Validation of a weight bearing ankle equinus value in older adults with diabetes.

BACKGROUND: Accurate measurement of ankle joint dorsiflexion is clinically important as a restriction has been linked to many foot and ankle pathologies, as well as increased ulcer risk and delayed ulcer healing in people with diabetes. Use of the reliable weight bearing (WB) Lunge test is limited as normal and restricted ranges for WB ankle joint dorsiflexion are not identified. Additionally the extent of WB dorsiflexion restriction that results in clinically adverse outcomes is unclear. Therefore the aim of this investigation is to validate a proposed weight bearing equinus value (dorsiflexion < 30°) in unimpaired cohorts, and secondly to investigate any clinical effects this degree of ankle dorsiflexion restriction has on forefoot plantar pressure variables in older adults with diabetes. METHODS: Ankle dorsiflexion was measured using a Lunge test with the knee extended in young adults without diabetes (YA) and older adults with diabetes (DA). In-shoe and barefoot plantar pressure was recorded for the DA group. Spearman's correlation was calculated to determine any association between the presence of ankle equinus and plantar pressure variables in the DA group. DA group differences in people with and without an equinus were examined. RESULTS: A weight bearing equinus of < 30°, assessed in a lunge using an inclinometer placed on the anterior tibia, falls within the restricted range in young unimpaired cohorts. In the DA group this degree of ankle restriction had a fair and significant association with elevated barefoot forefoot peak pressure (r = 0.274, p = 0.005) and pressure-time integrals (r = 0.321, p = .001). The DA equinus group had significantly higher barefoot peak pressure (mean kPa (SD): 787.1 (246.7) vs 652.0 (304.5), p = 0.025) and pressure-time integrals (mean kPa (SD): 97.8 (41.6) vs 80.4 (30.5), p = 0.017) than the DA non equinus group. CONCLUSIONS: We support a preliminary weight bearing ankle equinus value of < 30°. This value represents a restricted range in young adults and is correlated with increased forefoot plantar pressure variables in older adults with diabetes. Mean population weight bearing ankle dorsiflexion data presented here for older adults with diabetes, will allow use of the more functional Lunge test with knee extended in research and clinical practice.

Prevalence of ankle equinus and correlation with foot plantar pressures in people with diabetes.

BACKGROUND: An association between equinus and plantar pressure may be important for people with diabetes, as elevated plantar pressure has been linked with foot ulcer development. To determine the prevalence of equinus in community dwelling people with diabetes and to examine any association between presence of equinus and forefoot plantar pressures. METHODS: Barefoot (Tekscan HR Mat™) and in-shoe (Novel Pedar-X®) plantar pressure variables, non-weight bearing ankle range of motion and neuropathy status were assessed in 136 adults with diabetes (52.2% male; 47.8% with neuropathy; mean (standard deviation) age and diabetes duration: 68.4 (11.5) and 14.6 (11.1) years respectively). FINDINGS: Equinus, when measured as ≤5° dorsiflexion, was present in 66.9% of the cohort. There was a significant correlation between an equinus and barefoot (r = 0.247, p = 0.004) and in-shoe forefoot pressure time integrals (r = 0.214, p = 0.012) and in-shoe forefoot alternate pressure time integrals (r = 0.246, p = 0.004). Significantly more males (p < 0.01) and people with neuropathy (p = 0.02) or higher glycated haemoglobin levels (p < 0.01) presented with an equinus. INTERPRETATION: Community dwelling adults with diabetes have a high rate of ankle equinus which is associated with increased forefoot pressure time integrals and a two-fold increased risk of high in-shoe peak pressures. Clinical assessment of an ankle equinus may be a useful screening tool to identify adults at increased risk of diabetic foot complications.

Weight bearing versus non-weight bearing ankle dorsiflexion measurement in people with diabetes: a cross sectional study.

BACKGROUND: Accurate measurement of ankle dorsiflexion is important in both research and clinical practice as restricted motion has been associated with many foot pathologies and increased risk of ulcer in people with diabetes. This study aimed to determine the level of association between non-weight bearing versus weight bearing ankle dorsiflexion in adults with and without diabetes, and to evaluate the reliability of the measurement tools. METHODS: One hundred and thirty-six adults with diabetes and 30 adults without diabetes underwent ankle dorsiflexion measurement non-weight bearing, using a modified Lidcombe template, and weight bearing, using a Lunge test. Pearson product-moment correlation coefficients, intraclass correlation coefficients (ICCs) with 95% confidence intervals, standard error of measurement and minimal detectable change were determined. RESULTS: There was a moderate correlation (r = 0.62-0.67) between weight and non-weight bearing tests in the non-diabetes group, and a negligible correlation in the diabetes group(r = 0.004-0.007). Intratester reliability was excellent in both groups for the modified Lidcombe template (ICC = 0.89-0.94) and a Lunge test (ICC = 0.83-0.89). Intertester reliability was also excellent in both groups for the Lidcombe template (ICC = 0.91) and a Lunge test (ICC = 0.88-0.93). CONCLUSIONS: We found the modified Lidcombe template and a Lunge test to be reliable tests to measure non-weight bearing and weight bearing ankle dorsiflexion in adults with and without diabetes. While both methods are reliable, further definition of weight bearing ankle dorsiflexion normative ranges may be more relevant for clinical practice.

Association between ankle equinus and plantar pressures in people with diabetes. A systematic review and meta-analysis.

BACKGROUND: Diabetes is one of the most common chronic diseases in the world and is associated with a life-time risk of foot ulcer of 12-25%. Diabetes related restriction in ankle joint range of dorsiflexion is proposed to contribute to elevated plantar pressures implicated in the development of foot ulcers. METHODS: A systematic search of EBSCO Megafile Premier (containing MEDLINE, CINAHL, SPORTSdiscus and Academic Search Complete) and The Cochrane Library was conducted to 23rd November 2016. Two authors independently reviewed and selected relevant studies. Meta-analysis of study data were conducted where possible. FINDINGS: Fifteen studies met the inclusion criteria. Three studies were eligible to be included in the meta-analysis which found that equinus has a significant, but small, effect on increased plantar pressures (ES=0.26, CI 95% 0.11 to 0.41, p=0.001). Of the remaining studies, eight found evidence of an association between limited ankle dorsiflexion and increased plantar pressures while four studies found no relationship. INTERPRETATION: Limited ankle joint dorsiflexion may be an important factor in elevating plantar pressures, independent of neuropathy. Limited ankle dorsiflexion and increased plantar pressures were found in all the studies where the sample population had a history of neuropathic foot ulceration. In contrast, the same association was not found in those studies where the population had neuropathy and no history of foot ulcer. Routine screening for limited ankle dorsiflexion range of motion in the diabetic population would allow for early provision of conservative treatment options to reduce plantar pressures and lessen ulcer risk.

The use of etanercept as a non-surgical treatment for temporomandibular joint psoriatric arthritis: a case report.

Psoriatic arthritis (PsA) is a chronic inflammatory disease of the skin and joints characterized by extensive intra-articular bone resorption and silver-red scaly plaques most commonly found on extensor surfaces of the skin. When this arthritis affects the temporomandibular joint (TMJ) and does not successfully halt in its early degenerative process, patients may undergo invasive joint reconstruction that irreversibly changes the TMJ physiologic joint dynamics. This study presents a case of TMJ PsA: anterior open bite, limited range of motion, and erythematous desquamative plaques of the upper limb extensors surfaces. The patient previously received non-steroidal anti-inflammatory drugs, immunosuppressors, and corticosteroids over a four-year period while suffering the idiosyncratic drug side effects from long-term therapy without improvement in joint function or rash resolution. The treatment team then chose etanercept, a synthetic fusion protein therapy that binds with tumor necrosis factor (TNF)-alpha, to interrupt reactive inflammatory arthritis. The patient received the TNF-alpha inhibitor monthly for two years. This last treatment led to full remission of both joint symptomatology and skin lesions. Our results should encourage general dental practitioners' involvement in curing patients with psoriatic arthritis when it affects the TMJ.

Quantitative analysis of 3-alkyl-2-methoxypyrazines in juice and wine using stable isotope labelled internal standard assay.

A solid phase microextraction (HS-SPME)-GC-MS methodology was established for the analysis of 3-alkyl-2-methoxypyrazines (MPs) in wine using a stable isotope dilution assay. The compounds analysed were 3-isobutyl-2-methoxypyrazine (IBMP), 3-sec-butyl-2-methoxypyrazine (SBMP), and 3-isopropyl-2-methoxypyrazine (IPMP) using their respective deuterated analogues ([2H3]-IBMP, [2H3]-SBMP, [2H3]-IPMP) as internal standards, synthesised during this work. A divinylbenzene/carboxene/polydimethylsiloxane (DVB/CAR/PDMS) fibre was selected for isolation of MPs and the effects of matrix parameters such as pH and ethanol concentration were examined in the development of the method. Best results were obtained at a pH of approximately 6 and with a wine dilution factor of 1:2.5, resulting in an ethanol concentration of approximately 5% (v/v). Relative standard deviations (RSDs) of replicate samples were 5.6-7% for all MPs at 5 ng L(-1) and <5% for 15 and 30 ng L(-1) samples. The limit of detection was <0.5 ng L(-1) in juice and 1-2 ng L(-1) in wine. The recovery efficiencies for spiked wine samples were between 99 and 102% for all three MPs. Using this method, we investigated the impact of the Multicoloured Asian Lady Beetle (MALB) on MPs in wine. In red wine fermented with live MALB, IPMP is the most prevalent MP detected, although SBMP concentrations are also increased and IBMP is unchanged from background levels. MALB that have been dead for 1 day before addition to juice can still contribute to elevated SBMP concentrations in wine, but not if they have been dead for 3 days or longer. Clarifying juice prior to fermentation leads to substantially lower IPMP concentration in the subsequent wine when compared with unclarified juice.

[The making of AIDS news]. / A construção da AIDS-notícia.

This study is part of the overall research effort on the role of the media in making sense of events in late modernity. The main objective is to investigate the context in which news about AIDS is produced at the interface between norms for producing news (as expressed by professional journalists) and an analysis of news stories published in four mainstream Brazilian newspapers. The results are organized in three broad topics: (a) the construction of news about AIDS; (b) the visibility of AIDS news during the study period; and (c) factors that facilitate or hinder the production of AIDS news. Important factors include exclusiveness of the story and/or novelty of the content, the notion of hot (or cold) news, and the specific contents. The authors also emphasize the inevitable chance elements associated with organizational characteristics and daily journalism. They conclude by pointing to recent changes in both the shape of the AIDS epidemic and the communications dynamics resulting from recent developments in the electronic media.

[Tropics of risk discourse: risk-adventure as a metaphor in late modernity]. / Trópicos do discurso sobre risco: risco-aventura como metáfora na modernidade tardia.

This article discusses new uses of interpretative repertoires of risk, especially those related to adventure. The author argues that the language of risk as adventure has multiple uses, as both a hedge against de-traditionalizing processes typical of late modernity and a figure of speech for new sensitivities stemming from the imperative of coping with the imponderability and volatility of modern risks. The article begins with an overview of the historical meanings of risk, seeking to argue that, as language in use, risk is a useful vantage point for understanding the transformations currently under way in the forms of social control, suggesting that we are experiencing a transition from disciplinary society, typical of classic modernity, to risk society. The discussion then focuses on recent transformations in images of risk, with special emphasis on the trend to use risk-adventure as a metaphor for late modernity.