son, and Randall Bryner. Exercise training blunts microvascular rarefaction in the metabolic syndrome. Am J Physiol Heart Circ Physiol 291: H2483-H2492, 2006. First published June 23, 2006 doi:10.1152/ajpheart.00566.2006.-Reduced skeletal muscle microvessel density (MVD) in the obese Zucker rat (OZR) model of the metabolic syndrome is a function of a chronic reduction in vascular nitric oxide (NO) bioavailability. Previous studies suggest that exercise can improve NO bioavailability and reduce chronic inflammation and that low vascular NO bioavailability may be associated with impaired angiogenic responses via increased matrix metalloproteinase (MMP)-2 and MMP-9 activity. As such, we hypothesized that chronic exercise (EX) would increase NO bioavailability in OZR and blunt microvascular rarefaction through reduced MMP activity, and potentially via altered plasma cytokine levels. Ten weeks of treadmill exercise (1 h/day, 5 days/wk, 22 m/min) reduced body mass and fasting insulin and triglyceride levels in EX-OZR vs. sedentary (SED) OZR. In EX-OZR, gastrocnemius muscle MVD was improved by 19 Ϯ 4%, whereas skeletal muscle arteriolar dilation and conduit arterial methacholine-induced NO release were increased. In EX-OZR, functional hyperemia was improved vs. SED-OZR, and minimum vascular resistance within perfused gastrocnemius muscle was reduced, although no change in arteriolar stiffness was identified. Western blotting and gelatin zymography demonstrated that neither expression nor activity of MMP-2 or MMP-9 was altered in skeletal muscle of EX vs. SED animals. Plasma markers of inflammation associated with angiogenesis, monocyte chemoattractant protein-1 and IL-1␤, were increased in SED-OZR and were reduced with training, whereas IL-13 was reduced in SED-OZR and increased with exercise. These data suggest that exercise-induced improvements in skeletal muscle MVD in OZR are associated with increased NO bioavailability and may stem from altered inflammatory profiles rather than MMP function. skeletal muscle microcirculation; regulation of skeletal muscle perfusion; microvessel density; vascular remodeling; vascular resistance THE OBESE ZUCKER RAT (OZR) is a model of the metabolic syndrome based on chronic hyperphagia (5, 21). As such, this animal model rapidly becomes obese and develops profound insulin resistance and hypertriglyceridemia, with a clinically relevant hypertension and the genesis of a prothrombotic and proinflammatory state (2,17,24,51). We have previously demonstrated that, with evolution of the metabolic syndrome in the OZR, a progressive reduction in skeletal muscle microvessel density develops that can result in 25% reduction in the total number of microvessels within this tissue compared with levels determined in control animals (14). This rarefaction of the vascular network contributes to an elevation in peripheral vascular resistance in OZR (12, 14, 15) and appears to be largely independent of any developing increase in mean arterial pressure (13). In contrast, ongoing studies in our laborat...

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Conservative measures, including physical therapy, restriction of activities, core strengthening, improvement of sensory-motor, and control and nonsteroidal anti-inflammatories are the mainstays of nonsurgical treatment. However, surgical management is often necessary to allow full return to activity with options including surgical dislocation of the hip, hip arthroscopy, periacetabular and rotational osteotomies, and combined hip arthroscopy with a limited open exposure. Although the literature is replete with short-term evidence to support surgical treatment, there are currently no long-term prospective data or natural history studies examining the implications of FAI and effects of early intervention.

Core decompression (CD) for the treatment of osteonecrosis of the hip has been a surgical option since the 1960s. We performed a systematic review to evaluate CD with regard to pain relief, need for total hip arthroplasty (THA), and lesion size and Ficat stage. Only four articles of level IV evidence (139 total cases) met inclusion criteria. Three reported improvement in outcomes. Overall average outcomes were only "good" in one study and either "fair" or "poor" in the others. One-fourth (25.8%) of patients required THA. Patients with necrotic lesion size <50% had best outcomes with CD. Although CD may become a standard treatment option to prevent THA in early stages of ON, there are not currently rigorous studies that provide long-term outcome measures.

Therapeutic IV.