Male Runners With Lower Energy Availability Have Impaired Skeletal Integrity Compared to Nonathletes.

CONTEXT: Female athletes, particularly runners, with insufficient caloric intake for their energy expenditure [low energy availability (EA) or relative energy deficiency] are at risk for impaired skeletal integrity. Data are lacking in male runners. OBJECTIVE: To determine whether male runners at risk for energy deficit have impaired bone mineral density (BMD), microarchitecture, and estimated strength. DESIGN: Cross-sectional. SETTING: Clinical research center. PARTICIPANTS: 39 men (20 runners, 19 controls), ages 16-30 years. MAIN OUTCOME MEASURES: Areal BMD (dual-energy x-ray absorptiometry); tibia and radius volumetric BMD and microarchitecture (high-resolution peripheral quantitative computed tomography); failure load (microfinite element analysis); serum testosterone, estradiol, leptin; energy availability. RESULTS: Mean age (24.5 ± 3.8 y), lean mass, testosterone, and estradiol levels were similar; body mass index, percent fat mass, leptin, and lumbar spine BMD Z-score (-1.4 ± 0.8 vs -0.8 ± 0.8) lower (P < .05); and calcium intake and running mileage higher (P ≤ .01) in runners vs controls. Runners with EA

Prophylactic Ureteral Localization Stent with Guidewire Assistance Decreases Urologic-Induced Complication Rates: Quality Improvement Initiative and Review of Literature.

Background: We previously reported a 2% Clavien IIIb urologic-induced complication rate associated with blind (no guidewire, no fluoroscopy) prophylactic ureteral localization stent (PULSe) placement. As part of a quality improvement initiative, mandatory guidewire placement before PULSe was performed and urologic-induced Clavien IIIb or greater complication rates were evaluated. A systematic review was performed to elicit the overall urologic-induced complication rate in the literature. Materials and Methods: A retrospective review of all patients who underwent guidewire-assisted PULSe placement before colorectal surgery was performed. The contemporary cohort was compared with those in the prior cohort using age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, preoperative creatinine, postoperative creatinine, pre-/postoperative creatinine difference, and Clavien IIIb urologic-induced complication rates. A review of literature from 1982 to 2019 was performed using 14 unique search terms. Of 38 studies reviewed, 18 met predetermined inclusion criteria. Results: One hundred thirty-two patients underwent bilateral PULSe placement with mandatory guidewire utilization. Mean age and BMI were 55.78 (18-89) and 27.02, respectively, with zero Clavien IIIb complications, compared with a rate of 2% (P < .001) in our prior study. Our contemporary cohort yielded a more favorable postoperative creatinine (P < .022) and pre-/postoperative creatinine difference (P < .003). A review of literature identified a mean Clavien IIIb complication rate of 0.38%. Conclusions: Mandatory guidewire utilization before PULSe placement reduced the Clavien IIIb complication rate to zero, compared with a rate of 2% from our prior cohort. Guidewire utilization can decrease Clavien IIIb urologic-induced complication rates. A review of the literature shows a lack of uniformity concerning the technique of PULSe placement.