Physical activity and exercise motivation of multiple myeloma patients: a prospective cross-sectional study.

BACKGROUND: Multiple myeloma (MM) is the second most common hematological malignancy with its prevalence increasing. Patients with symptomatic MM can show numerous comorbidities, affecting their quality of life (QoL). Physical activity (PA) may improve QoL but is not a standardized intervention of comprehensive cancer centers (CCCs). Since data on the PA of patients with MM are scarce, we aimed to prospectively assess fitness levels and patients' motivation to join PA-interventions at our CCC. METHODS: We generated an exercise questionnaire to interview consecutive patients MM. We prospectively collected data on (a) past and current PA, defined by the World Health Organization (WHO) recommendations, (b) knowledge on exercise effects, (c) exercise motivation, and (d) willingness to participate in PA-interventions. Demographics, comorbidities, response, progression-free survival (PFS), and overall survival (OS) were assessed in 211 symptomatic patients MM. RESULTS: While our patients were elderly and most showed bone involvement, their PA was similar to healthy individuals. Aerobic PA (≥ 60 minutes/week) was performed by 65%, and 25% exercised ≥ 150 minutes/week. WHO PA recommendations were fulfilled by 17% of patients. No sport activities or complete physical inactivity were observed in 35% and 16%, respectively. Notably, 38% were motivated to join MM-specific sport interventions. Self-reported knowledge of PA-induced benefits for patients cancer was high (82%), but only 27% knew which exercises were safe to perform. CONCLUSION: This study provides an overview of the PA of patients MM. Our results suggest that the PA of patients MM might not be much lower than in the age-matched general population.

Close Relationship between Systemic Arterial and Portal Venous Pressure in an Animal Model with Healthy Liver.

It is unclear to what extent systemic arterial blood pressure influences portal pressure. This relationship is clinically important as drugs, which are conventionally used for therapy of portal hypertension, may also influence systemic arterial blood pressure. This study investigated the potential correlation between mean arterial (MAP) and portal venous pressure (PVP) in rats with healthy livers. In a rat model with healthy livers, we investigated the effect of manipulation of MAP on PVP. Interventions consisted of 0.9% NaCl (group 1), 0.1 mg/kg body weight (bw) Sildenafil (low dose), an inhibitor of phosphodiesterase-5 (group 2), and 1.0 mg/kg bw Sildenafil (high dose, group 3) in 600 µL saline injected intravenously. Norepinephrine was used to increase MAP in animals with circulatory failure while PVP was monitored. Injection of the fluids induced a transient drop in MAP and PVP, probably due to a reversible cardiac decompensation. The drop in MAP and drop in PVP are significantly correlated. The time lag between change in MAP and change in PVP by 24 s in all groups suggests a cause-and-effect relationship. Ten minutes after the injection of the fluid, cardiac function was normalized. Thereafter, MAP gradually decreased. In the NaCl group, PVP decreases by 0.485% for a 1% drop of MAP, by 0.550% in the low-dose sildenafil group, and by 0.651% in the high-dose sildenafil group (p < 0.05 for difference group two vs. group one, group three vs. group one, and group three vs. group two). These data suggest that Sildenafil has an inherent effect on portal pressure that exceeds the effect of MAP. Injection of norepinephrine led to a sudden increase in MAP followed by an increase in PVP after a time lag. These data show a close relationship between portal venous pressure and systemic arterial pressure in this animal model with healthy livers. A change in MAP is consequently followed by a change in PVP after a distinct time lag. This study, furthermore, suggests that Sildenafil influences portal pressure. Further studies should be performed in a model with cirrhotic livers, as these may be important in the evaluation of vasoactive drugs (e.g., PDE-5-inhibitors) for therapy of portal hypertension.

[Influence of the contact restrictions against SARS-CoV-2 on physical activity among public sector employees.] / Einfluss der Kontaktbeschränkungen gegen SARS-CoV-2 auf die körperliche Aktivität von Beschäftigten des öffentlichen Dienstes.

Objective: Preliminary results from activity surveys conducted in spring 2020 suggest that athletic activity may have decreased within the contact restrictions against the spread of coronavirus. The coronavirus pandemic poses many challenges to the workforce in the healthcare system. Therefore, this study investigated whether the measures to limit the pandemic have an influence on the activity behavior of employees in the public sector. Method: A retrospective cross-sectional survey was conducted to collate the activity behavior among employees of three institutions in the public sector before and during the measures against the coronavirus in April 2020. An online version of the Freiburg Activity Questionnaire was used. Using Wilcoxon tests on connected samples with a significance level of p < 0.05, the activity behavior was examined for differences before compared to during the contact restrictions in min/week and MET-min./week. Results: A total of 1797 public sector employees in Freiburg (36.0% male, 63.9% female, and 0.1% diverse) participated in the survey. For sports activity, a relevant difference (p < 0.05) was measured in the medians (Mdn) of activities per week before (Mdn = 180 min) and during (Mdn = 120 min) the relevant contact restrictions. Similarly, for energy expenditure through exercise, the median value within the contact restrictions decreased from Mdn = 1022 MET-min/week to Mdn = 750 MET-min./week. Conclusion: Measures to limit the spread of the coronavirus have led to a reduction in activity levels among public sector employees. In particular, fewer employees engaged in sports. This could be related to the closure of fitness studios as these activities were particularly reduced. Decreased physical activity can lead to unfavorable individual risk profiles, which must be compensated for in the future.

Cyclic GMP in Liver Cirrhosis-Role in Pathophysiology of Portal Hypertension and Therapeutic Implications.

The NO-cGMP signal transduction pathway plays a crucial role in tone regulation in hepatic sinusoids and peripheral blood vessels. In a cirrhotic liver, the key enzymes endothelial NO synthase (eNOS), soluble guanylate cyclase (sGC), and phosphodiesterase-5 (PDE-5) are overexpressed, leading to decreased cyclic guanosine-monophosphate (cGMP). This results in constriction of hepatic sinusoids, contributing about 30% of portal pressure. In contrast, in peripheral arteries, dilation prevails with excess cGMP due to low PDE-5. Both effects eventually lead to circulatory dysfunction in progressed liver cirrhosis. The conventional view of portal hypertension (PH) pathophysiology has been described using the "NO-paradox", referring to reduced NO availability inside the liver and elevated NO production in the peripheral systemic circulation. However, recent data suggest that an altered availability of cGMP could better elucidate the contrasting findings of intrahepatic vasoconstriction and peripheral systemic vasodilation than mere focus on NO availability. Preclinical and clinical data have demonstrated that targeting the NO-cGMP pathway in liver cirrhosis using PDE-5 inhibitors or sGC stimulators/activators decreases intrahepatic resistance through dilation of sinusoids, lowering portal pressure, and increasing portal venous blood flow. These results suggest further clinical applications in liver cirrhosis. Targeting the NO-cGMP system plays a role in possible reversal of liver fibrosis or cirrhosis. PDE-5 inhibitors may have therapeutic potential for hepatic encephalopathy. Serum/plasma levels of cGMP can be used as a non-invasive marker of clinically significant portal hypertension. This manuscript reviews new data about the role of the NO-cGMP signal transduction system in pathophysiology of cirrhotic portal hypertension and provides perspective for further studies.

Phosphodiesterases in the Liver as Potential Therapeutic Targets of Cirrhotic Portal Hypertension.

Liver cirrhosis is a frequent condition with high impact on patients' life expectancy and health care systems. Cirrhotic portal hypertension (PH) gradually develops with deteriorating liver function and can lead to life-threatening complications. Other than an increase in intrahepatic flow resistance due to morphological remodeling of the organ, a functional dysregulation of the sinusoids, the smallest functional units of liver vasculature, plays a pivotal role. Vascular tone is primarily regulated by the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway, wherein soluble guanylate cyclase (sGC) and phosphodiesterase-5 (PDE-5) are key enzymes. Recent data showed characteristic alterations in the expression of these regulatory enzymes or metabolite levels in liver cirrhosis. Additionally, a disturbed zonation of the components of this pathway along the sinusoids was detected. This review describes current knowledge of the pathophysiology of PH with focus on the enzymes regulating cGMP availability, i.e., sGC and PDE-5. The results have primarily been obtained in animal models of liver cirrhosis. However, clinical and histochemical data suggest that the new biochemical model we propose can be applied to human liver cirrhosis. The role of PDE-5 as potential target for medical therapy of PH is discussed.

Hemoglobin A1c and retinal arteriolar narrowing in children with type 1 diabetes: the diagnostics of early atherosclerosis risk in kids study.

BACKGROUND/OBJECTIVE: Microvascular alterations play a key role in the development of diabetes complications. Retinal vessel analysis is a unique method to examine microvascular changes in brain-derived vessels. METHODS: Sixty-seven pediatric and adolescent type 1 diabetes patients and 58 healthy control persons (mean age 12.4 ± 2.9 years) underwent non-mydriatic retinal photography of both eyes. Central retinal arteriolar and central retinal venular (CRVE) diameter equivalents as well as the arteriolar-to-venular ratio were calculated using a semiautomated software. All anthropometric and laboratory parameters were measured according to standardized procedures for children. RESULTS: Retinal vessel diameter did not differ between type 1 diabetic children and healthy controls. However, there was an independent association of higher hemoglobin A1c (HbA1c) levels with arteriolar narrowing. Arteriolar narrowing of 5.4 µm was observed with each percent increase in HbA1c. Longer duration of diabetes was associated with wider retinal arterioles. CRVE was not associated with diabetes duration or HbA1c. CONCLUSIONS: Microvascular arteriolar alterations are already present in childhood and may indicate subclinical atherosclerosis and increased risk of diabetes complications later in life. Future research will have to investigate the potential use of retinal vessel diameters for treatment monitoring and guidance of therapy in children.

Esophageal lichen planus: towards diagnosis of an underdiagnosed disease.

Background: Although lichen planus (LP) is a common skin disorder, the prevalence of esophageal involvement (ELP) and its clinical manifestations are poorly defined. We aimed to establish diagnostic criteria and characterize disease outcomes of ELP.Methods: Clinical, endoscopic, histological, and immunofluorescence data from consecutive patients with known LP between 2013 and 2018 were analyzed. We established endoscopic (denudation and tearing of the mucosa, hyperkeratosis and trachealization) and histological criteria (mucosal detachment, T-lymphocytic infiltrate, intraepithelial apoptosis, dyskeratosis, and fibrinogen deposits along the basement membrane) to grade disease severity. Endoscopic findings were correlated with clinical symptoms. Response to medical therapy was monitored.Results: Fifty-two consecutive patients (median age 59.5 years) were analyzed. According to our grading system, 16 patients were considered as severe and 18 as mild ELP. Dysphagia was the only symptom which differentiated patients with severe (14/16) or mild ELP (8/18) from patients without ELP (1/18). Concomitant oral and genital involvement of LP was associated with the presence of ELP, while oral involvement alone was not. Follow-up of 14/16 patients with severe EPL for at least one year revealed that most of these patients responded to topical corticosteroids (budesonide: n = 9/10 or fluticasone n = 2/2). Three budesonide patients experienced a resolution of symptomatic esophageal stenosis.Conclusions: Esophageal involvement of LP is frequent, but may be asymptomatic. ELP can be diagnosed using the diagnostic criteria proposed here. Dysphagia and combined oral and genital manifestation are associated with ELP. Therapy with topical corticosteroids appears to be a prudent therapeutic approach for ELP.

Phase-contrast MR flow imaging: A tool to determine hepatic hemodynamics in rats with a healthy, fibrotic, or cirrhotic liver.

PURPOSE: To test a magnetic resonance (MR) scanning protocol as a noninvasive tool to determine hepatic hemodynamics and to assess the degree of liver fibrosis in an animal model of liver fibrosis and cirrhosis. MATERIALS AND METHODS: Fifty-four male Wistar rats were studied. Thirty-nine received thioacetamide (TAA) in their drinking water for either 12 or 16 weeks. MR measurements were performed using flow-sensitive 2D phase-contrast MRI and a 9.4T preclinical scanner. The following hemodynamic parameters were investigated: portal cross-sectional area, mean portal flow velocity, and portal and aortic flow volume rate. Therefore, rats (n = 46) were divided into three groups: CON (control, n = 13), FIB (fibrosis, n = 25), and CIR (cirrhosis, n = 8). Furthermore, the degree of liver fibrosis was assessed by a self-established MR score and verified by a standardized histological score (n = 48). RESULTS: Portal and aortic flow parameters could be reliably detected. A significant decrease in portal flow velocity was found in FIB (FIB vs. CON: -21%, P = 0.006 and CIR vs. CON: -17%, P = 0.105) and in portal flow volume rate in FIB and CIR (FIB vs. CON: -20%, P = 0.009 and CIR vs. CON: -25%, P = 0.024). If the histological score is taken as standard, the self-established MR score enabled discrimination between healthy and diseased livers (sensitivity to identify diseased livers: 89% and specificity to identify healthy livers: 100%). CONCLUSION: This MR scanning protocol presents a noninvasive tool to determine hepatic hemodynamics in healthy and diseased rats. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1526-1534.

Value of MRI and MRS fat measurements to complement conventional screening methods for childhood obesity.

PURPOSE: To evaluate a protocol combining abdominal fat-water magnetic resonance imaging (MRI) and liver single voxel magnetic resonance spectroscopy (MRS) for studies of childhood obesity. MATERIALS AND METHODS: Six obese male children and five age-matched normal-weight controls underwent abdominal fat-water Dixon MRI based on a gradient echo sequence with multiple echo times and single voxel liver MRS at a field strength of 3T. The MRI/MRS data were compared with data previously acquired from an obese adult cohort and with anthropometric and blood parameters that are typically acquired for screening in childhood obesity. RESULTS: There was a very strong correlation (r = 0.96) between the body mass index standard deviation score (BMI-SDS) and the subcutaneous fat volume fraction in the examined children, but only a moderate correlation (r = 0.62) between the BMI-SDS index and the intraabdominal fat volume fraction, which is much lower in the obese children (5.3 ± 1.1%) than in the obese adult cohort (19.4 ± 2.9%). Furthermore, a significant difference between the two child cohorts was observed in the intrahepatic lipid (IHL) content as obtained with MRS (P = 0.017). However, even the obese child cohort shows an IHL content that is 1-2 orders of magnitude lower (1.0 ± 0.5%) than in the obese adult cohort (17.0 ± 8.7%). CONCLUSION: The proposed method was successfully applied in children and may complement traditional clinical screening methods for childhood obesity such as anthropometry and laboratory tests to better characterize the obesity-associated metabolic risk.

Whole-body MRI-based fat quantification: a comparison to air displacement plethysmography.

PURPOSE: To demonstrate the feasibility of an algorithm for MRI whole-body quantification of internal and subcutaneous fat and quantitative comparison of total adipose tissue to air displacement plethysmography (ADP). MATERIALS AND METHODS: For comparison with ADP, whole-body MR data of 11 volunteers were obtained using a continuously moving table Dixon sequence. Resulting fat images were corrected for B1 related intensity inhomogeneities before fat segmentation. RESULTS: The performed MR measurements of the whole body provided a direct comparison to ADP measurements. The segmentation of subcutaneous and internal fat in the abdomen worked reliably with an accuracy of 98%. Depending on the underlying model for fat quantification, the resultant MR fat masses represent an upper and a lower limit for the true fat masses. In comparison to ADP, the results were in good agreement with ρ ≥ 0.97, P < 0.0001. CONCLUSION: Whole-body fat quantities derived noninvasively by using a continuously moving table Dixon acquisition were directly compared with ADP. The accuracy of the method and the high reproducibility of results indicate its potential for clinical applications.

The impact of a weight reduction program with and without meal-replacement on health related quality of life in middle-aged obese females.

BACKGROUND: In addition to an increased risk for chronic illnesses, obese individuals suffer from social stigmatization and discrimination, and severely obese people may experience greater risk of impaired psychosocial and physical functioning. Lower health-related quality of life (HRQOL) has been reported among obese persons seeking intensive treatment for their disease. To aid in the treatment of obesity, meal replacements have been recommended as an effective therapeutic strategy for weight loss, particularly when consumed in the beginning of an intervention. Hence, the objective of this study was to assess the impact of two 12-month weight reduction interventions (one arm including a meal replacement) on changes in HRQOL among obese females. METHODS: This controlled trial compared two versions of a standardized 12-month weight reduction intervention: the weight-reduction lifestyle program without a meal replacement (LS) versus the same lifestyle program with the addition of a soy-based meal replacement product (LSMR). 380 women (LS: n = 190, LSMR: n = 190) were matched by age, gender, and weight (51.4 ± 7.0 yrs., 35.5 ± 3.03 kg/m2). This sample of women all completed the 12-month lifestyle intervention that was part of a larger study. The lifestyle intervention included instruction on exercise/sport, psychology, nutrition, and medicine in 18 theoretical and 40 practical units. Led by a sport physiologist, participants engaged in group-based exercise sessions once or twice a week. To evaluate HRQOL, all participants completed the SF-36 questionnaire pre- and post-intervention. Anthropometric, clinical, physical performance (ergometric stress tests), and self-reported leisure time physical activity (hours/day) data were collected. RESULTS: The LSMR sample showed lower baseline HRQOL scores compared to the LS sample in six of eight HRQOL dimensions, most significant in vitality and health perception (p < 0.01). After the intervention, body weight was reduced in both lifestyle intervention groups (LS: -6.6±6.6 vs. LSMR -7.6±7.9 kg), however, weight loss and HRQOL improvements were more pronounced in the LSMR sample (LSMR: seven of eight, LS: four of eight dimensions). CONCLUSIONS: Our results show that HRQOL may improve among middle-aged obese females during a standardized lifestyle weight reduction program and may be enhanced by consuming a soy-based meal replacement product. TRIAL REGISTRATION: ClinicalTrials.gov NCT00356785.

The effect of physical exercise interventions on insomnia: A systematic review and meta-analysis.

6-10 % of Europeans suffer from chronic insomnia. They have a higher risk to develop mental and cardiovascular diseases. Treatment of insomnia primarily recommended by the European guideline is cognitive behavioral therapy for insomnia (CBT-I). A quarter of patients treated with CBT-I do not respond sufficiently. The objective of this paper is to examine the influence of exercise interventions on insomnia by conducting a systematic review and meta-analysis. A database search was conducted, including randomized controlled trials (RCT) in which participants had received a diagnosis of insomnia or experienced symptoms thereof. Exercise interventions had to meet the definition of the World Health Organization (WHO), and their implementation was reported according to the FITT (Frequency, Intensity, Time and Type) principle. There was an inactive control and subjective or objective sleep parameters as outcomes. Nineteen studies were included. Results showed a significant improvement for objective (standardized mean difference, SMD = 0.37; confidence interval, CI = [0.17; 0.57]) as well as subjective (SMD = 0.90; CI = [0.61; 1.19]) sleep parameters. Meta-regression showed that the effect increased with intensity of intervention, mean age of participants and percentage of females, but showed high heterogeneity across studies. These results suggest great potential for treating insomnia. Conducting larger trials is advisable to provide precise recommendations.

A Comparison of the Impact of COVID-19-Related Restrictions on Physical Activity Among Public Employees.

OBJECTIVES: This article compares the impact of COVID-19-related restrictions on the level of physical activity, performed by public servants, in April and November 2020. METHODS: The survey examined the amount (in minutes per week) and the energy expenditure (in metabolic equivalent of task in minutes per week [METmin/week]) of physical activity for both before and during contact restrictions in April and November 2020, respectively. RESULTS: Especially for sports activity difference was determined by the medians before (April/November: median [Mdn] = 180.0 min/wk) and during (April: Mdn = 130 minutes, November: Mdn = 60 min/wk) restrictions ( P < 0.05).Also for energy consumption (METmin/wk), the medians before and during the contact restrictions declined for both periods. CONCLUSIONS: Measures against the coronavirus have led to a reduction in activity levels among public employees, regardless of their work environment. The decrease in participation in sport activities seemed to be even more noticeable within the second restriction period.

Influence of the COVID-19 Pandemic on Musculoskeletal Complaints and Psychological Well-Being of Employees in Public Services-A Cohort Study.

BACKGROUND: The COVID-19 pandemic resulted in unprecedented restrictions on public and private life. The aim of the study was to investigate the impact of the COVID-19 pandemic on the physical and mental health of employees in the public sector, especially patient-related professions. METHODS: For the data collection in summer 2021, an online questionnaire was used. Compared to a pre-pandemic point of time, the prevalence, frequency, and intensity of musculoskeletal pain, mental well-being, health status, and quality of life were recorded. RESULTS: The questionnaire was completed by 1678 employees (f: 1045, m: 617). A total of 1504 employees (89.6%) were affected by complaints. Compared to before the pandemic, the prevalence and intensity of musculoskeletal complaints and psychological distress increased significantly. Patient-related professions (n = 204) showed significantly higher levels of stress and discomfort in several aspects (p < 0.05). CONCLUSIONS: Due to the COVID-19 pandemic, there was an increase in musculoskeletal complaints and a decrease in psychological well-being. Preventive factors related to mental health were identified as male gender, a middle- to older-age group, employees with children, and working from home. Attention should be drawn to these findings and prevention strategies should be brought into focus to strengthen the employees' health. Special focus should be drawn to patient-related professions who are particularly confronted with pandemic-associated challenges.

Trends in the numbers of SARS-CoV-2 infections among students: a prospective cohort study comparing students in sports boarding schools with students in day schools during early COVID-19 pandemic.

Introduction: During the first months of the COVID pandemic it emerged that facilities where people gather or live together in cohorts, such as nursing homes or schools, were particularly at high risk for becoming hotspots of virus transmission. German political and health institutions responded with far-reaching interventions and preventive strategies to protect the population from infection with SARS-CoV-2. In this context, it remains unclear whether boarding schools for sports particularly pose a risk of infection to their residents. Methods: In a single-center prospective cohort study, numbers of SARS-CoV-2 infections of students in sports boarding schools (n = 11) vs. students attending regular day schools (n = 22) in the region Freiburg/Hochschwarzwald in Germany were investigated over a period from October 2020 to January 2021 via regular virus and antibody screening (German Clinical Trials Register; Study ID: DRKS00021909). In addition, individual and behavioral risk factors for infection were stratified via questionnaire, which provide an indication of cohort specific risk factors for infection and the success of the implementation of hygiene concepts, as well as other infection prevention strategies, within the respective facilities. Results: Regarding SARS-CoV-2 infection numbers, the screening detected no significant group difference between sports boarding schools vs. day schools. Discussion: The study results provide indications that sports boarding schools did not pose an increased risk of infection, assuming that the facilities prevent virus transmissions with appropriate preventive strategies and hygiene measures. In future pandemic scenarios larger-scale and multicenter studies are necessary to achieve more comprehensive epidemiological data in this field.

Normal and altered three-dimensional portal venous hemodynamics in patients with liver cirrhosis.

PURPOSE: To compare time-resolved three-dimensional (3D) phase-contrast magnetic resonance (MR) imaging with three-directional velocity encoding (flow-sensitive four-dimensional [4D] MR imaging), with Doppler ultrasonography (US) as standard of reference, for investigating alterations in 3D portal venous hemodynamics in patients with liver cirrhosis compared with healthy age-matched control subjects and healthy young volunteers. MATERIAL & METHODS: This prospective study was approved by the local ethics committee, and written informed consent was obtained from all participants. Three-dimensional portal venous hemodynamics was assessed, employing flow-sensitive 4D MR imaging with a 3-T MR system (spatial resolution, approximately 2 mm(3); temporal resolution, approximately 45 msec) in 20 patients with hepatic cirrhosis, 20 healthy age-matched control subjects, and 21 healthy young volunteers. Flow characteristics were analyzed by using 3D streamlines and time-resolved particle traces. Quantitative analyses were performed by retrospectively evaluating regional peak and mean velocities, flow volume, and vessel area. Doppler US was used as standard of reference. Independent-sample t tests or Wilcoxon-Mann-Whitney tests were applied for comparing each subject group. Paired-sample t tests or Wilcoxon tests were applied when comparing MR imaging and US. RESULTS: Three-dimensional visualization of portal venous hemodynamics was successful, with complete visualization of the vessels in 18 patients and 35 volunteers, with limitations in the left intrahepatic branches (87%, reader A; 89%, reader B). A moderate but significant correlation was observed between 4D MR imaging and Doppler US in nearly all maximum and mean velocities, flow volumes, and vessel areas (r = 0.24-0.64, P = .001-.044). With MR imaging, significant underestimation was observed of intrahepatic flow velocities and flow volumes, except vessel area, which Doppler US represented as even lower (P < .001 to P = .045). Six patients had collateralization with reopened umbilical vein, while one had flow reversal in the superior mesenteric vein visible at MR imaging only. CONCLUSION: Flow-sensitive 4D MR imaging may constitute a promising, alternative technique to Doppler US for evaluating hemodynamics in the portal venous system of patients with liver cirrhosis and may be a means of assessing pathologic changes in flow characteristics.

A soy-based supplement alters energy metabolism but not the exercise-induced stress response.

OBJECTIVE: To determine the changes in endurance capacity as well as in metabolic, hormonal and inflammatory markers induced by endurance training combined with a soy,protein based supplement. DESIGN: Randomized controlled study consisting of moderate endurance training without (GO) or with (G1) a soy protein based supplement. SUBJECTS: Two groups of 15 subjects (10 males and 5 females in each group): healthy sports students aged 23.6 +/- 1.9 years. MEASUREMENTS: Body composition (body mass (BM), body density (BD) by air displacement) and physical fitness (determined by treadmill ergometry) were measured at baseline and after 6 weeks of the intervention; changes in circulating metabolic and hormonal parameters (glucose, lactate, urea, uric acid, ammonia, cortisol, insulin, IGF-1), and exercise-induced stress and inflammatory markers (CK, LDH, myoglobin, hs-CRP, IL-6, IL-10, blood cell counts) were determined after the intervention period in afield test (11.5 km running on hilly ground). RESULTS: 30 participants completed the 6-week study; 28 students were able to perform the field test. No significant changes in BM and BD were noted after intervention with only slight increases in running performance and maximum aerobic capacity in the total group (2%, p=0.016). Subjects in the G1 group showed significant improvements in running velocity and lower lactate values following the intervention (-12%, p=0,003). In addition, the G1 group showed significantly lower differences in the exercise-induced increase of metabolic parameters (triglycerides, uric acid) and insulin in the post-exercise recovery period. CONCLUSIONS: Our data suggest that moderate endurance training in combination with a soy-based protein supplement improves aerobic energy supply and metabolic function in healthy sports students, even without changes in body composition and without changes in the exercise-induced stress and inflammatory reaction.

Case Report: Assessing COVID-19 Transmission in Professional Volleyball in Germany, September to December 2020: An Epidemiological Study.

Introduction: The SARS-CoV-2 pandemic poses extraordinary challenges in all fields of daily life. The WHO recommended social distancing guidelines and person-to-person contact was strongly discouraged to contain transmission. Team-based sports were questioned and widely debated. However, there is a lack of available evidence on the risk of in-game SARS-CoV-2 transmission. We aim to derive new insights regarding the risk of SARS-CoV2 infection during team sports and provide current opinion on how to behave during training and competition. Methods: We report on six competitive male volleyball players (national level) of the same team who were infected with COVID-19. The mode of transmission and potential virus spreading within the team was investigated. The entire course of infection was documented by detailed medical history of the players and RT-PCR tests confirmed suspected infections. Serological testing was performed to establish the antibody status of the team. Results: The investigation did not show strong evidence of viral transmission within the team during sporting activities. Only two players with PCR-proven infection hat detectable antibodies in two antibody assays. Conclusion: Private and social gatherings can spread infection into team sports. Clearly defined test strategies and strict adherence to standard COVID-19 hygiene guidelines during sports seasons cannot be overemphasized.

COVID-19 in German Competitive Sports: Protocol for a Prospective Multicenter Cohort Study (CoSmo-S).

Objective: It is unclear whether and to what extent COVID-19 infection poses health risks and a chronic impairment of performance in athletes. Identification of individual health risk is an important decision-making basis for managing the pandemic risk of infection with SARS-CoV-2 in sports and return to play (RTP). Methods: This study aims 1) to analyze the longitudinal rate of seroprevalence of SARS-CoV-2 in German athletes, 2) to assess health-related consequences in athletes infected with SARS-CoV-2, and 3) to reveal effects of the COVID-19 pandemic in general and of a cleared SARS-CoV-2 infection on exercise performance. CoSmo-S is a prospective observational multicenter study establishing two cohorts: 1) athletes diagnosed positive for COVID-19 (cohort 1) and 2) federal squad athletes who perform their annual sports medical preparticipation screening (cohort 2). Comprehensive diagnostics including physical examination, laboratory blood analyses and blood biobanking, resting and exercise electrocardiogram (ECG), echocardiography, spirometry and exercise testing added by questionnaires are conducted at baseline and follow-up. Results and Conclusion: We expect that the results obtained, will allow us to formulate recommendations regarding RTP on a more evidence-based level.

Soy protein based supplementation supports metabolic effects of resistance training in previously untrained middle aged males.

OBJECTIVE: To determine changes in body composition, physical performance, metabolic and hormonal parameters induced by lifestyle counselling, resistance training and resistance training with soy protein based supplemention in middle aged males. DESIGN: Randomised controlled study consisting of resistance training without (RT-G) or with (RTS-G) a soy protein based supplement and a control group with lifestyle education only (LE-G). SUBJECTS: Forty healthy middle aged men (50-65 years, BMI 25-29.9 kg/m2). MEASUREMENTS: Changes in body weight (BW) and waist circumference (WC) were measured and body composition (BC), fat mass (FM), lean body mass (LBM) were measured by skin fold anthropometry at baseline and after 12 weeks of intervention. In addition, changes in physical fitness, metabolic and hormonal parameters (lipids, glucose, fructosamines, insulin, insulin-like growth factor-1, Leptin, human growth hormone, dehydroepiandrosterone, testosterone, hs-CRP, Il-6) were evaluated. RESULTS: Thirty-five participants completed the 12 week study. No significant changes in BW were noted although RM and WC dropped and LBM increased after training, particularly in the RTS group (FM 22.6 ± 5.5 kg to 21.2 ± 4.7 kg; LBM 68.5 ± 7.2 kg to 70.1 ± 7.4; p < 0.01). Subjects in the RTS group experienced more pronounced improvements in the strength measurements than the RT group. After the training intervention there were significant changes in hormonal and metabolic parameters as well as in glycemic control, particularly in the RTS group. CONCLUSIONS: Our data suggest that resistance training, particularly in combination with a soy protein based supplement improves body composition and metabolic function in middle aged untrained and moderately overweight males.