Sports-Related Concussion Assessment: A New Physiological, Biomechanical, and Cognitive Methodology Incorporating a Randomized Controlled Trial Study Protocol.

BACKGROUND: Taking part in moderate-to-vigorous exercise in contact sports on a regular basis may be linked to an increase in cerebrovascular injury and head trauma. Validated objective measures are lacking in the initial post-event diagnosis of head injury. The exercise style, duration, and intensity may also confound diagnostic indicators. As a result, we propose that the new Interdisciplinary Group in Movement & Performance from Acute & Chronic Head Trauma (IMPACT) analyze a variety of functional (biomechanical and motor control) tests as well as related biochemistry to see how they are affected by contact in sports and head injury. The study's goal will be to look into the performance and physiological changes in rugby players after a game for head trauma and injury. METHODS: This one-of-a-kind study will use a randomized controlled trial (RCT) utilizing a sport participation group and a non-participation control group. Forty male rugby 7 s players will be recruited for the study and allocated randomly to the experimental groups. The intervention group will participate in three straight rugby matches during a local 7 s rugby event. At the pre-match baseline, demographic and anthropometric data will be collected. This will be followed by the pre-match baseline collection of biochemical, biomechanical, and cognitive-motor task data. After three consecutive matches, the same measures will be taken. During each match, a notational analysis will be undertaken to obtain contact information. All measurements will be taken again 24, 48, and 72 h after the third match. DISCUSSION: When the number of games increases owing to weariness and/or stressful circumstances, we expect a decline in body movement, coordination, and cognitive-motor tasks. Changes in blood biochemistry are expected to correspond to changes in biomechanics and cognitive-motor processes. This research proposal will generate considerable, ecologically valid data on the occurrence of head trauma events under game conditions, as well as the influence of these events on the biological systems of the performers. This will lead to a greater understanding of how sports participants react to exercise-induced injuries. This study's scope will have far-reaching ramifications for doctors, coaches, managers, scientists, and sports regulatory bodies concerned with the health and well-being of athletic populations at all levels of competition, including all genders and ages.

Plasma UCHL1, GFAP, Tau, and NfL Are Not Different in Young Healthy Persons With Mild COVID-19 Symptoms Early in the Pandemic: A Pilot Study.

Elevated levels of brain injury biomarkers have been found primarily in middle-aged or older persons experiencing moderate-to-severe COVID-19 symptoms. However, there is little research in young adults, and there is concern that COVID-19 causes brain injury even in the absence of moderate-to-severe symptoms. Therefore, the purpose of our study was to investigate whether neurofilament light (NfL), glial fibrillary acidic protein (GFAP), tau, or ubiquitin carboxyl-terminal esterase L1 (UCHL1) are elevated in the plasma of young adults with mild COVID-19 symptoms. Twelve participants diagnosed with COVID-19 had plasma collected 1, 2, 3, and 4 months after diagnosis to determine whether NfL, GFAP, tau, and UCHL1 concentrations increased over time or whether plasma concentrations were elevated compared with COVID-19-naïve participants. We also compared plasma NfL, GFAP, tau, and UCHL1 concentrations between sexes. Our results showed no difference between NfL, GFAP, tau, and UCHL1 concentrations in COVID-19-naïve participants and COVID-19-positive participants at any of the four time points (p = 0.771). Within the COVID-19-positive participants, UCHL1 levels were higher at month 3 after diagnosis compared to month 1 or month 2 (p = 0.027). Between sexes, females were found to have higher UCHL1 (p = 0.003) and NfL (p = 0.037) plasma concentrations compared to males, whereas males had higher plasma tau concentrations than females (p = 0.024). Based on our data, it appears that mild COVID-19 in young adults does not increase plasma NfL, GFAP, tau, or UCHL1.

Serum Amyloid Beta Precursor Protein, Neurofilament Light, and Visinin-like Protein-1 in Rugby Players: An Exploratory Study.

Concussion diagnosis is difficult and may be improved with the addition of a blood-based biomarker that indicates concussion. The purpose of this research was to investigate the capability of serum amyloid beta precursor protein (APP), neurofilament light (NfL), and visinin-like protein-1 (VILIP-1) to distinguish athletes who were diagnosed with a concussion pitch-side. An observational cross-sectional study design was used to replicate sideline concussion diagnosis. Subjects included mutually exclusive pre-match (n = 9), post-match (n = 15), and SRC (n = 7) groups. Six paired pre-and post-match subjects were analyzed for APP. APP increased significantly from pre-match (mean = 57.98 pg·mL−1, SD = 63.21 pg·mL−1) to post-match (mean = 111.37 pg·mL−1, SD = 106.89 pg·mL−1, p = 0.048) in the paired subjects. NfL was lower in the SRC group (median = 8.71 pg·mL−1, IQR = 6.09 pg·mL−1) compared to the post-match group (median = 29.60 pg·mL−1, IQR = 57.45 pg·mL−1, p < 0.001). VILIP-1 was higher in the post-match group (median = 212.18 pg·mL−1, IQR = 345.00 pg·mL−1) compared to both the pre-match (median = 32.63 pg·mL−1, IQR = 52.24 pg·mL−1), p = 0.001) and SRC (median = 30.21 pg·mL−1, IQR = 47.20 pg·mL−1), p = 0.003) groups. APP, NfL, and VILIP-1 were all able to distinguish between pre-match and post-match groups (AUROC > 0.700) but not from the SRC group (AUROC < 0.660). Our results show that APP, NfL, and VILIP-1 were not helpful in differentiating concussed from non-concussed athletes pitch-side in this study.

Ubiquitin carboxyl-terminal esterase L1 is not elevated in the serum of concussed rugby players: an observational cross-sectional study.

Concussion diagnosis is complicated by a lack of objective measures. Ubiquitin carboxyl-terminal esterase L1 (UCHL1) is a biomarker that has been shown to increase following traumatic brain injury but has not been investigated in concussed athletes on the sideline of athletic events. Therefore, this study was conducted to determine if UCHL1 can be used to aid in sideline concussion diagnosis. Blood was taken via standard venipuncture from a recreationally active control group, a group of rugby players prior to match play (pre-match), rugby players following match-play (match-control), and rugby players after suffering a sport-related concussion (SRC). UCHL1 was not significantly different among groups (p > 0.05) and was unable to distinguish between SRC and controls (AUROC < 0.400, p > 0.05). However, when sex-matched data were used, it was found that the female match-control group had a significantly higher serum UCHL1 concentration than the pre-match group (p = 0.041). Differences were also found in serum UCHL1 concentrations between male and female athletes in the match-control group (p = 0.007). This study does not provide evidence supporting the use of UCHL1 in sideline concussion diagnosis when blood is collected soon after concussion but does show differences in serum UCHL1 accumulation between males and females.

Red blood cell ATP release correlates with red blood cell hemolysis.

The precise matching of blood flow to skeletal muscle during exercise remains an important area of investigation. Release of adenosine triphosphate (ATP) from red blood cells (RBCs) is postulated as a mediator of peripheral vascular tone in response to shear stress, hypoxia, and mechanical deformation. We tested the following hypotheses: 1) RBCs of different densities contain different quantities of ATP; 2) hypoxia is a stimulus for ATP release from RBCs; and 3) hypoxic ATP release from RBCs is related to RBC lysis. Human blood was drawn from male and female volunteers (n = 11); the RBCs were isolated and washed. A Percoll gradient was used to separate RBCs based on cellular density. Density groups were then resuspended to 4% hematocrit and exposed to normoxia or hypoxia in a tonometer. Equilibrated samples were drawn and centrifuged; paired analyses of ATP (luminescence via a luciferase-catalyzed reaction) and hemolysis (Harboe spectrophotometric absorbance assay) were measured in the supernatant. ATP release was not different among low-density cells versus middle-density versus high-density cells. Similarly, hemoglobin (Hb) release was not different among the red blood cell subsets. No difference was found for either ATP release or Hb release following matched exposure to normoxic or hypoxic gas. The concentrations of ATP and Hb for all subsets combined were linearly correlated (r = 0.59, P ≤ 0.001). With simultaneous probing for Hb and ATP in the supernatant of each sample, we conclude that ATP release from RBCs can be explained by hemolysis and that hypoxia per se does not stimulate either ATP release or Hb release from RBCs.

Protein S100B and Brain Lipid-Binding Protein Concentrations in the Serum of Recently Concussed Rugby Players.

The purpose of this study was to test the ability of serum protein S100B (S100B) and brain lipid-binding protein (BLBP) to identify athletes who sustained a sports-related concussion (SRC). Subjects included a non-athlete group, whereas the rugby players were separated into two match-control and two SRC groups. The match-control <1-h group included players undergoing venipuncture within 60-min post-match, and the match-control >1-h/<8-h group included players undergoing venipuncture between 1 and 8 h post-match; the SRC <1-h group included players undergoing venipuncture within 60-min post-SRC, and the SRC >1-h/<8-h group included players undergoing venipuncture between 1 and 8 h post-SRC. Serum S100B concentrations were not significantly different (p = 0.112) among protocols. Serum BLBP was greater in the match-control <1-h group (p < 0.001) and the SRC >1-h/<8-h group (p = 0.003) compared to the non-athlete group. The ability of serum BLBP to distinguish between SRC groups and the non-athlete group was shown to be good to excellent (AUROC, >0.8; p < 0.05), and between match-control groups and the non-athlete group were shown to be excellent (AUROC, >0.9; p < 0.05). Our results show that serum S100B is not useful in distinguishing concussed or post-match athletes from non-athletes. However, serum BLBP was shown to distinguish non-athletes from post-match or concussed athletes. Serum BLBP could not distinguish between athletes experiencing an SRC within 1 h of blood draw and those participating in a contact sport.

Response of protein S100B to playing American football, lifting weights, and treadmill running.

OBJECTIVE: To determine if serum S100B increases similarly as a result of playing American football compared to exercise alone. METHODS: Serum S100B was measured in division III collegiate football players before and after every home game during a single football season. Serum S100B was also measured before and after subjects walked on a treadmill for 30 minutes at a leisurely pace, ran on a treadmill while wearing and not wearing a football helmet at 6 mph for 8 minutes, and performed low-, moderate-, or high-intensity resistance exercise. RESULTS: Serum S100B increased significantly (P < 0.05) when subjects played in a football game, ran on a treadmill, or performed moderate-intensity resistance exercise. Pre-game serum S100B did not accumulate throughout the football season in any of the players (P > 0.05). The increase in serum S100B during football games was moderately and significantly correlated with both the number of hits (R2  = 0.407) and the number of plays (R2  = 0.484) that each player experienced (P < 0.001). Post-game serum S100B was greater in football players who played more than 50 plays compared to those players who played <50 plays, subjects who exercised on a treadmill, or subjects performing resistance exercise (P < 0.05). CONCLUSION: It is unclear if the higher S100B concentration in football players playing at least 50 plays was caused by exercise or hits. Therefore, if serum S100B is to be used as a biomarker of impacts, and possible brain injury in sport, exercise time and intensity should be taken into account as confounding variables.

Lactate metabolism: historical context, prior misinterpretations, and current understanding.

Lactate (La-) has long been at the center of controversy in research, clinical, and athletic settings. Since its discovery in 1780, La- has often been erroneously viewed as simply a hypoxic waste product with multiple deleterious effects. Not until the 1980s, with the introduction of the cell-to-cell lactate shuttle did a paradigm shift in our understanding of the role of La- in metabolism begin. The evidence for La- as a major player in the coordination of whole-body metabolism has since grown rapidly. La- is a readily combusted fuel that is shuttled throughout the body, and it is a potent signal for angiogenesis irrespective of oxygen tension. Despite this, many fundamental discoveries about La- are still working their way into mainstream research, clinical care, and practice. The purpose of this review is to synthesize current understanding of La- metabolism via an appraisal of its robust experimental history, particularly in exercise physiology. That La- production increases during dysoxia is beyond debate, but this condition is the exception rather than the rule. Fluctuations in blood [La-] in health and disease are not typically due to low oxygen tension, a principle first demonstrated with exercise and now understood to varying degrees across disciplines. From its role in coordinating whole-body metabolism as a fuel to its role as a signaling molecule in tumors, the study of La- metabolism continues to expand and holds potential for multiple clinical applications. This review highlights La-'s central role in metabolism and amplifies our understanding of past research.

Biomarkers of brain injury following an American football game: A pilot study.

The goals of this study were to determine if the biomarkers of head injury, NSE and S100B, increased in serum following an American football game. Serum creatine kinase (CK) and cortisol levels were also measured to determine muscle damage and stress caused by the football game. NSE, S100B, CK, and cortisol were measured in the serum of 17 football players before and after a collegiate junior varsity football game. No head injuries were reported by the players, athletic training staff, or coaches yet both NSE (Pre-game: 7.0 µg•L-1 ± 2.2 versus Post-game: 13.1 µg•L-1 ± 7.0, P <0.001) and S100B (Pre-game: 0.013 µg•L-1 ± 0.012 versus Post-game: 0.069 µg•L-1 ± 0.036, P <0.001) increased significantly. Neither CK (Pre-game: 90.5 U•L-1 ± 41.9 versus Post-game: 120.2 U•L-1 ± 62.7, P = 0.116) nor cortisol (Pre-game: 369.2 nmoles•L-1 ± 159.8 versus Post-game: 353.0 nmoles•L-1 ± 170.5, P = 0.349) increased significantly following the football game. There was little correlation found between S100B and body mass (R2 = 0.029) or CK (R2 = 0.352) levels. Although serum NSE and S100B increase as a result of playing in an American football game, the values are similar to or lower than levels found following competition in other contact and non-contact sports. Furthermore, the lack of correlation between S100B and body mass or CK indicates that S100B increases independent of body mass or muscle injury.

Lactate is always the end product of glycolysis.

Through much of the history of metabolism, lactate (La(-)) has been considered merely a dead-end waste product during periods of dysoxia. Congruently, the end product of glycolysis has been viewed dichotomously: pyruvate in the presence of adequate oxygenation, La(-) in the absence of adequate oxygenation. In contrast, given the near-equilibrium nature of the lactate dehydrogenase (LDH) reaction and that LDH has a much higher activity than the putative regulatory enzymes of the glycolytic and oxidative pathways, we contend that La(-) is always the end product of glycolysis. Cellular La(-) accumulation, as opposed to flux, is dependent on (1) the rate of glycolysis, (2) oxidative enzyme activity, (3) cellular O2 level, and (4) the net rate of La(-) transport into (influx) or out of (efflux) the cell. For intracellular metabolism, we reintroduce the Cytosol-to-Mitochondria Lactate Shuttle. Our proposition, analogous to the phosphocreatine shuttle, purports that pyruvate, NAD(+), NADH, and La(-) are held uniformly near equilibrium throughout the cell cytosol due to the high activity of LDH. La(-) is always the end product of glycolysis and represents the primary diffusing species capable of spatially linking glycolysis to oxidative phosphorylation.

Slowed muscle oxygen uptake kinetics with raised metabolism are not dependent on blood flow or recruitment dynamics.

Oxygen uptake kinetics (τVO2) are slowed when exercise is initiated from a raised metabolic rate. Whether this reflects the recruitment of muscle fibres differing in oxidative capacity, or slowed blood flow (Q) kinetics is unclear. This study determined τVO2 in canine muscle in situ, with experimental control over muscle activation and Q during contractions initiated from rest and a raised metabolic rate. The gastrocnemius complex of nine anaesthetised, ventilated dogs was isolated and attached to a force transducer. Isometric tetanic contractions (50 Hz; 200 ms duration) via supramaximal sciatic nerve stimulation were used to manipulate metabolic rate: 3 min stimulation at 0.33 Hz (S1), followed by 3 min at 0.67 Hz (S2). Circulation was initially intact (SPON), and subsequently isolated for pump-perfusion (PUMP) above the greatest value in SPON. Muscle VO2 was determined contraction-by-contraction using an ultrasonic flowmeter and venous oximeter, and normalised to tension-time integral (TTI). τVO2/TTI and τQ were less in S1SPON (mean ± s.d.: 13 ± 3 s and 12 ± 4 s, respectively) than in S2SPON (29 ± 19 s and 31 ± 13 s, respectively; P < 0.05). τVO2/TTI was unchanged by pump-perfusion (S1PUMP, 12 ± 4 s; S2PUMP, 24 ± 6 s; P < 0.001) despite increased O2 delivery; at S2 onset, venous O2 saturation was 21 ± 4% and 65 ± 5% in SPON and PUMP, respectively. VO2 kinetics remained slowed when contractions were initiated from a raised metabolic rate despite uniform muscle stimulation and increased O2 delivery. The intracellular mechanism may relate to a falling energy state, approaching saturating ADP concentration, and/or slowed mitochondrial activation; but further study is required. These data add to the evidence that muscle VO2 control is more complex than previously suggested.

Blood ammonium and lactate accumulation response to different training protocols using the parallel squat exercise.

Three parallel squat protocols with equal total work volume were used to determine the metabolic response of resistance exercise with different practical training protocols combining program variables in the way that they are typically prescribed in field. Sixteen men able to back squat 1.5 times their body weight participated in the study. Individualized muscular endurance (ME), strength (STR), and hypertrophy (HYP) squat workouts were developed based on a 1 repetition maximum back squat. Each protocol was performed 3-7 days apart in random order. Venous blood was obtained after 5 minutes of seated rest both before and after each workout for ammonium and lactate analysis. The ME protocol (79.8 µM [SD = 45.4], 95% confidence interval [CI]: 55.7-104.0) produced a greater change of plasma ammonium than both the HYP (45.3 µM [SD = 34.5], 95% CI: 26.9-63.6, p = 0.017) and STR (31.7 µM [SD = 52.3], 95% CI: 3.9-59.6, p = 0.006) protocols. Change of blood lactate concentration from resting levels to postexercise levels was significantly different (p = 0.005) between ME (6.1 mM [SD = 2.9], 95% CI: 4.6-7.7) and STR (3.9 mM [SD = 2.5], 95% CI: 2.6-5.2) protocols. The main finding of this study is that blood ammonium and lactate seem to accumulate in response to an increasing number of repetitions with decreasing rest time between sets. As consequence, a greater number of repetitions should be added to a resistance workout, along with a shorter rest time between sets when training for events that induce a large metabolic load. The metabolic accumulation associated with high repetition exercise may represent the need for longer recovery time between these types of workouts compared with workouts using a low number of repetitions.

Peak muscle activation, joint kinematics, and kinetics during elliptical and stepping movement pattern on a Precor Adaptive Motion Trainer.

Kinematic, kinetic, and electromyography data were collected from the biceps femoris, rectus femoris (RF), gluteus maximus, and erector spinae (ES) during a step and elliptical exercise at a standardized workload with no hand use. Findings depicted 95% greater ankle plantar flexion (p = .01), 29% more knee extension (p = .003), 101% higher peak knee flexor moments (p < .001) 54% greater hip extensor moments (p < .001), 268% greater anterior joint reaction force (p = .009), 37% more RF activation (p < .001), and 200 % more ES activation (p <. 001) for the elliptical motion. Sixteen percent more hip flexion (p < .001), 42% higher knee extensor moments (p < .001), and 54% greater hip flexor moments (p = .041) occurred during the step motion. Biomechanical differences between motions should be considered when planning an exercise regimen.