Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot

Objective To determine the association of atrophy of the abductor digiti minimi muscle (ADMA), an MRI manifestation of chronic compression of the inferior calcaneal nerve suggesting the clinical diagnosis of Baxter’s neuropathy, with MRI markers of potential etiologies, including calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and posterior tibial tendon dysfunction (PTTD). Materials and methods Prevalence of calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and PTTD was assessed retrospectively on 100 MRI studies with ADMA and 100 MRI studies without ADMA. Patients ranged in age from 10–92 years. Pearson chi-square analyses and Fisher’s exact test were used to compare prevalence of the above findings in patients with and without ADMA. Logistic regression was used to determine which variables were significantly associated with ADMA. Results Among patients with ADMA, there was significantly greater age (57.2 years vs 40.8 years, p \u3c 0.001), presence of Achilles tendinosis (22.0% vs 3.0%, P \u3c 0.001), calcaneal edema (15.0% vs 3.0%, P = 0.005), calcaneal spur (48.0% vs 7.0%, P \u3c 0.001), plantar fasciitis (52.5% vs 11.0%, P \u3c 0.001), and PTTD (32.0% vs 11.0%, P \u3c 0.001). After multivariate logistic regression analysis, only age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.03, 1.09], calcaneal spur (OR 3.60, 95% CI 1.28, 10.17), and plantar fasciitis (OR 3.35, 95% CI 1.31, 8.56) remained significant. Conclusion Advancing age, calcaneal spur, and plantar fasciitis are significantly associated with ADMA. Their high odds ratios support the notion of a possible etiologic role for calcaneal spur and plantar fasciitis in the progression to Baxter’s neuropathy

Tracing the HIV-1 subtype B mobility in Europe: a phylogeographic approach

<p>Abstract</p> <p>Background</p> <p>The prevalence and the origin of HIV-1 subtype B, the most prevalent circulating clade among the long-term residents in Europe, have been studied extensively. However the spatial diffusion of the epidemic from the perspective of the virus has not previously been traced.</p> <p>Results</p> <p>In the current study we inferred the migration history of HIV-1 subtype B by way of a phylogeography of viral sequences sampled from 16 European countries and Israel. Migration events were inferred from viral phylogenies by character reconstruction using parsimony. With regard to the spatial dispersal of the HIV subtype B sequences across viral phylogenies, in most of the countries in Europe the epidemic was introduced by multiple sources and subsequently spread within local networks. Poland provides an exception where most of the infections were the result of a single point introduction. According to the significant migratory pathways, we show that there are considerable differences across Europe. Specifically, Greece, Portugal, Serbia and Spain, provide sources shedding HIV-1; Austria, Belgium and Luxembourg, on the other hand, are migratory targets, while for Denmark, Germany, Italy, Israel, Norway, the Netherlands, Sweden, Switzerland and the UK we inferred significant bidirectional migration. For Poland no significant migratory pathways were inferred.</p> <p>Conclusion</p> <p>Subtype B phylogeographies provide a new insight about the geographical distribution of viral lineages, as well as the significant pathways of virus dispersal across Europe, suggesting that intervention strategies should also address tourists, travellers and migrants.</p

Fatty Muscle Atrophy: Prevalence in the Hindfoot Muscles on MR Images of Asymptomatic Volunteers and Patients with Foot Pain

PURPOSE: To determine prevalence and degree of fatty muscle atrophy in plantar foot muscles in asymptomatic volunteers and in patients with foot pain. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. The prevalence and degree of fatty muscle atrophy were evaluated with magnetic resonance imaging in the abductor digiti minimi (ADM), flexor digitorum brevis (FDB), abductor hallucis (AH), and quadratus plantae (QP) muscles in 80 asymptomatic volunteers (mean age, 48 years; range, 23-84 years) and 80 patients with foot pain (mean age, 48 years; range, 20-86 years). Muscles were characterized as normal (grade 0) or as having mild (grade 1) or substantial (grade 2) fatty atrophy by two readers separately. Results of visual grading for both readers were compared by using the Mann-Whitney test. Associations between age and degree of fatty muscle atrophy were assessed by using the Kruskal-Wallis test. RESULTS: Readers 1 and 2 found substantial fatty atrophy of the ADM muscle in four (5%) and five (6%) volunteers, respectively, and in three (4%) and nine (11%) patients, respectively. One reader diagnosed substantial fatty atrophy of the AH muscle in three (4%) volunteers and of the FDB muscle in two (2%) volunteers. Prevalence for the QP muscle varied between 0% and 1%. An association between age and degree of fatty atrophy of the ADM muscle was found for volunteers by both readers and for patients by reader 1 (P < .01). CONCLUSION: Prevalence of fatty muscle atrophy of the ADM muscle-classically considered to represent entrapment neuropathy-is between 4% and 11% in both asymptomatic volunteers and patients with foot pain, and it increases with age

From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness.

Functional neuroimaging and electrophysiology studies are changing our understanding of patients with coma and related states. Some severely brain damaged patients may show residual cortical processing in the absence of behavioural signs of consciousness. Given these new findings, the diagnostic errors and their potential effects on treatment as well as concerns regarding the negative associations intrinsic to the term vegetative state, the European Task Force on Disorders of Consciousness has recently proposed the more neutral and descriptive term unresponsive wakefulness syndrome. When vegetative/unresponsive patients show minimal signs of consciousness but are unable to reliably communicate the term minimally responsive or minimally conscious state (MCS) is used. MCS was recently subcategorized based on the complexity of patients' behaviours: MCS+ describes high-level behavioural responses (i.e., command following, intelligible verbalizations or non-functional communication) and MCS- describes low-level behavioural responses (i.e., visual pursuit, localization of noxious stimulation or contingent behaviour such as appropriate smiling or crying to emotional stimuli). Finally, patients who show non-behavioural evidence of consciousness or communication only measurable via para-clinical testing (i.e., functional MRI, positron emission tomography, EEG or evoked potentials) can be considered to be in a functional locked-in syndrome. An improved assessment of brain function in coma and related states is not only changing nosology and medical care but also offers a better-documented diagnosis and prognosis and helps to further identify the neural correlates of human consciousness