Tarsal Tunnel Syndrome – a narrative review of the literature

International audienceThe effect of the mean effective stress on the elastic properties of unbound granular materials is a well-known experimental result. Power laws between the mean effective stress and the shear modulus G vhmax of three natural sands are established for isotropic stress paths using bender elements. Triaxial test results reveal that such power laws are also suitable for contracting deviatoric stress paths whereas it is no longer the case for dilating deviatoric stress paths. Fabric changes during shearing are therefore highlighted. These observations seem to be a typical feature of the behavior of granular materials

Adjustment of food textural properties for elderly patients

Over the next twenty years the number of people over 60 years will exceed one billion. Changes associated with ageing have an impact on food texture choices for healthy elders and those used therapeutically for people with swallowing difficulties (dysphagia). The ideal “swallow-safe” bolus is moist, cohesive and slippery. A general reduction in muscle strength is seen throughout the ageing oropharyngeal musculature, resulting in a reduced ability to safely and efficiently manage hard or fibrous textured foods. Reduced masticatory ability combined with dental loss further compounds the issue. Dry mouth is commonly associated with old age, making it difficult to propel dry or sticky textures through the pharynx, and increases the likelihood of pharyngeal residue. An age related reduction in laryngopharyngeal sensitivity dampens the ability to detect residue, increasing choking risk. Reduced tongue pressure, increases in pharyngeal transit time, valleculae residue, number of clearing swallows and slower and less efficient oesophageal transit occur with aged swallowing. Food textures that are sticky and adhesive will require increased lingual effort to propel them into and through the pharynx. Taken in combination these factors mean that food textures prescribed to the elderly need to be soft and moist and for fibers to be easily broken. To improve moisture content, additional nutrient dense products (e.g., milk, cream or butter) may be required to artificially moisten the bolus. Careful, individualized attention to diet recommendations will result in a diet that is appealing and also provide a variety of textures that are swallow-safe and nutrient dense. Practical Application: Aged related changes in the oral cavity and the oral, pharyngeal and oesophageal phases of swallowing require special thought to the suitability of food textures for the elderly. Foods that are fibrous, hard or dry may be unsuitable due to difficulties with safe particle size reduction and bolus formation for swallowing. Foods that are sticky and adhesive are also problematic and increase risk for both choking and residue. Food texture properties that are ideally suited for the elderly include those that are soft, moist, and easily reduced with minimal chewing effort. Hard food textures that break down and dissolve easily with minimal chewing should be investigated. Increased aroma and flavor may improve appeal lost through reduced variety in food textures. Diet reviews need to consider both textures that can be safely managed and the nutrient density of those textures

Molecular Modeling Studies of 4,5-Dihydro-1H-pyrazolo[4,3-h] quinazoline Derivatives as Potent CDK2/Cyclin A Inhibitors Using 3D-QSAR and Docking

CDK2/cyclin A has appeared as an attractive drug targets over the years with diverse therapeutic potentials. A computational strategy based on comparative molecular fields analysis (CoMFA) and comparative molecular similarity indices analysis (CoMSIA) followed by molecular docking studies were performed on a series of 4,5-dihydro-1H-pyrazolo[4,3-h]quinazoline derivatives as potent CDK2/cyclin A inhibitors. The CoMFA and CoMSIA models, using 38 molecules in the training set, gave r2cv values of 0.747 and 0.518 and r2 values of 0.970 and 0.934, respectively. 3D contour maps generated by the CoMFA and CoMSIA models were used to identify the key structural requirements responsible for the biological activity. Molecular docking was applied to explore the binding mode between the ligands and the receptor. The information obtained from molecular modeling studies may be helpful to design novel inhibitors of CDK2/cyclin A with desired activity

Screening adult patients with a tracheostomy tube for dysphagia: a mixed-methods study of practice in the UK

Background: Patients with tracheostomy tubes are at risk of aspiration and swallowing problems (dysphagia) and because of their medical acuity, complications in this patient population can be severe. It is well recognised that swallow screening in stroke significantly reduces potential complications by allowing early identification and appropriate management of patients at risk (by health professionals), thereby reducing delays in commencing oral intake and preventing unnecessary, costly interventions by speech and language therapists (SLTs). However, there is no standardised swallow screen for the tracheostomised population and there is a paucity of literature regarding either current or best practice in this area. Aims: The aim of this study was therefore to investigate current United Kingdom (UK) practice for swallow (dysphagia) screening for adult patients with tracheostomy tubes and to explore and describe health professionals’ perceptions of their current practice/current systems used. Methods and Procedures: A mixed methods approach was adopted, comprising a semi-structured online questionnaire and recorded follow-up telephone interviews. Participants were SLTs, nurses and physiotherapists working with patients with tracheostomies. Responses were analysed to determine current practice with regard to swallow screening. Thematic analysis of interviews allowed further exploration and clarification of the questionnaire findings. Outcomes and Results: Two-hundred and twenty one questionnaires were completed. Approximately half (45%) of the participants worked in trusts with formal swallow screens, whilst the remainder used a variety of other approaches to identify patients at risk, often relying on informal links with multidisciplinary teams (MDT). In line with current evidence, patients with neurological diagnoses and a tracheostomy were consistently referred directly to speech and language therapy. Only a quarter of questionnaire participants thought their current system was effective at identifying patients at risk of swallowing problems. Eleven questionnaire participants were interviewed. They highlighted the important role of MDT team working here, emphasising both its strengths and weaknesses when working with these patients. Conclusions and Implications: Current practice in the UK for screening patients with a tracheostomy for swallow problems is varied and often sub-optimal. Despite the evidence base for enhancing outcomes, MDT working is still perceived as problematic. A swallow screening tool for use with this population, to enhance MDT working and ensuring that practice fits in line with current evidence, may improve patient safety and care

Por un cuerpo del tacto: mirar, tocar, hender el poema Una puesta en diálogo de lecturas a Jean-Luc Nancy y José Watanabe

¿Cómo pensar el cuerpo sin someterlo al régimen del sentido, sin significarlo o hacerlo significar? ¿Cómo hacerle justicia si es evidente que, aquí y ahora, éste es mi cuerpo (Hoc est enim corpus meum)? Jean-Luc Nancy propone llevar la escritura lo más lejos posible, para tocar el cuerpo en el límite del sentido, donde éste se interrumpe. El cuerpo constituye una apertura, es lo abierto de la clausura y lo infinito de lo finito. Entonces se hace necesario abrir una pequeña hendidura en la corteza, tocando su cierre. Y, como indica Nancy: “Puede ser que sólo haya abertura gracias a un tacto o a un toque”. Derrida recupera la clasificación de cinco sentidos y su división en dos categorías: “los sentidos objetivos (tactus, visus, auditus) y los subjetivos (gustus, olfatus)” . Los primeros aportan significativamente al conocimiento, y entre ellos predomina el tacto. Éste es el más importante en la medida en que es el “único sentido de la percepción exterior inmediata” . El tacto funda así los dos sentidos objetivos restantes, la vista y el oído, los cuales deben ser referidos originalmente al tacto para poder “'constituir un conocimiento por la experiencia'” . Nancy conserva la idea de preeminencia del tacto, pero reformula su justificación afirmando que “sería mejor hablar del toque, o destacar el valor verbal de la palabra, como cuando se dice 'el sentir' […]. El tacto forma cuerpo con el sentir o hace de este -de su pluralidad- un cuerpo; no es más que el corpus de los sentidos”Fil: Cichero, Anuar. Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades. Escuela de Letras; Argentina.Otras Filosofía, Étnica y Religió

¿Sumar 1 + 2n + ... + mn para cualquier n? ¡Es fácil!

En este artículo obtenemos en forma directa mediante métodos elementales la suma de las n-ésimas potencias de los primeros m enteros positivos. La deducción se basa enteramente en los conceptos de recursión y prueba por Inducción Completa y parte de una idea simple: disponer la suma 1 + 2n + ... + mn en un arreglo triangular de potencias (n-1)-ésimas. La solución de este problema es bien conocida: las funciones Pn(m) son polinomios de grado n + 1 en la indeterminada m que se expresan en términos de los polinomios y números de Bernoulli. Al obtener los coeficientes de Pn(m) recobramos como subproducto de nuestro trabajo esta importante familia de números racionales. Sin embargo, hay algo nuevo: el cálculo directo de Pn(m) no sólo nos permite ver más de cerca cómo está constituido cada número de Bernoulli Bn, sino que nos facilita la construcción de un eficaz algoritmo de cómputo para obtenerlos hasta cualquier N fijo deseado