Outcomes of aortic surgery in patients with Takayasu arteritis.

OBJECTIVE: To investigate the presentation, aortic involvement, and surgical outcomes in patients with Takayasu arteritis undergoing aortic surgery. METHODS: We queried our surgical database for patients with Takayasu arteritis who underwent aortic surgery from 1994 to 2022. RESULTS: There were a total of 31 patients with Takayasu arteritis who underwent aortic surgery. Patients' median age at the time of diagnosis was 35.0 years (interquartile range, 25.0-42.0). The majority were female (n = 27, 87.0%). Most patients (n = 28, 90.3%) were diagnosed before surgery, and 3 patients (9.6%) were diagnosed perioperatively. The median time interval from diagnosis to surgery was 2.8 years (interquartile range, 0.5-13.9). The most common presentation was ascending aorta aneurysm (n = 22, 70.9%), and severe aortic regurgitation was the most common valve insufficiency (n = 17, 54.8%). The most common operation was ascending aorta replacement (n = 20, 64.5%), and aortic valve replacement was the most common valve intervention (n = 17, 54.8%). Active vasculitis was identified in 2 (11.7%) aortic valve specimens. Early mortality was 6.5% (n = 2). A total of 6 deaths occurred over a median follow-up of 13.1 years (interquartile range, 6.1-25.2). Survival at 10 years was 86.7% (95% CI, 75.4-99.7). A total of 5 patients (16.1%) required a subsequent operation in a median of 1.9 years (interquartile range, 0.2-7.4). Freedom from reoperation was 96.9% (95% CI, 90.1-100) at 1 year, 89.4% (95% CI, 78.7-100.0) at 5 years, and 77.5% (95% CI, 61.2-98.1) at 10 and 15 years. CONCLUSIONS: Ascending aorta aneurysm and aortic valve regurgitation are the most frequent presentations in patients with Takayasu arteritis requiring aortic surgery. Surgery in these individuals is safe, with acceptable short- and long-term results.

A national anti-doping education programme reduces doping susceptibility in British athletes.

The World Anti-Doping Agency's International Standard for Education instructs that national and international sport organisations evaluate their education programmes. We addressed this directive by examining the effectiveness of a national anti-doping programme. Athletes (N = 302, 41% female) completed measures of doping susceptibility, intention to use dietary supplements, Spirit of Sport and moral values, anti-doping knowledge and practice, and whistleblowing, prior-to and three-months after attending an anti-doping education programme. At three-month follow-up, athletes reported decreased doping susceptibility and intention to use dietary supplements coupled with increased importance of values, anti-doping knowledge, anti-doping practice and whistleblowing. Within-participant, moderated-mediation analyses revealed that programme-related changes in doping susceptibility were indirectly related to changes in intention to use dietary supplements, and, that this indirect relationship was moderated by moral values. These findings confirm the effectiveness of a national anti-doping education programme and highlight the contribution of dietary supplement use and personal values to changes in doping susceptibility.

Sodium Bicarbonate and Time-to-Exhaustion Cycling Performance: A Retrospective Analysis Exploring the Mediating Role of Expectation.

BACKGROUND: Research has shown that ingesting 0.3 g·kg-1 body mass sodium bicarbonate (NaHCO3) can improve time-to-exhaustion (TTE) cycling performance, but the influence of psychophysiological mechanisms on ergogenic effects is not yet understood. OBJECTIVE: This study retrospectively examined whether changes in TTE cycling performance are mediated by positive expectations of receiving NaHCO3 and/or the decline in blood bicarbonate during exercise. METHODS: In a randomised, crossover, counterbalanced, double-blind, placebo-controlled design, 12 recreationally trained cyclists (maximal oxygen consumption, 54.4 ± 5.7 mL·kg·min-1) performed four TTE cycling tests 90 min after consuming: (1) 0.3 g·kg-1 body mass NaHCO3 in 5 mL·kg-1 body mass solution, (2) 0.03 g·kg-1 body mass sodium chloride in solution (placebo), (3) 0.3 g·kg-1 body mass NaHCO3 in capsules and (4) cornflour in capsules (placebo). Prior to exercise, participants rated on 1-5 Likert type scales how much they expected the treatment they believe had been given would improve performance. Capillary blood samples were measured for acid-base balance at baseline, pre-exercise and post-exercise. RESULTS: Administering NaHCO3 in solution and capsules improved TTE compared with their respective placebos (solution: 27.0 ± 21.9 s, p = 0.001; capsules: 23.0 ± 28.1 s, p = 0.016). Compared to capsules, NaHCO3 administered via solution resulted in a higher expectancy about the benefits on TTE cycling performance (Median: 3.5 vs. 2.5, Z = 2.135, p = 0.033). Decline in blood bicarbonate during exercise was higher for NaHCO3 given in solution compared to capsules (2.7 ± 2.1 mmol·L-1, p = 0.001). Mediation analyses showed that improvements in TTE cycling were indirectly related to expectancy and decline in blood bicarbonate when NaHCO3 was administered in solution but not capsules. CONCLUSIONS: Participants' higher expectations when NaHCO3 is administered in solution could result in them exerting themselves harder during TTE cycling, which subsequently leads to a greater decline in blood bicarbonate and larger improvements in performance. KEY POINTS: Ingesting 0.3 g·kg-1 body mass sodium bicarbonate in solution and capsules improved time-to-exhaustion cycling performance Positive expectancy about the benefits of sodium bicarbonate and decline in blood bicarbonate were higher when sodium bicarbonate was administered in solution compared with capsules Improvements in time-to-exhaustion cycling performance for sodium bicarbonate administered in solution were related to expectancy and the enhanced extracellular buffering response.

Are dietary supplement users more likely to dope than non-users?: A systematic review and meta-analysis.

In the past decade, a body of evidence has reported that dietary supplement use is related to prohibited performance enhancing substance use (i.e., doping). To help international and national sport organisations understand the degree to which dietary supplement use is related to doping, the objectives of this systematic review and meta-analysis were to 1) compare the prevalence of doping between dietary supplement users and non-users and 2) identify whether supplement use is related to doping social cognitive factors. We searched for studies sampling athletes and that measured both dietary supplement use and doping in EMBASE, MEDLINE, PsychINFO, CINAHL and SPORTDiscus from database creation to May 2022. Risk of bias was assessed using JBI Critical Appraisal Checklist for cross-sectional studies and the STROBE checklist. Twenty-six cross-sectional studies, involving 13,296 athletes were included. Random-effect models revealed that doping was 2.74 (95% CI=2.10 to 3.57) times more prevalent in dietary supplement users (pooled prevalence = 14.7%) than non-users (6.7%), and that users reported stronger doping intentions (r=0.26, 0.18 to 0.34) and attitudes (r=0.21, 0.13 to 0.28) compared to non-users. Preliminary evidence also suggests that dietary supplement users were less likely to dope if they were more task oriented and had a stronger sense of morality. Results of the review are limited by the cross-sectional design used in all studies and lack of consistency in measurement of dietary supplement use and doping. Data indicate that athletes using dietary supplements are more likely to self-report doping Anti-doping policy should, therefore, target dietary supplement use in anti-doping education programmes by providing alternative strategies for performance enhancement or highlighting the safest ways they can be consumed. Similarly, as a large proportion of athletes use dietary supplements without doping, further research is needed to understand the factors that protect a dietary supplement user from doping. No funding was received for the review. A study protocol can be found here: https://osf.io/xvcaq.

I saw the "atoll sign" - and now I need a tropical vacation.

The atoll sign describes ring-shaped opacities surrounding central ground glass attenuation seen on chest CT and was first associated with organizing pneumonia. The name is derived from the Maldives' language, denoting a ring or crescentic-shaped coral reef island surrounding a central lagoon. Although biopsy is usually required for diagnosis, understanding some of the more common pathologies associated with the atoll sign may help narrow a differential and guide management.

Are Dietary Supplements a Gateway to Doping? A Retrospective Survey of Athletes' Substance Use.

Background: It is proposed that the use of dietary supplements might lead to the use of doping substances. This has been termed the gateway hypothesis. However, within an athletic sample, no research has examined the order in which these substances are consumed and what may explain the progression from dietary supplement use to doping. Objective: To identify whether dietary supplement use precedes doping and examine what moderates the dietary supplement-doping relationship. Methods: Competitive athletes (N=1,081, 42.0% female; Age=29.3±10.8 years) completed an online survey measuring dietary supplement use, doping use, doping subjective norms and age of using a supplement and/or doping substance. Results: Dietary supplement users were 11 times more likely to dope than non-users (OR=11.28, 95% CI = 2.72 to 46.77). Age for first use of a dietary supplement was younger than use of a doping substance (mean difference=-4.5±5.1 years old, p<0.001, d=0.90). Over three-quarters of doping users reported using a dietary supplement first (77.1%), whereas a small proportion of athletes started using dietary supplements and doping at the same time (12.5%) and some used doping substances before using dietary supplements (10.4%). Moderation analysis revealed that dietary supplement users may be more likely to dope because of a more favourable social acceptance of using prohibited substances than non-users. Conclusions: Data suggest that dietary supplement use is more likely to precede doping. However, not all doping users begin with using dietary supplements, which highlights the importance of measuring the temporal order of dietary supplement and doping use in future research.

Cardiac amyloidosis-An underdiagnosed cause of heart failure: A case report and review of literature.

Restrictive cardiomyopathy secondary to cardiac amyloidosis is an underdiagnosed, but treatable, cause of heart failure involving an extracellular deposition of misfolded protein. Hereby, we report a case of a female patient with history of nephrotic syndrome for 1 year who subsequently presented with symptoms of heart failure. The findings on cardiac imaging supported the suspicion of cardiac amyloidosis. Further laboratory workup for amyloidosis was pursued along with endomyocardial biopsy which confirmed amyloidosis-AL type. Patient was started on chemotherapy. The case underscores the importance of a timely diagnosis with the help of symptomatology and imaging along with a multidisciplinary approach for patient care.

Efficacy of sodium bicarbonate ingestion strategies for protecting blinding.

Sodium bicarbonate (NaHCO3) is a widely researched ergogenic aid, but the optimal blinding strategy during randomised placebo-controlled trials is unknown. In this multi-study project, we aimed to determine the most efficacious ingestion strategy for blinding NaHCO3 research. During study one, 16 physically active adults tasted 0.3 g kg-1 body mass NaHCO3 or 0.03 g kg-1 body mass sodium chloride placebo treatments given in different flavour (orange, blackcurrant) and temperature (chilled, room temperature) solutions. They were required to guess which treatment they had received. During study two, 12 recreational athletes performed time-to-exhaustion (TTE) cycling trials (familiarisation, four experimental). Using a randomised, double-blind design, participants consumed 0.3 g kg-1 body mass NaHCO3 or a placebo in 5 mL kg-1 body mass chilled orange squash/water solutions or capsules and indicated what they believed they had received immediately after consumption, pre-TTE and post-TTE. In study one, NaHCO3 prepared in chilled orange squash resulted in the most unsure ratings (44%). In study two, giving NaHCO3 in capsules resulted in more unsure ratings than in solution after consumption (92 vs 33%), pre-TTE (67 vs. 17%) and post-TTE (50 vs. 17%). Administering NaHCO3 in capsules was the most efficacious blinding strategy which provides important implications for researchers conducting randomised placebo-controlled trials.

Reproducibility of 20-min Time-trial Performance on a Virtual Cycling Platform.

This study aimed to analyse the reproducibility of mean power output during 20-min cycling time-trials, in a remote home-based setting, using the virtual-reality cycling software, Zwift. Forty-four cyclists (11 women, 33 men; 37±8 years old, 180±8 cm, 80.1±13.2 kg) performed 3×20-min time-trials on Zwift, using their own setup. Intra-class correlation coefficient (ICC), coefficient of variation (CV) and typical error (TE) were calculated for the overall sample, split into 4 performance groups based on mean relative power output (25% quartiles) and sex. Mean ICC, TE and CV of mean power output between time-trials were 0.97 [0.95-0.98], 9.4 W [8.0-11.3 W], and 3.7% [3.2-4.5], respectively. Women and men had similar outcomes (ICC: 0.96 [0.89-0.99] vs. 0.96 [0.92-0.98]; TE: 8.3 W [6.3-13.1] vs. 9.7 W [8.2-12.2]; CV: 3.8% [2.9-6.1] vs. 3.7% [3.1-4.7], respectively), although cyclists from the first quartile showed a lower CV in comparison to the overall sample (Q1: 2.6% [1.9-4.1] vs. overall: 3.7% [3.2-4.5]). Our results indicate that power output during 20-min cycling time-trials on Zwift are reproducible and provide sports scientists, coaches and athletes, benchmark values for future interventions in a virtual-reality environment.

Impact of Medicaid expansion on young adult firearm and motor vehicle crash trauma patients.

BACKGROUND: The Affordable Care Act Medicaid expansion has increased insurance coverage and reduced some disparities in care and outcomes among trauma patients, but its impact on subsets of trauma patients with particular mechanisms of injury are unclear. This study evaluated the association of the Affordable Care Act Medicaid expansion with insurance coverage, trauma care, and outcomes among young adults hospitalized for firearm- or motor vehicle crash-related injuries. MATERIALS AND METHODS: We used statewide hospital discharge data from 5 Medicaid expansion and 5 nonexpansion states to compare changes in insurance coverage and outcomes among firearm and motor vehicle crash trauma patients aged 19-44 from before (2011-2013) to after (2014-2017) Medicaid expansion. We examined difference in differences overall, by race/ethnicity, and by zip-code-level median income quartile. RESULTS: Medicaid expansion was associated with a decrease in the proportion of young adult motor vehicle crash and firearm trauma patients who were uninsured (motor vehicle crash: difference in differences - 12.7 percentage points, P < .001; firearm: difference in differences - 30.7 percentage points, P < .001). Medicaid expansion was also associated with increases in the percentage of patients discharged to any rehabilitation (motor vehicle crash: difference in differences 1.78 percentage points, P = .001; firearm: difference in differences 2.07 percentage points, P = .02) and inpatient rehabilitation (motor vehicle crash: difference in differences 1.21 percentage points, P = .001; firearm: difference in differences 1.58 percentage points, P = .002). Among patients with firearm injuries, Medicaid expansion was associated with a reduction in in-hospital mortality (difference in differences - 1.55 percentage points, P = .002). CONCLUSION: In its first 4 years, the Affordable Care Act Medicaid expansion increased insurance coverage and access to rehabilitation among young adults hospitalized for firearm- or motor vehicle crash-related injuries while reducing inpatient mortality among firearm trauma patients.

Moral values and moral identity moderate the indirect relationship between sport supplement use and doping use via sport supplement beliefs.

The Incremental Model of Doping Behaviour suggests doping grows out of the habitual use of performance-enhancing methods (e.g., sport supplements) and belief that they are necessary for performance. Importantly, in this model, doping is viewed as functional rather than moral choice. In two studies, we examined whether sport supplement use was indirectly related to doping use via sport supplement beliefs, and whether personal morality moderated this relationship. Competitive athletes (Study 1, N = 366; Study 2, N = 200) completed measures of supplement use, beliefs, and doping use. They also completed measures of moral values (Study 1) and moral identity (Study 2). In both studies, supplement use was indirectly related to doping use via beliefs. Moreover, this indirect relationship was moderated by moral values (Study 1) and moral identity (Study 2). That is, the relationship between supplement use and doping use via beliefs was negated when moral values and moral identity were high but not when they were low or moderate. Taken together, our findings suggest that sport supplement users, who believe they are necessary, are more likely to dope if they have low moral values and believe that being a moral person is unimportant to their self-image.

Blood pressure and cardiac autonomic adaptations to isometric exercise training: A randomized sham-controlled study.

Isometric exercise training (IET) is increasingly cited for its role in reducing resting blood pressure (BP). Despite this, few studies have investigated a potential sham effect attributing to the success of IET, thus dictating the aim of the present study. Thirty physically inactive males (n = 15) and females (n = 15) were randomly assigned into three groups. The IET group completed a wall squat intervention at 95% peak heart rate (HR) using a prescribed knee joint angle. The sham group performed a parallel intervention, but at an intensity (<75% peak HR) previously identified to be inefficacious over a 4-week training period. No-intervention controls maintained their normal daily activities. Pre- and post-measures were taken for resting and continuous blood pressure and cardiac autonomic modulation. Resting clinic and continuous beat-to-beat systolic (-15.2 ± 9.2 and -7.3 ± 5.6 mmHg), diastolic (-4.6 ± 5 and -4.5 ± 5.1), and mean (-7 ± 4.2 and -7.5 ± 5.3) BP, respectively, all significantly decreased in the IET group compared to sham and no-intervention control. The IET group observed a significant decrease in low-frequency normalized units of heart rate variability concurrent with a significant increase in high-frequency normalized units of heart rate variability compared to both the sham and no-intervention control groups. The findings of the present study reject a nonspecific effect and further support the role of IET as an effective antihypertensive intervention. Clinical Trials ID: NCT05025202.

Ego orientation is related to doping likelihood via sport supplement use and sport supplement beliefs.

ABSTRACTA growing body of evidence suggests sport supplement use is positively related to doping likelihood, both directly and indirectly via beliefs that sport supplements are effective for improving performance. However, it is unclear what leads an athlete to use sport supplements and whether such factors play a role in the supplement-beliefs-doping relationship. To address this issue, we examined whether motivational goal orientations were related to doping likelihood directly and indirectly via sport supplement use and sport supplement beliefs. Competitive athletes (N = 362, 39% female, mean ± SD; age = 23.6 ± 10.3 years, hours per week training = 5.8 ± 2.1, years competing = 5.8 ± 5.4) from a range of sports (e.g. athletics, soccer, weightlifting) completed an online survey measuring task and ego goal orientation, sport supplement use, sport supplement beliefs, and doping likelihood. Results indicated that ego orientation, but not task orientation, was indirectly related to doping likelihood via sport supplement use and sport supplement beliefs. This suggests that athletes who are ego oriented are more likely to use supplements, believe supplements are effective, and dope. These data suggest that researchers should consider ego goal orientations when interpreting relationships between sport supplement use and doping likelihood.Highlights Ego orientation is related to doping likelihood via sport supplement use and beliefs.Task orientation is not related to doping likelihood via sport supplement use and beliefs.Ego-orientated athletes using sport supplements may be more likely to dope.Researchers should consider ego goal orientation when interpreting relationships between sport supplement use and doping likelihood.

Prefrontal Cortex Oxygenation During Endurance Performance: A Systematic Review of Functional Near-Infrared Spectroscopy Studies.

Introduction: A myriad of factors underlie pacing-/exhaustion-decisions that are made during whole-body endurance performance. The prefrontal cortex (PFC) is a brain region that is crucial for decision-making, planning, and attention. PFC oxygenation seems to be a mediating factor of performance decisions during endurance performance. Nowadays, there is no general overview summarizing the current knowledge on how PFC oxygenation evolves during whole-body endurance performance and whether this is a determining factor. Methods: Three electronic databases were searched for studies related to the assessment of PFC oxygenation, through near-IR spectroscopy (NIRS), during endurance exercise. To express PFC oxygenation, oxygenated (HbO2) and deoxygenated hemoglobin (HHb) concentrations were the primary outcome measures. Results: Twenty-eight articles were included. Ten articles focused on assessing prefrontal oxygenation through a maximal incremental test (MIT) and 18 focused on using endurance tasks at workloads ranging from low intensity to supramaximal intensity. In four MIT studies measuring HbO2, an increase of HbO2 was noticed at the respiratory compensation point (RCP), after which it decreased. HbO2 reached a steady state in the four studies and increased in one study until exhaustion. All studies found a decrease or steady state in HHb from the start until RCP and an increase to exhaustion. In regard to (non-incremental) endurance tasks, a general increase in PFC oxygenation was found while achieving a steady state at vigorous intensities. PCF deoxygenation was evident for near-to-maximal intensities at which an increase in oxygenation and the maintenance of a steady state could not be retained. Discussion/Conclusion: MIT studies show the presence of a cerebral oxygenation threshold (ThCox) at RCP. PFC oxygenation increases until the RCP threshold, thereafter, a steady state is reached and HbO2 declines. This study shows that the results obtained from MIT are transferable to non-incremental endurance exercise. HbO2 increases during low-intensity and moderate-intensity until vigorous-intensity exercise, and it reaches a steady state in vigorous-intensity exercise. Furthermore, ThCox can be found between vigorous and near-maximal intensities. During endurance exercise at near-maximal intensities, PFC oxygenation increases until the value exceeding this threshold, resulting in a decrease in PFC oxygenation. Future research should aim at maintaining and improving PFC oxygenation to help in improving endurance performance and to examine whether PFC oxygenation has a role in other performance-limiting factors.

Can taste be ergogenic?

Taste is a homeostatic function that conveys valuable information, such as energy density, readiness to eat, or toxicity of foodstuffs. Taste is not limited to the oral cavity but affects multiple physiological systems. In this review, we outline the ergogenic potential of substances that impart bitter, sweet, hot and cold tastes administered prior to and during exercise performance and whether the ergogenic benefits of taste are attributable to the placebo effect. Carbohydrate mouth rinsing seemingly improves endurance performance, along with a potentially ergogenic effect of oral exposure to both bitter tastants and caffeine although subsequent ingestion of bitter mouth rinses is likely required to enhance performance. Hot and cold tastes may prove beneficial in circumstances where athletes' thermal state may be challenged. Efficacy is not limited to taste, but extends to the stimulation of targeted receptors in the oral cavity and throughout the digestive tract, relaying signals pertaining to energy availability and temperature to appropriate neural centres. Dose, frequency and timing of tastant application likely require personalisation to be most effective, and can be enhanced or confounded by factors that relate to the placebo effect, highlighting taste as a critical factor in designing and administering applied sports science interventions.

A Moral Intervention Reduces Doping Likelihood in British and Greek Athletes: Evidence From a Cluster Randomized Control Trial.

OBJECTIVES: The authors aimed to develop a moral intervention and to determine whether it was more effective in preventing doping than an educational (i.e., knowledge-based) intervention; their primary outcome was doping likelihood, and the secondary outcomes were moral identity, moral disengagement, moral atmosphere, and anticipated guilt. METHODS: Eligible athletes (N = 303) in the United Kingdom and Greece took part in the study. The authors randomly assigned 33 clubs to either the moral or the educational intervention. They measured outcomes pre- and postintervention and at 3- and 6-month follow-up. RESULTS: Athletes in both interventions in both countries reported lower doping likelihood and moral disengagement and higher guilt from pre- to postintervention. These effects were maintained at the 3- and 6-month follow-ups. There were no effects on moral identity or moral atmosphere. CONCLUSIONS: In addition to disseminating information about doping, doping prevention programs should include content that focuses on moral variables.

Athletes using ergogenic and medical sport supplements report more favourable attitudes to doping than non-users.

OBJECTIVES: Our study objectives were twofold: 1) examine whether users and non-users of different types of sport supplements vary in doping attitudes and sport supplement beliefs, and 2) determine whether the type of sport supplement is directly and indirectly (via sport supplement beliefs) related to doping attitudes. DESIGN: Cross-sectional survey. METHODS: Athletes (N=557; 77% male, mean±standard deviation; age=20.8±4.5 years, training=5.7±4.2h per week, competing=11.1±5.2 years) completed measures of sport supplement use, sport supplement beliefs, and doping attitudes. Sport supplements were classified into: ergogenic, medical, sport food and drinks, and superfoods. RESULTS: Compared to non-users, users of ergogenic (d=0.31, p<0.01) and medical (d=0.42, p<0.01) sport supplements reported more favourable attitudes towards doping. In addition, compared to non-users, users of ergogenic (d=1.10, p<0.01), medical (d=0.80, p<0.01) and sport food/drink (d=0.58, p<0.01) supplements reported stronger beliefs in the effectiveness of sport supplements to improve sport performance. Use of ergogenic, medical and sport food/drink supplements was indirectly related to doping attitudes via sport supplement beliefs. CONCLUSIONS: Researchers examining the relationship between sport supplement use and doping should differentiate between sport supplement types to improve measurement accuracy. Sport practitioners administering ergogenic and medical sport supplements to athletes may need to provide additional anti-doping education to counteract any favourable attitudes towards doping.