Effect of Stress Maneuvers at the Ankle Joint on Peak Systolic Velocity and Waveforms in Popliteal and Posterior Tibial Arteries in Healthy Individuals

2018 ◽  
Vol 2 ◽  
pp. 6
Author(s):  
Shyjumon George ◽  
Vikas K Yadav ◽  
Shyamkumar N Keshava ◽  
Sunil Agarwal
Keyword(s):  
Ankle Joint ◽  
Plantar Flexion ◽  
Peak Systolic Velocity ◽  
Neutral Position ◽  
Healthy Individuals ◽  
Posterior Tibial ◽  
Diastolic Flow ◽  
Tibial Arteries ◽  
The Mean ◽  
Significant Change

Purpose: The purpose of this study was to study the effects of ankle position on Doppler measurements of popliteal artery (PA) and posterior tibial arteries (PTA) in healthy individuals. Materials and Methods: PA and PTAs of 20 healthy (questionnaire based and ankle brachial pressure index assessed) subjects (40 limbs) were studied with Doppler ultrasound in neutral and after active ankle joint movements. Results: The mean increase in the velocity of PA from neutral position was more with plantar flexion as compared to dorsiflexion (22 vs. 15 cm/s, respectively). PA showed a significant change in waveform, with the absence of diastolic flow, more with dorsiflexion than plantar flexion (46% and 33%, respectively). Similarly, mean increase in the velocity of PTA was more with plantar flexion as compared to dorsiflexion (mean 36.7 vs. 33.2 cm/s, respectively). PTA showed a significant change from triphasic to biphasic and monophasic on plantar flexion (up to 39.2%). Dorsiflexion also showed similar results, however, to a lesser degree. None of the PA or PTA showed complete absence of flow on these maneuvers. Conclusion: Predominantly, a pattern of increase is seen in the mean velocity on plantar flexion and dorsiflexion in both the arteries. The most common change in the Doppler waveforms was the absence of diastolic flow (biphasic pattern). Our study confirms that waveforms in the popliteal and PTA can even be monophasic depending on the position of the foot in normal healthy individuals, therefore, when biphasic/monophasic in appearance, they should not be interpreted as abnormal or diseased.

Width of the Medial Tibiotalar Joint

1997 ◽  
Vol 38 (4) ◽  
pp. 520-522 ◽  
Author(s):  
B. Fiirgaard ◽  
J. K. Iversen ◽  
A. de Carvalho
Keyword(s):  
Healthy Volunteers ◽  
Ankle Joint ◽  
Plantar Flexion ◽  
Joint Space ◽  
Neutral Position ◽  
Tibiotalar Joint ◽  
Joint Injuries ◽  
Left Ankle

Purpose: To determine the extent to which the width of the space in the medial tibiotalar joint depends on plantar flexion. Material and Methods: Thirty healthy volunteers were studied by means of a.p. roentgenograms of the left ankle both in a neutral position and in plantar flexion. Results: The medial joint space showed significant widening (average 0.65 mm) between the neutral position and plantar flexion. Conclusion: When ankle joint injuries are studied on radiographs, the position of the foot must be taken into consideration.

scholarly journals Assessment of the ankle joint in clubfeet and normal feet to the age of four years by ultrasonography

2018 ◽  
Vol 12 (3) ◽  
pp. 262-272 ◽  
Author(s):  
A. Johansson ◽  
Y. Aurell ◽  
B. Romanus
Keyword(s):  
Ankle Joint ◽  
Interobserver Reliability ◽  
Plantar Flexion ◽  
Intraclass Correlation ◽  
Neutral Position ◽  
Healthy Children ◽  
Level Of Evidence ◽  
Posterior Aspect ◽  
Talocrural Joint ◽  
Interexaminer Reliability

Purpose To establish reproducible posterior ultrasonographic projections for evaluation of the movement in the talocrural joint in clubfeet and normal feet from the perinatal period up to the age of four years. Methods The feet in 105 healthy children and 46 patients (71 clubfeet and 21 normal feet) were examined. In all, 14 feet in seven patients were examined twice by two examiners independently to evaluate the repeatability of the ultrasonography scans. A posterior sagittal projection was used. The distance from the posterior aspect of the tibial physis to the posterior border of the talocalcaneal joint (Tib. phys – TCJ) was measured with the foot in neutral position and dorsiflexion. In plantar flexion the shortest distance between the tibial physis and the calcaneus was measured. The distance from the skin to the tibial epiphyses and the talus was measured in neutral position. The intraclass correlation coefficient (ICC) was calculated to evaluate the repeatability of the measurements. Results The interexaminer reliability was 0.71 to 0.89 ICC. The intra- and interobserver reliability measured as ICC was 0.68 to 0.99 for all measurements. The correlation between Tib. phys. – TCJ and clinical dorsiflexion varied much between the age groups. Conclusion Ultrasonography of the posterior aspect of the ankle joint can be done with high interexaminer reliability. The repeatability of image evaluation was high. Correlation to clinical measurements varied, therefore dynamic ultrasound in real time is clinically more useful than single measurements on frozen ultrasound images. Level of Evidence III

Effects of joint alignment and type on mechanical properties of thermoplastic articulated ankle-foot orthosis

2011 ◽  
Vol 35 (2) ◽  
pp. 181-189 ◽  
Author(s):  
Fan Gao ◽  
William Carlton ◽  
Susan Kapp
Keyword(s):  
Mechanical Properties ◽  
Ankle Joint ◽  
Plantar Flexion ◽  
Skin Irritation ◽  
Neutral Position ◽  
Motor Shaft ◽  
Ankle Foot Orthosis ◽  
Resistance Torque ◽  
Flexure Joints ◽  
Foot Orthosis

Background: Articulated or hinged ankle-foot orthosis (AFO) allow more range of motion. However, quantitative investigation on articulated AFO is still sparse.Objective: The objective of the study was to quantitatively investigate effects of alignment and joint types on mechanical properties of the thermoplastic articulated AFO.Study design: Tamarack dorsiflexion assist flexure joints with three durometers (75, 85 and 95) and free motion joint were tested. The AFO joint was aligned with the center of the motor shaft (surrogate ankle joint), 10 mm superior, inferior, anterior and posterior with respect to the motor shaft center.Methods: The AFO was passively moved from 20° plantar flexion to 15° dorsiflexion at a speed of 10°/s using a motorized device. Mechanical properties including index of hysteresis, passive resistance torque and quasi-static stiffness (at neutral, 5°, 10° and 15° in plantar flexion) were quantified.Results: Significant effects of joint types and joint alignment on the mechanical properties of an articulated thermoplastic AFO were revealed. Specifically, center alignment showed minimum resistance and stiffness while anterior and posterior alignment showed significantly higher resistance and stiffness. The dorsiflexion assist torques at neutral position ranged from 0.69 ± 0.09 to 1.88 ± 0.10 Nm.Conclusions: Anterior and posterior alignment should be avoided as much as possible.Clinical relevanceThe current study suggested that anterior and posterior alignment be avoided as much as possible in clinical practice due to potential skin irritation and increase in stress around the ankle joint.

Muscle activities of lower extremity and erector spinae muscles according to ankle joint position during squat exercise

2021 ◽  
pp. 1-6
Author(s):  
Ha-Rim Sung ◽  
Se-Jung Oh ◽  
Jun-Nam Ryu ◽  
Yong-Jun Cha
Keyword(s):  
Lower Extremity ◽  
Ankle Joint ◽  
Muscle Activity ◽  
Vastus Lateralis ◽  
Plantar Flexion ◽  
Erector Spinae ◽  
Neutral Position ◽  
Vastus Medialis ◽  
Joint Position ◽  
Squat Exercise

OBJECTIVE: The purpose of this study was to investigate the most effective ankle joint position for squat exercise by comparing muscle activities of lower extremity and erector spinae muscles in different ankle joint positions. METHODS: Thirty-seven normal healthy adults in their 20s participated in this study. Muscle activities of dominant vastus medialis oblique, vastus lateralis, biceps femoris, and erect spinae were measured in three ankle joint positions; dorsiflexion, neutral, and plantar flexion. RESULTS: Muscle activities of the vastus medialis oblique, vastus lateralis, and erector spinae muscles were statistically different in the three ankle joint positions during squat exercise (p< 0.05). Vastus medialis oblique muscles showed higher muscle activity in ankle plantar flexion than in the dorsiflexion or neutral positions (plantar flexion > neutral position, +3.3% of maximal voluntary isometric contraction (MVIC); plantar flexion > dorsiflexion, +12.2% of MVIC, respectively). Vastus lateralis muscles showed 7.1% of MVIC greater muscle activity in the neutral position than in dorsiflexion, and erector spinae muscles showed higher muscle activity in dorsiflexion than in plantar flexion or in the neutral position (dorsiflexion > neutral position, +4.3% of MVIC; dorsiflexion > plantar flexion, +7.1% of MVIC, respectively). CONCLUSION: In squat exercises designed to strengthen the vastus medialis oblique, ankle joint plantar flexion is probably the most effective ankle training position, and the dorsiflexion position might be the most effective exercise for strengthening the erector spinae muscle.

Dependence of Ankle Joint Width on Plantar Flexion

1989 ◽  
Vol 30 (5) ◽  
pp. 554-556 ◽  
Author(s):  
F. Farsø Nielsen ◽  
A. de Carvalho
Keyword(s):  
Ankle Joint ◽  
Joint Space Narrowing ◽  
Plantar Flexion ◽  
Joint Space ◽  
Neutral Position ◽  
Average Width ◽  
Left Ankle ◽  
Joint Width ◽  
Adult Volunteers

Joint space narrowing is the first roentgenologic sign of osteoarthrosis of the ankle. In this report the dependence of ankle joint width on plantar flexion was investigated. In 30 adult volunteers without ankle symptoms, standardized anteroposterior views of the left ankle joint in neutral position and in 25° plantar flexion were obtained. The average width of the joint space in neutral position was 2.7 mm in women, and 3.0 mm in men. A 25 per cent increment of the joint width following 25° plantar flexion was observed. Accurate standardized positioning of the ankle appears to be decisive for the estimation of ankle joint width.

The efficacy of forceful ankle and toe exercises to increase venous return: A comprehensive Doppler ultrasound study

2017 ◽  
Vol 33 (5) ◽  
pp. 330-337 ◽  
Author(s):  
Alexander T Kropp ◽  
A Ludwig Meiss ◽  
Angelika E Guthoff ◽  
Eik Vettorazzi ◽  
Sabine Guth ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Plantar Flexion ◽  
Peak Systolic Velocity ◽  
Ankle Dorsiflexion ◽  
Venous Stasis ◽  
Calf Muscle Pump ◽  
Ultrasound Study ◽  
The Mean ◽  
Ankle Plantar Flexion ◽  
Heel Lift

Objective Venous stasis is a risk factor for venous thromboembolism. We aimed to determine the efficacy of forceful foot exercises for actuation of the calf muscle pump to counteract stasis. Methods We examined 20 seated healthy subjects. The peak systolic velocity at the level of the popliteal vein was assessed by Doppler ultrasound. Results The mean peak systolic velocity measurements (in cm/s) were as follows: baseline = 5.6; ankle plantar flexion with toe flexion = 91.0; toe touch heel lift = 107.4; ankle dorsiflexion with toe extension = 193.6; isolated flexion of all toes = 118.8; ankle plantarflexion with 100 and 250 Newton forefoot force = 89.9 and 154.5, respectively. Conclusion All exercises achieved significant increases in peak systolic velocity compared to baseline. Ranking showed that forceful ankle dorsiflexion, plantarflexion with 250 Newtons and forceful flexion of all toes yielded the highest mean peak systolic velocity values (193.6, 154.5, and 118.8 cm/s, respectively).

Heparin Cofactor II Deficiency in Patients Infected with the Human Immunodeficiency Virus

1993 ◽  
Vol 70 (05) ◽  
pp. 730-735 ◽  
Author(s):  
P Toulon ◽  
M Lamine ◽  
I Ledjev ◽  
T Guez ◽  
M E Holleman ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Absolute Number ◽  
Thrombin Inhibitor ◽  
Unusual Complication ◽  
Healthy Individuals ◽  
Heparin Cofactor Ii ◽  
Immunodeficiency Virus ◽  
Coagulation Inhibitor ◽  
The Mean ◽  
Cd4 Lymphocytes

SummaryIn human plasma, heparin cofactor II (HCII) is a thrombin inhibitor, whose deficiency has been reported to be associated with recurrent thrombosis. The finding of two cases of low plasma HCII activity in two patients infected with the human immunodeficiency virus (HIV) led us to investigate this coagulation inhibitor in the plasma of a larger population of HIV-infected patients. The mean plasma HCII activity was significantly lower in 96 HIV-infected patients than in 96 age- and sex-matched healthy individuals (0.75 ± 0.24 vs 0.99 ± 0.17 U/ml, p <0.0001). HCII antigen concentration was decreased to the same extent as the activity. The proportion of subjects with HCII deficiency was significantly higher in the HIV-infected group than in healthy individuals (38.5% vs 2.1%). In addition, HCII was significantly lower in AIDS patients than in other HIV-infected patients, classified according to the Centers for Disease Control (CDC) on the basis of an absolute number of circulating CD4+ lymphocytes below 200 x 106/1. The link between HCII and immunodeficiency is further suggested by significant correlations between HCII activity and both the absolute number of CD4+ lymphocytes and the CD4+ to CD8+ lymphocyte ratio. Nevertheless, the mean HCII level was not different in the various groups of patients classified according to clinical criteria, except in CDC IVD patients in whom HCII levels were significantly lower. In addition, no correlation could be demonstrated between HCII and protein S activities, another coagulation inhibitor whose plasma level was also found to be decreased in HIV-infected patients. A similar prevalence of HCII deficiency was also found in a small series of 7 HIV-infected patients who developed thrombotic episodes, an unusual complication of the infection. This suggests that, in HIV-infected patients, HCII deficiency is not in itself the causative factor for the development of thrombosis.

The Expression of Dopamine Receptors Gene and their Potential Role in Targeting Breast Cancer Cells with Selective Agonist and Antagonist Drugs. Could it be the Novel Insight to Therapy?

2019 ◽  
Vol 16 (2) ◽  
pp. 184-197 ◽  
Author(s):  
Hossein Bakhtou ◽  
Asiie Olfatbakhsh ◽  
Abdolkhaegh Deezagi ◽  
Ghasem Ahangari
Keyword(s):  
Breast Cancer ◽  
Gene Expression ◽  
Cancer Cells ◽  
Dopamine Receptors ◽  
Breast Cancer Cells ◽  
D2 Receptors ◽  
Healthy Individuals ◽  
Agonist And Antagonist ◽  
The Mean ◽  
Mcf 7

Background:Breast cancer is one of the common causes of mortality for women in Iran and other parts of the world. The substantial increasing rate of breast cancer in both developed and developing countries warns the scientists to provide more preventive steps and therapeutic measures. This study is conducted to investigate the impact of neurotransmitters (e.g., Dopamine) through their receptors and the importance of cancers via damaging immune system. It also evaluates dopamine receptors gene expression in the women with breast cancer at stages II or III and dopamine receptor D2 (DRD2) related agonist and antagonist drug effects on human breast cancer cells, including MCF-7 and SKBR-3.Methods:The patients were categorized into two groups: 30 native patients who were diagnosed with breast cancer at stages II and III, with the mean age of 44.6 years and they were reported to have the experience of a chronic stress or unpleasant life event. The second group included 30 individuals with the mean age of 39 years as the control group. In order to determine the RNA concentration in all samples, the RNA samples were extracted and cDNA was synthesized. The MCF-7 cells and SKBR-3 cells were treated with dopamine receptors agonists and antagonists. The MTT test was conducted to identify oxidative and reductive enzymes and to specify appropriate dosage at four concentrations of dopamine and Cabergoline on MCF-7 and SKBR-3 cells. Immunofluorescence staining was done by the use of a mixed dye containing acridine orange and ethidiume bromide on account of differentiating between apoptotic and necrotic cells. Flow cytometry assay was an applied method to differentiate necrotic from apoptotic cells.Results:Sixty seven and thirty three percent of the patients were related to stages II and III, respectively. About sixty three percent of the patients expressed ER, while fifty seven percent expressed PR. Thirty seven percent of the patients were identified as HER-2 positive. All types of D2-receptors were expressed in PBMC of patients with breast cancer and healthy individuals. The expression of the whole dopamine receptor subtypes (DRD2-DRD4) was carried out on MCF-7 cell line. The results of RT-PCR confirmed the expression of DRD2 on SKBR-3 cells, whereas the other types of D2- receptors did not have an expression. The remarkable differences in gene expression rates between patients and healthy individuals were revealed in the result of the Real-time PCR analysis. The over expression in DRD2 and DRD4 genes of PBMCs was observed in the patients with breast cancer at stages II and III. The great amount of apoptosis and necrosis occurred after the treatment of MCF-7 cells by Cabergoline from 25 to 100 µmolL-1 concentrations.Conclusion:This study revealed the features of dopamine receptors associated with apoptosis induction in breast cancer cells. Moreover, the use of D2-agonist based on dopamine receptors expression in various breast tumoral cells could be promising as a new insight of complementary therapy in breast cancer.

A new simpler approach to measure the strength of toe plantar flexion requiring no mechanical restraint with a light-weight device

2021 ◽  
pp. 095441192110029
Author(s):  
Yuko Komuro ◽  
Yuji Ohta
Keyword(s):  
Plantar Flexion ◽  
Mean Value ◽  
Simple Approach ◽  
Light Weight ◽  
New Approach ◽  
Mean Values ◽  
Mechanical Restraint ◽  
Significant Difference ◽  
Ankle Joints ◽  
The Mean

Conventionally, the strength of toe plantar flexion (STPF) is measured in a seated position, in which not only the target toe joints but also the knee and particularly ankle joints, are usually restrained. We have developed an approach for the measurement of STPF which does not involve restraint and considers the interactions of adjacent joints of the lower extremities. This study aimed to evaluate this new approach and comparing with the seated approach. A thin, light-weight, rigid plate was attached to the sole of the foot in order to immobilize the toe area. Participants were 13 healthy young women (mean age: 24 ± 4 years). For measurement of STPF with the new approach, participants were instructed to stand, raise the device-wearing leg slightly, plantar flex the ankle, and push the sensor sheet with the toes to exert STPF. The sensor sheet of the F-scan II system was inserted between the foot sole and the plate. For measurement with the seated approach, participants were instructed to sit and push the sensor with the toes. They were required to maintain the hip, knee, and ankle joints at 90°. The mean values of maximum STPF of the 13 participants obtained with each approach were compared. There was no significant difference in mean value of maximum STPF when the two approaches were compared (new: 59 ± 23 N, seated: 47 ± 33 N). The coefficient of variation of maximum STPF was smaller for data obtained with the new approach (new: 39%, seated: 70%). Our simple approach enables measurement of STPF without the need for the restraints that are required for the conventional seated approach. These results suggest that the new approach is a valid method for measurement of STPF.

scholarly journals Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes, a single-centre cross-sectional study at Mpilo Central Hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clare Shakespeare ◽  
Handsome Dube ◽  
Sikhangezile Moyo ◽  
Solwayo Ngwenya
Keyword(s):  
Perinatal Outcomes ◽  
Control Measures ◽  
Central Hospital ◽  
Cross Sectional ◽  
Maternity Services ◽  
Before And After ◽  
The Mean ◽  
Significant Change ◽  
The Impact ◽  
Mpilo Central Hospital

Abstract Background On the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available. This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented. Methods This was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital. Results Between January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32. Conclusions Overall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women’s experiences and understand how bookings and deliveries at local clinics changed during this time.

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