Whole-Body MRI in Limb Girdle Muscular Dystrophy Type R1/2A: Correlation With Clinical Scores.

INTRODUCTION/AIM: The most common limb girdle muscular dystrophy (LGMD) worldwide is LGMD type R1 (LGMDR1). The aim of this study was to correlate the MRI findings with functional scores and to describe the whole-body MRI (WBMRI) pattern in a LGMDR1 Brazilian cohort. METHODS: LGMDR1 patients under follow-up in three centers were referred for the study. Clinical data were collected and a functional evaluation was performed, consisting of Gardner-Medwin and Walton (GMW) and Brooke scales. All patients underwent a WBMRI study (1.5T) with axial T1 and STIR images. Fifty-one muscles were semiquantitatively assessed regarding fatty infiltration and muscle edema. RESULTS: The study group consisted of 18 patients. The highest fatty infiltration scores involved the serratus anterior, biceps femoris long head, adductor magnus, and lumbar erector spinae. There was a latero-medial and caudo-cranial descending gradient of involvement of the paravertebral muscles, with erector spinae being significantly more affected than the transversospinalis muscles (p < 0.05). A striped appearance that has been dubbed the "pseudocollagen sign" was present in 72% of the patients. There was a positive correlation between the MRI score and GMW (Rho:0.83) and Brooke (Rho:0.53) scores. DISCUSSION: WBMRI in LGMDR1 allows a global patient evaluation including involvement of the paraspinal muscles, usually an underestimated feature in the clinical and imaging study of myopathies. Knowledge of the WBMRI pattern of LGMDR1 involvement can be useful in the diagnostic approach and in future studies to identify the best target muscles to serve as outcome measures in clinical trials.

Imaging Review of Normal and Abnormal Skeletal Maturation.

The growing skeleton undergoes well-described and predictable normal developmental changes, which may be misinterpreted a as pathologic condition at imaging. Primary and secondary ossification centers (SOCs), which form the diaphysis and the epiphysis of long bones, respectively, are formed by endochondral and intramembranous ossification processes. During skeletal maturation, the SOCs may appear irregular and fragmented, which should not be confused with fractures, osteochondritis dissecans, and osteochondrosis. These normal irregularities are generally symmetric with a smooth, round, and sclerotic appearance, which are aspects that help in the differentiation. The metaphysis, epiphysis, and growth plates or physes are common sites of injuries and normal variants in the pediatric skeleton. The metaphysis contains the newly formed bone from endochondral ossification and is highly vascularized. It is predisposed to easy spread of infections and bone tumors. The physis is the weakest structure of the immature skeleton. Injuries to this location may disrupt endochondral ossification and lead to growth disturbances. Pathologic conditions of the epiphyses may extend into the articular surface and lead to articular damage. At MRI, small and localized foci of bone marrow changes within the epiphysis and metaphysis are also a common finding. These can be related to residual red marrow (especially in the metaphysis of long bones and hindfoot), focal periphyseal edema (associated with the process of physeal closure), and ultimately to a normal ossification process. The authors review the imaging appearance of normal skeletal maturation and discuss common maturation disorders on the basis of developmental stage and location. ©RSNA, 2022.

Volume Load Rather Than Resting Interval Influences Muscle Hypertrophy During High-Intensity Resistance Training.

ABSTRACT: Longo, AR, Silva-Batista, C, Pedroso, K, de Salles Painelli, V, Lasevicius, T, Schoenfeld, BJ, Aihara, AY, de Almeida Peres, B, Tricoli, V, and Teixeira, EL. Volume load rather than resting interval influences muscle hypertrophy during high-intensity resistance training. J Strength Cond Res 36(6): 1554-1559, 2022-Interset rest interval has been proposed as an important variable for inducing muscle mass and strength increases during resistance training. However, its influence remains unclear, especially when protocols with differing intervals have equalized volume. We aimed to compare the effects of long (LI) vs. short rest interval (SI) on muscle strength (one repetition maximum [1RM]) and quadriceps cross-sectional area (QCSA), with or without equalized volume load (VL). Twenty-eight subjects trained twice a week for 10 weeks. Each subject's leg was allocated to 1 of 4 unilateral knee extension protocols: LI, SI, SI with VL -matched by LI (VLI-SI), and LI with VL-matched by SI (VSI-LI). A 3-minute rest interval was afforded in LI and VSI-LI protocols, while SI and VLI-SI employed a 1-minute interval. All subjects trained with a load corresponding to 80% 1RM. One repetition maximum and QCSA were measured before and after training. All protocols significantly increased 1RM values in post-training (p < 0.0001; LI: 27.6%, effect size [ES] = 0.90; VLI-SI: 31.1%, ES = 1.00; SI: 26.5%, ES = 1.11; and VSI-LI: 31.2%, ES = 1.28), with no significant differences between protocols. Quadriceps cross-sectional area increased significantly for all protocols in post-training (p < 0.0001). However, absolute changes in QCSA were significantly greater in LI and VLI-SI (13.1%, ES: 0.66 and 12.9%, ES: 0.63) than SI and VSI-LI (6.8%, ES: 0.38 and 6.6%, ES: 0.37) (both comparisons, p < 0.05). These data suggest that maintenance of high loads is more important for strength increases, while a greater VL plays a primary role for hypertrophy, regardless of interset rest interval.

Muscle Failure Promotes Greater Muscle Hypertrophy in Low-Load but Not in High-Load Resistance Training.

ABSTRACT: Lasevicius, T, Schoenfeld, BJ, Silva-Batista, C, Barros, TdS, Aihara, AY, Brendon, H, Longo, AR, Tricoli, V, Peres, BdA, and Teixeira, EL. Muscle failure promotes greater muscle hypertrophy in low-load but not in high-load resistance training. J Strength Cond Res 36(2): 346-351, 2022-The purpose of this study was to investigate the effects of an 8-week resistance training program at low and high loads performed with and without achieving muscle failure on muscle strength and hypertrophy. Twenty-five untrained men participated in the 8-week study. Each lower limb was allocated to 1 of 4 unilateral knee extension protocols: repetitions to failure with low load (LL-RF; ∼34.4 repetitions); repetitions to failure with high load (HL-RF; ∼12.4 repetitions); repetitions not to failure with low load (LL-RNF; ∼19.6 repetitions); and repetitions not to failure with high load (HL-RNF; ∼6.7 repetitions). All conditions performed 3 sets with total training volume equated between conditions. The HL-RF and HL-RNF protocols used a load corresponding to 80% 1 repetition maximum (RM), while LL-RF and LL-RNF trained at 30% 1RM. Muscle strength (1RM) and quadriceps cross-sectional area (CSA) were assessed before and after intervention. Results showed that 1RM changes were significantly higher for HL-RF (33.8%, effect size [ES]: 1.24) and HL-RNF (33.4%, ES: 1.25) in the post-test when compared with the LL-RF and LL-RNF protocols (17.7%, ES: 0.82 and 15.8%, ES: 0.89, respectively). Quadriceps CSA increased significantly for HL-RF (8.1%, ES: 0.57), HL-RNF (7.7%, ES: 0.60), and LL-RF (7.8%, ES: 0.45), whereas no significant changes were observed in the LL-RNF (2.8%, ES: 0.15). We conclude that when training with low loads, training with a high level of effort seems to have greater importance than total training volume in the accretion of muscle mass, whereas for high load training, muscle failure does not promote any additional benefits. Consistent with previous research, muscle strength gains are superior when using heavier loads.

Perceptual and Neuromuscular Responses Adapt Similarly Between High-Load Resistance Training and Low-Load Resistance Training With Blood Flow Restriction.

ABSTRACT: Teixeira, EL, Painelli, VdS, Schoenfeld, BJ, Silva-Batista, C, Longo, AR, Aihara, AY, Cardoso, FN, Peres, BdA, and Tricoli, V. Perceptual and neuromuscular responses adapt similarly between high-load resistance training and low-load resistance training with blood flow restriction. J Strength Cond Res 36(9): 2410-2416, 2022-This study compared the effects of 8 weeks of low-load resistance training with blood flow restriction (LL-BFR) and high-load resistance training (HL-RT) on perceptual responses (rating of perceived exertion [RPE] and pain), quadriceps cross-sectional area (QCSA), and muscle strength (1 repetition maximum [RM]). Sixteen physically active men trained twice per week, for 8 weeks. One leg performed LL-BFR (3 sets of 15 repetitions, 20% 1RM), whereas the contralateral leg performed HL-RT (3 sets of 8 repetitions, 70% 1RM). Rating of perceived exertion and pain were evaluated immediately after the first and last training sessions, whereas QCSA and 1RM were assessed at baseline and after training. Rating of perceived exertion was significantly lower (6.8 ± 1.1 vs. 8.1 ± 0.8, p = 0.001) and pain significantly higher (7.1 ± 1.2 vs. 5.8 ± 1.8, p = 0.02) for LL-BFR than that for HL-RT before training. Significant reductions in RPE and pain were shown for both protocols after training (both p < 0.0001), although no between-protocol differences were shown in absolute changes ( p = 0.10 and p = 0.48, respectively). Both LL-BFR and HL-RT were similarly effective in increasing QCSA (7.0 ± 3.8% and 6.3 ± 4.1%, respectively; both p < 0.0001) and 1RM (6.9 ± 4.1% and 13.7 ± 5.9%, respectively; both P < 0.0001), although absolute changes for 1RM in HL-RT were greater than LL-BFR ( p = 0.001). In conclusion, LL-BFR produces lower RPE values and a higher pain perception than HL-RT. However, consistent application of these approaches result in chronic adaptations so that there are no differences in perceptual responses over the course of time. In addition, muscle strength is optimized with HL-RT despite similar increases in muscle hypertrophy between conditions.

MR imaging of inherited myopathies: a review and proposal of imaging algorithms.

PURPOSE OF REVIEW: The aims of this review are to discuss the imaging modalities used to assess muscle changes in myopathies, to provide an overview of the inherited myopathies focusing on their patterns of muscle involvement in magnetic resonance imaging (MR), and to propose up-to-date imaging-based diagnostic algorithms that can help in the diagnostic workup. CONCLUSION: Familiarization with the most common and specific patterns of muscular involvement in inherited myopathies is very important for radiologists and neurologists, as imaging plays a significant role in diagnosis and follow-up of these patients. KEY POINTS: • Imaging is an increasingly important tool for diagnosis and follow-up in the setting of inherited myopathies. • Knowledge of the most common imaging patterns of muscle involvement in inherited myopathies is valuable for both radiologists and neurologists. • In this review, we present imaging-based algorithms that can help in the diagnostic workup of myopathies.

Blood Flow Restriction Does Not Promote Additional Effects on Muscle Adaptations When Combined With High-Load Resistance Training Regardless of Blood Flow Restriction Protocol.

ABSTRACT: Teixeira, EL, Ugrinowitsch, C, de Salles Painelli, V, Silva-Batista, C, Aihara, AY, Cardoso, FN, Roschel, H, and Tricoli, V. Blood flow restriction does not promote additional effects on muscle adaptations when combined with high-load resistance training regardless of blood flow restriction protocol. J Strength Cond Res 35(5): 1194-1200, 2021-The aim of this study was to investigate, during high-load resistance training (HL-RT), the effect of blood flow restriction (BFR) applied during rest intervals (BFR-I) and muscle contractions (BFR-C) compared with HL-RT alone (no BFR), on maximum voluntary isometric contraction (MVIC), maximum dynamic strength (one repetition maximum [1RM]), quadriceps cross-sectional area (QCSA), blood lactate concentration ([La]), and root mean square of the surface electromyography (RMS-EMG) responses. Forty-nine healthy and untrained men (25 ± 6.2 years, 178.1 ± 5.3 cm and 78.8 ± 11.6 kg) trained twice per week, for 8 weeks. One leg of each subject performed HL-RT without BFR (HL-RT), whereas the contralateral leg was randomly allocated to 1 of 2 unilateral knee extension protocols: BFR-I or BFR-C (for all protocols, 3 × 8 repetitions, 70% 1RM). Maximum voluntary isometric contraction, 1RM, QCSA, and acute changes in [La] and RMS-EMG were assessed before and after training. The measurement of [La] and RMS-EMG was performed during the control sessions with the same relative load obtained after the 1RM test, before and after training. Similar increases in MVIC, 1RM, and QCSA were demonstrated among all conditions, with no significant difference between them. [La] increased for all protocols in pre-training and post-training, but it was higher for BFR-I compared with the remaining protocols. Increases in RMS-EMG occurred for all protocols in pre-training and post-training, with no significant difference between them. In conclusion, despite of a greater metabolic stress, BFR inclusion to HL-RT during rest intervals or muscle contraction did not promote any additive effect on muscle strength and hypertrophy.

Varying the Order of Combinations of Single- and Multi-Joint Exercises Differentially Affects Resistance Training Adaptations.

Brandão, L, de Salles Painelli, V, Lasevicius, T, Silva-Batista, C, Brendon, H, Schoenfeld, BJ, Aihara, AY, Cardoso, FN, de Almeida Peres, B, and Teixeira, EL. Varying the order of combinations of single- and multi-joint exercises differentially affects resistance training adaptations. J Strength Cond Res 34(5): 1254-1263, 2020-Our study aimed to compare the effects of multi-joint (MJ) and single-joint (SJ) exercises, either isolated or in combination, and in different orders, on cross-sectional area (CSA) of the pectoralis major (PM) and different heads of the triceps brachii (TB), as well as on the one-repetition maximum (1-RM) in the bench press and lying barbell triceps press. Forty-three young men were randomly assigned to one of 4 possible RT protocols: barbell bench press plus lying barbell triceps press (MJ + SJ, n = 12); lying barbell triceps press plus barbell bench press (SJ + MJ, n = 10); barbell bench press (MJ, n = 10); or lying barbell triceps press (SJ, n = 11). Results showed significant within-group increases in 1-RM bench press for MJ, MJ + SJ, and SJ + MJ but not for SJ. Conversely, significantly greater within-group increases in elbow extension 1-RM were noted for SJ, MJ + SJ, and SJ + MJ but not for MJ. Significantly greater increases in PM CSA were observed for MJ, MJ + SJ, and SJ + MJ compared with SJ. Significant increases in TB CSA were noted for SJ, MJ + SJ, and SJ + MJ, but not for MJ, without observed between-group differences. Individual analysis of TB heads showed significantly greater CSA increases in the lateral head for MJ, MJ + SJ, and SJ + MJ compared with SJ. Alternatively, significantly greater increases in the long head were observed for SJ, MJ + SJ, and SJ + MJ compared with MJ. CSA increases for the medial head were statistically similar between conditions. Our findings indicate that muscular adaptations are differentially affected by performance of MJ and SJ exercises.

Differential muscle hypertrophy and edema responses between high-load and low-load exercise with blood flow restriction.

We sought to determine whether early increases in cross-sectional area (CSA) of different muscles composing the quadriceps with low-load resistance training with blood flow restriction (LL-BFR) were mainly driven by muscle hypertrophy or by edema-induced swelling. We also compared these changes to those promoted by high-load resistance training (HL-RT). In a randomized within-subject design, fifteen healthy, untrained men were submitted to magnetic resonance imaging (MRI) for CSA and edema-induced muscle swelling assessment (fast spin echo inversion recovery, FSE-STIR). MRI was performed in LL-BFR and HL-RT at baseline (W0) and after 3 weeks (W3), with a further measure after 6 weeks (W6) for HL-RT. Participants were also assessed at these time points for indirect muscle damage markers (range of motion, ROM; muscle soreness, SOR). CSA significantly increased for all the quadriceps muscles, for both LL-BFR and HL-RT at W3 (all P < .05) compared to W0. However, FSE-STIR was elevated at W3 for all the quadriceps muscles only for HL-RT (all P < .0001), not LL-BFR (all P > .05). Significant increases and decreases were shown in SOR and ROM, respectively, for HL-RT in W3 compared to W0 (both P < .05), while these changes were mitigated at W6 compared to W0 (both P > .05). No significant changes in SOR or ROM were demonstrated for LL-BFR across the study. Early increases in CSA with LL-BFR seem to occur without the presence of muscle edema, whereas initial gains obtained by HL-RT were influenced by muscle edema, in addition to muscle hypertrophy.

Magnetic resonance imaging reproducibility for rotator cuff partial tears in patients up to 60 years.

BACKGROUND: Magnetic resonance imaging (MRI) is the gold standard in diagnosing rotator cuff pathology; however, there is a lack of studies investigating the reliability agreement for supraspinatus partial-thickness tears among orthopaedic surgeons and musculoskeletal (MSK) radiologists. METHODS: Sixty digital MRI scans (1.5 Tesla) were reviewed by two orthopaedic shoulder surgeons, two MSK radiologists, two fellowship-trained shoulder surgeons, and two fellowship-trained orthopaedic surgeons at two distinct times. Thirty-two scans of partial-thickness tears and twenty-eight scans of the supraspinatus tendon with no tears were included. Supraspinatus tendonosis and tears, long head of the biceps pathology, acromial morphology, acromioclavicular joint pathology and muscle fatty infiltration were assessed and interpreted according to the Goutallier system. After a four-week interval, the evaluators were asked to review the same scans in a different random order. The statistical analyses for the intra- and interobserver agreement results were calculated using the kappa value and 95% confidence intervals. RESULTS: The intraobserver agreement for supraspinatus tears was moderate among the MSK radiologists (k = 0.589; 95% CI, 0.446-0.732) and the orthopaedic shoulder surgeons (k = 0.509; 95% CI, 0.324-0.694) and was fair among the fellowship-trained shoulder surgeons (k = 0.27; 95% CI, 0.048-0.492) and the fellowship-trained orthopaedic surgeons (k = 0.372; 95% CI, 0.152-0.592). The overall intraobserver agreement was good (k = 0.627; 95% CI, 0.576-0.678). The intraobserver agreement was moderate for biceps tendonosis (k = 0.491), acromial morphology (k = 0.526), acromioclavicular joint arthrosis (k = 0.491) and muscle fatty infiltration (k = 0.505). The interobserver agreement results for supraspinatus tears were fair and poor among the evaluators: the MSK radiologists and the orthopaedic shoulder surgeons had the highest agreement (k = 0.245; 95% CI, 0.055-0.435). CONCLUSIONS: In this sample of digital MRI scans, there was an overall good intraobserver agreement for supraspinatus partial tears; however, there were also poor and fair interobserver agreement results. The evaluators with higher levels of experience (the orthopaedic shoulder surgeons and the MSK radiologists) demonstrated better results than evaluators with lower levels of experience.

Similar Regional Hypertrophy of the Elbow Flexor Muscles in Response to Low-Load Training With Vascular Occlusion at Short Versus Long Muscle Lengths.

BACKGROUND: The regional hypertrophy response of elbow flexor muscles was compared after unilateral elbow flexion training in extended versus flexed shoulder position under vascular occlusion, which can induce muscle hypertrophy in the absence of muscle damage-induced edema/swelling. HYPOTHESIS: Hypertrophy of elbow flexor muscles would be greater in extended compared with flexed shoulder position. STUDY DESIGN: Randomized within-subject trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 21 resistance-trained men (age, 25 ± 5 years; height, 1.78 ± 0.07 m; weight, 79.3 ± 13.1 kg) performed unilateral elbow flexions with one shoulder extended/elbow flexor muscles lengthened/long muscle length (LONG) and the other flexed/elbow flexor muscles shortened/short muscle length (SHORT) under a low-load (30% 1-repetition maximum) vascular occlusion training regimen (15 repetitions per set, 4 sets per session, 4 sessions per week for 3 weeks, using 80% of vascular occlusion pressure). Magnetic resonance imaging measured elbow flexor muscles cross-sectional area (EFCSA) pre- and post-training at 45%, 65%, and 85% of humerus length. RESULTS: EFCSA significantly increased in both SHORT (P = 0.04) and LONG (P = 0.05) at 45% and 85% lengths (P < 0.01 for both). Changes in EFCSA between SHORT and LONG were statistically similar at the 45% (+6.20% vs +5.08%; Cohen d = 0.006; P = 0.98), 65% (+5.91% vs +3.83%, Cohen d = 0.28, P = 0.30), and 85% lengths (+8.51% vs +7.38%, Cohen d = 0.18,P = 0.56). CONCLUSION: Muscle hypertrophy of the elbow flexor muscles displayed a similar behavior after low-load elbow flexion training with vascular occlusion performed in the extended versus flexed shoulder position. CLINICAL RELEVANCE: Therapists, clinicians, and coaches may choose elbow flexion exercises expecting to achieve similar results for hypertrophy in this muscle group, such that exercise selection may rely on availability of equipment in the training room or personal preference.

Effects of strength and power training on neuromuscular variables in older adults.

The purpose of this study was to compare the neuromuscular adaptations produced by strength-training (ST) and power-training (PT) regimens in older individuals. Participants were balanced by quadriceps cross-sectional area (CSA) and leg-press 1-repetition maximum and randomly assigned to an ST group (n = 14; 63.6 ± 4.0 yr, 79.7 ± 17.2 kg, and 163.9 ± 9.8 cm), a PT group (n = 16; 64.9 ± 3.9 yr, 63.9 ± 11.9 kg, and 157.4 ± 7.7 cm), or a control group (n = 13; 63.0 ± 4.0 yr, 67.2 ± 10.8 kg, and 159.8 ± 6.8 cm). ST and PT were equally effective in increasing (a) maximum dynamic and isometric strength (p < .05), (b) increasing quadriceps muscle CSA (p < .05), and (c) decreasing electrical mechanical delay of the vastus lateralis muscle (p < .05). There were no significant changes in neuromuscular activation after training. The novel finding of the current study is that PT seems to be an attractive alternative to regular ST to maintain and improve muscle mass.

Imaging of Paget's Disease of Bone.

Paget's disease is a metabolic bone disorder affecting the elderly and characterized by bone resorption followed by compensatory bone formation. Radiography is the imaging modality of choice for the diagnosis whereas bone scintigraphy helps stage the extent of the disease and assess response to treatment. MRI and CT are important imaging methods in the assessment of complications and surgical planning. Osteolytic lesions of Paget's first phase present with well-defined margins on radiographs, most commonly in the femur, pelvis, and skull. Cortical thickening, trabecular coarsening, bone marrow sclerosis, and deformities of long bones are present in the mixed- and late-sclerotic phases.

Three-dimensional printing models increase inter-rater agreement for classification and treatment of proximal humerus fractures.

BACKGROUND: Proximal humerus fractures (PHF) are frequent, however, several studies show low inter-rater agreement in the diagnosis and treatment of these injuries. Differences are usually related to the experience of the evaluators and/or the diagnostic methods used. This study was designed to investigate the hypothesis that shoulder surgeons and diagnostic imaging specialists using 3D printing models and shoulder CT scans in assessing proximal humerus fractures. METHODS: We obtained 75 tomographic exams of PHF to print three-dimensional models. After, two shoulder surgeons and two specialists in musculoskeletal imaging diagnostics analyzed CT scans and 3D models according to the Neer and AO/OTA group classification and suggested a treatment recommendation for each fracture based on the two diagnostic methods. RESULTS: The classification agreement for PHF using 3D printing models among the 4 specialists was moderate (global k = 0.470 and 0.544, respectively for AO/OTA and Neer classification) and higher than the CT classification agreement (global k = 0.436 and 0.464, respectively for AO/OTA and Neer). The inter-rater agreement between the two shoulder surgeons were substantial. For the AO/OTA classification, the inter-rater agreement using 3D printing models was higher (k = 0.700) than observed for CT (k = 0.631). For Neer classification,  inter-rater agreement with 3D models was similarly higher (k = 0.784) than CT images (k = 0.620). On the other hand, the inter-rater agreement between the two specialists in diagnostic imaging was moderate. In the AO/OTA classification, the agreement using CT was higher (k = 0.532) than using 3D printing models (k = 0.443), while for Neer classification, the agreement was similar for both 3D models (k = 0.478) and CT images (k = 0.421). Finally, the inter-rater agreement in the treatment of PHF by the 2 surgeons was higher for both classifications using 3D printing models (AO/OTA-k = 0.818 for 3D models and k = 0.537 for CT images). For Neer classification, we saw k = 0.727 for 3D printing models and k = 0.651 for CT images. CONCLUSION: The insights from this diagnostic pilot study imply that for shoulder surgeons, 3D printing models improved the diagnostic agreement, especially the treatment indication for PHF compared to CT for both AO/OTA and Neer classifications On the other hand, for specialists in diagnostic imaging, the use of 3D printing models was similar to CT scans for diagnostic agreement using both classifications. TRIAL REGISTRATION: Brazil Platform under no. CAAE 12273519.7.0000.5505.

Double-Blinded Randomized Study of the Correlation between Simple Radiography and Magnetic Resonance Imaging in the Evaluation of the Critical Shoulder Angle: Reproducibility and Learning Curve.

Objective To evaluate the feasibility of magnetic resonance imaging (MRI) to obtain the critical shoulder angle (CSA) comparing the results obtained through radiography and MRI, and assess the learning curves. Methods In total, 15 patients were evaluated in a blinded and randomized way. The CSA was measured and compared among groups and subgroups. Results The mean angles measured through the radiographic images were of 34.61 ± 0.67 and the mean angles obtained through the MRI scans were of 33.85 ± 0.53 ( p = 0.29). No significant differences have been found among the groups. The linear regression presented a progressive learning curve among the subgroups, from fellow in shoulder surgery to shoulder specialist and radiologist. Conclusion There was no statistically significant difference in the X-rays and MRI assessments. The MRI seems to have its efficacy associated with more experienced evaluators. Data dispersion was smaller for the MRI data regardless of the experience of the evaluator.

Three-dimensional models increase the interobserver agreement for the treatment of proximal humerus fractures.

BACKGROUND: The agreement for the treatment of proximal humerus fractures is low. Interpretation of exams used for diagnosis can be directly associated with this limitation. This study proposes to compare the agreement between experts and residents in orthopedics for treatment indication of proximal humerus fractures, utilizing 3D-models, holography (augmented reality), x-rays, and tomography as diagnostic methods. METHODS: Twenty orthopedists (ten experts in shoulder and elbow surgery and ten experts in traumatology) and thirty resident physicians in orthopedics evaluated nine fractures of the proximal humerus, randomly distributed as x-rays, tomography, 3D-models and holography, using the Neer and AO / OTA Classifications. After, we evaluated the interobserver agreement between treatment options (conservative, osteosynthesis and arthroplasty) and whether the experience of the evaluators interfered with the results. RESULTS: The interobserver agreement analysis showed the following kappa-values: κ = 0.362 and κ = 0.306 for experts and residents (3D-models); κ = 0.240 and κ = 0.221 (X-ray); κ = 0.233 and κ = 0.123 (Tomography) and κ = 0.321 and κ = 0.160 (Holography), for experts and residents respectively. Moreover, residents and specialists were discordant in the treatment indication using Tomography as a diagnostic method (p = 0.003). The same was not seen for the other diagnostic methods (p > 0.05). CONCLUSIONS: Three-dimensional models showed, overall, the highest interobserver agreement (experts versus residents in orthopedics) for the choice of treatment of proximal humerus fractures compared to X-ray, Tomography, and Holography. Agreement in the choice of treatment among experts that used Tomography and Holography as diagnostic methods were two times higher compared to residents. TRIAL REGISTRATION: Registered in Brazil Platform under no. CAAE 12273519.7.0000.5505.

Estimating the productivity of radiologists in Brazil: the search for a benchmark.

OBJECTIVE: To determine the average productivity of radiologists, as measured by number of reports issued per 6-h shift, evaluating variables that could affect the results. MATERIALS AND METHODS: This was a study utilizing an online questionnaire sent to radiologists affiliated with the Brazilian College of Radiology and Diagnostic Imaging. The questions were related to the demographic profile and professional practice characteristics (form of remuneration, primary imaging method employed, and subspecialty) of the radiologists, as well as their individual productivity (average personal productivity) and the productivity considered reasonable in a 6-h shift. The association between productivity and the practice characteristics of the radiologists was determined by using Poisson regression to calculate the prevalence ratio. RESULTS: A total of 510 radiologists completed the questionnaire. The great majority of the respondents (84%) reported that their remuneration is directly related to their productivity. The productivity varied according to the subspecialty, work environment, and remuneration model. CONCLUSION: We demonstrated that the productivity of radiologists is associated with the characteristics of their employment. We hope that this study will encourage other studies aimed at evaluating the productive capacity of the radiologists in Brazil, addressing the various functions they perform in their daily routine, including activities other than issuing reports.

OBJETIVO: Estimar a produtividade média dos radiologistas brasileiros em número de laudos emitidos por período de trabalho de seis horas, analisando variáveis que possam influenciar os resultados. MATERIAIS E MÉTODOS: Pesquisa realizada por meio de questionários online respondidos por radiologistas brasileiros afiliados ao Colégio Brasileiro de Radiologia e Diagnóstico por Imagem. As questões incluíram dados demográficos e profissionais dos radiologistas (forma de remuneração, método de imagem de atuação e subespecialidade) e a produtividade individual e a considerada razoável em um período de seis horas de trabalho. A associação entre a produtividade e as características de trabalho dos radiologistas foi calculada pela razão de prevalência, por meio da regressão de Poisson. RESULTADOS: Ao todo, 510 radiologistas responderam ao questionário. A grande maioria dos respondedores (84%) relatou que a sua remuneração está diretamente relacionada à produtividade. A produtividade variou em função da subespecialidade de atuação, ambiente de trabalho e modelo de remuneração. CONCLUSÃO: Demonstramos a associação entre a produtividade do radiologista e as características relacionadas à forma de trabalho. Esperamos que este estudo impulsione outras pesquisas que avaliem a capacidade produtiva do radiologista brasileiro, considerando as diversas funções exercidas por este profissional em sua rotina de trabalho, contemplando outras atividades, além da emissão de laudos.

Cognitive map to support the diagnosis of solitary bone tumors in pediatric patients.

Abstract. OBJECTIVE: To present a cognitive map to support the radiological diagnosis of solitary bone tumors, as well as to facilitate the determination of the nature of the tumor (benign or malignant), in pediatric patients. MATERIALS AND METHODS: We selected 28 primary lesions in pediatric patients, and we identified the findings typically associated with each of the diagnoses. The method used for the construction of the final cognitive map was the Bayesian belief network model with backward chaining. RESULTS: We developed a logical, sequential structure, in the form of a cognitive map, based on the Bayesian belief network model, with the intention of simulating the sequence of human thinking, in order to minimize the number of unnecessary interventions and iatrogenic complications arising from the incorrect evaluation of bone lesions. CONCLUSION: With this map, it will be possible to develop an application that will provide support to physicians and residents, as well as contributing to training in this area and consequently to a reduction in diagnostic errors in patients with bone lesions.

OBJETIVO: Apresentar um mapa cognitivo para suporte na determinação da natureza benigna ou maligna, bem como no diagnóstico radiológico, de tumores ósseos solitários na faixa etária pediátrica. MATERIAIS E MÉTODOS: Foi realizada uma seleção de 28 lesões principais na faixa etária pediátrica e dos achados característicos e associados a cada um desses diagnósticos. O método utilizado para a construção da estrutura cognitiva final foi o modelo de rede de crenças bayesianas com a técnica de encadeamento regressivo. RESULTADOS: Foi desenvolvida uma estrutura lógica e sequencial no formato de um mapa cognitivo, segundo o modelo de rede de crenças bayesianas, na tentativa de simular o raciocínio humano sequencial e minimizar esforços e iatrogenias oriundas da avaliação equivocada de lesões ósseas. CONCLUSÃO: Com base nesse mapa, será possível oferecer um aplicativo para apoio a profissionais e residentes médicos e colaborar com o treinamento nessa área e, consequentemente, diminuir erros no diagnóstico de uma lesão óssea.

Effects of different strength training frequencies during reduced training period on strength and muscle cross-sectional area.

This study investigated the effects of different reduced strength training (RST) frequencies on half-squat 1 RM and quadriceps cross-sectional area (QCSA). Thirty-three untrained males (24.7 ± 3.9 years; 1.73 ± 0.08 m; 74.6 ± 8.4 kg) underwent a 16-week experimental period (i.e. eight weeks of strength training [ST] followed by additional eight weeks of RST). During the ST period, the participants performed 3-4 sets of 6-12 RM, three sessions/week in half-squat and knee extension exercises. Following ST, the participants were randomly allocated to one of three groups: reduced strength training with one (RST1) or two sessions per week (RST2), and ceased training (CT). Both RST1 and RST2 groups had their training frequency and total training volume-load (i.e. RST1 = 50.3% and RST2 = 57.1%) reduced, while the CT group stopped training completely. Half-squat 1 RM (RST1 = 27.9%; RST2 = 26.7%; and CT = 28.4%) and QCSA (RST1 = 6.1%; RST2 = 6.9%; and CT = 5.8%) increased significantly (p < .05) in all groups after eight weeks of ST. No significant changes were observed in 1 RM and QCSA for RST1 and RST2 groups after the RST period, while the CT group demonstrated a decrease in half-squat 1 RM (22.6%) and QCSA (5.4%) when compared to the ST period (p < .05). In conclusion, different RST frequencies applied were able to maintain muscle mass and strength performance obtained over the regular ST period. Thus, it appears that RST frequency does not affect the maintenance of muscle mass and strength in untrained males, as long as volume-load is equated between frequencies.