The Effect of Processing and Seasonallity on the Iodine and Selenium Concentration of Cow's Milk Produced in Northern Ireland (NI): Implications for Population Dietary Intake

Cow’s milk is the most important dietary source of iodine in the UK and Ireland, and also contributes to dietary selenium intakes. The aim of this study was to investigate the effect of season, milk fat class (whole; semi-skimmed; skimmed) and pasteurisation on iodine and selenium concentrations in Northern Ireland (NI) milk, and to estimate the contribution of this milk to consumer iodine and selenium intakes. Milk samples (unpasteurised, whole, semi-skimmed and skimmed) were collected weekly from two large NI creameries between May 2013 and April 2014 and were analysed by inductively coupled plasma-mass spectrometry (ICP-MS). Using milk consumption data from the National Diet and Nutrition Survey (NDNS) Rolling Programme, the contribution of milk (at iodine and selenium concentrations measured in the present study) to UK dietary intakes was estimated. The mean ± standard deviation (SD) iodine concentration of milk was 475.9 ± 63.5 µg/kg and the mean selenium concentration of milk was 17.8 ± 2.7 µg/kg. Season had an important determining effect on the iodine, but not the selenium, content of cow’s milk, where iodine concentrations were highest in milk produced in spring compared to autumn months (534.3 ± 53.7 vs. 433.6 ± 57.8 µg/kg, respectively; p = 0.001). The measured iodine and selenium concentrations of NI milk were higher than those listed in current UK Food Composition Databases (Food Standards Agency (FSA) (2002); FSA (2015)). The dietary modelling analysis confirmed that milk makes an important contribution to iodine and selenium intakes. This contribution may be higher than previously estimated if iodine and selenium (+25.0 and +1.1 µg/day respectively) concentrations measured in the present study were replicable across the UK at the current level of milk consumption. Iodine intakes were theoretically shown to vary by season concurrent with the seasonal variation in NI milk iodine concentrations. Routine monitoring of milk iodine concentrations is required and efforts should be made to understand reasons for fluctuations in milk iodine concentrations, in order to realise the nutritional impact to consumers

Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study

The Burden of Obstructive Lung Disease (BOLD) study was established to assess the prevalence of chronic airflow obstruction, a key characteristic of chronic obstructive pulmonary disease, and its risk factors in adults (≥40 years) from general populations across the world. The baseline study was conducted between 2003 and 2016, in 41 sites across Africa, Asia, Europe, North America, the Caribbean and Oceania, and collected high-quality pre- and post-bronchodilator spirometry from 28 828 participants. The follow-up study was conducted between 2019 and 2021, in 18 sites across Africa, Asia, Europe and the Caribbean. At baseline, there were in these sites 12 502 participants with high-quality spirometry. A total of 6452 were followed up, with 5936 completing the study core questionnaire. Of these, 4044 also provided high-quality pre- and post-bronchodilator spirometry. On both occasions, the core questionnaire covered information on respiratory symptoms, doctor diagnoses, health care use, medication use and ealth status, as well as potential risk factors. Information on occupation, environmental exposures and diet was also collected

The implementation of the chronic care model with respect to dealing with the biopsychosocial aspects of the chronic disease of diabetes.

PURPOSE: To enhance the learner\u27s competence with information about the Chronic Care Model (CCM) with respect to dealing with the biopsychosocial aspects of diabetes. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: ABSTRACT: Biopsychosocial illnesses, including diabetes, must be approached by clinicians who understand that not only are the biological factors, including the cause of the illness and the toll it takes on the body, important considerations, but that also psychological components experienced by the patient dealing with diabetes and social components are factors to be considered

Tibiocalcaneal arthrodesis in the high-risk foot.

The present case series outlines the history and surgical treatment of 6 patients who underwent tibiocalcaneal arthrodesis from April 2002 to May 2012, all with external fixation as the primary or secondary fixation. Surgical intervention was performed by the same surgeon at the same facility. The indication for surgery was a nonbraceable Charcot deformity in 5 (83.3%) patients and bone and soft tissue infection complicating previous intramedullary hindfoot fusion in 1 (16.7%) patient. Talectomy was performed in 2 (33.3%) patients secondary to widespread osteomyelitis of the talus and in 4 (66.7%) patients secondary to avascular necrosis and/or disintegration and fragmentation of the remaining talus. The postoperative complications have been discussed in detail and their management outlined. At the most recent follow-up visit, all patients were independently ambulating on a braceable limb with or without the use of an assistive device. In conclusion, tibiocalcaneal arthrodesis is a reasonable option for limb salvage to produce community ambulators in the high-risk population. We emphasize that although multiple fixation options are available for tibiocalcaneal arthrodesis, a combination of internal and external fixation is vital to its success

Tibialis Anterior Tendon Transfer.

Tendon transfer procedures are used commonly for the correction of soft tissue imbalances and instabilities. The complete transfer and the split transfer of the tibialis anterior tendon are well-accepted methods for the treatment of idiopathic equinovarus deformity in children and adults. Throughout the literature, complete and split transfer have been shown to yield significant improvements in ankle and foot range of motion and muscle function. At present, there is insufficient evidence to recommend one procedure over the other, although the split procedure has been advocated for consistently achieving inversion to eversion muscle balance without overcorrection

The Mechanical Axis of the First Ray: A Radiographic Assessment in Hallux Abducto Valgus Evaluation.

The present report describes a new method of hallux abducto valgus deformity correction planning using the mechanical axis of the medial column (mechanical axis planning). This method of radiographic evaluation identifies an ideal position for the first metatarsal after correction and is useful regardless of the surgical procedure chosen. We retrospectively reviewed 200 radiographs to identify a normal value for the mechanical axis angle. We reviewed 100 radiographs of patients with hallux abducto valgus deformity (deformity group) and 100 radiographs of patients without hallux abducto valgus deformity (control group). The deformity group revealed an M1-M2 anatomic axis angle of 13.5° ± 2.83° and an M1-M2 mechanical axis angle of 11.58° ± 1°. The control group revealed an M1-M2 anatomic axis angle of 7.5° ± 1.76° and an M1-M2 mechanical axis angle of 11.19° ± 0.9°. The differences in the M1-M2 anatomic axis angle and M1-M2 mechanical axis angle were statistically significant between the control and deformity groups. We sought to provide a reliable method for planning hallux abducto valgus deformity correction by aligning the mechanical axis of the medial column and the mechanical axis of the first ray to the normal value of 11° to reduce the deformity

Clinical Outcomes Following an Open Gastrocnemius Recession Combined With an Endoscopic Plantar Fasciotomy.

At present, there is a paucity of literature describing the clinical outcomes following a combined gastrocnemius recession and endoscopic plantar fasciotomy. The purpose of the present report is to describe our preliminary findings following a combined gastrocnemius recession and endoscopic plantar fasciotomy for the treatment of plantar fasciitis and gastrocnemius equinus recalcitrant to conservative therapy. Twenty-five consecutive ankles in 23 patients (age 51.2 ± 12.5 years, 4 men) met the inclusion and exclusion criteria. The average follow-up was 3.7 months. Compared across time, there were statistically significant improvements in pain, t(24) = 7.878, P \u3c .001; dorsiflexion, t(24) = -6.125, P \u3c .001; and eversion, t(23) = -3.610, P = .001. Plantar flexion and inversion remained similar across time ( P = .722 and P = .268, respectively). No statistically significant correlations were found between age and any of the postoperative outcome variables ( P ≥ .056) or body mass index and any of the postoperative outcome variables ( P ≥ .140). The authors believe that an isolated plantar fasciotomy alleviates symptoms in the majority of patients. When gastrocnemius equinus is also present, however, the authors advocate performing an open gastrocnemius recession as well. If the gastrocnemius pathology is not addressed, symptoms are likely to persist. The findings of the present report confirm the effectiveness of a combined gastrocnemius recession and endoscopic plantar fasciotomy to improve pain and range of motion. LEVELS OF EVIDENCE: Case series, Level IV: Retrospective

Salvage of Failed Total Ankle Replacement Using a Custom Titanium Truss.

Subsidence of the talar component results in significant morbidity after total ankle replacement. When recognized, prompt revision could be needed to preserve the function of the implant; however, this is not always the case. In situations in which the implant cannot be revised, tibiotalocalcaneal arthrodesis might be necessary to salvage the extremity. The purpose of the present report is to describe the use of a custom titanium alloy truss to fill a bony void created by explantation of the implant components. Total ankle replacement was performed as the initial surgery to address end-stage osteoarthritis. Two years after the index procedure, the patient underwent revision of the polyethylene and talar components with subtalar arthrodesis secondary to progressive subtalar osteoarthritis and talar subsidence. The implant subsequently became infected and was removed. The patient underwent re-implantation after the infection had resolved, but significant talar subsidence required conversion to a tibiotalocalcaneal arthrodesis with a custom titanium alloy truss and retrograde intramedullary nail. At the most recent follow-up appointment, the patient was weightbearing on a stable extremity and pain free. Radiographic examination confirmed appropriate implant alignment and evidence of bone formation throughout the titanium truss. Although our results are restricted to a single case with initial, limited follow-up data, combining sound structural mechanics with an open architecture and unique texture, the custom titanium truss appears to maintain the limb length and promote healing across a large void

Preoperative and Postoperative Range of Motion: A Retrospective Comparison of Two Total Ankle Replacement Systems.

The purpose of the present report was to compare the range of motion between a total ankle replacement requiring arched bony resection and a total ankle replacement requiring a flat cut for implantation. We hypothesized that the arched contour would more closely mimic the patient\u27s pre-existing anatomy and increase the range of motion. Pain was evaluated as a secondary outcome. Twenty-eight patients (age 55.95 ± 15.29 years) were included. Of the 28 patients, 14 were treated with an arch cut and 14 with a flat cut. Although no significant difference was found in dorsiflexion between the 2 implant groups (p = .38), preoperative dorsiflexion, body mass index, implant type, and preoperative plantarflexion emerged as significant predictors of postoperative plantarflexion (p = .04). This finding indicates that postoperative plantarflexion was significantly greater in patients treated with an arch cut (30.43° ± 10.01°) than a flat cut (21.79° ± 15.70°, p = .02), when controlling for the other explanatory variables. A statistically significant improvement in pain was observed after total ankle replacement (p \u3c .001). The mean change in pain was similar for the 2 implant groups when statistically controlling for the follow-up duration (p = .09). The findings from the present report suggest that plantarflexion significantly improves after total ankle replacement requiring an arched cut for implantation. Future studies should be designed to control for potentially confounding variables and assess the differences in range of motion after total ankle replacement

Supramalleolar Osteotomy: Indications and Surgical Techniques.

Supramalleolar osteotomies are a surgical treatment option for asymmetric varus or valgus ankle arthritis where at least 50% of the joint surface is spared. Procedure selection requires significant preoperative planning for appropriate execution. Thus, the surgeon must be familiar with the principles of deformity correction. With appropriate patient selection and proper preoperative planning, the procedure has been shown to yield excellent results, redistributing forces more evenly across the ankle joint by restoring the mechanical axis of the lower leg with minimal complications