RICARDO FULLER
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject CHRONIC EFFECTS OF A FLEXIBLE AND MINIMALIST FOOTWEAR ON CLINICAL, FUNCTIONAL AND GAIT BIOMECHANICAL ASPECTS IN THE KNEE OSTEOARTHRITIS: A SINGLE-BLIND RANDOMIZED CLINICAL TRIAL(2012) TROMBINI-SOUZA, F.; MATIAS, A.; YOKOTA, M.; SCHAINBERG, C.; FULLER, R.; SACCO, I. C.Purpose: Recent studies have shown that the acute use of shoes that mimic barefoot gait decrease substantially knee loads while walking in elderly with knee osteoarthritis (OA). Probably due to methodological difficulties to implement this type of conservative treatment during extended period, the effectiveness of minimalist footwear has not been evaluated yet in elderly patients with knee OA. The purpose is to describe a randomized clinical trial protocol for evaluating the therapeutic effect of a minimalist (flexible, non-heeled) and inexpensive footwear on clinical, functional, and biomechanical gait in elderly women with knee OA. Methods: Fifty six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence) will be randomized in blocks and allocated in the intervention group that will use a flexible non-heeled shoes- Moleca® forat least 6 hours daily or in the control group, which could not use these shoes or be under physical therapy or acupuncture treatment throughout these sis months. The use of Paracetamol 500 mg every six hour was allowed for both groups in case of pain. Moleca® (Calçados Beira Rio S.A., Novo Hamburgo, RS, Brazil) is a women's double canvas flexiblefl at walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. The mean weight is 172±19.6 g, ranging from 142 to 193 g depending on the size. Both groups will be followed during 6 months. They will be assessed at baseline condition, after 3 months (intervention group) and after 6 months of baseline condition(end of intervention, both groups). All the assessments will be performed by a physiotherapist that is blind to which group thepatient was allocated. The main outcome assessmentis the pain WOMAC score and the secondary outcomes are other WOMAC scores pain assessment (visual analogue scale - VAS), Lequesne index, Six-Minute Walk Test, and biomechanical gait analysis by means of 6 infrared cameras and a multi-component force plate to determine the knee adduction moment during gait. At baseline, all patients receive a diary to record the hours of daily use of footwear intervention. Every two weeks, the same physiotherapist carries phone calls to all patients in order to verify adherence to treatment and the correct filling this diary. Theinter group andinter-moments will be performed by repeated measures analysis of variance (α=0.05). This Trial was approved by the local Ethics Committee and was registered in ClinicalTrials.gov Identifier: NCT01342458. Results: Six hundred thirty-four elderly women have been contacted so far and 20 have already been allocated in the intervention group (9) and in the control (11). Five patients from intervention group have already completed all 3 assessments and finished the protocol. The preliminary results have shown that the elderly women of the intervention group have used the Moleca® shoe for an average monthly of 7 hours and 24 minutes (±3:47), corresponding to approximately 50% of the home-work hours of the day. Conclusion: This is the first randomized clinical trial protocol to assess the chronic effect of a minimalist footwear on the clinical, functional and gait biomechanics of elderly women with knee osteoarthritis. We expect that the use of Moleca® shoes for 6 months provides pain relief, reduction of the knee adduction moment while walking and improves joint function in elderly women with knee OA, and therefore can be considered as another inexpensive option for conservative OA treatment. The authors are pleased to acknowledge the financial support of State of São Paulo Research Foundation - FAPESP (processes: 2011/01640-8, 2011/03300-0, 2011/03069-6).conferenceObject COLLAGEN TYPE V FACILITATE THE DIFFERENTIATION OF RABBIT ADIPOSE TISSUE-DERIVED STEM CELLS INTO A CHONDROCYTE-LIKE PHENOTYPE ""IN VITRO""(2012) CRUZ, Isabele B.; GOLDENSTEIN-SCHAINBERG, C.; FULLER, R.; VELOSA, A. P.; CARRASCO, S.; CAPELOZZI, V.; YOSHINARI, N. H.; TEODORO, W. R.conferenceObject Metabolic Syndrome: The Genesis of Nephrolithiasis in Gout Patients?(2012) MELLO, Filipi M.; TOMITA, Rafael B.; FULLER, Ricardo; FILHO, Marco Antonio G. P.; BARROS, Thiago B. M.; PRADO, Leandro L. do; AUGUSTO, Kristopherson L.; GOLDENSTEIN-SCHAINBERG, ClaudiaBackground/Purpose: Gout patients have a high frequency of metabolic syndrome (MS), a disorder known to be associated with hyperinsulinemia. The latter condition augments proximal tubular sodium reabsorption and leads to reduced renal urate excretion and hyperuricemia. There are no data, however, evaluating whether MS can influence gout-associated clinical characteristics. Thus, we aimed to determine the prevalence of MS in our population and to investigate if the presence of MS would characterize a particular clinical and laboratorial gout profile. Methods: This was a cross-sectional study of 158 gout patients (ACR criteria). MS was defined in accordance to the National Cholesterol Education Program ATP III (NCEP-ATP III) and the International Diabetes Federation (IDF) criteria. Demographic, anthropometric (body mass index - BMI) and clinical data were evaluated. Fasting serum levels of UA, glucose, triglycerides and cholesterol fractions were analyzed by routine laboratory tests. Nephrolithiasis was demonstrated by usual ultrasonography and urate under-excretion defined as UA clearance lower than 7.5 ml/min. Statistical comparisons were performed using Fisher’s exact, chi-square, students T and Spearman’s tests and P<0.05 was considered significant. Results: The frequency of MS in gout patients was 73% and 71% according to NCEP ATPIII and IDF criteria respectively. Further comparison of 125 patients with MS and those 33 without this condition revealed similar mean ages (63.0 ± 11.5 vs 62.5 ± 12.9; p>0,05) and male predominance (94% and 75%). As expected, those with MS had higher BMI (30.2 ± 5.5kg/m2 vs 27.0 5.8kg/m2; p=0.005) and higher prevalences of systemic arterial hypertension (93.3% vs 75% p=0.012) and diabetes (25.8% vs 0, p=0.001), though comparable frequency of coronary artery disease (22.5% vs 16.7%; p=0.469). With regard to gout clinical/laboratorial characteristic, patients with MS had more nephrolitiasis (37.1% vs 16.7%, p=0.026), but they did not differ from patients without MS concerning the presence of tophi (52.8% vs. 55.6%; p = 0.780) or uric acid underexcretion (83.1% vs 94.4%; p=0.148). Current alcohol consumption, mean estimated creatinine clearance and mean serum levels of uric acid, were alike in both groups (p>0.05). Conclusion: The novel demonstration that MS in gout is associated to nephrolithiasis suggests that this condition may underlie the genesis of uric acid stones. Whether insulin resistance may account for a renal alteration that may ultimately impair buffering and amplification of acidic urine remains to be determined. Moreover, the elevated prevalence of MS in gout patients from our country (almost 3⁄4) is higher than overall rates of 63% MS in gout worldwide, indicating possible influence of dietary, geographical and/or genetic background.conferenceObject Collagen V induces differentiation of rabbit adipose tissue-derived stem cells in chondrocyte-like phenotype(2012) TEODORO, W.; CRUZ, I. Brindo da; VELOSA, A. P.; CARRASCO, S.; GOLDENSTEIN-SCHAINBERG, C.; FULLER, R.; PARRA, E.; CAPELOZZI, V.Objective: Stimulated mesenchymal stem cells (MSCs) have capacity of differentiation in many cell types. It is being used in degenerative diseases treatment protocols. We evaluated the collagen V (COL V) and collagen XI (COL XI) influence in the differentiation of rabbits adipose tissue-derived MSCs in a chondrocyte-like cell phenotype. Method: MSCs isolated of New Zealand rabbits adipose-tissue were maintained in culture by 4 weeks. COLV, COLXI and COLV/XI (10μg/ml) were added to culture during 72 h. The cells aggregates were stained with Toluidine blue, Alcian blue and Picrosirius. Chondrocyte-like phenotype was confirmed by immunofluorescence to CD34, vimentin and collagens I, II and III. Results: MSCs stimulated with COLV expressed proteoglicans and collagen, when compared with COLXI and COLV/XI and control. In the presence of COLV, MSCs was capable to increase collagen II expression confirming its chondro-cyte-like cell phenotype. In contrast, MSCs cultured with COLXI and COLV/XI express collagen I and III. Conclusion: The data suggest that COLV may facilitate the differentiation of rabbit adipose tissue-derived stem cells into a chondrocyte-like phenotype. Further studies are urged in order to evaluate the influence of COLV in the ability of chondrocytes to remodel osteoarthritic joint surface at ultrastructural and molecular levels.conferenceObject Creatine In Osteoarthritis, A Randomized, Double-blinded, Placebo-controlled Trial(2012) ROSCHEL, Hamilton; NEVES- JR., Manoel; FULLER, Ricardo; BENATTI, Fabiana; PINTO, Ana Lucia Sa; LIMA, Fernanda R.; PEREIRA, Rosa M.; LANCHA- JR., Antonio H.; BONFA, Eloisa; GUALANO, BrunoconferenceObject INCREASED PREVALENCE OF METABOLIC SYNDROME IS ASSOCIATED TO NEPHROLITHIASIS BUT NOT TO THE PRESENCE OF TOPHUS IN GOUT PATIENTS(2012) MELLO, F. M.; TOMITA, F. R. B.; FULLER, R.; PONTES FILHO, M. A. G.; BARROS, T. B. M.; PRADO, L. L.; AUGUSTO, K. L.; GOLDENSTEIN-SCHAINBERG, C.- Joint loading decreased by inexpensive and minimalist footwear in elderly women with knee osteoarthritis during stair descent(2012) SACCO, I. C. N.; TROMBINI-SOUZA, F.; BUTUGAN, M. K.; PASSARO, A. C.; ARNONE, A. C.; FULLER, R.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.
conferenceObject BENEFIC EFFECT OF THE USE OF FLEXIBLE AND MINIMALIST FOOTWEAR ON KNEE OSTEOARTHRITIS(2012) TROMBINI-SOUZA, Francis; YOKOTA, Mariane; MATIAS, Alessandra; GOLDENSTEIN-SCHAINBERG, Claudia; FULLER, Ricardo; SACCO, Isabel C. N.Objective(s): To analyze the therapeutic effect of chronic use of the flexible, nonheeled commercial shoe Moleca® on clinical aspects of women with knee osteoarthritis (OA). Material & Methods: Six women with an established diagnosis of knee OA according to ACR criteria were evaluated after assignment of approved informed consent. The intervention consisted of the use for a 6 month period of Moleca® footwear (RS, Brazil) for at least 6hours daily and for 7 days a week. This is a light (mean weight=172±19.6 g, range 142-193 g depending on size) double canvas flexible flat walking shoe nonheeled, with a 5-mm antislip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Assessment was done at baseline and 6 months later. All patients were screened and evaluated by a rheumatologist at baseline for clinical examination and x-rays. Subsequent procedures were performed by the same physiotherapist to assess pain (visual analogue scale–VAS), WOMAC index and knee adduction moment during gait calculated by inverse dynamics method using 6 infrared cameras and a multicomponent force plate. T-test was used to compare pre/post intervention effects and P<0.05 was considered significant. Results: Mean age of patients was 69±6 yrs, weight=65.9±12.1 kg, height=152±5 cm, BMI=28.6±4.9 kg/cm 2. Allwomen had knee OA grade 2 or 3 (Kellgren-Lawrence). Average use of Moleca® was 7:24±3:47 h monthly. Remarkably, 6 months after intervention, a reduction of 56.6% and 73.9% of VAS for pain at night and at the moment of assessment, respectively, was observed (P=0.048 and P=0.015). Total WOMAC score diminished 44.9% (p=0.001), WOMAC pain subscale decreased 55.2% (p=0.015), and WOMAC function index improved 43.6% (p=0.004). The first (p= 0.533) and the second (p=0.686) knee adduction moment peaks were alike, while significant reduction of 11.2% in knee loading (p=0.001) was achieved during midstance. Conclusion(s): We have demonstrated in this pilot study that elderly women with knee OA have a benefit effect on pain and function following a 6 month period of use of a specific flexible, nonheeled shoe. These preliminary results warrant further studies aiming to evaluate long term benefit of this intervention in a larger sample population.- Influenza A/H1N1 vaccination of patients with SLE: can antimalarial drugs restore diminished response under immunosuppressive therapy?(2012) BORBA, Eduardo F.; SAAD, Carla G. S.; PASOTO, Sandra G.; CALICH, Ana L. G.; AIKAWA, Nadia E.; RIBEIRO, Ana C. M.; MORAES, Julio C. B.; LEON, Elaine P.; COSTA, Luciana P.; GUEDES, Lissiane K. N.; SILVA, Clovis A. A.; GONCALVES, Celio R.; FULLER, Ricardo; OLIVEIRA, Suzimara A.; ISHIDA, Maria A.; PRECIOSO, Alexander R.; BONFA, EloisaObjective. To assess the efficacy and safety of pandemic 2009 influenza A (H1N1) in SLE under different therapeutic regimens. Methods. A total of 555 SLE patients and 170 healthy controls were vaccinated with a single dose of a non-adjuvanted preparation. According to current therapy, patients were initially classified as SLE No Therapy (n = 75) and SLE with Therapy (n = 480). Subsequent evaluations included groups under monotherapy: chloroquine (CQ) (n = 105), prednisone (PRED) epsilon 20 mg (n = 76), immunosuppressor (IS) (n = 95) and those with a combination of these drugs. Anti-H1N1 titres and seroconversion (SC) rate were evaluated at entry and 21 days post-vaccination. Results. The SLE with Therapy group had lower SC compared with healthy controls (59.0 vs 80.0%; P < 0.0001), whereas the SLE No Therapy group had equivalent SC (72 vs 80.0%; P = 0.18) compared with healthy controls. Further comparison revealed that the SC of SLE No Therapy (72%) was similar to the CQ group (69.5%; P = 0.75), but it was significantly reduced in PRED epsilon 20 mg (53.9%; P = 0.028), IS (55.7%; P = 0.035) and PRED epsilon 20 mg + IS (45.4%; P = 0.038). The concomitant use of CQ in each of these later regimens was associated with SC responses comparable with SLE No Therapy group (72%): PRED epsilon 20 mg + CQ (71.4%; P = 1.00), IS + CQ (65.2%; P = 0.54) and PRED epsilon 20 mg + IS + CQ (57.4%; P = 0.09). Conclusion. Pandemic influenza A H1N1/2009 vaccine response is diminished in SLE under immunosuppressive therapy and antimalarials seems to restore this immunogenicity.
conferenceObject Creatine Supplementation Increases Physical Function And Lower-limb Lean Mass In Osteoarthritis: A Role For Myostatin?(2012) SOLIS, Marina Y.; NEVES JR., Manoel; ARTIOLI, Guilherme Giannini; ROCHEL, Hamilton; FULLER, Ricardo; BENATTI, Fabiana Braga; PINTO, Ana Lucia De Sa; LIMA, Fernanda Rodrigues; LANCHA JR., Antonio Herbert; BONFA, Eloisa; GUALANO, BrunoPURPOSE: The purpose of this study was to determine the effects of Cr supplementation on vertical jump and sprint performance during 4 weeks of plyometric training. METHODS: Using a randomized, double-blind design, subjects were assigned to receive either Cr or placebo (Pl) for 4-weeks. A total of 13 subjects completed the study (6 = Pl, 7 = Cr). Data was collected at baseline (T0), post-loading (T1), and post-maintenance (T2). Measures included body weight, height, bioelectrical impedance analysis (BIA), single and multiple vertical jump performance, (4 x 10m) shuttle sprint time, and anaerobic power using a 30-s Wingate trial. BIA was used to determine total body water (TBW). Subjects were instructed to maintain a normal diet and to follow a training program designed for this study. Data was analyzed using repeated measures two-way ANOVA for differences (time x treatment) and t-tests to assess the absolute change in values for all measures. RESULTS: The interaction over time between treatment groups revealed significantly greater increases in body weight, body mass index (BMI), and average Wingate power (p < 0.05) for the Cr group. Using the absolute change in values, t-tests revealed significant increases in body weight (mean gain = 1.0 kg, p = 0.003) and TBW (mean gain = 0.4 kg, p = 0.03) in the Cr group compared to Pl after T1. No significant changes in single jump height or shuttle sprint time were seen were seen with either Cr or Pl groups. Average Wingate power tended to increase from T0 to T2 in the Cr group (mean % change = +5.9%) with no change in the Pl group (p = 0.06). Average repeated vertical jump height from T0 to T2 tended to decline in the Pl (mean change = -7.5%) compared to Cr (mean change = -0.2%, p = 0.07). CONCLUSION: Although weight increased with Cr supplementation, it did not impede sprint and jump performance. Cr supplementation did tend to increase power as measured using the non-weight impacted Wingate test. Cr supplementation can be recommended to athletes wishing to increase power and weight without negatively affecting sprint and vertical jump performance.