Purpose: Although lower body strength and size are often regarded as symbols of masculinity, their relationship to testosterone is unclear. This study aimed to determine the correlation between lower body strength, size, and testosterone levels. Materials and Methods: Serum testosterone levels, waist circumference, and body mass index (BMI) were measured in 69 men with erectile dysfunction (age >40 years). The circumferences of the thigh and calf were measured, and the muscle strength of the knee joints was evaluated using an isokinetic dynamometer. Patients were classified into three groups according to testosterone levels (group 1, <230 ng/dL; group 2, 230 to 350 ng/dL; group 3, >350 ng/dL). Differences in calf and thigh circumference, bilateral knee extension, and flexion strength between the three groups were investigated using a one-way analysis of variance. Pearson’s chi-square test was used to assess differences in lifestyle habits and underlying diseases. A partial correlation analysis was conducted to determine the association between testosterone levels and lower body size and strength. Results: There was no difference in BMI among the three groups, but waist circumference was significantly larger in group 1 than in groups 2 and 3. When comparing weight-adjusted values, bilateral thigh circumference showed a significant difference among the three groups. There was also a significant difference between the three groups in the weight-adjusted left calf circumference and in the weight-adjusted right knee extension strength. The partial correlation test showed a significant positive correlation between thigh and calf circumference values adjusted for weight and serum testosterone levels. Weight-adjusted knee extension strength demonstrated a significant positive correlation with serum testosterone levels. Conclusions Weight-adjusted thigh and calf circumferences, along with the thigh-to-waist ratio, showed a positive correlation with testosterone levels. Weight-adjusted knee extension strength was positively correlated with testosterone levels. Therefore, a robust thigh and strong lower body are related to testosterone.

Purpose: The purpose of this study was to compare the effectiveness of pericapsular nerve group (PENG) block with periarticular multimodal drug injection (PMDI) on postoperative pain management and surgical outcomes in patients who underwent total hip arthroplasty (THA). We hypothesized that PENG block with PMDI would exhibit superior effects on postoperative pain control after THA compared to PMDI alone. Materials and Methods: From April 2022 to February 2023, 58 patients who underwent THA were randomly assigned into two groups: PENG block with PMDI group (n=29) and PMDI-only group (n=29). Primary outcomes were postoperative numeric rating scale (NRS) at rest and during activity at 6, 24, and 48 hours postoperatively. Secondary outcomes were postoperative complications (nausea and vomiting), Richards-Campbell Sleep Questionnaire (RCSQ) score, length of hospital stay, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, Harris Hip Score (HHS), and total morphine usage after surgery. Results: There was no significant difference in postoperative pain for either resting NRS or active NRS. Postoperative nausea and vomiting, RCSQ score, length of hospital stay, WOMAC index, HHS, and total morphine usage exhibited no significant differences between the two groups. Conclusion Both groups showed no significant differences in postoperative pain and clinical outcomes, indicating that the addition of PENG block to PMDI does not improve pain management after applying the posterolateral approach of THA. PMDI alone during THA would be an efficient, fast, and safe method for managing postoperative pain. This article was registered with ClinicalTrials.gov (Gov ID: NCT05320913).

It is difficult to determine a cause of bile duct stricture and dilatation. Eosinophilic cholangitis, a rare benign condition, may be one cause of bile duct stricture and dilatation. It can be evaluated using various methods of histopathology, radiographs, endoscopy, and hematologic findings. Treatment generally involves steroid therapy which can lead to improvement. This case report will discuss eosinophilic cholangitis, emphasizing that while it can easily be overlooked but should be considered in differential diagnoses.

It is difficult to determine a cause of bile duct stricture and dilatation. Eosinophilic cholangitis, a rare benign condition, may be one cause of bile duct stricture and dilatation. It can be evaluated using various methods of histopathology, radiographs, endoscopy, and hematologic findings. Treatment generally involves steroid therapy which can lead to improvement. This case report will discuss eosinophilic cholangitis, emphasizing that while it can easily be overlooked but should be considered in differential diagnoses.

Purpose: Although lower body strength and size are often regarded as symbols of masculinity, their relationship to testosterone is unclear. This study aimed to determine the correlation between lower body strength, size, and testosterone levels. Materials and Methods: Serum testosterone levels, waist circumference, and body mass index (BMI) were measured in 69 men with erectile dysfunction (age >40 years). The circumferences of the thigh and calf were measured, and the muscle strength of the knee joints was evaluated using an isokinetic dynamometer. Patients were classified into three groups according to testosterone levels (group 1, <230 ng/dL; group 2, 230 to 350 ng/dL; group 3, >350 ng/dL). Differences in calf and thigh circumference, bilateral knee extension, and flexion strength between the three groups were investigated using a one-way analysis of variance. Pearson’s chi-square test was used to assess differences in lifestyle habits and underlying diseases. A partial correlation analysis was conducted to determine the association between testosterone levels and lower body size and strength. Results: There was no difference in BMI among the three groups, but waist circumference was significantly larger in group 1 than in groups 2 and 3. When comparing weight-adjusted values, bilateral thigh circumference showed a significant difference among the three groups. There was also a significant difference between the three groups in the weight-adjusted left calf circumference and in the weight-adjusted right knee extension strength. The partial correlation test showed a significant positive correlation between thigh and calf circumference values adjusted for weight and serum testosterone levels. Weight-adjusted knee extension strength demonstrated a significant positive correlation with serum testosterone levels. Conclusions Weight-adjusted thigh and calf circumferences, along with the thigh-to-waist ratio, showed a positive correlation with testosterone levels. Weight-adjusted knee extension strength was positively correlated with testosterone levels. Therefore, a robust thigh and strong lower body are related to testosterone.

Purpose: The purpose of this study was to compare the effectiveness of pericapsular nerve group (PENG) block with periarticular multimodal drug injection (PMDI) on postoperative pain management and surgical outcomes in patients who underwent total hip arthroplasty (THA). We hypothesized that PENG block with PMDI would exhibit superior effects on postoperative pain control after THA compared to PMDI alone. Materials and Methods: From April 2022 to February 2023, 58 patients who underwent THA were randomly assigned into two groups: PENG block with PMDI group (n=29) and PMDI-only group (n=29). Primary outcomes were postoperative numeric rating scale (NRS) at rest and during activity at 6, 24, and 48 hours postoperatively. Secondary outcomes were postoperative complications (nausea and vomiting), Richards-Campbell Sleep Questionnaire (RCSQ) score, length of hospital stay, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, Harris Hip Score (HHS), and total morphine usage after surgery. Results: There was no significant difference in postoperative pain for either resting NRS or active NRS. Postoperative nausea and vomiting, RCSQ score, length of hospital stay, WOMAC index, HHS, and total morphine usage exhibited no significant differences between the two groups. Conclusion Both groups showed no significant differences in postoperative pain and clinical outcomes, indicating that the addition of PENG block to PMDI does not improve pain management after applying the posterolateral approach of THA. PMDI alone during THA would be an efficient, fast, and safe method for managing postoperative pain. This article was registered with ClinicalTrials.gov (Gov ID: NCT05320913).

Background: and Purpose Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes. Methods: We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data. Results: Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m2 , and a 3-month modified Rankin Scale score of ≥4. Conclusion Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.

Background and Objectives: Among various emerging catheter-based treatments for severe tricuspid regurgitation (TR), the spacer device can reduce the regurgitation orifice without manipulating the valve leaflet. However, its clinical application has been hampered by traumatic anchoring to the myocardium and the coaxial alignment of the balloon resulting in insufficient TR reduction. This study aimed to evaluate the early-stage safety, technical feasibility, and preliminary efficacy of the novel atraumatic vertical spacer in patients with isolated severe TR. Methods: All procedures were guided by fluoroscopy and transthoracic echocardiography.The maximum device placement time with an inflated balloon was 24 hours. Changes in the amount of TR, right ventricular function, and patient hemodynamics were measured during balloon deployment. Results: A total of 7 patients (median age 74), underwent successful device implantation without procedure-related complications. During balloon inflation (median 25 minutes), there were no symptoms or signs indicative of TR intolerance. TR was reduced by 1 grade or greater in all patients, with 2 patients exhibiting a reduction of 3 grades, from torrential TR to a moderate degree. Mild TR after balloon inflation was achieved in 3 patients with baseline severe TR. The TR reduction observed during initial balloon deployment was sustained during the subsequent balloon maintenance period. Conclusions The Pivot-balloon procedure was safe, technically feasible, and effective in reducing TR in patients with severe TR. No periprocedural complications or adverse cardiovascular events were reported during device placement with TR reduction observed in all patients. However, longer-term follow-up is needed to confirm safety and treatment effect.