Atypical Calf Cyst Treated With Doxycycline Sclerotherapy: A Case Report.

ABSTRACT: There are many types of cysts in the leg; the most common is a popliteal (Baker's) cyst. This occurs when synovial fluid fills the tissue plane between the medial head of the gastrocnemius and the semimembranosus muscle and is often associated with intraarticular knee pathology. Treatment for various types of cysts includes aspiration with or without fenestration, injections with corticosteroids, dextrose, or various sclerosing agents, and surgical excision. This case describes a 58-yr-old man with a large cyst measuring 14.7 × 2.7 × 3.1 cm in size in the lateral calf, within the lateral gastrocnemius, with atypical size and location for a calf cyst. Computed tomography arthrogram showed intraarticular communication with the knee. The cyst recurred after two aspirations and injections with 25% dextrose/lidocaine. Aspiration and injection with doxycycline resulted in temporary relief followed by recurrence. Complete cyst resolution occurred after final aspiration without injectate. The cyst was likely synovial based on location, intraarticular communication, and fluid analysis. We suspect that complete resolution may have been due to repeated aspiration and injection, essentially performing longitudinal cyst fenestration, with possible contribution from doxycycline injection. Further study of intracyst doxycycline injection with reaspiration after 10 mins for treatment of refractory cysts may be warranted.

An Intervention of Four Weeks of Time-Restricted Eating (16/8) in Male Long-Distance Runners Does Not Affect Cardiometabolic Risk Factors.

Timing of nutrient intake for athletes may affect exercise performance and cardiometabolic factors. Our objective was to examine the effect of time-restricted eating (TRE) on cardiometabolic health. Using a cross-over study design, 15 endurance-trained male runners were randomized to either a normal dietary pattern (ND) first (12 h eating/fasting times) followed by time-restricted eating (TRE) pattern (16 h fast; 8 h eating) or the reverse, with a 4-week washout period between interventions. Body composition, resting energy expenditure, blood pressure and serum insulin, glucose and lipids were measured using standard laboratory methods. Exercise training and dietary intake (calories and macronutrients) were similar across interventions. No significant differences were observed in resting energy expenditure, markers of insulin resistance, serum lipids or blood pressure. Body composition did change significantly (p < 0.05) with whole body fat mass (-0.8 ± 1.3 kg with TRE vs. +0.1 ± 4.3 kg with ND), leg fat mass (-0.3 ± 0.5 kg with TRE vs. +0.1 ± 0.4 kg with ND), and percent body fat (-1.0 ± 1.5% with TRE vs. +0.1 ± 1.3% with ND) declining more in the TRE intervention, with no change in fat-free mass. This study is one of a few to investigate the effects of an isocaloric 16/8 TRE eating pattern in trained endurance athletes and confirms no change in cardiometabolic risk factors. In conclusion, TRE is not detrimental to cardiometabolic health in endurance-trained male runners but could be beneficial on exercise performance by reducing fat mass.

Chiropractic Clinical Outcomes Among Older Adult Male Veterans With Chronic Lower Back Pain: A Retrospective Review of Quality-Assurance Data.

Objective: The purpose of this study was to determine whether a sample of older adult male U.S. veterans demonstrated clinically and statistically significant improvement in chronic lower back pain on validated outcome measures after a short course of chiropractic care. Methods: We performed a retrospective review of a quality-assurance data set of outcome metrics for male veterans, aged 65 to 89 years, who had chronic low back pain, defined as pain in the lower back region present for at least 3 months before evaluation. We included those who received chiropractic management from January 1, 2010, to December 31, 2018. Paired t tests were used to compare outcomes after 4 treatments on both a numeric rating scale (NRS) and the Back Bournemouth Questionnaire (BBQ). The minimum clinically important difference (MCID) was set at 30% change from baseline. Results: There were 217 individuals who met the inclusion criteria. The mean NRS score change from baseline was 2.2 points, representing a 34.1% reduction (t = 13.5, P < .001). The mean score change for BBQ was 14.7 points, representing a 35.9% reduction (t = 16.7, P < .001). The percentage of participants reaching the MCID for the NRS was 57% (n = 124) and for the BBQ was 59% (n = 126), with 41% (n = 90) of the sample reaching the MCID for both the NRS and BBQ. Conclusion: This retrospective review revealed clinically and statistically significant improvement in NRS and BBQ scores for this sample of older male U.S. veterans treated with chiropractic management for chronic low back pain.

Four Weeks of 16/8 Time Restrictive Feeding in Endurance Trained Male Runners Decreases Fat Mass, without Affecting Exercise Performance.

BACKGROUND: Time restricted Feeding (TRF) is a dietary pattern utilized by endurance athletes, but there is insufficient data regarding its effects on performance and metabolism in this population. The purpose of this investigation was to examine the effects of a 16/8 TRF dietary pattern on exercise performance in trained male endurance runners. METHODS: A 4-week randomized crossover intervention was used to compare an 8-h TRF to a 12-h normal diet (ND) feeding window. Exercise training and dietary intake were similar across interventions. Runners completed a dual-energy X-ray absorptiometry (DXA) scan to assess body composition, a graded treadmill running test to assess substrate utilization, and ran a 10 km time trial to assess performance. RESULTS: There was a significant decrease in fat mass in the TRF intervention (-0.8 ± 1.3 kg with TRF (p = 0.05), vs. +0.1 ± 4.3 kg with ND), with no significant change in fat-free mass. Exercise carbon dioxide production (VCO2) and blood lactate concentration were significantly lower with the TRF intervention (p ≤ 0.02). No significant changes were seen in exercise respiratory exchange ratio or 10 km time trial performance (-00:20 ± 3:34 min:s TRF vs. -00:36 ± 2:57 min:s ND). CONCLUSION: This investigation demonstrated that adherence to a 4-week 16/8 TRF dietary intervention decreased fat mass and maintained fat-free mass, while not affecting running performance, in trained male endurance runners.

Passive Recovery Strategies after Exercise: A Narrative Literature Review of the Current Evidence.

ABSTRACT: Passive recovery techniques are popular and offer a diverse spectrum of options for athletes and the clinicians providing care for them. These techniques are intended to minimize the negative effects of training or competition, thus enabling the athlete a quicker return to peak performance. Current evidence demonstrates improved athlete recovery with compression garments, cold water immersion, partial body cryotherapy, hyperbaric oxygen, and vibratory therapies. Other popular modalities, such as compression devices, whole body cryotherapy, percussive gun-assisted therapy, neuromuscular electrical stimulation, and pulsed electromagnetic therapy lack convincing evidence concerning athlete recovery. This article seeks to review the current literature and offer the reader an updated understanding of the mechanisms for each modality and the evidence regarding each modality's potential benefit in an athlete's recovery strategy.

Energy Availability, Macronutrient Intake, and Nutritional Supplementation for Improving Exercise Performance in Endurance Athletes.

Endurance athletes use nutritional guidelines and supplements to improve exercise performance and recovery. However, use is not always based on scientific evidence of improved performance, which type of athlete would benefit most, or the optimal dose and timing of a particular supplement. Health professionals that give advice to athletes need to target their recommendations on the energy systems and muscle fiber types used for the athlete's sporting event, the goal of the training block, the time of the competitive season, and the characteristics and food preferences of the individual athlete. This review aims to summarize the most current research findings on the optimal calorie, carbohydrate, and protein intake for athlete health, performance, and recovery. We also summarized new findings on fluid intake and the optimal dose and timing of beetroot and caffeine supplementation on time trial performance in endurance athletes.

Betalain-rich concentrate supplementation improves exercise performance and recovery in competitive triathletes.

We aimed to determine the effects of a betalain-rich concentrate (BRC) of beetroots, containing no sugars or nitrates, on exercise performance and recovery. Twenty-two (9 men and 13 women) triathletes (age, 38 ± 11 years) completed 2 double-blind, crossover, randomized trials (BRC and placebo) starting 7 days apart. Each trial was preceded by 6 days of supplementation with 100 mg·day-1 of BRC or placebo. On the 7th day of supplementation, exercise trials commenced 120 min after ingestion of 50 mg BRC or placebo and consisted of 40 min of cycling (75 ± 5% maximal oxygen consumption) followed by a 10-km running time trial (TT). Subjects returned 24 h later to complete a 5-km running TT to assess recovery. Ten-kilometer TT duration (49.5 ± 8.9 vs. 50.8 ± 10.3 min, p = 0.03) was faster with the BRC treatment. Despite running faster, average heart rate and ratings of perceived exertion were not different between treatments. Five-kilometer TT duration (23.2 ± 4.4 vs 23.9 ± 4.7 min, p = 0.003), 24 h after the 10-km TT, was faster in 17 of the 22 subjects with the BRC treatment. Creatine kinase, a muscle damage marker, increased less (40.5 ± 22.5 vs. 49.7 ± 21.5 U·L-1, p = 0.02) from baseline to after the 10-km TT and subjective fatigue increased less (-0.05 ± 6.1 vs. 3.23 ± 6.1, p = 0.05) from baseline to 24 h after the 10-km TT with BRC. In conclusion, BRC supplementation improved 10-km TT performance in competitive male and female triathletes. Improved 5-km TT performances 24 h after the 10-km TT and the attenuated increase of creatine kinase and fatigue suggest an increase in recovery while taking BRC.

Betalain-Rich Concentrate Supplementation Improves Exercise Performance in Competitive Runners.

This study aimed to determine the effects of a betalain-rich concentrate (BRC) of red beets, containing antioxidant and anti-inflammatory properties, on performance and exercise-related muscle damage. Thirteen (25.3 ± 5.4 years) competitive male runners completed two double-blind, cross-over, randomized trials (BRC and control) separated by seven days. Each trial was preceded by six days of supplementation with 100 mg of BRC or control. On the seventh day, exercise trials commenced 150 min after supplementation with 50 mg BRC or control and consisted of 30 min of treadmill running (77 ± 4% VO2max) followed by a 5-km time trial (TT). During exercise at the same intensity, BRC resulted in a 3% lower heart rate, a 15% lower rate of perceived exertion (RPE) and a 14% lower blood lactate concentration compared to the control (p = 0.05). Five-kilometer TT duration (23.0 ± 4.2 versus 23.6 ± 4.0 min) was faster in 10 of the 13 subjects, and RPE was lower (p < 0.05) with the BRC treatment compared to the control. Lactate dehydrogenase, a marker of muscle damage, increased less from baseline to immediately and 30 min after the 5-km TT with the BRC treatment, despite no differences in subjective measures of muscle soreness and fatigue. In summary, BRC supplementation improved 5-km performance time in male competitive runners.

Natural versus commercial carbohydrate supplementation and endurance running performance.

BACKGROUND: We examined the metabolic, performance and gastrointestinal (GI) effects of supplementation with a natural food product (raisins) compared to a commercial product (sport chews). METHODS: Eleven male (29.3 ± 7.9 yrs; mean and SD) runners completed three randomized trials (raisins, chews and water only) separated by seven days. Each trial consisted of 80-min (75%VO2max) treadmill running followed by a 5-km time trial (TT). Heart rate (HR), respiratory exchange ratio (RER), blood lactate, serum free fatty acids (FFA), glycerol and insulin, plasma glucose and creatine kinase, GI symptoms and rating of perceived exertion (RPE) were recorded every 20-min. We employed a within-subject two-way analysis of variance (ANOVA) for repeated measures with a Fisher's post hoc analysis to determine significant differences. RESULTS: VO2, HR, lactate, glycerol and RPE did not differ due to treatment. Average plasma glucose was maintained at resting levels (5.3 ± 0.4 mmol·L-1) during the sub-maximal exercise bout (5.9 ± 0.6, 5.7 ± 0.6 and 5.5 ± 0.5 mmol·L-1 for chews, raisins and water respectively), and was significantly higher with chews than water only. RER and % of non-protein macronutrient oxidation derived from carbohydrate was highest with chews, followed by raisins and water was the lowest (74.4 ± 6.4, 70.0 ± 7.0 and 65.1 ± 8.7% for chews, raisins and water respectively) during the sub-maximal exercise period. Serum FFA was higher in the water treatment versus both raisins and chews at 80 min of sub-maximal exercise. Serum insulin was higher with the chews than both raisins and water (5.1 ± 2.0, 3.1 ± 0.8, 1.9 ± 0.6 uU·ml-1 for chews, raisins and water respectively). Plasma creatine kinase, corrected for baseline values, for the last 40 min of the sub-maximal exercise bout, was higher with raisins compared to other treatments. The TT was faster for both carbohydrate supplements (20.6 ± 2.6, 20.7 ± 2.5, 21.6 ± 2.7 min for raisin, chews and water respectively). GI disturbance was mild for all treatments. CONCLUSION: Raisins and chews promoted higher carbohydrate oxidation and improved running performance compared to water only. Running performance was similar between the raisins and chews, with no significant GI differences.

Synthetic biology approach to reconstituting the ubiquitylation cascade in bacteria.

Covalent modification of proteins with ubiquitin (Ub) is widely implicated in the control of protein function and fate. Over 100 deubiquitylating enzymes rapidly reverse this modification, posing challenges to the biochemical and biophysical characterization of ubiquitylated proteins. We circumvented this limitation with a synthetic biology approach of reconstructing the entire eukaryotic Ub cascade in bacteria. Co-expression of affinity-tagged substrates and Ub with E1, E2 and E3 enzymes allows efficient purification of ubiquitylated proteins in milligram quantity. Contrary to in-vitro assays that lead to spurious modification of several lysine residues of Rpn10 (regulatory proteasomal non-ATPase subunit), the reconstituted system faithfully recapitulates its monoubiquitylation on lysine 84 that is observed in vivo. Mass spectrometry revealed the ubiquitylation sites on the Mind bomb E3 ligase and the Ub receptors Rpn10 and Vps9. Förster resonance energy transfer (FRET) analyses of ubiquitylated Vps9 purified from bacteria revealed that although ubiquitylation occurs on the Vps9-GEF domain, it does not affect the guanine nucleotide exchanging factor (GEF) activity in vitro. Finally, we demonstrated that ubiquitylated Vps9 assumes a closed structure, which blocks additional Ub binding. Characterization of several ubiquitylated proteins demonstrated the integrity, specificity and fidelity of the system, and revealed new biological findings.

Bilateral and recurrent myositis ossificans in an athlete: a case report and review of treatment options.

An unusual case of recurrent myositis ossificans (MO) bilaterally in the hamstring muscles of a 47-year-old athlete secondary to trauma is presented with a review of the literature of current treatment options. MO is a common condition that occurs among athletes in association with muscle and/or tendon strain or contusion. After an extensive literature review, we believe this to be the first case reported of recurrent and bilateral MO in a nonsurgical setting from recurrent hamstring strains. Plain radiographs and physical examination revealed the appearance and chronology of this pathology. Treatment options to improve flexibility and decrease morbidity are discussed along with prophylaxis for future injury. Treatment of mobility and flexibility, rehabilitation goals and treatment with nonsteroidal anti-inflammatory drugs, bisphosphonates, and magnesium are discussed along with prophylaxis.

Femoral neuropathy due to patellar dislocation in a theatrical and jazz dancer: a case report.

This case report describes a teenage female, high-level modern dancer who suffered multiple left patellar dislocations. Her history is atypical in that after her fifth dislocation, her recovery was hindered secondary to persistent weakness and atrophy of her quadriceps out of proportion to disuse alone. Electrodiagnostic studies and magnetic resonance imaging showed evidence of a subacute femoral neuropathy correlating chronologically with her most recent patellar dislocation. This case suggests that further diagnostic study may be warranted in patients with persistent quadriceps weakness or atrophy after a patellar dislocation, because this may suggest the presence of a femoral neuropathy. This is important because the strength training goals and precautions differ in disuse atrophy and a neuropathy. We believe this is the first reported case of a femoral neuropathy associated with the mechanism of a patellar dislocation.

Endartery stenosis of the popliteal artery mimicking gastrocnemius strain: a case report.

This report presents a case of leg pain in a recreational athlete that was caused by a stenotic lesion of an endartery branch of the popliteal artery. Isolated areas of arterial stenosis are rarely reported in the sports medicine literature as the primary cause of leg pain. This may be due in part to the difficulty of obtaining the diagnosis. This study includes a review of the relevant anatomic, pathophysiologic, diagnostic, and therapeutic considerations and concludes with a discussion of the potentially underrecognized significance of arterial stenosis in the sports population.

Diagnosis and management of thoracic and rib pain in rowers.

Thoracic and lumbar injuries can dramatically affect a rower's performance and lead to time lost from practice and competition. Even though the number of injuries encountered by elite and competitive rowers appears to have increased over the past 20 years, rowing-specific research has been very limited in its scope and ability to guide practitioners caring for these athletes. Specifically, case reports relating to rib stress fractures abound, yet very few controlled studies discuss the mechanisms of injury and appropriate management of thoracic injuries. We believe that the identification and treatment of kinetic chain abnormalities in areas distant to the site of injury, such as the lower extremities, pelvis, and lumbar spine, should be an integral part of thoracic injury evaluation and treatment. Simultaneous evaluation of training regimen and equipment is also crucial to the management of rowers suffering from thoracic injuries.

Electrodiagnosis in carpal tunnel syndrome.

There is currently no gold standard to definitively diagnose carpal tunnel syndrome. It remains a clinical diagnosis supported by characteristic electrodiagnostic abnormalities. Properly performed electrodiagnostic studies should provide the hand surgeon with information regarding severity, progression if a previous study was performed, and a reasonable assurance that concomitant peripheral nervous system abnormalities are not present. Hand surgeons do not need to discern nuances of an electrodiagnostic evaluation; however, the ability to identify state-of-the-art techniques coupled with a thoughtful interpretation by the electrodiagnostician will improve their confidence in using this important diagnostic tool to evaluate carpal tunnel syndrome.

Farnesol as an inhibitor and substrate for rabbit liver microsomal P450 enzymes.

Farnesol and the related isoprenoids, geranylgeraniol, geranylgeranyl pyrophosphate, and farnesyl pyrophosphate, are produced in the endoplasmic reticulum of hepatocytes in mammals, and each serve important biological functions. Of these compounds, only farnesol was shown to significantly inhibit rabbit liver microsomal cytochrome P450 enzymes. The observed inhibition appeared to be reversible, and was not strictly competitive, but rather mixed in nature. Of the activities examined, ethoxycoumarin de-ethylase and diclofenac-4-hydroxylase activities were most sensitive to farnesol, with K(I) and K(I)' values between 11 and 40 microM. Caffeine-8-hydroxylation and taxol-6-hydroxylation were not inhibited at all by farnesol. Farnesol appeared to be a P450 substrate, as well as an inhibitor, as indicated by the NADPH-dependent decrease in farnesol concentration in microsomal incubations, and the metabolism was inhibited by CO, which pointed to the involvement of P450 isozymes.