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Biomedical subjects

J McWilliams

Publications and source records attributed to J McWilliams.

8 recordsLinked to original sources
PubMed1997

A comparison study of plantar foot pressure in a standardized shoe, total contact cast, and prefabricated pneumatic walking brace.

Total contact casting is the current recommended treatment for Wagner Stage 1 and 2 neuropathic plantar ulcers. The rationale for this treatment includes the equalization of plantar foot pressures and generalized unweighting of the foot through a total contact fit at the calf. Total contact casting requires meticulous technique and multiple cast applications to avoid complications before ulcer healing. An alternative to total contact casting is the use of a prefabricated brace designed to maintain a total contact fit. This study compares plantar foot pressure metrics in a standardized shoe (SS), total contact cast (TCC), and prefabricated pneumatic walking brace (PPWB). Five plantar foot sensors (Interlink Electronics, Santa Barbara, CA) were placed at the first, third, and fifth metatarsal heads, fifth metatarsal base, and midplantar heel of 10 healthy male subjects. Each subject walked at a constant speed over a distance of 280 meters in a SS, PPWB, and TCC. A custom-made portable microprocessor-based system, with demonstrated accuracy and reliability, was used to acquire the data. No significant differences in peak pressure or contact duration were found between the initial and repeat SS trials (P > 0.05). Peak pressures were reduced in the PPWB as compared to the SS for all sensor locations (P < 0.05). Similarly, peak pressures were reduced in the TCC compared to the SS for all sensor locations (P < 0.05) with the exception of the fifth metatarsal base (P = 0.45). Our results are summarized as follows: (1) the methods used in the current study were found to be reliable through a test-retest analysis; (2) the PPWB decreased peak plantar foot pressures to an equal or greater degree than the TCC in all tested locations of the forefoot, midfoot, and hindfoot; (3) compared to a SS, contact durations were increased in both the TCC and PPWB for most sensor locations; and (4) the relationship of peak pressure over time, the pressure-time integral, is lower in the brace compared to the shoe at the majority of sensor locations. The values are not significantly different between the cast and shoe. These findings suggest an unweighting of the plantar foot and equalization of plantar foot pressures with both the PPWB and TCC. Based on these findings, the PPWB may be useful in the treatment of neuropathic plantar ulcerations of the foot.

Braces↗
PubMed1996

Common mutation in methylenetetrahydrofolate reductase. Correlation with homocysteine metabolism and late-onset vascular disease.

BACKGROUND: Increased homocysteine levels are a risk factor for atherosclerosis and its sequelae. A common genetic mutation in methylenetetrahydrofolate reductase (MTHFR), an enzyme required for efficient homocysteine metabolism, creates a thermolabile enzyme with reduced activity. We determined the prevalence of this mutation in many subjects with and without vascular disease and related it to homocysteine and folate levels. METHODS AND RESULTS: DNA from 247 older subjects with vascular disease and 594 healthy subjects without vascular disease (in three different control groups) was screened for the MTHFR 677 C-to-T mutation. Within each group, 9% to 17% of the subjects were homozygous for this mutation, and the mutant allele frequency was 31% to 39%. The genotype distributions, homozygote frequencies, and allele frequencies did not differ significantly between the study groups. In the vascular disease subjects, despite significantly lower folate levels in MTHFR homozygotes, there was no significant difference in homocysteine levels among the MTHFR genotype groups. The negative slope of the regression line relating homocysteine and folate was significantly steeper for those with a homozygous MTHFR mutation compared with those without this mutation. CONCLUSIONS: Although the thermolabile MTHFR mutation is very common, it does not appear to be a significant genetic risk factor for typical late-onset vascular disease. Because MTHFR homozygotes have increased homocysteine with low folate levels, this mutation may contribute to early-onset or familial vascular disease. The genotype dependence of the folate-homocysteine correlation further suggests that homozygotes for this mutation may have both an exaggerated hyperhomocysteinemic response to folic acid depletion and a better response to folic acid therapy.

Adult↗
PubMed1984

Resistant childhood psoriasis: an analysis of patients seen in a day-care center.

During a three-and-one-half-year period, 54 children aged 1 to 16 years, all of whom had resistant psoriasis, were seen at a day-care center. The female: male ratio was 3:2. In 74% of the patients, the onset of psoriasis occurred when they were below 10 years of age. Papules and plaques occurred in 78% of cases, guttate lesions in 16%, and nail involvement in 21%. A family history of psoriasis was present in 69% of cases, preceding upper respiratory tract infections occurred in 35%, and prior cradle cap and/or diaper rash in 50%. In the day-care center, Goeckerman therapy was given to 31 children. The average duration of treatment was 12 days, producing maximum clearing of over 90% in 64% of patients, with substantial improvement in the remainder. After three months, the psoriasis in 83% of these patients was over 90% clear; 43% showed maximum clearing at one year. Two patients were treated with anthralin and ultraviolet light alone, one with good results. One patient with nail psoriasis alone was not treated. The remaining 20 patients were either unable to attend for treatment at the center or had less extensive psoriasis. Home treatment was prescribed for them, with less satisfactory results.

Administration, Topical↗
PubMed1975

Field dependence and self-actualization in alcoholics.

Field independence and self-actualization were significantly increased in alcoholic patients following a 6-week treatment program. There were no differences, however, between patients treated by drug-assisted individual therapy, individual therapy, or milieu therapy. Some causal factors are hypothesized, and implications for treatment are discussed.

Adult↗