Nutritional Risks Among Female Athletes.

Background: Limited research studies have been conducted on nutritional risks among female athletes. Therefore, this literature review focuses on rigorously designed studies that examined nutritional risks among female athletes with further recommendations for athletes, coaches, parents, and health professionals, which would help improve the health of female athletes. Methods: This review evaluates the most recent research on nutritional risk among female athletes. Inclusion criteria included peer-reviewed studies of original research on human subjects 13 years of age or older; sample size of N ≥ 19; and studies with a thorough description of their sample and methods. A systematic search of the databases PubMed and Cochrane for published studies (from year 2000 to year 2019) was conducted to identify articles that met inclusion criteria. Bibliographies of identified articles were also searched for relevant articles. Results: Of the 11 studies that met our inclusion criteria, most were mainly cross-sectional in design with few rigorous controls. Findings reveal that strategies to enhance nutrition patterns among female athletes may be important to avoid risks of disordered eating, eating disorders, low energy availability, and symptoms of relative energy deficiency in sports. In addition, general nutrition knowledge is lacking among athletes, sports teams, and coaches. Conclusions: This review highlights the scarcity of evidence-based, rigorous studies examining nutritional risks among female athletes. Findings suggest that interdisciplinary working groups, comprising physicians, sports dietitians, and other supportive health professionals, would be beneficial for female athletes in helping to improve their overall diet, performance, and health.

Preeclamptic Women Are at Significantly Higher Risk of Future Cardiovascular Outcomes Over a 15-Year Period.

Background: Preeclampsia (PE) may lead to maternal and infant mortality and severe medical complications. Understanding future short- and long-term cardiovascular (CV) outcomes of PE is important to women's health. Materials and Methods: A retrospective matched case-control study assessed the risks of CV outcomes over a 15-year period (1999-2013) in pregnant case women, with gravidity and parity of one, diagnosed with PE, compared to pregnant primiparous control women who were not diagnosed with PE. The New Jersey Electronic Birth Certificate (EBC) database and the Myocardial Infarction Data Acquisition System (MIDAS), a database of all hospital admissions in New Jersey with longitudinal follow-up, were used to conduct the analysis. Participants were 18 years and older with demographics consistent with New Jersey, a state with a range of racial and ethnic diversity. Main outcome measures postpregnancy and over this 15-year period were myocardial infarction (MI), stroke, CV death, and all-cause death. Results: Women with PE (N = 6,360) were more likely to suffer MI, stroke, CV death, and all-cause death than controls (N = 325,347). After matching cases to controls for demographics and comorbidities, hazard ratios of PE cases for the outcomes of MI (p adjusted for comorbidities and demographics = 0.0196), CV death (adjusted p = 0.007), and all-cause death (adjusted p = 0.0026) were significantly higher than 1 compared to matched controls. Women with PE had 3.94 (95% CI: 1.25-12.4) times higher hazard for MI, 4.66 (95% CI: 1.52-14.26) times higher hazard of CV death, and 2.32 (95% CI: 1.34-4.02) times higher hazard for all-cause death than matched controls. Conclusions: This 15-year study indicates that women who have PE with their first pregnancy have a significantly higher risk of adverse CV outcomes compared to controls and suggest a heightened and continued CV monitoring after birth for this population of women.

Cardiovascular outcomes after preeclampsia or eclampsia complicated by myocardial infarction or stroke.

OBJECTIVE: To assess the relationship between preeclampsia or eclampsia and stroke, myocardial infarction (MI), subsequent cardiovascular outcomes, and long-term survival. METHODS: Using the Myocardial Infarction Data Acquisition System in New Jersey (1994-2009), we analyzed cardiovascular outcomes in women with and without preeclampsia or eclampsia and a first MI or stroke but with a hospitalization for a first MI or stroke (analysis 1: MI case group, n=57; MI control group, n=155; stroke case group, n=132; stroke control group, n=379). We also compared these outcomes in women with preeclampsia or eclampsia and a first MI or stroke during pregnancy with women with preeclampsia or eclampsia without MI or stroke during pregnancy (analysis 2: MI case group, n=23; MI control group, n=67; stroke case group, n=90; stroke control group, n=263). A subsequent occurrence of MI, stroke, and cardiovascular death, as well as a combined cardiovascular outcome, was ascertained. RESULTS: In analysis 1, women with preeclampsia or eclampsia were at significantly lower risk for combined cardiovascular outcome with all deaths (frequency of outcome 16.7%) and with cardiovascular deaths (10.6%) compared with women without preeclampsia or eclampsia after a first stroke (33.8% and 23.5%, respectively). In analysis 2, women with preeclampsia or eclampsia and a first stroke during admission were at significantly higher risk of all death (11.1%) and the combined cardiovascular outcome with all deaths (11.1%) compared with women with preeclampsia or eclampsia without a stroke (1.9% and 2.7%, respectively) during that admission. CONCLUSION: Our study indicates that preeclampsia or eclampsia not complicated by MI or stroke during pregnancy may not confer a very high risk for subsequent MI and stroke in up to 16 years of follow-up. Our data suggest that other known risk factors put women at greater risk for stroke than preeclampsia or eclampsia complicated by a stroke. LEVEL OF EVIDENCE: II.

Robotic surgery: review of the latest advances, risks, and outcomes.

Using differing levels of evidence, we developed criteria to critically review 21 scientifically peer-reviewed articles on robot-assisted surgeries in various medical fields. The advantages and limitations of robotic systems are discussed and compared with traditional surgical methods. Since training in the use of robotic skills is essential, various training models are discussed to teach the complex skills necessary for robotic surgery. There is a paucity of control studies on a sufficient number of subjects in robot-assisted surgeries in all fields. Studies that meet more stringent clinical trials criteria show that robot-assisted surgery appears comparable to traditional surgery in terms of feasibility and outcomes but that costs associated with robot-assisted surgery are higher because of longer operating times and expense of equipment. While a limited number of studies on the da Vinci robotic system have proven the benefit of this approach in regard to patient outcomes, including significantly reduced blood loss, lower percentage of postoperative complications, and shorter hospital stays, there are mechanical and institutional risks that must be more fully addressed. In addition, trials are needed to identify simulators for learners that can enhance the da Vinci performance in order to shorten the learning curve.

Markers of preeclampsia and the relationship to cardiovascular disease: review of the twenty-first century literature.

OBJECTIVE: The objective of this article was to review the literature to identify the most promising markers of preeclampsia (PE) and the relationship to cardiovascular disease to gain a better understanding of the mechanism of PE to identify women at risk for cardiovascular disease to improve their outcomes. METHODS: Forty case-control studies were assessed for relationships between different serum markers to identify PE and to identify markers that may predict women who may be at greater risk for cardiovascular sequela in later life. RESULTS: Angiogenic, proteomic, and tumor necrosis markers were the most promising and important in the development of PE. The interplay among various growth factors, hormones, proteins, and other molecular compounds appears to be critical in the development of PE. Specific angiogenic (sVEGF, PLGF) and antiangiogenic (sFlt-1, sENG) markers and proteomic markers (fibrinogen and a-1-antichymotrypsin, SERPINA1, albumin, 1-antichymotryps) are the most promising markers of PE. Evidence of metabolic abnormalities associated with PE and common markers with cardiovascular disease include free leptin concentration which increases in normal pregnancy and is further increased in PE. CONCLUSIONS: Markers are important to help understand disease, potentially identify women at risk to improve their outcomes, design therapies to ameliorate symptoms so that pregnancy can be prolonged and neonatal outcomes improved, and provide a better understanding the link between PE and increased risk for disease later in life.