Combined transcatheter aortic valve and tricuspid valve-in-valve implantation in a patient with a mitral mechanical prosthesis.

Despite progressively uncommon in Western countries, rheumatic heart disease still portrays a significant global burden. In elderly or high-surgical risk patients, plurivalvular disease may require a complex percutaneous approach. Transcatheter aortic valve implantation (TAVI) in patients with previous monoleaflet mitral prosthesis is challenging due to interference between the aortic valve and the rigid mitral mechanical prosthesis "ring." Prior cases report the use of CoreValve or Edwards Sapien aortic valves in patients with adequate mitro-aortic distance. Performing a second major procedure, such as tricuspid valve-in-valve (TVIV), sequentially during a single percutaneous intervention, increases treatment complexity. An 83-year-old woman with rheumatic heart disease, with previous implantation of a Bjork-Shiley monoleaflet mitral prosthesis, and Carpentier-Edwards 29 tricuspid bioprosthesis presented with decompensated heart failure due to severe aortic stenosis and tricuspid bioprosthesis stenosis. After HeartTeam discussion, the patient was deemed as inoperable due to a prohibitive surgical risk. As an alternative, a TAVI (Navitor FlexNav) and a transcatheter TVIV replacement (Edwards Sapiens 3 Ultra) were discussed and proposed, with both techniques being performed sequentially in a single procedure. TAVI in a patient with a previous monoleaflet mitral mechanical prosthesis and TVIV may be a feasible approach in inoperable patients with plurivalvular disease.

Simulated Soccer Game Protocols: A Systematic Review on Validated Protocols That Represent the Demands of the Game.

ABSTRACT: Brito, P, Costa, J, Figueiredo, P, and Brito, J. Simulated soccer game protocols: A systematic review on validated protocols that represent the demands of the game. J Strength Cond Res 38(1): 192-205, 2024-Several laboratory and field testing protocols have been developed attempting to simulate the activity pattern and physiological demands of soccer. In the present systematic review, we aimed to analyze and discuss the appropriateness, strengths, and limitations of soccer-specific simulated tests. A systematic review of the literature was conducted based on the PRISMA guidelines. Studies conducted in soccer, simulated soccer match tests, and validated simulation protocols performed on-the-field or on a treadmill were considered. No sex restriction was applied, and age >18 years (i.e., adults) was considered. At least 1 outcome measure (e.g., neuromuscular performance, external load, internal load, or psychometric state) of post-simulated-match test or protocol had to be reported. Within the 14 studies included, the average methodological quality of the included articles was 0.61 ± 0.09 (mean ± SD) of 1. Overall, 9 validated protocols were identified. In the protocols, only amateur, university, or semiprofessional soccer players were analyzed. Only one study evaluated female soccer players. None of the studies evaluated the effect on performance over the 2-3 days after the protocol. Accelerations and decelerations, and changes in direction typically present in a game have not been clearly described in any protocol. Future research should address this issue and validate soccer-specific protocols in women.

Epidemiology of Injuries in Elite Male Futsal Players.

OBJECTIVE: This study aimed to describe and characterize injuries sustained by elite male futsal players in Portugal. DESIGN: Prospective cohort study. SETTING: Top-tier Portuguese league in the 2019 to 2020 season. PARTICIPANTS: One hundred sixty-seven players from 9 elite/international-level (tier 4) futsal teams. INDEPENDENT VARIABLES: The location, type, body side, body part, mechanism of injury, severity, occurrence, days lost, training, and match exposure were collected. MAIN OUTCOME MEASURES: Injury incidence, prevalence, and burden. RESULTS: The study was conducted during an 8-month season. A total of 133 injuries were recorded, and 92 (67.6%) players sustained injuries. The overall time-loss injury incidence was 4.5 injuries per 1000 hours of exposure. Injury incidence during matches was higher than during training sessions (25.9 vs 3.0 per 1000 hours of exposure, respectively). Average time loss was 9 days, and moderate injuries were the most frequent (44%), followed by mild injuries (24%). Injury burden was 73.8 days lost per 1000 hours of total player exposure. Sprains/ligament (29%) and muscle rupture/tear/strains (32%) were the most common injuries. The groin (19%), thigh (17%), knee (19%), and ankle (15%) were the most affected body areas. Noncontact injuries were the most reported mechanism (65%), and 24% were overuse injuries. CONCLUSIONS: This study showed that elite/international-level (tier 4) male futsal players are more prone to noncontact injuries, primarily affecting the lower limbs. The incidence during match play increased by 9-fold compared with training sessions.

Reliability of Maximal Strength and Peak Rate of Force Development in a Portable Nordic Hamstrings Exercise Device.

The Nordic hamstring exercise (NHE) is a very popular exercise used to improve eccentric strength and prevent injuries. The aim of this investigation was to assess the reliability of a portable dynamometer that measures maximal strength (MS) and rate of force development (RFD) during the NHE. Seventeen physically active participants (34.8 ± 4.1 years; n = 2 women and n = 15 men) participated. Measurements occurred on two different days separated by 48-72 h. Test-retest reliability was calculated for bilateral MS and RFD. No significant test-retest differences were observed in NHE (test-retest [95% CI, confidence interval]) for MS [-19.2 N (-67.8; 29.4); p = 0.42] and RFD [-70.4 N·s-1 (-178.4; 37.8); p = 0.19]. MS showed high reliability (intraclass correlation coefficient [ICC] [95% CI], =0.93 [0.80-0.97] and large within-subject correlation between test and retest [r = 0.88 (0.68; 0.95)]. RFD displayed good reliability [ICC = 0.76 (0.35; 0.91)] and moderate within-subject correlation between test and retest [r = 0.63 (0.22; 0.85)]. Bilateral MS and RFD displayed a coefficient of variation of 3.4% and 4.6%, respectively, between tests. The standard error of measurement and the minimal detectable change for MS was 44.6 arbitrary units (a.u.) and 123.6 a.u., and 104.6 a.u. and 290.0 a.u. for peak RFD. This study shows that MS and RFD can be measured for NHE using a portable dynamometer. However, not all exercises are suitable to apply to determine RFD, so caution must be taken when analyzing RFD during NHE.

Using Deadlifts as a Postactivation Performance Enhancement Strategy in Warm-ups in Football.

ABSTRACT: Abade, E, Brito, J, Gonçalves, B, Saura, L, Coutinho, D, and Sampaio, J. Using deadlifts as a postactivation performance enhancement strategy in warm-ups in football. J Strength Cond Res 37(9): 1821-1827, 2023-Postactivation performance enhancement activities may be relevant warm-up strategies aiming to improve subsequent physical performance. The purpose of the current study was to investigate the effects of adding barbell deadlift or hex-bar deadlift exercises to current warm-up routines on running and jumping performances in football players. Ten highly trained male football players participated in the study during the competitive phase of the season. All players performed 3 protocols in the same week: a standard warm-up that included players' regular routines and 2 other protocols with the addition of barbell or hex-bar deadlift, after the end of the warm-up (3 sets of 3 reps, progressing set by set from 60% to 85% repetition maximum). All protocols had the same time interval between pretest (immediately after the warm-up) and posttest (15 minutes after the warm-up). Vertical jumping (countermovement jump [CMJ]; Abalakov jump [AJ]) and running performances (505 test) were impaired 15 minutes after the standard warm-up (CMJ: -6.7 ± 4.2%; AJ: -8.1 ± 8.4%; and 505 time: 1.4 ± 2.5%). For warm-up with the addition of barbell deadlift, vertical jump increased by 4.3 ± 5.6% (Cohen's dunb : 0.23 [0.02-0.47]) and 505 time decreased by -5.9 ± 3.6% (Cohen's dunb : 0.97 [-1.68 to -0.43]). The warm-up with hex-bar deadlift led to trivial changes for CMJ and AJ, but 505 time decrease by -2.7 ± 2.6% (Cohen's dunb : -0.53 [-1.01 to -0.13]). The deadlift exercise can be added to warm-up routines to maintain or even enhance acute physical performance. However, coaches and practitioners should be aware that performance enhancements resultant from deadlift may vary according to individual physical profiles.

The Effects of Pre-Season and Relationships with Physical, Physiological, Body Composition, and Load Markers: A Case Study Comparing Starters versus Non-Starters from an Elite Female Professional Soccer Team.

Background and Objectives: Research on female soccer players that analyzes playing status is scarce and has previously only examined load monitoring, while other markers, such as physical (i.e., strength, power, and agility), physiological (i.e., maximal oxygen uptake), and body composition (i.e., body fat mass, fat-free mass, body water, and phase angle) markers, warrant further investigation. Thus, the study aims were to (a) compare physical, physiological, body composition, and load markers between starters and non-starters; (b) compare measurements pre- and post-training intervention (five weeks); and (c) analyze any relationships between physical, physiological, body composition, and load markers in an elite female soccer team. Materials and Methods: Fourteen first-team players participated in the study (age 23.29 ± 3.19 years, weight 59.14 ± 6.87 kg, height 1.66 ± 0.08 m). Several physical (n = 15), physiological (n = 1), body composition (n = 11), and load markers (n = 14) were collected. In addition, participants were sub-divided into starters (n = 7) and non-starters (n = 7). Results: No differences were revealed between starters and non-starters in any of the examined variables. Moreover, following the training intervention, a significantly lower value was found for total body water/fat-free mass ratio (p = 0.043; ES = 0.582). In addition, there were several correlations detected between load and physical/physiological markers (n = 28); load and body composition markers (n = 6); physical/physiological and body composition markers (n = 34); and physical and physiological markers (n = 42). Conclusions: In conclusion, only a slight tendency of higher load values for starters than non-starters was observed. In addition, no differences in physical, physiological, and body composition markers were found between starters and non-starters, possibly suggesting that five weeks were not enough to improve such variables. Finally, the present results provide novel information assessing the effects of the pre-season in elite female Portuguese soccer players and contribute to a better understanding of the associations between different types of measurements.

A review of machine learning applications in soccer with an emphasis on injury risk.

This narrative review paper aimed to discuss the literature on machine learning applications in soccer with an emphasis on injury risk assessment. A secondary aim was to provide practical tips for the health and performance staff in soccer clubs on how machine learning can provide a competitive advantage. Performance analysis is the area with the majority of research so far. Other domains of soccer science and medicine with machine learning use are injury risk assessment, players' workload and wellness monitoring, movement analysis, players' career trajectory, club performance, and match attendance. Regarding injuries, which is a hot topic, machine learning does not seem to have a high predictive ability at the moment (models specificity ranged from 74.2%-97.7%. sensitivity from 15.2%-55.6% with area under the curve of 0.66-0.83). It seems, though, that machine learning can help to identify the early signs of elevated risk for a musculoskeletal injury. Future research should account for musculoskeletal injuries' dynamic nature for machine learning to provide more meaningful results for practitioners in soccer.

Executive summary: Elite women's football-Performance, recovery, diet, and health.

The present special issue of Scandinavian Journal of Medicine & Science in Sports focuses on performance, recovery, diet, and health in elite women's football. Beside this summary, an editorial, topic reviews, and original articles written by several of the most published authors in football research are presented. It is, for example, highlighted that there is a great gender inequality in football research in favor of men, especially within elite football populations. Therefore, the broad-spectrum content of the special issue with focus on several performance areas in women's football, recovery strategies, nutrition, and psychological factors is highly warranted. Several of the topics examined and data presented are examined for the first on elite women's football, and therefore, we hope that this special issue will contribute to gender balance the research and emphasis on football in both genders.

Associations between 24-h heart rate variability and aerobic fitness in high-level female soccer players.

OBJECTIVE: The aim of this study was to investigate the changes in 24-h heart rate variability and aerobic fitness, and their associations, in female soccer players during the preseason period. METHODS: Sixteen players were assessed (24-h HRV and Yo-Yo Intermittent Recovery Test, level 1 [YYIR1]) before and after 4 weeks of preseason. The relationship between R-R24h length and high-frequency oscillations (HF24h) was analyzed by a quadratic regression model (revealing or not saturation of vagal activity) assessed 48-h before (PRE-preseason) and 48-h after (POST-preseason) the preseason period. Additionally, the mean HF24h was calculated from the linear portion of the R-R interval versus the HF24h regression curve (HF index). The average of the corresponding R-R24h values was defined as the R-R index. RESULTS: In PRE-preseason, seven players had a saturated HF24h, while in POST-preseason, five new cases of saturated HF24h were observed. The mean R-R24h, HF24h, R-R index, and HF index lengths significantly increased after preseason (p < 0.001). Significant differences were found in YYIR1 PRE- compared with POST-preseason (930 ± 286 m [individual range: 400-1240 m] versus 1265 ± 252 m [640-1640 m], respectively; p < 0.001). Additionally, the relative changes in HF24h and HF index were largely correlated with improvements in the distance covered during the YYIR1 (r = 0.68 and r = 0.56; respectively). CONCLUSION: Enhanced vagal activity after 4-week preseason period of soccer training increased the occurrence of vagal saturation in high-level female soccer players. Additionally, the increases in HF24h and HF index were significantly correlated with aerobic fitness change.

Gut microbiota of elite female football players is not altered during an official international tournament.

The current study aimed to investigate if the gut microbiota composition of elite female football players changes during an official international tournament. The study was conducted throughout ten consecutive days, encompassing seven training sessions, and three official matches. The matches were separated by 48-72 h. Seventeen elite female football players from the Portuguese women's national football team participated in the study. Fecal samples were collected at two time points: at the beginning and end of the tournament. Fecal microbiota was analyzed by sequencing the 16S rRNA gene. Throughout the study, the duration and rating of perceived exertion (RPE) were recorded after training sessions and matches. The internal load was determined by the session RPE. The gut microbiota of players was predominantly composed of bacteria from the phyla Firmicutes (50% of relative abundance) and Bacteroidetes (20%); the genera Faecalibacterium (29%) and Collinsella (16%); the species Faecalibacterium prausnitzii (30%) and Collinsella aerofaciens (17%). Overall, no significant changes were observed between time points (p ≥ 0.05). Also, no relationship was found between any exercise parameter and the gut microbiota composition (p ≥ 0.05). These findings demonstrate that the physical and physiological demands of training and matches of an official international tournament did not change the gut microbiota composition of elite female football players. Furthermore, it supports that the gut microbiota of athletes appears resilient to the physical and physiological demands of training and match play.

Dietary supplements usage by elite female football players: an exploration of current practices.

The present study aimed to investigate the prevalence of dietary supplements usage (types, reasons for usage, sources of information, purchase venues) among elite female football players, using a self-administered questionnaire. The study participants (n = 103) were recruited through team physicians during an official international tournament. Overall, 82% reported using dietary supplements at least once during the last 12 months. The most common dietary supplements were vitamin D (52%), omega-3 fatty acids (49%), and protein (45%). Primary reasons for dietary supplement use were to stay healthy (66%), to accelerate recovery (58%), and to increase energy/reduce fatigue (54%). Supplement advice came mainly from medical doctors (46%), dietitians/nutritionists (43%), and coaches/fitness coaches (41%). Most dietary supplements were acquired from supplement stores (30%), a sponsor (26%), or drugstores/pharmacies (22%). Elite female football players are frequent dietary supplement users. Further research needs to explore the frequency, dose, and timing of these supplements.

Economic evaluation of physical activity interventions for type 2 diabetes management: a systematic review.

BACKGROUND: Economic evaluation of physical activity interventions has become an important area for policymaking considering the high costs attributable to physical inactivity. However, the evidence for such interventions targeting type 2 diabetes control is scarce. Therefore, the present study aimed to synthesize economic evaluation studies of physical activity interventions for type 2 diabetes management. METHODS: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement (PROSPERO reference number CRD42021231021). An electronic search was performed in PubMed, Web of Science, Cochrane Library and NHS Economic Evaluation Database. Studies were eligible if they included: adults with type 2 diabetes; any physical activity intervention in the community settings; an experimental or quasi-experimental design; and a parameter of economic evaluation [cost analysis of interventions, cost-effectiveness analysis (including cost-utility analysis) and cost-benefit analysis] as an outcome. RESULTS: Ten studies were included in this review: seven were randomized controlled trials and three were quasi-experimental studies. All studies included direct costs, and four also included indirect costs. Four studies demonstrated that physical activity interventions were cost-saving, six studies showed cost-effectiveness, and two studies reported cost-utility. The estimates varied considerably across the studies with different analytical and methodological approaches. CONCLUSION: Overall, this systematic review found that physical activity interventions are a worth investment for type 2 diabetes management. However, comparability across interventions was limited due to heterogeneity in interventions type, design and delivery, which may explain the differences in the economic measures.

Predictors of physical activity promotion in clinical practice: a cross-sectional study among medical doctors.

BACKGROUND: Physical activity is a major determinant of physical and mental health. International recommendations identify health professionals as pivotal agents to tackle physical inactivity. This study sought to characterize medical doctors' clinical practices concerning the promotion of patients' physical activity, while also exploring potential predictors of the frequency and content of these practices, including doctors' physical activity level and sedentary behaviours. METHODS: A cross-sectional study assessed physical activity promotion in clinical practice with a self-report questionnaire delivered through the national medical prescription software (naturalistic survey). Physical activity and sedentary behaviours were estimated using the International Physical Activity Questionnaire (short form). Indicators of medical doctors' attitudes, knowledge, confidence, barriers, and previous training concerning physical activity promotion targeting their patients were also assessed. Multiple regression analysis was performed to identify predictors of physical activity promotion frequency by medical doctors, including sociodemographic, attitudes and knowledge-related variables, and physical activity behaviours as independent variables. RESULTS: A total of 961 medical doctors working in the Portuguese National Health System participated (59% women, mean age 44 ± 13 years) in the study. The majority of the participants (84.6%) reported to frequently promote patients' physical activity. Five predictors of physical activity promotion frequency emerged from the multiple regression analysis, explaining 17.4% of the dependent variable (p < 0.001): working in primary healthcare settings (p = 0.037), having a medical specialty (p = 0.030), attributing a high degree of relevance to patients' physical activity promotion in healthcare settings (p < 0.001), being approached by patients to address physical activity (p < 0.001), and having higher levels of physical activity (p = 0.001). CONCLUSIONS: The sample of medical doctors approached reported a high level of engagement with physical activity promotion. Physical activity promotion frequency seems to be influenced by the clinical practice setting, medical career position and specialty, attitudes towards physical activity, and perception of patients´ interest on the topic, as well as medical doctors' own physical activity levels.

Using the Rating of Perceived Exertion and Heart Rate to Quantify Training Intensity in Female Soccer Players: Validity and Utility.

ABSTRACT: Costa, JA, Brito, J, Nakamura, FY, Figueiredo, P, and Rebelo, A. Using the rating of perceived exertion and heart rate to quantify training intensity in female soccer players: validity and utility. J Strength Cond Res 36(1): 201-206, 2022-The aims of this study were as follows: (a) to analyze associations between session rating of perceived exertion (sRPE) and training impulse (TRIMP); (b) to verify whether significantly different ranges of percentage of heart rate peak (%HRpeak) would be reached in each discrete RPE category; and (c) to investigate the amount of time spent >90% of HRpeak and associated intraplayer and interplayer variability during soccer technical training sessions with similar contents and duration. This was a single-group observational study that measured the internal training load during 6 weeks of the competitive period in 17 high-level female soccer players. All training sessions started around 9 pm. and lasted on average 94 ± 5 minutes. During each training session, RPE, sRPE, TRIMP, HRex (%HRpeak), and time spent at >90% of HRpeak were assessed. A very large correlation was found between sRPE and TRIMP (r = 0.78; 95% confidence interval: [0.74-0.82]). Significant differences were observed between %HRpeak associated with each RPE value (i.e., RPE = 2 arbitrary unit [68%; 65-69% of %HRpeak]; RPE 3 [72%; 69-75%]; RPE 4 [79%; 76-82%]; RPE 5 [84; 81-87%]; χ2 = 73.34; df = 3; P < 0.001). Intraplayer and interplayer coefficients of variation for the time spent >90% of HRpeak (∼8% of training time, ∼7 minutes per session) during training sessions were 73 and 92%, respectively. In conclusion, it was confirmed that sRPE and TRIMP displayed good convergent validity, and different %HRpeak were observed for each discrete RPE. However, because of the high variability in the time >90% of HRpeak, careful monitoring of individual exercises should be performed to ensure the desired training stimulus for each player.

A New Portable Device to Reliably Measure Maximal Strength and Rate of Force Development of Hip Adduction and Abduction.

ABSTRACT: Gonçalves, BM, Mesquita, RNO, Tavares, F, Brito, J, Correia, P, Santos, P, and Mil-Homens, P. A new portable device to reliably measure maximal strength and rate of force development of hip adduction and abduction. J Strength Cond Res 36(9): 2465-2471, 2022-Groin injuries are a major issue in sports involving kicking or quick changes of direction. Decreased hip adduction and abduction strength have been indicated as one of the main risk factors for groin injury. The methods currently available to measure hip adduction and abduction strength are reliable but highly dependent on the evaluator skills. Furthermore, several studies have reported the reliability of maximal strength (MVIC), but very few studies investigated the reliability of explosive strength (RFD), a parameter that has been previously shown to have a higher functional value. The aim of the current investigation was to assess the reliability of a user-independent portable dynamometer that concurrently measures MVIC and RFD. Twenty-five healthy young subjects performed maximal isometric hip adduction and abduction in both sitting and supine positions. Measurements occurred in 2 different days separated by 48-72 hours. Test-retest reliability was calculated for both MVIC and RFD. Both MVIC and RFD showed good relative reliability (intraclass correlation coefficient = 0.77-0.98) with no differences between positions or muscle actions. Measurement error was similar between positions for MVIC in both hip adduction and abduction. Measurements of RFD showed higher reliability using a time window of at least 0-100 milliseconds, and lower measurement error was observed in sitting for adduction and in supine for abduction. This study shows that portable dynamometry can be used to concurrently measure hip adduction and abduction maximal and explosive strength, with levels of reliability that are similar to previously described methods.

Surgical versus transcatheter aortic valve replacement in low-risk patients: A long-term propensity score-matched analysis.

BACKGROUND: Recent studies suggest the use of transcatheter aortic valve implantation (TAVI) as an alternative to surgical aortic valve replacement (SAVR) in lower risk populations, but real-world data are scarce. METHODS: Single-center retrospective study of patients undergoing SAVR (between June 2009 and July 2016, n = 682 patients) or TAVI (between June 2009 and July 2017, n = 400 patients). Low surgical risk was defined as EuroSCORE II (ES II) < 4% for single noncoronary artery bypass graft procedure. TAVI patients were propensity score-matched in a 1:1 ratio with SAVR patients, paired by age, New York Heart Association class, diabetes mellitus, chronic obstructive pulmonary disease, atrial fibrillation, creatinine clearance, and left ventricular ejection fraction < 50%. RESULTS: A total of 158 patients (79 SAVR and 79 TAVI) were matched (mean age 79 ± 6 years, 79 men). TAVI patients had a higher incidence of permanent pacemaker implantation (0% vs. 19%, p < 0.001) and more than mild paravalvular leak (4% vs. 18%, p = 0.009), but comparable rates of stroke, major or life-threatening bleeding, emergent cardiac surgery, new-onset atrial fibrillation, and need for renal replacement therapy. Hospital length-of-stay and 30-day mortality were similar. At a median follow-up of 4.5 years (IQR 3.0-6.9), treatment strategy did not influence all-cause mortality (HR 1.19, 95% CI 0.77-1.83, log rank p = 0.43) nor rehospitalization (crude subdistribution HR 1.56, 95% CI 0.71-3.41, p = 0.26). ES II remained the only independent predictor of long-term all-cause mortality (adjusted HR 1.40, 95% CI 1.04-1.90, p = 0.029). CONCLUSION: In this low surgical risk severe aortic stenosis population, we observed similar rates of 30-day and long-term all-cause mortality, despite higher rates of permanent pacemaker implantation and more than mild paravalvular leak in TAVI patients. The results of this small study suggest that both procedures are safe and effective in the short-term, while the Heart Team remains essential to assess both options on the long-term.

Match Analysis of Soccer Refereeing Using Spatiotemporal Data: A Case Study.

This case study explored how spatiotemporal data can develop key metrics to evaluate and understand elite soccer referees' performance during one elite soccer match. The dynamic position of players from both teams, the ball and three elite referees allowed to capture the following performance metrics: (i) assistant referees: alignment with the second last defender; (ii) referee: referee diagonal movement-a position density was computed and a principal component analysis was carried to identify the directions of greatest variability; and (iii) referee: assessing the distance from the referee to the ball. All computations were processed when the ball was in-play and separated by 1st and 2nd halves. The first metric showed an alignment lower than 1 m between the assistant referee and the second last defender. The second metric showed that in the 1st half, the referee position ellipsis area was 548 m2, which increased during the 2nd half (671 m2). The third metric showed an increase in the distance from the referee to the ball and >80% of the distance between 5-30 m during the 2nd half. The findings may be used as a starting point to elaborate normative behavior models from the referee's movement performance in soccer.

In-Season Internal and External Workload Variations between Starters and Non-Starters-A Case Study of a Top Elite European Soccer Team.

Background and Objectives: Interpretation of the load variations across a period seems important to control the weekly progression or variation of the load, or to identify in-micro- and mesocycle variations. Thus, the aims of this study were twofold: (a) to describe the in-season variations of training monotony, training strain and acute:chronic workload ratio (ACWR) through session ratings of perceived exertion (s-RPE), total distance and high-speed running (HSR); and (b) to compare those variations between starters and non-starters. Materials and Methods: Seventeen professional players from a European First League team participated in this study. They were divided in two groups: starters (n = 9) and non-starters (n = 8). The players were monitored daily over a 41-week period of competition where 52 matches occurred during the 2015-2016 in-season. Through the collection of s-RPE, total distance and HSR, training monotony, training strain and ACWR were calculated for each measure, respectively. Data were analyzed across ten mesocycles (M: 1 to 10). Repeated measures ANOVA was used with the Bonferroni post hoc test to compare M and player status. Results: The results revealed no differences between starters vs. non-starters (p > 0.05). M6 had a greater number of matches and displayed higher values for monotony (s-RPE, total distance and HSR), strain (only for total distance) and ACWR (s-RPE, TD and HSR). However, the variation patterns for all indexes displayed some differences. Conclusions: The values of both starters and non-starters showed small differences, thus suggesting that the adjustments of training workloads that had been applied over the season helped to reduce differences according to the player status. Even so, there were some variations over the season (microcycles and mesocycles) for the whole team. This study could be used as a reference for future coaches, staff and scientists.

Football can tackle type 2 diabetes: a systematic review of the health effects of recreational football practice in individuals with prediabetes and type 2 diabetes.

This work aimed to summarize the health effects of recreational football practice in individuals with prediabetes and type 2 diabetes (T2D), through a systematic review. An electronic search was performed in PubMed, Scopus, Web of Science, LILACS and list of references of the available reviews, until July 2019. Studies were eligible if they included any form of football practice, in patients diagnosed with prediabetes or T2D. After recreational football practice, participants with prediabetes or T2D improved fasting glucose, total and LDL cholesterol, triglycerides, body mass, body fat percentage, waist circumference, blood pressure, and maximal oxygen uptake. Further benefits were found in fat-free mass and resting heart rate for participants with prediabetes, and in glycated haemoglobin, body mass index and fat mass in individuals with T2D. This systematic review showed promising benefits of recreational football practice on both the prevention and control of T2D and related cardiovascular risk.

Transcatheter aortic valve implantation (TAVI) in cardiogenic shock: TAVI-shock registry results.

OBJECTIVES: Aim of this study is to evaluate safety, feasibility, and mid-term outcome of transcatheter aortic valve implantation (TAVI) in cardiogenic shock (CS). BACKGROUND: Balloon aortic valvuloplasty in patients with severe aortic valve stenosis (SAS) complicated by CS is indicated but associated with a grim prognosis. TAVI might be a more reasonable treatment option in this setting but data are scant. METHODS: From March 2008 to February 2019, 51 patients with severe aortic valvulopathy (native SAS or degenerated aortic bioprosthesis) and CS treated by TAVI in 11 European centers were included in this multicenter registry. Demographic, clinical, and procedural data were collected, as well as clinical and echocardiographic follow-up. RESULTS: The mean age of our study population was 75.8 ± 13, 49% were women, and mean Society of Thoracic Surgeons (STS) score was 19 ± 15%. Device success was achieved in 94.1%, with a 5% incidence of moderate/severe paravalvular leak. The 30-day events were mortality 11.8%, stroke 2.0%, vascular complications 5.9%, and acute kidney injury 34%. Valve Academic Research Consortium-2 early safety endpoint was reached in 35.3% of cases. At 1-year of follow-up, the mortality rate was 25.7% and the readmission for congestive heart failure was 8.6%. CONCLUSIONS: TAVI seems to be a therapeutic option for patients with CS and SAS or degenerated aortic bioprosthesis in terms of both safety and efficacy at early and long-term follow-up.