Sleep Quality's Effect on Vigilance and Perceptual Ability in Adolescent and Adult Athletes.

The aim of the study was to investigate the effect of sleep quality in cognitive domains of perceptual ability after exhausting exercise in adolescent and adult athletes. Eighty-six male professional soccer players were included in our study and divided into two groups: adolescents (age: 17.3 ± 0.2 yrs, body mass: 68.9 ± 7.9 kg, body fat: 9.9 ± 3.6 %) versus adults (age: 26.3 ± 5.2 yrs, body mass: 76.5 ± 7.2 kg, body fat: 10.3 ± 3.1 %). For each athlete, prior to cardiopulmonary exercise testing (CPET), anthropometric and morphological characteristics were recorded and Pittsburgh Sleep Quality Index (PSQI) questionnaire was answered. Immediately after CPET, all athletes underwent the perceptual ability test (PATest) for 30 sec and the sum of hits (rep/30 sec) and the time between a visual stimulus and the following stimulus (mean reaction time; RT, sec) were recorded. Oxygen uptake in maximal effort and in anaerobic threshold showed differences between hits (P=0.037) and RT (P=0.025). The variable of PSQI questionnaire "had bad dreams" showed correlation with hits (P=0.021) and RT (P=0.011) and the RT showed correlation with variables "cannot breathe comfortably" (P=0.041) and "...enthusiasm to get things done" (P=0.041). Adolescents showed poorer sleep quality (PSQI score: 5.7 ± 3.6 vs. 2.4 ± 2.6) compared to adults and slower reaction time (0.9 ± 0.1 vs. 0.8 ± 0.1 sec, P=0.029) compared to adolescent athletes with PSQI score ≥5.5. The variable of PSQI score in adolescents is related to HR in maximal effort (r = -0.364, P=0.032) and in adults is related to speed (r = -0.335, P=0.016). Perceptual ability, which requires sustained attention, vigilance, and motor coordination, is often negatively affected by restricted sleep, especially in adolescents.

The Effect of Whole-Body Cryostimulation in Healthy Adults : Whole-Body Cryostimulation According to Gender and Smoking Status.

INTRODUCTION: Whole-body cryostimulation (WBC) refers to the therapeutic application of extremely cold dry air for a short period of time. The method has beneficial results in various diseases as well as the recovery of athletes. The effects of WBC in healthy individuals have not been extensively investigated. PURPOSE: We aim to explore differences in the effects of WBC on blood pressure (BP), oxygen saturation (SpO2), and heart rate (HR) in healthy adults (not athletes) as well as differences according to gender and smoking status. MATERIALS AND METHODS: Fifty adults (male/female: 32/18) smokers/nonsmokers: 26/24) were included in the study. WBC was performed in a cryochamber at -85 °C for 3 min. Systolic BP (SBP) and diastolic BP (DBP), HR, and SpO2 were measured before and immediately after WBC. RESULTS: Males and females differed significantly in SBP after WBC (138.1 ± 13.0 vs 128.5 ± 17.0 mmHg, respectively, p = 0.029), SpO2 after WBC (96.6 ± 1.8 vs 98.3 ± 1.5%, respectively, p = 0.001) and HR after WBC (60.1 ± 9.6 vs 70.2 ± 7.7 bpm, respectively, p < 0.001). In males, SpO2 remained unchanged before and after WBC, whereas in women SpO2 increased by 1.0 ± 1.4% (p = 0.038) (Table 2). HR after WBC displayed a downward trend by -9.8 ± 5.9% in males compared to an upward trend by 3.6 ± 15.1 in females (p < 0.001). Nonsmokers displayed higher increase in SBP after WBC (4.3 ± 9.0% in smokers compared to 13.3 ± 13.2% in nonsmokers, p = 0.007). Smokers presented an increase by 1.0 ± 1.6% in SpO2, while in nonsmokers, SpO2 decreased by 0.8 ± 2.1% following WBC (p = 0.001). CONCLUSIONS: Our results suggest that WBC affects the cardiovascular and the respiratory system differently in males versus females and smokers versus nonsmokers. More studies are needed in order to fully explore the effects of WBC in these population groups in order to design individualized treatment protocols.

The Reciprocal Association between Fitness Indicators and Sleep Quality in the Context of Recent Sport Injury.

The purpose of the study is to investigate whether the oxygen uptake and heart rate at rest, in Greek professional soccer players, are affected by recent injuries, as well as how sleep quality is affected. Forty-two male professional soccer players were included in the study and divided into two groups: injurygroup (n = 22, age: 21.6 ± 5.4 years, body fat: 11.0 ± 3.9%, total body water: 64.0 ± 2.5%) and no-injurygroup (n = 20, age: 24.2 ± 5.6 years, body fat: 10.1 ± 2.8%, total body water: 64.3 ± 1.8%). The oxygen uptake at rest (VO2resting, mL/min/kg) and heart rate (HR, bpm) were recorded in the upright position for 3 min, and the predicted values were calculated. One hour before, the athletes answered the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The results showed a difference between groups (injurygroup vs. no-injurygroup) in VO2resting (7.5 ± 1.4 vs. 5.5 ± 1.2 mL/min/kg, p < 0.001) and percent of predicted values (92.5 ± 17.2 vs. 68.3 ± 14.6%, p < 0.001) and HR, such as beats per min (100.6 ± 12.8 vs. 93.1 ± 4.6 bpm, p = 0.001), percent of predicted values (50.7 ± 6.4 vs. 47.6 ± 2.8%, p = 0.003) and sleep quality score (PSQI: 4.9 ± 2.2 vs. 3.1 ± 0.9, p = 0.005). Anthropometric characteristics were not different between groups. Oxygen consumption and heart rate at rest are affected by the systemic adaptations due to injury. These pathophysiological changes probably relate to increased blood flow in an attempt to restore the injury area.

Peripheral nerve blockade as an exclusive approach to obturator nerve block in anterior cruciate ligament reconstructive surgery.

BACKGROUND: Obturator nerve block plays an additive role on the quality of analgesia for knee surgery. Since the use of dual guidance increases the success rate of nerve blocks, we investigated the feasibility of performing anterior cruciate ligament reconstruction under dual-guided blockade of obturator with femoral and sciatic nerves. Furthermore, we propose a novel method for the assessment of obturator nerve block. METHODS: Fifty-seven patients undergoing anterior cruciate ligament repair were studied. Neurostimulating needles were guided out-of-plane by ultrasound. To induce the obturator nerve block, 10 ml of ropivacaine 0.5% were injected after eliciting contractions of adductor longus, brevis and magnus followed by block assessment for 30 minutes by examining the patient lift and left down the leg. RESULTS: The sonographic recognition of obturator nerve was easy and quick in all cases. Time for applying the block was 119.9 ± 79.2 sec. Assessing this block with lifting-leaving down the leg gave satisfactory results in 24.0 ± 5.07 min. After performing femoral-sciatic blocks, the inflation of tourniquet resulted in VAS score of > 0 in 2/57 patients and operation in 12/57. Total dose of fentanyl was 120.1 ± 64.6 µg and of midazolam 1.86 ± 0.8 mg. In 6 patients propofol was administered for sedation and 1 of them required ventilation with laryngeal mask airway, converting the anesthesia technique to general anesthesia. CONCLUSIONS: Our data suggest that anterior cruciate ligament reconstruction can be performed under obturator-femoral-sciatic blocks. Identification of obturator nerve with ultrasound is easy and the block can be assessed by observing how the patient lifts and leaves down the leg.

Effect of knee flexion angle on length and orientation of posterolateral femoral tunnel drilled through anteromedial portal during anatomic double-bundle anterior cruciate ligament reconstruction.

PURPOSE: Our purpose was to evaluate the radiologic orientation and length of the posterolateral (PL) femoral tunnel when drilled through the anteromedial (AM) portal at 90 degrees, 110 degrees, and 130 degrees of flexion. METHODS: In 9 fresh cadaveric knees the anterior cruciate ligament was excised and 2.4-mm guidewires were drilled through the center of the PL bundle footprint through an accessory AM portal. Pins were advanced, in a retrograde manner, until flush with the notch wall and left in place. Outcomes were measured by use of plain anteroposterior, lateral, and tunnel radiographs to determine tunnel orientation and clock position, and direct measurement was performed to determine the intraosseous length, the shortest distance to the posterior bone cortex, and the distance to the lateral collateral ligament attachment on the lateral aspect of the femoral condyle. RESULTS: With regard to tunnel orientation, each increase in knee flexion angle resulted in a more horizontal tunnel on both the lateral and anteroposterior views. On the tunnel view, the PL guidewire became more vertical with knee flexion. The mean clock position was 9 o'clock (standard deviation [SD], 00:12). No significant difference in the intraosseous length of the guidewires was observed. According to our hypothesis, knee flexion influenced the PL tunnel characteristics. At 90 degrees of flexion, the guidewire may blow out the posterior cortex of the lateral femoral condyle. CONCLUSIONS: A PL femoral tunnel drilled through the AM portal becomes more horizontal with bending of the knee during drilling. At 90 degrees, the tunnel is at risk of back wall blowout.

Validation of the position of the femoral tunnels in anatomic double-bundle ACL reconstruction with 3-D CT scan.

This study compares the positioning of femoral AM and PL tunnels obtained with specific ancillary instruments during anatomic double-bundle ACL reconstruction with the native ACL footprint using three-dimensional computed tomography (3-D CT). In 35 consecutive patients, anatomic double-bundle ACL reconstruction was performed with specific ancillary instruments. Three-dimensional CT reconstruction of both knees was performed using the volume rendering technique. In the controls (contralateral knee, with intact ACL), the angle between the longitudinal axis of the footprint and the axis of the femur, the "footprint angle" (FA) was measured. On the involved side, using the axis passing through the tunnel centers, FA was also measured. In both the groups, footprint's length and width, and distances to cartilage margins were measured. FA was 28.1 degrees +/- 5.0 degrees in the controls and 32.9 degrees +/- 15.8 degrees on the involved side (n.s.). There was no statistical difference between the two groups for the other morphometric parameters: footprint's length and width, and distances to cartilage margins. Using specific ancillary instruments the morphometric parameters of the reconstructed femoral ACL footprint were similar to the native ACL.

Protrusio of a ceramic femoral head through the acetabular metallic shell, extensive metallosis and 'bubble sign'.

A 24-year-old patient with a history of juvenile rheumatoid arthritis underwent a primary cementless left total hip arthroplasty (THA). The original THA consisted of an Optifix 54 cup with a 3-mm thick polyethylene liner, an Optifix size 4 stem (Smith & Nephew Richards, Memphis, Tennessee) and a Biolox aluminum 32-mm femoral head. Fourteen years later, radiographs demonstrated extensive wear of the polyethylene liner resulting in direct articulation and abrasion wear of the ceramic femoral head on the cup and a bubble sign. This article presents a case of a catastrophic failure of a ceramic/polyethylene bearing with destruction of the polyethylene liner and the metallic shell and protrusio of the nonfractured ceramic head through the metallic shell. To our knowledge this is the first description of extensive metallosis and subsequent radiograph bubble sign not presenting as a result of wear of a metal-on-metal articulation. At the time of revision surgery-Hydrocel TNT Monoblock 58 cup (Zimmer, Warsaw, Indiana), Wagner 265/14 stem (Zimmer), and a Co/Cr 28-mm head-copious metallic debris was seen both macroscopically and histologically, with the ceramic head protruding behind the metallic shell. Multiple factors may have been responsible for this failure including a thin polyethylene shell, a suboptimal locking mechanism, gamma in air sterilization for polyethylene, multiple screw-holes that reduce the contact surface between shell and polyethylene, the rough surface on the inside of the shell and non-articular wear at the metal polyethylene interface within the acetabular component and the high demands of this active young patient.

Low-molecular-weight heparin for prevention of thrombosis: inverted role.

BACKGROUND: Heparin induced thrombosis (HIT) after low-molecular-weight (LMWH) administration for thrombosis prevention is a limb and life threatening condition. METHODS: Two previously healthy individuals, with nonviable forearm amputation and knee osteoarthritis, suffered from multiple arterial thromboses (>2 sites each) after postoperative administration of LMWH. RESULTS: Both patients suffered from thrombocytopenia on the first postoperative days (4-7) and had signs of arterial occlusions on the 9th and 10th postoperative days. The patient with the initially successful forearm replantation was finally amputated below the elbow, whereas the lower extremity of the patient with total knee arthroplasty and contralateral femoral artery occlusion was salvaged with foot fingers amputation only. CONCLUSIONS: Early recognition of the syndrome by monitoring daily platelet counts during heparin therapy is essential. In case of postheparin (LMWH or unfractionated) platelet decrease, heparin administration should be ceased after emergency testing for heparin induced antibodies. When HIT syndrome is confirmed to have occurred, heparin/LMWH must be replaced with thrombin-specific inhibitors.

Tumor-like meniscal cyst.

A 50-year-old woman presented with a 5-year history of mild pain in her right knee, which had increased over the last 2 years. A palpable mass over the anterolateral aspect of the knee was obvious and the last 3 months she was experiencing locking episodes with consequent knee effusion. The differential diagnosis was driven between meniscal cyst, pigmented villonodular synovitis, synovial sarcoma, synovial chondromatosis, and aneurysm. After a diagnostic arthroscopy, the lesion was excised by a limited lateral arthrotomy. The pathologic findings revealed a synovial cyst. Intra-articular synovial cysts are uncommon, nonsymptomatic, and mostly incidental findings on magnetic resonance imaging (MRI) and arthroscopy. This lateral meniscus synovial cyst (2.5 x 2.5 cm) was enlarged within the intracondylar notch and produced disabling knee symptoms. The peculiarity of this lesion was the tumor-like appearance: its large size, the progress of symptoms, and the multilobulated, nonhomogenous signal on the MRI scan. One year postoperatively, the patient is asymptomatic and the MRI obtained at 6 months revealed no remnant of the fully excised cyst.