An Analysis of Optical Coherence Tomography Angiography (OCT-A) Perfusion Density Maps in Patients Treated for Retinal Vein Occlusion with Intravitreal Aflibercept.

AIM: The primary goal of this study was to evaluate the reduction in non-perfusion area and improvement in blood flow as well as the reduction in retinal edema on optical coherence tomography angiography (OCT-A) in patients with retinal vein occlusion treated with 2 mg intravitreal injections of aflibercept. MATERIAL AND METHODS: Fifty eyes of nine patients with central retinal vein occlusion (CRVO) and sixteen patients with branch retinal vein occlusion (BRVO), aged 50 to 75 years, were collectively analyzed as retinal vein occlusion (RVO). The following parameters were analyzed: superficial vessel density (VDSF), deep vessel density (VDD), flow area in the outer retina (FAOR), choriocapillaris flow area (FACC), non-flow area (NFA) and the foveal avascular zone (FAZ). RESULTS: OCT-A revealed a reduction in macular edema. The most significant change in central retinal thickness (CRT) was observed between measurement timepoint "5" and the baseline (46%). The non-flow area was also reduced. Following a significant decrease in superficial vessel density 30 days after the first dose of aflibercept, a non-significant increase was noted at the subsequent timepoints. An increase was also found in deep vessel density and choriocapillaris flow area. Improvements in the above OCT-A parameters resulted in increased retinal blood flow and improved visual acuity. CONCLUSIONS: Patients with retinal vein occlusion treated with 2 mg aflibercept exhibited reduced macular edema and FAZ, increased vessel density, improved blood flow, and better visual acuity.

Alterations in Circulating MicroRNAs and the Relation of MicroRNAs to Maximal Oxygen Consumption and Intima-Media Thickness in Ultra-Marathon Runners.

The impact of long-term training on cardiovascular disease (CVD) is not clear. Carotid intima-media thickness (CIMT) test is recommended as a useful measure to diagnose the early stages of atherosclerosis. MicroRNAs (miRNAs) are altered due to endurance exercise and can be promising biomarkers of pathophysiological changes. We aimed to evaluate the association of circulating miRNAs with physical fitness and markers of atherosclerosis in ultra-marathon runners. Ultra-marathon runners had 28-fold upregulation of miR-125a-5p expressions compared to control individuals (p = 0.002), whereas let-7e and miR-126 did not differ statistically between ultra-marathon runners and controls. In the ultra-marathon runners' group, negative correlations were observed between VO2max/kg and relative expression of miR-125a-5p and miR-126 (r = -0.402, p = 0.028; r = -0.438, p = 0.032, respectively). Positive correlations were observed between CIMT and miR-125a-5p and miR-126 (r = 0.388, p = 0.050; r = 0.504, p = 0.023, respectively) in ultra-marathon runners. Individuals with the highest quartile of VO2max/kg had 23-fold lower miR-126 expression in comparison to subgroups with lower VO2max/kg (p = 0.017). Our results may indicate that both miRNAs may serve as a biomarker for early pathological changes leading to atherosclerosis burden in athletes. Furthermore, the association between miRNAs and traditional risk factors for CVD indicate a possible use of these molecules as early biomarkers of future cardiovascular health.

Epicardial Adipose Tissue and Cardiovascular Risk Assessment in Ultra-Marathon Runners: A Pilot Study.

Epicardial adipose tissue (EAT) volume is associated with cardiovascular disease (CVD). Data regarding the influence of extremely intensive training on CVD are scarce. We compared EAT volume among ultra-marathon runners and in the sedentary control group, and assessed the correlations between EAT and risk factors of coronary artery disease (CAD). EAT volume around three main coronary vessels and right ventricle (RV) was measured in 30 healthy amateur ultrarunners and 9 sex- and age-matched sedentary controls using cardiac magnetic resonance. In addition, body composition, lipid profile, interleukin-6 (IL-6) plasma concentration, and intima-media thickness (IMT) were measured as well. The EAT volume was lower in all measured locations in the ultrarunners' group compared to control group (p < 0.001 for all). Ultrarunners had lower BMI and fat percentage (FAT%) and more favorable lipid profile compared to the control group (p < 0.05 for all). Ultrarunners had lower rate of pathologically high levels of plasma IL-6 (>1 pg/mL) compared to the control group (17% vs. 56%, p < 0.05). IMT was similar in both groups. In the ultrarunners' group, there was a positive correlation between EAT surrounding left anterior descending artery, circumflex artery, and RV and FAT%, and between EAT around circumflex artery and LDL and non-HDL cholesterol (p < 0.05 for all). In summary, extremely intensive training may decrease the risk of cardiovascular events in adult population of amateur athletes by reducing the amount and pro-inflammatory activity of EAT. However, more research is needed to draw firm conclusions regarding the anti- and pro-inflammatory effects of intensive training.

Effect of concentric vs. eccentric variant of lower limbs plyometric training on biomechanical and biochemical parameters.

AbstractThe study aimed to compare the effectiveness of two variants of 4 weeks plyometric training involving jumping up (dominance of concentric muscle work, UP) and jumping down (dominance of eccentric muscle work, DOWN) the stairs. Twenty-six young men were divided into two groups: UP (n = 13) and DOWN (n = 13). Control measurements of the muscle torques, vertical jumps, and creatine kinase (CK) activity were performed every week. The training resulted in significant changes (p < 0.001) in the muscle torques of the hip extensors (Δ ≈ 20% in both groups) and plantar flexors (ΔUP = 25%, ΔDOWN = 33%), but in the muscle torques of the knee extensors a significant (p < 0.001) increase occurred only in the group jumping down the stairs (ΔDOWN ≈ 15%). Furthermore, a significant increase (p < 0.001) of the height of the vertical jump was noted in the study only in the group jumping down (ΔDOWN = 8%). Training with the dominance of eccentric work caused greater weekly changes in the activity of creatine kinase in the plasma. The study confirmed that the exercise involving jumping on the stairs is viable in plyometric training, as it is an effective means of training the strength of the muscles of the lower limbs and vertical jump height, with a greater share assigned to jumping down consecutive steps.

The Effect of the Ultra-Marathon Run at a Distance of 100 Kilometers on the Concentration of Selected Adipokines in Adult Men.

Pro-inflammatory adipokines have a multifunctional role in adipogenesis, angiogenesis, glucose homeostasis, and inflammation. The aim of the present study is to evaluate the effect of running a 100 km ultra-marathon on serum levels of two adipokines: resistin and chemerin. Fifteen male participants complete a medical questionnaire and their body composition is assessed. Serum resistin, chemerin, high sensitivity C-reactive protein (hs-CRP), glucose, and lactate levels are measured at baseline and post-race. During-race data on fluid and food consumption and energy expenditure are calculated. There is a higher (p < 0.001) post-race concentration of resistin and hs-CRP compared with resting values, with no change in chemerin levels. There is an inverse correlation of the change in resistin levels with post-run glucose values (r = 0.742, p < 0.001) and a positive correlation between changes in hs-CRP and energy expenditure (r = 0.782, p < 0.001). The present results show the impact of running an ultra-marathon on serum levels of pro-inflammatory markers released by adipose tissue. It is difficult to establish whether these results may be due to the stress of exercise, high energy expenditure or caloric deficit. However, we suggest that an addition of resistin to traditional pro-inflammatory markers (including CRP) may improve the assessment of inflammation in conditions of high-energy expenditure.

Factors Related to Cardiac Troponin T Increase after Participation in a 100 Km Ultra-Marathon.

BACKGROUND: Intensive and prolonged exercise leads to a rise of troponin concentration in blood. The mechanism responsible for troponin release during exercise remains ill-defined. The study aim was to search for risk factors of troponin increase after a prolonged endurance competition. METHODS: The study included a group of 18 amateurs, healthy volunteers (median age 41.5 years, interquartile range - IQR 36-53 years, 83% male) who participated in a 100 km running ultra-marathon. Information on demographic characteristics, pre- and post-race heart rate, blood pressure, body composition and glucose, lactate (L), troponin T (hs-TnT) and C reactive protein (hs-CRP) concentration were obtained. Additionally, data on L and glucose levels every 9.2 km and fluid/food intakes during the race were collected. RESULTS: There was a significant hs-TnT increase after the race exceeding upper reference values in 66% of runners (from 5 IQR 3-7 ng/L to 14 IQR 12-26 ng/L, p < 0.0001). None of the baseline parameters predicted a post-race hs-TnT increase. The only factors, correlating with changes of hs-TnT were mean L concentration during the race (rho = 0.52, p = 0.03) and change of hs-CRP concentration (rho = 0.59, p = 0.01). CONCLUSIONS: Participation in a 100 km ultra-marathon leads to a modest, but significant hs-TnT increase in the majority of runners. Among analysed parameters only mean lactate concentration during the race and change in hs-CRP correlated with troponin change.

Cardiovascular magnetic resonance with parametric mapping in long-term ultra-marathon runners.

PURPOSE: There is a direct reverse dose-effect relationship between the amount of physical activity and cardiovascular risk. It is unknown whether this is true for extreme, persistent endurance training. The aim of the study was to assess structural changes of the heart in long-time ultra-marathon runners with special focus on myocardial fibrosis using parametric mapping. METHOD: We studied a group of 30 healthy, male ultra-marathon runners (mean age 40.9 ±â€¯6.6 yrs, median 9 yrs of running with frequent competitions) and 10 matched controls not engaged in any regular activities. All of them underwent cardiovascular magnetic resonance (CMR) with 3 T scanner including T1-mapping, late gadolinium enhancement (LGE) and extracellular volume (ECV) quantification. RESULTS: Athletes demonstrated significantly larger heart chambers and left ventricular (LV) mass. LV systolic function was unchanged. 73.3% of athletes fulfilled volumetric criteria for dilated cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy. Non-ischemic, small volume LGE was found in 8 athletes and in 1 control (27% vs. 10%, p = 0.40). It was localised at insertion points (5 athletes, 1 control) or in the septum or infero-lateral wall (3 athletes). Athletes with insertion point LGE had higher right ventricular end-diastolic volume index in comparison to athletes without LGE (p = 0.04), which suggests its relation to volume overload. There were no differences between athletes and non-athletes in terms of ECV values (26.1% vs. 25%, p = 0.29). CONCLUSIONS: Ultra-marathon runner's hearts demonstrate a high degree of structural remodelling, but there is no significant increase in focal or diffuse myocardial fibrosis.

Strength Abilities in Men 50+ as an Effect of Long-Distance Run Training.

The aim of this study was to evaluate the effect of long-term running training on muscle strength of men aged 50 and above. The study involved two groups of men aged 50 and above: physically active (E, n = 34) and inactive (NE, n = 20). Body composition was assessed with the electrical bioimpedance method. The isometric maximum voluntary contraction (MVC) was the main measurement. The value of muscle torque achieved by a group of synergists (operating in the given joint) during a short isometric contraction was evaluated. Ten groups of flexor and extensor muscles of the elbow, shoulder, hip, knee, and torso joints were measured. In addition, a 3 s measurement of grip strength of the right (Fr) and left (Fl) hand was taken using a hand dynamometer. The obtained values enabled to calculate the symmetry index (SI). Men who had been running regularly were characterized by a significantly lower strength level (p < .05). Results in the NE group were determined to a great extent by significantly different body weights (p < .001) and a significantly higher body fat mass (FAT) content (p < .001). SI was statistically higher in the reference group (p < .05). Long-distance run training reduces FAT while maintaining a high level of muscle strength. These studies indirectly confirm the effect of strengthening slow-twitch motor units in men aged 50 (Doherty & Brown 1993; Kanda & Hashizume 1989). In addition, stimulating the body through physical effort helps it also to maintain a high level of strength symmetry, which is a preventive factor in reducing the number of injuries.

Left ventricular hypertrophy in middle-aged endurance athletes: is it blood pressure related?

Both regular physical activity and hypertension may be related to increased myocardial thickness, but the interplay between these two factors in causing cardiac remodeling in athletes is still a matter of debate. The aim of this study was to analyze the relation between resting and peak exercise blood pressure (BP) and myocardial hypertrophy in healthy middle-aged amateur endurance athletes. The study included 30 male, long-term athletes (mean age 40.9±6.6 years) who underwent resting BP assessment, cardiopulmonary exercise testing with peak exercise BP measurement, and cardiac magnetic resonance. We found that interventricular septal diameter is increased in athletes with high-normal resting BP (n=11, 37%) - median 13 mm (interquartile range: 12-13.75 mm), but not in those with optimal or normal BP (n=19) - median 10 mm (10-11.75 mm), P=0.001. This finding is accompanied by significantly higher left and right ventricular mass index and larger left atrial area in the first group. These differences are even more pronounced in athletes in whom high-normal BP is accompanied by exaggerated blood pressure response (EBPR) to exercise, whereas isolated EBPR to exercise does not lead to hypertrophy or further left atrial enlargement. Prehypertension, isolated or combined with EBPR to exercise, affects cardiac remodeling in athletes. Identification of increased myocardial thickness in pure endurance middle-aged athletes should merit further investigation on masked hypertension.

Physiological Aspects of Different Roller Skiing Techniques in Field Conditions.

The main goal of the study was to evaluate the impact of different roller skiing techniques (classical CT and skating ST) performed under field conditions on physical capacity variables in cross-country skiers. The second purpose was to evaluate the possibility to use the test results conducted under field and laboratory conditions interchangeably to determine training loads. Eight international-level cross-country skiers (4 male, 4 female) with 8.8 ± 1.3 years of skiing experience took part in the study. The athletes performed three graded tests to exhaustion: two under field conditions (roller skiing CT and ST techniques) and one in the laboratory: treadmill running (TR). All tests were conducted within a period of two weeks to compare general and specific physical capacity outcomes. ANOVA demonstrated significant differences in the threshold heart rate (HRAT4) (ST 175.3 ± 10.8 bpm, CT 175.8 ± 10.9 bpm, TR 181.5 ± 11.1 bpm; p = 0.004), maximal oxygen uptake (VO2max) (ST 64.0 ± 4.65 ml/kg/min, CT 61.5 ± 5.09 ml/kg/min, TR 65.9 ± 2.30 ml/kg/min; p = 0.008) and maximal HR (ST 189.3 ± 10.9 bpm, CT 188.9 ± 10.6 bpm, TR 199.5 ± 10.3 bpm; p = 0.002). No significant differences were observed between classical and skating roller skiing techniques for maximal and threshold values except for threshold velocity (CT 13.4 ± 1.11 km/h vs. ST 14.7 ± 1.17 km/h p = 0.002). Maximal velocity was not measured. The main finding of the study is that it is possible to use threshold HR values obtained in roller skiing tests performed using the classical or skating techniques interchangeably to determine roller skiing training loads. The results of the study indicate that there is a need to verify maximal treadmill running exertion variables in specific roller skiing tests.

Effects of Short-Term Plyometric Training on Physical Performance in Male Handball Players.

The aim of this study was to compare the effects of plyometric and jump training on physical performance in young male handball players. Twenty-six young male handball players were divided into two sub-groups to perform a five-week pre-season training programme supplemented with two ground-reactive protocols with an equal number of jumping exercises referred as to ground contacts: plyometric training (PLY; n = 14) and standard jump training (CON; n = 12). Before and after training, repeated sprint ability (RSA), jumping ability (JA), maximal oxygen uptake (VO2max) and aerobic power at the anaerobic threshold (PAT) were measured. A two-factor analysis revealed significant time effects with improvements in fat mass (p = 0.012), maximal power during the incremental cycling test (p = 0.001) and PAT (p < 0.001), power decline (PDEC) and maximal power (Pmax) in the 5th repetition (p < 0.05 and p < 0.01, respectively). The training-induced changes in absolute and relative peak power in the RSA test and absolute VO2max approached significance (p = 0.06, p = 0.053 and p = 0.06). No intervention time × exercise protocol effects were observed for any indices of JA, RSA and aerobic capacity. A five-week pre-season conditioning programme supplemented with only 15 sessions of plyometric exercise did not induce any additional benefits, compared to a matched format of standard jump training, in terms of improving jumping performance and maximal power in the RSA test. Aerobic capacity and the fatigue index in RSA were maintained under these two training conditions.

Evaluation of the treatment results in patients with rhegmatogenous retinal detachment treated by pars plana vitrectomy with air: Preliminary results.

PURPOSE: The aim of this study was to evaluate the effectiveness of treatment and the restoration of the anatomic conditions (retinal reattachment) in rhegmatogenous retinal detachment treated by pars plana vitrectomy (PPV) using air as endotamponade. METHODS: Twelve patients (12 eyes) with rhegmatogenous retinal detachment were included in the study. These were eyes with retinal detachment both with and without macular involvement. During the PPV surgery, the peripheral and central part of the vitreous body was excised to eliminate the formation of vitreoretinal traction after surgery, laser therapy was performed peripherally and in retinal openings, and the eyeball was filled with filtered air. Local conditions were evaluated at 1, 7, 14, 30, 90, and 180 days after the procedure. RESULTS: The result of the patients' examination on the 30 day after surgery showed that 100% of cases achieved retinal reattachment and improved vision (best corrected visual acuity). In the long-term assessment, the final visual acuity was better in 11 patients (91.7%) compared to the initial results. On average, 7 days after the surgery, air in the eyeball occupied about one-fifth of the vitreous chamber and was completely absorbed about 10 to 14 days after surgery. CONCLUSIONS: In the above-mentioned study, very good results of treatment of open-rooted retinal detachment were achieved. The air was quickly absorbed and visual acuity improved. Owing to the relatively fast absorption time, this method could be used successfully in high altitude patients and people often travelling by airplane.