The athlete gut microbiota: state of the art and practical guidance.

The gut microbiota has been proposed to grant the athlete a metabolic advantage that might be key when optimising performance. While a taxonomic core set of microorganisms characterising the athlete's gut microbiota has not been delineated, some compositional features might be associated with improved metabolic efficiency, which appears to be driven by the production of bacterial metabolites, such as short-chain fatty acids. Not only long-term exercise but also dietary patterns associated with high-level sports practice contribute to this microbial environment, yet isolating the impact of individual dietary components is challenging. The present review synthetises the available evidence on the compositional aspects of the athlete's gut microbiota, discusses mechanisms involved in the bidirectional association between exercise and the gut environment, and evaluates the role of athletes' diet in this interplay. Additionally, a practical approach to indicators commonly reported in metagenomic and metabolomic analyses is provided to explore how these insights can translate to support dietary protocols.

Impact and control of the COVID pandemic in an elite sports club: Real Madrid.

The incidence and risk factors for poor outcome in patients with COVID are well known, as are the protective measures in high-risk populations. In contrast, the epidemiological and clinical behavior of this disease in the population of elite athletes who are the paradigm of good health is poorly understood. Data on COVID in athletes are scarce and have focused preferentially on the consequences on sports performance of confinement measures and on the pathophysiological risks of infected athletes. Real Madrid is a large elite sports institution with facilities in the City of Madrid where 600 athletes train daily. The incidence of COVID during a study period of 671 days of observation in athletes, professional or amateur, working in the institution has been 0,74 per 1,000 days of exposure. The disease has been asymptomatic or oligosymptomatic in all athletes and did not require any hospital admissions. The different teams did not have to suspend any of its sportive commitments for COVID during the study period and there was no evidence of outbreaks of internal transmission between members of the different teams.

Breast reconstruction following mastectomy; patient's satisfaction.

Breast cancer remains one of the most common malignancies in women and is one of the leading causes of cancer-related mortality. Despite the current emphasis on breast conservation, mastectomy rates remain at 30%. Mastectomy is often associated with significant psychological sequelae including distorted body image and sexual dysfunction. Breast restoration is assumed to allow a full emotional and physical recovery from a breast cancer crisis. The methods of reconstructive surgery currently practised comprise flap reconstruction, implant reconstruction and a combination of these procedures. The most commonly used flaps are transverse rectus abdominis myocutaneous (TRAM), deep inferior epigastric perforator (DIEP), latissimus dorsi (LD), gluteal artery perforator (GAP). Autogenous tissue gives the best results, and currently the best technique in most women is probably the free DIEP flap. The lower abdominal tissue can mimic the breast to a high degree.

A rational approach to the selection of an assist device for the failing right ventricle.

Assist devices have become available for the treatment of right ventricular (RV) failure. The present study assesses the efficacy of pulmonary artery balloon counterpulsation (PABC) in restoring RV output to normal levels. In a porcine model of RV failure during left heart bypass, PABC restored RV output to normal, provided that the RV output was not depressed to less than 50% of baseline values. When RV failure was more severe, PABC was not effective in restoring RV output to base line. This study suggests that a rational approach should be developed for the use of right heart assist devices. In moderately severe RV failure, PABC may be successful in restoring cardiac output to normal. However, in extreme failure a right heart bypass is necessary.

The effects of cardioplegic arrest on right atrial function.

Atrial electrical and mechanical activity persists during cardioplegic arrest. It has been postulated that atrial ischemia may occur and cause deterioration in atrial function. This study was designed to assess the effect of cardioplegic arrest on right atrial function. Twenty-one pigs were placed on cardiopulmonary bypass (CPB), and the right atrium was isolated from the circulation by snaring both venae cavae and incising the coronary sinus. The tricuspid valve was closed through a small right ventriculotomy, and baseline atrial function was assessed using a compliant balloon in the atrium. Fourteen pigs underwent one hour of cardioplegic arrest (7 with cardioplegia alone [CCA group] and 7 with the addition of topical hypothermia [CCA + TH group]) followed by one hour of normothermic reperfusion. Seven other pigs were placed on CPB for the same period of time (CPB group). Atrial electrical and mechanical activity persisted at 45 beats per minute in the CCA group but was virtually abolished in the CCA + TH group. Cardioplegic arrest caused considerable deterioration in right atrial function (developed pressure, 18.9 +/- 0.8 [baseline] versus 14.1 +/- 0.7 mm Hg; p less than 0.05; first derivative of atrial pressure [dP/dt], 187 +/- 19 versus 134 +/- 25 mm Hg per second; p less than 0.05; 60 minutes of reperfusion and balloon volume of 20 ml). It was not affected by topical cooling. Right atrial developed pressure was maintained, but dP/dt was significantly reduced in the CPB group. This study suggests that cardioplegic arrest does not protect the atrium.

Toward a better understanding of the etiology of left ventricular dysfunction after mitral valve replacement: an experimental study with possible clinical implications.

The relatively high morbidity and mortality of mitral valve replacement (MVR) appears to be related to an impairment in left ventricular (LV) function. This two-part investigation was designed to assess the effect of MVR on global LV function in an isolated heart preparation and to evaluate whether a mitral prosthesis with a flexible annulus would be of benefit. In Part I (14 pigs), the effects of each step in MVR were studied. Division of the chordae tendineae caused a severe deterioration in LV function (systolic pressure, 180 +/- 13 versus 120 +/- 10 mm Hg; p less than 0.05; developed pressure, 167 +/- 13 versus 108 +/- 11 mm Hg; p less than 0.05; first derivative of LV pressure [dP/dt], 2,630 +/- 300 versus 1,610 +/- 180 mm Hg/sec; p less than 0.05; balloon volume, 30 ml). Fixation of the mitral annulus prior to division of the chordae tendineae resulted in a small decrease (not significant) in LV function but had no effect after the chordae tendineae were divided. In Part II (10 pigs), two mitral annular prostheses were studied: a standard rigid prosthesis and a prosthesis of identical size but with a flexible annulus. LV function was better with the flexible than the rigid prosthesis (systolic pressure, 118 +/- 10 versus 89 +/- 5% control, p less than 0.02; developed pressure, 120 +/- 11 versus 87 +/- 5% control; p less than 0.02; dP/dt, 119 +/- 10 versus 85 +/- 4% control; p less than 0.02; balloon volume, 30 ml).(ABSTRACT TRUNCATED AT 250 WORDS)

A physiological approach to surgery for acute rupture of the papillary muscle.

There is controversy regarding the optimal management of patients in whom acute papillary muscle rupture develops. This study evaluates the effect of division of the anterolateral papillary muscle on left ventricular (LV) function and compares two methods of treatment--mitral valve replacement (MVR) and mitral valve repair. Thirteen pigs were placed on cardiopulmonary bypass, and interventions were performed in an isolated beating heart preparation. LV function was assessed with a compliant intraventricular balloon at baseline, after division of the anterolateral papillary muscle (Divided), after repair of the divided papillary muscle (Repair), and finally after MVR. Division of the anterolateral papillary muscle caused a significant deterioration in LV function. Function was maintained at this level after mitral valve repair but deteriorated with MVR. Developed pressure measured at baseline was 179 +/- 13 mm Hg; Divided, 148 +/- 11 mm Hg (p less than 0.05 versus baseline); Repair, 149 +/- 15 mm Hg; and MVR, 95 +/- 8 mm Hg (p less than 0.05 versus Divided) at a balloon volume of 20 ml. These results suggest that LV function is impaired by papillary muscle rupture. Repair of the ruptured papillary muscle is associated with better LV function than is MVR.

[Characteristics of the vascular network in the hypothalamic median eminence in man]. / Karakteristike vaskularne mreze eminentiae medianae hipotalamusa coveka.

The aim of these studies is to determine the sources of vascularization, the vascular areas, the appearance and density of the median eminence capillary network in prenatal human brains of both sexes. The brain blood vessels under examination were filled with a mixture of India ink and gelatin. Serial paraffin sections 20-40 microns thick, cleared after Spaltehol. Two arterial stems take part in median eminence vascularization together with their branches: a. hypophisialis superior and a. hypophisialis inferior. In order to quantify the density of the capillary network, the authors used the standard stereologic parameters--volume density and mean radius of blood vessels. No statistically significant sex-dependent differences were established regarding the appearance and density of the median eminence capillary network of the human brain in the course of the comparative testing of the mean values of these parameters in the male and female sex.

[Morphometric analysis of the vascular network in the preoptic area of the brain in man]. / Morfometrijska analiza vaskularne mreze preopticke areje mozga coveka.

Twenty brains of human beings of both sex aged 17-64 were used for morphometric analysis of the vascular network of preoptic area. Blood vessels of the brain were filled by the mixture od India ink and gelatine. Serial resections 200 microns thick were illuminated by the method of Spalteholz. Standard stereologic parameters--volume density, surface density and the average half diameter of blood vessels were used for the quantification of capillary blood network density. By the comparative test of obtained mean values of males and females no statistically significant differences pertaining to sex and in respect to the size and density of capillary network in preoptic area were confirmed. This fact supported the assumption that although there were no morphologic differences in the blood network changes in various functional states, accompanying neuroendocrine events in the body of adults were in all probability the main and responsible factors inducing greater or less vascularization of specific organs.

[Membranous lesions and histochemical changes in cardiac muscle cells during hypoxia in white rats]. / Membranska ostecenja i histohemijske promene u misicnih celija srca belog pacova u hipoksiji.

The authors of this paper have explored the effects of intermittent hypoxia on the cell membrane and histochemical changes in the muscle cardiac tissue of the white rat. The animals have been exposed to the experimental conditions characteristic of 7.000 m of height above sea level and divided in three groups. The first one consisted of animals sacrificed immediately after the final exposition (first experimental group), in the second one there were animals sacrificed 24 hours after (the second experimental group), and the third group made animals sacrificed 7 days after the final exposition (the third experimental group). The hypoxial stress elicited the vacuolation in the cardiac muscle fibers of the subendocardial layer of miocard which persisted, and did not reduce its intensity and extensity in all the three groups of animals, while in fuxinorrhagia the intensity and extensity falls to the half of the animals sacrificed 24 hours after the experiment, and completely disappeared in those sacrificed 7 days after the final exposure. Glycogen as well as the activity of succinat-dehydrogenase were preserved in all the three experimental groups of animals. It could be concluded that hypoxia elicites ischemical changes in the sense of vacuolation of muscle tissue which does not disappear or its disappearance is slower than is the case with fuxinorrhagia which leaves a clear evidence, too, that the permeability of cytoplasmatic membrane affected by hypoxia was disturbed.

[Vascular characteristics of the lamina terminalis of the human hypothalamus]. / Vaskularne karakteristike lamine terminalis hipotalamusa coveka.

The aim of the study is to discover the sources of vascularization, vascular area, the size and density of the capillary network of the vascular organ of the laminae terminalis of the hypothalamus. The brain blood vessels under examination were filled with a mixture of India ink and gelatin. The serial paraffin sections of 30 and 200 um were cleared after Spalteholz. In the vascularization of this neuroendocrine structure of the hypothalamus, two arterial stems take part with their branches: a cerebri anterior and a. communicans anterior. In order to quantify the density of the capillary network, the authors used standard stereologic parameters - volumene density, surface density and mean radius of blood vessels. While the precise functions of the vascular organ have yet to be fully elucidated, the similarity in organization of this region to the median eminence has led several authors to suggest a neurosecretory role for the vascular organ of the lamina terminalis.

[Morphometric analysis of the vascular network of the suprachiasmatic and paraventricular nucleus in the human brain]. / Morfometrijska analiza vaskularne mreze suprahijazmaticnog i paraventrikularnog jedra mozga coveka.

The aim of the study is to discover, the sources of vascularization, vascular areas, the size and density of the capillary network in the suprachiasmatic and the paraventricular nuclei of postnatal human brains of both sexes. The brain blood vessels under examination were filled with a mixture of India ink and gelatin. The serial paraffin sections of 200 microns cleared after Spalteholz. In the vascularization of the suprachiasmatic and the paraventricular nuclei, two arterial stems, take part with their branches (a. cerebri anterior and a. communicans anterior). In order to quantify the density of the capillary network, the authors used the standard stereologic parameters - volume density, surface density and mean radius of blood vessels. The comparative testing of the mean values obtained in male and female subjects did not reveal any significant sex - dependent differences regarding the size and density of the capillary network in the suprachiasmatic and the paraventricular nuclei of the human brain.

[Characteristics of the human lateral geniculate nucleus vascular network]. / Karakteristike vaskularne mreze humanog lateralnog genikulatnog jedra.

The blood supply of the lateral geniculate nucleus (LGN) was studied on ten human brains obtained at autopsy from patients of both sexes with no indication of either psychiatric and neurological disorders or trauma of CNS. The age range was form 30 to 50 years. The brain blood vessels-the basilar artery and the internal carotid artery were injected with a mixture of gelatin and Indian ink. Microdissection revealed that the arterial branches for the LGN arise from anterior choroidal artery and posterior cerebral artery through one of its central branches-lateral posterior choroidal artery. The morphology of arterial network was examined by the analysis of cleared paraffine sections. The arterial branches run in a dorsal to ventral direction of the nucleus, parallely with lines of projection and perpendicularly to the plane of the LGN laminae. Free anastomoses occur between these branches.

[Stereologic analysis of the density of the vascular network of the heart in hypoxia in laboratory rats]. / Stereoloska analiza gustine vaskularne mreze srca laboratorijskog pacova u hipoksiji.

The density of the myocardiac vascular network in 3-month-old female Wistar rats exposed to intermittent hypoxia was studied. The experimental rats were sacrificed immediately (1st experimental subgroup) or 4 days (2nd experimental subgroup) after the last exposition. The volume density was statistically highly significant in the animals of the 1st subgroup and significant in the rats of the 2nd subgroup. The highly significant rise in the volume density of the myocardiac vascular network could be explained by an acute stress effect, whereas the only significant increase in the second case indicates adaptability to stress.

[The effect of chronic alcohol administration on specific features of the adenohypophysis in young animals in relation to the adult adenohypophysis]. / Specificnosti adenohipofize mladunaca u odnosu na adenohipofizu odraslih pod hronicnim uticajem alkohola.

We investigated chronic effects of ethyl alcohol on adenohypophysis in adult Wistar rats and adenohypophysis in development including the postnatal period up to 30 days. Morphological findings in gonadotropic, prolactin and follicular cells were compared. After three months of constant alcohol consumption in the form of a 15% liquid solution, vacuolization of gonadotropic cells which acquire the shape of a seal ring, as well as nodular hyperplasia of chromophobe cells combined with sparse somatotropic cells, occur in the adenohypophysis of adult male rats. Electronic microscope revealed a small quantity of prolactin granules in light-microscopic chromophobe cells. In young rats exposed to alcohol gonadotropic and prolactin cells are unchanged but an accumulation of follicular cells within multiple smaller pseudofollicles is present. In the explanation of the differences between the findings obtained in adult and young rats with reference to LH/FSH and PRL cells, a stress is given to the role of the peripheral metabolism of testosterone and of hyperestrogenemia caused by alcohol consumption in adult rats lacking in young ones. The increased number of the follicular cells in adenohypophyses of young rats is likely to reflect the suppressed maturation of hypophyseal secretory cells.

[Total abdominal irradiation following combination chemotherapy and second-look laparotomy in the treatment of advanced ovarian cancer]. / Die Ganzabdomenbestrahlung nach Kombinationschemotherapie und Second-look-Laparotomie bei der Behandlung des fortgeschrittenen Ovarialkarzinoms.

From 1980 to 1984 fifty-four patients with advanced ovarian carcinoma after operation and concluding chemotherapy with alkeran (n = 7) or cis-platin/alkeran +/- hexamethylmelamine (n = 47) as well as second-look laparotomy received follow-up radiotherapy either with the moving-strip technique (n = 35) or later the open-field technique (n = 19). 32 patients in CR received radiation therapy. 15 patients in CR are without relapse after undergoing open-field radiation therapy and a mean observation period of 25 months. At this point of time 5 of 17 patients had relapses under the moving-strip radiation treatment. The frequency of the relapses is apparently due to the very long periods of radiation and numerous interruptions in treatment. If residual tumors were present at the begin of ray therapy, a CR could only be achieved in cases where the previous monotherapy was with alkeran.