Disgraced former USA Gymnastics team doctor Larry Nassar has been jailed for another 40 to 125 years for molesting girls and women in his care.
It came at the conclusion of his third and final sentencing hearing in Charlotte in Michigan.
The penalty adds to the 40 to 175 year sentence he received at a previous hearing last month, while he has also been sentenced to 60 years on child pornography charges.
The number of women who have now accused Nassar of abuse is more than 265, with the number including Olympic athletes.
Nassar attempted to show remorse, saying: "It's impossible to convey the depth and breadth of how sorry I am to each and every one involved."
However, this was dismissed in Charlotte by Judge Janice Cunningham.
"I am not convinced that you truly understand that what you did was wrong, and the devastating impact that you have had on the victims, their families and friends," she said.
"Clearly you are in denial.
"You don't get it."
Dozens of women have testified against Nassar in court hearings.
Last week, father Randall Musgraves, whose three daughters were abused, tried to attack him in the dock.
The United States Olympic Committee (USOC) has ordered an independent investigation, while USA Gymnastics has confirmed it has received resignations from all members of its Board of Directors.
The USOC had demanded that all members of the Board quit and had threatened to de-certify the organisation if it did not happen.
Both the USOC and USA Gymnastics have faced criticism due to Nassar going undetected for so long.
Angela Ruggiero, a former American ice hockey player and the outgoing chair of the International Olympic Committee's (IOC) Athletes' Commission, confirmed in Pyeongchang today that the scandal had been discussed by the IOC's Executive Board (EB).
"The EB have unwavering support of athletes who have brought light and visibility to this shocking situation," she said.
"The EB want to understand the facts, understand the circumstances.
"Who knew what, when?
"Could this have been prevented?"