Correction: In-season internal and external training load quantification of an elite European soccer team

[This corrects the article DOI: 10.1371/journal.pone.0209393.].

Antibacterial and Antiviral Properties of Chenopodin-Derived Synthetic Peptides

Antimicrobial peptides have been developed based on plant-derived molecular scaffolds for the treatment of infectious diseases. Chenopodin is an abundant seed storage protein in quinoa, an Andean plant with high nutritional and therapeutic properties. Here, we used computer- and physicochemical-based strategies and designed four peptides derived from the primary structure of Chenopodin. Two peptides reproduce natural fragments of 14 amino acids from Chenopodin, named Chen1 and Chen2, and two engineered peptides of the same length were designed based on the Chen1 sequence. The two amino acids of Chen1 containing amide side chains were replaced by arginine (ChenR) or tryptophan (ChenW) to generate engineered cationic and hydrophobic peptides. The evaluation of these 14-mer peptides on Staphylococcus aureus and Escherichia coli showed that Chen1 does not have antibacterial activity up to 512 µM against these strains, while other peptides exhibited antibacterial effects at lower concentrations. The chemical substitutions of glutamine and asparagine by amino acids with cationic or aromatic side chains significantly favoured their antibacterial effects. These peptides did not show significant hemolytic activity. The fluorescence microscopy analysis highlighted the membranolytic nature of Chenopodin-derived peptides. Using molecular dynamic simulations, we found that a pore is formed when multiple peptides are assembled in the membrane. Whereas, some of them form secondary structures when interacting with the membrane, allowing water translocations during the simulations. Finally, Chen2 and ChenR significantly reduced SARS-CoV-2 infection. These findings demonstrate that Chenopodin is a highly useful template for the design, engineering, and manufacturing of non-toxic, antibacterial, and antiviral peptides.

Return-to-performance in elite soccer players after Achilles tendon ruptures: a study using a weighted plus/minus metric and matched-control analysis

PURPOSE

Studies have shown decreased match participation and shortened careers in athletes suffering Achilles tendon ruptures (ATRs), but assessment using a true performance metric is lacking. Plus/minus (PM) metrics provide a practical and objective approach to player performance assessment and are commonly used in other sports. This study aimed to quantify and compare individual player performance variations in elite football league players who sustained ATRs and returned to play within 1 year compared to those without ATRs, using a PM metric.

METHODS

Player and team data were sourced from Transfermarkt.com. Male players sustaining ATRs between 2007 and 2018 were identified through injury reports. A control group (CTRL) was matched by position, age, height, and league, with a 6:1 ratio of controls to ATR subjects. The day of injury was considered "time zero". Year -1 corresponds to the 360 days preceding injury, and Year 1 to the interval between 360 and 720 days after. Performance in the player's main team was evaluated using a previously validated weighted PM metric. Only data from Year -1 and Year 1 were used for ATR versus CTRL group comparisons. Statistical significance was set at p < 0.05.

RESULTS

The ATR group included 125 athletes. Data from more than 76,000 matches were analyzed. No statistically significant differences in net weighted PM metric between Year -1 and Year 1 were found.

CONCLUSION

No differences were found between athletes suffering from ATRs and controls regarding the weighted PM metric.

LEVEL OF EVIDENCE

III.

Unlocking the potential of snake venom-based molecules against the malaria, Chagas disease, and leishmaniasis triad

Malaria, leishmaniasis and Chagas disease are vector-borne protozoal infections with a disproportionately high impact on the most fragile societies in the world, and despite malaria-focused research gained momentum in the past two decades, both trypanosomiases and leishmaniases remain neglected tropical diseases. Affordable effective drugs remain the mainstay of tackling this burden, but toxicicty, inneficiency against later stage disease, and drug resistance issues are serious shortcomings. One strategy to overcome these hurdles is to get new therapeutics or inspiration in nature. Indeed, snake venoms have been recognized as valuable sources of biomacromolecules, like peptides and proteins, with antiprotozoal activity. This review highlights major snake venom components active against at least one of the three aforementioned diseases, which include phospholipases A2, metalloproteases, L-amino acid oxidases, lectins, and oligopeptides. The relevance of this repertoire of biomacromolecules and the bottlenecks in their clinical translation are discussed considering approaches that should increase the success rate in this arduous task. Overall, this review underlines how venom-derived biomacromolecules could lead to pioneering antiprotozoal treatments and how the drug landscape for neglected diseases may be revolutionized by a closer look at venoms. Further investigations on poorly studied venoms is needed and could add new therapeutics to the pipeline.

Causative Agents of American Tegumentary Leishmaniasis Are Able to Infect 3T3-L1 Adipocytes In Vitro

Although macrophages have long been considered key players in the course of Leishmania infections, other non-professional phagocytes have lately been shown to maintain low levels of the parasite in safe intracellular niches. Recently, it was demonstrated that the adipose tissue is capable of harboring Old World L. (L.) infantum in mice. However, there is no evidence of experimental adipocyte infection with New World Leishmania species so far. In addition, it was not known whether adipocytes would be permissive for formation of the unique, large and communal parasitophorous vacuoles that are typical of L. (L.) amazonensis in macrophages. Here we evaluated the ability of L. (L.) amazonensis and L. (V.) braziliensis promastigotes and amastigotes to infect 3T3-L1 fibroblast-derived adipocytes (3T3-Ad) using light and transmission electron microscopy. Our results indicate that amastigotes and promastigotes of both species were capable of infecting and surviving inside pre- and fully differentiated 3T3-Ad for up to 144 h. Importantly, L. (L.) amazonensis amastigotes resided in large communal parasitophorous vacuoles in pre-adipocytes, which appeared to be compressed between large lipid droplets in mature adipocytes. In parallel, individual L. (V.) braziliensis amastigotes were detected in single vacuoles 144 h post-infection. We conclude that 3T3-Ad may constitute an environment that supports low loads of viable parasites perhaps contributing to parasite maintenance, since amastigotes of both species recovered from these cells differentiated into replicative promastigotes. Our findings shed light on the potential of a new host cell model that can be relevant to the persistence of New World Leishmania species.

Prostate Cancer Aggressiveness Prediction Using CT Images

Prostate Cancer (PCa) is mostly asymptomatic at an early stage and often painless requiring active surveillance screening. Transrectal Ultrasound Guided Biopsy (TRUS) is the principal method to diagnose PCa following a histological examination by observing cell pattern irregularities and assigning the Gleason Score (GS) according to the recommended guidelines. This procedure presents sampling errors and, being invasive may cause complications to the patients. External Beam Radiotherapy Treatment (EBRT) is presented as curative option for localised and locally advanced disease, as a palliative option for metastatic low-volume disease or after prostatectomy for prostate bed and pelvic nodes salvage. In the EBRT worflow a Computed Tomography (CT) scan is performed as the basis for dose calculations and volume delineations. In this work, we evaluated the use of data-characterization algorithms (radiomics) from CT images for PCa aggressiveness assessment. The fundamental motivation relies on the wide availability of CT images and the need to provide tools to assess EBRT effectiveness. We used Pyradiomics and Local Image Features Extraction (LIFEx) to extract features and search for a radiomic signature within CT images. Finnaly, when applying Principal Component Analysis (PCA) to the features, we were able to show promising results.

In-season monotony, strain and acute/chronic workload of perceived exertion, global positioning system running based variables between player positions of a top elite soccer team

Background

The interpretation of the load variations across a period seems important to control the weekly progression or variation of the load, or to identify within- micro and mesocycle variations. Thus, the aim of this study was to describe the in-season variations of training monotony, training strain, and acute: chronic workload ratio (ACWR) through session rating of perceived exertion (s-RPE), total distance and high-speed running (HSR) according to playing positions in an elite soccer team.

Methods

Seventeen professional players from an European First League team participated in this study. They were divided four central defenders (CD), three wide defenders (WD), four central midfielders (CM), three wide midfielders (WM) and three strikers (ST). The players were monitored daily over a 41-week period of competition where 52 matches occurred during the 2015–2016 in-season. Through the collection of s-RPE, total distance and HSR, training monotony, training strain and ACWR were calculated for each measure, respectively. Data were analysed across ten mesocycles (M: 1–10).

Results

The main results showed significant differences (p < 0.05) for TMs-RPE between CD vs. ST (moderate effect) in M2; between CD vs. CM (moderate effect) for TS of s-RPE; between CD vs. ST moderate effect) in M6 for ACWR of s-RPE. In addition, there was significant difference between CM vs. ST (moderate effect) in M2 for TS of TD; between WD vs. ST (moderate effect) in M3 for ACWR of TD. Moreover, there were significant differences for TM of HSR between CD vs. WD (very large effect); CD vs. WD (moderate effect) in M4 for TS of HSR.

Conclusions

The present study presents new insights to coaches and technical staff about the variation profiling of TM, TS, and ACWR calculated with internal and external load measures, between player positions during 10 mesocycles.

Dissection of phospholipases A2 reveals multifaceted peptides targeting cancer cells, Leishmania and bacteria

Cationic peptides bio-inspired by natural toxins have been recognized as an efficient strategy for the treatment of different health problems. Due to the specific interaction with substrates from biological membranes, snake venom phospholipases (PLA2s) represent valuable scaffolds for the research and development of short peptides targeting parasites, bacteria, and cancer cells. Considering this, we evaluated the in vitro therapeutic potential of three biomimetic peptides (pCergo, pBmTxJ and pBmje) based on three different amino acid sequences from Asp49 PLA2s. First, short amino acid sequences (12-17 in length) derived from these membranolytic toxins were selected using a combination of bioinformatics tools, including AntiCP, AMPA, PepDraw, ToxinPred, and HemoPI. The peptide, from each polypeptide sequence, with the greatest average antimicrobial index, no toxicity, and no hemolysis predicted was synthesized, purified, and characterized. According to in vitro assays performed, pBmje showed moderate cytotoxicity specifically against MCF-7 (breast cancer cells) with an EC50 of 464.85 µM, whereas pBmTxJ showed an antimicrobial effect against Staphylococcus aureus (ATCC 25923) with an MIC of 37.5 µM, and pCergo against E. coli (ATCC 25922) with an MIC of 75 µM. In addition, pCergo showed antileishmanial activity with an EC50 of 93.69 µM and 110.40 µM against promastigotes of Leishmania braziliensis and L. amazonensis, respectively. Altogether, these results confirmed the versatility of PLA2-derived synthetic peptides, highlighting the relevance of the use of these membrane-interacting toxins as specific archetypes for drug design focused on public health problems.

Cruzioseptins, antibacterial peptides from Cruziohyla calcarifer skin, as promising leishmanicidal agents

Screenings of natural products have significantly contributed to the discovery of novel leishmanicidal agents. In this study, three known cruzioseptins-antibacterial peptides from Cruziohyla calcarifer skin-were synthesized and evaluated against promastigotes and amastigotes stages of Leishmania (L.) amazonensis and L. (V.) braziliensis. EC50 ranged from 9.17 to 74.82 μM, being cruzioseptin-1 the most active and selective compound, with selectivity index > 10 for both promastigotes and amastigotes of L. (V.) braziliensis. In vitro infections incubated with cruzioseptins at 50 μM showed up to ∼86% reduction in the amastigote number. Cruzioseptins were able to destabilize the parasite's cell membrane, allowing the incorporation of a DNA-fluorescent dye. Our data also demonstrated that hydrophobicity and charge appear to be advantageous features for enhancing parasiticidal activity. Antimicrobial cruzioseptins are suitable candidates and alternative molecules that deserve further in vivo investigation focusing on the development of novel antileishmanial therapies.

In-Season Internal and External Workload Variations between Starters and Non-Starters-A Case Study of a Top Elite European Soccer Team

Background and Objectives: Interpretation of the load variations across a period seems important to control the weekly progression or variation of the load, or to identify in-micro- and mesocycle variations. Thus, the aims of this study were twofold: (a) to describe the in-season variations of training monotony, training strain and acute:chronic workload ratio (ACWR) through session ratings of perceived exertion (s-RPE), total distance and high-speed running (HSR); and (b) to compare those variations between starters and non-starters. Materials and Methods: Seventeen professional players from a European First League team participated in this study. They were divided in two groups: starters (n = 9) and non-starters (n = 8). The players were monitored daily over a 41-week period of competition where 52 matches occurred during the 2015-2016 in-season. Through the collection of s-RPE, total distance and HSR, training monotony, training strain and ACWR were calculated for each measure, respectively. Data were analyzed across ten mesocycles (M: 1 to 10). Repeated measures ANOVA was used with the Bonferroni post hoc test to compare M and player status. Results: The results revealed no differences between starters vs. non-starters (p > 0.05). M6 had a greater number of matches and displayed higher values for monotony (s-RPE, total distance and HSR), strain (only for total distance) and ACWR (s-RPE, TD and HSR). However, the variation patterns for all indexes displayed some differences. Conclusions: The values of both starters and non-starters showed small differences, thus suggesting that the adjustments of training workloads that had been applied over the season helped to reduce differences according to the player status. Even so, there were some variations over the season (microcycles and mesocycles) for the whole team. This study could be used as a reference for future coaches, staff and scientists.

Peptides to Tackle Leishmaniasis: Current Status and Future Directions

Peptide-based drugs are an attractive class of therapeutic agents, recently recognized by the pharmaceutical industry. These molecules are currently being used in the development of innovative therapies for diverse health conditions, including tropical diseases such as leishmaniasis. Despite its socioeconomic influence on public health, leishmaniasis remains long-neglected and categorized as a poverty-related disease, with limited treatment options. Peptides with antileishmanial effects encountered to date are a structurally heterogeneous group, which can be found in different natural sources—amphibians, reptiles, insects, bacteria, marine organisms, mammals, plants, and others—or inspired by natural toxins or proteins. This review details the biochemical and structural characteristics of over one hundred peptides and their potential use as molecular frameworks for the design of antileishmanial drug leads. Additionally, we detail the main chemical modifications or substitutions of amino acid residues carried out in the peptide sequence, and their implications in the development of antileishmanial candidates for clinical trials. Our bibliographic research highlights that the action of leishmanicidal peptides has been evaluated mainly using in vitro assays, with a special emphasis on the promastigote stage. In light of these findings, and considering the advances in the successful application of peptides in leishmaniasis chemotherapy, possible approaches and future directions are discussed here.

Semitendinosus and biceps femoris long head active stiffness response until failure in professional footballers with vs. without previous hamstring injury

This study sought to examine the active stiffness of semitendinosus (ST) and biceps femoris long head (BFlh) during a knee flexor isometric contraction at 20% of maximal voluntary isometric contraction until failure in elite footballers (n=50, age: 22.3±5.3 years; height: 1.82±0.08 m; body mass: 74.7±9.0 kg). Active stiffness was assessed using ultrasound-based shear wave elastography by means of shear modulus quantification. Comparisons were performed between limbs with (n=11) vs. without (n=89) previous hamstring injury. Similar time until failure in the knee flexor fatigue task was observed between groups (p=0.401). At the start of the task, lower limbs with previous hamstring injury showed a lower BFlh active stiffness (31.0.1±10.4 kPa, p=0.023) and BFlh/ST active stiffness ratio (0.50±0.29), and no differences for ST (72.8±26.8 kPa, p=0.221) compared to lower limbs without previous hamstring injuries (BFlh: 38.0±9.6 kPa; ST: 64.0±18.4 kPa; BFlh/ST: 0.65±0.27). During the task, the ST active stiffness in both groups decreased from 80% of task time (p=0.032), in the absence of changes in BFlh active stiffness (p=0.534), resulting in an increase in BFlh/ST active stiffness from 80% of task time (p=0.029). No differences between limbs were observed during the fatigue task for all parameters (p>0.099). Future research is warranted to verify if the differences found represent an increased risk of hamstring injury.

Assessment of subjective well-being and quality of life in patients with intestinal stoma

Objective To investigate the subjective well-being and quality of life in patients with intestinal stoma.

Method This study was conducted at Ostomized People's Pole of Pouso Alegre. Data were collected in the period between December 2012 and May 2013, after approval by the Ethics Committee of the Universidade do Vale do Sapucaí under opinion No. 23,277. The participants were selected by a convenience non-probability sampling. The following instruments were used: a questionnaire on demographics and stoma; a Subjective Well-being Scale; and a Quality Outcome Scale.

Results Regarding the Flanagan Quality of Life Scale, 16–22 points were obtained, indicating that these patients suffered changes in their quality of life. Regarding the scale of subjective well-being in three domains: positive affect – 43 (61.40%) individuals; negative affect – 31 (44.30%) individuals; and life satisfaction – 54 (77.10%), all subjects obtained a score of 3, characterizing a negative change in these domains. The mean Flanagan Quality of Life Scale score was 26.16, and the means for the domains included in the Subjective Well-being Scale were: positive affect: 2.51; negative affect: 2.23 and life satisfaction: 2.77, indicating that the intestinal stoma users who participated in the study had negative feelings related to their own self-esteem and to the loss of quality of life.

Conclusion Patients with intestinal stoma who participated in this study had a change in their quality of life and in subjective well-being.

Profile of ostomy patients residing in Pouso Alegre city

The objective was to characterize the clientele of ostomy patients living in Pouso Alegre, Minas Gerais, Brazil. Among the causes that led patients to acquire an ostomy, the most prevalent was neoplasia; the type of ostomy was a permanent colostomy. Most people were not told that they would be submitted to the stoma. In addition, individuals were not subject to stoma demarcation, and irrigation was not performed. Regarding the type of complication, 34 (48.60%) had dermatitis; 14 (20%), retraction; and 13 (18.60%), prolapse. With respect to stoma diameter, 34 (48.60%) had 20–40 mm and 23 (32.90%), 40–60 mm. With this study, we became aware of the profile of ostomized patients treated at the municipality of Pouso Alegre/MG; it is expected that, with these data, the improvement of care to this population can be subsidized. We suggest that nursing professionals think of health action strategies with respect to guidance on stoma manufacture and to measures aiming for the prevention of possible complications, promoting ways to help these patients to make decisions and to verbalize feelings, so that they feel supported in coping with changes in their body image, for the sake of survival.

Bothrops atrox from Ecuadorian Amazon: Initial analyses of venoms from individuals

Bothrops atrox is the most clinically relevant snake species within the Amazon region, which includes Ecuadorian territories. It comprises a large distribution, which could contribute to the genetic and venomic variation identified in the species. The high variability and protein isoform diversity of its venom are of medical interest, since it can influence the clinical manifestations caused by envenomation and its treatment. However, in Ecuador there is insufficient information on the diversity of venomic phenotypes, even of relevant species such as B. atrox. Here, we characterized the biochemical and toxicological profiles of the venom of six B. atrox individuals from the Ecuadorian Amazon. Differences in catalytic activities of toxins, elution profiles in liquid chromatography, electrophoretic patterns, and toxic effects among the analyzed samples were identified. Nonetheless, in the preclinical testing of antivenom, two samples from Mera (Pastaza) required a higher dose to achieve total neutralization of lethality and hemorrhage. Taken together, these data highlight the importance of analyzing individual venoms in studies focused on the outcomes of envenoming.

Variations of workload and well-being measures across a professional basketball season

Abstract The aims of this study were: (i) to describe weekly variations of acute load (AL), acute:chronic workload ratio, delayed onset muscle soreness (DOMS), and fatigue; (ii) to analyze variations of weekly workload and well-being in three periods of the season (P1, P2, and P3); and (iii) to analyze the relationships between workload and well-being measures. Fifteen professional basketball players from a first-league European club were monitored throughout the season using the CR-10 Borg scale and the Hooper questionnaire. Weekly AL and acute:chronic workload ratio (ACWR) were weekly calculated for monitoring of the internal load. In addition, DOMS and fatigue values were weekly calculated. Greater AL, DOMS, and fatigue values were found during the early season, and the highest ACWR value was found during the second period. Overall, AL presented large correlations with DOMS (r=0.60) and fatigue (r=0.62). The results of this study indicate that load is higher in the first period and then decreases throughout the season. The results also showed that AL is more closely related to well-being parameters than ACWR.

Does the distribution of the weekly training load account for the match results of elite professional soccer players?

PURPOSE

The aim of the study was to compare training load (TL) of the days preceding a win, draw or defeat in a sample of elite professional soccer players across the in-season 2015/16.

METHODS

Twenty elite soccer players participated in this study. Total distance covered, high-speed running distance (HSRD), average speed, session rate of perceived exertion (s-RPE) and Hooper index scores (HI) were collected. Data from 24 weeks with one match were analysed through the match-day (MD-5, 4, 3, 2, 1) and MD+1.

RESULTS

The main finding emerges in MD-1, where a longer training duration preceding draws (95.1 ± 1.5 min) > defeats (91.5 ± 1.6 min) > wins (84.7 ± 0.5 min) was found, while total distance and average speed were higher in wins (3628.6 ± 57.2 m) > draws (3391.3 ± 153.3 m) > defeats (3236.1 ± 113.7 m) and draws (130.7 ± 17.6 m/min) > wins (86.0 ± 6.9 m/min) > defeats (54.8 ± 7.1 m/min), respectively. HSRD was higher in draws (42.8 ± 0.6 m) > wins (36.1 ± 1.7 m) > defeats (35.8 ± 1.7 m). In MD+1, there were differences in HI between wins vs draws (p<0.01).

CONCLUSIONS

The results are drawn from one team that participated in UEFA Champions League. It was observed that different TL applied in training sessions can influence match result. Our findings can be considered in future soccer planning and periodization to win matches. This study emphasizes the use of HI especially in the day following the match.

Weekly Load Variations of Distance-Based Variables in Professional Soccer Players: A Full-Season Study

The aim of this study was two-fold: (1) to analyze the variations of acute load, training monotony, and training strain among early (pre-season), mid (first half of season), and end season (second half of season) periods; (2) to compare these training indicators for playing positions in different moments of the season. Nineteen professional players (age: 26.5 ± 4.3 years; experience as professional: 7.5 ± 4.3 years) from a European First League team participated in this study. The players were monitored daily over a 45-week period for the total distance (TD), distance covered (DC) at 14 km/h⁻¹ or above (DC > 14 km/h), high-speed running above 19.8 km/h⁻¹ (HSR) distance, and number of sprints above 25.2 km/h⁻¹. The acute load (sum of load during a week), training monotony (mean of training load during the seven days of the week divided by the standard deviation of the training load of the seven days), and training strain (sum of the training load for all training sessions and matches during a week multiplied by training monotony) workload indices were calculated weekly for each measure and per player. Results revealed that training monotony and training strain for HSR were meaningfully greater in pre-season than in the first half of the in-season (p ≤ 0.001; d = 0.883 and p ≤ 0.001; d = 0.712, respectively) and greater than the second half of the in-season (p ≤ 0.001; d = 0.718 and p ≤ 0.001; d = 0.717). The training monotony for the sprints was meaningfully greater in pre-season than in the first half of in-season (p < 0.001; d = 0.953) and greater than the second half of in-season (p ≤ 0.001; d = 0.916). Comparisons between playing positions revealed that small-to-moderate effect sizes differences mainly for the number of sprints in acute load, training monotony, and training strain. In conclusion, the study revealed that greater acute load, training monotony, and training strain occurred in the pre-season and progressively decreased across the season. Moreover, external defenders and wingers were subjected to meaningfully greater acute load and training strain for HSR and number of sprints during the season compared to the remaining positions.

Is Biceps Femoris Aponeurosis Size an Independent Risk Factor for Strain Injury?

This study examined whether professional footballers with previous biceps femoris long head (BF_LH) injury in the last 3-years present a smaller proximal aponeurosis (Apo-BF_LH) size compared to footballers with no previous injury. We examined the Apo-BF_LH and BF_LH size using magnetic resonance imaging and tested the knee flexor maximal isometric strength in 80 thighs of 40 footballers. Apo-BF_LH size parameters were processed using a semi-automated procedure. Outcomes were compared between thighs with (n=9) vs. without (n=71) previous BF_LH injury. No differences were observed between injured and non-injured thighs for the Apo-BF_LH and BF_LH size parameters (p>0.05) except for Apo-BF_LH volume, which was higher in the non-injured thighs of athletes with previous injury (3692.1±2638.4 mm3, p<0.006) compared to the left (2274.1±798.7 mm3) thighs of athletes without previous injury. A higher knee flexor isometric strength was observed in the injured limb of athletes with previous BF_LH injury (196.5±31.9 Nm, p<0.003) compared to the left (156.2±31.4 Nm) and right (160.0±31.4 Nm) thighs of non-injured athletes. The present results suggest that BF_LH proximal aponeurosis size should not be considered as an independent risk factor for strain injury.

Shear Wave Elastographic Investigation of the Immediate Effects of Slump Neurodynamics in People With Sciatica

OBJECTIVES

Neurodynamic techniques are often used to treat people with sciatica pain, but their mechanical effects on the sciatic nerve are unknown. Shear wave elastography (SWE) has been shown to effectively estimate the stiffness of peripheral nerves in real time. The aim of this study was to use SWE to assess the effects of slump neurodynamics in the sciatic stiffness of people with sciatica.

METHODS

Sixteen participants volunteered for this study. The sciatic stiffness of 8 patients with unilateral chronic sciatica and 8 healthy control participants was measured by SWE, with the participants in a prone position and during a dynamic condition (ie, ankle dorsiflexion). These measurements were performed before and immediately after the neurodynamic intervention, which consisted of a static slump position applied to the symptomatic limb of the patients with sciatica and in a randomly chosen limb of the healthy participants.

RESULTS

The 8 patients with sciatica included 6 male and 2 female patients, and the 8 healthy control participants included 5 male and 3 female volunteers. Slump neurodynamics resulted in an immediate decrease in the sciatic nerve stiffness of the symptomatic limb in people with sciatica by 16.1% (effect size = 0.65; P = .019). The intervention showed no significant changes in the sciatic nerve stiffness of the healthy participants (effect size = 0.05; P = .754).

CONCLUSIONS

Slump neurodynamics have the potential of decreasing the sciatic nerve stiffness in people with sciatica, and this effect can be quantified by SWE, which may provide valuable information for health professionals.

Assessing the stability of historical and desiccated snake venoms from a medically important Ecuadorian collection

Bothrops asper and Bothrops atrox are important venomous snakes from Ecuador responsible for the most of ophidic accidents, which in the past were treated with a national polyvant antivenom. For years, the venom pools were collected and stored at room temperature in a laboratory. Taking into account the controversial ability of desiccated samples to retain their biological effects and enzymatic activities, we investigated the biochemical and toxicological properties of venoms after years of storage. The proteomic profiles of historical venoms analyzed by high-performance liquid chromatography and electrophoresis are very similar. The fresh batches of venom were more lethal than those stored for years, just as the initial and current LD₅₀ values of these samples changed. Significant differences were showed in the myotoxic and hemorrhagic activity of some venom pools, while no significant statistical differences were found for the edema activity. The enzymatic assays revealed a variation in proteolytic activity on azocasein and phospholipase A₂ activity, and low differences were reported for thrombin-like serine protease activity. The maintenance of the proteomic profile and certain toxicological activities convert this venom library in a valuable source for research purposes. Nonetheless, the significative reduction of toxicological activities, such as hemorrhagic activity not feasible using these samples for the antivenom production.

Relationships between wellness status and perceived training load on daily and weekly bases over a basketball season

This study aimed to determine the relationships between internal training load (session-RPE) and wellness status (delayed onset muscle soreness – DOMS, stress, fatigue, and sleep quality) on both daily and weekly bases over a basketball season. Fifteen professional basketball players provided their wellness status and perceived training load for all training sessions and matches over a season. Daily correlations were based on the perceived load of a training session/match and the wellness status rated on the following day (before the next session). Weekly correlations were based on the sum of all ratings of the week for each variable. Results showed that DOMS and fatigue presented higher correlations with session-RPE than stress and sleep quality on both daily and weekly analyses. Daily measures presented small-to-moderate correlations between the perceived training load and wellness categories over the months. Weekly correlations increased (moderate-tolarge) for all wellness categories, except for stress. We concluded that DOMS and fatigue are more associated to session-RPE than stress and sleep quality in professional basketball players. Weekly analyses may help coaches to better understand the impact of training load on athletes’ physical wellness (DOMS and fatigue), possibly due to a delayed physiological response to training load.

Variations of season workload and well-being status among professional roller-hockey players: Full season analysis

The aims of this research were (i) to describe variations in the internal load and well-being between regular (one official match) and congested (two official matches) weeks in senior professional roller-hockey players and (ii) to analyse the variations of these determinants, within weeks, for an entire season. Ten professional roller-hockey players (29.3 ± 4.8 years; 178.3 ± 6.4 cm; 78.0 ± 3.9 kg) from the Portuguese 1st league division participated in this study. Perceptions of fatigue, stress, delayed onset muscle soreness, and quality of sleep were recorded, and the Hooper index (1-7) was constructed with the sum of the four subjective ratings. In addition, the rating of perceived exertion (RPE) was collected approximately 30 min after each training session using Borg's CR-10. The volume of training (in minutes) was also collected, and the session-RPE (RPE multiplied by training volume) was calculated. Among congested weeks, in MD-2 (two days before a match), players spend less time training (-20.7%; 90%CI: -22,5; -18,9) and have lower levels of RPE (-20.0%; 90%CI: -25,0; -14,7) and internal training load (-38.2%; 90%CI: -41,9; -34,4) when compared with normal weeks. Similar results were found in both congested and normal weeks regarding the training process of the days classified as MD-3 (three days before a match). After pooling data from the overall season, significant within-weeks differences among different dimensions of the training sessions were observed. Higher values of internal training load (ITL), RPE and volume, were consistently observed on MD-3 than on MD-2 and MD-1. Findings of well-being revealed no meaningful differences (trivial-to-small) between type of weeks. Professional roller-hockey athletes presented overall adjustments of the load based on the number of games and the number of training days across weeks.

Potential use of 13-mer peptides based on phospholipase and oligoarginine as leishmanicidal agents

Phospholipase A₂ toxins present in snake venoms interact with biological membranes and serve as structural models for the design of small peptides with anticancer, antibacterial and antiparasitic properties. Oligoarginine peptides are capable of increasing cell membrane permeability (cell penetrating peptides), and for this reason are interesting delivery systems for compounds of pharmacological interest. Inspired by these two families of bioactive molecules, we have synthesized two 13-mer peptides as potential antileishmanial leads gaining insights into structural features useful for the future design of more potent peptides. The peptides included p-Acl, reproducing a natural segment of a Lys49 PLA₂ from Agkistrodon contortrix laticinctus snake venom, and its p-AclR7 analogue where all seven lysine residues were replaced by arginines. Both peptides were active against promastigote and amastigote forms of Leishmania (L.) amazonensis and L. (L.) infantum, while displaying low cytotoxicity for primary murine macrophages. Spectrofluorimetric studies suggest that permeabilization of the parasite's cell membrane is the probable mechanism of action of these biomolecules. Relevantly, the engineered peptide p-AclR7 was more active in both life stages of Leishmania and induced higher rates of ethidium bromide incorporation than its native template p-Acl. Taken together, the results suggest that short peptides based on phospholipase toxins are potential scaffolds for development of antileishmanial candidates. Moreover, specific amino acid substitutions, such those herein employed, may enhance the antiparasitic action of these cationic peptides, encouraging their future biomedical applications.

In-season internal and external training load quantification of an elite European soccer team

Elite soccer teams that participate in European competitions need to have players in the best physical and psychological status possible to play matches. As a consequence of congestive schedule, controlling the training load (TL) and thus the level of effort and fatigue of players to reach higher performances during the matches is therefore critical. Therefore, the aim of the current study was to provide the first report of seasonal internal and external training load that included Hooper Index (HI) scores in elite soccer players during an in-season period. Nineteen elite soccer players were sampled, using global position system to collect total distance, high-speed distance (HSD) and average speed (AvS). It was also collected session rating of perceived exertion (s-RPE) and HI scores during the daily training sessions throughout the 2015-2016 in-season period. Data were analysed across ten mesocycles (M: 1 to 10) and collected according to the number of days prior to a one-match week. Total daily distance covered was higher at the start (M1 and M3) compared to the final mesocycle (M10) of the season. M1 (5589m) reached a greater distance than M5 (4473m) (ES = 9.33 [12.70, 5.95]) and M10 (4545m) (ES = 9.84 [13.39, 6.29]). M3 (5691m) reached a greater distance than M5 (ES = 9.07 [12.36, 5.78]), M7 (ES = 6.13 [8.48, 3.79]) and M10 (ES = 9.37 [12.76, 5.98]). High-speed running distance was greater in M1 (227m), than M5 (92m) (ES = 27.95 [37.68, 18.22]) and M10 (138m) (ES = 8.46 [11.55, 5.37]). Interestingly, the s-RPE response was higher in M1 (331au) in comparison to the last mesocycle (M10, 239au). HI showed minor variations across mesocycles and in days prior to the match. Every day prior to a match, all internal and external TL variables expressed significant lower values to other days prior to a match (p<0.01). In general, there were no differences between player positions. Conclusions: Our results reveal that despite the existence of some significant differences between mesocycles, there were minor changes across the in-season period for the internal and external TL variables used. Furthermore, it was observed that MD-1 presented a reduction of external TL (regardless of mesocycle) while internal TL variables did not have the same record during in-season match-day-minus.

Characterization of the Weekly External Load Profile of Professional Soccer Teams from Portugal and the Netherlands

The purpose of this study was to analyze the day-to-day variance of a typical weekly external training workload of two professional soccer teams from different countries. Twenty-nine players from two professional teams from Portugal and the Netherlands participated in this study. The players' external load was monitored for 7 weeks, by means of portable GPS devices (10 Hz, JOHAN, Noordwijk, Netherlands). Results revealed that match day -1 (MD-1), i.e. the training day before a match, had significantly (p = 0.001) less training volume (4584.50 m) than the other days. MD-5 (training five days before a match), MD-4 (four days before a match) and MD-3 (three days before a match) were the most intense (390.83, 176.90 and 247.32 m of sprinting distance, respectively) and with large volume (7062.66, 6077.30 and 6919.49 m, respectively). Interestingly, significant differences were found between clubs of different countries (p < 0.05) with the Portuguese team showing significantly higher intensity (sprinting distance) and volume (total distance) in all days with exception of MD-1 than the Dutch team. The results of this study possibly allow for the identification of different training workloads and tapering strategies between countries in relation to volume and intensity. It should be noted, however, that both clubs used a significant tapering phase in the last two days before the competition in an attempt to reduce residual fatigue accumulation.

Training load and well-being status variations of elite futsal players across a full season: Comparisons between normal and congested weeks

The aim of this study was two-fold: (i) to analyze the variations of internal load (IL) and well-being between normal and congested weeks in professional futsal (also known as indoor soccer) players and (ii) to analyze variations in training days (MD-1, MD-2 and MD-3 [matchday -1, -2, and -3, respectively]) within weeks. Twenty male professional futsal players (age: 27.8 ± 5.7 years old; height: 173.8 ± 5.6 cm; weight: 71.5 ± 7.9 kg) that participated in the first futsal league of Portugal were monitored in all training sessions and matches during a full season. Session ratings of perceived exertion and a Hooper questionnaire (to measure muscle soreness, stress, fatigue, and sleep) were used to monitor the IL and well-being, respectively. Almost certain large decreases in IL during congested weeks in training session MD-3 were observed (-27.7%, [-35.8;-18.6]). Likely moderate decreases in IL during congested weeks in the MD-2 session were also verified (-9.9%, [-17.2;-2.0]). Regarding muscle soreness, almost certain large decreases were found during congested weeks on MD-3 (-21.2%, [-30.0;-11.3]) and MD-1 (-17.3%, [-26.6;-6.9]). Similar evidence was found for fatigue level, as almost certain large decreases were observed during congested weeks on MD-3 (-23.5%, [-32.9;-12.7]) and MD-1 (-16.6%, [-24.8;-7.4]). Within-week changes during normal weeks revealed almost certain large increases in internal load on MD-2 (93.4%, [78.6;109.3]) and MD-3 (106.7%, [88.2;127.0]) in comparison with MD-1. Also, during congested weeks, almost certain large increases of internal load were observed on MD-2 (77.2%, [53.4;104.7]) and MD-3 (65.7%, [42.8;92.3]) in comparison with MD-1. The major findings of this study revealed meaningful increases of IL, muscle soreness, and fatigue in normal weeks in comparison to congested ones. Within-week changes were also observed, with the greatest loads being observed on MD-3 during normal weeks and on MD-2 during congested weeks.

Noninvasive Measurement of Sciatic Nerve Stiffness in Patients With Chronic Low Back Related Leg Pain Using Shear Wave Elastography

OBJECTIVES

The purpose of this study was to determine whether sciatic nerve stiffness is altered in people with chronic low back-related leg pain by using shear wave elastography.

METHODS

In this cross-sectional study, the sciatic nerve shear wave velocity (ie, an index of stiffness) was measured in both legs of 16 participants (8 with unilateral low back-related leg pain and 8 healthy controls). Sciatic stiffness was measured during a passive ankle dorsiflexion motion performed at 2°/s in an isokinetic dynamometer. The ankle range of motion and passive torque, as well as muscle activity, were also measured.

RESULTS

In people with low back-related leg pain, the affected limb showed higher sciatic nerve stiffness compared to the unaffected limb (+11.3%; P = .05). However, no differences were observed between the unaffected limb of people with low back-related leg pain and the healthy controls (P = .34).

CONCLUSIONS

People with chronic low back-related leg pain have interlimb differences in sciatic nerve stiffness, as measured by a safe and noninvasive method: shear wave elastography. The changes found may be related to alterations in nerve mechanical properties, which should be confirmed by future investigations.

Variations of perceived load and well-being between normal and congested weeks in elite case study handball team

The aim of this study was two-fold: (i) to analyze the variations in internal load and well-being in professional handball players between normal and congested weeks and (ii) to analyze the variations between training days within weeks. Twenty male players (26.5 ± 4.9 yo) were monitored during a full season. MD-1 (match day -1) revealed larger decreases in muscle soreness (-17.3%, [-26.6;-6.9]) and fatigue (-16.6%, [-24.8;-7.4]) in congested weeks. Regarding MD-2, larger decreases in DOMS (-19.9%, [-30.5;-7.6]), fatigue (-19.7%, [-30.0;-7.9] and the Hooper index (-16.7%, [-25.6;-6.7]) were found in congested weeks. The results of this study reveal that larger variations between normal and congested weeks occurred in MD-2 and MD-3, with greater values of load and lower levels of well-being occurring in normal weeks. Within-weeks changes revealed greater loads occurring on MD-3 and MD-2 in comparison to MD-1; in the opposite way, greater values of muscle soreness and fatigue occurred on MD-1.

Preventing and treating trench foot: validation of an educational manual for military personnel

OBJECTIVE:

To develop and validate an educational manual on the prevention and treatment of trench foot for military personnel.

METHOD:

This is a prospective, descriptive, observational study. A manual was developed based on a literature review of books, theses and articles published in the last 10 years. The manual was evaluated by an expert committee of the Brazilian Army, and tested and validated by military students from an Army Sargent School in Brazil. Students evaluated the following parameters: definition of trench foot, risk of trench foot development among the military, risk factors, identification of trench foot, preventive measures, treatment of trench foot, and final considerations.

RESULTS:

A total of 99 military students participated in the testing. Some parameters were exclusively evaluated by the experts, 12 physicians and 11 nurses, and rated as 'good or very good' as follows: thematic content (100%), graphic display (100%), topic sequence (100%), clarity of language and comprehension of information (91.3%) and illustrations (95.6%). Other parameters were rated as 'good or very good' by both the experts and military students, as follows: definition of trench foot (100% and 85.8%), risk of trench foot among the military (95.6% and 86.8%), risk factors (100% and 82.8%), identification of trench foot (100% and 86.8%), preventive measures (100% and 81.8%), treatment (95.6% and 84.8%) and final considerations (95.6% and 81.82 %), respectively. Cronbach's alpha was 0.891 for consistency and 0.854 for reliability.

CONCLUSION:

The educational manual was validated by health professionals, tested by military students, and showed to be a consistent, reliable and valid educational instrument for the prevention and treatment of trench foot.

Harnessing snake venom phospholipases A2 to novel approaches for overcoming antibiotic resistance

The emergence of antibiotic resistance drives an essential race against time to reveal new molecular structures capable of addressing this alarming global health problem. Snake venoms are natural catalogs of multifunctional toxins and privileged frameworks, which serve as potential templates for the inspiration of novel treatment strategies for combating antibiotic resistant bacteria. Phospholipases A₂ (PLA₂ s) are one of the main classes of antibacterial biomolecules, with recognized therapeutic value, found in these valuable secretions. Recently, a number of biomimetic oligopeptides based on small fragments of primary structure from PLA₂ toxins has emerged as a meaningful opportunity to overcome multidrug-resistant clinical isolates. Thus, this review will highlight the biochemical and structural properties of antibacterial PLA₂ s and peptides thereof, as well as their possible molecular mechanisms of action and key roles in development of effective therapeutic strategies. Chemical strategies possibly useful to convert antibacterial peptides from PLA₂ s to efficient drugs will be equally addressed.

Daily and weekly training load and wellness status in preparatory, regular and congested weeks: a season-long study in elite volleyball players

The study aimed to assess the changes in the perceived internal load and wellness status of volleyball players in preparatory, regular (i.e. uncongested), and congested weeks during a full season. Thirteen elite volleyball players were studied (237 training sessions and 37 official matches). Session-RPE, muscle soreness, stress, fatigue, sleep quality, and the Hooper Index were measured daily using questionnaires. Training sessions were classified based on the number of matches per week and the days before or after a match: preparatory (no match), regular (one match), and congested weeks (two or more matches). Pairwise comparisons found significantly greater session-RPE scores (p < 0.05) one day before the match (304.74 A.U.), in regular weeks than in congested weeks (204.40 A.U.). Matches during the congested weeks (364.71 A.U.) had significantly higher session-RPE scores (p < 0.05) than regular weeks (252.97 A.U.). Three days before the match involved significantly higher values of muscle soreness, fatigue, stress, and sleep quality than regular weeks. Match accumulation increased the session-RPE training load of the matches. This study provides insights into the training load and well-being status before competition, for training the day of competition, and after the competition.

In vitro effects of Crotalus atrox snake venom on chick and mouse neuromuscular preparations

The neuromuscular effect of venoms is not a major clinical manifestation shared between rattlesnakes native to the Americas, which showed two different venom phenotypes. Taking into account this dichotomy, nerve muscle preparations from mice and chicks were used to investigate the ability of Crotalus atrox venom to induce in vitro neurotoxicity and myotoxicity. Unlike crotalic venoms of South America, low concentrations of C. atrox venom did not result in significant effects on mouse neuromuscular preparations. The venom was more active on avian nerve-muscle, showing reduction of twitch heights after 120 min of incubation with 10, 30 and 100 μg/mL of venom with diminished responses to agonists and KCl. Histological analysis highlighted that C. atrox was myotoxic in both species of experimental animals; as evidenced by degenerative events, including edematous cells, delta lesions, hypercontracted fibers and muscle necrosis, which can lead to neurotoxic action. These results provide key insights into the myotoxicity and low neurotoxicity of C. atrox in two animal models, corroborating with previous genomic and proteomic findings and would be useful for a deeper understanding of venom evolution in snakes belonging to the genus Crotalus.

Seasonal player wellness and its longitudinal association with internal training load: study in elite volleyball

BACKGROUND

Monitoring training load is critical to minimize the risk of overreaching, injury or illness. The purpose of this study was to assess the relationships and variance between perceived internal load and wellness status of elite male volleyball.

METHODS

Thirteen elite volleyball players were studied during a full competitive season (nine months, 237 training sessions and 37 official matches). Perceived exertion, muscle soreness, stress, fatigue and sleep quality levels were daily measured using session RPE and the Hopper Questionnaire.

RESULTS

Moderate-to-large correlations were found between weekly training load and perceived status of muscle soreness, fatigue and stress. Stronger correlations were found between weekly training loads than daily training load. Significant greater stress levels in match days than in training were found. No correlations between load and wellness were not found in the last month when players perceived higher levels of stress due to the competition.

CONCLUSIONS

The analysis of the weekly training load had a higher relationship with players' wellness status in preseason and middle of the season. In the last part of the season (final matches for the title), despite of a decrease in perceived load of last month of the season, there was an increase stress and fatigue levels. These results suggest the importance of including the impact on the competition when elite athletes are monitored. The results show the monitoring tools used may help in to characterize the training process of teams and the player's acute and chronic responses.

Variance in Prominence Levels and in Patterns of Passing Sequences in Elite and Youth Soccer Players: A Network Approach

The aim of this study was to quantify the prominence levels of elite and highly competitive young soccer players. This study also analyzed the variation in general network properties at different competitive levels and periods of the season. A total of 132 matches, played by 28 teams during the 2015/2016 season, were analyzed. The results revealed significant differences in the composition of general network measures considering the competitive level (p = 0.002; ES = 0.077) and according to the location of the match (p = 0.001; ES = 0.147). There were positive correlations between network density and the final score (ρ = 0.172) and negative correlations between network density and goals conceded (ρ = - 0.300). Significant differences in the composite of centralities were found between positions (p = 0.001; ES = 0.293; moderate effect) and the location of the match (p = 0.001; ES = 0.013; no effect). This revealed that the general properties of cooperation increased with the competitive level, improved during the middle of the season and were better in home matches. Midfielders were most prominent players in elite and U19 teams in the mid-season and central defenders had the most prominent centralities in U17 and U15 during the early and late periods of the season.

Sciatic nerve stiffness is not changed immediately after a slump neurodynamics technique

Background

Neurodynamics techniques aim to assess and improve neural mechanosensitivity. However, there is no in vivo evidence regarding the mechanical effects of these techniques in the nerve stiffness. This study examined the immediate effects of a slump neurodynamics technique in the sciatic nerve shear wave velocity (SWV. i.e. an index of stiffness) using ultrasound-based elastography.

Methods

Fourteen healthy participants were included in this experiment. Sciatic SWV and ankle passive torque were measured during a passive ankle dorsiflexion motion (2°/s), before and immediately after 3 minutes of slump neurodynamics technique, randomly applied to one lower limb. The contralateral limb served as control.

Results

The slump intervention did not change the sciatic SWV (P=0.78), nor the dorsiflexion passive torque (P=0.14), throughout the ankle dorsiflexion motion. Excellent values of intra-rater repeatability (ICC=0.88, 0.68-0.96), and low values of standard error of measurement (0.59 m/s, 0.35-1.15m/s), were observed for the SWV measurements.

Conclusions

The sciatic nerve stiffness of healthy participants did not change immediately after a slump neurodynamics technique, suggesting a compliance of the neural tissue to tensile loads. However, these results ought to be confirmed using other neurodynamics techniques and in other populations (e.g. peripheral neuropathies).

Level of evidence

III.

Automatic calculation of patient size metrics in computed tomography: What level of computational accuracy do we need?

Objectives

To compare the effectiveness of two different patient size metrics based on water equivalent diameter (D_w), the mid‐scan water equivalent diameter D_{w_c}, and the mean (average) water equivalent diameter in the imaged region, D_{w_ave}, for automatic detection of accidental changes in computed tomography (CT) acquisition protocols.

Methods

Patient biometric data (height and weight) were available from a previous survey for 80 adult chest examinations, and 119 adult single‐acquisition chest–abdomen–pelvis (CAP) examinations for two 16 slice scanners (GE LightSpeed and Toshiba Aquilion RXL) equipped with automatic tube current modulation (ATCM). D_{w_c} and D_{w_ave} were calculated from the archived CT images. Size‐specific dose estimates (SSDE) were obtained from volume CT dose index (CTDI_vol), using the conversion factors for a patient diameter of D_{w_c}.

Results

CTDI_vol and SSDE correlate better with D_{w_ave} than with D_{w_c}. R‐squared values of linear fits to CTDI_vol of CAP examinations were 0.81–0.89 for D_{w_c} and 0.93–0.94 for D_{w_ave} (SSDE: 0.69–080 for D_{w_c}, 0.87–0.92 for D_{w_ave}). Percentage differences between D_{w_c} and D_{w_ave} were −4 ± 4% for chest and +5 ± 4% for CAP examinations (in % of D_{w_ave}). However, small D_w variations translated as larger variations in CTDI_vol for these ATCM systems (e.g., a 24% increase in D_w doubled CTDI_vol). The dependence of CTDI_vol on D_{w_ave} was similar for chest and CAP examinations performed with similar ATCM parameters, while use of D_{w_c} resulted in a clear separation of the same data according to examination type. Maximum D_w variation in the imaged region was 5.6 ± 1.6 cm for chest and 6.5 ± 1.4 cm for CAP examinations.

Conclusions

D_{w_ave} is a better metric than D_{w_c} for binning similar‐sized patients in dose comparison studies, despite the additional computational effort required for its calculation Therefore, when implementing automatic determination of D_w for SSDE calculations, automatic calculation of D_{w_ave} should be considered.

Development and validation of an algorithm for laser application in wound treatment

OBJECTIVE

To develop and validate an algorithm for laser wound therapy.

METHOD

Methodological study and literature review. For the development of the algorithm, a review was performed in the Health Sciences databases of the past ten years. The algorithm evaluation was performed by 24 participants, nurses, physiotherapists, and physicians. For data analysis, the Cronbach's alpha coefficient and the chi-square test for independence was used. The level of significance of the statistical test was established at 5% (p<0.05).

RESULTS

The professionals' responses regarding the facility to read the algorithm indicated: 41.70%, great; 41.70%, good; 16.70%, regular. With regard the algorithm being sufficient for supporting decisions related to wound evaluation and wound cleaning, 87.5% said yes to both questions. Regarding the participants' opinion that the algorithm contained enough information to support their decision regarding the choice of laser parameters, 91.7% said yes. The questionnaire presented reliability using the Cronbach's alpha coefficient test (α = 0.962).

CONCLUSION

The developed and validated algorithm showed reliability for evaluation, wound cleaning, and use of laser therapy in wounds.

Can chronic stretching change the muscle-tendon mechanical properties? A review

It is recognized that stretching is an effective method to chronically increase the joint range of motion. However, the effects of stretching training on the muscle-tendon structural properties remain unclear. This systematic review with meta-analysis aimed to determine whether chronic stretching alter the muscle-tendon structural properties. Published papers regarding longitudinal stretching (static, dynamic and/or PNF) intervention (either randomized or not) in humans of any age and health status, with more than 2 weeks in duration and at least 2 sessions per week, were searched in PubMed, PEDro, ScienceDirect and ResearchGate databases. Structural or mechanical variables from joint (maximal tolerated passive torque or resistance to stretch) or muscle-tendon unit (muscle architecture, stiffness, extensibility, shear modulus, volume, thickness, cross-sectional area, and slack length) were extracted from those papers. A total of 26 studies were selected, with a duration ranging from 3 to 8 weeks, and an average total time under stretching of 1165 seconds per week. Small effects were seen for maximal tolerated passive torque, but trivial effects were seen for joint resistance to stretch, muscle architecture, muscle stiffness, and tendon stiffness. A large heterogeneity was seen for most of the variables. Stretching interventions with 3- to 8-week duration do not seem to change either the muscle or the tendon properties, although it increases the extensibility and tolerance to a greater tensile force. Adaptations to chronic stretching protocols shorter than 8 weeks seem to mostly occur at a sensory level.