Artur da Rocha Corrêa Fernandes

Strength Training with Blood Flow Restriction Diminishes Myostatin Gene Expression

PURPOSE The aim of the study was to determine whether the similar muscle strength and hypertrophy responses observed after either low-intensity resistance exercise associated with moderate blood flow restriction or high-intensity resistance exercise are associated with similar changes in messenger RNA (mRNA) expression of selected genes involved in myostatin (MSTN) signaling. METHODS Twenty-nine physically active male subjects were divided into three groups: low-intensity (20% one-repetition maximum (1RM)) resistance training (LI) (n = 10), low-intensity resistance exercise associated with moderate blood flow restriction (LIR) (n = 10), and high-intensity (80% 1RM) resistance exercise (HI) (n = 9). All of the groups underwent an 8-wk training program. Maximal dynamic knee extension strength (1RM), quadriceps cross-sectional area (CSA), MSTN, follistatin-like related genes (follistatin (FLST), follistatin-like 3 (FLST-3)), activin IIb, growth and differentiation factor-associated serum protein 1 (GASP-1), and MAD-related protein (SMAD-7) mRNA gene expression were assessed before and after training. RESULTS Knee extension 1RM significantly increased in all groups (LI = 20.7%, LIR = 40.1%, and HI = 36.2%). CSA increased in both the LIR and HI groups (6.3% and 6.1%, respectively). MSTN mRNA expression decreased in the LIR and HI groups (45% and 41%, respectively). There were no significant changes in activin IIb (P > 0.05). FLST and FLST-3 mRNA expression increased in all groups from pre- to posttest (P < 0.001). FLST-3 expression was significantly greater in the HI when compared with the LIR and LI groups at posttest (P = 0.024 and P = 0.018, respectively). GASP-1 and SMAD-7 gene expression significantly increased in both the LIR and HI groups. CONCLUSIONS We concluded that LIR was able to induce gains in 1RM and quadriceps CSA similar to those observed after traditional HI. These responses may be related to the concomitant decrease in MSTN and increase in FLST isoforms, GASP-1, and SMAD-7 mRNA gene expression.

Effects of strength training and vascular occlusion

The purpose of our study was to determine if vascular occlusion produced an additive effect on muscle hypertrophy and strength performance with high strength training loads. Sixteen physically active men were divided into two groups: high-intensity (HI = 6 RM) and moderate-intensity training (MI = 12 RM). An occlusion cuff was attached to the proximal end of the right thigh, so that blood flow was reduced during the exercise. The left leg served as a control, thus was trained without vascular occlusion. Knee extension 1 RM and quadriceps cross-sectional area (MRI) were evaluated pre- and post-8 weeks of training. We only found a main time effect for both strength gains and quadriceps hypertrophy (p < 0.001). Therefore, we conclude that vascular occlusion in combination with high-intensity strength training does not augment muscle strength or hypertrophy when compared to high-intensity strength training alone.

Ultrasound-guided intra-articular injections in the wrist in patients with rheumatoid arthritis: a double-blind, randomised controlled study

Intra-articular (IA) injections with glucocorticoid are a valuable therapeutic intervention for patients with rheumatoid arthritis (RA) and wrist synovitis. Jones et al have demonstrated that half of the wrist blind injections were considered to be extra-articular.1 Musculoskeletal ultrasound (US) allows for the proper real-time allocation of the needle during the injections, limiting the risk of damage to the cartilage, tendons, nerves and peripheral blood vessels.2 In this study we compare the efficacy of blind and US-guided IA injections in patients with RA with wrist synovitis. The accuracy of the techniques used to inject the drug into wrist joint is …

Sonographic description and classification of tendinous involvement in relation to tophi in chronic tophaceous gout

ObjectiveTo describe and classify the varied ultrasound features of tendinous involvement in relation to tophi in chronic tophaceous gout so that they are better recognised.MethodsUltrasound images of 138 affected areas from 31 patients with chronic tophaceous gout were analysed using high-quality broadband linear transducers. The relationship between tendon and tophi was classified, and the inter-observer agreement regarding classification was analysed.ResultsTophi envelopment in the tendon was the most frequent characteristic (45%) followed by no relationship between tophi and tendon (41%), tophi at the insertion site of the tendon (7%), extrinsic compression (6%) and tophi within the tendon (1%). The inter-observer concordance on classification of the relationship between tophi and tendon was measured using McNemar’s test with P < 0.001 (χ2 = 30.0, degree of freedom = 9) and kappa test = 0.627 (P < 0.001), indicating substantial inter-observer concordance.ConclusionTophi generally envelope the tendon or there is no relationship between them. Tophi can also be found at the insertion site of the tendon, cause extrinsic compression or be located inside the tendon. There is substantial inter-observer agreement for ultrasound classification of tendon involvement by tophi. This study contributes to diagnostic elucidation and shows the diverse characteristic forms of tendon involvement by tophi.

Progressive resistance exercise in women with osteoarthritis of the knee: a randomized controlled trial:

Objective: To determine the effect of a progressive resistance exercise (PRE) program on women with osteoarthritis (OA) of the knee. Methods: Eligible subjects included women aged 40 to 70 years with pain between 3 and 8 on a 10-cm pain scale. Among the 144 subjects screened, 60 met the eligibility criteria and were randomized to the experimental group (EG) or control group (CG). Subjects in the EG participated in a 12-week PRE program twice a week and CG remained on a waiting list for physical therapy. The PRE program consisted of strengthening exercises for knee extensors, knee flexors, hip abductors and hip adductors, all performed with 50% and 70% of the one-repetition maximum (1RM) using machines with free weights. Resistance was reevaluated every two weeks. Assessments of pain, muscle strength, walking distance, function and quality of life were performed at baseline, six weeks and 12 weeks by a blinded assessor. Results: Twenty-nine female subjects were randomly assigned to the EG and 31 were randomly assigned to the CG. Repeated-measures ANOVA revealed significantly better results in the EG pain (from 7.0±1.3 to 4.3±3.1 in the EG and from 7.0±1.2 to 6.6±1.5 in the CG - p<0.001), function (p<0.001), some domains of quality of life (physical function: p=0.002; physical role limitation: p=0.002; and pain: p=0.044) and muscle strength (extensors: p<0.001; flexors: p=0.002; and abductors: p<0.001). Conclusion: The PRE program was effective in reducing pain and improving function, some quality of life domains and strength in women with OA of the knee.

Ultrasound characteristics of gouty tophi in the olecranon bursa and evaluation of their reproducibility

OBJECTIVES To describe the ultrasound characteristics of gouty tophi in the olecranon bursa and to evaluate their reproducibility. METHODS A prospective study of the ultrasound features of 35 sites of tophi nodulations in the elbows of 31 men (mean 54.6 years). The findings were evaluated dynamically following pre-established standards. The static images were evaluated by another radiologist and were reviewed by the first examiner. RESULTS The most frequent characteristics of tophi are: hyperechogenicity (91.7%), poorly defined contours (88.6%), multiple grouped nodules (85.6%) and heterogeneity (68.6%). Intra-observer agreement is almost perfect for echogenicity (K = 1.0), moderate for the involvement of the olecranon bursa (K = 0.47) and fair for other characteristics. Inter-observer agreement is substantial for the echogenicity (K = 0.65), fair for the echotexture (K = 0.27) and the presence of a perilesional hypoechoic halo (K = 0.34) and slight for other characteristics. CONCLUSIONS The most frequent characteristic of tophi is hyperechogenicity. The intra-observer and inter-observer concordance for echogenicity are almost perfect and substantial, respectively. Knowledge of characteristics of the tophi in the elbow and their intra and inter-observer reproducibility may assist in establishing parameters for monitoring treatment and setting up criteria for differential diagnosis of processes involving the olecraneon bursa.

Hyperplastic callus formation in osteogenesis imperfecta type V mimicking osteosarcoma: 4-year follow-up with resolution

We report a case of hyperplastic callus formation that occurred in both femurs in a patient with type V osteogenesis imperfecta (OI), with 4-year follow-up and resolution. The clinical, histological and imaging aspects of this condition are discussed. Recognition of the hyperplastic callus formation in this particular type of OI is important in order to avoid misdiagnosis.

Avaliação por imagem do comprometimento osteoarticular e de nervos periféricos na hanseníase

ABSTRACT In leprosy, bone lesions due direct invasion of bacilli are low in incidence and these lesions exhibit radiologic findings of acute and chronic osteomyelitis similar to those of other granulomatous infectious agents. The more common bone lesions are those due to injurious effects of trauma and infection imposed upon denervated tissues. Radiographycally are seen various degrees of reabsorption of the extremities involving hands and feet with the loss of digits and disorganizing arthropathies in small joints. The radiologic appearance are similar to other conditions in which there is sensory impairment like scleroderma, syringomielia and diabetes mellitus. The ultrasonography and magnetic resonance imaging (MRI) can be helpful in evaluation of the involvement of the peripheral nerves helping in the diagnosis of the neuritis, abscess and differential diagnosis in compressive syndromes. Keywords: leprosy, bone lesions, neuropathy, radiology, US, MRI. 1. Medica Reumatologista Assistente do Hospital Universitario Getulio Vargas, Universidade Federal do Amazonas (UFAM), pos-graduanda da Disciplina de Reumatologia da Universidade Federal de Sao Paulo (UNIFESP).2. Professora do Departamento de Clinica Medica, Disciplina de Reumatologia da UFAM, pos-graduanda da Disciplina de Reumatologia da Universidade de Sao Paulo (USP). 3. Medica Assistente Doutora da Disciplina de Reumatologia do Departamento de Medicina da UNIFESP.4. Departamento de Diagnostico por Imagem da UNIFESP.

Diagnóstico por imagem do punho na síndrome do túnel do carpo

A síndrome do túnel do carpo (STC) resulta da compressão do nervo mediano no túnel do carpo, sendo a neuropatia mais comum da extremidade superior. O túnel do carpo é um espaço restrito, elíptico, confinado ventralmente pelo retináculo dos flexores, inelástico e resistente e, dorsalmente, pela superfície anterior dos ossos do carpo. As maiores estruturas que passam pelo túnel são: quatro tendões flexores superficiais dos dedos e quatro tendões flexores profundos, tendão do flexor longo do polegar, e o nervo mediano. A incidência de STC na população geral é menor do que 1%, podendo ser encontrados, entretanto, valores acima de 15% em trabalhadores de risco, sendo a tendinite o achado mais comum. A compressão da STC é causada pela discrepância entre a capacidade rígida do canal e o volume de seu conteúdo. Dado que o volume do conteúdo e a capacidade do canal variam com a posição do punho em relação ao eixo do antebraço, os períodos de compressão podem ser inconstantes, e os sintomas resultantes tendem a flutuar (Tabela 1). A STC ocupacional é causa de absenteísmo no trabalho e de disputas legais. Como a incidência de STC continua a aumentar, a avaliação acurada desses pacientes torna-se de fundamental importância.

Ultra-sonografia na artrite reumatóide: aplicabilidade e perspectivas

This review discusses the usefulness of ultrasound in the early diagnosis of reumathoid arthritis, its utilization in these patients treatment and its utility in evaluation of the response to treatment. Reumathoid arthritis is a chronic disease that when it is not promptly diagnosed it can cause physical deformity and disability to work. The early introduction of disease modifying antirheumatic drugs (DMARDs), no matter traditional or newer (biologic agents), may modify the disease outcome. In order that , the diagnosis of RA must be made as soon as possible. Ultrasound makes possible to study the joints and can show signs of inflammatory activity, especially synovitis. Color Doppler and power Doppler can help differentiate between active inflammatory tissue (pannus) and inactive inflammatory tissues. Erosions, tenossynovitis, bursitis, cysts and effusions can also be found. This article demonstrates that methods to quantify de inflammatory activity on ultrasound must yet be established.