自身免疫性胰腺炎的18F-FDG PET/CT影像学特点

目的 探讨18F-FDG PET/CT在自身免疫性胰腺炎(AIP)诊断中的影像学特点及应用价值.方法 回顾性分析2005年至2012年6例AIP患者[均为男性,51～78(平均69)岁]治疗前的18 F-FDG PET/CT影像学特征(其中2例具备激素治疗前后的PET/CT影像资料).目测分析判定胰腺形态异常,并以肝脏为标准对胰腺放射性摄取进行评分(高于肝脏为3分,与肝脏近似为2分,低于肝脏为1分).半定量分析测定常规及延迟显像的胰腺SUV,并采用SPSS 17.0软件将延迟显像前后的SUV进行配对t检验.结果 6例AIP患者胰腺均表现为弥漫性增大,放射性摄取均呈弥漫斑片状分布,其中5例为3分,1例为2分,SUVmax3.2～6.0(5.2±1.1);5例延迟显像中,4例SUVmax增高,1例保持不变,延迟后SUVmax5.3～7.2,延迟显像前后SUVmax差异无统计学意义(4.8～6.0:t =-2.424,P＞0.05).5例出现胰腺外异常摄取,以颌下腺为著.2例治疗后显像者其胰腺均缩小,胰腺及胰腺外摄取灶SUV恢复正常.结论 18F-FDG PET/CT能够反映AIP胰腺和胰腺外代谢活性异常及治疗前后的病灶代谢变化,有助于AIP的诊断、鉴别诊断及疗效评价.     

自身免疫性胰腺炎的18F-FDG PET-CT全身影像分析

目的探讨PET-CT检查在AIP诊断及全身评估中的作用。方法回顾性分析2010年08月～2011年12月在我院行18F-FDG PET-CT全身检查的自身免疫性胰腺炎患者5例,所有患者均行全身PET-CT常规及胰腺延迟扫描。结果 5例AIP患者均为男性,年龄42～71岁,平均54.2岁。4例表现为胰腺弥漫性肿大,1例为节段性肿大,病变部位FDG条状摄取增高,SUVmax平均4.38±1.05,延迟扫描后SUVmax进一步升高SUVmax平均5.31±1.26,3例可见胰周少量炎性渗出。5例患者发现有胰腺外的病灶:4例出现淋巴结肿大,其中3例肿大淋巴结伴FDG摄取增高;合并涎腺肿大伴代谢增高者3例;合并胆管炎改变者3例;合并间质性肺炎者3例;4例患者前列腺出现不均匀FDG摄取增高。结论 AIP是一种系统性疾病,18F-FDG PET-CT在显示胰腺病灶的同时可以更好地发现胰外器官受累,在AIP的诊断和全身情况评估中发挥独特的作用。     

IgG4相关性疾病的18F-FDGPET／CT全身显像

目的：分析IgG4相关性疾病（IgG4 related disease,IgG4RD）全身PET/CT表现特点,提高对该病的认识及诊断,指导临床诊治。方法回顾性分析14例IgG4相关性疾病患者（男性12例,女性2例,年龄43-75岁,中位年龄59岁的18F-FDG全身PET/CT图像资料,分析受累脏器的形态、密度和18F-FDG葡萄糖代谢改变。结果14例患者血清IgG4水平均增高,（970．14±950．70）mg/dl（136-3690mg/dl）,18F-FDG全身PET/CT显像显示IgG4RD患者多个脏器受累：12例（85．7％）胰腺受累,表现为胰腺弥漫性或阶段性肿大,FDG摄取增高;9例（62．3％）唾液腺受累,表现为单侧或双侧唾液腺饱满、肿大,FDG摄取增高;6例（42．9％）胆管系统受累,表现为肝内外胆管轻度扩张,管壁轻度增厚,沿胆管FDG索条样摄取增高;12例男性患者中7例（58．3％）前列腺受累,表现为前列腺单侧叶或双侧叶FDG摄取增高;另还可见甲状腺（5例）、肺部（4例）、肠道（4例）、大动脉（2例）、肾脏（1例）受累改变。结论IgG4RD是一种全身性、系统性的疾病,18F-FDGPET/CT很好地显示了IgG4RD全身器官受累的形态和代谢改变,有利于IgG4RD的诊断和全身评估。     

18F-FDG PET/CT在黑色素瘤中的应用价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT显像在黑色素瘤诊断、临床分期及监测治疗后肿瘤复发与转移灶中的应用价值.方法 黑色素瘤患者61例,均进行18F-FDG PET/CT全身显像.所有PET、CT及PET/CT融合图像均通过融合软件进行帧对帧对比分析.肿瘤病灶根据病理学检查、多种影像学检查及临床随访结果诊断.结果 18F-FDG PET/CT显像对黑色素瘤病灶检出的灵敏度、特异性和准确性分别为90.9%(40/44)、88.2%(15/17)和90.2%(55/61).其中12例治疗前患者中,18F-FDG PET/CT显像诊断的灵敏度为83.3%(10/12).在黑色素瘤病灶局部切除、尚未进行其他治疗的9例患者中,5例残余病灶18F-FDG PET/CT显像检出3例;4例远处转移灶患者全被检出,提高了临床分期,改变了治疗方案.首先发现转移性黑色素瘤病灶并且手术切除后,寻找原发灶的7例患者中,18F-FDG PET/CT检出原发灶2例,4例其他转移灶全被检出.黑色素瘤患者根治术后监测肿瘤复发或转移患者33例,18F-FDG PET/CT显像灵敏度、特异性和准确性分别为100.0%(19/19)、85.7%(12/14)和93.9%(31/33).与同期临床其他影像学检查比较,18F-FDG PET/CT显像发现更多,33例患者中,16例(48.5%)病灶提高临床分期;7例(21.2%)排除可疑病灶,降低临床分期;10例(30.3%)检出病灶与临床一致.结论 18F-FDG PET/CT显像对于黑色素瘤的诊断,残余病灶、复发病灶及转移灶的检出,临床分期的明确具有重要价值.     

18F-FDG PET/CT显像联合HRCT对孤立性原发肺浸润性黏液腺癌的诊断价值

目的探讨孤立性原发肺浸润性黏液腺癌18F-FDG PET/CT显像和HRCT征象及两者联合对该病的诊断价值。方法回顾性分析经病理证实为浸润性黏液腺癌、有18F-FDG PET/CT双时相显像及病灶层面同机HRCT扫描资料的9例患者,对PET/CT早期、延迟显像及滞留指数、HRCT征象进行综合分析。结果HRCT图像上表现为2例呈实性结节、病灶周围无类似卫星灶样影,6例实性结节周围伴小点片及磨玻璃样影,1例为单纯磨玻璃样结节;分叶征(6例)、血管集束征(6例)、支气管充气征(4例)、空泡征(2例)、毛刺征(1例);18F-FDG PET/CT融合图像上8例病灶表现为不均匀FDG代谢增高,早期显像平均SUVmax为3.2±2.5,延迟现象SUVmax增高6例、降低2例,平均SUVmax为3.5±2.4,平均滞留指数为(10.4±29.3)%,9例均未见纵隔、双侧肺门淋巴结及其他部位转移征象,其18F-FDG PET/CT融合图像上18F-FDG摄取与HRCT相匹配,18F-FDG摄取相对集中于结节的实性区域,病灶磨玻璃区18F-FDG摄取不明显;综合手术病理结果等临床资料证实,9例均为T1N0M0期,与PET/CT分期一致。结论对于影像学检查发现肺孤立性占位患者,在单一影像学检查难以明确诊断的情况下,18F-FDG PET/CT双时相显像上病灶不均匀18F-FDG摄取相对集中于其实性区域的代谢方式与HRCT相联合,可辅助孤立性原发性肺浸润性黏液腺癌的诊断。     

噬血细胞综合征的18F-FDG PET/CT影像学特点

目的探讨噬血细胞综合征的18F-FDG PET/CT显像的影像学特点。方法回顾性分析我院7例HLH临床资料和18F-FDG PET/CT影像资料。结果 7例患者均因不明原因发热入院,7例患者均符合HLH诊断指南2004修订版的标准。肝脏增大4例,3例合并FDG摄取增高,脾脏增大6例,5例合并FDG摄取增高,2例出现全身多发淋巴结增大并FDG摄取增高,2例表现为脑皮质FDG摄取弥漫性减低,6例出现肺部改变(肺炎、肺不张、胸腔积液等)。结论认识该疾病的18F-FDG PET/CT影像表现,有助于提高该疾病的诊断率。     

11C-胆碱对18F-FDG PET/CT显像诊断鼻咽癌和肝细胞肝癌的补充价值

目的 探讨11C-胆碱(CHO) PET/CT对18F-FDG PET/CT显像诊断鼻咽癌(NPC)和HCC的补充价值.方法 将明确诊断的NPC和HCC患者纳入该研究.该研究经医院伦理委员会通过,患者均签署知情同意书.2007年12月至2010年1月,15例局部进展型NPC和76例HCC患者均行18 F-FDG PET/CT显像,其中43例(15例NPC和28例HCC)同时行局部11C-CHO PET/CT显像.病灶处出现18 F-FDG或11C-CHO高摄取者为阳性.半定量分析采用SUVmax、肿瘤/脑(T/B)比值和肿瘤/肝(T/L)比值等指标.统计学分析采用两样本t检验、x2检验、Fisher确切概率法和直线相关分析.结果 (1)在15例局部进展型NPC患者中,病灶处18F-FDG SUVmax明显高于11 C-CHO SUVmax (12.81 ±5.00与6.84±2.76;t =6.416,P＜0.01),但11C-CHO PET/CT显像T/B比值明显高于18F-FDG PET/CT显像(18.62±7.95与1.38±0.59;t=8.801,P＜0.01).2种显像剂在病灶处的摄取结果明显相关(r =0.712,P＜0.01).与18F-FDG PET/CT显像比较,11C-CHO显像改进了50.0％(12/12与6/12;x2=8.000,P＜0.05)患者颅内侵犯病灶、4/14患者颅底侵犯病灶和3/3患者眼眶侵犯病灶的显示.(2)在76例HCC患者中,63.1％ (48/76)的患者18F-FDG PET/CT显像阳性.在28例18 F-FDG PET/CT显像阴性者中,71.4％ (20/28)的患者11C-CHO PET/CT显像阳性.18F-FDG联合11C-CHO使PET/CT诊断HCC的灵敏度从63.1％(48/76)提高到89.5％ (68/76;x2=14.559,P＜0.01).与18F-FDG PET/CT显像比较,11C-CHO PET/CT显像倾向易于检出高分化HCC[6/9与35.7％(5/14);P =0.214];在检测中分化HCC方面,两者差异无统计学意义[6/7与72.0％(18/25),P=0.648].11C-CHO PET/CT显像在检测直径＜5.0 cm的HCC方面较18 F-FDG PET/CT显像灵敏[72.7％ (16/22)与42.1％ (16/38);x2=5.249,P＜0.05],特别是＜2.0 cm病灶[5/7与0/7;P=0.021].结论 11C-CHO与18F-FDG相结合可提高PET/CT对局部进展型NPC T分期诊断的准确性.11C-CHO可弥补18F-FDG显像在高中分化HCC诊断中的不足,从而提高PET/CT的诊断灵敏度.     

18氟-脱氧葡萄糖和11碳-乙酸PET/CT显像在原发性肝癌及肝脏肿瘤样病变诊断中的初步研究

目的探讨18氟-脱氧葡萄糖(18 F-fluorodexyoxyglucose,18F-FDG)和11碳-乙酸(11 C-acetate,11 C-ACT)PET/CT显像在原发性肝癌及肝脏肿瘤样病变诊断中的作用。方法回顾性分析9例患者资料,其中男性7例,女性2例,平均年龄70.2岁,所有患者均为肝内单发病灶。治疗前均先行18 F-FDG PET/CT,后行11 C-ACT PET/CT检查,两次检查间隔时间不超过1周。其中有7例肝细胞肝癌(hepatocelluar carcinoma,HCC)、1例胆管细胞癌(cholangiocarcinoma,CCC)、1例肝内感染性病灶,均经病理学或临床随访证实。结果 7例HCC患者18 F-FDG PET/CT显像均为阴性,11 C-ACT PET/CT显像有6例为阳性。18F-FDG PET/CT和11 C-ACT PET/CT显像均未发现1例高分化胆管细胞癌。对于1例肝内炎性病灶,18F-FDG PET/CT显像为阳性,而11 C-ACT PET/CT显像为阴性。结论①11 C-ACT PET/CT显像可以用来探测那些呈18 F-FDG等或低摄取的HCC病灶;②对于高分化的CCC,18 F-FDG PET/CT显像有可能会表现为假阴性结果;③11 C-ACT PET/CT显像可以用来诊断肝内感染性病灶。     

18F-FDG PET/CT对高18F-FDG摄取肝细胞肝癌经动脉插管化疗栓塞的疗效评价

目的 探讨18F-FDG PET/CT对高18F-FDG摄取的原发性HCC经动脉插管化疗栓塞术(TACE)治疗后的疗效评价价值.方法 回顾性分析24例经临床证实、且18F-FDG代谢增高的原发性HCC,经TACE治疗后行PET/CT复查的患者资料,其中男21例,女3例,年龄为40～75(平均58.1)岁.患者均在治疗后1～2个月行肝脏局部18F-FDG PET/CT复查,观察病灶治疗后18F-FDG的代谢变化.将病灶区的FDG SUVmax高于周围正常肝实质者定义为病理性的FDG代谢.以PET/CT复查后随访(临床症状、AFP、PET/CT检查结果)3个月结果为标准,计算复查对残留肿瘤组织的诊断效能,并采用x2检验分析PET/CT与AFP诊断效能的差异.结果 24例中有9例呈FDG代谢减低区(相对于正常肝实质而言),提示无残留肿瘤组织;11例仍呈FDG代谢增高,但代谢活性较治疗前降低,提示残留肿瘤组织;2例FDG代谢等同于正常肝组织,但随访证实为肿瘤残留;1例病灶FDG代谢活性较治疗前增高,提示病情进展;1例由于高密度碘油的过度衰减校正导致假阳性.18F-FDG PET/CT评价原发性HCC TACE治疗后残留病灶的灵敏度及准确性分别为100％ (14/14)、95.8％ (23/24),与单独以血清AFP为评价指标的灵敏度(71.4％,10/14)及准确性(70.8％,17/24)之间的差异有统计学意义(x2=6.56和4.18,均P＜0.05).结论 18F-FDG PET/CT对摄取18 F-FDG的原发性HCC患者的TACE治疗疗效评价有较大价值,可提供残留病灶的准确位置,为临床确定后续的治疗方案提供依据.     

18F-FDG PET/CT在继发性肾淋巴瘤与肾脏免疫性疾病鉴别诊断中的价值

目的 探讨18F-氟脱氧葡萄糖（FDG ）PET/CT对继发性肾淋巴瘤（SRL）的诊断价值,并与肾脏免疫性疾病（RID）进行鉴别分析。 方法 回顾性分析2017年12月至2020年12月于天津市第一中心医院行18F-FDG PET/CT检查并经组织病理学检查证实或临床综合诊断确诊的12例SRL患者的临床和影像学资料,其中男性7例、女性5例,年龄（50±15）岁,设为SRL组。同时选取18F-FDG PET/CT显像阳性、最终诊断为RID的患者10例,其中IgG4相关性肾病2例、肾抗中性粒细胞胞浆抗体相关性血管炎8例;男性5例、女性5例,年龄（60±10）岁,设为RID组。选取18F-FDG PET/CT显像肾脏正常的健康受检者10例,其中男性5名、女性5名,年龄（55±10）岁,设为正常对照组。观察和记录肾脏以及肾外组织受累的18F-FDG PET/CT影像学表现,测量并计算肾脏病变或肾皮质最大标准化摄取值（SUV_max）、肾脏病变或肾皮质SUV_max与肝脏平均标准化摄取值（SUV_mean）的比值（SUV _ratio）及肾外受累组织SUV_max。3组受检者SUV_max、SUV_ratio的比较采用单因素方差分析,SRL组与RID组肾外受累病变18F-FDG摄取SUV_max的比较采用独立样本t检验。 结果 12例SRL患者中,受累肾脏18F-FDG PET/CT显像表现为双侧肾脏多发结节与肿物型6例,肾脏弥漫性肿胀型6例,病变摄取18F-FDG均异常增高。10例RID患者中,受累肾脏18F-FDG PET/CT显像均表现为双肾弥漫性肿胀型,肾实质弥漫性18F-FDG摄取增高,与肾脏弥漫性肿胀型SRL表现相似。在肾外受累病变方面,RID组多有常见好发的累及部位,SRL组多伴全身不同组织脏器的受累,分布无规律性。SRL组患者肾脏病变的SUV_max、SUV_ratio显著高于RID组（21.88±12.04对9.09±3.51、11.38±6.52对3.67±1.12）,2组肾脏病变的SUV_max、SUV_ratio亦均显著高于正常对照组（SUV_max=3.23±0.39、SUV _ratio=1.47±0.25）,且差异均有统计学意义（F=17.189、18.361,均P<0.001）。SRL组肾外受累病变的SUV_max明显高于RID组（27.67±15.09对7.55±3.70）,且差异有统计学意义（t=?3.889,P=0.001）。 结论 18F-FDG PET/CT对SRL的诊断和全身受累范围的评估有较好的临床应用价值,且有助于与RID的鉴别。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.