The objective of this study was to find the effect of hallux valgus (HV) deformity on the inter‐segmental motion of the foot using an MFM with a 15‐marker set (DuPont Foot Model, DuFM) in comparison ...with age and sex controlled healthy adults. Fifty‐eight female symptomatic HV patients and 50 female asymptomatic older female volunteers were included in this study. According to the radiographic hallux valgus angle (HVA), the study population was divided into severe HV (SHV, HVA ≥ 40°, n = 25), moderate HV (MHV, 20° ≤ HVA < 40°, n = 47), and control (CON, n = 36). MHV group was divided into symptomatic MHV group (S‐MHV, n = 33) and asymptomatic MHV group (A‐MHV, n = 14) according to the symptoms associated with HV. For temporal parameters, gait speed and stride length were diminished according to the severity of HV deformity. Sagittal range of motion of hallux and hindfoot decreased significantly in SHV group. Loss of push‐off during the preswing phase was observed and forefoot adduction motion during terminal stance was decreased in SHV group. In a subgroup analysis of MHV, asymptomatic HV minimally affects gait and inter‐segmental motion during gait. HV deformity affects gait parameters and inter‐segmental motion of the foot during gait in proportion to the severity of the deformity. However, the effect of MHV itself on foot kinematics might be limited while pain or arthritic change of the joint might cause changes in gait in patients with symptomatic HV.
Category:
Bunion
Introduction/Purpose:
X-ray measurement for hallux valgus has been conducted with various results in the evaluation. However, it was not quite clarified yet and it still remains ...questionable why a mild case shifts to a severe case during the course. We report about the difference between the severity and the foot shape.
Methods:
The study subjects were 206 feet of 138 patients.
Mild case: 80 feet, mean age 53 y.o (A)
Moderate case: 61 feet, 62 y.o (B)
Severe case: 65 feet, 67 y.o (C)
For the examination items, HVA, M1-2 angle, and M1-5 angle were measured with the x-ray frontal radiograph for loading position, and First, Second, Fifth intermetatarsal angle (M1Y/M2Y/M5Y) on sagittal plane were also measured. We also evaluated the foot arch ratio with Yokokura Method, then compared/examined those results after dividing the cases into the mild, moderate, and severe group with age bracket.
Results:
The age of Group C were older than Group A, B.
M1-2 angle: In younger generation, three is significant difference between Group A and B.
M1-5 angle: Significant in 60 s between A and B. In 70 s, significant: all group.
Navicular height: all group is low arch with aging. Significant between A and C
It is becoming low arch at Lisfranc level with aging in all group.
There is significantly low height at M5 with aging in all group.
On sagittal plane, bone axis of M1 and M2 is lowered at 40 s in Group A and B and 70 s in Group C.
Conclusion:
In hallux valgus, the foot shape was changed in coronal and sagittal plane.
It means the collapse of bone structure at foot and ankle.
It may possibly be shifting to a severe case with aging.
However, we could not find any result definitely suggesting such condition.
Fever is frequently observed in critically ill patients. An independent association of fever with increased mortality has been observed in non-neurological critically ill patients with mixed febrile ...etiology. The association of fever and antipyretics with mortality, however, may be different between infective and non-infective illness.
We designed a prospective observational study to investigate the independent association of fever and the use of antipyretic treatments with mortality in critically ill patients with and without sepsis. We included 1,425 consecutive adult critically ill patients (without neurological injury) requiring >48 hours intensive care admitted in 25 ICUs. We recorded four-hourly body temperature and all antipyretic treatments until ICU discharge or 28 days after ICU admission, whichever occurred first. For septic and non-septic patients, we separately assessed the association of maximum body temperature during ICU stay (MAXICU) and the use of antipyretic treatments with 28-day mortality.
We recorded body temperature 63,441 times. Antipyretic treatment was given 4,863 times to 737 patients (51.7%). We found that treatment with non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen independently increased 28-day mortality for septic patients (adjusted odds ratio: NSAIDs: 2.61, P=0.028, acetaminophen: 2.05, P=0.01), but not for non-septic patients (adjusted odds ratio: NSAIDs: 0.22, P=0.15, acetaminophen: 0.58, P=0.63). Application of physical cooling did not associate with mortality in either group. Relative to the reference range (MAXICU ≥ 39.5°C increased risk of 28-day mortality in non-septic patients (adjusted odds ratio 8.14, P=0.01), but not in septic patients (adjusted odds ratio 0.47, P=0.11) corrected.
In non-septic patients, high fever (≥39.5°C) independently associated with mortality, without association of administration of NSAIDs or acetaminophen with mortality. In contrast, in septic patients, administration of NSAIDs or acetaminophen independently associated with 28-day mortality, without association of fever with mortality. These findings suggest that fever and antipyretics may have different biological or clinical or both implications for patients with and without sepsis.
ClinicalTrials.gov: NCT00940654.
To evaluate the efficacy and safety of additive triple disease modifying anti-rheumatic drug (DMARD) combination therapy of a low dose of sulfhydryl compounds ¿D-penicillamine, bucillamine or ...tiopronin¿, sulfasalazine (SSZ) and methotrexate (MTX) as a treatment for rheumatoid arthritis (RA) patients, we studied a total of 33 Japanese RA patients (6 males, 27 females). At 1 or 2 months after simultaneous administration of the 3 above-mentioned DMARDs was begun, significant improvements were seen in markers of joint inflammation, i.e., erythrocyte sedimentation rate and C-reactive protein in sera. At 6 months, clinical improvement judged by the physicians' overall assessment of joint symptoms and laboratory data was observed in 29 (88%) of the 33 RA patients. No marked effect was observed in the other 4 (12%) patients, however. We observed no significant adverse reaction to this therapy. This suggests that additive triple DMARD combination therapy of a low dose of sulfhydryl compounds, SSZ and MTX could be a useful drug therapy for the treatment of RA patients, even those who are refractory.
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