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The T Trials provided definitive evidence for short-term clinically meaningful, albeit modest benefits and risks of testosterone treatment in older men with unequivocal age-related hypogonadism. Larger and longer-term placebo-controlled clinical trials are needed to assess the long-term benefits and risks of testosterone treatment on clinical outcomes such as frailty, depression, fractures, prostate cancer and cardiovascular events.Introduction Approximately 15% of the US population experiences migraine, with women afflicted three times as often as men. While medications are often used as first-line treatments, up to 50% of people with migraine pursue complementary and integrative medicine. One promising non-pharmacological approach for migraine is chiropractic care, due to the co-occurrence of migraine disease and musculoskeletal tension and pain. To date, no large-scale trials have evaluated the impact of a comprehensive model of chiropractic care on migraine. Methods The Integrative Migraine Pain Alleviation through Chiropractic Therapy (IMPACT) study is a two-arm pilot pragmatic randomized clinical trial evaluating a multimodal chiropractic care intervention plus enhanced usual care (UC) vs. enhanced UC alone for adult women with episodic migraine. A total of 60 women aged 20-55 who meet criteria for episodic migraine will be randomly assigned to an evidence-informed, musculoskeletal focused multimodal chiropractic care (10 sessions over 14 weeks) plus enhanced UC vs. enhanced UC alone. Enhanced UC includes conventional care, migraine education materials, and biweekly check-in phone calls. Study specific aims include 1) Determine safety and feasibility of the study design; 2) Provide preliminary data on the effectiveness of chiropractic care on migraine frequency, severity, duration and medication use; and 3) Provide preliminary estimates of the effects of chiropractic care on disability, health-related quality of life, and psychosocial well-being. Discussion Findings will be used to inform the design of a full-scale trial evaluating chiropractic care for women with episodic migraines. © 2020 The Authors. Published by Elsevier Inc.One in five suicide deaths is a Veteran and in spite of enhanced suicide prevention services in the Veterans Health Administration (VHA), twenty Veterans die by suicide each day. One component of the VHA’s coordinated effort to treat high-risk suicidal Veterans, and diminish suicide risk, is the use of the safety plan. The current study aims to examine a novel intervention integrating skills training and social support with safety planning for Veterans at high-risk for suicide, “Project Life Force” (PLF). A randomized clinical trial (RCT) will be conducted examining if Veterans who are at high-risk for suicide will benefit from the novel group intervention, PLF, compared to Veterans who receive treatment as usual (TAU). We plan to randomize 265 Veterans over the course of the study. The primary outcome variable is the incidence of suicidal behavior, during follow-up, established using a rigorous, multi-method assessment. Secondary outcomes include depression, hopelessness, suicide coping and treatment utilization. Exploratory analyses include safety plan quality and belongingness for those in both arms as well as group cohesion for those in the PLF intervention. Strengths and limitations of this protocol are discussed.Lumbar spinal stenosis (LSS) is characterized by narrowing of the central canal, lateral recesses, or foramina leading to compression of neural tissue. The clinical syndrome associated with LSS is usually neurogenic claudication, which often presents as lower back and extremity pain, numbness, and tingling upon ambulation. Autonomic dysfunction is rarely observed in patients with LSS; however, a subset of male patients has been reported to experience intermittent priapism associated with the onset of neurogenic claudication symptoms. We present the case of a 33-year-old male who was diagnosed with LSS associated with neurogenic claudication and priapism who underwent minimally invasive decompressive surgery. Complete resolution of claudication and priapism was observed at the 6-week follow-up visit. This case report highlights minimally invasive lumbar decompression as an effective treatment for the rarely observed presentation of priapism associated with LSS. 2019 Journal of Spine Surgery. All rights reserved.Spinal fusion is a common procedure for the treatment of various spinal pathologies. Since the early days, spinal fusion has been carried out with the use of bone grafts as interbody spacers. With the development of synthetic interbody implants, bone grafts were used to facilitate fusion. Although autograft provides the best outcomes for fusion, allografts have been sought after due to donor site morbidity and other shortcomings. Tween 80 order Currently, a vast variety of demineralised bone matrix (DBM) products are available with their methods of processing and preparation impacting their properties and clinical outcomes. Demineralised bone fibres (DBF), a form a DBM can be easily packed into implants when mixed with other substances such as allograft bone and patient’s blood providing a scaffold for the mixture. We report two cases of anterior lumbar interbody fusion (ALIF) utilising a titanium-polyetheretherketone (PEEK) interbody cage filled with DBF, allograft and patient’s blood with a maximum of 12 months follow-up outcome. 2019 Journal of Spine Surgery. All rights reserved.Cervical disc replacements are commonly used to treat degenerative disc disease. We present a case an M6-C disc replacement failure associated with Propionibacterium acnes infection three years post implantation. 2019 Journal of Spine Surgery. All rights reserved.Chronic low back pain has both substantial social and economic impacts on patients and healthcare budgets. Adding to the magnitude of the problem is the difficulty in identifying the exact causes of disc degeneration with modern day diagnostic and imaging techniques. With that said, current non-operative and surgical treatment modalities for discogenic low back pain fails to meet the expectations in many patients and hence the challenge. The objective for newly emerging stem cell regenerative therapy is to treat degenerative disc disease (DDD) by restoring the disc’s cellularity and modulating the inflammatory response. Appropriate patient selection is crucial for the success of stem cell therapy. Regenerative modalities for discogenic pain currently focus on the use of either primary cells harvested from the intervertebral discs or stem cells from other sources whether autogenic or allogenic. The microenvironment in which stem cells are being cultured has been recognized to play a crucial role in directing or maintaining the production of the desired phenotypes and may enhance their regenerative potential.