High-standard predictive equations for estimating body composition using bioelectrical impedance analysis: a systematic review.

The appropriate use of predictive equations in estimating body composition through bioelectrical impedance analysis (BIA) depends on the device used and the subject's age, geographical ancestry, healthy status, physical activity level and sex. However, the presence of many isolated predictive equations in the literature makes the correct choice challenging, since the user may not distinguish its appropriateness. Therefore, the present systematic review aimed to classify each predictive equation in accordance with the independent parameters used. Sixty-four studies published between 1988 and 2023 were identified through a systematic search of international electronic databases. We included studies providing predictive equations derived from criterion methods, such as multi-compartment models for fat, fat-free and lean soft mass, dilution techniques for total-body water and extracellular water, total-body potassium for body cell mass, and magnetic resonance imaging or computerized tomography for skeletal muscle mass. The studies were excluded if non-criterion methods were employed or if the developed predictive equations involved mixed populations without specific codes or variables in the regression model. A total of 106 predictive equations were retrieved; 86 predictive equations were based on foot-to-hand and 20 on segmental technology, with no equations used the hand-to-hand and leg-to-leg. Classifying the subject's characteristics, 19 were for underaged, 26 for adults, 19 for athletes, 26 for elderly and 16 for individuals with diseases, encompassing both sexes. Practitioners now have an updated list of predictive equations for assessing body composition using BIA. Researchers are encouraged to generate novel predictive equations for scenarios not covered by the current literature.Registration code in PROSPERO: CRD42023467894.

The interplay between gut microbiome and physical exercise in athletes.

PURPOSE OF REVIEW: The gut microbiome regulates several health and disease-related processes. However, the potential bidirectional relationship between the gut microbiome and physical exercise remains uncertain. Here, we review the evidence related to the gut microbiome in athletes. RECENT FINDINGS: The effect of physical exercise on the intestinal microbiome and intestinal epithelial cells depends on the type, volume, and intensity of the activity. Strenuous exercise negatively impacts the intestinal microbiome, but adequate training and dietary planning could mitigate these effects. An increase in short-chain fatty acids (SCFAs) concentrations can modulate signaling pathways in skeletal muscle, contributing to greater metabolic efficiency, preserving muscle glycogen, and consequently optimizing physical performance and recovery. Furthermore, higher SCFAs concentrations appear to lower inflammatory response, consequently preventing an exacerbated immune response and reducing the risk of infections among athletes. Regarding dietary interventions, the optimal diet composition for targeting the athlete's microbiome is not yet known. Likewise, the benefits or harms of using probiotics, synbiotics, and postbiotics are not well established, whereas prebiotics appear to optimize SCFAs production. SUMMARY: The intestinal microbiome plays an important role in modulating health, performance, and recovery in athletes. SCFAs appear to be the main intestinal metabolite related to these effects. Nutritional strategies focusing on the intestinal microbiome need to be developed and tested in well controlled clinical trials.

Keep calm and keep rowing: the psychophysical effects of dragon boat program in breast cancer survivors.

PURPOSE: Dragon Boat discipline has become a popular type of physical exercise among women with breast cancer. The present study aims to investigate the effects of Dragon Boat activity on body composition, physical function, and psychosocial aspects (i.e., body appreciation and quality of life [QoL]) in women operated for breast cancer. METHODS: Thirty-one women (age, 57.88 ± 7.88 years; BMI, 27.86 ± 6.38 kg·m-2) with a previous breast removal surgery were recruited and randomized into two groups: Dragon Boat group (DB, N = 18) or a home-based non-supervised training program (home exercise group; HG, N = 13). All participants underwent body composition, handgrip test, 30-s chair stand test (30CST), 6-min walking test (6MWT), and shoulder mobility measurements at baseline and after 12 weeks of intervention. Participants also filled out the Body Appreciation Scale-2 (BAS-2) and the Short Form Health Survey-12 (SF-12) self-report questionnaires. RESULTS: Dragon Boat activity significantly improved the 30CST (+ 6%, p = .011) and 6MWT performance (+ 30%, p = .011) compared to a home-based non-supervised training program. Moreover, 20% (3/15 women) of women in the DB group obtained a reliable change from pre- to post-intervention in the BAS-2 and in the mental QoL component of the SF-12 (vs 15% and 0% of the HC group). No reliable change emerged for the physical component of the SF-12. CONCLUSION: Dragon Boat activity is efficient to improve lower limb strength in women operated for breast cancer. Furthermore, Dragon Boat activity emerged to improve body appreciation and mental QoL in some of the women assigned to this activity. Importantly, no adverse events were documented during the intervention. TRIAL REGISTRATION: NCT05206526 (10/02/2022).

Polycystic Ovary Syndrome and Alteration of Vocal Function: A Systematic Review and Meta-Analysis.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a common hormonal disorder among young women, correlated with hyperandrogenism. Among the symptoms of PCOS, vocal alterations are quite unknown. Dysphonia may be related to hyperandrogenism, and there is no consensus about its prevalence and the severity of vocal disorders, which can cause noticeable discomfort. METHODS: A systematic review of the literature was conducted. Four studies on PCOS that evaluated the phonatory system were included for a total of 174 patients (96 PCOS, 78 controls), and a meta-analysis on comparable data was performed. RESULTS: Four studies evaluated parameters related to vocal symptomatology, altered audiometric examination, and findings at the laryngoscopy in patients affected by PCOS versus controls. Although the individual studies showed increased incidence of alterations and a tendency to develop speech fatigue in women with PCOS, when the results of studies were pulled in meta-analysis, the overall difference was not statistically significant. The studies themselves were very different from each other; therefore, it is hard to draw any firm conclusions. DISCUSSION: The aim of this study was to assess the prevalence of vocal alterations, the correlation with hyperandrogenism, the quality of life, and the voice changes after starting a therapy for PCOS. The present meta-analysis failed to find any difference in terms of PCOS and control cohort. However, the lack of high-quality studies makes it difficult to draw firm conclusions. New and larger studies or big population program data are therefore warranted.

Non-invasive estimation of muscle fibre size from high-density electromyography.

Because of the biophysical relation between muscle fibre diameter and the propagation velocity of action potentials along the muscle fibres, motor unit conduction velocity could be a non-invasive index of muscle fibre size in humans. However, the relation between motor unit conduction velocity and fibre size has been only assessed indirectly in animal models and in human patients with invasive intramuscular EMG recordings, or it has been mathematically derived from computer simulations. By combining advanced non-invasive techniques to record motor unit activity in vivo, i.e. high-density surface EMG, with the gold standard technique for muscle tissue sampling, i.e. muscle biopsy, here we investigated the relation between the conduction velocity of populations of motor units identified from the biceps brachii muscle, and muscle fibre diameter. We demonstrate the possibility of predicting muscle fibre diameter (R2  = 0.66) and cross-sectional area (R2  = 0.65) from conduction velocity estimates with low systematic bias (∼2% and ∼4% respectively) and a relatively low margin of individual error (∼8% and ∼16%, respectively). The proposed neuromuscular interface opens new perspectives in the use of high-density EMG as a non-invasive tool to estimate muscle fibre size without the need of surgical biopsy sampling. The non-invasive nature of high-density surface EMG for the assessment of muscle fibre size may be useful in studies monitoring child development, ageing, space and exercise physiology, although the applicability and validity of the proposed methodology need to be more directly assessed in these specific populations by future studies. KEY POINTS: Because of the biophysical relation between muscle fibre size and the propagation velocity of action potentials along the sarcolemma, motor unit conduction velocity could represent a potential non-invasive candidate for estimating muscle fibre size in vivo. This relation has been previously assessed in animal models and humans with invasive techniques, or it has been mathematically derived from simulations. By combining high-density surface EMG with muscle biopsy, here we explored the relation between the conduction velocity of populations of motor units and muscle fibre size in healthy individuals. Our results confirmed that motor unit conduction velocity can be considered as a novel biomarker of fibre size, which can be adopted to predict muscle fibre diameter and cross-sectional area with low systematic bias and margin of individual error. The proposed neuromuscular interface opens new perspectives in the use of high-density EMG as a non-invasive tool to estimate muscle fibre size without the need of surgical biopsy sampling.

Athletic bioimpedance-based equations underestimate fat free mass components in male elite soccer players: development and validation of new soccer-specific predictive models.

BACKGROUND: Bioelectrical impedance analysis (BIA) is a rapid and user-friendly technique for assessing body composition in sports. Currently, no sport-specific predictive equations are available, and the utilization of generalized formulas can introduce systematic bias. The objectives of this study were as follows: (i) to develop and validate new predictive models for estimating fat-free mass (FFM) components in male elite soccer players; (ii) to evaluate the accuracy of existing predictive equations. METHODS: A total of 102 male elite soccer players (mean age 24.7 ± 5.7 years), participating in the Italian first league, underwent assessments during the first half of the in-season period and were randomly divided into development and validation groups. Bioelectrical resistance (R) and reactance (Xc), representing the bioimpedance components, were measured using a foot-to-hand BIA device at a single frequency of 50 kHz. Dual-energy X-ray absorptiometry was employed to acquire reference data for FFM, lean soft tissue (LST), and appendicular lean soft tissue (ALST). The validation of the newly developed predictive equations was conducted through regression analysis, Bland-Altman tests, and the area under the curves (AUC) of regression receiver operating characteristic (RROC) curves. RESULTS: Developed models were: FFM = - 7.729 + (body mass × 0.686) + (stature2/R × 0.227) + (Xc × 0.086) + (age × 0.058), R2 = 0.97, Standard error of estimation (SEE) = 1.0 kg; LST = - 8.929 + (body mass × 0.635) + (stature2/R × 0.244) + (Xc × 0.093) + (age × 0.048), R2 = 0.96, SEE = 0.9 kg; ALST = - 24.068 + (body mass × 0.347) + (stature2/R × 0.308) + (Xc × 0.152), R2 = 0.88, SEE = 1.4 kg. Train-test validation, performed on the validation group, revealed that generalized formulas for athletes underestimated all the predicted FFM components (p < 0.01), while the new predictive models showed no mean bias (p > 0.05), with R2 values ranging from 0.83 to 0.91, and no trend (p > 0.05). The AUC scores of the RROC curves indicated an accuracy of 0.92, 0.92, and 0.74 for FFM, LST, and ALST, respectively. CONCLUSIONS: The utilization of generalized predictive equations leads to an underestimation of FFM and ALST in elite soccer players. The newly developed soccer-specific formulas enable valid estimations of body composition while preserving the portability of a field-based method.

Effect of resistance training on bioelectrical phase angle in older adults: a systematic review with Meta-analysis of randomized controlled trials.

Resistance training has been proposed as a valid practice to counteract the aging effect on body mass and its components, which can be easily evaluated though the bioelectrical impedance analysis. This study aimed to achieve a systematic review with meta-analysis on the impact of resistance training on bioelectrical proprieties in older adults.A literature review was done in four electronic databases up to 1 January 2022. The inclusion criteria were: (i) participants aged ≥ 60 years; (ii) resistance training lasted ≥ 8 weeks; (iii) measurement of raw bioelectrical parameters in randomized controlled study designs.The outcomes of the trial had to be bioelectrical phase angle (PhA), resistance (R), and reactance (Xc). The methodological quality was assessed using the Rosendal scale.Overall, seven studies with a total of 344 participants were eligible for the analysis. The quality assessment yielded a score of 71.3%. Bioelectrical PhA (0.52 degree [95%CI 0.32, 0.71], p < 0.001) and Xc (3.58 ohms [95%CI 1.97, 5.19], p < 0.001) increased, whereas R decreased (-28.50 ohms [95%CI -41.39, -15.60], p < 0.001) after the resistance training programs.In this meta-analysis, resistance training promoted increases of PhA, which result from an increase in Xc concomitant with a reduction in R. According to the bioimpedance vector analysis, resistance-trained people experienced a beneficial leftward vector displacement, whilst inactivity induced a rightward vector displacement within the R-Xc graph. In future, more sophisticated and rigorous studies that address specific criteria, methods and targeted designs are required to identify which equipment and protocols allow for an optimization of the resistance training effects.Registration code in PROSPERO: CRD42020168057.

Success of blinding a procedural intervention in a randomised controlled trial in preterm infants receiving respiratory support.

BACKGROUND: Blinding of treatment allocation from treating clinicians in neonatal randomised controlled trials can minimise performance bias, but its effectiveness is rarely assessed. METHODS: To examine the effectiveness of blinding a procedural intervention from treating clinicians in a multicentre randomised controlled trial of minimally invasive surfactant therapy versus sham treatment in preterm infants of gestation 25-28 weeks with respiratory distress syndrome. The intervention (minimally invasive surfactant therapy or sham) was performed behind a screen within the first 6 h of life by a 'study team' uninvolved in clinical care including decision-making. Procedure duration and the study team's words and actions during the sham treatment mimicked those of the minimally invasive surfactant therapy procedure. Post-intervention, three clinicians completed a questionnaire regarding perceived group allocation, with the responses matched against actual intervention and categorised as correct, incorrect, or unsure. Success of blinding was calculated using validated blinding indices applied to the data overall (James index, successful blinding defined as > 0.50), or to the two treatment allocation groups (Bang index, successful blinding: -0.30 to 0.30). Blinding success was measured within staff role, and the associations between blinding success and procedural duration and oxygenation improvement post-procedure were estimated. RESULTS: From 1345 questionnaires in relation to a procedural intervention in 485 participants, responses were categorised as correct in 441 (33%), incorrect in 142 (11%), and unsure in 762 (57%), with similar proportions for each of the response categories in the two treatment arms. The James index indicated successful blinding overall 0.67 (95% confidence interval (CI) 0.65-0.70). The Bang index was 0.28 (95% CI 0.23-0.32) in the minimally invasive surfactant therapy group and 0.17 (95% CI 0.12-0.21) in the sham arm. Neonatologists more frequently guessed the correct intervention (47%) than bedside nurses (36%), neonatal trainees (31%), and other nurses (24%). For the minimally invasive surfactant therapy intervention, the Bang index was linearly related to procedural duration and oxygenation improvement post-procedure. No evidence of such relationships was seen in the sham arm. CONCLUSION: Blinding of a procedural intervention from clinicians is both achievable and measurable in neonatal randomised controlled trials.

Nasal high flow therapy for primary respiratory support in preterm infants.

BACKGROUND: Nasal high flow (nHF) therapy provides heated, humidified air and oxygen via two small nasal prongs, at gas flows of more than 1 litre/minute (L/min), typically 2 L/min to 8 L/min. nHF is commonly used for non-invasive respiratory support in preterm neonates. It may be used in this population for primary respiratory support (avoiding, or prior to the use of mechanical ventilation via an endotracheal tube) for prophylaxis or treatment of respiratory distress syndrome (RDS). This is an update of a review first published in 2011 and updated in 2016. OBJECTIVES: To evaluate the benefits and harms of nHF for primary respiratory support in preterm infants compared to other forms of non-invasive respiratory support. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date March 2022. SELECTION CRITERIA: We included randomised or quasi-randomised trials comparing nHF with other forms of non-invasive respiratory support for preterm infants born less than 37 weeks' gestation with respiratory distress soon after birth. DATA COLLECTION AND ANALYSIS: We used standard Cochrane Neonatal methods. Our primary outcomes were 1. death (before hospital discharge) or bronchopulmonary dysplasia (BPD), 2. death (before hospital discharge), 3. BPD, 4. treatment failure within 72 hours of trial entry and 5. mechanical ventilation via an endotracheal tube within 72 hours of trial entry. Our secondary outcomes were 6. respiratory support, 7. complications and 8. neurosensory outcomes. We used GRADE to assess the certainty of evidence. MAIN RESULTS: We included 13 studies (2540 infants) in this updated review. There are nine studies awaiting classification and 13 ongoing studies. The included studies differed in the comparator treatment (continuous positive airway pressure (CPAP) or nasal intermittent positive pressure ventilation (NIPPV)), the devices for delivering nHF and the gas flows used. Some studies allowed the use of 'rescue' CPAP in the event of nHF treatment failure, prior to any mechanical ventilation, and some allowed surfactant administration via the INSURE (INtubation, SURfactant, Extubation) technique without this being deemed treatment failure. The studies included very few extremely preterm infants less than 28 weeks' gestation. Several studies had unclear or high risk of bias in one or more domains. Nasal high flow compared with continuous positive airway pressure for primary respiratory support in preterm infants Eleven studies compared nHF with CPAP for primary respiratory support in preterm infants. When compared with CPAP, nHF may result in little to no difference in the combined outcome of death or BPD (risk ratio (RR) 1.09, 95% confidence interval (CI) 0.74 to 1.60; risk difference (RD) 0, 95% CI -0.02 to 0.02; 7 studies, 1830 infants; low-certainty evidence). Compared with CPAP, nHF may result in little to no difference in the risk of death (RR 0.78, 95% CI 0.44 to 1.39; 9 studies, 2009 infants; low-certainty evidence), or BPD (RR 1.14, 95% CI 0.74 to 1.76; 8 studies, 1917 infants; low-certainty evidence). nHF likely results in an increase in treatment failure within 72 hours of trial entry (RR 1.70, 95% CI 1.41 to 2.06; RD 0.09, 95% CI 0.06 to 0.12; number needed to treat for an additional harmful outcome (NNTH) 11, 95% CI 8 to 17; 9 studies, 2042 infants; moderate-certainty evidence). However, nHF likely does not increase the rate of mechanical ventilation (RR 1.04, 95% CI 0.82 to 1.31; 9 studies, 2042 infants; moderate-certainty evidence). nHF likely results in a reduction in pneumothorax (RR 0.66, 95% CI 0.40 to 1.08; 10 studies, 2094 infants; moderate-certainty evidence) and nasal trauma (RR 0.49, 95% CI 0.36 to 0.68; RD -0.06, 95% CI -0.09 to -0.04; 7 studies, 1595 infants; moderate-certainty evidence). Nasal high flow compared with nasal intermittent positive pressure ventilation for primary respiratory support in preterm infants Four studies compared nHF with NIPPV for primary respiratory support in preterm infants. When compared with NIPPV, nHF may result in little to no difference in the combined outcome of death or BPD, but the evidence is very uncertain (RR 0.64, 95% CI 0.30 to 1.37; RD -0.05, 95% CI -0.14 to 0.04; 2 studies, 182 infants; very low-certainty evidence). nHF may result in little to no difference in the risk of death (RR 0.78, 95% CI 0.36 to 1.69; RD -0.02, 95% CI -0.10 to 0.05; 3 studies, 254 infants; low-certainty evidence). nHF likely results in little to no difference in the incidence of treatment failure within 72 hours of trial entry compared with NIPPV (RR 1.27, 95% CI 0.90 to 1.79; 4 studies, 343 infants; moderate-certainty evidence), or mechanical ventilation within 72 hours of trial entry (RR 0.91, 95% CI 0.62 to 1.33; 4 studies, 343 infants; moderate-certainty evidence). nHF likely results in a reduction in nasal trauma, compared with NIPPV (RR 0.21, 95% CI 0.09 to 0.47; RD -0.17, 95% CI -0.24 to -0.10; 3 studies, 272 infants; moderate-certainty evidence). nHF likely results in little to no difference in the rate of pneumothorax (RR 0.78, 95% CI 0.40 to 1.53; 4 studies, 344 infants; moderate-certainty evidence). Nasal high flow compared with ambient oxygen We found no studies examining this comparison. Nasal high flow compared with low flow nasal cannulae We found no studies examining this comparison. AUTHORS' CONCLUSIONS: The use of nHF for primary respiratory support in preterm infants of 28 weeks' gestation or greater may result in little to no difference in death or BPD, compared with CPAP or NIPPV. nHF likely results in an increase in treatment failure within 72 hours of trial entry compared with CPAP; however, it likely does not increase the rate of mechanical ventilation. Compared with CPAP, nHF use likely results in less nasal trauma and likely a reduction in pneumothorax. As few extremely preterm infants less than 28 weeks' gestation were enrolled in the included trials, evidence is lacking for the use of nHF for primary respiratory support in this population.

Bubble devices versus other pressure sources for nasal continuous positive airway pressure in preterm infants.

BACKGROUND: Several types of pressure sources, including underwater bubble devices, mechanical ventilators, and the Infant Flow Driver, are used for providing continuous positive airway pressure (CPAP) to preterm infants with respiratory distress. It is unclear whether the use of bubble CPAP versus other pressure sources is associated with lower rates of CPAP treatment failure, or mortality and other morbidity.  OBJECTIVES: To assess the benefits and harms of bubble CPAP versus other pressure sources (mechanical ventilators or Infant Flow Driver) for reducing treatment failure and associated morbidity and mortality in newborn preterm infants with or at risk of respiratory distress. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2023, Issue 1); MEDLINE (1946 to 6 January 2023), Embase (1974 to 6 January 2023), Maternity & Infant Care Database (1971 to 6 January 2023), and the Cumulative Index to Nursing and Allied Health Literature (1982 to 6 January 2023). We searched clinical trials databases and the reference lists of retrieved articles. SELECTION CRITERIA: We included randomised controlled trials comparing bubble CPAP with other pressure sources (mechanical ventilators or Infant Flow Driver) for the delivery of nasal CPAP to preterm infants. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Two review authors separately evaluated trial quality, extracted data, and synthesised effect estimates using risk ratio (RR), risk difference (RD), and mean difference. We used the GRADE approach to assess the certainty of the evidence for effects on treatment failure, all-cause mortality, neurodevelopmental impairment, pneumothorax, moderate-severe nasal trauma, and bronchopulmonary dysplasia. MAIN RESULTS: We included 15 trials involving a total of 1437 infants. All trials were small (median number of participants 88). The methods used to generate the randomisation sequence and ensure allocation concealment were unclear in about half of the trial reports. Lack of measures to blind caregivers or investigators was a potential source of bias in all of the included trials. The trials took place during the past 25 years in care facilities internationally, predominantly in India (five trials) and Iran (four trials). The studied pressure sources were commercially available bubble CPAP devices versus a variety of mechanical ventilator (11 trials) or Infant Flow Driver (4 trials) devices.  Meta-analyses suggest that the use of bubble CPAP compared with mechanical ventilator or Infant Flow Driver CPAP may reduce the rate of treatment failure (RR 0.76, 95% confidence interval (CI) 0.60 to 0.95; (I² = 31%); RD -0.05, 95% CI -0.10 to -0.01; number needed to treat for an additional beneficial outcome 20, 95% CI 10 to 100; 13 trials, 1230 infants; low certainty evidence). The type of pressure source may not affect mortality prior to hospital discharge (RR 0.93, 95% CI 0.64 to 1.36 (I² = 0%); RD -0.01, 95% CI -0.04 to 0.02; 10 trials, 1189 infants; low certainty evidence). No data were available on neurodevelopmental impairment. Meta-analysis suggests that the pressure source may not affect the risk of pneumothorax (RR 0.73, 95% CI 0.40 to 1.34 (I² = 0%); RD -0.01, 95% CI -0.03 to 0.01; 14 trials, 1340 infants; low certainty evidence). Bubble CPAP likely increases the risk of moderate-severe nasal injury (RR 2.29, 95% CI 1.37 to 3.82 (I² = 17%); RD 0.07, 95% CI 0.03 to 0.11; number needed to treat for an additional harmful outcome 14, 95% CI 9 to 33; 8 trials, 753 infants; moderate certainty evidence). The pressure source may not affect the risk of bronchopulmonary dysplasia (RR 0.76, 95% CI 0.53 to 1.10 (I² = 0%); RD -0.04, 95% CI -0.09 to 0.01; 7 trials, 603 infants; low certainty evidence).  AUTHORS' CONCLUSIONS: Given the low level of certainty about the effects of bubble CPAP versus other pressure sources on the risk of treatment failure and most associated morbidity and mortality for preterm infants, further large, high-quality trials are needed to provide evidence of sufficient validity and applicability to inform context- and setting-relevant policy and practice.

Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation.

BACKGROUND: Nasal continuous positive airway pressure (NCPAP) is a useful method for providing respiratory support after extubation. Nasal intermittent positive pressure ventilation (NIPPV) can augment NCPAP by delivering ventilator breaths via nasal prongs. OBJECTIVES: Primary objective To determine the effects of management with NIPPV versus NCPAP on the need for additional ventilatory support in preterm infants whose endotracheal tube was removed after a period of intermittent positive pressure ventilation. Secondary objectives To compare rates of abdominal distension, gastrointestinal perforation, necrotising enterocolitis, chronic lung disease, pulmonary air leak, mortality, duration of hospitalisation, rates of apnoea and neurodevelopmental status at 18 to 24 months for NIPPV and NCPAP. To compare the effect of NIPPV versus NCPAP delivered via ventilators versus bilevel devices, and assess the effects of the synchronisation of ventilation, and the strength of interventions in different economic settings. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was January 2023. SELECTION CRITERIA: We included randomised and quasi-randomised trials of ventilated preterm infants (less than 37 weeks' gestational age (GA)) ready for extubation to non-invasive respiratory support. Interventions were NIPPV and NCPAP. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcome was 1. respiratory failure. Our secondary outcomes were 2. endotracheal reintubation, 3. abdominal distension, 4. gastrointestinal perforation, 5. necrotising enterocolitis (NEC), 6. chronic lung disease, 7. pulmonary air leak, 8. mortality, 9. hospitalisation, 10. apnoea and bradycardia, and 11. neurodevelopmental status. We used GRADE to assess the certainty of evidence. MAIN RESULTS: We included 19 trials (2738 infants). Compared to NCPAP, NIPPV likely reduces the risk of respiratory failure postextubation (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.67 to 0.84; number needed to treat for an additional beneficial outcome (NNTB) 11, 95% CI 8 to 17; 19 trials, 2738 infants; moderate-certainty evidence) and endotracheal reintubation (RR 0.78, 95% CI 0.70 to 0.87; NNTB 12, 95% CI 9 to 25; 17 trials, 2608 infants, moderate-certainty evidence), and may reduce pulmonary air leaks (RR 0.57, 95% CI 0.37 to 0.87; NNTB 50, 95% CI 33 to infinite; 13 trials, 2404 infants; low-certainty evidence). NIPPV likely results in little to no difference in gastrointestinal perforation (RR 0.89, 95% CI 0.58 to 1.38; 8 trials, 1478 infants, low-certainty evidence), NEC (RR 0.86, 95% CI 0.65 to 1.15; 10 trials, 2069 infants; moderate-certainty evidence), chronic lung disease defined as oxygen requirement at 36 weeks (RR 0.93, 95% CI 0.84 to 1.05; 9 trials, 2001 infants; moderate-certainty evidence) and mortality prior to discharge (RR 0.81, 95% CI 0.61 to 1.07; 11 trials, 2258 infants; low-certainty evidence). When considering subgroup analysis, ventilator-generated NIPPV likely reduces respiratory failure postextubation (RR 0.49, 95% CI 0.40 to 0.62; 1057 infants; I2 = 47%; moderate-certainty evidence), while bilevel devices (RR 0.95, 95% CI 0.77 to 1.17; 716 infants) or a mix of both ventilator-generated and bilevel devices likely results in little to no difference (RR 0.87, 95% CI 0.73 to 1.02; 965 infants). AUTHORS' CONCLUSIONS: NIPPV likely reduces the incidence of extubation failure and the need for reintubation within 48 hours to one-week postextubation more effectively than NCPAP in very preterm infants (GA 28 weeks and above). There is a paucity of data for infants less than 28 weeks' gestation. Pulmonary air leaks were also potentially reduced in the NIPPV group. However, it has no effect on other clinically relevant outcomes such as gastrointestinal perforation, NEC, chronic lung disease or mortality. Ventilator-generated NIPPV appears superior to bilevel devices in reducing the incidence of respiratory failure postextubation failure and need for reintubation. Synchronisation used to deliver NIPPV may be important; however, data are insufficient to support strong conclusions. Future trials should enrol a sufficient number of infants, particularly those less than 28 weeks' GA, to detect differences in death or chronic lung disease and should compare different categories of devices, establish the impact of synchronisation of NIPPV on safety and efficacy of the technique as well as the best combination of settings for NIPPV (rate, peak pressure and positive end-expiratory). Trials should strive to match the mean airway pressure between the intervention groups to allow a better comparison. Neurally adjusted ventilatory assist needs further assessment with properly powered randomised trials.

Impact of probiotic administration on the incidence of necrotising enterocolitis: A single-centre cohort study.

AIM: To examine the effect of probiotic administration on the incidence of necrotising enterocolitis (NEC) in preterm infants. METHODS: We conducted a retrospective study examining the incidence of NEC in a cohort of infants that received probiotics compared to those that had not, over an 18-year period in a single centre. Infants were included if they were born <32 weeks' gestation with birthweight <1500 g and survived beyond 72 h. Infants in the probiotic group received either ABC Dophilus or Infloran. The primary outcome was the rate of NEC. The main secondary outcomes were late-onset sepsis and mortality. Differences in these outcomes between cohorts were examined in univariate and multivariate analyses, taking account of confounding variables, reporting adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS: 805 infants were included in the study. Infants receiving probiotics had a lower risk of developing NEC compared with those that did not (32/419 (7.6%) vs. 14/386 (3.6%); aOR 0.37 (95% CI 0.18-0.74)). There was also a reduction in the late-onset sepsis rate (22.4% vs. 14.2%, aOR 0.52, 95% CI 0.35-0.77) and mortality rate (9.5% vs. 4.6%, aOR 0.35, 95% CI 0.17-0.73). CONCLUSION: The administration of a multi-organism probiotic formulation, including Bifidobacteria, to very preterm infants in our unit was associated with a reduced incidence of NEC, late-onset sepsis and mortality.

Effectiveness and therapeutic compliance of digital therapy in shoulder rehabilitation: a randomized controlled trial.

BACKGROUND: Interactive videogames, virtual reality, and robotics represent a new opportunity for multimodal treatments in many rehabilitation contexts. However, several commercial videogames are designed for leisure and are not oriented toward definite rehabilitation goals. Among the many, Playball® (Playwork, Alon 10, Ness Ziona, Israel) is a therapeutic ball that measures both movement and pressure applied on it while performing rehabilitation games. This study aimed: (i) to evaluate whether the use of this novel digital therapy gaming system was clinically effective during shoulder rehabilitation; (ii) to understand whether this gaming rehabilitation program was effective in improving patients' engagement (perceived enjoyment and self-efficacy during therapy; attitude and intention to train at home) in comparison to a control non-gaming rehabilitation program. METHODS: A randomized controlled experimental design was outlined. Twenty-two adults with shoulder pathologies were recruited for a rehabilitation program of ten consecutive sessions. A control (CTRL; N = 11; age: 62.0 ± 10.9 yrs) and an intervention group (PG; N = 11; age: 59.9 ± 10.2 yrs) followed a non-digital and a digital therapy, respectively. The day before (T0) and after (T1) the rehabilitation program, pain, strength, and mobility assessments were performed, together with six questionnaires: PENN shoulder Score, PACES-short, Self-efficacy, Attitudes to train at home, Intention to train at home, and System usability scale (SUS). RESULTS: MANOVA analysis showed significant improvements in pain (p < 0.01), strength (p < 0.05), and PENN Shoulder Score (p < 0.001) in both groups. Similarly, patients' engagement improved, with significant increments in Self-efficacy (p < 0.05) and attitude (p < 0.05) scores in both groups after the rehabilitation. Pearson correlation showed significant correlations of the Δ scores (T1 - T0) between PACES and Self-efficacy (r = 0.623; p = 0.041) and between PACES and Intention to train at home (r = 0.674; p = 0.023) only in the PG. SUS score after the rehabilitation (74.54 ± 15.60) overcame the cut-off value of 68, representative of good usability of a device. CONCLUSIONS: The investigated digital therapy resulted as effective as an equivalent non-digital therapy in shoulder rehabilitation. The reported positive relationship between the subject's enjoyment during digital therapy and intention to train at home suggests promising results in possible patient's exercise engagement at home after the rehabilitation in the medical center. RETROSPECTIVELY REGISTERED: NCT05230056.

Center of Pressure Behavior in Response to Unexpected Base of Support Shifting: A New Objective Tool for Dynamic Balance Assessment.

The translation of the base of support represents a promising approach for the objective assessment of dynamic balance control. Therefore, this study aimed to present a servo-controlled, electrically driven movable plate and a new set of parameters based on the center-of-pressure (CoP) trajectory. Twenty subjects were assessed on a force platform screwed over a movable plate that could combine the following settings: direction (forward (FW) and backward (BW)), displacement (25 mm, 50 mm, and 100 mm), and ramp rate (100 mm/s and 200 mm/s). The subjects underwent two sets of 12 trials randomly combining the plate settings. From the CoP trajectory of the 2.5 s time window after the perturbation, the 95% confidence-interval ellipse (Area95) and the CoP mean velocity (Unit Path) were calculated. Within the same time window, the first peak (FP), the maximal oscillations (ΔCoPMax), and the standard deviation (PPV) of the CoP anterior-posterior trajectory were calculated. The plate direction (p < 0.01), ramp rate (p < 0.001), and displacement (p < 0.01) affected the Area95, FP, and ΔCoPMax, while the Unit Path and PPV were influenced only by the ramp rate (p < 0.001) and displacement (p < 0.001). The servo-controlled, electrically driven movable plate and the CoP-related parameters presented in this study represent a new promising objective tool for dynamic balance assessment.

Two-Year Outcomes After Minimally Invasive Surfactant Therapy in Preterm Infants: Follow-Up of the OPTIMIST-A Randomized Clinical Trial.

Importance: The long-term effects of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome remain to be definitively clarified. Objective: To examine the effect of MIST on death or neurodevelopmental disability (NDD) at 2 years' corrected age. Design, Setting, and Participants: Follow-up study of a randomized clinical trial with blinding of clinicians and outcome assessors conducted in 33 tertiary-level neonatal intensive care units in 11 countries. The trial included 486 infants with a gestational age of 25 to 28 weeks supported with continuous positive airway pressure (CPAP). Collection of follow-up data at 2 years' corrected age was completed on December 9, 2022. Interventions: Infants assigned to MIST (n = 242) received exogenous surfactant (200 mg/kg poractant alfa) via a thin catheter; those assigned to the control group (n = 244) received sham treatment. Main Outcomes and Measures: The key secondary outcome of death or moderate to severe NDD was assessed at 2 years' corrected age. Other secondary outcomes included components of this composite outcome, as well as hospitalizations for respiratory illness and parent-reported wheezing or breathing difficulty in the first 2 years. Results: Among the 486 infants randomized, 453 had follow-up data available (median gestation, 27.3 weeks; 228 females [50.3%]); data on the key secondary outcome were available in 434 infants. Death or NDD occurred in 78 infants (36.3%) in the MIST group and 79 (36.1%) in the control group (risk difference, 0% [95% CI, -7.6% to 7.7%]; relative risk [RR], 1.0 [95% CI, 0.81-1.24]); components of this outcome did not differ significantly between groups. Secondary respiratory outcomes favored the MIST group. Hospitalization with respiratory illness occurred in 49 infants (25.1%) in the MIST group vs 78 (38.2%) in the control group (RR, 0.66 [95% CI, 0.54-0.81]) and parent-reported wheezing or breathing difficulty in 73 (40.6%) vs 104 (53.6%), respectively (RR, 0.76 [95% CI, 0.63-0.90]). Conclusions and Relevance: In this follow-up study of a randomized clinical trial of preterm infants with respiratory distress syndrome supported with CPAP, MIST compared with sham treatment did not reduce the incidence of death or NDD by 2 years of age. However, infants who received MIST had lower rates of adverse respiratory outcomes during their first 2 years of life. Trial Registration: anzctr.org.au Identifier: ACTRN12611000916943.

Does Stretching Training Influence Muscular Strength? A Systematic Review With Meta-Analysis and Meta-Regression.

ABSTRACT: Thomas, E, Ficarra, S, Nunes, JP, Paoli, A, Bellafiore, M, Palma, A, and Bianco, A. Does stretching training influence muscular strength? A systematic review with meta-analysis and meta-regression. J Strength Cond Res 37(5): 1145-1156, 2023-The aim of this study was to review articles that performed stretching training and evaluated the effects on muscular strength. Literature search was performed using 3 databases. Studies were included if they compared the effects on strength following stretching training vs. a nontraining control group or stretching training combined with resistance training (RT) vs. an RT-only group, after at least 4 weeks of intervention. The meta-analyses were performed using a random-effect model with Hedges' g effect size (ES). A total of 35 studies ( n = 1,179 subjects) were included in this review. The interventions lasted for a mean period of 8 weeks (range, 4-24 weeks), 3-4 days per week, applying approximately 4 sets of stretching of approximately 1-minute duration. The meta-analysis for the stretching vs. nontraining control group showed a significant small effect on improving dynamic (k = 14; ES = 0.33; p = 0.007) but not isometric strength (k = 8; ES = 0.10; p = 0.377), following static stretching programs (k = 17; ES = 0.28; p = 0.006). When stretching was added to RT interventions, the main analysis indicated no significant effect (k = 17; ES = -0.15; p = 0.136); however, moderator analysis indicated that performing stretching before RT sessions has a small but negative effect (k = 7; ES = -0.43; p = 0.014); the meta-regression revealed a significant negative association with study length (ß = -0.100; p = 0.004). Chronic static stretching programs increase dynamic muscular strength to a small magnitude. Performing stretching before RT and for a prolonged time (>8 weeks) can blunt the strength gains to a small-to-moderate magnitude. Performing stretching in sessions distant from RT sessions might be a strategy to not hinder strength development.

Relationship between external and internal load indicators and injury using machine learning in professional soccer: a systematic review and meta-analysis.

This study verified the relationship between internal load (IL) and external load (EL) and their association on injury risk (IR) prediction considering machine learning (ML) approaches. Studies were included if: (1) participants were male professional soccer players; (2) carried out for at least 2 sessions, exercises, or competitions; (3) correlated training load (TL) with non-contact injuries; (4) applied ML approaches to predict TL and non-contact injuries. TL included: IL indicators (Rating of Perceived Exertion, RPE; Session-RPE, Heart Rate, HR) and EL indicators (Global Positioning System, GPS variables); the relationship between EL and IL through index, ratio, formula; ML indicators included performance measures, predictive performance of ML methods, measure of feature importance, relevant predictors, outcome variable, predictor variable, data pre-processing, features selection, ML methods. Twenty-five studies were included. Eleven addressed the relationship between EL and IL. Five used EL/IL indexes. Five studies predicted IL indicators. Three studies investigated the association between EL and IL with IR. One study predicted IR using ML. Significant positive correlations were found between S-RPE and total distance (TD) (r = 0.73; 95% CI (0.64 to 0.82)) as well as between S-RPE and player load (PL) (r = 0.76; 95% CI (0.68 to 0.84)). Association between IL and EL and their relationship with injuries were found. RPE, S-RPE, and HR were associated with different EL indicators. A positive relationship between EL and IL indicators and IR was also observed. Moreover, new indexes or ratios (integrating EL and IL) to improve knowledge regarding TL and fitness status were also applied. ML can predict IL indicators (HR and RPE), and IR. The present systematic review was registered in PROSPERO (CRD42021245312).

Ketogenic diets, physical activity and body composition: a review.

Obesity remains a serious relevant public health concern throughout the world despite related countermeasures being well understood (i.e. mainly physical activity and an adjusted diet). Among different nutritional approaches, there is a growing interest in ketogenic diets (KD) to manipulate body mass (BM) and to enhance fat mass loss. KD reduce the daily amount of carbohydrate intake drastically. This results in increased fatty acid utilisation, leading to an increase in blood ketone bodies (acetoacetate, 3-ß-hydroxybutyrate and acetone) and therefore metabolic ketosis. For many years, nutritional intervention studies have focused on reducing dietary fat with little or conflicting positive results over the long term. Moreover, current nutritional guidelines for athletes propose carbohydrate-based diets to augment muscular adaptations. This review discusses the physiological basis of KD and their effects on BM reduction and body composition improvements in sedentary individuals combined with different types of exercise (resistance training or endurance training) in individuals with obesity and athletes. Ultimately, we discuss the strengths and the weaknesses of these nutritional interventions together with precautionary measures that should be observed in both individuals with obesity and athletic populations. A literature search from 1921 to April 2021 using Medline, Google Scholar, PubMed, Web of Science, Scopus and Sportdiscus Databases was used to identify relevant studies. In summary, based on the current evidence, KD are an efficient method to reduce BM and body fat in both individuals with obesity and athletes. However, these positive impacts are mainly because of the appetite suppressive effects of KD, which can decrease daily energy intake. Therefore, KD do not have any superior benefits to non-KD in BM and body fat loss in individuals with obesity and athletic populations in an isoenergetic situation. In sedentary individuals with obesity, it seems that fat-free mass (FFM) changes appear to be as great, if not greater, than decreases following a low-fat diet. In terms of lean mass, it seems that following a KD can cause FFM loss in resistance-trained individuals. In contrast, the FFM-preserving effects of KD are more efficient in endurance-trained compared with resistance-trained individuals.

Masks versus prongs as interfaces for nasal continuous positive airway pressure in preterm infants.

BACKGROUND: Nasal masks and nasal prongs are used as interfaces for providing continuous positive airway pressure (CPAP) for preterm infants with or at risk of respiratory distress, either as primary support after birth or as ongoing support after endotracheal extubation from mechanical ventilation. It is unclear which type of interface is associated with lower rates of CPAP treatment failure, nasal trauma, or mortality and other morbidity. OBJECTIVES: To assess the benefits and harms of nasal masks versus nasal prongs for reducing CPAP treatment failure, nasal trauma, or mortality and other morbidity in newborn preterm infants with or at risk of respiratory distress. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was October 2021. SELECTION CRITERIA: We included randomised controlled trials comparing masks versus prongs as interfaces for delivery of nasal CPAP in newborn preterm infants (less than 37 weeks' gestation) with or at risk of respiratory distress. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. treatment failure, 2. all-cause mortality, and 3. neurodevelopmental impairment. Our secondary outcomes were 4. pneumothorax, 5. moderate-severe nasal trauma, 6. bronchopulmonary dysplasia, 7. duration of CPAP use, 8. duration of oxygen supplementation, 9. duration of hospitalisation, 10. patent ductus arteriosus receiving medical or surgical treatment, 11. necrotising enterocolitis, 12. severe intraventricular haemorrhage, and 13. severe retinopathy of prematurity. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: We included 12 trials with 1604 infants. All trials were small (median number of participants 118). The trials occurred after 2001 in care facilities internationally, predominantly in India (eight trials). Most participants were preterm infants of 26 to 34 weeks' gestation who received nasal CPAP as the primary form of respiratory support after birth. The studied interfaces included commonly used commercially available masks and prongs. Lack of measures to blind caregivers or investigators was a potential source of performance and detection bias in all the trials. Meta-analyses suggested that use of masks compared with prongs may reduce CPAP treatment failure (risk ratio (RR) 0.72, 95% confidence interval (CI) 0.58 to 0.90; 8 trials, 919 infants; low certainty). The type of interface may not affect mortality prior to hospital discharge (RR 0.83, 95% CI 0.56 to 1.22; 7 trials, 814 infants; low certainty). There are no data on neurodevelopmental impairment. Meta-analyses suggest that the choice of interface may result in little or no difference in the risk of pneumothorax (RR 0.93, 95% CI 0.45 to 1.93; 5 trials, 625 infants; low certainty). Use of masks rather than prongs may reduce the risk of moderate-severe nasal injury (RR 0.55, 95% CI 0.44 to 0.71; 10 trials, 1058 infants; low certainty). The evidence is very uncertain about the effect on bronchopulmonary dysplasia (RR 0.69, 95% CI 0.46 to 1.03; 7 trials, 843 infants; very low certainty). AUTHORS' CONCLUSIONS: The available trial data provide low-certainty evidence that use of masks compared with prongs as the nasal CPAP interface may reduce treatment failure and nasal injury, and may have little or no effect on mortality or the risk of pneumothorax in newborn preterm infants with or at risk of respiratory distress. The effect on bronchopulmonary dysplasia is very uncertain. Large, high-quality trials would be needed to provide evidence of sufficient validity and applicability to inform policy and practice.

Age and training intensity differently affect male runners' endocrine and sexual parameters.

Physical activity is widely recognized to improve health and its inclusion in daily life at all ages is highly recommended. Gonadal hormones are known to be affected by physical activity. The exercise-induced effects on male runners of different ages were investigated by dividing 31 runners by age (Young, Y, 30-55 years; Old, O, 56-70 years) and amount of training (Light, L, <50 km/week; Heavy, H, 50 or more km/week). To test the somatic, sexual, and psychological health aspects, the Aging Male's Symptoms Scale (AMS) and the International Index of Erectile Function-6 (IIEF-6) questionnaires were administered and blood samples were drawn for adrenocorticotropic hormone, testosterone (Total-TT), free testosterone (Free-T), cortisol (C), dihydrotestosterone (DHT), estradiol, and sex hormone-binding globulin determinations. Clinical evaluations and questionnaire results showed the presence in all groups of some subclinical symptoms and "Light" dysfunctions. TT in the old-heavy (OH) group was significantly lower than in the OL group (2.38 ± 0.18 ng/mL vs. 3.36 ± 0.44 ng/ml, P = 0.05). The TT/DHT ratio was significantly higher in YH than in OH (3.64 ± 0.16 vs. 2.92 ± 0.23, P < 0.05). TT was positively correlated with AMS sexual subscale and negatively correlated with IIEF-6. Physical activity can significantly affect andrological health and testosterone levels in runners at all ages. Thus, due to the important testosterone-mediated vital functions in men, the evaluation of these parameters would be indicated in old as well as in young subjects.