Metabolic control level and glucose variability in adolescents with type 1 diabetes during low and high-intensity exercise

OBJECTIVE

The main purpose of this study was to characterize the determinants of metabolic changes in young type 1 diabetes (T1DM) and to determine glycemic variability during low and high-intensity exercise.

PATIENTS AND METHODS

20 young male T1DM patients were divided into two subgroups characterized by levels of glycated hemoglobin (HbA1c): HbA1c<7.3% (better HbA1c subgroup, n=10) and with levels HbA1c>7.3% (worse HbA1c subgroup, n=10). All participants performed a maximal oxygen uptake test and two efforts of various intensities (45 minutes of aerobic exercise and 30 minutes of mixed aerobic-anaerobic intensity exercise). Continuous glucose monitors (CGM) were used to control the glucose concentration.

RESULTS

Changes in biomarkers describing the metabolic response were similar in both groups. A comparison of applied efforts exhibited that maximal capacity effort resulted in the highest values of blood glucose (BG) at the end (150.9-160.6 mg/dl) and 1 hour after the exercise (140.2-161.3 mg/dl). BG concentration before, during, 1 hour, and 24 hours after each exercise was insignificantly higher in the worse Hb1Ac group.

CONCLUSIONS

HbA1c levels are insufficient to confirm whether the applied effort is performed in acceptable glycemic values. The CGM monitors allow for precise control of BG variations and accurate planning of physical activity by adjusting the insulin and carbohydrate consumption dose.

Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Effects of moderate- vs. high-intensity interval training on physical fitness, enjoyment, and affective valence in overweight/obese female adolescents: a pre-/post-test study

OBJECTIVE

The aim of this study was to compare the effects of 12-week moderate-intensity interval training (MIIT) vs. high-intensity interval training (HIIT) on body composition, physical fitness, and psychological valence in overweight/obese (OW/OB) female adolescents.

PATIENTS AND METHODS

Thirty-eight OW/OB female students were randomized into HIIT (n=13), MIIT (n=13) or control (n=12) groups. The participants underwent a 12-week interval-training program at 100% to 110% and 60% to 75% of maximal aerobic speed for HIIT and MIIT, respectively. The control group kept their usual physical activity without completing the training program. Pre- and post-training measurements were performed to assess body composition, aerobic capacity, and anaerobic performance (using selected tests evaluating speed, jumping ability, and strength). Ratings of perceived exertion and the feeling scale were evaluated every three weeks. Enjoyment was measured at the end of the program. A two-way analysis of variance with repeated measurements was applied to test for "group×time" interactions for body composition, physical fitness, and affective variables.

RESULTS

Significant "group×time" interactions were detected for aerobic and anaerobic performance, body composition indices, and the feeling scale. HIIT resulted in more noticeable improvements in body composition and physical performance than MIIT, while no significant changes were found in the control group. Throughout the program, the feeling score has progressively increased in the MIIT group but decreased in the HIIT group. Ratings of the perceived exertion have increased in both groups, more noticeably in the HIIT group. At the end of the program, the MIIT group showed a higher enjoyment score.

CONCLUSIONS

Despite offering better body composition improvement and physical fitness enhancement, HIIT offered lesser enjoyment and affective valence than MIIT in OW/OB female adolescents. MIIT might be an alternative time-efficient protocol for improving health in this population.

Skinfold thickness variation and associations with cardiorespiratory fitness in male soccer players of different ages

OBJECTIVE

The aim of the present study was to examine skinfold thickness (SKF) distribution in youth and adult male soccer players regarding cardiorespiratory fitness (CRF) and the role of age.

PATIENTS AND METHODS

Participants were youth [n=83, age 16.2 (1.0) years, mean (standard deviation)] and adult male soccer players [n=121, 23.2 (4.3) years], who were tested for SKF on 10 anatomical sites and Conconi test was used to assess velocity at maximal oxygen uptake (vVO2max).

RESULTS

A between-within-subjects analysis of variance revealed a small interaction between the anatomical site and age group on SKF (p=0.006, η2=0.022), where adolescents had larger cheek (+0.7 mm; p=0.022; 95% confidence intervals - CI  - 0.1, 1.3), triceps (+0.9 mm; p=0.017; 95% CI 0.2, 1.6) and calf (+0.9 mm; p=0.014; 95% CI 0.2, 1.5) SKF, while adults had larger chin (+0.5 mm; p=0.007; 95% CI 0.1, 0.8) SKF, and no difference was observed for the rest of the anatomical sites. No difference between adolescent and adult age groups was observed in average SKF (SKFavg) [9.0 (2.7) vs. 9.1 (2.5) mm; difference -0.1 mm; 95% CI, -0.8, 0.6; p=0.738]. Compared to adults, adolescents had a lower SKF coefficient of variation (SKFcv) [0.34 (0.10) vs. 0.37 (0.09); difference-0.03; 95% CI, -0.06, -0.01; p=0.020] and subscapular-to-triceps ration (STR) [1.08 (0.28) vs. 1.29 (0.37); difference-0.21; 95% CI, -0.31, -0.12; p<0.001]. The largest Pearson moment correlation coefficient between vVO2max and SKF was shown in the subscapular (r=-0.411; 95% CI, -0.537, -0.284; p<0.001) and the smallest in the patellar anatomical site (r=-0.221; 95% CI, -0.356, -0.085; p=0.002). In addition, vVO2max correlated moderately with SKFavg (r=-0.390; 95% CI, -0.517, -0.262; p<0.001) and SKFcv (r=-0.334; 95% CI, -0.464, -0.203; p<0.001).

CONCLUSIONS

In summary, CRF was related to the thickness of specific SKF and the magnitude of thickness variation by the anatomical site (i.e., the smaller the variation, the better the CRF). Considering the relevance of specific SKF for CRF, their further use would be recommended for monitoring physical fitness in soccer players.

How to end up on the podium after running a 6-days-run with type 1 diabetes mellitus - A case study and literature review

BACKGROUND

An increasing number of people living with type 1 diabetes mellitus (T1DM) are pushing their physical limits to compete at the sport's highest level. Muscle, liver, and glycogen metabolism can be normal in athletes with diabetes with good glucose management, and modifications to insulin dose and nutrition can facilitate exercise performance.

CASE PRESENTATION

We report on a 66-year-old runner with insulin-dependent T1DM. He has run over 90 marathons and ultra-marathons. Thanks to an insulin pump and continuous glucose monitoring, he has completed forty-eight 24-hour runs with an average performance of 133.8 km. Over the years, the runner increased his monthly running volume significantly and decreased his glycated Hemoglobin type A1C (hba1c) levels. Meanwhile, a significant association between monthly running kilometers and hba1c levels could be shown. At the age of 66 years, he finished his sixth 6-day-run in third place overall by covering a total distance of 467.424 km.

CONCLUSIONS

These findings show that it is possible to participate in ultra-endurance events while suffering from T1DM without glucose derailing. With a good understanding of the disease and its impact on an individual's body, we can curtail the preparation and execution phases of ultra-endurance events to allow athletes to compete with minimal risk.

Associations between Pretreatment Body Composition Features and Clinical Outcomes among Patients with Metastatic Clear Cell Renal Cell Carcinoma Treated with Immune Checkpoint Blockade

PURPOSE

High body mass index (BMI) may lead to improved immune-checkpoint blockade (ICB) outcomes in metastatic clear cell renal cell carcinoma (mccRCC). However, BMI is a crude body size measure. We investigated BMI and radiographically assessed body composition (BC) parameters association with mccRCC ICB outcomes.

EXPERIMENTAL DESIGN

Retrospective study of ICB-treated patients with mccRCC. BMI and BC variables [skeletal muscle index (SMI) and multiple adiposity indexes] were determined using pretreatment CT scans. We examined the associations between BMI and BC variables with ICB outcomes. Therapeutic responses per RECIST v1.1 were determined. We compared whole-transcriptomic patterns with BC variables in a separate cohort of 62 primary tumor samples.

RESULTS

205 patients with mccRCC were included in the cohort (74% were male, 71% were overweight/obese, and 53% were classified as low SMI). High-BMI patients experienced longer overall survival (OS) than normal-weight patients [unadjusted HR, 0.66; 95% confidence interval (CI), 0.45-0.97; P = 0.035]. The only BC variable associated with OS was SMI [unadjusted HR comparing low vs. high SMI 1.65 (95% CI: 1.13-2.43); P = 0.009]. However, this OS association became nonsignificant after adjusting for International Metastatic Renal Cell Carcinoma Database Consortium score and line of therapy. No OS association was seen for adiposity and no BC variable was associated with progression-free survival or radiological responses. Tumors from patients with low SMI displayed increased angiogenic, inflammatory, and myeloid signals.

CONCLUSIONS

Our findings highlight the relevance of skeletal muscle in the BMI paradox. Future studies should investigate if addressing low skeletal muscle in metastatic patients treated with ICB can improve survival.

Performance improvement in sport through vitamin D - a narrative review

OBJECTIVE

It is well known that vitamin D deficiency can lead to various health problems. However, it is not common knowledge among athletes and doctors that vitamin D deficiency is prevalent in sports. This deficiency can severely impact performance, while vitamin D supplementation can alleviate this effect and potentially improve performance.

MATERIALS AND METHODS

This narrative review aims to compile the current state of knowledge about the importance of vitamin D in increasing performance for active people. To this end, we searched the 'Scopus' and 'PubMed' databases for the terms 'vitamin D - athlete - performance' with an end date of 30 June 2022.

RESULTS

Study results indicated that the therapeutic impact of vitamin D on aerobic capacity, recovery, strength and sprint performance remains controversial.

CONCLUSIONS

Based on the previous findings on recovery, strength and performance, 4,000-5,000 IU of vitamin D per day may be a safe dose that can improve athletic performance.

Autoimmune hepatitis in monozygotic twins - a case report

OBJECTIVE

Autoimmune hepatitis is a chronic liver disease caused by a dysfunctional immune system. It is widely believed that autoimmune hepatitis accumulates in families. We found that autoimmune hepatitis does accumulate in monozygotic twins.

CASE REPORT

We present middle-aged monozygotic female twins developing autoimmune hepatitis consecutively within two years. Both twins had developed Graves' disease and were treated with carbimazole before the onset of autoimmune hepatitis. Both were cigarette smokers. The twins were treated with budesonide and azathioprine, which normalised liver parameters.

CONCLUSIONS

This case report supports the hypothesis that a genetic factor might be of great importance in the aetiology of autoimmune hepatitis.

The effects of daytime melatonin ingestion on arousal and vigilance vanish after sub-maximal exercise: a pilot study

OBJECTIVE

Daytime melatonin ingestion is known to induce sleep at rest, which may affect arousal and vigilance. Physical exercise is known to produce an increase in core temperature and circulating cortisol which can enhance arousal and vigilance. The effect of submaximal exercise on vigilance and arousal following acute melatonin ingestion has not yet been studied. The present study aimed at investigating the effect of submaximal exercise on vigilance and arousal following daytime melatonin ingestion.

PATIENTS AND METHODS

Eight physical education students undertook 45 min of submaximal exercise (at 60% of maximal aerobic speed) on a treadmill after melatonin-(6 mg) or placebo ingestion, in a randomized and counterbalanced order.

RESULTS

Heart rate (HR), rectal temperature (Tre), felt arousal scale (FAS), and thermal sensations (TS) were recorded at baseline (pre-exercise), immediately after exercise (post-exercise), and after 30 min of recovery (30 min post-exercise). Blood was sampled for lactate and cortisol. At 30 min post-exercise, the Tre, HR, blood pressure, lactate, FAS, and TS were measured. The participants performed vigilance tests pre-exercise, post-exercise and 30 min post-exercise. Daytime melatonin ingestion affected arousal and vigilance in the pre-exercise period (p < 0.05) but had no effect on Tre, HR, blood pressure, lactate, TS, arousal, and vigilance measured 30 min post-exercise (p > 0.05).

CONCLUSIONS

The negative effects of melatonin ingestion on vigilance and arousal vanished after a 45 min of submaximal exercise. The hypnotic effect of melatonin observed in the pre-exercise dissipated in the post-exercise period, possibly due to the significant elevation of Tre, HR, and cortisol at the end of submaximal exercise.

The effects of cognitive behavioral therapy on selected physical, physiological parameters, exercise and nutritional behaviors in diabetic persons

OBJECTIVE

Due to the high prevalence of diabetes in the world, it seems that one of the most important strategies to prevent and treat this disease are lifestyle changes. The present study aimed to investigate the effects of cognitive behavioral therapy on selected physical and psychological parameters, exercise, and nutritional behaviors in diabetic patients.

PATIENTS AND METHODS

This was a cross-sectional study of volunteers with type 2 diabetes. Patients were randomized into two groups: an intervention (n=32) and a control group (n=31). The Beck Physical Activity Questionnaire was used to assess physical activity in combination with the Beck Depression Inventory and the Pittsburgh Sleep Quality Index to assess the levels of depression and the quality of sleep. Cognitive behavior therapy (CBT) training consisted of six sessions of cognitive behavioral therapy interventions. The intervention consisted of a face-to-face individual counseling session. The patients received a special diet according to their basal metabolic rate (BMR). At all sessions, dietary advice was reviewed, and during the treatment period, they were asked to record their diet and physical activity. Body composition and blood samples were measured before and after three months of the experiment for both groups.

RESULTS

Blood glucose, blood lipid profiles (except high-density lipoprotein), lifestyle, behavior patterns and body composition were significantly improved following CBT intervention (p≤0.05).

CONCLUSIONS

CBT can play a key role in improving physiological and psychological parameters in diabetic patients.

Genomic and Metabolic Hallmarks of SDH- and FH-deficient Renal Cell Carcinomas

BACKGROUND

Succinate dehydrogenase-deficient and fumarate hydratase-deficient renal cell carcinomas (SDHRCC and FHRCC) are rare kidney cancers driven by loss of TCA cycle enzymes.

OBJECTIVE

To define and compare the genomic and metabolomic hallmarks of SDHRCC and FHRCC.

DESIGN, SETTING, AND PARTICIPANTS

We analyzed SDHRCC and FHRCC tumors with either immunohistochemical evidence of loss of protein expression or genomically confirmed biallelic inactivation of SDHA/B/C/D/AF2 or FH.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Somatic alterations were identified using clinical pipelines, with allele-specific copy number alterations (CNAs) identified using FACETS. Mass spectrometry-based metabolomic profiling was performed on available SDHRCC and FHRCC tumors.

RESULTS AND LIMITATIONS

Tumors were analyzed for 42 patients (25 FHRCC, 17 SDHRCC). In the germline analysis, 16/17 SDHRCCs harbored a germline alteration in SDHB, whereas only 17/22 FHRCCs had pathogenic germline FH variants. SDHRCCs had a lower mutation burden (p = 0.02) and CNA burden (p = 0.0002) than FHRCCs. All SDHRCCs presented with deletion of chromosome 1p (overlapping SDHB), whereas FHRCCs demonstrated high but not ubiquitous loss of 1q (FH locus). Both SDHRCCs and FHRCCs exhibited significant idiopathic accumulation of the metabolite guanine. FHRCC tumors had elevated levels of urea cycle metabolites (argininosuccinate, citrulline, and fumarate), whereas SDHRCC tumors had elevation of numerous acylcarnitines. These characteristic metabolic changes allowed identification of a previously unrecognized SDH-deficient RCC.

CONCLUSIONS

Despite sharing similar genetic etiology, SDHRCC and FHRCC represent distinct molecular entities with unique genetic and metabolic abnormalities.

PATIENT SUMMARY

Kidney cancers driven by loss of the gene encoding either the succinate dehydrogenase or fumarate hydratase enzyme are rare. We sought to define and compare the genetic and metabolic features of these cancer entities.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Factors associated with perceived performance drops and musculoskeletal injuries in Brazilian recreational triathletes

OBJECTIVE

The aim of the study was to investigate sleep characteristics, use of supplements, and training volume of recreational triathletes, and to verify possible associations with perceived performance drops and occurrence of injuries.

MATERIALS AND METHODS

Recreational triathletes (n=942) answered a questionnaire inquiring about their demographic characteristics, performance, injuries and training volume.

RESULTS

When comparing athletes who slept more (9-10 hours) with those who slept less, less sleep was associated with a higher prevalence of perceived performance drops. Regarding difficulties in initiating sleep, the absence of initiating difficulties (p<0.001) was a protective factor against perceived performance drops. Regarding weekly training volume, compared to those who trained more than 20 hours, training less than 3 hours (p<0.001), 3-5 hours (p<0.001), or 12-14 hours (p<0.001) were protective factors against perceived performance drops. Concerning training volume and injuries, we found that compared to those who trained more than 20 hours, training 18-20 hours (p<0.001), 15-17 hours (p<0.001), 12-14 hours (p<0.001), 6-8 hours (p<0.001), or 3-5 hours (p<0.001) were protective factors against injuries.

CONCLUSIONS

Triathletes with a lower sleep quantity and those who have difficulties initiating sleep frequently experience drops in performance. Training volumes can influence both performance and the likelihood of injuries.

Differences in pacing during cycling and running in ultra-triathlons - The example of 'Swissultra'

OBJECTIVE

The knowledge of the most predictive split discipline and the pacing during a triathlon race is of utmost importance for planning an ultra-triathlon race. This study aimed at investigating the pacing during cycling and running splits in three different multi-stage ultra-triathlon race formats (i.e., Quintuple, Deca, and Double Deca Iron ultra-triathlon with 5x, 10x and 20x the daily distance of a full Ironman-distance triathlon).

SUBJECTS AND METHODS

A total of 48 male ultra-triathletes competing in Quintuple (n=14), Deca (n=25), and Double Deca (n=9) Iron ultra-triathlon "swissultra" between 2016 and 2019 in Switzerland were analyzed. For each race day, we calculated the total performance (sum of all laps time), average individual performance (average of all laps time within a race day) and pacing variation (coefficient of variation of race laps time) for cycling and running. Discipline (cycling and running) and race distance (Quintuple, Deca, and Double Deca Iron ultra-triathlon) were used as independent parameters. The primary outcome variables were the time performance (daily and total) and the pacing variation. We applied two general linear models (GLM): the first model was a one-way ANOVA comparing total and daily performance by race distance, and the second model was a two-way ANOVA (race distance´ discipline) using pacing variation (average pace oscillation) as a dependent variable.

RESULTS

The first GLM identified a significant race distance effect for total performance in both cycling (F = 375.6; p < 0.001; ηp2 = 0.943) and running (F = 267.8; p < 0.001; ηp2 = 0.922) with Double Deca Iron ultra-triathlon being the fastest and Quintuple Iron ultra-triathlon the slowest. The GLM for daily average performance showed no significant effect of race distance on cycling performance (F = 0.171; p = 0.843; ηp2 = 0.008), but on running performance (F = 6.408; p = 0.004; ηp2 = 0.222). The two-way GLM comparing pacing variation showed a significant effect for race distance (F = 11.81; p<0.001; ηp2 = 0.344) with Deca presenting larger pace variation than Quintuple and Double Deca Iron ultra-triathlon in both cycling and running, but not for discipline (F = 0.067; p=0.797; ηp2 = 0.001), nor for interaction (F = 1.469; p=0.241; ηp2 = 0.061).

CONCLUSIONS

Athletes achieved a stable cycling performance independent of the length of the race, and the cycling split had an influence on the subsequent running split depending upon the length of the race.

POS0780 MONOGENIC SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) IN NORTHERN ISRAEL

Background

Systemic Lupus erythematous (SLE) is a heterogenic clinical syndrome with a multifactorial etiology including diverse environmental, immunological and genetic causes and modifiers. Increasingly, utilizing next generation sequencing tooIs, monogenic forms of SLE have been identified.

Objectives

The aim of our study was to identify monogenic causes of SLE in the unique pediatric population of Northern Israel.

Methods

A retrospective and prospective study was carried out between 2010-2021 in a single tertiary pediatric medical center. Genetic testing including Whole exome sequencing (WES) was performed for select patients including family history of SLE, consanguinity and\or clinical findings suggestive of specific disorder.

Results

75 children were diagnosed with SLE. 13/75 had one or more relatives with SLE, including a pedigree with 4 affected members. Mean age at presentation was 10.1±4.7. A monogenic disorder was identified in total of 7/75 of pedigrees. Four patients were diagnosed with Prolidase deficiency, one patient with ADAR1 mutation related to Aicardi–Goutières syndrome and one pedegree with APC5 mutations. Candidate variants in genes related to immune system were identified in one proband and her father requiring further study. Additional WES results are pending

Conclusion

We detected monogenic causes of SLE in a select cohort of patient in Northern Israel. Identification of a genetic basis for disease has direct clinical implication for patients and families and can also enhance our understanding of the pathogenesis and disease mechanisms involved in the more common sporadic forms of SLE.

Disclosure of Interests

ilia spivak: None declared, Tova Hershkovitz1 Grant/research support from: Regeneron Genetics center, Tarrytown, NY, USA, Rinat Zaid Grant/research support from: Regeneron Genetics center, Tarrytown, NY, USA, Karin Weiss Grant/research support from: Regeneron Genetics center, Tarrytown, NY, USA, Yonatan Butbul Aviel: None declared

Temperature and barometric pressure are related to running speed and pacing of the fastest runners in the 'Berlin Marathon'

OBJECTIVE

The influence of environmental conditions, such as temperature, barometric pressure, humidity, precipitation, sunshine and cloud cover on marathon running has been widely investigated. However, the influence of such conditions on the pacing of elite marathoners has not been considered yet. The present study aimed to investigate whether environmental conditions are related to the running speed and pacing of the fastest marathoners competing in the fastest racecourse in the world, the 'Berlin Marathon'.

SUBJECTS AND METHODS

A total of 668,735 finishers (520,715 men and 148,020 women) competing between 1999 and 2019 in the 'Berlin Marathon' were analyzed by comparing elite and recreational runners. The associations between time-adjusted averages of the environmental conditions, the race times and running speeds were investigated. The runners were divided into performance groups consisting of recreational (all runners) and elite runners (the top 100, the top 10 and the top 3) which were separately analyzed for male and female participants.

RESULTS

During race days, the temperature increased while humidity decreased showing a strong negative correlation between the two variables. For all runners, the average running speed through the race showed a strong negative correlation with temperature and a strong positive correlation with the level of humidity. Faster runners experienced lower temperatures and higher humidity levels than slower runners. When the performance groups were analyzed, temperature and humidity remained correlated to a similar extent for the top 100 but dropped dramatically for the top 10 and top 3, suggesting a weaker influence. In addition, barometric pressure showed a positive correlation with running speed in the top 100 and top 3 groups.

CONCLUSIONS

Temperatures increased during race days while humidity decreased and both variables were negatively and significantly correlated. Faster runners experienced lower temperatures and higher humidity levels, while slower runners experienced higher temperatures and lower humidity levels which had a stronger negative impact on running speeds. Running speed was also significantly and positively correlated with barometric pressure in elite runners.

Comparison of the levels of depression and anxiety during the first and fourth waves of coronavirus disease-2019 pandemic in Brazil

OBJECTIVE

To compare the levels of depression, anxiety, physical activity, and mobility restrictions between the first wave in June 2020 and the fourth wave in January 2022 of the coronavirus disease-2019 (COVID-19) pandemic in Brazil.

PATIENTS AND METHODS

Brazilian citizens answered a self-administered questionnaire that included questions related to personal information, mobility restriction levels, physical activity levels, and the status of mood disorders in June 2020 (n=1853) and January 2022 (n=728).

RESULTS

The levels of mobility restrictions (p<0.001), anxiety (p<0.001), and depression (p<0.001) significantly decreased from 2020 to 2022. In June 2020, 23.2% of the participants presented moderate to severe anxiety, and in January 2022, this percentage decreased to 14.8%. In June 2020, 29.6% of the participants presented moderate to severe depressive symptoms, and in January 2022 this percentage decreased to 19.3%. On the contrary, physical activity levels significantly increased between 2020 and 2022 (p<0.001).

CONCLUSIONS

During the fourth wave of the COVID-19 pandemic, participants were less restricted and more physically active than in the first wave. Furthermore, anxiety and depression levels were significantly lower in the fourth wave than in the first wave. Despite this reduction, levels of anxiety and depression remain high; therefore, the authors suggest measures to encourage physical activity and promote mental health.

Impact of the COVID-19 pandemic on competitive swimming performance

OBJECTIVE

This article aims to conduct a comparison of swimming performance during short course national championships (25-m) from 2019 and 2020 (before and during the pandemic).

MATERIALS AND METHODS

The data points from the championships will be compared for 5 European countries: Poland, Spain, Russia, Turkey, and Denmark. Times achieved in the finals were calculated by the analysis of variance. Post hoc pairwise comparison analysis was performed using Tukey's test. The analysis plan included the assessment of the main effects and the effect of interactions in the groups of women and men. The strength of the effect was expressed by the partial eta-squared ratio.

RESULTS

Two main trends were observed in the results. The first was a greater variation in the results in the group of men than in women (12-5 differences). The second was the development and improvement of sports performance in symmetrical strokes (69% improvement in recorded times measured during the pandemic, e.g., in Poland, women on 50-m breaststroke and butterfly Δ = 0.52, p <0.001 and Δ = 0.32, p = 0.034, men on 50-m and 100-m butterfly Δ = 0.34, p = 0.003 and Δ = 1.21, p <0.001).

CONCLUSIONS

The main conclusion of our analysis is that the pandemic influenced the development of sports performance in symmetrical techniques, i.e., in breaststroke and butterfly.

Aortic Z-scores in paediatric patients with marfan syndrome and other hereditary thoracic aortic diseases

Introduction

Marfan syndrome (MFS) and other hereditary thoracic aortic diseases (HTAD) are characterized by dilatation of the aorta caused by mutations in the FBN1-gene and other aortic genes. To prevent aortic dissection or rupture, patients are prophylactically treated by aortic surgery. Different z-scores of the aortic root are used for diagnosis and monitoring in paediatric patients.

Purpose

What are the differences between the various aortic Z-scores in their use for monitoring, assessing the severity of the aortic disease, and establishing the indication for surgery in this age group?

Methods

We retrospectively analyzed the diameters of aortic roots measured by echocardiography in 180 children and young adults (1 month to 25 years) with MFS and other HTADs presenting at our specialized outpatient clinic between January 2010 and August 2019. Thirteen patients underwent surgery during this period and 121 were monitored for a duration of one up to nine years. Five aortic z-scores were compared: Pettersen, Gautier, Cantinotti, Lopez, Boston. For evaluation of the severity of dilatation and indication for surgery, we used the last value before operation or the last follow-up value. For monitoring, we used the difference between the first and the last value. For comparison of the z-scores, values of the sinuses of Valsalva were analyzed. We investigated theoretic backgrounds and reference groups of each z-score.

Results

The z-score values differ significantly (p&lt;0,001) for each score. The medians reach from 2.06 to 3.45, in operated patients 4.90 to 8.52, non-operated patients 1.86 to 3.31 (p&lt;0,001). 93 aortic diameters to 136 were classified as dilatated (z-score ≥2). There were significant differences of almost all z-scores in the comparison with one another. During follow-up, the increase of the median z-score ranged from 0.11 to 0.24, in operated patients from 0.73 to 1.93, in non-operated patients from 0.02 to 0.21, respectively. The median monitoring time was 4.14 years and 2.93 years, for patients monitored for more than one year and all patients, respectively. In the operated subgroup, a weak correlation showed that the longer the monitoring time and the closer the surgery arrived, the faster the z-scores rose. Lopez, Boston and Cantinotti have higher values and label a value quicker than dilatated, but also reveal the severity of dilatation and the potential necessity of surgery.

Conclusions

Our data show that the various z-scores differ significantly. No z-score was superior regarding above-mentioned aspects, their differences in monitoring were small. However, it seems important to consistently use one same z-score. Expectedly, z-score values of each score were higher in the operated subgroup than in patients without surgery. However, there is no z-score value that determines a clear-cut indication for surgery.

Funding Acknowledgement

Type of funding sources: None.

High Response Rate and Durability Driven by HLA Genetic Diversity in Patients with Kidney Cancer Treated with Lenvatinib and Pembrolizumab

Immune checkpoint blockade (ICB) therapy has substantially improved the outcomes of patients with many types of cancers, including renal cell carcinoma (RCC). Initially studied as monotherapy, immunotherapy-based combination regimens have improved the clinical benefit achieved by ICB monotherapy and have revolutionized RCC treatment. While biomarkers like PD-L1 and tumor mutational burden (TMB) are FDA approved as biomarkers for ICB monotherapy, there are no known biomarkers for combination immunotherapies. Here, we describe the clinical outcomes and genomic determinants of response from a phase Ib/II clinical trial on patients with advanced RCC evaluating the efficacy of lenvatinib, a multi-kinase inhibitor mainly targeting VEGFR and FGFR plus pembrolizumab, an anti-PD1 immunotherapy. Concurrent treatment with lenvatinib and pembrolizumab resulted in an objective response rate of 79% (19/24) and tumor shrinkage in 96% (23/24) of patients. While tumor mutational burden (TMB) did not predict for clinical benefit, germline HLA-I diversity strongly impacted treatment efficacy. Specifically, HLA-I evolutionary divergence (HED), which measures the breadth of a patient's immunopeptidome, was associated with both improved clinical benefit and durability of response. Our results identify lenvatinib plus pembrolizumab as a highly active treatment strategy in RCC and reveal HLA-I diversity as a critical determinant of efficacy for this combination. HED also predicted better survival in a separate cohort of patients with RCC following therapy with anti-PD-1-based combination therapy. IMPLICATIONS: These findings have substantial implications for RCC therapy and for understanding immunogenetic mechanisms of efficacy and warrants further investigation.

The Clinicopathologic and Molecular Landscape of Clear Cell Papillary Renal Cell Carcinoma: Implications in Diagnosis and Management

BACKGROUND

Clear cell papillary renal cell carcinoma (CCPRCC) is a recently described tumor entity. Several questions remain about its epidemiology, molecular features, and clinical behavior.

OBJECTIVE

To comprehensively evaluate clinicopathologic and molecular features of CCPRCC, and compare it with more common kidney cancer subtypes.

DESIGN, SETTING, AND PARTICIPANTS

We identified 89 CCPRCC patients and compared their clinicopathologic features with 1120 localized clear cell renal cell carcinoma (ccRCC) and 129 type 1 papillary renal cell carcinoma (pRCC) patients.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Nonparametric statistical testing was used to compare relevant features between tumor types. Overall, cancer-specific survival (CSS) and metastasis-free survival estimates were calculated from initial diagnosis using the Kaplan-Meier method. Patients with ipsilateral multifocal disease were explored further. A subset of CCPRCC tumors underwent genomic analysis and were compared with other RCC subtypes.

RESULTS AND LIMITATIONS

A higher proportion of female (45% vs 32%) and African-American (19% vs 3%) patients were observed in the CCPRCC cohort than in the ccRCC and pRCC cohorts. CCPRCC tumors also had increased odds of presenting with additional ipsilateral masses (odds ratio [OR]: 4.41 [confidence interval {CI}: 2.34, 8.15], p < 0.001) and bilateral disease (OR: 4.80 [CI: 2.40, 9.59], p < 0.001) compared with ccRCC tumors. On molecular analysis, CCPRCC tumors showed fewer somatic aberrations and a greater degree of mitochondrial DNA depletion. In multifocal CCPRCC tumors, histologic concordance among the different renal cell carcinoma masses was estimated at 44% (7/16), and none of the individuals presenting exclusively with CCPRCC tumors developed metastatic disease after 5 yr. In contrast, multifocal tumors with CCPRCC and other nonconcordant histologies were more likely to experience adverse outcomes (CSS, log rank p = 0.034).

CONCLUSIONS

CCPRCC is characterized by distinct molecular and epidemiologic features that could be used to refine current diagnostic approaches. Although their clinical course is generally indolent, multifocal CCPRCC tumors represent a unique diagnostic challenge. In this context, single-mass biopsies could miss concomitant aggressive disease, with a potential negative impact on patient outcomes. Furthermore, high discordance rates in multifocal CCPRCC tumors have important clinical implications in management.

PATIENT SUMMARY

We explored the molecular and clinical features of clear cell papillary renal cell carcinoma (CCPRCC) relative to other kidney cancer subtypes. While CCPRCC generally conveys a good prognosis, additional caution should be taken when it is diagnosed using biopsy if multiple kidney masses are present.

Barriers and facilitators experienced in collaborative prospective research in orthopaedic oncology: A qualitative study

Objectives

As tumours of bone and soft tissue are rare, multicentre prospective collaboration is essential for meaningful research and evidence-based advances in patient care. The aim of this study was to identify barriers and facilitators encountered in large-scale collaborative research by orthopaedic oncological surgeons involved or interested in prospective multicentre collaboration.

Methods

All surgeons who were involved, or had expressed an interest, in the ongoing Prophylactic Antibiotic Regimens in Tumour Surgery (PARITY) trial were invited to participate in a focus group to discuss their experiences with collaborative research in this area. The discussion was digitally recorded, transcribed and anonymised. The transcript was analysed qualitatively, using an analytic approach which aims to organise the data in the language of the participants with little theoretical interpretation.

Results

The 13 surgeons who participated in the discussion represented orthopaedic oncology practices from seven countries (Argentina, Brazil, Italy, Spain, Denmark, United States and Canada). Four categories and associated themes emerged from the discussion: the need for collaboration in the field of orthopaedic oncology due to the rarity of the tumours and the need for high level evidence to guide treatment; motivational factors for participating in collaborative research including establishing proof of principle, learning opportunity, answering a relevant research question and being part of a collaborative research community; barriers to participation including funding, personal barriers, institutional barriers, trial barriers, and administrative barriers and facilitators for participation including institutional facilitators, leadership, authorship, trial set-up, and the support of centralised study coordination.

Conclusions

Orthopaedic surgeons involved in an ongoing international randomised controlled trial (RCT) were motivated by many factors to participate. There were a number of barriers to and facilitators for their participation. There was a collective sense of fatigue experienced in overcoming these barriers, which was mirrored by a strong collective sense of the importance of, and need for, collaborative research in this field. The experiences were described as essential educational first steps to advance collaborative studies in this area. Knowledge gained from this study will inform the development of future large-scale collaborative research projects in orthopaedic oncology.

Cite this article: J. S. Rendon, M. Swinton, N. Bernthal, M. Boffano, T. Damron, N. Evaniew, P. Ferguson, M. Galli Serra, W. Hettwer, P. McKay, B. Miller, L. Nystrom, W. Parizzia, P. Schneider, A. Spiguel, R. Vélez, K. Weiss, J. P. Zumárraga, M. Ghert. Barriers and facilitators experienced in collaborative prospective research in orthopaedic oncology: A qualitative study. Bone Joint Res 2017;6:–314. DOI: 10.1302/2046-3758.65.BJR-2016-0192.R1.

Bi-allelic IARS mutations in a child with intra-uterine growth retardation, neonatal cholestasis, and mild developmental delay

Recently, bi-allelic mutations in cytosolic isoleucyl-tRNA synthetase (IARS) have been described in three individuals with growth delay, hepatic dysfunction, and neurodevelopmental disabilities. Here we report an additional subject with this condition identified by whole-exome sequencing. Our findings support the association between this disorder and neonatal cholestasis with distinct liver pathology. Furthermore, we provide functional data on two novel missense substitutions and expand the phenotype to include mild developmental delay, skin hyper-elasticity, and hypervitaminosis D.

Antibiotic Stewardship and Hospital Hygiene in German Paediatric Inpatient Facilities: A Qualitative Survey from the Paed IC Working Group

BACKGROUND

Antibiotic stewardship (ABS) and hospital hygiene have both been identified as key components to increase patient safety in hospital inpatients. To set the stage for a new approach in this field, a working group of German Pediatric Infectious Disease (PID) Specialists invented the Paed IC Project in 2012.

METHODS

This article summarized the results of a qualitative study using telephone interviews, to which 18 German PID specialists were invited.

RESULTS

All local study coordinators and additional PID specialists from the 11 paediatric tertiary care inpatient facilities consented to participate. Only 3 of 18 participants (16.7%) are medical directors of an independent PID department. The majority of the participants agreed with the statement, that there is a need for a national clinical practice guideline (in Germany) which outlines specific paediatric aspects of ABS. In addition, concise internal clinical practice guidelines describing the most important PIDs in addition to the Handbook "Infections in Children and Adolescents" published by the DGPI were deemed necessary. 89% denied having access to any financial reimbursement allocated to cover systematic clinical audits. The hospital administration in most participating hospitals (72%) does not provide the medical specialties with personnel/financial resources to implement an ABS-program as recommended by recent guidelines.

CONCLUSION

This qualitative study adds important information to adjust future strategies for ABS implementation in German paediatric inpatient care facilities.

Clinical Practice Audit: Perioperative Antibiotic Prophylaxis in Paediatric Cancer Patients with Broviac Catheter Implantation

BACKGROUND

Perioperative antimicrobial prophylaxis (PAP) is an important target for internal audits, concerning the judicious use of antibiotics. Paediatric oncology patients face an increased risk of surgical site infection (SSI) after implantation of long term central venous catheters (CVAD).

PATIENTS

All PATIENTS<18 years admitted to the paediatric oncology centre (POC) with implantation of a CVAD.

METHODS

Systematic audit in 2 groups: retrospective (Jan 01, 2012 - March 31, 2014) and prospective (April 01, 2014 - March 31, 2015) referring to an internal PAP guideline, invented in Jan 2014. Surveillance of SSI up to 30 days after the operation.

RESULTS

In total, 97 CVAD implantations were analysed in 89 paediatric oncology patients (Broviac in 94%). The detailed analysis of PAP revealed lower Cefuroxim doses than requested (30 vs. 50 mg/kg). In addition, Cefotaxim was used in 1 case and in 3 cases Clindamycin was given without a medical history of Penicillin hypersensitivity. In the retrospective audit group PAP was administered in 22% for≤24 h); this was the case in 91% of the prospective group (p<0.001). No SSI was detected.

CONCLUSION

This first comprehensive audit of PAP in a German POC outlines significant opportunities for improvement in terms of correct dosing, correct choice of the antibiotic, and shorter duration of PAP. In addition our results illustrate the challenges of optimising standard workflows in clinical practice.

Representations of pesticides and social practices: the case of French farmers

Pesticides and their use in agriculture are important social issues. We conducted research to study the construction of this sensitive social object through the lens of social representations (study of the structural organisation of the social representations of pesticides) and their anchoring in three contexts that differ in terms of farming practices (Martinique, Brittany and Southern France). Our research was composed of two phases: hierarchical associations (n = 213) and a context independence test questionnaire (n = 124), conducted among farmers from the three study sites. The results indicate three representational fields that reflect salient issues in each agricultural territory. These illustrate the heuristic nature of social representations in the analysis of agricultural practices and pesticide use among French farmers.

[Modern magnetic resonance imaging of the liver]

Magnetic resonance imaging (MRI) of the liver has become an essential tool in the radiological diagnostics of both focal and diffuse diseases of the liver and is subject to constant change due to technological progress. Recently, important improvements could be achieved by innovations regarding MR hardware, sequences and postprocessing methods. The diagnostic spectrum of MRI could be broadened particularly due to new examination sequences, while at the same time scanning time could be shortened and image quality has been improved. The aim of this article is to explain both the technological background and the clinical application of recent MR sequence developments and to present the scope of a modern MRI protocol for the liver.

Identification and functional characterization of rare SHANK2 variants in schizophrenia

Recent genetic data on schizophrenia (SCZ) have suggested that proteins of the postsynaptic density of excitatory synapses have a role in its etiology. Mutations in the three SHANK genes encoding for postsynaptic scaffolding proteins have been shown to represent risk factors for autism spectrum disorders and other neurodevelopmental disorders. To address if SHANK2 variants are associated with SCZ, we sequenced SHANK2 in 481 patients and 659 unaffected individuals. We identified a significant increase in the number of rare (minor allele frequency<1%) SHANK2 missense variants in SCZ individuals (6.9%) compared with controls (3.9%, P=0.039). Four out of fifteen non-synonymous variants identified in the SCZ cohort (S610Y, R958S, P1119T and A1731S) were selected for functional analysis. Overexpression and knockdown-rescue experiments were carried out in cultured primary hippocampal neurons with a major focus on the analysis of morphological changes. Furthermore, the effect on actin polymerization in fibroblast cell lines was investigated. All four variants revealed functional impairment to various degrees, as a consequence of alterations in spine volume and clustering at synapses and an overall loss of presynaptic contacts. The A1731S variant was identified in four unrelated SCZ patients (0.83%) but not in any of the sequenced controls and public databases (P=4.6 × 10(-5)). Patients with the A1731S variant share an early prodromal phase with an insidious onset of psychiatric symptoms. A1731S overexpression strongly decreased the SHANK2-Bassoon-positive synapse number and diminished the F/G-actin ratio. Our results strongly suggest a causative role of rare SHANK2 variants in SCZ and underline the contribution of SHANK2 gene mutations in a variety of neuropsychiatric disorders.

Is the prevalence of antibiotic-resistant organisms changing in Canadian hospitals? Comparison of point-prevalence survey results in 2010 and 2012

A national point-prevalence survey for infection or colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), and for Clostridium difficile infection (CDI) was done in Canadian hospitals in 2010. A follow-up survey was done in November 2012 to determine whether there were any changes in the prevalence of these organisms; we also determined the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CREs). Associations between prevalence and infection prevention and control policies were evaluated in logistic regression models. A total of 143 (67% of eligible facilities) hospitals with 29 042 adult inpatients participated in the survey, with representation from all 10 provinces; 132 hospitals participated in 2010 and 2012. There were no significant changes in the median prevalence of MRSA in 2010 (4.3%) compared to 2012 (3.9%), or of CDI in 2010 (0.8%) compared to 2012 (0.9%). A higher median prevalence of VRE was identified in 2012 (1.3%) compared to 2010 (0.5%) (p 0.04), despite decreased VRE screening in 2012. The median prevalence of ESBLs was 0.7% and was 0 for CREs; CREs were reported from only 10 hospitals (7.0%). A policy of routinely caring for patients with MRSA or VRE in a private isolation room was associated with lower prevalence of these organisms. Targeted screening of high-risk patients at admission was associated with lower MRSA prevalence; better hand hygiene compliance was associated with lower VRE prevalence. These data provide national prevalence rates for antibiotic-resistant organisms among adults hospitalized in Canadian hospitals. Certain infection prevention and control policies were associated with prevalence.

Decreased infarct volume and intracranial hemorrhage associated with intra-arterial nonionic iso-osmolar contrast material in an MCA occlusion/reperfusion model

BACKGROUND AND PURPOSE

Infarct volume and intracranial hemorrhage after reperfusion with nonionic low-osmolar and iso-osmolar iodinated IRCM has not been previously compared. We postulated that iso-osmolar and low-osmolar iodinated contrast media exert varied effects on cerebral infarct after intra-arterial injection. We compared infarct volume and hemorrhagic changes following intra-arterial infusion of iodixanol, iopamidol, or normal saline in a rat MCA occlusion/reperfusion model.

MATERIALS AND METHODS

Infarct was induced in 30 rats by a previously validated method of MCA suture occlusion. Reperfusion was performed after 5 hours with either iodixanol (n = 9), iopamidol (n = 12), or saline (n = 9). MR images were obtained at both 6 and 24 hours after ischemia, followed by sacrifice. Infarct volume was measured with T2WI and DWI by semiautomatic segmentation. Incidence and area of hemorrhage were measured on brain sections postmortem.

RESULTS

T2WI mean infarct volumes were 242 ± 89, 324 ± 70, and 345 ± 92 mm(3) at 6 hours, and 341 ± 147,470 ± 91, and 462 ± 71 mm(3) at 24 hours in the iodixanol, iopamidol, and saline groups, respectively. Differences in infarct volume among groups were significant at 6 hours (P < .03) and 24 hours (P < .05). In the iodixanol, iopamidol, and saline groups, mean areas for cortical intracranial hemorrhage were 0.8, 18.2, and 25.7 mm(2); and 28, 31, and 56.7 mm(2), respectively, for deep intracranial hemorrhage. The differences in intracranial hemorrhage area among groups were statistically significant for cortical intracranial hemorrhage (P < .01).

CONCLUSIONS

Intra-arterial infusion of nonionic iso-osmolar iodixanol showed reduced infarct volume and reduced cortical intracranial hemorrhage areas in comparison with nonionic low-osmolar iopamidol and saline. Our results may be relevant in the setting of intra-arterial therapy for acute stroke in humans, warranting further investigation.