Thigh Research Articles

Effect of low-intensity resistance training with blood flow restriction on functional status in knee osteoarthritis

Background: Knee osteoarthritis is a joint pathology with high prevalence, resulting from the increase of aging and obesity in the world population. Articular cartilage destruction can cause pain and eventually reduces activities of daily living and affects functional status in subjects with knee osteoarthritis. Exercise interventions in knee-OA aimed at increasing knee extensor muscle strength involve high-intensity resistance training but may result in joint pain due to high-compressive forces. Other alternative method includes low-intensity resistance training performed with blood flow restriction, a potential intervention for a patient who does not tolerate high loads due to lower mechanical stress. This study aims to determine the effects of blood flow restriction with low-intensity resistance training on the quadriceps for six weeks on functional status in knee-OA patients. Methods: Twenty-eight patients aged 50-70 years old with knee-OA in Physical Medicine and Rehabilitation Outpatient Clinic Soetomo Hospital Surabaya were randomized into control and treatment groups. Both groups underwent a 6-week supervised training program consisting of LI-RT (30% 1-RM) two sessions/week. The treatment group received an additional application of blood flow restriction using a cuff on 1/3 of the upper thigh with 50 mmHg occlusion pressure. Both groups were assessed for functional status by self-reported WOMAC questionnaire before and after the protocol. Results: Both training methods were able to reduce WOMAC pain and improve physical function subscales significantly, but WOMAC stiffness subscales only reduced significantly in low-intensity resistance training with blood flow restriction. There were no significant differences between groups for any domain from WOMAC, nor any significant differences between delta scores (all P > 0.05). Conclusion: Low-intensity resistance training with and without blood flow restriction was similarly effective in enhancing functional status in subjects with knee osteoarthritis.

Association between physical fitness and musculoskeletal health in firefighters.

Introduction: Firefighters are often placed in situations that require high levels of physical exertion, leading to significant strain on firefighters' musculoskeletal system, predisposing them to musculoskeletal discomfort (MSD) and/or musculoskeletal injury (MSI). Physical fitness programs are often recommended and justified, in part, to prevent injuries. The aim of this study was to determine the association between physical fitness and musculoskeletal health (MSH) in firefighters. Methods: A total of 308 full-time firefighters took part in the study conducted in Cape Town, South Africa. Physical fitness tests encompassed a non-exercise estimation for cardiorespiratory fitness, grip and leg strength for upper and lower body strength, push-ups and sit-ups for muscular endurance, and sit-and-reach for flexibility. The Nordic Musculoskeletal Questionnaire and Cornell Musculoskeletal Discomfort Questionnaire were used to determine MSIs and MSD, respectively. A p-value <0.05 indicated statistical significance. Results: Every one-unit increase in AbVO2max, push-ups, sit-ups, and sit-and-reach decreased the odds of firefighters reporting MSIs by 5% (p = 0.005), 3% (p = 0.017), 3% (p = 0.006), and 3% (p = 0.034), respectively. Every one repetition increase in push-up capacity increased the odds of firefighters reporting neck, elbow and forearm, wrist and hand, and thigh discomfort by 3% (p = 0.039), 4% (p = 0.031), 5% (p = 0.002), and 5%` (p = 0.007), respectively. Every one repetition increase in sit-up capacity increased the odds of firefighters reporting upper back discomfort and thigh discomfort by 5% (p = 0.045) and 7% (p = 0.013), respectively. Conclusion: Maintenance of physical fitness is likely beneficial in reducing MSIs, which, however, may increase the feeling of MSD in firefighters. In addition, it may be noticed that there is an ideal level of physical fitness that is conducive to the reduction of MSIs and should be studied further.

Morphometric Measurements of Several Body Parts of Laying Phase Arabian Chickens

The objective of this research was to investigate the body measurements of female Arabian chickens during the laying phase. The study utilized a sample of 95 female Arabian chickens, aged 94 weeks, which were housed in battery cages and utilized for egg production. Direct measurements were taken on each chicken, with variables including body weight, head circumference, beak length, comb height, neck length, back length, wing length, chest width, chest depth, upper thigh length, lower thigh length, shank length, shank circumference, the distance between the pubis bones, the distance between the pubic bone and sternum, and the length of the phalanges. The results of the study indicated that the body weight and morphometric measurements of the Arabian chickens were consistent with prior research. Furthermore, the size of the chest, back, neck, and wings displayed a significant correlation with body weight. Therefore, these measurements can be used as indicative markers for predicting the body weight of Arabian chickens.

Left Hindquarter Amputation due to High-Grade Pleomorphic Sarcoma of the Groin: A Case Report

Introduction:Hindquarter amputation or known as hemipelvectomy is a surgical technique that is primarily used for the eradication of malignant primary soft tissue and bone tumors of the pelvis, hip, and upper thigh regions. Occasionally, hindquarter amputation has been employed in the treatment of severe trauma, metastases, and infection. This case report aims to give a lesson in the case of the High-Grade Pleomorphic Sarcoma of the Groin because this is a very rare case and most patients are not willing to undergo amputation.Case Presentation: A 54-year-old male patient came with a complaint of a lump in the thigh. Initially, the lump was as big as a marble and has been getting bigger since last year. The size of the lump was approximately 30 x 30 x 30 cmConclusions: The most common indications for amputation in patients with the primary localized disease were extensive involvement of the limb-girdle, multiple muscle compartment involvement, multifocality, and unsuitability for limb-sparing surgery, typically due to lack of a salvage option. Hindquarter amputation was used as a treatment for 13% of all pelvic bone sarcomas where there is a realistic chance of control of symptoms or long-term survival.comas.

Infrared Thermography Imaging for Assessment of Peripheral Perfusion in Patients with Septic Shock.

Skin temperature changes can be used to assess peripheral perfusion in circulatory shock patients. However, research has been limited to point measurements from acral parts of the body. Infrared thermography allows non-invasive evaluation of temperature distribution over a larger surface. Our study aimed to map thermographic patterns in the knee and upper thigh of 81 septic shock patients within 24 h of admission and determine the relationship between skin temperature patterns, mottling, and 28-day mortality. We extracted skin temperature measurements from zones corresponding to mottling scores and used a linear mixed model to analyze the distribution of skin temperature in patients with different mottling scores. Our results showed that the distribution of skin temperature in the anterior thigh and knee is physiologically heterogeneous and has no significant association with mottling or survival at 28 days. However, overall skin temperature of the anterior thigh and knee is significantly lower in non-survivors when modified by mottling score. No differences were found in skin temperature between the survivor and non-survivor groups. Our study shows the potential usefulness of infrared thermography in evaluating skin temperature patterns in resuscitated septic shock patients. Overall skin temperature of the anterior thigh and knee may be an important indicator of survival status when modified by mottling score.

Management of an Unexploded Intracorporeal Firework in a Low Resource Setting: Case Report and Tips.

Surgical removal of unexploded ordnance has been described in literature, usually in the context of the military. We describe a case of a 31-year-old gentleman who presented with a traumatic fireworks injury resulting in an unexploded three-inch aerial shell lodged in his left upper thigh. The sole regional Explosive Ordinance Disposal (EOD) expert was not available, so a local pyrotechnic engineer was contacted and he helped in identification of the firework. The firework was removed without the use of electrocautery, irrigation, or metal instrument contact after skin incision. The patient recovered well after prolonged wound healing. Creativity needs to be employed in low resource settings to identify all available resources that can impart knowledge when medical training is not enough. People with knowledge of explosives can be, as in our case, local pyrotechnics engineer or can be local cannon enthusiasts, veterans, or active military personnel at a nearby military base.

Effect of Donor Site Selection for Fat Grafting on the Yield and Viability of the Stromal Vascular Fraction.

The efficacy of stromal vascular fraction (SVF) treatment, or stem cell treatment, directly depends on the SVF cell count and the cells' viability. The SVF cell count and viability are in direct correlation with the adipose tissue harvesting site that yields SVF cells, making this research a contribution to developing tissue guidance. The aim of this study was to investigate the importance of harvesting subcutaneous adipose tissue-derived SVF cells on the concentration and viability of SVF. Adipose tissue was collected by vibration-assisted liposuction from the regions of the upper and lower abdomen, lumbar region, and inner thigh region. With the semiautomatic UNISTATION 2nd Version system, the obtained fat was chemically processed (with collagenase enzyme) and a concentrate of SVF cells was obtained by centrifugation. These samples were then analyzed with the Luna-Stem Counter device to measure the number and viability of SVF cells. When comparing the regions of the upper abdomen, lower abdomen, lumbar region, and inner thigh, the highest concentration of SVF was found in the lumbar region, specifically at an average of 97,498.00 per 1.0 mL of concentrate. The lowest concentration was found in the upper abdominal region. When ranking the viability values, the highest cell viability of SVF was observed in the lumbar region, measuring 36.6200%. The lowest viability was found in the upper abdominal region, measuring 24.4967%. By comparing the upper and lower abdominal, lumbar, and inner thigh regions, the authors have come to the conclusion that, on average, the largest number of cells with the highest viability was obtained from the lumbar region.

ID: 219117 Crossing Percutaneous Leads: A Case of Iatrogenic Spinal Stenosis

A 74 y.o. F was trialed with a percutaneous spinal cord stimulator system and had excellent efficacy. After an uneventful implant however, she reported worsening right upper hip and thigh pain that was different from prior to her implant. The pain had been steadily worsening since device placement, with workup being negative for acute hip articular process or venous embolism. Intra-articular hip injections appeared to help some of the hip pain, but not the thigh pain which prevented her from ambulating.

Pseudoaneurysm of the profunda femoris artery following hip surgery

Pseudoaneurysm of the profunda femoris artery has been described as an iatrogenic phenomenon following orthopedic surgery. It may result due to trauma or direct arterial wall injury during dynamic hip screw fixation for proximal femur fracture. We present a case of a 65-year-old female who developed sudden pain and left thigh swelling one month after surgery for left sided intertrochanteric femur fracture. Computed tomography angiography of the left lower limb revealed the presence of a pseudoaneurysm in the upper left thigh. It was successfully treated with endovascular glue embolization followed by surgical excision of the pseudoaneurysm.

Emergency-physician Performed, Ultrasound-guided Lateral Femoral Cutaneous Nerve Block for Meralgia Paresthetica: A Report of Two Cases.

Neuropathy of the lateral femoral cutaneous nerve, also known as meralgia paresthetica, causes pain and paresthesia to the anterolateral thigh. It commonly results from nerve irritation from extrinsic compression; however, it may occur spontaneously. Symptoms from this condition can be debilitating, and the pain may be ascribed to other conditions leading to delays in diagnosis. Peripheral nerve blockade can be useful both diagnostically and therapeutically for meralgia paresthetica. Two female patients in their sixties presented to the emergency department for chronic, atraumatic, left upper thigh pain. In both cases the patients had hyperalgesia and paresthesia to the anterolateral, upper thigh. The emergency physician performed an ultrasound-guided nerve block of the lateral femoral cutaneous nerve for each patient, which resulted in temporary, complete resolution of their pain. Meralgia paresthetica is an uncommon but painful condition that can elude diagnosis. Physical exam findings such as allodynia and hyperalgesia of the anterolateral thigh in the absence of back pain is suggestive of the diagnosis. Utrasound-guided nerve blockade can be helpful to the emergency physician to confirm the diagnosis and provide non-opioid pain relief to the patient.

Physical activity levels and statin therapy: differences between symptomatic and asymptomatic statin users

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Combining statin treatment and physical activity is highly effective to reduce cardiovascular diseases. Statin use may exacerbate statin-associated muscle symptoms (SAMS), making an active lifestyle more difficult for statin users. It is, however, unknown whether daily activity patterns differ between symptomatic and asymptomatic statin users. Purpose To objectively assess physical activity levels and sedentary time and compare these between long-term statin users with or without muscle complaints. Methods Ninety-seven symptomatic (66±9 years, 74% male) and 97 asymptomatic statin users, matched for age and gender in a 1:1 ratio, were recruited from general practitioners offices. Physical activity patterns were measured using the activPAL3 micro monitor, which was attached to the upper right thigh. Participants wore the activity monitor 24 hours per day during 7 consecutive days and were asked to maintain normal daily activities. Results Symptomatic statin users performed less physical activity of moderate to vigorous intensity per day (61.1 min, IQR: 43.1-77.0 min) compared to asymptomatic statin users (69.1 min, IQR: 50.7-94.6 min; P=0.02). There were no differences in physical activity levels of light intensity or sedentary time between the statin groups. Symptomatic statin users took less steps per day (7560 steps, IQR: 5649-9692 steps) compared to asymptomatic statins users (8721 steps, IQR 6306-11791 steps; P=0.02). Conclusion Symptomatic statin users have reduced levels of physical activity compared to asymptomatic statin users. These findings highlight the clinical relevance to explore possibilities for symptomatic statin users to increase physical activity levels and the associated health benefits.

An unusual presentation of penetrating bladder injury with vesicocutaneous fistula: a case report

BackgroundBlunt trauma to the urinary bladder is common with penetrating injury being a rare occasion. Most common entry pint for penetrating injuries includes buttock, abdomen and perineum with thigh being rare. There are a number of complications that may develop as a result of penetrating injury with vesicocutanous fistula being a rare occurrence that usually presents with typical sign and symptoms.Case presentationWe present a rare case of penetrating bladder injury through medial upper thigh as an entry point that had complicated into vesicocutaneous fistula with atypical presentation of long-standing pus discharge that had been managed by incision and drainage several times with no success. MRI demonstrated a presence of fistula tract and a foreign body (piece of wood) in-situ confirmed the diagnosis.ConclusionFistulas are a rare complication of bladder injuries and can cause negative impact on the quality of life of patients. Delayed urinary tract fistulations and secondary thigh abscesses are uncommon therefore a high index of suspicion is needed for early diagnosis. This case emphasizes the importance of radiological tests in aiding the diagnosis and ultimately proper management.

PO-04-048 LYME CARDITIS PRESENTING AS ACCELERATED JUNCTIONAL RHYTHM IN ADULT PATIENT

Lyme carditis occurs in 1.5%-10% untreated patients infected with Borrelia burgdorferi in United States and usually manifests as varying degrees of atrioventricular (AV) block, myopericarditis, and degenerative valve disease. Several cases of junctional tachycardia have been reported in children with Lyme disease, but there have not been any cases reported in the adult population. Here, we report a case of accelerated junctional tachycardia in a 42-year-old woman with Lyme carditis. To describe a case of a Lyme carditis presenting as accelerated junctional rhythm in a 42-year-old patient. N/A A 42-year-old woman with no significant past medical history presented with complaints of palpitations and lightheadedness. She had a tick bite on her left anterior upper thigh one month prior while working in her yard. The tick was removed after about 3 hours. At that time the patient had no fevers, arthralgias or rashes; however, a month later she developed symptoms of palpitations and lightheadedness. A 12-lead ECG showed accelerated junctional rhythm with AV and VA dissociation and was otherwise normal (Fig 1A). Her primary care physician conducted Lyme serology, which came back positive for both IgG and IgM. A diagnosis of Lyme carditis was made, and the patient was admitted to the hospital for IV antibiotics. Repeat ECG showed sinus with PR prolongation to 252 ms along with episodes of accelerated junctional rhythm (Figure 1B and 1C). She was started on intravenous ceftriaxone with continuous cardiac monitoring. Echocardiogram showed no abnormalities. A peripherally- inserted central catheter line was placed for a 4-week course of ceftriaxone. Her PR interval normalized within 2 weeks of treatment with no junctional rhythm or heart block on serial ECGs and Holter monitors (Figure 1D). Follow-up over the next year showed no recurrence of symptoms or arrhythmias and no other cardiac sequelae. To the best of our knowledge, accelerated junctional rhythm has not been previously reported in the setting of Lyme disease in adult patients. Herein, we report a case of a Lyme carditis presenting as symptomatic accelerated junctional rhythm in a 42-year-old patient, likely caused by inflammation of AV nodal tissue.

Bobot karkas dan persentase potongan karkas itik petelur mojosari yang diberi pakan dengan suplementasi kalsium fitobiotik

Feed additives is important to improve the appearance of duck production. The purpose of this study was to determine the weight and proportion of Mojosari Laying Duck carcass parts that contained calcium phytobiotics. Twenty-four flocks of 120 mojosari laying ducks (24-week-old) were used. Variation Analysis was used to statistically examine the data (ANOVA). Duncan's Multiple Distance Test is used if the study's data show a substantial difference between treatments. A Complete Randomized Design is employed using 6 treatments and 4 tests, each containing 5 mojosari laying ducks. Treatment (P0) is the control feed, (P1) is the control feed plus zinc bacitracin, (P2) is the control feed plus phytobiotics 0.25%, (P3) is the control feed plus phytobiotics 0.50%, (P4) is the control feed plus phytobiotics 0.75%, and (P5) is the control feed plus 1% phytobiotics. The findings demonstrated that the addition of phytobiotic calcium did not significantly affect carcass weight or the percentage of carcass parts (P&gt;0.05). However, (P2) increased the carcass weight compared to the control meal. Weight of the carcass produced is 792.50±91.06 – 972.50±86.84. The percentage of carcasses is 50±0.05 - 57±0.07. The percentage of back pieces was 32.19±1.54 – 36.32±2.94. The percentage of chest pieces was 7.26±0.84 – 8.63±0.97. The percentage of wing pieces was 14.46±0.48 – 13.63±1.93. The percentage of upper thigh pieces produced was 9.50±0.82 – 10.35±2.31, and the percentage of lower thigh pieces was 11.48±0.91 – 13.34±1.97. Results showed that the addition of phytobiotic calcium did not significantly affect the proportion of parts and carcass weight (P&gt;0.05).

Visualizing dynamic three-dimensional changes of human reticular dermal collagen under mechanical strain

In clinical practice, plastic surgeons are often faced with large skin defects that are difficult to close primarily. Management of large skin wounds e.g. burns or traumatic lacerations requires knowledge of skin biomechanic properties. Research into skin microstructural adaptation to mechanical deformation has only been performed using static regimes due to technical limitations. Here, we combine uniaxial stretch tests with fast second harmonic generation imaging and we apply this for the first time to investigate dynamic collagen rearrangement in reticular human dermis. Ex vivo human skin from the abdomen and upper thigh was simultaneously uniaxially stretched while either periodically visualizing 3D reorganization, or visualizing 2D changes in real time. We determined collagen alignment via orientation indices and found pronounced variability across samples. Comparing mean orientation indices at the different stages of the stress strain curves (toe, heel, linear) showed a significant increase in collagen alignment during the linear part of the mechanical response. We conclude that fast SHG imaging during uni-axial extension is a promising research tool for future studies on skin biomechanic properties.

Huge Rare Vaginal Fibromatosis in Postmenopausal Woman, Case Report and Literature Review, 2022

Background: Pelvic fibromatosis or desmoids tumor is an uncommon benign mesenchymal tumor that usually involves the vulvo-vaginal area in women of reproductive age, which are slow growing and painless mass. Case Report: A 70-year post-menopausal woman from Asmara presented with genital swelling which grows gradually over 15 years. She had history of trans-abdominal hysterectomy for abnormal uterine bleeding before 20 years. She had also history of right sided body weakness due to cerebro-vascular accident for the last10 years. She had no known chronic diseases such as hypertension or diabetes mellitus. On physical examination, she is a wheelchair patient with right sided hemiplegia and old midline abdominal scar. On genitourinary examination, patient had a large, about 20x18cm, non-tender, irregular, nodular mass, that hangs from the right side of the labia majora to the level of one third of upper thigh. She had also multiple nodular lesions around the ano-genital area. Different laboratory baseline investigations revealed normal finding. She was operated on 30/10/2022 and a 4kg vulvar mass was resected with right partial hemi-vulvoctomy and sample was sent for pathology which revealed fibromatosis. She was discharged with full improvement and currently on follow-up for possible recurrence. Conclusion: This is reported for its rarity and its enormously large size, slow growing and non-invasive nature. Besides, this was atypical being in a postmenopausal woman, and it’s important to highlight that desmoids tumors should be included in the differential diagnosis of any vulvar mass. She was managed with surgical intervention as it was extremely big. Enhancing community and health professionals’ awareness on similar health problems is crucial for early intervention of similar r conditions.

Systematic Review and Guidelines for Management of Scrotal Inguinal Hernias.

Introduction: Of the more than 20 million patients undergoing groin hernia repair annually worldwide, 6% are scrotal hernias in high resource countries rising to 67% in low resource countries which represents a heavy disease burden on relatively young men during their most productive period of life. There are many open questions concerning management of scrotal hernia. These guidelines aim to improve the care for scrotal hernia patients by reducing recurrence rates, chronic pain and infection. Methods: After developing 19 key questions a systematic literature review was performed till 31 March 2021 for all relevant publications with search terms related to Scrotal Hernia. The articles were scored by all co-authors according to Oxford, SIGN and Grade methodologies. Statements and recommendations were formulated. Online Consensus meetings with 25 HerniaSurge members were organised with voting and grading Recommendations as "strong" (recommendations) or "weak" (suggestions) and by consensus, in some cases upgraded. Results: Only 23 articles (two level 2 registry and 21 level 3-5) were selected. It is proposed to define scrotal hernia as an inguinal hernia which has descended into and causes any scrotal distortion. A new classification for scrotal hernias was proposed based on hernia size, SI for upper third thigh, SII for middle thigh and SIII for lower third thigh or below. Irreducibility is denoted with IR. Despite weak evidence antibiotic prophylaxis is recommended. Urinary catheterization is recommended (upgraded) in complex cases (S2-3) due to prolonged operative time. Scrotal hernia repairs have higher associated morbidity and mortality compared to non-complex groin hernia repairs irrespective of surgical experience. Open anterior (mesh) approach is commonest technique and suture techniques in low resource countries. For minimally invasive approaches, TAPP resulted in less conversion to open approach compared to TEP. Conclusion: Although the evidence is scarce and often low quality scrotal hernia management guidelines aim to lead to better surgical outcomes irrespective of where patients live. This necessarily means a more tailored approach based on available resources and appropriate skills. The guidelines provide an impetus for future research where adoption of proposed classification will enable more meaningful comparison of different techniques for different hernia sizes.

A Comparative Study of McKenzie Back Program and Conventional Physiotherapy in Relieving Backache due to Lumbar Disc Prolapse

Introduction: Low Back Pain (LBP) is considered as one of the commonest problems, in which pain felt in the lumbosacral spinal and paraspinal regions which encompass the buttocks and upper thigh. Objectives: The main objective of the study is to find the comparison between McKenzie back program and conventional physiotherapy in relieving backache due to lumbar disc prolapse. Material and methods: This cross sectional study was conducted in Rashid Latif Medical College Lahore during January 2022 to June 2022. Persons having MRI and previously diagnosed as Disc herniation or Lumbar disc herniation LDH or Prolapsed Lumbar intervertebral disc (PLID) were also enrolled and screened for the second time, the persons who had no MRI were advised to perform with proper justification. Results: Data was collected from 40 patients. There were 22 females and 18 males. Both groups were matched as regards age, gender, weight, height, and BMI. ODI scores showed a significant decrease in both groups post-treatment (p = 0.001) indicating a decrease of functional disability. The percentage of decrease in Oswestry scores was higher in group B than group A (6.87% versus 4.82%). Practical Implication: This study will be helpful in reducing pain, increasing lumbar spine mobility and decreasing disability. Conclusion: It is concluded that McKenzie back program is more effective in reducing pain, increasing lumbar spine mobility and decreasing disability than conventional physiotherapy and stretching exercises in patients with backache due to lumbar disc prolapse. Keywords: Effective, Backache, Pain, Disability

Effects of Ashwagandha (Withania somnifera) standardized root extract on physical endurance and VO2max in healthy adults preforming resistance training: An eight-week, prospective, randomized, double-blind, placebo-controlled study

Background: Ashwagandha is a well-known Ayurvedic herb used for youthful vigor and wellbeing. This study investigated the effects of 300 mg standardized root extract (&gt;5% withanolides) of Ashwagandha (Withania somnifera) on muscle mass, strength and cardiorespiratory endurance following resistance training. Methods: In this eight-week, parallel-group, multicenter, randomized, double-blind, placebo-controlled clinical study, 80 healthy male and female participants aged 18-45 years, who engaged in regular physical activity were randomly allocated in a 1:1 ratio to receive Ashwagandha (AG, n=40) 300 mg capsules twice daily for eight weeks, or identical placebo (PB, n=40). Seven (3 AG, 4 PB) participants were excluded due to poor compliance. All participants conducted eight-week resistance training. Study outcomes included muscle strength (1RM bench press and leg extension), muscle size (circumference of arm, chest and upper thigh) and cardio-respiratory endurance (VO2max) assessed at baseline and at eight weeks. Analysis of covariance (ANCOVA) was used to estimate adjusted differences based on sex, BMI and chest circumference at baseline. Results: AG caused greater improvement in chest press (males: p = 0.0084; females: p = 0.0005), leg press (males: p = 0.0049; females: p = 0.018) and endurance (males: p &lt;0.0001; females: p &lt;0.0001) as compared to PB. Also, greater improvements in muscle girth for arm, chest and thigh were seen in both male and female participants with AG. No adverse events were reported in the study. Conclusions: Eight weeks of AG root extract supplementation along with resistance training is effective in improving muscle strength, growth, endurance and recovery in both male and female participants. AG root extract could be a safer, effective and low-cost alternative for athletes to improve muscle endurance.

An Original Approach to Massive Weight Loss Deformities in the Lower Thigh: A Retrospective Assessment of Results and Patients' Satisfaction.

Massive weight loss (MWL) patients present skin and soft-tissue laxity and ptosis involving inner thighs. Previous efforts were focused on the upper two thirds of the thigh, while literature has never dealt specifically with lower thigh contouring. We present an original approach to the lower inner thigh, intended for patients who already had upper thigh lift, discussing outcomes, advantages, and limits of our technique. Sixteen female MWL patients with persisting severe deformities in the lower inner thigh, following an upper thigh lift, received lower third medial thigh contouring, through concurrent liposuction and skin excision, between 2017 and 2019. The excision pattern consisted of an inferiorly-based vertical triangular component, centered on the inner midline, and a distal horizontal crescent, resulting in an inverted-T scar. Our series was retrospectively investigated, comparing preoperative and 12-month postoperative pictures and assessing the outcomes by means of a tailor-made 11-item survey. Three patients had minor complications (two cases of skin de-epithelization at the wound margin, one granuloma). Photographic assessment showed a 15.9% transverse diameter reduction (p<0.05). The questionnaire showed encouraging scores for all the investigated items. Mean overall satisfaction was 9.6/10. Despite the retrospective design and the limited sample size, in consideration of the applicability of this technique in selected cases, and the need for a two-step procedure, separate upper and lower thigh contouring, the results of our study showed a considerable improvement of the inner thighs by our personal combined liposuction and lower medial thigh lift approach. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .