The role of Matrix Metalloproteinase-2 and Galectin-3 as predictive biomarkers for all-cause mortality in patients undergoing transfemoral transcatheter aortic valve implantation.

BACKGROUND: Currently available risk scores fail to accurately predict morbidity and mortality in patients with severe symptomatic aortic stenosis who undergo transcatheter aortic valve implantation (TAVI). In this context, biomarkers like matrix metalloproteinase-2 (MMP-2) and Galectin-3 (Gal-3) may provide additional prognostic information. METHODS: Patients with severe aortic stenosis undergoing consecutive, elective, transfemoral TAVI were included. Baseline demographic data, functional status, echocardiographic findings, clinical outcomes and biomarker levels were collected and analysed. RESULTS: The study cohort consisted of 89 patients (age 80.4 ± 5.1 years, EuroScore II 7.1 ± 5.8%). During a median follow-up period of 526 d, 28 patients (31.4%) died. Among those who died, median baseline MMP-2 (alive: 221.6 [170.4; 263] pg/mL vs. deceased: 272.1 [225; 308.8] pg/mL, p < 0.001) and Gal-3 levels (alive: 19.1 [13.5; 24.6] pg/mL vs. deceased: 25 [17.6; 29.5] pg/mL, p = 0.006) were higher than in survivors. In ROC analysis, MMP-2 reached an acceptable level of discrimination to predict mortality (AUC 0.733, 95% CI [0.62; 0.83], p < 0.001), but the predictive value of Gal-3 was poor (AUC 0.677, 95% CI [0.56; 0.79], p = 0.002). Kaplan-Meier and Cox regression analyses showed that patients with MMP-2 and Gal-3 concentrations above the median at baseline had significantly impaired long-term survival (p = 0.004 and p = 0.02, respectively). CONCLUSIONS: In patients with severe aortic stenosis undergoing transfemoral TAVI, MMP-2 and to a lesser extent Gal-3, seem to have additive value in optimizing risk prediction and streamlining decision-making.

Association of central blood pressure with an exaggerated blood pressure response to exercise among elite athletes.

PURPOSE: The systolic blood pressure/workload (SBP/MET) slope was recently reported to be a reliable parameter to identify an exaggerated blood pressure response (eBPR) in the normal population and in athletes. However, it is unclear whether an eBPR correlates with central blood pressure (CBP) and vascular function in elite athletes. METHODS: We examined 618 healthy male elite athletes (age 25.8 ± 5.1 years) of mixed sports with a standardized maximum exercise test. CBP and vascular function were measured non-invasively with a validated oscillometric device. The SBP/MET slope was calculated and the threshold for an eBPR was set at > 6.2 mmHg/MET. Two groups were defined according to ≤ 6.2 and > 6.2 mmHg/MET, and associations of CBP and vascular function with the SBP/MET slope were compared for each group. RESULTS: Athletes with an eBPR (n = 180, 29%) displayed a significantly higher systolic CBP (102.9 ± 7.5 vs. 100 ± 7.7 mmHg, p = 0.001) but a lower absolute (295 ± 58 vs. 384 ± 68 W, p < 0.001) and relative workload (3.14 ± 0.54 vs. 4.27 ± 1.1 W/kg, p < 0.001) compared with athletes with a normal SBP/MET slope (n = 438, 71%). Systolic CBP was positively associated with the SBP/MET slope (r = 0.243, p < 0.001). In multiple logistic regression analyses, systolic CBP (odds ratio [OR] 1.099, 95% confidence interval [CI] 1.045-1.155, p < 0.001) and left atrial volume index (LAVI) (OR 1.282, CI 1.095-1.501, p = 0.002) were independent predictors of an eBPR. CONCLUSION: Systolic CBP and LAVI were independent predictors of an eBPR. An eBPR was further associated with a lower performance level, highlighting the influence of vascular function on the BPR and performance of male elite athletes.

Association of cardiorespiratory fitness level with vascular function and subclinical atherosclerosis in the elderly.

PURPOSE: Physical exercise is crucial for healthy aging and plays a decisive role in the prevention of atherosclerotic cardiovascular disease (ASCVD). A higher level of cardiorespiratory fitness (CRF) in the elderly is associated with lower cardiovascular and all-cause mortality. This study investigated the association of CRF level with vascular function and cardiovascular risk factors in the elderly. METHODS: We examined 79 apparently healthy and physically active subjects aged > 55 years (64 ± 4 years). Cardiovascular functional parameters assessed included brachial and central blood pressure (BP), pulse wave velocity (PWV), augmentation index (Aix), and ankle-brachial index. Sonography of the common carotid artery was performed. CRF level was determined by a cardiopulmonary exercise test, and everyday activity was quantified with an accelerometer. RESULTS: All participants had a higher CRF level than the reported age-specific normative values. Twenty-nine subjects had subclinical atherosclerosis of the common carotid artery. Compared with participants without atherosclerosis, they were older (p = 0.007), displayed higher brachial systolic BP (p = 0.006), and higher central systolic BP (p = 0.014). Lower brachial (p = 0.036) and central (p = 0.003) systolic BP, lower PWV (p = 0.004), lower Aix (p < 0.001), lower body fat percentage (< 0.001), and lower LDL cholesterol (p = 0.005) were associated with a higher CRF level. CONCLUSIONS: In this cohort of healthy and physically active individuals, subjects with subclinical atherosclerosis displayed higher systolic brachial and central BP. A higher CRF level was associated with enhanced vascular function, consistent with an influence of CRF on both BP and vascular function in the elderly.

Body Composition of Competitive Bodybuilders: A Systematic Review of Published Data and Recommendations for Future Work.

ABSTRACT: Bauer, P, Majisik, A, Mitter, B, Csapo, R, Tschan, H, Hume, P, Martínez-Rodríguez, A, and Makivic, B. Body composition of competitive bodybuilders: a systematic review of published data and recommendations for future work. J Strength Cond Res 37(3): 726-732, 2023-The purpose of this review was to systematically summarize studies measuring the body composition of competitive bodybuilding athletes to provide recommended values for preparation and during competition. The protocol was preregistered with PROSPERO (CRD42020197921) and followed the guidelines of the Preferred Reported Items for Systematic Reviews and Meta-Analysis. A search of 5 electronic databases (PubMed, Web of Science, SportDiscus, CINAHL, and Scopus) was conducted to retrieve all relevant publications from January 1, 2000, up to June 13, 2021. Of 16 studies meeting the inclusion criteria, 6 presented longitudinal data on competition preparation and were discussed in detail. In the general preparation phase, body fat levels of bodybuilding athletes ranged between 15.3 and 25.2% (female) and from 9.6 to 16.3% (male). Close to competition, however, body fat levels were substantially lower, ranging from 8.1 to 18.3% for female and 5.8-10.7% for male athletes. All studies comparing relative body fat values at various time points during competition preparation found significant reductions between 30 and 60% in relative body fat, whereas lean mass was mostly maintained. Findings from the studies included in this review suggest that most bodybuilding competitors keep resistance training volume high while increasing aerobic training volume when preparing for competition. Findings on energy intake and macronutrient distribution were unclear and should be addressed in future studies. Further research, especially on contest preparation, is warranted and should include more details about training programs, nutritional strategies, psychosocial situation, anabolic androgen steroid, and supplement use as well as measurement protocols and preparation.

Sex differences in workload-indexed blood pressure response and vascular function among professional athletes and their utility for clinical exercise testing.

PURPOSE: Sex differences in blood pressure (BP) regulation at rest have been attributed to differences in vascular function. Further, arterial stiffness predicts an exaggerated blood pressure response to exercise (BPR) in healthy young adults. However, the relationship of vascular function to the workload-indexed BPR and potential sex differences in athletes are unknown. METHODS: We examined 47 male (21.6 ± 1.7 years) and 25 female (21.1 ± 2 years) athletes in this single-center pilot study. We assessed vascular function at rest, including systolic blood pressure (SBP). Further, we determined the SBP/W slope, the SBP/MET slope, and the SBP/W ratio at peak exercise during cycling ergometry. RESULTS: Male athletes had a lower central diastolic blood pressure (57 ± 9.5 vs. 67 ± 9.5 mmHg, p < 0.001) but a higher central pulse pressure (37 ± 6.5 vs. 29 ± 4.7 mmHg, p < 0.001), maximum SBP (202 ± 20 vs. 177 ± 15 mmHg, p < 0.001), and ΔSBP (78 ± 19 vs. 58 ± 14 mmHg, p < 0.001) than females. Total vascular resistance (1293 ± 318 vs. 1218 ± 341 dyn*s/cm5, p = 0.369), pulse wave velocity (6.2 ± 0.85 vs. 5.9 ± 0.58 m/s, p = 0.079), BP at rest (125 ± 10/76 ± 7 vs. 120 ± 11/73.5 ± 8 mmHg, p > 0.05), and the SBP/MET slope (5.7 ± 1.8 vs. 5.1 ± 1.6 mmHg/MET, p = 0.158) were not different. The SBP/W slope (0.34 ± 0.12 vs. 0.53 ± 0.19 mmHg/W) and the peak SBP/W ratio (0.61 ± 0.12 vs. 0.95 ± 0.17 mmHg/W) were markedly lower in males than in females (p < 0.001). CONCLUSION: Male athletes displayed a lower SBP/W slope and peak SBP/W ratio than females, whereas the SBP/MET slope was not different between the sexes. Vascular functional parameters were not able to predict the workload-indexed BPR in males and females.

The origins of goals in the German Bundesliga.

We propose to analyse the origin of goals in professional football (soccer) in a purely data-driven approach. Based on positional and event data of 3,457 goals from two seasons German Bundesliga and 2nd Bundesliga (2018/20,219 and 2019/2020), we devise a rich set of 37 features that can be extracted automatically and propose a hierarchical clustering approach to identify group structures. The results consist of 50 interpretable clusters revealing insights into scoring patterns. The hierarchical clustering found 8 alone standing clusters (penalties, direct free kicks, kick and rush, one-two's, assisted by header, assisted by throw-in) and nine categories (e.g., corners) combining more granular patterns (e.g., five subcategories of corner-goals). We provide a thorough discussion of the clustering and show its relevance for practical applications in opponent analysis, player scouting and for long-term investigations. All stages of this work have been supported by professional analysts from clubs and federation.

Concurrent Validity of Field-Based Diagnostic Technology Monitoring Movement Velocity in Powerlifting Exercises.

ABSTRACT: Mitter, B, Hölbling, D, Bauer, P, Stöckl, M, Baca, A, and Tschan, H. Concurrent validity of field-based diagnostic technology monitoring movement velocity in powerlifting exercises. J Strength Cond Res 35(8): 2170-2178, 2021-The study was designed to investigate the validity of different technologies used to determine movement velocity in resistance training. Twenty-four experienced powerlifters (18 male and 6 female; age, 25.1 ± 5.1 years) completed a progressive loading test in the squat, bench press, and conventional deadlift until reaching their 1 repetition maximum. Peak and mean velocity were simultaneously recorded with 4 field-based systems: GymAware (GA), FitroDyne (FD), PUSH (PU), and Beast Sensor (BS). 3D motion capturing was used to calculate specific gold standard trajectory references for each device. GA provided the most accurate output across exercises (r = 0.99-1, ES = -0.05 to 0.1). FD showed similar results for peak velocity (r = 1, standardized mean bias [ES] = -0.1 to -0.02) but considerably less validity for mean velocity (r = 0.92-0.95, ES = -0.57 to -0.29). Reasonably valid to highly valid output was provided by PU in all exercises (r = 0.91-0.97, ES = -0.5 to 0.28) and by BS in the bench press and for mean velocity in the squat (r = 0.87-0.96, ES = -0.5 to -0.06). However, BS did not reach the thresholds for reasonable validity in the deadlift and for peak velocity in the squat, mostly due to high standardized mean bias (ES = -0.78 to -0.63). In conclusion, different technologies should not be used interchangeably. Practitioners who require negligible measurement error in their assessment of movement velocity are advised to use linear position transducers over inertial sensors.

Dismantling Anti-Ageing Medicine: Why Age-Relatedness of Cardiovascular Disease is Proof of Robustness Rather Than of Ageing-Associated Vulnerability.

Ageing is perceived to be the common culprit behind the most prevalent noncommunicable chronic diseases (NCD) such as cardiovascular disease (CVD). Treating ageing as a means to prevent its downstream pathologies has become the logical extension of this idea, and the defining criterion of anti-ageing medicine (evidence-based early detection, prevention, and treatment of age-related diseases). Challenging the underlying rationale, we here argue that the disease's late-in-life occurrence is proof of a genetically conserved robustness that helps us resist disease long enough for it to masquerade as a consequence of living long rather than of living wrong. Robustness is an acknowledged hallmark phenomenon of all complex systems (while there exists no universally adopted definition, a hallmark of complex systems is that they consist of many networked components whose interactions may give rise to system behaviours which cannot be derived or predicted from a reductionist knowledge of the interacting parts, even if this knowledge is complete) and a key concept in the complexity sciences (a relatively new branch of science that attempts to find and understand the common mechanisms and patterns shared by all complex systems). To reconceptualise the age-relatedness of chronic diseases in this sense has important implications for medical research and practice. The goal of our essay is to open a discussion that may enhance the overall understanding of robustness and prevent a misguided redirection of funding away from established disease specific research and towards anti-ageing medicine. This essay is timely, as the forthcoming 11th version of the International Classification of Diseases (ICD) will be the first to recognise ageing as a condition, thereby legitimising anti-ageing medical research. On a more pragmatic note, and for the benefit of people alive today, we propose a practical strategy to remedy the mismatch between heritable robustness and the lifestyle challenges that gradually overwhelm it.

Attacking Key Performance Indicators in Soccer: Current Practice and Perceptions from the Elite to Youth Academy Level.

Key Performance Indicators (KPIs) are used to evaluate the offensive success of a soccer team (e.g. penalty box entries) or player (e.g. pass completion rate). However, knowledge transfer from research to applied practice is understudied. The current study queried practitioners (n = 145, mean ± SD age: 36 ± 9 years) from 42 countries across different roles and levels of competition (National Team Federation to Youth Academy levels) on various forms of data collection, including an explicit assessment of twelve attacking KPIs. 64.3% of practitioners use data tools and applications weekly (predominately) to gather KPIs during matches. 83% of practitioners use event data compared to only 52% of practitioners using positional data, with a preference for shooting related KPIs. Differences in the use and value of metrics derived from positional tracking data (including Ball Possession Metrics) were evident between job role and level of competition. These findings demonstrate that practitioners implement KPIs and gather tactical information in a variety of ways with a preference for simpler metrics related to shots. The low perceived value of newer KPIs afforded by positional data could be explained by low buy-in, a lack of education across practitioners, or insufficient translation of findings by experts towards practice.

Association of 25-hydroxy vitamin D level with the blood pressure response to a maximum exercise test among professional indoor athletes.

PURPOSE: Low vitamin D levels have been associated with elevated blood pressure (BP) in the general population. However, whether there is an association of vitamin D insufficiency with BP changes during maximum exercise in athletes is currently unclear. METHODS: A total of 120 male professional indoor athletes (age 26 ± 5 years) were examined. BP was measured at rest and during a graded cycling test. We assessed the BP response (BPR) during maximum exercise and the respective load. BP and BPR (peak-baseline BP) were analysed with respect to 25-OH vitamin D levels, with levels < 30 ng/mL defining vitamin D insufficiency. RESULTS: 35 athletes were classified as being vitamin D insufficient. BP was not different between sufficient and insufficient vitamin D groups (122 ± 10/75 ± 7 vs. 120 ± 12/77 ± 9 mmHg). At maximum exercise, however, systolic BP (198 ± 17 vs. 189 ± 19, p = 0.026) and the pulse pressure (118 ± 18 vs. 109 ± 21 mmHg, p = 0.021) were higher in the sufficient group; the BPR was not different between groups (76 ± 20/5 ± 6 vs. 69 ± 22/3 ± 6 mmHg, p = 0.103). Athletes with sufficient levels had a higher maximum power output (3.99 ± 0.82 vs. 3.58 ± 0.78 W/kg, p = 0.015) and achieved higher workloads (367 ± 78 vs. 333 ± 80 W, p = 0.003). The workload-adjusted BPR (maximum systolic BP/MPO) was not different between athletes with sufficient and insufficient vitamin D levels (51 ± 10 vs. 56 ± 14 mmHg × kg/W, p = 0.079). CONCLUSION: Athletes with sufficient vitamin D achieved a higher maximum systolic BP and a higher maximum power output. The workload-adjusted BPR was not different between groups, which suggests that this finding reflects a better performance of athletes with sufficient vitamin D.

Fractional flow reserve and frequency of PCI in patients with coronary artery disease.

BACKGROUND: Fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) has been validated in patients with stable coronary artery disease (CAD) but has not yet been verified under specific conditions such as heart failure or microvascular dysfunction. The aim of the present study was to examine the influence of specific patient comorbidities on FFR values and thus the frequency of PCI in patients with intermediate coronary stenosis. METHODS: A total of 652 patients with CAD and intermediate coronary stenosis who were assessed for FFR were included in this retrospective study. In a subgroup analysis, specific comorbidities such as heart failure with non-ST-segment-elevated acute coronary syndrome (NSTE-ACS), heart failure, diabetes mellitus, atrial fibrillation (AF), and left ventricular hypertrophy (LVH) were considered. RESULTS: In all lesions with an FFR ≤ 0.80 (n = 227/808, 28.1%), PCI was performed using drug-eluting stents. Pathological FFR values (FFR ≤ 0.80) before PCI were most frequently observed in the left anterior descending artery (LAD; n = 168/418, 39.9%) followed by the right coronary artery (RCA; n = 37/178, 20.7%) and the left circumflex artery (LCX; 22/223, 9.8%). The comorbidities NSTE-ACS (p = 0.28), heart failure with reduced ejection fraction (HFrEF; p = 0.63), heart failure with preserved ejection fraction (HFpEF; p = 0.3719), diabetes mellitus (p = 0.177), or LVH (p = 0.407) had no major impact on the occurrence of pathological FFR values; there was also no association between FFR and the occurrence of lesions in the different target vessels. CONCLUSION: The occurrence of pathological FFR values, most frequently documented in the LAD, was the same in patients with or without HFrEF, HFpEF, diabetes mellitus, AF, and LVH, demonstrating that these comorbidities did not influence FFR values and, thus, the indication for PCI.

Elite athletes as research model: vitamin D insufficiency associates with elevated central blood pressure in professional handball athletes.

PURPOSE: Low vitamin D levels have been associated with elevated blood pressure in the general population. Prospective studies, however, have produced conflicting evidence about the blood pressure-lowering effects of vitamin D supplementation. Cardiorespiratory fitness may modulate the vitamin D-blood pressure association. We therefore examined this association in professional athletes, whose high training load serves as a biological control for physical fitness. METHODS: 50 male professional handball players (age 26 ± 5 years) were examined. We assessed the central aortic pressure parameters using transfer function-based analysis of oscillometrically obtained peripheral arterial waveforms. Serum 25-OH vitamin D concentrations were determined by chemiluminescent immunoassay. The threshold for insufficiency was set at values of < 30 ng/mL. RESULTS: Central blood pressure (cBP) was 98 ± 7/60 ± 10 mmHg. The aortic pulse wave velocity (PWV) was 6.3 ± 1.0 m/s. Nine athletes (18%) displayed insufficient 25-OH vitamin D levels and had a significantly (p < 0.01) higher cBP compared with the 41 (82%) athletes with sufficient 25-OH vitamin D levels (106 ± 5/68 ± 8 vs. 97 ± 7/58 ± 9 mmHg). Central systolic blood pressure (cSBP) in vitamin D-sufficient athletes was significantly lower in comparison to the healthy reference population (97 mmHg vs. 103 mmHg, p < 0.001). This significance of difference was lost in vitamin D-insufficient athletes (106 mmHg vs. 103 mmHg, p = 0.12). CONCLUSION: Significantly raised central systolic and diastolic blood pressure in vitamin D-insufficient elite athletes implicates vitamin D as a potential modifier of vascular functional health.

Acute Effects of Back Squats on Countermovement Jump Performance Across Multiple Sets of a Contrast Training Protocol in Resistance-Trained Men.

Bauer, P, Sansone, P, Mitter, B, Makivic, B, Seitz, LB, and Tschan, H. Acute effects of back squats on countermovement jump performance across multiple sets of a contrast training protocol in resistance-trained men. J Strength Cond Res 33(4): 995-1000, 2019-This study was designed to evaluate the voluntary postactivation potentiation (PAP) effects of moderate-intensity (MI) or high-intensity (HI) back squat exercises on countermovement jump (CMJ) performance across multiple sets of a contrast training protocol. Sixty resistance-trained male subjects (age, 23.3 ± 3.3 years; body mass, 86.0 ± 13.9 kg; and parallel back squat 1-repetition maximum [1-RM], 155.2 ± 30.0 kg) participated in a randomized, crossover study. After familiarization, the subjects visited the laboratory on 3 separate occasions. They performed a contrast PAP protocol comprising 3 sets of either MI (6 × 60% of 1-RM) or HI back squats (4 × 90% of 1-RM) or 20 seconds of recovery (CTRL) alternated with 7 CMJs that were performed at 15 seconds, and 1, 3, 5, 7, 9 and 11 minutes after the back squats or recovery. Jump height and relative peak power output recorded with a force platform during MI and HI conditions were compared with those recorded during control condition to calculate the voluntary PAP effect. Countermovement jump performance was decreased immediately after the squats but increased across all 3 sets of MI and HI between 3 and 7 minutes after recovery. However, voluntary PAP effects were small or trivial, and no difference between the 3 sets could be found. These findings demonstrate that practitioners can use MI and HI back squats to potentiate CMJs across a contrast training protocol, but a minimum of 3 minutes of recovery after the squats is needed to benefit from voluntary PAP.

Probing depth is an independent risk factor for HbA1c levels in diabetic patients under physical training: a cross-sectional pilot-study.

BACKGROUND: This cross-sectional study investigates the potential association between active periodontal disease and high HbA1c levels in type-2-diabetes mellitus subjects under physical training. METHODS: Women and men with a diagnosis of non-insulin-dependent diabetes mellitus and ongoing physical and an ongoing exercise program were included. Periodontal conditions were assessed according to the CDC-AAP case definitions. Venous blood samples were collected for the quantitative analysis of HbA1c. Associations between the variables were examined with univariate and multivariate regression models. RESULTS: Forty-four subjects with a mean age of 63.4 ± 7.0 years were examined. Twenty-nine subjects had no periodontitis, 11 had a moderate and 4 had a severe form of periodontal disease. High fasting serum glucose (p < 0.0001), high BMI scores (p = 0.001), low diastolic blood pressure (p = 0.030) and high probing depth (p = 0.036) were significantly associated with high HbA1c levels. CONCLUSIONS: Within the limitations of this study HbA1c levels are positively associated with high probing pocket depth in patients with non-insulin-dependent diabetes mellitus under physical exercise training. Control and management of active periodontal diseases in non-insulin-dependent patients with diabetes mellitus is reasonable in order to maximize therapeutic outcome of lifestyle interventions.

Data analytics in the football industry: a survey investigating operational frameworks and practices in professional clubs and national federations from around the world.

The use of data and analytics in professional football organisations has grown steadily over the last decade. Nevertheless, how and whether these advances in sports analytics address the needs of professional football remain unexplored. Practitioners from national federations qualified for the FIFA World Cup Qatar 2022™ and professional football clubs from an international community of practitioners took part in a survey exploring the characteristics of their data analytics infrastructure, their role, and their value for elaborating player monitoring and positional data. Respondents from 29 national federations and 32 professional clubs completed the survey, with response rates of 90.6% and 77.1%, respectively. Summary information highlighted the underemployment of staff with expertise in applied data analytics across organisations. Perceptions regarding analytical capabilities and data governance framework were heterogenous, particularly in the case of national federations. Only a third of national federation respondents (~30%) perceived information on positional data from international sports data analytics providers to be sufficiently clear. The general resourcing limitations, the overall lack of expertise in data analytics methods, and the absence of operational taxonomies for reference performance metrics pose constraints to meaningful knowledge translations from raw data in professional football organisations.

Prognostic utility of mid-regional pro-adrenomedullin and growth differentiation factor 15 in patients undergoing transfemoral transcatheter aortic valve implantation.

BACKGROUND: Risk prediction in patients with severe, symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) remains an unsolved issue. In addition to classical risk scoring systems, novel circulating biomarkers like mid-regional pro-adrenomedullin (MR-proADM) and growth differentiation factor 15 (GDF-15) may be of value in assessing risk. METHODS: Consecutive patients undergoing elective transfemoral TAVI were included in this prospective observational study. Baseline information, imaging findings, blood samples, and clinical outcomes were collected. Blood levels of the classical biomarkers interleukin-6 (IL-6) and high-sensitivity C-reactive peptide (hsCRP) and of the novel biomarkers MR-proADM and GDF-15 were measured and their predictive utility for mortality assessed. RESULTS: The study cohort consisted of 92 patients undergoing TAVI. The median age was 80.7 years [IQR 77.2;83.3], and 48 (52.2%) were male. Analysis of the area under the curve (AUC) of the receiver-operating characteristics showed that the hsCRP levels discriminated poorly (AUC 0.66, 95% CI [0.52;0.8], p = 0.027), whereas all other biomarkers reached a higher level of discrimination (IL-6: AUC 0.76, 95% CI [0.66;0.86], p < 0.001; MR-proADM: AUC 0.73, 95% CI [0.61;0.85], p = 0.002; GDF-15: AUC 0.73, 95% CI [0.61;0.85], p = 0.002). Kaplan-Meier analysis in conjunction with Youden J-statistics yielded the optimal cutoff points for each biomarker to predict survival: IL-6 4.65 pg/mL, hsCRP 12.9 mg/L, MR-proADM 1.02 nmol/L, and GDF-15 2400.1 pg/mL. CONCLUSION: Novel circulating biomarkers like MR-proADM and GDF-15 may provide additional value in predicting survival after TAVI.

Comparison of vascular risk profile and clinical outcomes among patients with central (branch) retinal artery occlusion versus amaurosis fugax.

BACKGROUND: Retinal artery occlusions lead to sudden, painless vision loss, affecting millions globally. Despite their significance, treatment strategies remain unestablished, contrasting with acute ischemic stroke (AIS), where IVT has proven efficacy. Similar to AIS, retinal artery occlusions demand urgent evaluation and treatment, reflecting the principle "time is retina". Even for patients with transient monocular vision loss, also known as amaurosis fugax (AF), pertinent guidelines meanwhile recommend immediate emergency assessment in a specialized facility. However, data on the clinical benefit and comparability with persistent occlusions are missing. This study aimed to compare the results of a comprehensive stroke-workup among patients with persistent retinal artery occlusions (RAO), including both central retinal (CRAO) and branch retinal artery occlusion (BRAO) and those with AF. METHODS: Conducted at the University Hospital Giessen, Germany, this exploratory cross-sectional study enrolled patients with transient or permanent unilateral vision loss of non-arteritic origin. The primary outcome were differences between the two groups RAO and AF with regard to cardiovascular risk profiles and comorbidities, vascular and pharmacological interventions and clinical neurological and ophthalmological outcomes. Secondary outcome was a sub-group analysis of patients receiving IVT. RESULTS: Out of 166 patients assessed, 76 with RAO and 40 with AF met the inclusion criteria. Both groups exhibited comparable age, gender distribution, and cardiovascular risk profiles. Notably, RAO patients did not show significantly more severe vascular comorbidities than AF patients. However, AF patients received vascular interventions more frequently. Pharmacological intervention rates were similar across groups. RAO patients had slightly worse neurological outcomes, and IVT did not yield favorable ophthalmological outcomes within any observed patients. CONCLUSION: The study found similar vascular burden and risk factors in patients with RAO and AF, with implications for clinical workflows. IVT for RAO may only be effective in very early treatment windows. This emphasizes the need for public awareness and collaborative protocols between ophthalmologists and neurologists to improve outcomes.

Modelling the relationship between load and repetitions to failure in resistance training: A Bayesian analysis.

To identify the relationship between load and the number of repetitions performed to momentary failure in the pin press exercise, the present study compared different statistical model types and structures using a Bayesian approach. Thirty resistance-trained men and women were tested on two separate occasions. During the first visit, participants underwent assessment of their one-repetition maximum (1-RM) in the pin press exercise. On the second visit, they performed sets to momentary failure at 90%, 80% and 70% of their 1-RM in a fixed order during a single session. The relationship between relative load and repetitions performed to failure was fitted using linear regression, exponential regression and the critical load model. Each model was fitted according to the Bayesian framework in two ways: using an across-subjects pooled data structure and using a multilevel structure. Models were compared based on the variance explained (R2) and leave-one-out cross-validation information criterion (LOOIC). Multilevel models, which incorporate higher-level commonalities into individual relationships, demonstrated a substantially better fit (R2: 0.97-0.98) and better predictive accuracy compared to generalised pooled-data models (R2: 0.89-0.93). The multilevel 2-parameter exponential regression emerged as the best representation of data in terms of model fit, predictive accuracy and model simplicity. The relationship between load and repetitions performed to failure follows an individually expressed exponential trend in the pin press exercise. To accurately predict the load that is associated with a certain repetition maximum, the relationship should therefore be modelled on a subject-specific level.

Body fat of competitive volleyball players: a systematic review with meta-analysis.

BACKGROUND: Reference values of body fat for competitive volleyball players are lacking, making it difficult to interpret measurement results. This review systematically summarized published data on the relative body fat of volleyball players and calculated potential differences between sex, measurement method, and competitive level. METHODS: The protocol followed the Preferred Reported Items for Systematic Reviews and Meta-Analysis guidelines. The literature search was conducted using five electronic databases to retrieve all relevant publications from January 1, 2010, to July 1, 2021. The 63 studies including 2607 players that met the inclusion criteria were analyzed using random-effects models. Data were reported as pooled mean body fat with 95% confidence intervals. RESULTS: Body fat for males and females was 12.8% (11.9-13.8%) and 22.8% (21.9-23.7%), respectively. Body fat was 18.3% (16.3-20.4%) measured via skinfolds, 18.4% (15.6-21.2%) via bioelectrical impedance analysis, 24.2% (20.4-28.0%) via dual-energy x-ray absorptiometry and 21.6% (17.4-25.8%) via densitometry. Regional, national, and international-level players had body fat values of 19.5% (17.8-21.2%), 20.3% (18.6-22.0%), and 17.9% (15.7-20.4%), respectively. When the meta-regression was adjusted for the variables sex, measurement method, and competitive level, a significant difference between sex (p < 0.001), dual-energy x-ray absorptiometry and skinfolds (p = 0.02), and national and international-level players (p = 0.02) was found. However, sensitivity analysis revealed that findings regarding measurement method and competitive level were not robust and should, therefore, be interpreted with caution. CONCLUSIONS: Despite the limitations of published data, this meta-analysis provided pooled values for body fat of male and female volleyball players for different competitive levels and measurement methods.

T-cell-derived TNF-α and a cluster of immunological parameters from plasma allow a separation between SARS-CoV-2 convalescent versus vaccinated elite athletes.

Guidelines for medical clearing after SARS-CoV-2 infection in elite athletes do not include T-cell immunity aspects despite its relevance in the course of COVID-19 disease. Therefore, we aimed to analyze T-cell-related cytokines before and after in-vitro activation of CD4+ T-cells. We sampled professional indoor sports athletes at medical clearing after SARS-CoV-2 infection obtaining clinical, fitness data, and serological data including CD4+ T-cell cytokines. All data were analyzed by principal component analysis and 2 × 2 repeated measures ANOVA. CD4+ T-cells were sampled for cell culture activation with anti-CD3/anti-CD28 tetramers. At medical clearing, CD4+ T-cells from convalescent athletes secreted increased levels of TNF-α 72 h after in-vitro activation compared to vaccinated athletes. IL-18 levels in plasma were elevated and a cluster of parameters differentiated convalescent from vaccinated athletes by 13 parameters at the timepoint of medical clearing. All clinical data indicate infection is resolved, while increased TNF-α may reflect altered proportions of peripheral T-cells as a hangover of infection.