Clinical trial: An open-label, randomised trial of different re-start strategies after treatment withdrawal in HBeAg negative chronic hepatitis B.

BACKGROUND: Stopping nucleos(t)ide analogue (NA) therapy in patients with chronic hepatitis B (CHB) may trigger a beneficial immune response leading to HBsAg loss, but clinical trials on re-start strategies are lacking. AIM: To assess whether it is beneficial to undergo a prolonged flare after NA cessation. METHODS: One-hundred-and-twenty-seven patients with HBeAg negative, non-cirrhotic CHB with at least 24 months of viral suppression on NA therapy were included. All study participants stopped antiviral therapy and were randomised to either low-threshold (ALT > 80 U/L and HBV DNA > 2000 IU/mL) or high-threshold (ALT > 100 U/L for >4 months, or ALT > 400 U/L for >2 months) for the re-start of therapy. The primary endpoint was HBsAg loss within 36 months of stopping antiviral treatment. The primary analysis was based on intention-to-treat allocation with last observation carried forward. RESULTS: There was a numerical but not statistically significant difference in HBsAg loss between the low-threshold (3 of 64; 4.7%) and the high-threshold (8 of 63; 12.7%) group (risk difference: 8.0%, 95% CI: -2.3 to 19.6, p = 0.123). None of the patients with end-of-treatment HBsAg > 1000 IU/mL achieved HBsAg loss; among those with end-of-treatment HBsAg < 1000 IU/mL, 8 of 15 (53.3%) achieved HBsAg loss in the high-threshold group compared to 3 of 26 (11.5%) in the low-threshold group. CONCLUSIONS: We could not confirm our hypothesis that a higher threshold for restart of therapy after NA withdrawal improves the likelihood of HBsAg loss within 36 months in patients with HBeAg negative CHB. Further studies including only patients with HBsAg level <1000 IU/mL and/or larger sample size and longer follow-up duration are recommended.

Does vitamin-D intake during resistance training improve the skeletal muscle hypertrophic and strength response in young and elderly men? - a randomized controlled trial.

INTRODUCTION: Recent studies have shown that vitamin-D intake can improve skeletal muscle function and strength in frail vitamin-D insufficient individuals. We investigated whether vitamin-D intake can improve the muscular response to resistance training in healthy young and elderly individuals, respectively. METHODS: Healthy untrained young (n = 20, age 20-30) and elderly (n = 20, age 60-75) men were randomized to 16 weeks of daily supplementary intake of either 48 µg of vitamin-D + 800 mg calcium (Vitamin-D-group) or 800 mg calcium (Placebo-group) during a period and at a latitude of low sunlight (December-April, 56°N). During the last 12 weeks of the supplementation the subjects underwent progressive resistance training of the quadriceps muscle. Muscle hypertrophy, measured as changes in cross sectional area (CSA), and isometric strength of the quadriceps were determined. Muscle biopsies were analyzed for fiber type morphology changes and mRNA expression of vitamin-D receptor (VDR), cytochrome p450 27B1 (CYP27B1) and Myostatin. RESULTS: In the vitamin-D groups, serum 25(OH)D concentration increased significantly and at week 12 was significantly different from placebo in both young men (71.6 vs. 50.4 nmol/L, respectively) and elderly men (111.2 vs. 66.7 nmol/L, respectively). After 12 weeks of resistance training, quadriceps CSA and isometric strength increased compared to baseline in young (CSA p < 0.0001, strength p = 0.005) and elderly (CSA p = 0.001, strength p < 0.0001) with no difference between vitamin-D and placebo groups. Vitamin-D intake and resistance training increased strength/CSA in elderly compared to young (p = 0.008). In the young vitamin-D group, the change in fiber type IIa percentage was greater after 12 weeks training (p = 0.030) and Myostatin mRNA expression lower compared to the placebo group (p = 0.006). Neither resistance training nor vitamin-D intake changed VDR mRNA expression. CONCLUSION: No additive effect of vitamin-D intake during 12 weeks of resistance training could be detected on either whole muscle hypertrophy or muscle strength, but improved muscle quality in elderly and fiber type morphology in young were observed, indicating an effect of vitamin-D on skeletal muscle remodeling. TRIAL REGISTRATION: ClinicalTrials with nr. NCT01252381.

Tibial avulsion fracture of the posterior root of the medial meniscus in children.

Few reports have described avulsion fractures of the posterior root of the medial meniscus in skeletally immature patients. This lesion should not be overlooked as it damages the load absorptive (distributive) function of the meniscus, increasing the risk of cartilage degeneration. Two cases of displaced avulsion fractures of the posterior root of the medial meniscus in children are presented along with a concise report of the literature regarding avulsion fractures of the posterior root of the medial meniscus. Both avulsions were reattached arthroscopically by trans-tibial pull-out sutures with a good clinical result at 2-years follow-up, and in one case, the avulsion was found at re-arthroscopy after 6 weeks to have healed.

The victorian institute of sports assessment - achilles questionnaire (visa-a) - a reliable tool for measuring achilles tendinopathy.

BACKGROUND: Achilles tendinopathy (AT) is a common pathology and the aetiology is unknown. For valid and reliable assessment The Victorian Institute of Sports Assessment has designed a self-administered Achilles questionnaire, the VISA-A. The aim of the present study was to evaluate VISA-A as an outcome measure in patients with AT. METHODS: A systematic search of the literature was conducted using MEDLINE, EMBASE, CINAHL, PEDro, Web of Science, and Cochrane Controlled trials to identify trials using VISA-A for patients with AT. This was followed by data mining and analysis of the obtained data. RESULTS: Twenty-six clinical trials containing 1336 individuals were included. Overall mean VISA-A scores ranged from 24 (severe AT) to 100 (healthy). Mean VISA-A scores in patients with AT ranged from 24 to 96.6. Healthy subjects scored a minimum of 96. Only two groups of participants from two different studies had a post-VISA-A score as high as healthy individuals, indicating full recovery of the AT. CONCLUSIONS: A VISA-A score lower than 24 is rarely attained in AT. Only few patients with AT reach an equivalent VISA-A score compared to uninjured healthy subjects following treatment. The VISA-A is a reliable tool when assessing AT patients, providing a good assessment of the actual condition from very poor, (score around 24) to excellent (a score of 90), which based on this systematic review and previous studies could be considered full recovery from AT.