Toenail trace element status and risk of Barrett's oesophagus and oesophageal adenocarcinoma. Results from the FINBAR study

Trace elements have been cited as both inhibitory and causative agents of cancer but importantly exposure to them is potentially modifiable. Our study aimed to examine toenail trace element status and risk of Barrett's oesophagus (BO) and oesophageal adenocarcinoma (OAC). Toenail clippings from each hallux were obtained from 638 participants of the FINBAR (Factors Influencing the Barrett's Adenocarcinoma Relationship) study comprising 221 healthy controls, 98 reflux oesophagitis, 182 BO and 137 OAC cases. The concentrations of eight toenail trace elements were determined using instrumental neutron activation analysis. Using multivariable adjusted logistic regression analysis, odds ratios (OR) and 95% confidence intervals (CIs) were calculated within tertiles of trace element concentrations. A twofold increased risk of BO was observed, but not OAC, among individuals in the highest tertile of toenail zinc status OR 2.21 (95% CI, 1.11-4.40). A higher toenail selenium status was not associated with risk of OAC OR 0.94 (95% CI, 0.44-2.04) or BO OR 0.89 (95% CI, 0.37-2.12). A borderline significant increased risk of BO was detected with a higher toenail cobalt concentration, OR 1.97 (95% CI, 1.01-3.85). No association was found between toenail levels of chromium, cerium, mercury and OAC or BO risk. This is the first case-control study to investigate a variety of trace elements in relation to OAC and BO risk. Despite antioxidant and proapoptotic properties, no associations were found with selenium. Higher concentrations of toenail zinc and cobalt were associated with an increased BO risk, but not OAC. These findings need confirmation in prospective analysis.

Estudo comparativo entre criança com e sem joelhos valgos praticantes de hóquei em patins utilizando diferentes sistemas de análise

O presente estudo tem como objetivo comparar experimentalmente duas crianças praticantes de Hóquei em Patins, uma normal e uma com a patologia dos joelhos valgos, avaliando qualitativamente as diferenças posturais, estáticas e dinâmicas, decorrentes da utilização dos patins específicos desta modalidade, através do sistema de análise da Força de Reação do Solo (FRS), de Eletromiografia (EMG), de captura de movimento, e de modelação e simulação. Para atingir o objetivo definiu-se um protocolo de ensaios com as seguintes tarefas: repouso com e sem patins, marcha, corrida, deslizar com os dois pés apoiados e deslizar com o pé esquerdo levantado. No repouso avaliou-se a variação do ponto de aplicação da FRS da criança normal e patológica, com e sem patins. Ainda na tarefa de repouso avaliou-se também as componentes médio-lateral, antero-posterior individualmente e a componente vertical da FRS, juntamente com a atividade muscular dos músculos Gastrocnémio Medial (GM), Recto Femoral (RF), Vasto Medial (VM), Vasto Lateral (VL), Bicípete Femoral (BF), Semitendinoso (ST), Tensor da Fascia Lata (TFL), Gastrocnémio Lateral (GL), de forma a comparar os valores de intensidade de FRS e da atividade muscular dos diferentes instantes de tempo desta tarefa. Para as restantes tarefas apenas se avaliou individualmente as componentes médio-lateral e antero-posterior da FRS e a componente vertical da FRS juntamente com a atividade muscular dos referidos músculos, salientando as diferenças evidentes entre as curvas da criança normal e as curvas da criança patológica durante os diferentes instantes do movimento. Todas as tarefas referidas, exceto a tarefa de repouso com patins, foram ainda simuladas recorrendo a modelos músculo-esqueléticos. A partir destas simulações do movimento obtiveram-se os ângulos articulares e efetuou-se a respetiva análise. No final dos resultados obtidos apresentou-se uma tabela de resumo com o cálculo dos coeficientes de variação de cada grandeza, exceto nos gráficos da posição no espaço da FRS, onde se constatou que existe uma grande variabilidade inter-individuo em cada tarefa. A análise dos resultados de cada tarefa permite concluir que a utilização de patins pode trazer uma maior ativação muscular para a criança patológica, embora se verifique instabilidade articular. Apesar dessa instabilidade pode-se inferir que, uma maior ativação muscular decorrente da utilização de patins, tal como acontece na prática do hóquei em patins, pode trazer uma melhoria, a longo prazo, na estabilidade da articulação do joelho e na sustentação corporal, proporcionada pelo fortalecimento muscular.

In-shoe plantar pressures and ground reaction forces during overweight adults' overground walking

Purpose: Because walking is highly recommended for prevention and treatment of obesity and some of its biomechanical aspects are not clearly understood for overweight people, we compared the absolute and normalized ground reaction forces (GRF), plantar pressures, and temporal parameters of normal-weight and overweight participants during overground walking. Method: A force plate and an in-shoe pressure system were used to record GRF, plantar pressures (foot divided in 10 regions), and temporal parameters of 17 overweight adults and 17 gender-matched normal-weight adults while walking. Results: With high effect sizes, the overweight participants showed higher absolute medial-lateral and vertical GRF and pressure peaks in the central rearfoot, lateral midfoot, and lateral and central forefoot. However, analyzing normalized (scaled to body weight) data, the overweight participants showed lower vertical and anterior-posterior GRF and lower pressure peaks in the medial rearfoot and hallux, but the lateral forefoot peaks continued to be greater compared with normal-weight participants. Time of occurrence of medial-lateral GRF and pressure peaks in the midfoot occurred later in overweight individuals. Conclusions: The overweight participants adapted their gait pattern to minimize the consequences of the higher vertical and propulsive GRF in their musculoskeletal system. However, they were not able to improve their balance as indicated by medial-lateral GRF. The overweight participants showed higher absolute pressure peaks in 4 out of 10 foot regions. Furthermore, the normalized data suggest that the lateral forefoot in overweight adults was loaded more than the proportion of their extra weight, while the hallux and medial rearfoot were seemingly protected.

The influence of gait cadence on the ground reaction forces and plantar pressures during load carriage of young adults

Biomechanical gait parameters—ground reaction forces (GRFs) and plantar pressures—during load carriage of young adults were compared at a low gait cadence and a high gait cadence. Differences between load carriage and normal walking during both gait cadences were also assessed. A force plate and an in-shoe plantar pressure system were used to assess 60 adults while they were walking either normally (unloaded condition) or wearing a backpack (loaded condition) at low (70 steps per minute) and high gait cadences (120 steps per minute). GRF and plantar pressure peaks were scaled to body weight (or body weight plus backpack weight). With medium to high effect sizes we found greater anterior-posterior and vertical GRFs and greater plantar pressure peaks in the rearfoot, forefoot and hallux when the participants walked carrying a backpack at high gait cadences compared to walking at low gait cadences. Differences between loaded and unloaded conditions in both gait cadences were also observed.

Results of computer assisted navigation in Total Knee Arthroplasty (TKA): comparison with the conventional method

The aim of this retrospective study was to compare the clinical and radiographic results after TKA (PFC, DePuy), performed either by computer assisted navigation (CAS, Brainlab, Johnson&Johnson) or by conventional means. Material and methods: Between May and December 2006 we reviewed 36 conventional TKA performed between 2002 and 2003 (group A) and 37 navigated TKA performed between 2005 and 2006 (group B) by the same experienced surgeon. The mean age in group A was 74 years (range 62-90) and 73 (range 58-85) in group B with a similar age distribution. The preoperative mechanical axes in group A ranged from -13° varus to +13° valgus (mean absolute deviation 6.83°, SD 3.86), in group B from -13° to +16° (mean absolute deviation 5.35, SD 4.29). Patients with a previous tibial osteotomy or revision arthroplasty were excluded from the study. Examination was done by an experienced orthopedic resident independent of the surgeon. All patients had pre- and postoperative long standing radiographs. The IKSS and the WOMAC were utilized to determine the clinical outcome. Patient's degree of satisfaction was assessed on a visual analogous scale (VAS). Results: 32 of the 37 navigated TKAs (86,5%) showed a postoperative mechanical axis within the limits of 3 degrees of valgus or varus deviation compared to only 24 (66%) of the 36 standard TKAs. This difference was significant (p = 0.045). The mean absolute deviation from neutral axis was 3.00° (range -5° to +9°, SD: 1.75) in group A in comparison to 1.54° (range -5° to +4°, SD: 1.41) in group B with a highly significant difference (p = 0.000). Furthermore, both groups showed a significant postoperative improvement of their mean IKSS-values (group A: 89 preoperative to 169 postoperative, group B 88 to 176) without a significant difference between the two groups. Neither the WOMAC nor the patient's degree of satisfaction - as assessed by VAS - showed significant differences. Operation time was significantly higher in group B (mean 119.9 min.) than in group A (mean 99.6 min., p <0.000). Conclusion: Our study showed consistent significant improvement of postoperative frontal alignment in TKA by computer assisted navigation (CAS) compared to standard methods, even in the hands of a surgeon well experienced in standard TKA implantation. However, the follow-up time of this study was not long enough to judge differences in clinical outcome. Thus, the relevance of computer navigation for clinical outcome and survival of TKA remains to be proved in long term studies to justify the longer operation time. References 1 Stulberg SD. Clin Orth Rel Res. 2003;(416):177-84. 2 Chauhan SK. JBJS Br. 2004;86(3):372-7. 3 Bäthis H, et al. Orthopäde. 2006;35(10):1056-65.

La torsion des métatarses : étude de sa plasticité chez l'humain

Il a été démontré que la torsion des têtes métatarsiennes est influencée par le mode de locomotion chez les primates et peut être utilisée pour déterminer la présence ou non d’une arche longitudinale chez les ancêtres hominines. Chez l’humain moderne, l’arche longitudinale rend le pied plus inversé que chez les grands singes, provoquant un léger basculement de l’axe dorsoplantaire de l’articulation proximale des métatarses. Ainsi, les têtes métatarsiennes subissent une torsion par rapport à l’axe de la diaphyse pour que leur surface plantaire reste parallèle au sol. Comme les femmes ont une arche longitudinale plus haute que les hommes et comme le port du soulier à semelles rigides provoque des changements morphologiques au niveau du pied, rendant l’arche longitudinale plus haute et l’hallux moins divergeant, il est attendu que la torsion métatarsienne soit différente selon le sexe et le type de soulier porté. Ce mémoire examine donc l’effet du contexte environnemental du pied et de la plasticité de la torsion des têtes métatarsiennes en comparant différentes populations humaines. L’échantillon disponible pour cette étude est constitué de 166 individus provenant de 18 sites archéologiques différents comprenant 57 hommes, 35 femmes et 74 individus de sexe indéterminé qui ont été divisés en quatre grands groupes : Amérindiens, Inuits, Militaires et Euro-canadiens. Il n’y a aucune différence de torsion entre les hommes et les femmes, ce qui suggère que la différence de hauteur de l’arche longitudinale entre les hommes et les femmes n’est pas assez importante pour être perçues au niveau de la torsion des têtes métatarsiennes. La topographie ne semble pas provoquer assez de modifications au niveau du pied pour provoquer une torsion différentielle des têtes métatarsiennes. Cependant, la surface du sol, plat ou accidenté, pourrait être un facteur modifiant ce trait. Finalement, le port de souliers constrictif à semelles dures comparativement aux souliers souples, tels les mocassins, provoque une torsion différentielle des têtes métatarsiennes. Les individus chaussant des souliers à semelles souples ont un premier métatarsien présentant une plus grande éversion et un troisième, quatrième et cinquième métatarsien présentant une plus petite éversion comparativement aux individus chaussant des souliers constrictifs. Ces résultats viennent appuyer l’hypothèse de la capacité plastique de la torsion des têtes métatarsiennes.

Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis

Objective To determine overall, test–retest and inter-rater reliability of posture indices among persons with idiopathic scoliosis. Design A reliability study using two raters and two test sessions. Setting Tertiary care paediatric centre. Participants Seventy participants aged between 10 and 20 years with different types of idiopathic scoliosis (Cobb angle 15 to 60°) were recruited from the scoliosis clinic. Main outcome measures Based on the XY co-ordinates of natural reference points (e.g. eyes) as well as markers placed on several anatomical landmarks, 32 angular and linear posture indices taken from digital photographs in the standing position were calculated from a specially developed software program. Generalisability theory served to estimate the reliability and standard error of measurement (SEM) for the overall, test–retest and inter-rater designs. Bland and Altman's method was also used to document agreement between sessions and raters. Results In the random design, dependability coefficients demonstrated a moderate level of reliability for six posture indices (ϕ = 0.51 to 0.72) and a good level of reliability for 26 posture indices out of 32 (ϕ ≥ 0.79). Error attributable to marker placement was negligible for most indices. Limits of agreement and SEM values were larger for shoulder protraction, trunk list, Q angle, cervical lordosis and scoliosis angles. The most reproducible indices were waist angles and knee valgus and varus. Conclusions Posture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis. Despite the good reliability of marker placement, other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time.

A systematic evaluation of field-based screening methods for the assessment of anterior cruciate ligament (ACL) injury risk

BACKGROUND: Laboratory-based measures provide an accurate method to identify risk factors for anterior cruciate ligament (ACL) injury; however, these methods are generally prohibitive to the wider community. Screening methods that can be completed in a field or clinical setting may be more applicable for wider community use. Examination of field-based screening methods for ACL injury risk can aid in identifying the most applicable method(s) for use in these settings. OBJECTIVE: The objective of this systematic review was to evaluate and compare field-based screening methods for ACL injury risk to determine their efficacy of use in wider community settings. DATA SOURCES: An electronic database search was conducted on the SPORTDiscus™, MEDLINE, AMED and CINAHL databases (January 1990-July 2015) using a combination of relevant keywords. A secondary search of the same databases, using relevant keywords from identified screening methods, was also undertaken. STUDY SELECTION: Studies identified as potentially relevant were independently examined by two reviewers for inclusion. Where consensus could not be reached, a third reviewer was consulted. Original research articles that examined screening methods for ACL injury risk that could be undertaken outside of a laboratory setting were included for review. STUDY APPRAISAL AND SYNTHESIS METHODS: Two reviewers independently assessed the quality of included studies. Included studies were categorized according to the screening method they examined. A description of each screening method, and data pertaining to the ability to prospectively identify ACL injuries, validity and reliability, recommendations for identifying 'at-risk' athletes, equipment and training required to complete screening, time taken to screen athletes, and applicability of the screening method across sports and athletes were extracted from relevant studies. RESULTS: Of 1077 citations from the initial search, a total of 25 articles were identified as potentially relevant, with 12 meeting all inclusion/exclusion criteria. From the secondary search, eight further studies met all criteria, resulting in 20 studies being included for review. Five ACL-screening methods-the Landing Error Scoring System (LESS), Clinic-Based Algorithm, Observational Screening of Dynamic Knee Valgus (OSDKV), 2D-Cam Method, and Tuck Jump Assessment-were identified. There was limited evidence supporting the use of field-based screening methods in predicting ACL injuries across a range of populations. Differences relating to the equipment and time required to complete screening methods were identified. LIMITATIONS: Only screening methods for ACL injury risk were included for review. Field-based screening methods developed for lower-limb injury risk in general may also incorporate, and be useful in, screening for ACL injury risk. CONCLUSIONS: Limited studies were available relating to the OSDKV and 2D-Cam Method. The LESS showed predictive validity in identifying ACL injuries, however only in a youth athlete population. The LESS also appears practical for community-wide use due to the minimal equipment and set-up/analysis time required. The Clinic-Based Algorithm may have predictive value for ACL injury risk as it identifies athletes who exhibit high frontal plane knee loads during a landing task, but requires extensive additional equipment and time, which may limit its application to wider community settings.

Alterações posturais em atletas brasileiros do sexo masculino que participaram de provas de potência muscular em competições internacionais

Os esportes de alto nível determinam padrões corporais que extrapolam barreiras geopolíticas, sociais e culturais. Estas peculiaridades resultam em alterações posturais que estão associadas à eficiência do gesto desportivo, porém, em longo prazo, podem evoluir para processos mórbidos que limitam a prática de atividades físicas regulares. O objetivo da pesquisa foi descrever o perfil postural dos atletas que participam de provas de potência muscular e identificar processos anátomo-cinesiológicos responsáveis pelas principais alterações corporais. A casuística foi composta por 15 atletas do sexo masculino, especializados em provas de potência muscular. O protocolo para coleta de dados foi elaborado com base na proposta de: i) Kendall, para o exame físico e observacional, utilizando simetrógrafo e fio de prumo; ii) Souchard, para a análise postural em cadeia. As informações foram organizadas sob a forma de distribuição de freqüência absoluta e relativa. Os resultados apontaram que: i) o tornozelo em valgo (67%) foi a situação mais comum; ii) a rotação interna da pelve à direita (60%), seguida do lado oposto mais elevado (47%), pode estar relacionada com a corrida em curva que sobrecarrega a estrutura da pelve para a manutenção da velocidade com simultânea mudança de direção em função da força gravitacional; iii) a anteversão de pelve (73%) decorre da retração observada nos músculos flexores do quadril e extensores do joelho; iv) a alteração expressa no item iii contribui para a formação de hiperlordose lombar (73%) e desencadeia mecanismo compensatório de retração da cadeia posterior causando cifose torácica (53%) e cabeça em protrusão (73%). O diagnóstico precoce e a adoção de medidas profiláticas efetivas podem contribuir para o aumento da performance, bem como prevenir a ocorrência de lesões desportivas. Estudos envolvendo intervenção fisioterápica deverão avaliar se há redução dos efeitos crônicos que as alterações posturais decorrentes do treinamento causam ao atleta de alto nível.

Correlação entre padrão postural em jovens praticantes do atletismo

O estudo objetivou observar o alinhamento corporal de jovens atletas praticantes de atletismo e analisar a associação de tais padrões dentro e entre os grupos de provas desta modalidade. Participaram 63 atletas de ambos os sexos e o protocolo de coleta para análise postural baseou-se na observação e registro fotográfico com marcações nos principais acidentes ósseos visando à verificação do alinhamento dessas estruturas. Os segmentos considerados para análise foram: tronco, pelve, joelho e tornozelo. Foi utilizado para análise dos dados o teste de Goodman para contrastes entre e dentro de proporções binomiais. Os resultados mostraram que saltadores (58,33%) e arremessadores/lançadores (50,00%) apresentam o tronco em posição mais equilibrada que atletas de resistência (5,56%). Na região do quadril, arremessadores/lançadores apresentaram predomínio de pelve com rotação esquerda (66,67%), enquanto nos saltadores foi observada elevada frequência de anteversão pélvica (58,33%). A observação do joelho revelou altas taxas de normalidade e recurvatum em fundistas, valgo nos arremessadores/lançadores (50,00%) e varo para os demais grupos. Para a articulação do tornozelo, nota-se que, exceto os saltadores, os grupos apresentaram predominância de valgismo. Conclui-se que, para atender às características particulares de cada prova, níveis distintos de postura são estabelecidos.

Análise do equilíbrio estático e de deformidades nos pés de crianças com paralisia cerebral

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Artroscopia do joelho de ovinos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Selecting appropriate bedding to reduce locomotion problems in broilers

Two experiments were carried out at the Poultry Sector of the School of Agrarian Sciences of the Federal University of Grande Dourados to evaluate the incidence of leg problems in broilers reared on two distinct types of bedding material: rice husks or wood shavings, both new and reused. In both trials, a randomized experimental design was applied in factorial arrangement (2 x 2 x 2) using two genetic strains (Cobb® or Ross®); two sexes (male or female), and two litter materials (rice husks or wood shavings). In each trial 1080 one day pullets were reared equally divided in the treatments. The birds were placed in 4.5 m² boxes at a density of 10 birds m-2. All birds were fed diets with equal nutritional density, and water was offered ad libitum. Feeds were divided in three phases: starter diet (1 - 21 days), grower diet (22 - 35 days), and finisher diet (36 - 45 days). on day 45, fifty birds were randomly selected in each experiment to evaluate flock leg problems. The following parameters were analyzed: gait score, incidence of valgus and varus disorder, footpad dermatitis, femoral degeneration, tibial dyschondroplasia, and spondylolisthesis. Ambient temperature during rearing and litter caking and moisture content were recorded in four boxes per treatment. The analytical hierarchy process was used to organize the data into specific criteria. Several criteria, related to the attributes that were determinant according to the statistical analysis, were chosen in order to provide the best input to the process. Results indicated that new wood-shavings bedding was the most appropriate bedding to prevent locomotion problems, followed by new rice husks, reused wood shavings, and reused rice husks. However, when leg problems were associated to sex and genetic strain, male Ross birds strain presented less problems when reared on new rice husks, followed by new wood shavings

Análise do alinhamento dos membros inferiores em crianças com excesso de peso

O sobrepeso e a obesidade (SO) têm atingido proporções epidêmicas, principalmente, em idade escolar, tornando-se um problema mundial de saúde. Muitas adaptações podem ocorrer na organização postural de crianças com SO, provocando, graves consequências. A avaliação postural pode colaborar para o entendimento destas alterações. O objetivo do presente estudo foi verificar alterações na postura dos membros inferiores de crianças com SO, através de metodologia específica. Vinte e dois indivíduos, sendo distribuídos de acordo com o sexo: 9 do feminino e 13 do masculino, com faixa etária entre 5-9 anos, participaram do estudo. Na avaliação postural, foram utilizados a fotogrametria e o software SAPo. Foram analisados os ângulos articulares dos membros inferiores e a projeção plantar do centro de gravidade. Foi utilizada estatística não-paramétrica descritiva, além dos testes de Kruskal-Wallis e de Mann-Whitney (p<0,05), para comparação entre os sexos. Ambos os sexos apresentaram anteroversão e leve rotação pélvica, à direita para o feminino e à esquerda para o masculino hiperextensão e valgismo de joelhos e valgismo tornozelos. O centro de gravidade apresentou 26,95% de anteriorização. Conclui-se que a avaliação postural nessa população foi congruente aos achados da literatura e a metodologia utilizada possibilitou quantificar os dados para futuras comparações.

Locomotion problems of broiler chickens and its relationship with the gait score

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)