Clonal monosomy of chromosome 21 in a case of myelodysplastic syndrome

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Multiple endocrine neoplasia type 1 presenting as refractory epilepsy and polyneuropathy - A case report

Hypoglycemia is a well recognized cause of acute symptomatic seizures. The fact that hypoglycemia can cause peripheral neuropathy is less appreciated. We describe a case of insulinoma associated peripheral neuropathy. A 17 year-old previously healthy man was referred for investigation of refractory epilepsy. A history of recurrent seizures, slowly progressive weakness of his feet and hands, and weight gain was obtained. Physical examination showed signs of a chronic sensory-motor polyneuropathy. He was diagnosed with insulinoma and primary hyperparathyroidism, characterizing multiple endocrine neoplasia, type 1 syndrome. Cases of insulinoma associated peripheral neuropathy are very rare. The more characteristic clinical picture appears to be distal weakness, worse in the intrinsic hand and feet muscles, and no or mild sensory signs. Peripheral nervous system symptoms may not completely resolve, despite removal of the cause of hyperinsulinism/hypoglycemia and full reversion of central nervous system symptoms. Mechanisms underlying hypoglycemic neuropathy are still poorly understood. (C) 2011 Elsevier B.V. All rights reserved.

Early diagnosis of Gorlin-Goltz syndrome: case report

The Gorlin-Goltz syndrome, also known as nevoid basal cell carcinoma syndrome (NBCCS), is an infrequent multisystemic disease inherited in a dominant autosomal way, which shows a high level of penetrance and variable expressiveness. It is characterized by keratocystic odontogenic tumors (KCOT) in the jaw, multiple basal cell nevi carcinomas and skeletal abnormities. This syndrome may be diagnosed early by a dentist by routine radiographic exams in the first decade of life, since the KCOTs are usually one of the first manifestations of the syndrome. This article paper reports the case of a patient, a 10-year-old boy with NBCCS, emphasizing its clinical and radiographic manifestations. This study highlights the importance of health professionals in the early diagnosis of NBCCS and in a preventive multidisciplinary approach to provide a better prognosis for the patient.

Facial lesions caused by renal osteodystrophy in a patient with chronic renal insufficiency: a case report

PURPOSE: Chronic renal insufficiency (CRI) is the last stage of a chronic renal condition in which the kidney loses its filtration and endocrine functions. Chronic endocrine hypofunction causes generalized damage to the body known as Uremic Syndrome, which affects the central nervous system as well as the cardiovascular, hematologic, dermatologic, ophthalmic, endocrine, respiratory, gastrointestinal and skeletal systems. The present study reports the case of a female patient with CRI who presented facial osteodystrophy of the osteitis fibrosa type, and highlights the main features of this condition. CASE DESCRIPTION: A 24-year old, female, Caucasian patient presented chronic glomerulonephritis recurrence and lost the transplanted kidney five years before, undergoing arteriovenous fistula hemodialysis three times a week. She presented swelling of the left masseter area with a hard consistency on palpation, covered by intact skin, swelling at the bottom of the left atrium, with a hard consistency on palpation, a mucosa-like color and absence of inflammation signs, suggesting expansive bone lesions on the face. These features were compatible with hyperparathyroidism brown tumor and/or osteodystrophy. The CT scan showed expansive bone lesions of heterogeneous appearance on the left jaw, maxilla/nasal floor, and right frontotemporal suture areas. The clinical and histopathological characteristics of the lesion, in association with PHT hormone high serum levels led to renal osteodystrophy diagnosis. The patient was referred to the nephrology services. CONCLUSION: Osteodystrophic bone alterations have a high prevalence in renal disease patients, and the dentist must take these alterations into consideration in bone lesion diagnosis for this specific group of patients.

Assessment of publication bias in dental specialty journals

OBJECTIVE: The purpose of this study was to investigate the presence of publication bias (acceptance of articles indicating statistically significant results). METHODS: The journals possessing the highest impact factor (2008 data) in each dental specialty were included in the study. The content of the 6 most recent issues of each journal was hand searched and research articles were classified into 4 type categories: cross-sectional, case-control, cohort, and interventional (nonrandomized clinical trials and randomized controlled trials). In total, 396 articles were included in the analysis. Descriptive statistics and univariate and multivariate logistic regression was used to examine the association between article-reported statistical significance (dependent variable) and journal impact factor and article study type subject area (independent variables). RESULTS: A statistically significant acceptance rate of positive result was found, ranging from 75% to 90%, whereas the value of impact factor was not related to publication bias among leading dental journals. Compared with other research designs, clinical intervention studies (randomized or nonrandomized) presented the highest percentage of nonsignificant findings (20%); RCTs represented 6% of the examined investigations. CONCLUSIONS: Compared with the Journal of Clinical Periodontology, all other subspecialty journals, except the Journal of Oral and Maxillofacial Surgery, showed significantly decreased odds of publishing an RCT, which ranged from 60% to 93% (P < .05).

Assessing drinking water quality at source and point-of-use : a case study of Koila Bamana, Mali, West Africa

Ensuring water is safe at source and point-of-use is important in areas of the world where drinking water is collected from communal supplies. This report describes a study in rural Mali to determine the appropriateness of assumptions common among development organizations that drinking water will remain safe at point-of-use if collected from a safe (improved) source. Water was collected from ten sources (borehole wells with hand pumps, and hand-dug wells) and forty-five households using water from each source type. Water quality was evaluated seasonally (quarterly) for levels of total coliform, E.coli, and turbidity. Microbial testing was done using the 3M Petrifilm™ method. Turbidity testing was done using a turbidity tube. Microbial testing results were analyzed using statistical tests including Kruskal-Wallis, Mann Whitney, and analysis of variance. Results show that water from hand pumps did not contain total coliform or E.coli and had turbidity under 5 NTUs, whereas water from dug wells had high levels of bacteria and turbidity. However water at point-of-use (household) from hand pumps showed microbial contamination - at times being indistinguishable from households using dug wells - indicating a decline in water quality from source to point-of-use. Chemical treatment at point-of-use is suggested as an appropriate solution to eliminating any post-source contamination. Additionally, it is recommended that future work be done to modify existing water development strategies to consider water quality at point-of-use.

Cancer, meta-analysis and reporting biases: the case of erythropoiesis-stimulating agents.

Reporting and publication bias is a well-known problem in meta-analysis and healthcare research. In 2002 we conducted a meta-analysis on the effects of erythropoiesis-stimulating agents (ESAs) on overall survival in cancer patients, which suggested some evidence for improved survival in patients receiving ESAs compared with controls. However, a meta-analysis of individual patient data conducted several years later showed the opposite of our first meta-analysis, that is, evidence for increased on-study mortality and reduced overall survival in cancer patients receiving ESAs. We aimed to determine whether the results of our first meta-analysis could have been affected by publication and reporting biases and, if so, whether timely access to clinical study reports and individual patient data could have prevented this. We conducted a hypothetical meta-analysis for overall survival including all studies and study data that could have been available in 2002, at the time when we conducted our first meta-analysis. Compared with our original meta-analysis, which suggested an overall survival benefit for cancer patients receiving ESAs [hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.67‒0.99], our hypothetical meta-analysis based on the results of all studies conducted at the time of the first analysis did not show evidence for a beneficial effect of ESAs on overall survival (HR 0.97, 95% CI 0.83‒1.12). Thus we have to conclude that our first meta-analysis showed misleading overall survival benefits due to publication and reporting biases, which could have been prevented by timely access to clinical study reports and individual patient data. Unrestricted access to clinical study protocols including amendments, clinical study reports and individual patient data is needed to ensure timely detection of both beneficial and harmful effects of healthcare interventions.

Supraorbital cutaneous fetal rhabdomyoma of intermediate type: a case report.

A 7-year-old boy was presented with a long-standing slowly growing mass of the left supraorbital area. A biopsy specimen revealed a bland spindle cell proliferation with scattered polygonal cells with acidophilic cytoplasm and cross-striations. Our differential diagnosis included rhabdomyoma of fetal type, leiomyoma with trapping of regenerating skeletal muscle elements, and rhabdomyomatous mesenchymal hamartoma of the skin. Immunohistochemistry demonstrated strong positivity of myoglobin and desmin as well as negativity of caldesmon, suggesting skeletal muscle lineage. The excisional specimen confirmed our diagnosis of cutaneous fetal rhabdomyoma of intermediate type. Additional immunostaining performed on the excisional specimen showed strong Wilms Tumor 1 but only a very faint and focal p63 expression.

Incidence of and risk factors for severe hypoglycaemia in treated type 2 diabetes mellitus patients in the UK - a nested case-control analysis

AIMS To assess incidence rates (IRs) of and identify risk factors for incident severe hypoglycaemia in patients with type 2 diabetes newly treated with antidiabetic drugs. METHODS Using the UK-based General Practice Research Database, we performed a retrospective cohort study between 1994 and 2011 and a nested case-control analysis. Ten controls from the population at risk were matched to each case with a recorded severe hypoglycaemia during follow-up on general practice, years of history in the database and calendar time. Using multivariate conditional logistic regression analyses, we adjusted for potential confounders. RESULTS Of 130,761 patients with newly treated type 2 diabetes (mean age 61.7 ± 13.0 years), 690 (0.5%) had an incident episode of severe hypoglycaemia recorded [estimated IR 11.97 (95% confidence interval, CI, 11.11-12.90) per 10,000 person-years (PYs)]. The IR was markedly higher in insulin users [49.64 (95% CI, 44.08-55.89) per 10,000 PYs] than in patients not using insulin [8.03 (95% CI, 7.30-8.84) per 10,000 PYs]. Based on results of the nested case-control analysis increasing age [≥ 75 vs. 20-59 years; adjusted odds ratio (OR), 2.27; 95% CI, 1.65-3.12], cognitive impairment/dementia (adjusted OR, 2.00; 95% CI, 1.37-2.91), renal failure (adjusted OR, 1.34; 95% CI, 1.04-1.71), current use of sulphonylureas (adjusted OR, 4.45; 95% CI, 3.53-5.60) and current insulin use (adjusted OR, 11.83; 95% CI, 9.00-15.54) were all associated with an increased risk of severe hypoglycaemia. CONCLUSIONS Severe hypoglycaemia was recorded in 12 cases per 10,000 PYs. Risk factors for severe hypoglycaemia included increasing age, renal failure, cognitive impairment/dementia, and current use of insulin or sulphonylureas.

Poorly controlled type 2 diabetes mellitus is associated with a decreased risk of incident gout: a population-based case-control study

OBJECTIVE The aim of this study was to explore the risk of incident gout in patients with type 2 diabetes mellitus (T2DM) in association with diabetes duration, diabetes severity and antidiabetic drug treatment. METHODS We conducted a case-control study in patients with T2DM using the UK-based Clinical Practice Research Datalink (CPRD). We identified case patients aged ≥18 years with an incident diagnosis of gout between 1990 and 2012. We matched to each case patient one gout-free control patient. We used conditional logistic regression analysis to calculate adjusted ORs (adj. ORs) with 95% CIs and adjusted our analyses for important potential confounders. RESULTS The study encompassed 7536 T2DM cases with a first-time diagnosis of gout. Compared to a diabetes duration <1 year, prolonged diabetes duration (1-3, 3-6, 7-9 and ≥10 years) was associated with decreased adj. ORs of 0.91 (95% CI 0.79 to 1.04), 0.76 (95% CI 0.67 to 0.86), 0.70 (95% CI 0.61 to 0.86), and 0.58 (95% CI 0.51 to 0.66), respectively. Compared to a reference A1C level of <7%, the risk estimates of increasing A1C levels (7.0-7.9, 8.0-8.9 and ≥9%) steadily decreased with adj. ORs of 0.79 (95% CI 0.72 to 0.86), 0.63 (95% CI 0.55 to 0.72), and 0.46 (95% CI 0.40 to 0.53), respectively. Neither use of insulin, metformin, nor sulfonylureas was associated with an altered risk of incident gout. CONCLUSIONS Increased A1C levels, but not use of antidiabetic drugs, was associated with a decreased risk of incident gout among patients with T2DM.

First report of a multidrug-resistant Klebsiella pneumoniae of sequence type 11 causing sepsis in a free-ranging beaver (Castor fiber).

Klebsiella pneumoniae of sequence type (ST) 11 is a hyper-epidemic nosocomial clone spreading worldwide among humans and also emerging in pets. In this report, we describe a clinical case of fatal sepsis due to this multidrug-resistant (MDR) pathogen in a Eurasian beaver. The isolate showed resistance to six different classes of antimicrobials including third generation cephalosporins and fluoroquinolones. This is the first report describing the detection of a MDR K. pneumoniae ST11 in a free-ranging animal. Our finding highlights the potential for environmental dissemination of hyper-epidemic clones of K. pneumoniae and possible spread in wildlife and cause epizootics.

Outcomes and cost effectiveness of treating type 2 diabetes with a nurse case manager following treatment algorithms versus primary care physicians

Background. Diabetes places a significant burden on the health care system. Reduction in blood glucose levels (HbA1c) reduces the risk of complications; however, little is known about the impact of disease management programs on medical costs for patients with diabetes. In 2001, economic costs associated with diabetes totaled $100 billion, and indirect costs totaled $54 billion. ^ Objective. To compare outcomes of nurse case management by treatment algorithms with conventional primary care for glycemic control and cardiovascular risk factors in type 2 diabetic patients in a low-income Mexican American community-based setting, and to compare the cost effectiveness of the two programs. Patient compliance was also assessed. ^ Research design and methods. An observational group-comparison to evaluate a treatment intervention for type 2 diabetes management was implemented at three out-patient health facilities in San Antonio, Texas. All eligible type 2 diabetic patients attending the clinics during 1994–1996 became part of the study. Data were obtained from the study database, medical records, hospital accounting, and pharmacy cost lists, and entered into a computerized database. Three groups were compared: a Community Clinic Nurse Case Manager (CC-TA) following treatment algorithms, a University Clinic Nurse Case Manager (UC-TA) following treatment algorithms, and Primary Care Physicians (PCP) following conventional care practices at a Family Practice Clinic. The algorithms provided a disease management model specifically for hyperglycemia, dyslipidemia, hypertension, and microalbuminuria that progressively moved the patient toward ideal goals through adjustments in medication, self-monitoring of blood glucose, meal planning, and reinforcement of diet and exercise. Cost effectiveness of hemoglobin AI, final endpoints was compared. ^ Results. There were 358 patients analyzed: 106 patients in CC-TA, 170 patients in UC-TA, and 82 patients in PCP groups. Change in hemoglobin A1c (HbA1c) was the primary outcome measured. HbA1c results were presented at baseline, 6 and 12 months for CC-TA (10.4%, 7.1%, 7.3%), UC-TA (10.5%, 7.1%, 7.2%), and PCP (10.0%, 8.5%, 8.7%). Mean patient compliance was 81%. Levels of cost effectiveness were significantly different between clinics. ^ Conclusion. Nurse case management with treatment algorithms significantly improved glycemic control in patients with type 2 diabetes, and was more cost effective. ^

Penetrating injuries of the thorax and abdomen: Type of medical-care institution and case fatality

The purpose of this study was to determine, for penetrating injuries (gunshot, stab) of the chest/abdomen, the impact on fatality of treatment in trauma centers and shock trauma units compared with general hospitals. Medical records of all cases of penetrating injury limited to chest/abdomen and admitted to and discharged from 7 study facilities in Baltimore city 1979-1980 (n = 581) were studied: 4 general hospitals (n = 241), 2 area-wide trauma centers (n = 298), and a shock trauma unit (n = 42). Emergency center and transferred cases were not studied. Anatomical injury severity, measured by modified Injury Severity Score (mISS), was a significant prognostic factor for death, as were cardiovascular shock (SBP $\le$ 70), injury type (gunshot vs stab), and ambulance/helicopter (vs other) transport. All deaths occurred in cases with two or more prognostic factors. Unadjusted relative risks of death compared with general hospitals were 4.3 (95% confidence interval = 2.2, 8.4) for shock trauma and 0.8 (0.4, 1.7) for trauma centers. Controlling for prognostic factors by logistic regression resulted in these relative risks: shock trauma 4.0 (0.7, 22.2), and trauma centers 0.8 (0.2, 3.2). Factors significantly associated with increased risk had the following relative risks by multiple logistic regression: SBP $\le$ 70 (RR = 40.7 (11.0, 148.7)), highest mISS (42 (7.7, 227)), gunshot (8.4 (2.1, 32.6)), and ambulance/helicopter transport (17.2 (1.3, 228.1)). Controlling for age, race, and gender did not alter results significantly. Actual deaths compared with deaths predicted from a multivariable model of general-hospital cases showed 3.7 more than predicted deaths in shock trauma (SMR = 1.6 (0.8, 2.9)) and 0.7 more than predicted deaths in area-wide trauma centers (SMR = 1.05 (0.6, 1.7)). Selection bias due to exclusion of transfers and emergency center cases, and residual confounding due to insufficient injury information, may account for persistence of adjusted high case fatality in shock trauma. Studying all cases prospectively, including emergency center and transferred cases, is needed. ^

Criterios técnicos del proyecto con módulos tridimensionales ligeros: las casas del Solar Decathlon 2005 y 2007

Este trabajo se ocupa de la construcción modular ligera de viviendas unifamiliares, más concretamente aborda el problema de la definición constructiva de las mismas, habida cuenta de lo poco conocido y publicado de este aspecto en particular. Dado que la construcción es fruto de la evolución, resulta de gran importancia el estudio de los antecedentes para comprender la situación actual, por ello para documentar como corresponde el estado de la técnica y de la investigación se estudiaron los antecedentes desde sus primeras manifestaciones a finales del siglo XIX hasta nuestros días. Contrariamente a las profecías de Le Corbusier y otros, la industrialización no ha llegado a la construcción ni en la forma ni en la medida que era de esperar a principios del siglo XX. Sin embargo y a pesar del relativo “fracaso” de la industrialización en convertirse en la forma mayoritaria de producir edificios, lo cierto es que algunos sistemas altamente industrializados, como lo es la construcción modular ligera, han logrado un lugar en el mercado, que en algunos países resulta cuanto menos significativo. Delimitar el estado de la técnica y la situación actual es crucial en este trabajo, toda vez que la construcción industrializada la realizan empresas, y situarse al margen de las mismas y de su producción, nos guste o no, resulta contrario al sentido común. De este modo se han identificado y documentado ejemplos como el de EE.UU. y Japón, entre otros, que resultan muy ilustrativos tanto desde la evolución como del estado actual. Del estado de la técnica y la investigación también resulta la escasez de publicación de detalles constructivos específicos de la construcción modular ligera. Es obvio que los fabricantes intentan blindarse mediante el secreto industrial, logrando que las soluciones constructivas más interesantes queden fuertemente protegidas dentro del conocimiento reservado de la empresa. De este modo un sistema que alcanza grados de prefabricación del 95%, tan atractivo e interesante para el arquitecto queda reservado al conocimiento de unos pocos dentro de las empresas. La búsqueda de mayor información sobre estos sistemas encuentra un filón indiscutible en los proyectos de las casas del concurso Solar Decathlon. En efecto, debido a las condiciones particulares de este concurso, las casas que compiten deben ser instaladas en un plazo corto, por lo que en su mayoría recurren al método de construcción modular ligera, para lograr correctamente este objetivo. Adicionalmente todos los planos de proyecto incluidos los de detalle, así como memorias de especificaciones técnicas, quedan colgadas en la Web, a libre disposición del público. De este modo se ha considerado interesante, conveniente y útil, aprovechar como fuente documental de este trabajo, aparte de lo obtenido en el estado de la técnica y la investigación, los proyectos de las casas de los concursos 2005 y 2007, que fueron las dos últimas ediciones celebradas cuando se inició esta tesis. De modo similar a esta carencia de detalles publicados se observa igualmente una falta de investigación y de metodologías adecuadas a la misma sobre soluciones y detalles constructivos propios de la construcción modular ligera. Por eso y ante la dificultad de manejar adecuadamente una información disponible pero farragosa, este trabajo ha dedicado una parte importante de su esfuerzo a la creación de una metodología adecuada a este tipo de situación. Hay que destacar que cada proyecto puede constar fácilmente de 60 a casi 200 planos, sin contar las memorias técnicas y otros documentos, tales como galerías de imágenes, etc. Por otra parte resulta útil establecer esta metodología, no solo para esta tesis, sino para futuros trabajos de investigación sobre el tema, toda vez que con posterioridad a 2007 se han celebrado nuevas ediciones del concurso con su correspondiente volumen de información disponible. La metodología del análisis de los proyectos se basa en el diseño y creación de siete fichas tipo que resumen los aspectos fundamentales del proyecto desde el punto de vista constructivo, permitiendo de este modo su rápida visualización y comprensión sin pretender exhaustividad, ya que en caso de querer profundizar en el detalle de la información siempre está el proyecto original para ello. Tras estudiar la información obtenida de los proyectos de las casas de concurso, se contrastan y discuten los resultados para obtener conocimientos de interés para el objetivo propuesto en la tesis. Se comparan los resultados procedentes del estado de la técnica y de la investigación y se obtienen las conclusiones correspondientes. De este modo ha sido posible identificar una serie de criterios técnicos de proyecto de viviendas unifamiliares realizadas mediante construcción modular ligera, que además se organizan en varios niveles, por lo que el resultado es un conjunto de criterios como germen de una futura guía o manual. Como conclusiones fundamentales de la tesis hay que destacar las metodológicas, que habilitan la extensión de este estudio a otros trabajos y la aportación original al conocimiento con la definición de una serie de criterios técnicos de proyecto de viviendas realizadas mediante construcción modular ligera, que además de mejorar esta parte del saber constructivo serán de gran ayuda a los arquitectos de cara a la reducción de errores, que a menudo derivan en mayores costes y plazos, cuando no directamente al abandono del sistema constructivo. El trabajo de la tesis se estructura en siete capítulos a saber: Capítulo 1: Introducción, donde se explica el tema de la tesis, el objetivo principal, las limitaciones y se aportan algunas definiciones. Capítulo 2: Estado de la técnica y la investigación, dentro del cual se presentan los antecedentes desde sus inicios pasando por la primera y segunda mitad del siglo XX y finalizando con el estado actual que recorre los sistemas de EE.UU, Japón, Europa, Escandinavia, centro Europa, Francia, España y algunos ejemplos de Latinoamérica. En el estado de la investigación se presentan las publicaciones tanto en revistas científicas indexadas en el JCR, como publicaciones no indexadas en las que se muestran artículos científicos, comunicaciones a congresos, documentación sobre el concurso Solar Decathlon, libros específicos y libros genéricos sobre construcción modular ligera, tesis doctorales tanto generales como específicas sobre el concurso Solar Decathlon, documentos de idoneidad técnica, páginas Web del concurso Solar Decathlon y finalmente páginas Web de empresas de construcción modular ligera y patentes. También se expresan las conclusiones parciales del capítulo así también como la justificación y los objetivos particulares. Capítulo 3: Metodología, se expone en primer lugar el planteamiento del problema, para luego desarrollar los métodos utilizados para el estudio y clasificación del transporte y de la organización modular, la relación entre la organización modular y distribución espacial, el diseño y contenido de las fichas resumen de los 38 proyectos presentados al SD2005 y SD2007, así también como la información consultada para su realización. Se explica asimismo como se realizaron las tablas comparativas partiendo de la información de las fichas. Finalmente se expresa la manera en que se trató el estudio particular de la junta entre módulos. Capítulo 4: Discusión de resultados, dónde en primer lugar se presenta la clasificación y las estrategias del transporte así también como una clasificación de la organización modular, en segundo lugar se estudian las relaciones que existen entre el sistema modular y la organización espacial. A partir de aquí se muestra el estudio de la estructura de todas las casas del SD2005 y SD2007, según el tipo y material de las zapatas, mostrando tanto tablas cuantitativas como tablas gráficas con fotos. De la misma manera se tratan los forjados, los pilares y las vigas y las cubiertas. Se estudia además el cerramiento opaco y acristalado, la cubierta y el forjado según las capas que lo componen. En el caso de las instalaciones se estudian las que son especiales, descartando las normales en este tipo de casas, como son los paneles fotovoltaicos, placas térmicas o tubos de vacío y los sistemas de almacenamiento de energía, como las baterías, presentando tablas numéricas y gráficas con fotos. El transporte se analiza según corresponda al traslado de la vivienda o al transporte de apoyo, según el tipo y la cantidad utilizado. Con respecto al montaje se diferencia en si se usó grúa o no, y en el caso de no utilizarse se muestran los métodos alternativos. Con respecto a la exploración de la organización modular se presentan la cantidad de módulos que utilizó cada casa, así como también la cuantificación de los sistemas híbridos como son elementos lineales 1D, paneles 2D. Por último se muestra el estudio detallado de la junta entre módulos 3D. Finalmente se realiza la propuesta de un conjunto de criterios técnicos de proyecto organizado en cuatro niveles: 1º nivel de criterios generales, 2º nivel sobre sistemas constructivos, 3º nivel de detalles constructivos y el 4º nivel llamado logística obras previas, transporte y montaje. Capítulo 5: Conclusiones y líneas futuras de investigación, se exponen las conclusiones generales, metodológicas, documentales y por último las de construcción modular. Finalmente se realiza una propuesta de líneas futuras de investigación. Capítulo 6: Bibliografía. Capítulo 7: Anexos, en el que se presentan todas las fichas resumen de las casas realizadas por el autor de esta tesis. Además se incluyen los casos concretos de Voisin en Francia y la TVA (Tennessee Valley Authority) en EE.UU., así como referencias de manuales genéricos de construcción ligera, medidas de transporte en España e información sobre estadísticas de viviendas en la Unión Europea. ABSTRACT This paper deals with Light Modular Construction of houses, and specifically addresses the problem of the constructive definition of the same, given how little known and published this subject has been. Since building construction is the result of evolution, it is of great importance to study its background for understanding the current situation, therefore to document the state of the art and research, its history was studied from its origins dating to the end nineteenth century to our days. Contrary to the prophecies of Le Corbusier and others, industrialization has not reached the construction neither in the form nor to the extent that it was expected in the early twentieth century. However, despite the relative "failure" of industrialization to become the major form of production for buildings, the fact is that some highly industrialized systems, such as the so called Lightweight Modular Construction, have achieved a place in the market, which in some countries is at least significant. To outline the state of the art and the current situation is crucial in this work, since industrialized construction is carried out by companies, and to step away from them and their production, whether we like it or not, it is contrary to common sense. So that, several cases have been identified and documented, such as the US and Japan examples, among others, which are very illustrative both from evolution and the current status. The state of the art and research shows also a shortage of publication of specific construction details of light modular construction. Obviously, manufacturers try to shield themselves by trade secret, making the most interesting constructive solutions remain heavily protected within the reserved knowledge of the company, so a system that reaches levels of 95% prefabrication, so attractive and interesting for the architect It is reserved to the knowledge of a few people inside the companies. The search for more information on these systems finds an invaluable reef in the projects of the Solar Decathlon houses. Indeed, due to the particular conditions of this contest, houses competing must be installed in a short time, so mostly turn to modular construction methods for this purpose to achieve properly this goal. Additionally all levels of project, including detailed and technical specifications reports are published on the Web, freely available to the general public. Thus it was considered interesting, convenient and useful to take advantage as a documentary source of this work, apart from what it were obtained in the state of the art and research, the projects of the houses of the 2005 and 2007 contests, which were the last two editions already held before this thesis was started. Similar to this lack of published details it is also observed a lack of research and methodologies adapted to the solutions and construction details of lightweight modular construction. So that, and facing the difficulty of adequately manage the available but bulky information, this work has devoted a significant part of its effort to create an appropriate methodology for this type of situation. It is noteworthy that each project can easily consist of 60 to almost 200 blueprints, not including technical reports and other documents, such as photo galleries, etc. The methodology of the analysis of the projects is based on the design and creation of seven record sheets that summarize key aspects of the project from a construction point of view, thus allowing quick watching and understanding of the project, without claiming completeness, always keeping for further information the blueprints themselves. After studying the information obtained from the projects of the competition houses, the results are compared and discussed to obtain relevant knowledge according to the objective proposed in the thesis. The results from the state of the art and research are also compared and the conclusions so obtained make possible to identify a number of technical design criteria for single family homes made using lightweight modular construction, which also have been organized at various levels, so the result is a set of criteria as a seed for a future guide or manual. Among the main conclusions of the thesis must be noted the methodological ones, that enable the extension of this study to other works and are an original contribution to knowledge with the definition of a number of technical criteria for housing projects made by light modular construction, what in addition to improving this part of the constructive knowledge will be of great help for the architects to reduce errors that often result in higher costs and delays, if not in abandonment of the construction system itself. The work of the thesis is divided into seven chapters as follows: Chapter 1: Introduction, where the topic of the thesis, the main objective, limitations and the provided definitions is explained. Chapter 2: State of the art and research, within which history is presented from the beginning through the first and second half of the twentieth century and ending with the current systems, that spans from the USA to Japan, Europe, Scandinavia, Central Europe, France, Spain and some Latin American examples. In the state of research publications are presented both on scientific journals indexed in the JCR, and non-indexed publications in which scientific articles, conference papers, information about the Solar Decathlon competition, generic and specific books on light modular construction, articles both general and specific on the Solar Decathlon competition, technical approval documents, dissertations, the Solar Decathlon Web pages and finally lightweight modular construction companies Web pages and patents. The partial conclusions of the chapter as well as the rationale and specific objectives are also expressed. Chapter 3: Methodology first of all exposes the problem statement and then develops the methods used for the study and classification of transportation and modular organization, the relationship between the modular organization and spatial distribution, design and content summary records of the 38 projects submitted to the SD2005 and SD2007, as well as information consulted for its realization. It explains equally how the comparative tables based on information from the chips were made. Finally, the way the particular study of the joint between modules is carried out is also treated. Chapter 4: Discussion, first sorting a classification of transport strategies as well as of modular organization, secondly the relationship between the modular system and the spatial organization studied is presented. From then on, the study of the structure of every house Moreover, to establish this methodology is useful not only for this thesis, but for future research on the subject, since after 2007 there have been held new editions of the contest with a corresponding volume of information available. shown in the SD2005 and SD2007 contests, depending on the type and material of the shoe, showing both quantitative tables as graphic boards with pictures is carried out. Similarly slabs, columns and beams and roofs are treated. Furthermore, the opaque and transparent façades, as well as roof and floor enclosure, according to the layers that compose them are studied. In the case of facilities there have been only addressed that which are of a special type, discarding that considered usual in this type of houses such as photovoltaic panels, thermal panels or vacuum tubes and energy storage systems such as batteries, presenting numerical and graphical tables with photos .The transportation is analyzed depending on it is used to move the house or for additional support, depending on the type and quantity of items used. Regarding assembly it has been made a difference if crane is or not used and if not, what the alternative methods are. With respect to the exploration of the modular organization, the amount of modules used in each house is presented, as well as the quantification of hybrid systems such as linear members as well as 1D, 2D panels. Finally, it has been carried out the detailed study of the joint between 3D modules. Finally it is proposed a set of technical criteria organized into four levels, 1st level of general criteria, 2nd level on building systems, 3rd level construction details and 4th level called previous works and logistics, transportation and assembly. Chapter 5: Conclusions and future research, where general, methodological, documentary and finally modular construction findings are presented. A proposal for further research is done. Chapter 6: Bibliography. Chapter 7: Annexes, in which all the record sheets of houses made by the author of this thesis are presented. Besides the specific cases of Voisin in France and TVA (Tennessee Valley Authority) in the USA, as well as general reference manuals on lightweight construction, transportation dimensions in Spain, and information on housing statistics in the European Union are included.