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CLINICAL SCIENCE
The roles of Tenascin C and Fibronectin 1 in adhesive capsulitis: a pilot gene expression study
Carina CohenI,#, Mariana Ferreira LealI,II,
,#
, Paulo Santoro BelangeroI, Eduardo Antônio FigueiredoI, Marília Cardoso SmithII, Carlos Vicente AndreoliI, Alberto de Castro PochiniI, Moises CohenI, Benno EjnismanI, Flávio FaloppaI
I Universidade Federal de São Paulo, Departamento de Ortopedia e Traumatologia
II Departamento de Morfologia e Genética, Disciplina de Genética, São Paulo/SP, Brazil
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          "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Correlation between gene expression and duration of adhesive capsulitis &#40;months&#41;&#46; A&#41; <span class="elsevierStyleItalic">TGF&#946;1</span>&#59; B&#41; <span class="elsevierStyleItalic">TGF&#946;R1</span>&#59; C&#41; <span class="elsevierStyleItalic">LOX</span>&#59; D&#41; <span class="elsevierStyleItalic">PLOD1</span>&#59; E&#41; <span class="elsevierStyleItalic">PLOD2</span>&#59; F&#41; <span class="elsevierStyleItalic">COMP</span>&#59; G&#41; <span class="elsevierStyleItalic">FN1</span>&#59; H&#41; <span class="elsevierStyleItalic">TNC</span>&#59; and I&#41; <span class="elsevierStyleItalic">TNXB&#46;</span> &#961;&#58; Spearman correlation coefficient &#40;&#8220;rho&#8221;&#41;&#46; <span class="elsevierStyleItalic">&#42;</span>Significant correlation &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#41;&#46; A lower delta cycle threshold value &#40;&#916;Crt&#41; indicates higher gene expression&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle50">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Adhesive capsulitis&#44; or frozen shoulder&#44; is a debilitating condition in which patients present limited active and passive glenohumeral motion&#46; Adhesive capsulitis occurs in 3&#37;-5&#37; of the general population <a class="elsevierStyleCrossRef" href="#bib1">1</a> and the main cause of the painful restriction of movement is inflammatory contracture of the joint capsule&#46; The initial inflammation seems to lead to capsular fibrosis&#44; stiffness and pain <a class="elsevierStyleCrossRef" href="#bib2">2</a>&#46; Therefore&#44; it has been hypothesized that similarities exist between adhesive capsulitis and the fibrous contractures that occur in Dupuytren disease <a class="elsevierStyleCrossRef" href="#bib3">3</a>&#44;<a class="elsevierStyleCrossRef" href="#bib4">4</a>&#46; However&#44; the molecular mechanism responsible for the underlying glenohumeral capsule inflammation and fibrosis is poorly understood&#46;</p><p id="para20" class="elsevierStylePara elsevierViewall">Rodeo et al&#46; suggested that cytokines&#44; such as transforming growth factor beta &#40;TGF&#946;&#41;&#44; may be involved in the inflammatory and fibrotic processes that occur in adhesive capsulitis&#46; These cytokines may cause abnormal regulation of collagen expression and augment fibroblast proliferation <a class="elsevierStyleCrossRef" href="#bib5">5</a>&#46; Therefore&#44; TGF&#946; acts as a persistent stimulus that leads to capsular fibrosis&#46;</p><p id="para30" class="elsevierStylePara elsevierViewall">TGF&#946; induces fibroblasts to synthesize&#44; remodel and contract extracellular matrix &#40;ECM&#41;&#44; making this cytokine a key mediator of the fibrotic response <a class="elsevierStyleCrossRef" href="#bib6">6</a>&#46; TGF&#946; is activated by proteolytic cleavage <a class="elsevierStyleCrossRef" href="#bib7">7</a> mediated by the signaling receptors TGF&#946; receptor I &#40;TGF&#946;R1&#41; and TGF&#946; receptor 2 &#40;TGF&#946;R2&#41; <a class="elsevierStyleCrossRef" href="#bib8">8</a>&#46; TGFBR1 is the principal propagator of TGF&#946; signaling <a class="elsevierStyleCrossRef" href="#bib9">9</a>&#46;</p><p id="para40" class="elsevierStylePara elsevierViewall">TGF&#946;1&#44; a key member of the TGF&#946; superfamily&#44; regulates the collagen-modifying enzymes lysyl oxidase &#40;LOX&#41; <a class="elsevierStyleCrossRef" href="#bib10">10</a> and lysyl hydroxylases 1 and 2 &#40;encoded by the <span class="elsevierStyleItalic">PLOD1</span> and <span class="elsevierStyleItalic">PLOD2</span> genes&#44; respectively&#41; <a class="elsevierStyleCrossRefs" href="#bib11">11-13</a>&#46; LOX plays a role in connective tissue matrix biogenesis through the oxidation of lysine residues in collagen and elastin&#44; contributing to the formation of covalent cross-links and thereby stabilizing fibrous ECM proteins <a class="elsevierStyleCrossRef" href="#bib14">14</a>&#44;<a class="elsevierStyleCrossRef" href="#bib15">15</a>&#46; In several fibrotic injuries&#44; TGF&#946;1 controls the expression and enzymatic activity of LOX <a class="elsevierStyleCrossRef" href="#bib10">10</a>&#46;</p><p id="para50" class="elsevierStylePara elsevierViewall">Lysyl hydroxylases such as PLOD1 and PLOD2 promote cross-linking in ECM molecules&#44; which contribute to ECM structural stability and maturation <a class="elsevierStyleCrossRef" href="#bib16">16</a>&#44;<a class="elsevierStyleCrossRef" href="#bib17">17</a>&#46; Increased <span class="elsevierStyleItalic">PLOD2</span> expression has been reported in fibroblasts isolated from hypertrophic scars&#44; keloids and <span class="elsevierStyleItalic">palmar fascia</span> from patients with Dupuytren disease <a class="elsevierStyleCrossRef" href="#bib18">18</a>&#46; To the best of our knowledge&#44; no previous studies have evaluated the roles of lysyl oxidase and hydroxylase in adhesive capsulitis&#46;</p><p id="para60" class="elsevierStylePara elsevierViewall">TGF&#946; regulates and is regulated by several ECM proteins&#46; Cartilage oligomeric matrix protein &#40;COMP&#41;&#44; a glycoprotein found in the ECM of joints&#44; plays a catalytic role in fibrillogenesis <a class="elsevierStyleCrossRef" href="#bib19">19</a>&#46; Recent studies have shown that COMP also directly binds members of the TGF&#946; superfamily of proteins&#44; including TGF&#946;1 <a class="elsevierStyleCrossRef" href="#bib20">20</a>&#46; Haudenschild et al&#46; showed that TGF&#946;1 displays enhanced bioactivity when bound to COMP <a class="elsevierStyleCrossRef" href="#bib20">20</a>&#46; In addition&#44; TGF&#946;1 appears to have the capacity to induce COMP expression <a class="elsevierStyleCrossRef" href="#bib21">21</a>&#46;</p><p id="para70" class="elsevierStylePara elsevierViewall">Fibronectin &#40;FN&#41;&#44; a glycoprotein encoded by the <span class="elsevierStyleItalic">FN1</span> gene&#44; is involved in several biological processes&#44; including cell adhesion&#44; tissue development and wound healing <a class="elsevierStyleCrossRef" href="#bib22">22</a>&#46; FN also has a role in TGF&#946; regulation <a class="elsevierStyleCrossRef" href="#bib23">23</a>&#46; Moreover&#44; FN expression increases under stimuli induced by TGF&#946; <a class="elsevierStyleCrossRef" href="#bib24">24</a>&#46;</p><p id="para80" class="elsevierStylePara elsevierViewall">Moreover&#44; the tenascins &#40;TN&#41;&#44; including TNR&#44; TNC and TNX&#44; are a highly conserved family of ECM glycoproteins&#46; TNR is expressed only in the brain&#44; whereas TNC and TNX are expressed in several organs and tissues&#44; including in the joints <a class="elsevierStyleCrossRef" href="#bib25">25</a>&#46; TNC has an important role in modulating the actions of TGF&#946; <a class="elsevierStyleCrossRef" href="#bib26">26</a> and is also regulated by TGF&#946; <a class="elsevierStyleCrossRef" href="#bib27">27</a>&#46; TNXB seems to regulate collagen synthesis or deposition <a class="elsevierStyleCrossRef" href="#bib28">28</a>&#46; A recent study showed that TNX also regulates TGF&#946; bioavailability and modulates cell plasticity <a class="elsevierStyleCrossRef" href="#bib29">29</a>&#46;</p><p id="para90" class="elsevierStylePara elsevierViewall">In the present study&#44; we quantified the mRNA expression of the <span class="elsevierStyleItalic">TGF&#946;1&#44; TGF&#946;R1&#44; LOX</span>&#44; <span class="elsevierStyleItalic">PLOD1&#44; PLOD2&#44; COMP&#44; FN1&#44; TNC</span> and <span class="elsevierStyleItalic">TNXB</span> genes in glenohumeral synovium&#47;capsule samples collected from patients with adhesive capsulitis and from controls&#46; We also evaluated how these mRNA levels are associated with clinical features&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">MATERIALS AND METHODS</span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">Patients</span><p id="para100" class="elsevierStylePara elsevierViewall">The current study used a case-control study design &#40;level 3 evidence&#41;&#46; All patients and controls were treated at the Hospital S&#227;o Paulo of the Universidade Federal de S&#227;o Paulo&#46; Each patient agreed to participate by signing a written consent form before data and sample collection&#46; This study was approved by the ethics committee of the Universidade Federal de S&#227;o Paulo &#40;approval number&#58; CEP 1918&#47;11&#41;&#46;</p><p id="para110" class="elsevierStylePara elsevierViewall">The case group was composed of 9 patients with idiopathic adhesive capsulitis of the shoulder in freezing or frozen stages who were diagnosed by clinical evaluation&#46; During the clinical evaluations&#44; the patients presented with pain&#44; loss of motion and severe limitations during daily activities&#59; no history of trauma or previous shoulder pathologies&#59; and functional restriction of both active and passive shoulder motion&#46; Magnetic resonance imaging &#40;MRI&#41; was used to exclude secondary stiff shoulder&#46; The patients underwent arthroscopic shoulder capsular release after a concerted effort was made to treat them with conservative management for at least 5 complete months&#46; In all cases&#44; the physiotherapy had failed&#46; Additionally&#44;patients meeting the following exclusion criteria were omitted&#58; generalized arthritis&#59; previous compromise of the shoulder&#44; such as major trauma&#44; fracture&#44; rotator cuff tear&#44; calcifying tendinitis&#44; or shoulder instability&#59; and superior labral anterior and posterior &#40;SLAP&#41; lesions&#46; Additionally&#44; patients who did not agree with the informed consent terms were excluded&#46; All enrolled patients underwent an arthroscopic procedure&#46;</p><p id="para120" class="elsevierStylePara elsevierViewall">The control group consisted of 8 physically active subjects who underwent arthroscopically assisted treatment for acute acromioclavicular dislocation&#46; None of the controls presented with a history of adhesive capsulitis&#46; Moreover&#44; radiological indication of glenohumeral capsule alteration was detected&#46; A standard complete joint evaluation by arthroscopy confirmed that the controls did not present any other concomitant pathology in the shoulder&#46;</p><p id="para130" class="elsevierStylePara elsevierViewall">All patients answered a preoperative questionnaire concerning gender&#44; age at surgery&#44; age of pain onset&#44; duration of symptoms&#44; bilaterality&#44; suprascapular nerve block&#44; physical activity&#44; type of work and smoking habits &#40;<a class="elsevierStyleCrossRef" href="#t1-cln_71p325">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="t1-cln_71p325"></elsevierMultimedia></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">Tissue samples</span><p id="para140" class="elsevierStylePara elsevierViewall">Tissue samples of approximately 2 mm<span class="elsevierStyleSup">3</span> were obtained from the anterior-inferior portion of the glenohumeral capsule during the arthroscopic procedure&#46; To reduce sampling variation&#44; only two of the authors &#40;CC and BE&#41; were responsible for collecting the tissue samples&#46; The samples were collected as previously described <a class="elsevierStyleCrossRefs" href="#bib30">30-32</a>&#46; As the synovium is adhered to the capsule&#44; it cannot be separated from the capsule using arthroscopic instruments&#46;</p><p id="para150" class="elsevierStylePara elsevierViewall">To provide immediate stabilization of RNA&#44; all synovium&#47;capsule specimens were instantly preserved in Allprotect Tissue Reagent&#174; &#40;Qiagen&#44; Germany&#41; and then stored at -20 &#176;C&#46;</p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">RNA extraction</span><p id="para160" class="elsevierStylePara elsevierViewall">An AllPrep DNA&#47;RNA&#47;miRNA Universal Kit &#40;Qiagen&#44; Germany&#41; was used to purify total RNA from the synovium&#47;capsule specimens&#46; Tissue Lyser LT equipment &#40;Qiagen&#44; USA&#41; was used to mechanically lyse the tissue samples&#46; A NanoDrop ND-1000 spectrophotometer &#40;Thermo Scientific&#44; USA&#41; was used to determine RNA concentration and quality&#46; RNA integrity was verified by 1&#37; agarose gel electrophoresis&#46; The RNA samples were stored at -80 &#176;C&#46;</p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">mRNA expression analysis</span><p id="para170" class="elsevierStylePara elsevierViewall">Reverse transcription-quantitative polymerase chain reaction &#40;RT-qPCR&#41; was used to evaluate mRNA expression&#46; First&#44; a High-Capacity cDNA Archive kit &#40;Life Technologies&#44; USA&#41; was used for cDNA synthesis&#46; Then&#44; RT-qPCR was performed as previously described using a ViiA 7 Real-Time PCR System &#40;Life Technologies&#44; USA&#41; <a class="elsevierStyleCrossRef" href="#bib30">30</a>&#46; To exclude technical variations&#44; target and reference genes &#40;<a class="elsevierStyleCrossRef" href="#t2-cln_71p325">Table 2</a>&#41; were analyzed on the same TaqMan Low-Density Array &#40;TLDA&#41; cards &#40;Life Technologies&#44; USA&#41;&#46; All qPCR assays were performed in triplicate&#46; The <span class="elsevierStyleItalic">B2M</span> and <span class="elsevierStyleItalic">HPRT1</span> genes were used as reference genes to normalize sample input amount&#46; These genes were chosen based on a previous study of suitable internal controls for the evaluation of mRNA expression in shoulder capsule samples <a class="elsevierStyleCrossRef" href="#bib33">33</a>&#46;</p><elsevierMultimedia ident="t2-cln_71p325"></elsevierMultimedia><p id="para180" class="elsevierStylePara elsevierViewall">The relative cycle threshold method &#40;Crt method&#41; was used to quantify mRNA expression&#46; In this method&#44; the lower the cycle threshold value &#40;Crt&#41; value&#44; the greater the number of initial target copies in the sample&#46; Thus&#44; low Crt values indicate high gene expression&#46; The expression of the target genes was determined using the following equation&#58; &#916;Crt&#61;target gene Crt &#8211; the mean of the reference genes Crt&#46;</p></span><span id="cesec70" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">Statistical analysis</span><p id="para190" class="elsevierStylePara elsevierViewall">All &#916;Crt values are shown as the median with the interquartile range &#40;IQR&#41;&#46;</p><p id="para200" class="elsevierStylePara elsevierViewall">The gender and age distributions between the patients with adhesive capsulitis and the controls were compared using the Chi-square test and the Mann-Whitney test&#44; respectively&#46; The Mann-Whitney test was also applied to compare mRNA levels between the cases and the controls&#44; as well as to investigate the possible associations between mRNA expression and preoperative clinical variables&#44; such as gender&#44; practice of sports involving the upper limbs&#44; type of job &#40;manual <span class="elsevierStyleItalic">versus</span> non-manual job&#41; and smoking habits&#46; Spearman&#39;s correlation was used to assess possible correlations between mRNA levels and duration of symptoms or age at surgery&#58; a value below 0&#46;40 was considered a weak correlation&#44; a value between 0&#46;40 and 0&#46;59 was considered a moderate correlation&#44; a value between 0&#46;6 and 0&#46;79 was considered a strong correlation and a value &#8805;0&#46;80 was considered a very strong correlation&#46; For all analyses&#44; a <span class="elsevierStyleItalic">p</span>-value&#60;0&#46;05 was considered statistically significant&#46; Statistical analyses were performed using PASW &#40;SPSS&#41; software&#44; version 18 &#40;SPSS Inc&#46;&#44; Chicago&#44; USA&#41;&#46;</p></span></span><span id="cesec80" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle120">RESULTS</span><span id="cesec90" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle130">Differences between cases and controls</span><p id="para210" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#t1-cln_71p325">Table 1</a> presents the clinical variables of the study participants&#46; In the control group&#44; 1 &#40;12&#46;5&#37;&#41; individual was female and 7 &#40;87&#46;5&#37;&#41; were males&#46; The median age at the time of surgery was 31&#46;44 years &#40;IQR&#61;13&#46;5&#41;&#46; The gender distribution did not differ between the study groups &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#46;05&#41;&#46; However&#44; the controls were significantly younger than the patients with adhesive capsulitis &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#46;012&#44; Mann-Whitney test&#41;&#46;</p><p id="para220" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#t3-cln_71p325">Table 3</a> shows the median and IQR values for the expression levels of the studied genes in the samples from the patients and the controls&#46; The patients with adhesive capsulitis had higher levels of <span class="elsevierStyleItalic">TNC</span> &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#46;005&#59; <a class="elsevierStyleCrossRef" href="#fig1-cln_71p325">Figure 1A</a>&#41; and <span class="elsevierStyleItalic">FN1</span> &#40;<span class="elsevierStyleItalic">p</span>&#61;0&#46;043&#59; <a class="elsevierStyleCrossRef" href="#fig1-cln_71p325">Figure 1B</a>&#41; expression compared to the controls&#46; No other significant differences were observed between the patients and the controls &#40;<span class="elsevierStyleItalic">p</span>&#62;0&#46;05&#41;&#46;</p><elsevierMultimedia ident="t3-cln_71p325"></elsevierMultimedia><elsevierMultimedia ident="fig1-cln_71p325"></elsevierMultimedia></span><span id="cesec100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle140">Associations between the clinical characteristics of adhesive capsulitis and mRNA expression</span><p id="para230" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig2-cln_71p325">Figure 2</a> shows the correlations between the duration of adhesive capsulitis symptoms and the expression levels of the studied genes&#46; In the tissue samples&#44; the expression of <span class="elsevierStyleItalic">TGF&#946;R1</span> mRNA was significantly and directly correlated with the duration of symptoms &#40;&#961;&#61;-0&#46;731&#44; <span class="elsevierStyleItalic">p</span>&#61;0&#46;025&#59; <a class="elsevierStyleCrossRef" href="#fig2-cln_71p325">Figure 2B</a>&#41;&#46;</p><elsevierMultimedia ident="fig2-cln_71p325"></elsevierMultimedia><p id="para240" class="elsevierStylePara elsevierViewall">No correlation was found between the age of the patients at the time of surgery and the age at symptom onset &#40;<span class="elsevierStyleItalic">p</span>&#62;0&#46;05&#41;&#46; Additionally&#44; no association was found between the mRNA levels of the studied genes and any of the clinical features assessed in the patients with adhesive capsulitis &#40;<span class="elsevierStyleItalic">p</span>&#62;0&#46;05&#41;&#46;</p></span></span><span id="cesec110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle150">DISCUSSION</span><p id="para250" class="elsevierStylePara elsevierViewall">Although adhesive capsulitis is considered a self-limited disease&#44; some patients show little to no improvement&#44; maintain a limited range of motion and continue to experience shoulder pain&#46; Non-operative treatment is the initial approach used for adhesive capsulitis&#46; However&#44; operative treatment &#40;such as arthroscopic capsular release&#41; may be considered when patients remain in pain and do not regain satisfactory range of motion after prolonged nonoperative treatment <a class="elsevierStyleCrossRef" href="#bib34">34</a>&#44;<a class="elsevierStyleCrossRef" href="#bib35">35</a>&#46;</p><p id="para260" class="elsevierStylePara elsevierViewall">In this study&#44; we found higher levels of <span class="elsevierStyleItalic">TNC</span> and <span class="elsevierStyleItalic">FN1</span> expression in glenohumeral synovium&#47;capsule samples collected from patients with adhesive capsulitis compared to those collected from controls&#46; TNC immunoreactivity was previously reported in other shoulder diseases&#44; including in rotator cuff tendon tears and in the subacromial bursa of patients with impingement syndrome <a class="elsevierStyleCrossRef" href="#bib36">36</a>&#44;<a class="elsevierStyleCrossRef" href="#bib37">37</a>&#46; In addition&#44; we have previously found that both <span class="elsevierStyleItalic">TNC</span> and <span class="elsevierStyleItalic">FN1</span> mRNA levels were upregulated in the glenohumeral capsules of patients with traumatic anterior shoulder instability &#40;unpublished data&#41;&#46; TNC is a large hexameric ECM glycoprotein that has roles in cell adhesion&#44; fibroblast migration and other processes related to tissue remodeling and wound healing <a class="elsevierStyleCrossRef" href="#bib38">38</a>&#44;<a class="elsevierStyleCrossRef" href="#bib39">39</a>&#46; TNC is specifically expressed following tissue damage&#44; being upregulated within 24 h of injury <a class="elsevierStyleCrossRef" href="#bib38">38</a>&#46; It is activated after local injury and down-regulated after tissue repair or scarring is completed <a class="elsevierStyleCrossRef" href="#bib40">40</a>&#46; Persistent expression of TNC is associated with several fibrotic diseases and with chronic non-healing wounds <a class="elsevierStyleCrossRef" href="#bib38">38</a>&#46;</p><p id="para270" class="elsevierStylePara elsevierViewall">Therefore&#44; we hypothesize that increased TNC expression may be a marker of capsule injury and the genes involved may participate in inflammatory and fibrotic processes in the glenohumeral capsule&#46;</p><p id="para280" class="elsevierStylePara elsevierViewall">FN is essential for collagen fibril assembly <a class="elsevierStyleCrossRef" href="#bib41">41</a>&#46; During the early phase of wound healing&#44; FN is deposited at sites of injury and can induce inflammation&#59; increase ECM deposition&#44; including of FN and collagen&#59; and activate fibroblasts&#46; These pathways can create a vicious cycle that eventually induces keloid formation or fibrosis <a class="elsevierStyleCrossRef" href="#bib42">42</a>&#46; Additionally&#44; FN has been previously associated with Dupuytren&#39;s contracture <a class="elsevierStyleCrossRef" href="#bib24">24</a>&#46; In this disease&#44; FN can be found in its oncofetal form <a class="elsevierStyleCrossRef" href="#bib43">43</a>&#44;<a class="elsevierStyleCrossRef" href="#bib44">44</a>&#46; Additionally&#44; upregulation of FN1 has been associated with fibrosis in inflammatory orbital diseases <a class="elsevierStyleCrossRef" href="#bib45">45</a>&#44; hepatic fibrosis <a class="elsevierStyleCrossRef" href="#bib46">46</a>&#44; idiopathic pulmonary fibrosis <a class="elsevierStyleCrossRef" href="#bib47">47</a>&#44;<a class="elsevierStyleCrossRef" href="#bib48">48</a> and liver fibrosis <a class="elsevierStyleCrossRef" href="#bib49">49</a>&#46; These relationships indicate that this molecule may also be involved in the pathogenesis of other fibrosing diseases&#46; Interestingly&#44; Altrock et al&#46; showed that blocking FN deposition using an FN assembly inhibitor &#40;pUR4&#41; resulted in decreased collagen accumulation and improved liver function during liver fibrogenesis <a class="elsevierStyleCrossRef" href="#bib50">50</a>&#46; Although only a slight increase in FN1 expression was detected in the glenohumeral capsules of the patients with adhesive capsulitis in the current study&#44; our results suggest that FN1 may play a role in the fibrotic process&#46; Further investigation is still necessary to understand the dynamic transcriptional regulation of FN1 that occurs within the shoulder capsule&#46;</p><p id="para290" class="elsevierStylePara elsevierViewall">We also observed that the expression of <span class="elsevierStyleItalic">TGF&#946;R1</span> mRNA in the capsule was directly correlated with symptom duration in the patients with adhesive capsulitis&#46; To the best of our knowledge&#44; only one previous study has evaluated the role of the TGF&#946; receptor in adhesive capsulitis <a class="elsevierStyleCrossRef" href="#bib5">5</a>&#46; Rodeo et al&#46; analyzed both <span class="elsevierStyleItalic">TGF&#946;</span> and its receptor in capsule and synovium samples collected from patients with adhesive capsulitis and in those collected from controls <a class="elsevierStyleCrossRef" href="#bib5">5</a>&#46; They performed a semi-quantitative analysis by comparing the frequency of positive staining between the groups&#46; The authors described that the synovial and capsular cells of patients with adhesive capsulitis and synovitis showed clear TGF&#946; and TGF&#946;R staining&#44; whereas no or minimal staining was observed in the normal tissue specimens&#46; The blood vessels of the affected tissues also presented staining for both proteins&#46; Moreover&#44; there was a higher frequency of positive TGF&#946; and TGF&#946;R staining in the synovial cells of the patients with adhesive capsulitis&#46; In addition&#44; there was a greater frequency of positive TGF&#946; staining in the ECMs of patients with adhesive capsulitis compared to the controls&#44; particularly in the capsule tissue&#46;</p><p id="para300" class="elsevierStylePara elsevierViewall">In the present study&#44; we found no differences in the expression of <span class="elsevierStyleItalic">TGF&#946;1</span> and <span class="elsevierStyleItalic">TGF&#946;R1</span> mRNA between the cases and the controls&#46; Because the synovium is adhered to the capsule and cannot be separated from the capsule using arthroscopic instruments&#44; our investigation did not discriminate between gene expression in synovial and capsular tissues&#46; However&#44; molecular alterations in both tissues are important in adhesive capsulitis <a class="elsevierStyleCrossRef" href="#bib51">51</a>&#46; In addition&#44; our study is the first to use a quantitative approach to evaluate the role of <span class="elsevierStyleItalic">TGF&#946;R1</span> in adhesive capsulitis&#46; Our results suggest that <span class="elsevierStyleItalic">TGF&#946;R1</span> may have a role in adhesive capsulitis&#44; especially in the long-term disease&#46;</p><p id="para310" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; this study is the first to quantify <span class="elsevierStyleItalic">TGF&#946;1</span>&#44; <span class="elsevierStyleItalic">TGF&#946;R1&#44; LOX&#44; PLOD1</span>&#44; <span class="elsevierStyleItalic">PLOD2&#44; COMP&#44; FN1&#44; TNC</span> and <span class="elsevierStyleItalic">TNXB</span> mRNA expression in the shoulder capsules of patients with adhesive capsulitis&#46; However&#44; this study has some limitations&#46; First&#44; few patients with adhesive capsulitis are surgically treated&#59; as such&#44; there is a limited number of tissue samples available for studies of gene expression <a class="elsevierStyleCrossRef" href="#bib5">5</a>&#44;<a class="elsevierStyleCrossRef" href="#bib35">35</a>&#44;<a class="elsevierStyleCrossRefs" href="#bib52">52-59</a>&#46; Therefore&#44; some of our statistical analyses had reduced power to detect significant differences between the studied groups and false-negative results may have occurred&#46; Second&#44; we included patients who failed in conservative treatment in different phases of frozen shoulder&#44; some in freezing and others in frozen stages&#46; This heterogeneity may have also contributed to false negatives&#46; Third&#44; molecular alterations may occur in other capsule regions and may have a different etiological role in capsular injury <a class="elsevierStyleCrossRefs" href="#bib30">30-32</a>&#46; We evaluated the AI region because this portion of the capsule presented macroscopic injuries &#40;i&#46;e&#46;&#44; a high level of inflammation&#41; during arthroscopic examination of the studied patients&#46; Although we did not detect a correlation between age and gene expression in the tissue samples collected from the patients with adhesive capsulitis&#44; it is important to highlight that the age distribution between the patients and the controls was different&#46; Thus&#44; we cannot exclude that age might have influenced our findings&#46; Finally&#44; additional analysis of the protein products of the studied genes may be interesting because protein function is also affected by post-transcriptional and post-translational regulation&#46;</p><p id="para320" class="elsevierStylePara elsevierViewall">Elevated expression of <span class="elsevierStyleItalic">TNC</span> and <span class="elsevierStyleItalic">FN1</span> mRNA may be a marker of capsule injury and may be involved in capsule inflammation and fibrosis&#46; Upregulation of <span class="elsevierStyleItalic">TGF&#946;R1</span> seems to be related to symptom duration in adhesive capsulitis&#59; therefore&#44; TGF&#946; signaling may play a role in this condition&#46;</p></span><span id="cesec120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle160">AUTHOR CONTRIBUTIONS</span><p id="para330" class="elsevierStylePara elsevierViewall">Cohen C&#44; Leal MF&#44; Smith MC&#44; Ejnisman B and Faloppa F conceived and designed the experiments&#46; Cohen C&#44; Belangero PS&#44; Figueiredo EA&#44; Andreoli CV&#44; Pochini AC and Ejnisman B were involved in data collection&#46; Cohen C&#44; Belangero PS&#44; Figueiredo EA&#44; Figueiredo EA&#44; Pochini AC and Ejnisman B were responsible for sample collection&#46; Leal MF was involved in the genetic analysis&#46; Cohen C&#44; Leal MF&#44; Belangero PS and Figueiredo EA performed the literature search&#46; Leal MF and Smith MC were involved in data and statistical analyses&#46; Cohen C and Leal MF wrote the first draft of the manuscript&#46; All authors listed have contributed to all subsequent drafts and all have approved the final manuscript&#46;</p></span></span>"
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          "titulo" => "INTRODUCTION"
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          "titulo" => "MATERIALS AND METHODS"
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              "titulo" => "Patients"
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              "titulo" => "Tissue samples"
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              "identificador" => "cesec50"
              "titulo" => "RNA extraction"
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            3 => array:2 [
              "identificador" => "cesec60"
              "titulo" => "mRNA expression analysis"
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              "titulo" => "Statistical analysis"
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          "titulo" => "RESULTS"
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              "identificador" => "cesec90"
              "titulo" => "Differences between cases and controls"
            ]
            1 => array:2 [
              "identificador" => "cesec100"
              "titulo" => "Associations between the clinical characteristics of adhesive capsulitis and mRNA expression"
            ]
          ]
        ]
        4 => array:2 [
          "identificador" => "cesec110"
          "titulo" => "DISCUSSION"
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          "titulo" => "AUTHOR CONTRIBUTIONS"
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          "identificador" => "xack638307"
          "titulo" => "ACKNOWLEDGMENTS"
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          "titulo" => "REFERENCES"
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    "fechaRecibido" => "2015-12-15"
    "fechaAceptado" => "2016-03-21"
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          "palabras" => array:5 [
            0 => "Adhesive Capsulitis"
            1 => "Glenohumeral Capsule"
            2 => "Gene Expression"
            3 => "Extracellular Matrix"
            4 => "<span class="elsevierStyleItalic">TGF&#946;1</span> Signaling"
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        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">OBJECTIVES&#58;</span><p id="spara70" class="elsevierStyleSimplePara elsevierViewall">We evaluated mRNA expression levels of genes that encode TGF-&#946;1&#59; the TGF-&#946;1 receptor&#59; the collagen-modifying enzymes LOX&#44; PLOD1&#44; and PLOD2&#59; and the extracellular matrix proteins COMP&#44; FN1&#44; TNC and TNXB in synovial&#47;capsule specimens from patients with idiopathic adhesive capsulitis&#46; Possible associations between the measured mRNA levels and clinical parameters were also investigated&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">METHODS&#58;</span><p id="spara80" class="elsevierStyleSimplePara elsevierViewall">We obtained glenohumeral joint synovium&#47;capsule specimens from 9 patients with idiopathic adhesive capsulitis who had not shown improvement in symptoms after 5 months of physiotherapy&#46; Adhesive capsulitis was confirmed in all patients by magnetic resonance imaging&#46; We also obtained specimens from 8 control patients who had underwent surgery for acute acromioclavicular joint dislocation and who had radiological indication of glenohumeral capsule alteration based on arthroscopic evaluation&#46; mRNA expression in the synovium&#47;capsule specimens was analyzed by quantitative reverse transcription PCR&#46; The <span class="elsevierStyleItalic">B2M</span> and <span class="elsevierStyleItalic">HPRT1</span> genes were used as references to normalize target gene expression in the shoulder tissue samples&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESULTS&#58;</span><p id="spara90" class="elsevierStyleSimplePara elsevierViewall">The synovium&#47;capsule samples from the patients with adhesive capsulitis had significantly higher <span class="elsevierStyleItalic">TNC</span> and <span class="elsevierStyleItalic">FN1</span> expression than those from the controls&#46; Additionally&#44; symptom duration directly correlated with expression of <span class="elsevierStyleItalic">TGF&#946;1 receptor I</span>&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">CONCLUSION&#58;</span><p id="spara100" class="elsevierStyleSimplePara elsevierViewall">Elevated levels of <span class="elsevierStyleItalic">TNC</span> and <span class="elsevierStyleItalic">FN1</span> expression may be a marker of capsule injury&#46; Upregulation of <span class="elsevierStyleItalic">TGF&#946;1 receptor I</span> seems to be dependent on symptom duration&#59; therefore&#44; <span class="elsevierStyleItalic">TGF&#946;</span> signaling may be involved in adhesive capsulitis&#46; As such&#44; <span class="elsevierStyleItalic">TNC&#44; FN1</span> and <span class="elsevierStyleItalic">TGF&#946;1 receptor I</span> may also play roles in adhesive capsulitis by contributing to capsule inflammation and fibrosis&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="cenpara40">No potential conflict of interest was reported&#46;</p>"
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          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">TNC</span> &#40;A&#41; and <span class="elsevierStyleItalic">FN1</span> &#40;B&#41; expression levels in capsule samples collected from patients with adhesive capsulitis and controls&#46; A lower delta cycle threshold value &#40;&#916;Crt&#41; indicates higher gene expression&#46; Box plots show the median and interquartile range&#46; &#42;A significant difference between groups by Mann-Whitney test &#40;<span class="elsevierStyleItalic">p</span> &#60;0&#46;05&#41;&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Correlation between gene expression and duration of adhesive capsulitis &#40;months&#41;&#46; A&#41; <span class="elsevierStyleItalic">TGF&#946;1</span>&#59; B&#41; <span class="elsevierStyleItalic">TGF&#946;R1</span>&#59; C&#41; <span class="elsevierStyleItalic">LOX</span>&#59; D&#41; <span class="elsevierStyleItalic">PLOD1</span>&#59; E&#41; <span class="elsevierStyleItalic">PLOD2</span>&#59; F&#41; <span class="elsevierStyleItalic">COMP</span>&#59; G&#41; <span class="elsevierStyleItalic">FN1</span>&#59; H&#41; <span class="elsevierStyleItalic">TNC</span>&#59; and I&#41; <span class="elsevierStyleItalic">TNXB&#46;</span> &#961;&#58; Spearman correlation coefficient &#40;&#8220;rho&#8221;&#41;&#46; <span class="elsevierStyleItalic">&#42;</span>Significant correlation &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#41;&#46; A lower delta cycle threshold value &#40;&#916;Crt&#41; indicates higher gene expression&#46;</p>"
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        "etiqueta" => "Table 1"
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        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">N&#58; number of patients&#59; IQR&#58; interquartile range&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Distribution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age at surgery&#44; years &#91;median &#40;IQR&#41;&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;7 &#40;16&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age at symptom onset&#44; years &#91;median &#40;IQR&#41;&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;4 &#40;14&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gender &#91;N&#40;&#37;&#41;&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duration of condition&#44; months &#91;median &#40;IQR&#41;&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;67 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilaterality &#91;N&#40;&#37;&#41;&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Practice of sports involving the upper limbs &#91;N &#40;&#37;&#41;&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Type of job &#91;N&#40;&#37;&#41;&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Non-manual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Manual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smoking habits &#91;N&#40;&#37;&#41;&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Non-smoker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Smoker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Distribution of clinical variables for patients with adhesive capsulitis&#46;</p>"
        ]
      ]
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        "identificador" => "t2-cln_71p325"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Gene symbol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Name&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Assay<a class="elsevierStyleCrossRef" href="#tfn2-cln_71p325">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TGF&#946;1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transforming growth factor&#44; beta 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hs00998133&#95;m1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TGF&#946;R1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transforming growth factor&#44; beta receptor 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hs00610320&#95;m1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">LOX</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lysyl oxidase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hs00942480&#95;m1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PLOD1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lysyl hydroxylases 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hs00609368&#95;m1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PLOD2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lysyl hydroxylases 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hs01118190&#95;m1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">Cartilage oligomeric matrix protein&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Hs02800695&#95;m1&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="cenpara30">Significant difference between groups by Mann-Whitney test &#40;<span class="elsevierStyleItalic">p&#60;</span>0&#46;05&#41;&#46; IQR&#58; interquartile range&#46; A lower delta cycle threshold value &#40;&#916;Crt&#41; indicates higher gene expression&#46;</p>"
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          "en" => "<p id="spara60" class="elsevierStyleSimplePara elsevierViewall">Gene expression patterns in the glenohumeral capsules of patients with adhesive capsulitis and in controls&#46;</p>"
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      "titulo" => "REFERENCES"
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                      "titulo" => "Diagnosis and management of adhesive capsulitis"
                      "autores" => array:1 [
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                          "autores" => array:2 [
                            0 => """
                              RC Manske \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              D Prohaska \n
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                          ]
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                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/s12178-008-9031-6"
                      "Revista" => array:7 [
                        "tituloSerie" => "Curr Rev Musculoskelet Med"
                        "fecha" => "2008"
                        "volumen" => "1"
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        "titulo" => "ACKNOWLEDGMENTS"
        "texto" => "<p id="para340" class="elsevierStylePara elsevierViewall">This study was supported by grants and fellowships from the Conselho Nacional de Desenvolvimento Cient&#237;fico e Tecnol&#243;gico &#40;CNPQ&#59; MC and MACS&#41; and the Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado de S&#227;o Paulo &#40;FAPESP&#59; MC and MFL&#41;&#46; We are grateful to Sintia Iole Belangero&#44; Ph&#46; D&#44; for the scientific project support&#46;</p>"
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Article information
ISSN: 18075932
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos