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Several letters to the editors are presented in response to articles previously published in the journal "Leukemia and Lymphoma," including "Unusual Reaction to Rituximab with Intra-Vascular Hemolysis, Rhabdomyolysis, Renal Failure and Bone Marrow Necrosis," by S. K. Ramamoorthy, M. Marangolo, E. Durrant, S. Akima, and D. J. Gottlieb, "Regression of Large B-Cell Non-Hodgkin’s Lymphoma of Stomach with HAART: Case Report and Review," by Faraz Khan, Frank Bauer, Golam Gazi, and Syed Bilgrami, and "Hairy Cell Leukemia Variant Transforming Into Aggressive Lymphoma with Prostatic Involvement in a Patient with Polycythemia Vera," by Mohammad Razaq, Srisha Perumandla, Nagender Mankan, Sundara Sridhar, Jasotha Sanmugarajah, Gloria Fernandez and Shafkat Hussain.

Objective: To investigate the temperature changes in subcutaneous and intramuscular tissue during a 20-minute cold and hot-pack contrast therapy treatment. Design end Setting: Subjects were randomly exposed to 20 minutes of contrast therapy (5 minutes of heat with a hydrocollator pack followed by 5 minutes of cold with an ice pack, repeated twice) and 20 minutes of cold therapy (ice pack only) in a university laboratory. Subjects: Nine men and seven women with no history of peripheral vascular disease and no allergy to cephalexin hydrochloride volunteered for the study. Measurements: Subcutaneous and intramuscular tissue temperatures were measured by 26-gauge hypodermic needle microprobes inserted into the left calf just below the skin or 1 cm below the skin and subcutaneous fat, respectively. Results: With contrast therapy, muscular temperature did not fluctuate significantly over the 20-minute period compared with the subcutaneous temperature, which fluctuated from 8 degrees C to 14 degrees C each 5-minute interval. When subjects were treated with ice alone, muscle temperature decreased 7 degrees C and subcutaneous temperature decreased 17 degrees C over the 20-minute treatment. Conclusions: Our results show that contrast therapy has little effect on deep muscle temperature. Therefore, if most of the physiologic effects attributed to cold and hot contrast therapy depend on substantial fluctuations in tissue temperature, contrast therapy needs to be reconsidered as a viable therapeutic modality. [ABSTRACT FROM AUTHOR]

Objective: We investigated the effects of pulsed ultrasound on swelling, muscle soreness perception, relaxed-elbow extension angle, and muscular strength. Design and Setting: Eight sets of concentric and eccentric actions induced delayed-onset muscle soreness of the elbow flexors. Group 1 received 20% pulsed ultrasound treatments (1-MHz, 7 minutes, 1.5 W/cm2 temporal peak intensity) twice a day immediately after postexercise assessments and at 3, 24, 27, 48, 51, 72, and 75 hours postexercise. Group 2 received sham treatments immediately after postexercise assessments and at 3, 27, 51, and 75 hours postexercise and true treatments of pulsed ultrasound at 24, 48, and 72 hours postexercise. Group 3 received sham treatments of no ultrasonic output immediately after postexercise assessments and at 3, 24, 27, 48, 51, 72, and 75 hours postexercise. Subjects: Thirty-six college-age females. Measurements: We recorded upper-arm circumference, perceived soreness, relaxed-elbow extension angle, and elbow-flexion strength before (pretest), immediately postexercise, and at 24, 48, 72, and 96 hours postexercise. Results: We noted differences over time but no treatment effect between groups or interactions between time and group for upper-arm circumference, perceived soreness, relaxed-elbow extension angle, or elbow-flexion strength. Conclusions: Pulsed ultrasound as used in this study did not significantly diminish the effects of delayed-onset muscle soreness on soreness perception, swelling, relaxed-elbow extension angle, and strength. [ABSTRACT FROM AUTHOR]

Objective: Therapeutic ultrasound is an effective deep heating modality commonly applied alone or after cooling or heating of the treatment area. The purpose of this study was to examine the tissue temperature rise in the human triceps surae muscle group after ultrasound with prior heating via a silicate gel hot pack. Design and Setting: This study was designed as a 2 x 2 x 3 factorial with repeated measures on two factors (depth and time). Independent variables were temperature of pack (hot and room temperature), depth of measurement (1 cm and 3 cm), and time (beginning, after pack application, and after ultrasound). The dependent variable was tissue temperature. Subjects were assigned to one of two treatment groups: ultrasound preceded by a 15-minute hot pack treatment or ultrasound preceded by a 15-minute application with a silicate gel pack at room temperature. Measurements were taken while subjects were treated in a university training room. Subjects: Twenty-one uninjured male and female college student volunteers were randomly assigned to one of the two pack groups. Measurements: The hot packs were stored in 75 degrees C water. A 1-MHz ultrasound treatment was administered for 10 minutes at an intensity of 1.5 W/cm2 . Tissue temperature was measured every 30 seconds using 23-gauge hypodermic microprobes interfaced with a telethermometer and inserted 1 and 3 cm below the surface of anesthetized triceps surae muscle. Results: At both tissue depths, there was a 0.8 degrees C greater increase in tissue temperature with hot packs and ultrasound. At 1 cm, ultrasound increased temperature 3.5 degrees C after a 0.5 degrees C rise during the room temperature-pack application, but only 0.6 degrees C after a 3.8 degrees C increase during hot-pack application. At 3 cm, ultrasound increased temperature 3.85 degrees C following a slight (-0.26 degrees C) decrease during the room temperature-pack application and 3.68 degrees C after a 0.74 degrees C increase during hot-pack application. Conclusions: Vigorous increases in deep muscle temperature (>/= 4 degrees C) can be reached with 2 to 3 minutes less total sonation time when preheated with a hot pack. Thus, ultrasound and hot packs have an additive effect on intramuscular temperature, but the characteristics of the additive effect are different, primarily because there appears to be a tissue temperature plateau. [ABSTRACT FROM AUTHOR]

Objective: We investigated three 30-minute high-volt pulsed current electrical stimulation (HVPC) treatments of 125 pps to reduce pain, restore range of motion (ROM), and recover strength loss associated with delayed-onset muscle soreness (DOMS). Design and Setting: Randomized, masked comparison of three 30-minute treatment and sham HVPC regimens over a 48-hour period. Subjects: Twenty-eight college students. Measurements: Subjects performed concentric and eccentric knee extensions with the right leg to induce muscle soreness. Assessments were made before and after the exercise bout and each treatment at 24, 48, and 72 hours postexercise. Results: Three separate 2 x 3 x 2 ANOVAs were used to determine significant differences (p < .05) between days, treatments, and pre-post treatment effects and significant interaction among these variables. Scheffe post hoc tests showed no significant reduction in pain perception or improvement in loss of function at 24, 48, and 72 hours postexercise. Mean pain perception assessments (0 = no pain, 10 = severe pain) for the HVPC group were 2.9, 4.5, and 3.5 and for the sham group 3.8, 4.8, and 3.5). Mean ROM losses for the HVPC group were 9.0 degrees, 22.3 degrees, and 26.2 degrees and for the sham group were 9.5 degrees, 23.1 degrees, and 23.0 degrees. Mean strength losses (1RM) for the HVPC group were 25.9, 25.7, and 20.8 lbs and for the sham group were 22.3, 22.3, and 13.8 lbs. Conclusions: HVPC as we studied it was ineffective in providing lasting pain reduction and at reducing ROM and strength losses associated with DOMS. [ABSTRACT FROM AUTHOR]

Background and Context: The scale of land degradation worldwide has led to nearly one billion hectares committed to restoration globally. However, achieving such restoration targets will necessitate complex trade-offs against limited time, competing knowledge, costs, resources and varying stakeholder and societal preferences. Participatory scenarios allow a way to identify collaborative solutions for restoration planning and implementation best suited for the local cultures and societies they are tied to. They can be used to navigate uncertainties surrounding future trajectories of restored areas by evaluating trade-offs in outcomes. This research aims to systematically map the evidence on the use of participatory scenarios in restoration planning. We use the following research question: What evidence exists on the use of participatory scenarios in ecological restoration? This is answered by examining the characteristics of the evidence base, types of study design, types of outcomes, trade-offs in outcomes, and the role of participants., Methods: A comprehensive and reproducible search strategy was followed using bibliographic databases, web-based searches, and targeted searching. Search results underwent a two-step screening process according to eligibility criteria. Metadata on key areas of interest were extracted from included texts and were narratively synthesised alongside data visualisations to answer the research questions., Review Findings: 18,612 records were initially identified, and 106 articles were included in the final map. Most studies were conducted in Europe and North America, focusing on restoring agricultural land or forests. Most texts used mixed methods and explored multiple outcome types, but environmental outcomes were the most assessed. Within environmental outcomes, indicators for ecological function were assessed more frequently than structural or compositional indicators. The most common reason for choosing outcomes and indicators was stakeholder interest. Trade-offs in social, ecological, and economic outcomes were mainly examined across space using mapping techniques, while far fewer studies looked at trade-offs across stakeholders and time. Participants were mostly included in the scenario creation step and were usually chosen purposefully by the research team., Conclusions: It is difficult to understand how useful scenarios are for restoration planning because few texts reported how scenarios fed into the process. Despite this, the range of outcomes used and different method types adopted suggests participatory scenarios allow for integrating different knowledge and approaches, alongside facilitating the use of qualitative or semi-quantitative data when this is more appropriate or quantitative data is not widely available. To better use participatory scenarios as a tool for ecological restoration planning, decision-makers can push for greater levels and definitions of participation from the offset of restoration projects with specified, regular, and structured communication and participation channels. We also recommend more systematic methods of participant selection, such as stakeholder analysis. Further research is needed to understand the effectiveness of participatory scenarios in restoration planning and whether the participation of stakeholders was successful in meeting objectives. To improve the evidence base, future studies should clearly evaluate their effectiveness in the restoration planning process and their success in meeting their participatory objectives., (© 2023. The Author(s).)

Childhood muscle-related cancer rhabdomyosarcoma is a rare disease with a 50-year unmet clinical need for the patients presented with advanced disease. The rarity of ∼350 cases per year in North America generally diminishes the viability of large-scale, pharmaceutical industry driven drug development efforts for rhabdomyosarcoma. In this study, we performed a large-scale screen of 640,000 compounds to identify the dihydropyridine (DHP) class of anti-hypertensives as a priority compound hit. A structure-activity relationship was uncovered with increasing cell growth inhibition as side chain length increases at the ortho and para positions of the parent DHP molecule. Growth inhibition was consistent across n = 21 rhabdomyosarcoma cell line models. Anti-tumor activity in vitro was paralleled by studies in vivo. The unexpected finding was that the action of DHPs appears to be other than on the DHP receptor (i.e., L-type voltage-gated calcium channel). These findings provide the basis of a medicinal chemistry program to develop dihydropyridine derivatives that retain anti-rhabdomyosarcoma activity without anti-hypertensive effects., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Charles Keller reports equipment, drugs, or supplies was provided by Novartis GNF., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Reduced ankle dorsiflexion is associated with lower limb injury and dysfunction, with static stretching mostly used to increase ankle range of motion. Foam rolling is an alternative intervention, shown to immediately increase ankle range of motion, while the long-term application has conflicting evidence., Aims: To assess the effects of single and multiple foam rolling interventions on ankle dorsiflexion range of motion in healthy adults and appraise the methodological quality of the included studies., Design: Systematic literature review., Methods: Five electronic databases were systematically searched to identify randomised controlled trials reporting the effects of foam rolling on ankle dorsiflexion. Data was extracted from studies that met the inclusion criteria and independently appraised by each reviewer using the PEDro scale., Results: Thirty-two articles were identified; six studies included foam rolling compared to other interventions on ankle dorsiflexion range of motion. Five of the six studies reported a significant increase (p < 0.05) in ankle dorsiflexion within groups compared to baseline measurements, after a single foam rolling intervention. One study found a significant within group increase in long-term effects after foam rolling on ankle dorsiflexion over seven weeks. The mean PEDro score for all studies was 6/10 indicating a high-quality level of evidence., Conclusion: There is strong evidence suggesting that foam rolling may be effective in increasing range of motion in a healthy adult population in the short term up to 30 min; however, definitive conclusions on long-term effects cannot be drawn due to a lack of evidence, with further research recommended., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose: Benefits of overnight attending radiologist final reports are debated, often stating low resident discrepancy rates, usually assessed retrospectively. The objective of this study was to assess the impact of overnight final reporting on the recall rates for patients in the emergency department (ED) receiving overnight imaging., Methods: Retrospective matched cohorts of two separate years prior (prior-16 and prior-17) and 1 year after (post-18) introduction of overnight attending radiologist final reporting. Patients receiving imaging between 22:00 and 07:00 h and returned to ED within 48 h of initial visit discharge were electronically identified. String matching identified return visits possibly related to imaging completed on first visit. Identified return visit notes were scored by three observers individually. Unclear and discrepant cases were resolved by consensus meeting, using full patient charts where needed. Incidences were provided and logistic regression analysis defined if coverage model was a predictor for recall. Odds ratios were calculated., Results: ED patient count with imaging completed overnight in prior-16 was 9200, in prior-17 was 9543, and in post-18 was 9992. The number of overnight imaging studies performed was respectively 13,883, 14,463, and 15,112. Imaging-related ED recalls were respectively 54, 61, and 7, a decrease with the new coverage model of 89% to true and at least 90% of expected recalls.Logistic regression demonstrated that coverage model was a significant predictor of ED recalls with chi-square of 59.86 and p < 0.001, an R 2 of 0.03 (Hosmer and Lemeshow). Compared to post-18, ED patients had an odds ratio of 8.42 (prior-16) and 9.18 (prior-17) to be called back to ED., Conclusion: Overnight final reporting significantly decreases ED recalls for patients receiving diagnostic imaging overnight. While numbers are low even prior to rollout, the number should be minimized wherever possible to diminish patient anxiety and discomfort, reduce ED overcrowding and expedite definitive management., Key Messages/what This Paper Adds: Section 1: What is already known on this subject • Radiology resident preliminary report discrepancy rates are low. • Overnight attending radiologist coverage is a model increasingly applied in academic and large non-academic centers. • Patient recalls to the ED are a burden to the patient and impact patient throughput in (over)crowded EDs. Section 2: What this study adds • First study to look at the impact of overnight attending final reports on the recall rate for ED patients with overnight imaging performed. • While absolute numbers are low, there is a significant decrease in patients returning to ED for imaging related issues after introducing overnight attending coverage. • Resident autonomy can be preserved and training enhanced while increasing patient safety and comfort.

Since the advent of multidetecter computed tomography (CT), radiologist sensitivity in detection of traumatic bowel and mesenteric abnormalities has significantly improved. Although several CT signs have been described to identify intestinal injury, accurate interpretation of these findings can remain challenging. Early detection of bowel and mesenteric injury is important as it alters patient management, disposition, and follow-up. This article reviews the common imaging findings of traumatic small bowel and mesenteric injury.

Although recent evidence has pointed to the existence of small open reading frame (smORF)-encoded microproteins in mammals, their function remains to be determined. Skeletal muscle development requires fusion of mononuclear progenitors to form multinucleated myotubes, a critical but poorly understood process. Here we report the identification of Minion (microprotein inducer of fusion), a smORF encoding an essential skeletal muscle specific microprotein. Myogenic progenitors lacking Minion differentiate normally but fail to form syncytial myotubes, and Minion-deficient mice die perinatally and demonstrate a marked reduction in fused muscle fibres. The fusogenic activity of Minion is conserved in the human orthologue, and co-expression of Minion and the transmembrane protein Myomaker is sufficient to induce cellular fusion accompanied by rapid cytoskeletal rearrangement, even in non-muscle cells. These findings establish Minion as a novel microprotein required for muscle development, and define a two-component programme for the induction of mammalian cell fusion. Moreover, these data also significantly expand the known functions of smORF-encoded microproteins.

The existence of extracellular phosphoproteins has been acknowledged for over a century. However, research in this area has been undeveloped largely because the kinases that phosphorylate secreted proteins have escaped identification. Fam20C is a kinase that phosphorylates S-x-E/pS motifs on proteins in milk and in the extracellular matrix of bones and teeth. Here, we show that Fam20C generates the majority of the extracellular phosphoproteome. Using CRISPR/Cas9 genome editing, mass spectrometry, and biochemistry, we identify more than 100 secreted phosphoproteins as genuine Fam20C substrates. Further, we show that Fam20C exhibits broader substrate specificity than previously appreciated. Functional annotations of Fam20C substrates suggest roles for the kinase beyond biomineralization, including lipid homeostasis, wound healing, and cell migration and adhesion. Our results establish Fam20C as the major secretory pathway protein kinase and serve as a foundation for new areas of investigation into the role of secreted protein phosphorylation in human biology and disease., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Variations in clinical presentation can lead to delays in the diagnosis and initiation of treatment of anti-N-methyl-D-aspartate receptor encephalitis. Most patients have an EEG study performed early in the course of their illness. Although not specific, there may be clues in the electroclinical features that should alert clinicians and electroencephalographers to the possibility of this diagnosis. This case is a reminder that anti- anti-N-methyl-D-aspartate receptor encephalitis may present initially with a movement disorder as the sole symptom, without features of an encephalopathy. In addition, it adds to the growing body of evidence that recognition of certain electroclinical clues may shorten the time to diagnosis. [Published with video sequence].

A new family of adenylyltransferases, defined by the presence of a Fic domain, was recently discovered to catalyze the addition of adenosine monophosphate (AMP) to Rho GTPases (Yarbrough, M. L., Li, Y., Kinch, L. N., Grishin, N. V., Ball, H. L., and Orth, K. (2009) Science 323, 269-272; Worby, C. A., Mattoo, S., Kruger, R. P., Corbeil, L. B., Koller, A., Mendez, J. C., Zekarias, B., Lazar, C., and Dixon, J. E. (2009) Mol. Cell 34, 93-103). This adenylylation event inactivates Rho GTPases by preventing them from binding to their downstream effectors. We reported that the Fic domain(s) of the immunoglobulin-binding protein A (IbpA) from the pathogenic bacterium Histophilus somni adenylylates mammalian Rho GTPases, RhoA, Rac1, and Cdc42, thereby inducing host cytoskeletal collapse, which allows H. somni to breach alveolar barriers and cause septicemia. The IbpA-mediated adenylylation occurs on a functionally critical tyrosine in the switch 1 region of these GTPases. Here, we conduct a detailed characterization of the IbpA Fic2 domain and compare its activity with other known Fic adenylyltransferases, VopS (Vibrio outer protein S) from the bacterial pathogen Vibrio parahaemolyticus and the human protein HYPE (huntingtin yeast interacting protein E; also called FicD). We also included the Fic domains of the secreted protein, PfhB2, from the opportunistic pathogen Pasteurella multocida, in our analysis. PfhB2 shares a common domain architecture with IbpA and contains two Fic domains. We demonstrate that the PfhB2 Fic domains also possess adenylyltransferase activity that targets the switch 1 tyrosine of Rho GTPases. Comparative kinetic and phylogenetic analyses of IbpA-Fic2 with the Fic domains of PfhB2, VopS, and HYPE reveal important aspects of their specificities for Rho GTPases and nucleotide usage and offer mechanistic insights for determining nucleotide and substrate specificities for these enzymes. Finally, we compare the evolutionary lineages of Fic proteins with those of other known adenylyltransferases.

We present a patient with deletion of IgH associated with the reciprocal translocation (8;14) in Burkitt lymphoma. The patient had treatment resistant disease and died 10 weeks after diagnosis. The deletion was detected by fluorescence in situ hybridization at diagnosis and again after failure of chemotherapy. To our knowledge this is the first report of such a deletion.

Aims: The primary objective was to estimate prevalence of malnutrition on admission to four hospitals. Secondary objectives included assessing the relationship between nutritional status and length of hospital stay, numbers of new prescriptions, new infections and disease severity., Methods: We entered eligible patients according to predefined quotas for elective and emergency admissions to 23 specialties. We measured height, weight, Body Mass Index and anthropometrics, and recorded history of unintentional weight loss. Patients who had lost > or = 10% of their body weight, had a Body Mass Index <20, or had a Body Mass Index <20 with one anthropometric measurement <15th centile were considered malnourished., Results: Of 1611 eligible patients, 761 did not participate; 269 were too ill; 256 could not be weighed; and 236 refused consent. Eight hundred and fifty were subsequently evaluated. Prevalence of malnutrition on admission was 20%. Length of stay, new prescriptions and infections and disease severity were significantly higher in the malnourished., Conclusions: One patient in every five admitted to hospital is malnourished. Although this figure is unacceptably high, it may underestimate true prevalence. Malnutrition was associated with increased length of stay, new prescriptions and infections. Malnutrition may also have contributed to disease severity., (Copyright 2000 Harcourt Publishers Ltd.)

Thermal ultrasound can be effective in increasing extensibility of collagen, thus aiding joint mobilization and stretching. In 1995, we reported on the rate of temperature decay following 3-MHz ultrasound in subcutaneous tissues. We repeated that study at 1-MHz frequency to see if the stretching window is different for deep muscle. Twenty subjects had two 23-gauge thermistors inserted 2.5 cm and 5 cm deep into their triceps surae muscle. We administered 1-MHz continuous ultrasound at 1.5 W/cm(2) until the tissue temperature increased 4 degrees C (vigorous heating). Immediately following the treatment, we recorded the rate at which the temperature dropped at 30second intervals. We ran a stepwise nonlinear regression analysis to predict temperature decay as a function of time following ultrasound treatment. There was a significant nonlinear relationship between time and temperature decay. At 2.5 cm, the average time for the temperature to drop each degree was: 1 degrees C = 2:34; 2 degrees C = 6:35; 3 degrees C = 12:10: and 4 degrees C = 21:14. At 5 cm, the average time for the temperature to drop each degree was: 1 degrees C = 2:31, 2 degrees C = 6:50: 3 degrees C = 14:32; and 4 degrees C = 27:49. Based upon prior research, thermal decay of 1-MHz ultrasound was slower than 3 MHz, and the deeper tissue cooled at a slower rate than superficial tissue following 1-MHz ultrasound. The data illustrated that the stretching window was open longer for deep-seated structures than for superficial ones.

Increased joint laxity may predispose an individual to ligamentous injury. Female gymnasts have a high incidence of ligamentous injury, including the anterior cruciate ligament (ACL). Previous authors have found a relationship between ACL disruption and preexisting ligament laxity. The purpose of this study was to compare anterior knee laxity in the knees of female intercollegiate gymnasts with those of a normal female population. A secondary purpose was to measure genu recurvatum and assess the relationship between it and anterior laxity in the knee. We tested 30 gymnasts and 30 control subjects having no history of ACL injury with the KT-1000 knee arthrometer. The quadriceps active, 133 N (30 lb) anterior drawer, and manual maximum tests were performed on the subjects' right knees along with goniometer measurements. Using a two-way analysis of variance (ANOVA) with repeating measures, we detected a significant increase in anterior laxity when comparing the 133 N to the manual maximum test, but no significant difference between gymnasts and nongymnasts. We concluded that gymnasts, as a group, are not abnormally lax when compared to an active population of similar age. Future comparison of the longitudinal data of those who incur ACL injury during their gymnastics careers may show whether individuals with increased laxity have increased risk of ligamentous injury.

Contrast therapy, although having a long history of use in sports medicine and physical therapy, remains insufficiently researched. We investigated the thermal effects of contrast therapy on intramuscular temperature. We randomly assigned 28 college students to either a control or a contrast group, eight women and six men per group. We shaved and cleansed a 4- x 4-cm area of skin over the right medial calf and inserted a microprobe to a depth of 1 cm below the skin and subcutaneous fat in the center of the gastrocnemius. Each control subject immersed the treatment leg in a hot whirlpool (40.6 degrees C) for 20 minutes. Each contrast subject first immersed the treatment leg in a hot whirlpool (40.6 degrees C) for 4 minutes then into a cold whirlpool (15.6 degrees C) for 1 minute. Contrast subjects repeated this sequence three additional times. We recorded intramuscular temperatures every 30 seconds over the entire treatment time for both groups. The control group had a temperature increase of 2.83 +/- 1.14 degrees C over the 20-minute treatment. The contrast group temperature increased 0.39 +/- 0.46 degrees C from baseline to the end of the treatment. The largest temperature change from the end of one contrast immersion to the end of the next was only 0.15 +/- 0.10 degrees C. None of the differences between the end of one immersion to the end of the next were significant. Conversely, all differences between the same time periods in the control group had significant temperature increases. Apparently contrast therapy, as studied, is incapable of producing any significant physiological effect on the intramuscular tissue temperature 1 cm below the skin and subcutaneous tissue. We recommend that further research be done to examine the effects of longer periods in both the hot and cold environments on the intramuscular temperature of the human leg. Further investigation of intra-articular or peri-articular temperature change produced by contrast therapy should also be undertaken.

Therapeutic ultrasound is frequently employed as a deep heating rehabilitation modality. It is administered in one of three ways: a) ultrasound with no preceding treatment, b) ultrasound on preheated tissues, or c) ultrasound on precooled tissues. The purpose of this study was to investigate the effect of ultrasound treatments on the tissue temperature rise of precooled human gastrocnemius muscle. Sixteen male subjects had a 23-gauge hypodermic needle microprobe inserted 3 cm deep into the medial aspect of their anesthetized gastrocnemius muscles. Data were gathered on each subject for one of two randomly assigned treatments: a) ultrasound treatment on precooled tissue, or b) ultrasound with no preceding treatment. Each treatment consisted of ultrasound delivered topically at 1.5 watts/cm(2) in a continuous mode for 10 minutes. Ultrasound was applied in an overlapping longitudinal motion at 4 cm/s, with temperature readings recorded at 30-second intervals. We discovered a difference between the two treatment methods [t(14) = 16.26, p < .0001]. Ultrasound alone increased tissue temperature an average of 2 degrees C, whereas ultrasound preceded by 15 minutes of ice did not increase tissue temperature even to the original baseline level. We concluded that, at a depth of 3 cm, ultrasound alone provided a greater heating effect than ultrasound preceded by an ice treatment.

We investigated the effects of cryotherapy followed by sequential exercise bouts on concentric and eccentric strength of the quadriceps. Nineteen males (18-27 years) participated in a two-stage design involving four sequences: ice and exercise, ice and rest, no ice and exercise, and no ice and rest. We gathered concentric and eccentric strength measures (torque) using a kinetic communicator (KIN-COM) prior to exercise, immediately following treatment, and 20- and 40-minutes post-treatment. There were significant decreases in concentric and eccentric strength immediately following the 25-minute cryotherapy treatment. This suggests that applying ice immediately prior to participation or returning an athlete to competition immediately following cryotherapy treatment may adversely affect his/her ability to perform. It appears that the reduction in strength following cryotherapy is of short duration (less than 20 minutes). The delayed effect of the ice treatment and sequential exercise appears to affect concentric and eccentric strength differently. Ice did not have a delayed effect on concentric strength, but there was a significant difference in eccentric values. This difference was a failure to improve during post-tests at the rate of those not treated with ice. Exercise did not have a significant effect on eccentric strength recovery, but there was a significant difference in concentric values. Moderate exercise following cryotherapy appears to help the recovery of concentric strength.

We investigated the effects of ice massage, ice massage with exercise, and exercise on the prevention and treatment of delayed onset muscle soreness (DOMS). Twenty-two subjects were randomly assigned to one of four groups. Preexercise measures were recorded for range of motion (ROM), strength, perceived soreness, and serum creatine kinase (CK) levels. Subjects performed up to 300 concentric/eccentric contractions of the elbow flexors with 90% of their 10 repetition maximum to induce muscle soreness. Dependent variables were assessed at 2, 4, 6, 24, 48, 72, 96, and 120 hours postexercise. Significant differences occurred in all variables with respect to time (ANOVA(p<.05)). However, no significant mode of treatment, or mode of treatment/assessment time interaction was present. Decreases in range of motion and flexion strength correspond with increases in perceived soreness. The nonsignificant mode of treatment/assessment time interaction suggests that the use of ice massage, ice massage with exercise, or exercise alone is not effective in significantly reducing the symptoms of delayed onset muscle soreness. In fact, though not statistically significant, the pattern of the data suggested the use of ice in the treatment of DOMS may be contraindicated. Further investigation is recommended.