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.

Heart failure alters matrix metalloproteinase gene expression and activity in rat skeletal muscle

Heart failure is associated with a skeletal muscle myopathy with cellular and extracellular alterations. The hypothesis of this investigation is that extracellular changes may be associated with enhanced mRNA expression and activity of matrix metalloproteinases (MMP). We examined MMP mRNA expression and MMP activity in Soleus (SOL), extensor digitorum longus (EDL), and diaphragm (DIA) muscles of young Wistar rat with monocrotaline-induced heart failure. Rats injected with saline served as age-matched controls. MMP2 and MMP9 mRNA contents were determined by RT-PCR and MMP activity by electrophoresis in gelatin-containing polyacrylamide gels in the presence of SDS under non-reducing conditions. Heart failure increased MMP9 mRNA expression and activity in SOL, EDL and DIA and MMP2 mRNA expression in DIA. These results suggest that MMP changes may contribute to the skeletal muscle myopathy during heart failure.

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)

Linfoma primário de células T no líquido cefalorraquidiano de cão: relato de caso

Relata-se o diagnóstico de linfoma primário no sistema nervoso central em um cão Labrador Retrievier, de 10 anos de idade, que apresentava episódios convulsivos, incoordenação nos membros posteriores, head tilt, ataxia e sensibilidade diminuída no lado esquerdo. Constataram-se alterações laterais esquerdas, como ausências de propriocepção e de posicionamento tátil, alterações posteriores nas provas de carrinho de mão e de reação ao pulo e diminuição da extensão da postura e hemilocomoção. No líquido cefalorraquidiano (LCR), houve predomínio de linfócitos atípicos, caracterizados pela presença de anisocitose e anisocariose, nucléolos evidentes e anisonucleose, basofilia e microvacuolização citoplasmáticas, mitoses atípicas e corpúsculos linfoglandulares, compatíveis com linfoma, confirmado pelo exame histológico e imunocitoquímico, o qual revelou origem T, com expressão CD3+ e CD79-. A tomografia computadorizada não foi conclusiva e evidenciou diversas áreas hipodensas e intensificação de contraste na região de sulcos e giros do parênquima encefálico. A coleta do LCR foi essencial na rapidez do diagnóstico definitivo, indicando a natureza rara desta lesão primária.

Contribuição do contraste negativo na artrografia tomográfica do joelho normal de cães

A ruptura do ligamento cruzado cranial é uma das causas mais comuns de claudicação do membro pélvico de cães. A radiografia e a ultrassonografia são métodos de diagnóstico frequentemente utilizados na rotina clínica de pequenos animais, porém a tomografia computadorizada é uma modalidade de imagem ainda pouco estudada para avaliar a articulação do joelho de cães. O presente trabalho teve por objetivo avaliar a contribuição do contraste negativo na artrografia tomográfica do joelho normal de cães, para visibilizar as estruturas intra-articulares e padronizar o uso desse contraste na articulação. Foram utilizados 24 membros pélvicos de cães de raças variadas, selecionados pela ausência de histórico de doença articular prévia do joelho e por apresentarem exames radiográficos, ultrassonográficos e macroscópicos normais. O experimento foi delineado em dois grupos, sendo o grupo I constituído de animais com peso até 20 kg e grupo II acima de 20 kg. Foram feitos cortes tomográficos com o membro flexionado e estendido. A quantidade média de ar empregada para a distensão da cápsula articular foi de 49 ml para o Grupo I e de 81 ml para o Grupo II. Utilizou-se um tubo de látex na porção distal à articulação do joelho para reduzir o escape de ar pelo tendão extensor digital profundo, que possui comunicação intra-articular. Foi possível visibilizar pela imagem tomográfica, em todas as articulações, as seguintes estruturas: ligamento cruzado cranial e caudal, meniscos medial e lateral, ligamento patelar, ligamentos colaterais e cápsula articular. Desta forma, o contraste negativo se mostrou uma alternativa eficaz para auxiliar a identificação das estruturas anatômicas do joelho na artrografia tomográfica.

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.

Avaliação dos reflexos espinhais em bezerros

Este trabalho objetivou avaliar, quantificar e padronizar a ocorrência dos reflexos espinhais em bezerros da raça holandesa de 15 a 90 dias de idade, os quais foram submetidos a avaliação nos membros torácicos (reflexo carpo radial, reflexo bicipital, reflexo tricipital e reflexo flexor) e nos membros pélvicos (reflexo patelar, reflexo tibial cranial, reflexo gastrocnêmio, reflexo ciático e reflexo flexor). Para quantificação da resposta involuntária frente ao reflexo realizado, padronizou-se a ausência do reflexo como sendo o algarismo 0; resposta discreta do reflexo como sendo l e a presença evidente da resposta como sendo 2. Os reflexos mais evidentes e constantes foram os reflexos flexor, carpo radial, patelar e tricipital. Os reflexos menos evidentes e menos freqüentes foram os reflexos tibial cranial, bicipital, gastrocnêmio e ciático.

Avaliação dos reflexos espinhais em cordeiros da raça Suffolk

Fez-se a avaliação qualitativa e semiquantitativa dos reflexos espinhais em ovinos, utilizando-se 51 animais da raça Suffolk, machos e fêmeas, entre quatro e cinco meses de idade. Usaram-se os reflexos bilaterais dos membros torácicos, extensor carpo-radial, bicipital, tricipital e flexor, e pélvicos, isquiático, gastrocnêmio, patelar, tibial cranial e flexor, sendo zero indicativo de ausência de reflexo, 1= reflexo discreto e 2= reflexo evidente. Nos membros torácicos, as melhores respostas foram obtidas no flexor (99,0%) e no extensor carpo-radial (87,3%), seguidos de valores menos expressivos no bicipital (11,8%) e no tricipital (2,0%), com grau 2 de avaliação. Nos membros pélvicos, todos os ovinos produziram respostas em grau 2 para o reflexo flexor. Verificam-se também respostas evidentes nos reflexos patelar (98,0%) e isquiático (81,4%). Apenas 20,6% dos animais apresentaram resposta evidente ao reflexo tibial cranial, e nenhum ovino respondeu ao reflexo gastrocnêmio de forma satisfatória.

Rehabilitation of Atrophic Maxilla Using the Combination of Autogenous and Allogeneic Bone Grafts Followed by Protocol-Type Prosthesis

Currently, there are several techniques for the rehabilitation of atrophic maxillary ridges in literature. The grafting procedure using autogenous bone is considered ideal by many researchers, as it shows osteogenic capability and causes no antigenic reaction. However, this type of bone graft has some shortcomings, mainly the restricted availability of donor sites. In recent years, several alternatives have been investigated to supply the disadvantages of autogenous bone grafts. In such studies, allogeneic bone grafts, which are obtained from individuals with different genetic load, but from the same species, have been extensively used. They can be indicated in cases of arthroplasty, surgical knee reconstruction, large bone defects, and in oral and maxillofacial reconstruction. Besides showing great applicability and biocompatibility, this type of bone is available in unlimited quantities. on the other hand, allogeneic bone may have the disadvantage of transmitting infectious diseases. Atrophic maxillae can be treated with bone grafts followed by osseointegrated implants to obtain aesthetic and functional oral rehabilitation. This study aimed to show the viability of allogeneic bone grafting in an atrophic maxilla, followed by oral rehabilitation with dental implant and protocol-type prosthesis within a 3-year follow-up period by means of a clinical case report.

Temporal response pattern of biochemical analytes in experimental diabetes

The activities of the enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), lactate dehydrogenase (LD), creatine kinase (CK), amylase (AMS) and angiotensin converting enzyme (ACE) have been used to assess the toxic effects of xenobiotics that have hypoglycaemic action in hepatic, pancreatic, renal and muscle tissue. Using a validated experimental model of diabetes mellitus in rats, we ascertained whether this syndrome itself affected the serum activities of these enzymes over a 53-day period. Levels of hepatic enzymes AST, ALT and ALP were higher in the streptozotocin (STZ)diabetic rats (group D), but were controlled by insulin therapy (group DI). AMS was reduced in group D and unchanged in group DI rats. Proteinuria was detected 1 day after STZ administation and partially controlled by insulin (group DI); its early presence in group D rats, and the lack of any change in serum ACE in this group, indicates that proteinuria is the better marker for microangiopathy. Microscopic examination of liver, kidney, heart and skeletal muscles (soleus and extensor digitorum longus) revealed various alterations in group D rat tissues, which were less pronounced in group DI. The liver, pancreas and kidney tissue-damage was consistent with the altered serum levels of AST, ALT, ALP and AMS and proteinuria. We conclude that: (i) rigorous control is required when these serum-enzyme levels are used as indicators of tissue toxicity in experimental diabetes, and (ii) LD, CK and bilirubin serum levels, which are unaffected by diabetes, can be used when testing effects of xenobiotics on tissues.

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.

Differential morphofunctional characteristics and gene expression in fast and slow muscle of rats with monocrotaline-induced heart failure

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

Investigation of Risk Factors and Characteristics of Dance Injuries

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