The Relationship Between the Isometric Squat and Stretch Shortening Cycle Function and Sprint Acceleration Performance in Hurling Players.

ABSTRACT: Brady, CJ, Harrison, AJ, Flanagan, EP, Haff, GG, and Comyns, TM. The relationship between the isometric squat and stretch shortening cycle function and sprint acceleration performance in hurling players. J Strength Cond Res 38(6): e288-e298, 2024-The primary aim was to examine the relationship between sprint acceleration performance and the performance tests: isometric squat (ISqT), countermovement jump (CMJ), and reactive strength index (RSI). The secondary aim determined whether these tests could distinguish between sprint performance levels. Twenty-six male under-21 subjects completed the ISqT, with peak force (PF), relative PF, force at 100, 150, and 200 milliseconds (ms), and impulse (0-200 ms) measured. Jump height (JH) was calculated from the CMJ and RSI during the 10-5 repeated jump test. Subjects completed 3 × 30-m sprints with splits taken at 5, 10, 20, and 30 m. Pearson's product moment correlations were used to assess the relationships between measures, and independent samples t tests were used to determine whether differences existed in sprint ability of those in the top and bottom quartiles for force at 100 ms, CMJ, and RSI. Significant negative moderate correlations were reported between force at 100 ms and 0-5 m and 5-10 m, significant moderate and large negative correlations between CMJ and all splits and significant large correlations between RSI and splits over 5 m. Force at 100 ms distinguished between performance levels from 0 to 5 m, CMJ from 10 to 20 m, and RSI from 20 to 30 m; faster subjects produced significantly higher force, JHs, and RSI scores. Three principal components explaining 86.1% of the variation in the data set were identified: sprint times and stretch shortening cycle capabilities (33.3%), time-specific force (29.9%), and absolute and relative strength (22.8%).

Effects of Vest and Sled Resisted Sprint Training on Sprint Performance in Young Soccer Players: A Systematic Review and Meta-analysis.

ABSTRACT: Fernández-Galván, LM, Casado, A, García-Ramos, A, and Haff, GG. Effects of vest and sled resisted sprint training on sprint performance in young soccer players: A systematic review and meta-analysis. J Strength Cond Res 36(7): 2023-2034, 2022-The aim of the meta-analysis was to determine the effect of resisted sprint training (RST) on sprint performance in young (<20 years) soccer players and to analyze whether the training equipment (sled or vest) and magnitude of the resistive load (above or below 20% of body mass [BM]) influences the long-term adaptations in sprint performance. Resisted sprint training reduced the acceleration phase time [standardized mean difference (SMD) = -0.41], with greater reduction in sprint time occurring in response to applying resistance with a vest (SMD = -0.70) when compared with a sled (SMD = -0.27). Similar reductions were determined for resistive loads <20% (SMD = -0.55) and ≥20% of BM (SMD = -0.31). Full sprint time showed a small reduction after RST (SMD = -0.36), regardless of the training equipment (sled: SMD = -0.44; vest: SMD = -0.26) and resistive load (<20% of BM: SMD = -0.40 ≥ 20% of BM: SMD = -0.21). There was a small and nonsignificant reduction in the maximum-velocity phase after RST (SMD = -0.25), which was comparable when the training was performed with vest (SMD = -0.34) or sled (SMD = -0.22). No significant differences in the changes of the acceleration phase time (SMD = 0.05) or full sprint time (SMD = 0.08) were observed between the experimental (sled or vest RST) and control groups (only soccer or unresisted sprint training). In conclusion, RST is effective to improve sprint performance in young soccer players, but the improvements are not superior to unresisted sprint training.

Assessment of the loaded squat jump and countermovement jump exercises with a linear velocity transducer: which velocity variable provides the highest reliability?

This study aimed to compare the between-session reliability of three typically measured velocity variables (mean velocity [MV], mean propulsive velocity [MPV], and maximum velocity [Vmax]) to assess vertical jump performance. Totally, 23 men had their squat jump (SJ) and countermovement jump (CMJ) tested against five different loading conditions (17, 30, 45, 60 and 75 kg) during two consecutive weeks. The two sessions of each jump type were performed within the same week separated by 48-72 h. The main finding was a significant difference in reliability between the variables, which were ranked from the highest to the lowest reliable as follows (median coefficient of variation [CV] and range): Vmax (CV = 2.35% [1.85%-3.23%]) >MV (CV = 3.29% [2.18%-4.40%]) >MPV (CV = 3.69% [2.08%-5.17%]). A significant variable × exercise interaction was also observed showing that the differences in reliability between the variables were meaningful during the SJ (MV: CV = 3.93% [3.06%-4.40%], MPV: CV = 4.61% [4.07%-5.17%], and Vmax: CV = 2.14% [1.85%-2.71%]), while no significant differences were observed for the CMJ (MV: CV = 2.43% [2.18%-3.70%], MPV: CV = 2.71% [2.08%-3.63%], and Vmax: CV = 2.40% [1.97%-3.23%]). These results suggest that the Vmax should be the recommended variable for obtaining a reproducible measure of lower-body ballistic performance, especially during the SJ exercise.

Increased fascicle length but not patellar tendon stiffness after accentuated eccentric-load strength training in already-trained men.

PURPOSE: This study examined whether additional external load during the eccentric phase of lower limb strength training exercises led to greater adaptations in knee extensor strength, muscle architecture, and patellar tendon properties than traditional concentric-eccentric training in already-trained men. METHODS: Twenty-eight men accustomed to strength training were randomized to undertake 10 weeks of supervised traditional (TRAD) or accentuated eccentric loading (AEL) or continue their habitual unsupervised (CON) strength training. TRAD and AEL trained 2∙week-1 with a six-repetition maximum (RM) session and a ten-RM session. TRAD used the same external load in both concentric and eccentric phases, while AEL used 40% greater load during the eccentric than concentric phase. Tests were performed at pre- and post-training, including: maximum unilateral isokinetic (30°·s-1) concentric, eccentric and isometric torques by isokinetic dynamometry, unilateral isometric ramp contractions with muscle-tendon ultrasound imaging to measure tendon stiffness and hysteresis, and resting vastus lateralis and medialis fascicle angle and length measured by extended-field-of-view ultrasound. RESULTS: After training, both TRAD and AEL significantly increased maximum concentric and isometric torque (p < 0.05), but only AEL increased eccentric torque (AEL: + 10 ± 9%, TRAD: + 4 ± 9%) and vastus lateralis (AEL: + 14 ± 14%, TRAD: + 1 ± 10%) and medialis (AEL: + 19 ± 8%, TRAD: + 5 ± 11%) fascicle length. CONCLUSION: Both TRAD and AEL increased maximum knee extensor strength but only AEL increased VL and VM fascicle length. Neither training program promoted changes in fascicle angle or changes in patellar tendon properties in our already-trained men.

Acute effects of different set configurations during a strength-oriented resistance training session on barbell velocity and the force-velocity relationship in resistance-trained males and females.

PURPOSE: This study explored the acute effects of strength-oriented resistance training sessions performed using three different set configurations on barbell velocity and the force-velocity (F-v) relationship of upper-body muscles in men and women. METHOD: Thirteen men (age: 23.8 ± 2.5 years; 6-repetition maximum [6RM] load: 73.4 ± 15.6 kg) and 13 women (age: 21.5 ± 1.4 years; 6RM load: 32.8 ± 5.2 kg) performed 24 repetitions with a 6RM load during the bench press exercise using traditional (TR: 6 sets of 4 repetitions with 3 min of rest between sets), cluster (CL: 6 sets of 4 repetitions with 15 s of intra-set rest every two repetitions and 2 min and 45 s of rest between sets) and inter-repetition rest (IRR: 1 set of 24 repetitions with 39 s of rest between repetitions) set configurations. The F-v relationship parameters [maximum force (F0), maximum velocity (v0) and maximum power (Pmax)] were determined before and after each training session. RESULTS: The average training velocity did not differ between the three set configurations (p = 0.234), but the IRR set configuration generally provided higher velocities during the last repetition of each set. Significant decreases in F0 (p = 0.001) and Pmax (p = 0.024) but not in v0 (p = 0.669) were observed after the training sessions. Comparable velocity loss was observed for men and women (- 12.1% vs. - 11.3%; p = 0.699). CONCLUSIONS: The administration of very short intra-set rest periods does not allow for the attainment of higher velocities than traditional set configurations during strength-oriented resistance training sessions conducted with the bench press exercise when the work-to-rest ratio is equated.

Institutional Interventional Radiology Symposium Increases Medical Student Interest and Identifies Target Recruitment Candidates.

OBJECTIVES: To assess and raise medical student interest in interventional radiology (IR); and to evaluate student response across gender, level of training, and surgical vs nonsurgical specialty interest. MATERIALS AND METHODS: All Ohio medical students were invited to an IR Symposium held by a large academic medical center in central Ohio. The program encompassed didactic lectures, hands-on simulation models, and a networking luncheon with faculty, trainees, and industry partners. All attendees completed an anonymous, 5-point Likert scaled survey preattending and postattending the event to assess their awareness of IR as a specialty, understanding of the current training pathways, and level of interest. RESULTS: A total of 46 participants (M:F 60%:40%, MS1-53%, MS2-36%, and MS3-11%) attended the symposium. The cohort demonstrated increased interest in pursuing a career in IR following the symposium (4.12 vs 3.70, P < 0.001). Students with an interest in a nonsurgical specialty showed an increased interest in IR (4.20 vs 3.68, P < 0.001), whereas surgically oriented students did not demonstrate a significant increase (4.00 vs 3.71, P = 0.375). No statistically significant differences were noted across gender or level of training. The symposium experience significantly increased understanding of the IR training pathways (4.51 vs 2.94, P < 0.001). Students rated lectures (57%) and endovascular simulators (41%) as the most useful experiences. CONCLUSIONS: This study demonstrated the role of symposia in improving medical student awareness of IR and training pathways. Findings were validated across gender and training level, and identified the subset of students with nonsurgical interests as most responsive to such intervention and potential recruitment.

The Effect of Altering Body Posture and Barbell Position on the Between-Session Reliability of Force-Time Curve Characteristics in the Isometric Mid-Thigh Pull.

Seventeen strength and power athletes (n = 11 males, 6 females; height: 177.5 ± 7.0 cm, 165.8 ± 11.4 cm; body mass: 90.0 ± 14.1 kg, 66.4 ± 13.9 kg; age: 30.6 ± 10.4 years, 30.8 ± 8.7 years), who regularly performed weightlifting movements during their resistance training programs, were recruited to examine the effect of altering body posture and barbell position on the between-session reliability of force-time characteristics generated in the isometric mid-thigh pull (IMTP). After participants were familiarised with the testing protocol, they undertook two testing sessions which were separated by seven days. In each session, the participants performed three maximal IMTP trials in each of the four testing positions examined, with the order of testing randomized. In each position, no significant differences were found between sessions for all force-time characteristics (p = >0.05). Peak force (PF), time-specific force (F50, F90, F150, F200, F250) and IMP time-bands (0⁻50, 0⁻90, 0⁻150, 0⁻200, 0⁻250 ms) were reliable across each of the four testing positions (ICC ≥ 0.7, CV ≤ 15%). Time to peak force, peak RFD, RFD time-bands (0⁻50, 0⁻90, 0⁻150, 0⁻200, 0⁻250 ms) and peak IMP were unreliable regardless of the testing position used (ICC = <0.7, CV = >15%). Overall, the use of body postures and barbell positions during the IMTP that do not correspond to the second pull of the clean have no adverse effect on the reliability of the force-time characteristics generated.

Feasibility of the 2-Point Method for Determining the 1-Repetition Maximum in the Bench Press Exercise.

PURPOSE: This study compared the concurrent validity and reliability of previously proposed generalized group equations for estimating the bench press (BP) 1-repetition maximum (1RM) with the individualized load-velocity relationship modeled with a 2-point method. METHODS: Thirty men (BP 1RM relative to body mass: 1.08 [0.18] kg·kg-1) performed 2 incremental loading tests in the concentric-only BP exercise and another 2 in the eccentric-concentric BP exercise to assess their actual 1RM and load-velocity relationships. A high velocity (≈1 m·s-1) and a low velocity (≈0.5 m·s-1) were selected from their load-velocity relationships to estimate the 1RM from generalized group equations and through an individual linear model obtained from the 2 velocities. RESULTS: The directly measured 1RM was highly correlated with all predicted 1RMs (r = .847-.977). The generalized group equations systematically underestimated the actual 1RM when predicted from the concentric-only BP (P < .001; effect size = 0.15-0.94) but overestimated it when predicted from the eccentric-concentric BP (P < .001; effect size = 0.36-0.98). Conversely, a low systematic bias (range: -2.3 to 0.5 kg) and random errors (range: 3.0-3.8 kg), no heteroscedasticity of errors (r2 = .053-.082), and trivial effect size (range: -0.17 to 0.04) were observed when the prediction was based on the 2-point method. Although all examined methods reported the 1RM with high reliability (coefficient of variation ≤ 5.1%; intraclass correlation coefficient ≥ .89), the direct method was the most reliable (coefficient of variation < 2.0%; intraclass correlation coefficient ≥ .98). CONCLUSIONS: The quick, fatigue-free, and practical 2-point method was able to predict the BP 1RM with high reliability and practically perfect validity, and therefore, the authors recommend its use over generalized group equations.

Prediction of the Maximum Number of Repetitions and Repetitions in Reserve From Barbell Velocity.

PURPOSE: To provide 2 general equations to estimate the maximum possible number of repetitions (XRM) from the mean velocity (MV) of the barbell and the MV associated with a given number of repetitions in reserve, as well as to determine the between-sessions reliability of the MV associated with each XRM. METHODS: After determination of the bench-press 1-repetition maximum (1RM; 1.15 ± 0.21 kg/kg body mass), 21 men (age 23.0 ± 2.7 y, body mass 72.7 ± 8.3 kg, body height 1.77 ± 0.07 m) completed 4 sets of as many repetitions as possible against relative loads of 60%1RM, 70%1RM, 80%1RM, and 90%1RM over 2 separate sessions. The different loads were tested in a randomized order with 10 min of rest between them. All repetitions were performed at the maximum intended velocity. RESULTS: Both the general equation to predict the XRM from the fastest MV of the set (CV = 15.8-18.5%) and the general equation to predict MV associated with a given number of repetitions in reserve (CV = 14.6-28.8%) failed to provide data with acceptable between-subjects variability. However, a strong relationship (median r2 = .984) and acceptable reliability (CV < 10% and ICC > .85) were observed between the fastest MV of the set and the XRM when considering individual data. CONCLUSIONS: These results indicate that generalized group equations are not acceptable methods for estimating the XRM-MV relationship or the number of repetitions in reserve. When attempting to estimate the XRM-MV relationship, one must use individualized relationships to objectively estimate the exact number of repetitions that can be performed in a training set.

Differences in the Load-Velocity Profile Between 4 Bench-Press Variants.

PURPOSE: To compare the load-velocity relationship between 4 variants of the bench-press (BP) exercise. METHODS: The full load-velocity relationship of 30 men was evaluated by means of an incremental loading test starting at 17 kg and progressing to the individual 1-repetition maximum (1RM) in 4 BP variants: concentric-only BP, concentric-only BP throw (BPT), eccentric-concentric BP, and eccentric-concentric BPT. RESULTS: A strong and fairly linear relationship between mean velocity (MV) and %1RM was observed for the 4 BP variants (r2 > .96 for pooled data and r2 > .98 for individual data). The MV associated with each %1RM was significantly higher in the eccentric-concentric technique than in the concentric-only technique. The only significant difference between the BP and BPT variants was the higher MV with the light to moderate loads (20-70%1RM) in the BPT using the concentric-only technique. MV was significantly and positively correlated between the 4 BP variants (r = .44-.76), which suggests that the subjects with higher velocities for each %1RM in 1 BP variant also tend to have higher velocities for each %1RM in the 3 other BP variants. CONCLUSIONS: These results highlight the need for obtaining specific equations for each BP variant and the existence of individual load-velocity profiles.

Effects of different strength training frequencies on maximum strength, body composition and functional capacity in healthy older individuals.

There is controversy in the literature regarding the dose-response relationship of strength training in healthy older participants. The present study determined training frequency effects on maximum strength, muscle mass and functional capacity over 6months following an initial 3-month preparatory strength training period. One-hundred and six 64-75year old volunteers were randomly assigned to one of four groups; performing strength training one (EX1), two (EX2), or three (EX3) times per week and a non-training control (CON) group. Whole-body strength training was performed using 2-5 sets and 4-12 repetitions per exercise and 7-9 exercises per session. Before and after the intervention, maximum dynamic leg press (1-RM) and isometric knee extensor and plantarflexor strength, body composition and quadriceps cross-sectional area, as well as functional capacity (maximum 7.5m forward and backward walking speed, timed-up-and-go test, loaded 10-stair climb test) were measured. All experimental groups increased leg press 1-RM more than CON (EX1: 3±8%, EX2: 6±6%, EX3: 10±8%, CON: -3±6%, P<0.05) and EX3 improved more than EX1 (P=0.007) at month 9. Compared to CON, EX3 improved in backward walk (P=0.047) and EX1 in timed-up-and-go (P=0.029) tests. No significant changes occurred in body composition. The present study found no evidence that higher training frequency would induce greater benefit to maximum walking speed (i.e. functional capacity) despite a clear dose-response in dynamic 1-RM strength, at least when predominantly using machine weight-training. It appears that beneficial functional capacity improvements can be achieved through low frequency training (i.e. 1-2 times per week) in previously untrained healthy older participants.

Acute elevations in serum hormones are attenuated after chronic training with traditional isoinertial but not accentuated eccentric loads in strength-trained men.

It has been proposed that the maintenance of acute hormonal responses reveal an efficacy of a training stimulus to evoke ongoing increases in strength and muscle mass. We previously observed that maximum strength continued to improve throughout a 10-week period in an accentuated eccentric loading group (AEL) but not a traditional isoinertial loading (ISO) group. Therefore, this study investigated whether the magnitude of acute hormonal responses was greater (i.e., maintained) in AEL compared to ISO at the end of the training period. Subjects in AEL (eccentric load = concentric load + 40%) and ISO performed experimental loading tests (three sets of 10 repetitions in the leg press and knee extension exercises) during weeks 2 and 9 of the training period. Blood samples collected during these experimental loadings were analyzed for serum testosterone, growth hormone and cortisol concentrations. Maximum isometric knee extension torque (MVC) and lower-limb lean mass were assessed before and after 5 and 10 weeks of training. Acute testosterone, growth hormone and cortisol responses to traditional isoinertial loading were reduced at the end of the training period but were not reduced after accentuated eccentric load training (P < 0.05‒0.1 between-groups). Increases in MVC and lower-limb lean mass over weeks 6‒10 were greater in AEL compared to ISO (MVC: 7.3 ± 5.4 vs. -0.4 ± 7.2%, P = 0.026 for between-group difference; lower-limb lean mass: 1.6 ± 2.2 vs. -0.2 ± 1.4%, P = 0.063 for between-group difference). The maintenance of acute hormonal responses and continued strength gain in AEL but not ISO are consistent with the hypothesis that maintained acute responses indicate an efficacy of a training stimulus to evoke ongoing adaptation. However, since relationships between hormonal responses and training-induced adaptations were not statistically significant, the data suggest that tracking of acute hormonal responses on an individual level may not provide a sensitive enough guide for decisions regarding program design and periodization.

Transarterial Chemoembolization for Metastatic Neuroendocrine Tumors With Massive Hepatic Tumor Burden: Is the Benefit Worth the Risk?

BACKGROUND: Neuroendocrine tumors (NETs) have a propensity to metastasize to the liver, often resulting in massive tumor burden and hepatic dysfunction. While transarterial chemoembolization (TACE) is effective in treating patients with NET metastatic to the liver, there are limited data on its utility and benefit in patients with large hepatic involvement. The aim of our study was to determine the clinical benefit and complication rate of TACE in patients with massive hepatic tumor burden. METHODS: Medical records were reviewed in patients with grade 1 or 2 NETs with hepatic metastasis at our institution from January 2000 to September 2014 who underwent TACE. Of 201 total patients, 68 had massive hepatic tumor burden involving >75 % of liver parenchyma. RESULTS: Carcinoid syndrome was present in 40 (59 %) patients, and 57 (84 %) of the 68 patients were symptomatic from their disease. Complications beyond post-TACE syndrome occurred in 21.7 % of patients, with the most common complication being cardiac arrhythmias. The 30-day mortality rate was 7 %. Biochemical response was observed in 78 % of patients, while symptomatic relief and radiographic response was achieved in 85 and 82 % of patients, respectively. Median overall survival following TACE was 28 months, with 1-, 2-, and 5-year overall survival of 76, 54, and 26 %, respectively. CONCLUSIONS: In spite of massive tumor burden, clinical and biochemical improvements were seen in the majority of patients. Morbidity was acceptable and reversible but with a fairly high mortality rate of 7 %. TACE should still be considered in selective patients with massive hepatic tumor burden from metastatic NET for symptom control and palliation.

Elevated Alkaline Phosphatase Prior to Transarterial Chemoembolization for Neuroendocrine Tumors Predicts Worse Outcomes.

INTRODUCTION: We hypothesized that an elevated preoperative alkaline phosphatase (AP) predicted worse outcomes for patients undergoing transarterial chemoembolization (TACE) for neuroendocrine tumor (NET) liver metastases. METHODS: We reviewed all patients who underwent TACE for metastatic NET between 2009 and 2013. Survival was evaluated using preprocedure variables. RESULTS: One hundred and nine patients underwent 210 TACE procedures. The average age was 57.7 years (range 20-78). Primary sites included pancreas (N = 20), other gastrointestinal (N = 52), lung (N = 9), and unknown (N = 28). The tumor was grade 1 in 68 (62 %), grade 2 in 21 (19 %), and grade 3 in 3 (3 %). Extrahepatic disease was present in 54 (50 %) and greater than 50 % hepatic tumor burden by imaging in 63 (58 %). Elevated bilirubin occurred in 8 (7 %), elevated AP in 22 (20 %), elevated ALT in 21 (19 %), and elevated AST in 41 (38 %). Univariate predictors included tumor grade (43 vs 27 vs 21 months, p = 0.015), hepatic tumor burden (59 vs 37 months, p = 0.009), and elevated AP (59 vs 23 months, p < 0.001). On multivariate analysis, only elevated AP (p = 0.001) predicted worse survival. CONCLUSIONS: Elevated AP prior to TACE for metastatic NET portends a worse survival outcome, even more so than tumor grade or extent of hepatic disease.

Celect Inferior Vena Cava Wall Strut Perforation Begets Additional Strut Perforation.

PURPOSE: To identify risk factors for strut perforation following Celect inferior vena cava (IVC) filter (IVCF) placement and to use finite element modeling to predict the mechanical impact of long-dwelling filters. MATERIALS AND METHODS: Ninety-one patients with three computed tomography (CT) studies were evaluated following Celect IVCF placement (2007-2013). Three-dimensional finite element models of the Celect IVCF were developed to simulate mechanical deformation of the IVCF encountered in vivo. Simulated forces applied by the primary struts on the IVC wall were measured as a function of luminal area and tilt angle. RESULTS: Although 33 patients (36%) showed primary strut perforation on initial follow-up CT, 60 patients (66%) showed progressive perforation over time (P < .0001), with 72 patients (79%) showing primary strut perforation on the final CT (average, 554 d). Female patients (P = .004) and those with malignancy history (P = .01) had significantly higher perforation rates at a given time. Caval area also decreased after primary filter strut perforation, and we therefore proposed that this was the mechanism for progressive perforation. Consistent with this mechanism, three-dimensional finite element modeling demonstrated increasing strut force with decreasing IVC diameter. CONCLUSIONS: Celect IVCF primary strut perforation is progressive over time and is more common in female patients and those with a history of malignancy. In addition, this progressive perforation may be predicted by three-dimensional finite element modeling. These patient populations may require closer follow-up after IVCF placement to prevent or reduce the risk for filter complication or worsening perforation.

Transarterial chemoembolization is ineffective for neuroendocrine tumors metastatic to the caudate lobe: a single institution review.

BACKGROUND: Caudate lobe liver metastases occur commonly in patients with neuroendocrine tumors. It is unknown, however, how these lesions respond to regional therapy and how their presence impacts outcomes. We reviewed our experience treating these lesions using transarterial chemoembolization (TACE). METHODS: We reviewed radiographic response to TACE in 86 patients with metastatic neuroendocrine tumors to the liver. We determined the impact of caudate lesions on outcomes in comparison to the cohort of patients without caudate lesions, as well as response of caudate lesions to TACE versus lesions elsewhere in the liver. RESULTS: Caudate lesions were identified in 45 (52%) patients. All patients had disease in other liver segments. Only seven caudate lesions (12.3%) had a radiographic response to TACE, whereas 82% of lesions elsewhere in the liver demonstrated a response. The presence or absence of a caudate lesion did not impact the overall radiographic (82.2% vs. 82.9%), symptomatic (64.4% vs. 56.1%), or biochemical (97.6% vs. 88.9%) response to TACE (P > 0.1 for all). However, median overall survival was reduced in those presenting with caudate lesions (87.1 vs. 45.6 months, P = 0.031). CONCLUSIONS: Metastatic neuroendocrine tumors to the caudate lobe respond poorly to TACE. Symptomatic or threatening caudate lobe lesions should be considered for palliative resection in spite of additional inoperable liver metastases.

Social and Demographic Factors Influencing Inferior Vena Cava Filter Retrieval at a Single Institution in the United States.

PURPOSE: Retrievable inferior vena cava filters (IVCFs) are associated with long-term adverse events that have increased interest in improving filter retrieval rates. Determining the influential patient social and demographic factors affecting IVCF retrieval is important to personalize patient management strategies and attain optimal patient care. MATERIALS AND METHODS: Seven-hundred and sixty-two patients were retrospectively studied who had a filter placed at our institution between January 2011 and November 2013. Age, gender, race, cancer history, distance to residence from retrieval institution, and insurance status were identified for each patient, and those receiving retrievable IVCFs were further evaluated for retrieval rate and time to retrieval. RESULTS: Of the 762 filters placed, 133 were permanent filters. Of the 629 retrievable filters placed, 406 met the inclusion criteria and were eligible for retrieval. Results revealed patients with Medicare were less likely to have their filters retrieved (p = 0.031). Older age was also associated with a lower likelihood of retrieval (p < 0.001) as was living further from the medical center (p = 0.027). Patients who were white and had Medicare were more likely than similarly insured black patients to have their filters retrieved (p = 0.024). CONCLUSIONS: The retrieval rate of IVCFs was most influenced by insurance status, distance from the medical center, and age. Race was statistically significant only when combined with insurance status. The results of this study suggest that these patient groups may need closer follow-up in order to obtain optimal IVCF retrieval rates.

Complications of Celect, Günther tulip, and Greenfield inferior vena cava filters on CT follow-up: a single-institution experience.

PURPOSE: To evaluate and compare the rates of complications on follow-up computed tomography (CT) studies of patients with Celect, Günther Tulip, and Greenfield inferior vena cava (IVC) filters. MATERIALS AND METHODS: Retrospective review of CT studies obtained 0-1,987 days after infrarenal placement of an IVC filter identified 255 Celect, 160 Tulip, and 50 Greenfield filters. Follow-up CT studies were independently evaluated by two observers for IVC perforation, contact with adjacent organs, and filter fracture. Multivariate analysis was performed to identify factors associated with higher rates of IVC perforation, including age, IVC diameter, sex, and history of malignancy. RESULTS: IVC perforation was observed in 126 of 255 Celect filters (49%) with a mean follow-up of 277 days, 69 of 160 Tulip filters (43%) with a mean follow-up of 437 days, and one of 50 Greenfield filters (2%) with a mean follow-up of 286 days. A significantly higher IVC perforation rate was observed in women (45.5%) compared with men (30.8%; P = .002) and in patients with a history of malignancy (43.7%) compared with patients with no history of malignancy (29.9%; P < .001). Filter fracture was rare, observed in two of 255 Celect filters (0.8%), one of 160 Tulip filters (0.6%), and none of 50 Greenfield filters. CONCLUSIONS: No significant difference was observed in IVC perforation rate between Celect and Tulip filters. Greenfield filters had a significantly lower rate of IVC perforation than Celect and Tulip filters. Higher IVC perforation rates were observed in women and patients with a history of malignancy.

Best radiological response to trans-arterial chemoembolization for hepatocellular carcinoma does not imply better outcomes.

INTRODUCTION: Regional therapy with trans-arterial chemoembolization (TACE) is a common treatment for unresectable hepatocellular carcinoma (HCC). Outcomes were examined in patients with the best radiological response (BR) after the initial TACE. METHODS: This was a retrospective cohort study of patients who underwent TACE as the initial treatment for HCC between the years 2000 and 2010. BR was defined as complete disappearance of the tumour or no enhancement with contrast on the first cross-sectional imaging study after the initial TACE. RESULTS: Seventy-eight out of 104 total consecutive patients were identified with the potential for a BR to TACE therapy for unresectable HCC, and 24 met the criteria for BR. Patients with BR had a median survival of 12.8 months (2.2-54.9) compared with 18.9 months(1.3-56.7) for the entire cohort (P= 0.313). The median time to progression was 10.6 months (1.2-24.3) in the BR group and 3.2 months (0.7-49.2) in the patients without a BR (P= 0.003). DISCUSSION: BR to initial TACE for unresectable HCC is associated with comparable survival to those without BR in spite of a longer time to cancer progression. It may be reasonable to consider further therapy such as repeat TACE or biological/systemic therapy in patients with HCC even when the radiological response to the initial TACE is favourable.