RESUMO
Evaluating scars is fundamental to analyse the outcome of treatments that include surgical intervention. Scales facilitate this type of assessment, but most of these measuring instruments are in different languages. The Patient and Observer Scar Assessment Scale (POSAS) is one of the most robust instruments available in the literature for the evaluation of scars, although there is no validated version in Brazilian Portuguese. The aims of this study were to culturally translate and validate POSAS for the Portuguese language of Brazil and to test its reproducibility, face validity, content, and construct. Following the methodology proposed by Beaton DE, Bombardier C, Guillemin F, Ferraz, MB, Spine 2000, 25, 3186, the questionnaire was translated and adapted to the Brazilian culture. The reproducibility, face, content, and construct validity were then analysed. In all, the scale was applied to 35 patients with postoperative scars (patient version) and 35 hand surgery specialists (version for the observer). The internal consistency was tested by Cronbach's alpha, and construct validation was performed by correlating the translated instrument with the Brazilian Portuguese translation of the Vancouver Scar Scale (VSS). The cultural adaptation of POSAS Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP) was confirmed. Both subscales showed strong internal consistency (Cronbach's α = 0.77-0.93), demonstrating reliability. The reproducibility was excellent, and the adapted scale demonstrated significant intra- and inter-observer reproducibility (r > 0.9) (P < 0.05). The validity of the construct was significant and showed good sensitivity between POSAS EMP/UNIFESP and the VSS. This study confirmed that POSAS EPM/UNIFESP can be used to evaluate patients with surgical scars in the Brazilian population. It has proven to be useful for clinical and research purposes, lending itself to capturing medical opinions and those of the patients themselves.
Assuntos
Cicatriz/complicações , Inquéritos e Questionários , Brasil , Estudos Transversais , Cultura , Humanos , Reprodutibilidade dos Testes , TraduçõesRESUMO
The etiology of adolescent idiopathic scoliosis remains unknown. Angiotensin-converting enzyme and α-actinin-3 polymorphisms influence the characteristics of muscle fibers. The aim of this study was to examine the association between idiopathic scoliosis and genetic polymorphism of angiotensin-converting enzyme and α-actinin-3. Ninety-seven females with scoliosis, and 137 healthy, age-matched control females were studied. The presence of polymorphisms was determined by PCR. A χ2 test was used to analyze differences, and odds ratios were estimated. The frequencies of ACE genotypes in the scoliotic group were 46.4% DD, 45.4% ID, and 8.2% II, while in the control group they were 40.1% DD, 43.8% ID, and 16.1% II (P = 0.197). The D allele had a frequency of 69.1% in patients with idiopathic scoliosis and 62% in the control group (P = 0.116). The frequencies of ACTN3 genotypes in females with scoliosis were 31.8% RR, 49.4% RX, and 18.8% XX, while in the control group they were 35% RR, 49% RX, and 16% XX (P = 0.810). The frequency of the R allele was 56.4% in the scoliotic group and 59.6% in the control group (P = 0.518). There was no statistically significant association between angiotensin-converting enzyme or α-actinin-3 polymorphisms and the presence of adolescent idiopathic scoliosis in females.
Assuntos
Actinina/genética , Predisposição Genética para Doença , Mutação INDEL/genética , Peptidil Dipeptidase A/genética , Polimorfismo de Nucleotídeo Único/genética , Escoliose/genética , Adolescente , Adulto , Feminino , Técnicas de Genotipagem , Humanos , Razão de Chances , Adulto JovemRESUMO
PURPOSE: Determining the patterns of brachial plexus injuries is challenging. Diagnostic methods have been used to facilitate diagnosis, but there is no consensus regarding which tool best complements physical examination (PE). Magnetic resonance imaging (MRI) and nerve conduction studies (NCSs) are instruments with widespread use and feasibility for everyday assessment. In this study, we evaluated the diagnostic performance of these diagnostic instruments and PE. We also assessed the agreement in the PE and diagnostic instrument findings of two experienced and certified hand surgeons. METHODS: We reviewed data gathered from medical records and compared these data with the results of operative findings. We divided data according to the site of injury and the root injury patterns for all three diagnostic instruments (PE, MRI, and NCSs). RESULTS: We considered 102 assessments. We found poor inter-observer agreement for the PE assessments and poor agreement among the PE, NCS, and MRI assessments. Diagnostic performance was higher for PE: sensitivity = 97.8 [95% confidence interval (C.I.) = 92.1-99.7]; specificity = 30.8 [95% C.I. = 9.1-61.4], and NCSs (sensitivity = 98.9 [95% C.I. = 93.9-100]; specificity = 23.1 [95% C.I. = 5-53.8]. MRI had inferior performance for all measurements. Separate analysis using pre- and post-ganglionic injuries revealed that PE had the lowest sensitivity, 46.7 (95% C.I. = 21.3-73.4) despite having the highest specificity, 81.6 (95% C.I. = 71.9-89.1). DISCUSSION: Low agreement among the findings using different diagnostic instruments demonstrated that PE is the most specific tool, despite its low sensitivity. Detailed PE is cornerstone for evaluating brachial plexus injuries and NCSs are better than MRI for scrutinizing injuries not found in PE. CLINICAL RELEVANCE: In our study, NCSs exhibited superior performance to MRI, and should be considered a more reliable supporting tool after detailed PE.
Assuntos
Plexo Braquial/lesões , Adolescente , Adulto , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
OBJECTIVE: To investigate the hypothesis that strenuous running is a predisposing factor for osteoarthritis. DESIGN: Wistar rats were divided into two groups: a control group (CG) and a trained group (TG). The TG underwent a strenuous treadmill running training regimen of controlled intensity, exhibiting progressively improvement of fitness over 12 weeks, running at least 55 km during this period and finally performing an ultra-endurance running exercise to exhaustion. After this period, rats from both groups were euthanized and their knees removed. The articular cartilage was dissected and submitted to histomorphometrical, histomorphological, and immunohistochemical analyses evaluating cell death pathway (caspase-3 and terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL)) and inflammatory cytokines [interleukin-1α (IL-1α) and tumor necrosis factor-α (TNF-α)]. In addition, the tissues were analyzed regarding the types and the content of glycosaminoglycans. RESULTS: The TG knee joints exhibited increase in the number of chondrocytes and chondrocyte clusters, as well as significantly increased levels of caspase-3, a protein involved in apoptosis, and of inflammatory cytokines IL-1α and TNF-α. In addition, histologically higher grades of osteoarthritis (Osteoarthritis Research Society International - OARSI grading), and significantly decreased levels of chondroitin sulfate and hyaluronic acid. Knee cartilage thickness and TUNEL did not significantly differ between the two groups. CONCLUSIONS: The articular cartilage of rats subjected to a strenuous running regimen of controlled intensity exhibited molecular and histological characteristics that are present in osteoarthritis.
Assuntos
Cartilagem Articular/patologia , Glicosaminoglicanos/metabolismo , Corrida , Animais , Cartilagem Articular/metabolismo , Estudos de Casos e Controles , Caspase 3/metabolismo , Morte Celular , Condrócitos/metabolismo , Sulfatos de Condroitina/metabolismo , DNA Nucleotidilexotransferase/metabolismo , Ácido Hialurônico/metabolismo , Interleucina-1alfa/metabolismo , Masculino , Ratos , Ratos Wistar , Joelho de Quadrúpedes/patologia , Fator de Necrose Tumoral alfa/metabolismoRESUMO
The purpose of this report is to show how our anatomical findings have influenced the design of the dorsal homodigital adipofascial turnover arterial flap to the thumb. Thirty-six thumbs from 18 fresh cadavers were dissected at the Fèr à Moulin Laboratoire (Paris, France) between January 1998 and March 1999. All branches of the proper digital artery (PDA) were identified. During the clinical study, from 2002 to 2008, 12 patients with dorsal thumb skin defects were treated with adipofascial turnover flaps. The dorsal branches of the PDA typically emerge at the level of the metacarpophalangeal and interphalangeal joints, 10 mm apart from the joint line. Based on the anatomical study, the flap could be designed predictably and reliably. The main advantages of dorsal adipofascial turnover flaps include their simplicity; the possibility of a one stage procedure; avoiding the use of tissue from elsewhere on the limb/body; minimal donor-site deformity; and avoidance of damage to the volar digital arteries.
Assuntos
Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Polegar/cirurgia , Tecido Adiposo/transplante , Adulto , Cadáver , Dissecação , Estética , Fáscia/transplante , Feminino , Humanos , Masculino , Polegar/irrigação sanguínea , Polegar/lesões , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
Glycogen is the main store of readily energy in skeletal muscle and plays a key role in muscle function, demonstrated by the inability to sustain prolonged high-intensity exercise upon depletion of these glycogen stores. With prolonged exercise, glycogen depletion occurs and 5'-AMP-activated protein kinase (AMPK), a potent regulator of muscle metabolism and gene expression, is activated promoting molecular signalling that increases glucose uptake by muscular skeletal cells. The aim of this study was primarily to determine the effect of ultra-endurance exercise on muscle glycogen reserves and secondly to verify the influence of this type of exercise on AMPK protein expression. Twenty-four male Wistar rats, 60 days old, were divided into four experimental groups: sedentary, sedentary exhausted (SE), endurance trained (T) and endurance trained exhausted (TE). The animals ran for 10 to 90 min/day, 5 days/week, for 12 weeks to attain trained status. Rats were killed immediately after the exhaustion protocol, which consisted of running on a treadmill (at approximately 60% Vmax until exhaustion). Optical density of periodic acid-Schiff was detected and glycogen depletion observed predominantly in type I muscle fibres of the TE group and in both type I and II muscle fibres in the SE group. Plasma glucose decreased only in the TE group. Hepatic glycogen was increased in T group and significantly depleted in TE group. AMPK protein expression was significantly elevated in TE and T groups. In conclusion, acute exhaustive ultra-endurance exercise promoted muscle glycogen depletion. It seems that total AMPK protein and gene expression is more influenced by status training.
Assuntos
Proteínas Quinases Ativadas por AMP/metabolismo , Glicogênio/metabolismo , Fibras Musculares de Contração Rápida/metabolismo , Fibras Musculares de Contração Lenta/metabolismo , Esforço Físico , Proteínas Quinases Ativadas por AMP/genética , Animais , Glicemia/metabolismo , Expressão Gênica , Fígado/metabolismo , Masculino , Condicionamento Físico Animal , Ratos , Ratos Wistar , Transdução de Sinais , Regulação para CimaRESUMO
BACKGROUND: The ulnar styloid is a supportive structure for the capsular ligament complex of the distal radioulnar joint. The relation between fractures of the ulna and distal radius is not clear, especially in regard to whether ulnar fractures predict worse outcomes for distal radius fractures. The objective of this study was to analyze the influence of ulnar styloid fractures in patients with reducible and unstable distal radius fractures. METHODS: A total of 100 patients with unstable and reducible distal radius fractures, with or without an ulnar styloid fracture, were randomly assigned to treatment with transarticular bridging external fixation or transulnar percutaneous pinning. Follow-up was obtained for 91 patients. For the secondary data analysis, three patient cohorts were created: a no ulnar styloid fracture group with the radius fracture treated by pinning or external fixation (n = 30); an ulnar styloid fracture with radius fracture group treated by external fixation (n = 31); and an ulnar styloid fracture with radius fracture treated by pinning (n = 30). Functional and radiological outcomes were measured at 6 and 24 months. Functional outcome measures included wrist pain (visual analogue scale) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS: At 24 months, patients with both fractures had worse wrist pain and worse scores on the DASH questionnaire than the patients with an isolated distal radius fracture; and those treated by pinning had less wrist pain and showed better scores on the DASH questionnaire than the patients treated by fixation. CONCLUSIONS: Ulnar styloid fracture may be a predictive factor of worse functional outcome for distal radius fracture. Pinning and above-the-elbow casting, used to treat ulnar styloid fractures, led to better function than fixation.
Assuntos
Fixação de Fratura , Fraturas do Rádio/complicações , Fraturas do Rádio/cirurgia , Fraturas da Ulna/complicações , Fraturas da Ulna/cirurgia , Idoso , Pinos Ortopédicos , Fixadores Externos , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Resultado do TratamentoRESUMO
OBJECTIVE: To investigate the responsiveness of the Brazilian version of the Western Ontario Rotator Cuff Index (WORC) and compare it with the Disabilities of Arm, Shoulder and Hand questionnaire (DASH), the University of California Los Angeles Shoulder Rating Scale (UCLA), and the Short-Form 36 questionnaire (SF-36) in patients with rotator cuff disorders. METHODS: The four questionnaires were administered to 30 patients at baseline and 3 months after treatment (physiotherapy or surgery). The patients were divided into two groups: those who improved after treatment (n=20) and those who did not (n=10) based on an anchor-based strategy to distinguish between the two groups and assess responsiveness. The t-test, the t-value of the paired t-test, the effect size (ES), and the standardized response mean (SRM) were calculated. RESULTS: All four questionnaires registered statistically significant changes (p<0.05) in the "improved" group between baseline and 3 months after treatment, and no changes in patients who did not improve. All four instruments showed higher ES and SRM values for the patients who improved than those who did not. WORC registered moderate to high ES and SRM values for the "improved" group, as did the UCLA and DASH. The ES and SRM values measured by the SF-36 ranged from small to large, the physical subscales being more responsive than the other subscales. CONCLUSION: The Brazilian version of the WORC (like UCLA, DASH and SF-36 physical subscales) proved responsive to change and suitable for use in the short-term follow-up of patients after rotator cuff interventions.