Enxerto pediculado de omento maior como adjuvante no tratamento de osteomielite de tíbia em cão - relato de caso / [Greater omentum pedicle flap as adjunctive treatment of tibial osteomyelitis in a dog - case report]

A osteomielite é um desafio terapêutico em ortopedia, capaz de retardar ou mesmo impedir a consolidação óssea. O omento, há anos, tem sido empregado como alternativa em diferentes procedimentos cirúrgicos, por sua capacidade, entre outras, de angiogênese, sendo aplicado na ortopedia veterinária quando há o risco de não união óssea. Neste caso, um cão Fila Brasileiro foi submetido à realização de enxerto com retalho pediculado de omento maior, após osteomielite resistente presente em osteossíntese de fratura múltipla de tíbia aberta grau II. Durante 16 dias, manteve-se a comunicação do retalho, mas, diante do risco de peritonite, o pedículo foi seccionado. Numa sequência de intervenções cirúrgicas, após 89 dias, houve cicatrização óssea e remissão da osteomielite, mesmo na presença de bactérias multirresistentes. Neste relato, o omento foi efetivo como terapia adjuvante no tratamento da osteomielite e garantiu o retorno da função do membro.(AU)

Osteomyelitis is a therapeutic challenge in orthopedics, capable of delaying or even preventing bone healing. The omentum has been used in different surgical procedures as an alternative for its capacity, among others, of angiogenesis, being applied in veterinary orthopedics, when there is a risk of non-union of bone. In this case, a Brazilian row dog was submitted to grafting with pedicle flap of greater omentum, after resistant osteomyelitis present in open fracture osteosynthesis of open tibia grade II. For 16 days the communication of the flap was maintained, but at the risk of peritonitis, the pedicle was sectioned. In a sequence of surgical interventions, after 89 days, there was bone healing and remission of osteomyelitis, even in the presence of multi-resistant bacteria. In this report, the omentum was effective as adjuvant therapy in the treatment of osteomyelitis and guaranteed the return of limb function.(AU)

CONSENSUS REPORT: Recognizing non-melanoma skin cancer, including actinic keratosis, as an occupational disease - A Call to Action.

1. Non-melanoma skin cancer (NMSC) is by far the most common cancer diagnosed in westernized countries, and one of the few almost preventable cancers if detected and treated early as up to 90% of NMSC may be attributed to excessive exposure to ultraviolet radiation. 2. The incidence of NMSC is increasing: 2-3 million people are diagnosed worldwide annually, with an average yearly increase of 3-8% among white populations in Australia, Europe, the US and Canada over the last 30 years. 3. The link between solar ultraviolet (UV) radiation and certain forms of NMSC is clearly recognized. It is estimated that outdoor workers are exposed to an UV radiation dose 2-3 times higher than indoor workers, and there is a growing body of research linking UV radiation exposure in outdoor workers to NMSC: I. Occupationally UV-exposed workers are at least at a 43% higher risk of basal cell carcinoma (BCC) and almost doubled risk of squamous cell carcinoma (SCC) compared to the average population, with risk increasing with decreasing latitude. II. The risk for BCC, SCC and actinic keratosis (AK) among workers who have worked outdoors for more than 5 years is 3-fold higher than the risk among those with no years of working outdoors. 4. Primary prevention, early detection, treatment and regular follow-up of skin cancer (NMSC and melanoma) are shown to be beneficial from a health economic perspective. 5. Action is needed at international, European and national level to legislate for recognizing AK and NMSC as an occupational disease, which has the potential to improve access to compensation and drive preventative activities. 6. This report is a Call to Action for: I. The engagement of key stakeholders, including supranational institutions, national governments, trade organizations, employers, workers and patient organizations to drive change in prevention and protection of at-risk groups. II. Employers should be obliged to prevent outdoor worker's UV exposure from exceeding limit values, and to implement occupational skin cancer screening programmes among the at-risk workforce. III. Educational programmes for the outdoor workforce are needed to improve health literacy and drive behavioural change. IV. Nationally, steps to improve notifications and surveillance of skin cancers through both occupational services and public health programmes are required. V. Future research activities should focus on the precise definition of at-risk groups among outdoor workers through increased data gathering, including UV-dosimetry, and evaluation.

Musculoskeletal ultrasound in Paediatric Rheumatology: a retrospective analysis.

OBJECTIVES: Musculoskeletal Ultrasound (MSK-US) has become increasingly important in the diagnosis and follow-up of children with rheumatic diseases. We describe the experience of a large Portuguese centre and study the added value of MSK-US in the clinical assessment of paediatric rheumatic diseases. MATERIAL AND METHODS: Patients were observed by assistant Rheumatologists, a clinical diagnosis was assigned and MSK-US requested. 330 MSK-US exams were performed to 222 children with rheumatic inflammatory diseases. The children's ages were between 1 and 18 years (mean=11.7±4.7 years) and 67.6% were female. Synovial membrane proliferation, intra-articular effusion, cartilage abnormalities, erosions and periarticular affections were searched in each joint. Clinical and ultrasonography data were compared. RESULTS: MSK-US detected synovitis in 100 of 194 exams (51.5%) of patients with that clinical information and in 36 of 136 exams (26.5%) of patients who presented other clinical findings. In those in which MSK-US did not confirm the clinical information of synovitis (94; 48.5%), we detected tenosynovitis/tendinopathy in 13 cases (13.8%) and synovial cyst in four (4.3%). The remaining patients had no ultrasonography changes and MSK-US helped to exclude synovitis. The sensitivity for arthritis clinical assessment was good (73.5%), with modest specificity (51.5%), an accuracy of 60.6% and precision of 51.5%. Ultrasonography synovitis was mostly found in the knee (37.5%), followed by the ankle (22.8%) and hip (10.3%). Overall, 39 exams showed ultrasonographic tenosynovitis/tendinopathy, 15 of which had the same clinical diagnosis. Tenosynovitis/tendinopathy was mostly found in the ankle (59.0%) and knee (23.1%) areas. CONCLUSIONS: MSK-US is an important aid to clinical evaluation, allowing both the detection and exclusion of joint pathology in children, contributing to a better assessment.

Effects of 174 G/C polymorphism in the promoter region of the interleukin-6 gene on plasma IL-6 levels and muscle strength in elderly women

We investigated the effect of -174 G/C single-nucleotide polymorphism in the promoter region of the IL6 gene on plasma IL-6 levels and muscle strength, and the relationship between IL-6 levels and muscle strength in elderly women. The sample consisted of 199 elderly residents (73.0 ± 7.8 years old) from rest homes and the community in Belo Horizonte, MG, Brazil. -174 G/C polymorphism was determined by direct sequencing of the product by PCR, and plasma IL-6 concentrations were measured by ELISA. Muscle strength in the knee joint was evaluated using a Biodex System 3 Pro® isokinetic dynamometer. ANCOVA was used to determine the effect of polymorphism on IL-6 levels and muscle strength, and the Pearson correlation coefficient to assess the relationship between IL-6 levels and muscle strength. -174 G/C polymorphism was associated with the plasma IL-6 levels of elderly women (P < 0.01) since homozygotes for the G allele showed high IL-6 levels (GG 3.85 pg/mL, GC + CC 2.13 pg/mL). There was no association of polymorphism on muscle strength (P > 0.05). No association was found between IL-6 levels and knee extensor muscle (r = 0.087, P = 0.306) or flexor (r = -0.011, P = 0.894) strength. An interaction between -174 G/C polymorphism and housing conditions of the sample of elderly women was identified, with the effect of genotype on IL-6 levels being higher in the institutionalized elderly. These results support the evidence that -174 G/C polymorphism of the IL6 gene associates with individual variability of plasma IL-6 levels in elderly women.

Effects of 174 G/C polymorphism in the promoter region of the interleukin-6 gene on plasma IL-6 levels and muscle strength in elderly women.

We investigated the effect of -174 G/C single-nucleotide polymorphism in the promoter region of the IL6 gene on plasma IL-6 levels and muscle strength, and the relationship between IL-6 levels and muscle strength in elderly women. The sample consisted of 199 elderly residents (73.0 ± 7.8 years old) from rest homes and the community in Belo Horizonte, MG, Brazil. -174 G/C polymorphism was determined by direct sequencing of the product by PCR, and plasma IL-6 concentrations were measured by ELISA. Muscle strength in the knee joint was evaluated using a Biodex System 3 Pro® isokinetic dynamometer. ANCOVA was used to determine the effect of polymorphism on IL-6 levels and muscle strength, and the Pearson correlation coefficient to assess the relationship between IL-6 levels and muscle strength. -174 G/C polymorphism was associated with the plasma IL-6 levels of elderly women (P < 0.01) since homozygotes for the G allele showed high IL-6 levels (GG 3.85 pg/mL, GC + CC 2.13 pg/mL). There was no association of polymorphism on muscle strength (P > 0.05). No association was found between IL-6 levels and knee extensor muscle (r = 0.087, P = 0.306) or flexor (r = -0.011, P = 0.894) strength. An interaction between -174 G/C polymorphism and housing conditions of the sample of elderly women was identified, with the effect of genotype on IL-6 levels being higher in the institutionalized elderly. These results support the evidence that -174 G/C polymorphism of the IL6 gene associates with individual variability of plasma IL-6 levels in elderly women.

Muscle strength, muscle balance, physical function and plasma interleukin-6 (IL-6) levels in elderly women with knee osteoarthritis (OA).

An increased circulating level of inflammatory cytokines has been associated with sarcopenia, functional disability, chronic diseases, and mortality in the elderly. Osteoarthritis (OA) is a disease common to this population, the seriousness of articular degeneration has been associated to the increase in some cytokines, IL-6 among them. The aim of the present study was to correlate IL-6 plasma levels with muscle strength, endurance, muscle balance hamstring/quadriceps (H/Q) and physical function in 80 elderly women (71.2 ± 5.3) with knee OA. IL-6 was measured using enzyme-linked immunosorbent assay (ELISA). Quadriceps and hamstring muscle strength, endurance and hamstring-quadriceps muscle balance were assessed using a Biodex system 3 pro(®) isokinetic dynamometer. Physical function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Spearman's correlation coefficient was used to explore the relationship between the outcomes at the significance level of α=0.05. IL-6 was inversely correlated to the endurance of the hamstring muscles (r=-0.232; p=0.03) and muscle balance (H/Q) on the lower right side at 180°/s (r=-0.254; p=0.023). No significant correlation between IL-6, muscle strength and physical function was found. Our results show that elevated levels of IL-6 may possibly contribute to the reduction of the endurance of hamstring muscles and H/Q muscle balance in the elderly studied.

Muscle strength but not functional capacity is associated with plasma interleukin-6 levels of community-dwelling elderly women

The association of plasma interleukin-6 (IL-6) levels, muscle strength and functional capacity was investigated in a cross-sectional study of community-dwelling elderly women from Belo Horizonte, Brazil. Elderly people who present controlled chronic diseases with no negative impact on physical, psychosocial and mental functionality are considered to be community-dwelling. Psychological and social stress due to unsuccessfully aging can represent a risk for immune system disfunctions. IL-6 levels, isokinetic muscle strength of knee flexion/extension, and functional tests to determine time required to rise from a chair and gait velocity were measured in 57 participants (71.21 ± 7.38 years). Serum levels of IL-6 were measured in duplicate and were performed within one single assay (mouse monoclonal antibody against IL-6; High-Sensitivity, Quantikine®, R & D Systems, USA; intra-assay coefficient of variance = 6.9-7.4 percent; interassay coefficient of variance = 9.6-6.5 percent; sensitivity = 0.016-0.110 pg/mL; mean = 0.039 pg/mL). Muscle strength was assessed with the isokinetic dynamometer Biodex System 3 Pro®. After the Shapiro-Wilk normality test was applied, correlations were investigated using Spearman and Kruskal-Wallis tests. Post hoc analysis was performed using the Dunn test. A significant negative correlation was observed between plasma IL-6 levels (1.95 ± 1.77 pg/mL) and muscle strength for knee flexion (70.70 ± 21.14 percent; r = -0.265; P = 0.047) and extension (271.84 ± 67.85 percent; r = -0.315; P = 0.017). No significant correlation was observed between IL-6 levels and the functional tests (time to rise from a chair = 14.65 ± 2.82 s and gait velocity = 0.95 ± 0.14 m/s). These results suggest that IL-6 is associated with reduced muscle strength.

Muscle strength but not functional capacity is associated with plasma interleukin-6 levels of community-dwelling elderly women.

The association of plasma interleukin-6 (IL-6) levels, muscle strength and functional capacity was investigated in a cross-sectional study of community-dwelling elderly women from Belo Horizonte, Brazil. Elderly people who present controlled chronic diseases with no negative impact on physical, psychosocial and mental functionality are considered to be community-dwelling. Psychological and social stress due to unsuccessfully aging can represent a risk for immune system disfunctions. IL-6 levels, isokinetic muscle strength of knee flexion/extension, and functional tests to determine time required to rise from a chair and gait velocity were measured in 57 participants (71.21 +/- 7.38 years). Serum levels of IL-6 were measured in duplicate and were performed within one single assay (mouse monoclonal antibody against IL-6; High-Sensitivity, Quantikine, R & D Systems, USA; intra-assay coefficient of variance = 6.9-7.4%; interassay coefficient of variance = 9.6-6.5%; sensitivity = 0.016-0.110 pg/mL; mean = 0.039 pg/mL). Muscle strength was assessed with the isokinetic dynamometer Biodex System 3 Pro. After the Shapiro-Wilk normality test was applied, correlations were investigated using Spearman and Kruskal-Wallis tests. Post hoc analysis was performed using the Dunn test. A significant negative correlation was observed between plasma IL-6 levels (1.95 +/- 1.77 pg/mL) and muscle strength for knee flexion (70.70 +/- 21.14%; r = -0.265; P = 0.047) and extension (271.84 +/- 67.85%; r = -0.315; P = 0.017). No significant correlation was observed between IL-6 levels and the functional tests (time to rise from a chair = 14.65 +/- 2.82 s and gait velocity = 0.95 +/- 0.14 m/s). These results suggest that IL-6 is associated with reduced muscle strength.

Muscular function and functional mobility of faller and non-faller elderly women with osteoarthritis of the knee

Falls are a major concern in the elderly population with chronic joint disease. To compare muscular function and functional mobility among older women with knee osteoarthritis with and without a history of falls, 15 elderly women with a history of falls (74.20 ± 4.46 years) and 15 without a history of falls (71.73 ± 4.73 years) were studied. Muscular function, at the angular speed of 60, 120, and 180°/s, was evaluated using the Biodex Isokinetic Dynamometer. The sit-to-stand task was performed using the Balance Master System and the Timed Up and Go test was used to determine functional mobility. After collection of these data, the history of falls was investigated. A statistically significant difference was detected in the time taken to transfer the center of gravity during the sit-to-stand test (means ± SD; non-fallers: 0.35 ± 0.16 s; fallers: 0.55 ± 0.32 s; P = 0.049, Student t-test) and in the Timed Up and Go test (medians; non-fallers: 10.08 s; fallers: 11.59 s; P = 0.038, Mann-Whitney U-test). The results indicated that elderly osteoarthritic women with a history of falls presented altered functional mobility and needed more time to transfer the center of gravity in the sit-to-stand test. It is important to implement strategies to guarantee a better functional performance of elderly patients to reduce fall risks.

Nível de atividade física, dor e edema e suas relações com a disfunção muscular do joelho de idosos com osteoartrite / Physical activity levels, pain and swelling and their relationships with knee muscle dysfunction in elderly people with osteoarthritis

CONTEXTUALIZAÇÃO: O decréscimo da função dos músculos quadríceps (Q) e isquiotibiais (IT) apresenta-se potencializado na população idosa com osteoartrite (OA) de joelhos, podendo ser atribuído ao menor nível de atividade física (NAF) ou à dor e ao edema. OBJETIVOS: Comparar o desempenho de Q e IT de idosos assintomáticos e com OA de joelhos e correlacionar tal desempenho com a dor e o edema. MÉTODOS: A amostra constitui-se de quinze idosos com OA de joelho bilateral (grupo OA) e quinze assintomáticos (grupo AS). O dinamômetro isocinético, Biodex System 3-Pro, foi utilizado para avaliar a performance muscular e a escala visual análoga (EVA) numérica para registro da dor. O edema foi avaliado por teste manual. Teste t-Student foi empregado para comparar as variáveis demográficas, antropométricas, trabalho de Q (TRAB Q), de IT (TRAB IT) e Relação IT/Q. Teste Qui-quadrado foi utilizado para a comparação do NAF e o coeficiente de Spearman para verificar correlação entre as variáveis edema e dor com TRAB Q, TRAB IT e Relação IT/Q. RESULTADOS: Não houve diferença estatisticamente significante entre as variáveis antropométricas, demográficas e NAF (p>0,05). TRAB Q apresentou-se estatisticamente menor (p=0,001) no grupo OA e a Relação IT/Q, mostrou-se estatisticamente maior neste grupo (p=0,04). Não houve correlação entre as variáveis dor e edema com TRAB Q, TRAB IT e Relação IT/Q (rho < -0,468; p > 0,229). CONCLUSÃO: A redução da função muscular dos idosos com OA de joelhos não pode ser atribuída unicamente a um menor NAF desta população.

BACKGROUND: Decreased quadriceps and hamstring muscle function appears to be greater in the elderly population with knee osteoarthritis. This may be due to lower physical activity levels or to pain and swelling. OBJECTIVE: To compare quadriceps and hamstring performance in elderly people with and without knee osteoarthritis and to correlate this with pain and swelling. METHOD: The sample was composed of 15 elderly people with bilateral knee osteoarthritis (osteoarthritis group) and 15 asymptomatic elderly people (asymptomatic group). The Biodex System 3-Pro® isokinetic dynamometer was used to evaluate muscle performance, and a visual analog scale (VAS) to register the pain. The swelling was assessed by a manual test. Student's t test was applied to compare the demographics, anthropometric variables, quadriceps work, hamstring work and hamstring/quadriceps ratio. The chi-squared test was used to compare physical activity levels and Spearman coefficients to verify correlations between the swelling and pain variables and the quadriceps work, hamstring work and hamstring/quadriceps ratio. RESULTS: No statistically significant differences were detected between the anthropometric variables, demographics and physical activity levels (p > 0.05). Quadriceps work was statistically smaller (p = 0.001) in the osteoarthritis group and the hamstring/quadriceps ratio was statistically larger in this group (p = 0.04). There was no correlation between the pain and swelling variables and the quadriceps work, hamstring work and hamstring/quadriceps ratio (rho < -0.468; p > 0.229). CONCLUSION: The reduced muscle function among elderly people with knee osteoarthritis cannot solely be attributed to the lower physical activity levels of this population.

Relação entre intensidade de dor e capacidade funcional em indivíduos obesos com osteoartrite de joelho / Relationship between pain intensity and functional capacity of obese individuals with knee osteoarthritis

CONTEXTUALIZAÇÃO: A osteoartrite (OA) de joelho é uma doença crônica que acomete a cartilagem articular, provocando alterações ósseas, dor e rigidez à movimentação. A obesidade é um dos seus principais fatores de risco. As queixas de dificuldades funcionais são freqüentes, especialmente para a locomoção, que se torna mais lenta. Com os crescentes níveis de obesidade no Brasil, torna-se importante compreender como a OA de joelho afeta a capacidade funcional humana, a fim de se elaborar medidas de tratamento e prevenção. OBJETIVO: Analisar a influência da intensidade de dor, gravidade radiográfica, grau de obesidade e duração dos sintomas na capacidade funcional de indivíduos obesos com OA de joelho. MÉTODO: A intensidade de dor foi medida pelo questionário Western Ontario and McMaster Universities Index (WOMAC) e durante os testes funcionais. A gravidade radiográfica foi analisada pela classificação Kellgren-Lawrence e o grau de obesidade pelo índice de massa corporal (IMC). Foram realizados quatro testes funcionais de velocidade: marcha usual e rápida, subir e descer escadas. RESULTADOS: A amostra foi constituída de 31 mulheres e 4 homens, com idade média de 51,65 ± 10,72 anos e IMC médio de 41,16 ± 8,37 kg/m². As atividades em escadas estavam associadas a níveis mais intensos de dor. Apenas a intensidade de dor apresentou correlações significativas com os resultados nos testes de velocidade. CONCLUSÃO: A intensidade de dor é um fator que influencia a realização de atividades funcionais em indivíduos obesos com OA de joelho, mas outros estudos são necessários para identificar os fatores determinantes de capacidade funcional nesta população.

Transferencia da posicao sentada pra em pe: estudo comparativo entre idosas assintomaticas e idosas com osteoartite e correlacao entre tempo da tarefa e funcao muscular / Sit-to-stand transfer: comparasion between asymptomatic and osteoarthritic elderly women and correlation between movement time and muscle function

Em idosos, a capacidade de se levantar de uma posicao sentada sentada em um menor tempo associa-se a menos comorbidades ec para realizar essa atividade. Forca e potencia de extensores e plexores de joelho sao importantes. ao aumentar a velocidade do levantar

Avaliação isocinetica da função muscular do quadril e do tornozelo em idosos que sofrem quedas / Isokinetic evaluation of hip and ankle muscle function among elderly people who suffer falls

Analisar o impacto da funcao muscular dos membros inferiores sobre as quedas em uma populacao de idosos. Metodos: os participantes foram 30 idosos, 14 que nao haviam sofrido quedas e 16 que ja haviam sofrido quedas no ultimo 6 meses, selecionados aleatoriamente no ambulatorio de geriatria de um hospital universitario. Todos foram submetidos a avaliacao demografica e clinica e ao teste de funcao muscular no Dinamometro Isocientico Biodex. Os avaliadores nao foram informados sobre o grupo a que pertencia cada idoso ate o final do estudo. Foram feitas analises estatisticas descritivas para todas as variaveis e para a comparacao entre os grupos foram utilizados o test t-Student, Mann-whitney, qui-quadrado ou teste exato de fisher, no nivel de significancia < 0,05. Resultados Em relacao a funcao muscular do tornozelo, os idosos que ja cairam apresentaram menor potencia media (p variado entre 0,005 e 0,001), menor trabalho propocional ao peso corporal (p variado entre 0,046 e 0,028) e o menor pico de torque propocional ao peso corporal( p=0.23). Para a articulacao do quadril nao houve diferencas estatisticamente significativas entre os grupos em nenhuma das variaveis testadas.Conclusoes: idosos que ja cairam apresentaram menores valores de pico de torque, trabalho proporcional ao peso corporal e potencia media para a articulacao de tornozelo em relacao aos que nao cairam. Nao houve diferencas estatisticamente significatyivas para a funcao muscular do quadril. Nossos achados mostram que na abordagem fisioterapeutica do idoso e necessario incluir rxercicios de fortalecimento para o tornozelo, contribuindo para a prevencao de quedas

Relacao isquiotibiais/quadriceps em mulheres idosas utilizando o dinamometro isocinetico / Isokinetic hamstring/quadriceps ratio in elderly women

A relacao entre o torque isocinetico maximo dos isquiotibiais e o torque isocinetico maximo do quadriceps (relacao IQT/QUA) e um parametro utilizado para descrever o equilibrio muscular da articulacao do joelho. Uma alteracao desse equilibrio predispoe a articulacao ou o grupo muscular mais fraco a lesao. A obtencao de valores de referencia da relacao IQT/QUA de idosas e importante, p[ois possibilita comparacoes entre individuos dessa faixa etaria. O objetivo deste estudo foi estabelecer valores normativos para a relacao IQT/QUA de idosas nao-institucionalizadas que vivem na regiao metropolitana de Belo Horizonte. Este foi um estudo transversal de uma amostra composta por 47 idosas voluntarias (69,11+-3,64 anos). Como nao houve diferenca estatisticamente significativa entre os membros, foram descritos apenas a media, o desvio padrao, o coeficiente de variacao (CV) e o erro estimado (EE) da relacao IQT/QUA do membro inferior dominante, nas velocidades angulares de (60s e 180s), utilizando o dinamometro isocinetico Biodex System 3 Pro. Na velocidade de 60s, a media foi de 47,95+-10,99(por cento); o Cv, 22,91; e o EE, 6,85. Na velocidade de 180s a media foi 59,59+-13,40(por cento); o Cv, 22,49; e o EE, 6,43. Assim, o valor da relacao foi maior com o aumento da velocidade. Os resultados aqui encontrados, aliados a outros de diferentes regioes, podem ser considerados referencia para idosas vivendo na comunidade, o que podera direcionar a reabilitacao, tornando-a mais efetiva. Alem disso, esses dados permitirao comparacoes com futuros estudos que envolvam populacoes de idosas comunitarias, institucionalizadas ou com alguma doenca

Estudo da propriocepcao e desempenho funcional em idosos com osteoartrite de joelhos / Proprioception and funcional performance study in the elderly wit knee osteoarthritis

Ha evidencias de que a propriocepcao e o desempenho funcional tendem a declinar nos idosos saudaveis e essa tendencia e ainda maior nos idosos com osteoartite (OA). O objetivo deste foi verificar se havia diferenca quanto a propriocepcao e a funcao entre um grupo de 11 idosos assintomaticos (GASS) e 11 com OA de joelhos (GOA). A propriocepcao foi avaliada por meio de um dinamometro isocinetico e o protocolo consistiu de um teste de reposicionamentoativo a 20o. e 40o. de flexao de joelhos, em cadeia cinetica aberta. O desempenho funcional foi avaliado pelos testes de velocidade auto-selecionada de marcha e subida e descida de escadas. Para caracterizar a amostra foram usadas variaveis clinicas e para avaliar a gravidade da doenca, o Indice Lequesne. Os dados foram analizados utilizando-se o teste nao-parametrico de Mann-Whitney U. A maior proporcao do GOA apresentava OA leve, segundo o Indice de Lequesne. Houvee tendencia do GOA a apresentar maior deficit proprioceptivo comparado ao grupo assintomatico, apesar dessa diferenca nao ter sido estatisticamente significativa (p=0,056 e p=0,134 para 20o. e 40o., respectivamente). Os individuos com OA de joelhos foram mais lentos nos tres testes funcionais (p=0,003, p=0,000 e p=0,000 para velocidade de marcha, subida e dsecida de escadas, respectivamente). Concluimos que os individuos com OA leve de joelhos apresentam deficit funcional e tendencia a reducao da acuidade proprioceptiva em relacao aos idosos saudaveis. A intervencao precoce da fisioterapia ode contribuir para prevenir a progressao dos deficits de propriocepcao que tem impacto negativo sobre o desempenho funcional

Avaliacao da qualidade de vida relacionada a saude em idosos com osteoartite de joelhos / Health related quality of life and knee Osteoarthritis

Esta revisao apresenta uma discussao sobre o tema da avaliacao da qualidade de vida relacionada a saude (QVRS) no contexto do envelhecimento humano como uma medida complementar para estudar o impacto das doencas, tanto nas atividades dos individuos quanto em sua participacao social. Sao discutidas as alternativas de avaliacao generica e especifica da qualidade de vida relacionada a saude, apresentando alguns questionarios, suas vantagens, desvantagens e aplicabilidade na pesquisa e na clinica na area de Fisioterapia, em geriatria e gerontologia. Apresentamos uma analise do uso dessa forma de avaliacao como desfecho para ensaios clinicos controlados de exercicios terapeuticos em pacientes idosos com osteoartrite (OA) de joelhos. E, ao final, fazemos uma analise critica de ensaios clinicos controlados e nao controlados, pesquisados na base de dados MEDLINE, que estudaram o impacto de protocolos de exercicios terapeuticos sobre a QVRS de pacientes com OA de joelhos, discutindo sua metodologia e resultados

Structure refinement of the aldehyde oxidoreductase from Desulfovibrio gigas (MOP) at 1.28 A.

The sulfate-reducing bacterium aldehyde oxidoreductase from Desulfovibrio gigas (MOP) is a member of the xanthine oxidase family of enzymes. It has 907 residues on a single polypeptide chain, a molybdopterin cytosine dinucleotide (MCD) cofactor and two [2Fe-2S] iron-sulfur clusters. Synchrotron data to almost atomic resolution were collected for improved cryo-cooled crystals of this enzyme in the oxidized form. The cell constants of a=b=141.78 A and c=160.87 A are about 2% shorter than those of room temperature data, yielding 233,755 unique reflections in space group P6(1)22, at 1.28 A resolution. Throughout the entire refinement the full gradient least-squares method was used, leading to a final R factor of 14.5 and Rfree factor of 19.3 (4sigma cut-off) with "riding" H-atoms at their calculated positions. The model contains 8146 non-hydrogen atoms described by anisotropic displacement parameters with an observations/parameters ratio of 4.4. It includes alternate conformations for 17 amino acid residues. At 1.28 A resolution, three Cl- and two Mg2+ ions from the crystallization solution were clearly identified. With the exception of one Cl- which is buried and 8 A distant from the Mo atom, the other ions are close to the molecular surface and may contribute to crystal packing. The overall structure has not changed in comparison to the lower resolution model apart from local corrections that included some loop adjustments and alternate side-chain conformations. Based on the estimated errors of bond distances obtained by blocked least-squares matrix inversion, a more detailed analysis of the three redox centres was possible. For the MCD cofactor, the resulting geometric parameters confirmed its reduction state as a tetrahydropterin. At the Mo centre, estimated corrections calculated for the Fourier ripples artefact are very small when compared to the experimental associated errors, supporting the suggestion that the fifth ligand is a water molecule rather than a hydroxide. Concerning the two iron-sulfur centres, asymmetry in the Fe-S distances as well as differences in the pattern of NH.S hydrogen-bonding interactions was observed, which influences the electron distribution upon reduction and causes non-equivalence of the individual Fe atoms in each cluster.

Tungsten-containing formate dehydrogenase from Desulfovibrio gigas: metal identification and preliminary structural data by multi-wavelength crystallography.

The tungsten-containing formate dehydrogenase (W-FDH) isolated from Desulfovibrio gigas has been crystallized in space group P2(1), with cell parameters a = 73.8 A, b = 111.3 A, c = 156.6 A and beta = 93.7 degrees. These crystals diffract to beyond 2.0 A on a synchrotron radiation source. W-FDH is a heterodimer (92 kDa and 29 kDa subunits) and two W-FDH molecules are present in the asymmetric unit. Although a molecular replacement solution was found using the periplasmic nitrate reductase as a search model, additional phasing information was needed. A multiple-wavelength anomalous dispersion (MAD) dataset was collected at the W- and Fe-edges, at four different wavelengths. Anomalous and dispersive difference data allowed us to unambiguously identify the metal atoms bound to W-FDH as one W atom with a Se-cysteine ligand as well as one [4Fe-4S] cluster in the 92 kDa subunit, and three additional [4Fe-4S] centers in the smaller 29 kDa subunit. The D. gigas W-FDH was previously characterized based on metal analysis and spectroscopic data. One W atom was predicted to be bound to two molybdopterin guanine dinucleotide (MGD) pterin cofactors and two [4Fe-4S] centers were proposed to be present. The crystallographic data now reported reveal a selenium atom (as a Se-cysteine) coordinating to the W site, as well as two extra [4Fe-4S] clusters not anticipated before. The EPR data were re-evaluated in the light of these new results.

Expression of cre recombinase as a reporter of signal transduction in mammalian cells.

BACKGROUND: Cell-based reporter assays, which rely on a reporter gene under the control of a regulated promoter, are widely used to screen chemical libraries for novel receptor ligands. Here, we describe a reporter system that is based on ligand-induced DNA recombination to express the reporter gene. This system converts a transient activation of a signal transduction pathway into an amplified, constitutive and heritable expression of the reporter gene. RESULTS: We constructed gene fusions of Cre recombinase and mammalian promoters regulated by calcium, nuclear receptors or cyclic AMP. Reporter systems, comprising a Cre gene fusion and a loxP/reporter gene, were used to study the kinetics and dose responses to compounds that activate or inhibit the corresponding signal transduction pathway. We compared these reporters with conventional reporter systems in which the reporter gene is under the direct control of the responsive promoter. Reporter gene expression of the Cre reporters was greater than that of conventional reporters and could be measured more than a week after adding the stimulus. For all pathways studied here, the dose responses of the Cre reporters are nearly identical to those of conventional reporter systems. CONCLUSIONS: We have shown that Cre recombinase can be regulated by a variety of signal transduction pathways. It should therefore be possible to use receptor ligands to induce phenotypic conversion of mammalian cells for use in a variety of applications. One such application is high-throughput screening, and we developed loxP/luciferase reporter genes that provide an amplified and sustained luminescent response.

Crystal structure of the first dissimilatory nitrate reductase at 1.9 A solved by MAD methods.

BACKGROUND: The periplasmic nitrate reductase (NAP) from the sulphate reducing bacterium Desulfovibrio desulfuricans ATCC 27774 is induced by growth on nitrate and catalyses the reduction of nitrate to nitrite for respiration. NAP is a molybdenum-containing enzyme with one bis-molybdopterin guanine dinucleotide (MGD) cofactor and one [4Fe-4S] cluster in a single polypeptide chain of 723 amino acid residues. To date, there is no crystal structure of a nitrate reductase. RESULTS: The first crystal structure of a dissimilatory (respiratory) nitrate reductase was determined at 1.9 A resolution by multiwavelength anomalous diffraction (MAD) methods. The structure is folded into four domains with an alpha/beta-type topology and all four domains are involved in cofactor binding. The [4Fe-4S] centre is located near the periphery of the molecule, whereas the MGD cofactor extends across the interior of the molecule interacting with residues from all four domains. The molybdenum atom is located at the bottom of a 15 A deep crevice, and is positioned 12 A from the [4Fe-4S] cluster. The structure of NAP reveals the details of the catalytic molybdenum site, which is coordinated to two MGD cofactors, Cys140, and a water/hydroxo ligand. A facile electron-transfer pathway through bonds connects the molybdenum and the [4Fe-4S] cluster. CONCLUSIONS: The polypeptide fold of NAP and the arrangement of the cofactors is related to that of Escherichia coli formate dehydrogenase (FDH) and distantly resembles dimethylsulphoxide reductase. The close structural homology of NAP and FDH shows how small changes in the vicinity of the molybdenum catalytic site are sufficient for the substrate specificity.