HPV-associated vulvar carcinoma with sebaceous differentiation

•Sebaceous carcinoma is rare on the vulva and uncommonly associated with HPV.•Pregnancy may play a role in onset or exacerbation of HPV-associated vulvar cancers.•Treatment of vulvar sebaceous carcinoma is local excision and sentinel lymph node dissection with close follow-up.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Post-traumatic Splenic Injury Outcomes for Nonoperative and Operative Management: A Systematic Review

BACKGROUND

Splenectomies are widely performed, but there exists controversy regarding care for splenic injury patients. The purpose of this study is to provide a comprehensive review of the literature over the last 20 years for operative management (OM) versus nonoperative management (NOM) versus splenic artery embolization (SAE) for traumatic splenic injuries and associated outcomes.

METHODS

A review of literature was performed following the PRISMA guidelines through a search of PubMed, EMBASE, Cochrane Library, JAMA Network, and SAGE journals from 2000 to 2020 regarding splenic injury in trauma patients and their management. Articles were then selected based on inclusion/exclusion criteria with GRADE criteria used on the included articles to assess quality.

RESULTS

Twenty retrospective cohorts and one prospective cohort assessed patients who received OM versus NOM or SAE. Multiple studies indicated that NOM, in properly selected patients, provided better outcomes than its operative counterpart.

CONCLUSION

This review provides additional evidence to support the NOM of splenic injuries for hemodynamically stable patients with benign abdomens as it accounts for consistently shorter hospital length of stay, fewer complications, and lower mortality than OM. For hemodynamically unstable patients, management continues to be intervention with surgery. More studies are needed to further investigate outcomes of post-splenectomy patients based on grade of injury, hemodynamic status, type of procedure (i.e., SAE), and failure of NOM in order to provide additional evidence and improve outcomes for this patient population.

Observation of the pη^{'} Cusp in the New Precise Beam Asymmetry Σ Data for γp→pη

Data on the beam asymmetry Σ in the photoproduction of η mesons off protons are reported for tagged photon energies from 1130 to 1790 MeV (mass range from W=1748  MeV to W=2045  MeV). The data cover the full solid angle that allows for a precise moment analysis. For the first time, a strong cusp effect in a polarization observable has been observed that is an effect of a branch-point singularity at the pη^{'} threshold [E_{γ}=1447  MeV (W=1896  MeV)]. The latest BnGa partial wave analysis includes the new beam asymmetry data and yields a strong indication for the N(1895)1/2^{-} nucleon resonance, demonstrating the importance of including all singularities for a correct determination of partial waves and resonance parameters.

Maximal strength training in patients with Parkinson's disease: impact on efferent neural drive, force-generating capacity, and functional performance

Parkinson's disease (PD) is characterized by progressive neurological deterioration, typically accompanied by reductions in skeletal muscle force-generating capacity (FGC) and functional performance. Physical activity has the potential to counteract this debilitating outcome, however, it is elusive if high-intensity strength training included in conventional treatment may improve results. Therefore, we randomly assigned 22 PD patients (74 ± 9 yr) to conventional rehabilitation with or without maximal strength training (MST) performed as leg press and chest press at ~90% of one repetition maximum (1RM), five times per week for 4 wk. FGC, physical performance, and efferent neural drive assessed as evoked potentials (V-wave normalized to M-wave in m. soleus) were measured following training. Results revealed that only MST improved 1RM leg press (101 ± 23 to 118 ± 18 kg) and chest press (36 ± 15 to 41 ± 15 kg), plantar flexion maximal voluntary contraction (235 ± 125 to 293 ± 158 N·m), and rate of force development (373 ± 345 to 495 ± 446 N·m·s^-1; all P < 0.05; different from controls P < 0.05). FGC improvements were accompanied by an increased efferent neural drive to maximally contracting musculature (V-to-M ratio: 0.17 ± 0.12 to 0.24 ± 0.15; P < 0.05; different from controls P < 0.05), improved physical performance (stair climbing: 21.0 ± 9.2 to 14.4 ± 5.2 s; timed up and go: 7.8 ± 3.3 to 6.2 ± 2.5 s; both P < 0.05), and self-perceived improvement in health (3.1 ± 0.5 to 2.6 ± 0.9) and social activities functioning (2.2 ± 1.0 to 1.5 ± 1.1; both P < 0.05). No changes were observed in the control group. In conclusion, this study shows that MST improves FGC, neuromuscular function, and functional performance and advocates that high-intensity strength training should be implemented as an adjunct therapy in the treatment of PD patients.NEW & NOTEWORTHY This randomized, controlled trial documents that supervised high-intensity strength training improves efferent neural drive, maximal muscle strength, rate of force development, and functional performance in patients with Parkinson's disease (PD). In contrast, no differences were observed in these outcome variables in patients receiving conventional treatment consisting of recreational physical activity with low-to-medium intensity. Consequently, this study advocates that high-intensity strength training should be implemented in the clinical treatment of PD patients.

Development, Value, and Implications of a Comprehensive Primary Care Payment Calculator for Family Medicine

Background and Objectives: Fee for service (FFS), the dominant payment model for primary care in the United States, compensates physicians based on volume. There are many initiatives exploring alternative payment models that prioritize value over volume. The Family Medicine for America’s Health (FMAHealth) Payment Team has developed a comprehensive primary care payment (CPCP) model to support the move from activity- and volume-based payment to performance-based payment for value. Methods: In 2016-2017, the FMAHealth Payment Team performed a comprehensive study of the current state of primary care payment models in the United States. This study explored the features, motivations, successes, and failures of a wide variety of payment arrangements. Results: The results of this work have informed a definition of comprehensive primary care payment (CPCP) as well as a CPCP calculator. This quantitative methodology calculates a base rate and includes modifiers that recognize the importance of infrastructure and resources that have been found to be successful in innovative models. The modifiers also incorporate adjustments for chronic disease burden, social determinants of health, quality, and utilization. Conclusions: The calculator and CPCP methodology offer a potential roadmap for transitioning from volume to value and details how to calculate such an adjustable comprehensive payment. This has impact and interest for all levels of the health care system and is intended for use by practices of all types as well as health systems, employers, and payers.

The effect from maximal bench press strength training on work economy during wheelchair propulsion in men with spinal cord injury

OBJECTIVE

To assess the effect from maximal bench press strength training (MST) on wheelchair propulsion work economy (WE).

STUDY DESIGN

Pretest-posttest case-control group design.

SETTING

St Olavs Hospital, Trondheim, Norway.

METHODS

Seventeen male individuals with spinal cord injury (SCI) paraplegia were allocated to either MST bench press (n=11) or the control group (CG) (n=7). The MST group trained bench press three times per week, for 6 weeks, starting at 85-95% of their pretest bench press one-repetition maximum (1RM). For calculation of WE during wheelchair propulsion, oxygen uptake (VO₂) measurements were collected during wheelchair ergometry (WCE) at submaximal workload of 50 W. Similarly, peak oxygen uptake (VO_2peak) and peak power output (W) were measured during WCE.

RESULTS

Individuals in the MST regimen significantly improved WE compared with the CG by 17.3 % (mean between-group differences: 95% confidence interval) of 2.63 ml kg^-1 min^-1: (-4.34, -0.91) (P=0.007). Between pretest and posttest, the increase in bench press 1RM was by 17% higher in the MST group compared with the CG. At peak testing, the MST group generated significantly higher peak power compared with the CG. All other physiological variables were comparable within and between groups.

CONCLUSIONS

A 6-week MST bench press regimen significantly improved WE during wheelchair propulsion at 50 W workload. These preliminary data support a possible beneficial role for MST to reduce the energy cost of wheelchair propulsion for SCI individuals.

Impaired skeletal health and neuromuscular function among amphetamine users in clinical treatment

SUMMARY

This study examined musculoskeletal health in amphetamine users, compared with healthy age-matched controls. We show that amphetamine users have reduced bone mass at several skeletal sites and attenuated maximal muscle strength and force development capacity in the lower extremities.

INTRODUCTION

Amphetamine use may cause poor bone quality and elevated risk of osteoporosis. The purpose of this study was to investigate whether amphetamine users exhibit reduced regional and whole body bone mineral density (BMD), altered bone metabolism, and how muscle function may relate to the patient groups' skeletal health.

METHODS

We assessed hip, lumbar spine and whole body BMD, and trabecular bone score (TBS) by dual x-ray absorptiometry (DXA), and bone metabolism markers in serum and maximal strength and force development capacity in 36 amphetamine users (25 men, 30 ± 7 years; 11 women 35 ± 10 years) and in 37 healthy controls (23 men, 31 ± 9 years; 14 women, 35 ± 7 years).

RESULTS

Whole body BMD was lower in amphetamine users (8% in males and 7% females, p < 0.01), as were BMD at the total hip and sub-regions of the hip (9-11% in men and 10-11 % in women, p < 0.05). Male users had 4% lower TBS (p < 0.05) and higher serum level of type 1 collagen amino-terminal propeptide (p < 0.01). This coincided with reduced lower extremity maximal strength of 30% (males, p < 0.001) and 25% (females, p < 0.05) and 27% slower muscular force development in males compared to controls (p < 0.01).

CONCLUSIONS

These findings demonstrate that amphetamine users suffer from a generalized reduction in bone mass, which was associated with attenuated maximal muscle strength and force development capacity in the lower extremities.

Comparison of thoracic bioimpedance with acetylene uptake for measuring cardiac output

Cardiac output is shown to be a key determinant for oxygen transport, performance and health. Reliable and accurate non-invasive measurements of cardiac output, especially during exercise, are therefore of importance. The present study compared a new thoracic bioimpedance method with the established single-breath acetylene uptake method. We assessed cardiac output in 20 (24±4 years.) moderately trained males, at rest and during cycling. Both methods showed good test-retest reliabilities with ±2 SD limits of agreement of 3.67 and -4.50 L ∙ min(-1) (thoracic bioimpedance) and 4.46 and -5.69 L ∙ min(-1) (single breath), respectively. When thoracic bioimpedance was compared with single breath, the ±2 SD limits of agreement were poor (-6.05 and 9.57 L ∙ min(-1)). Thoracic bioimpedance displayed significantly lower (p<0.05) absolute cardiac output values than single breath, and the cardiac output-oxygen consumption slopes (y=5.7x+5.5 (single breath) and y=5.0x+5.0 (thoracic bioimpedance) tended (p=0.08) to show less increase for thoracic bioimpedance.

CONCLUSIONS

Results from the single-breath method are in line with previous findings, showing a good reliability. Although thoracic bioimpedance showed a similar reliability as the single-breath method, and is easier to use, the agreement with single breath was poor, and thoracic bioimpedance seems not to be able to replace it.

Short-term training alters the control of mitochondrial respiration rate before maximal oxidative ATP synthesis

AIM

Short-term exercise training may induce metabolic and performance adaptations before any changes in mitochondrial enzyme potential. However, there has not been a study that has directly assessed changes in mitochondrial oxidative capacity or metabolic control as a consequence of such training in vivo. Therefore, we used (31) P-magnetic resonance spectroscopy ((31) P-MRS) to examine the effect of short-term plantar flexion exercise training on phosphocreatine (PCr) recovery kinetics and the control of respiration rate.

METHOD

To this aim, we investigated 12 healthy men, experienced with this exercise modality (TRA), and 7 time-control subjects (TC).

RESULTS

After 5 days of training, maximum work rate during incremental plantar flexion exercise was significantly improved (P < 0.01). During the recovery period, the maximal rate of oxidative adenosine triphosphate synthesis (PRE: 28 ± 13 mm min(-1) ; POST: 26 ± 15 mm min(-1) ) and the PCr recovery time constant (PRE: 31 ± 19 s; POST: 29 ± 16) were not significantly altered. In contrast, the Hill coefficient (nH ) describing the co-operativity between respiration rate and ADP was significantly increased in TRA (PRE: nH = 2.7 ± 1.4; POST: nH = 3.4 ± 1.9, P < 0.05). Meanwhile, there were no systematic variations in any of these variables in TC.

CONCLUSION

This study reveals that 5 days of training induces rapid adaptation in the allosteric control of respiration rate by ADP before any substantial improvement in muscle oxidative capacity occurs.

Structural brain changes after 4 wk of unilateral strength training of the lower limb

Strength training enhances muscular strength and neural drive, but the underlying neuronal mechanisms remain unclear. This study used magnetic resonance imaging (MRI) to identify possible changes in corticospinal tract (CST) microstructure, cortical activation, and subcortical structure volumes following unilateral strength training of the plantar flexors. Mechanisms underlying cross-education of strength in the untrained leg were also investigated. Young, healthy adult volunteers were assigned to training ( n = 12) or control ( n = 9) groups. The 4 wk of training consisted of 16 sessions of 36 unilateral isometric plantar flexions. Maximum voluntary isometric contraction torque was tested pre- and posttraining. MRI investigation included a T1-weighted scan, diffusion tensor imaging and functional MRI. Probabilistic fiber tracking of the CST was performed on the diffusion tensor imaging images using a two-regions-of-interest approach. Fractional anisotropy and mean diffusivity were calculated for the left and right CST in each individual before and after training. Standard functional MRI analyses and volumetric analyses of subcortical structures were also performed. Maximum voluntary isometric contraction significantly increased in both the trained and untrained legs of the training group, but not the control group. A significant decrease in mean diffusivity was found in the left CST following strength training of the right leg. No significant changes were detected in the right CST. No significant changes in cortical activation were observed following training. A significant reduction in left putamen volume was found after training. This study provides the first evidence for strength training-related changes in white matter and putamen in the healthy adult brain.

Stroke volume does not plateau in female endurance athletes

It has been a long-lasting debate whether the heart's stroke volume (SV) increases at high aerobic intensities or plateau. Further, sex and level of aerobic power are shown to influence the response. The purpose of this study was to investigate the SV at increasing intensities in elite female athletes and moderately trained females. 13 elite athletes and 11 moderately trained controls with maximal oxygen consumption (VO(2max)) of 67.1 ± 6.1 and 49.5 ± 2.3 mL ∙ min (- 1) ∙ kg (- 1), respectively, were recruited. SV was measured at rest, and running on a treadmill at 40%, 60%, 80% and 100% of VO(2max) using the single breath acetylene uptake (SB) technique. Both groups showed a significant (p<0.05) increase in SV from 40% of VO2max to VO(2max), with increases from 105.3 ± 19.0 to 129.1 ± 16.3 mL∙ beat(-1) for the elite females and from 68.7 ± 21.7 to 82.7 ± 14.0 mL ∙ beat (- 1) for the moderately trained. No differences were observed between groups in these increases, but the elite athletes displayed a larger (p<0.05) SV at all intensities. It is concluded that the SV increases at high aerobic intensities both in elite athlete females and moderately trained females.

Abstract 2704: Tetraspanin CD151 drives mammary tumor onset and metastasis by coordinating integrin-dependent cell adhesion, motility, survival and signaling

The ErbB2+ subtype of human breast tumors remains a significant threat to women's health, as they are highly prone to recurrence or metastasis, and development of drug resistance. Here we report that CD151, a member of the tetraspanin family and a close partner of the laminin-binding (LB) integrins (≥3α1 and α6β4), contributes to the onset and malignancy of ErbB2-induced mammary tumors. By crossing gene-targeted mice onto a clinically-relevant MMTV-ErbB2 transgenic model, we demonstrated that deletion of CD151 significantly impaired the onset and metastasis of mammary tumors in mice. Our subsequent analyses of cell lines derived from mouse primary tumors showed that loss of CD151 decreased integrin-mediated cell-ECM adhesion and cell-cell contacts. Also, for ErbB2-overexpressing MCF-10A cells cultured in 2D or 3D, ablation of CD151 markedly reduced tumor cell motility, invasion and survival. However, only MAPK and FAK kinases among an array of signaling molecules downstream of integrins and ErbB receptors, exhibited a decreased activation in response to CD151 disruption. Importantly, there were corresponding changes in the activation and signaling of α6β4 integrin, as reflected by decreased phosphorylation of multiple serine residues at its cytoplasmic domain. Also, the cross-talk between integrins and ErbB receptors was strongly inhibited. Meanwhile, our analyses of clinical dataset revealed a strong correlation between CD151 gene expression and patients’ metastasis-free survival. Taken together, our results demonstrate that tetraspanin CD151 drives ErbB2-induced mammary tumorigenesis by coordinating the function and signaling of LB integrins. This newly-identified crucial role of CD151 offers a strong therapeutic potential for the treatment of breast cancer patients.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2704. doi:1538-7445.AM2012-2704

Effect of leg vascular occlusion on arm cycling peak oxygen uptake in spinal cord-injured individuals

STUDY DESIGN

Cross-sectional single-subject design.

OBJECTIVES

To determine whether leg vascular occlusion (LEVO) augment arm cycling (ACE) peak oxygen uptake in spinal cord-injured individuals.

SETTING

University Hospital, Norway.

METHODS

Fifteen individuals with C(4) to T(12) spinal cord injury (SCI) were recruited and divided into two groups: injury above (SCI-high, n=8) or below (SCI-low, n=7) the T(6) level. Peak oxygen uptake (VO(2peak)) was measured during (1) ACE combined with LEVO, (2) ACE alone and (3) ACE combined with functional electrical stimulation cycling (FES hybrid cycling).

RESULTS

In the SCI-high group, VO(2peak) and peak Watt during ACE with LEVO were higher than ACE alone: 20.0 (±5.0) versus 17.6 (±5.0) ml kg(-1) min(-1) (P=0.006), and 72.5(±32) versus 80.0 (±34) Watt (P=0.016), respectively. However, FES hybrid cycling VO(2peak) was significantly higher than ACE with LEVO: 24.4 (±4.1) versus 20.0 (±5.0) ml kg(-1) min(-1) (P=0.006). In the SCI-low group, there was no difference in VO(2peak) and related parameters between the three modalities.

CONCLUSIONS

For spinal cord-injured individuals with injury level above T(6) (high) in the present study, LEVO combined with ACE augment VO(2peak). However, this acute increase in VO(2peak) was lower than when FES cycling was combined with ACE. These findings may have future implications for exercise prescription for spinal cord-injured individuals.

Strength and endurance in elite football players

We aimed to improve the physical capacity of a top-level elite football team during its pre-season by implementing a maximal strength and high-intensity endurance training program. 21 first league elite football players (20-31 yrs, height 171-194 cm, mass 58.8-88.1 kg) having recently participated in the UEFA Champions' League, took part in the study. Aerobic interval-training at 90-95% of maximal heart rate and half-squats strength training with maximum loads in 4 repetitions × 4 sets were performed concurrently twice a week for 8 weeks. The players were not familiar with maximal strength training as part of their regular program. Maximal oxygen uptake (VO(2max)) increased 8.6% (1.7-16.6) (p<0.001), from 60.5 (51.7-67.1) to 65.7 (58.0-74.5) mL · kg (-1) · min (-1) whereas half-squat one repetition maximum increased 51.7% (13.3-135.3) (p<0.001), from 116 (85-150) to 176 (160-210) kg. The 10-m sprint time also improved by 0.06 s (0.02-0.16) (p<0.001); while counter movement jump improved 3.0 cm (0.1-6.2) (p<0.001), following the training program. The concurrent strength and endurance training program together with regular football training resulted in considerable improvement of the players' physical capacity and so may be successfully introduced to elite football players.

Interval and strength training in CAD patients

This study sought to study the effect of high intensity aerobic interval endurance training on peak stroke volume and maximal strength training on mechanical efficiency in coronary artery disease (CAD) patients. 8 CAD patients (age 61.4 ± 3.7 years) trained 30 interval training sessions with 4 × 4 min intervals at 85-95% of peak heart rate while 10 CAD patients (age 66.5 ± 5.5 years) trained 24 sessions of maximal horizontal leg press. In the interval training group peak stroke volume increased significantly by 23% from 94.1 ± 23.0 mL · beat (-1) to 115.8 ± 22.4 mL · beat (-1) (p<0.05). Peak oxygen uptake increased significantly by 17% from 27.2 ± 4.5 mL · kg (-1) · min (-1) to 31.8 ± 5.0 mL · kg (-1) min (-1) (p<0.05) in the same group. In contrast, there was no such exercise training-induced change in peak stroke volume or peak oxygen uptake in the maximal strength training group, despite a 35% improvement in sub maximal walking performance.

Predictors of recurrence in high-grade cervical lesions and a plan of management

PRÉCIS: Positive endocervical margins are an important predictor of recurrence in high-grade cervical lesions, and though they do not always warrant retreatment, closer surveillance is recommended.

OBJECTIVE

To identify predictors of recurrence and persistence of high-grade cervical dysplasia and to determine appropriate follow-up.

DESIGN

prospective pilot study.

SETTING

Gynaecological surgical center.

POPULATION

Three hundred fifty-two patients were treated between 1999 and 2002 for high-grade lesions.

METHODS

According to the accessibility of the transformation zone and the degree of dysplasia, patients were treated either by conization or by loop electrosurgical excision procedure (LEEP). Follow-up comprised colposcopy and Pap-smear screening 4-6 months after treatment as well as high-risk human papillomavirus (HR-HPV) testing before and after treatment.

MAIN OUTCOME MEASURES

underscore predictors of recurrence and propose a treatment flowchart for both management and follow-up.

RESULTS

Of the 352 patients, 37 (10.5%) had true recurrence 6 months after initial surgical treatment and 6 patients (1.7%) had persistent lesions. Overall, 43 patients (12.2%) were considered as having recurrent disease. Patients were followed up for 5 years with a mean of 73 months. The most important predictor of recurrence was a positive HR-HPV test at 6 months postoperatively (odds ratio 38.8, 95% confidence interval 14.09, 107.05). The second significant predictor was positive endocervical margins and the third was positive pre-treatment HPV typing. A positive post-treatment HPV test had a more significant influence on risk than a positive test before treatment.

CONCLUSION

In agreement with recent findings, our study supports the usefulness of the HR-HPV test in the follow-up of treated high-grade lesions, especially when excision margins were positive.

[Construction of a neo-vagina by sigmoidocolpoplasty]

Construction of a neo-vagina by sigmoidocolpoplasty has been effective in the treatment of vaginal aplasia, a condition most commonly seen with the Mayer Rokitansky Syndrome. This article describes the surgical technique and principal complications, and reviews the literature to compare this technique with other methods of repair, particularly the Davydov technique.

Predicting congenital cytomegalovirus infection: Guerra et al

The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Guerra B, Simonazzi G, Puccetti C, et al. Ultrasound prediction of symptomatic congenital cytomegalovirus infection. Am J Obstet Gynecol 2008;198:380.e1-380.e7. The full discussion appears at www.AJOG.org, page e1-e3.

Strength and Endurance Differences Between Elite and Junior Elite Ice Hockey Players. The Importance of Allometric Scaling

The aim of this study was to investigate differences in strength and endurance between elite and elite junior ice hockey players. Participants included 18 elite players and 21 junior elite male players (24.2 +/- 4.7 vs. 17.6 +/- 0.9 years of age, 84.2 +/- 8.1 vs. 72.3 +/- 6.0 kg body mass (p < 0.01), 179.9 +/- 6.1 vs. 179.0 +/- 7.0 cm). Absolute maximal oxygen uptake was significantly higher in elite than junior players (4.8 vs. 4.2 L x min(-1), p < 0.01), but relative expressions, including allometric scaling, eliminated the difference. Elite players lifted significantly more weight than juniors in 1 repetition maximum squats (200.0 +/- 28.9 vs. 140.3 +/- 19.5 kg, p < 0.01) and in bench press (100.8 +/- 12.8 vs. 75.3 +/- 12.8 kg, p < 0.01). Elite players also ran significantly faster in the 10 m sprint (1.80 +/- 0.07 vs. 1.88 +/- 0.08 s, p < 0.01), and had greater jumping height (27.2 +/- 3.2 vs. 20.5 +/- 3.0 cm, p < 0.01) and peak force (2336.4 +/- 219.9 vs. 2011.9 +/- 180.1 N, p < 0.01) when holding 50 extra kg. No differences were found for the 40 m sprint or for the rate of force development in jumping. This study revealed that the main differences between elite and junior ice hockey players at a high performance level seem to be in strength and body mass. The results therefore identify important factors for juniors to improve in the transition phase from junior to elite level.

Physiological adaptations to soccer specific endurance training in professional youth soccer players

BACKGROUND

Improved oxygen uptake improves soccer performance as regards distance covered, involvements with the ball, and number of sprints. Large improvements in oxygen uptake have been shown using interval running. A similar physiological load arising from interval running could be obtained using the soccer ball in training.

OBJECTIVES

The main aim was to study physiological adaptations to a 10 week high intensity aerobic interval training program performed by professional youth soccer players, using a soccer specific ball dribbling track.

METHODS

Eleven youth soccer players with a mean (SD) age of 16.9 (0.4) years performed high intensity aerobic interval training sessions twice per week for 10 weeks in addition to normal soccer training. The specific aerobic training consisted of four sets of 4 min work periods dribbling a soccer ball around a specially designed track at 90-95% of maximal heart frequency, with a 3 min recovery jog at 70% of maximal heart frequency between intervals.

RESULTS

Mean VO2max improved significantly from 63.4 (5.6) to 69.8 (6.6) ml kg(-1) min(-1), or 183.3 (13.2) to 201.5 (16.2) ml kg(-0.75) min(-1) (p<0.001). Squat jump and counter movement jump height increased significantly from 37.7 (6.2) to 40.3 (6.1) cm and 52.0 (4.0) to 53.4 (4.2) cm, respectively (p<0.05). No significant changes in body mass, running economy, rate of force development, or 10 m sprint times occurred.

CONCLUSION

Performing high intensity 4 min intervals dribbling a soccer ball around a specially designed track together with regular soccer training is effective for improving the VO2max of soccer players, with no negative interference effects on strength, jumping ability, and sprinting performance.

Strong correlation of maximal squat strength with sprint performance and vertical jump height in elite soccer players

BACKGROUND

A high level of strength is inherent in elite soccer play, but the relation between maximal strength and sprint and jumping performance has not been studied thoroughly.

OBJECTIVE

To determine whether maximal strength correlates with sprint and vertical jump height in elite male soccer players.

METHODS

Seventeen international male soccer players (mean (SD) age 25.8 (2.9) years, height 177.3 (4.1) cm, weight 76.5 (7.6) kg, and maximal oxygen uptake 65.7 (4.3) ml/kg/min) were tested for maximal strength in half squats and sprinting ability (0-30 m and 10 m shuttle run sprint) and vertical jumping height.

RESULT

There was a strong correlation between maximal strength in half squats and sprint performance and jumping height.

CONCLUSIONS

Maximal strength in half squats determines sprint performance and jumping height in high level soccer players. High squat strength did not imply reduced maximal oxygen consumption. Elite soccer players should focus on maximal strength training, with emphasis on maximal mobilisation of concentric movements, which may improve their sprinting and jumping performance.

Haemodynamic changes during halothane, sevoflurane and desflurane anaesthesia in dogs before and after the induction of severe heart failure

BACKGROUND AND OBJECTIVE

The effects of desflurane and sevoflurane on the failing myocardium are still uncertain. We investigated the effects of different concentrations of sevoflurane, desflurane and halothane in dogs with pacing induced chronic heart failure.

METHODS

Global (left ventricular pressure, left ventricular dP/dt, Konigsbergtransducer) and regional myocardial function (systolic segment length shortening, ultrasonic crystals) were measured in chronically instrumented dogs with tachycardia induced severe congestive heart failure. Measurements were performed in healthy dogs and after induction of heart failure in the awake state and during anaesthesia with 0.75, 1.0, 1.25 and 1.75 minimum alveolar concentration (MAC) of halothane, sevoflurane or desflurane.

RESULTS

The anaesthetics reduced dP/dtmax in a dose-dependent manner in healthy dogs (dP/dtmax decreased to 43-53% of awake values at 1.75 MAC). Chronic rapid left ventricular pacing increased heart rate and left ventricular end-diastolic pressure and decreased mean arterial pressure, left ventricular systolic pressure and dP/dtmax. The reduction in contractility was similar in the failing myocardium (to 41-50% of awake values at 1.75 MAC). Segmental shortening was reduced during anaesthesia by 50-62% after pacing compared with 22-44% in normal hearts. While there were similar effects of the different anaesthetics on diastolic function in healthy dogs, after induction of heart failure a more pronounced increase of the time constant of isovolumic relaxation and a greater decrease of dP/dtmin was observed with sevoflurane than with desflurane, indicating a stronger depression of diastolic function.

CONCLUSIONS

While the negative inotropic effects of sevoflurane and desflurane were similar in normal and in the failing myocardium in vivo, desflurane led to a better preservation of diastolic function in the failing myocardium.

Aging attenuates vascular and metabolic plasticity but does not limit improvement in muscle VO(2) max

The interactions between exercise, vascular and metabolic plasticity, and aging have provided insight into the prevention and restoration of declining whole body and small muscle mass exercise performance known to occur with age. Metabolic and vascular adaptations to normoxic knee-extensor exercise training (1 h 3 times a week for 8 wk) were compared between six sedentary young (20 +/- 1 yr) and six sedentary old (67 +/- 2 yr) subjects. Arterial and venous blood samples, in conjunction with a thermodilution technique facilitated the measurement of quadriceps muscle blood flow and hematologic variables during incremental knee-extensor exercise. Pretraining, young and old subjects attained a similar maximal work rate (WR(max)) (young = 27 +/- 3, old = 24 +/- 4 W) and similar maximal quadriceps O(2) consumption (muscle Vo(2 max)) (young = 0.52 +/- 0.03, old = 0.42 +/- 0.05 l/min), which increased equally in both groups posttraining (WR(max), young = 38 +/- 1, old = 36 +/- 4 W, Muscle Vo(2 max), young = 0.71 +/- 0.1, old = 0.63 +/- 0.1 l/min). Before training, muscle blood flow was approximately 500 ml lower in the old compared with the young throughout incremental knee-extensor exercise. After 8 wk of knee-extensor exercise training, the young reduced muscle blood flow approximately 700 ml/min, elevated arteriovenous O(2) difference approximately 1.3 ml/dl, and increased leg vascular resistance approximately 17 mmHg x ml(-1) x min(-1), whereas the old subjects revealed no training-induced changes in these variables. Together, these findings indicate that after 8 wk of small muscle mass exercise training, young and old subjects of equal initial metabolic capacity have a similar ability to increase quadriceps muscle WR(max) and muscle Vo(2 max), despite an attenuated vascular and/or metabolic adaptation to submaximal exercise in the old.

[Shock occurring shortly after inferior vena cava interruption using an endovascular device: think of filter thrombosis]

We report the case of a 47-year-old man who experienced a pulmonary embolism associated with a femoral thrombus after a traumatic intracranial haematoma and had caval interruption using a new generation endovascular percutaneous filter. A shock occurred soon after the procedure, associated with inferior cava system inflation related to a filter thrombosis. This is a rare complication since the cessation of surgical cava interruptions. The situation became stable after intensive volume expansion. This report underlines the risk of complication associated to vena cava interruption despite the use of new generation filters and the significance of mechanical measures in prevention of thrombosis when anticoagulants are contraindicated.

Soccer specific testing of maximal oxygen uptake

AIM

Endurance capacity in soccer players is important. A soccer specific test for direct measurement of maximal oxygen uptake does, however, not exist. The aim of this study was to evaluate maximal oxygen uptake in a soccer specific field test, compared to treadmill running.

METHODS

Ten male soccer players (age 21.9+/-3.0 years, body mass 73.3+/-9.5 kg, height 179.9+/-4.7 cm) participated in the study, and 5 endurance trained men (age 24.9+/-1.8 years, body mass 81.5+/-3.7 kg, height 185.6+/-3.1 cm) took part in a comparison of the portable and the stationary metabolic test systems. The soccer players accomplished a treadmill test and a soccer specific field test containing dribbling, repetitive jumping, accelerations, decelerations, turning and backwards running.

RESULTS

Maximal oxygen uptake was similar in field (5.0+/-0.5 L x min(-1)) and laboratory (5.1+/-0.7 L x min(-1)) tests, as were maximal heart rate, maximal breathing frequency, respiratory exchange ratio and oxygen pulse. Maximal ventilation was 5.4% higher at maximal oxygen uptake during treadmill running.

CONCLUSION

These findings show that testing of maximal oxygen uptake during soccer specific testing gives similar results as during treadmill running, and therefore serves as a valid test of maximal oxygen uptake in soccer players.

Non-dominant leg training improves the bilateral motor performance of soccer players

The aim of this experiment was to evaluate bilateral motor performance effects from training the non-dominant leg of competitive soccer players. The subjects were 39 soccer players, 15-20 years of age, performance-matched and randomly divided into a training group (n = 18) and a control group (n = 21) both belonging to the same team. Both groups were tested by using two standardised foot-tapping tests and three soccer-specific tests. The training intervention consisted of the experimental group participating in all parts of their soccer training except full play, using the non-dominant leg for 8 weeks. Statistical analyses for the soccer-specific tests revealed that the experimental group improved significantly as compared to the control group from the pre-test to the post-test period in their use of the trained non-dominant leg. Somewhat unexpectedly, the experimental group also improved significantly in the tests, which made use of the dominant side. The standardised foot-tapping tests revealed similar results. The results might be explained by improved generalised motor programmes, or from a Dynamic Systems Approach, indicating that the actual training relates to the handling of all the information available to the subject in the situation, and that the body self-organises the motor performance.

Maximal strength training improves aerobic endurance performance

The aim of this experiment was to examine the effects of maximal strength training with emphasis on neural adaptations on strength- and endurance-performance for endurance trained athletes. Nineteen male cross-country skiers about 19.7 +/- 4.0 years of age and a maximal oxygen uptake (VO(2 max)) of 69.4 +/- 2.2 mL x kg(-1) x min(-1) were randomly assigned to a training group (n = 9) or a control group (n = 10). Strength training was performed, three times a week for 8 weeks, using a cable pulley simulating the movements in double poling in cross-country skiing, and consisted of three sets of six repetitions at a workload of 85% of one repetition maximum emphasizing maximal mobilization of force in the concentric movement. One repetition maximum improved significantly from 40.3 +/- 4.5 to 44.3 +/- 4.9 kg. Time to peak force (TPF) was reduced by 50 and 60% on two different submaximal workloads. Endurance performance measured as time to exhaustion (TTE) on a double poling ski ergometer at maximum aerobic velocity, improved from 6.49 to 10.18 min; 20.5% over the control group. Work economy changed significantly from 1.02 +/- 0.14 to 0.74 +/- 0.10 mL x kg(-0.67) x min(-1). Maximal strength training with emphasis on neural adaptations improves strength, particularly rate of force development, and improves aerobic endurance performance by improved work economy.

Severe pneumonia due to Legionella pneumophila: prognostic factors, impact of delayed appropriate antimicrobial therapy

OBJECTIVE

To compare the outcome of patients with severe Legionella pneumonia (LP) according to the presence or absence of prognostic factors currently reported in the literature and delays in initiating fluoroquinolones and macrolides.

DESIGN

Retrospective clinical investigation.

SETTING

Intensive care unit (ICU) of an university hospital.

PATIENTS

Forty-three consecutive cases with no previous treatment with a macrolide or a fluoroquinolone.

MEASUREMENTS AND MAIN RESULTS

The 14 (33%) patients who died of LP were compared with the 29 survivors. Thirty-eight patients (88%) received a fluoroquinolone in combination with a macrolide agent, two patients erythromycin alone and three ofloxacin alone. In univariate analysis, SAPS II more than 46 ( p=0.006) and intubation requirement ( p=0.012) were associated with a higher mortality whereas the administration of fluoroquinolones ( p=0.011) or erythromycin ( p=0.044) within 8 h of arrival on the ICU was associated with better survival. By logistic regression analysis, SAPS II score more than 46 [odds ratio (OR) 8.69; 95% confidence interval (CI) 1.15-66.7; p=0.036], duration of symptoms prior to ICU admission longer than 5 days (OR 7.46; 95% CI 1.17-47.6) were independent risk factors for death. Fluoroquinolone administration within 8 h of ICU arrival (OR 0.16; 95% CI 0.03-0.96; p=0.035) was associated with a reduced mortality.

CONCLUSIONS

SAPS II score higher than 46, duration of symptoms prior to ICU admission longer than 5 days and intubation were associated with increased mortality. Initiation of fluoroquinolone therapy within 8 h of ICU admission significantly reduced mortality.

Aerobic endurance training improves soccer performance

PURPOSE

The aim of the present study was to study the effects of aerobic training on performance during soccer match and soccer specific tests.

METHODS

Nineteen male elite junior soccer players, age 18.1 +/- 0.8 yr, randomly assigned to the training group (N = 9) and the control group (N = 10) participated in the study. The specific aerobic training consisted of interval training, four times 4 min at 90-95% of maximal heart rate, with a 3-min jog in between, twice per week for 8 wk. Players were monitored by video during two matches, one before and one after training.

RESULTS

In the training group: a) maximal oxygen uptake (VO2max) increased from 58.1 +/- 4.5 mL x kg(-1) x min(-1) to 64.3 +/- 3.9 mL x kg(-1) x min(-1) (P < 0.01); b) lactate threshold improved from 47.8 +/- 5.3 mL x kg(-1) x min(-1) to 55.4 +/- 4.1 mL x kg(-1) x min(-1) (P < 0.01); c) running economy was also improved by 6.7% (P < 0.05); d) distance covered during a match increased by 20% in the training group (P < 0.01); e) number of sprints increased by 100% (P < 0.01); f) number of involvements with the ball increased by 24% (P < 0.05); g) the average work intensity during a soccer match, measured as percent of maximal heart rate, was enhanced from 82.7 +/- 3.4% to 85.6 +/- 3.1% (P < 0.05); and h) no changes were found in maximal vertical jumping height, strength, speed, kicking velocity, kicking precision, or quality of passes after the training period. The control group showed no changes in any of the tested parameters.

CONCLUSION

Enhanced aerobic endurance in soccer players improved soccer performance by increasing the distance covered, enhancing work intensity, and increasing the number of sprints and involvements with the ball during a match.