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Day MS, Boryan A. Current Evidence-based Approaches to Multimodal Pain Control and Opioid Minimization After Arthroscopic and Knee Preservation Surgery. J Am Acad Orthop Surg 2024; 32:e24-e32. [PMID: 37611405 DOI: 10.5435/jaaos-d-23-00342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023] Open
Abstract
Nonarthroplasty knee procedures are common and may cause a wide spectrum of postoperative pain, ranging from minimal to severe, depending on the patient, pathology, and procedure. Procedures include ligament repair and reconstruction, especially anterior cruciate ligament reconstruction, meniscal débridement, repair and transplant, periarticular osteotomy, and cartilage restoration. Multimodal analgesia regimens have been implemented successfully, but notable variation characterizes current protocols. Increased public and physician awareness of the burden of opioid usage in the United States has encouraged the medical community to embrace opioid-minimizing and nonopioid techniques to mitigate the deleterious effects of these medications. Nonopioid medications; anesthesia techniques; surgical techniques; and postoperative nonmedication strategies, including physical therapy, transcutaneous electrical nerve stimulation, cryotherapy, cognitive techniques, and non-Western interventions, can form part of an effective multimodal approach. A multimodal approach can facilitate adequate analgesia without compromising patient satisfaction or outcome.
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Affiliation(s)
- Michael Sean Day
- From the WellSpan Sports Medicine, WellSpan Chambersburg Orthopedic Surgery, WellSpan Health (Day), and the WellSpan Chambersburg Anesthesia, WellSpan Health, Chambersburg, PA (Boryan)
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2
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Rojas-Valverde D, Fallas-Campos A. Cannabidiol in sports: insights on how CBD could improve performance and recovery. Front Pharmacol 2023; 14:1210202. [PMID: 37808192 PMCID: PMC10556669 DOI: 10.3389/fphar.2023.1210202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Daniel Rojas-Valverde
- Sport Injury Clinic (Rehab Readapt), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia, Costa Rica
- Núcleo de Estudios para el Alto Rendimiento y la Salud (CIDISAD-NARS), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia, Costa Rica
| | - Andrea Fallas-Campos
- Núcleo de Estudios para el Alto Rendimiento y la Salud (ACUAUNA-NARS), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia, Costa Rica
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Sams L, Langdown BL, Simons J, Vseteckova J. The Effect Of Percussive Therapy On Musculoskeletal Performance And Experiences Of Pain: A Systematic Literature Review. Int J Sports Phys Ther 2023; 18:309-327. [PMID: 37020441 PMCID: PMC10069390 DOI: 10.26603/001c.73795] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/14/2023] [Indexed: 04/04/2023] Open
Abstract
Background There is a lack of specific research on the effect of percussive therapy (PT) delivered by massage guns on physiological adaptations. This systematic literature review investigates research conducted on the effects of PT interventions on performance in strength and conditioning settings, and on experiences of musculoskeletal pain. Purpose To determine the effect of PT delivered by massage guns on physiological adaptations: muscle strength, explosive muscle strength and flexibility, and experiences of musculoskeletal pain. Study Design Systematic literature review. Methods Data sources (CINAHL, Cochrane Library, Psychinfo, PubMed, SportDISCUS and OpenGrey) were searched from January 2006 onwards for full text literature in any language involving adult populations receiving PT delivered by massage guns, directly to any muscle belly or tendon, with comparisons to an alternative treatment, placebo or no treatment. Literature with outcomes relating to acute or chronic physiological adaptations in muscle strength, explosive muscle strength, flexibility or experiences of musculoskeletal pain were included. Articles were assessed for quality using the Critical Appraisal Skills Programme and PEDro scores. Results Thirteen studies met the inclusion criteria. All studies had limitations in methodological quality or reporting of findings but still included contextually-rich details that contributed to the overall narrative synthesis. A significant relationship was found between a single application of PT delivered by massage guns and an acute increase in muscle strength, explosive muscle strength and flexibility, with multiple treatments eliciting a reduction in experiences of musculoskeletal pain. Conclusion PT delivered by massage guns can help improve acute muscle strength, explosive muscle strength and flexibility, and reduce experiences of musculoskeletal pain. These devices may provide a portable and cost-effective alternative to other forms of vibration and interventions.
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Affiliation(s)
- Lorna Sams
- Faculty of welfare, education and language The Open University
| | - Ben L Langdown
- Faculty of welfare, education and language The Open University
| | - Joan Simons
- Faculty of welfare, education and language The Open University
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Hasumi A, Maeda H. Cannabidiol improves haloperidol-induced motor dysfunction in zebrafish: a comparative study with a dopamine activating drug. J Cannabis Res 2023; 5:6. [PMID: 36871008 PMCID: PMC9985202 DOI: 10.1186/s42238-023-00177-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Cannabidiol (CBD) extracted from the cannabis plant is believed to have a medicinal value due to its neuroprotective effect via anti-inflammatory and antioxidant action. Recent behavioral studies in rats have reported that CBD mediates serotonin (5-HT1A) receptor action to improve motor dysfunction induced by dopamine (D2) receptor blockade. In particular, its effect on D2 receptor blockade in the striatum is an important function associated with neurological disorders resulting from various extrapyramidal motor dysfunctions. Dopaminergic neurodegeneration associated with this site is known for inducing Parkinson's disease (PD), which often affects the elderly. It is also known to cause drug-induced Parkinsonism. This study examines the ameliorating effect of CBD, which does not act directly on D2 receptors, against drug-induced motor dysfunction induced by the antipsychotic drug (haloperidol). METHODS We created a drug-induced Parkinsonism model in zebrafish larvae using an antipsychotic drug (haloperidol). We evaluated the distance traveled and repetitive light-stimulation response. Furthermore, we examined whether administration of several concentrations of CBD ameliorates symptoms of the Parkinsonism model and compared its effects with those of antiparkinsonian drug ropinirole. RESULTS CBD concentrations equal to half of haloperidol's resulted in an almost complete reversal of haloperidol-induced motor dysfunction, as measured by the distance traveled by the zebrafish and their response to light-stimulus. While ropinirole also significantly reversed haloperidol's effects at the same concentration as CBD, CBD was more effective than ropinirole. CONCLUSIONS CBD-induced motor dysfunction improvement via D2 receptor blockade is a potential novel mechanism for the treatment of haloperidol-induced motor dysfunction.
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Affiliation(s)
- Akihiro Hasumi
- grid.410793.80000 0001 0663 3325Department of Forensic Medicine, Tokyo Medical University, 6-1-1 Shinjuku Shinjuku-ku, Tokyo, 160-8402 Japan
| | - Hideyuki Maeda
- Department of Forensic Medicine, Tokyo Medical University, 6-1-1 Shinjuku Shinjuku-ku, Tokyo, 160-8402, Japan.
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Jîtcă G, Ősz BE, Vari CE, Rusz CM, Tero-Vescan A, Pușcaș A. Cannabidiol: Bridge between Antioxidant Effect, Cellular Protection, and Cognitive and Physical Performance. Antioxidants (Basel) 2023; 12:antiox12020485. [PMID: 36830042 PMCID: PMC9952814 DOI: 10.3390/antiox12020485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
The literature provides scientific evidence for the beneficial effects of cannabidiol (CBD), and these effects extend beyond epilepsy treatment (e.g., Lennox-Gastaut and Dravet syndromes), notably the influence on oxidative status, neurodegeneration, cellular protection, cognitive function, and physical performance. However, products containing CBD are not allowed to be marketed everywhere in the world, which may ultimately have a negative effect on health as a result of the uncontrolled CBD market. After the isolation of CBD follows the discovery of CB1 and CB2 receptors and the main enzymatic components (diacylglycerol lipase (DAG lipase), monoacyl glycerol lipase (MAGL), fatty acid amino hydrolase (FAAH)). At the same time, the antioxidant potential of CBD is due not only to the molecular structure but also to the fact that this compound increases the expression of the main endogenous antioxidant systems, superoxide dismutase (SOD), and glutathione peroxidase (GPx), through the nuclear complex erythroid 2-related factor (Nrf2)/Keep1. Regarding the role in the control of inflammation, this function is exercised by inhibiting (nuclear factor kappa B) NF-κB, and also the genes that encode the expression of molecules with a pro-inflammatory role (cytokines and metalloproteinases). The other effects of CBD on cognitive function and physical performance should not be excluded. In conclusion, the CBD market needs to be regulated more thoroughly, given the previously listed properties, with the mention that the safety profile is a very good one.
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Affiliation(s)
- George Jîtcă
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
| | - Bianca E. Ősz
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
- Correspondence:
| | - Camil E. Vari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
| | - Carmen-Maria Rusz
- Doctoral School of Medicine and Pharmacy, I.O.S.U.D, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
| | - Amelia Tero-Vescan
- Department of Biochemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
| | - Amalia Pușcaș
- Department of Biochemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
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Kennedy M. Cannabis, cannabidiol and tetrahydrocannabinol in sport: An overview. Intern Med J 2022; 52:1471-1477. [PMID: 35191178 DOI: 10.1111/imj.15724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
Abstract
The World Antidoping Agency now allows cannabidiol (CBD) to be taken in elite sport but has retained all other cannabinoids on its banned list. This, together with liberalisation of cannabis laws have led to an increasing interest in its use in sport. This includes commercial sponsorship of sporting events and highlights the need for accurate information to be readily available to athletes and their advisers. This narrative review confirms that CBD and tetrahydrocannabinol (THC) do not enhance performance. CBD possesses anti-inflammatory and analgesic properties which have not been adequately evaluated in the area of sport. Some formulations of CBD contain THC or other cannabinoids that may result in a positive drug test. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Michael Kennedy
- University of New South Wales (Sydney), Department of Medicine and Clinical Pharmacology & Toxicology, St Vincent's Hospital Darlinghurst
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Kintz P. Le cannabidiol est-il un produit dopant ? TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2021.06.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Isenmann E, Veit S, Starke L, Flenker U, Diel P. Effects of Cannabidiol Supplementation on Skeletal Muscle Regeneration after Intensive Resistance Training. Nutrients 2021; 13:3028. [PMID: 34578906 PMCID: PMC8469280 DOI: 10.3390/nu13093028] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
Cannabidiol supplements (CBD) are increasingly consumed by athletes to improve regeneration. However, the evidence for the pro-regenerative effects of CBD in sports is quite limited. Therefore, our aim was to investigate the effects of a single CBD supplementation in a six-arm placebo-controlled crossover study after resistance training on performance and muscle damage. Before and after the resistance training, one-repetition maximum in the back squat (1RM BS), countermovement jump (CMJ), and blood serum concentrations of creatine kinase (CK) and myoglobin (Myo) were measured in healthy, well-trained participants. 16 out of 21 participants completed the study and were included in the analysis. In 1RM BS, a significant decrease was observed after 24 h (p < 0.01) but not after 48 and 72 h. A significant group difference was detected after 72 h (p < 0.05; ES = 0.371). In CMJ, no significant changes were observed. The CK and Myo concentrations increased significantly after 24 h (CK: p < 0.001; Myo: p < 0.01), 48 h (CK: p < 0.001; Myo: p < 0.01) and 72 h (CK: p < 0.001; Myo: p < 0.001). After 72 h, significant group differences were observed for both muscle damage biomarkers (CK: p < 0.05 ES = 0.24; Myo: p < 0.05; ES = 0.21). The results show small but significant effects on muscle damage and recovery of squat performance after 72 h. However, more data are required for clearer statements concerning potential pro-regenerative effects of CBD supplementation after resistance training.
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Affiliation(s)
- Eduard Isenmann
- Department of Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sports University, 50933 Cologne, Germany; (E.I.); (S.V.); (L.S.); (U.F.)
- Department of Fitness and Health, IST-University of Applied Sciences, 40233 Dusseldorf, Germany
| | - Sebastian Veit
- Department of Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sports University, 50933 Cologne, Germany; (E.I.); (S.V.); (L.S.); (U.F.)
| | - Lynn Starke
- Department of Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sports University, 50933 Cologne, Germany; (E.I.); (S.V.); (L.S.); (U.F.)
| | - Ulrich Flenker
- Department of Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sports University, 50933 Cologne, Germany; (E.I.); (S.V.); (L.S.); (U.F.)
| | - Patrick Diel
- Department of Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sports University, 50933 Cologne, Germany; (E.I.); (S.V.); (L.S.); (U.F.)
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Rojas-Valverde D. Potential Role of Cannabidiol on Sports Recovery: A Narrative Review. Front Physiol 2021; 12:722550. [PMID: 34413793 PMCID: PMC8369499 DOI: 10.3389/fphys.2021.722550] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/09/2021] [Indexed: 12/12/2022] Open
Abstract
The use of cannabidiol (CBD) among athletes is becoming extensive and frequent. This could be due to the elimination of CBD from the list of prohibited substances by federations and international institutions of sport. The legalization and resulting production, and commercialization of CBD, could increase its intake in sports professionals. This commercialization of cannabinoids has fueled a race to study their properties, benefits, and risks for health and performance in athletes. Although there is evidence that suggests some beneficial properties such as anxiolytics, antidepressants, anti-inflammatory, and antioxidants among others, the evidence presented so far is neither clear nor conclusive. There are significant gaps in knowledge of the physiological pathways that explain the role of CBD in sports performance. This mini-review examines evidence suggesting that CBD has the potential to be used as a part of the strategies to recover from fatigue and muscle damage related to physical and cognitive exertion in sports.
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Affiliation(s)
- Daniel Rojas-Valverde
- Clínica de Lesiones Deportivas (Rehabilitation and Readaptation), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia, Costa Rica.,Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia, Costa Rica.,Núcleo de Estudios para el Alto Rendimiento y la Salud (NARS), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia, Costa Rica
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Mareck U, Fusshöller G, Geyer H, Huestis MA, Scheiff AB, Thevis M. Preliminary data on the potential for unintentional antidoping rule violations by permitted cannabidiol (CBD) use. Drug Test Anal 2020; 13:539-549. [PMID: 33125823 DOI: 10.1002/dta.2959] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 12/23/2022]
Abstract
According to the World Anti-Doping Agency (WADA) regulations, cannabinoids use is prohibited in competition except for cannabidiol (CBD) use. For an adverse analytical finding (AAF) in doping control, cannabinoid misuse is based on identification of the pharmacologically inactive metabolite 11-nor-delta-9-carboxy-tetrahydrocannabinol-9-carboxylic acid (carboxy-THC) in urine at a concentration greater than 180 ng/ml. All other (minor) cannabinoids are reported as AAF when identified, except for CBD that has been explicitly excluded from the class of cannabinoids on WADA's Prohibited List since 2018. However, due to the fact that CBD isolated from cannabis plants may contain additional minor cannabinoids, the permissible use of CBD can lead to unintentional violations of antidoping regulations. An assay for the detection of 16 cannabinoids in human urine was established. The sample preparation consisted of enzymatic hydrolysis of glucuronide conjugates, liquid-liquid extraction, trimethylsilylation, and analysis by gas chromatography/tandem mass spectrometry (GC-MS/MS). Spot urine samples from CBD users, as well as specimens obtained from CBD administration studies conducted with 15 commercially available CBD products, were analyzed, and assay characteristics such as selectivity, reproducibility of detection at the minimum required performance level, limit of detection, and limit of identification were determined. An ethical committee approved controlled single dose commercially available CBD products administration study was conducted to identify 16 cannabinoids in urine samples collected after ingestion or application of the CBD products as well as their presence in spot urine samples of habitual CBD users. Variable patterns of cannabinoids or their metabolites were observed in the urine samples, especially when full spectrum CBD products were consumed. The presence of minor cannabinoids or their metabolites in an athlete's in-competition urine sample represents a substantial risk of an antidoping rule violation.
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Affiliation(s)
- Ute Mareck
- Institute of Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Gregor Fusshöller
- Institute of Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Hans Geyer
- Institute of Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anja B Scheiff
- National Anti Doping Agency Germany (NADA), Bonn, Germany
| | - Mario Thevis
- Institute of Biochemistry, German Sport University Cologne, Cologne, Germany
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Thevis M, Kuuranne T, Geyer H. Annual banned-substance review: Analytical approaches in human sports drug testing 2019/2020. Drug Test Anal 2020; 13:8-35. [PMID: 33185038 DOI: 10.1002/dta.2969] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 12/18/2022]
Abstract
Analytical chemistry-based research in sports drug testing has been a dynamic endeavor for several decades, with technology-driven innovations continuously contributing to significant improvements in various regards including analytical sensitivity, comprehensiveness of target analytes, differentiation of natural/endogenous substances from structurally identical but synthetically derived compounds, assessment of alternative matrices for doping control purposes, and so forth. The resulting breadth of tools being investigated and developed by anti-doping researchers has allowed to substantially improve anti-doping programs and data interpretation in general. Additionally, these outcomes have been an extremely valuable pledge for routine doping controls during the unprecedented global health crisis that severely affected established sports drug testing strategies. In this edition of the annual banned-substance review, literature on recent developments in anti-doping published between October 2019 and September 2020 is summarized and discussed, particularly focusing on human doping controls and potential applications of new testing strategies to substances and methods of doping specified the World Anti-Doping Agency's 2020 Prohibited List.
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Affiliation(s)
- Mario Thevis
- Center for Preventive Doping Research - Institute of Biochemistry, German Sport University Cologne, Cologne, Germany.,European Monitoring Center for Emerging Doping Agents, Cologne, Germany
| | - Tiia Kuuranne
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Genève and Lausanne, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Epalinges, Switzerland
| | - Hans Geyer
- Center for Preventive Doping Research - Institute of Biochemistry, German Sport University Cologne, Cologne, Germany.,European Monitoring Center for Emerging Doping Agents, Cologne, Germany
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