MRI analysis of and factors related to knee injuries in amateur marathon runners.

BACKGROUND: Marathons are the most challenging form of running, and amateur athletes may be more prone to injury due to a lack of professional knowledge and instruction in running. PURPOSE: To analyze the MRI manifestations of and factors related to knee injuries in amateur marathon runners. SUBJECTS: Data were collected from a hospital database of 105 qualified amateur marathon athletes (65 males,40 females), between May 2018 and December 2021. FIELD STRENGTH/SEQUENCE: 1.5T MR: sagittal fs-PDWI, sagittal T1WI and sagittal 3D-DESS sequence. ASSESSMENT: The MRI manifestations of knee joint injury were analyzed and evaluated by two radiologists. STATISTICAL TESTS: The inter-observer agreement on MRI readings was analyzed using the kappa coefficient, and binary logistic regression analysis was employed to identify factors associated with knee injuries. RESULTS: The overall prevalence of knee cartilage lesions, meniscus lesions and bone marrow edema among amateur marathon runners was 45.7%, 72.4%, and 49.5% respectively. Our analysis revealed that older age (OR = 1.135, P<0.001), higher BMI (OR = 1.236, P = 0.044), and slower pace (OR = 2.305, P = 0.017) were associated with increased risk of articular cartilage disease. Furthermore, older age (OR = 1.425, P<0.001) was identified as a risk factor for meniscal lesions, while older age (OR = 1.088, P = 0.002) was bone marrow edema. Notably, no significant correlation was observed between knee joint injuries of amateur marathon athletes and gender or the monthly running distance (P>0.05). CONCLUSIONS: The occurrence of knee injuries among amateur marathon athletes was highly prevalent, with the patellofemoral joint cartilage and posterior horn of medial meniscus being frequently affected areas. Moreover, age, BMI, running years and pace were significant risk factors of knee joint injury.

Effects of long-term running on the structure and biochemical composition of knee cartilage in males: a cross-sectional study.

Background: Running has been widely recognized as a beneficial activity for improving physical fitness, but it can also increase the risk of running-related injuries (RRIs). This study aims to assess the impact of long-term running on the structural and biochemical composition of the knee. Methods: This study recruited a total of 32 participants, including 16 male recreational runners, aged 28-49 years, with a running experience of 2-7 years, and 16 matched sedentary controls. Magnetic resonance (MR) scans of T2* mapping and three-dimensional double-echo steady-state (3D-DESS) were performed on all participants. The volumes, thickness, and T2* values of joint articular cartilage were obtained via automatic segmentation software. Results: Compared with the sedentary controls, runners exhibited significant increases in the volumes of both the femoral medial articular cartilage and the tibial medial articular cartilage. Additionally, there were significant increases in the thickness of several cartilage regions, including femoral medial cartilage, femoral medial articular cartilage, femoral medial thickness, femoral lateral cartilage, and tibial medial articular cartilage. Notably, the T2* values in the femoral lateral and tibial lateral cartilage of runners decreased significantly, while those in the patellar cartilage and medial tibial cartilage increased significantly. Runner pace was negatively correlated with the overall knee cartilage thickness (r=-0.556; P=0.02), femoral cartilage thickness (r=-0.533; P=0.03), and volume (r=-0.532; P=0.03) but positively correlated with the T2* value of the patellar cartilage (r=0.577; P=0.01). Conclusions: Our study suggests that long-term mechanical stress from running may lead to increased thickness and volume in certain knee joint cartilage regions, possibly enhancing the functional adaptability of knee cartilage. The varying changes in T2* value in the tibial and fibular cartilage areas may indicate differing adaptability to pressure.

Heterogeneities and impact profiles of early chronic obstructive pulmonary disease status: findings from the China Pulmonary Health Study.

Background: The prevalence, epidemiological and clinical heterogeneities, and impact profiles of individuals with preserved ratio impaired spirometry (PRISm), pre-COPD, young COPD, and mild COPD in general Chinese population were not known yet. Methods: Data were obtained from the China Pulmonary Health study (2012-2015), a nationally representative cross-sectional survey that recruited 50,991 adults aged 20 years or older. Definitions of the four early disease status were consistent with the latest publications and the Global Initiative for Chronic Obstructive Lung Disease criteria. Findings: The age-standardised prevalences of PRISm, pre-COPD, young COPD, and mild COPD were 5.5% (95% confidence interval, 4.3-6.9), 7.2% (5.9-8.8), 1.1% (0.7-1.8), and 3.1% (2.5-3.8), respectively. In summary, mild COPD was under more direct or established impact factor exposures, such as older age, male gender, lower education level, lower family income, biomass use, air pollution, and more accumulative cigarette exposures; young COPD and pre-COPD experienced more personal and parents' events in earlier lives, such as history of bronchitis or pneumonia in childhood, frequent chronic cough in childhood, parental history of respiratory diseases, passive smoke exposure in childhood, and mother exposed to passive smoke while pregnant; pre-COPD coexisted with heavier symptoms and comorbidities burdens; young COPD exhibited worse airway obstruction; and most of the four early disease status harbored small airway dysfunction. Overall, older age, male gender, lower education level, living in the urban area, occupational exposure, frequent chronic cough in childhood, more accumulated cigarette exposure, comorbid with cardiovascular disease and gastroesophageal reflux disease were all associated with increased presence of the four early COPD status; different impact profiles were additionally observed with distinct entities. Over the four categories, less than 10% had ever taken pulmonary function test; less than 1% reported a previously diagnosed COPD; and no more than 13% had received pharmaceutical treatment. Interpretation: Significant heterogeneities in prevalence, epidemiological and clinical features, and impact profiles were noted under varied defining criteria of early COPD; a unified and validated definition for an early disease stage is warranted. Closer attention, better management, and further research need to be administrated to these population. Funding: Chinese Academy of Medical Sciences Institute of Respiratory Medicine Grant for Young Scholars (No. 2023-ZF-9); China International Medical Foundation (No. Z-2017-24-2301); Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (No. 2021-I2M-1-049); National High Level Hospital Clinical Research Funding (No. 2022-NHLHCRF-LX-01); Major Program of National Natural Science Foundation of China (No. 82090011).

Mediating Effect of Tobacco Dependence on the Association Between Maternal Smoking During Pregnancy and Chronic Obstructive Pulmonary Disease: Case-Control Study.

BACKGROUND: Maternal smoking during pregnancy (MSDP) is a known risk factor for offspring developing chronic obstructive pulmonary disease (COPD), but the underlying mechanism remains unclear. OBJECTIVE: This study aimed to explore whether the increased COPD risk associated with MSDP could be attributed to tobacco dependence (TD). METHODS: This case-control study used data from the nationwide cross-sectional China Pulmonary Health study, with controls matched for age, sex, and smoking status. TD was defined as smoking within 30 minutes of waking, and the severity of TD was assessed using the Fagerstrom Test for Nicotine Dependence. COPD was diagnosed when the ratio of forced expiratory volume in 1 second to forced vital capacity was <0.7 in a postbronchodilator pulmonary function test according to the 2017 Global Initiative for Chronic Obstructive Lung Disease criteria. Logistic regression was used to examine the correlation between MSDP and COPD, adjusting for age, sex, BMI, educational attainment, place of residence, ethnic background, occupation, childhood passive smoking, residential fine particulate matter, history of childhood pneumonia or bronchitis, average annual household income, and medical history (coronary heart disease, hypertension, and diabetes). Mediation analysis examined TD as a potential mediator in the link between MSDP and COPD risk. The significance of the indirect effect was assessed through 1000 iterations of the "bootstrap" method. RESULTS: The study included 5943 participants (2991 with COPD and 2952 controls). Mothers of the COPD group had higher pregnancy smoking rates (COPD: n=305, 10.20%; controls: n=211, 7.10%; P<.001). TD was more prevalent in the COPD group (COPD: n=582, 40.40%; controls: n=478, 33.90%; P<.001). After adjusting for covariates, MSDP had a significant effect on COPD (ß=.097; P<.001). There was an association between MSDP and TD (ß=.074; P<.001) as well as between TD and COPD (ß=.048; P=.007). Mediation analysis of TD in the MSDP-COPD association showed significant direct and indirect effects (direct: ß=.094; P<.001 and indirect: ß=.004; P=.03). The indirect effect remains present in the smoking population (direct: ß=.120; P<.001 and indirect: ß=.002; P=.03). CONCLUSIONS: This study highlighted the potential association between MSDP and the risk of COPD in offspring, revealing the mediating role of TD in this association. These findings contribute to a deeper understanding of the impact of prenatal tobacco exposure on lung health, laying the groundwork for the development of relevant prevention and treatment strategies.