fernando; Fernández-Palacín, A.; Fernández Palacín, Fernando; Sainz Bueno, José Antonio Objective: The accurate diagnosis of multicompartment pelvic organ prolapse (POP) is fundamental to surgical success. This study aims to compare the diagnostic performance of transperineal ultrasound against clinical examination (pelvic organ prolapse quantification, POP-Q) for the detection of compartmental defects in patients with multicompartment POP, using assessment under spinal anesthesia as the reference standard. Method: A prospective randomized diagnostic accuracy study was designed, including 129 patients scheduled for multicompartment POP surgery. Patients were randomly assigned to undergo either a preoperative POP-Q two-dimensional transperineal ultrasound assessment. The reference standard for all patients was the intraoperative POP-Q assessment, conducted under spinal anesthesia immediately before surgery. Sensitivity, specificity, and likelihood ratios (LR) were calculated for each method and compartment. Results: Both techniques demonstrated high sensitivity for the diagnosis of cystocele (100% vs 98.3%). However, their performance varied across the other compartments. Ultrasound showed superior specificity for uterine prolapse (73.4% vs 45.4%) and rectocele (86.3% vs 66.0%) and was particularly robust in confirming enterocele (LR+ of 10.5). In turn, clinical examination had a higher sensitivity for detecting rectocele (61.5% vs 21.4%) and was highly reliable for ruling out cystocele and uterine prolapse (LR− of 0). Conclusion: Clinical examination and ultrasound are complementary in the diagnosis of prolapse. Their combined use is key to accurate surgical planning. 2026-01-01T00:00:00Z http://hdl.handle.net/10498/40247 Safety of Topical Estrogen Use in Patients with a History of Breast Cancer Domínguez González, Manuel; Sánchez Sampalo, Francisco Abstract Introduction: Genitourinary syndrome of menopause (GSM) is a very common condition in women with a history of breast cancer, especially those treated with anti-estrogen therapy. It is a health problem that has a major negative impact on the quality of life of patients who suffer from it, affecting their physical, social, sexual, and psychological health. Topical vaginal estrogens are very effective. However, there is controversy regarding their safety in patients with a history of breast cancer. Objectives: To determine the safety of using topical vaginal estrogens for the treatment of GSM in patients with a history of breast cancer. Methodology: A systematic review was conducted using the PubMed/MEDLINE, Cochrane Library, and EMBASE databases as sources of information, including articles published between 2010 and 2025 that evaluated the safety of topical vaginal estrogen use in patients with GSM and a history of breast cancer. Results: The results suggest that the use of topical vaginal estrogens in these patients appears to be associated with transient elevations in serum estrogen levels, with subsequent normalization of these levels, as well as having no significant impact on the breast cancer recurrence rate and appearing to have a slight protective effect on the breast cancer-specific mortality rate. Conclusions: The use of topical vaginal estrogens appears to be a safe option for the treatment of GSM in patients with a history of breast cancer. Keywords: Vulvovaginal atrophy, Breast cancer, Topical vaginal estrogens, Safety, Genitourinary syndrome of menopause. 2026-03-03T00:00:00Z http://hdl.handle.net/10498/40120 A Real-World Study Comparing Advanced Hybrid Closed-Loop Systems During Pregnancy in Women with Type 1 Diabetes Qurós, Carmen; Wägner, Ana M; Azriel, Sharona; Soldevila, Berta; Beato-Vibora, Pilar; Herrera Arranz, Mayte; Nattero, Lía; Picón-César, Maria José; Climent, Elisenda; Amigó, Judit; Colomo, Natalia; Durán-Martínez, María; Alpañes Buesa, Macarena; Megía, Ana; Vinagre, Irene; Vega Guedes, Begoña; Díaz-Soto, Gonzalo; Bandrés, Orosia; Barquiel, Beatriz; López Tinoco, Cristina; Márquez Pardo, Rosa; Martinez Brocca, Maria Asuncion; Corcoy, Rosa; Codina, Mercedes; Piedra, María; Rebollo Román, Ángel; Cuesta, Martín; López-Gallardo, Gema; Goya Canino, María M.; Bugatto González, Fernando; Mendoza, Lilian C.; Olvera Márquez, María Del Pilar; Perea, Verónica Este estudio multicéntrico nacional aporta evidencia en vida real crítica para el SNS, al realizar una comparación directa (head-to-head) de tres sistemas avanzados de asa cerrada híbrida (AHCL) en gestantes con diabetes tipo 1. La relevancia traslacional es inmediata y cubre un vacío de evidencia clínica sustancial, permitiendo optimizar el control glucémico y reducir el riesgo neonatal mediante medicina de precisión. Su impacto se refleja en la mejora de la práctica clínica asistencial y en su alta potencialidad para informar futuras guías y recomendaciones de manejo tecnológico en diabetes pregestacional. 2025-01-01T00:00:00Z