Single-Leg Squat Performance is Impaired 1 to 2 Years After Hip Arthroscopy

Objective: To evaluate single-leg squat performance 1-2 years after arthroscopy for intra-articular hip pathology compared with control subjects and the nonsurgical limb, and to investigate whether single-leg squat performance on the operated limb was associated with hip muscle strength

Hormones, muscles and oncological outcome in men with rectal cancer

Paper I. The aim was to elucidate if testosterone (T) dose-dependently increase muscle size in abdomen and pelvis, analogous to the known anabolic influence on appendicular muscles. Participants were young (age 18-50) healthy men participating in the 5a-reductase trail, a double blinded RCT. Endogenous T production was supressed and replaced with four dosages (50, 125, 300, or 600 mg) of T enanthate. Magnetic Resonance Imaging scans from baseline and end of study was used to analyse change in muscle areas of the lower trunk and pelvis. The estimated change (95% CI) of muscle area increase per 100 mg of T enanthate dosage increase was 0.622 cm2 (0.394, 0.850) for psoas; 1.789 cm2 (1.317, 2.261) for paraspinal muscles; 2.530 cm2 (1.627, 3.434) for total abdominal muscles; 0.455 cm2 (0.233, 0.678) for obturator internus; 0.082 cm2 (0.003, 0.045) for ischiocavernosus. Areas were also associated on-treatment T and free T levels. In conclusion, the abdominal and pelvic muscle are responsive to T administration, opening up for future studies regarding T treatment in frail men with risk for falls and men with pelvic dysfunction. Paper II. Preoperative radiotherapy (RT) is used in treatment of rectal cancer (RC) to enhance local control. Acute testicular failure with risk for permanent damage to T production is a less known adverse effect of RT. The aim was to elucidate long-term effects on T production, and the association of elevated luteinizing hormone (LH) and cancer recurrence. This was a longitudinal prospective cohort study including men with rectal- or prostate cancer stage I-III. Exposure was RT, quantified by mean cumulative testicular dose (TD). Testicular function was assessed by sampling of T, LH and follicle stimulating hormone (FSH) at baseline and at follow-ups after one and two years. Exposed men were additionally sampled preoperatively. Within two years after surgery, T levels recovered, but LH and FSH levels were significantly higher in exposed. Changes in LH and FSH were related to TD. Elevated LH one year after surgery inferred an incidence rate ratio for cancer recurrence in five years of 3·19 (95% C.I.: 0·97-11.2, mid-p=0·036). Paper III. The aim was to analyse the impact of RT induced primary testicular failure on severe postoperative adverse events (AE, Clavien-Dindo grade 3+) in men treated for RC. 104 men were included from the previous cohort study. T and LH were sampled at baseline and after RT. The association between of primary testicular failure and severe postoperative AE was analysed using longitudinal regression. 25% had severe postoperative AE (AE+). Baseline data did not differ significantly between groups. The AE+ group had comparably higher LH/T-ratio after RT. 0.603 (0.2-2.5) vs 0.452 (0.127-5.926, p=0.035). The longitudinal regression analysis found that preoperative change in T (OR 0.844, 95% CI 0.720-0.990, p=0.034), LH/T-ratio (OR 2.020, 95% CI 1.010-4.039, p=0.047) and low T (<8 nmol/L, OR 2.605, 95 CI 0.951-7.139, p=0.063) were associated to severe postoperative AE. Preoperative RT induced decline in T seems to be a risk factor for severe postoperative AE in men with RC. Paper IV. Sarcopenic signs have been related to worse cancer specific survival and the skeletal muscles in men are sensitive to T. The effect of RT induced testicular failure may therefore be of importance in men treated for RC. Based on the cohort study in Paper II, 102 men with RC were included. Using CT or MRI scans from routine examinations at baseline and one year after surgery, skeletal muscle (SM) area at 3rd lumbar vertebra was measured. Testicular function was evaluated by measurement of serum T and LH. The association between change in T (and calculated free T) and SM as well as systemic cancer recurrence and SM were analyzed. Change in free T level is associated with change in psoas major area (p=0.005) and abdominal muscle area (p<0.001). Systemic cancer recurrence was associated with changes in total SM area (-5.96 (-10.7 - -1.24) cm2, p=0.013). In conclusion, Abdominal and pelvic muscles are as androgen sensitive as appendicular muscles, and impaired testicular endocrine function due to RT impacts muscle area. Preoperative decrease in T increase risk of severe postoperative AE. Elevated LH and decreased muscle area are associated with systemic cancer disease

A comparison of multidisciplinary team residential rehabilitation with conventional outpatient care for the treatment of non-arthritic intra-articular hip pain in UK Military personnel:a protocol for a randomised controlled trial

BACKGROUND: Non-arthritic hip disorders are defined as abnormalities of the articulating surfaces of the acetabulum and femur before the onset of osteoarthritis, including intra-articular structures such as the acetabular labrum and chondral surfaces. Abnormal femoroacetabular morphology is commonly seen in young men who constitute much of the UK military population. Residential multidisciplinary team (MDT) rehabilitation for patients with musculoskeletal injuries has a long tradition in the UK military, however, there are no studies presenting empirical data on the efficacy of a residential MDT approach compared with individualised conventional outpatient treatment. With no available data, the sustainability of this care pathway has been questioned. The purpose of this randomised controlled trial is to compare the effects of a residential multidisciplinary intervention, to usual outpatient care, on the clinical outcomes of young active adults undergoing treatment for non-arthritic intra-articular hip pain. METHODS/DESIGN: The trial will be conducted at the Defence Medical Rehabilitation Centre, Headley Court, UK. One hundred military male participants with clinical indicators of non-arthritic intra-articular hip pain will be randomly allocated to either: (1) 7-day residential multidisciplinary team intervention, n = 50; (2) 6-week physiotherapist-led outpatient intervention (conventional care), n = 50. Measurements will be taken at baseline, post-treatment (1-week MDT group; 6-weeks physiotherapy group), and 12-weeks. The primary outcome measures are the function in daily living sub-scale of the Copenhagen Hip and Groin Outcome Score (HAGOS), the physical function subscale of the Non-arthritic Hip Score (NAHS), and VAS pain scale. Secondary outcomes include objective measures of physical capacity and general health. An intention-to-treat analysis will be performed using linear and mixed models. DISCUSSION: This study will be the first to assess the efficacy of intensive MDT rehabilitation, versus conventional outpatient care, for the management of non-arthritic hip pain. The results from this study will add to the evidence-base and inform clinical practice for the management of intra-articular non-arthritic hip pain and femoroacetabular impingement in young active adults. TRIAL REGISTRATION: ISRCTN Reference: ISRCTN 59255714 dated 11-Nov-2015 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12891-016-1309-z) contains supplementary material, which is available to authorized users

Strategic use of crutching and dicyclanil to protect unmulesed sheep against breech strike

Objective To test strategies for the application of dicyclanil and mid-season crutching to maximise protection of unmulesed sheep against breech strike. Procedure Three hundred and eighty unmulesed Merino weaners were randomly allocated to four groups either left untreated or treated by different strategies with 50 g/L dicyclanil. Treatments included breech treatment alone and breech plus body treatment, with two application times, immediately after shearing and 6 weeks after crutching or shearing. To assess protection, larval implants with newly hatched Lucilia cuprina larvae were applied to 10 different sheep from each group at 3, 4, 5 and 6 months after crutching and shearing and assessed for the development of strike at 48 hours. The concentration of dicyclanil was measured in wool samples clipped from the breeches of the test sheep. Results All dicyclanil treatments gave significant reduction in strike in comparison to controls up until 4 months after crutching but protection in the sheep treated immediately after shearing had waned at 5 months. Treating at 6 weeks after crutching provided significant reduction (P < 0.05) in strike for 6 months. Results for strike incidence immediately after shearing and concentration of dicyclanil in the breech wool also suggested improvements in protection by delaying treatment for 6 weeks. Conclusion In most environments it should be possible to protect unmulesed sheep against breech strike with a carefully planned integrated control program incorporating strategically timed crutching, shearing and dicyclanil application. Delaying treatment with dicyclanil to at least 6 weeks after shearing or crutching increased the protection provided in comparison to treatment immediately after shearing