Comparação e mobilidade, equilíbrio corporal e desempenho muscular segundo a auto-eficácia para quedas em idosas

The aging process modifies various systems in the body, leading to changes in mobility, balance and muscle strength. This can cause a drop in the elderly, or not changing the perceived self-efficacy in preventing falls. Objective: To compare the mobility, body balance and muscle performance according to self-efficacy for falls in community-dwelling elderly. Methods: A cross-sectional comparative study with 63 older (65-80 years) community. Were evaluated for identification data and sociodemographic, cognitive screening using the Mini Mental State Examination (MMSE), effective for the fall of Falls Efficacy Scale International Brazil (FES-I-BRAZIL), Mobility through the Timed Up and Go Test , the balance Berg Balance Scale (BBS) and the Modified Clinical Test tests of Sensory Interaction on Balance (mCTSIB), tandem walk (TW) and Sit to Stand (STS) of the Balance Master® System. Finally, muscle performance by using isokinetic dynamometry. Statistical analysis was performed Student t test for comparison between groups, with p value ≤ 0.05. Results: Comparing the elderly with low-efficacy for falls with high-efficacy for falls, we found significant differences only for the variable Timed Up and Go Test (p = 0.04). With regard to data on balance tests were significant differences in the speed of oscillation firm surface eyes open modified Clinical Test of Sensory Interaction on Test of Balance (p = 0.01). Variables to isokinetic dynamometry were no significant differences in movement knee extension, as regards the variables peak torque (p = 0.04) and power (p = 0.03). Conclusion: The results suggest that, compared to older community with low-and high-efficacy for falls, we observed differences in variables related to mobility, balance and muscle function

LMI-based algorithm for strictly positive real systems with static output feedback

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

Torque, myoeletric sygnal and heart rate responses during concentric and eccentric exercises in older men

Background: The literature reports that the eccentric muscular action produces greater force and lower myoelectric activity than the concentric muscular action, while the heart rate (HR) responses are bigger during concentric contraction. Objectives: To investigate the maximum average torque (MAT), surface electromyographic (SEMG) and the heart rate (HR) responses during different types of muscular contraction and angular velocities in older men. Methods: Twelve healthy men (61.7 +/- 1.6years) performed concentric (C) and eccentric (E) isokinetic knee extension-flexion at 60 degrees/s and 120 degrees/s. SEMG activity was recorded from vastus lateralis muscle and normalized by Root Mean Square-RMS (mu V) of maximal isometric knee extension at 60 degrees. HR (beats/min) and was recorded at rest and throughout each contraction. The data were analyzed by the Friedman test for repeated measures with post hoc Dunn's test (p<0.05). Results: The median values of MAT (N.m/kg) was smaller and the RMS (mu V) was larger during concentric contraction (C60 degrees/s=2.80 and 0.99; C120 degrees/s=2.46 and 1.0) than eccentric (E60 degrees/s=3.94 and 0.85; E120 degrees/s=4.08 and 0.89), respectively. The HR variation was similar in the four conditions studied. Conclusion: The magnitude of MAT and RMS responses in older men were dependent of the nature of the muscular action and independent of the angular velocity, whereas HR response was not influenced by these factors.

Histopathological evaluation of treatment with chondroitin sulphate for osteoarthritis induced by continuous immobilization in rabbits

The aim of this study was to evaluate histologically the action of chondroitin sulphate in osteoarthritis experimentally induced by continuous immobilization. Fourteen young female Norfolk rabbits aged 2.5-3 months at the beginning of the experiment were divided into two equitable groups submitted to immobilization of the right knee for a period of 12 weeks. The treated group received 1.0 ml/animal/s.c. of 12% chondroitin sulphate, once a week for 12 weeks, and the untreated group did not receive any treatment. Two additional animals were not submitted to knee immobilization (sham group). Microscopical examination of knee preparations stained with haematoxylin-eosin and Masson trichrome showed lesions of both joints in treated and untreated groups, with no significant difference between the scores obtained for the right and left knees. Examination of preparations stained with picrosirius red showed collagen fibre alignment and misalignment in the right and left knees of the animals of all groups, but statistic analysis could not be performed. It was not possible to differentiate the proteoglycan concentration between limbs or groups (treated and untreated) by safrtanin O or toluidine blue staining. It was possible to conclude that the chondroitin sulphate was not able to reduce the histological changes induced by this osteoarthritis experimental model.

Bloqueio contínuo do plexo lombar via posterior bilateral com bomba de infusão descartável: relato de caso

JUSTIFICATIVA E OBJETIVOS: O número de artroplastia total de quadril (ATQ) bilateral tem aumentado a cada ano. Analgesia pós-operatória pela infusão contínua perineural com anestésico local tem se mostrado favorável quando comparada com analgesia sistêmica. O uso de bombas elastoméricas tem aumentado a satisfação do paciente quando em comparação com os modelos eletrônicos. O objetivo deste relato foi descrever um caso de analgesia contínua bilateral do plexo lombar via posterior, com infusão contínua através de bomba elastomérica, em paciente submetido à uma artroplastia bilateral de quadril. RELATO do CASO: Paciente feminina, 46 anos, 65 kg, 162 cm, com artrite reumatoide e hipertensão arterial, estado físico ASA II, escalada para ser submetida a ATQ bilateral em um único estágio. Uso de corticosteroide por 13 anos. Hemoglobina = 10,1 g.dL-1, hematócrito = 32,7%. Monitoração de rotina. Raquianestesia com 15 mg de bupivacaína 0,5% isobárica. Anestesia geral com propofol (PFS) e remifentanil e intubação sem bloqueadores neuromusculares. ATQ direita e no final, bloqueio plexo lombar com estimulador e conjunto agulha 150 mm e injeção de 20 mL bupivacaína 0,2% e passagem de cateter. ATQ esquerda e, no final, mesmo procedimento. Estudado dispersão do anestésico e contraste. Instalado bomba elastomérica com bupivacaína 0,1% (400 mL) em velocidade de 14 mL.h-1. Transferida para Unidade de Cuidados Intensivos (UCI). Vinte e quatro horas após, nova bomba com a mesma solução. Nenhum bolus durante 50 horas. Após remoção de cateter, dor controlada por via oral com cetoprofeno e dipirona. CONCLUSÕES: O bloqueio bilateral contínuo periférico com infusão de bupivacaína a 0,1% com bombas elastoméricas é um procedimento seguro e efetivo em adultos.

Artroscopia do joelho de ovinos

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

Luxação aguda isolada da articulação tibiofibular proximal

A luxação traumática isolada da articulação tibiofibular proximal é rara. Esta lesão pode não ser reconhecida ou diagnosticada no atendimento inicial. A ausência de suspeita clínica pode causar problemas para o diagnóstico. O diagnóstico necessita de história precisa do mecanismo e sintomas da lesão, avaliação clínica e radiográfica adequada de ambos joelhos. Casos não reconhecidos são fonte de alterações crônicas. O tratamento é feito por redução fechada e imobilização ou, em casos irredutíveis ou instáveis, redução aberta com fixação interna temporária. Um caso raro de luxação tibiofibular proximal isolada em um jogador de basquetebol é relatado para ilustrar essa lesão.

Prophylaxis of deep-vein thrombosis after lower extremity amputation: Comparison of low molecular weight heparin with unfractionated heparin

OBJETIVO: Comparar a eficácia e segurança da profilaxia com heparina de baixo peso molecular (enoxaparina) versus heparina não fracionada (HNF). MÉTODOS: Setenta e cinco pacientes (59 homens e 16 mulheres ), submetidos a amputação maior dos membros inferiores (30 acima do joelho e 45 abaixo do joelho ), foram tratados ao acaso com HNF subcutânea (5,000 IU -2x/dia ) ou enoxaparina subcutânea (40mg/dia ) durante a hospitalização . A profilaxia teve início 12 horas antes da cirurgia ou , em casos emergenciais , no primeiro dia de pós-operatório. RESULTADOS: Os dois grupos de tratamento foram comparáveis em termos de características gerais . A avaliação da TVP foi feita por meio de exame clínico diário e pelo mapeamento dúplex antes e 5-8 dias após a cirurgia . A TVP foi documentada no lado operado em 9,75% dos pacientes tratados com enoxaparina e em 11,76% dos pacientes tratados com HNF (p=0,92) e houve um caso de TVP bilateral em cada grupo . Sangramentos não foram verificados nos 2 grupos . CONCLUSÃO: A enoxaparina e HNF foram igualmente eficientes e seguras para a profilaxia da TVP em pacientes submetidos à amputação de membros inferiores .

Cultura de condrócitos em arcabouço tridimensional: hidrogel de alginato

OBJETIVOS: O presente estudo teve como objetivo cultivar condrócitos retirados da articulação do joelho de coelhos encapsulados em hidrogel de alginato (HA) e caracterizar a produção de matriz extracelular (ECM). MÉTODOS: A cartilagem articular foi removida do joelho de coelhos, com três a seis meses, fragmentada em pedaços de 1mm e submetida à digestão enzimática. Uma concentração de 1x106 céls/mL foram ressuspensas em uma solução de alginato de sódio a 1,5% (w/v), em seguida fez-se o processo de gelatinização em CaCl2 (102 mM), permitindo a formação do HA e cultivo em meio DMEM-F12 durante quatro semanas. A distribuição das células e a ECM foram acessadas através das secções histológicas coradas com e azul de toluidina hematoxilina e eosina (HE). RESULTADOS: Houve um aumento no número e na viabilidade dos condrócitos durante as quatro semanas de cultura. Através das análises histológicas dos HAs corados com azul de toluidina e HE foi possível observar a distribuição definida dos condrócitos no hidrogel, assemelhando-se a grupos isógenos e formação de matriz territorial. CONCLUSÃO: Este estudo demonstrou a eficiência do HA como arcabouço para ser usado na cultura de condrócitos, constituindo uma alternativa no reparo de lesões na cartilagem articular.

Ximelagatran versus warfarin for prophylaxis of venous thromboembolism in major orthopedic surgery: systematic review of randomized controlled trials

INTRODUÇÃO: O ximelagatrano foi recentemente estudada para profilaxia do tromboembolismo venoso (TEV). OBJETIVO: Avaliar se o ximelagatrano comparado com a varfarina melhora a profilaxia do TEV em pacientes submetidos à cirurgia ortopédica do joelho. FONTE DE DADOS: Estudos randomizados identificados por pesquisa eletrônica na literatura médica, até 2006, cujos dados foram compilados no programa Review Manager, versão 4.2.5. RESULTADOS: Foram incluídos três estudos randomizados bem conduzidos envolvendo 4.914 participantes. Foram definidos dois sub-grupos com dosagens diferentes de ximelagatrano (24 mg and 36 mg, duas vezes ao dia). O tratamento com ximelagatrano mostrou freqüência significantemente menor de TEV que o tratamento com varfarina, mas somente na dosagem de 36-mg [risco relativo, RR 0.72 ([intervalo de confiança, IC, 95% 0.64, 0.81), p < 0.00001]. A freqüência de TEV no sub-grupo de 24-mg foi similar a da varfarina [RR 0.86 (IC 95% 0.73, 1.01), p = 0.06]. Para TEV maior, embolia pulmonar, sangramento e sangramento maior não houve diferença entre varfarina e a ximelagatrano. Ao final do tratamento, a elevação da alanino-aminotransferase (ALT) foi menos freqüente no sub-grupo de 24 mg de ximelagatrano que no grupo da varfarina [RR 0.33 (IC 95% 0.12, 0.91) p = 0.03], mas no período de acompanhamento essa elevação foi maior com 36 mg de ximelagatrano [RR 6.97 (IC 95% 1.26, 38.50) p = 0.03]. CONCLUSÃO: O ximelagatrano foi mais efetivo que a varfarina quando usado em dosagens maiores (36 mg, 2 vezes ao dia), mas às expensas de aumento de enzimas hepáticas no período de acompanhamento.

Efeitos do ultra-som terapêutico sobre o crescimento longitudinal do fêmur e da tíbia em ratos

Objectives: To determine the effects of ultrasound therapy on the femur and tibia growth in young rats. Method: Four-week-old male Ratus Norvegicus totaling 115 animals, divided into four groups, were submitted to ultrasound therapy (0.8 MHz, fixed tube head, continuous pulse, for 10 minutes, once a day, ten times) on the medial face of the right knee, with powers of 0.0 W/cm2 (group 31), 0.5 W/cm2 (group G2), 1.0 W/cm2 (group G3), and 1.5 W/cm2 (group G4). Histological slides of the epiphysis, growth plate and metaphysis and the femoral and tibial length measurements were studied in the sixth, thirteenth and twenty-sixth weeks of life. The data were submitted to factorial analysis of variance according to a one-way layout. Results: No statistically significant bone growth alteration was established between any of the three treated groups and the control group. However, alterations in femoral and tibial growth suggesting a decrease in G4 in relation to 02 and G3 were noted. In G4, histopathological alterations, such as cellular necrosis and post-necrosis bone neoformation were found. Conclusion: According to this study, no statistical evidence of bone growth stimulus or inhibition resulting from the application of ultrasound therapy was found when comparing the treated groups with the control group. Histological alterations regarded as pathological were only observed in G4. Also, smaller significant bone growth was found in G4 compared to G2 and G3. Level of Evidence: Level II, cross-sectional study.

Progression of articular and extraarticular damage in oligoarticular juvenile idiopathic arthritis

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

Alterações no líquido sinovial do joelho de cães com osteoartrite induzida pelo modelo Pond e Nuki

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

Radiography, computed tomography and magnetic resonance imaging at 0.5 Tesla of mechanically inducedosteoarthritis in rabbit knees

In the present experimental study we assessed induced osteoarthritis data in rabbits, compared three diagnostic methods, i.e., radiography (XR), computed tomography (CT) and magnetic resonance imaging (MRI), and correlated the imaging findings with those obtained by macroscopic evaluation. Ten young female rabbits of the Norfolk breed were used. Seven rabbits had the right knee immobilized in extension for a period of 12 weeks (immobilized group), and three others did not have a limb immobilized and were maintained under the same conditions (control group). Alterations observed by XR, CT and MRI after the period of immobilization were osteophytes, osteochondral lesions, increase and decrease of joint space, all of them present both in the immobilized and non-immobilized contralateral limbs. However, a significantly higher score was obtained for the immobilized limbs (XT: P = 0.016, CT: P = 0.031, MRI: P = 0.0156). All imaging methods were able to detect osteoarthritis changes after the 12 weeks of immobilization. Macroscopic evaluation identified increased thickening of joint capsule, proliferative and connective tissue in the femoropatellar joint, and irregularities of articular cartilage, especially in immobilized knees. The differences among XR, CT and MRI were not statistically significant for the immobilized knees. However, MRI using a 0.5 Tesla scanner was statistically different from CT and XR for the non-immobilized contralateral knees. We conclude that the three methods detected osteoarthritis lesions in rabbit knees, but MRI was less sensitive than XR and CT in detecting lesions compatible with initial osteoarthritis. Since none of the techniques revealed all the lesions, it is important to use all methods to establish an accurate diagnosis.

Cyclic-loading of the human gracilis and semitendinosus muscle tendons: Study of young adult cadavers

During knee ligament reconstruction, the tendon graft is tensioned to prevent the occurrence of excessive graft elongation during the postoperative period. Tensioning may be achieved by applying a cyclic or static load to the graft during fixation. Although this procedure is part of the surgery, there is no consensus in international literature regarding ideal tension levels to be used in this procedure. This study was conducted on 10 tendons of the human gracilis muscle and 10 tendons of semitendinosus muscle removed from five male cadavers whose mean age was 20.8 years. These tendons underwent 10 in vitro strain cycles at three levels of deformation (2.5, 3, and 4%) and the value of the deforming load used for each cycle was recorded. The statistical analysis demonstrated that in order to attain the same level of deformation during the 10 cycles there was a reduction in the value of strain applied to the graft, observed at the three levels of deformation. It was concluded that the semitendinosus tendon presents a more uniform mechanical behavior and that there is a need for new graft tensioning protocols that consider the force associated with deformation.