Accuracy of an artificial intelligence algorithm for detecting moderate-to-severe vertebral compression fractures on abdominal and thoracic computed tomography scans.

Objective: To describe the accuracy of HealthVCF, a software product that uses artificial intelligence, in the detection of incidental moderate-to-severe vertebral compression fractures (VCFs) on chest and abdominal computed tomography scans. Materials and Methods: We included a consecutive sample of 899 chest and abdominal computed tomography scans of patients 51-99 years of age. Scans were retrospectively evaluated by the software and by two specialists in musculoskeletal imaging for the presence of VCFs with vertebral body height loss > 25%. We compared the software analysis with that of a general radiologist, using the evaluation of the two specialists as the reference. Results: The software showed a diagnostic accuracy of 89.6% (95% CI: 87.4-91.5%) for moderate-to-severe VCFs, with a sensitivity of 73.8%, a specificity of 92.7%, and a negative predictive value of 94.8%. Among the 145 positive scans detected by the software, the general radiologist failed to report the fractures in 62 (42.8%), and the algorithm detected additional fractures in 38 of those scans. Conclusion: The software has good accuracy for the detection of moderate-to-severe VCFs, with high specificity, and can increase the opportunistic detection rate of VCFs by radiologists who do not specialize in musculoskeletal imaging.

Objetivo: Descrever a acurácia do software HealthVCF na detecção incidental de fraturas compressivas de corpos vertebrais moderadas a graves em exames de tomografia computadorizada do tórax e abdome. Materiais e Métodos: Foram incluídos 899 exames consecutivos de pacientes com idades entre 51 e 99 anos. As imagens foram retrospectivamente avaliadas pelo software e por dois radiologistas especializados em musculoesquelético que investigaram fraturas compressivas de corpos vertebrais com perda da altura somática > 25%. A análise comparativa foi realizada entre o software e um radiologista geral, usando a avaliação do especialista como referência. Resultados: O software apresentou uma acurácia de 89,6% (IC 95%: 87,4­91,5%) para fraturas compressivas moderadas a graves, com sensibilidade de 73,8%, especificidade de 92,7% e valor preditivo negativo de 94,8%. Entre as 145 tomografias positivas detectadas pelo software, o radiologista geral deixou de relatar as fraturas em 62 (42,8%) e o algoritmo detectou fraturas adicionais em 38 dessas tomografias. Conclusão: O software possui boa acurácia na detecção de fraturas compressivas moderadas a graves, com alta especificidade, podendo aumentar a taxa de detecção oportunística dessas fraturas por radiologistas não especializados em musculoesquelético.

Leukocyte-Rich Platelet-Rich Plasma Injection in an Acute-on-Chronic Rectus Femoris Injury of a Professional Soccer Player: A Case Report.

This is the case of an 18-year-old male professional soccer player, an attacking midfielder, who presented acute-onset pain in his right thigh during a training match but continued playing and training until the end of the session. Two weeks after the initial symptoms, the athlete's pain increased after kicking the ball and stopping training. He came for consultation a week later with tenderness in his right thigh and impaired gait. A 3 â€‹cm gap in his right mid-quadriceps muscle and tenderness during resisted knee extension and leg raises with no hip or knee range of motion limitations were observed on physical examination. He was scheduled for magnetic resonance imaging (MRI) after the consultation, revealing an acute-on-chronic type 2A lateral muscle tear of the distal rectus femoris. A 2 â€‹ml seroma aspiration was performed five weeks after the initial injury with a subsequent intra-lesional 1 â€‹ml liquid leukocyte-rich platelet-rich plasma (LR-PRP) injection using intermittent ultrasound guidance within 5 â€‹min after preparation. The LR-PRP preparation was classified as 3 14-1 3-0 0 according to the Universal Coding System (UCS) by Kon et al. Nine physiotherapy sessions, including an initial assessment, were conducted over five weeks. The rehabilitation started with pulley exercises with hip flexion, tension arch, leg extension, and squatting with supporting exercises for core and hip strength, with a gradual increase in loading. As the player's symptoms improved, he started doing eccentric exercises such as the reverse Nordics and leg extension. He also followed a running program, gradually increasing speed to a full sprint without pain or irritation. The return-to-sports clearance consultation was conducted seven weeks after the injury, previously confirming satisfactory healing on an MRI. The patient was cleared after passing the Rehabilitation Department battery tests and physical examination. The patient was asymptomatic and had no complaints despite his right quadriceps gap, returning to competition nine weeks after injury. After a one-year follow-up, the patient remains playing at a competitive level, asymptomatic, with no reported reinjury. Adequate reporting of rehabilitation programs and PRP injection characterization is crucial for future research quality improvement and reproducibility.

Timed-artificial insemination protocols for Bos indicus beef heifers: Evaluation of protocol length and variations in prostaglandin F2α treatments.

The aim was to compare reproductive outcomes of Nelore heifers submitted to timed AI (TAI) protocols, with 7 or 9 d of permanence of the intravaginal progesterone (P4) device and different times of prostaglandin F2α (PGF) administration, for first (n = 935) and second (n = 530) services. On Day -24, heifers without corpus luteum (CL) underwent a protocol for induction of ovulation. On Day 0, heifers received a P4 device (0.5 g) and 1.5 mg estradiol (E2) benzoate. In order for the TAI to be carried out on the same day, these treatments were performed 2 d later on the heifers treated with the 7-d protocol. Additionally, heifers received 0.5 mg PGF at different times, resulting in four experimental groups: 9dP4-PGFd9 (n = 365); 9dP4-PGFd7 (n = 369); 9dP4-PGFd0&9 (n = 364); 7dP4-PGFd0&7 (n = 367). These nomenclatures indicate for how many d the P4 device was kept and the specific day on which PGF was given. At P4 removal, all heifers received 0.5 mg E2 cypionate and 200 IU eCG, and TAI was performed 2 d later. Effects were considered significant when P ≤ 0.05 (superscript letters a,b) whereas a tendency was assumed when 0.05 < P ≤ 0.10. Groups 9dP4-PGFd0&9 and 7dP4-PGFd0&7 had lower percentage of heifers with CL at P4 removal. The diameter (mm) of the dominant follicle (DF) was affected by treatment at P4 removal (9dP4-PGFd9: 11.3 ± 0.3b; 9dP4-PGFd7: 11.8 ± 0.2ab; 9dP4-PGFd0&9: 12.6 ± 0.2a; 7dP4-PGFd0&7: 10.8 ± 0.2c) and at TAI (9dP4-PGFd9: 12.7 ± 0.3ab; 9dP4-PGFd7: 13.2 ± 0.2a; 9dP4-PGFd0&9: 13.4 ± 0.2a; 7dP4-PGFd0&7: 12.4 ± 0.3b). Expression of estrus (%) was affected by treatment (9dP4-PGFd9: 89.6a; 9dP4-PGFd7: 93.5a; 9dP4-PGFd0&9: 88.2ab; 7dP4-PGFd0&7: 85.6b). There were no differences among treatments for P/AI on Day 40 (30-35 d post AI), final P/AI (between Day 70 and parturition) and pregnancy loss (between Day 40 and final P/AI). When the permanence of the P4 device was compared, regardless of PGF treatments, 9-d protocols resulted in greater DF diameter at P4 removal and at TAI, and greater expression of estrus (90.4 vs. 85.6%) than the 7-d protocol. Despite that, the 7-d protocol resulted in greater P/AI on Day 40 (55.3 vs. 49.1%). In addition, there was an interaction between protocol duration and body weight, in which heavier heifers (≥ 307 kg) had greater P/AI when treated with the 7-d protocol, in comparison to 9-d. In conclusion, longer TAI protocols (9 d of P4 device duration) resulted in greater DF diameter and expression of estrus. However, the shorter TAI protocol (7 d of P4 device duration) produced greater P/AI on Day 40, particularly in heavier heifers. Within 9-d protocols, the additional dose of PGF on Day 0 or the anticipation of the PGF to Day 7 did not influence fertility.

Clinical and Genetic Characterization of a Cohort of Brazilian Patients With Congenital Ataxia.

Background and Objectives: Congenital ataxias are rare hereditary disorders characterized by hypotonia and developmental motor delay in the first few months of life, followed by cerebellar ataxia in early childhood. The course of the disease is predominantly nonprogressive, and many patients are incorrectly diagnosed with cerebral palsy. Despite significant advancements in next-generation sequencing in the past few decades, a specific genetic diagnosis is seldom obtained in cases of congenital ataxia. The aim of the study was to analyze the clinical, radiologic, and genetic features of a cohort of Brazilian patients with congenital ataxia. Methods: Thirty patients with a clinical diagnosis of congenital ataxia were enrolled in this study. Clinical and demographic features and neuroimaging studies were analyzed. Genetic testing (whole-exome sequencing) was also performed. Results: A heterogeneous pattern of genetic variants was detected. Eighteen genes were involved: ALDH5A1, BRF1, CACNA1A CACNA1G, CC2D2A, CWF19L1, EXOSC3, ITPR1, KIF1A, MME, PEX10, SCN2A, SNX14, SPTBN2, STXBP1, TMEM240, THG1L, and TUBB4A. Pathogenic/likely pathogenic variants involving 11 genes (ALDH5A1, CACNA1A, EXOSC3, MME, ITPR1, KIF1A, STXBP1, SNX14, SPTBN2, TMEM240, and TUBB4A) were identified in 46.7% of patients. Variants of uncertain significance involving 8 genes were detected in 33.3% of patients. Congenital ataxias were characterized by a broad phenotype. A genetic diagnosis was more often obtained in patients with cerebellar-plus syndrome than in patients with a pure cerebellar syndrome. Discussion: This study re-emphasizes the genetic heterogeneity of congenital ataxias and the absence of a clear phenotype-genotype relationship. A specific genetic diagnosis was established in 46.7% of patients. Autosomal dominant, associated with sporadic cases, was recognized as an important genetic inheritance. The results of this analysis highlight the value of whole-exome sequencing as an efficient screening tool in patients with congenital ataxia.

Accuracy of an artificial intelligence algorithm for detecting moderate-to-severe vertebral compression fractures on abdominal and thoracic computed tomography scans / Acurácia de um algoritmo de inteligência artificial na detecção de fraturas compressivas moderadas a graves na tomografia computadorizada abdominal e torácica

Abstract Objective: To describe the accuracy of HealthVCF, a software product that uses artificial intelligence, in the detection of incidental moderate-to-severe vertebral compression fractures (VCFs) on chest and abdominal computed tomography scans. Materials and Methods: We included a consecutive sample of 899 chest and abdominal computed tomography scans of patients 51-99 years of age. Scans were retrospectively evaluated by the software and by two specialists in musculoskeletal imaging for the presence of VCFs with vertebral body height loss > 25%. We compared the software analysis with that of a general radiologist, using the evaluation of the two specialists as the reference. Results: The software showed a diagnostic accuracy of 89.6% (95% CI: 87.4-91.5%) for moderate-to-severe VCFs, with a sensitivity of 73.8%, a specificity of 92.7%, and a negative predictive value of 94.8%. Among the 145 positive scans detected by the software, the general radiologist failed to report the fractures in 62 (42.8%), and the algorithm detected additional fractures in 38 of those scans. Conclusion: The software has good accuracy for the detection of moderate-to-severe VCFs, with high specificity, and can increase the opportunistic detection rate of VCFs by radiologists who do not specialize in musculoskeletal imaging.

Resumo Objetivo: Descrever a acurácia do software HealthVCF na detecção incidental de fraturas compressivas de corpos vertebrais moderadas a graves em exames de tomografia computadorizada do tórax e abdome. Materiais e Métodos: Foram incluídos 899 exames consecutivos de pacientes com idades entre 51 e 99 anos. As imagens foram retrospectivamente avaliadas pelo software e por dois radiologistas especializados em musculoesquelético que investigaram fraturas compressivas de corpos vertebrais com perda da altura somática > 25%. A análise comparativa foi realizada entre o software e um radiologista geral, usando a avaliação do especialista como referência. Resultados: O software apresentou uma acurácia de 89,6% (IC 95%: 87,4-91,5%) para fraturas compressivas moderadas a graves, com sensibilidade de 73,8%, especificidade de 92,7% e valor preditivo negativo de 94,8%. Entre as 145 tomografias positivas detectadas pelo software, o radiologista geral deixou de relatar as fraturas em 62 (42,8%) e o algoritmo detectou fraturas adicionais em 38 dessas tomografias. Conclusão: O software possui boa acurácia na detecção de fraturas compressivas moderadas a graves, com alta especificidade, podendo aumentar a taxa de detecção oportunística dessas fraturas por radiologistas não especializados em musculoesquelético.

Effects of forage quality and particle size on feed intake and ruminoreticulum content of goats.

The aim was to evaluate the effect of particle size and hay quality on feed intake, granulometric profile, and composition of the ruminoreticulum content in goats. We used 54 Alpine bucks in a completely randomized design with a factorial arrangement of 3 × 3. Treatments were a combination of Bermuda grass hay (Cynodon dactylon) with three quality levels: high (35 days), medium (50 days), and low (65 d) harvested at regrowth times. Were evaluated three particle sizes: small (16% ≥4.76 mm), medium (48% ≥4.76 mm), and large (75% ≥4.76 mm), which accounted for 66%, 75%, and 94% of physically effective fiber, respectively. Samples of offered diet, intake, and ruminoreticulum content were used to generate the granulometric profile. The offered diet, intake, and ruminoreticulum content presented different granulometric profiles regarding hay quality and particle size. Dry matter intake (DMI) and neutral detergent fiber intake (NDFI) increased (P < 0.05) when low-quality hay and large particles were offered. However, when particle size in low-quality hay was reduced, DMI and NDF decreased (P < 0.05). When analyzing the ruminoreticulum content (DM, NDF, peNDF, and indigestible DM), we did not observe any effect (P > 0.05) of hay quality or particle size on the variables. Thus, reducing hay quality and increasing particle size increase dry matter and fiber intake, presenting an interaction between forage quality and particle size. Forage quality and particle size promote intense selective behavior and chewing, which leads to a homogeneous content of particle profile in ruminoreticulum and a uniform average retention time.

The Decision-Making of High-Level Volleyball Setters in the 2021-2022 Volleyball Men's Superliga: Does the Opponent Matter?

Our primary objective in this study was to investigate the offensive strategies employed in the attack phase of men's volleyball, specifically focusing on side-out as stratified by the type of confrontation that was determined by the opponent's team performance. We analyzed 5524 attacking actions during 22 games of the 12 teams that participated in the Volleyball Men's Superliga (season 2021-2022). Based on their final rankings in the championship, we classified these teams into three tiers: high-performance, intermediate-performance, and low-performance. Subsequently, we examined the dynamics of these matches using Social Network Analysis. We found that the opponent teams' performance levels did not influence the game dynamics. Notably, the eigenvector values were prominently higher for Attack Zones 2 and 4, wherein the middle-blocker jumped to attack close to the setter across all networks. Thus, setters opted for traditional and low-risk strategies to minimize errors, disregarding available information about the skill level of the opposing team, making their offensive tactics predictable.

Motor imagery classification using sparse representations: an exploratory study.

The non-stationary nature of the EEG signal poses challenges for the classification of motor imagery. sparse representation classification (SRC) appears as an alternative for classification of untrained conditions and, therefore, useful in motor imagery. Empirical mode decomposition (EMD) deals with signals of this nature and appears at the rear of the classification, supporting the generation of features. In this work we evaluate the combination of these methods in a multiclass classification problem, comparing them with a conventional method in order to determine if their performance is regular. For comparison with SRC we use multilayer perceptron (MLP). We also evaluated a hybrid approach for classification of sparse representations with MLP (RSMLP). For comparison with EMD we used filtering by frequency bands. Feature selection methods were used to select the most significant ones, specifically Random Forest and Particle Swarm Optimization. Finally, we used data augmentation to get a more voluminous base. Regarding the first dataset, we observed that the classifiers that use sparse representation have results equivalent to each other, but they outperform the conventional MLP model. SRC and SRMLP achieve an average accuracy of [Formula: see text] and [Formula: see text] respectively while the MLP is [Formula: see text], representing a gain between [Formula: see text] and [Formula: see text]. The use of EMD in relation to other feature processing techniques is not superior. However, EMD does not influence negatively, there is an opportunity for improvement. Finally, the use of data augmentation proved to be important to obtain relevant results. In the second dataset, we did not observe the same results. Models based on sparse representation (SRC, SRMLP, etc.) have on average a performance close to other conventional models, but without surpassing them. The best sparse models achieve an average accuracy of [Formula: see text] among the subjects in the base, while other model reach [Formula: see text]. The improvement of self-adaptive mechanisms that respond efficiently to the user's context is a good way to achieve improvements in motor imagery applications. However, other scenarios should be investigated, since the advantage of these methods was not proven in all datasets studied. There is still room for improvement, such as optimizing the dictionary of sparse representation in the context of motor imagery. Investing efforts in synthetically increasing the training base has also proved important to reduce the costs of this group of applications.

Where is tibial edema located in cases of osteomeniscal impingement?

Objective: To characterize the location of tibial edema related to meniscal degeneration with a flap displaced into the meniscotibial recess (osteomeniscal impingement) on magnetic resonance imaging (MRI). Materials and Methods: We evaluated 40 MRI examinations of patients submitted to surgery due to inferior displacement of a meniscal flap tear into the meniscotibial recess and peripheral bone edema. Tibial edema was quantified in the coronal and axial planes. Results: On coronal MRI sequences, edema started in the tibial periphery and extended for a mean of 5.6 ± 1.4 mm, or 7.4 ± 2.1% of the tibial plateau. In the craniocaudal direction, the mean extension was 8.8 ± 2.9 mm. The mean ratio between the extent of craniocaudal and mediolateral edema was 1.6 ± 0.6. In the axial plane, the edema started in the medial periphery and extended for a mean of 6.2 ± 2.0 mm, or 8.2 ± 2.9% of the tibial plateau. In the anteroposterior measurement, the mean start and end of the edema was 21.4 ± 5.4 mm and 35.7 ± 5.7 mm, respectively, or 43.4 ± 10.2% and 72.8 ± 11.1% of the tibial plateau. Conclusion: Apparently, tibial edema resulting from osteomeniscal impingement always starts in the periphery of the meniscus. In the coronal plane, it appears to be more extensive in the craniocaudal direction than in the mediolateral direction. In the axial plane, we found it to extend, on average, approximately 6.2 mm in the mediolateral direction and to be most commonly located from the center to the posterior region of the medial tibial plateau.

Objetivo: Caracterizar a localização do edema ósseo tibial relacionado a lesão meniscal degenerativa com fragmento deslocado no recesso meniscotibial (impacto osteomeniscal) por meio de ressonância magnética (RM). Materiais e Métodos: Quarenta RMs de pacientes submetidos a cirurgia por fragmento deslocado do menisco medial no recesso meniscotibial e edema ósseo periférico foram avaliadas. Edema ósseo tibial foi quantificado nos planos coronal e axial. Resultados: No plano coronal, o edema iniciou-se na periferia tibial e estendeu-se por 5,6 ± 1,4 mm, ou 7,4 ± 2,1% do platô. Na direção craniocaudal, o edema estendeu-se em média 8,8 ± 2,9 mm. A média entre a extensão do edema craniocaudal e mediolateral foi 1,6 ± 0,6. No plano axial, o edema iniciou-se na periferia medial e estendeu-se por 6,2 ± 2,0 mm, ou 8,2 ± 2,9% da medida da tíbia. Na medida anteroposterior, o edema iniciou-se em 21,4 ± 5,4 mm e terminou em 35,7 ± 5,7 mm ou iniciou-se em 43,4 ± 10,2% e terminou em 72,8 ± 11,1% do platô tibial. Conclusão: O edema ósseo tibial relacionado aos casos de impacto osteomeniscal sempre se inicia na periferia do menisco. Ele é mais extenso na direção craniocaudal do que mediolateral no plano coronal. No plano axial, ele estende-se por 6,2 mm de medial a lateral e é mais frequentemente localizado no centro da região posterior do platô medial.

Where is tibial edema located in cases of osteomeniscal impingement? / Onde está o edema ósseo tibial em casos de impacto osteomeniscal?

Abstract Objective: To characterize the location of tibial edema related to meniscal degeneration with a flap displaced into the meniscotibial recess (osteomeniscal impingement) on magnetic resonance imaging (MRI). Materials and Methods: We evaluated 40 MRI examinations of patients submitted to surgery due to inferior displacement of a meniscal flap tear into the meniscotibial recess and peripheral bone edema. Tibial edema was quantified in the coronal and axial planes. Results: On coronal MRI sequences, edema started in the tibial periphery and extended for a mean of 5.6 ± 1.4 mm, or 7.4 ± 2.1% of the tibial plateau. In the craniocaudal direction, the mean extension was 8.8 ± 2.9 mm. The mean ratio between the extent of craniocaudal and mediolateral edema was 1.6 ± 0.6. In the axial plane, the edema started in the medial periphery and extended for a mean of 6.2 ± 2.0 mm, or 8.2 ± 2.9% of the tibial plateau. In the anteroposterior measurement, the mean start and end of the edema was 21.4 ± 5.4 mm and 35.7 ± 5.7 mm, respectively, or 43.4 ± 10.2% and 72.8 ± 11.1% of the tibial plateau. Conclusion: Apparently, tibial edema resulting from osteomeniscal impingement always starts in the periphery of the meniscus. In the coronal plane, it appears to be more extensive in the craniocaudal direction than in the mediolateral direction. In the axial plane, we found it to extend, on average, approximately 6.2 mm in the mediolateral direction and to be most commonly located from the center to the posterior region of the medial tibial plateau.

Resumo Objetivo: Caracterizar a localização do edema ósseo tibial relacionado a lesão meniscal degenerativa com fragmento deslocado no recesso meniscotibial (impacto osteomeniscal) por meio de ressonância magnética (RM). Materiais e Métodos: Quarenta RMs de pacientes submetidos a cirurgia por fragmento deslocado do menisco medial no recesso meniscotibial e edema ósseo periférico foram avaliadas. Edema ósseo tibial foi quantificado nos planos coronal e axial. Resultados: No plano coronal, o edema iniciou-se na periferia tibial e estendeu-se por 5,6 ± 1,4 mm, ou 7,4 ± 2,1% do platô. Na direção craniocaudal, o edema estendeu-se em média 8,8 ± 2,9 mm. A média entre a extensão do edema craniocaudal e mediolateral foi 1,6 ± 0,6. No plano axial, o edema iniciou-se na periferia medial e estendeu-se por 6,2 ± 2,0 mm, ou 8,2 ± 2,9% da medida da tíbia. Na medida anteroposterior, o edema iniciou-se em 21,4 ± 5,4 mm e terminou em 35,7 ± 5,7 mm ou iniciou-se em 43,4 ± 10,2% e terminou em 72,8 ± 11,1% do platô tibial. Conclusão: O edema ósseo tibial relacionado aos casos de impacto osteomeniscal sempre se inicia na periferia do menisco. Ele é mais extenso na direção craniocaudal do que mediolateral no plano coronal. No plano axial, ele estende-se por 6,2 mm de medial a lateral e é mais frequentemente localizado no centro da região posterior do platô medial.

Sensitive hydrazine detection and quantification with a fluorescent benzothiadiazole sensor: selective lipid droplets and in vivo imaging.

In this work, we describe the design, synthesis, characterization, photophysical evaluation, DFT calculations, and application of two novel fluorescent benzothiadiazole (BTD) sensors for hydrazine detection and quantification at the cellular and multicellular (in vivo) levels. The two probes were fully characterized, and their photophysical properties were evaluated. We tested the designed fluorogenic dye (named BTD-CHO) as a selective sensor for the rapid, sensitive, and selective detection of hydrazine. When treated with N2H4, the probe affords a new derivative named BTD-HZN, releasing water as the only byproduct. BTD-CHO exhibited a preference for lipid droplets (LDs) and accumulated inside these organelles. Hydrazine detection in LDs could be carried out by the in situ formation of BTD-HZN inside live cells. We efficiently visualized the lipids of a challenging cellular model, microalgae (Chlorella sorokiniana), using these sensors. In vivo experiments indicated rapid and efficient detection of the analyte using C. elegans and zebrafish (Danio rerio) as the multicellular models.

Medição automática de valva mitral a partir de ecocardiograma utilizando processamento digital de imagens / Automatic measurement of the mitral valve based on echocardiography using digital image processing

Fundamento: A avaliação da área valvar mitral por meio da reconstrução multiplano na ecocardiografia tridimensional é restrita a softwares específicos e à experiência dos ecocardiografistas. Eles precisam selecionar manualmente o frame do vídeo que contenha a área de abertura máxima da valva mitral, dimensão fundamental para a identificação de estenose mitral. Objetivo: Automatizar o processo de determinação da área de abertura máxima da valva mitral, por meio da aplicação de Processamento Digital de Imagens (PDI) em exames de ecocardiograma, desenvolvendo um algoritmo aberto com leitura de vídeo no formato avi. Método: Este estudo piloto observacional transversal foi realizado com vinte e cinco exames diferentes de ecocardiograma, sendo quinze com abertura normal e dez com estenose mitral reumática. Todos os exames foram realizados e disponibilizados por dois especialistas, com autorização do Comitê de Ética em Pesquisa, que utilizaram dois modelos de aparelhos ecocardiográficos: Vivid E95 (GE Healthcare) e Epiq 7 (Philips), com sondas multiplanares transesofágicas. Todos os vídeos em formato avi foram submetidos ao PDI através da técnica de segmentação de imagens. Resultados: As medidas obtidas manualmente por ecocardiografistas experientes e os valores calculados pelo sistema desenvolvido foram comparados utilizando o diagrama de Bland-Altman. Observou-se maior concordância entre valores no intervalo de 0,4 a 2,7 cm². Conclusão: Foi possível determinar automaticamente a área de máxima abertura das valvas mitrais, tanto para os casos advindos da GE quanto da Philips, utilizando apenas um vídeo como dado de entrada. O algoritmo demonstrou economizar tempo nas medições quando comparado com a mensuração habitual. (AU)

Background: The evaluation of mitral valve area through multiplanar reconstruction in 3-dimensional echocardiography is restricted to specific software and to the experience of echocardiographers. They need to manually select the video frame that contains the maximum mitral valve opening area, as this dimension is fundamental to identification of mitral stenosis. Objective: To automate the process of determining the maximum mitral valve opening area, through the application of digital image processing (DIP) in echocardiography tests, developing an open algorithm with video reading in avi format. Method: This cross-sectional observational pilot study was conducted with 25 different echocardiography exams, 15 with normal aperture and 10 with rheumatic mitral stenosis. With the authorization of the Research Ethics Committee, all exams were performed and made available by 2 specialists who used 2 models of echocardiographic devices: Vivid E95 (GE Healthcare) and Epiq 7 (Philips), with multiplanar transesophageal probes. All videos in avi format were submitted to DIP using the image segmentation technique. Results: The measurements obtained manually by experienced echocardiographers and the values calculated by the developed system were compared using a Bland-Altman diagram. There was greater agreement between values in the range from 0.4 to 2.7 cm². Conclusion: It was possible to automatically determine the maximum mitral valve opening area, for cases from both GE and Philips, using only 1 video as input data. The algorithm has been demonstrated to save time on measurements when compared to the usual method. (AU)

Inter e intra-variability of the best ranked teams: A network analysis in male high-level volleyball.

The present research objective was to analyze the offensive phase from Complex I in high-level male volleyball teams in a macro- and micro-level view, through the inter e intra-team variability analysis of eight best teams of the 2018 Men's Volleyball World Championship over the social network analysis and eigenvector centrality. The sample consisted of 22 matches and 2,743 offensive actions, resulting in 8 sub-networks with 368 nodes and 6221 edges. The results showed from macro view the variables that presented highest centrality values were Attack Zone 4 (range 0.56-0.90), Attack Tempo 2 (0.65-0.87), Power Attack (0.62-0.94), No Touch Block (0.61-1), Attack Effect Continuity (0.59-0.94), and Middle Blocker Centralized (0.60-0.95). In a micro view, Reception Effect, Play Position, Reception Zone, and Block Composition showed high variability in each sub-network. The intra- and inter-team variability presented the importance of to respect each team idiosyncrasies and to consider the different approaches to the game and success.

Venous thrombosis: a mimic of musculoskeletal injury on MR imaging.

Clinical signs and symptoms of venous thrombosis and musculoskeletal pathologies frequently overlap. Sometimes, patients with venous thrombosis undergo MR examinations under an equivocal suspicion of muscle, tendon or articular injury. A low pretest clinical suspicion and lack of familiarity with the conventional MR imaging signs of venous thrombosis may result in failure to diagnose venous thrombosis, delaying treatment and raising morbimortality. In MR imaging, thrombosis presents as venous ectasia with intraluminal heterogeneous content. Small vein thrombosis is often identified as having a branching aspect. Perivenous edema and inflammatory soft tissue changes may be the most prominent findings. The purpose of this paper is to illustrate MR findings of venous thrombosis in patients who underwent MR examinations due to suspected musculoskeletal pathologies. Cases of venous thrombosis in different sites of the body diagnosed through MR are presented.

Anterolateral ligament MRI of the knee in ACL injuries: MRI abnormalities association with instability.

OBJECTIVE: To evaluate anterolateral ligament abnormalities (ALL) at MRI scans and correlate with data from clinical instability tests (Lachman and pivot shift) performed under anesthesia in patients with acute anterior cruciate ligament (ACL) tears. Furthermore, perform multivariate analysis with other variables to isolate the ALL contribution to instability from other abnormalities. METHODS: Retrospective analysis of MRI and instability tests of 95 patients with ACL tears. The ALL was classified as no abnormality, abnormality without discontinuity, and discontinuity. Injuries in other knee ligament structures and menisci were also assessed. Results of instability tests (pivot shift and Lachman) with the patient anesthetized for arthroscopic ACL reconstruction were obtained from the patient database. Statistical analysis was performed using the IBM SPSS 22. RESULTS: ALL abnormalities and iliotibial band (ITB), lateral (LCL), and medial (MCL) collateral ligament injuries showed a statistically significant correlation with the pivot shift test. The ALL MRI abnormalities were associated with the high-grade pivot shift results (p < 0.0005), with an odds ratio of 55.9 for high degrees of pivot shift in patients with abnormal ALL. The logistic model for all variables analyzed with the results of the pivot shift test demonstrated that the ALL was the only variable with a statistically significant correlation in the model (p < 0.0005). CONCLUSION: MRI ALL abnormalities in patients with ACL injuries have a significant association with pivot shift test results in patients under anesthesia. The logistic model for high - grade pivot shift test results demonstrated that ALL abnormalities were the only variable with significant correlation. KEY POINTS: • Evaluating the anterolateral ligament with MRI in acute anterior cruciate ligament injuries is useful to predict higher grades of pivot shift test in the moment of the arthroscopic reconstruction. • An abnormal anterolateral ligament presented an odds ratio of 55 for high degrees of pivot shift. • ALL MRI abnormalities association with knee instability is independent from other internal knee injuries.

Patient demographic and magnetic resonance imaging evaluation of isolated posterolateral corner knee injuries.

Background: Posterolateral stability of the knee is maintained by capsular, ligamentous and tendinous structures, which collectively are known as the posterolateral corner (PLC). Injuries to the PLC of the knee rarely occur without associated anterior (ACL) or posterior cruciate (PCL) ligament tears. The main objectives of our study were to report patient demographics and magnetic resonance imaging (MRI) findings of patients with isolated PLC injuries. Methods: This study consists of a retrospective analysis of knee MRI from January 2011 to June 2016, in two hospitals in São Paulo, Brazil, where PLC injuries without associated ACL and PCL injuries were identified in MRI by two radiologists specialized in musculoskeletal injuries. Relative and absolute frequencies were used to describe the injuries of each of the PLC structures in the study cases. Results: A total of 23 cases of PLC injuries without associated cruciate ligament injuries were identified. The mean age of patients was 32.0±8.1 years and 91% patients were male. The main sport associated with isolated PLC injury was Brazilian Jiu-Jitsu (48%), followed by soccer (35%). MRI evaluations of the knees showed lateral collateral ligament (LCL) injuries in 70% of cases, popliteus tendon injuries in 26% of cases and distal biceps tendon injuries in 30% of cases. The popliteofibular ligament (PFL) was damaged in 83% of cases. An associated ALL injury was observed in 43% of cases. Conclusions: Isolated PLC injuries occurred mainly in young men when practicing Brazilian Jiu-Jitsu and soccer. The LCL was the most frequently injured larger structure in association, and the capsuloligamentous structures (PFL) were the most frequently injured structures overall. ALL injuries occurred in approximately half of the cases, most often concomitantly with LCL injuries.

Que alterações de aprendizado tiveram os residentes de obstetrícia e ginecologia durante a COVID­19? / What changes in learning have obstetrics and gynecoligic residents experienced during COVID­19?

Introdução: A pandemia da COVID-19 teve repercussão significativa na educação médica, incluindo na formação de residentes afetando o ensino presencial e levando as instituições a adotar métodos de ensino à distância. Objetivo: Avaliar a percepção dos residentes em ginecologia e obstetrícia em relação ao impacto da pandemia em seu aprendizado, identificando sua segurança ao realizarem seus atendimentos e buscando investigar se os residentes considerariam estender sua residência. Métodos: Foi utilizado um questionário com perguntas fechadas e respostas em escala Likert, abordando diferentes aspectos da residência médica durante a pandemia para atender aos objetivos. Resultados: Dos 71 residentes a maioria era de mulheres (74,65%). A análise dos dados revelou que a prática cirúrgica foi afetada para a maioria deles (85,92%), com o adiamento de operações eletivas em ginecologia (97,18%). Em relação ao aprendizado prático, 42,25% consideraram que foi parcialmente satisfatório, enquanto 14,08% o consideraram insatisfatório. No campo teórico, a percepção dos residentes foi melhor, com 43,66% considerando o aprendizado satisfatório e 47,89% parcialmente. A pandemia afetou parcialmente a residência médica para a maioria dos residentes (85,92%), e foram adotadas alternativas para substituir a falta de aulas teóricas e atividades práticas. Conclusão: A pandemia teve efeito negativo na educação médica e na formação dos residentes. A interrupção das atividades presenciais afetou tanto o aprendizado prático quanto o teórico.

Introduction: The COVID-19 pandemic had a significant impact on medical education, including the training of residents, affecting in-person teaching and leading institutions to adopt distance learning methods. Objective: To evaluate the perception of residents in gynecology and obstetrics regarding the impact of the pandemic on their learning, identifying their safety when providing care and seeking to investigate whether residents would consider extending their residency. Methods: A questionnaire with closed questions and responses on a Likert scale was used, addressing different aspects of medical residency during the pandemic to meet the objectives. Results: Of the 71 residents, the majority were women (74.65%). Data analysis revealed that surgical practice was affected for the majority of them (85.92%), with the postponement of elective operations in gynecology (97.18%). Regarding practical learning, 42.25% considered it to be partially satisfactory, while 14.08% considered it unsatisfactory. In the theoretical field, residents' perception was better, with 43.66% considering the learning satisfactory and 47.89% partially so. The pandemic partially affected medical residency for the majority of residents (85.92%), and alternatives were adopted to replace the lack of theoretical classes and practical activities. Conclusion: The pandemic had a negative effect on medical education and resident training. The interruption of face-to-face activities affected both practical and theoretical learning.

Interconsulta médico-enfermeiro na Atenção Primária à Saúde: discursos do sujeito coletivo / Doctor-nurse interconsultation in primary health care: collective subject discourses / Interconsulta médico-enfermero en la atención primaria de la salud: discursos del sujeto colectivo

Objetivando compreender a interconsulta entre médicos e enfermeiros na Atenção Primária à Saúde (APS), empreendeu-se um estudo exploratório e descritivo, qualitativo, com a técnica de grupo focal, analisado à luz do Discurso do Sujeito Coletivo. Participaram quatro enfermeiras e três médicos, cujos discursos sobre sua compreensão da interconsulta e seus formatos originaram quatro ideias centrais: 1. a interconsulta é um trabalho integrado e complementar entre categorias, protagonizado por quem iniciou o atendimento, baseado na comunicação e buscando a integralidade; 2. seu formato depende da segurança dos profissionais, do tempo trabalhando juntos, do ambiente e da demanda do paciente; 3. é importante manter o protagonismo da Enfermagem, rompendo com a lógica centrada no médico; e 4. o modelo "ping-pong" de interconsulta não é funcional. Revelou-se a interconsulta como dispositivo de cuidado bem-sucedido, desafiando a lógica centrada no médico pela atuação integrada e complementar de médicos e enfermeiros da APS.(AU)

With the aim of understanding doctor-nurse interconsultation in primary health care, we conducted a descriptive exploratory qualitative study using focus groups. The data were analyzed using collective subject discourse. Four nurses and three doctors participated in the study, whose discourses on their understanding of interconsultation and its different formats gave rise to four central ideas: interconsultation is integrated and complementary across professions, instigated by the person who began the appointment, communication-based and seeks to promote comprehensiveness; format depends on professional confidence, length of time working together, the environment and patient demands; it is important to maintain nurse protagonism, breaking with doctor-centered logic; the "ping-pong" interconsultation model does not work. The findings reveal that interconsultation is a successful care tool that challenges doctor-centered logic by promoting integrated and complementary working between doctors and nurses.(AU)

Con el objetivo de comprender la interconsulta entre médicos y enfermeros en la Atención Primaria de la Salud (APS), se realizó un estudio exploratorio y descriptivo, cualitativo, con la técnica de grupo focal, analizado a la luz del Discurso del Sujeto Colectivo. Participaron cuatro enfermeras y tres médicos, cuyos discursos sobre su comprensión de la interconsulta y sus formatos originaron cuatro Ideas Centrales: la interconsulta es un trabajo integrado y complementario entre categorías, protagonizado por quien comenzó la atención, con base en la comunicación y buscando la integralidad; su formato depende de la seguridad de los profesionales, del tiempo trabajando juntos, del ambiente y de la demanda del paciente; es importante mantener el protagonismo de la enfermería, rompiendo con la lógica médico-centrada; el modelo "ping-pong" de interconsulta no es funcional. La interconsulta se reveló como un dispositivo de cuidado exitoso, desafiando la lógica médico-centrada por la actuación integrada y complementaria de médicos y enfermeros de la APS.(AU)

Magnetic resonance imaging findings in patients with polymyalgia rheumatica.

Objective: To describe the prevalence of magnetic resonance imaging (MRI) findings in patients with the clinical diagnosis of polymyalgia rheumatica (PMR). Materials and Methods: Sixteen consecutive patients with untreated PMR, meeting the American College of Rheumatology criteria, underwent MRI examinations of the shoulder(s), hip(s), or both, depending on clinical complaints. Six patients also underwent MRI of the spine. Results: We evaluated 24 shoulders, among which we identified subacromial-subdeltoid bursitis in 21 (87.5%), glenohumeral joint effusion in 17 (70.8%), and fluid distention of the long head of the biceps tendon sheath in 15 (62.5%). Peritendinitis and capsular edema were observed in 21 (87.5%) and 17 (70.8%) shoulders, respectively. We also evaluated 17 hips, identifying hip joint effusion in 12 (70.6%), trochanteric bursitis in 11 (64.7%), peritendinitis in 17 (100%), and capsular edema in 14 (82.4%). All six of the patients who underwent MRI of the spine were found to have interspinous bursitis. Conclusion: Subacromial-subdeltoid bursitis, glenohumeral joint effusion, and hip joint effusion are common findings in patients with PMR. In addition, such patients appear to be highly susceptible to peritendinitis and capsular edema. There is a need for case-control studies to validate our data and to determine the real impact that these findings have on the diagnosis of PMR by MRI.

Objetivo: Descrever os achados de ressonância magnética (RM) mais prevalentes em pacientes com diagnóstico clínico de polimialgia reumática (PMR). Materiais e Métodos: Dezesseis pacientes com PMR não tratada, classificados pelos critérios do American College of Rheumatology, foram submetidos a RM do ombro e/ou quadril, segundo suas queixas clínicas. Seis pacientes também foram submetidos a RM da coluna. Resultados: Foram avaliados 24 ombros, identificando-se bursite subacromial-subdeltoide em 21 (87,5%), sinovite glenoumeral em 17 (70,8%) e distensão líquida da bainha do tendão da cabeça longa do bíceps em 15 (62,5%). Peritendinite e edema capsular foram observados em 21 (87,5%) e 17 (70,8%) ombros, respectivamente. Dezessete quadris foram analisados, identificando-se sinovite em 12 (70,6%), bursite trocantérica em 11 (64,7%), peritendinite em 17 (100%) e edema capsular em 14 (82,4%). Os seis pacientes que realizaram RM da coluna apresentavam bursite interespinhosa. Conclusão: Bursite subacromial-subdeltoide, sinovite glenoumeral e do quadril são achados de imagem prevalentes em pacientes com PMR. Além disso, achados como peritendinite e edema capsular tiveram alta prevalência nesses pacientes. Estudos de casocontrole devem ser realizados para validar esses dados e estabelecer o real impacto desses achados no diagnóstico de PMR.