Recovery profiles of eccentric hamstring strength in response to cooling and compression

IntroductionThe effectiveness of different forms of cryotherapy and combined compression (cryo-compression) commonly used in sport to enhance recovery following exercise are not fully understood. Therefore, the exploration of protocols that use contemporary cryo-compression is warranted. The purpose of the study was to investigate the effectiveness of using a cryo-compression device to recover hamstrings eccentric strength following a fatiguing exercise.MethodsEighteen healthy male adult footballers were randomly allocated to receive cryo-compression or rest following a lower limb fatiguing protocol. Cryo-compression was applied for 15-min, target temperature of 10 °C, and high intermittent pressure (5–75 mm Hg) using the Game Ready® device. Rest consisted of 15-min in a prone position on a plinth. To induce hamstring fatigue, participants performed the Yo-Yo intermittent fatigue test (IFT). Skin surface temperature (T_sk) and hamstring eccentric strength measures were taken at three time points; pre-IFT, immediately post-fatigue test (IPFT), and immediately post-intervention (IPI) (rest or Game Ready®). Participants returned one week later and performed the Yo-Yo IFT again and were exposed to the opposite intervention and data collection.ResultsSignificant decreases in T_sk over the posterior thigh were reported for all timepoints compared to pre cryo-compression temperatures (p=<0.05). Overall data displayed no significant main effects for timepoint or condition for PT or AvT (p=<0.05). There was no timepoint × condition interaction for PT or AvT (p=<0.05). Collapse of the data by condition (CC/R) demonstrated no significant effect for time for PT or AvT (p=>0.05).ConclusionsNo significant changes in HES occurred after exposure to cryo-compression or rest applied immediately following the Yo-Yo IFT. Further investigations to maximise beneficial application of contemporary cryo-compression applications in sport are required. Multiple measures of performance over rewarming periods, within competitive training schedules after sport-specific training are required to develop optimal cooling protocols for recovery.     

Imaging techniques for muscle injury in sports medicine and clinical relevance

Magnetic resonance imaging (MRI) and ultrasound are the imaging modalities of choice to assess muscle injuries in athletes. Most authors consider MRI as the reference standard for evaluation of muscle injuries, since it superiorly depicts the extent of injuries independently of its temporal evolution, and due to the fact that MRI seems to be more sensitive for the detection of minimal injuries. Furthermore, MRI may potentially allow sports medicine physicians to more accurately estimate recovery times of athletes sustaining muscle injuries in the lower limbs, as well as the risk of re-injury. However, based on data available, the specific utility of imaging (including MRI) regarding its prognostic value remains limited and controversial. Although high-quality imaging is systematically performed in professional athletes and data extracted from it may potentially help to plan and guide management of muscle injuries, clinical (and functional) assessment is still the most valuable tool to guide return to competition decisions.     

Dissemination,Implementation, and Improvement Science Research in Population Health: Opportunities for Public Health and CTSAs

Importance

The complex, dynamic nature of health systems requires dissemination, implementation, and improvement (DII) sciences to effectively translate emerging knowledge into practice. Although they hold great promise for informing multisector policies and system‐level changes, these methods are often not strategically used by public health.

Objectives and Methods

More than 120 stakeholders from Southern California, including the community, federal and local government, university, and health services were convened to identify key priorities and opportunities for public health departments and Clinical and Translational Science Awards programs (CTSAs) to advance DII sciences in population health.

Main Outcomes

Participants identified challenges (mismatch of practice realities with narrowly focused research questions; lack of iterative learning) and solutions (using methods that fit the dynamic nature of the real world; aligning theories of change across sectors) for applying DII science research to public health problems. Pragmatic steps that public health and CTSAs can take to facilitate DII science research include: employing appropriate study designs; training scientists and practicing professionals in these methods; securing resources to advance this work; and supporting team science to solve complex‐systems issues.

Conclusions

Public health and CTSAs represent a unique model of practice for advancing DII research in population health. The partnership can inform policy and program development in local communities.     

Early Changes in Liver Distribution Following Implementation of Share 35

In June 2013, a change to the liver waitlist priority algorithm was implemented. Under Share 35, regional candidates with MELD ≥ 35 receive higher priority than local candidates with MELD < 35. We compared liver distribution and mortality in the first 12 months of Share 35 to an equivalent time period before. Under Share 35, new listings with MELD ≥ 35 increased slightly from 752 (9.2% of listings) to 820 (9.7%, p = 0.3), but the proportion of deceased‐donor liver transplants (DDLTs) allocated to recipients with MELD ≥ 35 increased from 23.1% to 30.1% (p < 0.001). The proportion of regional shares increased from 18.9% to 30.4% (p < 0.001). Sharing of exports was less clustered among a handful of centers (Gini coefficient decreased from 0.49 to 0.34), but there was no evidence of change in CIT (p = 0.8). Total adult DDLT volume increased from 4133 to 4369, and adjusted odds of discard decreased by 14% (p = 0.03). Waitlist mortality decreased by 30% among patients with baseline MELD > 30 (SHR = 0.70, p < 0.001) with no change for patients with lower baseline MELD (p = 0.9). Posttransplant length‐of‐stay (p = 0.2) and posttransplant mortality (p = 0.9) remained unchanged. In the first 12 months, Share 35 was associated with more transplants, fewer discards, and lower waitlist mortality, but not at the expense of CIT or early posttransplant outcomes.     

The prevalence of abnormal ECG in trained sportsmen

Background

Competitive sports training causes structural and conductive system changes manifesting by various electrocardiographic alterations. We undertook this study to assess the prevalence of abnormal ECG in trained Indian athletes and correlate it with the nature of sports training, that is endurance or strength training.

Methods

We evaluated a standard resting, lying 12 lead Electrocardiogram (ECG) in 66 actively training Indian athletes. Standard diagnostic criteria were used to define various morphological ECG abnormalities.

Results

33/66 (50%) of the athletes were undertaking endurance training while the other 33 (50%) were involved in a strength-training regimen. Overall 54/66 (81%) sportsmen had significant ECG changes. 68% of these changes were considered as normal training related features, while the remaining 32% were considered abnormal. There were seven common training related ECG changes–Sinus Bradycardia (21%), Sinus Arrhythmia (16%), 1st degree Atrioventricular Heart Block (6%), Type 1 2nd-degree Atrioventicular Heart Block (3%), Incomplete Right bundle branch block (RBBB) (24%), Early Repolarization (42%), Left Ventricular Hypertrophy (LVH) (14%); while three abnormal ECG changes--T-wave inversion (13%), RBBB(4%), Right ventricular hypertrophy (RVH) with strain (29%) were noted. Early repolarization (commonest change), sinus bradycardia, and incomplete RBBB were the commoner features noticed, with a significantly higher presence in the endurance trained athletes.

Conclusion

A high proportion of athletes undergoing competitive level sports training are likely to have abnormal ECG recordings. Majority of these are benign, and related to the physiological adaptation to the extreme levels of exertion. These changes are commoner during endurance training (running) than strength training (weightlifting).     

Anthropology of microbes

We describe the need to further integrate the fields of human microbial ecology and anthropology and outline some of the potential goals and benefits of this collaborative work.     

Examination of the Construct Validity of Impact™ Computerized Test,Traditional, and Experimental Neuropsychological Measures

Although computerized neuropsychological screening is becoming a standard for sports concussion identification and management, convergent validity studies are limited. Such studies are important for several reasons: reference to established measures is needed to establish validity; examination of the computerized battery relative to a more traditional comprehensive battery will help understand the strengths and limitations of the computer battery; and such an examination will help inform the output of the computerized battery. We compared scores on the ImPACT? battery to a comprehensive battery of traditional neuropsychological measures and several experimental measures used in the assessment of sports-related concussion in 54 healthy male athletes. Convergent validity was demonstrated for four of the five ImPACT? domain scores. Two cognitive domains often compromised as a result of mild TBI were not directly identified by the ImPACT? battery: sustained attention and auditory working memory. Affective symptoms correlated with performance on measures of attention and working memory. In this healthy sample the correlations between the domains covered by ImPACT? and the neuropsychological battery supports ImPACT? as a useful screening tool for assessing many of the cognitive factors related to mTBI. However, the data suggest other sources of data need to be considered when identifying and managing concussions.     

Immunopathology of exercise-induced bronchoconstriction in athletes — A new modified inflammatory hypothesis

Elite athletes have a higher prevalence of exercise-induced bronchoconstriction than the general population. The pathogenesis of exercise-induced bronchoconstriction is not fully elucidated. Increasing evidence suggests that airway inflammation plays a major role in the immunopathogenesis of exercise-induced bronchoconstriction. The aim of our review is to discuss existing evidence and to present a new, modified inflammatory hypothesis of exercise-induced bronchoconstriction. Exercise alters the number and function of circulating immune cells. Episodes of upper respiratory symptoms in elite athletes do not follow the usual seasonal patterns. Moreover, they have an unusual short-term duration, which suggests a non-infectious etiology. If the pro-inflammatory response to exercise has the potential to induce symptoms that mimic respiratory tract infection, it definitely up-regulates pro-inflammatory cytokine expression in the airways. We can conclude that exercise up-regulates airway cytokine expression in a way that favors inflammation and allergic reactions in bronchi and lowers the threshold for bronchoconstriction to different stimuli like cool, dry air, allergens, and pollutants.