Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging.

Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.

Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging / Recomendações da Sociedade Brasileira de Cirurgia Torácica, Sociedade Brasileira de Pneumologia e Tisiologia e Colégio Brasileiro de Radiologia e Diagnóstico por Imagem para o rastreamento do câncer de pulmão no Brasil

ABSTRACT Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.

RESUMO O câncer de pulmão (CP) é uma das neoplasias mais comuns e letais no Brasil, e apenas 15% dos pacientes são diagnosticados nos estágios iniciais. O tabagismo persiste como o responsável por mais de 85% de todos os casos. O rastreamento do CP (RCP) por meio da TC de baixa dosagem de radiação (TCBD) reduz a mortalidade do CP em 20%, e, quando combinado com a cessação do tabagismo, essa redução chega a 38%. Na última década, diversos países adotaram o RCP como recomendação de saúde populacional. No Brasil, embora ainda incipiente, a discussão sobre o tema é cada vez mais ampla e necessária. Com o intuito de aumentar o conhecimento e estimular o debate sobre o RCP, a Sociedade Brasileira de Cirurgia Torácica, a Sociedade Brasileira de Pneumologia e Tisiologia e o Colégio Brasileiro de Radiologia e Diagnóstico por Imagem constituíram um painel de especialistas para elaborar as recomendações para o RCP. As recomendações aqui apresentadas foram baseadas em revisão narrativa da literatura, com ênfase em grandes estudos populacionais, em revisões sistemáticas e em recomendações de diretrizes internacionais, sendo construídas após ampla discussão pelo grupo de especialistas. Os temas revisados foram os seguintes: porque rastrear, considerações gerais sobre tabagismo, epidemiologia do CP, critérios de elegibilidade, achados incidentais, lesões granulomatosas, modelos probabilísticos, requisitos mínimos da TCBD, aquisições volumétricas, riscos do rastreamento, estrutura mínima e papel da equipe multidisciplinar, conduta segundo o Lung CT Screening Reporting and Data System (Lung-RADS), custos vs. benefícios e perspectivas do rastreamento.

Development of a convolutional neural network for diagnosing osteoarthritis, trained with knee radiographs from the ELSA-Brasil Musculoskeletal / Desenvolvimento de rede neural convolucional para o diagnóstico radiográfico de osteoartrite dos joelhos no ELSA-Brasil Musculoesquelético

Abstract Objective: To develop a convolutional neural network (CNN) model, trained with the Brazilian "Estudo Longitudinal de Saúde do Adulto Musculoesquelético" (ELSA-Brasil MSK, Longitudinal Study of Adult Health, Musculoskeletal) baseline radiographic examinations, for the automated classification of knee osteoarthritis. Materials and Methods: This was a cross-sectional study carried out with 5,660 baseline posteroanterior knee radiographs from the ELSA-Brasil MSK database (5,660 baseline posteroanterior knee radiographs). The examinations were interpreted by a radiologist with specific training, and the calibration was as established previously. Results: The CNN presented an area under the receiver operating characteristic curve of 0.866 (95% CI: 0.842-0.882). The model can be optimized to achieve, not simultaneously, maximum values of 0.907 for accuracy, 0.938 for sensitivity, and 0.994 for specificity. Conclusion: The proposed CNN can be used as a screening tool, reducing the total number of examinations evaluated by the radiologists of the study, and as a double-reading tool, contributing to the reduction of possible interpretation errors.

Resumo Objetivo: Desenvolver um modelo computacional - rede neural convolucional (RNC) - treinado com radiografias da linha de base do Estudo Longitudinal de Saúde do Adulto Musculoesquelético (ELSA-Brasil Musculoesquelético), para a classificação automática de osteoartrite dos joelhos. Materiais e Métodos: Trata-se de um estudo transversal abrangendo todos os exames da linha de base do ELSA-Brasil Musculoesquelético (5.660 radiografias dos joelhos em incidência posteroanterior). Os exames foram interpretados por médico radiologista com treinamento específico e calibração previamente publicada. Resultados: A RNC desenvolvida apresentou área sob a curva característica de operação do receptor de 0,866 (IC 95%: 0,842-0,882). O modelo pode ser calibrado para alcançar, não simultaneamente, valores máximos de 0,907 para acurácia, 0,938 para sensibilidade e 0,994 para especificidade. Conclusão: A RNC desenvolvida pode ser utilizada como ferramenta de triagem, reduzindo o número total de exames avaliados pelos radiologistas do estudo, e/ou como ferramenta de segunda leitura, contribuindo com a redução de possíveis erros de interpretação.

Findings from Positron Emission Tomography-Computed Tomography with 18F-Fluorodeoxyglucose Uncover a Potential Marker of Nutritional Status in Cancer Patients: A Cross-Sectional Pilot Study.

BACKGROUND: Cancer patients often have altered nutritional status and periodically undergo imaging tests. We hypothesized that standard uptake values (SUV) by positron emission tomography-computed tomography (PET/CT) with 18 F-fluorodeoxyglucose (18F-FDG) could be associated with the nutritional status of cancer patients. MATERIALS AND METHODS: Adult cancer patients who underwent clinical evaluation and PET/CT with 18 F-FDG on the same day were included in a cross-sectional pilot study. The focus was on evaluating 18 F-FDG findings with regard to nutritional status, with an emphasis on liver SUVmean and tumor SUVmax. RESULTS: A total of 179 patients were evaluated. One hundred and three (57.5%) were classified as well-nourished, 54 (30.1%) as suspected/moderately malnourished, and 22 (12.2%) as severely malnourished. The median hepatic SUVmean was 2.29, with 1.87 corresponding to the 10th percentile. There was a significant difference between the severely malnourished (2.02) and well-nourished or suspected/moderately malnourished (2.36) patients. Severely malnourished patients were more likely to have a SUVmean < 1.87 (p = .035). The tumor SUVmax also was significantly higher in severely malnourished patients (p = .003). CONCLUSION: Cancer patients with severe malnutrition have lower values of hepatic SUVmean and higher values of tumor SUVmax in PET/CT with 18F-FDG when compared to well-nourished patients.

Development of a convolutional neural network for diagnosing osteoarthritis, trained with knee radiographs from the ELSA-Brasil Musculoskeletal.

Objective: To develop a convolutional neural network (CNN) model, trained with the Brazilian "Estudo Longitudinal de Saúde do Adulto Musculoesquelético" (ELSA-Brasil MSK, Longitudinal Study of Adult Health, Musculoskeletal) baseline radiographic examinations, for the automated classification of knee osteoarthritis. Materials and Methods: This was a cross-sectional study carried out with 5,660 baseline posteroanterior knee radiographs from the ELSA-Brasil MSK database (5,660 baseline posteroanterior knee radiographs). The examinations were interpreted by a radiologist with specific training, and the calibration was as established previously. Results: The CNN presented an area under the receiver operating characteristic curve of 0.866 (95% CI: 0.842-0.882). The model can be optimized to achieve, not simultaneously, maximum values of 0.907 for accuracy, 0.938 for sensitivity, and 0.994 for specificity. Conclusion: The proposed CNN can be used as a screening tool, reducing the total number of examinations evaluated by the radiologists of the study, and as a double-reading tool, contributing to the reduction of possible interpretation errors.

Objetivo: Desenvolver um modelo computacional - rede neural convolucional (RNC) - treinado com radiografias da linha de base do Estudo Longitudinal de Saúde do Adulto Musculoesquelético (ELSA-Brasil Musculoesquelético), para a classificação automática de osteoartrite dos joelhos. Materiais e Métodos: Trata-se de um estudo transversal abrangendo todos os exames da linha de base do ELSA-Brasil Musculoesquelético (5.660 radiografias dos joelhos em incidência posteroanterior). Os exames foram interpretados por médico radiologista com treinamento específico e calibração previamente publicada. Resultados: A RNC desenvolvida apresentou área sob a curva característica de operação do receptor de 0,866 (IC 95%: 0,842-0,882). O modelo pode ser calibrado para alcançar, não simultaneamente, valores máximos de 0,907 para acurácia, 0,938 para sensibilidade e 0,994 para especificidade. Conclusão: A RNC desenvolvida pode ser utilizada como ferramenta de triagem, reduzindo o número total de exames avaliados pelos radiologistas do estudo, e/ou como ferramenta de segunda leitura, contribuindo com a redução de possíveis erros de interpretação.

Imaging evaluation of nonobstetric conditions during pregnancy: what every radiologist should know.

In recent decades, there has been a significant increase in the number of imaging examinations performed on pregnant patients. That increase has occurred across the various modalities, including ultrasound, computed tomography, and magnetic resonance imaging. However, little is known about the risks that these examinations generate for the mother and fetus, related to the use of ionizing radiation or the use of contrast media. When pregnant patients are submitted to imaging studies, the principles of protection established by the International Commission on Radiological Protection should always be respected, to avoid injury to the pregnant woman and the fetus. The potential deleterious effects on the fetus must be weighed against the damage caused by not performing an examination that is clearly indicated, given that a delayed or missed diagnosis can be even more harmful to the health of the mother and of the fetus itself. The purpose of this review article is to address concerns regarding the safety of imaging methods used during pregnancy, as well as to identify typical clinical situations that require decisions to be made about the indication and optimal planning of imaging examinations.

Nas últimas décadas observou-se um aumento expressivo no número de exames de imagem realizados em pacientes gestantes. Este aumento inclui diferentes modalidades, como a ultrassonografia, a tomografia computadorizada e a ressonância magnética. Entretanto, ainda se sabe pouco sobre os riscos que esses exames geram para o binômio mãe-feto, seja no contexto da utilização de radiação ionizante ou da utilização de diferentes meios de contraste. Ao se submeter pacientes grávidas a estudos por imagem, deve-se sempre respeitar os princípios de limitação do uso estabelecidos pela Comissão Internacional de Proteção Radiológica, visando a poupar a gestante e o feto de danos evitáveis. Ressalta-se que os potenciais efeitos deletérios sobre o feto se contrapõem aos danos causados pela não realização de um exame bem indicado, já que um diagnóstico protelado ou perdido pode ser ainda mais nocivo para a saúde materna e do próprio concepto. O objetivo deste artigo de revisão é esclarecer dúvidas sobre a segurança dos métodos de imagem durante o período gestacional, bem como identificar situações clínicas típicas que exigem decisões sobre a indicação e o planejamento otimizado dos exames de imagem.

Imaging evaluation of nonobstetric conditions during pregnancy: what every radiologist should know / Avaliação por imagem de condições não obstétricas na gestação: o que todo radiologista deve saber

Abstract In recent decades, there has been a significant increase in the number of imaging examinations performed on pregnant patients. That increase has occurred across the various modalities, including ultrasound, computed tomography, and magnetic resonance imaging. However, little is known about the risks that these examinations generate for the mother and fetus, related to the use of ionizing radiation or the use of contrast media. When pregnant patients are submitted to imaging studies, the principles of protection established by the International Commission on Radiological Protection should always be respected, to avoid injury to the pregnant woman and the fetus. The potential deleterious effects on the fetus must be weighed against the damage caused by not performing an examination that is clearly indicated, given that a delayed or missed diagnosis can be even more harmful to the health of the mother and of the fetus itself. The purpose of this review article is to address concerns regarding the safety of imaging methods used during pregnancy, as well as to identify typical clinical situations that require decisions to be made about the indication and optimal planning of imaging examinations.

Resumo Nas últimas décadas observou-se um aumento expressivo no número de exames de imagem realizados em pacientes gestantes. Este aumento inclui diferentes modalidades, como a ultrassonografia, a tomografia computadorizada e a ressonância magnética. Entretanto, ainda se sabe pouco sobre os riscos que esses exames geram para o binômio mãe-feto, seja no contexto da utilização de radiação ionizante ou da utilização de diferentes meios de contraste. Ao se submeter pacientes grávidas a estudos por imagem, deve-se sempre respeitar os princípios de limitação do uso estabelecidos pela Comissão Internacional de Proteção Radiológica, visando a poupar a gestante e o feto de danos evitáveis. Ressalta-se que os potenciais efeitos deletérios sobre o feto se contrapõem aos danos causados pela não realização de um exame bem indicado, já que um diagnóstico protelado ou perdido pode ser ainda mais nocivo para a saúde materna e do próprio concepto. O objetivo deste artigo de revisão é esclarecer dúvidas sobre a segurança dos métodos de imagem durante o período gestacional, bem como identificar situações clínicas típicas que exigem decisões sobre a indicação e o planejamento otimizado dos exames de imagem.

Performance of distinct knee osteoarthritis classification criteria in the ELSA-Brasil musculoskeletal study.

OBJECTIVE: To compare the performance of different knee osteoarthritis (OA) classification criteria in a subsample of subjects of ELSA-Brasil Musculoskeletal cohort (ELSA-Brasil MSK) in comparison with the clinical-radiographic evaluation of an experienced rheumatologist. METHOD: A cross-sectional study of the diagnostic accuracy of different knee OA classification criteria: radiographic OA, symptomatic OA, clinical and clinical-radiographic criteria of the American College of Rheumatology (ACR), and the definition proposed by the National Institute for Health and Care Excellence (NICE), UK. The study also evaluated some alternative definitions of OA including a combination of criteria. In total, 250 subjects participated. Only one knee per subject was included. When both or none of the knees were affected, one knee was randomly selected for analysis. OA prevalence, sensitivity, specificity, positive and negative predictive values, and accuracy were presented (CI 95%; α = 5%). RESULTS: The mean age was 56.1 years (SD = 8.7), 48.8% female, and 39.2% presented knee OA according to the rheumatologist. The sensitivity and the specificity of radiographic OA were 51% and 96.7%, respectively, while the NICE definition showed 57.0% and 76.3%, respectively. The other OA criteria showed good levels of specificity, but the levels of sensitivity were below 30%. Considering NICE and/or X-ray result in combination, the sensitivity increased (73.4%), while the specificity reduced slightly (73.0%) in relation to the original NICE definition. CONCLUSIONS: Radiographic OA showed the best performance, followed by NICE definition, especially in combination with X-ray results.

MR elastography is effective for the non-invasive evaluation of fibrosis and necroinflammatory activity in patients with nonalcoholic fatty liver disease.

OBJECTIVES: To evaluate the performance of magnetic resonance elastography (MRE) in diagnosing and staging hepatic fibrosis in patients with histologically confirmed nonalcoholic fatty liver disease (NAFLD) and in distinguishing simple steatosis from nonalcoholic steatohepatitis (NASH). METHODS: Ninety subjects (49 NAFLD patients and 41 healthy volunteers) were prospectively enrolled. Liver stiffness measured by MRE was correlated with the grade of fibrosis and/or inflammation determined by liver biopsy. Correlations, ROC (receiver operator characteristic) curves and diagnostic performance were evaluated. The study was approved by the local ethics committee. RESULTS: The area under the ROC curve (AUROC) of MRE in discriminating healthy from NAFLD individuals was 0.964 (P<0.0001), and that for distinguishing advanced (F3-F4) from absent/mild fibrosis (F0-F2) was 0.928 (P<0.0001). The use of a threshold >4.39 kPa resulted in a sensitivity of 90.9% and a specificity of 97.3% for diagnosing advanced fibrosis. For discriminating NASH from simple steatosis, the AUROC was 0.783 (P<0.0001), and the threshold, 3.22 kPa. CONCLUSIONS: MRE is an effective, non-invasive method for detecting/staging hepatic fibrosis in NAFLD. This method has good performance in discriminating normal from NAFLD subjects and between the extreme grades of fibrosis. NAFLD patients with inflammation and without fibrosis have higher liver stiffness than those with simple steatosis.

Fixed-flexion knee radiography using a new positioning device produced highly repeatable measurements of joint space width: ELSA-Brasil Musculoskeletal Study (ELSA-Brasil MSK) / A radiografia do joelho em flexão fixa utilizando um novo posicionador produziu medidas da largura do espaço articular com alta repetibilidade: estudo ELSA-Brasil Musculoesquelético (ELSA-Brasil ME)

Abstract Objective: To describe the performance of a non-fluoroscopic fixed-flexion PA radiographic protocol with a new positioning device, developed for the assessment of knee osteoarthritis (OA) in Brazilian Longitudinal Study of Adult Health Musculoskeletal Study (ELSA-Brasil MSK). Material and methods: A test–retest design including 19 adults (38 knee images) was conducted. Feasibility of the radiographic protocol was assessed by image quality parameters and presence of radioanatomic alignment according to intermargin distance (IMD) values. Repeatability was assessed for IMD and joint space width (JSW) measured at three different locations. Results: Approximately 90% of knee images presented excellent quality. Frequencies of nearly perfect radioanatomic alignment (IMD ≤1 mm) ranged from 29% to 50%, and satisfactory alignment was found in up to 71% and 76% of the images (IMD ≤1.5 mm and ≤1.7 mm, respectively). Repeatability analyses yielded the following results: IMD [SD of mean difference = 1.08; coefficient of variation (%CV) = 54.68%; intraclass correlation coefficient (ICC) (95%CI) = 0.59 (0.34–0.77)]; JSW [SD of mean difference = 0.34–0.61; %CV = 4.48%–9.80%; ICC (95%CI) = 0.74 (0.55–0.85)–0.94 (0.87–0.97)]. Adequately reproducible measurements of IMD and JSW were found in 68% and 87% of the images, respectively. Conclusions: Despite the difficulty in achieving consistent radioanatomic alignment between subsequent radiographs in terms of IMD, the protocol produced highly repeatable JSW measurements when these were taken at midpoint and 10 mm from the medial extremity of the medial tibial plateau. Therefore, measurements of JSW at these locations can be considered adequate for the assessment of knee OA in ELSA-Brasil MSK.

Resumo Objetivo: Descrever o desempenho de um protocolo radiográfico em flexão fixa sem fluoroscopia em incidência PA com um novo posicionador, desenvolvido para a avaliação da osteoartrite de joelho (OA) no estudo ELSA-Brasil ME. Material e métodos: Fez-se um estudo de teste e reteste que incluiu 19 adultos (38 imagens de joelho). A viabilidade do protocolo radiográfico foi avaliada por meio de parâmetros de qualidade da imagem e presença de alinhamento radioanatômico de acordo com as medidas da distância intermarginal (DIM). Avaliaram-se a repetibilidade dos valores de DIM e do espaço articular (EA) em três locais diferentes. Resultados: Aproximadamente 90% das imagens de joelho apresentaram uma qualidade excelente. As frequências de imagens com alinhamento radioanatômico quase perfeito (DIM<1mm) variaram de 29% a 50%, e de alinhamento satisfatório (DIM<1,5mm e <1,7mm) de 71% a 76%, respectivamente. As análises de repetibilidade produziram os seguintes resultados: DIM [DP da média das diferenças = 1,08; coeficiente de variação (% CV) = 54,68%; coeficiente de correlação intraclasse (CCI) (IC 95%) = 0,59 (0,34 a 0,77)]; EA [DP da média das diferenças = 0,34 a 0,61; % CV = 4,48% a 9,80%; CCI (IC 95%) = 0,74 (0,55 a 0,85) a 0,94 (0,87 a 0,97]. Encontraram-se medidas adequadamente reprodutíveis de DIM e EA em 68% e 87% das imagens, respectivamente. Conclusões: Apesar da dificuldade de obter um alinhamento radioanatômico consistente entre radiografias repetidas em termos de DIM, o protocolo produziu medições de EA altamente repetíveis quando essas foram tomadas no ponto médio e a 10 mm da extremidade medial do platô tibial medial. Portanto, as medidas de EA nesses locais podem ser consideradas adequadas para a avaliação da OA de joelho no estudo ELSA-Brasil ME.

Fixed-flexion knee radiography using a new positioning device produced highly repeatable measurements of joint space width: ELSA-Brasil Musculoskeletal Study (ELSA-Brasil MSK).

OBJECTIVE: To describe the performance of a non-fluoroscopic fixed-flexion PA radiographic protocol with a new positioning device, developed for the assessment of knee osteoarthritis (OA) in Brazilian Longitudinal Study of Adult Health Musculoskeletal Study (ELSA-Brasil MSK). MATERIAL AND METHODS: A test-retest design including 19 adults (38 knee images) was conducted. Feasibility of the radiographic protocol was assessed by image quality parameters and presence of radioanatomic alignment according to intermargin distance (IMD) values. Repeatability was assessed for IMD and joint space width (JSW) measured at three different locations. RESULTS: Approximately 90% of knee images presented excellent quality. Frequencies of nearly perfect radioanatomic alignment (IMD ≤1mm) ranged from 29% to 50%, and satisfactory alignment was found in up to 71% and 76% of the images (IMD ≤1.5mm and ≤1.7mm, respectively). Repeatability analyses yielded the following results: IMD [SD of mean difference=1.08; coefficient of variation (%CV)=54.68%; intraclass correlation coefficient (ICC) (95%CI)=0.59 (0.34-0.77)]; JSW [SD of mean difference=0.34-0.61; %CV=4.48%-9.80%; ICC (95%CI)=0.74 (0.55-0.85)-0.94 (0.87-0.97)]. Adequately reproducible measurements of IMD and JSW were found in 68% and 87% of the images, respectively. CONCLUSIONS: Despite the difficulty in achieving consistent radioanatomic alignment between subsequent radiographs in terms of IMD, the protocol produced highly repeatable JSW measurements when these were taken at midpoint and 10mm from the medial extremity of the medial tibial plateau. Therefore, measurements of JSW at these locations can be considered adequate for the assessment of knee OA in ELSA-Brasil MSK.

Psychometric properties of Multidimensional Health Locus of Control - A and General Self-Efficacy Scale in civil servants: ELSA-Brasil Musculoskeletal Study (ELSA-Brasil MSK).

BACKGROUND: Health-related control and self-efficacy beliefs can be assessed in the general population using Multidimensional Health Locus of Control-A subscales (MHLC-A) and the General Self-Efficacy Scale (GSES), respectively. OBJECTIVE: To test construct validity, internal consistency, reliability (test-retest) and ceiling and floor effects of Portuguese-Brazil versions of MHLC-A and GSES. METHOD: Civil servants (N=2901) enrolled in a large Brazilian cohort were included. A new version of the GSES was produced (GSES-Brazil). Procedures for cross-cultural adaptation and testing of psychometric properties followed well-accepted international guidelines. RESULTS: Confirmatory factor analyses yielded the following indices: MHLC-A (tridimensional model): χ2[df]=223.45[132], p-value <0.01; CFI=0.87; TLI=0.85; RMSEA=0.07 (0.07-0.08); WRMR=3.00. GSES-Brazil (unidimensional model): χ2[df]=788.60[35], p-value <0.01; CFI=0.95; TLI=0.94; RMSEA=0.09 (0.08-0.09); WRMR=2.50. Cronbach's alpha coefficients and Intraclass Correlation Coefficients (ICC2,1) ranged from 0.57 (0.54-0.59) and 0.57 (0.47-0.65) for MHLC-A internality to 0.80 (0.79-0.81) and 0.71 (0.66-0.77) for GSES-Brazil, respectively. There was no evidence of ceiling and floor effects. Convergent validity analyses provided further support for construct validity of both scales. CONCLUSION: These findings support the use of the newly developed version of GSES-Brazil for the assessment of general self-efficacy of adult Brazilians. Internal consistency was lower than ideal for MHLC-A, indicating these subscales may need further refinements to provide a more psychometrically sound measure of control beliefs.

Psychometric properties of Multidimensional Health Locus of Control - A and General Self-Efficacy Scale in civil servants: ELSA-Brasil Musculoskeletal Study (ELSA-Brasil MSK)

Abstract Background Health-related control and self-efficacy beliefs can be assessed in the general population using Multidimensional Health Locus of Control-A subscales (MHLC-A) and the General Self-Efficacy Scale (GSES), respectively. Objective To test construct validity, internal consistency, reliability (test-retest) and ceiling and floor effects of Portuguese-Brazil versions of MHLC-A and GSES. Method Civil servants (N=2901) enrolled in a large Brazilian cohort were included. A new version of the GSES was produced (GSES-Brazil). Procedures for cross-cultural adaptation and testing of psychometric properties followed well-accepted international guidelines. Results Confirmatory factor analyses yielded the following indices: MHLC-A (tridimensional model): χ2[df]=223.45[132], p-value <0.01; CFI=0.87; TLI=0.85; RMSEA=0.07 (0.07-0.08); WRMR=3.00. GSES-Brazil (unidimensional model): χ2[df]=788.60[35], p-value <0.01; CFI=0.95; TLI=0.94; RMSEA=0.09 (0.08-0.09); WRMR=2.50. Cronbach’s alpha coefficients and Intraclass Correlation Coefficients (ICC2,1) ranged from 0.57 (0.54-0.59) and 0.57 (0.47-0.65) for MHLC-A internality to 0.80 (0.79-0.81) and 0.71 (0.66-0.77) for GSES-Brazil, respectively. There was no evidence of ceiling and floor effects. Convergent validity analyses provided further support for construct validity of both scales. Conclusion These findings support the use of the newly developed version of GSES-Brazil for the assessment of general self-efficacy of adult Brazilians. Internal consistency was lower than ideal for MHLC-A, indicating these subscales may need further refinements to provide a more psychometrically sound measure of control beliefs.

Beneficial Effect of Synbiotic Supplementation on Hepatic Steatosis and Anthropometric Parameters, But Not on Gut Permeability in a Population with Nonalcoholic Steatohepatitis.

Nonalcoholic fatty liver disease is the most prevalent chronic liver disease in Western countries; it can progress to nonalcoholic steatohepatitis (NASH), cirrhosis and hepatocarcinoma. The importance of gut-liver-adipose tissue axis has become evident and treatments targeting gut microbiota may improve inflammatory and metabolic parameters in NASH patients. In a randomized, controlled clinical trial, involving 50 biopsy-proven NASH patients, we investigated the effects of synbiotic supplementation on metabolic parameters, hepatic steatosis, intestinal permeability, small intestinal bacterial overgrowth (SIBO) and lipopolysaccharide (LPS) serum levels. Patients were separated into two groups receiving Lactobacillus reuteri with guar gum and inulin for three months and healthy balanced nutritional counseling versus nutritional counseling alone. Before and after the intervention we assessed steatosis by magnetic resonance imaging, intestinal permeability by lactulose/mannitol urinary excretion and SIBO by glucose breath testing. NASH patients presented high gut permeability, but low prevalence of SIBO. After the intervention, only the synbiotic group presented a reduction in steatosis, lost weight, diminished BMI and waist circumference measurement. Synbiotic did not improve intestinal permeability or LPS levels. We concluded that synbiotic supplementation associated with nutritional counseling seems superior to nutritional counseling alone for NASH treatment as it attenuates steatosis and may help to achieve weight loss.

Ischemic cerebrovascular burden evaluated by magnetic resonance imaging in an elderly Brazilian community: The Pietà study.

In developing countries, cardiovascular risk factors are poorly controlled, leading to high prevalence of cerebrovascular diseases. The aim of the study was to evaluate the burden of white matter lesions in magnetic resonance through the Fazekas scale in a population aged 75 + years living in the community, and to investigate possible associations between vascular lesions, cardiovascular risk factors and cognitive status. Subjects were selected from a community-based study on brain aging conducted in Caeté (Minas Gerais state), Brazil. Overall, 177 participants (112 cognitively healthy, 36 with cognitive impairment-no dementia and 29 with dementia), being 108 women, aged 79.3 ± 3.8 years, with 3.1 ± 2.9 years of educational level, underwent a 3 Tesla magnetic resonance scanner with fluid attenuated image recovery acquisition. Severity of white matter lesions was assessed through the Fazekas scale. Severe white matter lesions were present in 31.1% of the whole sample and in 25.0% of the cognitively healthy individuals. A significant association was found between severe white matter lesions and cognitive impairment (OR = 2.20, 95% CI 1.17-6.53; p = 0.021), as well as with hypertension (OR = 1.92, 95% CI 1.03-7.39; p = 0.043). In conclusion, a high prevalence of severe white matter lesions was observed in this elderly Brazilian population sample, and white matter lesions were associated with hypertension and cognitive status. Importantly, the prevalence of white matter lesions was also high in cognitively healthy subjects.

MR enterography for the assessment of small bowel diseases.

This article focuses on MR enterography in the evaluation of small bowel diseases, including the protocol, enteric contrast agents, imaging timing and sequence selection. It is becoming the first-line radiological investigation to evaluate the small bowel in patients diagnosed with Crohn disease, particularly in young adults, in whom ionizing radiation is a concern. A key question in the management of such patients is the assessment of disease activity. Knowledge of the location, severity, and presence of complications may assist in providing patients with appropriate treatment options. Other small bowel diseases beyond Crohn disease will also be discussed.

Magnetic resonance imaging of rectal cancer.

Optimal treatment decisions for patients with rectal cancer are based on knowledge of tumor characteristics and prognostic features and any initial treatment must aim to reduce the risk of both local and distant recurrence. The radiologist has become an increasingly important part of multidisciplinary team managing rectal cancer. The primary goal of MRI staging of rectal tumors is to identify prognostic factors in order to offer patients a tailored treatment based on individual risks. Restaging of rectal tumors using MRI after chemoradiation therapy is becoming more relevant issue, since further tailoring of treatment is increasingly being considered after the treatment.

Multiple symmetric lipomatosis.

BACKGROUND: Multiple symmetric lipomatosis (MSL) is a relatively uncommon entity of unknown etiology characterized by symmetrically subcutaneous accumulation of nonencapsulated adipose tissue. Approximately 200 to 300 cases have been published. OBJECTIVES: The aims of this article are to report the case of a 58-year-old Brazilian patient with MSL and provide a comprehensive overview of the current concepts concerning this disease. METHODS: Our search yielded 28 articles on MSL, including case reports and reviews of the literature. RESULTS: MSL predominantly affects Mediterranean males with a history of chronic alcohol abuse. It is usually asymptomatic and may be associated with diabetes mellitus, hyperlipidemia, hyperuricemia, macrocytic anemia, and oral cancer. Surgical resection is the best treatment option. CONCLUSION: The case reported is a classic presentation of MSL; however, it is particularly uncommon owing to the association with immune thrombocytopenic purpura. This association has been described only once in the medical literature.