Joint stabilizing response to expected and unexpected tilts

BACKGROUND: The results found in the literature regarding functional ankle joint stabilization are controversial possibly because of the testing methods used. METHODS: The responses of 22 subjects to unexpected and expected sudden inversions of the foot were compared for all subjects together, as well as grouped by their self-perceived stability. A three-dimensional foot model was used to describe ankle and foot motion. Electromyographic signals of six muscles of the lower limb as well as the horizontal ground reaction forces were recorded. RESULTS: Whereas unexpected and expected trials did not show significant differences (p > 0.05) in kinematics, higher activation and horizontal force integrals were found for the unexpected trials. In addition, no differences in electromyographic or ground reaction force parameters were found between stable and unstable ankles; however, the kinematics revealed higher amplitudes and velocities for the stable group. CONCLUSIONS: The awareness of the instant of tilt enhances stabilization in that the same motion is achieved with a lower muscle activation. Evidence suggests that this is triggered at supraspinal levels. We found that timing of the EMG signal is not as relevant to stabilization as the amplitude (which has often been disregarded in the literature).     

Joint stabilising response to lateral and medial tilts

BACKGROUND: Joint stabilisation processes have been mainly studied comparing groups or joints with different stabilities and mainly focusing on one single parameter. The inherent limitations are discussed and a study, where kinematic, kinetic and electromyografic parameters gained from sudden tilt tests were measured, is presented. METHODS: The response of 24 subjects to sudden lateral and medial tilts of the foot during one legged stance were compared. A three-dimensional foot model was utilised to describe ankle and foot motion. Electromyografic signals of six muscles of the lower limb as well as the horizontal ground reaction forces were analysed. FINDINGS: Forefoot to rearfoot motion was faster and greater than ankle motion. In general medial tilts showed lower motion amplitudes and angular velocities than lateral tilts but higher horizontal ground reaction force integrals. The electromyography patterns where similar for both conditions. However, a specificity of the muscular response could be identified in the electromyography amplitudes. INTERPRETATION: The higher mediolateral ground reaction forces, together with the reduced kinematic and no general increase in muscular activation in medial tilts suggest, that passive structures seem to be able to counteract destabilising forces and thus reduce the otherwise needed muscular activation.     

Factors increasing local recurrence in breast-conserving surgery

From 20-year follow-up results of two pioneering randomized controlled trials demonstrating equal survival after mastectomy and breast-conservation therapy, recent high-quality, evidence-based clinical practice recommendations have been made. Breast-conservation therapy undoubtedly represents substantial progress for a better quality of life for women with early-stage breast cancer. However, lumpectomy is associated with a substantial proportion, approximately 10-20%, of local recurrence in long-term follow-up studies even after accounting for postoperative radiotherapy. Risk factors for local failure include margin status, young age and an extensive intraductal component. Young age and family history strongly suggest the need for genetic testing before initiation of treatment. Women with BRCA1 or BRCA2 mutations should be informed about the increased risk of contralateral breast cancer and ipsilateral failure after breast-conservation therapy. Bilateral mastectomy should also be offered as a treatment option. There is controversy over whether current effective adjuvant treatment, including chemotherapy and endocrine therapy, beyond appropriate local treatment as surgery and radiotherapy, can improve local control. Instead of debate over whether an ipsilateral tumor after breast-conservation therapy is local recurrence or a new primary cancer by analyzing conflicting data lacking strong evidence, efforts should be focused on reducing this risk irrespective of origin. Selecting women for breast-conservation therapy and achieving margin control can reduce ipsilateral failures.     

Cooperation of Psychiatry and the Church in a Deinstitutionalization Project

In pre-World War II Greece, mental illness and mental retardation carried significant stigma, and treatment for these conditions was far from adequate. Mental health had never been high on the political agenda. Following the defeat of Greece by Turkey in 1922, the increasing numbers of inmates of psychiatric institutions made conditions in such hospitals deplorable. This article investigates whether the quality of life for psychiatric patients further deteriorated during the German occupation and the civil war that followed. The war years were a time of great hardship for all the citizens of Greece. For those in the asylums, the hardship was much greater. Patients were neglected both by their families and by a professional staff depleted by war. Parts of asylums were used as army barracks or arsenals, resulting in cramped living conditions for patients. The occupying forces imposed strict food rationing and, during the winter of 1941-1942, fully half the population of psychiatric asylums died of starvation. This outcome can be viewed as mass murder, but it was not deliberate and was not based on eugenic beliefs. The large-scale decimation of mentally ill patients in Greece was a result of their total neglect during a time of great difficulty for the entire country.     

Identifying governance strategies that effectively support ecosystem services, resource sustainability, and biodiversity

Conservation scientists, national governments, and international conservation groups seek to devise, and implement, governance strategies that mitigate human impact on the environment. However, few studies to date have systematically investigated the performance of different systems of governance in achieving successful conservation outcomes. Here, we use a newly-developed analytic framework to conduct analyses of a suite of case studies, linking different governance strategies to standardized scores for delivering ecosystem services, achieving sustainable use of natural resources, and conserving biodiversity, at both local and international levels. Our results: (i) confirm the benefits of adaptive management; and (ii) reveal strong associations for the role of leadership. Our work provides a critical step toward implementing empirically justified governance strategies that are capable of improving the management of human-altered environments, with benefits for both biodiversity and people.     

Simultaneous clinical resolution of focal segmental glomerulosclerosis associated with chronic lymphocytic leukaemia treated with fludarabine, cyclophosphamide and rituximab

Background

Severe hypokalemia is known to cause muscle paralysis, and renal tubular acidosis is a recognized cause. Cystic disease of the kidney is associated with severe hypokalemia.

Case presentation

We report a 33-year-old male patient who presented with generalized limb weakness caused by severe hypokalemia due to renal tubular acidosis, who was found to have renal medullary cysts.

Conclusion

The association of cystic renal disease with hypokalemia, and the possible pathophysiological basis of the development of renal cysts in patients with severe hypokalemia, are discussed.