Plantar fasciopathy: revisiting the risk factors

Background Plantar fasciopathy is the most common cause of acquired sub-calcaneal heel pain in adults. To-date, research of this condition has mainly focused on management rather than causal mechanisms. The aetiology of plantar fasciopathy is likely to be multifactorial, as both intrinsic and extrinsic risk factors have been reported. The purpose of this review is to critically reevaluate risk factors for plantar fasciopathy. Methods A detailed literature review was undertaken using English language medical databases. Results No clear consensus exists as to the relative strength of the risk factors reported. Conclusions To-date numerous studies have examined various intrinsic and extrinsic risk factors implicated in the aetiology of plantar fasciopathy. How these factors interact may provide useful data to establish an individuals’ risk profile for plantar fasciopathy and their potential for response to treatment. Further research is indicated to rank the relative significance of these risk factors

Simultaneous Measurement Imputation and Outcome Prediction for Achilles Tendon Rupture Rehabilitation

Achilles Tendon Rupture (ATR) is one of the typical soft tissue injuries. Rehabilitation after such a musculoskeletal injury remains a prolonged process with a very variable outcome. Accurately predicting rehabilitation outcome is crucial for treatment decision support. However, it is challenging to train an automatic method for predicting the ATR rehabilitation outcome from treatment data, due to a massive amount of missing entries in the data recorded from ATR patients, as well as complex nonlinear relations between measurements and outcomes. In this work, we design an end-to-end probabilistic framework to impute missing data entries and predict rehabilitation outcomes simultaneously. We evaluate our model on a real-life ATR clinical cohort, comparing with various baselines. The proposed method demonstrates its clear superiority over traditional methods which typically perform imputation and prediction in two separate stages

Mathematics and the Internet: A Source of Enormous Confusion and Great Potential

Graph theory models the Internet mathematically, and a number of plausible mathematically intersecting network models for the Internet have been developed and studied. Simultaneously, Internet researchers have developed methodology to use real data to validate, or invalidate, proposed Internet models. The authors look at these parallel developments, particularly as they apply to scale-free network models of the preferential attachment type

Angola Shows Ottawa Achilles Heel

Landmines are a bad thing. I know that. You know that. Everyone at Ottawa knew that. Even the Angolan Representative who signed the Mine Ban Treaty in Ottawa in December of 1997 knew that. But someone forgot to tell Dr. Jonas Savimbi. Whatever we may think of him, the head of Angola\u27s UNITA (Union for Total Liberation of Angola) liberation group is not out of place in history along with many others intent on being King and overthrowing what they see as a repressive government. Landmines, it seems, are simply a tool in a deadly toolbox

Modified Zadek osteotomy without excision of the intratendinous calcific deposit is effective for the surgical treatment of calcific insertional Achilles tendinopathy

Introduction: Nonoperative management of calcific insertional Achilles tendinopathy (CIAT) may fail in 10-30% of patients, and various operative procedures have been described to manage those. Methods: A modified Zadek (dorsal closing wedge) calcaneal osteotomy, without removing the calcific deposits and without detaching the insertion of the Achilles tendon, was performed between November 2016 and December 2017 in 25 consecutive patients (mean age 53.5 years), who were followed for at least 2 years. Results: The osteotomies had united at an average of 5 weeks. Two superficial wound infections (8%) were documented. Patients had returned to their normal activities at an average time of 23 +/- 7.7 weeks. Three out of four patients, who practised recreational sport activity, returned to their pre-injury level. VAS and VISA-A scores had significantly improved at 3 months postoperatively (p < .001) and continued to improve for 24 months. Conclusion: The modified Zadek osteotomy, without excision of the intra-tendinous calcification, was safe, and significantly improved clinical outcome in patients with CIAT at 2 years after surgery. Level of evidence IV. (c) 2020 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved

Studying the origins of primary tumours and residual disease in breast cancer

Breast cancer is the leading cause of death in women worldwide and these deaths are mostly attributed to metastasis and tumour recurrence following initially successful therapy. Metastasis refers to the development of invasive disease, wherein malignant cells dissociate from primary tumours, infiltrating other organs and tissues to give rise to secondary outgrowths. Previously, metastasis was thought to be initiated in advanced tumours, but breast cancer cellsh with metastatic potential have now been shown to disseminate very early from the primary site via largely unknown mechanisms. These early interactions of tumour cells with their cellular micro-environment and normal neighbours also results in early tumour cell heterogeneity and must therefore be elucidated such that we can prevent metastatic spread in the patient situation and better treat the resulting heterogenous tumours. However, studying tumour initiation is not possible in patients because it happens on a cellular level not detectable by current technology. Tumour recurrence is another major cause of breast cancer related death and is believed to be caused by residual disease cells that survive initial therapy. These are a reservoir of refractory cells that can lay dormant for many years (sometimes decades) before resulting in relapse tumours. They are also difficult to obtain from human patients, since they are very few and cannot be detected easily, and thus their molecular mechanisms have not been fully explored. In addition to the unavailability of human tissue, mouse models of breast cancer also fall short in helping us study early cancer initiation, because they allow oncogenic expression in all cells of the tissue instead of initiating cancer like in the human situation|one neoplastic transformed cell proliferating unchecked in a normal epithelium. To address this issue, we used primary organoids from an inducible mouse model of breast cancer and lentivirally transduced single cells within these organoids to express oncogenes. We further optimized parameters for long term imaging using light sheet microscopy and developed big data analysis pipelines that lead us to discern that single transformed cells had a lower chance at establishing tumorigenic foci, when compared to clusters of cells. Thus, we postulate a proximity-controlled signalling that is imperative to tumour initiation within epithelial tissues using the first ever in vitro stochastic breast tumorigenesis model system. This new stochastic tumorigenesis system can be further used to identify the molecular interactions in the early breast cancer cells. Our group has already revealed distinct characteristics, such as dysregulated lipid metabolism, of the residual disease correlate obtained from an inducible mouse model. As survival mechanisms invoked by residual cells remain largely unknown, we analysed the dynamic transcriptome of regressing tumours at important timepoints during the establishment of residual disease. Key molecular players upregulated during regression {like c-Jun and BCL6 { were identified and the inflammatory arm of the Nf-kB cascade was found to be dysregulated among others. Further validation of these molecular targets as potentially synthetic lethal interactors remains to be performed so that they can be used to limit the residual disease reservoir and eventually tumour recurrence

Hidden in plain sight: is there a crucial role for enthesitis assessment in the treatment and monitoring of axial spondyloarthritis?

OBJECTIVE: To review the evidence surrounding the pathophysiology of enthesitis in axial spondyloarthritis (axSpA), its prevalence and contribution to the overall disease burden, and response to treatment at axial and peripheral sites. METHODS: Literature searches of the Cochrane Library, PubMed, and Embase / Medline using the terms “enthesitis“, “enthesopathy”, “spondyloarthritis”, “axial spondyloarthritis”, and “ankylosing spondylitis” were conducted. Publications mentioning enthesitis or enthesopathy in the context of pathophysiology, diagnosis, or treatment were included. RESULTS: Enthesitis is a common symptom of axSpA, occurring with high prevalence at axial and several peripheral sites. Inflammation at the site of enthesis is an early key manifestation of axSpA. Clinically evaluable enthesitis contributes significantly to the burden of disease, correlating with worse symptomatology and downstream structural damage. Despite its importance in driving axSpA disease processes, enthesitis is somewhat neglected in current approaches to disease assessment and management. Enthesitis is excluded from some commonly used disease activity measures, is not routinely assessed in clinical practice, and many methods of clinical assessment omit key accessible axial sites, such as the spinous processes. CONCLUSION: Enthesitis plays a central role in driving the pathophysiology of axSpA. There is a need for a renewed focus on the early detection, measurement and treatment of enthesitis