Effects of exercise and cold-water exposure on microvascular muscle perfusion.

PURPOSE: Microvascular blood flow (MBF) and its intramuscular regulation are of importance for physiological responsiveness and adaptation. The quantifiable in-vivo monitoring of MBF after cycling or systemic cold-water exposure may reveal new insights into capillary regulatory mechanisms. This study aimed to assess the role of exercise and cold therapy on MBF by using contrast-enhanced ultrasound (CEUS). METHODS: Twenty healthy athletes were recruited and randomly assigned to an intervention (IG) or a control group (CG). MBF was quantified in superficial (rectus femoris, RF) and deep muscle layers (vastus intermedius, VI). Representative perfusion parameters (peak enhancement (PE) and wash-in area under the curve (WiAUC)) were measured after a standardized measurement protocol for both groups at resting conditions (t0) and after cycling (20 min., 70% Watt max, t1) for both groups, after cold-water immersion exposure for IG (15 min., 12°C) or after precisely 15 minutes of rest for CG (t2) and for both groups after 60 minutes of follow-up (t3). RESULTS: At t1, MBF in VI increased significantly compared to resting conditions in both groups in VI (p= 0.02). After the cold-water exposure (t2), there were no statistically significant changes in perfusion parameters as well as after 60 minutes of follow-up (t3) (p = 0.14). CONCLUSION: Cycling leads to an upregulation of MBF. However, cold exposure does not change the MBF. The implementation of CEUS during different physiological demands may provide deeper insight into intramuscular perfusion regulation and regenerative processes.

Non-invasively measured central and peripheral factors of oxygen uptake differ between patients with chronic heart failure and healthy controls.

BACKGROUND: Maximum oxygen uptake is an established measurement of diagnosing chronic heart failure and underlies various central and peripheral factors. However, central and peripheral factors are little investigated, because they are usually measured invasively. The aim of this study was to compare non-invasively measured central and peripheral factors of oxygen uptake between patients with chronic heart failure and healthy controls. METHODS: Ten male patients with heart failure with reduced ejection fraction (62 ± 4 years; body mass index: 27.7 ± 1.8 kg/m2; ejection fraction: 30 ± 4%) and ten male healthy controls (59 ± 3 years; body mass index: 27.7 ± 1.3 kg/m2) were tested for blood pressure, heart rate, stroke volume, cardiac output, and cardiac power output (central factors) as well as muscle oxygen saturation of the vastus lateralis and biceps brachii muscle (peripheral factors) during an incremental cycling test. Stroke volume and muscle oxygen saturation were non-invasively measured by a bioreactance analysis and near-infrared spectroscopy, respectively. Additionally, a maximum isometric strength test of the knee extensors was conducted. Magnitude-based inferences were computed for statistical analyses. RESULTS: Patients had a likely to most likely lower oxygen uptake, mean arterial pressure, and heart rate at maximum load as well as very likely lower isometric peak torque. Contrary, patients had a possibly to likely higher stroke volume and muscle oxygen saturation of the vastus lateralis muscle at maximum load. Differences in cardiac output, cardiac power output, and muscle oxygen saturation of the biceps brachii muscle at maximum load were unclear. CONCLUSIONS: Non-invasively measured central and peripheral factors of oxygen uptake differ between patients with chronic heart failure and healthy controls. Therefore, it is promising to measure both types of factors in patients with chronic heart failure to optimize the diagnosis and therapy.

Validity of a Local Positioning System during Outdoor and Indoor Conditions for Team Sports.

This study aimed to compare the validity of a local positioning system (LPS) during outdoor and indoor conditions for team sports. The impact of different filtering techniques was also investigated. Five male team sport athletes (age: 27 ± 2 years; maximum oxygen uptake: 48.4 ± 5.1 mL/min/kg) performed 10 trials on a team sport-specific circuit on an artificial turf and in a sports hall. During the circuit, athletes wore two devices of a recent 20-Hz LPS. From the reported raw and differently filtered velocity data, distances covered during different walking, jogging, and sprinting sections within the circuit were computed for which the circuit was equipped with double-light timing gates as criterion measures. The validity was determined by comparing the known and measured distances via the relative typical error of estimate (TEE). The LPS validity for measuring distances covered was good to moderate during both environments (TEE: 0.9-7.1%), whereby the outdoor validity (TEE: 0.9-6.4%) was superior than indoor validity (TEE: 1.2-7.1%). During both environments, validity outcomes of an unknown manufacturer filter were superior (TEE: 0.9-6.2%) compared to those of a standard Butterworth filter (TEE: 0.9-6.4%) and to unprocessed raw data (TEE: 1.0-7.1%). Our findings show that the evaluated LPS can be considered as a good to moderately valid tracking technology to assess running-based movement patterns in team sports during outdoor and indoor conditions. However, outdoor was superior to indoor validity, and also impacted by the applied filtering technique. Our outcomes should be considered for practical purposes like match and training analyses in team sport environments.

Sex Differences in Physical Capacities of German Bundesliga Soccer Players.

Cardoso de Araújo, M, Baumgart, C, Jansen, CT, Freiwald, J, and Hoppe, MW. Sex differences in physical capacities of German Bundesliga soccer players. J Strength Cond Res 34(8): 2329-2337, 2020-Sex differences in physical capacities of elite soccer players have received limited attention. Therefore, this study investigated sex differences in linear and nonlinear sprint, squat and countermovement jump, core endurance, as well as incremental and intermittent endurance capacities in German Bundesliga soccer players. A total of 76 field players (29 women) were tested for the mentioned anaerobic- and aerobic-related physical capacities in a noninterventional cross-sectional design. The largest sex differences were evident in the explosive- and intermittent endurance-related capacities, with women presenting largely to extremely largely lower values in sprints, jumps, and intermittent endurance (effect size [ES] ≥1.77, p < 0.01). The differences in the total core endurance, running velocity at 2 and 4 mmol·L capillary blood lactate (v2 and v4), maximal heart rate (HR) (ES ≤ 0.72, p ≥ 0.06), and distance covered during the incremental endurance test (ES = 1.09, p = 0.01) were trivially to moderately lower for women. However, women had small to moderately higher ventral and dorsal core endurance (ES ≤ 0.69, p ≥ 0.07) and largely higher relative HR at the lactate thresholds (ES ≥ 1.54, p < 0.01). The individual data of female players showed more variability. Some individual data of women overlapped those of men, most evident in the total core endurance and v2. The findings indicate that there are sex differences in physical capacities according to the underlying amount of anaerobic and aerobic energy supply. The sex specificities should be considered to optimize training and testing procedures for soccer players.

Different Effects of Foam Rolling on Passive Tissue Stiffness in Experienced and Nonexperienced Athletes.

CONTEXT: Foam rolling (FR) has been developed into a popular intervention and has been established in various sports disciplines. However, its effects on target tissue, including changes in stiffness properties, are still poorly understood. OBJECTIVE: To investigate muscle-specific and connective tissue-specific responses after FR in recreational athletes with different FR experience. DESIGN: Case series. SETTING: Laboratory environment. PARTICIPANTS: The study was conducted with 40 participants, consisting of 20 experienced (EA) and 20 nonexperienced athletes (NEA). INTERVENTION: The FR intervention included 5 trials per 45 seconds of FR of the lateral thigh in the sagittal plane with 20 seconds of rest between each trial. MAIN OUTCOME MEASURES: Acoustic radiation force impulse elastosonography values, represented as shear wave velocity, were obtained under resting conditions (t0) and several times after FR exercise (0 min [t1], 30 min [t2], 6 h [t3], and 24 h [t4]). Data were assessed in superficial and deep muscle (vastus lateralis muscle; vastus intermedius muscle) and in connective tissue (iliotibial band). RESULTS: In EA, tissue stiffness of the iliotibial band revealed a significant decrease of 13.2% at t1 (P ≤ .01) and 12.1% at t3 (P = .02). In NEA, a 6.2% increase of stiffness was found at t1, which was not significantly different to baseline (P = .16). For both groups, no significant iliotibial band stiffness changes were found at further time points. Also, regarding muscle stiffness, no significant changes were detected at any time for EA and NEA (P > .05). CONCLUSIONS: This study demonstrates a significant short-term decrease of connective tissue stiffness in EA, which may have an impact on the biomechanical output of the connective tissue. Thus, FR effects on tissue stiffness depend on the athletes' experience in FR, and existing studies have to be interpreted cautiously in the context of the enrolled participants.

Contrasts in intermittent endurance performance and heart rate response between female and male soccer players of different playing levels.

This study compared intermittent endurance performance and heart rate (HR) response, as well as their relationship, by sex and competitive level in soccer. A total of 68 outfield (18 elite and 16 sub-elite female, 17 elite and 17 sub-elite male) soccer players performed the Interval Shuttle Run Test (ISRT) with monitored HR. Sex and level effects were evaluated by two-way analysis of variance (ANOVA) and the relationships between parameters using Pearson's correlation coefficient. Female players presented lower performance (effect sizes [ES]: 2.12-4.71, p < 0.01) and higher submaximal HR during the ISRT (ES: 1.66-3.40, p < 0.01). Elite players showed higher performance and reduced submaximal HR compared with their sub-elite counterparts, with a large level effect only evident between the female groups (ES: 1.22-1.56, p < 0.01). The maximum and the HR recovery 1 min after the ISRT (HRR) did not differ among all groups (ES: 0.01-0.51, p ≥ 0.18). The HRR was slightly related to the test performance for all groups (r = 0.20, p = 0.12). Large to very large negative correlations were verified between HR at 6 and 9 min during the ISRT and the test performance for each group (r = -0.54 to -0.84, p ≤ 0.04). However, 16 (3 elite and 13 sub-elite) female players did not reach the 9th minute of the test. The gap between competitive levels among female soccer players is greater than that observed for male players in intermittent endurance performance and submaximal HR response. The HRR had only a minor impact on performance and was influenced neither by sex nor by level.

Do ground reaction forces during unilateral and bilateral movements exhibit compensation strategies following ACL reconstruction?

PURPOSE: The aims of the study were (1) to evaluate the leg asymmetry assessed with ground reaction forces (GRFs) during unilateral and bilateral movements of different knee loads in anterior cruciate ligament (ACL) reconstructed patients and (2) to investigate differences in leg asymmetry depending on the International Knee Documentation Committee Subjective Form (IKDC) in order to identify potential compensation strategies. METHODS: The knee function of 50 ACL reconstructed (patella tendon) patients was examined at 31 ± 7 months after the surgery. GRFs were quantified during the sit-to-stand and stand-to-sit test, the step-up and step-down test, and the two- and one-leg vertical jump. Further, the IKDC score, the anterior-posterior knee laxity, and the concentric torque of the quadriceps and hamstring muscles were evaluated. RESULTS: Differences between the operated and non-operated leg were found in the knee laxity, the quadriceps torque, and GRFs. The patients with low IKDC scores demonstrated greater leg asymmetries in GRFs compared to the patients with high IKDC scores. CONCLUSIONS: ACL reconstructed patients showed GRF asymmetries during unilateral and bilateral movements of different knee loads. Three compensation strategies were found in patients with low subjective knee function: (1) a reduced eccentric load, (2) an inter-limb compensation during bilateral movements, and (3) the avoidance of high vertical impact forces. These compensation strategies may be indicative of a protective adaptation to avoid excessive ACL strain. GRF measurements are practicable and efficient tools to identify individual compensation strategies during early rehabilitation.

Effects of Static Stretching and Playing Soccer on Knee Laxity.

OBJECTIVE: This study investigated exercise-induced effects of static stretching and playing soccer on anterior tibial translation (ATT) of the knee joint. DESIGN: Randomized controlled trial. SETTING: University biomechanics laboratory. PARTICIPANTS: Thirty-one athletes were randomly assigned into a stretching (26.9 ± 6.2 years, 1.77 ± 0.09 m, 67.9 ± 10.7 kg) and a control group (27.9 ± 7.4 years, 1.75 ± 0.08 m, 72.0 ± 14.9 kg). Thirty-one amateur soccer players in an additional soccer group (25.1 ± 5.6 years, 1.74 ± 0.10 m, 71.8 ± 14.8 kg). All participants had no history of knee injury requiring surgery and any previous knee ligament or cartilage injury. INTERVENTIONS: The stretching group performed 4 different static stretching exercises with a duration of 2 × 20 seconds interspersed with breaks of 10 seconds. The soccer group completed a 90-minute soccer-specific training program. The control group did not perform any physical activity for approximately 30 minutes. MAIN OUTCOME MEASURES: Anterior tibial translation was measured with the KT-1000 knee arthrometer at forces of 67 N, 89 N, and maximal manual force (Max) before and after the intervention. RESULTS: There was a significant increase in ATT after static stretching and playing soccer at all applied forces. Maximal manual testing revealed a mean increase of ATT after static stretching of 2.1 ± 1.6 mm (P < 0.0005) and after playing soccer of 1.0 ± 1.5 mm (P = 0.001). The ATT increase after static stretching at 67 and 89 N is significantly higher than in controls. At maximum manual testing, significant differences were evident between all groups. CONCLUSIONS: Static stretching and playing soccer increase ATT and may consequently influence mechanical factors of the anterior cruciate ligament. The ATT increase after static stretching was greater than after playing soccer. CLINICAL RELEVANCE: The observed increase in ATT after static stretching and playing soccer may be associated with changes in kinesthetic perception and sensorimotor control, activation of muscles, joint stability, overall performance, and higher injury risk.

Running activity profile of adolescent tennis players during match play.

The aims of this study were (1) to assess the running activities of adolescent tennis players during match play with respect to velocity, acceleration, and deceleration; (2) to characterize changes in these activities during the course of a match; and (3) to identify potential differences between winners and losers. Twenty well-trained adolescent male athletes (13 ± 1 y) played one simulated match each (giving a total of 10 matches), during which distances covered at different velocity categories (0 to < 1, 1 to < 2, 2 to < 3, 3 to < 4, and ≥ 4 m·s(-1)) and number of running activities involving high velocity (≥ 3 m·s(-1)), acceleration (≥ 2 m·s(-2)), and deceleration (≤ -2 m·s(-2)) were monitored using a global positioning system (10 Hz). Heart rate was also assessed. The total match time, total distance covered, peak velocity, and mean heart rate were 81.2 ± 14.6 min, 3362 ± 869 m, 4.4 ± 0.8 m·s(-1), and 159 ± 12 beats·min(-1), respectively. Running activities involving high acceleration (0.6 ± 0.2 n·min(-1)) or deceleration (0.6 ± 0.2 n·min(-1)) were three times as frequent as those involving high velocity (0.2 ± 0.1 n·min(-1)). No change in the pattern of running activities (P ≥ .13, d ≤ 0.39) and no differences between winners and losers (P ≥ .22, d ≤ 0.53) were evident during match play. We conclude that training of well-trained adolescent male tennis players need not focus on further development of their running abilities, since this physical component of multifactorial tennis performance does not change during the course of a match and does not differ between the winners and losers.

Effects of Digital Physical Health Exercises on Musculoskeletal Diseases: Systematic Review With Best-Evidence Synthesis.

BACKGROUND: Musculoskeletal diseases affect 1.71 billion people worldwide, impose a high biopsychosocial burden on patients, and are associated with high economic costs. The use of digital health interventions is a promising cost-saving approach for the treatment of musculoskeletal diseases. As physical exercise is the best clinical practice in the treatment of musculoskeletal diseases, digital health interventions that provide physical exercises could have a highly positive impact on musculoskeletal diseases, but evidence is lacking. OBJECTIVE: This systematic review aims to evaluate the impact of digital physical health exercises on patients with musculoskeletal diseases concerning the localization of the musculoskeletal disease, patient-reported outcomes, and medical treatment types. METHODS: We performed systematic literature research using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was conducted using the PubMed, BISp, Cochrane Library, and Web of Science databases. The Scottish Intercollegiate Guidelines Network checklist was used to assess the quality of the included original studies. To determine the evidence and direction of the impact of digital physical health exercises, a best-evidence synthesis was conducted, whereby only studies with at least acceptable methodological quality were included for validity purposes. RESULTS: A total of 8988 studies were screened, of which 30 (0.33%) randomized controlled trials met the inclusion criteria. Of these, 16 studies (53%) were of acceptable or high quality; they included 1840 patients (1008/1643, 61.35% female; 3 studies including 197 patients did not report gender distribution) with various musculoskeletal diseases. A total of 3 different intervention types (app-based interventions, internet-based exercises, and telerehabilitation) were used to deliver digital physical health exercises. Strong evidence was found for the positive impact of digital physical health exercises on musculoskeletal diseases located in the back. Moderate evidence was found for diseases located in the shoulder and hip, whereas evidence for the entire body was limited. Conflicting evidence was found for diseases located in the knee and hand. For patient-reported outcomes, strong evidence was found for impairment and quality of life. Conflicting evidence was found for pain and function. Regarding the medical treatment type, conflicting evidence was found for operative and conservative therapies. CONCLUSIONS: Strong to moderate evidence was found for a positive impact on musculoskeletal diseases located in the back, shoulder, and hip and on the patient-reported outcomes of impairment and quality of life. Thus, digital physical health exercises could have a positive effect on a variety of symptoms of musculoskeletal diseases.

Myotonometry and extended field-of-view ultrasound imaging allow reliable quantification of patellar tendon stiffness and length at rest and during maximal load, whereas several restrictions exist for the Achilles tendon.

Introduction: Stiffness and length are well-established tendon parameters in sports and medicine. Myotonometry and ultrasound imaging are the commonly used methods to quantify these parameters. However, further studies are needed to clarify the reliability of these methods, especially when assessing maximally loaded tendons and when conducted by different experienced investigators. This study aimed to determine the intra- and interrater reliabilities of measuring the stiffness and length of the patellar tendon (PT) and Achilles tendon (AT) using the myotonometry method and the extended field-of-view ultrasound (EFOV-US) technique at rest and maximal load performed by different experienced investigators. Methods: Twenty-seven participants were examined on three different days by one experienced investigator and one novice investigator. Primary outcomes were the intraclass correlation coefficient (ICC) and associated 95% confidence interval (95% CI), coefficient of variation (CV), standard error of measurement (SEM), and minimal detectable change (MDC) across the measurement days and investigators. Results: For PT measurements at rest and maximal load, the estimated ICCs for stiffness and length were ≥.867 and ≥.970, respectively, with 95% CIs ranging from poor (.306) to excellent (.973) and good (.897) to excellent (.999). The CV, SEM, and MDC for PT stiffness and length were ≤5.2% and ≤2.0%, ≤39.3 N/m and ≤0.9 mm, and ≤108.9 N/m and ≤2.6 mm, respectively. For AT measurements, some restrictions were evident for stiffness at rest and both parameters at maximal load. However, regarding AT length at rest, the estimated ICC was ≥.996, with an excellent 95% CI (.987-.999). The CV, SEM, and MDC for AT length at rest were 2.8%, ≤1.1 mm, and ≤2.9 mm, respectively. Conclusion: The estimated ICCs show good to excellent reliability for the myotonometry method and the EFOV-US technique for measuring PT stiffness and length at rest and maximal load for experienced and novice investigators. However, some restrictions are evident for the AT, especially for measurements at maximal load.

Preoperatively-determined Red Distribution Width (RDW) predicts prolonged length of stay after single-level spinal fusion in elderly patients.

Introduction: Elderly patients receiving lumbar fusion surgeries present with a higher risk profile, which necessitates a robust predictor of postoperative outcomes. The Red Distribution Width (RDW) is a preoperative routinely determined parameter that reflects the degree of heterogeneity of red blood cells. Thereby, RDW is associated with frailty in hospital-admitted patients. Research question: This study aims to elucidate the potential of RDW as a frailty biomarker predictive of prolonged hospital stays following elective mono-segmental fusion surgery in elderly patients. Material and methods: In this retrospective study, we included all patients with age over 75 years that were treated via lumbar single-level spinal fusion from 2015 to 2022 at our tertiary medical center. Prolonged length of stay (pLOS) was defined as a length ≥ the 3rd quartile of LOS of all included patients. Classical correlation analysis, Receiver-operating characteristic (ROC) and new machine learning algorithms) were used. Results: A total of 208 patients were included in the present study. The median age was 77 (IQR 75-80) years. The median LOS of the patients was 6 (IQR 5-8) days. The data shows a significant positive correlation between RDW and LOS. RDW is significantly enhanced in the pLOS group. New machine learning approaches with the imputation of multiple variables can enhance the performance to an AUC of 71%. Discussion and conclusion: RDW may serve as a predictor for a pLOS in elderly. These results are compelling because the determination of this frailty biomarker is routinely performed at hospital admission. An improved prognostication of LOS could enable healthcare systems to distribute constrained hospital resources efficiently, fostering evidence-based decision-making processes.

Comparison of cardiac output estimates obtained from the Antares oscillometric pulse wave analysis algorithm and from Doppler transthoracic echocardiography.

BACKGROUND: In cardiology, cardiac output (CO) is an important parameter for assessing cardiac function. While invasive thermodilution procedures are the gold standard for CO assessment, transthoracic Doppler echocardiography (TTE) has become the established method for routine CO assessment in daily clinical practice. However, a demand persists for non-invasive approaches, including oscillometric pulse wave analysis (PWA), to enhance the accuracy of CO estimation, reduce complications associated with invasive procedures, and facilitate its application in non-intensive care settings. Here, we aimed to compare the TTE and oscillometric PWA algorithm Antares for a non-invasive estimation of CO. METHODS: Non-invasive CO data obtained by two-dimensional TTE were compared with those from an oscillometric blood pressure device (custo med GmbH, Ottobrunn, Germany) using the integrated algorithm Antares (Redwave Medical GmbH, Jena, Germany). In total, 59 patients undergoing elective cardiac catheterization for clinical reasons (71±10 years old, 76% males) were included. Agreement between both CO measures were assessed by Bland-Altman analysis, Student's t-test, and Pearson correlations. RESULTS: The mean difference in CO was 0.04 ± 1.03 l/min (95% confidence interval for the mean difference: -0.23 to 0.30 l/min) for the overall group, with lower and upper limits of agreement at -1.98 and 2.05 l/min, respectively. There was no statistically significant difference in means between both CO measures (P = 0.785). Statistically significant correlations between TTE and Antares CO were observed in the entire cohort (r = 0.705, P<0.001) as well as in female (r = 0.802, P<0.001) and male patients (r = 0.669, P<0.001). CONCLUSIONS: The oscillometric PWA algorithm Antares and established TTE for a non-invasive estimation of CO are highly correlated in male and female patients, with no statistically significant difference between both approaches. Future validation studies of the Antares CO are necessary before a clinical application can be considered.

Comparison between three different endurance tests in professional soccer players.

The aims of this study were (a) to assess and correlate interval shuttle run test (ISRT) performance, maximum oxygen uptake (V[Combining Dot Above]O(2)max), running economy (RE), running velocity at the first rise in blood lactate concentrations above baseline (vLT) and running velocity at 4 mmol·L(-1) blood lactate concentration (v4) in professional soccer players and (b) to investigate whether a correlation exists between the respective results of time to exhaustion (T(lim)) from continuous and intermittent endurance tests, respectively. Eleven male professional field soccer players (mean ± SD: age 23.8 ± 3.0 years, V[Combining Dot Above]O(2)max 58.2 ± 4.9 ml·kg(-1)·min(-1)) completed a continuous Incremental Test with lactate measurements to determine vLT and v4, a continuous Ramp Test with gas exchange analysis to determine V[Combining Dot Above]O(2)max and RE, and an intermittent ISRT to determine intermittent endurance capacity during the first week of preseason preparation. There were significant correlations between ISRT performance and V[Combining Dot Above]O(2)max (r = 0.70, p < 0.05), and between T(lim) in both continuous endurance tests (r = 0.89, p < 0.01). Between all other variables no significant correlations were found overall (best r = 0.60, p > 0.05). The assessment of all values of V[Combining Dot Above]O(2)max, RE, vLT, and v4 should be included when investigating aerobic endurance performance among groups or over time in professional soccer players. Although V[Combining Dot Above]O(2)max, RE, vLT, and v4 have been regarded as important factors of aerobic performance in endurance related sports, the present data revealed that V[Combining Dot Above]O(2)max was the only factor, which correlated with intermittent endurance capacity in professional soccer players. Hence, V[Combining Dot Above]O(2)max should be increased through soccer-specific training interventions including universal agility components. The T(lim) in continuous and intermittent endurance tests differs and is therefore an independent endurance performance factor in professional soccer players.

Moderate evidence exists for four microRNAs as potential biomarkers for tendinopathies and degenerative tendon ruptures at the upper extremity in elderly patients: conclusion of a systematic review with best-evidence synthesis.

PURPOSE: The aim of this systematic review was to investigate tendon-specific microRNAs (miRNAs) as biomarkers for the detection of tendinopathies or degenerative tendon ruptures. Also, their regulatory mechanisms within the tendon pathophysiology were summarized. METHODS: A systematic literature research was performed using the PRISMA guidelines. The search was conducted in the Pubmed database. The SIGN checklist was used to assess the study quality of the included original studies. To determine the evidence and direction of the miRNA expression rates, a best-evidence synthesis was carried out, whereby only studies with at least a borderline methodological quality were considered for validity purposes. RESULTS: Three thousand three hundred seventy studies were reviewed from which 22 fulfilled the inclusion criteria. Moderate evidence was found for miR-140-3p and miR-425-5p as potential biomarkers for tendinopathies as well as for miR-25-3p, miR-29a-3p, miR-140-3p, and miR-425-5p for the detection of degenerative tendon ruptures. This evidence applies to tendons at the upper extremity in elderly patients. All miRNAs were associated with inflammatory cytokines as interleukin-6 or interleukin-1ß and tumor necrosis factor alpha. CONCLUSIONS: Moderate evidence exists for four miRNAs as potential biomarkers for tendinopathies and degenerative tendon ruptures at the upper extremity in elderly patients. The identified miRNAs are associated with inflammatory processes.

[Groin pain in sports games: a systematic review]. / Risikofaktoren für Leistenschmerzen in den Sportspielen: Eine systematische Literaturrecherche.

BACKGROUND: In sports games, epidemiological data show that groin pain is relatively common and can lead to repeated loss of time. Consequently, it is essential to be aware of the evidence-based prevention strategies. The aim of this systematic review was to examine risk factors and prevention strategies for groin pain and to rank them based on their evidence in sports games. METHODS: The review was conducted according to the PRISMA guidelines, using a PICO-scheme in the PubMed, Web of Science and SPOLIT databases. We included all available intervention and observational studies on the influence of risk factors and prevention strategies on groin pain in sports games. The methodological quality and level of evidence was assessed using the PEDro-Scale and OCEBM model, respectively. Finally, the quantity, quality and level of evidence was used to rank each risk factor for its grade. RESULTS: Moderate evidence was found for four risk factors that significantly influence the risk of groin pain: male sex, previous groin pain, hip adductor strength and not participating in the FIFA 11+ Kids. Moreover, moderate evidence was found for the following non-significant risk factors: older age, body height and weight, higher BMI, body fat percentage, playing position, leg dominance, training exposure, reduced hip abduction, adduction, extension, flexion, and internal rotation-ROM, hip flexor strength, hip abductor, adductor, flexor and core strengthening with balance exercises, clinical hip mobility tests and physical capacities. CONCLUSION: The identified risk factors can be considered when developing prevention strategies to reduce the risk of groin pain in sports games. Thereby, not only the significant, but also the non-significant risk factors should be considered for prioritisation.

Age, sex, endurance capacity, and chronic heart failure affect central and peripheral factors of oxygen uptake measured by non-invasive and continuous technologies: support of pioneer work using invasive or non-continuous measures.

Introduction: It is known that maximum oxygen uptake depends on age, sex, endurance capacity, and chronic heart failure. However, due to the required invasive or often applied non-continuous approaches, less is known on underlying central and peripheral factors. Thus, this study aimed to investigate the effects of age, sex, endurance capacity, and chronic heart failure on non-invasively and continuously measured central and peripheral factors of oxygen uptake. Methods: 15 male children (11 ± 1 years), 15 male (24 ± 3 years) and 14 female recreationally active adults (23 ± 2 years), 12 male highly trained endurance athletes (24 ± 3 years), and 10 male elders (59 ± 6 years) and 10 chronic heart failure patients (62 ± 7 years) were tested during a cardiopulmonary exercise test on a cycling ergometer until exhaustion for: blood pressure, heart rate, stroke volume, cardiac output, cardiac power output, vastus lateralis muscle oxygen saturation, and (calculated) arterio-venous oxygen difference. For the non-invasive and continuous measurement of stroke volume and muscle oxygen saturation, bioreactance analysis and near-infrared spectroscopy were used, respectively. A two-factor repeated measure ANOVA and partial eta-squared effect sizes (ηp2) were applied for statistical analyses at rest, 80, and 100% of oxygen uptake. Results: For the age effect, there were statistically significant group differences for all factors (p ≤ .033; ηp2≥.169). Concerning sex, there were group differences for all factors (p ≤ .010; ηp2≥.223), except diastolic blood pressure and heart rate (p ≥ .698; ηp2≤.006). For the effect of endurance capacity, there were no group differences for any of the factors (p ≥ .065; ηp2≤.129). Regarding chronic heart failure, there were group differences for the heart rate and arterio-venous oxygen difference (p ≤ .037; ηp2≥.220). Discussion: Age, sex, endurance capacity, and chronic heart failure affect central and peripheral factors of oxygen uptake measured by non-invasive and continuous technologies. Since most of our findings support pioneer work using invasive or non-continuous measures, the validity of our applied technologies is indirectly confirmed. Our outcomes allow direct comparison between different groups serving as reference data and framework for subsequent studies in sport science and medicine aiming to optimise diagnostics and interventions in athletes and patients.

Physical match demands of four LIQUI-MOLY Handball-Bundesliga teams from 2019-2022: effects of season, team, match outcome, playing position, and halftime.

Introduction: Due to the development in team handball, there is a need to optimize the physical capacities of team handball players for which knowledge of the physical match demands is essential. The aim of this study was to investigate the physical match demands of four LIQUI-MOLY Handball-Bundesliga (HBL) teams across three seasons with respect to the effects of season, team, match outcome, playing position, and halftime. Methods: A fixed installed local positioning system (Kinexon) was used, collecting 2D positional and 3D inertial measurement unit data at 20 and 100 Hz, respectively. The physical match demands were operationalized by basic (e.g., distance, speed, and acceleration) and more advanced variables (e.g., jumps, throws, impacts, acceleration load, and metabolic power). A total of 347 matches (213 with an additional ball tracking) were analyzed from four teams (one top, two middle, and one lower ranked) during three consecutive seasons (2019-2022). One-way ANOVAs were calculated to estimate differences between more than two groups (e.g., season, team, match outcome, playing position). Mean differences between halftimes were estimated using Yuen's test for paired samples. Results: Large effects were detected for the season (0.6≤ξ^≤0.86), team (0.56≤ξ^≤0.72), and playing position (0.64≤ξ^≤0.98). Medium effects were found for match outcome (ξ^≤0.36) and halftime (ξ^≤0.47). Conclusion: For the first time, we provide a comprehensive analysis of physical match demands in handball players competing in the LIQUI-MOLY Handball-Bundesliga. We found that physical match demands differ on that top-level with up to large effect sizes concerning the season, team, match outcome, playing position, and halftime. Our outcomes can help practitioners and researchers to develop team and player profiles as well as to optimize talent identification, training, regeneration, prevention, and rehabilitation procedures.

Invasively measured and estimated central blood pressure using the oscillometric algorithm Antares in patients with and without obesity.

BACKGROUND: Obesity is a global health concern and risk factor for cardiovascular disease. The assessment of central blood pressure (cBP) has been shown to improve prediction of cardiovascular events. However, few studies have investigated the impact of obesity on cBP in adults, and invasive data on this issue are lacking. This study aimed to evaluate cBP differences between patients with and without obesity, identify cBP determinants, and evaluate the accuracy of the algorithm Antares for non-invasive cBP estimation. METHODS: A total of 190 patients (25% female; 39% with BMI ≥30kg/m2; age: 67±12 years) undergoing elective cardiac catheterization were included. cBP was measured invasively and simultaneously estimated non-invasively using the custo screen 400 device with integrated Antares algorithm. RESULTS: No significant cBP differences were found between obese and non-obese patients. However, females, especially those with obesity, had higher systolic cBP compared to males (P<0.05). Multiple regression analysis showed that brachial mean arterial pressure, pulse pressure, BMI, and heart rate predicted cBP significantly (adjusted R2 = 0.82, P<0.001). Estimated cBP correlated strongly with invasive cBP for systolic, mean arterial, and diastolic cBP (r = 0.74-0.93, P<0.001) and demonstrated excellent accuracy (mean difference <5 and SD <8 mmHg). CONCLUSIONS: This study discovered no significant difference in cBP between obese and non-obese patients. However, it revealed higher cBP values in women, especially those with obesity, which requires further investigation. Additionally, the study highlights Antares' effectiveness in non-invasively determining cBP in obese individuals. This could improve the diagnosis and treatment of hypertension in this special patient population.

Unilateral autoscopic phenomena as a lateralizing sign in focal epilepsy.

Positive autoscopic phenomena - autoscopy, heautoscopy and out-of-body experience - may occur in a variety of diseases and also in physiological conditions. They are a rare but probably underreported phenomenon in focal epilepsies. Here, we investigate whether ictal lateralized autoscopic phenomena give lateralizing information about the underlying epileptic focus. We present the cases of seven patients from our center who experienced ictal lateralized autoscopic phenomena and analyzed their focus lateralization and localization of the underlying brain lesion. In addition, we reviewed seven cases published in German and English language literature. In the total group of 14 patients with ictal lateralized autoscopic phenomena, 12 (85.7%) of them had a well-defined epileptic focus contralateral to the side of the autoscopic appearance. Therefore, the data point to an association between ictal lateralized autoscopy and contralateral epileptic focus.