Physiological profile of water polo players in different competitive levels.

AIM: The purpose of this study was to determine if there are different physiological characteristics in water polo players of three different competitive levels (national team, NT, junior national team, NJ, and amateur club, AC). METHODS: To better define the training levels of water polo players competing at different levels, we administered a shuttle swim test (SST, a specific test used by Italian coaches) and a classic speed-lactate test. The shuttle swim test is based on actions at maximum intensity followed by incomplete recoveries. To compare the athletes, we used their morphological characteristics, the speed during an incremental test associated with fixed blood lactate concentrations of 2 mmol*1-1 (Aerobic Threshold, AT) and 4 mmol*1-1 (Anaerobic Threshold, AnT), and the SST data (speed, heart rate and lactate concentration). RESULTS: The heart rate at the end of the SST was 164+/-12 beats*min-1 for NT, 166+/-10 beats*min-1 for NJ (no significant difference, P>0.05) and 179+/-9 beats*min-1 for AC (significantly different from NT and NJ, P<0.05). The AT and AnT speeds were significantly higher in NT than in AC and NJ (P<0.05). No significant differences were found in AT and AnT speeds between AC and NJ (P>0.05). The mean speed during the shuttle swim test was significantly higher in NT and NJ than in AC (P<0.05). Lactate values were similar in the NT, AC and NJ groups (P>0.05). The SST mean speed was significantly correlated with the AT (P<0.01) and AnT speeds (P<0.05) in three groups . In all groups no significant correlation was found between SST blood lactate and AT or AnT speeds (P>0.05). CONCLUSION: Some differences were found among the senior and junior professional and amateur water polo players in both SST performance and Aerobic and Anaerobic Thre-shold speeds. The shuttle swim test for water polo provides conditioning coaches and sport scientists with data on the sport-specific movement speed and the competition-specific fatigue resistance in each athlete.

Shuttle swim test for water polo players: validity and reliability.

AIM: The purpose of this study, carried out on elite water polo players, was to examine: 1) the relationship between the shuttle swim test (SST) and the performance during official water polo games, and 2) the SST reliability. METHODS: Sixteen male players of the Italian National Water Polo Team (age: 27.9 + or - 2.1 years, body mass: 88.5 + or - 10.3 kg, height: 186.6 + or - 6.9 cm) performed the SST, consisting of two sets of seven repetitions from 40 to 10 m (total of 120 m for each set) at a maximal intensity with 90 s of rest between sets. During the SST, average swimming speed, blood lactate concentration and heart rate were recorded. Direct validity of the SST was evaluated by comparing the average swimming speed with the total distance covered (TD) and the distance covered at high intensity swimming (above 1.8 m x s(-1), HIS) during three official water polo games. SST reliability was assessed by testing the same athletes one week apart. RESULTS: Average swimming speed during the SST was significantly correlated with TD (r=0.67, P<0.01) and HIS (r=0.74, P<0.004). The mean average speed during SST showed high reliability (TE=0.4%; CI 95%: 0.2% to 1.0% ). The T1 vs. T2 difference in mean average speed was not significant. CONCLUSIONS: Present findings demonstrate the validity and reliability of the SST for evaluation of the swimming fitness of water polo players.

Quality in emergency departments: a study on 3,285,440 admissions.

INTRODUCTION: A multi-centre study has been conducted, during 2005, by means of a questionnaire posted on the Italian Society of Emergency Medicine (SIMEU) web page. Our intention was to carry out an organisational and functional analysis of Italian Emergency Departments (ED) in order to pick out some macro-indicators of the activities performed. Participation was good, in that 69 ED (3,285,440 admissions to emergency services) responded to the questionnaire. METHODS: The study was based on 18 questions: 3 regarding the personnel of the ED, 2 regarding organisational and functional aspects, 5 on the activity of the ED, 7 on triage and 1 on the assessment of the quality perceived by the users of the ED. RESULTS AND CONCLUSION: The replies revealed that 91.30% of the ED were equipped with data-processing software, which, in 96.83% of cases, tracked the entire itinerary of the patient. About 48,000 patients/year used the ED: 76.72% were discharged and 18.31% were hospitalised. Observation Units were active in 81.16% of the ED examined. Triage programmes were in place in 92.75% of ED: in 75.81% of these, triage was performed throughout the entire itinerary of the patient; in 16.13% it was performed only symptom-based, and in 8.06% only on-call. Of the patients arriving at the ED, 24.19% were assigned a non-urgent triage code, 60.01% a urgent code, 14.30% a emergent code and 1.49% a life-threatening code. Waiting times were: 52.39 min for non-urgent patients, 40.26 min for urgent, 12.08 for emergent, and 1.19 for life-threatening patients.

Energy cost of swimming of elite long-distance swimmers.

The aim of this study was: (1) to assess the energy cost of swimming (C(s), kJ km(-1)) in a group of male (n = 5) and female (n = 5) elite swimmers specialised in long-distance competitions; (2) to evaluate the possible effect of a 2-km trial on the absolute value of C(s). C(s) was assessed during three consecutive 400-m trials covered in a 50-m pool at increasing speeds (v1, v2, v3). After these experiments the subjects swam a 2-km trial at the 10-km race speed (v2km) after which the three 400-m trials were repeated at the same speed as before (v5 = v1, v6 = v2, v7 = v3). C(s) was calculated by dividing the net oxygen uptake at steady state VO2ss by the corresponding average speed (v, m s(-1)). VO2ss was estimated by using back extrapolation technique from breath-to-breath VO2 recorded during the first 30 s of recovery after each test. C(s) increased (from 0.69 kJ m(-1) to 1.27 kJ m(-1)) as a function of v (from 1.29 m s(-1) to 1.50 m s(-1)), its values being comparable to those measured in elite short distance swimmers at similar speeds. In both groups of subjects the speed maintained during the 2-km trial (v2km) was on the average only 1.2% faster than of v2 and v6 (P>0.05), whereas C(s) assessed at the end of the 2-km trial (v2km) turned out to be 21 +/- 26% larger than that assessed at v2 and v6 (P<0.05); the average stroke frequency (SF, cycles min(-1)) during the 2-km trial turned to be about 6% (P<0.05) faster than that assessed at v2 and v6. At v5, C(s) turned out to be 19 +/- 9% (P<0.05) and 22 +/- 27% (0.1 < P = 0.05) larger than at v1 in male and female subjects (respectively). SF was significantly faster (P<0.05, in male subjects) and the distance per stroke (Ds = v/SF) significantly shorter (P<0.05) in female subjects at v5 and v6 than at v1 and v2. These data suggest that the increase of C(s) found after the 2-km trial was likely related to a decrease in propelling efficiency, since the latter is related to the distance per stroke.

Multicompartment model to assess body composition in professional water polo players.

AIM: The aim of this study was to compare differences between skinfold thicknesses (SK), bioelectrical impedance analysis (BIA), a 2-compartment model (2C), and 2, 3-compartment models (3C) of percent body fat (%BF) assessment with a 4-compartment model (4C) in professional water polo athletes. METHODS: Ten male subjects, 18 to 29 years of age, participated in this study. Under water weighing, deuterium dilution, and dual-energy X-ray absorptiometry (DXA) were used to provide the required values for the models. The two, 3C models used were established by Withers et al. (3C-W) and by the DXA manufacturers (3C-DXA). 4C was also established by Withers et al. RESULTS: There were no significant differences between 2C, 3C-W, and 3C-DXA when compared with 4C (criterion model). There were no significant differences between 2C and 3C-W. %BF was significantly greater using 2C compared with 3C-DXA. %BF derived from SK and BIA were significantly greater than all other METHODS: 4C was best correlated with 3C-W (R2=0.998), followed by 2C (R2=0.806), 3C-DXA (R2=0.5071), SK (R2=0.2945), and BIA (R2=0.2377). CONCLUSION: We conclude that 2C and 3C-W assess %BF equally as well as 4C; however, SK and BIA significantly over-estimated %BF in water polo athletes.

Myositis ossificans as a complication of a muscle tendon junction strain of long head of biceps. A case report.

An unusual case of myositis ossificans secondary to a muscle tendon junction (MTJ) strain of long head of biceps in a young athlete is reported. Plain radiographs, ultrasonography and MRI in association with clinical assessment showed the appearance and the evolution of this pathological entity. This case had a resolution of pain and function after 3 months of conservative treatment. At 6 months follow-up, the athlete became asymptomatic and he gradually returned back to his sports activity.

VO2 slow component correlates with vastus lateralis de-oxygenation and blood lactate accumulation during running.

BACKGROUND: In the present study, vastus lateralis de-oxygenation was monitored contemporarily with VO2 changes along a severe constant intensity running exercise, after the 3rd min up to volitional exhaustion. Blood lactate accumulation was also measured before, during and after running. METHODS: Eleven male amateur soccer players volunteered for the study. Subjects mean age, height, and body weight were 22.9+/-2 yrs, 177.5+/-6.2 cm, 71.7+/-4 kg, respectively. Measurements were carried out during running on a treadmill. Ventilatory and gas exchange parameters were measured at the mouth on a breath-by-breath basis. For blood lactate concentration accumulation measurement, capillary blood samples were taken from the fingertip. The oxygenation of the vastus lateralis muscle were measured by a continuous wave NIRS portable instrument. By means of two pretests the onset of [La]b accumulation and its associated velocity (vOBLA), and the peak of oxygen uptake and its associated velocity (vVO2,peak) were assessed. The test consisted of running on the treadmill up to volitional exhaustion at a constant velocity corresponding to vOBLA plus 50% of the difference between vVO2,peak and vOBLA (v50%Delta). RESULTS: The principal finding of this study was that vastus lateralis de-oxygenation changes measured during running correlate with a) oxygen uptake changes between the 3rd min of exercise and the time corresponding to the subject's volitional exhaustion; b) blood lactate concentration increments measured at the 3rd and the 6th min of exercise and at the time corresponding to the subject's volitional exhaustion. CONCLUSIONS: In conclusion, the results of the present study support our hypothesis that the vastus lateralis de-oxygenation contributes consistently to the VO2 slow component development in running.

The VO2 slow component in swimming.

All studies on the oxygen uptake (VO2) slow component have been carried out for the sporting disciplines of cycling or running, but never for swimming. Considering that front crawl swimming is a sport discipline that is fundamentally different from both running and cycling, the aim of this study was to verify whether this slow component also appears in swimming. Six elite pentathletes were tested in a swimming flume while front crawl swimming to exhaustion. Swimming velocity for the slow component test was determined as v50% delta = CV + [vVO2peak - CV)/2], where CV is the critical velocity and vVO2peak the lowest velocity at which peak VO2 occurred. To set the subject's CV, expressed as the slope of a straight line that describes the correlation between swimming distance and time, the record times over three swimming distances were recorded in a 50 m swimming pool. The vVO2peak was measured by means of an incremental test in the swimming flume. Gas exchange was measured by means of a telemetric metabolimeter (K4 RQ, Cosmed, Italy) that was connected to a snorkel. The slow component was found in all subjects, with a mean (SD) value of 239 (194) mlO2.min-1. Therefore, although front crawl swimming is fundamentally different from both running and cycling, it appears that it also incurs a VO2 slow component. The origin of this phenomenon, however, is even more uncertain than for the other sport disciplines.

Salmonella flagellin fused with a linear epitope of colonization factor antigen I (CFA/I) can prime antibody responses against homologous and heterologous fimbriae of enterotoxigenic Escherichia coli.

In this work, a 15-amino-acid-long peptide derived from the enterotoxigenic Escherichia coli CFA/I fimbria (11VDPVIDLLQADGNAL25) was genetically fused to the Salmonella flagellin and used to prime and boost serum antibody responses (IgG) against homologous (CFA/I) and heterologous (CS1) colonization factors (CFs) in BALB/c mice. Antibodies raised against the hybrid flagellin (Fla II) cross-reacted with CFA/I, CS1, CS2, and PCFO166 but not with CS4. Parenteral administration of Fla II primed antibody responses against both CFA/I and CS1 but boosted IgG responses only against CFA/I. These findings confirm that linear epitopes derived from the CFA/I fimbria can prime antibody responses against homologous and heterologous CFs and indicate that Salmonella flagellin represents a potential carrier for the development of broad-range peptide-based anti-colonization ETEC vaccines.

Preparatory versus main competitions: differences in performances, lactate responses and pre-competition plasma cortisol concentrations in elite male swimmers.

Two groups of elite male swimmers were studied using a similar protocol during the winter training seasons of two consecutive years. In the first season (September 1997-January 1998), eight male swimmers (age 19-25 years) of the Italian National Team participated, after 12 weeks of increased training volume, in a preparatory national competition (PWC) and then, after a further 6 weeks of specific training, in the World Championships (WC, both competitions in a 50-m pool), which represented the main competition at the end of the 18-week-long winter season. In the second season (September 1998-December 1998), a group of ten high-level male swimmers (18-22 years) participated, after 8 weeks of increased training volume, in a preparatory national competition (PIC) and then, after a further 6 weeks of specific training, in the Italian Championships (IC, both competitions in a 25-m pool), the main competition at the end of the 14-week-long winter season. A tapering period lasting 1-3 weeks was observed before the main competition in both seasons. All swimmers were competing at distances of up to 400 m; two of them participated in the study in both seasons. The swimming velocities and post-competition blood lactate concentrations were higher in the main competitions than in the preparatory competitions in both seasons. Pre-competition plasma cortisol (CORT) concentrations were higher than the initial values at the beginning of the season, reaching maximal values at the preparatory competitions and then decreasing before the main competitions in both seasons. The percentage increase in individual swimming velocity from the preparatory to the main competition was positively correlated with the corresponding increase in post-competition blood lactate (r = 0.63, P = 0.046) in the 1997 season (WC), and negatively correlated with the corresponding decrease in pre-competition CORT concentration (r = -0.66, P = 0.019) in the 1998 season (IC). Our results indicate that a decrease in pre-competition CORT could be a prerequisite for an improvement in swimming performance.

[A case of arterial hypertension after use of oral contraceptives]. / Un caso di ipertensione arteriosa dopo uso di contraccettivo orale.

It is known that oral contraceptives may induce high blood pressure that usually returns to normal values a few weeks after interruption of the drugs, and without any specific treatment. The precise mechanism by which oral contraceptives cause hypertension is not clear. A severe hypertension and mild heart failure in a young woman using oral contraceptives has been observed in the case described. The patient needed a careful and prolonged therapy to maintain a normal blood pressure.

A comparison of time to exhaustion at VO2 max in élite cyclists, kayak paddlers, swimmers and runners.

A recent study has shown the reproducibility of time to exhaustion (time limit: tlim) at the lowest velocity that elicits the maximal oxygen consumption (vVO2 max). The same study found an inverse relationship between this time to exhaustion at vVO2 max and vVO2 max among 38 élite long-distance runners (Billat et al. 1994b). The purpose of the present study was to compare the time to exhaustion at the power output (or velocity) at VO2 max for different values of VO2 max, depending on the type of exercise and not only on the aerobic capacity. The time of exhaustion at vVO2 max (tlim) has been measured among 41 élite (national level) sportsmen: 9 cyclists, 9 kayak paddlers, 9 swimmers and 14 runners using specific ergometers. Velocity or power at VO2 max (vVO2 max) was determined by continuous incremental testing. This protocol had steps of 2 min and increments of 50 W, 30 W, 0.05 m s-1 and 2 km-1 for cyclists, kayak paddlers, swimmers and runners, respectively. One week later, tlim was determined under the same conditions. After a warm-up of 10 min at 60% of their vVO2 max, subjects were concluded (in less than 45 s) to their vVO2 max and then had to sustain it as long as possible until exhaustion. Mean values of vVO2 max and tlim were respectively equal to 419 +/- 49 W (tlim = 222 +/- 91 s), 239 +/- 56 W (tlim = 376 +/- 134 s), 1.46 +/- 0.09 m s-1 (tlim = 287 +/- 160 s) and 22.4 +/- 0.8 km h-1 (tlim = 321 +/- 84 s), for cyclists, kayak paddlers, swimmers and runners. Time to exhaustion at vVO2 max was only significantly different between cycling and kayaking (ANOVA test, p < 0.05). Otherwise, VO2 max (expressed in ml min-1 kg-1) was significantly different between all sports except between cycling and running (p < 0.05). In this study, time to exhaustion at vVO2 max was also inversely related to VO2 max for the entire group of élite sportsmen (r = -0.320, p < 0.05, n = 41). The inverse relationship between VO2 max and tlim at vVO2 max has to be explained, it seems that tlim depends on VO2 max regardless of the type of exercise undertaken.

Scintigraphic recording of blood volume shifts.

UNLABELLED: A scintigraphic device consisting of small scintillation probes tightly fixed to the skin was developed to record intravascular blood volume shifts continuously and simultaneously at several sites. The aim of the present study was to ascertain the reliability of the measurements obtained, show the blood shifts induced by common daily activities in healthy subjects and clarify the mechanisms responsible for hemodynamic changes. METHODS: Measurements were made in three fields of the right lung, the liver, thighs and calves of 16 men during Valsalva maneuver, hyperventilation, various posture changes and treadmill walking. Some tests were repeated. RESULTS: The measured blood volume shifts were always in the expected direction and in accordance with those reported in the literature; they also were reproducible. Therefore, the measurements were reliable. A pattern of blood volume changes peculiar to some common daily activities was recorded in subjects moving freely. Insights were obtained on the mechanisms responsible for the blood volume shifts. CONCLUSION: Our noninvasive technique provides reliable continuous measurements of blood volume changes at several sites during common daily activities and could be applied not only in healthy subjects but also in patients.

Pulmonary gas exchange in athletes with exercise-induced hypoxaemia.

Hypoxaemia that is induced by physical exercise (EIH) in some athletes, who are however capable of enduring intense muscolar work, is a phenomenon that has been known for some time. However, assumptions such as alveolar hypoventilation, veno-arterial shunt, limitation of diffusion, or mismarch of the VA/Q ratio, have not to date been able to exhaustively explain this phenomenon. In this study five athletes displaying exercise-induced hypoxaemia were evaluated by increasing-load exercise tests, as proposed by other authors, and by means of intermittent tests with supermaximal exercise steps (130% VO2 max) with breaks for incomplete recovery (3 min). The fundamental fact arising from our study is that the intermittent tests did not bring about hypoxaemia in the tests subjects. Analysis of the ventilator and metabolic parameters, of the alveolar pressure of the O2, and of the partial pressures of the CO2 in the arterial blood, all measured during the two different types of muscular exercise, lead to the belief that the different distribution of the pulmonary blood flow, which has been documented in highly trained athletes, plays a very important role in inducing EIH.

[Chest pain similar to angina. Identification of patients at risk of developing acute coronary failure]. / Dolore toracico simil-anginoso. Identificazione dei pazienti a rischio di sviluppare una insufficienza coronarica acuta.

In order to improve the diagnostic procedure for patients with chest pain suspected of having acute ischemic heart disease we elaborated a mathematical model to predict ischemic risk and then compared its predictive capacity with that of the physician. From September 1989 to December 1992, 564 patients with a chief symptom of chest pain were seen at our Emergency Room (ER). Sixty-two percent of them were male, mean age was 58 +/- 13 years, and none had acute myocardial infarction or unstable angina. Clinical and historical data, serial sampling of enzymes and ECG patterns were collected for 4 hours after admission to the ER. At that point a decision was made to hospitalize or discharge that patient. Follow-up was completed within 2 months. At the end of follow-up, we observed that the physician's assessment resulted in 35% true positive, 55% true negative, 4.7% false positive, and 5.3% false negative judgments for acute ischemic heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)

A new respiratory valve system for measuring oxygen uptake during swimming.

We describe a new respiratory valve system with minimal dead space, which allows measurement of ventilation and oxygen uptake during swimming. The device offers considerable advantages in efficiency and accuracy over current equipment, and can be used in conjunction either with a miniaturized telemetry system for oxygen uptake measurement or with a conventional system. The valve has a low airflow resistance, a small dead space (15 ml), and an electrically operating, closed-circuit pump to remove excess water from the expiratory tube. The external form and the buoyancy of the valve have been hydrostatically and hydrodynamically designed to reduce drag and to ensure a correct mass in the water. To obtain this result a very sophisticated material, carbon fibre, has been utilized. Our studies showed that this respiratory system is ideal for obtaining valid and reliable values of oxygen uptake during swimming, even at high speed and in endurance swimming tests.

Simultaneous recording of blood volume shifts in different vascular beds in man by a versatile scintigraphic method.

A device was developed to record the blood volume changes occurring in the lung and calf during postural changes, physical exercise, and the Valsalva maneuver in man. The changes in regional counting rates from the right middle lung and the calf mirrored the well-known changes in venous return that are expected to occur in response to the above-mentioned external stimuli. Thus a sustained decrease in lung blood volume was noted on assumption of the erect posture as well as during the forced expiration of the Valsalva maneuver. In addition a rapid increase and a sharp decrease in lung blood volume took place at the very onset and at the very end of walking, respectively. The calf blood volume declined immediately at the onset of walking, increased slightly in the ensuing two minutes, and returned to baseline quickly at the termination of walking. The authors' method enables real-time equilibrium blood pool scintigraphy to be recorded continuously and simultaneously from different districts over sustained periods of time irrespective of the posture and the physical activity performed by the patient. Their method might improve knowledge of the systemic circulatory responses to selective physiologic and therapeutic interventions in health and disease.

Blood lactate accumulation in top level swimmers following competition.

The purposes of this study were to evaluate the significance of blood lactate values after competitions and the blood lactate-swimming speed relationship to swimming performances. Auricular blood samples (N = 421) were collected in 203 top level Italian swimmers (116 males and 87 females) at the end of competitions performed in a 25 m swimming pool. The distribution of all lactate values differed between males and females. The lowest lactate values occurred in swimmers performing the longest distances both in males (1500 m) and females (800 m). In swimmers performing freestyle events a relationship between V-4 mM (swimming speed at 4 mmol/l blood lactate value) and competition velocities was observed, in males, at 200, 400 and 1500 m and, in females, at 400 and 800 m. The predicted velocity corresponding to the competition lactate value assessed by the individual blood lactate-swimming speed relationship was found to be highly related to the actual competition velocity. Results suggest that blood lactate values in swimmers are a useful indication of individual aptitudes.

Hemodynamic and clinical effects of captopril in patients with severe congestive heart failure.

In a group of 10 patients (9 male, 1 female, aged 16 to 56, mean 43 years) with severe congestive heart failure (CHF), due to ischemic heart disease (8 cases) or dilatative cardiomyopathy (2 cases), the acute hemodynamic response to captopril (CPT) (90 min after 50 mg po) was evaluated. CPT was then given starting with 15 mg q 8 hr, gradually increased within 2 or 3 days to 50 or 75 mg q 8 hr. A hemodynamic re-evaluation was performed after 20 days, and, in 5 patients, after 1 year of CPT treatment. The clinical follow-up done every 3 months in the outpatient clinic. CPT acutely produced a decrease in mean pulmonary wedge pressure: 23.8 +/- 8.9 to 18.6 +/- 8.6 mmHg, p less than 0.01, and an increase in cardiac index: 2.43 +/- 0.73 to 2.91 +/- 0.85 l/min/m2, p less than 0.01; systemic and pulmonary resistances decreased significantly, with no significant changes in heart rate and in mean brachial artery pressure. This favourable hemodynamic response persisted after 20 days of CPT treatment. In the group of 5 patients, who underwent a third hemodynamic evaluation, no statistically significant differences were demonstrated in respect to the previous control values. All patients on chronic CPT treatment experienced a gradual clinical improvement, reaching a steady state after 2 to 3 weeks; the surviving patients remained stable in the improved functional class for at least 6 months. The mortality rate was 30% in the first year, increasing to 50% in the second and to 60% in the third year of treatment. After a mean follow-up 35.7 months (range 33 to 39) the 4 surviving patients remained in the same functional class as after the first year for therapy. In our CHF patients CPT improved the quality of life, with the best clinical and hemodynamic results the first few months of treatment; life expectancy probably was not affected.