Incidental diagnosis of cardiac fibroma in an infant with acute viral bronchiolitis.

OBJECTIVE: Pediatric cardiac tumors are rare and, among them, 90% are benign. Cardiac fibroma is the second most frequent tumor, after rhabdomyoma. The objective of this study is to report a case of cardiac fibroma diagnosed incidentally in a patient admitted with acute viral bronchiolitis. CASE DESCRIPTION: A 5-month-old male infant was admitted to the pediatric emergency department with acute viral bronchiolitis requiring hospitalization. He presented a detectable respiratory syncytial virus in oropharyngeal swab, blood test with lymphocytosis and a chest radiography revealed cardiomegaly. Further cardiologic testing was performed detecting elevation of cardiac biomarkers, an electrocardiogram with alteration of left ventricular repolarization and echocardiogram with a heterogeneous mass in the left ventricular, with areas of calcification. A chest angiotomography suggested rhabdomyosarcoma or cardiac fibroma and a magnetic resonance showed a mass, with characteristics suggesting fibroma. The final diagnosis was made after two cardiac catheterizations for biopsy of the lesion, confirming cardiac fibroma by anatomopathological examination. Because the patient had moderate to severe systolic dysfunction, he was submitted to heart transplant. COMMENTS: One third of cardiac fibromas are asymptomatic, generally diagnosed late through tests ordered for other reasons. The gold-standard test for definitive diagnosis is biopsy. Cardiac fibroma usually does not present spontaneous regression and, in most cases, partial or total surgical resection is necessary. When tumors are unresectable, heart transplantation should be indicated. It is essential to have detailed characterization of the cardiac mass to establish the most appropriate therapeutic approach for each patient.

Evaluation of Light Cementitious Matrix with Composite Textile Reinforcement from Garment Waste.

The use of recycled waste has been the focus of several studies due to its potential to allow a more sustainable use of construction materials and minimize improper waste disposal in landfills or incinerators. More specifically, garment textile waste has been examined as internal reinforcement of cementitious matrices to increase the deformability and control fissure formation. In this study, polyester textiles are analyzed and incorporated in cementitious composites in order to evaluate their mechanical properties. Results show that significant improvements in mechanical properties of composites are obtained depending on the impregnation treatment applied to the textile waste. In the direct tensile stress test, the waste impregnation with styrene butadiene polymer plus silica fume improved 35.95% in the weft direction and 9.33% in the warp direction. Maximum stress increased 53.57% and 64.48% for composites with styrene-butadiene rubber impregnation and styrene-butadiene rubber plus silica fume impregnation, respectively, when compared to the unreinforced composite. The flexural tensile strength of composites impregnated reinforcements with styrene-butadiene rubber and styrene-butadiene rubber plus silica fume presented increases in strength by 92.10% and 94.73%, respectively, when compared to the unreinforced sample. The impact test confirmed that styrene-butadiene rubber plus silica fume impregnation produced greater tenacity of the composite. In the microstructure, it is confirmed that the impregnated textile reinforcement resulted in composites with greater adhesion between the fabric and the cementitious matrix. Thus, light textile waste is concluded to be a viable construction material for non-structural elements.

Effect of lateral decubitus acquisition in accuracy and lung severity estimation of chest computed tomography in children with suspected COVID-19.

OBJECTIVE: To compare inter-rater reliability, diagnostic accuracy, and extension of pulmonary involvement in children with suspected COVID-19 submitted to supine or supine and lateral decubitus computed tomography imaging. METHODS: Retrospective study carried out between March 2020 and March 2021 with patients submitted to reverse transcription-polymerase chain reaction testing and chest computed tomography. Patients were divided into two groups: supine or supine and lateral decubitus imaging. Standardized reporting systems of computed tomographic findings in COVID-19 and chest computed tomography score were used. RESULTS: One hundred and seventeen patients were enrolled. Moderate to substantial inter-rater reliability was observed for standardized reporting systems (weighted kappa, 0.553-0.764; p<0.001). Inter-rater reliability for the chest computed tomography score was substantial (weighted kappa, 0.620-0.670; p<0.001). Standardized reporting systems failed to predict COVID-19 in children, regardless of additional lateral decubitus imaging (area under the receiver operating characteristic curve, 0.491-0.608). Chest computed tomography scores assigned to lateral decubitus images were significantly lower. CONCLUSION: Additional lateral decubitus imaging does not improve the accuracy of standardized reporting systems of computed tomographic findings in COVID-19 but may provide a more accurate estimation of lung involvement in uncooperative patients.

Incomplete hippocampal inversion: diagnostic criteria and effect on epilepsy, seizure localization and therapeutic outcome in children.

PURPOSE: Elaborate a simple Magnetic Resonance Imaging (MRI)-based score to define Incomplete Hippocampal Inversion (IHI) in children (Phase 1), and evaluate the relation of IHI with (A) epilepsy, (B) seizure localization and (C) therapeutic response in a paediatric population (Phase 2). METHODS: In Phase 1, incompletely inverted hippocampi were matched to completely inverted hippocampi. Multiple qualitative and quantitative hippocampal and extra-hippocampal features were evaluated in coronal-oblique T1-weighted (T1W) and coronal T2-weighted (T2W) images. Multivariate analysis was performed to elaborate the MRI-based score to define IHI. In Phase 2, epilepsy patients were matched to controls, and the T1W and T2W scores were applied. Multivariate analysis was performed to assess the relation of IHI and epilepsy, seizure localization and therapeutic response. RESULTS: The hippocampal diameter ratio and parahippocampal angle in the coronal-oblique T1-weighted images, and the hippocampal diameter ratio and collateral sulcus depth in the coronal T2-weighted images predicted IHI in Phase 1. Simple and practical imaging-based scores were developed and are available on the website: https://ihiscore.netlify.app/. The Area Under the Receiver Operating Characteristic Curve of the T1W and T2W scores were, respectively, 0.965 and 0.983. In Phase 2, IHI independently predicted epilepsy (OR = 3.144, 95% CI = 1.981-4.991, p < 0.001), temporal lobe epilepsy (OR = 4.237, 95% CI = 1.586-11.318, p = 0.004), and drug resistant epilepsy (OR = 7.000, 95% CI = 2.800-17.500, p < 0.001). CONCLUSION: The association between IHI and temporal lobe epilepsy (and the lack of association with extra-temporal epilepsy) favours the possibility of a relation between IHI and the pathophysiology of seizures in epileptic patients. Furthermore, IHI is a potential prognostic marker for therapeutic response in epilepsy.

Effect of lateral decubitus acquisition in accuracy and lung severity estimation of chest computed tomography in children with suspected COVID-19

ABSTRACT Objective To compare inter-rater reliability, diagnostic accuracy, and extension of pulmonary involvement in children with suspected COVID-19 submitted to supine or supine and lateral decubitus computed tomography imaging. Methods Retrospective study carried out between March 2020 and March 2021 with patients submitted to reverse transcription-polymerase chain reaction testing and chest computed tomography. Patients were divided into two groups: supine or supine and lateral decubitus imaging. Standardized reporting systems of computed tomographic findings in COVID-19 and chest computed tomography score were used. Results One hundred and seventeen patients were enrolled. Moderate to substantial inter-rater reliability was observed for standardized reporting systems (weighted kappa, 0.553-0.764; p<0.001). Inter-rater reliability for the chest computed tomography score was substantial (weighted kappa, 0.620-0.670; p<0.001). Standardized reporting systems failed to predict COVID-19 in children, regardless of additional lateral decubitus imaging (area under the receiver operating characteristic curve, 0.491-0.608). Chest computed tomography scores assigned to lateral decubitus images were significantly lower. Conclusion Additional lateral decubitus imaging does not improve the accuracy of standardized reporting systems of computed tomographic findings in COVID-19 but may provide a more accurate estimation of lung involvement in uncooperative patients.

Effect of the acromial inferolateral tilt on subacromial impingement syndrome: a retrospective magnetic resonance imaging assessment.

OBJECTIVE: To evaluate the effect of acromial inferolateral tilt on subacromial impingement syndrome. MATERIALS AND METHODS: The acromial inferolateral tilt was retrospectively quantified by two researchers on 346 shoulder magnetic resonance images using the glenoacromial (between the inferior proximal acromial surface and the glenoidal face) and acromioclavicular (between the axis of the proximal acromion and distal clavicle) angles. RESULTS: The glenoacromial angle was associated with subacromial impingement syndrome (p < 0.001) and complete supraspinatus tendon rupture (p < 0.001), and the acromioclavicular angle was associated with partial or complete supraspinatus tendon rupture (p = 0.003). The area under the receiver operating characteristic curve (AUC), best cut-off angle, and odds ratio (OR) of the glenoacromial angle for impingement syndrome were 0.579 (95% confidence interval [CI]: 0.508-0.649; p = 0.032), 72°, and 2.1 (95% CI: 1.136-4.053), respectively. For complete supraspinatus tendon rupture, the AUC, best cut-off angle, and OR of the glenoacromial angle were 0.731 (95% CI: 0.626-0.837; p = 0.001), 69°, and 8.496 (95% CI: 2.883-28.33), respectively. For partial or complete supraspinatus tendon rupture, the AUC, best cut-off angle and OR of the acromioclavicular angle were 0.617 (95% CI: 0.539-0.694; p = 0.002), 17°, and 3.288 (95% CI: 1.886-5.768), respectively. Interobserver agreement found for the glenoacromial and acromioclavicular angles were 0.737 (95% CI: 0.676-0.787; p < 0.001) and 0.507 (95% CI: 0.391-0.601; p = 0.001), respectively. CONCLUSION: Inferolateral acromial tilt may have some impact on subacromial impingement syndrome; however, the best quantification method identified (glenoacromial angle) showed a moderate interobserver agreement and a fair performance to assess the risk of complete supraspinatus tendon rupture.

OBJETIVO: Avaliar a contribuição da inclinação inferolateral do acrômio na síndrome do impacto subacromial. MATERIAIS E MÉTODOS: A inclinação inferolateral do acrômio foi quantificada retrospectivamente por dois pesquisadores em 346 ressonâncias magnéticas de ombro por meio dos ângulos glenoacromial (entre a superfície inferior proximal do acrômio e a face glenoidal no plano coronal) e acromioclavicular (entre o eixo do acrômio proximal e o eixo da clavícula distal no plano coronal). RESULTADOS: Houve associação entre ângulo glenoacromial e síndrome do impacto subacromial (p < 0,001) e ruptura completa do tendão supraespinal (p < 0,001). Ângulo acromioclavicular associou-se a ruptura parcial ou completa do tendão supraespinal (p = 0,003). A área sob a curva (area under the curve - AUC) característica de operação do receptor, o melhor ângulo de corte e a razão de chances (odds ratio - OR) do ângulo glenoacromial para a síndrome do impacto foram, respectivamente: 0,579 (intervalo de confiança [IC] 95%: 0,508-0,649; p = 0,032), 72° e 2,1 (IC 95%: 1,136-4,053). Para ruptura completa do tendão supraespinal, a AUC, o melhor ângulo de corte e a OR do ângulo glenoacromial foram, respectivamente: 0,731 (IC 95%: 0,626-0,837; p = 0.001), 69° e 8,496 (IC 95%: 2,883-28,33). Para ruptura parcial ou completa do tendão supraespinal, a AUC, o melhor ângulo de corte e a OR do ângulo acromioclavicular foram, respectivamente: 0,617 (IC 95%: 0,539-0,694; p = 0,002), 17° e 3,288 (IC 95%: 1,886-5,768). As concordâncias interobservador encontradas para os ângulos glenoacromial e acromioclavicular foram, respectivamente: 0,737 (IC 95%: 0,676-0,787; p < 0,001) e 0,507 (IC 95%: 0,391-0,601; p = 0,001). CONCLUSÃO: Inclinação inferolateral do acrômio pode determinar alguma influência sobre a síndrome do impacto subacromial, entretanto, o melhor método de quantificação identificado (o ângulo glenoacromial) apresentou moderada concordância interobservador e desempenho moderado para estratificar o risco de ruptura completa do tendão supraespinal.

Effect of the acromial inferolateral tilt on subacromial impingement syndrome: a retrospective magnetic resonance imaging assessment / A contribuição da inclinação inferolateral do acrômio na síndrome do impacto subacromial: uma avaliação retrospectiva por ressonância magnética

Abstract Objective: To evaluate the effect of acromial inferolateral tilt on subacromial impingement syndrome. Materials and Methods: The acromial inferolateral tilt was retrospectively quantified by two researchers on 346 shoulder magnetic resonance images using the glenoacromial (between the inferior proximal acromial surface and the glenoidal face) and acromioclavicular (between the axis of the proximal acromion and distal clavicle) angles. Results: The glenoacromial angle was associated with subacromial impingement syndrome (p < 0.001) and complete supraspinatus tendon rupture (p < 0.001), and the acromioclavicular angle was associated with partial or complete supraspinatus tendon rupture (p = 0.003). The area under the receiver operating characteristic curve (AUC), best cut-off angle, and odds ratio (OR) of the glenoacromial angle for impingement syndrome were 0.579 (95% confidence interval [CI]: 0.508-0.649; p = 0.032), 72°, and 2.1 (95% CI: 1.136-4.053), respectively. For complete supraspinatus tendon rupture, the AUC, best cut-off angle, and OR of the glenoacromial angle were 0.731 (95% CI: 0.626-0.837; p = 0.001), 69°, and 8.496 (95% CI: 2.883-28.33), respectively. For partial or complete supraspinatus tendon rupture, the AUC, best cut-off angle and OR of the acromioclavicular angle were 0.617 (95% CI: 0.539-0.694; p = 0.002), 17°, and 3.288 (95% CI: 1.886-5.768), respectively. Interobserver agreement found for the glenoacromial and acromioclavicular angles were 0.737 (95% CI: 0.676-0.787; p < 0.001) and 0.507 (95% CI: 0.391-0.601; p = 0.001), respectively. Conclusion: Inferolateral acromial tilt may have some impact on subacromial impingement syndrome; however, the best quantification method identified (glenoacromial angle) showed a moderate interobserver agreement and a fair performance to assess the risk of complete supraspinatus tendon rupture.

Resumo Objetivo: Avaliar a contribuição da inclinação inferolateral do acrômio na síndrome do impacto subacromial. Materiais e Métodos: A inclinação inferolateral do acrômio foi quantificada retrospectivamente por dois pesquisadores em 346 ressonâncias magnéticas de ombro por meio dos ângulos glenoacromial (entre a superfície inferior proximal do acrômio e a face glenoidal no plano coronal) e acromioclavicular (entre o eixo do acrômio proximal e o eixo da clavícula distal no plano coronal). Resultados: Houve associação entre ângulo glenoacromial e síndrome do impacto subacromial (p < 0,001) e ruptura completa do tendão supraespinal (p < 0,001). Ângulo acromioclavicular associou-se a ruptura parcial ou completa do tendão supraespinal (p = 0,003). A área sob a curva (area under the curve - AUC) característica de operação do receptor, o melhor ângulo de corte e a razão de chances (odds ratio - OR) do ângulo glenoacromial para a síndrome do impacto foram, respectivamente: 0,579 (intervalo de confiança [IC] 95%: 0,508-0,649; p = 0,032), 72° e 2,1 (IC 95%: 1,136-4,053). Para ruptura completa do tendão supraespinal, a AUC, o melhor ângulo de corte e a OR do ângulo glenoacromial foram, respectivamente: 0,731 (IC 95%: 0,626-0,837; p = 0.001), 69° e 8,496 (IC 95%: 2,883-28,33). Para ruptura parcial ou completa do tendão supraespinal, a AUC, o melhor ângulo de corte e a OR do ângulo acromioclavicular foram, respectivamente: 0,617 (IC 95%: 0,539-0,694; p = 0,002), 17° e 3,288 (IC 95%: 1,886-5,768). As concordâncias interobservador encontradas para os ângulos glenoacromial e acromioclavicular foram, respectivamente: 0,737 (IC 95%: 0,676-0,787; p < 0,001) e 0,507 (IC 95%: 0,391-0,601; p = 0,001). Conclusão: Inclinação inferolateral do acrômio pode determinar alguma influência sobre a síndrome do impacto subacromial, entretanto, o melhor método de quantificação identificado (o ângulo glenoacromial) apresentou moderada concordância interobservador e desempenho moderado para estratificar o risco de ruptura completa do tendão supraespinal.

Diagnostic accuracy of retrospective application of the Vesical Imaging-Reporting and Data System: preliminary results.

OBJECTIVE: To evaluate the retrospective accuracy of the Vesical Imaging-Reporting and Data System (VI-RADS) in detecting muscle invasion in bladder cancer. MATERIALS AND METHODS: We investigated patients who underwent pelvic magnetic resonance imaging and were submitted to transurethral resection of a bladder tumor between 2015 and 2018. Thirty cases were reviewed by radiologists blinded to the final clinical stage. The VI-RADS score was applied and compared with the histopathological findings in the surgical specimen. RESULTS: Of the 30 patients with suspicious bladder lesions, 5 (16.6%) had benign histopathological findings, 17 (56.6%) had non-muscle-invasive bladder cancer, and 8 (26.6%) had muscle-invasive bladder cancer. The optimal criterion to detect muscle-invasive bladder cancer was a final VI-RADS score > 3, for which the sensitivity and specificity were 100% (95% CI: 56.0-100%) and 90.9% (95% CI: 69.3-98.4%), respectively. CONCLUSION: The VI-RADS appears to estimate correctly the degree of muscle invasion in suspicious bladder lesions. However, prospective studies evaluating larger samples are needed in order to validate the method.

Diagnostic accuracy of retrospective application of the Vesical Imaging-Reporting and Data System: preliminary results / Resultados preliminares da aplicação retrospectiva do Vesical Imaging-Reporting and Data System

Abstract Objective: To evaluate the retrospective accuracy of the Vesical Imaging-Reporting and Data System (VI-RADS) in detecting muscle invasion in bladder cancer. Materials and Methods: We investigated patients who underwent pelvic magnetic resonance imaging and were submitted to transurethral resection of a bladder tumor between 2015 and 2018. Thirty cases were reviewed by radiologists blinded to the final clinical stage. The VI-RADS score was applied and compared with the histopathological findings in the surgical specimen. Results: Of the 30 patients with suspicious bladder lesions, 5 (16.6%) had benign histopathological findings, 17 (56.6%) had non-muscle-invasive bladder cancer, and 8 (26.6%) had muscle-invasive bladder cancer. The optimal criterion to detect muscle-invasive bladder cancer was a final VI-RADS score > 3, for which the sensitivity and specificity were 100% (95% CI: 56.0-100%) and 90.9% (95% CI: 69.3-98.4%), respectively. Conclusion: The VI-RADS appears to estimate correctly the degree of muscle invasion in suspicious bladder lesions. However, prospective studies evaluating larger samples are needed in order to validate the method.

Resumo Objetivo: O objetivo deste estudo foi avaliar retrospectivamente a acurácia do Vesical Imaging-Reporting and Data System (VI-RADS) para detectar invasão muscular em câncer de bexiga. Materiais e Métodos: Foram inseridos pacientes submetidos a ressonância magnética pélvica e a ressecção transuretral de bexiga entre 2015 e 2018. Trinta casos foram revisados, sem o conhecimento do estágio clínico final. O escore do VI-RADS foi aplicado e comparado aos achados histopatológicos da ressecção transuretral de bexiga. Resultados: Entre os 30 pacientes com lesões vesicais suspeitas, 5 (16,6%) tinham achados histopatológicos benignos, 17 (56,6%) tinham câncer de bexiga não músculo invasivo e 8 (26,6%) tinham câncer de bexiga músculo invasor. O critério ideal para detectar câncer de bexiga músculo invasor foi o escore final do VI-RADS > 3, em que sensibilidade e especificidade foram, respectivamente, 100% (IC 95%: 56,0-100%) e 90,9% (IC 95%: 69,3-98,4%). Conclusão: O VI-RADS parece estimar corretamente o grau de invasão muscular em lesões suspeitas da bexiga; no entanto, estudos maiores e prospectivos são necessários para validar o método.

Sertoli Cell Alterations in Peripubertal Varicocelized Rats: Evidence of Primary Damage on Spermatogenesis.

Idiopathic varicocele is closely associated with male infertility or subfertility. Sertoli cell is a very important regulator of spermatogenesis. We investigated the morphofunctional alterations in the Sertoli cell and its possible involvement in the establishment of testicular primary lesion in experimental left-sided varicocele, induced from peripuberty. Twenty-five male peripubertal rats (44 days postpartum [dpp]) were distributed into two groups: control (C) and varicocele (V). Experimental left varicocele was induced in rats through the partial ligature of the left renal vein. Euthanasia was performed at 100 dpp. Testicular histopathology and testosterone plasmatic level were evaluated. Transferrin and vimentin proteins were, respectively, used as immunomarkers of Sertoli cell function and structure. Significant reductions in vimentin and transferrin expressions were noticed in androgen-dependent stages (VII and VIII) of the seminiferous epithelium cycle in V rats; testosterone plasmatic level was also reduced. Bilateral testicular histopathological alterations were found in V rats, mainly massive germ cell desquamation. The histological damage and changes in protein expressions occurred bilaterally. The relevant impairment of the functional and structural characteristics of the Sertoli cell, together with the typical massive germ cell desquamation, indicates that Sertoli cell changes can primarily contribute to the significant testicular dysfunction associated with varicocele.