Dosimetric comparison of intensity-modulated radiation therapy for early-stage glottic cancers with and without the air cavity in the planning target volume

For early-stage glottic cancers, intensity-modulated radiation therapy (IMRT) has been shown to have comparable local control to 3D-conformal radiotherapy with the advantage of decreased dose to the carotid arteries. The planning target volume (PTV) for early glottic cancers typically includes the entire larynx, plus a 3 to 5 mm uniform margin. The air cavity within the larynx creates a challenge for the inverse optimization process as the software attempts to “build up” dose within the air. This unnecessary attempt at dose build-up in air can lead to hot spots within the rest of the PTV and surrounding soft tissue. We hypothesized that removal of the air from the PTV would decrease hot spots and allow for a more homogeneous plan while still maintaining adequate coverage of the PTV.We analyzed 20 consecutive patients with early-stage glottic cancer, T1-2N0, who received IMRT at our institution from April 2015 to December 2016. Each patient received 63 to 65.25 Gy in 2.25 Gy per fraction. Two plans were created for each case: one in which the PTV included the laryngeal air cavity and one in which the air cavity was subtracted from the PTV to create a new PTV-air structure. Dosimetric variables were collected for PTV-air structure from both IMRT plans, including V100%, D98% D2%, and D0.2%. Dosimetric variables for spinal cord and the carotid arteries were also recorded. Homogeneity index (HI) defined as D98/D2 was calculated. Two-sided t-tests were used to compare dosimetric variables.The median PTV volume was 69.9 cc (standard deviation [SD] ± 28.7 cc) and the median air cavity volume removed was 11.0 cc (SD ± 3.4 cc). A 2-sided t-test revealed a statistically significant decrease in max dose (112.7% vs 108.8%, p value = 0.0002) and improvement of HI (0.93 vs 0.91, p value = 0.0023) for the PTV air in the IMRT plan optimized for PTV air, which had air excluded, compared to the IMRT plan optimized for PTV with air included. There was no significant worsening of PTV-air coverage or significant increase in doses to the organs at risk (OARs).The removal of the air cavity from the PTV for early-stage glottic cancers does not compromise PTV coverage or sparing of OARs and can result in a more homogeneous IMRT plan. A more homogeneous plan has the potential to reduce treatment morbidity, although further study is warranted to investigate the clinical impact of air cavity removal from the PTV.     

A randomized trial of traditional and golf-specific resistance training in amateur female golfers: Benefits beyond golf performance

ObjectiveCompare golf-specific resistance training (GSRT) with traditional resistance training (TRAD) with regard to golf performance and other outcome measures.DesignRandomized controlled study.SettingOutpatient gym.Participants45 female golfers were randomized into TRAD or GSRT, both of which targeted muscles active during the golf swing. Participants performed supervised training 3d^.wk⁻¹ for 10 weeks.Outcome MeasuresGolf performance, bone density, body composition, and physical performance tests.Results29 individuals (58.1 ± 2.1y; 15 TRAD, 14 GSRT) completed training. Completers were older (p = 0.048) and played golf more frequently than non-completers (p = 0.002), but were not otherwise different. Training decreased whole body fat mass (p = 0.013) and visceral fat mass (p = 0.033) across groups, but did not influence lean mass (p = 0.283) or bone mineral density (p = 0.205). Training increased driver speed (p = 0.001), driver distance (p = 0.020), and 7I distance (p < 0.001), but not 7I speed (p = 0.160), but no group or interaction effects were present. Training increased all physical performance tests (p ≤ 0.005) regardless of group, but the seated medicine ball throw was most related to baseline driver speed (r² = 0.384), and also most responsive to training (r² = 0.250).Conclusion10 weeks of supervised TRAD and GSRT provided similar improvements in body composition, golf performance, and physical performance in amateur female golfers.     

Efficacy and Safety of "URSA Complex" in Subjects with Physical Fatigue: A Multicenter,Randomized, Double-blind,Placebo-controlled Trial

Background:

Fatigue is a common symptom both in diseases status and in healthy subjects. Various supplements and nutraceuticals for relieving of fatigue have been used. However, there are a few studies to evaluate the efficacy and the safety of the drug for fatigue alleviation, we conducted using URSA Complex to evaluate the efficacy on physical fatigue via score changes in the checklist individual strength (CIS).

Methods:

The study was designed as a multicenter, randomized, double-blind, placebo-controlled trial, with subjects randomized to one of the two arms, receiving either placebo or URSA Complex administered as identical capsules. The primary efficacy endpoints of this clinical trials are the ratio of improving CIS scores < 76 points in patients at the end (4 weeks). Secondary efficacy variables are as follows one is an improvement of fatigue and the other is an improvement of the liver enzyme.

Results:

The fatigue recovery rate in who had improved CIS scores of < 76 points were 70.0%, 50.9% in the therapy group and placebo group, respectively (P = 0.019). The fatigue recovery rate in CIS score was higher in URSA Complex therapy group than placebo group. The difference between therapy group and placebo group was statistically significant at 4 weeks later, but not 2 weeks.

Conclusions:

Our results provided that the URSA Complex was effective in alleviating physical fatigue. The adverse event frequency in the therapy groups was similar to that in the placebo group.     

Proximal medial gastrocnemius release: Muscle strength evaluation

BackgroundContracture of the gastrocnemius has been associated with different foot and ankle pathologies. The present study’s aim is to evaluate the effect of the proximal medial gastrocnemius release (PMGR) in triceps surae strength.MethodsProspective study with 14 patients (12 women; mean age 52 years). Inclusion criteria were patients undergoing PMGR due to forefoot and/or hindfoot injury with medial gastrocnemius contracture that has not improved with physical therapy. Isometric and isokinetic force evaluation tests with an isokinetic dynamometer (Con-Trex) were performed preoperatively, at 6 and 12 months postoperative, of both limbs.ResultsAfter isokinetic assessment, the statistically significant difference in the preoperative isometric strength of the triceps between the two ankles was confirmed, being stronger the asymptomatic limb. An improvement in the triceps strength in isokinetics was observed at 60°/s at 6 months after surgery (p = 0.008), that was maintained after one year (p = 0.05). No differences were observed at 120°/sec speed.ConclusionPatients with gastrocnemius contracture present a decrease in isometric force with respect to the asymptomatic limb preoperatively. There is an improvement in isokinetic strength after 6 months postoperatively.     

Back Muscle Function in Older Women With Age-Related Hyperkyphosis: A Comparative Study

ObjectiveThe purpose of this study was to compare static maximal back extensor muscle force, endurance, and characteristics of flexion relaxation phenomenon (FRP) in older women with and without age-related hyperkyphosis.MethodsMaximum back extensor force and endurance measured in a sitting position with a designed load cell setup; appearance, onset, and offset angles of FRP; and extension relaxation ratio (ERR) during a dynamic flexion-extension task were compared between 24 older women with hyperkyphosis (thoracic kyphosis angle ≥50°), mean age 65 ± 4.4 years, and 24 older women without hyperkyphosis (thoracic kyphosis angle ?50°), mean age 63 ± 4.3 years. Variables of force, endurance, angles of FRP, and ERR were analyzed using an independent sample t test. A χ² test was used to identify differences between groups in FRP appearance.ResultsStatic back extensor force and endurance were significantly lower among those with versus those without hyperkyphosis (P ? .001). Although the 2 groups did not differ in FRP appearance and ERR in the superficial erector spinal muscles (P ? .05), FRP in the hyperkyphosis group started sooner and ended later than in the group without hyperkyphosis (P ? .05).ConclusionOur study indicates that women with age-related hyperkyphosis had decreased static maximal force and endurance of the back extensor muscles and prolonged myoelectrical silence of the superficial erector spinal muscles. Reduced endurance of the superficial erector spinal muscles may trigger early onset of FRP and prolonged relaxation of these muscles.     

Walking speed best explains perceived locomotion ability in ambulatory people with chronic stroke,assessed by the ABILOCO questionnaire

BackgroundThe identification of the predictors of locomotion ability could help professionals select variables to be considered during clinical evaluations and interventions.ObjectiveTo investigate which impairment measures would best predict locomotion ability in people with chronic stroke.MethodsIndividuals (n = 115) with a chronic stroke were assessed. Predictors were characteristics of the participants (i.e. age, sex, and time since stroke), motor impairments (i.e. muscle tonus, strength, and motor coordination), and activity limitation (i.e. walking speed). The outcome of interest was the ABILOCO scores, a self-reported questionnaire for the assessment of locomotion ability, designed specifically for individuals who have suffered a stroke.ResultsAge, sex, and time since stroke did not significantly correlate with the ABILOCO scores (−0.07 < ρ < 0.05; 0.48 < p < 0.99). Measures of motor impairments and walking speed were significantly correlated with the ABILOCO scores (−0.25 < r < 0.57; p < 0.001), but only walking speed and strength were kept in the regression model. Walking speed alone explained 35% (F = 55.5; p < 0.001) of the variance in self-reported locomotion ability. When strength was included in the model, the explained variance increased to 37% (F = 31.4; p < 0.001).ConclusionsWalking speed and lower limb strength best predicted locomotion ability as perceived by individuals who have suffered a stroke.     

Mast cells derived from human induced pluripotent stem cells are useful for allergen tests

Background

Several methods have been developed to detect allergen-specific IgE in sera. The passive IgE sensitization assay using human IgE receptor-expressing rat cell line RBL-2H3 is a powerful tool to detect biologically active allergen-specific IgE in serum samples. However, one disadvantage is that RBL-2H3 cells are vulnerable to high concentrations of human sera. Only a few human cultured cell lines are easily applicable to the passive IgE sensitization assay. However, the use of human induced pluripotent stem cells (iPSCs) to generate human mast cells (MCs) has not yet been reported.

Battery of behavioral tests in mice that models age-associated changes in human motor function

Motor function in humans can be characterized with tests of locomotion, strength, balance, and endurance. The aim of our project was to establish an analogous test battery to assess motor function in mice. Male C57BL/6 mice were studied at 3 (n = 87), 20 (n = 48) and 26 (n = 43) months of age. Tests assessed locomotion, strength, balance/coordination, and endurance capacity in mice. Motor function was reduced in the older groups of mice for the locomotion, strength, and endurance subdomains (p < 0.001). As indicated with a summary score, motor function declined by 7.4 % from 3 to 20 months and by 13.5 % from 20 to 26 months. Based on comparison with previously published data in humans, the magnitude and relative time course of changes were similar in mice and humans in each subdomain except balance/coordination. Power calculations confirmed that the age-associated differences depicted by several of the individual tests and domain summary scores would be sufficient to assess the efficacy of interventions aimed at prevention or treatment of motor dysfunction with aging. The current study describes a mouse model that characterizes age-associated changes in clinically relevant domains of motor function and indicates that the preclinical model can be used to test strategies to attenuate age-associated declines in motor function.

Electronic supplementary material

The online version of this article (doi:10.1007/s11357-013-9589-9) contains supplementary material, which is available to authorized users.     

Comparison of shoulder range of motion,strength, and upper quarter dynamic balance between NCAA division I overhead athletes with and without a history of shoulder injury

ObjectiveTo determine differences in shoulder range of motion, strength, and upper quarter dynamic balance between collegiate overhead athletes with and without a history of a shoulder injury.DesignCross-sectional study.SettingAthletic training clinic.Participants58 overhead athletes who were fully participating in NCAA Division I overhead sports (baseball, softball, volleyball, and tennis) and free of any current shoulder injury were included. Participants were divided into a shoulder injury history group (n = 25) and uninjured group (n = 33). Participants in the shoulder injury history group had a previously resolved shoulder injury.Main outcome measuresActive range of motion assessments for shoulder internal rotation, external rotation, and horizontal adduction. Isometric strength assessments for shoulder IR and ER. The Upper Quarter Y-Balance Test.ResultsThe shoulder injury history group demonstrated a lower Upper Quarter Y-Balance Test mean score in the superolateral direction (p = .03, d = 0.56), but no group differences existed for other results (p > .05).ConclusionsOverhead athletes with a history of shoulder injury had worse upper quarter dynamic balance versus those without the history. From a clinical perspective, the findings may have significant implications for developing shoulder re-injury prevention and rehabilitation protocols in relation to their shoulder injury history.