Diagnostic Performance of MRI for the Detection of Pulmonary Nodules: A Systematic Review and Meta-Analysis.

Purpose To perform a meta-analysis of the diagnostic performance of MRI for the detection of pulmonary nodules, with use of CT as the reference standard. Materials and Methods PubMed, Embase, Scopus, and other databases were systematically searched for studies published from January 2000 to March 2023 evaluating the performance of MRI for diagnosis of lung nodules measuring 4 mm or larger, with CT as reference. Studies including micronodules, nodules without size stratification, or those from which data for contingency tables could not be extracted were excluded. Primary outcomes were the per-lesion sensitivity of MRI and the rate of false-positive nodules per patient (FPP). Subgroup analysis by size and meta-regression with other covariates were performed. The study protocol was registered in the International Prospective Register of Systematic Reviews, or PROSPERO (no. CRD42023437509). Results Ten studies met inclusion criteria (1354 patients and 2062 CT-detected nodules). Overall, per-lesion sensitivity of MRI for nodules measuring 4 mm or larger was 87.7% (95% CI: 81.1, 92.2), while the FPP rate was 12.4% (95% CI: 7.0, 21.1). Subgroup analyses demonstrated that MRI sensitivity was 98.5% (95% CI: 90.4, 99.8) for nodules measuring at least 8-10 mm and 80.5% (95% CI: 71.5, 87.1) for nodules less than 8 mm. Conclusion MRI demonstrated a good overall performance for detection of pulmonary nodules measuring 4 mm or larger and almost equal performance to CT for nodules measuring at least 8-10 mm, with a low rate of FPP. Systematic review registry no. CRD42023437509 Keywords: Lung Nodule, Lung Cancer, Lung Cancer Screening, MRI, CT Supplemental material is available for this article. © RSNA, 2024.

Prognostic value of nutritional screening tools in hospitalized patients with decompensated heart failure: A systematic review and meta-analysis.

Nutritional risk screening is fundamental to prevent undesirable outcomes in heart failure (HF). Current reviews of nutritional screening tools encompass both hospitalized and outpatient settings, which may not be suitable because of different clinical manifestations. We hypothesize that multidimensional tools would better identify prognosis of decompensated patients because the tools assess more than isolated aspects. This systematic review aims to explore the association of multidimensional nutritional risk screening tools and prognosis in patients hospitalized with decompensated HF. Five databases were searched for studies that assessed nutritional risk through multidimensional screening tools and its association with prognosis in adults hospitalized with decompensated HF. The 95% confidence interval and relative risk were computed using a random-effects model. Inverse variance method was used. Thirty-eight studies were included. Most studies demonstrated higher nutritional risk was significantly associated with worse prognosis. Quantitative analysis identified higher nutritional risk by using the Mini Nutritional Assessment Short Form (MNA-SF), Controlling Nutritional Status, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index to be associated with all-cause mortality. The MNA-SF demonstrated greater magnitude of association with all-cause mortality in older subjects (relative risk, 4.85; 95% confidence interval, 2.0-11.75). Higher nutritional risk was associated with poor prognosis and higher mortality in patients hospitalized with decompensated HF, especially when screened by MNA-SF. Tools were not directly compared. That might reinforce the importance of evaluating multiple aspects when screening hospitalized HF patients once symptoms associated with decompensation frequently mask the underlying nutritional status and risk. PROSPERO registration number (CRD42021256271).

Artificial intelligence to predict the need for mechanical ventilation in cases of severe COVID-19.

Objective: To determinate the accuracy of computed tomography (CT) imaging assessed by deep neural networks for predicting the need for mechanical ventilation (MV) in patients hospitalized with severe acute respiratory syndrome due to coronavirus disease 2019 (COVID-19). Materials and Methods: This was a retrospective cohort study carried out at two hospitals in Brazil. We included CT scans from patients who were hospitalized due to severe acute respiratory syndrome and had COVID-19 confirmed by reverse transcription-polymerase chain reaction (RT-PCR). The training set consisted of chest CT examinations from 823 patients with COVID-19, of whom 93 required MV during hospitalization. We developed an artificial intelligence (AI) model based on convolutional neural networks. The performance of the AI model was evaluated by calculating its accuracy, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. Results: For predicting the need for MV, the AI model had a sensitivity of 0.417 and a specificity of 0.860. The corresponding area under the ROC curve for the test set was 0.68. Conclusion: The high specificity of our AI model makes it able to reliably predict which patients will and will not need invasive ventilation. That makes this approach ideal for identifying high-risk patients and predicting the minimum number of ventilators and critical care beds that will be required.

Objetivo: Determinar a acurácia da tomografia computadorizada (TC), avaliada por redes neurais profundas, na ventilação mecânica, de pacientes hospitalizados por síndrome respiratória aguda grave por COVID-19. Materiais e Métodos: Trata-se de estudo de coorte retrospectivo, realizado em dois hospitais brasileiros. Foram incluídas TCs de pacientes hospitalizados por síndrome respiratória aguda grave e COVID-19 confirmada por RT-PCR. O treinamento consistiu em TC de tórax de 823 pacientes com COVID-19, dos quais 93 foram submetidos a ventilação mecânica na hospitalização. Nós desenvolvemos um modelo de inteligência artificial baseado em redes de convoluções neurais. A avaliação do desempenho do uso da inteligência artificial foi baseada no cálculo de acurácia, sensibilidade, especificidade e área sob a curva ROC. Resultados: A sensibilidade do modelo foi de 0,417 e a especificidade foi de 0,860. A área sob a curva ROC para o conjunto de teste foi de 0,68. Conclusão: Criamos um modelo de aprendizado de máquina com elevada especificidade, capaz de prever de forma confiável pacientes que não precisarão de ventilação mecânica. Isso significa que essa abordagem é ideal para prever com antecedência pacientes de alto risco e um número mínimo de equipamentos de ventilação e de leitos críticos.

Artificial intelligence to predict the need for mechanical ventilation in cases of severe COVID-19 / Inteligência artificial na predição de necessidade de ventilação mecânica em casos graves de COVID-19

Abstract Objective: To determinate the accuracy of computed tomography (CT) imaging assessed by deep neural networks for predicting the need for mechanical ventilation (MV) in patients hospitalized with severe acute respiratory syndrome due to coronavirus disease 2019 (COVID-19). Materials and Methods: This was a retrospective cohort study carried out at two hospitals in Brazil. We included CT scans from patients who were hospitalized due to severe acute respiratory syndrome and had COVID-19 confirmed by reverse transcriptionpolymerase chain reaction (RT-PCR). The training set consisted of chest CT examinations from 823 patients with COVID-19, of whom 93 required MV during hospitalization. We developed an artificial intelligence (AI) model based on convolutional neural networks. The performance of the AI model was evaluated by calculating its accuracy, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. Results: For predicting the need for MV, the AI model had a sensitivity of 0.417 and a specificity of 0.860. The corresponding area under the ROC curve for the test set was 0.68. Conclusion: The high specificity of our AI model makes it able to reliably predict which patients will and will not need invasive ventilation. That makes this approach ideal for identifying high-risk patients and predicting the minimum number of ventilators and critical care beds that will be required.

Resumo Objetivo: Determinar a acurácia da tomografia computadorizada (TC), avaliada por redes neurais profundas, na ventilação mecânica, de pacientes hospitalizados por síndrome respiratória aguda grave por COVID-19. Materiais e Métodos: Trata-se de estudo de coorte retrospectivo, realizado em dois hospitais brasileiros. Foram incluídas TCs de pacientes hospitalizados por síndrome respiratória aguda grave e COVID-19 confirmada por RT-PCR. O treinamento consistiu em TC de tórax de 823 pacientes com COVID-19, dos quais 93 foram submetidos a ventilação mecânica na hospitalização. Nós desenvolvemos um modelo de inteligência artificial baseado em redes de convoluções neurais. A avaliação do desempenho do uso da inteligência artificial foi baseada no cálculo de acurácia, sensibilidade, especificidade e área sob a curva ROC. Resultados: A sensibilidade do modelo foi de 0,417 e a especificidade foi de 0,860. A área sob a curva ROC para o conjunto de teste foi de 0,68. Conclusão: Criamos um modelo de aprendizado de máquina com elevada especificidade, capaz de prever de forma confiável pacientes que não precisarão de ventilação mecânica. Isso significa que essa abordagem é ideal para prever com antecedência pacientes de alto risco e um número mínimo de equipamentos de ventilação e de leitos críticos.

Postoperative computed tomography of insufflated lung specimens obtained by video-assisted thoracic surgery: detection and margin assessment of pulmonary nodules.

Objective: To investigate the utility of computed tomography (CT) scans to detect and assess the margin status of pulmonary nodules that were insufflated after being resected by video-assisted thoracic surgery. Materials and Methods: This was a novel multicenter study conducted at two national referral centers for thoracic diseases. Patients suspected of having lung cancer underwent video-assisted thoracic surgery for the resection of pulmonary nodules, which were submitted to postoperative CT. Measurements from the CT scans were compared with the results of the histopathological analysis. Results: A total of 37 pulmonary nodules from 37 patients were evaluated. The mean age of the patients was 65 years (range, 36-84 years), and 27 (73%) were female. A CT analysis of insufflated specimens identified all 37 nodules, and 33 of those nodules were found to have tumor-free margins. The histopathological analysis revealed lung cancer in 30 of the nodules, all with tumor-free margins, and benign lesions in the seven remaining nodules. Conclusion: Postoperative CT of insufflated suspicious lung lesions provides real-time detection of pulmonary nodules and satisfactory assessment of tumor margins. This initial study shows that CT of insufflated lung lesions can be a valuable tool at centers where intraoperative histopathological analysis is unavailable.

Objetivo: Investigar a utilidade da tomografia computadorizada (TC) para a detecção e avaliação de margens de nódulos pulmonares que foram insuflados após ressecção por cirurgia torácica videoassistida. Materiais e Métodos: Um inédito estudo multicêntrico foi conduzido em dois centros de referência nacional para doenças torácicas. Nódulos foram ressecados por cirurgia torácica videoassistida de pacientes com suspeita de câncer de pulmão e submetidos a TC pós-operatória. As medidas radiológicas da TC foram comparadas com as da análise patológica. Resultados: Um total de 37 pacientes foi avaliado. A idade média foi de 65 anos (variação: 36-84 anos) e 27 indivíduos (73%) eram do sexo feminino. A análise por TC dos espécimes insuflados identificou todas as 37 lesões e 33 delas com margens livres. A análise patológica revelou 30 casos de câncer de pulmão, todos com margens livres, e sete lesões não malignas. Conclusão: A TC pós-operatória de lesões pulmonares insufladas com suspeita de malignidade provê detecção em tempo real de nódulos pulmonares e aceitável avaliação de margens tumorais. Este estudo inicial demonstra que a TC de lesões pulmonares insufladas pode ser uma ferramenta valiosa em centros em que a análise histopatológica intraoperatória é indisponível.

ACCURACY OF ABBREVIATED PROTOCOL OF MAGNETIC RESONANCE CHOLANGIO-PANCREATOGRAPHY IN THE DIAGNOSIS OF CHOLEDOCHOLITHIASIS.

BACKGROUND: Abbreviated magnetic resonance imaging protocols have emerged to reduce the examination time of the long protocols eliminating unnecessary pulse sequences to answer a targeted clinical question, without compromising diagnostic information. OBJECTIVE: The objective of this study was to evaluate the diagnostic accuracy of an abbreviated magnetic resonance cholangiopancreatography (A-MRCP) protocol in patients with suspected choledocholithiasis. METHODS: This retrospective study evaluated patients (ages 10 + years) that performed consecutive MRCP examination from October 2019 to June 2020, with the clinical suspicion of choledocholithiasis. Readers first evaluated the biliary tree using a four-sequence A-MRCP protocol and later reviewed the entire conventional eleven-sequence MRCP. Presence of choledocholithiasis, stone size, common bile duct caliber, and additional findings were evaluated. RESULTS: A total of 148 patients with MRCP were included (62.8% female, mean 50.9 years). The prevalence of choledocholithiasis was 32.2%. The accuracy of the abbreviated MRCP protocol for choledocholithiasis was 98.7%. There was no difference between the performance of the abbreviated and conventional MRCP image sets for detection of choledocholithiasis (kappa=0.970), with a sensitivity of 98% and a specificity of 99%. There was excellent inter-reader agreement evaluating for choledocholithiasis on both imaging sets of MRCP protocols (kappa values were 0.970). CONCLUSION: An abbreviated MRCP protocol to evaluate for choledocholithiasis provides similar diagnostic over the conventional MRCP protocol, offering potential for decreased scanning time and improved patient tolerability.

Effect of Tacrolimus and Cyclosporine Immunosuppressants on Peripheral Nerve Regeneration: Systematic Review and Meta-analysis.

Peripheral nerve damage is an important cause of seeking medical attention. It occurs when the continuity of structures is interrupted and the propagation of nervous impulses is blocked, affecting the functional capacity of individuals. To assess the effects of the immunosuppressants tacrolimus and cyclosporine on the regeneration of peripheral nerves, a systematic review of the literature was carried out. The articles included were published until September 2018 and proposed to evaluate the effects of the immunosuppressants tacrolimus and cyclosporine on nerve regeneration and neuroprotection, available in the MEDLINE, EMBASE, Cochrane Library, Web of Science, Oxford Pain Relief Database, and LILACS databases. The research analysed a total of 56 articles, of which 22 were included in the meta-analysis. Statistical analysis suggests the protective effect of tacrolimus in the regeneration of the number of myelinated axons (95% confidence interval [CI]: 0.93-2.39; p < 0.01); however, such effect was not observed in relation to cyclosporine (95%CI: - 0.38-1.18; p = 0.08) It also suggests that there is a significant relationship between the use of tacrolimus and myelin thickness (95%CI= 2.00-5.71; p < 0. 01). The use of immunosuppressants in the regeneration of peripheral nerve damage promotes an increase in the number of myelinated axons in general, regardless of the administered dose. In addition, it ensures greater myelin thickness, muscle weight and recovery of the sciatic functional index. However, heterogeneity was high in most analyses performed.

Acurácia do protocolo abreviado de colangioressonância magnética no diagnóstico de coledocolitíase / Accuracy of abbreviated protocol of magnetic resonance cholangio-pancreatography in the diagnosis of choledocholithiasis

ABSTRACT Background: Abbreviated magnetic resonance imaging protocols have emerged to reduce the examination time of the long protocols eliminating unnecessary pulse sequences to answer a targeted clinical question, without compromising diagnostic information. Objective: The objective of this study was to evaluate the diagnostic accuracy of an abbreviated magnetic resonance cholangiopancreatography (A-MRCP) protocol in patients with suspected choledocholithiasis. Methods: This retrospective study evaluated patients (ages 10 + years) that performed consecutive MRCP examination from October 2019 to June 2020, with the clinical suspicion of choledocholithiasis. Readers first evaluated the biliary tree using a four-sequence A-MRCP protocol and later reviewed the entire conventional eleven-sequence MRCP. Presence of choledocholithiasis, stone size, common bile duct caliber, and additional findings were evaluated. Results: A total of 148 patients with MRCP were included (62.8% female, mean 50.9 years). The prevalence of choledocholithiasis was 32.2%. The accuracy of the abbreviated MRCP protocol for choledocholithiasis was 98.7%. There was no difference between the performance of the abbreviated and conventional MRCP image sets for detection of choledocholithiasis (kappa=0.970), with a sensitivity of 98% and a specificity of 99%. There was excellent inter-reader agreement evaluating for choledocholithiasis on both imaging sets of MRCP protocols (kappa values were 0.970). Conclusion: An abbreviated MRCP protocol to evaluate for choledocholithiasis provides similar diagnostic over the conventional MRCP protocol, offering potential for decreased scanning time and improved patient tolerability.

RESUMO Contexto: Protocolos abreviados de ressonância magnética (RM) surgiram a fim de reduzir o tempo de exame, eliminando sequências de pulso desnecessárias para responder a uma questão clínica específica, sem comprometer o diagnóstico. Objetivo: O objetivo do estudo foi avaliar a acurácia diagnóstica de um protocolo abreviado de colangiopancreatografia por ressonância magnética (colangioRM) em pacientes com suspeita de coledocolitíase. Métodos Estudo retrospectivo, com pacientes acima de 10 anos que realizaram exame de colangioRM, entre outubro de 2019 a junho de 2020, com suspeita clínica de coledocolitíase. Os observadores, radiologistas especialistas, primeiro avaliaram a árvore biliar usando um protocolo abreviado de colangioRM composto por quatro sequências de pulso e, posteriormente, revisaram o protocolo convencional de colangioRM de 11 sequências. A presença de coledocolitíase, o tamanho do cálculo, o calibre do ducto hepático comum e achados adicionais foram avaliados. Resultados Um total de 148 pacientes foram incluídos, sendo 62,8% do sexo feminino, com média de 50,9 anos de idade. A prevalência de coledocolitíase foi de 32,2%. A acurácia do protocolo abreviado de colangioRM para coledocolitíase foi de 98,7%. Não houve diferença entre o desempenho dos protocolos abreviado e convencional de colangioRM para a detecção de coledocolitíase (k=0,970), com uma sensibilidade de 98% e uma especificidade de 99%. Além disso, observou-se excelente concordância entre observadores na avaliação de coledocolitíase em ambos os protocolos de colangioRM (k=0,925). Conclusão O protocolo abreviado de colangioRM apresentou excelente acurácia para o diagnóstico de coledocolitíase quando comparado ao protocolo convencional.

Breast MRI: Simplifying Protocol and BI-RADS Categories.

BACKGROUND: Breast magnetic resonance imaging (MRI) is a useful imaging method, and studies have proven abbreviated protocols may reduce its time and costs with comparable accuracy. To assess the agreement of the abbreviated and full MRI protocols for breast cancer. PATIENTS AND METHODS: This retrospective cross-sectional study included consecutive women who underwent breast MRI from June 2019 to May 2020. Breast MRIs were performed in 2 hospitals, and 3 board-certified radiologists conducted its evaluations. The abbreviated breast MRI was assessed in the following order: MIP; subtraction; and T1W pre- and post-contrast. Findings were categorized according Breast Imaging - Reporting and Data System (BI-RADS 5th edition). The groups were named simplified BI-RADS and were adapted from BI-RADS 5-point scoring system. RESULTS: Four hundred and nineteen women (838 BI-RADS), with mean age of 49.5 ± 12.3 years were evaluated. A very good agreement was found between the protocols for total population (weighted kappa: 0.95; P <.001) and for MRI indication subgroups (weighted kappa: 0.86-1.00; P <.001). A high accuracy was also observed comparing abbreviated breast MRI compared to a full diagnostic MRI (97.6%). CONCLUSION: Abbreviated breast MRI has demonstrated performance comparable to full diagnostic MRI protocols for breast cancer screening and diagnostic. In addition, the present study proposes the use of the simplified BI-RADS as a new classification, in order to assist physicians in clinical management.

Postoperative computed tomography of insufflated lung specimens obtained by video-assisted thoracic surgery: detection and margin assessment of pulmonary nodules / Tomografia computadorizada pós-operatória de espécimes pulmonares insuflados após cirurgia torácica videoassistida: detecção e avaliação de margens de nódulos pulmonares

Abstract Objective: To investigate the utility of computed tomography (CT) scans to detect and assess the margin status of pulmonary nodules that were insufflated after being resected by video-assisted thoracic surgery. Materials and Methods: This was a novel multicenter study conducted at two national referral centers for thoracic diseases. Patients suspected of having lung cancer underwent video-assisted thoracic surgery for the resection of pulmonary nodules, which were submitted to postoperative CT. Measurements from the CT scans were compared with the results of the histopathological analysis. Results: A total of 37 pulmonary nodules from 37 patients were evaluated. The mean age of the patients was 65 years (range, 36-84 years), and 27 (73%) were female. A CT analysis of insufflated specimens identified all 37 nodules, and 33 of those nodules were found to have tumor-free margins. The histopathological analysis revealed lung cancer in 30 of the nodules, all with tumor-free margins, and benign lesions in the seven remaining nodules. Conclusion: Postoperative CT of insufflated suspicious lung lesions provides real-time detection of pulmonary nodules and satisfactory assessment of tumor margins. This initial study shows that CT of insufflated lung lesions can be a valuable tool at centers where intraoperative histopathological analysis is unavailable.

Resumo Objetivo: Investigar a utilidade da tomografia computadorizada (TC) para a detecção e avaliação de margens de nódulos pulmonares que foram insuflados após ressecção por cirurgia torácica videoassistida. Materiais e Métodos: Um inédito estudo multicêntrico foi conduzido em dois centros de referência nacional para doenças torácicas. Nódulos foram ressecados por cirurgia torácica videoassistida de pacientes com suspeita de câncer de pulmão e submetidos a TC pós-operatória. As medidas radiológicas da TC foram comparadas com as da análise patológica. Resultados: Um total de 37 pacientes foi avaliado. A idade média foi de 65 anos (variação: 36-84 anos) e 27 indivíduos (73%) eram do sexo feminino. A análise por TC dos espécimes insuflados identificou todas as 37 lesões e 33 delas com margens livres. A análise patológica revelou 30 casos de câncer de pulmão, todos com margens livres, e sete lesões não malignas. Conclusão: A TC pós-operatória de lesões pulmonares insufladas com suspeita de malignidade provê detecção em tempo real de nódulos pulmonares e aceitável avaliação de margens tumorais. Este estudo inicial demonstra que a TC de lesões pulmonares insufladas pode ser uma ferramenta valiosa em centros em que a análise histopatológica intraoperatória é indisponível.

Effect of Tacrolimus and Cyclosporine Immunosuppressants on Peripheral Nerve Regeneration: Systematic Review and Meta-analysis / Efeito dos imunossupressores tacrolimus e ciclosporina na regeneração de nervos periféricos: Revisão sistemática e metanálises

Abstract Peripheral nerve damage is an important cause of seeking medical attention. It occurs when the continuity of structures is interrupted and the propagation of nervous impulses is blocked, affecting the functional capacity of individuals. To assess the effects of the immunosuppressants tacrolimus and cyclosporine on the regeneration of peripheral nerves, a systematic review of the literature was carried out. The articles included were published until September 2018 and proposed to evaluate the effects of the immunosuppressants tacrolimus and cyclosporine on nerve regeneration and neuroprotection, available in the MEDLINE, EMBASE, Cochrane Library, Web of Science, Oxford Pain Relief Database, and LILACS databases. The research analysed a total of 56 articles, of which 22 were included in the meta-analysis. Statistical analysis suggests the protective effect of tacrolimus in the regeneration of the number of myelinated axons (95% confidence interval [CI]: 0.93-2.39; p< 0.01); however, such effect was not observed in relation to cyclosporine (95%CI: - 0.38-1.18; p» 0.08) It also suggests that there is a significant relationship between the use of tacrolimus and myelin thickness (95%CI» 2.00-5.71; p< 0. 01). The use of immunosuppressants in the regeneration of peripheral nerve damage promotes an increase in the number of myelinated axons in general, regardless of the administered dose. In addition, it ensures greater myelin thickness, muscle weight and recovery of the sciatic functional index. However, heterogeneity was high in most analyses performed.

Resumo As lesões nervosas periféricas são uma causa importante de busca por atendimento médico. Elas ocorrem quando há a interrupção da continuidade das estruturas e do bloqueio da propagação dos impulsos nervosos, afetando a capacidade funcional dos indivíduos. Para avaliar os efeitos dos imunossupressores tacrolimus e ciclosporina na regeneração de nervos periféricos, foi realizada uma revisão sistemática da literatura. Foram incluídos artigos publicados até setembro de 2018, que se propunham avaliar os efeitos dos imunossupressores tacrolimus e ciclosporina na regeneração nervosa e neuroproteção, disponíveis nas bases de dados MEDLINE, EMBASE, Cochrane Library, Web of Science, Oxford Pain Relief Database e LILACS. A pesquisa analisou um total de 56 artigos, dos quais 22 foram para metanálise. A análise estatística sugere o efeito protetor do tacrolimus na regeneração do número de axônios mielinizados (intervalo de confiança [IC] 95%: 0,93-2,39; p< 0,01); todavia tal efeito não foi observado em relação à ciclosporina (IC95%: - 0,38-1,18; p» 0,08). Ela também sugere haver uma relação significativa entre o uso do tacrolimus e a espessura da mielina (IC95%: 2,00-5,71; p< 0,01). O uso de imunossupressores na regeneração de lesão nervosa periférica promove um aumento no número de axônios mielinizados de forma geral, independentemente da dose administrada. Além disso, garante uma maior espessura da mielina, um maior peso muscular e restabelecimento do índice da função do nervo ciático. Todavia, a heterogeneidade foi alta na maioria das análises realizadas.

Shear wave elastography and Doppler ultrasound in kidney transplant recipients.

OBJECTIVE: To evaluate the association between shear wave elastography parameters and arterial resistance in kidney transplant recipients. MATERIALS AND METHODS: This was a prospective cross-sectional study involving consecutive adult kidney transplant recipients. All patients underwent color Doppler to evaluate the resistive index (RI) and ultrasound shear wave elastography for the quantification of renal allograft stiffness. RESULTS: We evaluated 55 patients, of whom 9 (16.4%) had an RI defined as abnormal (≥ 0.79) and 46 (83.6%) had an RI defined as normal (< 0.79). The mean age was higher in the abnormal RI group than in the normal RI group (68.0 ± 8.6 years vs. 42.6 ± 14.1 years; p < 0.001), as was the mean shear wave velocity (2.6 ± 0.4 m/s vs. 2.2 ± 0.4 m/s; p = 0.013). Multivariate analysis identified two independent predictors of arterial resistance: age (OR = 1.169; 95% CI: 1.056 to 1.294; p = 0.003) and shear wave velocity (OR = 17.1; 95% CI: 1.137 to 257.83; p = 0.040). CONCLUSION: We observed an association between rigidity in the cortex of the transplanted kidney, as evaluated by shear wave elastography, and arterial resistance, as evaluated by color Doppler, in kidney transplant recipients.

OBJETIVO: Avaliar a associação entre parâmetros de elastografia por onda de cisalhamento e resistência arterial em pacientes transplantados renais. MATERIAIS E MÉTODOS: Estudo transversal prospectivo. O estudo incluiu de forma consecutiva indivíduos adultos transplantados renais. Foram coletados dados demográficos e clínicos. Todos os pacientes foram submetidos à técnica ultrassonográfica para avaliação do índice de resistência (IR) e à quantificação da elasticidade do tecido por ondas de cisalhamento para avaliar a rigidez do aloenxerto renal. RESULTADOS: Foram avaliados 55 pacientes. A média de idade e a velocidade da onda de cisalhamento foram maiores em pacientes com IR ≥ 0,79 (respectivamente, 68,0 ± 8,6 anos e 2,6 ± 0,4 m/s) quando comparados a pacientes com IR < 0,79 (respectivamente, 42,6 ± 14,1 anos, p < 0,001 e 2,2 ± 0,4 m/s, p = 0,013). A análise multivariada identificou a idade (OR = 1,169, IC 95%: 1,056 a 1,294; p = 0,003) e a velocidade da onda de cisalhamento (OR = 17,1, IC 95%: 1,137 a 257,83; p = 0,040) como fatores independentes associados a resistência arterial. CONCLUSÃO: Observou-se associação entre a rigidez do córtex do transplante renal avaliada por elastografia por onda de cisalhamento e a resistência arterial em pacientes pós-transplantados renais avaliados por Doppler.

Shear wave elastography and Doppler ultrasound in kidney transplant recipients / Elastografia por onda de cisalhamento e ultrassom Doppler em pacientes renais pós-transplantados

Abstract Objective: To evaluate the association between shear wave elastography parameters and arterial resistance in kidney transplant recipients. Materials and Methods: This was a prospective cross-sectional study involving consecutive adult kidney transplant recipients. All patients underwent color Doppler to evaluate the resistive index (RI) and ultrasound shear wave elastography for the quantification of renal allograft stiffness. Results: We evaluated 55 patients, of whom 9 (16.4%) had an RI defined as abnormal (≥ 0.79) and 46 (83.6%) had an RI defined as normal (< 0.79). The mean age was higher in the abnormal RI group than in the normal RI group (68.0 ± 8.6 years vs. 42.6 ± 14.1 years; p < 0.001), as was the mean shear wave velocity (2.6 ± 0.4 m/s vs. 2.2 ± 0.4 m/s; p = 0.013). Multivariate analysis identified two independent predictors of arterial resistance: age (OR = 1.169; 95% CI: 1.056 to 1.294; p = 0.003) and shear wave velocity (OR = 17.1; 95% CI: 1.137 to 257.83; p = 0.040). Conclusion: We observed an association between rigidity in the cortex of the transplanted kidney, as evaluated by shear wave elastography, and arterial resistance, as evaluated by color Doppler, in kidney transplant recipients.

RESUMO Objetivo: Avaliar a associação entre parâmetros de elastografia por onda de cisalhamento e resistência arterial em pacientes transplantados renais. Materiais e Métodos: Estudo transversal prospectivo. O estudo incluiu de forma consecutiva indivíduos adultos transplantados renais. Foram coletados dados demográficos e clínicos. Todos os pacientes foram submetidos à técnica ultrassonográfica para avaliação do índice de resistência (IR) e à quantificação da elasticidade do tecido por ondas de cisalhamento para avaliar a rigidez do aloenxerto renal. Resultados: Foram avaliados 55 pacientes. A média de idade e a velocidade da onda de cisalhamento foram maiores em pacientes com IR ≥ 0,79 (respectivamente, 68,0 ± 8,6 anos e 2,6 ± 0,4 m/s) quando comparados a pacientes com IR < 0,79 (respectivamente, 42,6 ± 14,1 anos, p < 0,001 e 2,2 ± 0,4 m/s, p = 0,013). A análise multivariada identificou a idade (OR = 1,169, IC 95%: 1,056 a 1,294; p = 0,003) e a velocidade da onda de cisalhamento (OR = 17,1, IC 95%: 1,137 a 257,83; p = 0,040) como fatores independentes associados a resistência arterial. Conclusão: Observou-se associação entre a rigidez do córtex do transplante renal avaliada por elastografia por onda de cisalhamento e a resistência arterial em pacientes pós-transplantados renais avaliados por Doppler.

Down syndrome and breastfeeding: A systematic review.

Several conditions related to serious difficulty in initiating and maintaining breastfeeding in neonates with Down syndrome are described in the literature. This study aimed to investigate the frequency of breastfeeding in neonates with Down syndrome, as well as the reasons for not breastfeeding, through a systematic literature review by searching MEDLINE via PubMed, Cochrane Library, Scopus, Embase via Elsevier, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Sixteen studies were included with a total sample size of 2022 children with Down syndrome. The frequency of exclusive breastfeeding was 31.6-55.4%, with five studies reporting breastfeeding for longer than 6 months. Breastfeeding from birth was present for 48-92.5% of the children with Down syndrome in six studies. Two studies reported that around 50% and 23.3% of the children with Down syndrome were never breastfed, and rates of breastfeeding in infants with Down syndrome were lower than those in controls in three studies. The reasons for not breastfeeding or cessation of breastfeeding were associated with Down syndrome-specific challenges, maternal reasons, and healthcare aspects.

Desnutrição e desfechos clínicos e nutricionais de pacientes oncológicos atendidos em um ambulatório de nutrição: um estudo transversal / Malnutrition and clinical and nutritional outcomes in patients with cancer treated at an outpatient nutrition clinic: a cross-sectional study

Introdução: O câncer causa alterações metabólicas e disfunções imunológicas e nutricionais significativas que podem acarretar desnutrição e síndrome de anorexia-caquexia. O objetivo do presente estudo foi avaliar a associação entre a Avaliação Subjetiva Global produzida pelo paciente e os desfechos clínicos e nutricionais.Métodos: Foi realizado um estudo transversal, com coletas de dados retrospectivos, de pacientes atendidos em Ambulatório de Nutrição e Oncologia de um hospital público no Rio Grande do Sul, entre Janeiro de 2018 a Janeiro de 2020. Foram incluídos adultos com diagnóstico de câncer hematológico ou tumor sólido. Os dados demográficos e clínicos foram coletados a partir de prontuário eletrônico e os dados nutricionais e sintomas coletados através da ficha de anamnese. A relação entre variáveis categóricas foi avaliada pelos testes do qui-quadrado ou exato de Fischer, e de variáveis contínuas através dos testes de Pearson ou correlação de Spearman. O nível de significância utilizado foi de 5%.Resultados: Foram avaliados 260 pacientes, sendo 51,5% do sexo feminino, a maioria de raça branca (84,2%), com idade média de 59 anos. Em relação ao diagnóstico nutricional, observou-se que 41,5% dos pacientes eram bem nutridos, 39,6% apresentavam suspeita de desnutrição ou desnutrição moderada e 18,8% eram desnutridos graves. Observou-se associação significativa entre pacientes com desnutrição (ASGPPP B e/ou C) e os seguintes desfechos: idade, óbito, tipo de câncer, em especial, esôfago, pulmão e cólon, presença de diabetes melito, tipo de tratamento clínico e via alimentar. Também foi observada associação significativa com os sintomas de disfagia, odinofagia, saciedade precoce, alteração do paladar, xerostomia e inapetência quando comparado os pacientes desnutridos com os classificados como bem nutrido.Conclusão: Observou-se associação entre os pacientes com algum grau de desnutrição e diversos sintomas que influenciam negativamente no consumo alimentar. Além disso, foi associada à localização do câncer e seu tratamento.

Introduction: Cancer causes metabolic changes and relevant immune and nutritional disorders, which can lead to malnutrition and anorexia-cachexia syndrome. The aim of the present study was to evaluate the association between the Patient-Generated Subjective Global Assessment and clinical and nutritional outcomes.Methods: This was a cross-sectional, retrospective study of patients treated at the Outpatient Nutrition and Oncology Clinic of a public hospital in Rio Grande do Sul, Brazil, between January 2018 and January 2020. Adults with a diagnosis of hematologic cancer or solid tumor were included. Demographic and clinical data were collected from electronic medical records, and nutritional data and symptoms were collected using a medical history form. The relationship between categorical variables was assessed using the chi-square test or Fischer's exact test, and continuous variables were assessed using Pearson's or Spearman's correlation. The significance level was set at 5%.Results: A total of 260 patients were evaluated, 51.5% of whom were women, mostly white (84.2%), with a mean age of 59 years. In relation to the nutritional diagnosis, 41.5% of patients were well nourished, 39.6% had suspected malnutrition or moderate malnutrition, and 18.8% were severely malnourished. There was a significant association between patients with malnutrition and the following outcomes: age, death, type of cancer (especially esophageal, lung, and colon), presence of diabetes, type of clinical treatment, and diet. Patients with malnutrition were also significantly associated with symptoms of dysphagia, odynophagia, early satiety, altered taste, dry mouth, and lack of appetite.Conclusion: Patients with some degree of malnutrition were associated with several symptoms that negatively affect food consumption, as well as with cancer site and cancer treatment.

Whole-body magnetic resonance imaging for the diagnosis of metastasis in children and adolescents: a systematic review and meta-analysis.

Whole-body magnetic resonance imaging (WB-MRI) is a noninvasive imaging method that can be used to diagnose and stage tumors, as well as to assess therapeutic responses in oncology. The objective of this meta-analysis was to evaluate the accuracy of WB-MRI for the diagnosis of metastases in pediatric patients. The following electronic databases were searched: Medline, Embase, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, Latin-American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and ClinicalTrials.gov. All of the selected studies included children and adolescents with histopathological confirmation of a primary tumor. Collectively, the studies included 118 patients ranging in age from 7 months to 19 years. The pooled sensitivity and specificity of WB-MRI were, respectively, 0.964 (95% CI: 0.944-0.978; I 2 = 0%) and 0.902 (95% CI: 0.882-0.919; I 2 = 98.4%), with an area under the curve (AUC) of 0.991. We found that WB-MRI had good accuracy for the diagnosis of metastases in pediatric patients and could therefore provide an alternative to complete the staging of tumors in such patients, being a safer option because it does not involve the use of ionizing radiation.

A ressonância magnética de corpo inteiro (WB-MRI) é um método de imagem não invasivo que pode ser usado para diagnosticar, estadiar e avaliar a resposta terapêutica em oncologia. O objetivo desta meta-análise foi avaliar a precisão do diagnóstico de WB- MRI no diagnóstico de metástases em crianças. Foram pesquisadas as seguintes bastes de dados: Medline, Embase, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, Latin-American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and ClinicalTrials.gov. Todos os estudos incluíram crianças e adolescentes com prova histopatológica de um tumor original. Os estudos selecionados incluíram 118 pacientes com idade variando de 7 meses a 19 anos. A sensibilidade e especificidade combinadas de WB-MRI foram, respectivamente, 0,964 (IC 95%: 0,944-0,978; I 2 = 0%) e 0,902 (IC 95%: 0,882-0,919; I 2 = 98,4%), com AUC de 0,991. A WB-MRI tem uma boa precisão para o diagnóstico de metástases em pediatria e pode potencialmente fornecer um método alternativo não ionizante mais seguro para completar o estadiamento da doença maligna em crianças.

Whole-body magnetic resonance imaging for the diagnosis of metastasis in children and adolescents: a systematic review and meta-analysis / A ressonância magnética de corpo inteiro no diagnóstico de metástases em crianças e adolescentes: uma revisão sistemática e meta-análise

Abstract Whole-body magnetic resonance imaging (WB-MRI) is a noninvasive imaging method that can be used to diagnose and stage tumors, as well as to assess therapeutic responses in oncology. The objective of this meta-analysis was to evaluate the accuracy of WB-MRI for the diagnosis of metastases in pediatric patients. The following electronic databases were searched: Medline, Embase, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, Latin-American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and ClinicalTrials.gov. All of the selected studies included children and adolescents with histopathological confirmation of a primary tumor. Collectively, the studies included 118 patients ranging in age from 7 months to 19 years. The pooled sensitivity and specificity of WB-MRI were, respectively, 0.964 (95% CI: 0.944-0.978; I2 = 0%) and 0.902 (95% CI: 0.882-0.919; I2 = 98.4%), with an area under the curve (AUC) of 0.991. We found that WB-MRI had good accuracy for the diagnosis of metastases in pediatric patients and could therefore provide an alternative to complete the staging of tumors in such patients, being a safer option because it does not involve the use of ionizing radiation.

Resumo A ressonância magnética de corpo inteiro (WB-MRI) é um método de imagem não invasivo que pode ser usado para diagnosticar, estadiar e avaliar a resposta terapêutica em oncologia. O objetivo desta meta-análise foi avaliar a precisão do diagnóstico de WB- MRI no diagnóstico de metástases em crianças. Foram pesquisadas as seguintes bastes de dados: Medline, Embase, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, Latin-American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and ClinicalTrials.gov. Todos os estudos incluíram crianças e adolescentes com prova histopatológica de um tumor original. Os estudos selecionados incluíram 118 pacientes com idade variando de 7 meses a 19 anos. A sensibilidade e especificidade combinadas de WB-MRI foram, respectivamente, 0,964 (IC 95%: 0,944-0,978; I2 = 0%) e 0,902 (IC 95%: 0,882-0,919; I2 = 98,4%), com AUC de 0,991. A WB-MRI tem uma boa precisão para o diagnóstico de metástases em pediatria e pode potencialmente fornecer um método alternativo não ionizante mais seguro para completar o estadiamento da doença maligna em crianças.

Can skinfold thickness equations be substituted for bioimpedance analysis in children?

Abstract Objective: The aim of the present study was to evaluate the agreement between the most used skinfold thickness equations with multi-frequency bioimpedance analysis in the prediction of body fat levels in children. Method: A cross-sectional study of healthy Brazilian community-dwelling individuals. The anthropometric assessment included height, body mass, arm circumference, and waist circumference. The percentage of body fat was obtained by measuring skinfold thickness equations and using bioimpedance analysis, and skinfold thickness was measured using a scientific skinfold caliper. Bland-Altman plot analysis was used to verify the agreement between the methods. Results: There were 439 children and adolescents evaluated, with a mean age of 11.6 ± 3.7 years. The mean body fat by bioimpedance analysis was 22.8% ± 10.4%, compared to 22.4% ± 8.8% by Slaughter (1), 20.4% ± 9.2% by Slaughter (2), 19.6% ± 4.4% by Goran, and 24.7% ± 10.0% by Huang equations. Bland-Altman plot analysis revealed limits of agreement greater than 8% between the bioimpedance analysis approach and equations, exceeding the clinically acceptable limit predefined a priori. None of the equations had good agreement with bioimpedance analysis. Conclusion: It was concluded that skinfold thickness and bioimpedance analysis should not be used interchangeably in children and adolescents.

Can skinfold thickness equations be substituted for bioimpedance analysis in children?

OBJECTIVE: The aim of the present study was to evaluate the agreement between the most used skinfold thickness equations with multi-frequency bioimpedance analysis in the prediction of body fat levels in children. METHOD: A cross-sectional study of healthy Brazilian community-dwelling individuals. The anthropometric assessment included height, body mass, arm circumference, and waist circumference. The percentage of body fat was obtained by measuring skinfold thickness equations and using bioimpedance analysis, and skinfold thickness was measured using a scientific skinfold caliper. Bland-Altman plot analysis was used to verify the agreement between the methods. RESULTS: There were 439 children and adolescents evaluated, with a mean age of 11.6±3.7 years. The mean body fat by bioimpedance analysis was 22.8%±10.4%, compared to 22.4%±8.8% by Slaughter (1), 20.4%±9.2% by Slaughter (2), 19.6%±4.4% by Goran, and 24.7%±10.0% by Huang equations. Bland-Altman plot analysis revealed limits of agreement greater than 8% between the bioimpedance analysis approach and equations, exceeding the clinically acceptable limit predefined a priori. None of the equations had good agreement with bioimpedance analysis. CONCLUSION: It was concluded that skinfold thickness and bioimpedance analysis should not be used interchangeably in children and adolescents.

Clinical Outcomes in Critically Ill Children With Excess Weight: A Retrospective Cohort Study.

BACKGROUND: Because of its high prevalence and negative impact on quality of life and longevity, overweight in childhood and adolescence is a major public health concern. The objective of the present study was to determine whether excess weight is associated with clinical outcomes in critically ill children and adolescents admitted to the pediatric intensive care unit (PICU). METHOD: This retrospective cohort study was performed with children and adolescents admitted to a PICU over 3 years. Nutrition status was classified based on the body mass index z-score for age, following World Health Organization (WHO) criteria. The following outcomes were assessed: mortality, need for mechanical ventilation, length of admission, and multiple organ dysfunction syndrome. RESULTS: Of 1468 patients admitted during the study period, 1407 were included in the study: 956 (68.0%) had adequate weight, 228 (16.2%) were overweight, and 223 (15.8%) were underweight. Associations were detected between most variables and all nutrition categories (underweight, adequate weight, and overweight). In the descriptive analysis, mortality was more prevalent in nutrition status extremes (extremely underweight or overweight). An independent association between nutrition status and mortality was not detected in any category. CONCLUSION: Nutrition status was not independently associated with poor outcomes. However, overweight should be considered a potential risk factor for adverse clinical outcomes in PICU admissions.