Genomic analysis reveals association of specific SNPs with athletic performance and susceptibility to injuries in professional soccer players.

The development of specific and individualized training programs is a possible way to improve athletic performance and minimize injuries in professional athletes. The information regarding the sport's physical demands and the athletes' physical profile have been, so far, considered as exhaustive for the design of effective training programs. However, it is currently emerging that the genetic profile has to be also taken into consideration. By merging medical and genetic data, it is thus possible to identify the athlete's specific attitude to respond to training, diet, and physical stress. In this context, we performed a study in which 30 professional soccer players, subjected to standard sport medical evaluation and practices, were also screened for genetic polymorphism in five key genes (ACTN3, COL5A1, MCT1, VEGF, and HFE). This genetic analysis represents the central point of a multidisciplinary method that can be adopted by elite soccer teams to obtain an improvement in athletic performance and a concomitant reduction of injuries by tailoring training and nutritional programs. The genetic fingerprinting of single athletes led to the identification of two performance-enhancing polymorphisms (ACTN3 18705C>T, VEGF-634C>G) significantly enriched. Moreover, we derived a genetic model based on the gene set analyzed, which was tentatively used to reduce athletes' predisposition to injuries, by dictating a personalized nutrition and training program. The potential usefulness of this approach is concordant with data showing that this team has been classified as the healthiest and least injured team in Europe while covering the highest distance/match with the highest number of high-intensity actions/match.

Vascular access for hemodialysis: experience of a team of nephrologists.

A survey conducted by Bonucchi et al. underlined the different types of doctors placing arteriovenous fistula (AVF) for hemodialysis in the United States and Europe (in particular Italy). In fact, nephrologists definitely prevail in Italy, where almost 48.8% of nephrologists place an AVF themselves or with the help of a vascular surgeon (26.4%). In Europe, only 35% do so, whereas 89% of AVF are performed by surgeons in the United States. In 98% of the cases occurring at our center, the AVF was placed and reviewed by the nephrologists. This paper reports surgery cases related to the period between January 1983 and September 2006. Over this time, 1386 operations for placing and reviewing vascular access were conducted. Among these, 47 (3.3%) were related to a cuffed central venous catheter (CVC); 1138 (80.2%) related to a distal AVF; 201 (10.6%) related to a proximal AVF; and 51 (3.6%) related to an arteriovenous graft (AVG). In addition, 33 (2.3%) operations performed before January 1983 relating to AV Scribner shunts were included. Arteriovenous fistulas or AVGs were provided to our patients (only 2.6% of them have a CVC), and AVF rescue operations were performed in the shortest possible time with advantages for the patient and his vascular access.

Arteriovenous fistula: end-to-end or end-to side anastomosis?

The purpose of the present study was to compare the end-to-end (ETEa) with the end-to-side (ETSa) anastomosis in patients starting hemodialysis by means of radio-cephalic artero-venous fistulae (AVF). In our experience, we compared the results, as early failure (EF), late thrombosis (LT), stenosis, steal syndrome, and primary patency (PP), in 2 groups of hemodialysis incident patients that had been placed an AVF by means of ETEa or ETSa. The observation period lasted 24 months for each of the 2 types of AVF, starting from October 2005 to September 2007 for ETEa and from October 2007 to September 2009 for ETSa. One hundred forty patients were included in the present study. We have consecutively performed 99 AVF interventions at the wrist or at the third distal of the forearm, in 70 patients by means of ETEa and 82 AVF interventions in the same anatomical places in 70 patients by means of ETSa. The patients with ETEa had a mean age of 64.4 ± 14.6 years, males were 65.8% and the age dialysis at the end of observation was 10.4 ± 5.7 months. Those with ETSa had a mean age of 65.9 ± 15.5 years and the males were 62.9%, the age dialysis at the end of observation was 9.2 ± 5.5 months. The surgical team was composed by the same nephrologists. The statistical study was performed by means of the χ chi-square and Fisher's exact test. We have observed more late thrombosis (10% vs. 4.1%) and stenosis (21.4% vs. 2.7%) in ETEa than in ETSa. The number of early thrombosis was similar in the 2 types of anastomosis. The primary patency 1-year rate was better though not significantly in the ETS (80% vs. 85.7%) In our experience the ETSa provides, overall better results, both regarding the complications and primary survival than ETEa. For the benefits that seem to come from it, we believe, that a broad ETSa in the distal native AVF is preferable to the ETEa.