COVID-19 Vaccines and Axillary Nerve Dysfunction: A Case Report.

COVID-19 resulted in a worldwide pandemic and the rapid introduction of vaccines in an attempt to mitigate it. Neuritis and neuropathy after intramuscular injection had been previously seen with influenza vaccines and appear to be a side effect of the COVID-19 vaccine as well. In the following report, we present the case of a 43-year-old female who developed axillary nerve symptoms after administration of the COVID-19 vaccine and her subsequent recovery.

An Examination of the Associations between Nutritional Composition, Social Jet Lag and Temporal Sleep Variability in Young Adults.

While dietary intake has previously been related to various indices of poor sleep (e.g., short sleep duration, poor sleep quality), to date, few studies have examined chrononutrition from the perspectives of the relationship between dietary intake and social jet lag and temporal sleep variability. Moreover, recently it has been suggested that previous methods of measuring social jet lag have the potential to lead to large overestimations. Together, this precludes a clear understanding of the role of nutritional composition in the pathophysiology of poor sleep, via social jet lag and temporal sleep variability, or vice versa. The aim of the present study was to determine the relationships between nutrient intake and social jet lag (using a revised index, taking account of intention to sleep and sleep onset and offset difficulties), and temporal sleep variability. Using a cross-sectional survey, 657 healthy participants (mean age 26.7 ± 6.1 years), without sleep disorders, were recruited via an online platform and completed measures of weekly dietary intake, social jet lag, temporal sleep variability, stress/sleep reactivity and mood. Results showed limited associations between nutritional composition and social jet lag. However, levels of temporal sleep variability were predicted by consumption of polyunsaturated fats, sodium, chloride and total energy intake. The results suggest further examinations of specific nutrients are warranted in a first step to tailoring interventions to manage diet and temporal variabilities in sleep patterns.

Effect of intensified training on cognitive function, psychological state & performance in trained cyclists.

Athletes often undertake intensified training loads prior to competition with the goal of functionally overreaching for temporary performance enhancement; however, little is known about the impact of this on cognitive function. The aim of this study was to investigate the effect of intensified training induced fatigue on cognitive function, psychological state and performance in trained cyclists. Twenty-three trained male cyclists were randomly assigned to an intensified training group or a control group for two-weeks, followed by a two-week taper period. At baseline, one-week, two-weeks and post-taper, participants undertook a series of cognitive, performance, mood and recovery-stress assessments. The training intervention significantly increased training volume, load and strain by 108%, 116% and 151% respectively. Peak and mean power output on a maximal test and time trial significantly decreased by 4.8% and 9.4% following the two-week training intervention compared to baseline, in addition to a 169% change in total mood disturbance and significant disruption to recovery-stress balance. No change in any cognitive measure was observed across the study period. Following a two-week taper, performance, mood and well-being measures returned to baseline. Two weeks of intensified training resulted in overreaching as identified by performance and psychological measures. Cognitive function was not sensitive to intensified training promoting caution with its use as a measure for the early identification of overreaching.HighlightsTwo-weeks of intensified training significantly increased training volume, load and strain eliciting a state of overreaching in trained male cyclists.Intensified training caused deteriorations in physical performance but did not influence cognitive measures.Mood and recovery-stress balance were negatively affected by intensified training but recovered back to baseline following a two-week taper at a reduced training volume.A two-week taper period following two-weeks of intensified training did not result in improved physiological measures, physical performance parameters or mood above initial baseline values highlighting the need for careful consideration over the purpose, desired outcomes and necessity of intensified training on an individualised basis.

A Nutrient Formulation Affects Developmental Myelination in Term Infants: A Randomized Clinical Trial.

BACKGROUND AND OBJECTIVES: Observational studies suggest differences between breast-fed and formula-fed infants in developmental myelination, a key brain process for learning. The study aims to investigate the efficacy of a blend of docosahexaenoic acid (DHA), arachidonic acid (ARA), iron, vitamin B12, folic acid, and sphingomyelin (SM) from a uniquely processed whey protein concentrate enriched in alpha-lactalbumin and phospholipids compared with a control formulation on myelination, cognitive, and behavioral development in the first 6 months of life. METHODS: These are 6-month results from an ongoing two-center, randomized controlled trial with a 12-month intervention period (completed for all participants). In this study, full term, neurotypical infants of both sexes (N = 81) were randomized into investigational (N = 42) or control groups (N = 39). In addition, non-randomized breast-fed children (N = 108) serve as a natural reference group. Main outcomes are myelination (MRI), cognitive (Bayley Scales of Infant and Toddler Development, 3rd edition [Bayley-III]), social-emotional development (Ages and Stages Questionnaires: Social-Emotional, 2nd edition [ASQ:SE-2]), sleep (Brief Infant Sleep Questionnaire [BISQ]), and safety (growth and adverse events [AEs]). RESULTS: The full analyses set comprises N = 66 infants. Significant differences in myelin structure, volume, and rate of myelination were observed in favor of the investigational myelin blend at 3 and 6 months of life. Effects were demonstrated for whole brain myelin and for cerebellar, parietal, occipital, and temporal regions, known to be functionally involved in sensory, motor, and language skills. No statistically significant differences were found for early behavior and cognition scores. CONCLUSIONS: This is the first study demonstrating the efficacy of a myelin nutrient blend in well-nourished, term infants on developmental myelination, which may be foundational for later cognitive and learning outcomes. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT03111927.

Sleep Deprivation Training to Reduce the Negative Effects of Sleep Loss on Endurance Performance: A Single Case Study.

PURPOSE: Sleep deprivation (SD) is very common during ultraendurance competitions. At present, stimulants such as caffeine and naps are the main strategies used to reduce the negative effects of SD on ultraendurance performance. In this case study, the authors describe the application of a novel strategy consisting of the intermittent repetition of SD (SD training [SDT]) during the weeks preceding an ultraendurance competition. METHODS: A male ultraendurance runner underwent a 6-week SDT program (consisting of 1 night SD every Sunday) in addition to his regular physical training program before taking part in a 6-day race. Before and after SDT, the participant performed 5 consecutive days of daily 2-hour constant-pace running with SD on the first and third night. Psychological and physiological responses were measured during this multiday test. RESULTS: SDT was well tolerated by the athlete. A visual analysis of the data suggests that including SDT in the weeks preceding an ultraendurance competition may have beneficial effects on sleepiness and perceived mental effort in the context of 5 consecutive days of prolonged running and 2 nights of SD. This multiday test seems a feasible way for assessing ultraendurance athletes in the laboratory. CONCLUSIONS: The results provided some encouraging initial information about SDT that needs to be confirmed in a randomized controlled trial in a group of ultraendurance athletes. If confirmed to be effective and well tolerated, SDT might be used in the future to help ultraendurance athletes and other populations that have to perform in conditions of SD.

Detrimental effects on executive function and mood following consecutive days of repeated high-intensity sprint interval exercise in trained male sports players.

Intensified periods of competition are common in many team sports, potentially leading to increased fatigue and reduced performance. The purpose of this study was to investigate the effect of repeated high-intensity sprint interval exercise on cognitive function, mood and perceptions of energy and fatigue. Twenty-four trained rugby players completed multiple bouts of repeated sprints across two consecutive days. Prior to and following each set of maximal effort sprints or equivalent control duration, a battery of cognitive tasks assessing simple and choice reaction time, visuo-spatial working memory and inhibition were completed as well as visual analogue scales that assessed mood, energy, and fatigue. Accuracy of incongruent Stroop responses was significantly lower across day 2 compared to day 1 and the control condition. Four-choice reaction time was slower across day 2 whilst feelings of alertness, contentedness, and physical and mental energy were reduced while ratings of physical and mental fatigue increased. These findings suggest that intensified periods of high-intensity sprint interval exercise have detrimental effects on executive function, mood and perceptions of physical and mental energy, and fatigue. These deleterious effects have the potential to impact performance and may increase the propensity for injury/accidents in certain sporting and non-sporting contexts.

Singapore Sling: F1 Race Team Cognitive Function and Mood Responses During the Singapore Grand Prix.

O'Neill, BV, Davies, KM, and Morris-Patterson, TE. Singapore sling: F1 race team cognitive function and mood responses during the Singapore grand prix. J Strength Cond Res 34(12): 3587-3592, 2020-The current investigation measured cognitive performance and subjective ratings of mood and sleep in Formula 1 (F1) race team members during the 2013 Singapore Grand Prix. Two weeks before the Singapore Grand Prix, subjects (n = 16; mean age 33.5 years, range 22-48 years) underwent baseline cognitive assessments and a questionnaire on mood and sleep quality/duration. These assessments were repeated on the race weekend before practice (S1) and after qualifying (S2). A significant increase in simple reaction time (SRT), i.e., slowing of total response time was observed from baseline to S1 (33.69 ± 6.52 ms; p < 0.001) and from baseline to S2 (34.63 ± 8.19 ms; p = 0.002). Mood-related effects were observed with subjective stress levels increased from baseline to S1 (18.06 ± 6.18; p = 0.032) and a decrease in how refreshed the race team members felt between S1 and S2 (18.56 ± 6.14; p = 0.029). In addition, a negative association between change in SRT and change in quality of sleep (R = 0.47; p = 0.016) as well as negative association in how refreshed individuals reported feeling and SRT between S1 and S2 (R = 0.37; p = 0.017). The findings suggest that the demands presented by an F1 race environment have significant effects on cognitive function and mood; however, the exact cause of any decrements would most likely be a combination and interaction of multiple factors. Future research should endeavor to adopt a holistic approach and investigate physiological and cognitive endpoints to fully explore the demands of this challenging motor sport.

Sphingomyelin in Brain and Cognitive Development: Preliminary Data.

Sphingomyelin (SM) supports brain myelination, a process closely associated with cognitive maturation. The presence of SM in breast milk suggests a role in infant nutrition; however, little is known about SM contribution to healthy cognitive development. We investigated the link between early life dietary SM, later cognitive development and myelination using an exploratory observational study of neurotypical children. SM levels were quantified in infant nutrition products fed in the first three months of life and associated with myelin content (brain MRI) as well as cognitive development (Mullen scales of early learning; MSEL). Higher levels of SM were significantly associated with higher rates of change in verbal development in the first two years of life (r = 0.65, p < 0.001), as well as, higher levels of myelin content at 12-24 months, delayed onset and/or more prolonged rates of myelination in different brain areas. Second, we explored mechanisms of action using in vitro models (Sprague Dawley rat pups). In vitro data showed SM treatment resulted in increased proliferation [p = 0.0133 and p = 0.0434 at 4 and 10 d in vitro (DIV)], maturation (p = 0.467 at 4 d DIV) and differentiation (p = 0.0123 and p = 0.0369 at 4 and 10 DIV) of oligodendrocyte precursor cells (OPCs), as well as increased axon myelination (p = 0.0005 at 32 DIV). These findings indicate an impact of dietary SM on cognitive development in healthy children, potentially modulated by oligodendrocytes and increased axon myelination. Future research should include randomized controlled trials to substantiate efficacy of SM for cognitive benefits together with preclinical studies examining SM bioavailability and brain uptake.

Dietary Polar Lipids and Cognitive Development: A Narrative Review.

Polar lipids are amphiphilic lipids with a hydrophilic head and a hydrophobic tail. Polar lipids mainly include phospholipids and sphingolipids. They are structural components of neural tissues, with the peak rate of accretion overlapping with neurodevelopmental milestones. The critical role of polar lipids in cognitive development is thought to be mediated through the regulation of signal transduction, myelination, and synaptic plasticity. Animal products (egg, meat, and dairy) are the major dietary sources of polar lipids for children and adults, whereas human milk and infant formula provide polar lipids to infants. Due to the differences observed in both concentration and proportion of polar lipids in human milk, the estimated daily intake in infants encompasses a wide range. In addition, health authorities define neither intake recommendations nor guidelines for polar lipid intake. However, adequate intake is defined for 2 nutrients that are elements of these polar lipids, namely choline and DHA. To date, limited studies exist on the brain bioavailability of dietary polar lipids via either placental transfer or the blood-brain barrier. Nevertheless, due to their role in pre- and postnatal development of the brain, there is a growing interest for the use of gangliosides, which are sphingolipids, as a dietary supplement for pregnant/lactating mothers or infants. In line with this, supplementing gangliosides and phospholipids in wild-type animals and healthy infants does suggest some positive effects on cognitive performance. Whether there is indeed added benefit of supplementing polar lipids in pregnant/lactating mothers or infants requires more clinical research. In this article, we report findings of a review of the state-of-the-art evidence on polar lipid supplementation and cognitive development. Dietary sources, recommended intake, and brain bioavailability of polar lipids are also discussed.

The effects of GSK2981710, a medium-chain triglyceride, on cognitive function in healthy older participants: A randomised, placebo-controlled study.

OBJECTIVE: This double-blind, randomised, placebo-controlled, two-part study assessed the impact of GSK2981710, a medium-chain triglyceride (MCT) that liberates ketone bodies, on cognitive function, safety, and tolerability in healthy older adults. METHODS: Part 1 was a four-period dose-selection study (n = 8 complete). Part 2 was a two-period crossover study (n = 80 complete) assessing the acute (Day 1) and prolonged (Day 15) effects of GSK2981710 on cognition and memory-related neuronal activity. Safety and tolerability of MCT supplementation were monitored in both parts of the study. RESULTS: The most common adverse event was diarrhoea (100% and 75% of participants in Parts 1 and 2, respectively). Most adverse events were mild to moderate, and 11% participants were withdrawn due to one or more adverse events. Although GSK2981710 (30 g/day) resulted in increased peak plasma ß-hydroxybutyrate (BHB) concentrations, no significant improvements in cognitive function or memory-related neuronal activity were observed. CONCLUSION: Over a duration of 14 days, increasing plasma BHB levels with daily administration of GSK2981710 had no effects on neuronal activity or cognitive function. This result indicates that modulating plasma ketone levels with GSK2981710 may be ineffective in improving cognitive function in healthy older adults, or the lack of observed effect could be related to several factors including study population, plasma BHB concentrations, MCT composition, or treatment duration.

Quantification of bowling workload and changes in cognitive function in elite fast bowlers in training compared with Twenty20 Cricket.

BACKGROUND: Bowling overs are the primary recorded measure for workloads in cricket for youth through to professionals. However, the validity of this measure has never been tested. Additionally, despite the cognitive component of cricket being suggested to be very high, changes in psychomotor processing speed has again not been explored. METHODS: Eight professional English county cricket bowlers participated in the study. Participants wore global positioning systems with a tri-axial accelerometer during a Twenty20 match and training. Bowling overs were expressed relative to external forces. Additionally, cognitive function (as measured by psychomotor speed) was assessed pre and post Twenty20 game and training. RESULTS: When expressed relative to high intensity running distance or external forces from the tri-axial accelerometer, the cost of each over (6 deliveries) was over 100% higher in a Twenty20 game compared to training. Psychomotor speed was unchanged although error within the cognitive task increased post Twenty20 (391±82±547±104 ms) and training (414±110±561±238 ms). This data suggests that reaction time is unchanged from cricket but the chance of making the incorrect decision is increased. CONCLUSIONS: Movements in fielding should be quantified or bowling workloads adjusted to account for the high intensity fielding associated with Twenty20 cricket. Cognitive function was impaired following bowling, suggesting practitioners may also monitor psychomotor changes when assessing fatigue and allow appropriate time to mentally recover.

Levels of evidence in pelvic trauma: a bibliometric analysis of the top 50 cited papers.

BACKGROUND: Scientific research is an essential aspect in the ongoing development of medical education and improved patient care. Dissemination of findings is a pivotal goal of any health research study. The number of citations that a published article receives is reflective of the importance that paper has on clinical practice. To date, it is unknown which journals are most frequently cited as influencing the management of pelvic trauma. METHODS: The aim of this study was to identify the top 50 publications relating to the management of pelvic trauma. The database of the Science Citation Index of the Institute for Scientific Information (1945 to 2016) was reviewed to identify the 50 papers most commonly cited. RESULTS: A total of 1535 papers were included. Of these, 31 papers were cited over 100 times with the top 50 cited 69 times or more. The top 50 were subjected to further analysis to identify the authors and institutions involved. The majority of these publications originated in the USA, followed by Canada. The most cited paper is "pelvic ring fractures-should they be fixed", published by Tile in 1988. CONCLUSION: We have identified and analysed the publications that have contributed most to the assessment and management of pelvic trauma over the past 50 years. We have also identified the researchers and institutions which have most influenced the evidence-based approach currently employed in the management of pelvic trauma.

Effectiveness of above real-time training on decision-making in elite football: A dose-response investigation.

We examined the effects of video-based training in elite footballers' decision-making by presenting videos with training and testing scenarios at above real-time speeds. We also examined different training protocols to establish how much training is beneficial. We found that above real-time training improved accuracy and response time in football decision-making. In terms of scheduling, we found that the benefits were short lasting and did not last beyond 2 weeks.

Effects of acute high-intensity exercise on cognitive performance in trained individuals: A systematic review.

BACKGROUND: High-intensity exercise is generally considered to have detrimental effects on cognition. However, high fitness levels are suggested to alleviate this effect. OBJECTIVES: The specific objective of this review was to evaluate the literature on the effect of acute high-intensity exercise on cognitive performance in trained individuals. METHODS: Studies were sourced through electronic databases, reference lists of retrieved articles, and manual searches of relevant reviews. Included studies examined trained participants, included a high-intensity exercise bout, used a control or comparison group/condition, and assessed cognitive performance via general laboratory tasks during or ≤10min following exercise cessation. RESULTS: Ten articles met the inclusion criteria. Results indicated that the effect of acute high-intensity exercise on cognitive performance in trained individuals is dependent on the specific cognitive domain being assessed. Generally, simple tasks were not affected, while the results on complex tasks remain ambiguous. Accuracy showed little tendency to be influenced by high-intensity exercise compared to measures of speed. CONCLUSION: Multiple factors influence the acute exercise-cognition relationship and thus future research should be highly specific when outlining criteria such as fitness levels, exercise intensity, and exercise mode. Furthermore, greater research is needed assessing more cognitive domains, greater exercise durations/types, and trained populations at high intensities.

Marjolin's squamous cell carcinoma of the hallux following recurrent ingrown toenail infections.

Marjolin's squamous cell carcinoma (SCC) affecting the toe is rare. Due to resemblance with benign conditions it can often result in misdiagnosis. We report a case of Marjolin's SCC affecting the proximal hallux in a patient with recurrent ingrown toenail infections. A 58-year-old woman with a background of wedge resections for ingrown toenail and distal phalanx amputation for osteomyelitis presented with pain and hyperkeratotic raised ulcer around the proximal phalanx. MRI scan revealed soft tissue mass infiltrating the proximal phalanx with biopsies confirming a SCC. The patient underwent first ray amputation and made a good clinical recovery and remains disease free. Due to clinical similarities with benign conditions, awareness of Marjolin's SCC as a potential diagnosis when treating patients with recurrent ingrown toenail is imperative. We recommend patients with recurrent ingrown toenail or ulceration with a background of chronic infection have biopsies performed to exclude potential malignancy.

Physiological and Cognitive Responses to an Antarctic Expedition: A Case Report.

PURPOSE: To assess changes in body composition and monitor cognitive function, subjective well-being, and physiological stress, as measured by salivary hormones and markers of mucosal immunity, during an Antarctic expedition. METHODS: A 36-y-old man (188.2 cm height, 94.5 kg body mass) took part in a world-record attempt. A total-body dual-energy X-ray absorptiometry scan and measurement of 8 skinfolds and 5 girths were performed before and after the expedition. In addition, daily subjective data were recorded (sleep quality, total hours of sleep, energy levels, perceived exertion, mood, muscle soreness, and muscle/joint pain) along with distance covered and hours of physical activity per day. As a measure of cognitive function, the athlete completed a computerized battery of tasks (Axon Sports Cognitive Priming Application) every third morning. Saliva samples were collected before, during, and after the expedition to determine salivary cortisol (sCort), testosterone (sT), alpha amylase (sAA), and secretory immunoglobulin A (sIgA). RESULTS: The athlete lost 5.3 kg body mass and sum of 8 skinfolds decreased from 73 mm to 59 mm from preexpedition to postexpedition. Psychomotor speed declined over the course of the expedition. sT increased and sCort decreased throughout, and sAA and sIgA peaked toward the end of the expedition. CONCLUSIONS: This case study provides novel data about the physiological and cognitive impact of an Antarctic expedition. The findings may inform strategies for future expeditions, allowing individuals undertaking expeditions of this nature to better prepare for success.

Protrusio acetabuli: a rare cause of pulmonary embolus.

Protrusio acetabuli is an uncommon complication of total hip arthroplasty, which results in intrapelvic implant migration after erosion of medial acetabular wall. We present a case of severe prosthetic migration with the formation of haematoma and impingement on iliac vessels leading to thrombosis and subsequent pulmonary embolus. This is the first reported case of protrusio acetabuli as a cause of pulmonary embolus.

Bilateral distal tibial stress fractures in a healthy field-hockey goalkeeper.

Stress fractures occurring within the lower limbs are relatively common in athletes and military personnel. The specific bones affected are often predictable when the patient's activities are considered. We present an unusual case of bilateral distal tibial stress fractures sustained while playing as a goalkeeper in field hockey, in an otherwise healthy 46-year-old woman.