Disruptions to sleep and circadian rhythms are associated with poorer athlete mental health in female, but not male, elite Australian Rules footballers.

Elite athletes are vulnerable to sleep and circadian disruption and associated mental health symptoms. This study aimed to investigate sex differences in sleep, circadian rhythms, and mental health, as well as the moderating role of sex in the prediction of mental health, among male professional and female semi-professional elite athletes. Participants were 87 elite Australian Rules football (ARF) athletes (43% female; mean [standard deviation] age 24.0 [4.1] years). Participants completed baseline questionnaires, 2 weeks of sleep/wake monitoring via actigraphy, and a circadian phase assessment (dim-light melatonin onset [DLMO]). Cross-sectional data were collected in training-only Australian Football League (AFL) Men's and Women's pre-season periods, with 53 providing data in two pre-seasons. Female athletes, relative to males, reported poorer mental health (a higher athlete psychological strain score), had a later mid-sleep time (by 28 min), reported a greater preference towards eveningness, and displayed a later circadian phase (by 33 min). For female athletes, lower sleep efficiency and lower sleep regularity were associated with poorer mental health. For female athletes, there were U-shaped relationships between both morningness-eveningness and phase angle (interval between sleep onset and DLMO time) and mental health. No significant relationships were found for male athletes. In summary, elite female ARF athletes reported poorer mental health, relative to males, especially when experiencing sleep or circadian disruption. Lifestyle factors associated with sex differences in ARF professionalism (scheduling, finances, supports) may contribute to these findings. Programmes to improve sleep, circadian alignment, and mental health among female semi-professional elite athletes should be strongly considered.

Preconception Micronutrient Supplementation Affects Maternal BMI and Body Composition Postpartum: A Randomized Controlled Trial in Vietnam.

BACKGROUND: Although there is growing evidence on the role of preconception nutrition for birth outcomes, limited evidence exists for its effects on maternal health. OBJECTIVES: This study evaluates the impact of preconception micronutrient supplementation on maternal BMI (kg/m2) and body composition at 6 to 7 y postpartum (PP). METHODS: We followed females who participated in a randomized controlled trial of preconception supplementation in Vietnam and delivered live offspring (n = 1599). Females received weekly supplements containing either 2800 µg folic acid (FA) only, 60 mg iron and 2800 µg FA (IFA), or multiple micronutrients (MMs) (15 micronutrients including IFA) from baseline until conception followed by daily prenatal IFA supplements until delivery. Height, weight, mid-upper arm circumference, triceps skinfold, and waist-hip circumference were measured at recruitment and at 1, 2, and 6 to 7 y PP. Body fat was assessed using bioelectric impedance at 6 to 7 y PP (n = 867). Group comparisons were made using analysis of variance or chi-square tests and general linear models for adjusted models. RESULTS: At 6 to 7 y PP, we found significant differences (P < 0.05) by treatment group for mean percent fat (MM: 29.2%; IFA: 27.6%; FA: 27.8%), absolute fat mass (MM: 15.1 kg; IFA: 14.0 kg; FA: 14.3 kg), and prevalence of underweight based on BMI < 18.5 (MM: 5.8%; IFA: 10.3%; FA: 14.3%). Mean BMI and triceps skinfold thickness were higher in the MM group, but these differences were not statistically significant; the differences in absolute fat mass were also attenuated after controlling for body weight. No differences were observed for fat-free mass, prevalence of overweight (BMI >23), or other anthropometric measurements. CONCLUSIONS: Preconception MM supplementation was associated with lower prevalence of underweight and higher percent fat when compared with IFA and/or FA only. Preconception micronutrient interventions may have long-term effects on maternal health and merit further examination. This trial was registered at clinicaltrials.gov as NCT01665378.

Tibial bone strength is negatively affected by volumetric muscle loss injury to the adjacent muscle in male mice.

This study's objective was to investigate how contractile strength loss associated with a volumetric muscle loss (VML) injury affects the adjacent tibial bone structural and functional properties in male C57BL/6J mice. Mice were randomized into one of two experimental groups: VML-injured mice that were injured at age 12 weeks and aged to 20 weeks (8 weeks postinjury, VML) and 20-week-old age-matched uninjured mice (Uninjured-20). Tibial bone strength, mid-diaphysis cortical geometry, intrinsic material properties, and metaphyseal trabecular bone structure were assessed by three-point bending and microcomputed tomography (µCT). The plantar flexor muscle group (gastrocnemius, soleus, plantaris) was analyzed for its functional capacities, that is, peak-isometric torque and peak-isokinetic power. VML-injured limbs had 25% less peak-isometric torque and 31% less peak-isokinetic power compared to those of Uninjured-20 mice (p < 0.001). Ultimate load, but not stiffness, was significantly less (10%) in tibias of VML-injured limbs compared to those from Uninjured-20 (p = 0.014). µCT analyses showed cortical bone thickness was 6% less in tibias of VML-injured limbs compared to Uninjured-20 (p = 0.001). Importantly, tibial bone cross-section moment of inertia, the primary determinant of bone ultimate load, was 16% smaller in bones of VML-injured limbs compared to bones from Uninjured-20 (p = 0.046). Metaphyseal trabecular bone structure was also altered up to 23% in tibias of VML-injured limbs (p < 0.010). These changes in tibial bone structure and function after a VML injury occur during a natural maturation phase between the age of 12 and 20 weeks, as evidenced by Uninjured-20 mice having greater tibial bone size and strength compared to uninjured-aged 12-week mice.

Inadequate Lymph Node Yield: An Inadequate Indication for Adjuvant Chemotherapy in Stage II Colon Cancer.

Background: Optimal therapy for stage II colon cancer remains unclear, and national guidelines recommend "consideration" of adjuvant chemotherapy (ACT) in the presence of high-risk features, including inadequate lymph node yield (LNY, <12 nodes). This study aims to determine whether the survival benefit of ACT in stage II disease varies based on the adequacy of LNY. Methods: We used the National Cancer Database (NCDB) to identify adults who underwent resection for a single primary T3 or T4 colon cancer between 2006 and 2018. Multivariable logistic regression tested for associations between ACT and prespecified demographic and clinical characteristics, including the adequacy of LNY. We used Cox proportional hazards models to assess overall survival and restricted cubic splines to estimate the optimal LNY threshold to dichotomize patients based on overall survival. Results: Unadjusted 5- and 10-year survival rates were 84% and 75%, respectively, among patients who received ACT and 70% and 50% among patients who did not (log-rank P < 0.01). Inadequate LNY was independently associated with both receipt of ACT (odds ratios, 1.50; P < 0.01) and decreased overall survival [hazard ratio (HR), 1.56; P < 0.01]. ACT was independently associated with improved survival (HR, 0.67; P < 0.01); this effect size did not change based on the adequacy of LNY (interaction P = 0.41). Results were robust to re-analysis with our cohort-optimized threshold of 18 lymph nodes. Conclusions: Consistent with contemporary guidelines, patients with inadequate LNY are more likely to receive ACT. LNY adequacy is an independent prognostic factor but, in isolation, should not dictate whether patients receive ACT.

Greater male variability in daily energy expenditure develops through puberty.

There is considerably greater variation in metabolic rates between men than between women, in terms of basal, activity and total (daily) energy expenditure (EE). One possible explanation is that EE is associated with male sexual characteristics (which are known to vary more than other traits) such as musculature and athletic capacity. Such traits might be predicted to be most prominent during periods of adolescence and young adulthood, when sexual behaviour develops and peaks. We tested this hypothesis on a large dataset by comparing the amount of male variation and female variation in total EE, activity EE and basal EE, at different life stages, along with several morphological traits: height, fat free mass and fat mass. Total EE, and to some degree also activity EE, exhibit considerable greater male variation (GMV) in young adults, and then a decreasing GMV in progressively older individuals. Arguably, basal EE, and also morphometrics, do not exhibit this pattern. These findings suggest that single male sexual characteristics may not exhibit peak GMV in young adulthood, however total and perhaps also activity EE, associated with many morphological and physiological traits combined, do exhibit GMV most prominently during the reproductive life stages.

A Machine Learning Approach to Predict Postoperative Pancreatic Fistula After Pancreaticoduodenectomy Using Only Preoperatively Known Data.

BACKGROUND: Clinically-relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD) is a major postoperative complication and the primary determinant of surgical outcomes. However, the majority of current risk calculators utilize intraoperative and postoperative variables, limiting their utility in the preoperative setting. Therefore, we aimed to develop a user-friendly risk calculator to predict CR-POPF following PD using state-of-the-art machine learning (ML) algorithms and only preoperatively known variables. METHODS: Adult patients undergoing elective PD for non-metastatic pancreatic cancer were identified from the ACS-NSQIP targeted pancreatectomy dataset (2014-2019). The primary endpoint was development of CR-POPF (grade B or C). Secondary endpoints included discharge to facility, 30-day mortality, and a composite of overall and significant complications. Four models (logistic regression, neural network, random forest, and XGBoost) were trained, validated and a user-friendly risk calculator was then developed. RESULTS: Of the 8666 patients who underwent elective PD, 13% (n = 1160) developed CR-POPF. XGBoost was the best performing model (AUC = 0.72), and the top five preoperative variables associated with CR-POPF were non-adenocarcinoma histology, lack of neoadjuvant chemotherapy, pancreatic duct size less than 3 mm, higher BMI, and higher preoperative serum creatinine. Model performance for 30-day mortality, discharge to a facility, and overall and significant complications ranged from AUC 0.62-0.78. CONCLUSIONS: In this study, we developed and validated an ML model using only preoperatively known variables to predict CR-POPF following PD. The risk calculator can be used in the preoperative setting to inform clinical decision-making and patient counseling.

Matters of Frequency, Immediacy and Regularity: Engagement in an Online Asynchronous Course.

Many models of online student engagement posit a "more is better" relationship between students' course-related actions and their engagement. However, recent research indicates that the timing of engagement is also an important consideration. In addition to the frequency (how often) of engagement, two other constructs of timing were explored in this study: immediacy (how early) and regularity (in what ordered pattern). These indicators of engagement were applied to three learning assessment types used in an online, undergraduate, competency-based, technology skills course. The study employed advanced data collection and learning analytics techniques to collect continuous behavioral data over seven semesters (n = 438). Results revealed that several indicators of engagement predicted academic success, but significance differed by assessment type. "More" is not always better, as some highly engaged students earn lower grades. Successful students tended to engage earlier with lessons regardless of assessment type.

Resected Tumor Outcome and Recurrence (RESTORE) Index for Hepatocellular Carcinoma Recurrence after Resection.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the fourth most common cause of cancer-related death worldwide [...].

An evaluation of nutrition, culinary, and production interventions using African indigenous vegetables on nutrition security among smallholder farmers in Western Kenya.

Introduction: Nutrition security continues to worsen in sub-Saharan Africa. Current research is limited on how seasonality may influence the impact of nutrition, culinary, and production interventions on food security, diet quality, and consumption of African Indigenous Vegetables (AIV); a culturally accepted source of micro-and-macronutrients that are easily produced due to their adaptation to the local environment. The objective of this study was to evaluate the programmatic impact of AIV interventions on nutrition security among smallholder farmers. Methods: In a randomized control trial, five target counties in Western Kenya were randomly assigned to one of four treatments: (1) control; (2) production intervention (PI); (3) nutrition and culinary intervention (NCI); and (4) NCI and PI (NCI/PI). After the counties were randomly assigned to a treatment, 503 smallholder farmers (18-65 years) were selected from participatory farmer groups. The PI consisted of five agricultural production modules delivered between 2016 and 2019. The NCI was delivered twice: (1) household nutrition education (2017) and (2) community culinary training (2019). The NCI/PI included communities receiving both interventions at these time periods. Baseline and endline surveys were administered to all participants once in October 2016 (harvest season) and to all available participants (n = 250) once in June to July 2019 (dry season), respectively. The impact evaluation was analyzed by Household Hunger Scale (HHS), Women's Dietary Diversity Score (WDDS), AIV consumption frequency, and AIV market availability. Statistical tests included descriptive statistics (means and frequencies), paired t-test, McNemar's test, Wilcoxon Signed-Rank test, ANOVA test with Tukey post hoc, and χ2 test. Open-ended questions were aggregated, and responses were selected based on relevancy and thoroughness of the response to provide context to the quantitative data. A value of p < 0.05 was used to denote statistical significance. Results: There was an overall decrease in WDDS, HHS, and consumption frequency between baseline and endline attributed to seasonal differences. Despite this, post-intervention, households that received NCI/PI had a higher WDDS relative to the control: WDDS 5.1 ± 1.8 vs. 4.2 ± 1.5, p = 0.035. In addition, between baseline and endline, there was an overall increase in the percentage of respondents that reported an adequate supply of key AIVs, particularly for households that received PI. Furthermore, seasonal effects caused a reported shift in the primary location for purchasing AIVs from the village to the town market. There was no reported difference in HHS. While "diet awareness" significantly influenced diet quality among the NCI treatment group, "production" was reported to have the greatest influence on diet quality among all intervention groups. Discussion: The findings revealed that coupled nutrition, culinary, and production interventions could create a protective effect against seasonal fluctuations in the availability and affordability of AIV as evidenced by a higher WDDs. Conclusion and Recommendations: These findings suggest that future programming and policy should focus on promoting the availability, accessibility, acceptability, and affordability of improved agronomic practices and germplasm for both smallholder farmers with particular emphasis on AIV varieties that contain high levels of micro-and macronutrients, improved agronomic characteristics (e.g., delayed flowering, multiple harvests, higher yields, and disease resistance), and are aligned with the communities' cultural preferences. In addition, agricultural training and extension services should incorporate nutrition and culinary interventions that emphasize the importance of farmers prioritizing harvests for their household consumption.

Response of terminal Schwann cells following volumetric muscle loss injury.

An often-overlooked component of traumatic skeletal muscle injuries is the impact on the nervous system and resultant innervation of the affected muscles. Recent work in a rodent model of volumetric muscle loss (VML) injury demonstrated a progressive, secondary loss of neuromuscular junction (NMJ) innervation, supporting a role of NMJ dysregulation in chronic functional deficits. Terminal Schwann cells (tSCs) are known to be vital for the maintenance of NMJ structure and function, in addition to guiding repair and regeneration after injury. However, the tSC response to a traumatic muscle injury such as VML is not known. Thus, a study was conducted to investigate the effect of VML on tSC morphological characteristics and neurotrophic signaling proteins in adult male Lewis rats that underwent VML injury to the tibialis anterior muscle using a temporal design with outcome assessments at 3, 7, 14, 21, and 48 days post-injury. The following salient observations were made; first, although there is a loss of innervation over time, the number of tSCs per NMJ increases, significantly so at 48 days post-injury compared to control. The degree of NMJ fragmentation was positively correlated with tSC number after injury. Moreover, neurotrophic factors such as NRG1 and BDNF are elevated after injury through at least 48 days. These results were unanticipated and in contrast to neurodegenerative disease models, in which there is a reduction in tSC number that precedes denervation. However, we found that while there are more tSCs per NMJ after injury, they cover a significantly smaller percent of the post-synaptic endplate area compared to control. These findings support a sustained increase in neurotrophic activity and tSC number after VML, which is a maladaptive response occurring in parallel to other aspects of the VML injury, such as over-accumulation of collagen and aberrant inflammatory signaling.

Total daily energy expenditure has declined over the past three decades due to declining basal expenditure, not reduced activity expenditure.

Obesity is caused by a prolonged positive energy balance1,2. Whether reduced energy expenditure stemming from reduced activity levels contributes is debated3,4. Here we show that in both sexes, total energy expenditure (TEE) adjusted for body composition and age declined since the late 1980s, while adjusted activity energy expenditure increased over time. We use the International Atomic Energy Agency Doubly Labelled Water database on energy expenditure of adults in the United States and Europe (n = 4,799) to explore patterns in total (TEE: n = 4,799), basal (BEE: n = 1,432) and physical activity energy expenditure (n = 1,432) over time. In males, adjusted BEE decreased significantly, but in females this did not reach significance. A larger dataset of basal metabolic rate (equivalent to BEE) measurements of 9,912 adults across 163 studies spanning 100 years replicates the decline in BEE in both sexes. We conclude that increasing obesity in the United States/Europe has probably not been fuelled by reduced physical activity leading to lowered TEE. We identify here a decline in adjusted BEE as a previously unrecognized factor.

Cognitive fitness modulates gender differences in sleep and mental health among competitive athletes under chronic stress.

Objectives: Mental fitness is increasingly considered a key component of an athlete's competitive arsenal. Active domains of mental fitness include cognitive fitness, sleep, and mental health; and these domains can differ between men and women athletes. Our study investigated the associations of cognitive fitness and gender to sleep and mental health, and the interaction between cognitive fitness and gender on sleep and mental health, in competitive athletes during the COVID-19 pandemic. Methods: 82 athletes competing at levels from regional/state to international (49% women, M-age = 23.3 years) completed measures of self-control, intolerance of uncertainty, and impulsivity (together representing constructs of cognitive fitness), items about sleep (total sleep time, sleep latency, and mid-sleep time on free days) and a measure of mental health (depression, anxiety, and stress). Results: Women athletes reported lower self-control, higher intolerance of uncertainty, and higher positive urgency impulsivity compared with men athletes. Women reported sleeping later, but this gender difference disappeared after controlling for cognitive fitness. Women athletes-after controlling for cognitive fitness-reported higher depression, anxiety, and stress. Across genders, higher self-control was associated with lower depression, and lower intolerance of uncertainty was associated with lower anxiety. Higher sensation seeking was associated with lower depression and stress, and higher premeditation was associated with greater total sleep time and anxiety. Higher perseverance was associated with higher depression for men-but not women-athletes. Conclusion: Women athletes in our sample reported poorer cognitive fitness and mental health compared to men athletes. Most cognitive fitness factors protected competitive athletes under chronic stress, but some exposed them to poorer mental health. Future work should examine the sources of gender differences. Our findings suggest a need to develop tailored interventions aimed at improving athlete wellbeing, with a particular focus on women athletes.

Minimally Invasive Versus Open Liver Resections for Hepatocellular Carcinoma in Patients With Metabolic Syndrome.

OBJECTIVE: To compare minimally invasive (MILR) and open liver resections (OLRs) for hepatocellular carcinoma (HCC) in patients with metabolic syndrome (MS). BACKGROUND: Liver resections for HCC on MS are associated with high perioperative morbidity and mortality. No data on the minimally invasive approach in this setting exist. MATERIAL AND METHODS: A multicenter study involving 24 institutions was conducted. Propensity scores were calculated, and inverse probability weighting was used to weight comparisons. Short-term and long-term outcomes were investigated. RESULTS: A total of 996 patients were included: 580 in OLR and 416 in MILR. After weighing, groups were well matched. Blood loss was similar between groups (OLR 275.9±3.1 vs MILR 226±4.0, P =0.146). There were no significant differences in 90-day morbidity (38.9% vs 31.9% OLRs and MILRs, P =0.08) and mortality (2.4% vs 2.2% OLRs and MILRs, P =0.84). MILRs were associated with lower rates of major complications (9.3% vs 15.3%, P =0.015), posthepatectomy liver failure (0.6% vs 4.3%, P =0.008), and bile leaks (2.2% vs 6.4%, P =0.003); ascites was significantly lower at postoperative day 1 (2.7% vs 8.1%, P =0.002) and day 3 (3.1% vs 11.4%, P <0.001); hospital stay was significantly shorter (5.8±1.9 vs 7.5±1.7, P <0.001). There was no significant difference in overall survival and disease-free survival. CONCLUSIONS: MILR for HCC on MS is associated with equivalent perioperative and oncological outcomes to OLRs. Fewer major complications, posthepatectomy liver failures, ascites, and bile leaks can be obtained, with a shorter hospital stay. The combination of lower short-term severe morbidity and equivalent oncologic outcomes favor MILR for MS when feasible.

Medial Gastrocnemius Muscle Properties of Children With Cerebral Palsy After Different Tone Treatments: A Pilot Study.

OBJECTIVE: Spasticity in children with cerebral palsy can be managed by a spectrum of approaches, from conservative therapy, to temporary botulinum toxin A injections, to permanent transection of sensory nerves with a selective dorsal rhizotomy. This pilot study investigated whether these three tone management approaches are associated with histological and biochemical properties of the medial gastrocnemius. DESIGN: A convenience sample of children with cerebral palsy undergoing gastrocnemius lengthening surgery was enrolled. Intraoperative biopsies were obtained from three individuals (one each: minimal tone treatment; frequent gastrocnemius botulinum toxin A injections; previous selective dorsal rhizotomy). All individuals had plantarflexor contractures, weakness, and impaired motor control before the biopsy. RESULTS: Differences between participants were observed for muscle fiber cross-sectional area, fiber type, lipid content, satellite cell density, and centrally located nuclei. The most pronounced difference was the abundance of centrally located nuclei in the botulinum toxin A participants (52%) compared with the others (3-5%). Capillary density, collagen area and content, and muscle protein content were similar across participants. CONCLUSIONS: Several muscle properties seemed to deviate from reported norms, although age- and muscle-specific references are sparse. Prospective studies are necessary to distinguish cause and effect and to refine the risks and benefits of these treatment options.

Model to predict major complications following liver resection for HCC in patients with metabolic syndrome.

BACKGROUND: Metabolic syndrome (MS) is rapidly growing as risk factor for HCC. Liver resection for HCC in patients with MS is associated with increased postoperative risks. There are no data on factors associated with postoperative complications. AIMS: The aim was to identify risk factors and develop and validate a model for postoperative major morbidity after liver resection for HCC in patients with MS, using a large multicentric Western cohort. MATERIALS AND METHODS: The univariable logistic regression analysis was applied to select predictive factors for 90 days major morbidity. The model was built on the multivariable regression and presented as a nomogram. Performance was evaluated by internal validation through the bootstrap method. The predictive discrimination was assessed through the concordance index. RESULTS: A total of 1087 patients were gathered from 24 centers between 2001 and 2021. Four hundred and eighty-four patients (45.2%) were obese. Most liver resections were performed using an open approach (59.1%), and 743 (68.3%) underwent minor hepatectomies. Three hundred and seventy-six patients (34.6%) developed postoperative complications, with 13.8% major morbidity and 2.9% mortality rates. Seven hundred and thirteen patients had complete data and were included in the prediction model. The model identified obesity, diabetes, ischemic heart disease, portal hypertension, open approach, major hepatectomy, and changes in the nontumoral parenchyma as risk factors for major morbidity. The model demonstrated an AUC of 72.8% (95% CI: 67.2%-78.2%) ( https://childb.shinyapps.io/NomogramMajorMorbidity90days/ ). CONCLUSIONS: Patients undergoing liver resection for HCC and MS are at high risk of postoperative major complications and death. Careful patient selection, considering baseline characteristics, liver function, and type of surgery, is key to achieving optimal outcomes.