Fractures in professional footballers: 7-years data from 106 team seasons in the Middle East.

Epidemiological studies on fractures in European professional football (soccer) are in abundance. However, such data are lacking in Middle Eastern professional footballers and information on fracture treatment is scarce. The aim of this study is to describe the epidemiology of fractures across seven seasons in Qatar Stars League (QSL) footballers. A prospective study of fractures in professional male footballers over 7 consecutive seasons (2013 to 2020), involving 3255 players and 106 team' seasons. Time loss and injuries and illnesses were recorded using standardised digital tools in accordance with international consensus procedures. Fractures were recorded according to onset mechanism, location, diagnoses, treatment and return to play. A total of 108 players sustained fractures during 638,247 hours of player exposure (88.9% training and 11.1% matches), representing 2.7% of all time-loss injuries. The incidence was 0.17 fractures per 1000 h of exposure (match and training incidence of 0.9 and 0.07 fractures / 1000 h, respectively), equivalent to an average of one fracture per team per season. Fractures mostly occurred in the feet (28.2%), hands (21.1%), shoulders (11.3%) and head (i.e., face) (9.9%). Mean (median) absence was 71 (47 days), with 4.6% refractures. Only 34.3% of the fractures required surgery and nearly all players (98.1%) returned to play at the professional level. Almost all professional football players with fractures return to play at the same competitive level after an average of 10 weeks of absence (mean absence was 71 ± 81 (median: 47, Inter Quartile Range [14-93]) days). One in ten continue to play with symptoms and one in twenty may refracture. Long-term effects of fractures are still unknown.

Investigating the potential link between lunar cycle and multiple sclerosis relapses: a call for further studies.

Multiple sclerosis (MS) is a debilitating disease that causes inflammation of the central nervous system, resulting in myelin damage and axon degeneration. Although the cause of MS remains unknown, various factors such as sex, latitude, sun exposure, serum vitamin D levels, Epstein Barr Virus infection, diet, microbiota and ethnicity are being studied for their potential roles in the development of the disease. While chronobiological factors such as circadian rhythm and seasonality have been explored for their potential influence on the onset, exacerbation, and/or relapses of MS, the potential influence of the lunar cycle on MS has yet to be studied. Therefore, the authors of this letter call for future studies to investigate the possible effects of the lunar cycle on MS activity and course, given evidence suggesting that the lunar cycle may affect sleep, fatigue, melatonin secretion, and mood state in humans. A deeper understanding of the chronobiology of MS could have practical implications for the development of chronotherapeutic strategies and the prevention or mitigation of MS relapses, potentially improving the quality of life of MS patients.

Leptin Signaling Could Mediate Hippocampal Decumulation of Beta-Amyloid and Tau Induced by High-Intensity Interval Training in Rats with Type 2 Diabetes.

Leptin (LEP) can cross the blood-brain barrier and facilitate cross-talk between the adipose tissue and central nerve system (CNS). This study aimed to investigate the effect of 8-week high-intensity interval training (HIIT) on the LEP signaling in the hippocampus of rats with type 2 diabetes. 20 rats were randomly divided into four groups: (i) control (Con), (ii) type 2 diabetes (T2D), (iii) exercise (EX), and (iv) type 2 diabetes + exercise (T2D + EX). The rats in the T2D and T2D + EX were fed a high-fat diet for two months, then a single dose of STZ (35 mg/kg) was injected to induce diabetes. The EX and T2D + EX groups performed 4-10 intervals of treadmill running at 80-100% of Vmax. Serum and hippocampal levels of LEP as well as hippocampal levels of LEP receptors (LEP-R), Janus kinase 2 (JAK-2), signal transducer and activator of transcription 3 (STAT-3), activated protein kinase (AMP-K), proxy zoster receptor α (PGC-1α), beta-secretase 1 (BACE1), Beta-Amyloid (Aß), Phosphoinositide 3-kinases (PI3K), protein kinase B (AKT), mammalian target of rapamycin (mTOR), Glycogen Synthase Kinase 3 Beta (GSK3ß), and hyperphosphorylated tau proteins (TAU) were measured. One-way ONOVA and Tukey post-hoc tests were used to analyze the data. Serum and hippocampal levels of LEP as well as hippocampal levels of LEP-R, JAK-2, STAT-3, AMP-K, PGC1α, PI3K, AKT, and mTOR were increased while hippocampal levels of BACE1, GSK3B, TAU, and Aß were decreased in T2D + EX compared with T2D group. Serum LEP and hippocampal levels of LEP, LEP-R, JAK-2, STAT-3, AMP-K, PGC1α, PI3K, AKT, and mTOR were decreased. Conversely hippocampal levels of BACE1, GSK3B, TAU, and Aß were increased in T2D group compared with CON group. HIIT could improve LEP signaling in the hippocampus of rats with type 2 diabetes and decrease the accumulation of Tau and Aß, which may reduce the risk of memory impairments.

Sleep and psychological factors are associated with meeting discharge criteria to return to sport following ACL reconstruction in athletes.

This study aimed to determine if sleep quality and psychological factors were associated with time to meet the discharge criteria to return to sport (RTS) following anterior cruciate ligament reconstruction (ACL-R) among athletes. A cohort-study design included 89 athletes following ACL-R. Each participant completed a battery of questionnaires at 6 different time points: within 3 days of injury occurrence and at post-surgery (1.5 m, 3 m, 4.5 m, 6 m and when discharge criteria were met). Assessment included sleep quality and quantity, symptoms of depression, anxiety, stress, psychological readiness to RTS and fear of re-injury. The primary outcome was the time needed to meet all discharge criteria to RTS. Sleep parameters and psychological factors were not associated with time to meet the discharge criteria to RTS. However, athletes that had lower scores of anxiety (OR 1.2 (95% CI 1.0, 1.3) and insomnia (OR 1.2 (95% CI 1.0, 1.3) at baseline were more likely to meet the RTS discharge criteria. Athletes with better sleep quality at 3m, 4.5m and 6m were more likely to meet the RTS discharge criteria OR 1.3 (95% CI 1.1, 1.7), 2.0 (95% CI 1.1-3.4) and 1.4 (95% CI 1.0, 1.9) respectively. Sleep quality and psychological factors were not associated with time to meet the discharge criteria to RTS but impacted whether athletes adhered and completed their rehabilitation program or not. Monitoring sleep quality and psychological factors of athletes before and following ACL-R surgery is important to identify athletes who could have difficulties in adhering to and completing their rehabilitation program to RTS.

Adiponectin: Structure, Physiological Functions, Role in Diseases, and Effects of Nutrition.

Adiponectin (a protein consisting of 244 amino acids and characterized by a molecular weight of 28 kDa) is a cytokine that is secreted from adipose tissues (adipokine). Available evidence suggests that adiponectin is involved in a variety of physiological functions, molecular and cellular events, including lipid metabolism, energy regulation, immune response and inflammation, and insulin sensitivity. It has a protective effect on neurons and neural stem cells. Adiponectin levels have been reported to be negatively correlated with cancer, cardiovascular disease, and diabetes, and shown to be affected (i.e., significantly increased) by proper healthy nutrition. The present review comprehensively overviews the role of adiponectin in a range of diseases, showing that it can be used as a biomarker for diagnosing these disorders as well as a target for monitoring the effectiveness of preventive and treatment interventions.

Moderators of the Impact of (Poly)Phenols Interventions on Psychomotor Functions and BDNF: Insights from Subgroup Analysis and Meta-Regression.

BACKGROUND: Recent anti-aging interventions have shown contradictory impacts of (poly)phenols regarding the prevention of cognitive decline and maintenance of brain function. These discrepancies have been linked to between-study differences in supplementation protocols. This subgroup analysis and meta-regression aimed to (i) examine differential effects of moderator variables related to participant characteristics and supplementation protocols and (ii) identify practical recommendations to design effective (poly)phenol supplementation protocols for future anti-aging interventions. METHODS: Multiple electronic databases (Web of Science; PubMed) searched for relevant intervention published from inception to July 2019. Using the PICOS criteria, a total of 4303 records were screened. Only high-quality studies (n = 15) were included in the final analyses. Random-effects meta-analysis was used, and we calculated standard differences in means (SDM), effect size (ES), and 95% confidence intervals (CI) for two sufficiently comparable items (i.e., psychomotor function and brain-derived neurotrophic factor (BDNF)). When significant heterogeneity was computed (I2 > 50%), a subgroup and meta-regression analysis were performed to examine the moderation effects of participant characteristics and supplementation protocols. RESULTS: The reviewed studies support the beneficial effect of (poly)phenols-rich supplementation on psychomotor functions (ES = -0.677, p = 0.001) and brain plasticity (ES = 1.168, p = 0.028). Subgroup analysis revealed higher beneficial impacts of (poly)phenols (i) in younger populations compared to older (SDM = -0.89 vs. -0.47 for psychomotor performance, and 2.41 vs. 0.07 for BDNF, respectively), (ii) following an acute compared to chronic supplementation (SDM = -1.02 vs. -0.43 for psychomotor performance), and (iii) using a phenolic compound with medium compared to low bioavailability rates (SDM = -0.76 vs. -0.68 for psychomotor performance and 3.57 vs. 0.07 for DBNF, respectively). Meta-regressions revealed greater improvement in BDNF levels with lower percentages of female participants (Q = 40.15, df = 6, p < 0.001) and a skewed scatter plot toward a greater impact using higher (poly)phenols doses. CONCLUSION: This review suggests that age group, gender, the used phenolic compounds, their human bioavailability rate, and the supplementation dose as the primary moderator variables relating to the beneficial effects of (poly)phenol consumption on cognitive and brain function in humans. Therefore, it seems more advantageous to start anti-aging (poly)phenol interventions in adults earlier in life using medium (≈500 mg) to high doses (≈1000 mg) of phenolic compounds, with at least medium bioavailability rate (≥9%).

Leg asymmetry and muscle function recovery after anterior cruciate ligament reconstruction in elite athletes: a pilot study on slower recovery of the dominant leg.

The aim of this study was to examine performance in hopping tests in male athletes after anterior cruciate ligament reconstruction (ACLR) in the 4-to-6 months post-surgery period. A total of 36 athletes (24 ACLR and 12 controls) participated in this study. The ACLR group consisted of athletes who had undergone an ACLR on their dominant side (ACL DG n=16) or non-dominant side (ACL NDG n=8). Participants completed the following functional tests: a single-leg hop (SLH), single-leg triple hop (SL3H) and single-leg counter movement jump (SLCMJ), then the limb symmetry index (LSI) was calculated. There were no significant differences between the dominant and the non-dominant legs for all functional tests when comparing the ACL DG and the ACL NDG at 6 months after surgery. At 6 months after ACLR, the LSI of the two legs was within acceptable values, whether the athlete had the operation on their dominant or non-dominant leg (except the mean LSI for the ACL DG in the SLCMJ test). Furthermore, the control group showed higher performances as compared to the ACL group for all variables at 6 months after surgery, despite acceptable LSI. We concluded that an early return to "full participation to training" is not recommended in participants who have undergone an ACLR with patellar tendon grafts.

Effects of COVID-19 Home Confinement on Eating Behaviour and Physical Activity: Results of the ECLB-COVID19 International Online Survey.

BACKGROUND: Public health recommendations and governmental measures during the COVID-19 pandemic have resulted in numerous restrictions on daily living including social distancing, isolation and home confinement. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on health behaviours and lifestyles at home is undefined. Therefore, an international online survey was launched in April 2020, in seven languages, to elucidate the behavioural and lifestyle consequences of COVID-19 restrictions. This report presents the results from the first thousand responders on physical activity (PA) and nutrition behaviours. METHODS: Following a structured review of the literature, the "Effects of home Confinement on multiple Lifestyle Behaviours during the COVID-19 outbreak (ECLB-COVID19)" Electronic survey was designed by a steering group of multidisciplinary scientists and academics. The survey was uploaded and shared on the Google online survey platform. Thirty-five research organisations from Europe, North-Africa, Western Asia and the Americas promoted the survey in English, German, French, Arabic, Spanish, Portuguese and Slovenian languages. Questions were presented in a differential format, with questions related to responses "before" and "during" confinement conditions. RESULTS: 1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%) were included in the analysis. The COVID-19 home confinement had a negative effect on all PA intensity levels (vigorous, moderate, walking and overall). Additionally, daily sitting time increased from 5 to 8 h per day. Food consumption and meal patterns (the type of food, eating out of control, snacks between meals, number of main meals) were more unhealthy during confinement, with only alcohol binge drinking decreasing significantly. CONCLUSION: While isolation is a necessary measure to protect public health, results indicate that it alters physical activity and eating behaviours in a health compromising direction. A more detailed analysis of survey data will allow for a segregation of these responses in different age groups, countries and other subgroups, which will help develop interventions to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.

Anterior cruciate ligament injury risk factors in football.

INTRODUCTION: Anterior cruciate ligament (ACL) lesion represents one of the most dramatic injuries in a football (soccer) player's career. There are many injury risk factors related to intrinsic (non-modifiable) and/or extrinsic (modifiable) factors of ACL injury. EVIDENCE ACQUISITION: Research of the studies was conducted until September 2018 without publication data limitation or language restriction on the following databases: PubMed/MEDLINE, Scopus, ISI, EXCERPTA. EVIDENCE SYNTHESIS: To date, evidence from the literature suggests that the risk of ACL injury is multifactorial and involves biomechanical, anatomical, hormonal, and neuromuscular factors. Despite this relative complexity, the mechanisms of injury are well known and rationally classified into two categories: mechanisms of injury based on contact or on non-contact with another player, with the non-contact injury mechanisms clearly prevailing over the mechanisms of contact injury. One of the most frequent biomechanical risk factors, associated with ACL non-contact injury, is represented by the valgus knee in the pivoting and cutting movements and in the landing phase after jumping. Gender-related risk factors show female populations to have a higher predisposition to ACL injury than males However, there are still some theoretical and practical aspects that need further investigation such as; genetic risks together with the role of estrogen and progesterone receptors in female populations, and the in-vivo interaction shoe-playing surface. In particular, the genetic risk factors of ACL lesion seem to be an interesting and promising field of investigation, where considerable progress has still to be made. CONCLUSIONS: This narrative review provides an insight into the risk factors of ACL injury that could be used by practitioners for preventing injury in football (soccer).

Correlation of gas exchange threshold and first muscle oxyhemoglobin inflection point with time-to-exhaustion during heavy-intensity exercise.

BACKGROUND: The twofold aim of the study was to: 1) compare the gas exchange threshold (GET), the first oxyhemoglobin inflection point ([O2Hb]-T), and perceptual threshold as determined during an incremental exercise test, and 2) investigate the link between each threshold and time-to-exhaustion during heavy intensity exercise. METHODS: Fourteen competitive cyclists performed an incremental exercise test to exhaustion on a cycloergometer to determine the different thresholds and peak workload (Wpeak). The participants then performed a sub-maximal constant workload test (90% Wpeak) to exhaustion to determine time-to-exhaustion. The thresholds were identified from: 1) the first breakpoint in the oxygen uptake vs. carbon dioxide output curve (GET), 2) the [O2Hb]-T, and 3) a rating of 13 in perceived exertion (perceptual threshold: RPE13-T). RESULTS: Oxygen uptake at the different thresholds was not significantly different (P>0.05). Moreover, GET and [O2Hb]-T were significantly correlated: 1) to each other (r≥0.79; P≤0.001), and 2) to time-to-exhaustion (r=0.81 and r=0.72, respectively; P<0.01). RPE13-T, however, was not significantly correlated with the time-to-exhaustion (P=0.148). CONCLUSIONS: The anaerobic threshold as identified from GET was concomitant to [O2Hb]-T. Both thresholds were correlated to time-to-exhaustion, and could therefore be used as a performance index in middle-duration events.

Ramadan Fasting and Patients with Cancer: State-of-the-Art and Future Prospects.

Ramadan fasting represents one of the five pillars of the Islam creed. Even though some subjects (among which patients) are exempted from observing this religious duty, they may be eager to share this particular moment of the year with their family and peers. However, there are no guidelines or standardized protocols that can help physicians to properly address the issue of patients with cancer fasting in Ramadan and correctly advising them. Moreover, in a more interconnected and globalized society, in which more and more Muslim patients live in the Western countries, this topic is of high interest also for the general practitioner. For this purpose, we carried out a systematic review on the subject. Our main findings are that (1) very few studies have been carried out, addressing this issue, (2) evidence concerning quality of life and compliance to treatment is contrasting and scarce, and (3) generally speaking, few patients ask their physicians whether they can safely fast or not. For these reasons, further research should be performed, given the relevance and importance of this topic.