Wearable laser Doppler flowmetry for non-invasive assessment of diabetic foot microcirculation: methodological considerations and clinical implications.

Significance: Type 2 diabetes mellitus (T2DM) is a global health concern with significant implications for vascular health. The current evaluation methods cannot achieve effective, portable, and quantitative evaluation of foot microcirculation. Aim: We aim to use a wearable device laser Doppler flowmetry (LDF) to evaluate the foot microcirculation of T2DM patients at rest. Approach: Eleven T2DM patients and twelve healthy subjects participated in this study. The wearable LDF was used to measure the blood flows (BFs) for regions of the first metatarsal head (M1), fifth metatarsal head (M5), heel, and dorsal foot. Typical wavelet analysis was used to decompose the five individual control mechanisms: endothelial, neurogenic, myogenic, respiratory, and heart components. The mean BF and sample entropy (SE) were calculated, and the differences between diabetic patients and healthy adults and among the four regions were compared. Results: Diabetic patients showed significantly reduced mean BF in the neurogenic (p=0.044) and heart (p=0.001) components at the M1 and M5 regions (p=0.025) compared with healthy adults. Diabetic patients had significantly lower SE in the neurogenic (p=0.049) and myogenic (p=0.032) components at the M1 region, as well as in the endothelial (p<0.001) component at the M5 region and in the myogenic component at the dorsal foot (p=0.007), compared with healthy adults. The SE in the myogenic component at the dorsal foot was lower than at the M5 region (p=0.050) and heel area (p=0.041). Similarly, the SE in the heart component at the dorsal foot was lower than at the M5 region (p=0.017) and heel area (p=0.028) in diabetic patients. Conclusions: This study indicated the potential of using the novel wearable LDF device for tracking vascular complications and implementing targeted interventions in T2DM patients.

Consumer Preferences and Willingness to Pay for High-Quality Vegetable Oils: A Cross-Sectional Analysis of Chinese Residents.

The consumption of edible vegetable oil is an important source of essential fatty acids and vitamin E for the human body. Guiding residents to consume scientifically and reasonably control the intake of edible oils is an important part of promoting the construction of a healthy China. Currently, Chinese residents have an insufficient understanding of the scientific consumption of edible oils, leading to an intake exceeding the dietary recommendations, resulting in excessive fat intake and increasing the risk of chronic diseases such as obesity and cardiovascular diseases. Based on the Theory of Planned Behavior (TPB) and using Structural Equation Modeling (SEM), this study analyzed the cognitive preferences and willingness to pay a premium for edible vegetable oils among urban consumers in China. The survey included 1098 Chinese urban consumers of vegetable oils. The research found that attitudes, health value, monetary value, and environmental endowment of urban residents are the main predicting factors of the intention to purchase high-quality vegetable oils. This study confirms the applicability of the Theory of Planned Behavior in the consumption of high-quality vegetable oils and provides theoretical contributions and insights for Chinese enterprises and policymakers in formulating marketing strategies for vegetable oils.

A Joy-Stick Assistant Three-Dimensional Modified Technique of Minimally Invasive Surgery for Mild or Moderate Hallux Valgus.

BACKGROUND: Minimally invasive surgery (MIS) such as minimally invasive chevron osteotomy and Akin osteotomy (MICA) has become popular in the treatment of hallux valgus. However, how to correct three-dimensional deformities in hallux valgus effectively and simply in MICA is still difficult. Special equipment is required in MICA as has been reported before. It is meaningful and necessary to reduce the reliance on special equipment in MICA. METHODS: From January 2021 to July 2022, patients with mild or moderate hallux valgus were treated with a joy-stick assistant three-dimensional modified technique (Joy-stick 3D technique) of MIS. VAS, AOFAS Hallux MTP-IP scores, hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured pre- and postoperatively at the last follow-up of at least 6 months. Scores and radiologic angles were compared using paired sample t-test. RESULTS: A total of 36 cases were included. HVA, IMA, and DMAA were (22.3 ± 6.1)°, (14.0 ± 3.2)°, and (8.9 ± 3.2)° preoperatively, and decreased to (7.0 ± 1.8)°, (3.7 ± 1.0)°, and (3.3 ± 1.1)° postoperatively. VAS decreased from 4.3 ± 1.7 to 0.7 ± 0.7. AOFAS Hallux MTP-IP scores improved from 68.6 ± 7.6 to 92.9 ± 6.1. Comparing mild and moderate cases, though HVA, IMA, and DMAA were significantly different preoperatively, the angles became statistically similar after surgery. CONCLUSIONS: A joy-stick assistant three-dimensional modified technique is proposed to control the three-dimensional position of the metatarsal head and to reduce dependence on special tools. Mild and moderate hallux valgus deformities are effectively corrected using Joy-stick 3D technique.

Chinese consumers' psychology and behavior of the foods with nutrition claims based on AISAS model.

Objective: We analyzed the impact of nutrition claims on Chinese consumer psychology and behavior process based on the theoretical framework of AISAS (Attention-Interest-Search-Action-Share) model. Design: To adopt questionnaires to collect gender, age, income and other basic information of adult residents and a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) to collect data on residents' attention to nutrition claims, interest in nutrition claims, search on nutrition claim information, purchasing behavior on food with nutrition claims, sharing information on food with nutrition claims. Then to study the relationship between the basic situation of residents and their attention, interest, search, food purchase behavior and sharing of nutrition claims by using exploratory factor analysis, reliability and validity test, structural equation modeling estimation and hypothesis testing. Participants: Chinese adults. Setting: Multi-stage stratified random sampling method was used to collect the valid online questionnaire of 630 Chinese adults from Central, North, East, South, Northwest, Southwest, and Northeast China. Results: Younger adults and those with higher household incomes exhibited heightened attention to nutrition claims. Furthermore, consumers' attention to nutrition claims could be transformed into food information sharing through interest, information search, and food purchase. Consumers' interest in food with nutrition claims could be transformed directly into food purchase. Consumers' search for related information could be directly transformed into food information sharing. Conclusion: Chinese consumers' age and household income could be included in the AISAS model for the foods with nutrition claims, and the consumers' action and share could transform from their interest and search.

Combined vertical and external rotational force in plantarflexion position produces posterior pilon fracture: A preliminary cadaveric study.

BACKGROUND: Posterior pilon fracture is speculated to occur by a combination of rotation and axial load, which makes it different from rotational posterior malleolar fracture or pilon fracture, but is not validated in vitro. The aim of the current study is to investigate the injury mechanisms of posterior pilon fracture on cadaveric specimens. METHODS: Eighteen cadaveric specimens were mounted to a loading device to undergo solitary vertical loading, solitary external rotational loading, and combined vertical and external rotational loading until failure, in initial position of plantarflexion with or without varus. The fracture characteristics were documented for each specimen. RESULTS: Vertical loading force combined with external rotation force diversified the fracture types resulting in pilon fracture, tibial spiral fracture, rotational malleolar fracture, talar fracture or calcaneal fracture. Vertical violence combined with external rotational loading in position of 45° of plantarflexion and 0° of varus produced posterior pilon fracture in specimens No. 13 and 14. CONCLUSION: Combination of vertical and external rotational force in plantarflexion position on cadaveric specimens produce posterior pilon fracture.

Pain alleviation improves balance control and muscular coordination of lower limbs in patients with chronic ankle instability during sinusoidal perturbations.

BACKGROUND: It is well established that individuals with chronic ankle instability manifest deficits in balance control and muscle activation. Given the prevalence of pain as a prominent symptom in this population, there is a need for in-depth investigation of its role in contributing to these impairments. METHODS: A Stewart platform was used to generate translational sinusoidal perturbations in the antero-posterior direction. Eighteen individuals with chronic ankle instability and concurrent ankle pain were recruited. They were instructed to assume a central stance on the support surface with open eyes both before and 30 min after local analgesia. Data of center of pressure and electromyography of the tibialis anterior and medial gastrocnemius were recorded. Statistical analysis was performed to make comparisons pre- and post-analgesia using two-tailed paired t-test for the continuous variables. FINDINGS: Pain intensity was significantly decreased after local anesthetic injections. Antero-posterior center of pressure parameters significantly decreased following the injection. Also, there was an increase in the regularity of the center of pressure pattern. The electromyographic pattern of the tibialis anterior and medial gastrocnemius exhibited various activation patterns. After pain alleviation, the characteristic electromyographic response of the tibialis anterior and medial gastrocnemius was reciprocal contraction and relaxation that corresponded with the sinusoidal pattern of the perturbations. INTERPRETATION: Individuals who had chronic ankle instability and ankle pain demonstrated impaired balance control during sinusoidal perturbations. Mitigating pain improved their balance performance, evident in the center of pressure pattern and the coordination of lower limb muscles.

Chinese Adults' Willingness to Pay for Mandatory Nutrients Reporting on Nutrition Facts Table.

The Chinese food industry has opposed the mandatory inclusion of increased nutrients in the Nutrition Facts Table (NFT), thus impeding its improvement. This poses a challenge to the endeavors aiming to assist consumers in cultivating healthy dietary habits that incorporate reduced saturated fatty acids and added sugars while ensuring the adequate intake of essential micronutrients. This study conducted a choice experiment to investigate Chinese consumers' preference for updated labeling schemes among 630 adults that were randomly selected from Central, North, East, South, Northwest, Southwest, and Northeast China. It revealed that respondents were willing to pay the highest premium for the most mandatory nutrients (22.575% of the food price per unit). Respondents preferred the NFT with the most mandatory nutrients if they met the following population characteristics: female; non-overweight or obese; without a college degree; possessed an annual household disposable income between 50,000 and 99,999 CNY; from North China; lived in rural areas and often cooked for family; cared about food nutrition. Two combinations of NFT information received the highest preference: (1) the NFT detailing the most mandatory nutrients and their content values and nutrient reference values (NRV%); (2) the NFT containing the most nutrients and the nutrients in 100 g/mL or a serving. The first and second combinations attracted a premium of 14.884% and 31.833% of the food price per unit, respectively.

The potentially dangerous zone of the dorsomedial cutaneous nerve in minimally invasive surgery for hallux valgus: a cadaveric study.

BACKGROUND: This study aims to describe the distribution of the dorsomedial cutaneous nerve (DMCN) in the middle and proximal parts of the metatarsal from a lateral view. The purpose is to provide guidance to surgeons in protecting the nerve during the 3rd and 4th generation minimally invasive surgery (MIS) for hallux valgus (HV). METHODS: A total of 20 cadaveric feet were dissected to expose the course of the DMCN and sentinel vein. Measurements of the distances between the nerve/vein and the upper border of the metatarsal, as well as the height of the metatarsal, were taken from a lateral view. The distribution area was then described in proportion. RESULTS: At the base of the metatarsal, the DMCN was distributed in the upper 25.7% of the area. When it reached the middle of the metatarsal, the DMCN was distributed in the upper 13.2-47.2% of the area. As for the sentinel vein, it was distributed in the upper 23.5-71.9% and upper 4.1-52.7%, respectively, at these two positions. CONCLUSIONS: The area, which is above the line connecting the upper 1/4 point at the base of the first metatarsal and the 1/2 point at the middle of the first metatarsal, is a dangerous zone for the DMCN. Avoiding the zone is recommended during MIS for HV.

Mid-term assessment of subtalar arthroereisis with Talar-Fit implant in pediatric patients with flexible flatfoot and comparing the difference between different sizes and exploring the position of the inserted implant.

Background: Subtalar arthroereisis (STA) has gained growing acceptance as a viable approach solution for the management of pediatric flexible flatfoot. However, STA still remains controversial. The purpose of this study is to assess the effect of STA using the Talar-Fit implant for treating pediatric flexible flatfoot. Specifically, the aims of the study are as follows: first, to present the mid-term outcomes of STA using the Talar-Fit implant; second, to compare the radiographic and clinical outcomes associated with varying sizes of Talar-Fit implant; and third, to analyze the optimal position of the inserted implants. Methods: A retrospective analysis was conducted on a cohort of 57 pediatric patients diagnosed with flexible flatfoot (77 feet) who underwent STA utilizing Talar-Fit between January 2014 and December 2021. The participants were categorized into five groups according to the size of the implant: Group 8, Group 9, Group 10, Group 11, and Group 12. The evaluation included the assessment of clinical function using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score, as well as the assessment of radiographic data such as the calcaneal pitch angle (CPA), lateral Meary angle (LMA), talar declination angle (TDA), and medial longitudinal arch angle (MLAA) were evaluated. Furthermore, the position of the inserted implants was also recorded, including angle, depth, and distance. The comparison of pre- and postoperation was conducted using the paired Student's t-test, whereas the analysis of differences among subgroups was performed using the Wilcoxon rank-sum test. A P-value < 0.05 is considered statistically significant. Results: In total, 57 pediatric patients (77 feet) were successfully followed-up for an average period of 26.8 months. The overall AOFAS score significantly improved from 58.6 ± 10.9 to 85.2 ± 8.6 (P < 0.001). Furthermore, the LMA decreased from 20.3° ± 3.6° to 4.5° ± 1.3°, the CPA increased from 14.8° ± 1.6° to 23.6° ± 2.7°(P < 0.05), the TDA decreased from 40.2° ± 2.3° to 25.5° ± 3.2°(P < 0.05), and the MLAA decreased from 140.1° ± 2.8° to 121.4° ± 3.9°(P < 0.05). No statistically significant differences were observed among subgroups regarding the final outcomes. The improvements of CPA, TDA, and MLAA among different groups were significantly different; however, the adjusted P-values were all greater than 0.05. The implant were inserted at a mean angle of 89.5° ± 2.4°, a mean depth of 0.9 mm ± 2.1 mm, and a mean distance of 9.9 mm ± 0.9 mm. Eight patients experienced complications, including six cases of pain occurrence and two cases of implant dislocation. Conclusion: STA with Talar-Fit has demonstrated satisfactory mid-term outcomes. A Talar-Fit with a larger size may demonstrate a superior effect when compared with that of a smaller size. The implants were inserted in a similar position, indicating that the medial edge of the implant may be possible to transcend the midline of the talus neck.

Statistical shape modeling of mean shape and principal variability of the human talar bone in the Chinese population.

PURPOSE: The talar bone plays a crucial role in ankle biomechanics and stability. Understanding the shape variability of the talar bone within specific populations is essential for various clinical applications. In this study, we aimed to investigate the mean shape and principal variability of the human talar bone in the Chinese population using statistical shape modeling (SSM). METHODS: CT scans of 214 tali were included to create SSM models. Principal component analysis was used to describe shape variation among the male, female, and overall groups. RESULTS: The largest amount of variation among three groups ranges from 17.2%-18.8% of each variation. The first seven principal components (modes) captured 62.4%-67.5% of the cumulative variance. No dominant shape of the talus was found. Male tali generally have a larger size than the female tali, with the exception of the articular surface of the anterior subtalar joint. CONCLUSIONS: SSM is an effective method of finding mean shape and principal variability. Considerable variabilities were noticed among these three groups and all principal modes of variation. No dominant talar model was found to represent the majority of tali, regardless the gender. Such information is crucial to improve the current understanding of talar pathologies and their treatment strategies.

Is a Preoperative MRI Scan Necessary for Acute Achilles Tendon Rupture?

BACKGROUND: Different treatment methods have been developed for acute Achilles tendon rupture (ATR), including conservative treatment, minimally invasive or transdermal surgery, and open surgery, and there is no consensus about which method is superior. It is important to clarify the presence of Achilles tendon (AT) degeneration, the rupture site, and the rupture shape before surgery to determine whether minimally invasive or open surgery should be selected, thereby reducing the re-rupture rate following acute ATR. The aim of this study was to investigate the diagnostic value of MRI in identifying the presence of AT degeneration, the rupture site, and the rupture shape for acute closed ATR. METHODS: From January 2016 to December 2019, patients with acute closed ATR who had undergone repair surgery were retrospectively enrolled. All patients received MRI examination, and the distance between the insertion site and broken end and the rupture shape (types I, II, and III) were independently determined by two observers. Then, the stump of the AT was exposed during the operation. The rupture site and rupture shape were recorded and compared and analyzed with the MRI results. Consistency analyses (using Cohen's kappa coefficient or intraclass correlation coefficient-ICC) and calculation of diagnostic performance indexes were, respectively, conducted to evaluate the diagnostic value of the MRI. RESULTS: This study included 47 consecutive patients with acute ATR, with an average age of 38.4 years. Among them, 40 were male, and seven were female. The intraoperative exploration demonstrated a total of 34 (72.3%), 10 (21.3%), and three (6.4%) patients with type I, II, and III ruptures, respectively. The average distance between the insertion site and the proximal broken end measured intraoperatively was 4.07 ± 1.57 cm. High or excellent consistencies were found for ATR classifications (kappa: 0.739-0.770, p < 0.001) and rupture sites (ICC: 0.962-0.979, p < 0.001) between two observers and between observers 1 and 2 and intraoperative findings. Tendinopathy was identified in 22 patients by MRI and confirmed during surgery. CONCLUSIONS: MRI scanning of acute closed ATR can help determine whether there is degeneration of the AT, as well as the location and shape of the rupture, which can guide the selection of the optimal operation method for orthopedic surgeons. Therefore, it is necessary to take preoperative MRI scans for patients with acute Achilles tendon ruptures.

Stress Tests for Deltoid Ligament and Syndesmosis Injury in Patients With Ankle Fracture: A Systemic Review With Meta-Analysis.

OBJECTIVES: To determine the diagnostic accuracy of various stress tests for deltoid ligament and syndesmosis injury in patients with ankle fracture. DATA SOURCES: A systemic literature search was conducted in the MEDLINE, Embase, and Cochrane Library databases to identify studies published from January 1990 to August 2022. STUDY SELECTION: Studies that evaluated external rotation or gravity stress tests or hook or tap tests for the diagnosis of deltoid ligament or syndesmosis injury were included. DATA EXTRACTION: Authors, publication years, study design, index tests, reference standards, demographic features of participants, reliability, and the numbers of true-positive, true-negative, false-positive, and false-negative subjects were extracted from 14 included studies. Article quality was assessed through the revised Quality Assessment of Diagnostic Accuracy Studies tool. DATA SYNTHESIS: The pooled sensitivity and specificity of each index test for each structure were calculated with a random-effects model using the extracted data of true-positive, true-negative, false-positive, and false-negative outcomes in all relevant studies. The overall diagnostic performance of the different index tests for different structures was determined with the estimation of the area under the curve using the summary receiver operating characteristics curve. CONCLUSIONS: The gravity stress test and the tap test exhibited high sensitivity and specificity in diagnosing deltoid ligament injury. The hook test has relatively high accuracy in diagnosing syndesmosis injury. Further studies with large sample sizes are warranted to confirm the results of this review. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Humic acids alleviate dextran sulfate sodium-induced colitis by positively modulating gut microbiota.

Humic acids (HAs) are natural polymers with diverse functional groups that have been documented and utilized in traditional Chinese medicine. Dextran sulfate sodium (DSS)-induced colitis has been used as a model to study inflammatory bowel disease. In this research, we investigate the effect of HAs on ameliorating DSS-induced colitis in mice. Our aim here was to investigate if HAs could be a remedy against colitis and the mechanisms involved. The results show that HAs facilitated a regain of body weight and restoration of intestinal morphology after DSS-induced colitis. HAs treatment alters the community of gut microbiota with more Lactobacillus and Bifidobacterium. Changes in bacterial community result in lower amounts of lipopolysaccharides in mouse sera, as well as lower levels of inflammatory cytokines through the Toll-like receptor 4 (TLR4)-NF-κB pathway. HAs also promoted the expression of tight junction proteins, which protect the intestinal barrier from DSS damage. Cell experiments show that HAs display an inhibitory effect on DSS growth as well. These results suggest that HAs can alleviate colitis by regulating intestinal microbiota, reducing inflammation, maintaining mucosal barriers, and inhibiting pathogen growth. Thus, HAs offer great potential for the prevention and treatment of colitis.

Diagnostic Evaluation of Mechanical Ankle Instability by Comparing Injured and Uninjured Contralateral Ankles Using Arthrometry.

CONTEXT: Individuals with mechanical ankle instability (MAI) have obvious lateral ligament laxity and excessive ankle joint motion beyond the physiological range. Arthrometry has been introduced to quantitatively measure the laxity of the ankle joint. However, the diagnostic accuracy of arthrometry in MAI is still debatable. OBJECTIVES: To (1) evaluate the difference in laxity between bilateral ankles in patients with and those without MAI and (2) calculate the diagnostic accuracy of ankle arthrometry using bilateral comparisons. DESIGN: Cross-sectional study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 38 individuals with unilateral MAI (age = 31.24 ± 7.90 years, height = 168.93 ± 7.69 cm, mass = 65.72 ± 10.47 kg) and 38 individuals without MAI (control group; age = 32.10 ± 7.10 years, height = 166.59 ± 7.89 cm, mass = 62.93 ± 10.72 kg). MAIN OUTCOME MEASURE(S): Bilateral ankle laxity in each participant was quantitatively measured by performing the arthrometric anterior drawer test. Continuous data of loading force and joint displacement were recorded. Data from both ankles were compared for the ankle joint displacement at a loading force of 75 N (D75) and load-displacement ratio from 10 to 40 N (LDR 10-40). RESULTS: The D75 between injured and uninjured ankles in patients with MAI was different (t37 = 9.78, P < .001). The mean LDR 10-40 in injured ankles was higher than that in uninjured ankles (t37 = 9.80, P < .001). In the control group, no differences were found between the left and right ankles. The MAI group had larger bilateral differences than the control group (t37 range = 7.33-8.18; P < .001). When LDR 10-40 was used to diagnose MAI, the arthrometer showed sensitivity and specificity of 0.900 and 0.933, respectively, with a cutoff value of 0.0351 mm/N. CONCLUSIONS: An ankle arthrometer can be used to quantitatively measure the difference in bilateral ankle laxity in patients with MAI. Arthrometer-measured LDR 10-40 can be used to diagnose MAI with high diagnostic accuracy.

In Vivo Evaluation of the Position and Orientation of the Geometric Axis of the Tibiotalar Joint.

Background: Fitting the surface morphology of the talar trochlea is one of the common methods to define the geometric axis of the tibiotalar joint (GATJ). However, the in vivo motion of such axis during gait has not been fully investigated. Methods: The ankle kinematic data of fifteen volunteers were collected by a dual fluoroscopic imaging system with a model-image registration method. The GATJ was defined by sphere-fitting the medial or lateral part of the trochlear surface of the talus. The position and orientation of this axis during gait were measured. To verify this axis, the distances of the feature points of the talus to the GATJ during gait were also measured. Results: There was no statistically significant difference in the distances of feature points of the talus to the GATJ among the seven key poses of the gait cycle. And the position and orientation of the GATJ during gait also showed no statistically significant difference. Conclusion: The GATJ is the axis about which the talus rotated. And it is one fixed axis during gait. The current finding may help the design of the talar component for total ankle replacement based on the surface morphology of the talar trochlea.

Influence of different thermal treatment methods on the processing qualities of sesame seeds and cold-pressed oil.

This study investigated the impact of multiple thermal treatments (explosion-puffing, microwave, and roasting) on the processing qualities of sesame seeds and cold-pressed oil. The scanning electron microscopy (SEM) showed fissures and cavities of sesame seed surface upon thermal treatments. The microwave treatment promoted the maximum conversion of sesamolin into sesamol in the sesame oil. Compared with other treatments, explosion-puffing treatment resulted in most significant increases in the multiple beneficial phytochemicals, as well as in vitro antioxidant properties determined by 2,2-dipheny1-1-picrylhydrazyl radical (DPPH) radical scavenging activity, Ferric reducing antioxidant power (FRAP) and oxidative stability index (OSI). Additionally, thermal treatment processing caused varying degrees of damage of crude protein, total amino acids (TAA) and protein structure (tertiary and second structure). In which, explosion-puffing achieved minimal reduction in the first two indicators. Collectively, explosion-puffing might be a preferable thermal treatment method for industrial sesame processing with improved quality specifications.

Comparison of material properties of heel pad between adults with and without type 2 diabetes history: An in-vivo investigation during gait.

Objective: This study was aimed to compare the material properties of heel pad between diabetes patients and healthy adults, and investigate the impact of compressive loading history and length of diabetes course on the material properties of heel pad. Methods: The dual fluoroscopic imaging system (DFIS) and dynamic foot-ground contact pressure-test plate were used for measuring the material properties, including primary thickness, peak strain, peak stress, stiffness, viscous modulus and energy dissipation ratio (EDR), both at time zero and following continuous loading. Material properties between healthy adults and DM patients were compared both at time zero and following continuous weight bearing. After then, comparison between time-zero material properties and properties following continuous loading was performed to identify the loading history-dependent biomechanical behaviour of heel pad. Subgroup-based sensitivity analysis was then conducted to investigate the diabetes course (<10 years vs. ≥10 years) on the material properties of heel pad. Results: Ten type II DM subjects (20 legs), aged from 59 to 73 (average: 67.8 ± 4.9), and 10 age-matched healthy adults (20 legs), aged from 59 to 72 (average: 64.4 ± 3.4), were enrolled. Diabetes history was demonstrated to be associated with significantly lower primary thickness (t=3.18, p=0.003**), higher peak strain (t=2.41, p=0.021*), lower stiffness (w=283, p=0.024*) and lower viscous modulus (w=331, p<0.001***) at time zero, and significantly lower primary thickness (t=3.30, p=0.002**), higher peak strain (w=120, p=0.031*) and lower viscous modulus (t=3.42, p=0.002**) following continuous loading. The continuous loading was found to be associated with significantly lower primary thickness (paired-w=204, p<0.001***) and viscous modulus (paired-t=5.45, p<0.001***) in healthy adults, and significantly lower primary thickness (paired-w=206, p<0.001***) and viscous modulus (paired-t=7.47, p<0.001***) in diabetes group. No any significant difference was found when conducting the subgroup analysis based on length of diabetes course (<10 years vs. ≥10 years), but the regression analysis showed that the length of diabetes history was positively associated with the peak strain, at time zero (r=0.506, p<0.050) and following continuous loading (r=0.584, p<0.010). Conclusions: Diabetes patients were found to be associated with decreased primary thickness and viscous modulus, and increased peak strain, which may contribute to the vulnerability of heel pad to injury and ulceration. Pre-compression history-dependent behaviour is observable in soft tissue of heel pad, with lowered primary thickness and viscous modulus.

Chinese Consumers' Heterogeneous Preferences for the Front-of-Package Labeling on Fresh Pork: A Choice Experiment Approach.

Excessive average daily pork intake of Chinese residents increases the risk of obesity and related chronic diseases. Understanding consumers' preference for the Front-of-Package (FOP) labeling on fresh pork is of practical significance for designing an FOP labeling scheme that meets market demand and effectively guides moderate pork consumption. This study used the conditional logit model to reveal the stated preferences of 930 nationally representative respondents in China for FOP labeling attributes elicited by a choice experiment approach. The results indicated that respondents preferred the nutritional information to be printed in Chinese characters, the label size to be a quarter of the front package surface, the label color to be green, and the label price to account for 10% of the retail price of 500 g standard fresh pork. Moreover, these preferences were heterogeneous across the sample population due to respondents' different levels of education and trust in labeling. People with primary and junior high school education preferred nutritional information in Chinese characters, while those with junior high education and above preferred green labeling. The higher the respondents' trust in the labeling, the stronger their willingness to accept the appropriate FOP labeling price. Information campaigns and educational programs can be used to increase the acceptance of FOP labelling, particularly among consumers with low education levels and distrust of FOP labeling.

Dynamic Reach Deficit Is a Predictive Factor of Inferior Outcomes After Modified Broström Procedure for Lateral Ankle Instability.

BACKGROUND: Only a few studies have analyzed functional predictive factors for inferior outcomes after modified Broström procedure (MBP). The aim of the current study is to identify the influence of the preoperative dynamic reach deficit on the surgical outcomes of MBP. METHODS: Sixty-one patients with lateral ankle instability who underwent MBP were included in the current study and followed up for a median of 24 months. The Karlsson scores and the reaches of the Star Excursion Balance Test (SEBT) were evaluated before surgery and during the last follow-up. A total of 19 prognostic factors were analyzed. The relationship between the variables and inferior outcomes (Karlsson score < 90) in the bivariate analysis was tested through the Mann-Whitney U test or the Fisher exact test. A multivariate logistic regression model was developed to investigate the influence of the selected factors on inferior outcomes. RESULTS: Thirty-two of the patients had superior outcomes, and the rest had inferior outcomes. The age, gender, and body mass index of the groups with superior and inferior outcomes did not differ. Preoperative dynamic reach deficit (P = .032), osteochondral lesion of the talus (P = .004), and decreased preoperative Karlsson score (P = .004) were independent predictors of inferior outcomes. CONCLUSION: Patients with preoperative dynamic reach deficit, osteochondral lesion of the talus, or decreased preoperative Karlsson score have inferior outcomes after MBP. LEVEL OF EVIDENCE: Level III, case-control study.