The effect of frailty in older community-dwelling outpatients with atrial fibrillation: a new score HAS-BLED-F (rail).

OBJECTIVE: This study aims to determine the effect of frailty on thromboembolic events (TEE) and bleeding in older patients with non-valvular atrial fibrillation (AF). PATIENTS AND METHODS: Patients aged ≥65 years who were diagnosed as having non-valvular AF in a geriatric outpatient clinic between June 2015 and February 2021 were included in the study. Frailty, the risk of thrombosis secondary to AF, and the risk of bleeding as a complication of AF treatment were evaluated using the FRAIL scale, and CHA2DS2-VASc and HAS-BLED scores, respectively. RESULTS: Out of 83 patients included in the study, 72.3% were frail and 21.7% were pre-frail. TEE was observed in 14.5% (n=12) and bleeding was observed in 25.3% (n=21) of the patients. A total of 21 (25.3%) patients had a history of bleeding. There was no difference between the normal, pre-frail, and frail groups in terms of TEE and bleeding history (p=0.112 and p=0.571, respectively). In multivariate analysis, mortality decreased with the use of apixaban; frailty and malnutrition were found to increase mortality (p=0.014, p=0.023, and p=0.020, respectively). HAS-BLED-F score was obtained as a result of the sum of the patients' HAS-BLED and FRAIL scores to predict the bleeding risk. A HAS-BLED-F score of ≥6 predicted the risk of bleeding with 90.5% sensitivity and 40.3% specificity. CONCLUSIONS: Frailty is not associated with a statistically significant increase in the risk of thromboembolic events or bleeding in patients with non-valvular AF. HAS-BLED-F score can be used to better predict the risk of bleeding in frail patients.

Unconventional isoquinoline-based SERMs elicit fulvestrant-like transcriptional programs in ER+ breast cancer cells.

Estrogen receptor alpha (ERα) is a ligand-dependent master transcriptional regulator and key driver of breast cancer pathology. Small molecule hormones and competitive antagonists favor unique ERα conformational ensembles that elicit ligand-specific transcriptional programs in breast cancer and other hormone-responsive tissues. By affecting disparate ligand binding domain structural features, unconventional ligand scaffolds can redirect ERα genomic binding patterns to engage novel therapeutic transcriptional programs. To improve our understanding of these ERα structure-transcriptional relationships, we develop a series of chemically unconventional antagonists based on the antiestrogens elacestrant and lasofoxifene. High-resolution x-ray co-crystal structures show that these molecules affect both classical and unique structural motifs within the ERα ligand binding pocket. They show moderately reduced antagonistic potencies on ERα genomic activities but are effective anti-proliferative agents in luminal breast cancer cells. Interestingly, they favor a 4-hydroxytamoxifen-like accumulation of ERα in breast cancer cells but lack uterotrophic activities in an endometrial cell line. Importantly, RNA sequencing shows that the lead molecules engage transcriptional pathways similar to the selective estrogen receptor degrader fulvestrant. This advance shows that fulvestrant-like genomic activities can be achieved without affecting ERα accumulation in breast cancer cells.

Anaerobic co-digestion of oil-extracted spent coffee grounds with various wastes: Experimental and kinetic modeling studies.

The effect of oil extraction from spent coffee grounds as a pre-treatment strategy prior to anaerobic digestion besides assessing the feasibility of defatted spent coffee grounds co-digestion with spent tea waste, glycerin, and macroalgae were examined. Mesophilic BMP tests were performed using defatted spent coffee grounds alongside four co-substrates in the ratio of 25, 50, and 75%, respectively. The highest methane yield was obtained with the mono-digestion of defatted spent coffee grounds with 336 ± 7 mL CH4/g VS and the yield increased with the increase in the mass ratio of defatted spent coffee grounds during co-digestion. Moreover, defatted spent coffee grounds showed the highest VS and TS removal at 35.5% and 32.1%, respectively and decreased thereafter. Finally, a linear regression model for the interaction effects between substrates was demonstrated and showed that distinctly mixing defatted spent coffee grounds, spent coffee grounds, and spent tea waste outperforms other triple mixed substrates.

Evaluation of fractioned nitric oxide in chronic cough patients.

INTRODUCTION: Cough exceeding 3-8 weeks was defined as chronic cough in various guides. Asthma is the most common cause of chronic-specific cough. Causes other than asthma include prolonged bacterial bronchitis and upper airway cough syndrome (UACS). Nitric oxide (NO) causes vascular smooth muscle relaxation, bronchodilation, and oxidant effects via its metabolite, peroxynitrite. An increase in NO results in inflammation, vasodilatation, and bronchial edema. MATERIALS AND METHODS: The study group included 90 patients aged 6-17 years selected from individuals presenting to the Pediatric Immunology and Allergic Diseases Clinic with cough persisting for 4 weeks and 30 other patients representing to the control group. Patients with a history of premature birth and long-term ventilatory support, neuromotor retardation, or chronic lung and heart disease received systemic corticosteroid therapy in the previous 4 weeks, a chest deformity, with any chronic disease or received immunotherapy were excluded from the study. RESULTS: The most common diagnosis among the 90 patients in this study was asthma, observed in 27 (30%). Fractional exhaled NO values were highest in the asthma group at 39.5 ± 26.6 parts per billion (ppb) and lowest in the UACS group at 11.6 ± 4.0 ppb. Values in the control group were 17.8 ± 11.1 ppb. The differences between the groups were statistically significant (P < 0.001). CONCLUSION: Fractional exhaled NO measurement can be used as a quick and reliable diagnostic method in patients presenting with chronic cough due to its high positive predictive value, its practical nature, the fact that it is a noninvasive method and that it does not require the use of medication.

Impact of physical activity on patient self-reported outcomes of lifelong premature ejaculation patients: Results of a prospective, randomised, sham-controlled trial.

Previous studies have investigated whether physical activity increases serotonin hormone levels. Serotonin receptor dysfunction is one of the frequently accused factors of premature ejaculation (PE). Nevertheless, no studies up to date have demonstrated that the association between physical activity and premature ejaculation. We aimed to investigate the relationship between physical activity and PE and determine whether moderate physical activity might delay ejaculation time or be an alternative treatment for PE. A total of 105 patients diagnosed with PE were enrolled in this study. Of the patients, 35 were treated with dapoxetine, (30 mg) on demand (Group 1), 35 performed moderate physical activities (Group 2), and 35 performed minimal physical activity (Group 3-sham). Demographic characteristics, metabolic equivalents (MET), premature ejaculation diagnostic tool (PEDT) and intravaginal ejaculatory latency time (IELT) were recorded. There were no significant differences among three groups in terms of age, BMI, MET, PEDT or IELT before treatment. At the end of the study, there was significant decrease in PEDT scores, and increase in IELT in groups 1 and 2 as compared to Group 3. In conclusion, a moderate physical activity longer than 30 min at least 5 times a week leads to ejaculation delay, and appears as an alternative to dapoxetine on demand for the treatment of PE.

Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions.

BACKGROUND: Rotator cuff lesions are one of the major causes of shoulder pain and dysfunction. Numerous non-surgical treatment modalities have been described for chronic rotator cuff lesions, but the debate continues over the optimal procedure. The aim of this report is to present the results of prolotherapy in the treatment of chronic refractory rotator cuff lesions. HYPOTHESIS: Dextrose prolotherapy will reduce pain and improve shoulder function and patient satisfaction. MATERIAL AND METHODS: We recruited 120 patients with chronic rotator cuff lesions and symptoms that persisted for longer than 6 months. Patients were divided into two groups: one treated with exercise (control group; n=60) and the other treated with prolotherapy injection (prolotherapy group; n=60). In the latter, ultrasound-guided prolotherapy injections were applied under aseptic conditions. In the former, patients received a physiotherapy protocol three sessions weekly for 12 weeks. Both groups were instructed to carry out a home exercise program. Clinical assessment of shoulder function was performed using a visual analog scale (VAS) for pain, Shoulder Pain and Disability Index (SPADI), Western Ontario Rotatory Cuff (WORC) Index, patient satisfaction, and shoulder range of motion. Patients were examined at baseline, weeks 3, 6, and 12, and last follow-up (minimum of one year). RESULTS: A total of 101 patients (44 controls and 57 in the prolotherapy group) completed all study protocols and were included in the study. Using a within-group comparison, both groups achieved significant improvements over baseline, as measured by the VAS, SPADI, WORC index, and shoulder range of motion (P<0.001). Using a between-group comparison, a significant difference was found in the VAS scores at baseline, weeks 3, 6, and 12, and last follow-up. In addition, significant differences were found in the SPADIs and WORC indices at weeks 6 and 12 and the last follow-up. Significant differences were found in shoulder abduction and flexion at week 12 and last follow-up, and in internal rotation at last follow-up. However, no significant was found in external rotation at any follow-up period. In the prolotherapy group, 53 patients (92.9%) reported excellent or good outcomes; in the control group, 25 patients (56.8%) reported excellent or good outcomes. CONCLUSION: Prolotherapy is an easily applicable and satisfying auxiliary method in the treatment of chronic rotatory cuff lesions. STUDY TYPE: Randomized prospective comparative trial. LEVEL OF EVIDENCE: Level of evidence 1.

Prognostic value of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with epithelial ovarian cancer.

PURPOSE: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have recently been evaluated in many cancers in prediction of survival outcomes. The purpose of this study was to investigate the impact of NLR and PLR on the prognosis of patients with epithelial ovarian cancer (EOC). MATERIALS AND METHODS: A total of 208 patients with EOC were included in the study. Hematological parameters and clinicopathological data during diagnosis were retrospectively evaluated. The cut-off values were determined by calculating receiver operating characteristic (ROC) curve analysis of the patients. RESULTS: The median over-all survival (OS) of patients with low NLR was 69 months (95% CI, 43.0-94.9) whereas high NLR was 36 months (95% CI, 29.1-42.8). The median OS with low PLR patients was 76 months (95% CI, 46.4-105.5) and high PLR was 35 months (95% CI, 28.5-41.4). In serous tumors (70.7%), the median OS with low NLR and high NLR was 54 months (95% CI, 27.9-80.0) and 34 months (95% CI, 28.2-39.7), and for the median OS with low PLR and high PLR it was 51 months (95% CI, 2 1.2-80.7) and 35 months (95% CI, 27.8-42.1), respectively. CONCLUSION: The present findings showed that the high NLR and high PLR were associated with poor prognosis and these values are significantly remarkable in EOC patients.

Impact of unilateral carbon dioxide laser posterior transverse cordotomy on vocal and aerodynamic parameters in bilateral vocal fold paralysis.

OBJECTIVES: Carbon dioxide laser posterior transverse cordotomy is a common option for bilateral vocal fold paralysis. This study prospectively evaluated aerodynamic and acoustic effects of unilateral carbon dioxide laser posterior transverse cordotomy in bilateral vocal fold paralysis patients. METHODS: The study comprised 11 bilateral vocal fold paralysis patients (9 females, 2 males), with a mean age of 46.6 ± 14.1 years. All patients were treated by laser posterior transverse cordotomy. Pre-operative and two-month post-operative assessments were conducted, including: dyspnoea scales, maximum phonation time measurement, spirometry and bicycle ergometry. RESULTS: All subjective and objective aerodynamic parameters showed statistically significant improvements between the pre- and post-operative period. Objective spirometric and ergometric parameters showed a significant increase post-operatively. The changes in objective voice parameters (fundamental frequency (f0), jitter, shimmer, soft phonation index and noise-to-harmonic ratio) were statistically non-significant; however, there was a significant improvement in subjective voice parameters post-operatively, as assessed by the voice handicap index and grade-roughness-breathiness-asthenia-strain scale (p = 0.026 and p = 0.018 respectively). CONCLUSION: Unilateral carbon dioxide laser posterior transverse cordotomy is an effective procedure that results in improved dyspnoea and aerodynamic performance with some worsening of voice parameters.

Adrenal gland volume assessed by magnetic resonance imaging in women with polycystic ovary syndrome.

PURPOSE: To determine adrenal gland volume (AGV) in women with polycystic ovary syndrome (PCOS) by comparison with healthy control subjects and to investigate the relationship between AGV and hormonal status. PATIENTS AND METHODS: AGV was measured on transverse sections of T1-weighted MRI imaging data in 27 PCOS patients and 40 age-matched control subjects for this prospectively designed study. A comparative analysis of AGV in PCOS and controls was performed and possible correlations between AGV and hormonal parameters were evaluated. RESULTS: PCOS patients had significantly larger AGV compared to controls ((11.7±4.4 cm(3), 7.2±1.9 cm(3), respectively, P<0.001). A significant positive correlation was found between total AGV and dehydroepiandrosterone sulfate, 17-OH progesterone, and total and free testosterone levels in the PCOS group (r=+0.51, +0.48, +0.43, +0.62, respectively; P values<0.05). In addition, AGV was significantly negatively correlated with LH and LH/FSH ratio in the PCOS group (r= -0.55, P=0.02; r=-0.51, P=0.01, respectively). CONCLUSIONS: PCOS patients have significantly increased AGV as well as a positive correlation of AGV and androgens. We conclude that the assessment of AGV with MRI shows a significant correlation with the androgenic activity of the gland, and that hypertrophy of the adrenal gland may be involved in the pathogenesis of PCOS.

Can diffusion weighted MRI differentiate between inflammatory-infectious and malignant pleural effusions?

AIM: To assess exudative pleural effusions with diffusion-weighted magnetic resonance imaging (DW-MRI) in order to determine non-invasive differentiation criteria for inflammatory-infectious and malignant effusions. MATERIALS AND METHODS: Thirty-two patients with pleural effusions underwent DW-MRI with 4 different b values (10, 500, 750 and 1000 s/mm2). ADC maps were generated automatically. Signal intensity and ADC values were measured. Following MRI, pleural fluid of 10-15 ml was obtained and analyzed. AUC values were compared for different diffusion levels of ADC and SI measurements. The relationship between ADC values and pleural effusion LDH and total protein levels was examined. RESULTS: The cut-off values obtained from signal intensity and ADC measurements to differentiate exudates with malignant pathology were not found to be statistically significant. In the inflammatory-infectious group, a significant negative correlation was observed between ADC values and pleural fluid LDH measurements in all b values. In the malignant group, a significant positive correlation was observed between ADC values and pleural fluid total protein measurements in b values of 500 and 1000. CONCLUSION: Infectious/inflammatory and malignant effusions overlap strongly and cannot therefore be differentiated using DW MRI.

In contrast to leptin, serum concentrations of ghrelin are not related to premenstrual syndrome.

OBJECTIVE: Premenstrual syndrome (PMS) is a disorder related to mood and appetite changes during the premenstrual phase. Unfortunately, the understanding of the pathophysiology of PMS is quite poor. Though, ghrelin and leptin play important roles in the control of food intake. The aim of this study was to evaluate leptin and ghrelin serum concentrations in PMS patients. PATIENTS AND METHODS: Forty-five PMS patients diagnosed according to ICD-10 diagnostic criteria and 45 healthy women as a control group, were included in the study. These groups were matched for age, body mass index and duration of menstrual cycle. Symptoms of the patients were evaluated using "Menstrual Distress Questionnaires". Serum leptin and ghrelin serum concentrations were measured using ELISA in the postmenstrual phase (5-9 days) and 2-3 days before menstruation. Mann-Whitney U test, independent sample t-test and Wilcoxon test were used for statistical analyses. RESULTS: In the PMS group, there was no difference in the serum concentrations of ghrelin; however, leptin serum concentrations were 31.05 (± 14.16) and 16.42 (± 15.81) ng/ml during the premenstrual and postmenstrual periods, respectively (p < 0.05). Ghrelin serum concentrations in the premenstrual period were 6.9 (± 9.3) ng/ml in the PMS group and 8.8 (± 9.3) ng/ml in the control group, but this difference was not statistically significant (p = 0.79). CONCLUSIONS: Ghrelin serum concentrations were not associated with PMS, while leptin serum concentrations were found to be higher in the premenstrual period in PMS patients. Though, these two hormones work antagonistically to control the food intake and body weight, we suggest that this function is not relevant to PMS.

Can first trimester placental protein-13 and pregnancy-associated plasma protein-A predict pre-eclampsia in Turkish women?

The aim of study was to evaluate placental protein-13 (PP-13) and pregnancy-associated plasma protein-A (PAPP-A) in first trimester maternal serum, for predicting pre-eclampsia. A prospective case-control study included 30 pre-eclampsia patients and 90 control pregnant women. Pre-eclampsia patients were divided into two subgroups: early- and late-onset (9 vs 21), and PP-13 and PAPP-A levels were compared between the groups and the comparison of risks for pre-eclampsia were calculated. Results showed that there was a significant inverse correlation between PAPP-A and late pre-eclampsia (p = 0.003), with a cut-off value of 0.805 (ROC analysis area under curve = 0.751). There was a significant reverse correlation between PAPP-A and early pre-eclampsia (p = 0.02). There was no significant relationship between PP-13 and early pre-eclampsia, nor with late pre-eclampsia (p = 0.7, p = 0.6, respectively). It was concluded that neither of these markers can serve as a sufficient and reliable screening test of pre-eclampsia because of inadequate sensitivity in the Turkish pregnant population.

Serum adiponectin in gestational diabetes and its relation to pregnancy outcome.

We investigated adiponectin levels in women with gestational diabetes mellitus (GDM) and normal glucose tolerance (NGT) at 24-28 gestational weeks. Fasting serum adiponectin, glucose and glycated haemoglobin (HbA1c) were determined in 88 pregnant women, 44 with GDM and 44 with NGT. Pre-pregnancy and current body mass indices (BMI), weight gain and pregnancy outcomes were investigated. Serum adiponectin was significantly reduced in GDM compared with the NGT group (p = 0.000). Adiponectin was negatively correlated with age (r = -0.419, p = 0.000); glucose (r = -0.263, p = 0.013); HbA1c (r = -0.274, p = 0.01); BMI (pre-pregnancy and current) (r = -0.317, p = 0.003 and r = -0.303, p = 0.004) and positively correlated with gestational age at delivery (r = 0.278, p = 0.009). The GDM group delivered significantly earlier than the NGT group (p = 0.001). Adverse pregnancy outcomes and abdominal delivery were higher in the GDM group (p = 0.000, p = 0.033, respectively), and adiponectin was significantly reduced in patients with adverse outcomes (p = 0.003) and abdominal delivery (p = 0.032). Adiponectin is reduced in patients with GDM. Association of adiponectin with adverse pregnancy outcomes remains to be elucidated.

Maternal serum pregnancy-associated plasma protein-A levels in hyperemesis gravidarum: a prospective case control study.

PURPOSE: To investigate if maternal serum pregnancy-associated plasma protein-A levels are affected in hyperemesis gravidarum (HG). MATERIALS AND METHODS: A prospective case control study was conducted in 169 HG cases who had one or more antepartum hospitilization for HG. The control pregnancies were 132 and were selected randomly among all women who had first trimester prenatal screening in antenatal outpatient clinic between 2011 and 2012. RESULTS: Maternal serum pregnancy-associated plasma protein-A levels were significantly higher in hyperemesis gravidarum group compared with control group (p = 0.002 p < 0.05 95% CI). Power analysis of independent sample t-test, two-sided, for pregnancy-associated plasma protein-A was 0.88. Maternal serum free beta-human chorionic gonadotropin values were not different between two groups (p > 0.05). CONCLUSION: Increased pregnancy-associated plasma protein-A levels associated with HG, even after excluding potential cofounders.

Impaired hypothalamo-pituitary-adrenal axis in patients with ankylosing spondylitis.

BACKGROUND: To investigate the hypothalamic-pituitary- adrenal (HPA) axis in patients with ankylosing spondylitis (AS) and healthy controls. METHODS: Forty-nine AS patients and 20 healthy controls were included. Lowdose ACTH test (LDST) was used to assess the HPA axis. Basal cortisol, stimulated peak cortisol levels, and acutephase reactants [C-reactive protein (CRP), erythrocyte sedimentation rate, and fibrinogen] were studied. Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Metrology Index were also evaluated. RESULTS: Patient and control groups were not different regarding age, sex, body mass index and waist circumference (WC). Basal cortisol levels did not show a significant difference between groups. However, cortisol increment after low-dose ACTH was significantly impaired in AS subjects with respect to controls (20.0+/-4.4 vs 24+/-2.2 microg/dl, p<0.001). Eleven AS patients had impaired cortisol peak after LDST when a cortisol cut-off is accepted as 500 nmol/l (18 microg/dl) and none of the controls exhibited a peak cortisol responses to LDST<500 nmol/l. Comparison of AS subjects who were receiving anti-tumor necrosis factor (TNF) (no.=23), and conventional therapy (no.=26) yielded similar basal and peak cortisol concentrations. Peak cortisol concentrations were associated with basal cortisol, impaired cortisol response, CRP, and fibrinogen. Impaired cortisol response (subjects with peak cortisol levels <18 microg/dl) was significantly correlated with basal and peak cortisol concentrations and BASDAI. CONCLUSION: Our results indicate an increased prevalence of subclinical glucocorticoid deficiency in AS patients. Anti-TNF treatment seems not to have effect on HPA axis.

Hyperparathyroidism secondary to maternal hypoparathyroidism and vitamin D deficiency: an uncommon cause of neonatal respiratory distress.

A 4-day-old neonate presented with respiratory distress owing to chest wall deformity associated with metabolic bone disease. He was found to have congenital hyperparathyroidism and his mother was suffering from post-surgical hypoparathyroidism and vitamin D deficiency. The patient was given calcium lactate and maintenance doses of vitamin D. The respiratory distress subsided, the parathyroid hormone level returned to normal and by 4 weeks of age bone mineral content had improved. Congenital hyperparathyroidism should be considered in neonates presenting with respiratory distress and chest deformity.

Reliability of a functional test battery evaluating functionality, proprioception, and strength in recreational athletes with functional ankle instability.

AIM: In contrast to the single evaluation methods used in the past, the combination of multiple tests allows one to obtain a global assessment of the ankle joint. The aim of this study was to determine the reliability of the different tests in a functional test battery. METHODS: Twenty-four male recreational athletes with unilateral functional ankle instability (FAI) were recruited for this study. One component of the test battery included five different functional ability tests. These tests included a single limb hopping course, single-legged and triple-legged hop for distance, and six and cross six meter hop for time. The ankle joint position sense and one leg standing test were used for evaluation of proprioception and sensorimotor control. The isokinetic strengths of the ankle invertor and evertor muscles were evaluated at a velocity of 120 degrees /s. The reliability of the test battery was assessed by calculating the intraclass correlation coefficient (ICC). Each subject was tested two times, with an interval of 3-5 days between the test sessions. RESULTS: The ICCs for ankle functional and proprioceptive ability showed high reliability (ICCs ranging from 0.94 to 0.98). Additionally, isokinetic ankle joint inversion and eversion strength measurements represented good to high reliability (ICCs between 0.82 and 0.98). CONCLUSION: The functional test battery investigated in this study proved to be a reliable tool for the assessment of athletes with functional ankle instability. Therefore, clinicians may obtain reliable information from the functional test battery during the assessment of ankle joint performance in patients with functional ankle instability.

Primary muscular hydatidosis mimicking soft tissue tumour: a report of five cases.

Primary muscular hydatidosis is rare and usually presents as an asymptomatic, slowly growing mass mimicking a soft tissue tumour. Adequate preoperative planning and wide excision is recommended, as incomplete excision may lead to anaphylactic reactions and local recurrence. It should be considered in the differential diagnosis of soft tissue tumours especially in regions endemic for the parasite.

Shoulder terminal range eccentric antagonist/concentric agonist strength ratios in overhead athletes.

OBJECTIVE: The agonist-antagonist strength relationship for shoulder external rotation and internal rotation was formerly described by the relatively more functional ratios of eccentric external rotator to concentric internal rotator moments, and eccentric internal rotator to concentric external rotator moments for the entire range of motion. The aim of this study was to provide descriptive data for terminal range eccentric antagonist/concentric agonist rotator cuff strength in overhead athletes. METHOD: The dominant and non-dominant shoulders of 40 asymptomatic military overhead athletes were tested through a range of 20 degrees of external rotation to 90 degrees of internal rotation using the Cybex NORM isokinetic dynamometer at a speed of 90 degrees /s. Differences between the dominant and non-dominant shoulders were assessed using the paired samples t-test. RESULTS: The terminal range ratios during external rotation (20 degrees of internal rotation - 10 degrees of external rotation) were found to be 2.09 and 1.58 for the dominant and non-dominant shoulders, respectively, whereas the terminal range ratios during internal rotation (60-90 degrees of internal rotation) were 1.03 and 1.19 for the dominant and non-dominant shoulders, respectively. These ratio differences between the dominant and non-dominant shoulders were significant (P<0.01 for external and internal rotation). CONCLUSION: The muscle torque ratios of eccentric antagonist/concentric agonist are different between dominant and non-dominant shoulders of skilled overhead athletes at terminal ranges. This functional assessment of strength testing that reflects dynamic shoulder joint stability during the throwing activity at these specific ranges may provide valuable information either during preventive exercise programs or in the evaluation of the injured shoulder of the overhead athlete. We recommended functional exercises that improve eccentric external rotation strength on the dominant shoulder during the rehabilitation and prevention programs in overhead athletes.

Management of sacrococcygeal chordomas.

A total of 16 patients in our clinic (six women, ten men; mean age 54.87 years, range 38-78 years) were diagnosed as having a sacrococcygeal chordoma. Pain was the presenting symptom in all patients. In five patients, the chordoma was inoperable. A total of 11 patients were followed-up for a mean period of 64.8 months (range 7-152 months). Five patients were lost to follow-up (3 in the operable group and two in the inoperable group). The three remaining inoperable patients received radiation therapy. The eight remaining operable patients underwent a total of 12 operations (four anterior and posterior, eight posterior only). Five of these patients received adjuvant radiotherapy and two patients received both radiotherapy and chemotherapy. In follow-up, eight patients had evidence of disease and one patient remained disease-free. Problems encountered during therapy and follow-up included urinary incontinence (72%), rectal incontinence (36%), wound infection (36%), and lower extremity muscle weakness (36%). Two patients died from metastases to the lung. Of the remaining nine patients, eight were ambulatory, with seven needing support to walk. One patient was unable to walk at all due to lower extremity muscle weakness.