Baseball-Funded ‘Andro’ Study Shows Testosterone Increase

Abstract

Objective: Patellofemoral pain syndrome (PFPS) is one of the most frequently diagnosed knee conditions in the primary care, orthopedic, and sports medicine settings. Although strength training and stretching programs have traditionally been the mainstay of patient treatment, there are no consensus recovery protocols for runners experiencing PFPS. The purpose of our review is to examine recent literature regarding the efficacy of various treatment modalities in the management of patients with PFPS. Methods: Our review included 33 articles from a PubMed literature search using the search term PFPS treatment. The search was limited to randomized controlled trials, crossover case-controlled studies, and cohort studies with ? 10 participants, with trial data that were published within the last 5 years. Results: Strength training and stretching exercises continue to be strongly supported by research as effective treatment options for runners with PFPS. Recent studies have confirmed that quadriceps and hip strengthening combined with stretching in a structured physiotherapy program comprise the most effective treatment for reducing knee pain symptoms and improving functionality in patients with PFPS. As previous studies have shown, therapies such as proprioceptive training, orthotics, and taping may offer benefits as adjunctive therapies but do not show a significant benefit when they are used alone in patients with PFPS. Additionally, recent research has confirmed that surgical and pharmacologic therapies are not effective for the management of patients with PFPS. Conclusion: A large number of athletes are impacted by PFPS every year, particularly young runners. Sports medicine researchers have investigated many possible therapies for patients with PFPS; however, no clear guidelines have emerged regarding the management of the syndrome. Our review analyzes recent literature on PFPS and identifies specific treatment recommendations. The most effective and strongly supported treatment modality for patients with PFPS is a combined physiotherapy program, including strength training of the quadriceps and hip abductors and stretching of the quadriceps muscle group. Adjunctive therapies, including taping, biofeedback devices, and prefabricated orthotic inserts, may provide limited additive benefits in select populations. Surgery should be avoided in all patients with PFPS.     

Feasibility Study of “Snuffbox” Radial Access for Visceral Interventions

“Snuffbox” radial access entails sheath insertion into the dorsal branch of the radial artery within the so-called anatomic snuffbox. The purpose of this report is to describe the technique and early experience in 50 visceral interventional procedures performed in 31 patients, which included liver embolotherapy, visceral arterial stent insertion, aneurysm embolization, and emergency embolization. In all cases, the procedures were successfully completed by using the snuffbox access, with a single case of asymptomatic pseudoaneurysm as the only access-related complication. Early experience showed that snuffbox radial access is technically feasible and represents a viable alternative to conventional radial access for visceral intervention procedures.     

Study of the normal internal organ weights in Tehran’s population

ObjectiveExamine the normal adult internal organ weight and its relationship with body height, body weight, body mass index and age.Materials and methodsProspective analysis of data from 1222 autopsies in Legal Medicine Organization of Iran from 1st January, 2007 to 1st September, 2008. All the subjects were adult residents of Tehran died from external causes and showed no pathological changes.ResultsThe weight of the brain, heart, lungs, liver, spleen, pancreas, kidneys, thyroid gland, the pituitary gland, the suprarenal glands, testes, prostate, ovaries and the uterus were collected from 914 males and 308 females between 15 and 88 years. The weight of all the organs was correlated statistically with at least one external parameter with the exception of the pancreas in men, the uterus, the spleen and the thyroid in women. Organ weights decreased with age except for the heart and the prostate, and increased in relation to body height and/or BMI. Except for the brain, the organ weight showed a better statistical correlation with the BMI than the body height.ConclusionThese results can be used as standard organ weights to determine abnormal evidences in Forensic and Pathologic corpses. However such results have to be regularly updated by pathologists in order to keep organ weight as a good criterion used in postmortem diagnosis.     

Can Neck Size in Elastase-Induced Aneurysms Be Controlled? A Retrospective Study

BACKGROUND AND PURPOSE: Reproducible animal models with appropriate neck size are crucial for preclinical assessment of aneurysm therapies. Our purpose was to determine whether the neck size of elastase-induced aneurysms could be controlled by adjusting the position of the temporary occlusion balloon. METHODS: Seventy-two elastase-induced aneurysms in rabbits were retrospectively analyzed. Three groups (group 1, n = 35; group 2, n = 32; group 3, n = 5) were defined according to different balloon position (lowest, intermediate, and highest, respectively) related to the origin of right common carotid artery (CCA). Aneurysm sizes in different groups were measured and compared; parent artery dilation was assessed as present or absent. The Wilcoxon rank sum test, the Fisher exact test, and the chi(2) test were used for statistics process. RESULTS: The mean aneurysm neck diameter in group 1 was significantly wider than that in group 2 (P = .0001). The proportion of wide-necked (diameter of neck >4 mm) aneurysms in group 1 was significantly higher than that in group 2 (P = .0011). The mean dome/neck ratio in group 1 was smaller than that of group 2 (P = .0031). Aneurysm width and height and the frequency of parent artery dilation were not different in groups 1 and 2 (P = .43, P = .10, and P = .25). No aneurysms formed in group 3. CONCLUSION: The neck size of elastase-induced aneurysms can be controlled by adjusting the position of the inflated balloon, with balloon positioning that bridges from the CCA to the subclavian/brachiocephalic arteries yielding narrow-necked aneurysms.     

Ganzk?rper-MRT in der ?Study of Health in Pomerania��

Population-based whole-body MRI examinations have been evaluated for the first time within the Study of Health in Pomerania (SHIP). This ongoing cohort study investigates associations of overweight (57.9% of the female and 74.1% of the male population) and obesity (25.1% and 26.0%, respectively) with cardiovascular and metabolic diseases in a population with decreased life expectancy compared to the total German average. Whole-body MRI offers the possibility to evaluate parameters, such as the amount of visceral and liver fat and can contribute to further conclusions on these common diseases.     

A Simulation Study on +Gz Protection Afforded by Extended Coverage Anti-G Suits

为检验所建立的心血管系统仿真模型，对扩大囊覆盖面积抗荷服（ＥＣＧＳ）的囊覆盖面积及压力制度对人体Ｇ耐力及心血管反应的影响进行了仿真实验，得到了与耿喜臣等（１９９６）离心机实验数据基本吻合的结果。仿真结果表明，ＥＣＧＳ比标准抗荷服能显著提高被试者的松弛＋Ｇｚ耐力，且在提高耐力的同时，被试者的心率没有明显增加。仿真揭示出ＥＣＧＳ的抗荷性能主要依赖于其囊下血管及组织的压力传递效率。虽然ＥＣＧＳ的抗荷性能随压力制度的增加显著提高，但抗荷服压力制度高于１０ｋＰａ／Ｇ时，这一上升趋势变缓。     

Familial aggregation of physical activity levels in the Québec Family Study

PURPOSE: Familial aggregation of physical activity phenotypes was investigated in 696 subjects from 200 families of the Quebec Family Study. The mean age of offspring and parents was 27 and 53 yr, respectively. METHODS: The levels of physical activity were estimated using a 3-d diary and a questionnaire dealing with physical activity during the past year. RESULTS: An ANOVA performed on the age and sex adjusted physical activity phenotypes revealed that there were 1.40-1.52 times more variation in physical activity levels between families than within families (0.001 < P < 0.0001), suggesting that physical activity levels aggregate in families. Maximal heritabilities (SEGPATH), adjusted for the degree of spouse resemblance, reached 25%, 16%, 19%, and 17% for the degree of inactivity, time spent in moderate to strenuous physical activities, total level of daily activity, and weekly time spent in the main activity during the previous year, respectively. CONCLUSION: These results suggest that physical activity level is characterized by a significant degree of familial resemblance, and that inactivity has a slightly higher heritability level than moderate to strenuous physical activity or total physical activity phenotypes. The pattern of familial correlations suggests that shared familial environmental factors along with genetic factors are also important in accounting for the familial resemblance in physical activity level.     

Percutaneous Sclerotherapy for Giant Symptomatic Liver Hemangiomas: A Pilot Study

This single-center prospective trial evaluated the safety and efficacy of percutaneous sclerotherapy for liver hemangiomas in 5 patients (1 man, 4 women; mean age 41.2 y) between 2016 and 2017. All patients were symptomatic (4 abdominal pain; 1 early satiety) and refused surgery. A single session of sclerotherapy with 20 cc mixture of 45 IU. Bleomycin in 10 cc distilled water and 10 cc Lipiodol (Ultra Fluide, Guerbet, France) was performed in all patients, achieving a 45.6%–71.1% lesion volume reduction and a 12.9%–41% reduction in the largest diameter of the lesion. Symptoms subsided in all patients during the 5-month follow-up period. Adverse events included a self-limited intraperitoneal hemorrhage in 1 patient.     

The Optional VenaTech? Convertible? Vena Cava Filter: Experimental Study in Sheep

Purpose

Retrieval of optional caval filters may be impaired by filter tilting, migration, fracture, or embedding in the IVC wall. The goal of this experimental study was to evaluate a new optional filter, convertible by unlocking and removing the filter head.

Methods

Forty-nine Pre-Alp sheep (average weight, 55?kg) were anesthetized. IVC was catheterized via the right femoral vein (n?=?46) or via the internal jugular vein (n?=?3) with a 12.9-F sheath. VenaTech^? Convertible^? IVC filters were inserted as either permanent filters (n?=?14)?or as filters to be converted. Conversion was immediately after deployment (n?=?19) or delayed after 1, 3, or 6?months (n?=?20). Filter delivery, deployment, and conversion with measurement of migration and tilting were evaluated by cavography. Incorporation of the filter’s stabilizers and arms in the IVC wall was assessed by gross anatomy.

Results

Delivery system insertion, filter release, and immediate conversion were successful in all cases. Delayed conversion was completed in all but one sheep, due to insufficient snare tension. Complimentary balloon-catheter inflation was required in 12 of 20 delayed conversions to achieve filter opening. In all 49 sheep, no thrombosis, migration, or significant tilting occurred. Within 4?weeks of conversion, the filter’s stabilizers and arms were incorporated into the IVC wall. Upon removal, the filter head was free of intimal growth.

Conclusions

The VenaTech^? Convertible^? optional IVC filter was successfully implanted in all sheep with no migration or tilting. Conversion at various dates by filter head removal was feasible in all but one case.     

Locoregional Therapy of Hepatocellular-Cholangiocarcinoma versus Hepatocellular Carcinoma: A Propensity Score–Matched Study

PurposeTo compare outcomes of unresectable hepatocellular-cholangiocarcinoma (HCC-CC) with hepatocellular carcinoma (HCC) after locoregional therapy (LRT).Materials and MethodsConsecutive patients with histologically confirmed HCC-CC or HCC treated with LRT between 2007 and 2017 were retrospectively reviewed. Ten patients (8 men; median age, 60 y) with 12 HCC-CCs (mean diameter, 4.2 cm ± 1.9; mean number, 3.7 ± 3.3) treated with chemoembolization (n = 6), yttrium-90 radioembolization (n = 2), RF ablation (n = 1), or chemoembolization/RF ablation (n = 1) were compared with 124 patients (92 men; median age, 59 y) with 134 HCCs (mean diameter, 4.8 cm ± 4.0; mean number, 2.6 ± 2.2) treated with chemoembolization (n = 51), yttrium-90 radioembolization (n = 17), RF ablation (n = 41), or chemoembolization/RF ablation (n = 15). Propensity score–matched analysis with conditional logistic regression adjusted for age, sex, LRT modality, tumor-specific features, and Child-Pugh class. Tumor-volume doubling time (TVDT) before LRT and objective response rates were compared by Kruskal-Wallis and Fisher exact test; progression-free survival (PFS) and transplant-free survival (TFS) were compared by Cox proportional hazards model.ResultsOn univariate analysis, HCC-CC was associated with lower median TVDT (2.4 months vs 5.2 months, P = .03), objective response (30% vs 71%, P = .01), and median PFS (2.4 months vs 7.4 months, HR 4.3, 95% CI 2.2–8.4, P < .0001). Propensity score–matched analysis demonstrated greater distant progression (60% vs 30%, P = .003) and significantly shorter median PFS (2.4 months vs 6.0 months, HR 3.3, 95% CI 1.3–8.9, P = .017) for HCC-CC. No significant difference was observed in TFS (7.5 months vs 13.8 months, HR 1.5, 95% CI 0.4–6.1).ConclusionsHCC-CC was associated with reduced PFS and greater distant progression after LRT compared with HCC, indicating a need for adjunctive treatment strategies to improve outcomes.     

Biomechanical Study and Clinical Application of Interference Screw Fixation for Cervical Spine Bone Grafts

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Angioplasty with Stent for Symptomatic Intracranial Stenosis Trial I (ASSIT-Ⅰ) Study

Angioplasty with Stent for Symptomatic Intracranial Stenosis Trial I (ASSIT-Ⅰ) Study     

Palonosetron—A Single-Dose Antiemetic Adjunct for Hepatic Artery Radioembolization: A Feasibility Study

Nausea and vomiting may occur in a significant minority of patients following hepatic artery embolization with yttrium-90 spheres (K. T. Sato et al. Radiology 247:507–515, 2008). This encumbers human and economic resources and undercuts the assertion that it is as a well-tolerated outpatient treatment. A single intravenous dose of palonosetron HCl was administered before hepatic artery embolization with yttrium-90 spheres to ameliorate posttreatment nausea and vomiting, in 23 consecutive patients. The patients were discharged the day of procedure on oral antiemetics, steroids, and blockers of gastric acid release. All patients had clinical and laboratory evaluation at 2 weeks after the procedure. The data were gathered and reviewed retrospectively. At 2-week follow-up, none reported significant nausea, vomiting, additional antiemetic use, need for parenteral therapy, hospital readmission, or palonosetron-related side effects. All patients recovered from postembolization symptoms within a week after treatment. In conclusion, this retrospective study suggests that single-dose palonosetron is feasible, safe, and effective for acute and delayed nausea and vomiting in this group of patients. The added cost may be offset by benefits.     

Study of ECG-gated thallium-201 myocardial scintigraphy: Is imaging time a limiting factor?

Twenty patients underwent gated synchronized ²⁰¹Tl myocardial scanning (TMS). Twelve also performed a rest blood pool multigated acquisition (MUGA) study. A static image was obtained by adding all the gated frames of the study. In this way we found the conventional static study quite unnecessary.Comparing the gated TMS to the static one revealed significantly improved resolution in the gated images and additional information concerning wall motion and myocardial thickness. Close agreement was found with results of MUGA studies of the same patients.By the addition of diastolic frames the imaging time needed to obtain improved image quality was found to be not more than 10 min per view. The exclusion of imaging time as a limiting factor for gated TMS is stressed.     

Yttrium-90 Transarterial Radioembolization for Chemotherapy-Refractory Intrahepatic Cholangiocarcinoma: A Prospective,Observational Study

PurposeTo evaluate the safety and efficacy of yttrium-90 transarterial radioembolization (TARE) for the treatment of unresectable, chemotherapy-refractory intrahepatic cholangiocarcinoma (ICC).MethodsA prospective, observational study was carried out in 10 centers between 2013 and 2017. TARE plus standard care was delivered to patients with unresectable, chemotherapy-refractory or chemotherapy-intolerant ICC. Primary outcome was overall survival. Secondary outcomes included safety, progression-free survival (PFS), and liver-specific progression-free survival (LPFS).ResultsSixty-one patients were treated with TARE. Patients were 53% male; median age was 64 years; 91% had performance status 0/1; 92% had received prior chemotherapy; and 59% had no extrahepatic disease. Median follow-up was 13.9 months (95% confidence interval [CI], 9.6–18.1). Overall survival was 8.7 months (95% CI, 5.3–12.1), and 37% of patients survived to 12 months. PFS was 2.8 months (95% CI, 2.6–3.1), and LPFS was 3.1 months (95% CI, 1.3–4.8). One severe complication (abdominal pain) occurred at the time of the TARE procedure. Thirty patients experienced a total of 49 adverse events, of which 8% were grade ≥3; most common were grade 1–2 fatigue and abdominal pain. A total of 77 abnormal laboratory value events were recorded, of which 4% were grade ≥3.ConclusionsPatients with advanced ICC have limited therapeutic options and a poor prognosis. This prospective study examined the survival of patients with unresectable, chemotherapy-refractory primary ICC treated with TARE in real-world practice. The results demonstrate that this treatment merits further investigation in this patient cohort in a larger study, including collection of patient-reported outcomes.     

Feasibility of Targeting Atherosclerotic Plaques by High-Intensity–focused Ultrasound: An In Vivo Study

PurposeTo investigate the feasibility and acute safety of targeting atherosclerotic plaques by high-intensity–focused ultrasound (US) in vivo through a noninvasive extracorporeal approach.Materials and MethodsFour swine were included in this prospective study, three of which were familial hypercholesterolemic swine. The procedure was done under general anesthesia. After US identification of atherosclerotic plaques within the femoral arteries, plaques were targeted by high-intensity focused US with an integrated dual-mode US array system. Different ablation protocols were used to meet the study objectives, and animals were then euthanized at different time points. Targeted arterial segments were stained by hematoxylin and eosin for histopathologic examination. Numeric values are presented as means ± standard deviation.ResultsAll swine tolerated the procedure well, with no arterial dissection, perforation, or rupture. Discrete lesions were detected in the first two swine, measuring 0.54 mm ± 0.10 and 0.25 mm ± 0.03 in cross-sectional dimensions in the first and 0.50 mm ± 0.12 and 0.24 mm ± 0.15 in the second. Confluent ablation zones were identified in the last two swine, measuring 6.92 mm and 0.93 mm in the third and 2.97 mm and 2.52 mm in the fourth. Lesions showed necrotic cores and peripheral reactive inflammatory infiltration. The endothelium overlying targeted arterial segments remained intact.ConclusionsThe results demonstrate the feasibility and acute safety of targeting atherosclerotic plaques by high-intensity–focused US in vivo. Further long-term studies are needed to assess how induction of these lesions can modify the progression of atherosclerotic plaques.