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Ibiebele A, Dubon M, D'Hemecourt P. Right Periscapular Pain In An Ice Hockey Athlete. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000879244.68820.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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2
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Chanchi MBL, Lempke AD, Kocher M, Shore B, Meehan W, Willwerth S, Hunt D, D'Hemecourt P, Stracciolini A, Whitney K. Running Biomechanics And Clinical Features Among Adolescent Athletes With Lower Leg Chronic Exertional Compartment Syndrome. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000879092.64845.9c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ibiebele A, Scott D, D'Hemecourt P, Meehan WP. The use of bracing in the management of lumbar spondylolysis. PM R 2022; 14:604-610. [PMID: 35014189 DOI: 10.1002/pmrj.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Abiye Ibiebele
- Medical Sports Medicine Fellow, Boston Children's Hospital, 9 Hope Avenue, Suite 100, Waltham, Massachusetts, United States
| | - Daphne Scott
- Primary Sports Medicine, HSS
- Hospital for Special Surgery, 535 East 70th Street, New York, New York, United States
| | | | - William P Meehan
- Micheli Center for Sports Injury Prevention, Clinical Effectiveness Research Center, Department of Orthopedics , Boston Children's Hospital, 9 Hope Avenue, Suite 100 Waltha m, Massachusetts 02453, United States, HSS
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Breslow RG, Collins JE, Troyanos C, Cohen MC, D'Hemecourt P, Dyer KS, Baggish A. Exertional Heat Stroke at the Boston Marathon: Demographics and the Environment. Med Sci Sports Exerc 2021; 53:1818-1825. [PMID: 33756522 DOI: 10.1249/mss.0000000000002652] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to assess associations between exertional heat stroke (EHS) and sex, age, prior performance, and environmental conditions, and report on resources needed for EHS cases at the Boston Marathon. METHODS We analyzed participant characteristics, environmental data, and EHS medical encounters during the 2015-2019 Boston Marathon races. RESULTS Among 136,161 starters, there was an incidence of 3.7 EHS cases per 10,000 starters (95% confidence interval, 2.8-4.9), representing 0.5% of all medical encounters. There were significant associations between sex and age (P < 0.0001), sex and start wave (P < 0.0001), and age group and start wave (P < 0.0001). Sex was not significantly associated with increased EHS incidence; however, age younger than 30 yr and assignment to the first two start waves were. All cases occurred at races with average wet bulb globe temperatures of 17°C-20°C. There was a linear correlation between EHS incidence and greater increases in wet bulb globe temperature from start to peak (R2 = 0.7688). A majority of cases (37; 72.5%) were race finishers; nonfinishers all presented after mile 18. Most were triaged 3-4 h after starting, and all were treated with ice water immersion. Treatment times were prolonged (mean (SD), 78.1 (47.5) min; range, 15-190 min); 29.4% (15 cases) developed posttreatment hypothermia, and 35.3% (18 cases) were given intravenous fluids. Most (31 cases; 64.6%) were discharged directly, although 16 cases (33.3%) required hospital transport. There were no fatalities. CONCLUSIONS Younger and faster runners are at higher risk for EHS at the Boston Marathon. Greater increases in heat stress from start to peak during a marathon may exacerbate risk. EHS encounters comprise a small percentage of race-day medical encounters but require extensive resources and warrant risk mitigation efforts.
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Affiliation(s)
| | | | | | | | | | - K Sophia Dyer
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA
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5
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Krabak BJ, Roberts WO, Tenforde AS, Ackerman KE, Adami PE, Baggish AL, Barrack M, Cianca J, Davis I, D'Hemecourt P, Fredericson M, Goldman JT, Harrast MA, Heiderscheit BC, Hollander K, Kraus E, Luke A, Miller E, Moyer M, Rauh MJ, Toresdahl BG, Wasfy MM. Youth running consensus statement: minimising risk of injury and illness in youth runners. Br J Sports Med 2020; 55:305-318. [PMID: 33122252 DOI: 10.1136/bjsports-2020-102518] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 01/25/2023]
Abstract
Despite the worldwide popularity of running as a sport for children, relatively little is known about its impact on injury and illness. Available studies have focused on adolescent athletes, but these findings may not be applicable to preadolescent and pubescent athletes. To date, there are no evidence or consensus-based guidelines identifying risk factors for injury and illness in youth runners, and current recommendations regarding suitable running distances for youth runners at different ages are opinion based. The International Committee Consensus Work Group convened to evaluate the current science, identify knowledge gaps, categorise risk factors for injury/illness and provide recommendations regarding training, nutrition and participation for youth runners.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, Univesrity of Washington, Seattle, Washington, USA
| | - William O Roberts
- Family Medicine and Community Health, University of Minnesota, St Paul, Minnesota, USA
| | - Adam S Tenforde
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | | | - Paolo Emilio Adami
- Health and Science, IAAF Health & Science Department, International Association of Athletics Federations (IAAF), Monaco
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michelle Barrack
- Family and Consumer Sciences, California State University, Long Beach, Long Beach, California, USA
| | - John Cianca
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Irene Davis
- Physical Medicine and Rehabilitation, National Running Center, Cambridge, Massachusetts, USA
| | | | | | - Joshua T Goldman
- Sports Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Mark A Harrast
- Rehabilitation, Orthopedics and Sports Medicine, Univesrity of Washington, Seattle, Washington, USA
| | - Bryan C Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Emily Kraus
- Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, California, USA
| | - Anthony Luke
- Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Emily Miller
- Sports Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Melissa Moyer
- Sports Physical Therapy, Sanford Health, Sioux Falls, South Dakota, USA
| | - Mitchell J Rauh
- School of Exercise and Nutritional Sciences, Doctor of Physical Therapy Program, San Diego State University, San Diego, California, USA
| | - Brett G Toresdahl
- Primary Care Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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6
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Scott C, Kobelski G, Miller P, D'Hemecourt P, Stracciolini A. Is Dynamic Ultrasound Of Femoroacetabular Translation Increased In Female Dancers With Acetabular Dysplasia? Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000681360.19984.d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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7
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Schwellnus M, Kipps C, Roberts WO, Drezner JA, D'Hemecourt P, Troyanos C, Janse van Rensburg DC, Killops J, Borresen J, Harrast M, Adami PE, Bermon S, Bigard X, Migliorini S, Jordaan E, Borjesson M. Medical encounters (including injury and illness) at mass community-based endurance sports events: an international consensus statement on definitions and methods of data recording and reporting. Br J Sports Med 2019; 53:1048-1055. [PMID: 30796105 DOI: 10.1136/bjsports-2018-100092] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 12/19/2022]
Abstract
Mass participation endurance sports events are popular but a large number of participants are older and may be at risk of medical complications during events. Medical encounters (defined fully in the statement) include those traditionally considered 'musculoskeletal' (eg, strains) and those due to 'illness' (eg, cardiac, respiratory, endocrine). The rate of sudden death during mass endurance events (running, cycling and triathlon) is between 0.4 and 3.3 per 100 000 entrants. The rate of other serious medical encounters (eg, exertional heat stroke, hyponatraemia) is rarely reported; in runners it can be up to 100 times higher than that of sudden death, that is, between 16 and 155 per 100 000 race entrants. This consensus statement has two goals. It (1) defines terms for injury and illness-related medical encounters, severity and timing of medical encounters, and diagnostic categories of medical encounters, and (2) describes the methods for recording data at mass participation endurance sports events and reporting results to authorities and for publication. This unifying consensus statement will allow data from various events to be compared and aggregated. This will inform athlete/patient management, and thus make endurance events safer.
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Affiliation(s)
- Martin Schwellnus
- Faculty of Health Sciences, Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, Gauteng, South Africa.,Director, IOC Research Centre of South Africa, Pretoria, Gauteng, South Africa
| | | | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, St Paul, Minnesota, USA
| | | | | | - Chris Troyanos
- International Institute for Race Medicine (IIRM), Boston, Massachusetts, USA
| | - Dina Christina Janse van Rensburg
- Section Sports Medicine and Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, Gauteng, South Africa
| | - Jannelene Killops
- Section Sports Medicine, Faculty of Health Sciences, Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, Gauteng, South Africa
| | - Jill Borresen
- Sport, Exercise Medicine and Lifestyle Institute, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Mark Harrast
- Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Paolo E Adami
- IAAF Health and Science Department, International Association of Athletics Federations (IAAF), Rome, Italy
| | | | - Xavier Bigard
- Union Cycliste Internationale (UCI), Aigle, Switzerland
| | | | - Esme Jordaan
- Biostatistics Unit, Medical Research Council, Parow, South Africa
| | - Mats Borjesson
- Neuosciences and Physiology, Goteborgs Universitet Sahlgrenska Akademin, Goteborg, Sweden.,Ostra Sjukhuset, Goteborg, Sweden
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Abstract
A 14-year-old female ballet dancer sustained an injury during a routine ballet movement that was diagnosed as an ischial tuberosity avulsion fracture. This diagnosis was complicated by extensive soft tissue injury to the hamstrings, adductors, and external rotator musculature. Although uncommon, the potential for this injury should be uniformly considered in adolescent dancers due to the unique stresses in ballet training and the added risk of growth spurts during this stage of development. Prevention targeting individual deficiencies in flexibility and strength is essential to avoid similar devastating injuries. In most cases that are diagnosed early, avulsions heal with conservative treatment. Early imaging and correct diagnosis can serve to guide clinical management and prevent unnecessary surgery in the young dancer.
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Affiliation(s)
- Jessica Biernacki
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia, Melbourne Medical School, University of Melbourne, Victoria, Australia 3010;,
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts; and Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Pierre D'Hemecourt
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts; and Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Andrea Stracciolini
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts; and Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- Katherine V Yao
- 1Boston Children's Hospital, Boston, MA; 2Sports Medicine Consultants, LLC Norfolk, VA; 3Boston Children's Hospital, Newton, MA; 4UMN Phalen Village Clinic St. Paul, MN
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Sousa T, Skaggs DL, Chan P, Yamaguchi KT, Borgella J, Lee C, Sawyer J, Moisan A, Flynn JM, Gunderson M, Hresko MT, D'Hemecourt P, Andras LM. Benign Natural History of Spondylolysis in Adolescence With Midterm Follow-Up. Spine Deform 2017; 5:134-138. [PMID: 28259265 DOI: 10.1016/j.jspd.2016.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/29/2016] [Accepted: 10/11/2016] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVES To use the Micheli Functional Scale to assess adolescent patients with spondylolysis treated conservatively at midterm follow-up. SUMMARY OF BACKGROUND Spondylolysis is a common source of back pain for adolescents and is generally managed with bracing and physical therapy. There is little data regarding the results of conservative management of spondylolysis over time. METHODS Four major academic pediatric institutions performed a retrospective chart review of patients from 5 to 21 years of age with the initial diagnosis of spondylolysis. Inclusion criteria were patients who initially underwent conservative management and had a minimum of 2 years' follow-up. The patients were contacted and asked to complete the Micheli Functional Scale Survey. RESULTS A total of 295 patients with the diagnosis of spondylolysis were identified and contacted. Sixty-one subjects with spondylolysis completed the follow-up survey. Sixty of 61 respondents (98%) answered questions regarding their current pain level. Thirty-five of 60 (58.3%) reported no pain (0/10) and 47/60 (78%) rated their pain at 3 or less, whereas 22% (13/60) rated their pain as 4 or higher. There was no correlation with pain ratings on the follow-up survey and radiographic healing at initial management. Of the 61 patients, 50 returned to sports (82%), 8 did not return (13%), and 5 returned to most but not all of their sports (8%). No correlation was observed between radiographic healing and return to sports (p = .4885). CONCLUSION Using a validated functional scale, this study demonstrated that with conservative management of spondylolysis a majority of patients at an average of 8 years out self-report a return to sports (90%), though many reported continued pain (42%) and interference with activities (67%). There was no correlation observed between radiographic evidence of healing and pain or return to sports with a mean follow-up of 8 years. LEVEL OF EVIDENCE Multicenter retrospective case series.
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Affiliation(s)
- Ted Sousa
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #69, Los Angeles, CA 90027, USA
| | - David L Skaggs
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #69, Los Angeles, CA 90027, USA.
| | - Priscella Chan
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #69, Los Angeles, CA 90027, USA
| | - Kent T Yamaguchi
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Jerald Borgella
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN 38104, USA
| | - Christopher Lee
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Jeffrey Sawyer
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN 38104, USA
| | - Alice Moisan
- LeBonheur Children's Hospital, 51 N Dunlap St #100, Memphis, TN 38105, USA
| | - John M Flynn
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Melissa Gunderson
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - M Timothy Hresko
- Division of Sports Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Pierre D'Hemecourt
- Division of Sports Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Lindsay M Andras
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #69, Los Angeles, CA 90027, USA
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11
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Cheuvront SN, Caruso EM, Heavens KR, Karis AJ, Santee WR, Troyanos C, D'Hemecourt P. Effect of WBGT Index Measurement Location on Heat Stress Category Classification. Med Sci Sports Exerc 2016; 47:1958-64. [PMID: 25628176 DOI: 10.1249/mss.0000000000000624] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED The location of the wet bulb globe temperature (WBGT) index measurement may affect heat stress flag category classification. PURPOSE This study aimed to compare WBGT measurements at three locations along the Boston Marathon race course and compare WBGT estimates for meteorological stations and 72-h advanced WBGT forecasts. METHODS WBGT was measured hourly from 1000 to 1400 h at approximately 7 km, approximately 18 km, and approximately 30 km on the Boston Marathon race course. Simultaneous WBGT estimates were made for two meteorological stations southeast of the course via a commercial online system, which also provided 72-h advanced forecasts. RESULTS The measurement difference (mean ± SD) among course locations was 0.2°C ± 1.8°C WBGT (ANOVA, P > 0.05). The difference between course and stations was 1.9°C ± 2.4°C WBGT (t-test, P < 0.05). Station values underestimated (n = 98) or overestimated (n = 13) course values by >3°C WBGT (>0.5 flag category) in 111 of 245 paired comparisons (45%). Higher black globe and lower wet bulb temperatures explained over- and underestimates, respectively. Significant underestimates of WBGT resulted in misclassification of green (labeled white) and black (labeled red) course flag categories (χ2, P < 0.05). Forecast data significantly underestimated red (labeled amber) and black (labeled red) course flag categories. CONCLUSIONS Differences in WBGT index along 23 km of the Boston Marathon race route can be small enough to warrant single measurements. However, significant misclassification of flag categories occurred using WBGT estimates for meteorological stations; thus, local measurements are preferred. If the relation between station WBGT forecasts and the race sites can be established, the forecast WBGT values could be corrected to give advanced warning of approximate flag conditions. Similar work is proposed for other venues to improve heat stress monitoring.
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Affiliation(s)
- Samuel N Cheuvront
- 1U.S. Army Research Institute of Environmental Medicine, Natick, MA; and 2Boston Athletic Association, Boston, MA
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12
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Min PK, Park J, Isaacs S, Taylor BA, Thompson PD, Troyanos C, D'Hemecourt P, Dyer S, Chan SY, Baggish AL. Influence of statins on distinct circulating microRNAs during prolonged aerobic exercise. J Appl Physiol (1985) 2015; 120:711-20. [PMID: 26472872 DOI: 10.1152/japplphysiol.00654.2015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/12/2015] [Indexed: 12/29/2022] Open
Abstract
Statins exacerbate exercise-induced skeletal muscle injury. Muscle-specific microRNAs (myomiRs) increase in plasma after prolonged exercise, but the patterns of myomiRs release after statin-associated muscle injury have not been examined. We examined the relationships between statin exposure, in vitro and in vivo muscle contraction, and expression of candidate circulating myomiRs. We measured plasma levels of myomiRs, circulating microRNA-1 (c-miR-1), c-miR-133a, c-miR-206, and c-miR-499-5p from 28 statin-using and 28 nonstatin-using runners before (PRE), immediately after (FINISH), and 24 h after they ran a 42-km footrace (the 2011 Boston marathon) (POST-24). To examine these cellular-regulation myomiRs, we used contracting mouse C2C12 myotubes in culture with and without statin exposure to compare intracellular and extracellular expression of these molecules. In marathoners, c-miR-1, c-miR-133a, and c-miR-206 increased at FINISH, returned to baseline at POST-24, and were unaffected by statin use. In contrast, c-miR-499-5p was unchanged at FINISH but increased at POST-24 among statin users compared with PRE and runners who did not take statins. In cultured C2C12 myotubes, extracellular c-miR-1, c-miR-133a, and c-miR-206 were significantly increased by muscle contraction regardless of statin use. In contrast, extracellular miR-499-5p was unaffected by either isolated statin exposure or isolated carbachol exposure but it was increased when muscle contraction was combined with statin exposure. In summary, we found that statin-potentiated muscle injury during exercise is accompanied by augmented extracellular release of miR-499-5p. Thus c-miR-499-5p may serve as a biomarker of statin-potentiated muscle damage.
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Affiliation(s)
- Pil-Ki Min
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts; Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joseph Park
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Isaacs
- Cardiovascular Performance Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Beth A Taylor
- Henry Low Heart Center, Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Paul D Thompson
- Henry Low Heart Center, Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | | | | | - Sophia Dyer
- Boston Athletic Association, Boston, Massachusetts; and
| | - Stephen Y Chan
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts;
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Boston Athletic Association, Boston, Massachusetts; and
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Ashish N, Bamman MM, Cerny FJ, Cooper DM, D'Hemecourt P, Eisenmann JC, Ericson D, Fahey J, Falk B, Gabriel D, Kahn MG, Kemper HCG, Leu SY, Liem RI, McMurray R, Nixon PA, Olin JT, Pianosi PT, Purucker M, Radom-Aizik S, Taylor A. The clinical translation gap in child health exercise research: a call for disruptive innovation. Clin Transl Sci 2014; 8:67-76. [PMID: 25109386 DOI: 10.1111/cts.12194] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
In children, levels of play, physical activity, and fitness are key indicators of health and disease and closely tied to optimal growth and development. Cardiopulmonary exercise testing (CPET) provides clinicians with biomarkers of disease and effectiveness of therapy, and researchers with novel insights into fundamental biological mechanisms reflecting an integrated physiological response that is hidden when the child is at rest. Yet the growth of clinical trials utilizing CPET in pediatrics remains stunted despite the current emphasis on preventative medicine and the growing recognition that therapies used in children should be clinically tested in children. There exists a translational gap between basic discovery and clinical application in this essential component of child health. To address this gap, the NIH provided funding through the Clinical and Translational Science Award (CTSA) program to convene a panel of experts. This report summarizes our major findings and outlines next steps necessary to enhance child health exercise medicine translational research. We present specific plans to bolster data interoperability, improve child health CPET reference values, stimulate formal training in exercise medicine for child health care professionals, and outline innovative approaches through which exercise medicine can become more accessible and advance therapeutics across the broad spectrum of child health.
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Affiliation(s)
- Naveen Ashish
- Department of Neurology, University of Southern California, California, USA
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Baggish AL, Park J, Min PK, Isaacs S, Parker BA, Thompson PD, Troyanos C, D'Hemecourt P, Dyer S, Thiel M, Hale A, Chan SY. Rapid upregulation and clearance of distinct circulating microRNAs after prolonged aerobic exercise. J Appl Physiol (1985) 2014; 116:522-31. [PMID: 24436293 DOI: 10.1152/japplphysiol.01141.2013] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Short nonprotein coding RNA molecules, known as microRNAs (miRNAs), are intracellular mediators of adaptive processes, including muscle hypertrophy, contractile force generation, and inflammation. During basal conditions and tissue injury, miRNAs are released into the bloodstream as "circulating" miRNAs (c-miRNAs). To date, the impact of extended-duration, submaximal aerobic exercise on plasma concentrations of c-miRNAs remains incompletely characterized. We hypothesized that specific c-miRNAs are differentially upregulated following prolonged aerobic exercise. To test this hypothesis, we measured concentrations of c-miRNAs enriched in muscle (miR-1, miR-133a, miR-499-5p), cardiac tissue (miR-208a), and the vascular endothelium (miR-126), as well as those important in inflammation (miR-146a) in healthy male marathon runners (N = 21) at rest, immediately after a marathon (42-km foot race), and 24 h after the race. In addition, we compared c-miRNA profiles to those of conventional protein biomarkers reflective of skeletal muscle damage, cardiac stress and necrosis, and systemic inflammation. Candidate c-miRNAs increased immediately after the marathon and declined to prerace levels or lower after 24 h of race completion. However, the magnitude of change for each c-miRNA differed, even when originating from the same tissue type. In contrast, traditional biomarkers increased after exercise but remained elevated 24 h postexercise. Thus c-miRNAs respond differentially to prolonged exercise, suggesting the existence of specific mechanisms of c-miRNA release and clearance not fully explained by generalized cellular injury. Furthermore, c-miRNA expression patterns differ in a temporal fashion from corollary conventional tissue-specific biomarkers, emphasizing the potential of c-miRNAs as unique, real-time markers of exercise-induced tissue adaptation.
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Affiliation(s)
- Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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15
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Zaleski A, Capizzi J, Ballard KD, Troyanos C, Baggish A, D'Hemecourt P, Thompson PD, Parker B. Statins Attenuate the Increase in P-Selectin Produced by Prolonged Exercise. J Sports Med (Hindawi Publ Corp) 2013; 2013:487567. [PMID: 26464882 PMCID: PMC4590908 DOI: 10.1155/2013/487567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 04/15/2013] [Indexed: 02/08/2023]
Abstract
Strenuous endurance exercise increases inflammatory markers and acutely increases cardiovascular risk; however, statins may mitigate this response. We measured serum levels of p-selectin in 37 runners treated with statins and in 43 nonstatin treated controls running the 2011 Boston Marathon. Venous blood samples were obtained the day before (PRE) as well as within 1 hour after (FINISH) and 24 hours after (POST) the race. The increase in p-selectin immediately after exercise was lower in statin users (PRE to FINISH: 20.5 ± 19.4 ng/mL) than controls (PRE to FINISH: 30.9 ± 27.1 ng/mL; P < 0.001). The increase in p-selectin 24 hours after exercise was also lower in statin users (PRE to POST: 21.5 ± 26.6 ng/mL) than controls (PRE to POST: 29.3 ± 31.9 ng/mL; P < 0.001). Furthermore, LDL-C was positively correlated with p-selectin at FINISH and POST (P < 0.01 and P < 0.05, resp.), irrespective of drug treatment, suggesting that lower levels of LDL-C are associated with a reduced inflammatory response to exercise. We conclude that statins blunt the exercise-induced increase in p-selectin following a marathon and that the inflammatory response to a marathon varies directly with LDL-C levels.
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Affiliation(s)
- Amanda Zaleski
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, Hartford, CT 06102, USA
| | - Jeffrey Capizzi
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, Hartford, CT 06102, USA
| | - Kevin D. Ballard
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, Hartford, CT 06102, USA
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | | | - Aaron Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Paul D. Thompson
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, Hartford, CT 06102, USA
| | - Beth Parker
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, Hartford, CT 06102, USA
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Abstract
Pediatric intramedullary spinal cord tumors are rare and account for 3% to 6% of all central nervous system tumors. Astrocytomas are infiltrating neoplasms, and they predominate in the pediatric population. We report a case of an intramedullary spinal cord astrocytoma in a 5-year-old boy with nonspecific mid-back pain for 3 months. Physical examination revealed clonus, thoracolumbar tenderness, and pain with sitting straight leg raises. An urgent magnetic resonance imaging showed an intramedullary tumor in the mid-thoracic cord, confirmed by surgical excision. The physician should maintain a high index of suspicion when evaluating the pediatric patient who presents with unexplained and persistent back pain. Associated findings, including nocturnal pain and neurological symptoms may indicate a more serious underlying pathology such as a tumor. Early detection, prompt treatment, and proper post surgical management will often lead to improved outcomes in patients.
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Affiliation(s)
- Michael O'Brien
- Children's Hospital Boston, Havard Medical School, Boston, MA 02115, USA.
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Affiliation(s)
- James MacDonald
- Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
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18
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O'Brien MJ, Curtis CM, D'Hemecourt P. Unusual Back Pain in a Young Child. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000273421.02761.2a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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Mersey J, D'Hemecourt P, Blaze K. Once-daily fixed combination of captopril and hydrochlorothiazide as first line therapy for mild to moderate hypertension. Curr Ther Res Clin Exp 1993. [DOI: 10.1016/s0011-393x(05)80657-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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