The Effects of Unilateral and Bilateral Battle Rope Exercise on the Lower Extremity Joint Force: A Pilot Study

The battle rope exercise recently has increased its popularity due to cross fit gyms implementing it into the workout programs. Individuals use this workout to strengthen their upper body, however it is unknown how different modalities of using the battle ropes affects the lower extremity joint force required to stabilize the body. PURPOSE: To examine the effects of unilateral and bilateral battle ropes exercises on lower extremity joint force. METHODS: Subjects performed four bilateral battle rope trials and four unilateral battle rope trials. The trials consisted of twenty seconds of continuous activity with three minutes of rest in between during a single visit to the lab. Lower extremity joints were tracked using a Qualisys motion capture system and Bertec force platforms. Joint force data (normalized to body mass) and ground reaction force (reported in Newtons, both in the medial-lateral axis) were analyzed in the down phase of the movement (from peak rope height to the bottom of the motion). RESULTS: There was decreased lateral force in the hip joint during the bilateral exercise for the left hip (0.601BM) and the right hip (0.586BM) compared to the unilateral (0.803BM and 0.614BM, respectively). However, the knee and ankle showed decreased lateral force during the unilateral exercise (0.376BM and 0.200BM for the left and right knee, respectively and 0.829BM and 1.052BM for the left and right ankle respectively) compared to the bilateral exercise (0.569BM and 0.336BM for the left and right knee, respectively and 1.047BM and 1.145BM for the left and right ankle, respectively). The bilateral exercise showed increased medially-directed forces in the right limb (133.4N) and left limb (148.7N) -compared to the unilateral (109.3N and 110.1N, respectively). CONCLUSION: The results show a discrepancy in terms of medial-lateral joint force. The unilateral exercise shows increased lateral stress on the hip joints while the bilateral shows an increased lateral stress on the ankle and knee. During unilateral exercises, the non-active side (side without the moving arm) hip and knee show increased lateral forces while the active-side ankle shows increased lateral forces. Lower extremity joint position should be considered when using these activities due to their impact on joint force experienced in the lower extremities

Comparing Knee Kinetics and Muscular Activity between the Barbell Squat and Flywheel Squat in Recreationally Trained Females

Previous literature has supported flywheel (FW) training with inducing muscular size and strength comparable to resistance training with free weights. However, it remains unclear how the biomechanical demands of these two training methods differ regarding reducing the risk of load-dependent injuries. PURPOSE: With the growing population of female astronauts, this study aimed to compare knee joint kinetics and muscle activation when squatting to full depth on the barbell back (BB) squat and a gravity-independent FW device utilizing technology to be deployed in future long-term space missions. METHODS: Twenty recreationally trained females (22.3 ± 2.7 yrs, 1.6 ± 0.1 m, 59.8 ± 6.8 kg) with at least two years of experience in BB squat training participated in this study. The first session involved one-repetition maximum (1RM) testing on the BB squat and familiarizing the participants with squatting on the FW device (YoYo ™ Multigym). In session two, the participants conducted: 1) one set of seven repetitions at 83% of their 1 RM in the BB and 2) one set of seven maximal repetitions on the FW training device using an inertial load of 0.100 kg ⋅ m2. The order of the exercises in session two was randomized. Three-dimensional motion capture, force platforms, and electromyography assessed knee joint moments and muscle activation on the participants\u27 dominant limb. Paired t-tests were conducted to compare these variables, with a significance set at p ≤ 0.05. RESULTS: Analysis revealed peak knee extensor moments were greater in the BB squat (BB: 2.14 ± 0.36 Nm/kg, p = 0.004; FW: 1.94 ± 0.06 Nm/kg). The BB squat elicited greater mean muscle activity over the set compared to FW squats in the following: (vastus lateralis: +5.68%, p = 0.015; bicep femoris: +4.63%, p \u3c 0.001; gluteus maximus: +4.67%, p = 0.024; gluteus medius: +2.75%, p = 0.011; gastrocnemius lateralis: +3.09%, p = 0.028; gastrocnemius medius: +2.48%, p = 0.024). However, FW squats attained greater tibialis anterior activity (+5.56%, p = 0.04). There was no significant difference in muscle activity observed in the rectus femoris and vastus medialis. CONCLUSION: Although FW training requires less mechanical demand on the knee extensors when squatting to similar depths, participants achieved greater muscular activation during the BB squat

adolescents and young adults with cancer care in asia the joint esmo siope siop asia survey

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Immunohistochemical Profile for Unknown Primary Adenocarcinoma

BACKGROUND: Development of tailored treatment based on immunohistochemical profiles (IPs) of tumors for cancers of unknown primary is needed. METHODOLOGY/PRINCIPAL FINDINGS: We developed an algorithm based on primary known adenocarcinoma for testing sensitivity and specificity. Formalin-fixed paraffin-embedded tissue samples from 71 patients of unfavorable subsets of unknown primary adenocarcinoma were obtained. We examined 15 molecular markers using the algorithm incorporating these IPs and classified the tumours into 9 subsets based on the primary tumour site. The sensitivity and specificity of this algorithm were 80.3% and 97.6%, respectively. Apparent primary sites were lung in 17 patients, digestive organs in 13, gynecological organs in 9, prostate in 7, liver or kidney in 6, breast in 4, urothelial organ in 2, biliary tract and pancreatic profile in none, and unclassified in 13. The response rate to chemotherapy was highest for the gynecological IPs. Patients with gynecological or lung cancer IPs had longer median progression-free survival than those with others: 11.2 months for gynecological IPs (p<0.001) and 6.8 months for lung IPs (p = 0.05). Lung, digestive, prostate, and gynecological profiles were associated with significantly longer median survival time than the other profiles. Multivariate analysis confirmed that the IPs were independent prognostic factors for survival. CONCLUSIONS/SIGNIFICANCE: The IPs identified in this study can be used to further stratify patient prognosis for unfavorable subsets of unknown primary adenocarcinoma

Avelumab alone or in combination with chemotherapy versus chemotherapy alone in platinum-resistant or platinum-refractory ovarian cancer (JAVELIN Ovarian 200): an open-label, three-arm, randomised, phase 3 study

BACKGROUND: Most patients with ovarian cancer will relapse after receiving frontline platinum-based chemotherapy and eventually develop platinum-resistant or platinum-refractory disease. We report results of avelumab alone or avelumab plus pegylated liposomal doxorubicin (PLD) compared with PLD alone in patients with platinum-resistant or platinum-refractory ovarian cancer. METHODS: JAVELIN Ovarian 200 was an open-label, parallel-group, three-arm, randomised, phase 3 trial, done at 149 hospitals and cancer treatment centres in 24 countries. Eligible patients were aged 18 years or older with epithelial ovarian, fallopian tube, or peritoneal cancer (maximum of three previous lines for platinum-sensitive disease, none for platinum-resistant disease) and an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients were randomly assigned (1:1:1) via interactive response technology to avelumab (10 mg/kg intravenously every 2 weeks), avelumab plus PLD (40 mg/m2 intravenously every 4 weeks), or PLD and stratified by disease platinum status, number of previous anticancer regimens, and bulky disease. Primary endpoints were progression-free survival by blinded independent central review and overall survival in all randomly assigned patients, with the objective to show whether avelumab alone or avelumab plus PLD is superior to PLD. Safety was assessed in all patients who received at least one dose of study treatment. This trial is registered with ClinicalTrials.gov, NCT02580058. The trial is no longer enrolling patients and this is the final analysis of both primary endpoints. FINDINGS: Between Jan 5, 2016, and May 16, 2017, 566 patients were enrolled and randomly assigned (combination n=188; PLD n=190, avelumab n=188). At data cutoff (Sept 19, 2018), median duration of follow-up for overall survival was 18·4 months (IQR 15·6-21·9) for the combination group, 17·4 months (15·2-21·3) for the PLD group, and 18·2 months (15·8-21·2) for the avelumab group. Median progression-free survival by blinded independent central review was 3·7 months (95% CI 3·3-5·1) in the combination group, 3·5 months (2·1-4·0) in the PLD group, and 1·9 months (1·8-1·9) in the avelumab group (combination vs PLD: stratified HR 0·78 [repeated 93·1% CI 0·59-1·24], one-sided p=0·030; avelumab vs PLD: 1·68 [1·32-2·60], one-sided p>0·99). Median overall survival was 15·7 months (95% CI 12·7-18·7) in the combination group, 13·1 months (11·8-15·5) in the PLD group, and 11·8 months (8·9-14·1) in the avelumab group (combination vs PLD: stratified HR 0·89 [repeated 88·85% CI 0·74-1·24], one-sided p=0·21; avelumab vs PLD: 1·14 [0·95-1·58], one-sided p=0·83]). The most common grade 3 or worse treatment-related adverse events were palmar-plantar erythrodysesthesia syndrome (18 [10%] in the combination group vs nine [5%] in the PLD group vs none in the avelumab group), rash (11 [6%] vs three [2%] vs none), fatigue (ten [5%] vs three [2%] vs none), stomatitis (ten [5%] vs five [3%] vs none), anaemia (six [3%] vs nine [5%] vs three [2%]), neutropenia (nine [5%] vs nine [5%] vs none), and neutrophil count decreased (eight [5%] vs seven [4%] vs none). Serious treatment-related adverse events occurred in 32 (18%) patients in the combination group, 19 (11%) in the PLD group, and 14 (7%) in the avelumab group. Treatment-related adverse events resulted in death in one patient each in the PLD group (sepsis) and avelumab group (intestinal obstruction). INTERPRETATION: Neither avelumab plus PLD nor avelumab alone significantly improved progression-free survival or overall survival versus PLD. These results provide insights for patient selection in future studies of immune checkpoint inhibitors in platinum-resistant or platinum-refractory ovarian cancer. FUNDING: Pfizer and Merck KGaA, Darmstadt, Germany

Avelumab Alone or in Combination With Chemotherapy Versus Chemotherapy Alone in Platinum-Resistant or Platinum-Refractory Ovarian Cancer (JAVELIN Ovarian 200): An Open-Label, Three-Arm, Randomised, Phase 3 Study

The majority of patients with ovarian cancer will experience relapse and develop platinum-resistant disease after being treated with frontline platinum-based chemotherapy. Treatment options for platinum-resistance or platinum-refractory disease are very limited, usually involving nonplatinum chemotherapy, and they are associated with poor objective response rates and life expectancy

Dabrafenib plus trametinib in BRAFV600E-mutated rare cancers:the phase 2 ROAR trial

BRAFV600E alterations are prevalent across multiple tumors. Here we present final efficacy and safety results of a phase 2 basket trial of dabrafenib (BRAF kinase inhibitor) plus trametinib (MEK inhibitor) in eight cohorts of patients with BRAFV600E-mutated advanced rare cancers: anaplastic thyroid carcinoma (n = 36), biliary tract cancer (n = 43), gastrointestinal stromal tumor (n = 1), adenocarcinoma of the small intestine (n = 3), low-grade glioma (n = 13), high-grade glioma (n = 45), hairy cell leukemia (n = 55) and multiple myeloma (n = 19). The primary endpoint of investigator-assessed overall response rate in these cohorts was 56%, 53%, 0%, 67%, 54%, 33%, 89% and 50%, respectively. Secondary endpoints were median duration of response (DoR), progression-free survival (PFS), overall survival (OS) and safety. Median DoR was 14.4 months, 8.9 months, not reached, 7.7 months, not reached, 31.2 months, not reached and 11.1 months, respectively. Median PFS was 6.7 months, 9.0 months, not reached, not evaluable, 9.5 months, 5.5 months, not evaluable and 6.3 months, respectively. Median OS was 14.5 months, 13.5 months, not reached, 21.8 months, not evaluable, 17.6 months, not evaluable and 33.9 months, respectively. The most frequent (=20% of patients) treatment-related adverse events were pyrexia (40.8%), fatigue (25.7%), chills (25.7%), nausea (23.8%) and rash (20.4%). The encouraging tumor-agnostic activity of dabrafenib plus trametinib suggests that this could be a promising treatment approach for some patients with BRAFV600E-mutated advanced rare cancers. ClinicalTrials.gov registration: .Y