Risk factors for injury complaints leading to restricted participation in Athletics (Track and Field): a secondary analysis of data from 320 athletes over one season.

Objective: To investigate if several potential risk factors were associated with time to injury complaints leading to participation restriction in Athletics (ICPR). Methods: We performed a secondary analysis of data collected during 39 weeks of the 2017-2018 Athletics season in a cluster-randomised controlled trial ('PREVATHLE'). Univariate and multivariable analyses using Cox regression models were performed to analyse the association between the time to first ICPR and potential risk factors collected (1) at baseline: sex, age, height, body mass, discipline, the usual duration of Athletics training and non-specific sports training, ICPR in the preceding season (yes/no), ICPR at baseline (yes/no); (2) weekly during the season: duration and intensity of Athletics training and competition, and non-specific sports training, fitness subjective state, sleep duration and illness (yes/no); and (3) combined. Results: Data from 320 athletes were included; 138 (43.1%) athletes reported at least one ICPR during the study follow-up. The combined multivariable analyses revealed that the risk of ICPR at any given time was significantly higher in athletes with a pre-existing ICPR (hazard rate ratio, HRR 1.90, 95% CI 1.15 to 3.15; p=0.012) and lower in athletes with a higher fitness subjective state (HRR 0.63, 95% CI 0.55 to 0.73; p<0.001) and who had had at least one illness during the season (HRR 0.42, 95% CI 0.29 to 0.62; p<0.001). Conclusions: Our results provide new insights into injury risk factors in Athletics that could help with potential injury risk reduction strategies. These could be to explore the pre-existing injury presence at the season's beginning and to monitor the fitness subjective state and illnesses occurrence during the season. Trial registration: ClinicalTrials.gov Identifier: NCT03307434.

Long-Term Functional Outcomes After Surgery of Functional Popliteal Artery Entrapment Syndrome.

BACKGROUND: Functional popliteal artery entrapment syndrome (fPAES) is a subtype of PAES without anatomic abnormalities entrapment of the popliteal artery. One of the management of symptomatic fPAES is surgical exploration of the popliteal region with popliteal artery release with lysis of fibrous bands. There is a lack of data regarding the long-term functional results of this surgery, most of the studies focusing on vascular patency in anatomical PAES. The aim of this study was to assess the efficacy of surgery in functional PAES, focusing on long-term physical activity return after surgery with the Tegner activity scale. METHODS: All patients who underwent surgery for fPAES from January 1, 2010, to December 31, 2020, were searched. After ethical approval, all patients were called to evaluate physical activity since surgery. The Tegner activity scale is a numerical scale with each value (0 to 10) representing specific activity. The aim was to evaluate everyday activity limitations and participation restriction after surgery. The results for each patient were recorded: "before symptoms," "before surgery," and "after surgery." RESULTS: Over the study period, 33 patients were included with 61 symptomatic legs. The mean time between surgery and phone call was 38.6 ± 21.9 months. The median score of the Tegner activity scale "before symptoms" was 7 (4-7), the median score "before surgery" was 3 (2-3), and the median score at the time of the phone call "after surgery" was 5 (3-7). P value was <0.0001 by comparing results "before surgery" and "after surgery." CONCLUSIONS: Results demonstrated that the sport activity and intensity level is significantly higher after surgery even if patients did not reach their initial sport activity level.

Relationship between a daily injury risk estimation feedback (I-REF) based on machine learning techniques and actual injury risk in athletics (track and field): protocol for a prospective cohort study over an athletics season.

INTRODUCTION: Two-thirds of athletes (65%) have at least one injury complaint leading to participation restriction (ICPR) in athletics (track and field) during one season. The emerging practice of medicine and public health supported by electronic processes and communication in sports medicine represents an opportunity for developing new injury risk reduction strategies. Modelling and predicting the risk of injury in real-time through artificial intelligence using machine learning techniques might represent an innovative injury risk reduction strategy. Thus, the primary aim of this study will be to analyse the relationship between the level of Injury Risk Estimation Feedback (I-REF) use (average score of athletes' self-declared level of I-REF consideration for their athletics activity) and the ICPR burden during an athletics season. METHOD AND ANALYSIS: We will conduct a prospective cohort study, called Injury Prediction with Artificial Intelligence (IPredict-AI), over one 38-week athletics season (from September 2022 to July 2023) involving competitive athletics athletes licensed with the French Federation of Athletics. All athletes will be asked to complete daily questionnaires on their athletics activity, their psychological state, their sleep, the level of I-REF use and any ICPR. I-REF will present a daily estimation of the ICPR risk ranging from 0% (no risk for injury) to 100% (maximal risk for injury) for the following day. All athletes will be free to see I-REF and to adapt their athletics activity according to I-REF. The primary outcome will be the ICPR burden over the follow-up (over an athletics season), defined as the number of days lost from training and/or competition due to ICPR per 1000 hours of athletics activity. The relationship between ICPR burden and the level of I-REF use will be explored by using linear regression models. ETHICS AND DISSEMINATION: This prospective cohort study was reviewed and approved by the Saint-Etienne University Hospital Ethical Committee (Institutional Review Board: IORG0007394, IRBN1062022/CHUSTE). Results of the study will be disseminated in peer-reviewed journals and in international scientific congresses, as well as to the included participants.

Popliteal Entrapment Syndrome: Diagnostic, Surgical Management, and Short-Term Results of a Ten-Year Experience.

BACKGROUND: Popliteal artery entrapment syndrome (PAES) is a rare cause of lower limb claudication in young sportsperson without cardiovascular risk factor. We reported our diagnostic approach, surgical management, and short-term outcomes of this syndrome, over a 10-year period. METHODS: Sportsperson with intermittent claudication systematically received color duplex ultrasonography with dynamic maneuvers in the sport medicine department. In case of PAES suspicion, diagnosis was confirmed by dynamic computed tomography or dynamic magnetic resonance angiography. Each patient was then evaluated by a vascular surgeon and surgery was performed. We retrospectively screened patients who underwent PAES surgery between 2010 and 2020 in the Department of Surgery in Angers University Hospital. RESULTS: Between January 2010 and December 2020, 38 patients with 67 symptomatic legs underwent surgery for PAES. Twenty three (60.5%) were men. The mean age at the time of surgery was 24.7 +/- 9 years. Clinical presentation was bilateral in 30 patients (81.1%). Duplex ultrasound demonstrated severe stenosis or occlusion in 45 legs (77%). When performed, CT-scan demonstrated popliteal artery compression in all cases (100%). As per Whelan and Rich classification, 36 patients (94.7%) had type 6 PAES. There was no mortality or severe complication after surgery. Morbidity included 4 postoperative hematoma (6%) and 8 prolonged healing (13%). The mean time of follow-up was 2.3 months +/- 1.2 months. After surgery, D-scan showed no signs of remaining popliteal artery compression in 92.5% of the case. Twelve patients (33.3%) were able to resume sport, 18 (50%) partially, and 6 (16.6%) did not resume sport yet. CONCLUSIONS: We report a cohort of 38 patients who underwent surgery for PAES. Among them, 36 (94.7%) were functional PAES. Morbidity included 13% of prolonged healing. Two months follow-up demonstrated good results at dynamic D-scan without signs of remaining popliteal artery compression in 92.5% of the cases. These short-term results showed that one-third of patients were able to resume sport activity at an initial level.

Effects of a microprocessor-controlled ankle-foot unit on energy expenditure, quality of life, and postural stability in persons with transtibial amputation: An unblinded, randomized, controlled, cross-over study.

BACKGROUND: Microprocessor-controlled prostheses are designed to improve mobility and quality of life through better balance and energy restoration in persons with transtibial amputation. Quasi-active microprocessor-controlled ankles (MPA) adapt to variable terrain by ankle angle adjustment. OBJECTIVES: To compare energy expenditure, balance, quality of life, and satisfaction of Proprio-foot® (a quasi-active MPA model) with standard prescribed ankle prosthesis (prescribed ankle-foot units [PA]) (standard energy storage and return prosthesis). STUDY DESIGN: Multicenter, unblinded, randomized, controlled, cross-over study. METHODS: Energy expenditure (primary outcome) was assessed by oxygen uptake (VO2) measured at the maximum level reached with the 2 prostheses during treadmill walking at progressively increasing incline and speed. Balance was assessed by stabilometry in different static positions. Quality of life and satisfaction were assessed by "Short Form 36" questionnaire (0-100) and by Evaluation de la Satisfaction envers une Aide Technique (0-5) questionnaires after wearing each of the 2 prostheses for 34 days. RESULTS: Forty-five patients tested the 2 prostheses. No statistical difference in VO2 was observed. Significant improvement of balance was observed both during standing on an incline or decline with MPA and PA (p < 0.01). Short Form 36 questionnaire physical scores and Short Form 36 questionnaire mental scores were 68.5 ± 19.5 vs. 62.1 ± 19.6 (p < 0.01) and 72.0 ± 20.8 vs. 66.2 ± 20.9 (p < 0.01) in MPA and PA, respectively. Evaluation de la Satisfaction envers une Aide Technique score on the device was not statistically significant between the 2 groups (MPA 4.4 ± 0.5 vs. PA 4.3 ± 0.5, p = 0.360). CONCLUSION: Proprio-foot® improved balance, quality of life, and patient satisfaction despite no reduction or increase in energy expenditure in comparison with standard energy storage and return prosthesis.

Burden of Inappropriate Prescription of Direct Oral Anticoagulants at Hospital Admission and Discharge in the Elderly: A Prospective Observational Multicenter Study.

INTRODUCTION: Direct oral anticoagulants (DOACs) were developed to overcome some of the limitations associated with vitamin K antagonists (VKAs), such as interindividual variability or the need for therapeutic drug monitoring. However, the complexity of DOAC dose regimens can still lead to dosing errors and potential bleeding-related or thromboembolic adverse events, especially in the elderly. OBJECTIVE: Our objective was to evaluate the rate of inappropriate preadmission DOAC prescriptions at hospital and to evaluate the ability of hospitals to correct them. METHODS: An observational prospective study was conducted in elderly patients (aged ≥ 65 years) hospitalized in six acute units of three Parisian university hospitals between February and July 2018. DOAC prescriptions prior to admission and at discharge were analyzed according to the guidelines in the summaries of product characteristics. RESULTS: A total of 157 patients were included in the study, with a median age of 84 years (interquartile range [IQR] 77-89). The median glomerular filtration rate, determined with the Cockcroft-Gault equation, was 48 mL/min (IQR 35-61). Apixaban was the most frequently prescribed drug, mainly for atrial fibrillation. Overall, 48 (30.6%) and 34 (22.4%) prescriptions were inappropriate prior to admission and at discharge, respectively, showing a significant decrease (p < 0.001). Hospitals significantly corrected more inappropriate prescriptions (37.5%) than they generated (4.6%) (p < 0.05). The nature of the inappropriate prescribing was underdosing (68.8% and 76.5% prior to admission and at discharge, respectively), followed by overdosing (stable rate at almost 20%) and indication errors. No risk factors for inappropriate use were identified by our analysis. CONCLUSION: One-third of DOAC preadmission prescriptions for elderly patients were inappropriate, indicating that a need remains to strengthen DOAC prescribing guidelines in ambulatory clinical practice. However, the rate of inappropriate prescriptions decreased at patient discharge. Future studies are needed to test actions to promote the proper use of DOACs.

[Gut microbiota: What impact on colorectal carcinogenesis and treatment?] / Le microbiote intestinal : quels impacts sur la carcinogenèse et le traitement du cancer colorectal ?

The gut microbiota, composed of 1014 microorganisms, is now considered as a "hidden organ", regarding to its digestive, metabolic and immune functions, which are helpful to its host. For the last 15 years, advances in molecular biology have highlighted the association of gut microbiota dysbiosis with several diseases, including colorectal cancer. An increased abundance of some bacteria (including Fusobacterium nucleatum, Bacteroides fragilis, Escherichia coli) is associated with cancer, whereas others seem to be protective (Faecalibacterium prausnitzii). Several mechanisms, which are species-specific, are involved in colorectal carcinogenesis. Most of the time, bacterial toxins are involved in pro-inflammatory processes and in activation of angiogenesis and cellular proliferation pathways. The identification of these bacteria leads to envisage the gut microbiota as potential screening tool for colorectal cancer. Recent studies showed a relation between the gut microbiota and the efficacy and toxicity of chemotherapies (oxaliplatin, irinotecan) and immunotherapies (including ipilimumab). Therapeutic approaches targeting the gut microbiota are now available (probiotics, fecal microbiota transplantation…). New therapeutic strategy combining both chemotherapy and/or immunotherapy with an adjuvant treatment targeting the gut microbiota can now be developed in order to improve treatment response and tolerance.

Myoadenylate deaminase deficiency: a frequent cause of muscle pain A case detected by exercise testing.

Myoadenylate deaminase deficit (MAD, MIM#615511) is the most common cause of metabolic myopathies with an estimated prevalence of 1-2% in the general population. We report the case of a 39-year-old man suffering from severe skeletal muscle pain that had developed gradually for 4 years. A moderate increase in creatine kinase (CK) was the only biological sign observed. This study takes a closer look at a common but poorly known pathology and highlights the interest of the dynamic metabolic investigations carried out during exercise stress test with a cycle ergometer. Our non-invasive clinical and biological examination, at the interface between physiology and biology, disclosed the total absence of a physiological increase in plasma ammonia evocative of MAD. However, MAD was later confirmed by histochemistry and molecular studies, which revealed the presence of the recurrent homozygous pathogenic variant affecting the adenosine monophosphate deaminase 1 gene (AMPD1) in most patients with MAD.

Abdominal Pain due to a Wandering Liver.

Wandering liver syndrome is an extremely rare congenital disorder. It is mainly diagnosed within the first years of life. Herein we report the case of a 40-year-old woman with hepatoptosis due to the absence of anatomical peritoneal attachments of the liver. Surgical treatment consisted in inserting the floppy right lobe of the liver in a subphrenic retroperitoneal pouch. This original technique provided excellent postoperative result.

Time and reliability issues associated with automatic vs. manual measurements of Ankle to Brachial pressure Index (ABI) following heavy load exercise.

OBJECTIVES: Ankle to brachial index after heavy load exercise is the most accurate way of diagnosing minor arterial lesions in athletes, such as endofibrosis. The reliability and practical aspects of ankle to brachial index measurements after heavy-load exercise have not been studied. The purpose of this study was to analyze the interest of oscillometric automatic vs. manual Doppler measurements, for the calculation of ankle to brachial index, after heavy-load exercise in athletes. DESIGN: Prospective single-center study. METHODS: Fifteen healthy trained athletes performed an incremental test twice. Ankle to brachial index measurements were performed at Rest, as soon as possible after exercise (Rec-0), and then started at the 3rd minute of recovery (Rec-3), by two operators using each one of the two ankle to brachial index measurement methods. RESULTS: Mean times for automatic vs. manual ankle to brachial availability were 99 ± 18 s vs. 113 ± 25 s (p = 0.005) and 44 ± 25 s vs. 53 ± 12 s (p = 0.001) respectively at Rec-0 and Rec-3. Ankle to brachial index values from the two methods were highly correlated (r = 0.89). Mean absolute differences of automatic vs. manual ankle to brachial values from test-retest were 0.04 ± 0.05 vs. 0.08 ± 0.08 (p > 0.05) and 0.07 ± 0.05 vs. 0.09 ± 0.10 (p > 0.05) at Rest and Rec-0. CONCLUSIONS: Automatic method allows obtaining faster and simultaneously post-exercise ankle to brachial index measurement compare to the manual Doppler. This time issue does not result in a significant change in absolute ankle to brachial index values, nor in the absolute differences of these in test-retest. Nevertheless, the test-retest variability of post-exercise ankle to brachial index results seems smaller with the automatic than the manual method.

Ankle to brachial systolic pressure index at rest increases with age in asymptomatic physically active participants.

BACKGROUND: It is commonly acknowledged that the ability to use the ankle-brachial index (ABI), a reliable way to diagnose atherosclerosis, decreases with age in the general population. The aim of this study was to determine the relationship between resting ABI and age in different populations. METHODS: 674 physically active participants with (active high risk, ACTHR) or without (active low risk, ACTLR) cardiovascular risk factors or/and sedentary (SED) subjects, aged 20-70 years. Systolic arterial pressure was recorded at rest and simultaneously with automatic sphygmomanometers at the arms and ankles. ABI was calculated as the ratio of the lowest, highest or mean ankle pressure to the highest arm pressure. RESULTS: Proportion of ABImin<0.90 was 10.3% in SEDHR subjects versus 0.5% and 1.2%, respectively, in ACTHR and ACTLR groups. The averaged ABI value of each group was in the normal range in all groups (ABI>0.90) but was significantly lower in SEDHR compared with all active participants (p<0.001). Regression lines from ABImean versus age could lead to approximately +0.05 every 15 years of age in apparently healthy active participants (ACTLR). CONCLUSION: ABI at rest increases with the increase in age in the groups of low-risk asymptomatic middle-aged trained adults. The previously reported decrease in ABI with age is found only in SEDHR subjects, and is very likely to rely on the increased prevalence of asymptomatic arterial disease in this group. The increase of ABI with age is consistent with the 'physiological' stiffness observed in ageing arteries even in the absence of 'pathological' atherosclerotic lesions. TRIAL REGISTRATION NUMBER: NIH clinicaltrial.gov: NCT01812343.

The walking-induced transient hack concept is valid & relies on a transient early-exercise hypoxemia.

BACKGROUND: Decreased arterial oxygen pressure obtained at peak exercise is strong evidence of walking-induced hypoxemia, assuming that the lower pressure occurs just before exercise is stopped. Using empirical predefined models and transcutaneous oximetry, we have shown that some patients reporting exercise intolerance show a minimal value at the onset of walking and a post-exercise overshoot. These changes are referred to as transcutaneous "walking-induced transient hacks". METHODS: In 245 patients, walking-induced transcutaneous oxygen pressure changes in the chest were analyzed using observer-independent clustering techniques. Clustering classes were compared to the profile types previously proposed with the cross-correlation technique. The classifications of patients according to both approaches were compared using kappa statistics. In 10 patients showing a hack on transcutaneous oximetry, we analyzed the results of direct iterative arterial sampling recorded during a new walking treadmill test. RESULTS: Clustering analysis resulted in 4 classes that closely fit the 4 most frequently proposed empirical models (cross-correlation coefficients: 0.93 to 0.97). The kappa between the two classifications was 0.865. In 10 patients showing transcutaneous hacks, the minimal direct arterial oxygen pressure value occurred at exercise onset, and these patients exhibited a recovery overshoot reaching a maximum at two minutes of recovery, confirming the walking-induced transient hypoxemia. CONCLUSIONS: In patients reporting exercise intolerance, transcutaneous oximetry could help to detect walking-induced transient hypoxemia, while peak-exercise arterial oximetry might be normal.

Objective determination of the predefined duration of a constant-load diagnostic tests in arterial claudication.

OBJECTIVE: The predefined duration to arbitrarily stop the tests during constant-load treadmill exercise is a subject of debate and widely variable in the literature. We hypothesized that the upper and lower limits for predefined durations of constant-load 3.2 km/hour 10% grade tests could be derived from the distribution of walking distances observed on a treadmill in a population of subjects referred for claudication or from the optimal cutoff point distance on a treadmill to confirm a limitation self-reported by history. METHODS: We conducted a retrospective analysis using a referral center, institutional practice, and ambulatory patients. We studied 1290 patients (86% male), 62.1 +/- 11.2 years of age, 169 +/- 8 cm height, 75.7 +/- 14.2 kg weight. Patients performed a standard constant-load treadmill test: 3.2 km hour(-1), 10% slope, maximized to 1000 meters (approximately 20 minutes). We analyzed the maximal walking distance self-reported (MWD(SR)) by history and the maximal walking distance measured on the treadmill (MWD(TT)). Patients reporting MWD(SR) >or=1000 meters were considered unlimited by history. RESULTS: Only 197 patients (15.3%) completed the 20-minute treadmill test. Among the 504 patients who did not stop before 250 meters, 47.8% stopped within the next 250 meters (were unable to walk 500 meters). This proportion falls to 7.5% among the 213 patients who did not stop before 750 meters. When the final goal was to estimate whether the treadmill test can discriminate patients with or without limitation by history, area under the receiver operating characteristic (ROC) curve was 0.809 +/- 0.016 (95% confidence interval [CI], 0.778-0.841; P < .0001), the best diagnostic performance was attained for an MWD(TT) of 299 meters (approximately 6.15 minutes). CONCLUSION: In patients undergoing constant-load treadmill exercise with a protocol of 3.2 km hour(-1) and 10% slope: a predefined duration of 7 minutes could be proposed as a lower limit for the predefined duration of the tests specifically if one aims at confirming the limitation by history with treadmill testing. Owing to the low risk that patients that could walk 750 meters (approximately 15 minutes) will have to stop in the next 250 meters, 15 minutes seems a reasonable upper limit for the predefined test duration in clinical routine.

Endofibrosis in athletes: is a simple bedside exercise helpful or sufficient for the diagnosis?

OBJECTIVE: Ankle-to-brachial index (ABI) can be easily performed by all physicians. The Ruffier-Dickson (RD) test is an easy procedure to attain moderate exercise at the bedside for physicians who do not have an ergometer. DESIGN: Retrospective analysis. SETTING: Tertiary care, institutional practice. PATIENTS: Fifty-three asymptomatic athletes and 22 patients suffering from unilateral pain due to histologically proven exercise-induced arterial endofibrosis (EIAE). INTERVENTION: Brachial and ankle systolic blood pressures were measured in the supine position on the suspected leg in EIAE or left leg in controls, at rest (rest) and at the first minute of the recovery from incremental maximal cycle ergometer exercise (maxCE) and Ruffier-Dickson (RD) exercise tests. MAIN OUTCOME MEASURES: Comparison of ABI(rest), ABI(maxCE), and ABI(RD) in discriminating patients from normal subjects, using receiver operating characteristics (ROC) curves. RESULTS: Area (+/-SE of area) of ROC curve was 0.76 +/- 0.06 for ABI(rest), 0.83 +/- 0.05 for ABI(RD) (nonsignificant from rest), and 0.99 +/- 0.01 for ABI(maxCE) (P < 0.01 from ABI(RD) and P < 0.001 from ABI(rest)). An ABI(maxCE) below 0.48 was 100% specific and 80% sensitive for EIAE. For the RD test, a 100% negative predictive value was only attained for postexercise ABI values higher than 0.92. CONCLUSION: ABI after maximal cycle ergometer exercise is more accurate than ABI after an RD test to search for unilateral EIAE in athletes.