The preoperative serum ratio of total prostate specific antigen (PSA) to free testosterone (FT), PSA/FT index ratio, and prostate cancer. Results in 220 patients undergoing radical prostatectomy.

OBJECTIVES: To evaluate associations of preoperative total prostate specific antigen (PSA) to free testosterone (FT), the PSA/FT index ratio, with features of pathology prostate cancer (PCA) and to investigate its prognostic potential in clustering the PCA population. PATIENTS AND METHODS: After excluding criteria, the records of 220 patients who underwent radical prostatectomy (RP) were retrospectively reviewed. Serum samples of PSA, total testosterone (TT) and FT were collected at 8.00 A.M., one month after biopsies and before RP. The PSA/FT ratio was computed in the population of patients who were clustered in groups according to ranking intervals of the PSA/FT ratio which identified at least 4 clusters which were coded as A, B, C, and D. The independent associations of the PSA/FT index ratio were assessed by statistical methods and a two-sided P < 0.05 was considered to indicate statistical significance. RESULTS: TT correlated to FT which was a significant predictor of PSA in the population of patients who were subsequently clustered, according to increasing interval values of the PSA/FT index ratio, in groups that showed a stronger linear association of FT with PSA. The PSA/FT index ratio significantly associated with pathology features of prostate cancer such as pathology Gleason score (pGS), invasion of the seminal vesicles (pT3b), proportion of positive cores (P+) and proportion of cancer involving the volume of the prostate. In the population of patients, TT, PSA/FT index ratio and P+ independently associated with pGS ≥ 7 and pT3b; moreover, the odds ratio (OR) of the PSA/FT index ratio resulted 9.11 which was stronger than TT (OR = 1.11) and P+ (OR = 8.84). In the PCA population, TT, PSA/FT index ratio and P+ also independently associated with pT3b PCA; interestingly, the OR of PSA/FT index resulted 54.91 which was stronger than TT (OR = 1.31) and P+ (26.43). CONCLUSIONS: Preoperative PSA/FT index ratio is an independent strong factor which directly associates with aggressive features of pathology PCA; moreover, it might express prognostic potential for clustering the patient population in risk classes. Confirmatory studies are required.

Introduction of an enhanced recovery protocol to reduce short-term complications following radical cystectomy and intestinal urinary diversion with vescica ileale Padovana neobladder.

OBJECTIVES: To reduce short-term complications of radical cystectomy (RC) and intestinal urinary diversion with vescica ileale Padovana (VIP) neobladder, we described and assessed an enhanced recovery protocol (ERP) in a series of consecutive patients. METHODS: An ERP was introduced focusing on reduced bowel preparation, standardized feeding and analgesic regimens. We analyzed the outcomes with all patients consecutively undergoing RC and VIP neobladder who met the following inclusion criteria: American Society of Anesthesiologists score <3; absence of malnutrition according to the Mini Nutritional Assessment-Short Form criteria; absence of inflammatory bowel diseases. RESULTS: Thirty-one consecutive patients were recruited to undergo our ERP. Mean age of patients was 62.16 years. No patients died due to surgical complications. Nine of 31 patients experienced complications (29.03%), none requiring surgical intervention. According to Clavien grading, all complications were grade <2. CONCLUSION: The application of our ERP to our patients undergoing RC and VIP neobladder contributed to reduce postoperative morbidity.

Rare case of intra-testicular adenomatoid tumour.

Adenomatoid tumors are rare benign neoplasms considered of mesothelial origin. They are usually asymptomatic and slow growing masses. They account for 30% of paratesticular tumors and very rarely involve the testicular parenchyma. Only ten such cases have been reported in the literature so far. Ideal treatment should be excision of the tumor avoiding orchidectomy. Nevertheless, because of the rarity of the lesion and the difficulty of distinguishing it from malignancy, radical orchidectomy is often performed. We describe a case of a 31 years old caucasian man who presented with a moderately symptomatic left testicular mass, normal tumor markers and normal sex hormones levels. The ultrasound showed an hypoechoic intratesticular nodule of 0.8 cm in diameter. The patient underwent intraoperative frozen section of the nodule which could not exclude malignancy with certainty. A radical orchiectomy was therefore performed. Subsequent definitive histological and molecular report described an adenomatoid tumor involving the parenchyma of the testis.

Carbohydrate supplementation during a simulated 10-km open water swimming race: effects on physiological, perceptual parameters and performance.

The aim of the present study was to test the effect of carbohydrate ingestion, simulating a 10-km open water race competition on energy cost (Csw), perceived exertion (RPE), heart rate (HR), stroke rate (SR) and performance. We hypothesized that carbohydrate ingestion would reduce Csw and RPE in elite open water swimmers (OW-swimmers) and improve performance. Eight elite OW-swimmers swam for 3 × 30 min with 20-s of interval necessary to collect data in the swimming flume at a pre-set pace corresponding to their 10-km race pace, followed by a time to exhaustion test (TTE) at 100% of the peak oxygen uptake (V̇O2peak). During the set, OW-swimmers ingested 45-g of carbohydrates (CHO) in 550-mL of water (8% solution) during each of the two intervals or a placebo solution (PLA). HR, RPE, V̇O2 and SR were measured. Shapiro-Wilk test was used to verify the normal distribution of data. Two-way repeated measures ANOVA and t-test was performed (p < 0.05). A significant difference emerged in TTE between the trials (169.00 ± 91.06 s in CHO; 102.31 ± 57.47 s in PLA). HR, RPE and SR increased during the TTE but did not differ between trials. Csw did not show a significant main effect between the two conditions and in time course in both conditions. CHO ingestion significantly increased TTE at 100% of V̇O2peak after 90-min of swimming at 10-km race pace. These findings indicate that CHO intake during a 10-km open water swimming competition should have a beneficial impact on performance in the final part of the race.

The Impact of a 14-Day Altitude Training Camp on Olympic-Level Open-Water Swimmers' Sleep.

Despite the common belief that sleep quality at altitude is poor, the scientific evidence to support this notion is still modest. Therefore, the purpose of the present study was to evaluate possible changes of actigraphy-based and subjective sleep parameters in a group of elite open-water swimmers during a 14-day altitude training camp (ATC) at 1500 m. The study subjects were five Olympic-level open-water swimmers (mean age: 25.0 ± 3.2 years; 3 females and 2 males). All subjects wore a wrist activity monitor and filled a sleep diary for 18 consecutive nights, 4 nights before and 14 nights during ATC. The data were then analyzed at four different time points: before ATC (PRE), the first two days of ATC (T1), and after one (T2) and two weeks of ATC (T3). Training load, assessed as the covered distance (km), session rating of perceived exertion (sRPE), and heart rate (HR), was monitored during the week before and the first and second week of ATC. No significant differences in objective and subjective scores of sleep quality were detected, whereas the sleep onset time (p = 0.018; η2p = 0.83, large) and sleep offset time (p < 0.001; η2p = 0.95, large) significantly differed among PRE, T1, T2, and T3: elite athletes started to sleep and woke up ≃ 1 h earlier the first two days of ATC compared to PRE (sleep onset time: p = 0.049; sleep offset time: p = 0.016). Further, an increase in the training volume during the two weeks of the ATC was observed, with the most time spent in a low-intensity regime and an increase in time spent in a high-intensity regime compared to PRE. Sleep quality was not negatively influenced by a 14-day altitude training camp at 1500 m in a group of Olympic-level elite swimmers despite an increase in perceived exertion during training sessions. Nonetheless, early sleep onset and sleep offset times were observed for the first two nights of ATC: elite athletes started to sleep and woke up ≃ 1 h earlier compared to the baseline nights.

Pacing and Hazard Score of Elite Open Water Swimmers During a 5-km Indoor Pool Race.

PURPOSE: The sensation of fatigue experienced at a certain point of the race is an important factor in the regulation of pacing. The rating of perceived exertion (RPE) is considered one of the main mediators utilized by athletes to modify pacing. The aim was to analyze the relationship between pacing and RPE of elite open water swimmers during national indoor pool championships. METHODS: A total of 17 elite open water swimmers (males, n = 9; females, n = 8) agreed to provide RPE every 500 m during the finals of the national championships 5-km indoor pool race. Time splits, stroke rate, and RPE were collected every 500 m. The Hazard score was calculated by multiplying the momentary RPE by the remaining fraction of the race. Athletes were placed in one of two categories: medalists or nonmedalists. For all variables, separate mixed analysis of variances (P ≤ .05) with repeated measures were used considering the splits (ie, every 500 m) as within-subjects factor and the groups (ie, medalists and nonmedalists) as between-subjects factor. RESULTS: Average swimming speed showed a significant main effect for split for both males and females (P < .001). A significant interaction was observed between average swimming speed and groups for females (P = .032). RPE increased in both groups (P < .001) with no difference observed between groups. However, the female nonmedalists showed a disproportionate nonlinear increase in RPE (5.20 [2.31]) halfway through the event that corresponded to the point where they started significantly decreasing speed. CONCLUSIONS: The results of the present study show different pacing strategies adopted by medalists and nonmedalists despite a similar RPE.

Monitoring Rating of Perceived Exertion Time in Zone: A Novel Method to Quantify Training Load in Elite Open-Water Swimmers?

PURPOSE: To analyze training-intensity distribution (TID) using different independent monitoring systems for internal training load in a group of elite open-water swimmers. METHODS: One hundred sixty training sessions were monitored in 4 elite open-water swimmers (2 females and 2 males: 23.75 [4.86] y, 62.25 [6.18] kg, 167 [6.68] cm) during 5 weeks of regular training. Heart-rate-based methods, such as time in zone (TIZ), session goal (SG), and hybrid (SG/TIZ), were used to analyze TID. Similarly to SG/TIZ, a new hybrid approach, the rating of perceived exertion (RPE)/TIZ for a more accurate analysis of TID was used. Moreover, based on the 3-zone model, the session ratings of perceived exertion of the swimmers and the coach were compared. RESULTS: Heart-rate- and RPE-based TID methods were significantly different in quantifying Z1 (P = .012; effect size [ES] = 0.490) and Z2 (P = .006; ES = 0.778), while no difference was observed in the quantification of Z3 (P = .428; ES = 0.223). The heart-rate-based data for Z1, Z2, and Z3 were 83.2%, 7.4%, and 8.1% for TIZ; 80.8%, 8.3%, and 10.8% for SG/TIZ; and 55%, 15.6%, and 29.4% for SG. The RPE-based data were 70.9%, 19.9%, and 9.2% for RPE/TIZ% and 41.2%, 48.9%, and 9.7% for the session rating of perceived exertion. No differences were observed between the coach's and the swimmers' session ratings of perceived exertion in the 3 zones (Z1: P = .663, ES = -0.187; Z2: P = .110, ES = 0.578; Z3: P = .149, ES = 0.420). CONCLUSION: Using RPE-based TID methods, Z2 was significantly larger compared with Z1. These results show that RPE-based TID methods in elite open-water swimmers are affected by both intensity and volume.

Wetsuit Use During Open Water Swimming. Does It "Suit" Everybody? A Narrative Review.

PURPOSE: Although wearing a wetsuit while swimming, when permitted, is primarily for safety reasons (ie, to protect against hypothermia), changes in buoyancy, biomechanics, and exercise performance have been reported. This narrative review covers the benefits of different wetsuit models on performance in swimming and triathlon. METHODS: A computer search of online databases was conducted to locate relevant published research until March 2021. After the screening process, 17 studies were selected for analysis. RESULTS: Most of the selected studies involved pool swimmers or triathletes completing short or middle distances in a pool while using a full or a long sleeveless wetsuit. Swimming with wetsuit elicited significant improvements in performance (maximum 11%), mainly by decreasing drag and energy cost, by increasing buoyancy, and by affecting technique. Different rates of change in each factor were found according to swimming ability and wetsuit model. In addition, wearing a wetsuit was often rated as uncomfortable by athletes. CONCLUSIONS: Although improvement in swimming performance by wearing a wetsuit has been reported in the literature, the amplitude of the improvement remains questionable. The enhancement in swimming performance is attributable merely to improvements in propulsion proficiency and buoyancy, as well as a reduction in drag. The extent to which athletes are familiar with the use of a wetsuit, their swimming ability, and the wetsuit model may play important roles in this improvement. More studies simulating competition and comparing elite versus nonelite athletes are needed.

Session RPE Breakpoints Corresponding to Intensity Thresholds in Elite Open Water Swimmers.

This study aims to assess the correspondence between session rating of perceived exertion (sRPE) breakpoints with both the first lactate threshold (LT1) and the second lactate threshold (LT2) in elite open water swimmers (OWS). Six elite OWS of the National Olympic Team specialized in distances between 5 and 25 km participated to the study. OWS performed a set of 6 times 500 m incremental swimming step test during which blood lactate concentration (BLC), split time (ST), stroke frequency (SF), and rating of perceived exertion (RPE) were collected. To assess the corresponding breakpoints, we considered LT1 as the highest workload not associated with rise in BLC and LT2 as the increase of 2mM above LT1. According to the LT1 and LT2, the identified zones were: Z1 ≤3, Z2 between 4 and 6, Z3 ≥ 7. In conclusion, the intensity zones determined for OWS resulted different from what previously reported for other endurance disciplines.

Pacing profile in the main international open-water swimming competitions.

PURPOSE: Different aspects of pacing in endurance events have been investigated, however, there are very limited information on pacing strategies during open-water swimming. The aim was to describe and compare the pacing profile used by male and female open-water swimmers (OW-swimmers) during the 5-, 10- and 25 km races in the main international competitions. METHODS: A total of 438 performances were analysed for 5 km, 579 for 10 km and 189 for 25 km, from 2012 to 2017. Swimmers were divided into four groups based on finishing time. G1 whose finishing times were within 0.5% of the winner's time, G2 between 0.51% and 1% slower than winner's time; G3 between 1.1% and 2% slower than winner's time; G4 over 2% of winner's time. Kolmogorov-Smirnov test was used to verify the normal distribution of data and repeated measures ANOVA was performed. RESULTS: G1 adopted a negative pacing and significantly increased the speed in the last split compared with the other groups during the 5-, 10- and 25-km races in both males and females (p < .001). During the 5- and 10-km race, the last split speed of G1 was significantly faster compared to the other groups in both males and females (p < .05). CONCLUSIONS: OW-swimmers that used a conservative approach remaining in G1 until the finish of the race, increase the possibility to win a medal in the main international competitions.

The Road to Rio: A Brief Report of Training-Load Distribution of Open-Water Swimmers During the Olympic Season.

PURPOSE: The 10-km open-water swimming race is an endurance event that takes place in lakes, rivers, or sea and has been an Olympic event since 2008. The aim of the present brief report is to describe training volume and intensity distribution of elite open-water swimmers during the 2016 Olympic season, verifying if, in order to maximize performance, most of the training would be performed at low intensities. METHODS: Eight elite Italian open-water swimmers (3 male and 5 female; 25 [2] y, 1.74 [0.05] m, 68.26 [8.17] kg) specialized in distances between 5 and 25 km participated in the study. Training load was determined using an online training diary. Training intensity was categorized according to the 3-zone model: Z1, light intensity; Z2, moderate intensity; and Z3, high intensity. Session rating of perceived exertion was used to quantify training-intensity distribution. This method assigns the entire session into a single intensity zone based on the rating of perceived exertion recorded 30 min posttraining. RESULTS: Total yearly training volume was 3576.93 (272.390) km (3220.80-4041.97), distributed across 446 (37) (397-484) sessions monitored during the 2016 Olympic season. Training-intensity distribution in each zone was 76.83% (8.11%) in Z1, 17.70% (6.79%) in Z2, and 5.47% (5.93%) in Z3. CONCLUSIONS: High volumes in Z1 appear to be an important training method used by elite open-water swimmers. However, future research is necessary to study the effects of different training-intensity distribution on open-water swimming performances.

Do the Fastest Open-Water Swimmers have A Higher Speed in Middle- and Long-Distance Pool Swimming Events?

BACKGROUND: It has been shown that the fastest open-water swimmers (OW-swimmers) increase significantly the speed in the last split of the open-water events. The aim of the present work was to determine if the fastest OW-swimmers have a higher speed in the middle- and long-distance pool swimming events, and to develop a multivariate model that can predict the medalist group in the 10-km competition. METHODS: A total of 484 athletes (252-males and 232-females) were included in the analysis. Swimmers were divided into four groups based on their finishing position in the competition. For each swimmer, the absolute best performance (PB) of 200, 400, 800 and 1500-meter in long course, the seasonal best performance (SPB) obtained before the open-water events and critical velocity (CV) were analyzed. Multivariate analysis of variance (MANOVA) was used to detect significant differences between groups and discriminant analysis was used to predict a grouping variable. RESULTS: All the variables analyzed were significantly different between groups (p < 0.001). The first discriminant function correctly classified 50% of the overall female and male swimmers. CONCLUSION: Fastest OW-swimmers have a higher speed in middle- and long-distance pool swimming events. Further studies should include different anthropometric and physiological variables to increase the accuracy of classification.

Carbohydrate Supplementation Does Not Improve 10 km Swimming Intermittent Training.

The aim of the present study was to test the effectiveness of carbohydrate (CHO) feeding supplemented every 2.5-km, as in official races, on the performance, rating of perceived exertion (RPE), and glycaemia during a 10-km intermittent training workout in elite open-water swimmers. A randomized crossover design was used. Participants completed two 10-km intermittent training sessions (20 × 500-m). The relative velocity was expressed in percentage of a single 500-m. Glycaemia was monitored by continuous glucose monitoring. Participants had to ingest either 1 L of tap water (WAT; 0.50 L·h-1) or 120 g of CHO in the form of 8% solution (60 g·h-1). The 15-point RPE scale was used during the trials. A two-way ANOVA for repeated measures was performed (p < 0.05). The relative velocity of each 500-m was not significantly different between the two trials. No significant differences emerged in the relative velocity of the last 500-m between trials. Average RPE was not statistically different between the two trials (11 ± 3 in WAT and 12 ± 3 in CHO). In the last 500-m, glycaemia was significantly higher in the CHO trial (5.92 ± 0.47 mmol·L-1 in CHO; 5.61 ± 0.61 mmol·L-1 in WAT). CHO ingestion did not improve performance or affect RPE during a 10-km intermittent training in elite open-water swimmers.

Characteristics and Challenges of Open-Water Swimming Performance: A Review.

CONTEXT: Although the popularity of open-water swimming (OWS) events has significantly increased in the last decades, specific studies regarding performance of elite or age-group athletes in these events are scarce. PURPOSE: To analyze the existing literature on OWS. METHODS: Relevant literature was located via computer-generated citations. During August 2016, online computer searches on PubMed and Scopus databases were conducted to locate published research. RESULTS: The number of participants in ultraendurance swimming events has substantially increased in the last 10 y. In elite athletes there is a higher overall competitive level of women than of men. The body composition of female athletes (different percentage and distribution of fat tissue) shows several advantages (more buoyancy and less drag) in aquatic conditions that determine the small difference between males and females. The main physiological characteristics of open-water swimmers (OW swimmers) are the ability to swim at high percentage of [Formula: see text] (80-90%) for many hours. Furthermore, to sustain high velocity for many hours, endurance swimmers need a high propelling efficiency and a low energy cost. CONCLUSION: Open-water races may be characterized by extreme environmental conditions (water temperature, tides, currents, and waves) that have an overall impact on performance, influencing tactics and pacing. Future studies are needed to study OWS in both training and competition.

Ratings of Perceived Exertion and Self-reported Mood State in Response to High Intensity Interval Training. A Crossover Study on the Effect of Chronotype.

The aim of this study was to investigate the influence of chronotype on mood state and ratings of perceived exertion (RPE) before and in response to acute high intensity interval exercise (HIIE) performed at different times of the day. Based on the morningness-eveningness questionnaire, 12 morning-types (M-types; N = 12; age 21 ± 2 years; height 179 ± 5 cm; body mass 74 ± 12 kg) and 11 evening-types (E-types; N = 11; age 21 ± 2 years; height 181 ± 11 cm; body mass 76 ± 11 kg) were enrolled in a randomized crossover study. All subjects underwent measurements of Profile of Mood States (POMS), before (PRE), after 12 (POST12) and 24 h (POST24) the completion of both morning (08.00 am) and evening (08.00 p.m.) training. Additionally, Global Mood Disturbance and Energy Index (EI) were calculated. RPE was obtained PRE and 30 min POST HIIE. Two-way ANOVA with Tukey's multiple comparisons test of POMS parameters during morning training showed significant differences in fatigue, vigor and EI at PRE and POST24 between M-types and E-types. In addition, significant chronotype differences were found only in POST12 after the evening HIIE for fatigue, vigor and EI. For what concerns Borg perceived exertion, comparing morning versus evening values in PRE condition, a higher RPE was observed in relation to evening training for M-types (P = 0.0107) while E-types showed higher RPE values in the morning (P = 0.008). Finally, intragroup differences showed that E-types had a higher RPE respect to M-types before (P = 0.002) and after 30 min (P = 0.042) the morning session of HIIE. No significant changes during the evening training session were found. In conclusion, chronotype seems to significantly influence fatigue values, perceived exertions and vigor in relation to HIIE performed at different times of the day. Specifically, E-types will meet more of a burden when undertaking a physical task early in the day. Practical results suggest that performing a HIIE at those times of day that do not correspond to subjects' circadian preference can lead to increased mood disturbances and perceived exertion. Therefore, an athlete's chronotype should be taken into account when scheduling HIIE. Trial registration: ACTRN12617000432314, registered 24 March 2017, "retrospectively registered". Web address of trial: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371862&showOriginal=true&isReview=true.

Robotic-assisted radical prostatectomy is less stressful than the open approach: results of a contemporary prospective study evaluating pathophysiology of cortisol stress-related kinetics in prostate cancer surgery.

The objective of this study was to investigate the effects of prostate cancer (PCA) surgery on the stress system and to identify potential independent factors associating with stress recovery. The design of the study was prospective and PCA surgery included robot-assisted radical prostatectomy (RARP) or retro pubic radical prostatectomy. Between February and December 2013, 151 consecutive patients were evaluated. The effects of PCA surgery on the stress system were measured by cortisol serum levels before and after surgery on post-operative day (POD) 0, 1, 3, 5 and 45. Statistical methods were applied. RARP was performed in 71% of cases. PCA surgery triggered the stress system which immediately (POD 0) responded by cortisol overproduction which induced the negative feedback mechanism that started on POD 1, continued on POD.

Twelve-month self-reported quality of life after retropubic radical prostatectomy: a prospective study with Rand 36-Item Health Survey (Short Form-36).

OBJECTIVES: To evaluate the health-related quality of life (HRQoL) in patients undergoing retropubic radical prostatectomy (RRP) for clinically localized prostate cancer. PATIENTS AND METHODS: From February 2002 to September 2003 all patients undergoing RRP in our department were invited to participate in the study; the data from 75 of them comprised the present analysis. For evaluating HRQoL the RAND 36-Item Health Survey (SF-36) was used. RESULTS: Comparing the baseline scores of the SF-36 domains to those at 3, 6 and 12 months, there was a statistically significant difference in 'physical function', 'role limitations due to physical health problems', 'role limitations due to emotional problems', and 'energy/fatigue'. There were no statistically significant changes in the follow-up values for the other scales of the questionnaire. However, the baseline scores overlapped the 12-month follow-up values for all the SF-36 scales. The mean SF-36 scores reported by incontinent patients were lower than those of the continent patients, although this trend was not statistically significant. At the 12-month follow-up some variables were independent predictors of lower mean scores of some SF-36 scales, i.e. age >65 years, education level less than secondary school, pathological extracapsular extension of cancer and erectile dysfunction. CONCLUSION: At 1 year after RRP, HRQoL levels in each of the SF-36 domains overlapped those of the baseline in >80% of patients. The age, educational level of patients, local extension of the tumour, and erectile dysfunction could significantly affect the HRQoL scores.

An unusual inguino-scrotal presentation of disseminated peritoneal adenomucinosis.

We report a rare case of disseminated peritoneal adenomucinosis presenting as an inguino-scrotal mass. Imaging studies showed the presence of a mass, with liquid content, expanding from right colon into the retrovesical space and downward into the right inguinal canal. Intraoperatively, we observed and removed an appendiceal gelatinous mass. The inguinal-scrotal mass consisted of a hernial sac filled with mucinous material. Histological examination allowed the diagnosis of peritoneal adenomucinosis.

Clinical and radiological evolution of a case of idiopathic retroperitoneal fibrosis treated with Tamoxifen.

The authors report a case of retroperitoneal fibrosis conservatively treated with Tamoxifen. The computerized tomography (TC) control at ten months showed the persistence of a slight residual of peri-aortic fibrotic tissue. This result allowed removal of the double J catheter.