Joint loading decreased by inexpensive and minimalist footwear in elderly women with knee osteoarthritis during stair descent.

OBJECTIVE: Previous studies indicate that flexible footwear, which mimics the biomechanics of walking barefoot, results in decreased knee loads in patients with knee osteoarthritis (OA) during walking. However, the effect of flexible footwear on other activities of daily living, such as descending stairs, remains unclear. Our objective was to evaluate the influence of inexpensive and minimalist footwear (Moleca) on knee adduction moment (KAM) during stair descent of elderly women with and without knee OA. METHODS: Thirty-four elderly women were equally divided into an OA group and a control group (CG). Stair descent was evaluated in barefoot condition, while wearing the Moleca, and while wearing heeled shoes. Kinematics and ground reaction forces were measured to calculate KAM by using inverse dynamics. RESULTS: The OA group experienced a higher KAM during midstance under the barefoot condition (233.3%; P = 0.028), the Moleca (379.2%; P = 0.004), and heeled shoes (217.6%; P = 0.007). The OA group had a similar knee load during early, mid, and late stance with the Moleca compared with the barefoot condition. Heeled shoes increased the knee loads during the early-stance (versus barefoot [16.7%; P < 0.001] and versus the Moleca [15.5%; P < 0.001]), midstance (versus barefoot [8.6%; P = 0.014] and versus the Moleca [9.5%; P = 0.010]), and late-stance phase (versus barefoot [10.6%; P = 0.003] and versus the Moleca [9.2%; P < 0.001]). In the CG, the Moleca produced a knee load similar to the barefoot condition only during the early-stance phase. CONCLUSION: Besides the general foot protection, the inexpensive and minimalist footwear contributes to decreasing knee loads in elderly women with OA during stair descent. The loads are similar to the barefoot condition and effectively decreased when compared with heeled shoes.

The frequency of anti-beta2-glycoprotein I antibodies is low and these antibodies are associated with pulmonary hypertension in mixed connective tissue disease.

The objective of this study is to evaluate the prevalence of antiphospholipid antibodies, mainly anti-beta(2)-glycoprotein I (anti-beta(2)-GPI), and their possible clinical and laboratory relevance in mixed connective tissue disease (MCTD). This study included 39 consecutive patients with MCTD (Kasukawa's criteria) from January, 2005, to March, 2007, and compared them with 21 age- and sex-matched healthy controls. IgG and IgM anticardiolipin (aCL) and anti-beta(2)-GPI were measured by ELISA. Lupus anticoagulant (LA) was detected by functional coagulation tests. Medium to high titres of aCL and anti-beta(2)-GPI antibodies were found in sera from four (10.2%) MCTD patients. One of these patients was found to be positive for IgM aCL, IgM anti-beta(2)-GPI and LA antibodies simultaneously. Additionally, this patient had a previous history of foetal loss in the second trimester and new-onset pulmonary arterial hypertension (PAH). The other three patients had none of the manifestations of antiphospholipid syndrome (APS) or PAH. The mean value of IgG anti-beta(2)-GPI was higher among those MCTD patients with PAH than in the group without PAH (34.2 +/- 46.8 vs 12.3 +/- 9.1, P = 0.018). None of the controls were positive for antiphospholipid antibodies. High to moderate titres of anti-beta(2)-GPI as well as APS were rare in MCTD, and these antibodies may be correlated with the development of PAH in these patients.

Capillaroscopy is a dynamic process in mixed connective tissue disease.

To determine the clinical relevance of 'scleroderma-pattern' (SD-pattern) in mixed connective tissue disease (MCTD), 63 (MCTD) patients (Kasukawa's criteria) were consecutively selected. The main inclusion criterion was availability of previous nailfold capillaroscopy (NC) five years before inclusion. At entry, organ involvement and autoantibody evaluation were performed. The mean age and disease duration were 45.3 +/- 10 and 8.45 +/- 5.42 years, respectively. SD-pattern was observed in 41 patients at entry (65%) and in 45 at previous NC (71.5%), P = 0.20. Ten patients (16%) changed NC, seven normalized, and three developed SD-pattern. Disease duration, number and frequency of organ involvement were similar in patients with and without SD-pattern. In contrast, analysis of each SD-pattern parameter revealed a significantly lower frequency of moderate/severe avascular areas (AA) at entry compared to previous examination (26.5 versus 53%, P = 0.013). Moreover, 76% of patients with interstitial lung disease (HRCT) had AA at entry, whereas only 24% of patients with this alteration did not have this NC finding (P = 0.017). Furthermore, reduced capillary density was more frequently observed in patients taking immunosuppressive therapy than in those without this medication (66.7 versus 33.3%, P = 0.001). NC in MCTD is a dynamic process and analysis of each SD-pattern parameter seems to be a good indicator of lung involvement and disease severity.

Lactic acid bacteria and their effect on the immune system.

Lactic acid bacteria (LAB) are present in the intestine of most animals. The beneficial role played by these microorganisms in the humans and other animals, including the effect on the immune system, has been extensively reported. They are present in many foods and are frequently used as probiotics to improve some biological functions in the host. The activation of the systemic and secretory immune response by LAB requires many complex interactions among the different constituents of the intestinal ecosystem (microflora, epithelial cells and immune cells). Through different mechanisms they send signals to activate immune cells. Thus the knowledge of the normal intestinal microflora, the contribution of LAB and their role in the numerous functions in the digestive tract as well as the functioning of the mucosal immune system form the basis for the study and selection of a probiotic strain with immunostimulatory properties. In the selection of LAB by their immunostimulatory capacity it helps to know not only the effect which they have on the mucosal immune system, but the specific use to which these oral vaccine vectors are being put. Although there are reports of the protection of animals and humans against diseases such as microbial infections and cancer, more work remains to be done on the factors affecting the design of oral vaccine vectors and the use of LAB for therapeutic purposes. The basic knowledge of LAB immunostimulation and the criteria for selection of LAB by their immunostimulatory capacity, will be extensively discussed and appraised in this review.

[Gastrointestinal damage in osteoarthritis patients]. / Lesão gastroduodenal assintomática em portadores de osteoartrose.

Seventy-seven patients with symptomatic osteoarthritis of the hip and/or knee, with clinical indication for nonsteroidal anti-inflammatory drugs were studied. However, no patient was submitted to any anti-inflammatory medication seven days, prior the beginning of the study and did not complain of any gastrointestinal disease. Shortly before starting the anti-inflammatory drug therapy all patients were submitted to gastroduodenal endoscopy. This diagnostic procedure revealed that 54.6% of the patients presented at least one gastroduodenal damage, 22.1%, hyperemia, 3.9%, petechias, 23.4%, erosions and 5.2%, peptic ulcers. There results permitted to conclude that to identify and/or exclude damage of the gastrointestinal tract, data obtained in the anamnese are not sufficient. For these patients the endoscopic examination is a need. Anti-inflammatory therapy must be careful associated with dietetic orientation and the prescription of drugs to protect the gastrointestinal mucosa.

[Radiological staging index of osteoarthrosis]. / Indice de estadiamento radiológico na osteoarthrose.

The association of joint pain with radiological changes (such as osteophytes, joint space narrowing, and sometimes, bone cysts and erosion) is the most commonly criteria used in daily medical practice for the diagnosis of osteoarthrosis. However, these findings do not allow objective quantification of the intensity of the joint involvement. In an attempt to measure quantitatively the radiological lesions encountered in osteoarthrosis the authors elaborated a radiological index based on the following parameters: I. severity of radiological changes, II. area of the affected joint and III. number of affected joints. The application of this index in the medical practice allows a simple way of quantification of radiological lesions of osteoarthrosis and thus, a better clinical monitorization of the disease.

[Minipulses of cyclophosphamide in the treatment of dermatopolymyositis with lung involvement]. / Mini-pulsos de ciclofosfamida no tratamento da dermatopolimiosite com envolvimento pulmonar.

A new scheme for the treatment of dermatopolymyositis with pulmonary fibrosis not responding to corticosteroid therapy is presented. Monthly endovenous administration of a small dose of cyclophosphamide is advocated. Two patients with dermatopolymyositis not responding to prednisone were treated for two years with small doses of cyclophosphamide given monthly after which recovered from muscular and pulmonary involvement showing at present normal clinical parameters.

[Selectivity of rural migrants from the Sierra of Ecuador]. / La selectividad de los emigrantes rurales de la sierra ecuatoriana.

"This paper examines characteristics of recent rural-urban out-migrants leaving households in the Sierra of Ecuador. A large, household survey focussing specifically on migration is utilized, allowing detailed crosstabulations by sex and origin-destination combination and providing information about migrants generally not found in more generic surveys or censuses. Differences are noted between migrants and non-migrants in basic demographic characteristics, reasons for migrating, and economic activities prior to and subsequent to moving. Differences in the characteristics of migrants moving between various types of place of origin and place of destination are also noted." (SUMMARY IN ENG)

The impact of origin community characteristics on rural-urban out-migration in a developing country.

It is widely believed that structural variables such as inequitable land distribution, lack of rural employment opportunities, and rural-urban wage and amenity gaps influence population movements in developing countries. Yet quantitative evidence is scant. In this paper a multilevel model is used to investigate the effects of individual-, household-, and areal-level factors on rural-urban out-migration in the Ecuadorian Sierra. Data from a detailed survey carried out in 1977-1978 and from government macro-areal statistics are used to investigate factors affecting the out-migration of youths aged 12-25. Preliminary conclusions are presented on the usefulness of multilevel models in studying migration and policy implications for Ecuador.