Corticospinal and spinal responses following a single session of lower limb motor skill and resistance training.

Prior studies suggest resistance exercise as a potential form of motor learning due to task-specific corticospinal responses observed in single sessions of motor skill and resistance training. While existing literature primarily focuses on upper limb muscles, revealing a task-dependent nature in eliciting corticospinal responses, our aim was to investigate such responses after a single session of lower limb motor skill and resistance training. Twelve participants engaged in a visuomotor force tracking task, self-paced knee extensions, and a control task. Corticospinal, spinal, and neuromuscular responses were measured using transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS). Assessments occurred at baseline, immediately post, and at 30-min intervals over two hours. Force steadiness significantly improved in the visuomotor task (P < 0.001). Significant fixed-effects emerged between conditions for corticospinal excitability, corticospinal inhibition, and spinal excitability (all P < 0.001). Lower limb motor skill training resulted in a greater corticospinal excitability compared to resistance training (mean difference [MD] = 35%, P < 0.001) and control (MD; 37%, P < 0.001). Motor skill training resulted in a lower corticospinal inhibition compared to control (MD; - 10%, P < 0.001) and resistance training (MD; - 9%, P < 0.001). Spinal excitability was lower following motor skill training compared to control (MD; - 28%, P < 0.001). No significant fixed effect of Time or Time*Condition interactions were observed. Our findings highlight task-dependent corticospinal responses in lower limb motor skill training, offering insights for neurorehabilitation program design.

Corticospinal and spinal adaptations following lower limb motor skill training: a meta-analysis with best evidence synthesis.

Motor skill training alters the human nervous system; however, lower limb motor tasks have been less researched compared to upper limb tasks. This meta-analysis with best evidence synthesis aimed to determine the cortical and subcortical responses that occur following lower limb motor skill training, and whether these responses are accompanied by improvements in motor performance. Following a literature search that adhered to the PRISMA guidelines, data were extracted and analysed from six studies (n = 172) for the meta-analysis, and 11 studies (n = 257) were assessed for the best evidence synthesis. Pooled data indicated that lower limb motor skill training increased motor performance, with a standardised mean difference (SMD) of 1.09 being observed. However, lower limb motor skill training had no effect on corticospinal excitability (CSE), Hoffmann's reflex (H-reflex) or muscle compound action potential (MMAX) amplitude. The best evidence synthesis found strong evidence for improved motor performance and reduced short-interval cortical inhibition (SICI) following lower limb motor skill training, with conflicting evidence towards the modulation of CSE. Taken together, this review highlights the need for further investigation on how motor skill training performed with the lower limb musculature can modulate corticospinal responses. This will also help us to better understand whether these neuronal measures are underpinning mechanisms that support an improvement in motor performance.

Patient Factors Influencing Speech Outcomes in Velopharyngeal Function Following Initial Cleft Palate Repair: A Systematic Review and Meta-Analysis.

OBJECTIVE: Identification of patient factors influencing velopharyngeal function for speech following initial cleft palate repair. DESIGN: A literature search of relevant databases from inception until 2018 was performed using medical subject headings and keywords related to cleft palate, palatoplasty and speech assessment. Following three stage screening data extraction was performed. SETTING: Systematic review and meta-analysis of relevant literature. PATIENTS/PARTICIPANTS: Three hundred and eighty-three studies met the inclusion criteria, comprising data on 47 658 participants. INTERVENTIONS: Individuals undergoing initial palatoplasty. MAIN OUTCOME MEASURES: Studies including participants undergoing initial cleft palate repair where the frequency of secondary speech surgery and/or velopharyngeal function for speech was recorded. RESULTS: Patient factors reported included cleft phenotype (95% studies), biological sex (64%), syndrome diagnosis (44%), hearing loss (28%), developmental delay (16%), Robin Sequence (16%) and 22q11.2 microdeletion syndrome (11%). Meta-analysis provided strong evidence that rates of secondary surgery and velopharyngeal dysfunction varied according to cleft phenotype (Veau I best outcomes, Veau IV worst outcomes), Robin Sequence and syndrome diagnosis. There was no evidence that biological sex was associated with worse outcomes. Many studies were poor quality with minimal follow-up. CONCLUSIONS: Meta-analysis demonstrated the association of certain patient factors with speech outcome, however the quality of the evidence was low. Uniform, prospective, multi-centre documentation of preoperative characteristics and speech outcomes is required to characterise risk factors for post-palatoplasty velopharyngeal insufficiency for speech. SYSTEMATIC REVIEW REGISTRATION: Registered with PROSPERO CRD42017051624.

A Closer Look at Delayed Primary Cleft Surgery and Unrepaired Cleft Lip and/or Palate in 5 UK Cleft Centers.

BACKGROUND: There may be many reasons for delays to primary cleft surgery. Our aim was to investigate the age of children undergoing primary cleft lip or primary cleft palate repair in 5 cleft centers within the United Kingdom. Identify the reasons for delayed primary cleft lip repair (beyond 6 months) and delayed primary palate repair (beyond 13 months). Identify children who had a cleft lip and/or palate (CL±P) that was intentionally unrepaired and the reasons for this. METHODS: A retrospective, multicenter review of patients born with a CL±P between December 1, 2012, and December 31, 2016. Three regional cleft centers, comprising of 5 cleft administrative units in the United Kingdom participated. RESULTS: In all, 1826 patients with CL±P were identified. Of them, 120 patients had delayed lip repair, outside the expected standard of 183 days. And, 178 patients in total had delayed palate repair, outside the expected standard of 396 days. Twenty (1%) patients had an unrepaired cleft palate. CONCLUSIONS: This large retrospective review highlights variations between centers regarding the timing of lip and palate surgery and details the reasons stated for delayed primary surgery. A small number of patients with an unrepaired cleft palate were identified. All had complex medical problems or comorbidities listed as a reason for the decision not to operate and 50% had a syndromic diagnosis. The number of patients receiving delayed surgery due to comorbidities, being underweight or prematurity, highlights the importance of the cleft specialist nurse and pediatrician within the cleft multidisciplinary team.

The effect of equipment modification on the performance of novice junior cricket batters.

Equipment scaling has yielded better performance in children in comparison to using adult equipment. To better inform applied practice in junior sport, an investigation of additional equipment modifications designed to further simplify the task is required. This study, therefore, aims to determine the effect of increasing surface area of cricket equipment (bats and balls) on batting performance and technique. Forty-three children (M age = 5.2, SD = 0.8 years) completed a cricket batting task in which they aimed to hit the ball through a target zone while using either regular-scaled, or modified bat and ball with an increased surface area. The number of bat-ball contacts was significantly higher when using the modified (M = 13.81, SE = 0.42) compared to the regular-scaled ball (M = 10.65, SE = 0.49). Batting performance measured as shots played through target areas was also significantly higher when using the modified (M = 31.78, SE = 1.97) than the regular-scaled ball (M = 28.85, SE = 2.27). More desirable technique was also observed when using the modified compared to the regular bat. Findings suggest that further modifications to regular-scaled equipment can enhance skill production.

The effect of consistent and varied follow-through practice schedules on learning a table tennis backhand.

In table tennis the follow-through action after a shot is an important part of skill execution. In this experiment, we aimed to extend literature around the contextual interference effect by investigating whether the way the follow-through is organised in practice affects learning of the backhand shot in table tennis. Thirty unskilled participants were allocated to blocked-variable practice, random-variable practice or a control-constant group and aimed backhand shots towards a target following ball projection from a machine. Each group completed these shots in a pre-test, a training phase with follow-through manipulations, a post-test, and a retention test. The random-variable group improved their shot accuracy from pre-test to post-test and from pre-test to retention test (both P < 0.01, d = 1.03), whereas neither the blocked-variable nor the control-constant group displayed any change in shot accuracy. Practising the follow-through in a random-variable fashion enhanced learning of the preceding shot compared with blocked-variable practice or no follow-through instructions. The benefits of learning motor skills under conditions of high contextual interference also apply to how follow-through actions are organised. The findings are valuable to coaches and suggest that instructions related to the follow-through action should be considered as well as the primary skill itself.

3D rotational angiography in the endovascular treatment of visceral aneurysms: preliminary experience in a single centre.

OBJECTIVES: Endovascular embolization is a valid option for the management of visceral artery aneurysms. Imaging is crucial for providing anatomical assessments, but preoperative non-invasive investigations may not be exhaustive. The aim of this work is to present preliminary experience with the use of three-dimensional rotational angiography (3DRA) in this particular theatre. METHODS: Seven patients were treated for eight visceral aneurysms (six splenic and two renal) by endovascular embolization. 3DRA was performed before the treatment using a standard protocol. Different parameters (location of the lesion, the afferent and efferent vessels, aneurysm neck, vascular diameters, working incidence) were analyzed. RESULTS: 3DRA was successfully accomplished in all procedures. Mean aneurysm diameter was 23 mm and mean C-arm working incidence was 29° (R-L) and 9° (C-C). The sandwich technique was used in four lesions and the packing in the remaining four. Technical success was 100 %. The mean radiation dose per procedure was 291 600 mGy.cm(2). The mean procedural time was 2.25 hours. There were no immediate or short-term complications. CONCLUSIONS: 3DRA could be an interesting intraoperative tool to provide anatomical and technical assessments of the visceral arteries necessary for endovascular treatment, especially when information from preoperative imaging is not exhaustive. KEY POINTS: Endovascular embolization is a valid alternative solution for visceral artery aneurysm treatment. Imaging is crucial for anatomical assessments and treatment guidance. 3DRA can contribute to endovascular treatment in lieu of preoperative imaging.

Sports-Related Maxillofacial Injuries.

BACKGROUND: Sports-related maxillofacial injuries contribute a significant proportion of the workload in a maxillofacial unit. The aim of this study was to identify the incidence of maxillofacial sports-related injuries, treatments required, and assess the impact of the injury on future sport participation. METHOD: A retrospective review was carried out on all maxillofacial trauma referrals from September 1, 2009 to August 31, 2010. Patient records were reviewed and the following variables were recorded: age, sex, sport involved, injury sustained, mechanism of injury, treatment, subsequent participation, and interval before return to sport. RESULTS: The study population included 162 patients with sports-related facial injuries. The most common sporting injuries were as follows: Gaelic football 35.3% (N = 57), soccer 22.3% (N = 36), rugby 12.4% (N = 20), and equine sports 12.4% (N = 20). The most common injury sustained was zygomatic complex fracture 36.4% (N = 59). Mandibular fracture occurred in 20% (N = 33), orbit fracture in 14.2% (N = 23), and nasal bone fracture in 12.3% (N = 20). The most common mechanism of injury was from a clash of heads (23.4%) followed by an elbow to the face (17.2%). The majority of patients (84%) resumed participation in their chosen sport at mean interval of 7.3 weeks (range 1-18 weeks). CONCLUSIONS: This study identified a significant number of sporting facial injuries, which presented over 1 year. In total, 113 patients underwent a surgical procedure for the management of their injuries. This study highlights the need to educate all players regarding use of personal protective equipment and adherence to the rules of sports.

Early identification of the opposition shot taker characterises elite goalkeepers' ability to read the game.

Researchers investigating expertise in soccer goalkeepers have overwhelmingly focused on anticipating penalty kicks and identifying kinematic cues that are used to anticipate action outcomes. In this study, we took a novel approach to exploring 'game reading' skills in soccer goalkeepers. Specifically, we investigated whether and by what point during an attacking sequence in open play, elite goalkeepers can identify the opposition shot taker, a skill that is likely to facilitate organisation of the defensive line and interception of forward creative attacking passes. We used a moving window temporal occlusion paradigm to present elite, sub-elite, and amateur goalkeepers with 11-vs-11 attacking sequences that were divided into progressive segments. After viewing each segment, participants identified the player they thought would shoot at goal at the end of the attacking sequence. Elite goalkeepers identified the opposition shot taker earlier and more accurately than sub-elite and amateur participants. Findings suggest that elite goalkeeping is underpinned not only by anticipation of action outcomes but also game-reading skill that enables identification of the player most likely to carry out those actions.

The effect of task load, information reliability and interdependency on anticipation performance.

In sport, coaches often explicitly provide athletes with stable contextual information related to opponent action preferences to enhance anticipation performance. This information can be dependent on, or independent of, dynamic contextual information that only emerges during the sequence of play (e.g. opponent positioning). The interdependency between contextual information sources, and the associated cognitive demands of integrating information sources during anticipation, has not yet been systematically examined. We used a temporal occlusion paradigm to alter the reliability of contextual and kinematic information during the early, mid- and final phases of a two-versus-two soccer anticipation task. A dual-task paradigm was incorporated to investigate the impact of task load on skilled soccer players' ability to integrate information and update their judgements in each phase. Across conditions, participants received no contextual information (control) or stable contextual information (opponent preferences) that was dependent on, or independent of, dynamic contextual information (opponent positioning). As predicted, participants used reliable contextual and kinematic information to enhance anticipation. Further exploratory analysis suggested that increased task load detrimentally affected anticipation accuracy but only when both reliable contextual and kinematic information were available for integration in the final phase. This effect was observed irrespective of whether the stable contextual information was dependent on, or independent of, dynamic contextual information. Findings suggest that updating anticipatory judgements in the final phase of a sequence of play based on the integration of reliable contextual and kinematic information requires cognitive resources.

Henri Cochet's theory of angles in tennis (1933) reveals a new facet of anticipation.

In this study, we tested the theory of angles that was proposed almost a century ago by the tennis player Henri Cochet. This theory proposes that expert tennis players should position themselves on the bisector of the angle of the opponent's possibilities in order to optimize shot return, suggesting a geometric occupation of the court relative to the opponent's affordances; namely what he/she is capable of doing. We tested this hypothesis by analysing player and ball positioning data from professional tennis matches recorded with a Hawk-Eye system. We compared this hypothesis with two alternative computational and probabilistic hypotheses which would consist in positioning oneself on the average or the median of the shots usually played from a given location. The results show that expert tennis players apply the principles of the theory of angles and thus confirm Henri Cochet's intuition. That is, for lateral court positioning, a geometric strategy is deemed optimal by expert players. It also appears that the more experienced the players are, the more precise their application of this strategy becomes.

Mandibular angle fractures: a demographic review, with particular reference to post-operative complications.

BACKGROUND: Mandibular angle fractures (MAF) have a recognized complexity of treatment and an increased risk of incurring complications. METHODS: This retrospective study included 45 consecutive patients who were diagnosed with an isolated MAF and no other facial fractures. The average age was 27.3 (SD = 7.7). RESULTS: A comparatively low rate of complications (11.1%) and a low rate of reoperation (1.8%) are reported, along with a significant role of smoking in complications (p = 0.022). A non-significant association was noted between complications, male gender and assault as an aetiological factor. CONCLUSIONS: Review of the data from this study confirms that complication rates for patients attending the National Maxillofacial Unit are similar to or better than that of international studies. An overview of the aetiology of fracture complications is included.

Reduced-dose low-voltage chest CT angiography with Sinogram-affirmed iterative reconstruction versus standard-dose filtered back projection.

PURPOSE: To evaluate image quality of low-voltage chest computed tomographic (CT) angiography with raw data-based iterative reconstruction (sonogram-affirmed iterative reconstruction) in comparison with image quality of standard-dose standard-voltage filtered back projection (FBP) CT. MATERIALS AND METHODS: This prospective study was approved by the institutional review board, and the informed consent requirement was waived. Eighty consecutive patients who were referred for follow-up chest CT angiography underwent reduced-dose CT (hereafter, T2 examination) under technical conditions similar to those of the initial examination (hereafter, T1 examination), except the voltage selection was reduced by 20 kV with adaptation of the tube current to ensure a 50% reduction in CT dose index, and regular FBP was replaced by iterative reconstruction with sonogram-affirmed iterative reconstruction. The two techniques were compared by using paired tests (Student t test, Wilcoxon test, or McNemar test, according to the nature of variables). RESULTS: When compared with standard-dose T1 studies, reduced-dose T2 images showed: (a) significantly less objective noise at the level of the trachea on mediastinal and lung parenchymal images (P < .001) and no significant difference in objective noise at the level of the aorta on mediastinal images (P = .507); (b) significantly higher signal-to-noise and contrast-to-noise (P < .001) ratios; (c) similar visual perception of noise on mediastinal (P = .132) and lung (P = .366) images, mainly rated as moderate; and (d) similar overall subjective image quality (P = .405). CONCLUSION: Raw data-based iterative reconstruction yielded equivalent subjective and improved objective image quality of low-voltage half-dose CT angiograms compared with standard-dose FBP CT images for an average dose-length product of less than 80 mGy · cm in this population. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120414/-/DC1.

Structure, material characteristics and function of the upper respiratory tract of the pygmy sperm whale.

Cetaceans are neckless, so the trachea is very short. The upper respiratory tract is separate from the mouth and pharynx, and the dorsal blowhole connects, via the vestibular and nasopalatine cavities, directly to the larynx. Toothed cetaceans (Odontoceti) are capable of producing sounds at depth, either for locating prey or for communication. It has been suggested that during dives, air from the lungs and upper respiratory tract can be moved to the vestibular and nasal cavities to permit sound generation to continue when air volume within these cavities decreases as ambient pressure rises. The pygmy sperm whale, Kogia breviceps, is a deep diver (500-1000 m) that is known to produce hunting clicks. Our study of an immature female shows that the upper respiratory tract is highly asymmetrical: the trachea and bronchi are extremely compressible, whereas the larynx is much more rigid. Laryngeal and tracheal volumes were established. Calculations based on Boyle's Law imply that all air from the lungs and bronchi would be transferred to the larynx and trachea by a depth of 270 m and that the larynx itself could not accommodate all respiratory air mass at a depth of 1000 m. This suggests that no respiratory air would be available for vocalisation. However, the bronchi, trachea and part of the larynx have a thick vascular lining featuring large, thin-walled vessels. We propose that these vessels may become dilated during dives to reduce the volume of the upper respiratory tract, permitting forward transfer of air through the larynx.

Predictors of adverse gambling behaviours amongst elite athletes.

Problem gambling levels amongst elite sportspeople are above populational baseline. We assess gambling in an elite Irish sporting population. An anonymous web-based questionnaire including the validated Problem Gambling Severity Index was distributed. Univariate and multivariate analyses were performed to evaluate predictors of moderate/high risk gambling. 608 players (mean age 24) were included. Seventy nine percent of respondents were current gamblers and 6% problem gamblers. Amongst high-risk gamblers, significantly more were male (100% vs 76%, p = 0.003), fewer completed university (52% vs 69%, p = 0.024), and more were smokers (48% vs 24%, p = 0.002). They were also more likely to avail of free online gambling offers (90% vs 44%, p < 0.001), gamble with teammates (52% vs 21%, p < 0.001) and have placed their first bet before age 16 (41% vs 19%, p = 0.003). In multivariate analysis, moderate/high risk gambling was associated with: male gender (OR = 8.9 [1.1-69], p = 0.035), no 3rd level education (OR = 2.5 [1.4-5.0], p = 0.002), free online gambling use (OR = 4.3 [2.1-5.3], p < 0.001), gambling with teammates (OR = 3.0 [1.7-5.3], p < 0.001), and being under 18 at first bet (OR = 2.0 [1.1-3.3], p = 0.013). This study shows a harmful gambling culture amongst elite Irish athletes. Male gender, lower educational status, free online gambling use, gambling with teammates and first bet at less than age 18 were associated with moderate/high risk gambling. These groups may benefit from targeted interventions.

The effect of attentional focus instructions on performance and technique in a complex open skill.

External focus of attention has been shown to promote more automatic motor control, yielding better performance and more efficient technique, than an internal focus. However, most research has used closed-skill tasks in novices. The extent to which the reported pattern of findings generalises to more complex, time-constrained tasks requires further investigation. In this study, we investigated the effect of attentional focus instructions on performance and technique in an open-skill task in skilled performers. Thirteen skilled cricket batters batted from a ball projector in four conditions, receiving instructions to focus on the movement of their hands (internal focus), the movement of their bat (proximal external focus), the flight of the ball (distal external focus), or no instruction (control). Performance and technique were measured by quality of bat-ball contacts and step length/knee flexion, respectively, whilst playing straight drives. Compared to external focus and control conditions, focusing internally yielded significantly worse batting performance and shorter step lengths, with the largest effects observed between internal and distal external focus conditions. Quality of bat-ball contact data suggested that participants' ability to protect the wicket (as evidenced by more miss/edge shots) was more negatively affected by focusing internally than their ability to play shots to score runs (as evidenced by fewer good bat-ball contacts). Findings suggest that, for skilled performance of open-skill tasks, a distal external focus yields more effective performance and technique compared with focusing internally. Findings highlight the need for further research on attentional focus effects between different skills within specific sports.Highlights A distal external focus of attention enhances performance and technique of skilled cricket batters compared with an internal focus.Providing skilled batters with no instructions yields similar performance benefits to distal external focus instructions.Focusing internally differentially negatively affects skilled cricket batters depending on the strategic intention of the shot being played (e.g. protecting the wicket vs attempting to score runs).

A thematic analysis of alcohol use and culture amongst elite (intercounty) Gaelic Athletic Association (GAA) players.

BACKGROUND: There are limited studies examining alcohol consumption in Gaelic Athletic Association (GAA) players. In a previous paper, we reported excess alcohol consumption, alcohol-related harms and binge drinking amongst elite GAA players. In that survey, the players were provided with an opportunity to provide comments on alcohol. This current study analyses these comments. AIMS: The aim of this study was to provide a qualitative analysis of elite GAA players opinions on alcohol consumption, harms, behaviours and culture. METHODS: An anonymous, web-based e-questionnaire was distributed to all registered adult elite (inter-county) GAA players. This analysed demographics, alcohol consumption, alcohol culture and alcohol-related harms. This paper is a thematic analysis of the players comments on alcohol in the GAA. RESULTS: Seven hundred seventy-three of 3592 (21%) players responded. One hundred fifty-two respondents (21%) commented in the free text section of the survey regarding alcohol. One hundred eleven comments (73%) were suitable for analysis. Relevant themes were a pattern of abstinence and bingeing (n = 44), excess alcohol consumption (n = 40) and drinking bans contributing to a binge drinking culture (n = 37). There was a mixed attitude to alcohol sponsorship. CONCLUSION: These data show players recognise intermittent binge drinking with periods of abstinence and alcohol-related harms. Further initiatives regarding alcohol harm reduction merit consideration including prohibition of alcohol sponsorship, similar to the GAA's ban on gambling.

Shape and material characteristics of the trachea in the leatherback sea turtle promote progressive collapse and reinflation during dives.

The leatherback turtle regularly undertakes deep dives and has been recorded attaining depths in excess of 1200 m. Its trachea is an almost solid, elliptical-section tube of uncalcified hyaline cartilage with minimal connective tissue between successive rings. The structure appears to be advantageous for diving and perfectly designed for withstanding repeated collapse and reinflation. This study applies Boyle's law to the respiratory system (lungs, trachea and larynx) and estimates the changes in tracheal volume during a dive. These changes are subsequently compared with the results predicted by a corresponding finite element (FE) structural model, itself based on laboratory studies of the trachea of an adult turtle. Boyle's law predicts that the lungs will collapse first during the initial stages of a dive with tracheal compression beginning at much deeper depths after complete air mass expulsion from the lungs. The FE model reproduces the changes extremely well (agreeing closely with Boyle's law estimations) and provides visual representation of the deformed tracheal luminal area. Initially, the trachea compresses both ventrally and dorsally before levelling ventrally. Bulges are subsequently formed laterally and become more pronounced at deeper depths. The geometric configuration of the tracheal structure confers both homogeneity and strength upon it, which makes it extremely well suited for enduring repeated collapse and re-expansion. The structure actually promotes collapse and is an adaptation to the turtle's natural environment in which large numbers of deep dives are performed annually.

Harmful alcohol consumption in elite sports players in Ireland.

BACKGROUND: Sportspeople are more prone to binge drink than their peers. AIMS: We aimed to assess alcohol consumption, harms and behaviours in an elite Irish sporting population (Gaelic footballers and hurlers). METHODS: An anonymous web-based questionnaire (demographics, alcohol consumption, culture and related harms) was administered to all elite players. The AUDIT-C questionnaire (frequency, quantity of alcohol consumption and frequency of binge drinking) was used to assess for adverse alcohol use. Univariate and multivariate analyses assessed for predictors of adverse alcohol use. RESULTS: 717 players (mean age 24 years) were analysed. The majority of patients were male (75%), unmarried (93%) and had completed university (67%). 96% were current drinkers. Players consumed more alcohol during the off-season (median 20 versus 8 standard drinks in 28 days) compared to the elite season. Amongst current drinkers, 73% exhibit adverse alcohol use, 93% reported binge drinking and 65% an alcohol related harm in the past year. Most players would turn to family (36%) or friends (21%) for help. There were significant associations between monthly bingeing (OR 18.4), smoking (OR 3.3), generally drinking in public (OR 3.2), current gambling (OR 2.3), male gender (OR 2.1), an alcohol harm in the past year (OR 1.9) and adverse alcohol use. In contrast, co-habiting with a partner (OR 0.5) was protective. CONCLUSIONS: Excess alcohol consumption, alcohol related harms and binge drinking are prevalent in an elite sporting population, particularly during the off-season. Specific strategies are required to reduce alcohol related harms, particularly amongst high-risk groups during the off-season.

Iron-overload cardiomyopathy: pathophysiology, diagnosis, and treatment.

BACKGROUND: The prevalence of primary (hereditary) hemochromatosis and secondary iron overload (hemosiderosis) is reaching epidemic levels worldwide. Iron-overload leads to excessive iron deposition in a wide variety of tissues, including the heart and endocrine tissues. METHODS AND RESULTS: Iron-overload cardiomyopathy is the primary determinant of survival in patients with secondary iron overload, while also being a leading cause of morbidity and mortality in patients with primary hemochromatosis. Iron-induced cardiovascular injury also occurs in acute iron toxicosis (iron poisoning), myocardial ischemia-reperfusion injury, cardiomyopathy associated with Friedreich ataxia, and vascular dysfunction. The mainstay therapies for iron overload associated with primary hemochromatosis and secondary iron overload is phlebotomy and iron chelation therapy, respectively. L-type Ca(2+) channels provide a high-capacity pathway for ferrous (Fe(2+)) uptake into cardiomyocytes in iron-overload conditions; calcium channel blockers may represent a new therapeutic tool to reduce the toxic effects of excess iron. CONCLUSIONS: Iron-overload cardiomyopathy is a an important and potentially reversible cause of heart failure at an international scale and involves diastolic dysfunction, increased susceptibility to arrhythmias and a late-stage dilated cardiomyopathy. The early diagnosis of iron-overload cardiomyopathy is critical since the cardiac dysfunction is reversible if effective therapy is introduced before the onset of overt heart failure.