ARNALDO JOSE HERNANDEZ
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Ortopediae Traumatologia, Faculdade de Medicina - Docente
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
9 resultados
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- Macrophage: A Potential Target on Cartilage Regeneration(2020) FERNANDES, Tiago Lazzaretti; GOMOLL, Andreas H.; LATTERMANN, Christian; HERNANDEZ, Arnaldo Jose; BUENO, Daniela Franco; AMANO, Mariane TamiCartilage lesions and osteoarthritis (OA) presents an ever-increasing clinical and socioeconomic burden. Synovial inflammation and articular inflammatory environment are the key factor for chondrocytes apoptosis and hypertrophy, ectopic bone formation and OA progression. To effectively treat OA, it is critical to develop a drug that skews inflammation toward a pro-chondrogenic microenvironment. In this narrative and critical review, we aim to see the potential use of immune cells modulation or cell therapy as therapeutic alternatives to OA patients. Macrophages are immune cells that are present in synovial lining, with different roles depending on their subtypes. These cells can polarize to pro-inflammatory (M1) and anti-inflammatory (M2) phenotypes, being the latter associated with wound-healing by the production of ARG-1 and pro-chondrogenic cytokines, such as IL-10, IL-1RA, and TGF-b. Emerging evidence reveals that macrophage shift can be determined by several stimuli, apart from the conventional in vitro IL-4, IL-13, and IL-10. Evidences show the potential of physical exercise to induce type 2 response, favoring M2 polarization. Moreover, macrophages in contact with oxLDL have effect on the production of anabolic mediators as TGF-b. In the same direction, type II collagen, that plays a critical role in development and maturation process of chondrocytes, can also induce M2 macrophages, increasing TGF-b. The mTOR pathway activation in macrophages was shown to be able to polarize macrophages in vitro, though further studies are required. The possibility to use mesenchymal stem cells (MSCs) in cartilage restoration have a more concrete literature, besides, MSCs also have the capability to induce M2 macrophages. In the other direction, M1 polarized macrophages inhibit the proliferation and viability of MSCs and impair their ability to immunosuppress the environment, preventing cartilage repair. Therefore, even though MSCs therapeutic researches advances, other sources of M2 polarization are attractive issues, and further studies will contribute to the possibility to manipulate this polarization and to use it as a therapeutic approach in OA patients.
- CrossFit Overview: Systematic Review and Meta-analysis(2018) CLAUDINO, Joao Gustavo; GABBETT, Tim J.; BOURGEOIS, Frank; SOUZA, Helton de Sa; MIRANDA, Rafael Chagas; MEZENCIO, Bruno; SONCIN, Rafael; CARDOSO FILHO, Carlos Alberto; BOTTARO, Martim; HERNANDEZ, Arnaldo Jose; AMADIO, Alberto Carlos; SERRAO, Julio CercaBackground: CrossFit is recognized as one of the fastest growing high-intensity functional training modes in the world. However, scientific data regarding the practice of CrossFit is sparse. Therefore, the objective of this study is to analyze the findings of scientific literature related to CrossFit via systematic review and meta-analysis. Methods: Systematic searches of the PubMed, Web of Science, Scopus, Bireme/MedLine, and SciELO online databases were conducted for articles reporting the effects of CrossFit training. The systematic review followed the PRISMA guidelines. The Oxford Levels of Evidence was used for all included articles, and only studies that investigated the effects of CrossFit as a training program were included in the meta-analysis. For the meta-analysis, effect sizes (ESs) with 95% confidence interval (CI) were calculated and heterogeneity was assessed using a random-effects model. Results: Thirty-one articles were included in the systematic review and four were included in the meta-analysis. However, only two studies had a high level of evidence at low risk of bias. Scientific literature related to CrossFit has reported on body composition, psycho-physiological parameters, musculoskeletal injury risk, life and health aspects, and psycho-social behavior. In the meta-analysis, significant results were not found for any variables. Conclusions: The current scientific literature related to CrossFit has few studies with high level of evidence at low risk of bias. However, preliminary data has suggested that CrossFit practice is associated with higher levels of sense of community, satisfaction, and motivation.
- BILATERAL LOCALIZED PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEE: CASE REPORT AND REVIEW(2018) FERNANDES, Tiago Lazzaretti; VIDEIRA, Livia Dau; SASAKI, Sandra Umeda; NATALINO, Renato Jose Mendonca; ALMEIDA, Adriano Marques de; PEDRINELLI, Andre; HERNANDEZ, Arnaldo JoseObjectives: Several cases of bilateral diffuse pigmented villonodular synovitis (PVNS) or tenosynovial giant cell tumor have been described in the literature. Nevertheless, some presentations are rare and differential diagnoses are necessary. Methods: The purpose of this study was to perform a systematic review of the literature related to PVNS and to report a rare supra-patellar bilateral and focal presentation. We performed a systematic data review in the Pubmed Clinical Queries database using MeSH and keywords related to PVNS and tenosynovial giant cell tumor. Results: Two cases of bilateral and local PVNS had been previously described, but neither was localized in the supra-patellar compartment. To our knowledge, this case report is the first to describe supra-patellar bilateral and localized PVNS of the knee. This case involves a 28-year-old woman with bilateral localized PVNS of the supra-patellar recess of the knee. MRI showed a low-signal intensity nodule in T1-and T2-weighted images. These were associated with hemosiderin pigmentation. Conclusion: The most important finding of the case reported is related to rarity and location. Histopathology analysis confirmed a rare case of hemosiderin pigmentation in the capsular nodule with internal non-pigmented villous content. Lipoma arborescens in the supra-patellar form must be ruled out as a differential diagnosis since it occurs in the same site.
- CLINICAL APPLICATION OF THERMOGRAPHY FOR ENERGY BALANCE IN ATHLETES - STATE OF THE ART AND NEW PARADIGMS(2018) FERNANDES, Tiago Lazzaretti; HERNANDEZ, Arnaldo Jose; ALBUQUERQUE, Cyro; MADY, Carlos Eduardo KeutenedjianThis article aims to describe the evolution of techniques that have enabled the proper application of the Laws of Thermodynamics for physical activity and athletes. The objective is to propose performance indicators to help add information to the current indices used in medicine and sports, such as the lactate threshold and maximum oxygen consumption. A number of analyses of the results obtained by the group were carried out for this purpose. Moreover, a discussion regarding which techniques would provide a better response to the measurements was analyzed. Some examples are the substitution of the treadmill running test with the stationary bicycle (known performed work), and a literature search in order to measure internal temperature more accurately.
- Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis(2021) FERNANDES, Tiago Lazzaretti; MOREIRA, Hugo Henrique; ANDRADE, Renato; SASAKI, Sandra Umeda; BERNARDO, Wanderley Marques; PEDRINELLI, Andre; ESPREGUEIRA-MENDES, Joao; HERNANDEZ, Arnaldo JoseBackground: There have been conflicting results about the theoretical advantages of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. Purpose: To evaluate the clinical and functional outcomes comparing anatomic single- versus double-bundle techniques, anatomic versus nonanatomic techniques, and transportal versus outside-in tunnel drilling for ACL reconstruction. Study Design: Systematic review; Level of evidence, 3. Methods: A search was performed in the MEDLINE and EMBASE databases up to August 2018 for clinical trials comparing anatomic ACL reconstruction (with tunnel positioning demonstrated using gold standard radiologic techniques) with another technique, with a minimum functional and biomechanical follow-up of 6 months. A meta-analysis was performed to compare clinical and functional outcomes between anatomic single- versus double-bundle reconstruction and between anatomic versus nonanatomic techniques, using the risk difference or the mean difference. Risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale for cohort and case-control studies and the Cochrane Risk of Bias tool and Jadad Score for randomized controlled trials. Results: Included were 15 studies comprising 1290 patients (follow-up, 12-36 months). No significant differences favoring anatomic double-bundle over anatomic single-bundle reconstruction or outside-in over transportal techniques were found. The meta-analyses showed significant differences in the International Knee Documentation Committee (IKDC) objective score (risk difference, -0.14; 95% confidence interval, -0.27 to -0.01) favoring anatomic over nonanatomic reconstruction. No statistically significant differences were found between anatomic and nonanatomic surgical techniques on other functional scores or clinical examination outcomes, including the IKDC subjective score, Lysholm score, Tegner score, KT-1000 arthrometer test, or pivot-shift test. Conclusion: Double-bundle reconstruction was not superior to the single-bundle technique in clinical and functional outcomes. Anatomic ACL reconstruction shows significantly superior results over nonanatomic ACL reconstruction, reinforcing the anatomic technique as the gold standard choice for clinical practice.
- Locking intramedullary nails versus locking plates for the treatment of proximal humerus fractures(2017) GRACITELLI, Mauro E. C.; MALAVOLTA, Eduardo A.; ASSUNCAO, Jorge H.; FERREIRA NETO, Arnaldo A.; SILVA, Jorge S.; HERNANDEZ, Arnaldo JoseIntroduction: Proximal humerus fractures (PHF) are common fractures and are the third most common type of fractures among older adults. The most commonly used implants include the locking plate and the locking intramedullary nail. Areas covered: The aim of this study is to perform a literature review of biomechanical and clinical studies that compare the locking plate and intramedullary nail for PHF osteosynthesis. Expert commentary: Twelve clinical studies and seven biomechanical studies were identified that met this criterion. The findings of this review showed that intramedullary nailing and locking plate fixation yielded similar functional results, but with contrasting complication rates. The biomechanical studies showed controversial results, with most of the studies demonstrating better biomechanical properties for the intramedullary nail. Different types of intramedullary nail for PHF have different characteristics, with curvilinear nails presenting a higher risk of complications.
- Quality assessment of muscle injury classification in sports: a systematic literature review(2018) SANTANNA, Joao Paulo C.; ALMEIDA, Adriano M. de; PEDRINELLI, Andre; HERNANDEZ, Arnaldo J.; FERNANDES, Tiago L.Introduction: Muscular injuries are very common and lesion categorization is important for patient treatment and orientation. There is no study in literature that assessed methodological quality of classifications for muscle injury in sports. The objective of this study was to evaluate the quality of manuscripts that proposed a classification of muscular injury in sports. Methods: A systematic search for articles in English, Spanish and Portuguese languages containing terms related to ""muscle, skeletal/injuries"", ""athletic injuries"", ""classification"", ""diagnosis"" and ""etiology"" were carried out. Articles included for evaluation proposed classifications of muscular injuries related to sports and were submitted to methodological quality appraisal from Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) protocol. Results: 1606 articles were found. From those, 17 proposed an organized system with different sorts of muscular injury. The 17 studies were graded according to methodological quality, considering risk of bias and applicability of each classification. Three studies presented very good results and one showed good results. The remaining articles presented a high or undetermined risk of bias and problems related to applicability. Conclusion: There is a wide variety of methodological quality of classification studies. Most classifications system are only a theoretical model and therefore have important limitations.
- Systematic Review of Human Dental Pulp Stem Cells for Cartilage Regeneration(2020) FERNANDES, Tiago Lazzaretti; SANTANNA, Joao Paulo Cortez de; FRISENE, Igor; GAZARINI, Joao Paulo; PINHEIRO, Carla Cristina Gomes; GOMOLL, Andreas H.; LATTERMANN, Christian; HERNANDEZ, Arnaldo Jose; BUENO, Daniela FrancoBackground: Symptomatic cartilage lesions and early osteoarthritis produce significant clinical and economic burdens. Cartilage repair can improve the symptoms and delay arthroplasty. The complete healing of damaged cartilage with the consistent reproduction of normal hyaline cartilage has not yet been achieved. The choice of harvesting site might influence the cells' abilities to modulate immunologic and inflammatory responses. Recently, dental pulp has been shown to contain a stem cell niche consisting of dental pulp stem cells (DPSCs) that maintain their self-renewal capacity due to the active environment in the dental pulp of deciduous teeth. Objective: The aim of this study was to critically review the current literature on the potential and limitations of the use of dental pulp-derived mesenchymal stem cells in cell-based therapies for cartilage regeneration. Methods: An electronic, customized search of scientific articles was conducted using the PubMed/MEDLINE and EMBASE databases from their inception to December 2018. The inclusion criteria were applied, and the articles that described the use of DPSC in cartilage treatment were selected for complete evaluation. The articles were classified according to the scaffold used, experimental model, chondrogenic differentiation features, defect location, cartilage evaluation, and results. After the application of the eligibility criteria, a total of nine studies were selected and fully analyzed. Results: A variety of animal models were used, including mice, rats, rabbits, and miniature pigs, to evaluate the quality and safety of human DPSCs in the repair of cartilage defects. Among the articles, two studies focused on preclinical models of cartilage tissue engineering. Five studies implanted DPSCs in other animal sites. Conclusion: The use of DPSCs is a potential new stem cell therapy for articular cartilage repair. The preclinical evidence discussed in this article provides a solid foundation for future clinical trials. Impact statement Osteoarthritis presents an ever-increasing clinical and socioeconomic burden. While cartilage repair has the potential to improve symptoms and delay joint replacement, complete regeneration of hyaline cartilage has been an elusive goal. Dental pulp has been shown to contain a niche that protects dental pulp stem cells (DPSCs) from the cumulative effects of genetic and environmental factors and maintains their self-renewal capacity due to the active environment. Transplantation and preclinical trials have demonstrated the strong potential of regenerative tissue-engineering protocols using DPSCs.
- Articles Published in Brazilian Journals Relevant to Sports and Exercise Medicine; a Review(2011) HERNANDEZ, Arnaldo JoseThe purpose of this new series of 34 articles is to alert national and international readers to some of the most important recent contributions of the Brazilian medical literature in other areas of specialization. These are works that offer support to many lines of research in this area. The most relevant original articles are selected by experienced editors, who provided us with key words, which are highlighted in order to attract readers' attention. To facilitate reading, the articles are organized by area of interest. To make the maximum use of the limited editorial space, the authors' names are omitted. The final result brings the best of each article, in the authors' opinion, with a personal summary interpretation. Targeted at busy doctors, we hope this initiative will help further knowledge of scientific evidence for use in clinical practice, facilitating access to works of specific interest to the reader.