ALEXANDRE LEME GODOY DOS SANTOS

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Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina

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  • article 5 Citação(ões) na Scopus
    ER PvuII and XbaI polymorphisms in postmenopausal women with posterior tibial tendon dysfunction: a case control study
    (2018) PONTIN, P. A.; NOGARA, P. R. B.; FONSECA, F. C. P.; NETTO, C. Cesar; CARVALHO, K. C.; SOARES JUNIOR, J. M.; BARACAT, E. C.; FERNANDES, T. D.; MAFFULLI, N.; SANTOS, M. C. L.; GODOY-SANTOS, A. L.
    BackgroundPosterior tibial tendon (PTT) insufficiency is considered as the main cause of adult acquired flat foot and is three times more frequent in females. High estrogen levels exert a positive effect on the overall collagen synthesis in tendons. We have previously demonstrated the association between some genetic single-nucleotide polymorphism (SNP) and tendinopathy. In the present study, we investigated the association of PvuII c454-397T>C (NCBI ID: rs2234693) and XbaI c454-351A>G (NCBI ID: rs9340799) SNPs in estrogen receptor alfa (ER-) gene with PPT dysfunction.MethodsA total of 92 female subjects with PTT dysfunction, with histopathological examination of the tendon and magnetic resonance image (MRI) evidence of tendinopathy, were compared to 92 asymptomatic females who presented an intact PPT at MRI for PvuII and XbaI SNPs in the ER- gene. Genomic DNA was extracted from saliva and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism.ResultsThe analysis of PvuII SNPs showed no significant differences in the frequency of alleles and genotypes between control and PTT dysfunction groups. The XbaI SNPs in the ER- gene showed significant differences in the frequency of genotypes between control and test groups (p=0.01; OR 95% 1.14 (0.55-2.33).ConclusionsThe XbaI SNP in the ER gene may contribute to tendinopathy, and the A/A genotype could be a risk factor for PTT tendinopathy in this population. The PvuII SNP studied was not associated with PTT tendinopathy.
  • article 2 Citação(ões) na Scopus
    FLEXOR HALLUX TENDON TRANSFER: COMPARATIVE STUDY THROUGH DOUBLE OR SINGLE APPROACH
    (2014) SAKAKI, Marcos Hideyo; GODOY-SANTOS, Alexandre Leme; ORTIZ, Rafael Trevisan; ARAUJO, Antonio; FERNANDES, Tulio Diniz
    Objective: To quantify the FHL length difference obtained through a single approach and by a double combined approach. Methods: 16 fresh cadavers, a total of 32 feet, were used to measure the FHL graft length. With the cadaver positioned in ventral decubitus, a posteromedial incision in the ankle and a second incision in the plantar cavus were performed. Results: The average gain of tendon's length (GTL) was of 42.43 mm, the lowest value being 32 mm and the largest 48 mm. The comparative analysis of the GTL on the right and left sides through the paired ""t"" Test does not show statistical differences, with a p-value = 0.463 and a statistical power of 0.1443. The height analysis of the sample and the right and left GTL performed through linear regression do not show statistically significant differences, with a p-value of 0.38311 and 0.82640, respectively. Conclusion: Harvesting the FHL graft using a double combined approach yields a 42.43 mm length gain in comparison to harvesting using the single approach.
  • article 3 Citação(ões) na Scopus
    Charcot neuroarthropathy: realignment of diabetic foot by means of osteosynthesis using intramedullary screws – case report,
    (2014) SANTOS, Alexandre Leme Godoy dos; ALBINO, Rômulo Ballarin; ORTIZ, Rafael Trevisan; SAKAKI, Marcos Hideyo; CORSATO, Marcos de Andrade; FERNANDES, Tulio Diniz
    Diabetes mellitus is a serious disease that affects a large portion of the population. Charcot neuroarthropathy is one of its major complications and can lead to osteoarticular deformities, functional incapacity, ulcers and ankle and foot infections. Realignment of the foot by means of arthrodesis presents a high rate of implant failure due to weight-bearing on an insensitive foot. The aim of this report was to describe successful use of intramedullary osteosynthesis with compression screws to stabilize the deformed foot, in a diabetic patient with neuroarthropathy.
  • article 13 Citação(ões) na Scopus
    Epidemiological study on talus fractures
    (2014) SAKAKI, Marcos Hideyo; SAITO, Guilherme Honda; OLIVEIRA, Rafael Garcia de; ORTIZ, Rafael Trevisan; SILVA, Jorge dos Santos; FERNANDES, Túlio Diniz; SANTOS, Alexandre Leme Godoy dos
    Objective: To analyze the characteristics of patients with talus fractures and the injuries that they present. Methods: Retrospective analysis on patients hospitalized in the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine of the University of São Paulo, between 2006 and 2011, with talus fractures. Patient profile parameters, risk factors, fracture characteristics, treatment data and acute complications were analyzed. Results: Analysis on 23 cases showed that men were more affected than women, with a ratio of 4.8:1. The most frequent trauma mechanism was traffic accidents, followed by falls from a height. The most frequent type of fracture was at the neck of the talus, with 17 cases. Among the 23 cases, seven had peritalar dislocation at the time of presentation, four had exposed fractures and 11 presented other associated fractures. The mean length of time between the trauma and the definitive treatment was six days, while the mean length of hospital stay was 11 days. Three patients presented acute postoperative complications. Conclusion: Talus fractures occurred most commonly in the region of the talar neck and most frequently in young males who suffered high-energy trauma. In almost half of the cases, there were other associated fractures. The length of hospital stay was 11 days.
  • article 7 Citação(ões) na Scopus
    EPIDEMIOLOGICAL STUDY ON LISFRANC INJURIES
    (2017) SOBRADO, Marcel Faraco; SAITO, Guilherme Honda; SAKAKI, Marcos Hideyo; PONTIN, Pedro Augusto; SANTOS, Alexandre Leme Godoy dos; FERNANDES, Tulio Diniz
    Objective: To analyze the characteristics of patients with Lisfranc injuries and their associated fractures. Methods: This is a retrospective analysis on 42 patients with Lisfranc injuries hospitalized at Instituto de Ortopedia e Traumatologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, between 2006 and 2010. Parameters on patient profile, risk factors, fracture characteristics, data on treatment and acute complications were analyzed. Results: Analysis of 42 cases showed that in our sample, men were more affected than women, with a ratio of 4.25:1. The most frequent trauma mechanism was car accident, followed by motorcycle accident. The most frequent type of injury was isolated lesion type B of Quenu and Kuss classification, representing 50% of cases. The most common fracture on the sample was the second metatarsal bone, with 16 cases, followed by cuboid bone fracture. Among the 42 cases, 17% had exposed fractures and 33 patients presented other associated fractures. The mean time elapsed between the trauma and definitive treatment was 6.7 days, while the mean length of hospital stay was 13.8 days. Six patients presented acute postoperative complications. Conclusion: Lisfranc injuries are more common in men undergoing automobile trauma. The prevalence of associated fractures is a frequent finding and the hospital stay may be longstanding.
  • article 22 Citação(ões) na Scopus
    MMP-1 promoter genotype and haplotype association with posterior tibial tendinopathy
    (2014) BARONEZA, Jose Eduardo; GODOY-SANTOS, Alexandre; MASSA, Bruno Ferreira; MUNHOZ, Francielle Bocon de Araujo; FERNANDES, Tulio Diniz; SANTOS, Maria Cristina Leme Godoy dos
    Purpose: Posterior tibial tendon (PIT) is particularly vulnerable and its insufficiency is recognized as the main cause of adult acquired flatfoot. Some patients have a predisposition without clinically recognized cause, suggesting that individual characteristics play an important role in tendinopathy. The objective of the present study is to investigate the association of -519 (rs1144393) matrix metalloproteinase-1 (MMP-1) polymorphism and the -1607 (rs1799750) and -519 MMP-1 haplotypes and risk of PTT dysfunction. Methods: The test group included 50 females who presented PTT dysfunction Grade 2 or 3, and who were submitted to surgical treatment, with histopathological examination of the tendon and magnetic resonance image (MRI) confirming tendinopathy, while the control group was 100 asymptomatic women who present intact MT at MRI. We analyzed functional polymorphisms MMP-1 and their haplotypes using polymerase chain reaction and restriction fragment length analysis. Results: There was a significant difference in the presence of the different alleles and genotypes between the control group and test group for the MMP-1 gene (p <= 0.01). The G allele of the -519 MMP-1 polymorphism increased susceptibility to degeneration in the PTT tendon and seems to be a genetic risk factor. Global haplotype analysis indicated a significant difference between both groups (p < 0.0001). Haplotypes G-2G and A-2G had statistically significant risk effect on PTT insufficiency. G-2G, p < 0.001; OR = 5.72 (CI, 2.84-11.52) and A-2G p = 0.002, OR = 3.95 (CI, 1.65-9.44). Conclusion: According to our results, -519 MMP-1 isolated and -1607/-519 MMP-1 haplotypes are associated to tendinopathy in posterior tibial tendon. (C) 2014 Published by Elsevier B.V.
  • article 28 Citação(ões) na Scopus
    MMP-1 promoter polymorphism is associated with primary tendinopathy of the posterior tibial tendon
    (2013) GODOY-SANTOS, Alexandre; CUNHA, Mirella V.; ORTIZ, Rafael Trevisan; FERNANDES, Tulio Diniz; MATTAR JR., Rames; SANTOS, Maria Cristina L. G. dos
    Posterior tibial tendon (PTT) dysfunction is recognized as an etiology leading to acquired flatfoot in adults, causing significant functional loss. Many risk factors and systemic conditions have been proposed in literature. However, many patients present PTT dysfunction without any of these characteristics. This suggests that there could be a genetic influence associated with posterior tibial tendinopathy. The purpose of the present study is to investigate the association of the 1607 polymorphism in the promoter gene of MMP-1 and posterior tibial tendinopathy. The test group included 50 women, who presented PTT dysfunction grade 2 or 3, and who were submitted to surgical treatment, with histopathological examination of the tendon and magnetic resonance image (MRI) confirming tendinopathy, while the control group was 100 asymptomatic women who presented intact PTT at MRI. The results were analyzed using the chi-square test. The data showed a 75% incidence of the allele 1G and 62% of the genotype 1G/1G at the control group while, at the test group, they showed a 78% incidence of the allele 2G and 72% of the genotype 2G/2G (p<0.001). The 1607 polymorphism of promoter gene of MMP-1 is associated with the posterior tibial tendinopathy in the studied population. (c) 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:11031107, 2013
  • article 11 Citação(ões) na Scopus
    Posterior tibial tendinopathy associated with matrix metalloproteinase 13 promoter genotype and haplotype
    (2016) MUNHOZ, Francielle Bocon de Araujo; BARONEZA, Jose Eduardo; GODOY-SANTOS, Alexandre; FERNANDES, Tulio Diniz; BRANCO, Filipe Polese; ALLE, Lupe Furtado; SOUZA, Ricardo Lehtonen de; SANTOS, Maria Cristina Leme Godoy dos
    BackgroundPosterior tibial tendon (PTT) is particularly vulnerable and its insufficiency is recognized as the main cause of adult acquired flat foot. Some patients have a predisposition without a clinically recognized cause, suggesting that individual characteristics play an important role in tendinopathy. The present study investigated whether genetic variants in matrix metalloproteinases (MMPs) are associated with PTT dysfunction. MethodsOne hundred women who presented PTT dysfunction, with histopathological examination of the tendon and magnetic resonance imaging (MRI) confirming tendinopathy, as well as 100 asymptomatic women who presented intact PPT as assessed by MRI and constituting the control group, were evaluated for MMP-13g.-77 A>G (rs2252070) polymorphism, individually and in haplotypes, as well as in combination with MMP-1g.-519 A>G (rs1144393), MMP-1g.-1607G>GG (rs1799750) and MMP-8g.-799 C>T (rs11225395) polymorphisms with PTT dysfunction. Genomic DNA was extracted from the saliva and genotypes were obtained by polymerase chain reaction-restriction fragment length polymorphism. Statistical analysis of the results included a Mann-Whitney U-test, Fisher's exact test, multiple logistic regression, chi-squared and SNPstats software (http://bioinfo. ). p<0.05 was considered statistically significant. ResultsThe A allele frequency (MMP-13g.-77 A>G (rs2252070) polymorphism) was significantly higher in the case group (76% and 61%, respectively; p=0.010, odds ratio=2.02; 95% confidence interval=1.32-3.12). The genotype distribution was also significantly different between groups (p=0.001, odds ratio=2.82; 95% confidence interval=1.58-5.02). Global haplotype analysis indicated a significant difference between both groups. ConclusionsIn conclusion, these findings indicate that MMP-13g.-77 A>G (rs2252070) polymorphism individually, as well as its haplotypes MMP-1g.-519 A>G (rs1144393), MMP-1g.-1607G>GG (rs1799750) and MMP-8g.-799 C>T (rs11225395), may contribute to PTT dysfunction.
  • article 6 Citação(ões) na Scopus
    EPIDEMIOLOGIC STUDY OF ANKLE FRACTURES IN A TERTIARY HOSPITAL
    (2014) SAKAKI, Marcos Hideyo; MATSUMURA, Bruno Akio Rodrigues; DOTTA, Thiago De Angelis Guerra; PONTIN, Pedro Augusto; SANTOS, Alexandre Leme Godoy dos; FERNANDES, Tulio Diniz
    Objectives: To evaluate the epidemiology of ankle fractures surgically treated at the Instituto de Ortopedia e Traumatologia do Hospital das Clinicas da Universidade de Sao Paulo. Methods: Medical records of patients admitted with foot and ankle fractures between 2006 and 2011 were revised. Seventy three ankle fractures that underwent surgical treatment were identified. The parameters analyzed included age, gender, injured side, AO and Gustilo & Anderson classification, associated injuries, exposure, need to urgent treatment, time to definitive treatment and early post-operative complications. Study design: retrospective epidemiological study. Results: Male gender was predominant among subjects and the mean age was 27.5 years old. Thirty nine fractures resulted from traffic accidents and type B fracture according to AO classification was the most common. Twenty one were open fractures and 22 patients had associated injuries. The average time to definitive treatment was 6.5 days. Early post-operative complications were found in 21.3% of patients. Conclusions: Ankle fractures treated in a tertiary hospital of a large city in Brazil affect young people victims of high-energy accidents and present significant rates of associated injuries and post-operative complications.
  • article 16 Citação(ões) na Scopus
    Matrix metalloproteinase-1 (MMP-1) and (MMP-8) gene polymorphisms promote increase and remodeling of the collagen III and V in posterior tibial tendinopathy
    (2018) DINIZ-FERNANDES, Tulio; GODOY-SANTOS, Alexandre Leme; SANTOS, Maria Cristina; PONTIN, Pedro; PEREIRA, Caio Augusto Alves; JARDIM, Yuri Justi; VELOSA, Ana Paula Pereira; MAFFULLI, Nicola; TEODORO, Walcy Rosolia; CAPELOZZI, Vera Luiza
    Posterior tibial tendinopathy (PTT) can lead to acquired flatfoot in adults. Many patients develop PTT without any identifiable risk factors. Molecular changes in extracellular matrix (ECM) and matrix metalloproteinase (MMP) polymorphism may influence the risk of developing PTT. We aim to investigate the association between matrix metalloproteinase-1 (MMP-1) and (MMP-8) gene polymorphisms with changes in collagen I, III and V in PTT. A case-control study with 22 patients and 5 controls was performed. The MMP-1 (2G/2G) and MMP-8 (T/T) genotypes were determined by PCR-restriction fragment length polymorphism. Tendon specimens were evaluated by a histologic semiquantitative score, immunofluorescence and histomorphometry for collagen I, III and V. Tendon specimens from PTT demonstrated marked distortion of the architecture with necrosis, large basophilic areas with disruption of the normal linear orientation of collagen bundles, infiltration of inflammatory cells, dystrophic calcification and ossification. Under immunofluorescence, PTT tendon specimens showed weak green fluorescence and diffuse distribution of collagen I fibers, but strong fluorescence of collagen III and V. The collagen I fibers were significantly decreased whereas an increase of collagen III and V were found in PTT compared to control groups. In addition, PTT group presented a significant association with MMP-1 and MMP-8 gene polymorphisms. Patients with PTT matrix metalloproteinase-1 (MMP-1) and (MMP-8) gene polymorphisms presented an increase of the collagen III and V ratio, suggesting that the higher proportion in degenerated tendons could contribute to a decrease in the mechanical resistance of the tissue. Still, functional and association studies are needed to elucidate evident roles of MMPs in PTT.