Expression of receptors of advanced glycation end product (RAGE) and types I, III and IV collagen in the vastus lateralis muscle of men in early stages of knee osteoarthritis.

Alterations in the contractile and non-contractile proteins of the skeletal muscle may reduce muscle function in knee osteoarthritis (OA), and the formation and accumulation of advanced glycation end products, particularly in collagen, can influence the quality of these muscle proteins. The objective of this study was to evaluate the reactivity of types I, III and IV collagen and the expression and localization of receptor for advanced glycation end products (RAGE) in the vastus lateralis (VL) muscle in early stages of knee OA. The hypothesis was that these patients present a higher expression of RAGE and increased immunoreactivity in the collagen. Thirty-five men were divided into two groups: the control group (CG; n = 17) and the osteoarthritis group (OAG; n = 18). All participants were submitted to a biopsy of the VL. The muscle samples were analyzed by immunohistochemistry for collagen and for RAGE and laminin. The expression of RAGE was counted (intracellular, extracellular and total). Student's t-test for independent samples and Mann-Whitney U test were used for the RAGE's intergroup analysis (α ≤ 0.05). A semiquantitative analysis was performed to assess the collagen reactivity. No significant differences were observed in the intracellular, extracellular or total localization of RAGE (p > 0.05). Higher immunoreactivity was observed in the OAG for all types of collagen, with more reactivity for collagen III and IV. We concluded that in the initial stages of knee OA, no differences were observed for RAGE levels between the groups. However, the OAG's higher collagen expression may represent adaptations for reducing muscle stiffness and avoiding injury.

Scope of services provided to childhood cancer patients by the Brazilian Pediatric Palliative Care Network.

Introduction: Brazil is a developing and an Upper Middle Income, categorized by the World Bank. Therefore, it is a country that needs a special vision for children with oncological diseases who require Pediatric Palliative Care. This study aimed to understand the specificities of services that provide oncology services in comparison to those that do not provide oncological care. Methods: This is a descriptive, cross-sectional, and online survey study. A questionnaire was created by a multidisciplinary group of leaders from the Brazilian Pediatric Palliative Care Network and then the survey was distributed using a snowball strategy. Results: Of the 90 services that answered the questionnaire, 40 (44.4%) attended oncologic patients. The Southeast represented most of the services (57.57%), followed by the Northeast, with 18.89% (17 services), the South with 12.22% (11 services), and the Center West with 8.89% (8 services). No differences were observed in access to opioid prescriptions between the services. It was observed that those services that attended oncologic patients had a tendency to dedicate more time to Pediatric Palliative Care. Discussion: The distribution of services that cover oncology and those that do not, are similar in the different regions of Brazil. In Brazil, there are difficulties in accessing opioids in pediatrics: access to opioid prescriptions without differences revealed that even pediatric oncologists might have difficulty with this prescription, and this should improve. It is concluded that education in Pediatric Palliative Care is the key to improvements in the area.

Effects of low level laser therapy (808 nm) on physical strength training in humans.

Recent studies have investigated whether low level laser therapy (LLLT) can optimize human muscle performance in physical exercise. This study tested the effect of LLLT on muscle performance in physical strength training in humans compared with strength training only. The study involved 36 men (20.8±2.2 years old), clinically healthy, with a beginner and/or moderate physical activity training pattern. The subjects were randomly distributed into three groups: TLG (training with LLLT), TG (training only) and CG (control). The training for TG and TLG subjects involved the leg-press exercise with a load equal to 80% of one repetition maximum (1RM) in the leg-press test over 12 consecutive weeks. The LLLT was applied to the quadriceps muscle of both lower limbs of the TLG subjects immediately after the end of each training session. Using an infrared laser device (808 nm) with six diodes of 60 mW each a total energy of 50.4 J of LLLT was administered over 140 s. Muscle strength was assessed using the 1RM leg-press test and the isokinetic dynamometer test. The muscle volume of the thigh of the dominant limb was assessed by thigh perimetry. The TLG subjects showed an increase of 55% in the 1RM leg-press test, which was significantly higher than the increases in the TG subjects (26%, P = 0.033) and in the CG subjects (0.27%, P < 0.001). The TLG was the only group to show an increase in muscle performance in the isokinetic dynamometry test compared with baseline. The increases in thigh perimeter in the TLG subjects and TG subjects were not significantly different (4.52% and 2.75%, respectively; P = 0.775). Strength training associated with LLLT can increase muscle performance compared with strength training only.

Abnormal isokinetic time-to-peak torque of the medial rotators of the shoulder in subjects with impingement syndrome.

The time-to-peak torque (TPT) and the peak torque ratio of the lateral to medial rotators (LR/MR) during isokinetic lateral and medial rotation of the shoulder were evaluated in patients with shoulder impingement and in healthy subjects. Fifteen patients with shoulder impingement on the dominant side and 9 healthy subjects were evaluated. TPT and LR/MR were measured bilaterally during isokinetic concentric lateral and medial rotation at 60 degrees/s and 180 degrees/s. The impingement group showed a bilateral decrease in the TPT during medial rotation for both 60 degrees/s and 180 degrees/s. No differences were found in the LR/MR between the groups. It is proposed that decreased (TPT) of the medial rotators can be used as a tool for early detection of shoulder impingement. Notably, the decreased time-to-peak torque of the medial rotators may occur before the alteration in the peak torque ratio.

Effects of Light-Emitting Diode Therapy on Muscle Hypertrophy, Gene Expression, Performance, Damage, and Delayed-Onset Muscle Soreness: Case-control Study with a Pair of Identical Twins.

OBJECTIVE: The aim of this study was to verify how a pair of monozygotic twins would respond to light-emitting diode therapy (LEDT) or placebo combined with a strength-training program during 12 weeks. DESIGN: This case-control study enrolled a pair of male monozygotic twins, allocated randomly to LEDT or placebo therapies. Light-emitting diode therapy or placebo was applied from a flexible light-emitting diode array (λ = 850 nm, total energy = 75 J, t = 15 seconds) to both quadriceps femoris muscles of each twin immediately after each strength training session (3 times/wk for 12 weeks) consisting of leg press and leg extension exercises with load of 80% and 50% of the 1-repetition maximum test, respectively. Muscle biopsies, magnetic resonance imaging, maximal load, and fatigue resistance tests were conducted before and after the training program to assess gene expression, muscle hypertrophy and performance, respectively. Creatine kinase levels in blood and visual analog scale assessed muscle damage and delayed-onset muscle soreness, respectively, during the training program. RESULTS: Compared with placebo, LEDT increased the maximal load in exercise and reduced fatigue, creatine kinase, and visual analog scale. Gene expression analyses showed decreases in markers of inflammation (interleukin 1ß) and muscle atrophy (myostatin) with LEDT. Protein synthesis (mammalian target of rapamycin) and oxidative stress defense (SOD2 [mitochondrial superoxide dismutase]) were up-regulated with LEDT, together with increases in thigh muscle hypertrophy. CONCLUSIONS: Light-emitting diode therapy can be useful to reduce muscle damage, pain, and atrophy, as well as to increase muscle mass, recovery, and athletic performance in rehabilitation programs and sports medicine.

Motion of the shoulder complex in individuals with isolated acromioclavicular osteoarthritis and associated with rotator cuff dysfunction: part 2 - muscle activity.

This study aimed to compare muscle activity in individuals with isolated acromioclavicular osteoarthritis (ACO), ACO associated with rotator cuff disease (ACO+RCD), and controls. Seventy-four participants (23 isolated ACO, 25 ACO+RCD, 26 controls) took part in this study. Disability was assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Muscle activity of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and anterior deltoid (AD) was collected during arm elevation in the sagittal and scapular planes. Pain during motion was assessed with the numerical pain rating scale. Analysis of the DASH, pain and kinematics were reported in part 1 of this study. For each muscle, separate 2-way linear mixed-model ANOVAs were performed to compare groups. ACO+RCD group had more UT and AD activity than the the isolated ACO and control other groups, more AD activity than the isolated ACO group during the ascending phase, and more AD activity than the ACO and control groups during the descending phase in both planes. Isolated ACO group had less SA activity than the control group only in the sagittal plane. Alterations in shoulder muscle activity are present in individuals with isolated ACO and with ACO+RCD and should be considered in rehabilitation.

Men with early degrees of knee osteoarthritis present functional and morphological impairments of the quadriceps femoris muscle.

OBJECTIVE: Quadriceps muscle weakness is common in knee osteoarthritis (OA). Reasons for weakness may include atrophy, reduction in the muscle fibers number, and changes in the muscle activation. It is uncertain when these muscular changes begin to appear. Therefore, the purpose of this study was to determine whether men with early stages of knee OA already had functional and quadriceps muscle morphologic alterations. DESIGN: Forty men were divided into two groups: control group (healthy subjects) and OA group (subjects with knee OA). A biopsy of the vastus lateralis muscle was performed for morphometric analysis. Isokinetic evaluation of knee extensor torque, concentric and eccentric (90 and 180 degrees/sec), was performed simultaneously with vastus lateralis electromyographic activity evaluation. RESULTS: Significant differences were found in knee extensor torque (P < 0.05) and in normalized root mean square (P < 0.01) during the eccentric contractions (both velocities), with higher values for the control group. No differences were found during concentric contractions. The OA group presented greater values of the minimum diameter of type 1 fibers and greater proportion and relative cross-sectional area of type 2b fibers (P < 0.05). CONCLUSIONS: Men with early stages of knee OA do not present alterations of concentric strength but had decreased eccentric strength and morphologic quadriceps muscle changes, indicating neuromuscular adaptations.

Motion of the shoulder complex in individuals with isolated acromioclavicular osteoarthritis and associated with rotator cuff dysfunction: part 1 - Three-dimensional shoulder kinematics.

This study described the three-dimensional shoulder motion during the arm elevation in individuals with isolated acromioclavicular osteoarthritis (ACO) and ACO associated with rotator cuff disease (RCD), as compared to controls. Seventy-four participants (ACO=23, ACO+RCD=25, Controls=26) took part of this study. Disability was assessed with the DASH, three-dimensional kinematics were collected during arm elevation in the sagittal and scapular planes, and pain was assessed with the 11-point numeric pain rating scale. For each kinematic variable and demographic variables, separate linear mixed-model 2-way ANOVAs were performed to compare groups. Both ACO groups had higher DASH and pain scores. At the scapulothoracic joint, the isolated ACO group had greater internal rotation than control, and the ACO+RCD group had greater upward rotation than both other groups. At the sternoclavicular joint, both groups with ACO had less retraction, and the isolated ACO group had less elevation and posterior rotation. At the acromioclavicular joint, the isolated ACO group had greater upward rotation, and both ACO groups had greater posterior tilting. Patients with ACO had altered shoulder kinematics, which may represent compensatory responses to reduce pain and facilitate arm motion during arm elevation and lowering.

Axial compressive strength of human vertebrae trabecular bones classified as normal, osteopenic and osteoporotic by quantitative ultrasonometry of calcaneus

Abstract Introduction Biomechanical assessment of trabecular bone microarchitecture contributes to the evaluation of fractures risk associated with osteoporosis and plays a crucial role in planning preventive strategies. One of the most widely clinical technics used for osteoporosis diagnosis by health professionals is bone dual-energy X-ray absorptiometry (DEXA). However, doubts about its accuracy motivate the introduction of congruent technical analysis such as calcaneal ultrasonometry (Quantitative Ultrasonometry - QUS). Methods Correlations between Bone Quality Index (BQI), determined by calcaneal ultrasonometry of thirty (30) individuals classified as normal, osteopenic and osteoporotic, and elastic modulus (E) and ultimate compressive strength (UCS) from axial compression tests of ninety (90) proof bodies from human vertebrae trabecular bone, which were extracted from cadavers in the twelfth thoracic region (T12), first and fourth lumbar (L1 and L4). Results Analysis of variance (ANOVA) showed significant differences for E (p = 0.001), for UCS (p = 0.0001) and BQI. Spearman's rank correlation coefficient (rho) between BQI and E (r = 0.499) and BQI and UCS (r = 0.508) were moderate. Discussion Calcaneal ultrasonometry technique allowed a moderate estimate of bone mechanical strength and fracture risk associated with osteoporosis in human vertebrae.

The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study.

OBJECTIVES: To study the effect of additional strengthening of hip abductor and lateral rotator muscles in a strengthening quadriceps exercise rehabilitation programme for patients with the patellofemoral pain syndrome. DESIGN: Randomized controlled pilot trial. SETTING: Clinical setting with home programme. PARTICIPANTS: Fourteen patients with patellofemoral pain syndrome. INTERVENTION: The subjects were randomly assigned to the intervention group (strengthening of quadriceps plus strengthening of hip abductor and lateral rotator muscles) or to the control group (strengthening of quadriceps). Both groups participated in a six-week home exercise protocol. MAIN OUTCOME MEASURES: The perceived pain symptoms, isokinetic eccentric knee extensor, hip abductor and lateral rotator torques and the gluteus medius electromyographic activity were assessed before and after treatment. Parametric and non-parametric tests were used to compare the groups before and after treatment with alpha=0.05. RESULTS: Only the intervention group improved perceived pain symptoms during functional activities (P=0.02-0.04) and also increased their gluteus medius electromyographic activity during isometric voluntary contraction (P=0.03). Eccentric knee extensors torque increased in both groups (P=0.04 and P=0.02). There was no statistically significant difference in the hip muscles torque in either group. CONCLUSION: Supplementation of strengthening of hip abductor and lateral rotator muscles in a strengthening quadriceps exercise programme provided additional benefits with respect to the perceived pain symptoms during functional activities in patients with patellofemoral pain syndrome after six weeks of treatment.

Funcionalidade após a cirurgia de quadril: correlação entre equilíbrio, idade, independência e depressão em idosos / Functionality after hip surgery: correlation between balance, age, independence, and depression among the elderly

Objetivo: Verificar correlações entre a idade e o equilíbrio, a independência, tempo de internação, e a depressão em idosos que sofreram fratura do quadril após quedas. Método: A amostra consecutiva incluiu idosos que sofreram fratura de quadril há até 24 meses. Foram avaliados 14 idosos (12 mulheres e dois homens), com idade média de 78 anos ± 6,9. Foi aplicado um questionário para obtenção de dados gerais, Time Up and Go (TUG test), Escala de Equilíbrio Berg (EEB), Escala de Depressão Geriátrica Abreviada (EDGA), Índice de Barthel e Razão cintura-quadril (RCQ). Foi aplicado ANOVA one-way, teste t e teste de correlação de Pearson com um nível de significânciade 5%. Resultados: As médias dos testes: EEB (35,38 ± 33,06), o TUG test (28,40 ± 10,59); a EDGA pré-queda 6,33 ± 1,52; a EDGA pós-queda 7,66 ± 1,52; o RCQ 1,05 ± 0,35 para homens e 0,92 ± 0,12 para mulheres. O Índice de Barthel pré-queda 16, 20 ± 5,4 e o Índice de Barthel pós-queda 15,12 ± 6,78. Quanto maior a idade, maior é o tempo de internação e que não há correlação entre idade e função (IC: 0,643; valor p ? 0,013). Houve correlação negativa entre idade e equilíbrio, mas a idade não está relacionada ao nível de depressão (IC: -0,556; valor p ? 0,048). Conclusão: Foi verificada correlação positiva entre idade e tempo de internação e correlação negativa entre idade e equilíbrio. Houve a diminuição da pontuação de EEB, aumento do tempo do TUG Test e aumento da RQC.

Objective: To determine correlations between age and balance, independence, and depression among the elderly who suffered hip fractures following a fall. Method: The consecutive sample included elderly who had suffered hip fractures within the past 24 months. We evaluated 14 elderly patients (12 women and two men); with an average age of 78 ± 6.9 years old. A questionnaire was applied to obtain general data, Timed Up and Go (TUG test), Berg Balance Scale (BBS), Geriatric Depression Scale - Short form (GDS-S), Barthel Index (BI), and Waist-hip ratio (WHR). We used the one-way ANOVA, t-test, and Pearson correlation tests with a significance levels of 5%. Results: Mean tests: BBS (35.38 ± 33.06), the TUG test (28.40 ± 10.59), the pre-fall GDS-S 6.33 ± 1.52, the post-fall GDS-S 7.66 ± 1.52, and the WHR 1.05 ± 0.35 for men and 0.92 ± 0.12 for women. The Barthel Index pre-fall was 16.20 ± 5.4 and the Barthel Index post-fall was 15.12 ± 6.78. The greater the age, the longer the stay, but there was no correlation between age and function. There was a negative correlation between age and balance, but age was not related to the level of depression. Conclusion: A positive correlation was found between age and length of stay and a negative correlation was found between age and balance. There was a decrease in the BBS, and an increase in the length of the TUG test and WHR.

Estudo comparativo de propriedades biomecânicas da porção central do tendão calcâneo congelado e a fresco / Comparative study on biomechanical properties of the central portion of frozen and fresh calcaneus tendon

Métodos de armazenamento de aloenxertos podem alterar certas características mecânicas dos tecidos. Com o objetivo de analisar a influência do fenômeno de congelamento e do tempo de armazenamento sobre as propriedades biomecânicas de tendões, os autores estudaram 40 tendões calcâneos obtidos de 20 cadáveres humanos com idade média de 41,95 anos, variando de 31 a 54 anos, sendo 17 do sexo masculino e três do sexo feminino. De cada cadáver foram retirados dois tendões, sendo que um foi testado a fresco e o contralateral congelado a - 85° C em freezer elétrico, durante um período de seis ou 12 semanas. Os corpos de prova foram submetidos a ensaios de tração em uma máquina de ensaios mecânicos Kratos K5002, fornecendo gráficos força-deformação. Foram analisados os parâmetros de força no limite de resistência máxima, rigidez, tensão no limite de resistência máxima, deformação relativa e módulo de elasticidade. Os resultados foram comparados e a analisados estatisticamente pelo método de "t-student", com índice de significância de 0,05, sendo que não houve diferença significativa nos valores obtidos entre os grupos. Concluímos que o congelamento a - 85° C não altera as propriedades biomecânicas de tendões, a despeito do tempo de armazenamento.

Allograft storage methods can change some mechanical characteristics of tissues. With the objective of analyzing the influence of freezing phenomenon and storage time on tendonsÆ biomechanical properties, the authors studied 40 calcaneus tendons obtained from 20 human cadavers, with an average age of 41.95 years, ranging from 31 to 54 years old, being 17 males and three females. From each cadaver, two tendons were removed, one tested in its fresh state and the contralateral one frozen at -85° C in an electric freezer, during a period of six or 12 weeks. The bodies of evidence were submitted to traction assays in a Kratos K5002 mechanical assay machine, delivering strength-deformation graphics. Strength at maximum resistance limit, stiffness, tension at maximum resistance limit, relative deformation, and elasticity module parameters were assessed. The results were compared and statistically analyzed by "StudentÆs t- method", with a significance level of 0.05, with no significant difference on values achieved between groups. We concluded that freezing at -85° C does not cause changes to tendonsÆ biomechanical properties, despite of storage time.

Reparo de defeito osteocondral no joelho de coelhos utilizando centrifugado de medula óssea autóloga / Repair of osteochodral defect in the knee of rabbits using autologous bone marrow centrifuged

A cartilagem articular, por sua natureza avascular, apresenta uma capacidade limitada de regeneração. Uma abordagem terapêutica para o tratamento de defeitos da cartilagem consiste na utilização de células ou tecidos aplicados ao local da lesão. O objetivo deste estudo foi avaliar o efeito da aplicação de centrifugado de medula óssea autóloga em lesões osteocondrais no joelho de coelhos, em comparação com um grupo controle de lesões osteocondrais sem preenchimento, analisando o comportamento histológico destes grupos em função do tempo. Foram utilizados doze coelhos da raça Nova Zelândia, albinos, machos, adultos, submetidos a uma lesão osteocondral, de 4 mm de diâmetro e 3 mm de profundidade, em ambos os joelhos, na região da tróclea femoral. Nos joelhos direitos, que constituíram o Grupo Estudo, o defeito osteocondral foi preenchido por um coágulo de células mesenquimais, obtidas por centrifugação de um aspirado da medula óssea e selado com cola de fibrina. Nos joelhos esquerdos, que constituíram o Grupo Controle, o defeito osteocondral não recebeu qualquer preenchimento. Os animais foram divididos em três grupos de quatro coelhos, estudados após oito, 16 e 24 semanas. Os resultados foram descritos com base em uma escala de pontuação histológica que avaliou a morfologia celular, a reconstrução do osso subcondral, o aspecto da matriz, o preenchimento do defeito, a regularidade da superfície e a conexão das margens. A análise estatística foi realizada pelo Teste t-student para dados pareados na comparação entre Grupo Estudo e Grupo Controle. Para as comparações através do fator temporal, utilizou-se o Teste ANOVA one way. Com 5% de confiança, rejeitou-se a hipótese de igualdade entre os Grupos Estudo e Controle. Notou-se uma distância decrescente entre os escores dos Grupos Estudo e Controle com o aumento do tempo, bem como uma tendência crescente do valor da escala para o Grupo Controle. Concluiu-se que a aplicação de centrifugado de medula óssea...

The articular cartilage, due to its avascular nature, presents a limited regeneration capacity. A therapeutical approach to the treatment of cartilage defects consists of the utilization of cells or tissues applied to the lesion site. The aim of this study was to evaluate the effect of applying autologous bone marrow centrifuged in osteochondral lesions in the knees of rabbits, compared to a control group of osteochondral lesions without any filling, analyzing the behavior of these groups in terms of time. Twelve adult albino male New Zealand rabbits were used being submitted to an osteochondral lesion of 4 mm in diameter and 3 mm deep in both knees, at the femoral trochlea area. On the right knees, which comprised the Study Group, the osteochondral defect was filled by a clot of mesenchymal cells, obtained by centrifugation of an aspirate from bone marrow and sealed with fibrin glue. On the left knees, which comprised the Control Group, the osteochondral defect did not get any filling. The animals were divided into 3 groups of 4 rabbits, and studied after eight, 16 and 24 weeks. The results were described based on a histological grading scale which took into account the cell morphology, the subchondral bone reconstruction, the matrix staining, the filling of the defect, the surface regularity and the bonding of the edges. The statistical analysis was made by the t-student Test for paired data in the comparison between the Study Group and the Control Group. For the comparisons made by the time factor, it was used the ANOVA Test one way. With 5% level of confidence, the hypothesis of equality between the Study and Control Groups was rejected. It was observed a decreasing distance between scores of the Study and Control Groups as time increased, as well as an increasing tendency of the scale value for the Control Group. It was concluded that the application of autologous bone marrow centrifuged in osteochondral defects in the knees of rabbits showed better...

Trombose venosa profunda em artroplastia total de quadril / Deep venous thrombosis in total hip arthroplasty

Total hip arthroplasty is a common surgical procedure in a population with the organic frailty of aging. Deep venous thrombosis and pulmonary thromboembolism are the more common and dangerous complications of this procedure. Therefore, surgeon knowledge of diagnosis, prevention and treatment of these complications is mandatory both technically and ethically. The authors make a descriptive and critical revision of the literature regarding the most recent acquisitions in diagnosid, prevention, and treatment of these complications