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Kinds of Heel Terms modified by Heel Selected AbstractsEffects of 6° elevation of the heels on 3D kinematics of the distal portion of the forelimb in the walking horseEQUINE VETERINARY JOURNAL, Issue 8 2004H. CHATEAU Summary Reasons for performing study: Understanding of the biomechanical effects of heel elevation remains incomplete because in vivo studies performed with skin markers do not measure the actual movements of the 3 digital joints. Objective: To quantify the effects of 6° heel wedge on the 3-dimensional movements of the 4 distal segments of the forelimb in the walking horse. Methods: Four healthy horses were used. Kinematics of the distal segments was measured invasively with a system based on ultrasonic triangulation. Three-dimensional rotations of the digital joints were calculated by use of a ,joint coordinate system' (JCS). Data obtained with heel wedges were compared to those obtained with standard shoes during the stance phase of the stride. Results: Heel wedges significantly increased maximal flexion of the proximal (PIPJ) and distal (DIPJ) interphalangeal joints and maximal extension (mean ± s.d. +0.8 ± 0.3°) of the metacarpophalangeal joint (MPJ). Extension of the PIPJ and DIPJ was decreased at heel-off. Few effects were observed in extrasagittal planes of movement. Conclusions: Heel wedges affect the sagittal plane kinematics of the 3 digital joints. Potential relevance: Controversial effects previously observed on the MPJ may be explained by the substantial involvement of the PIPJ, which was wrongly neglected in previous studies performed on the moving horse. [source] Osteoporosis and Fracture Risk in Women of Different Ethnic GroupsJOURNAL OF BONE AND MINERAL RESEARCH, Issue 2 2005Elizabeth Barrett-Connor MD Abstract Osteoporosis and 1-year fracture risk were studied in 197,848 postmenopausal American women from five ethnic groups. Weight explained differences in BMD, except among blacks, who had the highest BMD. One SD decrease in BMD predicted a 50% increased fracture risk in each group. Despite similar relative risks, absolute fracture rates differed. Introduction: Most information about osteoporosis comes from studies of white women. This study describes the frequency of osteoporosis and the association between BMD and fracture in women from five ethnic groups. Materials and Methods: This study was made up of a cohort of 197,848 community-dwelling postmenopausal women (7784 blacks, 1912 Asians, 6973 Hispanics, and 1708 Native Americans) from the United States, without known osteoporosis or a recent BMD test. Heel, forearm, or finger BMD was measured, and risk factor information was obtained; 82% were followed for 1 year for new fractures. BMD and fracture rates were compared, adjusting for differences in covariates. Results: By age 80, more than one-fifth of women in each ethnic group had peripheral BMD T scores <,2.5. Black women had the highest BMD; Asian women had the lowest. Only the BMD differences for blacks were not explained by differences in weight. After 1 year, 2414 new fractures of the spine, hip, forearm, wrist, or rib were reported. BMD at each site predicted fractures equally well within each ethnic group. After adjusting for BMD, weight, and other covariates, white and Hispanic women had the highest risk for fracture (relative risk ,RR' 1.0 ,referent group' and 0.95, 95% CI, 0.76, 1.20, respectively), followed by Native Americans (RR, 0.87; 95% CI, 0.57, 1.32), blacks (RR, 0.52; 95% CI, 0.38, 0.70), and Asian Americans (RR, 0.32; 95% CI, 0.15, 0.66). In age- and weight-adjusted models, each SD decrease in peripheral BMD predicted a 1.54 times increased risk of fracture in each ethnic group (95% CI, 1.48-1.61). Excluding wrist fractures, the most common fracture, did not materially change associations. Conclusions: Ethnic differences in BMD are strongly influenced by body weight; fracture risk is strongly influenced by BMD in each group. Ethnic differences in absolute fracture risk remain, which may warrant ethnic-specific clinical recommendations. [source] A New Look at Women's Work in the CaribbeanANTHROPOLOGY & HUMANISM, Issue 1 2001Elizabeth Crespo Carla Freeman. High Tech and High Heels in the Global Economy,Women, Work and Pink-Collar Identities in the Caribbean. Durham: Duke University Press, 2000. xiii. 334 pp. [source] Reliability and validity of the Observational Gait Scale in children with spastic diplegiaDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 1 2003Anna H Mackey MS PT The aim of this study was to establish the reliability and validity of visual gait assessment in children with spastic diplegia, who were community or household ambulators, using a modified version of the Physicians Rating Scale, known as the Observational Gait Scale (OGS). Two clinicians viewed edited split-screen video recordings of 20 children/adolescents (11 males, 9 females; mean age 12 years, range 6 to 21 years) made at the time of three-dimensional gait analysis (3-DGA). Walking ability in each child was scored at initial assessment and reassessed from the same videos three months later using the first seven sections of the OGS. Validity of the OGS score was determined by comparison with 3-DGA. The OGS was found to have acceptable interrater and intrarater reliability for knee and foot position in mid-stance, initial foot contact, and heel rise with weighted kappas (wk) ranging from 0.53 to 0.91 (intrarater) and 0.43 to 0.86 (interrater). Comparison with 3-DGA suggests that these sections might also have high validity(wk range 0.38,0.94). Base of support and hind foot position had lower interrater and intrarater reliabilities (wk 0.29 to 0.71 and wk 0.30 to 0.78 respectively) and were not easily validated by 3-DGA. [source] Heart rate variability in response to pain stimulus in VLBW infants followed longitudinally during NICU stayDEVELOPMENTAL PSYCHOBIOLOGY, Issue 8 2009Nikhil S. Padhye Abstract The objective of this longitudinal study, conducted in a neonatal intensive care unit, was to characterize the response to pain of high-risk very low birth weight infants (<1,500,g) from 23 to 38 weeks post-menstrual age (PMA) by measuring heart rate variability (HRV). Heart period data were recorded before, during, and after a heel lanced or wrist venipunctured blood draw for routine clinical evaluation. Pain response to the blood draw procedure and age-related changes of HRV in low-frequency and high-frequency bands were modeled with linear mixed-effects models. HRV in both bands decreased during pain, followed by a recovery to near-baseline levels. Venipuncture and mechanical ventilation were factors that attenuated the HRV response to pain. HRV at the baseline increased with post-menstrual age but the growth rate of high-frequency power was reduced in mechanically ventilated infants. There was some evidence that low-frequency HRV response to pain improved with advancing PMA. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 638,649, 2009 [source] Lack of desquamation , the Achilles heel of the reconstructed epidermisINTERNATIONAL JOURNAL OF COSMETIC SCIENCE, Issue 5 2002M. Ponec Synopsis The use of human skin equivalents for screening tests aiming to assess repetitive application of various test agents is hampered by the lack of desquamation in vitro. The present study was undertaken to examine whether the desquamation can be induced by various treatments including mechanical stress, application of various agents that should decrease the surface pH and calcium level, activate the enzymes involved in desquamation process or UV irradiation. In addition, the effect of ,-hydroxyacids, known to enhance desquamation and to improve the stratum corneum barrier function in vivo, was examined as well. Human epidermis reconstructed on de-epidermized dermis or on fibroblast-populated collagen matrices during a 2-week culture at the air,liquid interface underwent various treatments during an additional 3-week period. The effects of treatments were evaluated on the basis of tissue morphology and lipid composition. The results of the present study revealed that cell shedding could only be induced by a mild repetitive mechanical treatment. The lack of desquamation, under most in vitro conditions, has a practical consequence, since it may hamper the use of reconstructed epidermis for various screening studies aiming to examine the repetitive exposure to topical agents or UV irradiation. The gradual thickening of the stratum corneum will lead to its higher resistance to the environmental stimuli and in this way affect the outcome of the tests. Furthermore, from the results obtained in the present study, it became evident that one should be careful in selecting endpoints when, for example, the effects of agents known to modulate melanogenesis are examined. Résumé L'utilization d'équivalents cutanés humains dans les procédures de criblage, afin d'estimer l'action répétée de divers agents, est entravée par l'absence de desquamation in vitro. La présente étude a été entreprise afin de déterminer dans quelle mesure la desquamation peut être induite par différents traitements tels que stress mécanique, application d'agents divers qui conduiraient à une chute du pH de surface et du taux de Calcium, activeraient les enzymes impliquées dans le processus de desquamation, ou l'irradiation UV. De plus, l'effet des , hydroxy-acides, connus pour favouriser la desquamation et d'améliorer la fonction barrière du Stratum-Corneum in vivo, a étéétudié. L'épiderme humain reconstruit sur un derme dé-épidermisé ou sur des matrices de collagène colonisées par des fibroblastes pendant 2 semaines de culture, en interface air × liquide, a subi divers traitements pendant une période additionnelle de 3 semaines. Les effets de ces traitements étaient évalués sur des critères morphologiques du tissu ainsi que la composition en lipides. Les résultats de cette étude montrent que l'élimination cellulaire ne peut être induite que par un léger traitement mécanique répété. L'absence de desquamation dans la plupart des conditions in vitro a une conséquence pratique puisqu'elle peut entraver l'utilization de l'épiderme reconstruit à des fins diverses de criblage en vue d'appréhender les expositions répétées à des agents topiques, ou l'irradiation UV. L'épaississement progressif du Stratum-Corneum lui confèrera une résistance accrue aux stimuli environnementaux qui, en retour, modifiera les résultats des tests. De plus, les résultats de cette présente étude impliquent à l'évidence une précaution dans la sélection des cinétiques de mesures lorsque, par exemple, les effets des agents connus pour moduler la mélanogénèse sont étudiés. [source] Multiple keratoacanthomas in a young woman: report of a case emphasizing medical management and a review of the spectrum of multiple keratoacanthomasINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2007Ron J. Feldman MD A 27-year-old white woman was referred for consultation with regard to the presence of extensive multiple keratotic lesions. She began to develop these lesions at the age of 9 years, with healing of the lesions resulting in scar formation. A biopsy was performed at the age of 16 years, but the patient was unsure of the results. Since then, she had not had any treatment or biopsies, and stated that she had not suffered from any health problems during the intervening period. She was most concerned about the tumors on her heels and soles, which caused difficulty with ambulation. The family history was negative for skin diseases, including melanoma, nonmelanoma skin cancer, psoriasis, and eczema, and positive for Type II diabetes mellitus. A relative reported that the patient's grandfather had similar lesions, but the patient's parents and siblings were healthy. She was married and had one child, a 9-year-old daughter. Her child had no skin lesions. The patient's only medication was Ortho-Tricyclene birth control pills. She had no known drug allergies. Physical examination revealed the presence of multiple lesions on her body (Fig. 1). Her left superior helix contained a well-demarcated, dome-shaped nodule with a rolled, mildly erythematous border with a central hyperkeratotic plug. A similar lesion was present in the scaphoid fossa of the left ear and smaller lesions were scattered on her face. Numerous lesions were present on the arms and legs bilaterally, with the majority of lesions being located on the anterior lower legs. There were also lesions present on the palms and soles. The lesions ranged in size from 5 mm to 3 cm, the largest being a verrucous exophytic nodule on the anterior aspect of her left leg. Overall, there appeared to be two distinct types of lesion. One type appeared round, oval, and symmetric with a central keratotic plug, similar to that on the ear. The other type was larger, more exophytic, and verrucous, including the lesions on the volar surfaces. Also present were numerous, irregularly shaped atrophic scars where previous lesions had healed spontaneously. There were no oral lesions or lesions on her fingernails or toenails, and her teeth and hair were normal. Figure 1. Initial presentation of left ear and anterior legs before treatment A biopsy was obtained from an early lesion on the right dorsal forearm. Histology revealed an exo-/endophytic growth having a central crater containing keratinous material (Fig. 2). The crater was surrounded by markedly hyperplastic squamous epithelium with large squamous epithelial cells having abundant glassy cytoplasm. Some cells were dyskeratotic. Within the dermis was a dense, chiefly mononuclear inflammatory infiltrate. A buttress of epidermis surrounded the crater. The clinical and pathologic data were consistent with keratoacanthomas. Figure 2. Keratoacanthoma exhibiting an exo- and endophytic growth pattern with a central crater containing keratin (hematoxylin and eosin; original magnification, ×40) Initial laboratory screenings revealed elevated triglycerides and total cholesterol, 537 mg/dL (normal, < 150 mg/dL) and 225 mg/dL (normal, < 200 mg/dL), respectively, with all other laboratory results within normal limits. In anticipation of starting oral retinoid therapy for her multiple keratoacanthomas, she was referred to her primary care physician for control of hyperlipidemia. After her lipids had been controlled, she was placed on isotretinoin (Accutane) 40 mg/day. There was some interval improvement with regression of some lesions leaving atrophic scars. She was also started on topical application of tazarotene (Tazorac) for all nonresolving lesions. Possible side-effects from the isotretinoin occurred, including dry mouth and eyes. After 8 months of isotretinoin, the patient was switched to acitretin (Soriatane) 25 mg to determine whether it might have a more beneficial effect on the resistant lesions. Many of the larger lesions regressed leaving atrophic scars. The dose of acitretin was subsequently increased to 35 mg because the lesions on her heel and the ball of her foot persisted. Almost all of the lesions resolved, except those on her feet, which are slowly regressing. Currently, the patient is on a regimen of acitretin 25 mg once a day with tazarotene 0.1% gel applied directly to the few residual keratoacanthomas on her feet, which are slowly improving. [source] Leg ulcers and hydroxyurea: report of three cases with essential thrombocythemiaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 12 2002Zeynep Demirçay MD Case 1,A 65-year-old woman with essential thrombocythemia (ET) had been taking oral hydroxyurea (HU), 1000 mg daily, for 7 years. Six months ago, she developed an ulcer on the outer part of her left ankle, which healed spontaneously within 2 months. She presented with a new, tender, shallow ulcer, 2 cm × 2 cm in size, at the same site. Doppler examination revealed thrombosis of the left common femoral vein and a calcified atheroma plaque of the left common femoral artery. The dosage of HU was decreased to 500 mg daily when the platelet counts were found to be within normal levels. The ulcer completely healed within 2 months with occlusive wound dressings, and has not recurred within the follow-up period of 1 year. Case 2,A 56-year-old women presented with multiple, painful, leg ulcers of 1 year duration. She had been diagnosed as having ET and had been on HU therapy, 1500 mg/day, for the past 5 years. Interferon-,-2b was started 3 months ago, in addition to HU, which was tapered to 1000 mg daily. She had suffered from hypertension for 20 years treated with nifedipine and enalapril, and had recently been diagnosed with diabetes mellitus which was controlled by diet. Examination revealed three ulcers located on the lateral aspects of both ankles and right distal toe. Arterial and venous Doppler examinations were within normal limits. Histopathology of the ulcer revealed nonspecific changes with a mixed inflammatory cell infiltrate around dermal vessels. The ulcers completely healed within 10 weeks with topical hydrocolloid dressings. After healing, she was lost to follow-up. A year later, it was learned that she had developed a new ulcer at her right heel, 3 months after her last visit (by phone call). This ulcer persisted for 8 months until HU was withdrawn. Case 3,A 64-year-old woman with ET presented with a painful leg ulcer of 6 months' duration. She had been taking oral HU for 5 years. She had a 20-year history of hypertension treated with lisinopril. Examination revealed a punched-out ulcer of 2 cm × 2 cm over the right lateral malleolus (Fig. 1). Doppler examination of the veins revealed insufficiency of the right greater saphenous and femoral veins. Angiography showed multiple stenoses of the right popliteal and femoral arteries. As her platelet count remained high, HU was continued. During the follow-up period of 13 months, the ulcer showed only partial improvement with local wound care. Figure 1. Punched-out ulcer surrounded by an erythematous border over the right malleolus (Case 3) [source] Eccrine poroma of the heelINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2000Harvey Lemont A 67-year-old African,American woman had a tender red nodule on the posterior aspect of her left heel of 20 years' duration. The lesion had initially grown quickly to its present size, but subsequently remained unchanged through the years. No previous history of trauma to the area could be elicited. The lesion was not tender or painful, although the patient related some recent discomfort when wearing shoes with high heel counters. Examination revealed a soft, multilobulated, skin-colored nodule, measuring approximately 1.1 cm at its greatest diameter ( Fig. 1), with a rim space or moat ( Fig. 2) surrounding the lesion. Biopsy of the lesion demonstrated a uniform proliferation of basaloid cells exhibiting a sharp demarcation between the adjacent normal epidermis ( Fig. 3). No horn cysts were present. The papillary dermis demonstrated multiple ectatic blood vessels ( Fig. 4) which may be responsible for its reddish appearance. Figure 1 Multilobulated,. red, granulating lesion on the posterior heel Figure 2 Note. the characteristic ,,moat'' surrounding the lesion Figure 3 Biopsy. reveals a proliferation of uniformly small cuboidal cells sharply demarcated from the adjacent normal epidermal cells Figure 4 Ectatic. vessel dilatation most likely responsible for the reddish color of the lesion [source] Respiratory Function as a Marker of Bone Health and Fracture Risk in an Older Population,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 5 2009Alireza Moayyeri Abstract Identification of those at high risk of osteoporosis and fractures using clinically available tests beyond BMD measures is a major clinical challenge. We examined forced expiratory volume in 1 s (FEV1), an easily obtainable measure of respiratory function, as a clinical measure for fracture prediction. In the context of the European Prospective Investigation into Cancer-Norfolk Study, 8304 women and 6496 men 42,81 yr of age underwent a health check including spirometry and heel quantitative ultrasonography between 1997 and 2000 and were followed up for incident hip fractures until 2007. The main outcome measures were broadband ultrasound attenuation (BUA) of the heel (cross-sectional analysis) and hip fracture risk (prospective analysis). In multivariate regression models, a 1-liter increase in FEV1 was associated with a statistically significant 2.2-dB/MHz increase in BUA, independent of age, smoking, height, body mass index, history of fracture, and use of corticosteroids. Mean FEV1 was significantly lower among 84 women and 36 men with hip fracture compared with other participants. In multivariate proportional-hazard regression models, the relative risk (RR) of hip fracture associated with a 1-liter increase in FEV1 was 0.5 (95% CI, 0.3,0.9; p < 0.001) for both men and women. RR of hip fracture for a 1 SD increase in FEV1 was approximately equivalent to a 0.5 SD increase in BUA among women (1 SD among men) and an ,5-yr decrease in age among both men and women. Middle-aged and older people with low respiratory function are at increased risk of osteoporosis and hip fracture. FEV1, an easy, low-cost, and feasible clinical measure, may help improve the identification of high-risk groups. [source] Assessment of the 10-Year Probability of Osteoporotic Hip Fracture Combining Clinical Risk Factors and Heel Bone Ultrasound: The EPISEM Prospective Cohort of 12,958 Elderly Women,,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2008Didier Hans Abstract This study aimed to develop a hip screening tool that combines relevant clinical risk factors (CRFs) and quantitative ultrasound (QUS) at the heel to determine the 10-yr probability of hip fractures in elderly women. The EPISEM database, comprised of ,13,000 women ,70 yr of age, was derived from two population-based white European cohorts in France and Switzerland. All women had baseline data on CRFs and a baseline measurement of the stiffness index (SI) derived from QUS at the heel. Women were followed prospectively to identify incident fractures. Multivariate analysis was performed to determine the CRFs that contributed significantly to hip fracture risk, and these were used to generate a CRF score. Gradients of risk (GR; RR/SD change) and areas under receiver operating characteristic curves (AUC) were calculated for the CRF score, SI, and a score combining both. The 10-yr probability of hip fracture was computed for the combined model. Three hundred seven hip fractures were observed over a mean follow-up of 3.2 yr. In addition to SI, significant CRFs for hip fracture were body mass index (BMI), history of fracture, an impaired chair test, history of a recent fall, current cigarette smoking, and diabetes mellitus. The average GR for hip fracture was 2.10 per SD with the combined SI + CRF score compared with a GR of 1.77 with SI alone and of 1.52 with the CRF score alone. Thus, the use of CRFs enhanced the predictive value of SI alone. For example, in a woman 80 yr of age, the presence of two to four CRFs increased the probability of hip fracture from 16.9% to 26.6% and from 52.6% to 70.5% for SI Z-scores of +2 and ,3, respectively. The combined use of CRFs and QUS SI is a promising tool to assess hip fracture probability in elderly women, especially when access to DXA is limited. [source] Long-Term Fracture Prediction by DXA and QUS: A 10-Year Prospective Study,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2006Alison Stewart PhD Abstract This study investigated the ability of DXA and QUS to predict fractures long term when measured around the time of the menopause. We found both DXA and QUS are able to predict both any fracture and "osteoporotic" fractures and that QUS can predict independently of BMD. Introduction: There are now many treatments available for prevention of osteoporotic fracture. To be cost-effective, we need to target those most at risk. This study examines the ability of DXA and QUS to predict fractures in an early postmenopausal population of women. Materials and Methods: We prospectively measured 3883 women who had been randomly selected from a community-based register. At baseline, they were measured using DXA of spine and hip (Norland XR-26) and QUS of the heel (Walker Sonix UBA 575). Follow-up had a mean of 9.7 ± 1.1 (SD) years. All incident fractures were identified and validated by examination of X-ray reports, and these were compared with those without fracture in a Cox-regression model to calculate hazard ratios (HRs). Results: We found adjusted HRs for any fracture per 1 SD reduction in spine BMD to be 1.61 (1.42-1.83), whereas neck of femur BMD was 1.54 (1.34-1.75). Areas under the curve (AUC) for a receiver operator characteristic (ROC) analysis were 0.62 for spine BMD and 0.59 for neck BMD. In a subgroup where QUS was also measured, the HR for a 1 SD reduction in BMD was 1.69 (1.29-2.22) for spine BMD and 1.55 (1.17-2.06) for neck BMD. The HR for a 1 SD reduction in broadband ultrasound attenuation (BUA) was 1.53 (1.19-1.96), and 1.44 (1.12-1.86) when further adjusted for neck BMD. The AUCs were 0.63 for spine BMD, 0.59 for neck BMD, and 0.62 for BUA. When only osteoporotic fractures were examined, the HRs increased in all situations. BUA showed the highest HR of 2.25 (1.51-3.34), and when further adjusted for neck BMD was 2.12 (1.38-3.28). Conclusions: In conclusion, it may be possible to scan women around the time of the menopause to predict future fractures. It seems that, for "osteoporotic" fractures, BUA may be an improved predictor of fractures in comparison with DXA, because the relative risk is highest for BUA, and independent of BMD. [source] Carbonated Soft Drink Consumption and Bone Mineral Density in Adolescence: The Northern Ireland Young Hearts Project,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 9 2003C McGartland Abstract In an observational study of 1335 boys and girls aged 12 and 15 years, higher intakes of carbonated soft drinks (CSDs) were significantly associated with lower bone mineral density at the heel, but only in girls. Owing to the upward trend in CSD intake in adolescence, this finding may be of concern. Introduction: High consumption of carbonated soft drinks (CSD) during adolescence may reduce bone mineral accrual and increase fracture risk. The aim of this study was to examine the relationship between CSD consumption and bone mineral density (BMD) in a representative sample of adolescents. Materials and Methods: This was a cross-sectional observational study in 36 postprimary schools in Northern Ireland. Participants included 591 boys and 744 girls either 12 or 15 years old. BMD was measured by DXA, and usual beverage consumption was assessed by the diet history method. Adjusted regression modeling was used to investigate the influence of CSD on BMD. Results: A significant inverse relationship between total CSD intake and BMD was observed in girls at the dominant heel (,, ,0.099; 95% CI, ,0.173 to ,0.025). Non-cola consumption was inversely associated with dominant heel BMD in girls (,, ,0.121; 95% CI, ,0.194 to ,0.048), and diet drinks were also inversely associated with heel BMD in girls (,, ,0.087; 95% CI, ,0.158 to ,0.016). However, no consistent relationships were observed between CSD intake and BMD in boys. Cola consumption and nondiet drinks were not significantly related to BMD in either sex. Conclusion: CSD consumption seems to be inversely related to BMD at the dominant heel in girls. It is possible that the apparent association results from the displacement of more nutritious beverages from the diet. Although the inverse association observed between CSD consumption and BMD is modest and confined to girls, this finding may have important public health implications given the widespread use and current upward trend in CSD consumption in Western populations. [source] The Association Between Heel Ultrasound and Hormone Replacement Therapy Is Modulated by a Two-Locus Vitamin D and Estrogen Receptor GenotypeJOURNAL OF BONE AND MINERAL RESEARCH, Issue 6 2000Yves Giguère Abstract Evidence supports the role of estrogen deprivation in the process of bone remodeling and increased risk of fracture in postmenopausal women but little is known about the genetic basis of individual differences in response to therapy. In a cross-sectional study, 425 ambulatory postmenopausal French-Canadian women from Quebec (age range, 42,85 years old) were genotyped for a common Bsm I polymorphism at the vitamin D receptor (VDR) gene as well as a Pvu II polymorphism in the estrogen receptor (ESR1) gene. Heel ultrasound was determined by right calcaneal quantitative ultrasound (QUS) and results were expressed as an age- and-weight-adjusted stiffness index (heel SI z score). Our aim was to investigate the interaction between hormone-replacement therapy (HRT) and receptor genotypes in an effect on heel SI. Notably, a two-locus genotype (VDR-bb/ESR-PP) present in 9.5% of women was responsible for over 30% of the total HRT-related heel SI difference in the whole sample. Women bearing this combined VDR/ESR1 genotype who received HRT for more than 5 years had a 21% (1.25 SD) greater heel SI (p = 0.002) than those bearing the same genotype but who received HRT for <5 years. This may translate into a 2- to 3-fold difference in the risk of fracture. Although follow-up studies are needed, our findings suggest that QUS of the heel in postmenopausal women taking HRT is affected by variation in VDR and ESR1 loci, jointly. [source] Cell cycle checkpoints and their impact on anticancer therapeutic strategiesJOURNAL OF CELLULAR BIOCHEMISTRY, Issue 2 2004Alan Eastman Abstract Cells contain numerous pathways designed to protect them from the genomic instability or toxicity that can result when their DNA is damaged. The p53 tumor suppressor is particularly important for regulating passage through G1 phase of the cell cycle, while other checkpoint regulators are important for arrest in S and G2 phase. Tumor cells often exhibit defects in these checkpoint proteins, which can lead to hypersensitivity; proteins in this class include ataxia,telangiectasia mutatated (ATM), Meiotic recanbination 11 (Mre11), Nijmegen breakage syndrome 1 (Nbs 1), breast cancer susceptibility genes 1 and 2 (BRCA1), and (BRCA2). Consequently, tumors should be assessed for these specific defects, and specific therapy prescribed that has high probability of inducing response. Tumors defective in p53 are frequently considered resistant to apoptosis, yet this defect also provides an opportunity for targeted therapy. When their DNA is damaged, p53-defective tumor cells preferentially arrest in S or G2 phase where they are susceptible to checkpoint inhibitors such as caffeine and UCN-01. These inhibitors preferentially abrogate cell cycle arrest in p53-defective cells, driving them through a lethal mitosis. Wild type p53 can prevent abrogation of arrest by elevating levels of p21waf1 and decreasing levels of cyclins A and B. During tumorigenesis, tumor cells frequently loose checkpoint controls and this facilitates the development of the tumor. However, these defects also represent an Achilles heel that can be targeted to improve current therapeutic strategies. © 2003 Wiley-Liss, Inc. [source] Insufficiency fracture of the calcaneum: Sonographic findingsJOURNAL OF CLINICAL ULTRASOUND, Issue 7 2009Delphine Arni Abstract We present a case of insufficiency fracture (IF) of the calcaneum diagnosed by sonography (US). An 83-year-old woman consulted because of pain and swelling of the left heel without history of trauma. Standard radiographs showed osteoporosis without fracture. US revealed thickening of the calcaneal periosteum associated with edema of the adjacent soft tissues. Color Doppler imaging showed marked increased vascularity of the periosteum. US changes, together with the clinical and radiographic findings, were consistent with an IF of the calcaneum that was confirmed by MRI. The patient was treated successfully by conservative treatment. In the proper clinical setting, US can suggest the diagnosis of IF of the calcaneum. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009 [source] Sonoanatomy of the Achilles tendon insertion in childrenJOURNAL OF CLINICAL ULTRASOUND, Issue 7 2004Wolfgang Grechenig MD Abstract Purpose The aim of this study was to describe typical age-related sonographic features of the Achilles tendon and calcaneal apophysis in children, providing a reference for the assessment of heel pathologies during the growth period. Methods The calcaneal apophysis and Achilles tendon insertion of 100 children 2 months to 18 years old were examined by high-frequency gray-scale and color Doppler sonography along both the longitudinal and transverse planes. The thicknesses of the apophyseal cartilage at the calcaneal tuberosity and of the Achilles tendon were measured. Also, the sonographic appearance of the bone-cartilage interface was studied. Results In children 2 months to 3 years old, the cartilage of the calcaneal tuberosity apophysis was anechoic, with small scattered echoes. In 19 of these 25 children (76%), the echogenic areas contained at least 1 small vessel, visualized on color Doppler sonography. In 15 of 25 children (60%) 4,6 years old, a wavy interface was noted at the junction of the calcaneus and the apophyseal cartilage. Conclusions High-frequency sonography can yield reliable information about the bone-cartilage interface and the Achilles tendon insertion site at the calcaneal tuberosity in children. The sonographic features of the normal heel described here may contribute to improved assessment of pathologies in this anatomic region. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:338,343, 2004 [source] Waiting for scheduled services in Canada: development of priority-setting scoring systemsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2003T. W. Noseworthy MD MSc MPH FRCPC FACP FCCP FCCM CHE Abstract Rationale, aims and objectives An Achilles' heel of Canadian Medicare is long waits for elective services. The Western Canada Waiting List (WCWL) project is a collaboration of 19 partner organizations committed to addressing this issue and influencing the way waiting lists are structured and managed. The focus of the WCWL project has been to develop and refine practical tools for prioritizing patients on scheduled waiting lists. Methods Scoring tools for priority setting were developed through extensive clinical input and highly iterative exchange by clinical panels constituted in five clinical areas: cataract surgery; general surgery procedures; hip and knee replacement; magnetic resonance imaging (MRI) scanning, and children's mental health. Several stages of empirical work were conducted to formulate and refine criteria and to assess and improve their reliability and validity. To assess the acceptability and usability of the priority-setting tools and to identify issues pertaining to implementation, key personnel in the seven regional health authorities (RHAs) participated in structured interviews. Public opinion focus groups were conducted in the seven western cities. Results Point-count scoring systems were constructed in each of the clinical areas. Participating clinicians confirmed that the tools offered face validity and that the scoring systems appeared practical for implementation and use in clinical settings. Reliability was strongest for the general surgery and hip and knee criteria, and weakest for the diagnostic MRI criteria. Public opinion focus groups endorsed wholeheartedly the application of point-count priority measures. Regional health authorities were generally supportive, though cautiously optimistic towards implementation. Conclusions While the WCWL project has not ,solved' the problem of waiting lists and times, having a standardized, reliable means of assigning priority for services is an important step towards improved management in Canada and elsewhere. [source] Review of Pododermatitis Circumscripta (Ulceration of the Sole) in Dairy CowsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2006Sarel R. van Amstel Sole ulcers are among the most frequent causes of lameness in dairy cattle. They are found most commonly in the hind lateral claw, are frequently bilateral, and have a high rate of reoccurrence. The pathogenesis of sole ulceration is primarily based on mechanical injury by the 3rd phalanx to the corium, basement membrane, and basal layers of the sole epidermis as a result of failure of the suspensory apparatus in the claw. The main pathways in the failure of the suspensory system include inflammatory (dermal vascular changes followed by disruption of keratinocyte proliferation and differentiation caused by local and systemic mediators) and noninflammatory (hormonal and biochemical changes in the peripartum period resulting in alterations of connective tissue in the suspensory system) pathways. Sole ulcers tend to occur in specific locations; the most reported site is the junction of the axial heel and sole. Other locations include the apex of the toe and the heel. Varying degrees of lameness may result, and the most severe are seen with complicated cases in which ascending infection affects the deeper structures of the claw. Pathologic changes at the ulcer site include dyskeratosis and dilated horn tubules with microcracks. Vascular changes include dilatation and thrombosis of capillaries with "neocapillary formation." Areas of dyskeratosis may remain for as long as 50 days at the ulcer site. Treatment includes corrective trimming and relief of weight bearing. Complicated cases may require surgical intervention. [source] Performance-Based Regulation and Regulatory Regimes: The Saga of Leaky BuildingsLAW & POLICY, Issue 4 2003Peter J. May Regulatory reformers have widely endorsed greater use of a performance-based approach to regulation that defines objectives in terms of desired outcomes. The appeal of the performance-based approach is as much about introducing a regime that overcomes problems of overly rigid rules and inflexible enforcement as it is about regulating for results. The case of leaky buildings in New Zealand provides a cautionary tale of a flawed performance-based regulatory regime. It allowed for flexibility without sufficient accountability and in so doing showed the Achilles' heel of performance-based regulation. [source] Transfer of the second to the first metatarsal ray in a case of lawn mower injury: A case reportMICROSURGERY, Issue 3 2009Paolo Sassu M.D. The medial longitudinal arch of the foot plays a major role for a physiologic transfer of the load from the heel to the forefoot during walking and running. Traumatic amputation that involve either the great toe or the whole first metatarsal bone can lead to collapse of the medial longitudinal arch, overload of the metatarsal heads, and painful callus formation. If replant of the amputated part is not possible or has failed, it is advisable to reconstruct the medial longitudinal arch in order to re-establish a functional transfer of the load in the foot. We present a case of a young lady who suffered from traumatic amputation at the distal third of the first metatarsal. Replantation failed due to the severity of the initial injury. Despite a good coverage of the defect with a lateral arm flap, the patient developed a painful plantar callus underneath the amputated stump. The adjacent second metatarsal ray was then raised as a pedicled flap including bone and soft tissues and transferred to the first ray in order to reconstruct a physiologic medial longitudinal arch. The patient had excellent functional results with no recurrence of the callus. © 2008 Wiley-Liss, Inc. Microsurgery, 2009. [source] Technique for determining when plantar heel pain can be neural in originMICROSURGERY, Issue 6 2008A. Lee Dellon M.D., Ph.D. The surgeon doing microsurgery will encounter problems related to the heel not only in terms of how to reinnervate the transferred tissue, but also in patients presenting with heel pain. While most heel pain is thought to be related to the plantar fascia arising from the calcaneus, conceptually heel pain can be of neural origin. The technique for documenting sensibility in the heel is described using the Pressure-Specified Sensory DeviceÔ. Knowledge of calcaneal nerve sensibility can determine whether there is sufficient sensation to prevent ulceration, whether there is a nerve entrapment that would benefit from neurolysis, or whether there is a neuroma that would benefit from resection. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source] The sural artery patency test: A useful precaution in risky patients for the reverse sural flapMICROSURGERY, Issue 3 2008Onder Tan M.D. The arterial insufficiency is not rare in high risky patients for the reverse sural flap. Thus, we introduce a novel practical technique by performing intraoperative patency test to the sural artery to predetermine the arterial potential, to avoid a possible arterial insufficiency and to increase the reliability of the sural flap in these patients. We succesfully applied the reverse sural flap to seven risky patients with crushing injury, mine explosion, and diabetes, in whom the sural artery patency test was positive. The flap size varied from 8 × 5 cm to 16 × 10 cm. The major defect localization was the heel with/without sole. All flaps survived uneventfully with good contours and durabilities. The sural artery patency test obtain us to decide to safely raise the sural flap or not, and to predict the outcomes of the operative procedure in critical wounds associated with poor arterial supply. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source] Reconstruction of foot defects with free lateral arm fasciocutaneous flaps: Analysis of fifty patientsMICROSURGERY, Issue 8 2005Betul Gozel Ulusal M.D. In this article, long-term outcomes of foot reconstruction with free lateral arm fasciocutaneous flaps were retrospectively analyzed in 50 patients. The patients, 38 men and 12 women, ranged in age from 7,73 years (mean, 43.5 years). Indications for surgery included trauma (32 patients), diabetes mellitus (7 patients), burns (7 patients), chronic ulcers (3 patients), and tumor (1 patient). The locations of defects were the dorsum (n = 21), ankle (n = 12), medial (n = 6), lateral (n = 6), posterior heel (n = 2), and distal sole (n = 3) Concomitant bone injury occurred in 5 cases, and the weight-bearing surface of the foot was involved in 5 patients. Defects ranged in size from 27,76 cm2 (mean, 36.4 cm2). Successful reconstructions were accomplished in 46 cases (92%). Flap complications included total flap loss and below-knee amputation (1 patient) and partial flap loss (3 patients); 75% (3/4) of these cases had diabetes as a comorbid factor, and 25% (1/4) had a concomitant bone injury. Six patients with dorsum defects required debulking of the flap (11.1%). None of the patients required modified shoes. In the majority of cases, flaps provided stable coverage and a gain in protective deep-pressure sensation. In long-term follow-up (up to 4 years), patients regained their ambulation, free of pain. Even in weight-bearing areas, none of the cases experienced ulceration or skin breakdown. Free lateral arm flaps provided excellent durability, with solid bony union and successful restoration of the contour of the foot in moderate-sized foot defects. © 2005 Wiley-Liss, Inc. Microsurgery 25:581,588, 2005. [source] A Neo-Boasian Conception of Cultural BoundariesAMERICAN ANTHROPOLOGIST, Issue 3 2004IRA BASHKOW For the past 30 years, anthropology's critics have repeatedly questioned the notion of "cultural boundaries," arguing that concepts of culture inappropriately posit stable and bounded "islands" of cultural distinctiveness in an ever-changing world of transnational cultural "flows." This issue remains an Achilles' heel,or at least a recurring inflamed tendon,of anthropology. However, in the conception of boundaries, we still have much to learn from Boasian anthropologists, who conceived of boundaries not as barriers to outside influence or to historical change, but as cultural distinctions that were irreducibly plural, perspectival, and permeable. In this article, I retheorize and extend the Boasians' open concept of cultural boundaries, emphasizing how people's own ideas of "the foreign",and the "own" versus the "other" distinction,give us a way out of the old conundrum in which the boundedness of culture, as conceived in spatial terms, seems to contradict the open-ended nature of cultural experience. [source] Performance after surgical treatment of patients with ankle fractures , 14-month follow-upPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2003Gertrud Nilsson RPT Abstract Background and Purpose Few studies have been published that extensively evaluate physical outcome after ankle fractures. In addition, there is a lack of knowledge of how physical outcome correlates with subjective assessments of symptoms and function after ankle fracture. The purpose of the present study was to investigate outcome after surgical treatment of patients with ankle fracture and to study how well the experience of symptoms and function correlated with the results of clinical physical tests. Method The study used a retrospective cross-sectional study design. Fifty-four patients, aged 17,64 years, were evaluated 14 months post-operatively. Evaluation included a questionnaire containing the Olerud,Molander Ankle Score (OMAS) (Olerud and Molander, 1984) and some additional questions. Patients were also called for a physical and radiographic examination. Results The median OMAS obtained was 75 (range 10,100). Only 10 (19%) of the patients reported complete recovery and 16 (30%) scored ,90, indicating good function. The results of the following clinical tests were correlated with OMAS: loaded dorsal extension; ankle circumference; number of toe and heel rises; and single-limb stance. Those who showed poorer results in physical outcome on the affected side had lower OMAS. No ankles with clear mechanical instability were found, although almost half the patients experienced functional instability that, in turn, was associated with decreased total OMAS. Conclusions Both subjectively scored function and physical performance after surgically treated ankle fractures indicated poor results. One reason for this might be insufficient rehabilitation. Copyright © 2003 Whurr Publishers Ltd. [source] Brief communication: Dynamic plantar pressure distribution during locomotion in Japanese macaques (Macaca fuscata)AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 1 2010Eishi Hirasaki Abstract To better place the form and motion of the human foot in an evolutionary context, understanding how foot motions change when quadrupeds walk bipedally can be informative. For this purpose, we compared the pressures beneath the foot during bipedal and quadrupedal walking in Japanese macaques (Macaca fuscata). The pressure at nine plantar regions was recorded using a pressure mat (120 Hz), while the animals walked on a level walkway at their preferred speeds. The results revealed substantial differences in foot use between the two modes of locomotion, and some features observed during bipedal walking resembled human gait, such as the medial transfer of the center of pressure (COP), abrupt declines in forefoot pressures, and the increased pressure beneath the hallux, all occurring during the late-stance phase. In particular, the medial transfer of the COP, which is also observed in bonobos (Vereecke et al.: Am J Phys Anthropol 120 (2003) 373,383), was due to a biomechanical requirement for a hind limb dominant gait, such as bipedal walking. Features shared by bipedal and quadrupedal locomotion that were quite different from human locomotion were also observed: the heel never contacted the ground, a foot longitudinal arch was absent, the hallux was widely abducted, and the functional axis was on the third digit, not the second. Am J Phys Anthropol, 2010. © 2009 Wiley-Liss, Inc. [source] Experimentally generated footprints in sand: Analysis and consequences for the interpretation of fossil and forensic footprintsAMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 4 2010K. D'Août Abstract Fossilized footprints contain information about the dynamics of gait, but their interpretation is difficult, as they are the combined result of foot anatomy, gait dynamics, and substrate properties. We explore how footprints are generated in modern humans. Sixteen healthy subjects walked on a solid surface and in a layer of fine-grained sand. In each condition, 3D kinematics of the leg and foot were analyzed for three trials at preferred speed, using an infrared camera system. Additionally, calibrated plantar pressures were recorded. After each trial in sand, the depth of the imprint was measured under specific sites. When walking in sand, subjects showed greater toe clearance during swing and a 7° higher knee yield during stance. Maximal pressure was the most influential factor for footprint depth under the heel. For other foot zones, a combination of factors correlates with imprint depth, with pressure impulse (the pressure-time integral) gaining importance distally, at the metatarsal heads and the hallux. We conclude that footprint topology cannot be related to a single variable, but that different zones of the footprint reflect different aspects of the kinesiology of walking. Therefore, an integrated approach, combining anatomical, kinesiological, and substrate-mechanical insights, is necessary for a correct interpretation. Am J Phys Anthropol, 2010. © 2009 Wiley-Liss, Inc. [source] Revisiting the "midtarsal break",AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 2 2010Jeremy M. DeSilva Abstract The midtarsal break was first described in this journal nearly 75 years ago to explain the ability of non-human primates to lift their heel independently of the rest of the foot. Since the initial description of the midtarsal break, the calcaneocuboid joint has been assumed to be the anatomical source of this motion. Recently, however, it has been suggested that the midtarsal break may occur at the cuboid-metatarsal joint, rather than at the calcaneocuboid joint. Data compiled from X-rays, dissections, manual manipulation of living primate feet, video of captive catarrhines, and osteological specimens concur that the midtarsal break is a complex motion caused by dorsiflexion at both joints with the cuboid-metatarsal joint contributing roughly 2/3 of total midfoot dorsiflexion, and the calcaneocuboid joint only about 1/3 of total midfoot dorsiflexion. The convexity of the proximal articular surface of the fourth and fifth metatarsals and corresponding concave cuboid facets provide skeletal correlates for the presence of midfoot dorsiflexion at the cuboid-metatarsal joint. Study of hominin metatarsals from Australopithecus afarensis, A. africanus, Homo erectus, and the metatarsals and a cuboid from the OH 8 foot show little capacity for dorsiflexion at the cuboid-metatarsal joint. These results suggest that hominins may have already evolved a stable midfoot region well adapted for the push-off phase of bipedalism by at least 3.2 million years ago. These data illuminate the evolution of the longitudinal arch and show further evidence of constraints on the arboreal capacity in early hominins. Am J Phys Anthropol 2010. © 2009 Wiley-Liss, Inc. [source] Civil Disobedience and Test CasesRATIO JURIS, Issue 3 2004María José Falcón y Tella The novelty of our focus resides in the priority given to the legal aspect of civil disobedience, especially to the possible legal justification of civil disobedience, a perspective that is generally overlooked in analysing the phenomenon. This is where the Achilles heel is to be found, though it may provide unexploited insights into the issue from which significant conclusions can be drawn. [source] | |||||||||||||||||||||||||