Rotational Thromboelastometry as a Diagnostic Tool for Persistent Infection in Two-Stage Exchange Arthroplasty.

Background/Objectives: There is a lack of reliable biomarkers for diagnosis of infection eradication prior to second-stage reimplantation in two-stage exchange arthroplasty for periprosthetic joint infections (PJIs). The aim of this study was to assess the diagnostic accuracy of rotational thromboelastometry (ROTEM) for persistent infection in two-stage exchange arthroplasties. Methods: A pilot, retrospective analysis was performed including 70 patients who underwent a two-stage exchange arthroplasty for PJI. They were categorized as patients without (n = 64) or patients with persistent infection (n = 6) prior to reimplantation. Definition of persistent infection prior to reimplantation was based on the 2018 ICM criteria. Conventional coagulation biomarkers and ROTEM parameters were compared between groups. Results: Higher FIBTEM MCF values were associated with persistent infection (odds ratio [OR], 1.30, 95% confidence interval [CI], 1.04-1.63; p = 0.020), and FIBTEM MCF had the highest diagnostic accuracy for persistent infection prior to second-stage reimplantation (AUC, 0.907; 95% CI, 0.812-1.000). A cut-off value ≥ 18 mm for FIBTEM MCF was found to have 100.0% sensitivity and 73.4% specificity for diagnosing persistent infection prior to second-stage reimplantation. Moreover, the diagnostic accuracy of FIBTEM MCF was higher than that of fibrinogen levels (p = 0.036) and D-dimer (p = 0.006). Conclusions: Our findings indicate that ROTEM parameters have the potential to identify persistent infections before reimplantation in two-stage exchange arthroplasties for PJI. Such coagulation biomarkers could provide guidance regarding the optimal timing for reimplantation. Further studies in larger populations are warranted to validate the diagnostic accuracy of ROTEM parameters for persistent PJI.

Excessive Knee Internal Rotation during Grand Plié in Classical Ballet Female Dancers.

Classical ballet dancers are exposed daily to physically demanding movements. Among these, the Grand Plié stands out for its biomechanical complexity, particularly the stress applied to the knee joint. This study investigates the knee kinematics of healthy professional classical ballet dancers performing the Grand Plié. Twenty dancers were evaluated with a motion analysis system using a marker-based protocol. Before measurements, the self-reported Global Knee Functional Assessment Scale was delivered for the knees' functional ability, and the passive range of knee motion was also assessed. The average score on the Global Knee Functional Assessment Scale was 94.65 ± 5.92. During a complete circle of the Grand Plié movement, executed from the upright position, the average maximum internal rotation of the knee joint was 30.28° ± 6.16°, with a simultaneous knee flexion of 134.98° ± 4.62°. This internal rotation observed during knee flexion exceeds the typical range of motion for the joint, suggesting a potential risk for knee injuries, such as meniscal tears. The findings provide an opportunity for future kinematic analysis research, focusing on the movement of the Grand Plié and other common ballet maneuvers. These data have the potential to yield valuable information about the knee kinematics concerning meniscus damage.

Preliminary Insights into the Diagnostic Accuracy of the Modified Arm Care Screen Test for Overhead Athletes: An On-Field Tool for Injury Prevention.

BACKGROUND: The Arm Care Screen was developed to detect musculoskeletal limitations that could affect performance or even increase the risk for shoulder injuries in overhead athletes. This study aimed to assess the discriminant validity of the modified Arm Care Screen in overhead athletes. METHODS: Sixty-two overhead athletes (mean age: 24.5 ± 4.2 years) were recruited. The athletes underwent a comprehensive Arm Care Screen evaluation, including reciprocal shoulder mobility, total body rotation, lower body diagonal reach, and rotary stability assessments. Ten different musculoskeletal measurements were independently measured by two physical therapists. RESULTS: The modified Arm Care Screen showed moderate to strong associations (phi values ranged from 0.273 to 0.905) with the respective musculoskeletal range of motion and balance measurements. Sensitivity ranged from 81.25% to 88.57%, indicating a high true positive rate, and specificity ranged from 43.75% to 94.44%, indicating a moderate to strong positive rate. Positive and negative likelihood ratios ranged from 1.48 to 15.92 and 0.12 to 0.38, respectively. The positive and negative predictive value ranged from 58.14% to 92% and from 73.68% to 93.18%, respectively. The accuracy of the modified ACS ranged from 62.90% to 91.94%. CONCLUSION: The modified Arm Care Screen demonstrated promising diagnostic accuracy in identifying significant movement restrictions.

Patellar Dislocation: Workup and Decision-Making.

Acute patellar dislocation (PD) is usually a problem of adolescents and young adults. In most cases, it is a sports-related injury. It is the result of an indirect force on the knee joint, which leads to valgus and external rotation of the tibia relative to the femur. PD is unlikely to occur on a knee with normal patellofemoral joint (PFJ) anatomy. Acute PD consists of an acute injury of the ligamentous medial patellar stabilizers in the background of factors predisposing to patellar instability. These factors are classified into three groups. The first group refers to the integrity of the ligamentous medial patellar restraints, particularly, the medial patellofemoral ligament (MPFL). The second group refers to an abnormal PFJ anatomy, which renders the patella inherently unstable inside the trochlea. The third group refers to the overall axial and torsional profile of the lower limb and to systemic factors, such as ligament laxity and neuromuscular coordination of movement. PD at a younger age is associated with an increased number and severity of patellar instability predisposing factors and lower stress to dislocate the patella. Acute primary PD is usually treated conservatively, while surgical treatment is reserved for recurrent PD. The aim of treatment is to restore the stability and function of the PFJ and to reduce the risk of patellar redislocation. Surgical procedures to treat patellar instability are classified into non-anatomic and anatomic procedures. Non-anatomic procedures are extensor mechanism realignment techniques that aim to center the patella into the trochlear groove. Anatomic procedures aim to restore the PFJ anatomy (ruptured ligaments, osteochondral fractures), which has been severed after the first incident of PD. Anatomic procedures, especially MPFL reconstruction, are more effective in preventing recurrent PD, compared with non-anatomic techniques. Theoretically, all factors that affect PFJ stability should be evaluated and, if possible, addressed. This is practically impossible. Considering that the MPFL ruptures in almost all PDs, MPFL reconstruction is the primary procedure, which is currently selected by most surgeons as a first-line treatment for patients with recurrent PD. Restoration of the axial and torsional alignment of the lower limbs is also increasingly implemented by surgeons. Non-anatomic surgical techniques, such as tibial-tuberosity osteotomy, are used as an adjunct to anatomic procedures. In the presence of multiple PFJ instability factors, acute MPFL reconstruction may be the treatment of choice for acute primary PD as well. Skeletal immaturity of the patient precludes osseous procedures to avoid premature physis closure and subsequent limb deformity. Unfortunately, restoration of the patient's previous activity level or participation in more strenuous sports is questionable and not easy to predict. In the case of competitive athletes, PD may prevent participation in elite levels of sports.

A Pilot Observational Study Evaluating the Diagnostic Capacity of Rotational Thromboelastometry in Periprosthetic Joint Infections.

BACKGROUND: Periprosthetic joint infections (PJIs) are associated with altered hemostatic dynamics; therefore, coagulation laboratory methods such as rotational thromboelastometry (ROTEM) may be valuable in their diagnosis. The aim of this study was to evaluate the diagnostic role of ROTEM in PJI. METHODS: A diagnostic study was conducted including 65 patients who underwent revision total hip arthroplasty or total knee arthroplasty due to PJI (30 patients) or aseptic loosening (35 patients). Preoperative laboratory evaluation included conventional coagulation studies, inflammatory markers, and ROTEM analysis. These parameters were compared between patients with PJI and patients with aseptic loosening. RESULTS: Several ROTEM parameters differed in the patients with PJI, indicating a higher coagulation potential associated with PJI. Specifically, the development of PJI was associated with higher EXTEM maximum clot firmness (MCF) (odds ratio [OR], 1.12 [95% confidence interval (CI), 1.04 to 1.20]; p = 0.001). Among the ROTEM parameters, EXTEM MCF was found to have the highest diagnostic accuracy for PJI (area under the receiver operating characteristic curve, 0.850; sensitivity, 76.6%; specificity, 91.4%), which was comparable with C-reactive protein (CRP) (p = 0.22) and erythrocyte sedimentation rate (ESR) (p = 0.65), but higher than D-dimer (p = 0.037). Moreover, the combined diagnostic accuracy of elevated EXTEM MCF and CRP was improved compared with CRP alone (p = 0.019). CONCLUSIONS: Our results indicate that ROTEM analysis might be helpful for the detection of the hemostatic derangements that are associated with the development of PJI. However, because of the small size of this pilot study, further research is needed to investigate the value of incorporating viscoelastic studies in diagnostic scores for PJI. LEVEL OF EVIDENCE: Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Delayed Effect of Dry-Land Strength Training Sessions on Swimming Performance.

The purpose of the study was to examine the effects of dry-land strength endurance (SE) and maximum strength (MS) sessions on next-day swimming performance. Eight swimmers (age: 18.6 ± 2.9 years) performed evening training sessions (19:00-19:40), including: (i) SE (2 × 15 - 20 repetitions, 50% of 1-RM), (ii) MS (2 × 5 repetitions, 90% of 1-RM), (iii) control (CON: no dry-land training). All sessions were followed by a 90-min swimming training (20:00-21:30). Medicine ball throw and countermovement jump, free countermovement jump and squat jump were evaluated before and after the dry-land training session and 12 h later, before a 100-m front crawl sprint (next day at 8:30 a.m.). Performance time, RPE, blood lactate and biomechanical variables in 100-m sprint were no different between conditions (time, MS: 64.70 ± 7.35, SE: 63.81 ± 7.29, CON: 64.52 ± 7.71 s, p > 0.05). Jump height was not changed before and after dry-land and before the 100-m sprint in all conditions (p > 0.05). Medicine ball throw was lower in MS compared to CON before the 100-m sprint (MS: 4.44 ± 1.11, vs. CON: 4.66 ± 1.21 m, p < 0.05). Upper-body but not lower- body muscle function may be affected by MS training. However, performance in a 100-m test is not affected by dry-land training performed 12 h earlier.

Pre- and Postoperative Exercise Effectiveness in Mobility, Hemostatic Balance, and Prognostic Biomarkers in Hip Fracture Patients: A Study Protocol for a Randomized Controlled Trial.

Hip fractures are a major health concern, particularly for older adults, as they can reduce life quality, mobility loss, and even death. Current evidence reveals that early intervention is recommended for endurance in patients with hip fractures. To our knowledge, preoperative exercise intervention in patients with hip fractures remains poorly researched, and no study has yet applied aerobic exercise preoperatively. This study aims to investigate the short-term benefits of a supervised preoperative aerobic moderate-intensity interval training (MIIT) program and the added effect of an 8-week postoperative MIIT aerobic exercise program with a portable upper extremity cycle ergometer. The work-to-recovery ratio will be 1-to-1, consisting of 120 s for each bout and four and eight rounds for the pre- and postoperative programs, respectively. The preoperative program will be delivered twice a day. A parallel group, single-blinded, randomized controlled trial (RCT) was planned to be conducted with 58 patients each in the intervention and control groups. This study has two primary purposes. First, to study the effect of a preoperative aerobic exercise program with a portable upper extremity cycle ergometer on immediate postoperative mobility. Second, to investigate the additional effect of an 8-week postoperative aerobic exercise program with a portable upper extremity cycle ergometer on the walking distance at eight weeks after surgery. This study also has several secondary objectives, such as ameliorating surgical and keeping hemostatic balance throughout exercise. This study may expand our knowledge of preoperative exercise effectiveness in hip fracture patients and enhance the current literature about early intervention benefits.

Knee Arthrodesis with a Modular Silver-Coated Endoprosthesis for Infected Total Knee Arthroplasty with Extensive Bone Loss: A Retrospective Case-Series Study.

INTRODUCTION: Knee arthrodesis is a limb salvage intervention for persistent periprosthetic joint infection (PJI) when revision total knee arthroplasty fails. Conventional arthrodesis techniques are associated with the increased rate of complications, especially in patients with extensive bone loss and extensor tendon deficiency. METHODS: Eight patients with a modular silver-coated arthrodesis implant after failed exchange arthroplasty for infection, were retrospectively reviewed. All patients had significant bone loss, while 5 displayed extensor tendon deficiency. Survivorship, complications, leg length discrepancy, median Visual Analogue Scale (VAS) and Oxford Knee score (OKS) were evaluated. RESULTS: The median follow up was 32 months (range 24-59 months). The survivorship rate of the prosthesis was 86% during the minimum time of follow up of 24 months. In one patient recurrence of the infection was observed and above-knee amputation was performed. The median postoperative leg length discrepancy was 2.07 ± 0.67 cm. Patients were able to ambulate with mild or no pain. The median VAS and OKS was 2.14 ± 0.9 and 34.7 ± 9.3, respectively. CONCLUSIONS: The results of our study demonstrated that knee arthrodesis with a silver coated arthrodesis implant, performed for persistent PJI in patients with significant bone loss and extensor tendon deficit, provided a stable construct, allowed eradication of infection and was associated with good functional outcome.

The science of child and adolescent mental health in Greece: a nationwide systematic review.

Evidence-based information is essential for effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a systematic review of scientific evidence on child and adolescent mental health in Greece encompassing three research topics: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality were ascertained using validated tools. This review was registered in protocols.io [68583]. We included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics was compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource online [ https://rpubs.com/camhi/sysrev_table ]. Scientific evidence on child and adolescent mental health in Greece has now been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policymaking in Greece and may encourage similar assessments in other countries.

The Acute and Chronic Effects of Resistance and Aerobic Exercise in Hemostatic Balance: A Brief Review.

Hemostatic balance refers to the dynamic balance between blood clot formation (coagulation), blood clot dissolution (fibrinolysis), anticoagulation, and innate immunity. Although regular habitual exercise may lower the incidence of cardiovascular diseases (CVD) by improving an individual's hemostatic profile at rest and during exertion, vigorous exercise may increase the risk of sudden cardiac death and venous thromboembolism (VTE). This literature review aims to investigate the hemostatic system's acute and chronic adaptive responses to different types of exercise in healthy and patient populations. Compared to athletes, sedentary healthy individuals demonstrate similar post-exercise responses in platelet function and coagulatory and fibrinolytic potential. However, hemostatic adaptations of patients with chronic diseases in regular training is a promising field. Despite the increased risk of thrombotic events during an acute bout of vigorous exercise, regular exposure to high-intensity exercise might desensitize exercise-induced platelet aggregation, moderate coagulatory parameters, and up-regulate fibrinolytic potential via increasing tissue plasminogen activator (tPA) and decreasing plasminogen activator inhibitor (PAI-1) response. Future research might focus on combining different types of exercise, manipulating each training characteristic (frequency, intensity, time, and volume), or investigating the minimal exercise dosage required to maintain hemostatic balance, especially in patients with various health conditions.

Lumbar Kinematics Assessment of Patients with Chronic Low Back Pain in Three Bridge Tests Using Miniaturized Sensors.

Lumbar muscle atrophy, diminished strength, stamina, and increased fatigability have been associated with chronic nonspecific low back pain (LBP). When evaluating patients with LBP, trunk or core stability, provided by the performance and coordination of trunk muscles, appears to be essential. Several clinical tests have been developed to identify deficiencies in trunk performance, demonstrating high levels of validity and reproducibility. The most frequently prescribed tests for assessing the core body muscles are the prone plank bridge test (PBT), the side bridge test (SBT), and the supine bridge test (SUBT). However, quantitative assessments of the kinematics of the lumbar spine during their execution have not yet been conducted. The purpose of our study was to provide objective biomechanical data for the assessment of LBP patients. The lumbar spine ranges of motion of 22 healthy subjects (Group A) and 25 patients diagnosed with chronic LBP (Group B) were measured using two inertial measurement units during the execution of the PBT, SUBT, and SBT. Statistically significant differences between the two groups were found in all three tests' kinematic patterns. This quantitative assessment of lumbar spine motion transforms the three bridge tests into an objective biomechanical diagnostic tool for LPBs that may be used to assess the efficacy of applied rehabilitation programs.

Fibrinolysis shutdown and elevated D-dimer levels have high prognostic capacity for postoperative thromboembolic complications in patients with bone tumors.

Surgical resection of malignant bone tumors is associated with a high risk of venous thromboembolism (VTE). The purpose of this study was to evaluate the association between rotational thromboelastometry (ROTEM) parameters and VTE following oncologic resections, and to evaluate their prognostic capacity for this complication. A prospective observational study was conducted including 113 patients who underwent surgical resection of malignant bone tumors. ROTEM analysis and conventional coagulation studies were performed preoperatively and on the 2nd postoperative day, while patients were followed for the development of VTE. Logistic regression was used to assess the association between ROTEM parameters and occurrence of VTE. The area under the receiver operating characteristic curve (AUC), sensitivity and specificity were calculated as measures of discrimination and predictive accuracy. Fourteen patients (12.4%) developed symptomatic VTE. Development of VTE was associated with shortened INTEM CFT (Odds Ratio [OR] 0.90, 95% Confidence Interval [CI] 0.84 - 0.96, p = 0.004), higher INTEM A10 (OR 1.21, 95% CI 1.07 - 1.36, p = 0.002), higher INTEM MCF (OR 1.22, 95% CI 1.08 - 1.37, p = 0.001) and higher INTEM LI60 (OR 2.10, 95% CI 1.38 - 3.21, p = 0.001). An INTEM LI60 value indicative of fibrinolysis shutdown (≥ 98%) had the best predictive accuracy for VTE (AUC = 0.887, 95% CI 0.824 - 0.951, sensitivity = 100%, specificity = 67.0%), higher than that of D-dimer levels (p = 0.028). ROTEM parameters were promising predictors of symptomatic VTE. Fibrinolysis shutdown as reflected by ROTEM LI60 and high D-dimer levels can aid the identification of high-risk patients. Future studies should evaluate whether the addition of ROTEM findings to an expanded risk-assessing model can improve the predictive capacity and provide better guidance in thromboprophylaxis.

Practices and educational needs of Hellenic Police Officers in providing first aid/cardiopulmonary resuscitation: A cross-sectional survey.

BACKGROUND: It is well known that police officers (POs) are expected to be the first responders in emergency cases requiring First Aid (FA) such as cardiac arrest. OBJECTIVE: Description of practices and educational needs of Hellenic POs in providing FA/Cardiopulmonary Resuscitation (CPR) in case of medical emergencies and description of the equipment of professional FA kit. METHODS: An anonymous cross-sectional survey was conducted from January 1, 2016, to December 31, 2017, using a self-administered questionnaire designed to serve the purposes of this particular survey. The instrument consisted of 53 questions (multiple choice and open-ended questions) administered in a convenience sample of 700 POs of the Attica prefecture. RESULTS: A sample of 520 POs (constables and lieutenants) completed the questionnaire (response rate = 74.28%). Among the participants, 248 (47.7 %) declared that they had provided FA/CPR in the past, while among those declaring that they had never provided FA/PCR (n = 248), 153 (61.7%) said that they had experienced FA/CPR needs, but did not know what they had to do. Moreover, only 18.1% (94/520) of the POs answered that they have FA equipment in their professional equipment, which mainly includes bandages (54/94, 57.4%), while 29.7% of POs provided answers about their educational needs (313 in total) declared that they would like to be educated in bleeding control. CONCLUSION: There is a need to educate and train Greek POs in first aid and CPR in an organized and mandatory way in order to meet emergency needs.

The effect of gender, age and sports specialisation on isometric trunk strength in Greek high level young athletes.

Aim of the study was to compare the isometric strength of flexors and extensors trunk muscles between male and female elite adolescent athletes of different age and training experience. Absolute and relative trunk muscle isometric peak extension (PTE) and flexion (PTF) torque, as well as flexion/extension (F/E) ratio were evaluated in 388 elite adolescent athletes 188 males (Age: 15.4±1.8 years, Body height: 175.5±11.2 cm, Body mass: 68.8±14.5 kg, BMI: 22.1±0.3 kg/m2) and 207 females (Age: 15.1±1.6 years, Body height: 166.8±7.8 cm, Body mass: 60.8±8.4 kg and BMI: 21.8±0.4 kg/m2). Participants were assigned into seven different groups according to their sport specialisation (oars-paddle, swimming, contact-combat, team, racket, winter and mixed other sports). Significant effect of age (η2: 0.077-0.112, p < 0.05), gender (η2: 0.020-0.077; p < 0.05) and sport category factors (η2: 0.057-0.154. p < 0.005) for absolute/relative PTE, PTF and F/E ratio was found. The highest values were observed in contact-combat and the lowest in mixed other sports groups. F/E ratio significantly differs between the age groups, especially in female athletes. The present data suggest that TMSs and F/E ratio are highly affected by age, gender and sports specialisation in high level trained adolescents.

Effect of a home-based exercise training program on anthropometric characteristics and exercise performance during Covid-19 quarantine in young high-level kayak athletes.

Purpose: The Covid-19 restriction exposed most athletes to insufficient training stimuli leading to detraining. This study investigated whether a home-based exercise training program could preserve body composition and exercise performance in young high-level kayak athletes during Covid-19 restriction. Methods: Seventeen healthy young high-level kayak athletes (10 males and 7 females), aged 14.7 ± 1 yrs, participated in this study. A 7-week home-based training program was followed during Covid-19 restriction. Baseline measurements were assessed 4 weeks before Covid-19 pandemic and ended on 4 May 2020. Body composition, flexibility, isometric muscle trunk strength (Biodex), anaerobic power (30-s all-out trial), and aerobic capacity (4-min maximal test) were evaluated. Personal daily loads and wellness details were collected with AthleteMonitoring.com software. Results: Home-based exercise training program was effective to improve flexibility (9.20 ± 2.85%) and lean body mass (3.96 ± 0.89%), to maintain muscle strength, anaerobic power, body mass, and body fat percentage but insufficient to maintain aerobic capacity (- 8.96 ± 2.49%). Conclusion: The findings of the present study potentially highlight the importance of the implementation of such a program to minimize the detraining effect on young athletes during periods of movement restriction caused by pandemics.

Unraveling the "golden ratio": a pilot study investigating acute-to-chronic workload ratio in breast cancer patients undergoing active treatment.

Training load monitoring is a common practice in sports medicine for supporting athletes' health and performance. Despite progress in exercise oncology research for breast cancer patients, training load monitoring is underutilized. This study retrospectively investigated the relationship between maintained training load within a defined range and physical and health outcomes of ten breast cancer patients during active anticancer treatment who underwent a 12-week exercise program. Intervention consisted of endurance and resistance training, three times a week, with each session lasting 30-45 min. Assessments were conducted at baseline, 6 and 12 weeks after enrollment, evaluating physical function (6-min walk test-6MWT, and sit-to-stand), muscle strength, body composition, sleep quality (Pittsburgh Sleep Quality Index-Pittsburgh Sleep Quality Index), quality of life (EORTC-QLQ-C30), heart rate variability and physical activity levels (International Physical Activity Questionnaire-International Physical Activity Questionnaire). The Physiological Cost Index/Energy Expenditure Index (PCI/EEI) was estimated using the 6MWT and Heart rate. Training load monitoring was performed by session rating of perceived exertion (sRPE, relative intensity multiplying with session duration). Acute-to-Chronic Workload Ratio (ACWR) (7:28, rolling average) was calculated accordingly. Analyses were performed within-subjects across time points and between-subjects, comparing those who maintained from weeks 6-12 an ACWR of 0.8-1.3 with those who did not. Adherence rates were similar between groups. Physical function improved in the total sample with large effect sizes (Δ6MWT = 56.5 m [95%CI: 6-100 m], effect size [w] = 0.52, p = 0.006; ΔSit-to-Stand = 1.5 [95%CI: 1-5], effect size [w] = 0.681, p < 0.001), demonstrating greater changes in patients with higher ACWR. Sleep quality improvements were higher in the appropriate ACWR group (p = 0.016). A positive correlation was demonstrated between global health status and 6MWT change from baseline to 12 weeks (ρ = 0.689, p = 0.04). Despite a small sample size, patients maintaining sufficient relative training load presented greater physical fitness and sleep quality improvements. Thus, training load monitoring may enhance exercise program benefits in breast cancer patients under active treatment.

The Correlation Between the Strength of the Shoulder and Trunk Muscular Systems in Elite Adolescent Water Polo Athletes.

Introduction Water polo is a competitive team sport played in the water between two teams of seven players each. Water polo players must have swimming speed, strong abdominal and back muscles, and strong shoulder muscles to cope with this sport's special conditions. In this study, we investigate the possible association of shoulder and trunk muscle systems in adolescent water polo athletes of high demands. Materials and methods The research included 42 water polo players aged 14-16, who train regularly for at least five years, six times a week, and participate in national championships and national teams. The athletes were evaluated on the strength and torque of these muscular systems using the isokinetic dynamometer Biodex System 4 Pro (Biodex Medical Systems, Inc, Shirley, NY). The correlation of the results was done using the statistical package SPSS 21. Results The correlations revealed statistically significant differences in trunk extension in combination with the shoulder external/internal rotation ratio. Also, most of the correlations occurred between the trunk and non-dominant limb of the athletes and, more often, in the female athletes. Furthermore, for the hand grip, the male athletes showed a greater difference in strength between the dominant and the non-dominant member than female athletes. Finally, the evaluation of the trunk extension/flexion ratio and external/internal rotation ratio for the shoulder joint showed that many athletes are outside the normal range and need targeted strengthening. Conclusion The negative correlation coefficient between trunk extension/flexion and shoulder external/internal rotation indicates that the trunk extension mechanism helps for better internal rotation of the shoulder. Therefore, water polo players should focus on the training of the stretching mechanism of the trunk and also give weight to achieving a balance between the competing muscular systems of the trunk and the shoulder. Thus, athletes can maximize their skills and, at the same time, protect themselves from injuries.

The Impact of Obesity on the Fitness Performance of School-Aged Children Living in Rural Areas-The West Attica Project.

This study aimed to investigate the relationship of body mass index (BMI) with muscle and cardiorespiratory fitness in children living within rural areas (regional unit of West Attica) in Greece. Participants included 399 students (187 boys, 212 girls), ages 8-12 years old, and were evaluated in physical performance tests. The point prevalence of overweight and obesity was 21.39% and 26.20% in boys, and 19.90% and 23.79% in girls. Significant differences were observed in all physical performance tests (handgrip, long jump, shuttle run, trunk flexors, and extensors endurance) between normal weight and obese participants. BMI was positively correlated with handgrip (r = 0.442-0.462, p < 0.001). There was a negative association with long jump (r = -0.206, p < 0.001), 20 m shuttle run (r = -0.394, p < 0.001), trunk flexors (r = -0.403, p < 0.001) and trunk extensors endurance (r = -0.280, p < 0.001). The regression analysis showed that 20-30% of the overall variation for physical performance assessments could be accounted for by BMI, age, and sex. With the exception of the long jump and the endurance of the trunk extensors, BMI alone may explain more than 10% of the outcome of most tests. This study highlights the determinant of BMI on muscle and cardiorespiratory fitness. The management of obesity should begin early in childhood to prevent adult chronic cardiovascular and metabolic diseases.

Validity and Reliability of New Equations for the Prediction of Maximal Oxygen Uptake in Male and Female Elite Adolescent Rowers.

The aim of this study was to develop accurate, reliable, and reproductive equations for the prediction of maximum oxygen uptake ( V ˙ O2max) in male and female high-level adolescent rowers. This study included two parts. In the first part, V̇O2max was evaluated in 106 male and 83 female high-level adolescent rowers during an incremental step test (IRT) on a rowing ergometer, and stepwise multiple regression analyses were used for the development of new equations. In the second part, these equations were tested in 26 new high-level adolescent rowers of the same age and anthropometrical characteristics (boys: 15.27 ± 2.70 yrs and 15.34 ± 2.80 yrs; 72.37 ± 10.96 kg and 70.96 ± 10.65 kg; girls: 15.00 ± 2.11 yrs and 15.94 ± 2.71 yrs; 62.50 ± 7.14 kg and 63.41 ± 6.72 kg for parts 1 and 2, respectively; p > 0.05). V̇O2max was predicted from the combination of lean body mass (LBM) and the distance covered during the last 4 min stage of the IRT (boys: r2 = 0.715, F = 68.74, p = 0.001; girls: r2 = 0.769, F = 57.81, p = 0.001). In the second part, no significant differences were identified when the new equations were tested against measured V̇O2max (boys: 3971.15 ± 713.38 mL·min-1 vs. 3915.83 ± 704.43 mL·min-1; girls: 3272.75 ± 551.46 mL·min-1 vs. 3308.94 ± 557.59 mL·min-1 for measured and predicted values, respectively; p > 0.05). In conclusion, V̇O2max of high-level adolescent rowers can be predicted with high accuracy, reliability, and repeatability using simple and easily evaluated anthropometric and performance variables.

The Hypercoagulable Profile of Patients with Bone Tumors: A Pilot Observational Study Using Rotational Thromboelastometry.

Introduction: A detailed evaluation of the malignancy-associated coagulopathy (MAC) in surgical patients with bone tumors may allow for more effective thromboprophylactic measures. The purpose of this study was to assess the perioperative hemostatic changes in patients with bone tumors, using rotational thromboelastometry (ROTEM). Methods: An observational study was performed, including 50 patients with bone tumors who underwent oncologic resection and 30 healthy controls, matched for age and gender. The preoperative and postoperative laboratory evaluation of coagulation in both groups included conventional coagulation tests and a ROTEM analysis. The results of the conventional coagulation tests and the ROTEM analysis were compared between the two groups. Results: The results of the conventional coagulation tests were comparable between the tumor patients and the healthy controls. However, compared to the healthy adults, the tumor patients had lower CT (p < 0.001) and CFT (p < 0.001) values suggesting a rapid induction of the coagulation cascade, elevated A10 (p < 0.001) and MCF (p < 0.001) values indicating a higher clot strength and platelet activation, and elevated LI60 (p < 0.001) values indicating hypofibrinolysis in patients with bone tumors. The multiple linear regression analysis (controlling for potential confounding factors) confirmed the independent association of bone tumors with these hemostatic changes. Conclusions: Our results support the advantageous use of a ROTEM in patients with bone tumors over conventional coagulation tests because the qualitative changes in the hemostatic profile of these patients that can be detected by a ROTEM analysis cannot be identified by conventional tests. The ROTEM results indicate that the hypercoagulable state in patients with bone tumors is caused by the malignancy-associated activation of the coagulation cascade, platelet activation, and hypofibrinolysis.