Differences in the key parameters of the individual versus relay swimming starts

The purpose of the present study was twofold: (i) to compare the kinematic characteristics of individual and relay swimming starts; and (ii) to relate the kinematic variables to 5 m performance for both starts. Twelve elite-level swimmers performed 2 × 25 m at maximal effort (one with an individual and one with a relay start randomly). Two-dimensional direct linear transformation algorithms were used to calculate swimmers' centre of mass (CM) kinematics during each subphase. The results indicated moderate to much faster 5 m, 10 m 15 and 15 m times (29.4, 10.7 and 6.5%) for relay than individual starts as well as the differences at specific parameters, but no differences in take-off horizontal velocity between start techniques. Large correlations to performance times were found in block time, horizontal take-off velocity, take-off velocity and entry angle (r = 0.77 to 0.83) 20 for individual start, but in changeover time, take-off height and entry distance (r = 0.69 to 0.90) for relay start. Differences on swim start regulations between individual and relay events were in line with different key parameters related to start performances in each event. This should be considered by swimmers and coaches when addressing the starting improvement.

Detection of harmful algal blooms from satellite-based inherent optical properties of the ocean in Paracas Bay - Peru

Harmful algal bloom (HAB) events in front of Pisco River, inside Paracas Bay and Lagunillas inlet on the southern coast of Peru was identified from a satellite index (IOPifa) generated with daily high-resolution satellite data of phytoplankton absorption (aphy,GIOP) and non-algal detrital material plus CDOM (adCDOM,GIOP) from the Generalized Inherent Optical Properties (GIOP) model of Modis-Aqua, Viirs-Snpp and Viirs-Jpss1 satellites were used. Phytoplankton density field data sampling from HAB's monitoring programs of IMARPE of 2018 and 2019 were used to validate and identify the extent and spatio-temporal variability of these events. The satellite index (IOPifa) identified for Modis-Aqua 9 active HABs, 8 events in final conditions and 6 events that do not represent HAB conditions, while for Viirs-Snpp found 14 active HABs, 7 events in decaying bloom conditions and 13 events that do not represent HABs; and for Viirs-Jpss1 the index identified 7 active events, 14 in final bloom conditions and 6 that do not represent HABs conditions. The one-factor anova model was applied (p-value = 0.32 > 0.05), indicating that there is no evidence of a difference in the population means of the indices for each sensor. Subsequently, the pairwise multiple comparisons analysis with a 95 % confidence level of Tukey's test confirmed that there are no significant differences in the satellite index value, the differences could be associated with the spectral characteristics of the cell density of the species community and the oceanographic and environmental conditions. The spatial overlap between the in situ harmful algal blooms areas and the calculated satellite index, shows the capacity of the IOP satellite data for the HABs detection. However, it was also evidenced that some HAB events with high phytoplankton cell density had low IOPifa values, while other events with lower cell density were easily identified by the satellite index. This would indicate the ability of the ocean inherent optical properties to differentiate the phytoplankton types that cause algal blooms.

Impact of Spectators, League and Team Ability on Home Advantage in Professional European Basketball

Our aim in this study was to examine the impact of fans (vs. no fans), geographical location of league, and team ability on home winning percentage (HW%) or home advantage (HA) in professional European basketball. Data were collected from five prestigious professional, national basketball leagues within Europe (Spain, Germany, Italy, Greece and Israel) across 16 regular seasons (2005-2006 to 2020-2021). We conducted comparisons between matches with and without fans, location of leagues, team ability (High, Medium, Low), and combinations of these factors via non-parametric tests (e.g., Mann-Whitney tests, Kruskal-Wallis). We found significantly greater HA during matches with fans for leagues in Germany (p = .001), Italy (p = .012) and Spain (p = .002). For matches with fans, HA and HW% were significantly different between several, but not all, leagues for high (p < .05), medium (p < .05) and low (p < .02) team abilities. In conclusion, HA and HW% were enhanced by spectator attendance, with this phenomenon varying by location/region and team ability. Consideration of these multiple contextual factors may assist coaches and sport organizations to develop key strategies for enhanced team success.

Deep learning of renal scans in children with antenatal hydronephrosis

INTRODUCTION

Antenatal hydronephrosis (ANH) is one of the most common anomalies identified on prenatal ultrasound, found in up to 4.5% of all pregnancies. Children with ANH are surveilled with repeated renal ultrasound and when there is high suspicion for a ureteropelvic junction obstruction on renal ultrasound, a mercaptuacetyltriglycerine (MAG3) Lasix renal scan is performed to evaluate for obstruction. However, the challenging interpretation of MAG3 renal scans places patients at risk of misdiagnosis.

OBJECTIVE

Our objective was to analyze MAG3 renal scans using machine learning to predict renal complications. We hypothesized that our deep learning model would extract features from MAG3 renal scans that can predict renal complications in children with ANH.

STUDY DESIGN

We performed a case-control study of MAG3 studies drawn from a population of children with ANH concerning for ureteropelvic junction obstruction evaluated at our institution from January 2009 until June of 2021. The outcome was renal complications that occur ≥6 months after an equivocal MAG-3 renal scan. We created two machine learning models: a deep learning model using the radiotracer concentration versus time data from the kidney of interest and a random forest model created using clinical data. The performance of the models was assessed using measures of diagnostic accuracy.

RESULTS

We identified 152 eligible patients with available images of which 62 were cases and 90 were controls. The deep learning model predicted future renal complications with an overall accuracy of 73% (95% confidence inteveral [CI] 68-76%) and an AUC of 0.78 (95% CI 0.7, 0.84). The random forest model had an accuracy of 62% (95% CI 60-66%) and an AUC of 0.67 (95% CI. 0 64, 0.72) DISCUSSION: Our deep learning model predicted patients at high risk of developing renal complications following an equivocal renal scan and discriminate those at low risk with moderately high accuracy (73%). The deep learning model outperformed the clinical model built from clinical features classically used by urologists for surgical decision making.

CONCLUSION

Our models have the potential to influence clinical decision making by providing supplemental analytical data from MAG3 scans that would not otherwise be available to urologists. Future multi-institutional retrospective and prospective trials are needed to validate our model.

A Narrative Review of the Most Demanding Scenarios in Basketball: Current Trends and Future Directions

Since the analysis of most demanding scenarios (MDS) in basketball has improved the practical knowledge about match demands and possible impacts for the training process, it seems important to summarize the scientific evidence providing useful information and future directions related to MDS. This review assesses the results reflected in the available literature about the MDS in basketball, synthesizing and discussing data from scientific papers, and then providing relevant insights about terminology, sex and sample size, competition category, workload variables recorded, technology used, method of calculation, time windows analyzed, and activities evaluated related to MDS. Therefore, the present narrative review would be of practical use for coaches, scientists, athletes as well as strength and conditioning trainers exploring the current trends and future directions related to MDS in basketball.

Do You Want to Increase Physical Activity in Adolescents? A School-Based Physical Activity Program Could Be an Efficient Way

The aim of this study was to assess the effects of a classroom-based physical activity program, using bike desks, on academic and physical performance in adolescents. The Program to Enhance and Develop Active Lessons (PEDAL) was designed for this purpose, expecting an increase in students' physical activity without any decrease in academic performance. This intervention based on pedal or bike desks-stationary bikes that integrate with a desk workspace-was conducted with 55 high- school students who were randomly assigned to two groups: a PEDAL group (n = 28, 14.86 ± 0.65 years old, 46.4% girls) and a control group (n = 27, 15 ± 0.68 years old, 51.9% girls). Throughout the intervention, the PEDAL students pedaled 4 days a week for 10 weeks during their Spanish-language arts lessons. The comparisons between the PEDAL group and the control group, as well as the pre- and post-test results, were statistically analyzed to verify the students' physical activity (i.e., IPAQ-SF, heart rate monitors, polar OH1+), cardiorespiratory capacity (20 m shuttle run test), and academic performance (d2 test of attention and language proficiency test). Regarding the physical aspect, only the PEDAL group showed significant growth in their physical activity levels as compared to the pre-test data (p = 0.001), and they achieved higher results compared with the control group (p = 0.022) and less sedentary time than control students (p = 0.012). Concerning cardiorespiratory fitness, there were no post-test differences between the two groups (p = 0.697), probably because the physical activity performed with the bike desks was light-moderate. As far as academic performance is concerned, no significant post-test effects were discovered in either group on the levels of language competence (p = 0.48), attention (TOT, p = 0.432), and concentration (CON, p = 0.216). In conclusion, adolescents who move while learning, using bike desks, increase their light and moderate physical activity without any detriment to academic performance.

Skin lesions by Scedosporium apiospermum and Nocardia pulmonary infection in an oncologic patient: a case report

BACKGROUND

Fungal infections, other than candidiasis and aspergillosis, are an uncommon entity. Despite this, emerging pathogens are a growing threat. In the following case report, we present the case of an immunocompromised patient suffering from two serious opportunistic infections in the same episode: the first of these, Nocardia multilobar pneumonia; and the second, skin infection by Scedosporium apiospermum. These required prolonged antibacterial and antifungal treatment.

CASE PRESENTATION

This case is a 71-year-old oncological patient admitted for recurrent pneumonias that was diagnosed for Nocardia pulmonary infection. Nervous system involvement was discarded and cotrimoxazole was started. Haemorrhagic skin ulcers in the lower limbs appeared after two weeks of hospital admission. We collected samples which were positive for Scedosporium apiospermum and we added voriconazole to the treatment. As a local complication, the patient presented a deep bruise that needed debridement. We completed 4 weeks of intravenous treatment with slow improvement and continued with oral treatment until the disappearance of the lesions occurs.

CONCLUSIONS

Opportunistic infections are a rising entity as the number of immunocompromised patients is growing due to more use of immunosuppressive therapies and transplants. Clinicians must have a high suspicion to diagnose and treat them. A fluid collaboration with Microbiology is necessary as antimicrobial resistance is frequent.

Influence of analysis focus and playing time on internal average and peak physical demands of professional male basketball players during competition. [Influencia del tiempo de juego en las demandas de carga interna pico y promedio en jugadores de baloncesto.]

The main aim of this study was identifying the internal demands during competition including the impact of analysis method (i.e., average vs. peak demands). A secondary aim was to analyze the effects of playing time on the internal demands (average and peak). Methods: Twenty-two professional basketball players were mo- nitored during 11 games. The following internal workload variables were recorded as averages (i.e., value per minute considering the entire game) and peak values (i.e., greatest 1-minute window): 1) average Heart Rate (HR), peak HR, average Respiration Rate (RR), peak RR, average Ventilation (VE), peak VE, average VO2 and peak VO2. Results: Significantly higher peak values (very large effect size) for all internal variables were evident when compared to their average demand. Concerning playing time comparison, significantly greater average values were reached for large playing time group (24.54 ± 3.23 min) for all variables compared to small playing time group (14.13 ± 3.78 min). However, non-significant differences were apparent between large playing time and small playing time group at their internal PD. Conclusions: Understanding internal load demands using averages values drastically underestimates the internal peak values of games. Thus, 14 minutes of total playing time (1.5 quarters; ~37% of a game) is enough to expose to the players to internal peak demands.

Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

Background

Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.

Methods

This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.

Results

Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.

Conclusion

The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.

Fluctuations in External Peak Demands Across Quarters During Basketball Games

The purpose of this study was to compare external peak demands (PDs) across quarters (Q) in basketball. Thirteen elite, junior, male basketball players were monitored using electronic performance tracking systems. There were studied intervals for different time windows to determine the external PD for distance (m); player load; distance covered in four different zones; accelerations; and decelerations. A mixed linear model was run to identify differences among quarters, and the auto-correlation function was carried out to determine fluctuations across the whole game. The results showed significant differences between Q1 vs. Q2 for distance, player load, and standing–walking distance; between Q1 vs. Q3 for distance, player load, and HSR; between Q1 vs. Q4 for distance, player load, standing–walking, and HSR; and between Q3 vs. Q4 for distance and player load. These findings suggest that external PD for running-based demands (distance, player load, and high-speed running) decrease across basketball games with the most notable declines occurring between the first and fourth quarters. Nevertheless, it is important to note that non-significant differences were found between quarters for several external PD variables (jogging, running, acceleration, and deceleration) across different time windows. Findings from the present study reinforce the importance of considering specific PD variables for different functions due to the specific insight each provides.

Especies de Carangidae inusuales durante el Niño costero 2017 en el litoral de Pisco, sur del Perú

Este trabajo reporta la presencia inusual de especies de la familia Carangidae en los desembarcaderos de la provincia de Pisco (13.5° S), departamento de Ica, ocurridos durante el evento El Niño costero 2017. Se observaron 4 especies: Caranx caballus, Caranx caninus, Oligoplites saurus y Selene brevoortii capturadas con el arte de pesca “cortina agallera”. Durante el periodo de El Niño costero 2017 en el área de estudio se registraron temperaturas superiores a los 26 °C y salinidades moderadamente elevadas (> 35.1 ups), condiciones que habrían favorecido el desplazamiento de estas especies, frecuentes en el norte del Perú, hacia latitudes superiores.

IMPACT OF COVID-19 PANDEMIC ON HOME ADVANTAGE IN DIFFERENT EUROPEAN PROFESSIONAL BASKETBALL LEAGUES

Our purpose in this study was to examine the impact of the COVID-19 pandemic on home advantage (HA) in sports by comparing European professional basketball games in which spectators were present (pre-pandemic) with “ghost” games in which spectators were absent (during the pandemic). A secondary objective was to analyze how team ability interacted with HA by comparing HA affects pre-pandemic and during the pandemic in the context of differing team ability levels. We used Wilcoxon and Mann–Whitney U tests to identify HA through differences in home win percentages (HW%) between pre-pandemic and pandemic games. Additionally, we ran the Kruskal–Wallis test to identify HA and HW% differences between different team ability levels (high to low). Teams had higher HA and HW% pre-pandemic than during the pandemic. In turn, low level teams presented a higher HA compared to teams at other team ability levels. Thus, low level teams benefited more from playing at their home-court. However, low level teams showed lower HW% than medium and high team ability levels, showing that team ability is more important than HA in determining game outcomes.

Higher Playing Times Accumulated Across Entire Games and Prior to Intense Passages Reduce the Peak Demands Reached by Elite, Junior, Male Basketball Players

The aim of this study was to analyze the effects of different factors on the external peak demands (PD) encountered by elite, junior, male basketball players in games, including the (1) total playing time during games and (2) playing time accumulated directly prior to each PD episode. Workload variables included the PD for total distance, distance covered in different intensity zones, accelerations >2 m·s-2 (ACC), decelerations <-2 m·s-2 (DEC), and PlayerLoad. PD were calculated across different sample durations for each variable. Linear mixed models were used to identify differences in PD between groups based on playing times. PD for total distance (5-min window), high-speed running (>18 km·h-1) distance (2-min window), and ACC (30-s, 45-s, 1-min, 2-min, and 5-min windows) were significantly (p < .05) higher for players who completed lower total playing times (16.6 ± 2.4 min) than players who completed higher total playing times (25.0 ± 3.4 min). The PD for total distance (30-s, 45-s, 1-min, and 2-min windows), high-speed running distance (30-s and 5-min windows), and PlayerLoad (1-min and 2-min windows) were significantly (p < .05) higher for players who accumulated lower playing times before each PD episode than players who accumulated higher playing times before each PD episode. Players who undertake less playing time overall and prior to each PD episode can reach higher peak external loads aggregated across varied time windows. These findings can inform tactical coaching decisions during games for high external loads to be accomplished during important passages of play.

The Relative Age Effect on Competition Performance of Spanish International Handball Players: A Longitudinal Study

Background: Competitive success is the ultimate objective of elite professional sport organisations. Relative age effects (RAE) impact athlete selection processes in the short and long-term performance. The aims of this study were: (i) examine the presence of RAE by gender, competitive level, and playing position, as well as evaluate the impact of RAE on individual (goals, percentage of effectiveness in shots, saves; percentage of effectiveness in saves, assists, turnovers, steals, blocked shots, penalties, minutes played, and minutes played per match) and collective competition performance (final team position); and (ii) analyse the impact of RAE on the evolutionary trends of individual performance in international competitions throughout 16 seasons in Spanish handball (2005–2020).

Methods: The sample included 631 Spanish handball players (male: n = 359; female: n = 272). A Chi-square goodness-of-fit test was used to assess whether a skewed birthdate distribution occurred. A one-way analysis of variance (ANOVA) of independent measures was used to examine the individual and collective statistical parameters by birth quartiles. A linear regression in a Hopkins sheet were performed to compare individual performance trends.

Results: The results revealed RAE in the male formative categories (p < 0.001), as well as the male and female senior categories (p < 0.05). By position, RAE especially affected the “centre-back” in the male formative (p < 0.01) and senior categories (p < 0.05). No significant relationship between RAE and individual performance was found in male formative categories, while an impact of RAE on the “minutes played” was detected in the female senior category (p < 0.05). With regard to collective performance, a higher number of relatively older handball players was observed in the best ranked teams in the male formative categories and in the quarter-final teams in the female formative categories (p < 0.05). Among the male players, relatively older players spent more minutes on the court than relatively younger players, although this advantage dissipated over time and did not lead to better performance. Among the female players, relatively younger players were found to perform better as the level of competitive handball increased.

Discussion: These findings are important for talent identification and development policies in sport federations and other elite sport institutions by demonstrating the many unintended consequences of selections to international competitions at the youth level.

Comparison of Starts and Turns between Individual and Relay Swimming Races

The present study investigated swimmers’ performances on the starting and turning segments between individual and relay races. A total number of 72 race performances of the same swimmers in both relay 4 × 100 m finals (freestyle, medley, and mixed freestyle) and individual 100 m finals or semi-finals (butterfly, breaststroke, and freestyle) from the LEN European Swimming Championships were compared with repeated measures MANOVA. Swimmers performed 5–7% faster starts in the relay than in the corresponding individual events, despite no differences in the flight phase and a lower performance (shorter distances and slower velocities) on the underwater start section. The 15 m turn times were slower in the butterfly relay races although no specific differences in the underwater parameters were observed. These results suggest that specific training of the starting and turning segments should be performed under relay conditions to optimise pacing and performance in the underwater sections.

The Influence of Contextual Aspects in Talent Development: Interaction Between Relative Age and Birthplace Effects in NBA-Drafted Players

The aims of this study were two-fold: (1) to inspect separately for the relative age and birthplace effects for players selected in the National Basketball Association (NBA) draft; (2) to explore the interaction among these factors and analyse this interaction in players' career performance. The database was obtained from the official records of the players (n = 1,738), who were selected during the annual editions of the NBA Draft from 1990 to 2019. The participants' date of birth was analyzed according to the month of birth and divided into four quartiles. The place of birth was compared to the distribution of the general population' places of birth based on different communities' sizes. Chi-square analysis were used to determine if the relative age and birthplace of the players drafted differed in any systematic way from official census population distributions. Cluster analysis and standardized residuals were calculated to analyse the interaction among the contextual factors and the players' career performance. The data revealed that early-born players (Q1 and Q2) were over-represented. Moreover, players born in smaller cities (<100,000) were over-represented. The interaction analysis revealed that the players born in the bigger communities relate mainly with relatively younger players, and clusters that correspond to players born in smaller communities integrated the relatively older players. No differences were found in the players' career performance. Researchers, coaches and practitioners should be aware of the interaction between contextual factors to help nurture the development of sport talent regardless of age-related issues or communities' size.

Comparative clinical prognosis of massive and non-massive pulmonary embolism: A registry-based cohort study

AIMS

Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non-massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non-massive PE during anticoagulation and after its discontinuation.

METHODS AND RESULTS

We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (<90 mm Hg). We compared the risks of recurrent VTE, major bleeding, and mortality using time-to-event multivariable competing risk modeling. There were 3.5% of massive PE among 38 996 patients with PE. During the anticoagulation period, massive PE was associated with a greater risk of major bleeding (subhazard ratio [sHR] 1.72, 95% confidence interval [CI] 1.28-2.32), but not of recurrent VTE (sHR 1.15, 95% CI 0.75-1.74) than non-massive PE. An increased risk of mortality was only observed in the first month after PE. After discontinuation of anticoagulation, among 11 579 patients, massive PE and non-massive PE had similar risks of mortality, bleeding, and recurrent VTE (sHR 0.85, 95% CI 0.51-1.40), but with different case fatality of recurrent PE (11.1% versus 2.4%, P = .03) and possibly different risk of recurrent fatal PE (sHR 3.65, 95% CI 0.82-16.24).

CONCLUSION

In this large prospective registry, the baseline hemodynamic status of the incident PE did not influence the risk of recurrent VTE, during and after the anticoagulation periods, but was possibly associated with recurrent PE of greater severity.

Is metabolically healthy obesity indeed healthy at the microvascular level?

Background

In the current “obesity epidemic”, obese individuals without insulin resistance, lipid disorders, or hypertension, have been called “metabolically healthy” (MHO) and considered to have intermediate cardiovascular risk, between that of healthy nonobese (HNO) individuals and of metabolically unhealthy obese (MUO). Nonetheless, this is controversial, as MHO may have subclinical abnormalities, and indeed may be a transitory state in the way to the unhealthy phenotype.

Purpose

To evaluate systemic microvascular reactivity in MHO, MUO and HNO.

Methods

Ten MHO, 10 MUO and 20 HNO individuals were studied. Obesity was considered as a BMI ≥30 kg/m2. The NCEP/ATPIII criteria, excluding waist circumference, were used to define the metabolically healthy phenotype (absence of all criteria) or unhealthy phenotype (presence of any of the criteria). Laser speckle contrast imaging coupled with skin acetylcholine (Ach) iontophoresis was employed to study cutaneous microvascular reactivity (endothelial-dependent vasodilatation), as a surrogate for systemic microvascular function, and cutaneous vascular conductance [CVC in arbitrary perfusion units of microvascular flow (APU)/mean arterial pressure (mmHg)] was measured.

Results

Mean age was 34.8, 36.7 and 32.3 years (P=0.17, ANOVA) and BMI was 20.7, 32.2 and 33.3 kg/m2 (P&lt;0.0001) for HNO, MHO and MUO, respectively. Both MHO and MUO had significantly decreased microvascular vasodilation in comparison to HNO (Figure 1). Of note, there was no significant difference between MHO and MUO regarding CVC (both similarly decreased when compared to the healthy controls).

Conclusions

This study underscores that MHO is not a “benign” condition, as it has adverse effects on microvascular function, similarly to those found in MUO. The study of cutaneous microvascular function may be useful to identify subclinical abnormalities in obese individuals who might deserve more intensive management.

Figure 1

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): FAPERJ - Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro - Brazil

Does the Relative Age Effect Influence Short-Term Performance and Sport Career in Team Sports? A Qualitative Systematic Review

Background: The impact on athletes based on grouping methods according to the date of birth within the constituent year, known as the relative effect of age (RAE), is a factor that can influence the achievement of sports success. Many studies have examined the magnitude of this phenomenon in sport; however, the relationship between the RAE and performance in team sports competition has not been accurately evaluated so far. The purpose of this study was to conduct a systematic review on the influence of the RAE on competition performance in team sports through analysis of published peer-reviewed articles from 2000 to 2019.

Methods: According to Preferred Reporting Items for Systematic Reviews and Meta-Analysis systematic search guidelines, 19 studies were identified of the 2,093 that were found in the systematic searching process carried out in four databases: Sport Discus, PubMed, Web of Knowledge, and Scopus. The sample of the study was composed by 77,329 players, of which 92.08% were male and 7.92% were female, whereas the recorded performance measurements were 87,556. The relation between relative age effects and competition performance was registered according to constraints-based theoretical model: individual constraints (sample characteristics) and task constraints (sport context). Moreover, study quality analysis, Strengthening the Reporting of Observational Studies in Epidemiology, was carried out.

Results: The short-term individual (10.20%) and collective (18.09%) performance was influenced by the RAE, whereas the long-term individual performance (49.71%) was affected by the RAE reverse. However, in 16.99% of the measurements, no relationship was found between the RAE and competition performance. In the analysis by subcategory, the influence of the RAE was higher in men, in adulthood (senior category), in invasion games, and in national contexts.

Discussion: The findings clearly demonstrated that the RAE has a great influence on the performance in team sport. Possible implications for policy and practice should be discussed in order to prevent unequal practice based on biased models that prioritize the athlete's current performance and therefore obviate their maturational development. The heterogeneity and variability of the identified results require a relativization of the findings of this study.

Modelling the Relationship between Match Outcome and Match Performances during the 2019 FIBA Basketball World Cup: A Quantile Regression Analysis

The FIBA Basketball World Cup is one of the most prominent sporting competitions for men’s basketball, with coaches interested in key performance indicators (KPIs) that give a better understanding of basketball competitions. The aims of the study were to (1) examine the relationship between match KPIs and outcome in elite men’s basketball; and (2) identify the most suitable analysis (multiple linear regression (MLR) vs. quantile regression (QR)) to model this relationship during the men’s basketball tournament. A total of 184 performance records from 92 games were selected and analyzed via MLR and QR, using 10th, 25th, 50th, 75th and 90th quantiles. Several offensive (Paint Score, Mid-Range Score, Three-Point Score, Offensive Rebounds and Turnovers) and defensive (Defensive Rebounds, Steals and Personal Fouls) KPIs were associated with match outcome. The QR model identified additional KPIs that influenced match outcome than the MLR model, with these being Mid-Range Score at the 10th quantile and Offensive Rebounds at the 90th quantile. In terms of contextual variables, the quality of opponent had no impact on match outcome across the entire range of quantiles. Our results highlight QR modelling as a potentially superior tool for performance analysts and coaches to design and monitor technical–tactical plans during match-play. Our study has identified the KPIs contributing to match success at the 2019 FIBA Basketball World Cup with QR modelling assisting with a more detailed performance analysis, to support coaches with the optimization of training and match-play styles.

The Talent Development Pathway for Elite Basketball Players in China

A large portion of previous sport talent development research has been conducted using Western countries study subjects such as Canadian, Swedish, Spanish, British, or American athletes. However, the factors that affect oriental culture athletes remain an unexplored field. The aims of this investigation were to consolidate the exploration of the pilot study that studied the key factors for Chinese elite basketball players' careers and understand what facts have helped them to achieve the highest sportive level through qualitative research. The pathway to excellence of 11 Chinese elite basketball players were analyzed through a semi-structured interview with different categories such as social context, sport context, tactical factors, or anthropometric factors. Results showed that cultural factors, family tradition, academic studies, coaches, mental strength, training structuration, and international competitions had a great effect and influence in the talent development of Chinese basketball players.

Inspiratory Muscle Training in Intermittent Sports Modalities: A Systematic Review

The fatigue of the respiratory muscles causes the so-called metabolic reflex or metaboreflex, resulting in vasoconstriction of the blood vessels in the peripheral muscles, which leads to a decrease in respiratory performance. Training the respiratory muscles is a possible solution to avoid this type of impairment in intermittent sports. The objective of this systematic review was to evaluate the results obtained with inspiratory muscle training (IMT) in intermittent sports modalities, intending to determine whether its implementation would be adequate and useful in intermittent sports. A search in the Web of Science (WOS) and Scopus databases was conducted, following the Preferred Reporting Elements for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The methodological quality of the articles was assessed using the PEDro (Physiotherapy Evidence Database) scale. In conclusion, the introduction of specific devices of IMT seems to be a suitable method to improve performance in intermittent sports, mainly due to a reduction of the metaboreflex, fatigue sensation, and dyspnea. The ideal protocol would consist of a combination of acute and chronic treatment, and, even if IMT is done daily, the duration will not exceed one hour per week.

Peak Match Demands in Young Basketball Players: Approach and Applications

Background: The aim of this study is to describe the peak match demands and compare them with average demands in basketball players, from an external load point of view, using different time windows. Another objective is to determine whether there are differences between positions and to provide an approach for practical applications. Methods: During this observational study, each player wore a micro technology device. We collected data from 12 male basketball players (mean ± SD: age 17.56 ± 0.67 years, height 196.17 ± 6.71 cm, body mass 90.83 ± 11.16 kg) during eight games. We analyzed intervals for different time windows using rolling averages (ROLL) to determine the peak match demands for Player Load. A separate one-way analysis of variance (ANOVA) was used to identify statistically significant differences between playing positions across different intense periods. Results: Separate one-way ANOVAs revealed statistically significant differences between 1 min, 5 min, 10 min, and full game periods for Player Load, F (3,168) = 231.80, η_p² = 0.76, large, p < 0.001. It is worth noting that guards produced a statistically significantly higher Player Load in 5 min (p < 0.01, η_p² = −0.69, moderate), 10 min (p < 0.001, η_p² = −0.90, moderate), and full game (p < 0.001, η_p² = −0.96, moderate) periods than forwards. Conclusions: The main finding is that there are significant differences between the most intense moments of a game and the average demands. This means that understanding game demands using averages drastically underestimates the peak demands of the game. This approach helps coaches and fitness coaches to prepare athletes for the most demanding periods of the game and present potential practical applications that could be implemented during training and rehabilitation sessions.

D-dimer levels and risk of recurrence following provoked venous thromboembolism: findings from the RIETE registry

BACKGROUND

Patients with venous thromboembolism (VTE) secondary to transient risk factors may develop VTE recurrences after discontinuing anticoagulation. Identifying at-risk patients could help to guide the duration of therapy.

METHODS

We used the RIETE database to assess the prognostic value of d-dimer testing after discontinuing anticoagulation to identify patients at increased risk for recurrences. Transient risk factors were classified as major (postoperative) or minor (pregnancy, oestrogen use, immobilization or recent travel).

RESULTS

In December 2018, 1655 VTE patients with transient risk factors (major 460, minor 1195) underwent d-dimer measurements after discontinuing anticoagulation. Amongst patients with major risk factors, the recurrence rate was 5.74 (95% CI: 3.19-9.57) events per 100 patient-years in those with raised d-dimer levels and 2.68 (95% CI: 1.45-4.56) in those with normal levels. Amongst patients with minor risk factors, the rates were 7.79 (95% CI: 5.71-10.4) and 3.34 (95% CI: 2.39-4.53), respectively. Patients with major risk factors and raised d-dimer levels (n = 171) had a nonsignificantly higher rate of recurrences (hazard ratio [HR]: 2.14; 95% CI: 0.96-4.79) than those with normal levels. Patients with minor risk factors and raised d-dimer levels (n = 382) had a higher rate of recurrences (HR: 2.34; 95% CI: 1.51-3.63) than those with normal levels. On multivariate analysis, raised d-dimers (HR: 1.74; 95% CI: 1.09-2.77) were associated with an increased risk for recurrences in patients with minor risk factors, not in those with major risk factors.

CONCLUSIONS

Patients with raised d-dimer levels after discontinuing anticoagulant therapy for VTE provoked by a minor transient risk factor were at an increased risk for recurrences.

191 Effect of the time of oocyte collection through slicing method on meiosis resumption and invitro embryo production

Oocytes from juvenile goats are collected by slicing the ovary surface because the high percentage of small antral follicles limits follicular aspiration. The time of oocyte collection can impair oocyte developmental competence due to spontaneous resumption of meiosis. The aim of this study was to assess whether the time of slicing period affects oocyte meiosis and embryo development after invitro fertilization. Ovaries from juvenile goats (1-2 months old) were recovered at a local slaughterhouse. Cumulus-oocyte complexes (COCs) were collected by slicing, selected, and kept in the slicing medium at 38.5°C in humidified air with 5% CO2 until analysis or culture. The slicing medium was HEPES-buffered (25mM) TCM-199 with 2.2mgmL−1 NaHCO3 and 50mgmL−1 gentamicin. Two slicing periods were tested: T1 (1 h) and T4 (4 h). After this time, a group of oocytes were stained with 1% orcein in 45% acetic acid solution for assessing meiotic arrest and observed as the rate of germinal vesicle (GV; 61-67 oocytes/group from 5 replicates). The remaining COCs were cultured in our conventional IVM medium (TCM-199 with FSH, LH, oestradiol, sodium pyruvate, glutamine, cysteamine, epidermal growth factor, and fetal bovine serum) at 38.5°C with 5% CO2. After 24h, a sample of oocytes were stained for assessing nuclear maturation (28-29 oocytes/group, 3 replicates), and the rest were invitro fertilized with 4×106 spermmL−1 in BO-IVF medium (IVF Bioscience) for 20h and embryo cultured in BO-IVC medium for 7 days (70-81 oocytes/group, 3 replicates). Blastocysts were stained with Hoechst 33258 for determining the number of cells. Data were analysed with two-way ANOVA with RStudio version 1.2.1335. The time of slicing was set as a fixed factor and the replicate as random variable. Data presented as percentage did not follow a normal distribution and were square root arcsine transformed before analysis. At the end of slicing periods T1 and T4, oocytes at GV were 100% and 84.7±5.0%, respectively (P&lt;0.05). After 24h of IVM, the oocytes at MII were 77.0±7.1% and 88.6±7.3%, respectively, without statistical differences. However, oocytes from T1 produced a higher rate of cleaved oocytes (84.6±0.9%) and expanded blastocysts (11.03±5.2%) than T4 (49.8±7.9%, 0%, respectively; P&lt;0.05). The total blastocyst rate for T1 and T4 was 25.4±5.8% and 9.4±4.9%, respectively (P=0.068). No differences were observed in blastocyst cell number (75.9±4.0 and 67.5±10.9, respectively). In conclusion, oocytes resume meiosis before IVM during a long slicing period, even though the slicing medium is not supplemented with hormones or growth factors. The longer slicing period does not affect nuclear maturation but impairs oocyte competence, observed as lower cleavage and blastocyst development. Further experiments are needed to determine whether the use of meiotic inhibitors in the slicing medium can prevent the negative effect of the long slicing period. This study was funded by the Spanish Ministry of Science, Innovation and Universities (AGL2017-85837-R).

Situation, challenges, and SEOM recommendations for the future of undergraduate education in Oncology in Spain

PURPOSE

The Spanish Society of Medical Oncology (SEOM, for its Spanish acronym) would like to attest to the relevance of training in Oncology as part of the undergraduate education in Medicine program and issue recommendations to improve said training, with the aim of responding better to the challenges that cancer poses to our society.

MATERIALS AND METHODS

The curricula of 42 schools of medicine were reviewed with interviews with at least one teaching medical oncologist from each faculty. The qualitative and opinion analysis was completed by means of an online questionnaire targeting lecturers, resident tutors, and residents in Medical Oncology (MO), enabling the detection of needs and areas for improvement at an organizational level and in terms of skill acquisition.

RESULTS

While the number of medical schools with a specific, mandatory program in MO has grown by up to 90%, it has not been accompanied by an increase in independent programs. Instead, they largely consist of programs shared with other specialties (61% of the medical faculties). In most of the undergraduate education programs, Oncology contents are fragmented and approached from the perspective of each organ system.

CONCLUSIONS

Despite the positive evolution in recent years, the heterogeneity in Oncology contents during undergraduate education training continues to be remarkable. Cross-sectional programs with an integral vision, taught in the final years of undergraduate medical education would be desirable. Among the recommendations for improvement of training in Medical Oncology, the SEOM proposes that updated, theoretical content be incorporated and clinical practice in Medical Oncology departments be promoted.

Long-Term Analysis of Elite Basketball Players' Game-Related Statistics Throughout Their Careers

The aim of the present study was to analyze the changes of game-related statistics in expert players across their whole sports careers. From an initial sample including 252 professional basketball players competing in Spanish first division basketball league (ACB) in the 2017-2018 season, 22 met the inclusion criteria. The following game-related statistics were studied: average points, assist, rebounds (all normalized by minute played), 3-point field goals percentage, 2-point field goals percentage, and free throws percentage per season. Each variable was individually investigated with a customized excel spreadsheet assessing individual variations and career trends were calculated. The results showed a positive trend in most of the investigated players in assists (91% of cases) and free throw percentages (73% of cases). Similar percentages of positive and negative trends were observed for all the other game-related statistics (range: 41-59% for negative and positive, respectively). In conclusion, an increase in assist and free throw performance was shown in the investigated players across their playing career. This information is essential for basketball coaches suggesting the use of most experienced players in the final moments of the game.

Immune-related adverse events predict the therapeutic efficacy of anti-PD-1 antibodies in cancer patients

BACKGROUND

Cancer immune therapy has shown remarkable benefit in the treatment of a range of cancer types, although it may initiate autoimmune-related disorders in some patients. We have attempted to establish whether the incidence of irAEs after the use of anti-PD-1 antibodies nivolumab or pembrolizumab in advanced malignancies is associated with anti-PD-1 treatment efficacy.

PATIENTS AND METHODS

We studied patients treated with single-agent nivolumab or pembrolizumab for advanced cancer. irAEs (immune-related adverse events) were identified clinically and graded as per the Common Terminology Criteria for Adverse Events version 4.0. Efficacy was evaluated with objective response rate (ORR, immune-Response Evaluation Criteria in Solid Tumours [RECIST] criteria) progression-free survival (PFS) and overall survival (OS). Tests were performed to determine the association between irAEs and ORR, PFS or OS.

RESULTS

We identified 106 patients. Primary diagnoses were lung cancer (n = 77), melanoma (n = 8), head and neck carcinoma (n = 7), renal carcinoma (n = 5), Hodgkin's lymphoma (n = 3), urothelial carcinoma (n = 3) and gallbladder adenocarcinoma, hepatocellular carcinoma and Merkel cell carcinoma (n = 1 each). IrAEs were observed in 40 patients (37.7%). The most frequent irAEs were hypothyroidism (n = 15), nephritis (n = 5) and hyperthyroidism (n = 4). Objective response was observed in 44 patients (41.5%), and median PFS was 5.5 months (0.5-31 months). Thirty-three of the 40 patients with irAEs had objective response (82.5%) in contrast with 11 of the 66 cases without irAEs (16.6%) (OR 23.5, P < 0.000001). PFS in patients with irAEs was 10 months and 3 months in those without irAEs (HR 2.2, P = 0.016). OS in patients with irAEs was 32 months and 22 in those without irAEs, without statistically significant differences.

CONCLUSION

In advanced cancer treated with single-agent anti-PD-1 antibodies, patients with irAEs showed a markedly improved efficacy over patients without irAEs (ORR of 82.5% and PFS of 10 months vs ORR of 16.6% and PFS of 3 months). Future studies of anti-PD-1 immune-therapy should address this association to explore the underlying biological mechanisms of efficacy.

Effects of a strength protocol combined with electrical stimulation on patellar tendinopathy: 42 months retrospective follow-up on 6 high-level jumping athletes

STUDY DESIGN

A retrospective study.

INTRODUCTION

Patellar tendinopathy (PT) or jumper's knee (JK) in elite athletes is a challenging condition for sports medicine professionals. This study analyzes the development of a protocol using eccentric, isometric, concentric exercises, and electrostimulation to treat elite athletes suffering from JK. The semiannual strength protocol was completed during a total of 36 months by six high-level jumping athletes with chronic painful JK. Pain during patellar tendon loading activity was evaluated on a visual analogue pain scale (VAS). Upon protocol completion, promising clinical results were evidenced by significant pain reduction during tendon loading activity.

MATERIAL AND METHODS

Six high level jumping athletes with chronic painful JK completed a semiannual strength program using eccentric, isometric, concentric and electrical stimulation exercises. The protocol was done 12 weeks in the winter pre-season and 10 weeks in the summer pre-season, for altogether 36 months, with an interruption of the protocol at 24 months for 6 months. Pain during patellar tendon loading activity was evaluated on a visual analogue pain scale (VAS), before the first session and then every 6 months, coinciding with the competitive phase, the time of maximum pain.

RESULTS

There was a significant (p < 0.01) decrease in the VAS from start to the 18, 24 and 48 months follow-ups.

CONCLUSIONS

In a small group of high level jumping athletes with chronic painful JK, a strength protocol combined with electrical stimulation showed promising clinical results with significant pain reduction during tendon loading activity.

Shaq is not Alone: Free-Throws in the Final Moments of a Basketball Game

It has been previously observed that basketball free-throw (FT) shooting efficiency decreases towards the end of the game. The aim of the current study was to explore possible determinants for this distinctive pattern during close games (point differential of equal or under 2 points during the final minute of the game). A sample of shots attempted by 92 players in the Spanish professional basketball league (ACB) was collected. Several personal (age, experience, playing position and career FT percentage) and contextual (team ability, competition stage, game location, seconds remaining and score differential) variables were considered for the analysis of the data. The effects of the predictor variables on the players' performance were analyzed according to two game contexts (FT attempted during the final minute or the last pair of FTs) using binomial logistic regression analysis. The results showed that during the final minute the only statistically significant variable was being in the center playing position (OR = 1.58), which decreased the FT shooting percentage compared to forwards and guards. In addition, the results during the last pair of FTs showed that the playing position of guards (OR = 1.70) and centers (OR = 2.22) was significant (a decrease in their FT percentage). Conversely, the score differential when tied (OR = -1.17) or losing (OR = -2.43) was significant, reflecting a lower probability of missing the shot. The results were interpreted and discussed from the viewpoints of crisis theory and the literature on choking in athletic performance.

Clustering performances in the NBA according to players' anthropometric attributes and playing experience

The aim of this study was: (i) to group basketball players into similar clusters based on a combination of anthropometric characteristics and playing experience; and (ii) explore the distribution of players (included starters and non-starters) from different levels of teams within the obtained clusters. The game-related statistics from 699 regular season balanced games were analyzed using a two-step cluster model and a discriminant analysis. The clustering process allowed identifying five different player profiles: Top height and weight (HW) with low experience, TopHW-LowE; Middle HW with middle experience, MiddleHW-MiddleE; Middle HW with top experience, MiddleHW-TopE; Low HW with low experience, LowHW-LowE; Low HW with middle experience, LowHW-MiddleE. Discriminant analysis showed that TopHW-LowE group was highlighted by two-point field goals made and missed, offensive and defensive rebounds, blocks, and personal fouls; whereas the LowHW-LowE group made fewest passes and touches. The players from weaker teams were mostly distributed in LowHW-LowE group, whereas players from stronger teams were mainly grouped in LowHW-MiddleE group; and players that participated in the finals were allocated in the MiddleHW-MiddleE group. These results provide alternative references for basketball staff concerning the process of evaluating performance.

ROC Analysis of Diagnostic Performance Utilizing Serum Antiproteases in Cancer Patients

Assessment of the accuracy of diagnostic procedures is made independent of diagnostic criteria by means of a receiver-operating-characteristics (ROC) curve. We performed ROC analysis for the major serum antiproteases: alpha-1-antitrypsin (A1AT) and alpha-2-macroglobulin (A2M), in 99 cancer patients compared with 71 normal individuals. A1AT and A2M were significantly higher in cancer patients (p < 0.0005). By comparing true positive and false positive rates for different serum levels, ROC analysis showed that serum A1AT quantification seems more useful in clinical practice than serum A2M.

Plasmatic Fibronectin in Malignancies

Plasmatic fibronectin has been studied in tumor patients on the basis of the role that unspecific opsonin may play in tumor growth and spreading. Alterations in fibronectin levels might be used as a biological marker and our purpose has been to evaluate the significance of this test in the biological diagnosis of cancer. When comparing the levels found in the control group (22.86 ± 1.40 mg/dl) and in tumor patients (23.80 ± 1.90 mg/dl), we observed no difference in the overall group. However, in relation to the localization of tumors, a significant increase was found in breast cancer (31.83 ± 3.83 mg/dl) and a significant decrease in squamous cell carcinoma of the head and neck (9.56 ± 1.68 mg/dl). These results suggest that plasmatic fibronectin could be useful as a biomarker in some types of tumors. Our conclusion was confirmed by analysis of ROC curves related to every one of the studied tumors.

[Quality of care and safety indicators in anticoagulated patients with non-valvular auricular fibrillation and deep venous thromboembolic disease]

OBJECTIVES

To identify and prioritise indicators to assess the quality of care and safety of patients with non-valvular auricular fibrillation (NVAF) and deep vein thrombosis (DVT) treated with anticoagulants.

MATERIALS AND METHODS

Using the consensus conference technique, a group of professionals and clinical experts, the determining factors of the NVAF and DVT care process were identified, in order to define the quality and safety criteria. A proposal was made for indicators of quality and safety that were prioritised, taking into account a series of pre-established attributes. The selected indicators were classified into indicators of context, safety, action, and outcomes of the intervention in the patient.

RESULTS

A set of 114 health care and safety quality indicators were identified, of which 35 were prioritised: 15 for NVAF and 20 for DVT. About half (49%) of the indicators (40% for NVAF and 55% for DVT) applied to patient safety, and 26% (33% for NVAF and 20% for DVT) to the outcomes of interventions in the patient.

CONCLUSIONS

The present work presents a set of agreed indicators by a group of expert professionals that can contribute to the improvement of the quality of care of patients with NVAF and DVT treated with anticoagulants.

Long-term follow-up after traditional versus modified perineal approach in the management of female epispadias

OBJECTIVE

Isolated female epispadias (IFE) is a rare congenital anomaly. The defect extends to the bladder neck, which is usually incompetent. The traditional surgical approach includes urethral and genital reconstruction in the first year, followed by bladder neck reconstruction (Young-Dees-Leadbetter cervicoplasty (YDL)) at the age of social continence. An alternative single-stage technique includes urethral, bladder neck and clitoris repair by a perineal approach. The aim of the present study was to describe long-term follow-up of patients who underwent the traditional vs alternative approach.

MATERIALS AND METHODS

A retrospective review was performed of all female epispadias cases managed between 2000 and 2013. The YDL procedure (Group 1) vs single-stage perineal approach (Group 2) cases were followed and compared. Collected variables included: patients' demographics, age at diagnosis and surgery, presence of associated anomalies, clinical presentation, presence of vesicoureteral reflux (VUR), and pre-operative and postoperative continence.

RESULTS

A total of 12 cases of female epispadias were managed and followed between 2000 and 2013. No major complications occurred in either group. Urinary continence evaluated in seven children showed that none (0/3) and 4/7 (57%) were continent following the initial procedure in Group 1 and Group 2, respectively. All patients in Group 1 failed to achieve continence and required re-intervention.

CONCLUSIONS

Female epispadias could be successfully repaired using a single-stage modified perineal approach that achieved good continence with volitional voiding, good cosmetic results and compared favorably with the ones repaired with the YDL technique. The additional step of performing bladder neck tailoring to achieve a funneling configuration seemed to be useful in improving continence.