Compliance with needle-use declarations at two Olympic Winter Games: Sochi (2014) and PyeongChang (2018).

OBJECTIVES: We describe compliance with the 'IOC Needle Policy' at two Winter Olympic Games (Sochi and PyeongChang) and compare these findings to those of the Summer Olympic Games of Rio de Janeiro. METHOD: All needle-use declaration(s) (NUD) received during the course of the 2014 and 2018 Olympic Games were reviewed. We recorded socio-demographic data, the nature and purpose of needle use, product(s) injected, and route of administration. Data were analysed descriptively. RESULTS: In total, doctors from 22 National Olympic Committees (NOCs) submitted 122 NUD involving 82 athletes in Sochi; in PyeongChang, doctors from 19 NOCs submitted 82 NUD involving 61 athletes. This represented approximately 2% of all athletes at both Games, and 25% and 20% of all NOCs participating in Sochi and PyeongChang, respectively. No marked differences in the NUD distribution patterns were apparent when comparing the two Winter Olympic Games. The most commonly administered substances were as follows: local anaesthetics, non-steroidal anti-inflammatory drug and glucocorticoids. Physicians submitted multiple NUD for 24% of all athletes who required a NUD. CONCLUSION: A limited number of NOCs submitted NUD suggesting a low incidence of needle use or limited compliance (approximately 2%). A key challenge for the future is to increase the rate of compliance in submitting NUD. More effective education of NOCs, team physicians and athletes regarding the NUD policy, its purpose, and the necessity for NUD submissions, in association with the enforcement of the appropriate sanctions following non-compliance are needed.

Sex-Related Differences After a Single Bout of Maximal Eccentric Exercise in Response to Acute Effects: A Systematic Review and Meta-analysis.

Morawetz, D, Blank, C, Koller, A, Arvandi, M, Siebert, U, and Schobersberger, W. Sex-related differences after a single bout of maximal eccentric exercise in response to acute effects: a systematic review and meta-analysis. J Strength Cond Res 34(9): 2697-2707, 2020-The most prominent effects after unaccustomed eccentric exercise are muscle damage, muscle soreness, strength loss, and higher concentrations of muscle proteins in the plasma. The aim of this systematic review is to evaluate sex-related differences in these acute effects. A systematic literature search in MEDLINE following the PRISMA guidelines was performed. Inclusion criteria were the difference in absolute outcomes between sexes in eccentric muscle strength, strength loss after eccentric exercise, blood concentrations of creatine kinase (CK), and delayed onset muscle soreness (DOMS). Results for maximal eccentric torque and CK data were pooled using a random-effect meta-analysis. A meta-regression was conducted to explain heterogeneity. Based on the 23 included trials, men showed significantly higher absolute eccentric strength. No sex-related differences were detected when normalizing strength for body mass, cross-sectional area of the muscle, or fat-free mass. Women displayed a tendency toward greater relative strength loss immediately after exercise. The absolute CK concentrations of men were significantly higher after exercise-induced muscle damage. No significant difference was found between sexes in DOMS. Untrained men and women display similar responses in all measures of relative muscle strength and DOMS. Apart from the enzymatic activity after exercise and the levels of absolute eccentric torque, there is no evidence for sex-related differences immediately after eccentric exercise. Therefore, eccentric training might have the same impact on men and women. One potential sex difference with practical relevance would be the possible difference in fatigue pattern immediately after eccentric exercise.

Higher hamstring-to-quadriceps isokinetic strength ratio during the first post-operative months in patients with quadriceps tendon compared to hamstring tendon graft following ACL reconstruction.

PURPOSE: The aim of this study was to compare isokinetic quadriceps and hamstring muscle strength in patients following anterior cruciate ligament (ACL) reconstruction who received either hamstring (HT) or quadriceps (QT) tendon autografts at two time intervals within the first year after surgery. METHODS: One hundred twenty-four patients, 81 males (age 22.0 ± 6.2 years) and 43 females (age 20.9 ± 8.7 years), participated in this study. ACL reconstruction was performed with either quadriceps tendon autografts (QT; n = 61) or hamstring tendon autografts (HT; n = 63). Two isokinetic muscle strength tests (t1: 5.5 ± 1.2 months; t2: 7.6 ± 1.6 months) were performed at an angular velocity of 60°/s in both the injured and contralateral knees. An independent t test as well as a two-factor analysis of variance with repeated measurements was used. The significance level was set at p < 0.05. RESULTS: A statistically significant lower knee extensor strength was observed in the QT group within one year after surgery (p < 0.001). Additionally, data showed a significant higher H/Q ratio in QT patients compared to the HT group at t1 (p < 0.001) and t2 (p = 0.001) as well as a significant effect over time (p < 0.001) and interaction effect of time and graft (p = 0.007). Side-to-side values for extensor muscle strength were significantly (p < 0.001) greater in HT graft patients, while QT patients showed significantly (p < 0.001) greater values for flexor muscle strength at both time points of isokinetic testing, respectively. CONCLUSION: The results of this study indicate that graft choice has an impact on extensor strength in the first months after ACL reconstruction; however, there is no impact on flexor strength. The finding of a higher H/Q ratio in patients with QT grafts within the first months following surgery is possibly of clinical relevance. This may potentially be associated with lower stress on the maturing ACL graft. Furthermore, normal thigh strength can be restored over time. LEVEL OF EVIDENCE: III.

Story behind meldonium-from pharmacology to performance enhancement: a narrative review.

Recent reports from the World Anti-Doping Agency (WADA) indicate an alarming prevalence in the use of meldonium among elite athletes. Therefore, in January 2016, meldonium was added to WADA's prohibited list after being monitored since 2015. Meldonium has been shown to have beneficial effects in cardiovascular, neurological and metabolic diseases due to its anti-ischaemic and cardioprotective properties, which are ascribed mainly to its inhibition of ß-oxidation and its activation of glycolysis. Despite its widespread use, there are only a few clinical studies or clinical trials available. Meldonium is registered in most Baltic countries and is easily accessible through the internet with no serious adverse effects reported by the manufacturer so far. Among athletes, meldonium is used with the purpose of increasing recovery rate or exercise performance. The benefit of taking meldonium in view of performance enhancement in athletes is quite speculative and is discussed without sound scientific evidence. This narrative review provides a detailed overview of the drug meldonium, focusing on the main topics pharmacology and biochemical actions, clinical applications, pharmacokinetics, methods of detection and potential for performance enhancement in athletes.

Diagnostic accuracy of random massively parallel sequencing for non-invasive prenatal detection of common autosomal aneuploidies: a collaborative study in Europe.

OBJECTIVE: The objective of this study is to validate the diagnostic accuracy of a non-invasive prenatal test for detecting trisomies 13, 18, and 21 for a population in Germany and Switzerland. METHODS: Random massively parallel sequencing was applied using Illumina sequencing platform HiSeq2000. Fetal aneuploidies were identified using a median absolute deviation based z-score equation. A bioinformatics algorithm based on guanine-cytosine normalization was applied after the data were unblinded. Results of massively parallel sequencing and invasive procedures were compared. RESULTS: Overall, 40/42 samples were correctly classified as trisomy 21-positive, including a translocation trisomy 21 [46,XY,der(13;21),+21] and a structural aberration of chromosome 21 [46,XX,rec(21)dup(21q)inv(21)(p12q21.1)] but not including a low percentage mosaic trisomy 21 [47,XY,+21/46,XY], [sensitivity: 95.2%; one-sided lower confidence limit: 85.8%]; 430/430 samples were correctly classified as trisomy 21-negative (specificity: 100%; one-sided lower CL: 99.3%). Using a new bioinformatics algorithm with guanine-cytosine normalization, detection of trisomy 21 was facilitated, and five of five trisomy 13 cases and eight of eight trisomy 18 cases were correctly identified. CONCLUSION: Our newly established non-invasive prenatal test allows detection of fetal trisomies 13, 18, and 21 with high accuracy in a population in Germany and Switzerland.

Does climate therapy at moderate altitudes improve pulmonary function in asthma patients? A systematic review.

PURPOSE: Allergic bronchial asthma is one of the most common chronic diseases worldwide. For many years, the climate at moderate altitude has been used as an alternative therapy for patients suffering from bronchial asthma. The aim of such therapy is to reduce the medication dose and to improve the quality of life for each patient. The aim of our current work was to assess published data evaluating the effects of climate therapy at moderate altitude on the health status of patients with bronchial asthma. The health status is represented through surrogate parameters for the pulmonary function (forced expiratory volume in one second (FEV1)), bronchial hyperresponsiveness (PC20), and inflammation (total number of eosinophils, eosinophilic cationic protein, and exhaled nitric oxide). METHODS: Our systematic review included randomized controlled trials (RCTs) and single-armed studies with adults and children participating. Included in our review were climate therapies occurring at moderate altitudes between 1,500 and 2,500 m and evaluation of patient FEV1 or PC20 values. RESULTS: A literature research in MEDLINE and EMBASE identified three RCTs, two clinically controlled trials, and 15 single-armed studies. Analysis revealed a lack of evidence regarding the moderate altitude therapy arising from small sample sizes, deficits in documentation, and heterogeneous results. Most of the studies, however, showed a tendency for improvement of the analyzed parameters. CONCLUSIONS: The currently available data do not allow for valid and generalizable recommendations with respect to moderate altitude therapy for patients with allergic bronchial asthma. There is a need for additional, qualitatively strong research including larger sample sizes and randomized, controlled trial design.

Doping in Paralympic sport: perceptions, responsibility and anti-doping education experiences from the perspective of Paralympic athletes and parasport coaches.

Introduction: Limited effort has been invested in understanding doping in Paralympic sport. The limited evidence that exists suggests that factors influencing doping in parasport are similar to Olympic sport. However, based on the design and nature of the previous studies, where methods have been mostly limited to qualitative data and prevalence numbers, further research is warranted to extend previous findings. Methods: Informed by current evidence from Paralympic and Olympic sport, we aimed to investigate (1) para-athletes' perceptions of Anti-Doping Rule Violations (ADRVs) and responsibility for them, (2) descriptive norms for doping in parasport (3) perceptions of anti-doping education and legitimacy of anti-doping authorities, and (4) coach engagement in doping prevention and levels of doping confrontation efficacy using a quantitative survey approach. Results: In total, valid survey responses from 126 Paralympic athletes and 35 coaches from four countries (Germany, Austria, Switzerland, UK) were analysed for experience with anti-doping, descriptive norms, anti-doping education, perceived legitimacy, knowledge, and doping confrontation efficacy (coaches only). Across both athletes and coaches, the level of education was generally good and doping willingness was low. Classification cheating was considered a form of doping and seems to be an important issue for athletes and coaches, especially within the UK sample. For 33.3% of the athletes, doping control was their first experience with anti-doping. Coaches' engagement with doping prevention activities and their perceived efficacy to confront doping-related matters appears to be higher compared to Olympic coaches' samples. Discussion: Sport organisations/NADOs in Paralympic sport could use synergies with those organisations in Olympic sport, adopting similar approaches to anti-doping education, also focusing on a balanced communication of doping prevalence numbers and testing figures. Efforts to ensure athletes are educated about anti-doping before they are tested should be upheld. It seems that in para sport, different compared to able-bodied coaches, anti-doping organizations do not have to convince the coaches about their roles (i.e., being responsible for anti-doping education) anymore but can directly build on these resources. Overall, it seems that there are few differences between parasport and able-bodied sports and thus responsible organisations could use the existing programmes in Olympic sport and only adapt special content (e.g., boosting) which is unique to Paralympic athletes.

Medical services at the first Winter Youth Olympic Games 2012 in Innsbruck/Austria.

BACKGROUND: The Youth Olympic Games (YOG) are a new format designed by the International Olympic Committee. So far no reference data are available regarding the organisation or implementation of the medical services that were needed for the Winter Youth Olympic Games that took place for the first time in Innsbruck 9-24 January 2012. OBJECTIVES: (1) To provide insight into what is needed to prepare for such a complex high level sporting event from a medical perspective, (2) to provide data on medical services for future organising committees and (3) to provide information on different National Olympic Committee (NOC) delegation structures and the consequences of registering a National Olympic Committee Team Physician. METHODS: A medical information system in the form of a patient data-management system was developed with all involved parties to standardise data collection. All medical encounters occurring at any IYOGOC medical service centre (including physiotherapy and psychology facilities) were tracked and collected in daily reports. Data evaluation was prepared based on different interest groups (Athletes, National Olympic Committees, Workforce, International Olympic Committee and Media) and analysed. RESULTS: 327 medical encounters (42.8% athletes; out of these, 57.9% were accounted to athletes with own NOC team physician) were seen during the YOG 2012. The total number of hospital transports was 27.3%, of which 8.9% were hospitalised with an average length of 1.9 nights. Physiotherapy usage was low with only 19 medical encounters resulting in a referral to physiotherapy accounting for 67 treatments during the entire YOG. Psychological care service was not used at all. The main reason for illnesses was disorders of the respiratory system (28.8%), injuries mostly affected upper extremities (49.6%) and were mostly diagnosed with lacerations and contusions (26.2%). Injury (70.7%) and illness (29.3%) incidences in athletes were slightly lower than previous studies showed. 40.0% of NOC delegations registered their own team physicians, which led to a significant difference in usage frequency of medical service (-3%, p=0.012). CONCLUSIONS: Medical service coverage at the first Winter Youth Olympic Games seemed to be appropriate. No disaster or epidemic disease challenged the medical service plan. Future organising committees could use the provided data as a reference for their planning efforts.

Sport injuries and illnesses during the first Winter Youth Olympic Games 2012 in Innsbruck, Austria.

BACKGROUND: Data on the injury and illness risk among young elite athletes are of utmost importance, because injuries and illnesses can counter the beneficial effects of sports participation at a young age, if children or adolescents are unable to continue to participate because of residual effects of injury or chronic illness. OBJECTIVE: To analyse the frequencies and characteristics of injuries and illnesses during the 2012 Innsbruck Winter Youth Olympic Games (IYOG). METHODS: We employed the International Olympic Committee (IOC) injury surveillance system for multisport events, which was updated for the Winter Olympic Games in Vancouver 2010. All National Olympic Committees (NOCs) were asked to report the daily occurrence (or non-occurrence) of newly sustained injuries and illnesses on a standardised reporting form. In addition, information on athletes treated for injuries and illnesses by the Local Organizing Committee medical services was retrieved from the medical centre at the Youth Olympic Village and from the University hospital in Innsbruck. RESULTS: Among the 1021 registered athletes (45% women, 55% men) from 69 NOCs, a total of 111 injuries and 86 illnesses, during the IYOG, were reported, resulting in an incidence of 108.7 injuries and 84.2 illnesses per 1000 registered athletes, respectively. Injury frequency was highest in skiing in the halfpipe (44%) and snowboarding (halfpipe and slope style: 35%), followed by ski cross (17%), ice hockey (15%), alpine skiing (14%) and figure skating (12%), taking into account the respective number of participating athletes. Knee, pelvis, head, lower back and shoulders were the most common injury locations. About 60% of injuries occurred in competition and about 40% in training, respectively. In total, 32% of the injuries resulted in an absence from training or competition. With regard to illnesses, 11% of women and 6% of men suffered from an illness (RR=1.84 (95% CI 1.21 to 2.78), p=0.003). The respiratory system was affected most often (61%). CONCLUSIONS: Eleven per cent of the athletes suffered from an injury and 9% from illnesses, during the IYOG. The presented data constitute the basis for future analyses of injury mechanisms and associated risk factors in Olympic Winter sports, which, in turn, will be essential to develop and implement effective preventive strategies for young elite winter-sport athletes.

The Influence of Environmental Hypoxia on Hemostasis-A Systematic Review.

Humans have been ascending to high altitudes for centuries, with a growing number of professional- and leisure-related sojourns occurring in this millennium. A multitude of scientific reports on hemostatic disorders at high altitude suggest that hypoxia is an independent risk factor. However, no systematic analysis of the influence of environmental hypoxia on coagulation, fibrinolysis and platelet function has been performed. To fill this gap, we performed a systematic literature review, including only the data of healthy persons obtained during altitude exposure (<60 days). The results were stratified by the degree of hypoxia and sub-categorized into active and passive ascents and sojourns. Twenty-one studies including 501 participants were included in the final analysis. Since only one study provided relevant data, no conclusions regarding moderate altitudes (1,500-2,500 m) could be drawn. At high altitude (2,500-5,400 m), only small pathophysiological changes were seen, with a possible impact of increasing exercise loads. Elevated thrombin generation seems to be balanced by decreased platelet activation. Viscoelastic methods do not support increased thrombogenicity, with fibrinolysis being unaffected by high altitude. At extreme altitude (5,400-8,850 m), the limited data showed activation of coagulation in parallel with stimulation of fibrinolysis. Furthermore, multiple confounding variables at altitude, like training status, exercise load, fluid status and mental stress, prevent definitive conclusions being drawn on the impact of hypoxia on hemostasis. Thus, we cannot support the hypothesis that hypoxia triggers hypercoagulability and increases the risk of thromboembolic disorders, at least in healthy sojourners.

GRADE IT-A Literacy-Based Assessment Tool for Generating Research-Based Assessment Data to Evidence the ImpacT of Anti-doping Education via Athletes' Capability to Make the Right Decision.

The International Standard for Education (ISE) mandates Code Signatories to plan, deliver, and evaluate anti-doping education. Performance-based evaluation of anti-doping education requires alignment between educational goals, content, and defined outcomes. Based on an existentialist teaching and learning philosophy, we aimed to develop and test an anti-doping impact evaluation tool, to assess the impact of anti-doping education on doping awareness, literacy (DAL), perceived trust, and legitimacy. We propose that the impact of anti-doping education is best captured through assessment of situation-specific (social) cognitive mediators of actions that influence athletes' choices in the context of sport-related goals. In phase one, we aimed to develop and test the Generating Research-based Assessment Data to Evidence the ImpacT of anti-doping education (GRADE IT) evaluation tool that comprised a set of social cognitive components: anti-doping knowledge, DAL, perceived trust, and legitimacy of anti-doping (organizations). In phase two we assessed whether anti-doping education impacts knowledge, the three DAL stages (functional, interactive, and critical literacy), perceived trust and legitimacy. Phase one enrolled 986 junior elite athletes, and we showed that all GRADE IT components performed well. After revision of the tool for phase two, we validated the assumption that anti-doping education impacts the likelihood that athletes will make the "right" choice (based on a new set of data from 1,255 junior elite athletes). Comprehensive education was associated with higher scores for all stages of DAL, as well as perceived trust and legitimacy. Even athletes reporting no education had positive scores for all included outcomes, supporting the assumption that most athletes wish to engage in clean sport behaviors and might need anti-doping education not to prevent them from doping, but rather to reinforce their commitment to clean sport. In conclusion, GRADE IT, which is available in 23 languages, is a suitable tool for application to young, emerging athletes to satisfy the ISE requirement for evaluating anti-doping education programs. Researchers and practitioners alike are advised to collect additional data to further validate the tool for adult athletes, and to apply it longitudinally to identify if changes in doping prevention policies have a delayed effect on DAL, perceived trust, and legitimacy.

Effect of Tai Chi on muscle strength, physical endurance, postural balance and flexibility: a systematic review and meta-analysis.

OBJECTIVE: To investigate the impact of Tai Chi training on muscle strength, physical endurance, postural balance and flexibility, as measured by tests commonly used in health-related fitness or competitive sports contexts. DESIGN: Systematic review and meta-analysis. DATA SOURCES: The following databases were searched up to 31 July 2020: CINAHL, Cochrane Library, MEDLINE via PubMed and SPORTDiscus. ELIGIBILITY CRITERIA FOR STUDIES: Inclusion: (1) Randomised controlled trials published in German or English; (2) Tai Chi used as an intervention to improve physical performance; (3) Test methods commonly used in health-related fitness or competitive sports and (4) Participants aged ≥16 years (irrespective of health status). Exclusion: (1) Studies not focusing on Tai Chi or including Tai Chi mixed with other interventions and (2) Modified or less than eight Tai Chi movements. RESULTS: Out of 3817 records, 31 studies were included in the review, 21 of them in the meta-analysis. Significant improvements in handgrip strength (2.34 kg, 95% CI 1.53 to 3.14), walking distance during 6 min (43.37 m, 95% CI 29.12 to 57.63), standing time in single-leg-stance with open eyes (6.41 s, 95% CI 4.58 to 8.24) and thoracolumbar spine flexibility (2.33 cm, 95% CI 0.11 to 4.55) were observed. CONCLUSION: Tai Chi training seems to moderately improve physical fitness when evaluated by tests used in health-related fitness or competitive sports. Moreover, thoracolumbar spine flexibility seems to be a factor in the improvement of postural balance. Further research is needed, including younger healthy participants performing a widely used, standardised form (eg, Peking-style routine) with high-intensity movements (eg, use of lower stances).

Are There Associations Between Submaximal and Maximal Aerobic Power and International Ski Federation World Cup Ranking in Elite Alpine Skiers?

PURPOSE: To analyze the predictive value of parameters of submaximal and maximal cardiopulmonary exercise performance on International Ski Federation (Fédération Internationale de Ski) World Cup ranking (FIS ranking) in elite Austrian Alpine skiers. METHODS: Over 7 World Cup seasons (2012-2018), exercise data (maximal oxygen uptake and maximum power output, lactate threshold 2, and ventilatory threshold 2, based on stepwise cycle spiroergometry) were analyzed to determine whether there was a correlation between world FIS ranking and exercise capacity of male and female elite Alpine skiers. RESULTS: The data of 39 male skiers (age: 27.67 [4.20] y, body mass index: 26.03 [1.25] kg/m2) and 36 female skiers (age: 25.49 [3.18] y, body mass index: 22.97 [1.71] kg/m2) were included in this study. The maximum oxygen uptake and maximum power output ranged from 4.37 to 4.42 W/kg and 53.41 to 54.85 mL/kg/min in men and from 4.17 to 4.30 W/kg and 45.96 to 49.16 mL/kg/min in women, respectively, over the 7 seasons; the yearly mean FIS ranking ranged from 17 to 24 in men and 9 to 18 in women. In a fixed-effects model used for the subsequent panel regression analysis, no statistically significant effect on FIS ranking was found for the exercise parameters of interest. CONCLUSIONS: Neither maximal aerobic tests nor maximum power output significantly predicted competitive performance, as indexed by the FIS ranking. This reinforces the assumption that no single parameter determines competition performance in this complex sport. Therefore, identifying the optimum amount of endurance training remains a major challenge for athletes and coaches, as does identifying and improving the factors that determine performance.

Geographical heterogeneity of doping-related knowledge, beliefs and attitude among 533 Youth Olympics participants.

OBJECTIVES: Doping-related knowledge, beliefs and attitude influence adolescent athletes' susceptibility to prohibited performance-enhancing substances. They might be modified by different cultural backgrounds. This study's aim was to analyse the geographical heterogeneity of doping-related knowledge, beliefs and attitude among adolescent elite athletes. DESIGN: Cross-sectional study. METHODS: A questionnaire was distributed to athletes participating in the Winter Youth Olympic Games 2020 in Switzerland. Main outcomes ('subjective and actual knowledge', 'beliefs' and 'attitude') were stratified for athletes' region of origin. Geographical heterogeneity was tested with a two-way analysis of variance, and two multiple regression analyses were conducted to assess independent associations of knowledge, age and athletes' geographical region with doping-related beliefs and attitude. RESULTS: 533 athletes (54% females, mean age: 16.0 ±â€¯1.0 years), completed the questionnaire (response rate: 33%). Actual knowledge was moderate-to-good (9.2 ±â€¯2.9 correct answers out of 13), and scores of attitude and beliefs showed favourable patterns. Considerable geographical heterogeneity was found for knowledge (p < 0.001), beliefs (p = 0.004) and attitude (p < 0.001). Higher subjective knowledge and actual knowledge were favourably associated with attitude (ß = -0.096, p = 0.049; ß = -0.316, p < 0.001) and beliefs (ß = 0.120, p = 0.016; ß = 0.212, p < 0.001), independent of age and geographical region. CONCLUSIONS: This study demonstrates considerable geographical heterogeneity of doping-related knowledge, beliefs and attitude, which are three essential target factors of doping prevention in adolescent elite athletes. This evidence should encourage medical doctors and other professionals to change their educative anti-doping approach from teaching knowledge about negative consequences into investigating and forming a young athlete's mind-set.

Return to Sports after Anterior Cruciate Ligament Injury: a Matched-Pair Analysis of Repair with Internal Brace and Reconstruction Using Hamstring or Quadriceps Tendons.

PURPOSE: The purpose of this study was to evaluate sports activity before anterior cruciate ligament (ACL) injury and after surgical treatment of ACL rupture comparing ACL repair with an Internal Brace to ACL reconstruction using either a hamstring (HT) or quadriceps tendon (QT) autograft. METHODS: Between 12/2015 and 10/2016, we recruited 69 patients with a mean age of 33.4 years for a matched-pair analysis. Twenty-four patients who underwent Internal Brace reconstruction were matched according to age (±â€Š5 years), gender, Tegner activity scale (±â€Š1), BMI (±â€Š1) and concomitant injuries with 25 patients who had undergone HT reconstruction and 20 patients who had undergone QT reconstruction. The minimum follow-up was 12 months. RESULTS: Overall, the return-to-sports rate was 91.3 %. There were no significant differences (p ≥ 0.05) in the number of sports disciplines and the time before return to sports within or among the groups. Overall and within the groups, the level of sports participation did not change significantly (p ≥ 0.05) postoperatively. The patients' sense of well-being was excellent after either ACL repair with an Internal Brace or ACL reconstruction with autologous HT or QT. CONCLUSION: At short-term follow-up, ACL repair using an Internal Brace enables sports activity and provides a sense of well-being similar to that of classic ACL reconstruction using hamstring or quadriceps tendon autografts in a selected patient population. LEVEL OF EVIDENCE: Level III Retrospective comparative study.

The questionable benefit of pectus excavatum repair on cardiopulmonary function: a prospective study.

OBJECTIVES: Since the introduction of the minimally invasive technique for repair of pectus excavatum (MIRPE), increasing numbers of patients are presenting for surgery. However, controversy remains regarding cardiopulmonary outcomes of surgical repair. Therefore, the aim of our prospective study was to investigate cardiopulmonary function, at rest and during exercise before surgery, first after MIRPE and then after pectus bar removal. METHODS: Forty-seven patients were enrolled in a prospective, open-label, single-arm, single-centre clinical trial (Impact of Surgical Treatments of Thoracic Deformation on Cardiopulmonary Function) [NCT02163265] between July 2013 and November 2019. All patients underwent a modified MIRPE technique for surgical correction of pectus excavatum (PE), called Minor Open Videoendoscopically Assisted Repair of Pectus Excavatum. The patients underwent pre- and postoperative chest X-ray, three-dimensional volume-rendering computer tomography thorax imaging, cardiopulmonary function tests at rest and during stepwise cycle spiroergometry (sitting and supine position) and Doppler echocardiography. Daily physical activity questionnaires were also completed. RESULTS: The study was completed by 19 patients (15 males, 4 females), aged 13.9-19.6 years at the time of surgery. The surgical patient follow-up was 5.7 ± 7.9 months after pectus bar removal. No significant differences in cardiopulmonary and exercise parameters were seen after placement of the intrathoracic bar, or after pectus bar removal, compared to presurgery. CONCLUSIONS: Our findings indicate that surgical correction of PE does not impair cardiopulmonary function at rest or during exercise. Therefore, no adverse effects on exercise performance should be expected from surgical treatment of PE via the modified MIRPE technique. CLINICAL TRIAL REGISTRATION NUMBER: clinicaltrials.gov [ClinicalTrials.gov number, NCT02163265].

Impact of surgical treatment of pectus carinatum on cardiopulmonary function: a prospective study.

OBJECTIVES: The frequency of sternochondroplasty in cases of pectus carinatum (PC) has increased due to greater surgeon experience and modified surgical techniques. PC deformity does not usually cause cardiopulmonary malfunction or impairment. However, whether cardiopulmonary function changes after surgical repair remains a matter of controversy. The aim of our prospective study was to determine if surgery changes preoperative cardiopulmonary function. METHODS: Nineteen patients (16 males, 3 females) were enrolled in a prospective, open-label, single-arm, single-centre clinical trial (Impact of Surgical Treatments of Thoracic Deformation on Cardiopulmonary Function) (NCT02163265) between July 2013 and January 2017. All patients underwent PC repair via a modified Ravitch procedure and wore a lightweight, patient-controlled chest brace for 8 weeks postoperatively (the Innsbruck protocol). The average follow-up surgical examination was 8.3 months after surgery. In all enrolled patients, before surgery and not before 6 months postoperatively chest X-ray, 3-dimensional volume-rendered computed tomography thorax imaging, cardiopulmonary function tests with stepwise cycle spiroergometry (sitting and supine position) and Doppler echocardiography were performed; questionnaires about daily physical activity were also completed. RESULTS: Fourteen patients (aged 16.3 ± 2.6 years at study entry) completed the study. Changes in submaximal and peak power output were not detected during sitting, or when in the supine position. Also, no clinically relevant postoperative changes in spirometry or echocardiography were noted. CONCLUSIONS: Our findings confirm that surgical correction of PC does not impair cardiopulmonary function at rest or during physical exercise. CLINICAL REGISTRATION NUMBER: clinicaltrials.gov NCT02163265.

An evaluation of prevention initiatives by 53 national anti-doping organizations: Achievements and limitations.

BACKGROUND: One main purpose of the World Anti-Doping Agency was to harmonize anti-doping efforts, including the provision of anti-doping education. A multifaceted approach to doping prevention can play a key role in preventing intentional and unintentional doping. This article aimed to systematically record and evaluate doping prevention approaches in the form of information and education activities of national anti-doping organizations (NADOs) and assess the extent to which a multifaceted doping prevention approach has been realized. METHODS: Data on anti-doping information and education activities of 53 NADOs were collected via a survey and an online search of the NADOs' websites. Prevention activities were classified into knowledge focused, affective focused, social skills, life skills, and ethic- and value- based. The implementation of the prevention activities was assessed by 4 independent raters using a modified visual analogue scale. RESULTS: In total, 59% of the NADOs (n = 38) returned the survey and 70% (n = 45) had information available online. The data were combined for the visual analogue scale assessment. Overall, 58% of the NADOs (n = 37) reported offering activities including elements of all 5 approaches. Results of the raters' assessments indicated that the knowledge-focused approach was best implemented; the implementation of the other 4 approaches was largely unsatisfactory. The most common barriers to implementing doping prevention programs reported by the NADOs were lack of resources (n = 26) and difficulties in collaborating with sports organizations (n = 8). CONCLUSION: Results show a discrepancy between NADOs' self-report data and the implementation assessment. Even though the NADOs indicated otherwise, most of their education-based approaches did not address aspects of the visual analogue scale (e.g., resisting peer pressure) and only a few programs were ongoing. Possible explanations might be found in the reported barriers (e.g., financial). Concrete guidelines defining multifaceted, values-based education, and best practice examples should be developed to indicate how to include all 5 approaches in prevention.

Does Physical Activity during Alpine Vacations increase Tourists' Well-Being?

Physical activities have been proven to have an impact on general well-being in everyday life; however, literature lacks an analysis of the effects of physical activities in vacation settings. Thus, the study aimed at assessing the impacts of physical activity on well-being during vacation by taking a longitudinal approach. We utilized a pre-post within-subject design (n = 101) by testing vacationers prior to, during, and after their vacation in an alpine environment. Therefore, a series of eight linear mixed model analyses of co-variance was performed. The results suggested that the duration of a vacation and the amount of physical activity have a positive impact on the components of well-being, which was expressed by changes in the activation, elation, excitement, and calmness subscales of the Mood Survey Scale. Demographic patterns did not reveal any influences. Physical activity might be a marker for well-being, which influences people's everyday life and leisure time behavior by motivating them to engage in more physical activity. This research extends the existing literature by (1) proving the effects of vacations on well-being, (2) pointing out the effects of demographic predeterminations, and (3) gathering in-depth knowledge about the role of physical activity in changes to well-being.