Lifetime use of multiple substances and youth suicide risk: assessing the role of depressive symptoms using structural equation modeling.

OBJECTIVES: This study assessed the direct and indirect effects (via depressive symptoms) of lifetime use of a broad range of substances on suicide risk among US adolescents. STUDY DESIGN: This was a cross-sectional study. METHODS: Data from the 2021 Youth Risk Behavior Survey were used (N = 12,303, 48.7% female). Associations between five types of substance use (cigarette, e-cigarette, alcohol, marijuana, and prescription pain medicine) and three dimensions of suicide risk (suicidal ideation, suicide plan, and suicide attempt) were measured by multivariate logistic regression models. The role of depressive symptoms was further examined by structural equation modeling. RESULTS: Almost three in five (57.5%) adolescents had used one or more substances in their lifetime (18.1% one type, 12.2% two types, 13.1% three types, 10.2% four types, and 3.8% five types). Adolescents using five substances were up to 16 times more likely to experience suicidal ideation and behaviors. Depressive symptoms significantly linked the pathway from substance use to suicide risk, resulting in much stronger indirect effects than the direct effects. Collectively, the five substance use behaviors and depressive symptoms explained about 60.4% of variance in suicidal ideation, 53.6% of variance in suicide plan, and 55.0% of variance in suicide attempt. CONCLUSIONS: Lifetime use of multiple substances is significantly correlated with suicidal ideation and behaviors among adolescents via the pathway of depressive symptoms. Routine screening for a broad range of substance use behaviors is needed to identify adolescents at risk for suicide and accessible mental health services could potentially attenuate the linkage between substance use and suicide risk.

Suicidal Thoughts and Behaviors Among US Adolescents: The Cumulative Effects of Polysubstance Use Behaviors.

Background: The linkage between substance use and youth suicidality is less developed due to the predominant focus on certain types of substances (e.g., alcohol consumption, prescription opioid misuse). This study examines polysubstance use and its mutual impact on suicidal thoughts and behaviors among US adolescents. Methods: Data from 2019 Youth Risk Behavior Survey were utilized. Associations between the concurrent use of five substances (cigarette, e-cigarette, alcohol, marijuana, and prescription opioid) and suicidality (suicidal thoughts, suicide plans, and suicide attempts) were measured by logistic regression models. The combined effect of polysubstance use on suicidality was further assessed by structural equation modeling. Results: About two in five (42.1%) adolescents used at least one type of substances in the past month and one in seven (13.5%) used three or more types concurrently (polysubstance use). Adolescents with polysubstance use behaviors were three to five times more likely to experience suicidal thoughts (OR=3.8, p < 0.05), make a suicide plan (OR=3.5, p < 0.05), or attempt suicide (OR=4.6, p < 0.05) than non-users. In the final structural model, polysubstance use and suicidality were significantly correlated with each other (ß=0.37, p < 0.05). Collectively, polysubstance use explained about 14% of variance in youth suicidality. Conclusions: Polysubstance use shows a significant impact on youth suicidality. School-based health centers and educational programs are recommended to reduce substance use and suicidal behaviors among adolescents. Accessible mental health services and targeted treatments are needed for polysubstance users to mitigate their risk of suicide.

Enhancing contrast distribution with the far lateral approach in lumbar transforaminal epidural steroid injections: A retrospective analysis.

BACKGROUND: Herniated intervertebral disc (HIVD) with radiculopathy is a common degenerative spine disorder. Transforaminal epidural steroid injection (TFESI) is one of the pain relief treatments for lumbar radiculopathy recommended by evidence-based guidelines. Adequate contrast distribution is correlated with better pain control, but the best approach has not been confirmed yet. AIM: To confirm the distribution of contrast medium injected with a new approach of TFESI, that is, far lateral lateral recess approach (FLLR-TFESI). METHODS: Patients receiving TFESI due to HIVD with radiculopathy between 2010 January and 2020 August were retrospectively enrolled. While the FLLR-TFESI was taken as the experimental group, the conventional approach was viewed as the control group. The baseline characteristics, the pattern of contrast enhancement under fluoroscopic guidance, and the complications of these patients were collected and analyzed. RESULTS: A total of 380 patients were analyzed (143 in control group and 237 in experimental group). The two groups were balanced in most baseline characteristics, except disc extrusion (p = 0.01) and scoliosis (p = 0.04). The FLLR-TFESI have a better contrast distribution (p < 0.01), even after adjustment (p < 0.001). No intrathecal injection was noted, but higher rate of intra-disc injection was noted in FLLR-TFESI group (10% vs. 3%, p = 0.008). CONCLUSION: The FLLR-TFESI has a superior contrast enhancement and distribution in comparison to conventional approach. Prospective study to confirm the study result as well as the clinical benefits is suggested in the future.

Phenyl-Extended Resorcin[4]arenes: Synthesis and Highly Efficient Iodine Adsorption.

The continuous exploration of new analogs of calixarenes and pillararenes unlocks infinite opportunities in supramolecular chemistry and materials. In this work, we introduce a new class of macrocycle, phenyl-extended resorcin[4]arenes (ExR4), a unique and innovative design that incorporates unsubstituted phenylene moieties into the resorcin[4]arene scaffold. Single-crystal analysis reveals a chair-like conformation for per-methylated ExR4 (Me-ExR4) and a twisted "Figure-of-eight" shaped conformation for per-hydroxylated ExR4 (OH-ExR4). Notably, OH-ExR4 demonstrates exceptional adsorption capability toward I3 - ions in an aqueous solution, with a rapid kinetic rate of 1.18×10-2 g ⋅ mg-1 ⋅ min-1. Furthermore, OH-ExR4 shows excellent recyclability and potential as a stationary phase in column setups. The discovery of ExR4 opens up new avenues for constructing new macrocycles and inspires further research in functional adsorption materials for water pollutant removal.

Self-Assembled Nanohelixes Driven by Host-Guest Interactions and Metal Coordination.

Helical nanostructures fabricated via the self-assembly of artificial motifs have been a captivating subject because of their structural aesthetics and multiple functionalities. Herein, we report the facile construction of a self-assembled nanohelix (NH) by leveraging an achiral aggregation-induced emission (AIE) luminogen (G) and pillar[5]arene (H), driven by host-guest interactions and metal coordination. Inspired by the "sergeants and soldiers" effect and "majority rule" principle, the host-guest complexation between G and H is employed to fixate the twisted conformation of G for the generation of "contortion sites", which further induced the emergence of helicity as the 1D assemblies are formed via Ag(I) coordination and hexagonally packed into nano-sized fibers. The strategy has proved feasible in both homogeneous and heterogeneous syntheses. Along with the formation of NH, boosted luminescence and enhanced productivity of reactive oxygen species (ROS) are afforded because of the efficient restriction on G, indicating the concurrent regulation of NH's morphology and photophysical properties by supramolecular assembly. In addition, NH also exhibits the capacity for bacteria imaging and photodynamic antibacterial activities against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli).

Supramolecular Modular Assembly of Imaging-Trackable Enzymatic Nanomotors.

Self-propelled micro/nanomotors (MNMs) have shown great application potential in biomedicine, sensing, environmental remediation, etc. In the past decade, various strategies or technologies have been used to prepare and functionalize MNMs. However, the current preparation strategies of the MNMs were mainly following the pre-designed methods based on specific tasks to introduce expected functional parts on the various micro/nanocarriers, which lacks a universal platform and common features, making it difficult to apply to different application scenarios. Here, we have developed a modular assembly strategy based on host-guest chemistry, which enables the on-demand construction of imaging-trackable nanomotors mounted with suitable driving and imaging modules using a universal assembly platform, according to different application scenarios. These assembled nanomotors exhibited enhanced diffusion behavior driven by enzymatic reactions. The loaded imaging functions were used to dynamically trace the swarm motion behavior of assembled nanomotors with corresponding fuel conditions both in vitro and in vivo. The modular assembly strategy endowed with host-guest interaction provides a universal approach to producing multifunctional MNMs in a facile and controllable manner, which paves the way for the future development of MNMs systems with programmable functions.

DAC-Net: A light-weight U-shaped network based efficient convolution and attention for thyroid nodule segmentation.

Recently, there has been a focused effort to improve the efficiency of thyroid nodule segmentation algorithms. This endeavor has resulted in the development of increasingly complex modules, such as the Transformer, leading to models with a higher number of parameters and computing requirements. Sophisticated models have difficulties in being implemented in clinical medicine platforms because of limited resources. DAC-Net is a Lightweight U-shaped network created to achieve high performance in segmenting thyroid nodules. Our method consists of three main components: DWSE, which combines depthwise convolution and squeeze-excitation block to enhance feature extraction and connections between samples; ADA, which includes Split Atrous and Dual Attention to extract global and local feature information from various viewpoints; and CSSC, which involves channel- scale and spatial-scale connections. This module enables the fusing of multi-stage features at global and local levels, producing feature maps at different channel and geographical scales, delivering a streamlined integration of multi-scale information. Combining these three components in our U- shaped design allows us to achieve competitive performance while also decreasing the number of parameters and computing complexity. Several experiments were conducted on the DDTI and TN3K datasets. The experimental results demonstrate that our model outperforms state-of-the-art thyroid nodule segmentation architectures in terms of segmentation performance. Our model not only reduces the number of parameters and computing expenses by 73x and 56x, respectively, but also exceeds TransUNet in segmentation performance. The source code is accessible at https://github.com/Phil-y/DAC-Net.

Pillararene-Based Stimuli-Responsive Supramolecular Delivery Systems for Cancer Therapy.

Cancer poses a significant challenge to global public health, seriously threatening human health and life. Although various therapeutic strategies, such as chemotherapy (CT), radiotherapy, phototherapy, and starvation therapy, are applied to cancer treatment, their limited therapeutic effect, severe side effects, and unsatisfactory drug release behavior need to be carefully considered. Thus, there is an urgent need to develop efficient drug delivery strategies for improving cancer treatment efficacy and realizing on-demand drug delivery. Notably, pillararenes, as an emerging class of supramolecular macrocycles, possess unique properties of highly tunable structures, superior host-guest chemistry, facile modification, and good biocompatibility, which are widely used in cancer therapy to achieve controllable drug release and reduce the toxic side effects on normal tissues under various internal/external stimuli conditions. This review summarizes the recent advance of stimuli-responsive supramolecular delivery systems (SDSs) based on pillararenes for tumor therapy from the perspectives of different assembly methods and hybrid materials, including molecular-scale SDSs, supramolecular nano self-assembly delivery systems, and nanohybrid SDSs. Moreover, the prospects and critical challenges of stimuli-responsive SDSs based on pillararenes for cancer therapy are also discussed.

Emerging strategies for combating Fusobacterium nucleatum in colorectal cancer treatment: Systematic review, improvements and future challenges.

Colorectal cancer (CRC) is generally characterized by a high prevalence of Fusobacterium nucleatum (F. nucleatum), a spindle-shaped, Gram-negative anaerobe pathogen derived from the oral cavity. This tumor-resident microorganism has been closely correlated with the occurrence, progression, chemoresistance and immunosuppressive microenvironment of CRC. Furthermore, F. nucleatum can specifically colonize CRC tissues through adhesion on its surface, forming biofilms that are highly resistant to commonly used antibiotics. Accordingly, it is crucial to develop efficacious non-antibiotic approaches to eradicate F. nucleatum and its biofilms for CRC treatment. In recent years, various antimicrobial strategies, such as natural extracts, inorganic chemicals, organic chemicals, polymers, inorganic-organic hybrid materials, bacteriophages, probiotics, and vaccines, have been proposed to combat F. nucleatum and F. nucleatum biofilms. This review summarizes the latest advancements in anti-F. nucleatum research, elucidates the antimicrobial mechanisms employed by these systems, and discusses the benefits and drawbacks of each antimicrobial technology. Additionally, this review also provides an outlook on the antimicrobial specificity, potential clinical implications, challenges, and future improvements of these antimicrobial strategies in the treatment of CRC.

An Antibiotic Nanobomb Constructed from pH-Responsive Chemical Bonds in Metal-Phenolic Network Nanoparticles for Biofilm Eradication and Corneal Ulcer Healing.

In the treatment of refractory corneal ulcers caused by Pseudomonas aeruginosa, antibacterial drugs delivery faces the drawbacks of low permeability and short ocular surface retention time. Hence, novel positively-charged modular nanoparticles (NPs) are developed to load tobramycin (TOB) through a one-step self-assembly method based on metal-phenolic network and Schiff base reaction using 3,4,5-trihydroxybenzaldehyde (THBA), ε-poly-ʟ-lysine (EPL), and Cu2+ as matrix components. In vitro antibacterial test demonstrates that THBA-Cu-TOB NPs exhibit efficient instantaneous sterilization owing to the rapid pH responsiveness to bacterial infections. Notably, only 2.6 µg mL-1 TOP is needed to eradicate P. aeruginosa biofilm in the nano-formed THBA-Cu-TOB owing to the greatly enhanced penetration, which is only 1.6% the concentration of free TOB (160 µg mL-1). In animal experiments, THBA-Cu-TOB NPs show significant advantages in ocular surface retention, corneal permeability, rapid sterilization, and inflammation elimination. Based on molecular biology analysis, the toll-like receptor 4 and nuclear factor kappa B signaling pathways are greatly downregulated as well as the reduction of inflammatory cytokines secretions. Such a simple and modular strategy in constructing nano-drug delivery platform offers a new idea for toxicity reduction, physiological barrier penetration, and intelligent drug delivery.

Metal-Phenolic Nanocapsules with Photothermal Antibacterial and Ros Scavenging Ability for Diabetic Wound Healing.

The presence of bacteria in diabetic wounds not only leads to the formation of biofilms but also triggers oxidative stress and inflammatory responses, which hinder the wound-healing process. Therefore, it is imperative to formulate a comprehensive strategy that can proficiently eliminate bacteria and enhance the wound microenvironment. Herein, this work develops multifunctional metal-phenolic nanozymes (TA-Fe/Cu nanocapsules), wherein the one-pot coordination of tannic acid (TA)and Fe3+/Cu2+ using a self-sacrificial template afforded hollow nanoparticles (NPs) with exceptional photothermal and reactive oxygen species scavenging capabilities. After photothermal disruption of the biofilms, TA-Fe/Cu NPs autonomously capture bacteria through hydrogen bonding interactions with peptidoglycans (the bacterial cell wall component), ultimately bolstering the bactericidal efficacy. Furthermore, these NPs exhibit peroxidase-like enzymatic activity, efficiently eliminating surplus hydrogen peroxide in the vicinity of the wound and mitigating inflammatory responses. As the wound transitions into the remodeling phase, the presence of Cu2+ stimulates vascular migration and regeneration, expediting the wound-healing process. This study innovatively devises a minimalist approach to synthesize multifunctional metal-phenolic nanozymes integrating potent photothermal antibacterial activity, bacterial capture, anti-inflammatory, and angiogenesis properties, showcasing their great potential for diabetic wound treatment.

Guest-Induced Helical Superstructure from a Gold Nanocluster-Based Supramolecular Organic Framework Enables Efficient Catalysis.

Mimicking hierarchical assembly in nature to exploit atomically precise artificial systems with complex structures and versatile functions remains a long-standing challenge. Herein, we report two single-crystal supramolecular organic frameworks (MSOF-4 and MSOF-5) based on custom-designed atomically precise gold nanoclusters Au11(4-Mpy)3(PPh3)7, showing distinct and intriguing host-guest adaptation behaviors toward 1-/2-bromopropane (BPR) isomers. MSOF-4 exhibits sev topology and cylindrical channels with 4-mercaptopyridine (4-Mpy) ligands matching well with guest 1-BPR. Due to the confinement effect, solid MSOF-4 undergoes significant structural change upon selective adsorption of 1-BPR vapor over 2-BPR, resulting in strong near-infrared fluorescence. Single-crystal X-ray diffraction reveals that Au11(4-Mpy)3(PPh3)7 in MSOF-4 transforms into Au11Br3(PPh3)7 upon ligand exchange with 1-BPR, resulting in 1-BPR@MSOF-6 single crystals with a rarely reported helical assembly structure. Significantly, the double-helical structure of MSOF-6 facilitates efficient catalysis of the electron transfer (ET) reaction, resulting in a nearly 6 times increase of catalytic rates compared with MSOF-4. In sharp contrast, solid MSOF-5 possesses chb topology and cage-type channels with narrow windows, showing excellent selective physical adsorption toward 1-BPR vapor but a nonfluorescent feature upon guest adsorption. Our results demonstrate a powerful strategy for developing advanced assemblies with high-order complexity and engineering their functions in atomic precision.

Speed response after strength training in chinese boxing athletes / Resposta de velocidade após treinamento de força em atletas de boxe chinês / Respuesta de velocidad tras el entrenamiento de fuerza en atletas de boxeo chino

ABSTRACT Introduction: Chinese boxing demands the maximum potential from its practitioners. The quality of executions of single or multiple punches depends on adequate strength training, and the quality of speed is a crucial factor for victory in Chinese boxing competitions. Objective: Explore the effects of strength training on the speed of punches in Chinese boxing athletes. Methods: Eighteen Chinese boxers were selected by random sampling. The competitors perform functional exercises directed at strength training for ten weeks. Several key points of sports aerobics were comprehensively evaluated. Mathematical and statistical methods were applied in processing the data before and after the intervention. Results: The speed quality of Chinese boxing practitioners after strength training was statistically beneficial (P<0.05). Only the particular qualities of strength did not show significant differences among the four unique qualities of strength analyzed; there were significant differences among the other three abilities (P<0.05). Conclusion: The introduction of functional strength training into the physical training of high-level Chinese boxing athletes can significantly improve the quality of movement speed. Functional strength exercises are a safe and efficient form of exercise. This training protocol provides a good reference to compensate for the shortfall in conventional strength exercises. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: O boxe chinês exige o potencial máximo de seus praticantes. A qualidade das execuções de golpes únicos ou múltiplos dependem de um treinamento de força adequado, sendo a qualidade da velocidade um fator crucial para a vitória nas competições do boxe chinês. Objetivo: Explorar os efeitos do treinamento de força sobre a velocidade dos golpes em esportistas do boxe chinês. Métodos: Foram selecionados 18 praticantes de boxe chinês por amostragem aleatória. Os competidores realizam exercícios funcionais direcionados ao treinamento de força durante dez semanas. Foram avaliados abrangentemente vários pontos-chave da aeróbica esportiva. Foram aplicados os métodos matemáticos e estatísticos no processamento dos dados antes e após a intervenção. Resultados: A qualidade da velocidade dos praticantes de boxe chinês após o treinamento de força foi beneficiada estatisticamente (P<0,05). Somente as qualidades particulares de força não apresentaram diferença significativa entre as quatro qualidades únicas de força analisadas, havendo diferenças significativas entre as outras três habilidades (P<0,05). Conclusão: A introdução do treinamento de força funcional no treinamento físico dos atletas de boxe chinês de alto nível pode melhorar significativamente a qualidade de velocidade do movimento. Os exercícios de força funcional são uma forma segura e eficiente de exercício. Este protocolo de treinamento fornece uma boa referência para compensar a carência existente nos exercícios de força convencionais. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: El boxeo chino exige el máximo potencial de sus practicantes. La calidad de las ejecuciones de golpes simples o múltiples depende de un adecuado entrenamiento de la fuerza, siendo la calidad de la velocidad un factor crucial para la victoria en las competiciones de boxeo chino. Objetivo: Explorar los efectos del entrenamiento de fuerza sobre la velocidad de los golpes en atletas de boxeo chino. Métodos: Se seleccionaron 18 practicantes de boxeo chino por muestreo aleatorio. Los competidores realizan ejercicios funcionales dirigidos al entrenamiento de la fuerza durante diez semanas. Se evaluaron exhaustivamente varios puntos clave del aeróbic deportivo. Se aplicaron métodos matemáticos y estadísticos para procesar los datos antes y después de la intervención. Resultados: La calidad de la velocidad de los practicantes de boxeo chino tras el entrenamiento de fuerza se vio beneficiada estadísticamente (P<0,05). Sólo las cualidades particulares de la fuerza no mostraron diferencias significativas entre las cuatro cualidades únicas de la fuerza analizadas, hubo diferencias significativas entre las otras tres habilidades (P<0,05). Conclusión: La introducción del entrenamiento de fuerza funcional en la preparación física de los atletas de boxeo chino de alto nivel puede mejorar significativamente la calidad de la velocidad de movimiento. Los ejercicios de fuerza funcional son una forma de ejercicio segura y eficaz. Este protocolo de entrenamiento proporciona una buena referencia para compensar las carencias existentes en los ejercicios de fuerza convencionales. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Physiological changes in martial arts athletes in altitude training / Alterações fisiológicas dos atletas de artes marciais em treinos de altitude / Cambios fisiológicos de los atletas de artes marciales en el entrenamiento en altitud

ABSTRACT Introduction: Recent studies have shown that altitude training can significantly improve hemoglobin content in athletes. This allows for greater oxygen transport to the muscles and, consequently, greater load capacity during training. However, there is no confirmed evidence of athlete-specific training in martial arts. Objective: Explore the load capacity and ability changes caused by high altitude training in athletes. Methods: The research selected ten high-level martial arts athletes as volunteers to compare the functional changes caused by high-altitude training. Physical and functional data were collected before the beginning of the experiment and at its conclusion after three weeks. Results: Measured abilities were significantly improved after 11 days of altitude physical training. After 21 days of altitude training, these abilities improved significantly. The urea nitrogen and creatine kinase values increased rapidly with increasing load intensity in the first stage, peaked in the second stage, and decreased in the third stage. Conclusion: Training in the low-pressure hypoxic environment at high altitude, using dual stimulation of hypoxia and exercise to make the athletes stress response, can stimulate the physical potential to achieve a range of physiological abilities to improve the body's resistance to hypoxia. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Estudos recentes mostraram que o treinamento de altitude pode melhorar significativamente o conteúdo da hemoglobina em atletas. Isso permite um maior transporte de oxigênio para a musculatura e, consequentemente, maior capacidade de carga durante os treinos. Porém, não há evidências confirmadas nos treinos específicos de atletas em artes marciais. Objetivo: Explorar as alterações na capacidade de carga e as mudanças de habilidade provocada nos atletas pelo treinamento físico em alta altitude. Métodos: 10 atletas de artes marciais de alto nível foram selecionados como voluntários para pesquisa no intuito de comparar as alterações funcionais ocasionadas pelo treino de altitude. Os dados físicos e funcionais foram coletados antes do início do experimento e, ao seu término, após três semanas. Resultados: As habilidades mensuradas foram significativamente aprimoradas após 11 dias de treinamento físico de altitude. Após 21 dias de treinamento físico de altitude, essas habilidades melhoraram significativamente. Os valores de nitrogênio uréico e creatinoquinase aumentaram rapidamente com o aumento da intensidade de carga no primeiro estágio, atingiram o pico na segunda etapa e diminuíram no terceiro estágio. Conclusões: O treinamento no ambiente de hipóxia de baixa pressão em altitude elevada, utilizando a estimulação dupla de hipóxia e exercício para fazer os atletas terem resposta ao estresse, pode estimular o potencial físico, de modo a alcançar uma série de habilidades fisiológicas para melhorar a resistência do corpo à hipóxia. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Estudios recientes han demostrado que el entrenamiento en altitud puede mejorar significativamente el contenido de hemoglobina en los atletas. Esto permite un mayor transporte de oxígeno a los músculos y, en consecuencia, una mayor capacidad de carga durante el entrenamiento. Sin embargo, no hay pruebas confirmadas en el entrenamiento específico de los atletas en las artes marciales. Objetivo: Explorar las alteraciones en la capacidad de carga y los cambios de habilidad provocados en los atletas por el entrenamiento físico en altura. Métodos: Se seleccionaron 10 atletas de artes marciales de alto nivel como voluntarios para la investigación con el fin de comparar los cambios funcionales causados por el entrenamiento en altura. Se recogieron datos físicos y funcionales antes del inicio del experimento y, al final del mismo, después de tres semanas. Resultados: Las habilidades medidas mejoraron significativamente tras 11 días de entrenamiento físico en altitud. Tras 21 días de entrenamiento en altitud, estas capacidades mejoraron significativamente. Los valores de nitrógeno ureico y creatina quinasa aumentaron rápidamente con el incremento de la intensidad de la carga en la primera etapa, alcanzaron un máximo en la segunda etapa y disminuyeron en la tercera. Conclusión: El entrenamiento en el entorno hipóxico de baja presión a gran altura, utilizando la estimulación dual de la hipoxia y el ejercicio para hacer que los atletas respondan al estrés, puede estimular el potencial físico para lograr una serie de habilidades fisiológicas para mejorar la resistencia del cuerpo a la hipoxia. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.