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PurposeA cyclist’s rate of force/torque development (RFD/RTD) and peak force/torque can be measured during single-joint or whole-body isometric tests, or during cycling. However, there is limited understanding of the relationship between these measures, and of the mechanisms that contribute to each measure. Therefore, we examined the: (i) relationship between quadriceps central and peripheral neuromuscular function with RFD/RTD in isometric knee extension, isometric mid-thigh pull (IMTP), and sprint cycling; and (ii) relationship among RFD/RTD and peak force/torque between protocols.MethodsEighteen trained cyclists completed two familiarisation and two experimental sessions. Each session involved an isometric knee extension, IMTP, and sprint cycling protocol, where peak force/torque, average and peak RFD/RTD, and early (0–100 ms) and late (0–200 ms) RFD/RTD were measured. Additionally, measures of quadriceps central and peripheral neuromuscular function were assessed during the knee extension.ResultsStrong relationships were observed between quadriceps early EMG activity (EMG50/M) and knee extension RTD (r or ρ = 0.51–0.65) and IMTP late RFD (r = 0.51), and between cycling early or late RTD and peak twitch torque (r or ρ = 0.70–0.75). Strong-to-very strong relationships were observed between knee extension, IMTP, and sprint cycling for peak force/torque, early and late RFD/RTD, and peak RFD/RTD (r or ρ = 0.59–0.80).ConclusionIn trained cyclists, knee extension RTD or IMTP late RFD are related to measures of quadriceps central neuromuscular function, while cycling RTD is related to measures of quadriceps peripheral neuromuscular function. Further, the strong associations among force/torque measures between tasks indicate a level of transferability across tasks.

Strong relationships exist between sprint cycling torque and isometric mid‐thigh pull (IMTP) force production at one timepoint; however, the relationships between the changes in these measures following a training period are not well understood. Accordingly, this study examined the relationships in the changes of sprint cycling torque and IMTP force following six‐weeks of sprint cycling and resistance training performed by strength‐trained novice cyclists (n = 14). Cycling power, cadence, torque and IMTP force (Peak force [PF]/torque, average and peak rate of force/torque development [RFD/RTD], and RFD/RTD from 0 to 100 ms and 0–200 ms) were assessed before and after training. Training consisted of three resistance and three sprint cycling sessions per week. Training resulted in improvements in IMTP PF (13.1%) and RFD measures (23.7%–32.5%), cycling absolute (10.7%) and relative (10.5%) peak power, peak torque (11.7%) and RTD measures (27.9%–56.7%). Strong‐to‐very strong relationships were observed between cycling torque and IMTP force measures pre‐ (r = 0.57–0.84; p < 0.05) and post‐training (r = 0.63–0.87; p < 0.05), but no relationship (p > 0.05) existed between training‐induced changes in cycling torque and IMTP force. Divergent training‐induced changes in sprint cycling torque and IMTP force indicate that these measures assess distinct neuromuscular attributes. Training‐induced changes in IMTP force are not indicative of training‐induced changes in sprint cycling torque. Highlights Six weeks of resistance and sprint cycling training resulted in improvements in isometric mid‐thigh pull (IMTP) peak force (13.1%) and rate of force development measures (23.7%–32.5%), cycling absolute (10.7%) and relative (10.5%) peak power, peak torque (11.7%), and rate of torque development measures (27.9%–56.7%) in strength‐trained novice cyclists. No significant relationships were observed between the training‐induced changes in IMTP force measures and sprint cycling torque measures following training. No significant relationships were observed between the training‐induced changes in cycling peak power and changes in cycling torque, IMTP force, back squat and trap bar deadlift with three repetition maximum.

This study was designed to quantify inter- and intra-individual variability in performance, physiological, and perceptual responses to high-intensity interval training prescribed using the percentage of delta (%Δ) method, in which the gas exchange threshold and maximal oxygen uptake (V̇O2max) are taken into account to normalise relative exercise intensity. Repeated-measures, within-subjects design with mixed-effects modelling. Eighteen male and four female cyclists (age: 36 ± 12 years, height: 178 ± 10 cm, body mass: 75.2 ± 13.7 kg, V̇O2max: 51.6 ± 5.3 ml·kg−1·min−1) undertook an incremental test to exhaustion to determine the gas exchange threshold and V̇O2max as prescription benchmarks. On separate occasions, participants then completed four high-intensity interval training sessions of identical intensity (70 %Δ) and format (4-min on, 2-min off); all performed to exhaustion. Acute high-intensity interval training responses were modelled with participant as a random effect to provide estimates of inter- and intra-individual variability. Greater variability was generally observed at the between- compared with the within-individual level, ranging from 50 % to 89 % and from 11 % to 50 % of the total variability, respectively. For the group mean time to exhaustion of 20.3 min, inter- and intra-individual standard deviations reached 9.3 min (coefficient of variation = 46 %) and 4.5 min (coefficient of variation = 22 %), respectively. Due to the high variability observed, the %Δ method does not effectively normalise the relative intensity of exhaustive high-intensity interval training across individuals. The generally larger inter- versus intra-individual variability suggests that day-to-day biological fluctuations and/or measurement errors cannot explain the identified shortcoming of the method.

Introduction Accessory cavitated uterine malformation (ACUM) is a relatively recent term used to describe a noncommunicating, accessory uterine cavity. ACUM have been published under different terms ranging from juvenile cystic adenomyosis to “uterus‐like mass”. The objective of this study was to systematically identify all cases of ACUM and definitions described in the literature, regardless of label, and identify morphological, epidemiological, and clinical characteristics as well as management, while also highlighting knowledge gaps. Material and methods A systematic literature search of three databases was performed, reviewing all records of cystic myometrial lesions. Cases that fitted common definitions for ACUM were included and clinical and imaging characteristics were documented in detail. This work was registered to PROSPERO and reporting followed PRISMA guidelines for scoping reviews. Results A total of 53 articles were included, comprising 115 cases that met the minimal criteria for ACUM. The median age at onset of symptoms was 17 years, presenting with dysmenorrhea soon after menarche. A total of 19 women were parous. On ultrasound, ACUM appears as unilocular myometrial cysts, usually with ground‐glass content. Hemorrhagic content is also observed on magnetic resonance imaging (MRI), with high signal intensity on both T2 and T1‐weighted images. Ninety‐five (83%) cases were managed surgically, with a trend towards primary nonsurgical options. Although no adverse outcomes were reported, long‐term follow‐up on subsequent fertility and pregnancy was rare. Conclusions Despite its increasing recognition as a clinical entity, ACUM often remains underdiagnosed as it shares similarities with other myometrial masses. We propose a unified terminology and definition for ACUM based on the data in this review. ACUM presents as a cavitated lesion, surrounded by a myometrial mantle, in continuity with the anterolateral uterine wall and located beneath the insertion of the round ligament and the interstitial portion of the fallopian tube. In contrast to other uterine abnormalities, a normal uterine cavity is visualized. Future studies are needed, using a clear definition for ACUM, and prospectively investigating management strategies, including long‐term follow‐up of patient‐reported symptoms, fertility, and pregnancy outcomes. Accessory cavitated uterine malformation is a distinct, yet unclassified uterine anomaly. This systematic review summarizes diagnostic and clinical findings as well as management strategies from all described cases in the literature and suggests unified diagnostic criteria and definitions.

To the Editor: In their Clinical Practice article, Stewart and Laughlin-Tommaso (Nov. 7 issue) 1 describe management strategies for uterine fibroids. They describe, justly, the importance of reducing rates of hysterectomy and offering conservative options, such as medical or procedural interventions. However, we were surprised by their recommending myomectomy only in persons actively seeking pregnancy. A recent meta-analysis of randomized, controlled trials 2 showed that women undergoing myomectomy had better quality of life than those undergoing uterine artery embolization, along with a reduced risk of reintervention and a longer interval before needing additional treatment. The incidence of major perioperative complications was similar . . .

Ovarian tumours are usually surgically removed because of the presumed risk of complications. Few large prospective studies on long-term follow-up of adnexal masses exist. We aimed to estimate the cumulative incidence of cyst complications and malignancy during the first 2 years of follow-up after adnexal masses have been classified as benign by use of ultrasonography. In the international, prospective, cohort International Ovarian Tumor Analysis Phase 5 (IOTA5) study, patients aged 18 years or older with at least one adnexal mass who had been selected for surgery or conservative management after ultrasound assessment were recruited consecutively from 36 cancer and non-cancer centres in 14 countries. Follow-up of patients managed conservatively is ongoing at present. In this 2-year interim analysis, we analysed patients who were selected for conservative management of an adnexal mass judged to be benign on ultrasound on the basis of subjective assessment of ultrasound images. Conservative management included ultrasound and clinical follow-up at intervals of 3 months and 6 months, and then every 12 months thereafter. The main outcomes of this 2-year interim analysis were cumulative incidence of spontaneous resolution of the mass, torsion or cyst rupture, or borderline or invasive malignancy confirmed surgically in patients with a newly diagnosed adnexal mass. IOTA5 is registered with ClinicalTrials.gov, number NCT01698632, and the central Ethics Committee and the Belgian Federal Agency for Medicines and Health Products, number S51375/B32220095331, and is ongoing. Between Jan 1, 2012, and March 1, 2015, 8519 patients were recruited to IOTA5. 3144 (37%) patients selected for conservative management were eligible for inclusion in our analysis, of whom 221 (7%) had no follow-up data and 336 (11%) were operated on before a planned follow-up scan was done. Of 2587 (82%) patients with follow-up data, 668 (26%) had a mass that was already in follow-up at recruitment, and 1919 (74%) presented with a new mass at recruitment (ie, not already in follow-up in the centre before recruitment). Median follow-up of patients with new masses was 27 months (IQR 14–38). The cumulative incidence of spontaneous resolution within 2 years of follow-up among those with a new mass at recruitment (n=1919) was 20·2% (95% CI 18·4–22·1), and of finding invasive malignancy at surgery was 0·4% (95% CI 0·1–0·6), 0·3% (<0·1–0·5) for a borderline tumour, 0·4% (0·1–0·7) for torsion, and 0·2% (<0·1–0·4) for cyst rupture. Our results suggest that the risk of malignancy and acute complications is low if adnexal masses with benign ultrasound morphology are managed conservatively, which could be of value when counselling patients, and supports conservative management of adnexal masses classified as benign by use of ultrasound. Research Foundation Flanders, KU Leuven, Swedish Research Council.

Background Assessing malignancy risk is important to choose appropriate management of ovarian tumors. We compared six algorithms to estimate the probabilities that an ovarian tumor is benign, borderline malignant, stage I primary invasive, stage II-IV primary invasive, or secondary metastatic. Methods This retrospective cohort study used 5909 patients recruited from 1999 to 2012 for model development, and 3199 patients recruited from 2012 to 2015 for model validation. Patients were recruited at oncology referral or general centers and underwent an ultrasound examination and surgery ≤ 120 days later. We developed models using standard multinomial logistic regression (MLR), Ridge MLR, random forest (RF), XGBoost, neural networks (NN), and support vector machines (SVM). We used nine clinical and ultrasound predictors but developed models with or without CA125. Results Most tumors were benign (3980 in development and 1688 in validation data), secondary metastatic tumors were least common (246 and 172). The c-statistic (AUROC) to discriminate benign from any type of malignant tumor ranged from 0.89 to 0.92 for models with CA125, from 0.89 to 0.91 for models without. The multiclass c-statistic ranged from 0.41 (SVM) to 0.55 (XGBoost) for models with CA125, and from 0.42 (SVM) to 0.51 (standard MLR) for models without. Multiclass calibration was best for RF and XGBoost. Estimated probabilities for a benign tumor in the same patient often differed by more than 0.2 (20% points) depending on the model. Net Benefit for diagnosing malignancy was similar for algorithms at the commonly used 10% risk threshold, but was slightly higher for RF at higher thresholds. Comparing models, between 3% (XGBoost vs. NN, with CA125) and 30% (NN vs. SVM, without CA125) of patients fell on opposite sides of the 10% threshold. Conclusion Although several models had similarly good performance, individual probability estimates varied substantially.

Accurate triage of ovarian masses is facilitated in many centers by the guideline-endorsed, extensively validated IOTA-ADNEX risk model, yet the model still relies on manual measurements of key tumor features. We developed ADNEX-AI, a multi-task deep-learning system that automatically segments four ADNEX ultrasound predictors – lesion, locules, solid tissue, papillary projections – and outputs their quantitative values. The network was trained on 816 annotated images from 369 consecutive women recruited at 11 centers (43% malignancies) and prospectively evaluated on a temporally separate cohort of 1088 patients scanned at 10 of those centers (8008 images; 35% malignancies). ADNEX-AI discriminated benign from malignant tumors with an AUC of 0.930 (95% CI 0.913-0.943), less than but close to examiner-derived ADNEX (0.945; 0.930-0.957; P = 0.004) while delivering better calibration and markedly lower inter-center variability. By removing manual caliper work yet preserving full interpretability, ADNEX-AI could extend high-quality ovarian-cancer risk stratification to clinics that lack specialized ultrasound expertise.

The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group, and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the pre-operative diagnosis of ovarian tumors, including imaging techniques, biomarkers, and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the pre-operative diagnosis of ovarian tumors and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when a consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the pre-operative diagnosis of ovarian tumors and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.