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Patients with hallux rigidus (HR) tend to develop a characteristic alteration in walking to lessening pain and compensate for the limited range of motion at the first metatarsophalangeal (MTP1) joint that might be affected balance and gait. The goal of this study was to perform an integrated biomechanical description of gait and balance of symptomatic patients with either grade as III or IV HR in comparison with healthy subjects. Eleven patients (7 men) with HR (60 ± 7 years, 1.60 ± 0.07 m, and 70 ± 13 kg) and 16 (7 men) healthy subjects (70 ± 8 years, 1.66 ± 0.10 m, and 74 ± 14 kg) were included. Subjects performed 2 tasks: walking (5 trials of straight walking for at least 6 meters) and bipedal quiet standing for 30 seconds. For these 2 tasks the following variables were measured: range of motion of the MTP1 joint, plantar pressure distribution during the stance phase of walking, and the postural sway during quiet standing. Plantar pressure was measured in up 15 walking trials with a mat pressure sensor. The MTP1 joint range of motion for flexion/extension during walking was significantly smaller for the patients with HR than for the control group (HR: 14 ± 8°, control: 44 ± 5°; t(17) = -9.7, p.001). The forefoot plantar pressure distribution among different regions of the foot in patients with HR was not statistically different than the control group, but there was a tendency of higher pressures in the lateral metatarsal heads (p = .06). As description of the postural sway during quiet standing, the center of pressure area was not different between HR and the control group (p.05). Decreased MTP1 joint range of motion for flexion/extension during walking in symptomatic high-grade HR patients can be associated with higher pressure in the lateral metatarsal heads while the impact on postural sway is not affected.

Objetivo: o objetivo é analisar os resultados do rastreamento do câncer de pulmão por tomografia computadorizada de baixa dose (LDCT) por meio do Sistema de Relatórios e Dados de Triagem de TC de Pulmão (Lung-RADS) em um centro de câncer brasileiro. Materiais e métodos: revisamos retrospectivamente os prontuários de pacientes submetidos ao programa de rastreamento de câncer de pulmão de LDCT basal no A.C. Camargo Cancer Center. Os critérios de inclusão e exclusão foram iguais aos do National Lung Cancer Screening Trial (NLST). Os critérios para achados de imagem foram aqueles classificados de acordo com as categorias de avaliação do Lung Imaging Reporting and Data System (Lung-RADS). Resultados: Dos 287 indivíduos avaliados neste estudo, 72,1% apresentaram TC de triagem negativa (categorias 1 ou 2 do Lung-RADS), o restante teve TC de triagem positiva, considerando 5,6% na categoria 4A de Lung-RADS, 2,1% na categoria 4B e 1,0% na categoria 4X. Os principais achados foram avaliados em 218 (75,9%) indivíduos, com nódulos sólidos (64,8%), parcialmente sólidos (2,7%) e não sólidos (8,3%). A maioria dos pacientes (59,1%) apresentaram nódulos sólidos menores que 6 mm. Os resultados histológicos confirmaram câncer de pulmão em 2 casos (prevalência de 0,7% de todos os pacientes triados). Conclusões: A prevalência de câncer de pulmão em nossa amostra foi compatível com a literatura. No entanto, tivemos uma prevalência maior das categorias 3 e 4A do Lung-RADS do que o esperado. Isso pode estar associado à maior incidência de doenças granulomatosas, principalmente tuberculose, na população brasileira.

Objetivo: avaliar o papel da ressonância magnética (RM) no atendimento de urgência e emergência em um centro de referência oncológica, identificando suas principais indicações, achados e seus impactos na conduta terapêutica e tomada de decisão. Materiais e métodos: estudo analítico retrospectivo, que envolveu a revisão de registros médicos e relatórios de imagem para todos os pacientes que foram submetidos a exames de RM na urgência ou emergência entre junho de 2017 e junho de 2018 no departamento de imagem. Resultados: 317 laudos de RM revisados foram incluídos na análise. A RM foi realizada para investigar metástases e complicações relacionadas à doença de base em 246 (77,6%) casos e em 71 (22,4%) para explorar os motivos clínicos apresentados durante o atendimento de emergência. Os achados foram positivos (confirmando as indicações suspeitas) em 211 (66,6%) casos e negativos em 106 (33,4%). Nenhum paciente morreu durante a hospitalização. Conclusão: o método de imagem foi capaz de caracterizar as lesões, com concordância clínica, permitindo melhor compreensão da complexidade tumoral e do acompanhamento terapêutico.

A COVID-19 é uma doença altamente contagiosa e patogênica causada pelo coronavírus, sendo responsável pela maior pandemia da história moderna. Alerta-se para como o vírus se manifesta nos profissionais de saúde, que atuam diretamente com os infectados. Assim, o objetivo do estudo consistiu em analisar aspectos clínicos, demográficos e radiológicos de profissionais da saúde suspeitos ou confirmados com COVID-19. Trata-se de uma pesquisa observacional, retrospectiva e descritiva envolvendo 721 profissionais de saúde de um hospital referência no atendimento de sintomáticos respiratórios. Os mais acometidos foram jovens, pardos e do sexo feminino. Em 9 casos, foram descritos fatores de risco para o agravamento da doença, sendo eles idade, obesidade e hipertensão. A maioria dos profissionais não apresentou sintomas. Dentre os sintomáticos, os sintomas frequentes foram tosse, dor de cabeça, coriza, febre e dor de garganta. No total, 18,3% apresentaram resultados positivos para a infecção, destes, técnicos de enfermagem, enfermeiros e médicos foram os mais frequentes. Os setores com maior número de acometidos foram clínica médica, emergência e UTI. Aproximadamente, 92% evoluíram para cura e nenhum óbito foi constatado. Foram realizados 22 exames radiológicos do tórax, dos quais 50% demonstraram alterações. Destes, 60% foram achados típicos, 13,3% atípicos e 26,7% indeterminados para COVID-19. Dentre os achados típicos, 44,5% apresentaram acometimento pulmonar entre 25% e 50% e 22,2% apresentaram acometimento inferior a 25%. Os achados dessa análise foram concordantes com outros dados da literatura, fortalecendo a importância da proteção e segurança daqueles que seguem na linha de frente no combate à COVID-19.

As síndromes respiratórias agudas graves são responsáveis por um número considerável de internamentos em Unidades de Terapias Intensiva. Atualmente, este contingente vem crescendo consideravelmente em virtude da pandemia causada pelo novo corona vírus, o SARS-CoV-2. Diferentes aspectos clínicos e radiológicos têm sido relacionados ao desenvolvimento da doença. Este estudo tem como objetivo avaliar aspectos clínicos e radiológicos dos indivíduos admitidos em um hospital regional localizado na região do semiárido do nordeste brasileiro. Foram estudados 104 pacientes de forma retrospectiva, dos quais, 17 (27%) tiveram testes laboratoriais positivos para Covid-19. Sintomas como dispneia, febre e tosse foram os mais frequentes, presentes em 77,88%, 72,11% e 59,61% dos casos, respectivamente. Idade inferior a 60 anos, sexo masculino, hipertensão, riscos cardiovasculares e diabetes mellitus foram as variáveis clínicas mais frequentes presentes em 66,4%, 62%, 18,26% e 10,57% dos casos, respectivamente. Oitenta e cinco (81,73%) pacientes realizaram exame tomográfico do tórax, sendo os achados considerados típicos os mais comuns nos pacientes que testaram positivos para Covid-19, presentes em 70,5% dos casos. O presente estudo demonstra que a maioria dos achados clínicos e radiológicos foi semelhante a outros estudos da literatura.

Objetivo: analisar o perfil clínico, radiológico e patológico dos tumores da sela túrcica em um hospital universitário da região do submédio do vale do São Francisco. Materiais e métodos: Trata-se de um estudo retrospectivo, com análise de exames de tomografia computadorizada e ressonância magnética de crânio realizados em 21 pacientes portadores de neoplasias da sela túrcica entre os anos de 2011 e 2016. Resultados: Os métodos de imagem foram as principais ferramentas para pesquisa e diagnóstico de tumor selar em 17 (80,9%) casos, com maior prevalência do adenoma hipofisário com 11 (52,4%) casos, com os macroadenomas correspondendo a 9 (42,8%) casos, do total. Compressão do quiasma óptico, extensão suprasselar e infiltração das estruturas adjacentes (parasselares) foram os achados radiológicos mais frequentes com 9 (42,9%), 7 (33,3%) e 5 (23,8%) casos, respectivamente. Conclusão: Os métodos de imagem são fundamentais para a caracterização, planejamento terapêutico e controle pós terapêutico, com elevada concordância clínica e cirúrgica.

This is a comparative analysis of two patients diagnosed with pulmonary epithelioid hemangioendothelioma (PEH). The objective is to educate readers to PEH, a rare disease with a wide range of clinical manifestations that may be mistaken for lung adenocarcinoma or pulmonary metastases. This study is a retrospective analysis of electronic medical records and PACS diagnostic imaging files followed by literature review using PubMed. Case 1 is a male diagnosed incidentally with multiple lung nodules during a job admission exam. Case 2 is a female, symptomatic, found to have multiple lung nodules on investigation. Both patients had a CT-guided biopsy that established their diagnoses. Case 1 remains asymptomatic in his ninth year of follow-up, whereas case 2 died less than 9 months after development of symptoms despite treatment with radiotherapy, endobronchial prosthesis, and an oral multikinase inhibitor with anti-angiogenics properties. In this study, we aimed to illustrate the heterogeneity of PEH. Because of PEH’s rarity, its natural history and prognostic factors remain obscure. Medical literature is primarily composed of case studies with inconsistent methodology and diagnostic criteria.

The aim of this work was to evaluate whether the immune-modulatory bacterium Lactobacillus fermentum CECT5716 (LC40) protects the kidneys in a female mouse model of lupus with hypertension. Twenty-week-old female NZBWF1 (lupus) and NZW/LacJ (control) mice were treated with vehicle or LC40 (5 × 108 colony-forming units day-1) for 13 weeks. LC40 treatment reduced the increased plasma anti-dsDNA, endotoxemia, and high blood pressure in NZBWF1 mice. In parallel, LC40 also prevented alterations in kidney function parameters, measured by reduced creatinine and urea in urine excretion, and kidney injury, evaluated by albumin excretion in lupus mice. The main histological features found in the kidneys of lupus mice, such as glomerular, tubulointerstitial or vascular lesions present in the renal parenchyma, accompanied by immune-complex deposition and inflammatory infiltrates were also reduced by LC40. In addition, LC40 inhibited the increased levels of pro-inflammatory cytokines, NADPH oxidase activity and infiltration of Th17 and Th1 cells in the kidneys of NZBWF1 mice. Interestingly, no significant changes were observed in control mice treated with LC40. In conclusion, these results indicate that the consumption of LC40 can prevent the impairment of kidney function and damage, in part due to its capacity to reduce anti-dsDNA production and circulating levels of lipopolysaccharides, with the subsequent reduction of immune complex deposition, inflammation and oxidative stress. These results open new possibilities for the prevention of renal complications associated with hypertensive systemic lupus erythematosus by the chronic administration of the probiotic LC40.

Objective: To evaluate the success and complication rates of ultrasound-guided renal biopsy at a tertiary care hospital. Materials and Methods: This was a retrospective analysis of 97 ultrasound-guided renal biopsies, all performed by the same radiologist, between 1 March, 2017 and 31 October, 2019. Results: Of the 97 biopsies evaluated, 87 had a definitive pathological diagnosis. In five cases (5.4%), the biopsy results were inconclusive and a second procedure was required. In seven procedures (7.6%), there were complications, all of which were properly resolved. Conclusion: Ultrasound-guided renal biopsy has proven to be a safe, effective method for the diagnosis of nephropathies, with high success rates. Resumo Objetivo: Avaliar taxas de sucesso e de complicações de biópsias renais guiadas por ultrassonografia em um hospital terciário. Materiais e Métodos: Análise retrospectiva de 97 biópsias renais realizadas entre 1º de março de 2017 e 31 de outubro de 2019, guiadas por ultrassonografia e executadas por um único médico radiologista. Resultados: Oitenta e sete biópsias apresentaram diagnóstico anatomopatológico definitivo. Cinco biópsias foram inconclusivas (5,4%) e precisaram de um segundo procedimento. Houve complicações em sete procedimentos (7,6%), todas devidamente solucionadas. Conclusão: A biópsia renal guiada por ultrassonografia demonstrou ser um método efetivo e seguro para o diagnóstico de nefropatias, com elevada taxa de sucesso em sua execução.

The aim of this study was to investigate the effects of the use of an occlusal splint on postural balance considering the occlusal splint as a device for treating temporomandibular joint disorder. A randomized, controlled, prospective clinical trial was conducted. The research group consisted of 49 patients (36 as test group and 13 as control group) between 18 and 75 years old, both genders, diagnosed as temporomandibular disorder by Research Diagnostic Criteria/Temporomandibular Disorders questionnaire and magnetic resonance imaging of the temporomandibular joints. Test group was treated with orientations for physiotherapeutic exercises and occlusal splint, whereas control group received orientation for physiotherapeutic exercises only. Postural equilibrium was evaluated by means of a force plate. After 12 weeks, the groups were re‐evaluated. Patients from both groups presented a significant increase in antero‐posterior speed with eyes closed, test group (P

Background: Pegylated liposomal doxorubicin (PLD) is among the most active therapies for recurrent/progressive ovarian cancer (OC). Low-density lipoprotein receptor-related protein 1B (LRP1B) is one of the 10 most significantly deleted genes in human cancers. It mediates endocytosis of several factors from the cellular environment including liposomes. Although the LRP1B role in cancer has not been fully disclosed, its contribution to resistance to liposomal therapies has been hypothesized. This study aimed to evaluate the impact of LRP1B protein as a possible marker of response to PLD in patients with OC. Methods: LRP1B expression and response to PLD were analyzed in OC cell lines by qRT-PCR and PrestoBlue viability assay, respectively. LRP1B protein expression was evaluated for the first time, in tumor samples from PLD-treated patients and controls (other chemotherapies) by immunohistochemistry. Association of LRP1B staining score (determined based on intensity and percentage of positively stained cells) with clinicopathological features, response to therapy and survival outcomes was evaluated. Results: OC cells with increased expression of LRP1B were more sensitive to PLD. LRP1B staining score was associated with clinicopathological features, response to therapy, and survival outcomes. Higher LRP1B levels were associated with prolonged progression-free survival. This association was more evident in patients treated with PLD and in responders to PLD. Conclusion: Our results support a possible role of LRP1B as a predictor of response to PLD in patients with OC.

Background: Running-related injuries (RRIs) are a pervasive menace that can interrupt or end the participation of recreational runners in this healthy physical activity. To date, no satisfactory treatment has been developed to prevent RRIs. Purpose: To investigate the efficacy of a novel foot core strengthening protocol based on a ground-up approach to reduce the incidence of RRIs in recreational long-distance runners over the course of a 1-year follow-up. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: The participants, 118 runners, were assessed at baseline and randomly allocated to either an intervention group (n = 57) or a control group (n = 61). The intervention group received an 8-week training course focused on the foot-ankle muscles, followed by remotely supervised training thereafter. Assessments consisted of 3 separate biomechanical evaluations of foot strength and foot posture and a weekly report on each participant’s running distance, pace, and injury incidence over 12 months. Results: The control group participants were 2.42 times (95% CI, 1.98-3.62) more likely to experience an RRI within the 12-month study period than participants in the intervention group ( P = .035). Time to injury was significantly correlated with Foot Posture Index ( P = .031; r = 0.41) and foot strength gain ( P = .044; r = 0.45) scores. This foot exercise program showed evidence of effective RRI risk reduction in recreational runners at 4 to 8 months of training. Conclusion: Recreational runners randomized to the new foot core strengthening protocol had a 2.42-fold lower rate of RRIs compared with the control group. Further studies are recommended to better understand the underlying biomechanical mechanisms of injury, types of injuries, and subgroups of runners who might benefit maximally. Registration: NCT02306148 (ClinicalTrials.gov identifier).

Structural and functional changes in the foot have been associated with age-related changes in gait mechanics, but walking speed may be a confounding factor in this relationship. The aim of this study was to investigate the effect of aging and speed on the ankle–foot power output during level walking. The effects of speed and aging on features of the mechanical power and work of the ankle and foot were quantified with a gait analysis of 24 young and 16 older individuals walking at different speeds. We observed gait speed having a significant effect on all the investigated features: peak power and positive and negative work of the ankle, foot, and sum of the ankle and foot (average effect size: 0.64 ± 0.22, from 0.26 to 0.87). We observed age having no effect on these same features (average effect size: 0.23 ± 0.12, from 0.03 to 0.39), with the exception of age’s effect when combined with speed on the negative work of the foot. We performed additional analysis to illustrate how the speed can become a confounding factor to the understanding of the age effect on the gait biomechanics. Based on the influence of gait speed on the mechanical power of the ankle–foot system, it is essential that studies control for the effect of gait speed if there is interest in understanding age-related effects, particularly when studying frail older individuals.

We performed a randomized, controlled trial to analyse the effects of resistance training (RT) on cognitive and physical function among older adults. Fifty participants (mean age 67 years, ~60% woman) were randomly assigned to an RT program or a control group. Participants allocated to RT performed three sets of 10-15RM in nine exercises, three times per week, for 12-weeks. Control group did not perform any exercise. Variables included cognitive (global and executive function) and physical function (gait, mobility and strength) outcomes. At completion of the intervention, RT was shown to have significantly mitigated the drop in selective attention and conflict resolution performance (Stroop test: -494.6; 95%CI: -883.1; -106.1) and promoted a significant improvement in working memory (digit span forward: -0.6; 95%CI: -1.0; -0.1 and forward minus backward: -0.9; 95% CI: -1.6; -0.2) and verbal fluency (animal naming: +1.4, 95%CI 0.3, 2.5). No significant between-group differences were observed for other cognitive outcomes. Regarding physical function, at completion of the intervention, the RT group demonstrated improved fast-pace gait performance (-0.3; 95% CI: -0.6; -0.0) and 1-RM (+21.4 kg; 95%CI: 16.6; 26.2). No significant between-group differences were observed for other mobility-related outcomes. In conclusion, RT improves cognitive and physical function of older adults.

This study describes an open data set of inertial, magnetic, foot–ground contact, and electromyographic signals from wearable sensors during walking at different speeds. These data were acquired from 22 healthy adults using wearable sensors and walking at self-selected comfortable, fast and slow speeds, and standing still. All data are publicly available in the Internet (https://doi.org/10.6084/m9.figshare.7778255). In total, there are data of 9,661 gait strides. This data set also contains files with the instants of the gait events identified using the foot–ground contact sensors and notebooks exemplifying how to access and visualize the data. This data set gives the opportunity to all interested researchers to work with such data, for example, making tests of algorithms for gait event estimation against a common reference, possible.

Introduction: Tumor infiltrating lymphocytes (TIL) are generally measured using subjective methods unable to differentiate subpopulations and to locate immune cells in the tumor microenvironment. The identification and location of these cells is of great importance as they present different responses to immune stimuli. Objective: to analyze the presence of TIL in early-stage breast cancer of the triple negative molecular subtype, and to evaluate the association of TIL with the overall survival time (OS). Methods: a cross-sectional study was carried out at the Hospital de Câncer de Pernambuco (HCP), where patients diagnosed with triple negative breast cancer were selected between 2009 and 2013. TIL evaluation was performed by two methods: on slides stained with hematoxylin and eosin (H&E), by two pathologists blindly and independently, and on slides submitted to immunohistochemistry, with CD3 and CD8 lymphocyte marking. In this case, the sample was then subjected to computerized histophotometry and morphometric analysis. Results: 87 patients were included, of which 22 patients had an event in the follow-up period. The evaluation of TIL, by two pathologists, showed regular agreement between the evaluators, with an intraclass correlation coefficient of 0.574 and p=0.001. CD3+ and CD8+ lymphocytes were in greater quantity in the intra tumor area compared to those outside the tumor margin (extra tumor). When the association between the presence of lymphocytes and the patient’s OS was analyzed, a directly proportional relationship with this survival was observed, that is, the greater the amount of lymphocytes, the lower the risk of death. Conclusion: results suggest that there is a correlation between the tumor lymphocyte infiltrate of triple negative breast cancer and OS. As this tumor subtype has a poor prognosis and does not have specific target therapy, TIL analysis can be explored as a prognostic marker for the treatment of breast cancer.

Objective To compare the performance in gross motor, fine motor-adaptive, language, cognitive and personal-social development skills of girls with a mean age of 36 to 71 months with Congenital Hypothyroidism treated from the neonatal period with that of their peers without thyroid alterations. Methods The participants included in the study were 30 children aged between 36 and 70 months divided into two groups paired for chronological age and socioeconomic status: 15 girls diagnosed with Congenital Hypothyroidism - Experimental Group (EG) and 15 girls without thyroid changes - Control Group (CG). The following assessment instruments were used: Interview with parents, Peabody Picture Vocabulary Test - Revised (PPVT-R), and Denver Developmental Screening Test - 2nd edition (DDST-II). Psychological testing of intellectual functioning was conducted with application of the Stanford-Binet Intelligence Scale (SBIS). The descriptive statistical analysis was performed using Student's t-test and the Mann-Whitney test at a significance level of 5% (p Results Comparison of the PPVT-R and SBIS results showed a statistically significant difference between the EG and CG. Comparison of the DDST-II results showed a statistically significant difference between the groups for the fine motor-adaptive, language and gross motor areas. Conclusion The present study confirms that Congenital Hypothyroidism affects child development, even when children are diagnosed and treated early, leading to alterations that can impair their motor, cognitive and language development.

Highlights • PNs with irregular, lobuled or spiculated margins exhibited faster growth than PNs with regular, smooth margins. • Malignancy was significantly associated with male gender, a colorectal cancer diagnosis and advanced stage disease. • Oncologic patients should have an individualized CT follow-up strategy, as the rate of malignant pulmonary nodules is higher than in the general population., Introduction Technological advancements in computed tomography (CT) have enabled the frequent detection of small pulmonary nodules (PNs), especially in patients with an oncologic history. It is important the malignant versus benign etiology of PNs be determined. The aim of the present study was to evaluate the behavior and clinical/radiological characteristics of subcentimeter PNs detected by CT in oncologic patients. Methods An observational, longitudinal, retrospective and single-center study was conducted with a sample of 100 patients with a diagnosis of a primary malignant solid tumor outside of the lungs who developed indeterminate subcentimeter PNs (n = 251) detected on consecutive thoracic CT scans from 2015 to 2017. Follow-up CTs for each patients were examined in each of three periods (0–3 months, 3–6 months, and 6 months to 1 year). Results In our study sample, 28 patients (28 %) showed one or more signs suspicious of pulmonary metastasis, including ≥50 % PN growth, nodule growth followed by size reduction in patients undergoing chemotherapy, and the appearance of multiple nodules. The majority (56 %) of the PNs were detected during the 3–6-month follow-up CT scan. PNs with irregular, lobuled, or spiculated margins exhibited faster growth than PNs with regular, smooth margins. Malignancy of PNs was found to be significantly associated with being male, a primary colorectal cancer diagnosis, and advanced stage disease. Conclusion Our findings reinforce the necessity of an individualized CT follow-up strategy for patients with an oncologic history, as well as the importance of early nodule screening, with the inter-scan interval being dependent on the primary neoplasm.

BackgroundThe purpose of this study was to determine whether whole-body MRI (WBMRI) with diffusion-weighted sequences, which is free of ionizing radiation, can perform as well as traditional methods when used alone for staging or follow-up of pediatric cancer patients.MethodsAfter obtaining approval from our institutional research ethics committee and appropriate informed consent, we performed 34 examinations in 32 pediatric patients. The examinations were anonymized and analyzed by two radiologists with at least 10 years' experience.ResultsThe sensitivity and specificity findings, respectively, were as follows: 100% and 100% for primary tumor; 100% and 86% for bone metastasis; 33% and 100% for lung metastasis; 85% and 100% for lymph node metastasis; and 100% and 62% for global investigation of primary or secondary neoplasias. We observed excellent interobserver agreement for WBMRI and excellent agreement with standard staging examination results.ConclusionsOur results suggest that pediatric patients can be safely imaged with WBMRI, although not as the only tool but in association with low-dose chest CT (for subcentimeter pulmonary nodules). However, additional exams with ionizing radiation may be necessary for patients who tested positive to correctly quantify and locate the lesions.

Background Diffusion-weighted magnetic resonance imaging (DW-MRI) provides information on the cellularity and movement of water molecules in tissues and 18F–fluorodeoxyglucose (18F–FDG) positron emission tomography/computed tomography (18F–FDG PET/CT) assesses cellular glucose metabolism, however both variables are related to tumour aggressiveness. The aim of this study is to investigate the potential correlation of the apparent diffusion coefficient (ADC) assessed by diffusion-weighted MRI (DWI) and glucose metabolism determined by the standardized uptake value (SUV) calculated from 18F–FDG PET/CT data in non-small cell lung cancer (NSCLC) with the occurrence of metastasis to the lymph nodes. Methods 18F–FDG PET/CT and DWI (TR/TE, 1800/93 ms; b-values, 0 and 600 s/mm2) were performed in 37 consecutive patients with histologically verified NSCLC. SUVmax was calculated based on the PET-CT data. The minimum ADC (ADCmin) was determined by placing a region-of-interest (ROI) covering the entire tumou. Results of 18F–FDG PET/CT and DWI were compared on a per-patient basis. Pearson’s correlation coefficient was used for statistical analysis. Results Correlation analysis of the ADCmin and SUVmax revealed that the inverse correlation was good for all the masses (p

CONTEXT: Adenocarcinoma already comprises half the cases of lung cancer. Its insidious clinical evolution contributes to the fact that, in absolute numbers, lung tumor is the cancer with the highest mortality in the world. When still in situ, the adenocarcinoma is even quieter, making its typical presentation on the computerized tomography of an irregular semisolid nodule smaller than 3.0 cm. It is often diagnosed in a finding of examination in an asymptomatic patient. The prevalence of in situ adenocarcinoma (ISA) is less than 5% of pulmonary malignancies and its radiological presentation with a diffuse mosaic paving pattern is even more unusual, mimicking other conditions more frequent to this finding. CASE REPORT: We describe the case of a 44-year-old male patient with a history of chronic smoking admitted to the emergency room at a referral hospital in Sao Paulo on 12/16/2016 with a complaint of progressive dyspnea associated with dry cough for 3 months, intermittent fever and weight loss of 8 kg in 2 months. A chest X-ray and computed tomography showed discrete focal points of peribroncovascular consolidation, predominantly central, areas with frosted glass attenuation associated with smooth thickening of the interlobular septa, sometimes interspersed with areas of preserved parenchyma, giving an aspect of “crazing paving” with diffuse distribution by the pulmonary parenchyma. The patient underwent a biopsy with the anatomicopathological diagnosis of primary Adenocarcinoma in situ of the lung. CONCLUSION: We emphasize that the “crazing paving” of adenocarcinoma in situ pulmonary should be considered and known by the radiologist, because although isolated it is a rare condition, its early distrust in cases of atypical evolution of the most common injuries can avoid a diagnosis in phases more advanced and higher mortality.

Combined hepatocholangiocarcinoma is a rare and unique form of primary hepatic neoplasm, expressing histopathological and phenotypic aspects of hepatocellularcarcinoma and cholangiocarcinoma in the same tumor. Diagnosis may be performed by imaging, showing typical features of both components. We present a case of a 55-year-old woman presenting with abdominal pain and a hepatic mass. The patient underwent surgery and combined hepatocholangiocarcinoma with stem cells features was confirmed on pathological analysis. There are no signs of recurrence to date. Combined hepatocholangiocarcinoma requires a preoperative diagnosis, since it is a unique entity with higher rates of local and lymph node recurrence, compared to isolated forms.

As infecções hospitalares são um desafio para a saúde pública, pois impactam no prognóstico do paciente e nos custos hospitalares. O objetivo deste estudo foi avaliar a ocorrência e o perfil bacteriano de aspirados traqueais de pacientes internados na Unidade de Terapia Intensiva. Trata-se de um estudo retrospectivo, descritivo e documental, tendo como fonte as planilhas disponibilizadas pelo laboratório de Análises Clínicas do Hospital Universitário. Dos 307 laudos analisados em 2017, 142 estavam positivos, e em 2018 dentre os 319, 213 foram positivos. O micro-organismo de maior ocorrência nos dois anos foi Acinetobacter baumannii, seguido de Pseudomonas aeruginosa, Staphylococcus aureus e Klebsiella pneumoniae. Acinetobacter baumannii apresentou resistência à diversos betalactâmicos, dentre eles o meropenem e o imipenem, e para a ampicilina + sulbactam; sendo sensível a colistina e a tigeciclina. Os isolados de P. aeruginosa de 2017 e 2018 foram resistentes a: meropenem, imipenem, ceftazidima, cefepima, ciprofloxacino e levofloxacino; no entanto, para a piperacilina + tazobactam observou-se resistência nas amostras obtidas em 2018. S. aureus foi resistente a clindamicina, ao sulfametoxazol + trimetoprima e a oxacilina; apresentou sensibilidade a linezolida, tigecliclina e vancomicina. Os isolados de K. pneumoniae demonstraram resistência, dentre outras drogas, ao imipenem, meropenem, piperacilina + tazobactam; por outro lado, foram sensíveis a amicacina e a colistina. As resistências observadas denotam a importância do uso racional dos antimicrobianos e fornecem dados para a criação de protocolos de antibioticoterapia empírica para o tratamento dos pacientes internados na Instituição.

As infecções hospitalares (IH) são um grande problema de saúde pública mundial e estão relacionadas a fatores como a utilização inadequada de antibióticos, procedimentos invasivos, higienização inadequada dos objetos e das mãos dos profissionais da saúde. O presente estudo teve como objetivo isolar, identificar e analisar o perfil de resistência antimicrobiana das bactérias presentes nas superfícies das macas de um Hospital Universitário de Pernambuco. Trata-se de um estudo descritivo-exploratório com abordagem quantitativa realizado em duas salas de um Hospital Universitário. A coleta dos swabs foi realizada em 60 macas nas seguintes superfícies: a) Grade esquerda; b) Grade direita; c) Centro superior e d) Centro inferior. As amostras das superfícies foram coletadas, utilizando-se um molde de papel filtro de área de 4 cm² e swabs embebidos em solução salina 0,9% estéril. Após a passagem do swab, nas superfícies, eles foram armazenados em tubo contendo 5 mL meio líquido BHI (Brain Heart Infusion). Em seguida, as amostras foram transportadas para o Laboratório de Análises Clínicas/ Setor Microbiologia, onde foram realizadas as análises microbiológicas e antibiogramas. O total de isolados bacterianos nas superfícies das macas foi de 562, independentemente do local amostrado, sendo 11 espécies possíveis causadoras de infecções hospitalares, entre elas: Staphylococcus aureus, Acinetobacter baumannii, Klebsiella pneumoniae e Escherichia coli. Com relação ao perfil de resistência, alguns desses microrganismos apresentaram 100% de resistência aos antibióticos testados. Esses resultados permitem concluir que as macas analisadas podem reservar bactérias resistentes que favorecem as IHs e necessitam de protocolos de higienização.

BACKGROUND Pain impairs available cognitive resources and somatosensory information, but its effects on postural control during standing are inconclusive. The aim of this study was to investigate whether postural sway is affected by the presence of pain and a secondary task during standing. METHODS Sixteen healthy subjects stood as quiet as possible at a tandem stance for 30s on a force platform at different conditions regarding the presence of pain and a secondary task. Subjects received painful stimulations on the right upper arm or lower leg according to a relative pain threshold [pain 7 out 10 on a Visual Analog Scale (VAS) - 0 representing "no pain" and 10 "worst pain imaginable"] using a computer pressurized cuff. The secondary task consisted of pointing to a target using a head-mounted laser-pointer as visual feedback. Center of Pressure (COP) sway area, velocity, mean frequency and sample entropy were calculated from force platform measures. FINDINGS Compared to no painful condition, pain intensity (leg: VAS = 7; arm VAS = 7.4) increased following cuff pressure conditions (P

Avaliar o perfil bacteriano das amostras de aspirados traqueais e uroculturas de pacientes internados na Sala de Cuidados Intermediários do Hospital Universitário do Vale do São Francisco, Petrolina/PE. Trata-se de um estudo descritivo, quantitativo e retrospectivo envolvendo a análise do perfil microbiológico das amostras coletadas no período de janeiro a dezembro de 2020 pelo Laboratório de Análises Clínicas do Hospital Universitário. Os dados foram tabulados em planilhas do Excel®, sendo feito a análise descritiva com valores percentuais e absolutos. As identificações bacterianas e os antibiogramas foram realizados através do sistema automatizado BD Phoenix ™, seguindo a metodologia do Clinical and Laboratory Standards Institute. Foram coletados 120 aspirados traqueais, sendo 55 positivos (46%) para achados bacterianos; os patógenos mais prevalentes foram: Acinetobacter baumannii (40%), Klebsiella pneumoniae (16%) e Pseudomonas aeruginosa (11%). Em relação às uroculturas, foram realizadas 183, sendo 10 (5,46%) positivas para achados bacterianos; as bactérias mais prevalentes foram: Escherichia coli (40%) e Enterobacter cloacae (20%). A. baumannii apresentou 100% de sensibilidade à colistina e polimixina B nos aspirados traqueias, assim como a K. pneumoniae apresentou à amicacina em todas as amostras coletadas. A E. coli demonstrou certa restência às cefalospororinas, com exceção da cefoxitina, sendo sensível; além disso, teve sensibilidade parcial ao sulfametoxazol+trimetoprima no estudo. O conhecimento do perfil microbiológico das bactérias permite a elaboração de protocolos preventivos e a realização de tratamento efetivos, diminuindo as taxas de mortalidade, o tempo de internação e os custos em saúde.

Zurstrassen CE, Bitencourt AGV, Guimaraes MD, Cavalcante ACBS, Tyng CJ, Amoedo MK, Matsushita Junior JPK, Szklaruk J, Marchiori E, Chojniak R.Percutaneous stent placement for the treatment of malignant biliary obstruction: nitinol versus elgiloy stents. Radiol Bras. 20 17 Mar/Abr;50(2):97–102.AbstractResumoObjective: This study aimed to compare two self-expanding stents, a nitinol stent and an elgiloy stent, both placed percutaneously, interms of their efficacy in palliating inoperable malignant biliary obstruction.Materials and Methods: We retrospectively investigated 99 patients with unresectable malignant biliary obstruction treated with percu-taneous placement of a self-expanding metallic stent at our institution between May 2007 and January 2010. Serum bilirubin and liverenzyme levels were measured before and 30 days after stenting. For all procedures using elgiloy or nitinol stents, stent occlus ion andpatient survival rates were calculated using Kaplan-Meyer analysis.Results: All of the patients showed clinical improvement after stent placement, with no difference between the two groups. In both grou ps,the occlusion-free survival rate was 67% at 30 days, 37% at 90 days, 25% at 180 days, and 10% at 360 days, with no significantdifference in relation to the type of stent.Conclusion: The two stents evaluated showed comparable efficacy for the percutaneous treatment of unresectable biliary malignancy,with good clinical results.Keywords: Radiology, interventional; Drainage; Stents; Biliary tract/pathology; Oncology.Objetivo: Este estudo procurou comparar a eficacia do implante percutâneo do stent autoexpansivel de nitinol versus o stent de elgiloypara paliacao da obstrucao biliar maligna irressecavel.Materiais e Metodos: Nos investigamos, retrospectivamente, 99 pacientes com obstrucao maligna irressecavel tratada com implantepercutâneo de stent metalico autoexpansivel em nossa instituicao, de marco de 2007 ate janeiro de 2010. Os niveis sericos de bilirru-bina e enzimas hepaticas foram medidos antes e 30 dias apos o implante do stent. Para os procedimentos em que foi utilizado o stentde elgiloy ou o stent de nitinol, as taxas de oclusao dos stents e as taxas de sobrevida dos pacientes foram calculadas pela analise deKaplan-Meyer.Resultados: Os pacientes mostraram melhora clinica apos o implante dos stents, sem diferenca entre os dois grupos. As taxas desobrevida livre de oclusao foram 67% aos 30 dias, 37% aos 90 dias, 25% aos 180 dias e 10% aos 360 dias para ambos os grupos,sem diferenca significativa em relacao ao tipo de stent.Conclusao: Os dois stents mostraram eficacias comparaveis no tratamento da doenca biliar maligna irressecavel, com bons resultadosclinicos.Unitermos: Radiologia intervencionista; Drenagem; Stents; Trato biliar; Oncologia.

Context: Bronchopulmonary sequestration is defined as a congenital malformation in which a portion of lung tissue does not communicate with the normal bronchial tree and the pulmonary arteries. Case Report: We present a case of a 35-year-old male complaining of left lower back pain and with a mass in the left thoracoabdominal transition. Imaging studies have suggested a pulmonary sequestration and its diagnosis was confirmed by histopathological study. Conclusion: Diaphragmatic extralobar pulmonary sequestration is a rare anomaly whose radiological diagnosis is difficult. This case is illustrative and demonstrates the importance of imaging methods to the correct diagnosis and effective treatment.

Background Understanding the effects of gait speed on biomechanical variables is fundamental for a proper evaluation of alterations in gait, since pathological individuals tend to walk slower than healthy controls. Therefore, the aim of the study was to perform a systematic review of the effects of gait speed on spatiotemporal parameters, joint kinematics, joint kinetics, and ground reaction forces in healthy children, young adults, and older adults. Methods A systematic electronic search was performed on PubMed, Embase, and Web of Science databases to identify studies published between 1980 and 2019. A modified Quality Index was applied to assess methodological quality, and effect sizes with 95% confidence intervals were calculated as the standardized mean differences. For the meta-analyses, a fixed or random effect model and the statistical heterogeneity were calculated using the I2 index. Results Twenty original full-length studies were included in the final analyses with a total of 587 healthy individuals evaluated, of which four studies analyzed the gait pattern of 227 children, 16 studies of 310 young adults, and three studies of 59 older adults. In general, gait speed affected the amplitude of spatiotemporal gait parameters, joint kinematics, joint kinetics, and ground reaction forces with a decrease at slow speeds and increase at fast speeds in relation to the comfortable speed. Specifically, moderate-to-large effect sizes were found for each age group and speed: children (slow, − 3.61 to 0.59; fast, − 1.05 to 2.97), young adults (slow, − 3.56 to 4.06; fast, − 4.28 to 4.38), and older adults (slow, − 1.76 to 0.52; fast, − 0.29 to 1.43). Conclusions This review identified that speed affected the gait patterns of different populations with respect to the amplitude of spatiotemporal parameters, joint kinematics, joint kinetics, and ground reaction forces. Specifically, most of the values analyzed decreased at slower speeds and increased at faster speeds. Therefore, the effects of speed on gait patterns should also be considered when comparing the gait analysis of pathological individuals with normal or control ones. Electronic supplementary material The online version of this article (10.1186/s13643-019-1063-z) contains supplementary material, which is available to authorized users.

CT-guided biopsy of indeterminate lung lesions sometimes provides insufficient histological results due to tumor necrosis. Functional and metabolic methods such as DWI-MR and PET-CT may help by directing sample collection to a lesion area of greater biological representativeness. The objective is to evaluate the histopathological results based on findings on ADC and SUV levels in lung lesions suspected for primary cancer. Tissue samples were evaluated after undergoing biopsies guided by either DWI-MR or PET-CT findings. In each patient, sample collection from two lesion areas was guided by local ADC and SUV. Values were used to define areas of low vs. high suspicion for cancer. Patients who underwent DWI-MR had median lesion size of 78.0 mm. Areas of higher suspicion (HSA) had a median ADC of 1.1 × 10-3 mm2/s, while areas of lower suspicion (LSA) had median ADC of 1.8 × 10-3 mm2/s (p = 0.0001). All HSA samples and 71.43% of LSA samples were positive for cancer (p = 0.0184). Patients who performed PET-CT had median lesion size of 61.0 mm. Median SUV was 7.1 for HSA and 3.9 for LSA (p = 0.0002). Positivity for cancer was observed in 76.9% of samples for both HSA and LSA (p = 0.0522). Use of DWI-MR and PET-CT showed that tumors are functional and metabolically heterogeneous and that this heterogeneity has implications for histopathological diagnosis. • Lung cancer is heterogeneous regarding functional and metabolic imaging. • Tumor heterogeneity may have implications in histopathological diagnosis. • Intralesional lower levels of ADC target highly suspected areas with a significant improvement in lung cancer diagnosis.

Objective: To identify the characteristics of thoracic calcifications on magnetic resonance (MR) imaging, as well as correlations between MR imaging and CT findings. Methods: This was a retrospective study including data on 62 patients undergoing CT scans and MR imaging of the chest at any of seven hospitals in the Brazilian states of Rio Grande do Sul, São Paulo, and Rio de Janeiro between March of 2014 and June of 2016 and presenting with calcifications on CT scans. T1- and T2-weighted MR images (T1- and T2-WIs) were semiquantitatively analyzed, and the lesion-to-muscle signal intensity ratio (LMSIR) was estimated. Differences between neoplastic and non-neoplastic lesions were analyzed. Results: Eighty-four calcified lesions were analyzed. Mean lesion density on CT was 367 ± 435 HU. Median LMSIRs on T1- and T2-WIs were 0.4 (interquartile range [IQR], 0.1-0.7) and 0.2 (IQR, 0.0-0.7), respectively. Most of the lesions were hypointense on T1- and T2-WIs (n = 52 [61.9%] and n = 39 [46.4%], respectively). In addition, 19 (22.6%) were undetectable on T1-WIs (LMSIR = 0) and 36 (42.9%) were undetectable on T2-WIs (LMSIR = 0). Finally, 15.5% were hyperintense on T1-WIs and 9.5% were hyperintense on T2-WIs. Median LMSIR was significantly higher for neoplastic lesions than for non-neoplastic lesions. There was a very weak and statistically insignificant negative correlation between lesion density on CT and the following variables: signal intensity on T1-WIs, LMSIR on T1-WIs, and signal intensity on T2-WIs (r = −0.13, p = 0.24; r = −0.18, p = 0.10; and r = −0.16, p = 0.16, respectively). Lesion density on CT was weakly but significantly correlated with LMSIR on T2-WIs (r = −0.29, p < 0.05). Conclusions: Thoracic calcifications have variable signal intensity on T1- and T2-weighted MR images, sometimes appearing hyperintense. Lesion density on CT appears to correlate negatively with lesion signal intensity on MR images.

Descrever a etiologia e a resistência dos isolados bacterianos das hemoculturas de pacientes internados na Sala de Cuidados Intermediários do Hospital Universitário do Vale do São Francisco, Petrolina/PE. Foram analisadas, retrospectivamente, todas as hemoculturas, realizadas pelo Laboratório de Análises Clínicas do Hospital Universitário, entre janeiro a dezembro de 2020 de pacientes internados na Sala de Cuidados Intermediários através da análise descritiva e quantitativa. Os dados foram tabulados em planilhas do Excel® e foi realizada análise dos valores absolutos e percentuais. As identificações das bactérias e os antibiogramas foram realizadas através do sistema automatizado BD Phoenix ™, de acordo com a metodologia do Clinical and Laboratory Standards Institute de 2020. Foram coletadas 113 hemoculturas, sendo 29 positivas (26%) para crescimento bacteriano. As bactérias mais prevalentes foram Staphylococcus coagulase negativa (45%), Escherichia coli (17%) e Staphylococcus aureus (10%). As bactérias Staphylococcus spp apresentaram resistência à ampicilina e penicilina, enquanto as Klebsiella pneumoniae e Acinetobacter baumannii demonstraram importante resistência aos carbapenêmicos e às cefalosporinas. Houve o predomínio das bactérias gram-positivas e 55% das bactérias foram Staphylococcus spp, sendo que todas essas apresentaram resistência a ampicilina e penicilina. Além disso, observou-se resistência por parte do K. pneumoniae e A. baumannii aos carbapenêmicos e às cefalosporinas. Através do estudo do perfil microbiológico das bactérias relacionadas às infecções hospitalares é possível construir protocolos de antibioticoterapia empírica adequados, assim como a elaboração e implementação de medidas preventivas e de controle dessas infecções.

Background Li-Fraumeni syndrome (LFS) is an autosomal dominant disease that is associated with germline TP53 mutations and it predisposes affected individuals to a high risk of developing multiple tumors. In Brazil, LFS is characterized by a different pattern of TP53 variants, with the founder TP53 p.R337H mutation being predominant. The adoption of screening strategies to diagnose LFS in its early stages is a major challenge due to the diverse spectrum of tumors that LFS patients can develop. The purpose of this study was to evaluate two rounds of whole-body magnetic resonance imaging (WB-MRI) which were conducted as a screening strategy for LFS patients. Methods Over a 4-year period, 59 LFS patients underwent two rounds of WB-MRI. Each MRI was characterized as positive or negative, and positive cases were further investigated to establish a diagnosis. The parameters used to evaluate the WB-MRI results included: positive rate, number of invasive investigations of positive results, and cancer detection rate. Results A total of 118 WB-MRI scans were performed. Positive results were associated with 11 patients (9.3%). Seven of these patients (11.8%) were identified in the first round of screening and 4 patients (6.7%) were identified in the second round of screening. Biopsies were performed in three cases (2.5%), two (3.4%) after the first round of screening and one (1.7%) after the second round of screening. The histopathological results confirmed a diagnosis of cancer for all three cases. There was no indication of unnecessary invasive procedures. Conclusions WB-MRI screening of LFS carriers diagnosed cancers in their early stages. When needed, positive results were further examined with non-invasive imaging techniques. False positive results were less frequent after the first round of WB-MRI screening. Electronic supplementary material The online version of this article (10.1186/s40644-018-0162-8) contains supplementary material, which is available to authorized users.

Background: The Gait Profile Score (GPS) measures the quality of an individual’s walking by calculating the difference between the kinematic pattern and the average walking pattern of healthy individuals. Research questions: The purposes of this study were to quantify the effect of speed on the GPS and to determine whether the prediction of gait patterns at a specific speed would make the GPS outcome insensitive to gait speed in the evaluation of post-stroke individuals. Methods: The GPS was calculated for able-bodied individuals walking at different speeds and for the comparison of post-stroke individuals with able-bodied individuals using the original experimental data (standard GPS) and the predicted gait patterns at a given speed (GPS velocity, GPSv). We employed standard gait analysis for data collection of the subjects. Sixteen participants with a stroke history were recruited for the post-stroke group, and 15 age-matched, able-bodied participants formed the control group. Results: Gait speed significantly affects the GPS and the method to predict the gait patterns at any speed is able to mitigate the effects of gait speed on the GPS. Overall, the gap between the GPS and GPSv values across the post-stroke individuals was small (0.5° on average, range from 0.0° to 1.4°) and not statistically significant. However, there was a significant negative linear relationship in the absolute difference between the GPS and GPSv values for the participants of the post-stroke group with gait speed, indicating that a larger difference between the speeds of the post-stroke participant and the reference dataset resulted in a larger difference between the GPS and GPSv. Significance: The modified version of the GPS, the GPSv, is effective in reducing the impact of gait speed on GPS; however, the observed difference between the two methods was only around 1° for the slowest individuals in comparison to the reference dataset.

The accurate diagnosis of pulmonary thromboembolism is essential to reducing the morbidity and mortality associated with the disease. The diagnosis of pulmonary thromboembolism is challenging because of the nonspecific nature of the clinical profile and the risk factors. Imaging methods provide the definitive diagnosis. Currently, the imaging method most commonly used in the evaluation of pulmonary thromboembolism is computed tomography. The recent development of dual-energy computed tomography has provided a promising tool for the evaluation of pulmonary perfusion through iodine mapping. In this article, we will review the importance of diagnosing pulmonary thromboembolism, as well as the imaging methods employed, primarily dual-energy computed tomography. Resumo A acurácia no diagnóstico de tromboembolismo pulmonar é essencial para reduzir a morbimortalidade causada por esta enfermidade. Devido ao quadro clínico e fatores de risco inespecíficos, o diagnóstico de tromboembolismo pulmonar torna-se um desafio. Os métodos de imagem fornecem o diagnóstico definitivo, sendo a tomografia computadorizada o método mais utilizado atualmente. Nos últimos anos, houve o desenvolvimento da tomografia computadorizada com dupla energia e essa ferramenta tem se mostrado promissora para avaliação da perfusão pulmonar por meio do mapa de iodo. Neste artigo é feita revisão acerca da importância do diagnóstico de tromboembolismo pulmonar, bem como os métodos de imagem disponíveis, com ênfase na tomografia computadorizada com dupla energia.

Background The purpose of this phase II trial was to evaluate the tolerability, safety, and efficacy of a non–5-fluorouracil (5-FU)-based induction chemotherapy followed by chemoradiotherapy (CRT) for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Methods Sixty patients with stage III to IV HNSCC were treated with induction paclitaxel and cisplatin (TP; paclitaxel 175 mg/m2 and cisplatin 80 mg/m2, 3 cycles) followed by CRT (cisplatin 100 mg/m2; D1, 22, and 43 of radiotherapy). Results Fifty-six patients (93.3%) completed 3 cycles of induction TP (no treatment-related deaths), 52 (86.7%) completed definitive CRT per protocol (adverse event [AE] grade ≥2 in 53.3%). The overall response rate after induction TP was 82.5% for patients with resectable disease and 55.5% for unresectable disease (p = .023), and complete response (CR) rate after CRT was 70.0% for patients with resectable disease and 30.0% for unresectable disease (p = .005). Conclusion Induction TP followed by cisplatin based-CRT was well-tolerated, safe, and had high overall response rate in selected patients with locally advanced HNSCC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

This study considers the problem of indexing fixed-income portfolios to the ANBIMA Market Index – Series B (IMA-B), composed of Brazilian National Treasury Notes – Series B (NTNBs). We propose a mathematical model that minimizes the deviations of the returns of the chosen portfolio in relation to the returns of the index’s theoretical portfolio. The resulting model is a mathematical programming problem with convex objective function, linear constraints and free and non-negative integer variables. Five numerical examples with real data are presented to illustrate the model’s practical use. The results obtained from the fits are analyzed together with data for funds indexed to the IMA-B existing in the Brazilian financial market. The proposed method resulted in fits with optimal control of the tracking errors of the indexed portfolio.

We investigated the effects on women of carrying an infant in front, focusing on the pelvic and spinal posture and the displacement of the body's center of gravity. For such, we compared mothers to non-mothers not carrying anything or carrying the same load (a doll) and the mothers carrying their infants. Twenty mothers and 44 women who did not have children were analyzed for their movement and posture during walking and standing still with a motion capture system. Walking while carrying a load was slower and with a shorter stride length than while not carrying a load. The mothers' group walked slower and with a shorter stride length than the non-mothers' group. During walking and standing still, the women decreased their angle of pelvic anteversion, increased lumbar lordosis, increased thoracic kyphosis, and increased trunk backward inclination while carrying a load in comparison with not carrying anything. In addition, we observed some small differences in the spinal angles of mothers when carrying their infants compared to when carrying a doll. When standing still, the women carrying a load displaced backwards their vertical projection of the center of gravity to exactly compensate the destabilizing load at the front that resulted in no net change of the body-plus-load center of gravity. In general, these changes are qualitatively similar to the ones observed during pregnancy.

Birt-Hogg-Dubé syndrome (BHDS) is a rare, inherited autosomal-dominant disorder characterized by the development of cutaneous lesions, renal tumors, pulmonary cysts, and spontaneous pneumothorax. The gene responsible for BHDS is located on the short arm of chromosome 17 (17p11.2) and codes for the protein folliculin, which is believed to be an oncogene suppressor protein.We reviewed currently published literature on the main characteristics of BHDS.Pulmonary cysts and spontaneous pneumothorax are often the presenting manifestations that lead to a final diagnosis in family members affected by the syndrome.Certain imaging characteristics of pulmonary cysts, including size and location, can suggest the diagnosis of BHDS based on chest computed tomography alone. The main concern in patients with BHDS is the increased risk of renal carcinoma. The aim of this review is to describe the main pathological, clinical, and imaging aspects of BHDS, ranging from its genetic basis to treatment, with emphasis on pulmonary involvement.

Magnetic resonance imaging (MRI) has several advantages in the evaluation of cancer patients with thoracic lesions, including involvement of the chest wall, pleura, lungs, mediastinum, esophagus and heart. It is a quite useful tool in the diagnosis, staging, surgical planning, treatment response evaluation and follow-up of these patients. In the present review, the authors contextualize the relevance of MRI in the evaluation of thoracic lesions in cancer patients. Considering that MRI is a widely available method with high contrast and spatial resolution and without the risks associated with the use of ionizing radiation, its use combined with new techniques such as cine-MRI and functional methods such as perfusion- and diffusion-weighted imaging may be useful as an alternative tool with performance comparable or complementary to conventional radiological methods such as radiography, computed tomography and PET/CT imaging in the evaluation of patients with thoracic neoplasias.

Krukenberg tumor is a rare ovarian metastatic cancer from the gastrointestinal tract. It accounts for 1%-5% of malignant tumors of the ovaries, usually being bilateral, of solid consistency and may have cystic areas. The World Health Organization (WHO) defined it as an ovarian metastasis when the mucus-secreting cells of “signet ring” are present, associated with sarcomatous stromal proliferation. We present a 58-year-old woman with the diagnosis of peripheric cholangiocarcinoma with ovarian metastasis, showing history of pain and increased abdominal volume. Magnetic Resonance Imaging (MRI) showed multiple hepatic solid nodules with predominantly peripheral, centripetal and progressive enhancement, demonstrating hipersignal and restriction on diffusion weighted imaging (DWI). In the anexial region, bulky heterogeneous multiloculated cystic formations with solid components, of probable ovarian origin, were noted. Biopsy of the liver nodules confirmed the diagnosis of cholangiocarcinoma.

The aim of this study was to evaluate the high-resolution computed tomography (HRCT) findings in patients diagnosed with metastatic pulmonary calcification (MPC).We retrospectively reviewed the HRCT findings from 23 cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26-89) years]. The patients were examined between 2000 and 2014 in nine tertiary hospitals in Brazil, Chile, and Canada. Diagnoses were established by histopathologic study in 18 patients and clinical-radiological correlation in 5 patients. Two chest radiologists analyzed the images and reached decisions by consensus.The predominant HRCT findings were centrilobular ground-glass nodules (MPC manifested with three main patterns on HRCT, most commonly centrilobular ground-glass nodules, often containing calcifications, followed by dense consolidation and small solid nodules, most of which were calcified. We also described another pattern of peripheral reticular opacities associated with small calcified nodules. These findings should suggest the diagnosis of MPC in the setting of hypercalcemia.O objetivo deste estudo foi avaliar os achados de tomografia computadorizada de alta resolução (TCAR) em pacientes com diagnóstico de calcificação pulmonar metastática (CPM).Revisamos, retrospectivamente, os achados na TCAR de 23 casos de CPM [14 homens e 9 mulheres; idade média, 54,3 (intervalo, 26-89) anos]. Os pacientes foram examinados entre 2000 e 2014 em nove hospitais terciários no Brasil, Chile e Canadá. O diagnóstico foi estabelecido por estudo histopatológico em 18 pacientes e correlação clinicorradiológica em 5 pacientes. Dois radiologistas de tórax analisaram as imagens e chegaram a decisões por consenso.Os achados predominantes na TCAR foram nódulos centrolobulares em vidro fosco (CPM manifestou-se com três padrões principais na TCAR. O aspecto mais comum foram os nódulos centrolobulares em vidro fosco, frequentemente contendo calcificações, seguido de consolidação densa e de pequenos nódulos sólidos, a maioria deles calcificada. Também descrevemos o padrão de opacidades reticulares periféricas associadas a pequenos nódulos calcificados. Esses achados devem sugerir o diagnóstico de CPM no contexto de hipercalcemia.