In clinical setting, there is a high correlation between the GRE and SE MRE stiffness measurements, independently of the degree of liver fat infiltration measured by PDFF. A strong correlation between SE-MRE sequences is found even in patients with iron overload.  Advances in knowledge: Our study addresses liver iron and fat content simultaneously to describing the technical feasibility and correlation between different MRE sequences in consecutive unselected patients refereed for liver MRI. EPI SE-MRE should be considered an optimal alternative to assess liver fibrosis in patients in whom GRE-MRE failures, such as iron-overloaded, in pediatric, elderly, or severely ill populations.

Objectives Recently, controlled attenuation parameter (CAP) was incorporated for XL probe. However, its performance through M and XL probes has been scarcely evaluated in nonalcoholic fatty liver disease (NAFLD). The performance of probes regarding transient elastography by Fibroscan is still under debate. Aim Compare the performance of CAP and transient elastography in NAFLD patients obtained through XL with M probes using histological analysis as gold standard. Methods NAFLD patients underwent liver biopsy and FibroScan/CAP with M and XL probes the same day. C-statistic evaluated CAP performance in the identification of moderate/severe (≥33%) and severe (≥66%) steatosis by both probes and transient elastography performance for identification of significant fibrosis (≥F2). Results Eighty-one patients (74% female; age 54.2 ± 9.9 years; BMI 32.8 ± 5.2/ BMI ≥ 25 92.6%; 96% metabolic syndrome; 60% diabetes mellitus) were included. Mean CAP with M and XL probes was 314 ± 39 and 325 ± 47 dB/m, respectively. The areas under receiver operating characteristic curves (AUROCs) of the M and XL probes for steatosis detection ≥33% were 0.75 (0.64–0.84) and 0.76 (0.65–0.84) (P = 0.95) and for steatosis ≥66% 0.83 (0.73–0.90) and 0.82 (0.71–0.89) (P = 0.73), respectively, with similar performances for both degrees of steatosis. Regarding transient elastography, AUROCs of M and XL probes for ≥F2 were 0.82 (0.71–0.93) and 0.80 (0.69–0.92) (P = 0.66). Conclusion Performance of M and XL probes is similar for the diagnosis of moderate and severe steatosis and significant fibrosis even on a overweight population with NAFLD.

O objetivo deste artigo é sustentar a hipótese de uma precariedade subjetiva como face fundamental do fenômeno da terceirização. Para isso, primeiramente foi desenvolvido o argumento de que o fenômeno da terceirização precisa ser compreendido como parte de um processo histórico mais amplo, caracterizado pela transformação do modo de produção fordista no de produção flexível. Numa segunda parte, analisou-se o fenômeno da terceirização em um setor específico do mundo do trabalho, qual seja, dos trabalhadores de telemarketing e call center ou, como serão chamados, dos teleatendentes. Para isso foi realizada revisão bibliográfica de livros e artigos, bem como de uma análise documental com base nos arquivos do Departamento de Saúde do Sindicato dos Trabalhadores em Telecomunicações do Rio de Janeiro (Sinttel Rio) e em dados da Previdência Social do Brasil. Visa-se nesse momento compreender a lógica de funcionamento das empresas terceirizadas desse setor, assim como as relações entre trabalho e adoecimento, próprias desse campo de atividade. Por fim, numa última parte, foram analisadas relações existentes entre terceirização e precariedade subjetiva, que se evidencia, conforme nossa análise, pela fragmentação dos laços sociais, pelo crescimento do assédio moral, pelo medo da exclusão, pela extrema vigilância, pela falta de autonomia, pelo individualismo competitivo e pela impotência.

Introduction and objectives Liver stiffness measurement (LSM) by transient elastography has been validated to predict high-risk varices (HRV). We aimed to evaluate the accuracy of shear-wave elastography (SWE) and platelet count (Baveno VI criteria) to rule out HRV in patients with compensated advanced chronic liver disease (c-ACLD). Methods This retrospective study analyzed data of patients with c-ACLD (transient elastography ≥ 10 kPa) submitted to two-dimensional SWE (2D-SWE) (GE-LOGIQ-S8) and/or point SWE (p-SWE) (ElastPQ) who had a gastrointestinal endoscopy within 24 months. HRV definition was a large size and presence of red wale marks or sequelae from previous treatment. Optimal thresholds of SWE systems for HRV were identified. The proportion of spared gastrointestinal endoscopies and missing HRV considering a favorable SWE Baveno VI criteria were assessed. Results Eighty patients [36% male, median age = 63 (interquartile range, 57–69) years] were included. The prevalence of HRV was 34% (n = 27/80). The optimal thresholds to predict HRV were 10 kPa and 12 kPa for 2D-SWE and p-SWE, respectively. A favorable 2D-SWE Baveno VI criteria (LSM < 10 kPa and platelets count > 150 × 109/mm3) avoided 19% of gastrointestinal endoscopies without missing HRVs. A favorable p-SWE Baveno VI criteria (LSM < 12 kPa and platelets count > 150 × 109/mm3) spared 20% of gastrointestinal endoscopy without missing HRVs. Using a lower threshold of platelet count (<110 × 109/mm3, expanded Baveno VI), 2D-SWE (<10 kPa) avoided 33% of gastrointestinal endoscopy with 8% of missing HRVs, while p-SWE (<12 kPa) avoided 36% of gastrointestinal endoscopy with 5% of missing HRVs. Conclusion LSM by p-SWE or 2D-SWE combined with platelet count (Baveno VI criteria) can spare a considerable number of gastrointestinal endoscopies missing a negligible proportion of HRV.