Longitudinal perioperative patient-reported outcomes in open compared with minimally invasive hysterectomy.

BACKGROUND: There are few prospective studies in the gynecologic surgical literature that compared patient-reported outcomes between open and minimally invasive hysterectomies within enhanced recovery after surgery pathways. OBJECTIVE: This study aimed to compare prospectively collected perioperative patient-reported symptom burden and interference measures in open compared with minimally invasive hysterectomy cohorts within enhanced recovery after surgery pathways. STUDY DESIGN: We compared patient-reported symptom burden and functional interference in 646 patients who underwent a hysterectomy (254 underwent open surgery and 392 underwent minimally invasive surgery) for benign and malignant indications under enhanced recovery after surgery protocols. Outcomes were prospectively measured using the validated MD Anderson Symptom Inventory, which was administered perioperatively up to 8 weeks after surgery. Cohorts were compared using Fisher exact and chi-squared tests, adjusted longitudinal generalized linear mixed modeling, and Kaplan Meier curves to model return to no or mild symptoms. RESULTS: The open cohort had significantly worse preoperative physical functional interference (P=.001). At the time of hospital discharge postoperatively, the open cohort reported significantly higher mean symptom severity scores and more moderate or severe scores for overall (P<.001) and abdominal pain (P<.001), fatigue (P=.001), lack of appetite (P<.001), bloating (P=.041), and constipation (P<.001) when compared with the minimally invasive cohort. The open cohort also had significantly higher interference in physical functioning (score 5.0 vs 2.7; P<.001) than the minimally invasive cohort at the time of discharge with no differences in affective interference between the 2 groups. In mixed modeling analysis of the first 7 postoperative days, both cohorts reported improved symptom burden and functional interference over time with generally slower recovery in the open cohort. From 1 to 8 postoperative weeks, the open cohort had worse mean scores for all evaluated symptoms and interference measures except for pain with urination, although scores indicated mild symptomatic burden and interference in both cohorts. The time to return to no or mild symptoms was significantly longer in the open cohort for overall pain (14 vs 4 days; P<.001), fatigue (8 vs 4 days; P<.001), disturbed sleep (2 vs 2 days; P<.001), and appetite (1.5 vs 1 days; P<.001) but was significantly longer in the minimally invasive cohort for abdominal pain (42 vs 28 days; P<.001) and bloating (42 vs 8 days; P<.001). The median time to return to no or mild functional interference was longer in the open than in the minimally invasive hysterectomy cohort for physical functioning (36 vs 32 days; P<.001) with no difference in compositive affective functioning (5 vs 5 days; P=.07) between the groups. CONCLUSION: Open hysterectomy was associated with increased symptom burden in the immediate postoperative period and longer time to return to no or mild symptom burden and interference with physical functioning. However, all patient-reported measures improved within days to weeks of both open and minimally invasive surgery and differences were not always clinically significant.

Evaluation of a tiered opioid prescription algorithm in an ERAS pathway: exploring opportunities for further refinement.

BACKGROUND: Opioid over-prescription is wasteful and contributes to the opioid crisis. We implemented a personalized tiered discharge opioid protocol and education on opioid disposal to minimize over-prescription. OBJECTIVE: To evaluate the intervention by investigating opioid use post-discharge for women undergoing abdomino-pelvic surgery, and patient adherence to opioid disposal education. METHODS: We analyzed post-discharge opioid consumption among 558 patients. Eligible patients included those who underwent elective gynecologic surgery, were not taking scheduled opioids pre-operatively, and received discharge opioids according to a tiered prescribing algorithm. A survey assessing discharge opioid consumption and disposal safety knowledge was distributed on post-discharge day 21. Over-prescription was defined as >20% of the original prescription left over. Descriptive statistics were used for analysis. RESULTS: The survey response rate was 61% and 59% in the minimally invasive surgery and open surgery cohorts, respectively. Overall, 42.8% of patients reported using no opioids after hospital discharge, 45.2% in the minimally invasive surgery and 38.6% in the open surgery cohort. Furthermore, 74.9% of respondents were over-prescribed, with median age being statistically significant for this group (p=0.004). Finally, 46.4% of respondents expressed no knowledge regarding safe disposal practices, with no statistically significant difference between groups (p>0.99). CONCLUSION: Despite implementation of the tiered discharge opioid algorithm aimed to personalize opioid prescriptions to estimated need, we still over-prescribed opioids. Additionally, despite targeted education, nearly half of all patients who completed the survey did not know how to dispose of their opioid tablets. Additional efforts are needed to further refine the algorithm to reduce over-prescription of opioids and improve disposal education.

Concurrent Validity and Reliability of Two Portable Powermeters (Power2Max vs. PowerTap) to Measure Different Types of Efforts in Cycling.

The purpose was to assess the concurrent validity and reliability of two portable powermeters (PowerTap vs. Power2Max) in different types of cycling efforts. Ten cyclists performed two submaximal, one incremental maximal and two supramaximal sprint tests on an ergometer, while pedaling power and cadence were registered by both powermeters and a cadence sensor (GarminGSC10). During the submaximal and incremental maximal tests, significant correlations were found for power and cadence data (r = 0.992-0.997 and 0.996-0.998, respectively, p < 0.001), with a slight power underestimation by PowerTap (0.7-1.8%, p < 0.01) and a high reliability of both powermeters (p < 0.001) for measurement of power (ICC = 0.926 and 0.936, respectively) and cadence (ICC = 0.969 and 0.970, respectively). However, during the supramaximal sprint test, their agreement to measure power and cadence was weak (r = 0.850 and -0.253, p < 0.05) due to the low reliability of the cadence measurements (ICC between 0.496 and 0.736, and 0.574 and 0.664, respectively; p < 0.05) in contrast to the high reliability of the cadence sensor (ICC = 0.987-0.994). In conclusion, both powermeters are valid and reliable for measuring power and cadence during continuous cycling efforts (~100-450 W), but questionable during sprint efforts (>500 W), where they are affected by the gear ratio used (PowerTap) and by their low accuracy in cadence recording (PowerTap and Power2Max).

Patient outcomes and adherence to an enhanced recovery pathway for open gynecologic surgery: a 6-year single-center experience.

OBJECTIVES: To evaluate compliance with an Enhanced Recovery After Surgery (ERAS) protocol for open gynecologic surgery at a tertiary center and the relationship between levels of compliance and peri-operative outcomes. METHODS: This retrospective cohort study was conducted between November 2014 and December 2020. Two groups were defined based on compliance level (<80% vs ≥80%). The primary outcome was to analyze overall compliance since implementation of the ERAS protocol. The secondary endpoint was to assess the relationship between compliance and 30-day re-admission, length of stay, re-operation, opioid-free rates, and post-operative complications. We also assessed compliance with each ERAS element over three time periods (P1: 2014-2016, P2: 2017-2018, P3: 2019-2020), categorizing patients according to the date of surgery. Values were compared between P1 and P3. RESULTS: A total of 1879 patients were included. Overall compliance over the period of 6 years was 74% (95% CI 71.9% to 78.2%). Mean overall compliance increased from 69.7% to 75.8% between P1 and P3. Compliance with ERAS ≥80% was associated with lower Clavien-Dindo complication rates (grades III (OR 0.55; 95% CI 0.33 to 0.93) and V (OR 0.08, 95% CI 0.01 to 0.60)), 30-day re-admission rates (OR 0.61; 95% CI 0.43 to 0.88), and length of stay (OR 0.59; 95% CI 0.47 to 0.75). No difference in opioid consumption was seen. Pre-operatively, there was increased adherence to counseling by 50% (p=0.01), optimization by 21% (p=0.02), and carbohydrate loading by 74% (p=0.02). Intra-operatively, compliance with use of short-acting anesthetics increased by 37% (p=0.01) and avoidance of abdominal drainage increased by 7% (p=0.04). Use of goal-directed fluid therapy decreased by 16% (p=0.04). Post-operatively, there was increased compliance with avoiding salt and water overload (8%, p=0.02) and multimodal analgesia (5%, p=0.02). CONCLUSIONS: Over the time period of the study, overall compliance increased from 69.7% to 75.8%. Compliance (≥80%) with ERAS is associated with lower complication rates, fewer 30-day re-admissions, and shorter length of stay without impacting re-operation rates and post-operative opioid use.

Influence of Sex on Current Methods of Adjusting Saddle Height in Indoor Cycling.

ABSTRACT: Encarnación-Martínez, A, Ferrer-Roca, V, and García-López, J. Influence of sex on current methods of adjusting saddle height in indoor cycling. J Strength Cond Res 35(2): 519-526, 2021-The popularity of indoor cycling has increased in fitness centers, and therefore, proper bike fitting is important to avoid biomechanical-related injuries. However, no previous studies have compared the biomechanical kinematics of various existing protocols of saddle-height adjustment in indoor cycling. Furthermore, it was not clear if these protocols were appropriate for both men and women, as these equations were primarily obtained in male cyclists. Therefore, lower-limb joint kinematics were compared among 4 different protocols of saddle-height adjustment (1-Preferred, 2-Ferrer-Roca et al., 3-Lemond & Guimard, and 4-Static Goniometry) in 30 experienced indoor-cycling subjects (15 men and 15 women). Only 20-33% of the women had a knee extension while pedaling within the recommended range for each of the different protocols except for the preferred adjustment (73% were within). By contrast, all the protocols were moderately suitable for men (47-60% were within the recommended range). A multiple linear equation to estimate the recommended saddle height in both men and women (R2 = 0.917, p = 0.001) was obtained from the following variables: inseam length, stature, foot length, and knee angle. The differences in the findings between men and women may be partially explained by differences in anatomical structures, as well as the male-based equations, which argues the need for future investigations in female cyclists.

Bogdanov Map for Modelling a Phase-Conjugated Ring Resonator.

In this paper, we propose using paraxial matrix optics to describe a ring-phase conjugated resonator that includes an intracavity chaos-generating element; this allows the system to behave in phase space as a Bogdanov Map. Explicit expressions for the intracavity chaos-generating matrix elements were obtained. Furthermore, computer calculations for several parameter configurations were made; rich dynamic behavior among periodic orbits high periodicity and chaos were observed through bifurcation diagrams. These results confirm the direct dependence between the parameters present in the intracavity chaos-generating element.

Acute effects of small changes in crank length on gross efficiency and pedalling technique during submaximal cycling.

The main purpose of this study was to assess the acute effects of small changes in crank length (assumable by competitive cyclists) on metabolic cost and pedalling technique during submaximal cycling. Twelve amateur road cyclists performed three sets of submaximal pedalling (150, 200 and 250 W) at a constant cadence (91.3 ± 0.8 rpm) in a randomised order with three commonly used crank lengths, preferred (172.5-175 mm), +5 mm and -5 mm. Energy cost of pedalling, kinetic and kinematic variables were simultaneously registered. Changes in crank length had no significant effect on heart rate (144 ± 13, 145 ± 12 and 145 ± 13 bpm, respectively) and gross efficiency (GE) (20.4 ± 2.1, 20.1 ± 2.2 and 20.3 ± 2.4%, respectively). A longer crank induced a significant (P < 0.05) reduction of positive impulse proportion (PIP) (0.9-1.9%) due to a greater maximum (1.0-2.3 N · m) and minimum torque (1.0-2.2 N · m). At the same time, the maximum flexion and range of motion of the hip and knee joints were significantly increased (1.8-3.4° and P < 0.05), whereas the ankle joint was not affected. In conclusion, the biomechanical changes due to a longer crank did not alter the metabolic cost of pedalling, although they could have long-term adverse effects. Therefore, in case of doubt between two lengths, the shorter one might be recommended.

Differences in Spatiotemporal Parameters Between Trained Runners and Untrained Participants.

Gómez-Molina, J, Ogueta-Alday, A, Stickley, C, Tobalina, JC, Cabrejas-Ugartondo, J, and García-López, J. Differences in spatiotemporal parameters between trained runners and untrained participants. J Strength Cond Res 31(8): 2169-2175, 2017-The aim of this study was to compare the spatiotemporal parameters of trained runners and untrained participants with the same foot strike pattern (rearfoot) during running at controlled speeds. Twenty-one participants were classified in 2 groups according to their training experience: Trained (n = 10, amateur runners with long distance training experience) and Untrained (n = 11, healthy untrained participants). Anthropometric variables were recorded, and the participants performed both a submaximal (between 9 and 15 km·h) and a graded exercise running test (from 6 km·h until exhaustion) on a treadmill. Physiological (V[Combining Dot Above]O2max, heart rate, running economy [RE], peak speed …) and biomechanical variables (contact and flight times, step rate, and length) were simultaneously registered. Trained runners showed higher step rate and shorter step length than the Untrained group at the same running speeds (between 4 and 7%, p ≤ 0.05) and at the same physiological intensities (between 7 and 11%, p ≤ 0.05). However, there were no differences in contact and flight times between groups. Significant differences (p ≤ 0.05) and large effect sizes (Cohen's d) between groups were found for body mass, sum of 6 skinfolds, V[Combining Dot Above]O2max, peak speed, and ventilatory threshold and respiratory compensation threshold speeds. The Trained group also showed a ∼7% better RE (ml·kg·km) than the Untrained group. In conclusion, adopting higher step rate and shorter step length may be an adaptive mechanism of the Trained group to reduce injury risk and possibly improve RE. However, contact and flight times were consistent regardless of training level.

Predictive Variables of Half-Marathon Performance for Male Runners.

The aims of this study were to establish and validate various predictive equations of half-marathon performance. Seventy-eight half-marathon male runners participated in two different phases. Phase 1 (n = 48) was used to establish the equations for estimating half-marathon performance, and Phase 2 (n = 30) to validate these equations. Apart from half-marathon performance, training-related and anthropometric variables were recorded, and an incremental test on a treadmill was performed, in which physiological (VO2max, speed at the anaerobic threshold, peak speed) and biomechanical variables (contact and flight times, step length and step rate) were registered. In Phase 1, half-marathon performance could be predicted to 90.3% by variables related to training and anthropometry (Equation 1), 94.9% by physiological variables (Equation 2), 93.7% by biomechanical parameters (Equation 3) and 96.2% by a general equation (Equation 4). Using these equations, in Phase 2 the predicted time was significantly correlated with performance (r = 0.78, 0.92, 0.90 and 0.95, respectively). The proposed equations and their validation showed a high prediction of half-marathon performance in long distance male runners, considered from different approaches. Furthermore, they improved the prediction performance of previous studies, which makes them a highly practical application in the field of training and performance.

Differences in pedalling technique between road cyclists of different competitive levels.

The purpose of this study was to compare the pedalling technique in road cyclists of different competitive levels. Eleven professional, thirteen elite and fourteen club cyclists were assessed at the beginning of their competition season. Cyclists' anthropometric characteristics and bike measurements were recorded. Three sets of pedalling (200, 250 and 300 W) on a cycle ergometer that simulated their habitual cycling posture were performed at a constant cadence (~90 rpm), while kinetic and kinematic variables were registered. The results showed no differences on the main anthropometric variables and bike measurements. Professional cyclists obtained higher positive impulse proportion (1.5-3.3% and P < 0.05), mainly due to a lower resistive torque during the upstroke (15.4-28.7% and P < 0.05). They also showed a higher ankle range of movement (ROM, 1.1-4.0° and P < 0.05). Significant correlations (P < 0.05) were found between the cyclists' body mass and the kinetic variables of pedalling: positive impulse proportion (r = -0.59 to -0.61), minimum (r = -0.59 to -0.63) and maximum torques (r = 0.35-0.47). In conclusion, professional cyclists had better pedalling technique than elite and club cyclists, because they opted for enhancing pulling force at the recovery phase to sustain the same power output. This technique depended on cycling experience and level of expertise.

Acute effects of small changes in bicycle saddle height on gross efficiency and lower limb kinematics.

The aim of the present study was to assess the acute effects of small changes in bicycle saddle height on gross efficiency (GE) and lower-limb kinematics. Well-trained cyclists (n = 14) performed a submaximal pedaling test (~70-75% of the v[Combining Dot Above]O2max) at constant cadence (90 rpm). It consisted of 3 randomized sets of 6 minutes with the preferred saddle height, 2% higher and 2% lower. Gross efficiency was significantly lower and oxygen consumption (v[Combining Dot Above]O2) was significantly higher when raising the saddle (GE = 19.9 ± 1.5%; V[Combining Dot Above]O2max = 43.8 ml·kg·min) than when lowering it (GE = 20.4 ± 1.3%; V[Combining Dot Above]O2 = 42.8 ml·kg·min). Additionally, a change of 0.8% in GE (20.6 ± 1.6% to 19.8 ± 1.6%, p < 0.05) was observed when comparing the positions where the best and worst GE was obtained. A significant effect of the small changes in saddle height on lower limb kinematics was also observed (p < 0.05). The differences between lower and higher saddle positions, in hip, knee, and ankle joints were an increase of extension (~4, 7, and 8°, respectively), a decrease of flexion (~3, 4, and 4°, respectively) and, consequently, an increase of the range of movement (~1, 3, and 4°, respectively). The results of the present study indicate that small changes in saddle height affected GE and lower limb kinematics The observed changes in lower limb kinematics could justify, in part, the GE changes. Further research should evaluate long-term effects of these small modifications in the seat height on GE and lower limb kinematics.

Correspondence between training load executed by volleyball players and the one observed by coaches.

The main aim of this study was to compare the training load (TL) executed by volleyball players with that observed by coaches. Second, we analyzed the influence of the coaches' experience in the estimated TL. Twelve female volleyball players and 4 male coaches participated in this study. During a period of 15 weeks, physical (PT) and technical-tactical training sessions and matches were monitored. In each session, the session rating of perceived exertion (sRPE) was recorded to analyze the players' exercise intensity and TL(RP)E. Coaches were present in all sessions and rated their estimate of sRPE at the same time as the players to calculate the coaches' TL(RPE). Both players' and coaches' mean sRPE (4.0 ± 1.1, 3.7 ± 1.1, and 3.8 ± 1.0 in players and expert and beginning coaches, respectively) and TLRPE (380.1 ± 106.8, 358.3 ± 110.5, and 359.7 ± 108.0 in players and expert and beginning coaches, respectively) were similar. However, a higher (p < 0.01) sRPE and TL(RPE) were observed in the players during PT. In general, the weekly TL(RPE) variation over the course of this study was similar in players and coaches. The players' sRPE and TL(RPE) were correlated (p < 0.01) with expert and beginner coaches' RPE (r = 0.70 and 0.72, respectively) and TL(RPE) (r = 0.75 and 0.76, respectively). In conclusion, the present findings show the correspondence between players' and coaches' sRPE and TL(RPE) regardless of their experience. Hence, coaches' TL(RPE) could be a useful and practical method to monitor and control the TL and other derived parameters in an easy way during volleyball.

Strategies of management for the whole treatment of leachates generated in a landfill and in a composting plant.

This study compares the leachates generated in the treatment of Municipal Solid Wastes (MSW) of similar origin but managed in two different ways: (a) sorting and composting in a Treatment Plant in Aranda de Duero (Burgos, Spain), and (b) direct dumping in a landfill in Aranda de Duero (Burgos, Spain) with no prior treatment. Two different leachates were considered for the former: those generated in the fermentation shed (P1) and those generated in the composting tunnels (P2); another leachate was collected from the landfill (P3). Physical and chemical properties, including heavy metal contents, were seasonally monitored in the different leachates. This study allowed us to conclude that the sampling season had a significant effect on Pb, Cd, Ni, Mg and total-N contents (P < 0.01). Similarly, leachates P1, P2 and P3 exhibited significant overall differences for most of the measured parameters except for Cd, Cu, Pb, K, Fe, C-inorg and C-org contents (P < 0.01). This study concludes with the feasibility of a whole treatment for both leachates using ultrafiltration in a membrane bioreactor (MBR).

Relationship between the talk test and ventilatory thresholds in well-trained cyclists.

The aim of this study was to extend the range of populations where the Talk Test (TT) might be used as a marker of physiologic thresholds. Eighteen highly trained cyclists underwent 2 incremental tests. One test included measurement of respiratory gas exchange to determine the ventilatory (VT) and respiratory compensation thresholds (RCTs). On a separate day, a TT was performed using the same exercise protocol. During TT, subjects read a standard paragraph at the end of each stage. The first stage at which the cyclists could not talk comfortably and could definitely not talk were referred to as the equivocal (EQ) and the negative stages (NEG), respectively. There were no significant differences in workload, heart rate, lactate, and rating of perceived exertion between VT (3.7 ± 0.4 W kg, 150 ± 10 b min, 1.6 ± 0.3 mm L, and 4.1 ± 1.4, respectively) vs. EQ (3.6 ± 0.4 W kg, 148 ± 12 b min, 1.3 ± 0.5 mm L, and 3.8 ± 1.2, respectively) and RCT (5.3 ± 0.4 W kg, 177 ± 7 b min, 4.0 ± 0.9 mm L, and 7.2 ± 1.0, respectively) vs. NEG (5.3 ± 0.5 W kg, 176 ± 10 b min, 4.2 ± 1.3 mm L, and 6.8 ± 1.5, respectively). We found significant relationships (p < 0.01) between VT and EQ and RCT and NEG for workload (r = 0.86 and 0.94, respectively), heart rate (r = 0.79 and 0.92, respectively), and rating of perceived exertion (r = 0.79 and 0.88, respectively). In conclusion, the present study showed that the EQ and NEG stages of TT can be used as a simple and practical surrogate of the VT and RCT in highly trained cyclists.

Validation of a new method to measure contact and flight times during treadmill running.

The purpose of this study was to validate a new method to measure contact and flight times during treadmill running and to test its reliability and sensitivity. Fifteen well-trained runners performed 7 sets of running at different speeds (from 10 to 22 km·h). Contact and flight times were simultaneously recorded by a high-speed video system (gold standard method) and a new method based on laser technology (SportJump System Pro). Athletes were classified according to their foot strike pattern (rearfoot vs. midfoot and forefoot). The new method overestimated the contact time and underestimated the flight time with respect to the gold standard method (p < 0.001). However, relationships and intraclass correlation coefficients (ICCs) between both systems were very strong (r and ICC > 0.99, p < 0.001). Contact time differences between the 2 systems depended on running speed (p < 0.001) but not on foot strike pattern or runners' body mass. This allowed to correct the differences in contact time and flight time. The new method was sensitive for detecting small differences in contact time (<20 ms) when the running speed increased and when the type of foot strike patterns changed. Additionally, a low intraindividual step variability (coefficient of variation = 2.0 ± 0.5%) and high intra- (ICC = 0.998) and interobserver (ICC = 0.977) reliability were shown. In conclusion, the new method was validated, being reliable and sensitive for detecting small differences in contact and flight times during treadmill running. Therefore, it could be used to compare biomechanical variables between groups in cross-sectional studies and to verify the influence of some independent variables (i.e., training, running economy, or performance) on running biomechanics.

The type of mat (Contact vs. Photocell) affects vertical jump height estimated from flight time.

The purposes of this study were to analyze the validity and reliability of 2 photocell mats and to probe the possible influence of the type of mat (contact vs. photocell) on vertical jump height estimated from flight time. In 2 separate studies, 89 and 92 physical students performed 3 countermovement jumps that were simultaneously registered by a Force Plate (gold standard method), 2 photocell mats (SportJump System Pro and ErgoJump Plus), and a contact mat (SportJump-v1.0). The first study showed that the 2 photocell mats underestimated the vertical jump height (1.3 ± 0.2 cm and 5.9 ± 5.2 cm, respectively), but only SportJump System Pro showed a high correlation with the Force Plate (r = 0.999 and 0.676, respectively) and good intraday reliability (coefficient of variation = 2.98 and 15.94%, intraclass correlation coefficients = 0.95-0.97 and 0.45-0.57, respectively). The second study demonstrated a strong correlation (r = 0.994) between the 2 technologies (contact vs. photocell mats) with differences in vertical jump height of 2.0 ± 0.8 cm (95% confidence interval = 1.9-2.1 cm), which depended on both flight time and subjects' body mass. In conclusion, SportJump System Pro was a valid and reliable device. The new devices to measure vertical jump height from flight time should be validated. The type of mat (contact vs. photocell) affected approximately 6% the vertical jump height (approximately 2 cm in this study), which should be considered in further studies. The use of validated photocell mats instead of the contact mats was recommended.

Training Characteristics and Competitive Demands in Women Road Cyclists: A Systematic Review.

PURPOSE: To identify the main training characteristics and competitive demands in women's road cycling. METHODS: A systematic search was conducted on 5 databases according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. The articles had to be primary studies, written after 1990 with a sample of competitive women between the ages of 15 and 50. The Quality Assessment Tool for Quantitative Studies and the Oxford Levels of Evidence scales were used. RESULTS: The search yielded 1713 articles, of which 20 were included. Studies on training and competitive demands (n = 5) found that both external and internal loads are higher in women than in men. Studies on strength and endurance training (n = 5) showed that both velocity-based and heavy-load strength training programs performed at least 2 days per week and including 3 to 4 lower-body exercises improved performance. Altitude-training studies (n = 3) found that "Live High-Train Low" was effective to increase performance during the first 9 days after the training camp. The 7 remaining studies focused on a range of topics. The methodological quality was strong for 12 studies and moderate for 8. In contrast, the level of evidence was high in 7 and low in the other 13. CONCLUSIONS: Endurance training and competitive demands in women's road cycling are higher than those of men. Strength training is effective in women when the frequency, intensity, and number of exercises are appropriate, while altitude training should be completed a few days before competing. Further studies are warranted to better define the participants' competitive level, using a methodological design with a higher level of evidence.

Variable Pacing Is Associated with Performance during the OCC® Ultra-Trail du Mont-Blanc® (2017-2021).

The current evidence suggests that pacing may not be affected by performance level or sex in trail-running races as may occur in road running races. However, the previous studies included races of >100 km. Therefore, we aimed to verify the influence of performance level and sex on pacing in the last four (2017, 2018, 2019, and 2021) editions of a shorter (56.3 km) ultra-trail running race (i.e., Orsières-Champex-Chamonix; OCC®) that maintained the same race profile. The mean finishing time for the 5656 participants was 10 h 20 min 33 s ± 2 h 01 min 19 s. Pacing variability (CV%) was higher in high-level participants, thus showing a greater ability to adapt their pace to the race profile than low-level runners. Males also had a higher pacing variability than females although the effect sizes were small. Based on the current findings, we may recommend for non-elite OCC® participants to adapt their pace to the race profile with a slower pace during uphills and a faster pace during downhills. Further studies including participants' experience are necessary to confirm the effectiveness of this suggestion in trail-running races of variable distances.

The Fine-Tuning Approach for Training Monitoring.

PURPOSE: Monitoring is a fundamental part of the training process to guarantee that the programmed training loads are executed by athletes and result in the intended adaptations and enhanced performance. A number of monitoring tools have emerged during the last century in sport. These tools capture different facets (eg, psychophysiological, physical, biomechanical) of acute training bouts and chronic adaptations while presenting specific advantages and limitations. Therefore, there is a need to identify what tools are more efficient in each sport context for better monitoring of training process. METHODS AND RESULTS: We present and discuss the fine-tuning approach for training monitoring, which consists of identifying and combining the best monitoring tools with experts' knowledge in different sport settings, designed to improve (1) the control of actual training loads and (2) understanding of athletes' training adaptations. Instead of using single-tool approaches or merely subjective decision making, the identification of the best combination of monitoring tools to assist experts' decisions in each specific context (ie, triangulation) is necessary to better understand the link between acute and chronic adaptations and their impact on health and performance. Future studies should elaborate on the identification of the best combination of monitoring tools for each specific sport setting. CONCLUSION: The fine-tuning monitoring approach requires the simultaneous use of several valid and practical tools, instead of a single tool, to improve the effectiveness of monitoring practices when added to experts' knowledge.

Ontogenetically distinct neutrophils differ in function and transcriptional profile in zebrafish.

The current view of hematopoiesis considers leukocytes on a continuum with distinct developmental origins, and which exert non-overlapping functions. However, there is less known about the function and phenotype of ontogenetically distinct neutrophil populations. In this work, using a photoconvertible transgenic zebrafish line; Tg(mpx:Dendra2), we selectively label rostral blood island-derived and caudal hematopoietic tissue-derived neutrophils in vivo during steady state or upon injury. By comparing the migratory properties and single-cell expression profiles of both neutrophil populations at steady state we show that rostral neutrophils show higher csf3b expression and migration capacity than caudal neutrophils. Upon injury, both populations share a core transcriptional profile as well as subset-specific transcriptional signatures. Accordingly, both rostral and caudal neutrophils are recruited to the wound independently of their distance to the injury. While rostral neutrophils respond uniformly, caudal neutrophils respond heterogeneously. Collectively, our results reveal that co-existing neutrophils populations with ontogenically distinct origin display functional differences.