Higher percentage of positive biopsy cores and Gleason score are associated with a greater degree of prostate gland shrinkage after neoadjuvant cytoreductive therapy

PurposeTo determine whether adverse pathologic features, including tumor grade and percent positive biopsy (PPB) cores, predict for prostate size reduction after neoadjuvant cytoreductive therapy.Methods and MaterialsEighty-two consecutive patients who were diagnosed with prostate cancer by transperineal template–guided mapping biopsy (TTMB) received neoadjuvant cytoreductive therapy. The median number of biopsy cores was 59. Thirty patients received a leutinizing hormone–releasing hormone agonist and bicalutamide, whereas 52 patients received bicalutamide (50 mg daily) and dutasteride (0.5 mg daily). A transrectal ultrasound volumetric study of the prostate gland and ellipsoid volume determinations of the prostate gland and transition zone (TZ) were obtained immediately before TTMB and at 90 days (±7 days) after the initiation of neoadjuvant medical therapy. Univariate and multivariate regression analyses were performed to identify predictors of prostate gland and TZ volume reduction.ResultsAt TTMB, the mean prostate volumetric and ellipsoid volumes were 55.4 cm³ and 49.0 cm³, respectively. After neoadjuvant medical therapy, the mean volumetric and ellipsoid prostate volumes were 30.8 cm³ and 28.5 cm³, respectively. On average, the prostate volume decreased by 43.9% and 41.0% on volumetric and ellipsoid measurements, respectively. The TZ volume decreased from 19.8 cm³ to 10.1 cm³ (mean volume reduction of 47.7%). In multivariate analysis, prostate volume cytoreduction was most closely associated with PPB (p = 0.014), TTMB prostate volume (p = 0.01), and drug regimen (p = 0.001).ConclusionsThe degree of prostate volume cytoreduction was positively associated with higher Gleason score and PPBs. Greater reductions in prostate volume may be an indicator of more aggressive cancer.     

Relationship between prostate-specific antigen bounce body fat distribution and body mass index in permanent seed brachytherapy for prostate cancer

PurposeTo analyze the influence of body mass index (BMI) and adipose tissue distribution on prostate-specific antigen (PSA) bounce after iodine-125 prostate brachytherapy.Methods and MaterialsWe studied 20 patients who had PSA bounce (≥0.50 ng/mL) after exclusive prostate brachytherapy. These patients were compared with 48 patients without a bounce (<0.50 ng/mL). All patients in the comparison group had a followup of ≥24 months and a last PSA ≤0.5 ng/mL. Within these 48 patients, there was a group matched for age (n = 20). Univariate and multivariate logistic models were estimated to assess the association between age, baseline PSA, prostate volume, D₉₀, visceral fat (VF) volume, and BMI on PSA-bouncing status.ResultsWhen comparing the patients with a bounce to those without, only BMI showed a significantly different distribution (mean, 25.18 vs. 27.47 kg/m²; p = 0.0342). On a multivariate analysis, BMI had an odds ratio of 0.85 (95% confidence interval, 0.71–0.99, p = 0.049), indicating that an increase of 1 kg/m² in BMI is associated with a 15% reduction in the odds of having a bounce. In the univariate analysis with the matching patients, BMI was a significant predictor of a bounce (p = 0.0147). In the multivariate conditional logistic model, BMI showed a trend toward an influence on a bounce (p = 0.0615). All other factors, including VF, did not have any influence on a PSA bounce.ConclusionsPatients with a lower BMI are more likely to experience a PSA bounce ≥0.50 ng/mL. VF did not have an influence on a PSA bounce.     

Biochemical and clinical experience with real-time intraoperatively planned permanent prostate brachytherapy

PurposeTo evaluate patient characteristics and dosimetric parameters that predict biochemical failure (BCF) after real-time planned low-dose-rate prostate brachytherapy.MethodsFrom 1998 to 2008, a low-risk cohort by National Comprehensive Cancer Network criteria of 341 men with a median followup of 41.6 months was analyzed. This cohort had a median age of 65.1 years, prostate volume of 35.8 cc, and pretreatment prostate-specific antigen of 5.6 ng/mL. Patients had predominately Gleason 6 (95.9%) and T1c (81.3%) disease. About 3.6% of the patients received androgen deprivation therapy. Kaplan–Meier and Cox proportional hazards survival analysis methods were used to analyze predictors of BCF (Phoenix definition).ResultsAt 72 months, freedom from BCF was 91.1% (95% confidence interval = 85.0–94.8). The median D₉₀ was 145.9 Gy, and the median V₁₀₀ was 90.3%. Because of infrequent BCF, the following prostate volume groups were examined: 15–<25, 25–<35, 35–<45, and 45+ cc. Of all possible predictors, only small prostate volume (15–<25 cc group) was significantly associated with BCF (hazard ratio = 8.44, 95% confidence interval = 1.82–39.14, p = 0.007). Using Kaplan–Meier analysis, time to BCF was also significantly increased in the lowest prostate volume 15–<25 cc group with 24.1% failing at 48 months compared with 1.6–5.1% among the other groups.ConclusionsReal-time planned low-dose-rate prostate brachytherapy provides excellent biochemical control as a single-agent treatment for low-risk prostate cancer with 91.1% freedom from BCF at 72 months. Only prostate volume less than 25 cc was an independent predictor of BCF.     

Unusually high prostate-specific antigen bounce after prostate brachytherapy: Searching for etiologic factors

PurposeDetermine whether fat distribution, body mass index, or clinical and dosimetric factors are associated with prostate specific antigen (PSA) bounce (PSAb) of ≥1.6 ng/mL in patients treated with permanent seed ¹²⁵I prostate brachytherapy (PB).Methods and MaterialsWe identified 23 patients with a PSAb of ≥1.6 ng/mL. For each patient with a bounce, at least one control with similar age (age ± 2 years, n = 31) was identified. Control patients had to have no bounce (≤0.2 ng/mL) and a most recent PSA of <1 ng/mL. CT at Day 30 after PB was used to determine the volume of subcutaneous adipose tissue, visceral adipose tissue, and peri-prostatic fat. Univariate and multivariate logistic models were used to assess the association between PSAb and adipose tissue distribution and clinical and dosimetric factors.ResultsMean patient age was 62.3 ± 5.3 years. Mean PSAb height was 2.7 ± 0.8 ng/mL, and mean time to bounce was 9.6 ± 4 months. More than 90% of the patients reached a PSA nadir before PSAb within 12 months post-PB. Patients showing PSAb were more likely to have a T1c disease vs. T2a (odds ratio = 18.87; 95% confidence interval: 2.32–454.55; p = 0.019) and a lower seed activity per cc of prostate volume (odds ratio = 0.02; 95% confidence interval = 0.42–2.22; p = 0.026). Neither fat distribution nor body mass index was associated with PSAb (p = 0.11–0.597).ConclusionsClinical and dosimetric factors play a role in PSAb of ≥1.6 ng/mL. Fat distribution is not associated with a PSAb. There is presently no satisfactory theory to explain the etiology of PSAb.     

Comparison of 3'-deoxy-3'-[(18)F]fluorothymidine PET and O-(2-[(18)F]fluoroethyl)-L-tyrosine PET in patients with newly diagnosed glioma

PurposeThe purpose of this prospective study was to clarify the value of FLT PET and FET PET for the noninvasive grading and prognosis of newly diagnosed gliomas.Materials and methodsTwenty patients with newly diagnosed gliomas were investigated with FLT and FET PET before surgery. FLT and FET uptakes were assessed by the maximum standardized uptake (SUVmax) of tumor, and the ratio to uptake in the normal brain parenchyma (TNR). All tumors were graded by WHO system.ResultsFLT PET detected all 17 high-grade gliomas (HGG) and did not detect all 3 low-grade gliomas (LGG). FET PET detected all 20 HGG and LGG regardless of grading. The average FLT SUVmax in HGG and LGG was 1.51 ± 0.72 and 0.30 ± 0.07, and the average FLT TNR in HGG and LGG was 5.52 ± 3.09 and 1.12 ± 0.14, respectively. The differences of FLT SUVmax and TNR between HGG and LGG were statistically significant (p = 0.0069, p = 0.0070). The average FET SUVmax in HGG and LGG was 2.68 ± 0.86 and 1.36 ± 0.15, and the average FET TNR in HGG and LGG was 2.31 ± 0.73 and 1.27 ± 0.12, respectively. The differences of FET SUVmax and TNR between HGG and LGG were statistically significant (p = 0.0129, p = 0.0095).ConclusionsFET PET has higher sensitivity in detection of gliomas rather than FLT PET, but it seems that FLT PET is better than FET PET for noninvasive grading and predicting prognosis of newly diagnosed gliomas, considering high contrast of FLT and overlap of FET uptakes between HGG and LGG.     

Comparison of intraoperative ultrasound with postimplant computed tomography--dosimetric values at Day 1 and Day 30 after prostate brachytherapy

PurposeTo compare the results of intraoperative dosimetry with those of postimplant computed tomography (CT)-based dosimetry after ¹²⁵I prostate brachytherapy.Methods and materialsWe treated 412 prostate cancer patients with ¹²⁵I prostate brachytherapy, with or without external beam radiotherapy at our institution. Neoadjuvant hormone therapy was administered to 331 patients (80.3%). Implantation was performed using an intraoperative interactive technique. Postimplant dosimetry was performed on Day 1 and Day 30 using CT imaging. The dosimetric results for the prostate, urethra, and rectum were compared among intraoperative ultrasound, and CT scans of Day 1 and Day 30.ResultsThe mean intraoperative minimal dose received by 90% of the prostate volume (D₉₀) was 118.8% of the prescribed dose vs. 106.4% for Day 1 (p < 0.01) and 119.2% for Day 30 (p = 0.25). There were no significant correlations between the intraoperative D₉₀ and the postimplant D₉₀ values (intraclass correlation coefficients = 0.42 and 0.33 for Day 1 and Day 30, respectively). Prostatic edema at Day 1 had the largest effect on the Day 1 D₉₀ (p < 0.01). The factor significantly affecting the Day 30 D₉₀ was neoadjuvant hormone therapy (p < 0.01). The mean Day 30 D₉₀ for the hormone-treated patients was 117.9%, compared with 124.6% for those who remained hormone naïve. The intraoperative and postimplant dosimetric values differed significantly for the urethra and rectum.ConclusionsOur results demonstrate that there are no significant differences between the D₉₀ assessments obtained intraoperatively and at Day 30 postoperatively. Furthermore, there are no definite correlations between intra- and postimplantation dosimetric values. Other D₉₀ values differed significantly between the intraoperative and postimplant dosimetry. This study suggests that dosimetry has negligible clinical utility for informing patients, at discharge, of whether or not their implants are adequate.     

Biopsy and implantation of the seminal vesicles

PurposeTo describe the technique and outcomes of seminal vesicle biopsy (SVB) and permanent implantation in patients with T3b prostate cancer.Methods and MaterialsIntermediate- and high-risk prostate cancer patients who elected brachytherapy as their treatment of choice were offered SVB for either Gleason score ≥7, prostate-specific antigen levels >10 ng/mL, or clinical stage ≥T2b. Three cores were taken from both seminal vesicles at the base of the prostate using transrectal ultrasound. Patients with a positive SVB and either a negative pelvic lymph node dissection or pelvic computerized tomogram were treated with a combination of a partial implant followed by 45 Gy of external beam irradiation therapy. During the seed implant, sources were positioned in the anterior wall of the seminal vesicles using intraoperative dosimetry to guide placement. Biochemical freedom from failure was determined using a definition of >0.2 ng/mL. Survival was measured using the Kaplan–Meier and Cox proportions projections.ResultsOf 526 patients who underwent SVB, 52 (9.9%) were positive for prostate cancer invasion. Clinical stage, prostate-specific antigen levels, and Gleason score were all predictive of a positive SVB (p < 0.001). The 10-year biochemical freedom from failure was 64%. Cox regression demonstrated Gleason score (p = 0.044) and biologic effective dose (p = 0.013) as significant.ConclusionsPatients with pathologically confirmed seminal vesicle involvement of prostate cancer can be successfully identified and managed by a combined approach of permanent seed implantation to the prostate and seminal vesicles followed by external beam irradiation therapy. SVB should be encouraged in men with high-risk prostate cancer and aggressively treated when encountered.     

Impact of training and hypocaloric diet on fat oxidation and body composition in obese adolescents

ObjectiveWe undertook to evaluate the effects of training and hypocaloric diet on fat oxidation and weight loss in obese adolescents within a two-month program.MethodsThe longitudinal intervention of a two-month program was performed in 54 adolescents, whose body mass index was 30.3 ± 4.0 kg/m². They were divided into three groups: hypocaloric diet program (D), individualized training program at the level of maximal lipid oxidation Lipox_max (T) and hypocaloric diet combined with training program (D + T). The body composition, the substrate “crossover” point and the Lipox_max point were determined before and after each protocol.ResultsThe decreases in body weight and fat mass were more significant in the D + T group (p < 0.01) than in the D (p < 0.05) or T (p = 0.07) groups. In the D + T group, the crossover point was observed at a higher intensity at the end of the program (+ 19.7% ± 2.4 of W_max; p < 0.001), and the fat oxidation at Lipox_max has increased by 83.2 ± 15.3 mg/min (p < 0.01). A significant correlation between Lipox_max and weight was also observed after the program in D + T subject.     

Utility of T1-weighted MRI as a predictor of liver lesion visibility on ultrasound: A clinical tool to determine feasibility of ultrasound-guided percutaneous interventions

PurposeTo determine the utility of fat-suppressed T1-weighted gradient recalled echo (FS-T1W-GRE) MRI to predict visibility of focal liver lesions (FLL) on abdominal ultrasound (US).Materials and methodsWith IRB approval, between 2010 and 2013, 109 patients (28.4% females, age 66.9 ± 10.9 years) with 177 FLL (hepatocellular carcinoma = 132, metastases = 44, other = 1) underwent MRI and prospective, radiologist-performed treatment-planning US (to determine eligibility for US-guided ablation). MRI examinations were reviewed by a blinded radiologist who assessed: a) size and location of FLL, b) presence of hepatic steatosis on dual-echo T1W-GRE, and c) quantitative signal intensity of FLL relative to liver on FS-T1W-GRE. Associations between MR imaging findings and visibility on US were assessed using independent t-tests and the chi-squares test.Results69.5% (123/177) FLL were identified with US and 30.5% (54/177) were not visible. Size of FLL on MRI was associated with visibility on US (p < 0.0001) with no association between FLL visibility on US and segmental or subcapsular location (p = 0.29 and p = 0.25, respectively). 20.2% (22/109) patients had hepatic steatosis on MRI, which was not associated with non-visibility of FLL on US (p = 0.67). 38.4% (68/177) FLL were isointense to liver on FS-T1W-GRE which was associated with non-visibility on US (p = 0.036) particularly in non-steatotic livers (p = 0.014).ConclusionFLL size and isointensity of FLL to liver parenchyma on FS-T1W-GRE MRI are associated with non-visibility on US, particularly in non-steatotic livers. These results have implications when planning US-guided percutaneous interventions of FLL detected with MRI.     

Differentiation of prostate cancer from benign lesions using strain index of transrectal real-time tissue elastography

ObjectiveThis study was to assess the diagnostic value of strain index (SI) for transrectal real-time tissue elastography (TRTE) on differentiating malignant from benign lesions in the prostate peripheral zone.Methods83 patients suspected of having prostate cancer (PCa) underwent transrectal ultrasonography (TRUS) and TRTE examinations. The lesions in the prostate peripheral zone detected by TRTE were set as the regions of interest (ROI) for strain ratio (SR) measurement (SRA). The moderate texture tissues without lesion were set as the reference ROI for SR measurement (SRB). Then, SI (SRB/SRA) of total lesions (ASI) and local lesion (PSI) were calculated, and the diagnostic values of ASI and PSI on differentiating benign from malignant lesions were assessed respectively.ResultsThe range of PSI was 2.23–67.21 (29.97 ± 15.58) in malignant tumors and 0. 4–43.6 (7.79 ± 8.75) in benign lesions (AUC = 0.90), while the range of ASI was 2.84–47.9 (8.38 ± 12.20) in malignant tumors and 0.4 –2.79 (5.85 ± 7.29) in benign lesions (AUC = 0.62). There was significant difference of PSI values between the benign and malignant lesions (P < 0.01). At the cutoff value of 17.44, PSI yielded the highest sensitivity (74.5%) and specificity (83.3%) for discriminating PCa from benign lesions. The capability of PSI in the diagnosis of PCa improved with the increase of Gleason scores.ConclusionPSI is one of the elasticity parameters obtained easily by TRTE, it can provide more information in the differentiation of prostate peripheral zone lesions.     

Walking velocity and lower limb coordination in hemiparesis

Background/objectiveGait training at fast speed has been suggested as an efficient rehabilitation method in hemiparesis. We investigated whether maximal speed walking might positively impact inter-segmental coordination in hemiparetic subjects.MethodsWe measured thigh–shank and shank–foot coordination in the sagittal plane during gait at preferred (P) and maximal (M) speed using the continuous relative phase (CRP), in 20 healthy and 27 hemiparetic subjects. We calculated the root-mean square (CRP_RMS) and its variability (CRP_SD) over each phase of the gait cycle. A small CRP_RMS indicates in-phasing, i.e. high level of synchronization between two segments along the gait cycle. A small CRP_SD indicates high stability of the inter-segmental coordination across gait cycles.ResultsIncrease from preferred to maximal speed was 57% in healthy and 49% in hemiparetic subjects (difference NS). In healthy subjects, the main change was shank–foot in-phasing at stance (CRP_{Shank–Foot/RMS}, P, 98 ± 10; M, 67 ± 12, p < 0.001). In hemiparetic subjects, we also found shank–foot in-phasing at late stance bilaterally (non-paretic CRP_{Shank–Foot/RMS}, P, 37 ± 9; M, 29 ± 8, p < 0.001; paretic CRP_{Shank–Foot/RMS}, P, 38 ± 13; M, 32 ± 12, p < 0.001), and thigh–shank in-phasing at mid-stance in the non-paretic limb (CRP_{Thigh–Shank/RMS}, P, 57 ± 9; M, 49 ± 9, p < 0.001). CRP_{Thigh–Shank} variability diminished in the paretic limb (CRP_{Thigh–Shank/SD}, P, 18.3 ± 6.3; M, 16.1 ± 5.2, p < 0.001).ConclusionDuring gait velocity increase in hemiparesis, there is improvement of thigh–shank coordination stability in the paretic limb and of shank–foot synchronization at late stance bilaterally, which optimizes the propulsive phase similarly to healthy subjects. These findings may add incentive for rehabilitation clinicians to explore maximal velocity gait training in hemiparesis.     

Prostate cancer control and survival in Vietnam veterans exposed to Agent Orange

BackgroundIn this study, we evaluated the impact of Agent Orange exposure on survival in Vietnam Veterans undergoing prostate brachytherapy.Methods and MaterialFrom May 1995 to January 2005, 81 Vietnam veterans (29 with Agent Orange exposure and 52 without) and 433 nonveterans of comparable age (mean age, 58 years) underwent prostate brachytherapy. The mean follow-up was 5.0 years. Biochemical progression-free survival (bPFS) was defined as a prostate-specific antigen (PSA) ≤ 0.40 ng/mL after nadir. Patients with metastatic prostate cancer or hormone refractory disease without obvious metastases who died of any cause were classified as died of prostate cancer. All other deaths were attributed to the immediate cause of death. Multiple parameters were evaluated for impact on survival.ResultsAt 9 years, Agent Orange–exposed men were least likely to remain biochemically controlled (89.5%, 100%, and 97.2% in Agent Orange–exposed, nonexposed veterans, and nonveterans, respectively, p = 0.012). No significant differences in cause-specific (CSS) (p = 0.832) or overall survival (OS) (p = 0.363) were discerned. In multivariate analysis, CSS was best predicted by Gleason Score and day 0 D₉₀, whereas Gleason Score, % positive biopsies, and D₉₀ predicted for bPFS. None of the evaluated parameters predicted for OS, however, a trend was identified for better OS in younger patients and those with a higher D₉₀. In addition, Agent Orange exposure did not predict for any of the survival parameters. To date, 22 patients have died (metastatic prostate cancer two, second malignancies nine, cardiovascular disease eight, trauma two, and pulmonary one).ConclusionsIn this cohort of prostate brachytherapy patients, Agent Orange exposure did not statistically impact survival in multivariate analysis.     

Comparison of PSA relapse-free survival in patients treated with ultra-high-dose IMRT versus combination HDR brachytherapy and IMRT

PurposeWe report on a retrospective comparison of biochemical outcomes using an ultra-high dose of conventionally fractionated intensity-modulated radiation therapy (IMRT) vs. a lower dose of IMRT combined with high-dose-rate (HDR) brachytherapy to increase the biologically effective dose of IMRT.MethodsPatients received IMRT of 86.4 Gy (n = 470) or HDR brachytherapy (21 Gy in three fractions) followed by IMRT of 50.4 Gy (n = 160). Prostate-specific antigen (PSA) relapse was defined as PSA nadir + 2. Median followup was 53 months for IMRT alone and 47 months for HDR.ResultsThe 5-year actuarial PSA relapse-free survival (PRFS) for HDR plus IMRT vs. ultra-high-dose IMRT were 100% vs. 98%, 98% vs. 84%, and 93% vs. 71%, for National Comprehensive Cancer Network low- (p = 0.71), intermediate- (p < 0.001), and high-risk (p = 0.23) groups, respectively. Treatment (p = 0.0006), T stage (p < 0.0001), Gleason score (p < 0.0001), pretreatment PSA (p = 0.0037), risk group (p < 0.0001), and lack of androgen-deprivation therapy (p = 0.0005) were significantly associated with improved PRFS on univariate analysis. HDR plus IMRT vs. ultra-high-dose IMRT (p = 0.0012, hazard ratio [HR] = 0.184); age (p = 0.0222, HR = 0.965); and risk group (p < 0.0001, HR = 2.683) were associated with improved PRFS on multivariate analysis.ConclusionDose escalation of IMRT by adding HDR brachytherapy provided improved PRFS in the treatment of prostate cancer compared with ultra-high-dose IMRT, independent of risk group on multivariate analysis, with the most significant benefit for intermediate-risk patients.     

Time course of prostatic edema post permanent seed implant determined by magnetic resonance imaging

PurposeTo quantify the time course of postimplant prostatic edema magnitude and spatial isotropy using serial magnetic resonance imaging (MRI).Methods and MaterialsForty patients with histologic diagnosis of prostate cancer received an iodine-125 seed implant (Day 0) and consented to 1.5-T MRI on Days ?1, 0, 14, and 28. Seeds of strength 0.39 mCi were placed in a modified peripheral loading pattern to deliver 145 Gy to the target volume. MR images consisted of 3–4 mm thick axial slices with no gap. The image sets were anonymized and randomized to minimize contouring bias, then contoured by a single radiation oncologist. Contours were reoriented about their center of mass to align the prostate long axis with the superior–inferior (S?I) direction; prostate volumes and dimensions in the left–right (L?R), anterior–posterior (A?P), and S?I directions through the center of mass were calculated.ResultsThe average relative edema volume was 1.18 ± 0.14 (1 standard deviation) on Day 0 and 1.01 ± 0.15 on Day 30. Between Days 0 and 30, the edema resolved linearly with time on average. Average relative edema dimensions on Day 0 in the L?R, A?P, and S?I directions were 1.01 ± 0.07, 1.11 ± 0.09, and 1.08 ± 0.13, respectively.ConclusionsAs measured using MRI, the average edema magnitude for our study population was ～20% on Day 0 and resolved linearly with time to ～0% on Day 30. The edema exhibited spatial anisotropy, the prostate expanding on Day 0 by ～10% in each of the A?P and S?I directions and by ～0% in the L?R direction.     

During step descent, older adults exhibit decreased knee range of motion and increased vastus lateralis muscle activity

PurposeThere is substantial evidence indicating an increase in the incidence of lower limb joint osteoarthritis with increasing age. One factor that may contribute to this is an age related reduction in the ability to attenuate the impulse generated during gait and step descent.ScopeThe aim of this study was to investigate the differences between older and younger adults, in the strategies used to attenuate the force generated between initial contact (IC) and maximum vertical ground reaction force (vGRF) (impulse phase) when descending a step.MethodsTen older participants aged 60–80 years (mean 65.3, SD ±5) and 10 younger participants aged 20–30 years (mean 22.8, SD ±2.5) took part in the study. Vertical ground reaction force (vGRF) and the time taken to reach maximum vGRF were measured. The maximum joint range of motion of the hip and knee during step descent was measured between IC and the maximum vGRF. Electromyography (EMG) was measured from four lower limb muscles and normalised to task for each individual.ResultsThere was a statistically significant difference between older and younger adults in the amount of knee flexion and vastus lateralis EMG activity in the leading leg during the impulse phase of step descent. Older adults had less knee flexion (F(1,18) = 5.48; p = 0.031) and more vastus lateralis EMG activity (F(1,18) = 5.21; p = 0.035) during step descent than younger adults.ConclusionOlder and younger adults used different strategies during step descent. Older adults demonstrated two strategies that have the potential to increase the impulse of a step.     

The potential of multi-slice computed tomography based volumetry for demonstrating reverse remodeling induced by cardiac resynchronization therapy

BackgroundMulti-slice computed tomography (MSCT) was proved to provide precise cardiac volumetric assessment. Cardiac resynchronization therapy (CRT) is an effective treatment for selected patients with heart failure and reduced ejection fraction (HFREF). In HFREF patients we investigated the potential of MSCT based wall motion analysis in order to demonstrate CRT-induced reversed remodeling.MethodsBesides six patients with normal cardiac pump function serving as control group seven HFREF patients underwent contrast enhanced MSCT before and after CRT. Short cardiac axis views of the left ventricle (LV) in end-diastole (ED) and end-systole (ES) served for planimetry. Pre- and post-CRT MSCT based volumetry was compared with 2D echo. To demonstrate CRT-induced reverse remodeling, MSCT based multi-segment color-coded polar maps were introduced.ResultsWith regard to the HFREF patients pre-CRT MSCT based volumetry correlated with 2D echo data for LV-EDV (MSCT 278.3 ± 75.0 mL vs. echo 274.4 ± 85.6 mL) r = 0.380, p = 0.401, LV-ESV (MSCT 226.7 ± 75.4 mL vs. echo 220.1 ± 74.0 mL) r = 0.323, p = 0.479 and LV-EF (MSCT 20.2 ± 8.8% vs. echo 20.0 ± 11.9%) r = 0.617, p = 0.143. Post-CRT MSCT correlated well with 2D echo: LV-EDV (MSCT 218.9 ± 106.4 mL vs. echo 188.7 ± 93.1 mL) r = 0.87, p = 0.011, LV-ESV (MSCT 145 ± 71.5 mL vs. echo 125.6 ± 78 mL) r = 0.84, p = 0.018 and LV-EF (MSCT 29.6 ± 11.3 mL vs. echo 38.6 ± 14.6 mL) r = 0.89, p = 0.007. There was a significant increase of the mid-ventricular septum in terms of absolute LV wall thickening of the responders (pre 0.9 ± 2.1 mm vs. post 3.3 ± 2.2 mm; p < 0.0005).ConclusionMSCT based volumetry involving multi-segment color-coded polar maps offers wall motion analysis to demonstrate CRT-induced reverse remodeling which needs to be further validated.     

Prostate brachytherapy in men with gland volume of 100 cc or greater: Technique,cancer control,and morbidity

PurposeTo determine the outcomes of prostate seed implantation in men with prostate volume (PV) of 100 cc or greater (PV100).MethodsA total of 2051 men with localized prostate cancer were treated with permanent prostate brachytherapy of whom 34 (1.7%) had PV100 (mean, 126.2; range, 100–205 cc). The PV100 patients were older (mean, 69 vs. 66 years; p = 0.031), had higher initial prostate-specific antigen level (20.4 vs. 9.6 ng/mL, p < 0.001), and received a lower dose (182 vs. 194 Gy₂ biologic equivalent dose, p = 0.032). There were no differences in clinical stage, Gleason score, and baseline International Prostate Symptom Score. The mean followup time was 6.7 years (range, 2–18). Biochemical freedom from failure (bFFF) was defined using the Phoenix definition.ResultsThe BFFF at 10 years was no different between PV100 and smaller glands (82.4% vs. 84.5%, p = 0.71). At last followup, mean International Prostate Symptom Score for PV100 increased from 8.5 to 9.1 against 7.4 to 9.2 for smaller glands (p = 0.935). Urinary retention rates were higher for PV100 (6/34, 17.6% vs. 148/2017, 7.3%; odds ratio, 2.71; 95% confidence interval, 1.1–6.6; p = 0.038). Postimplant transurethral resection of the prostate was performed in none of the 34 patients with PV100 against 66 of the 2017 patients (3.3%, p < 0.001). Long-term radiation proctitis for PV100 were 1 of 34 (2.9%) against 82 of 2017 (4.1%, p = 0.741). Rectourethral fistula occurred in 4 patients (0.19%), that is, 1 of 34 (2.9%) in PV100 group and 3 of 2017 (0.1%, p < 0.001).ConclusionThis study demonstrates the feasibility of implanting patients with PV100. Very large PV does not influence bFFF. Although urinary retention rates were higher, the long-term urinary symptoms were no different between the two groups. Requirement for transurethral resection of the prostate was no higher in patients with PV100. Radiation proctitis rates were similar for both.     

Extensor hallucis longus tendon injury in taekwondo athletes

ObjectivesExtensor hallucis longus (EHL) tendon injuries can occur in taekwondo athletes when performing hyperplantarflexed barefoot kicking exercises. A state of full excursion of the extensor tendon is used to strike opponents in which the metatarsal bone and the proximal phalanx area is in contact with the opponent. The purpose of this study is to examine the incidence of extensor hallucis longus tendon injury in taekwondo athletes.DesignCase–control study.Participants50 Athletes from the Korean taekwondo national team and a control group of 50 healthy subjects.Main outcome measuresHistory of sports participation, the American Orthopaedic Foot and Ankle Society (AOFAS) score and ultrasound imaging of the EHL.ResultsDifference in the AOFAS scores were noted with the control group at 92.95 ± 9.18, and the experimental group score at 88.45 ± 10.93 (p < 0.01). Only one person (one tendon) from the control group demonstrated changes on sonography (2%), whilst 10 subjects from the taekwondo group displayed changes in 16 tendons (20%). EHL thickness of the experimental group (1.52 ± 0.16 mm) was greater and the control group (1.46 ± 0.11 mm) (p < 0.01).ConclusionTaekwondo athletes have a higher incidence of changes on sonographic imaging of the EHL compared to non-taekwando participating healthy subjects.