Effect of proprioception training on knee joint position sense in female team handball players.

BACKGROUND: A number of studies have shown that proprioception training can reduce the risk of injuries in pivoting sports, but the mechanism is not clearly understood. AIM: To determine the contributing effects of propioception on knee joint position sense among team handball players. STUDY DESIGN: Prospective cohort study. METHODS: Two professional female handball teams were followed prospectively for the 2005-6 season. 20 players in the intervention team followed a prescribed proprioceptive training programme while 19 players in the control team did not have a specific propioceptive training programme. The coaches recorded all exposures of the individual players. The location and nature of injuries were recorded. Joint position sense (JPS) was measured by a goniometer on both knees in three angle intervals, testing each angle five times. Assessments were performed before and after the season by the same examiner for both teams. In the intervention team a third assessment was also performed during the season. Complete data were obtained for 15 subjects in the intervention team and 16 in the control team. Absolute error score, error of variation score and SEM were calculated and the results of the intervention and control teams were compared. RESULTS: The proprioception sensory function of the players in the intervention team was significantly improved between the assessments made at the start and the end of the season (mean (SD) absolute error 9.78-8.21 degrees (7.19-6.08 degrees ) vs 3.61-4.04 degrees (3.71-3.20 degrees ), p<0.05). No improvement was seen in the sensory function in the control team between the start and the end of the season (mean (SD) absolute error 6.31-6.22 degrees (6.12-3.59 degrees ) vs 6.13-6.69 degrees (7.46-6.49 degrees ), p>0.05). CONCLUSION: This is the first study to show that proprioception training improves the joint position sense in elite female handball players. This may explain the effect of neuromuscular training in reducing the injury rate.

The role of insertion allele of angiotensin converting enzyme gene in higher endurance efficiency and some aspects of pathophysiological and drug effects.

BACKGROUND: None of the genetic markers are selectively associated with elite athletes, but potential candidates are found in the renin-angiotensin system, which plays a key role in the regulation of cardiovascular physiology. The most extensively examined gene in connection with the hemodynamics category is the angiotensin converting enzyme (ACE). This review paper has focused on ACE I/D allele polymorphism regarding the evidence of the effects of physiological and pathophysiological drugs and has completed with an original work in the exercise physiology. METHODS: In this study we examined genetic polymorphisms of ACE in female (n=26) and male (n=24) athletes as well as in a well-trained control group (n=24). MVV(ex), VE and VO(2max) were determined at rest and during an exhaustive step test. RESULTS: The frequency of the ACE I allele was significantly higher (p<0.041) in the group showing a higher intensity of breathing metabolism. The ACE D allele frequency was significantly higher in the excellent endurance athletes group than in unsuccessful athletes (p<0.054). CONCLUSION: The ACE I allele is a genetic marker for higher endurance efficiency in acute physical activity and higher adaptation of the cardiovascular system. The measurement of acute physical status needs to be completed with examination of genotype, which is related to the athletic excellence also, because the D allele could be associated with good performance by endurance athletes in future world championships. Further studies are needed to assess the view that the ACE D allele has a significant role in athletic efficiency.

Changes in joint position sense after surgically treated chronic lateral ankle instability.

BACKGROUND: A search of the literature shows that the effect of surgery on ankle proprioception has been hardly investigated. OBJECTIVE: To examine the effect of anatomical reconstruction of the anterolateral capsuloligamentous complex on ankle joint position sense. METHODS: A prospective study using the "slope box" test. Ten consecutive patients were included in the study, and 10 healthy athletes represented the control group. RESULTS: Similar test-retest reliability rates (overall reliability 0.92; p = 0.0013) were obtained to those of the original designers of the method. There were no significant differences with respect to side dominance (p = 0.9216). Investigation of the characteristics of mean absolute estimate errors showed that the controls tested became error prone in the range of slope altitudes 7.5-25 degrees in every direction, compared with the range 0-5 degrees (range of p values 0.00003-0.00072). The results of the intervention group showed that, for the two main directions of interest (anterior and lateral), preoperative differences in mean absolute estimate errors between injured (anterior 3.91 (2.81) degrees ; lateral 4.06 (2.85) degrees ) and healthy (anterior 2.94 (2.21) degrees , lateral 3.19 (2.64) degrees ) sides (anterior, p = 0.0124; lateral, p = 0.0250) had disappeared (postoperative differences: anterior, p = 0.6906; lateral, p = 0.4491). The afflicted ankle had improved significantly after surgery in both important directions (anterior, p<0.0001; lateral, p = 0.0023). CONCLUSIONS: The study shows that differences in joint position sense between healthy and injured ankles disappeared as the result of surgery. Preoperative data show that proprioceptive malfunction is a cause of functional instability. If treatment is by means of surgery, the retensioning of the original anterolateral structures is inevitable, even if other grafting or surgical techniques are used.

Oxytocinase (CAP) activity in serum during normal pregnancy.

Reference values for the activity of oxytocinase were determined in the sera of 371 women during normal pregnancy. An exponential relationship between enzyme activities and gestational age was found. The activity of oxytocinase (CAP) increased progressively from the beginning to the end of pregnancy. Statistical evaluation showed a significant difference between the 5th and 2nd months, as well as after the 20th week of pregnancy.

Determination of free and esterified cholesterol by a kinetic method. I. The introduction of the enzymatic method with 2,2'-azino-di-3[ethyl-benzthiazolin sulfonic acid (6)] (ABTS).

A new, simple kinetic method is described for the determination of serum cholesterol based on the oxidation of 2,2'-azino-di-3[ethyl-benzthiazolin sulfonic acid (6)] (ABTS) by use of a single aqueous reagent. This assay procedure is rapid, specific, reproducible and applicable to the measurement of free and esterified cholesterol in a continuous procedure. The method requires no prior treatment of sample and linear kinetics are obtained up to 13 mmol/l cholesterol. The use of ABTS permits the direct calculation of cholesterol concentrations from absorbance changes at 410 nm (A = epsilon - c - d).

[A kinetic method for the determination of the activity of "aerobic transhydrogenases" (author's transl)]. / Eine kinetische Methode zur Bestimmung von "Aeroben Transhydrogenasen"

The chromogen ABTS is the di-ammonium salt of 2,2'-azino-di[3-ethyl-benzthiazolin-sulfonic acid (6)] routinely used in the "glucose-oxidase assay" with the peroxidase (GOD-Perid method, Boehringer). 1. The specific property of ABTS to give a stable radical cation by oxidation with hydrogen peroxide in the presence of peroxidase was used to design a kinetic method, for enzyme-activity determinations. 2. The assay is suitable for the specific oxido-reductase using oxygen as acceptor, known also as "aerobic transhydrogenases" which are H2O2 formers (EC 1.-.3.-). 3. L-Amino acid: oxygen oxidoreductase (deaminating) (EC 1.4.3.2), was used throughout, being a representative model for such determinations.

Determination of free and esterified cholesterol by a kinetic method. II. Evaluation of the enzymic method which uses 2,2-azino-di(3-ethyl-benzthiazoline-6-sulfonate) (ABTS) as chromogen.

A simple kinetic method for the determination of free and esterified serum cholesterol based on the oxidation of 2,2'-azino-di(3-ethyl-benzthiazoline-6-sulfonate) (ABTS) by use of choilesterol esterase, cholesterol oxidase and peroxidase has already been reported. Here the method is statistically examined. The method is very sensitive and precise (C.V. below 5%). The standard curve is linear up to 25.9 mmol/l. Comparison with results by Abell's method gave a linear regression of Yx = 0.2025 + 1.0043X with a correlation coefficient (r) of 0.983. Comparison with the enzymic methods of Roeschlau et al., Trinder, and Allain et al. gave Yx = 0.2037 + 0.9549X (r = 0.975), Yx = 0.4777 +0.8857X (r = 0.958) and Yx = 0.244 + 0.932X (r = 0.970), respectively. The effects of haemoglobin and bilirubin were studied and normal ranges for the method were determined on 150 healthy mature subjects of both sexes between 20 and 45 years of age. They are 3.375 to 6.948 mmol/l for total cholesterol, and 0.7196 to 2.089 mmol/l for free cholesterol.

Evaluation of the enzymatic assay of serum uric acid with 2,2'-azino-di(3-ethylbenzthiazoline-6-sulphonate) (ABTS) as chromogen.

A spectrophotometric method for the determination of serum uric acid based on the oxidation of 2,2'-azino-di(3-ethylbenzthiazoline-6-sulphonate) by use of uricase and peroxidase has already been reported. The method is very precise (CV less than 4.7%). The standard curve is linear up to 4640 mumol/L. Comparison with other enzymatic methods gave good correlation. The method gave results 9% lower than the phosphotungstate method. The effects of bilirubin, haemoglobin, glucose, ascorbic acid, anticoagulants and purine compounds were studied. The reference values for this method are 140.8-407.8 mumol/L for female subjects and 145.6-514.7 mumol/L for male subjects.

[Comparative study of arthroscopy and arthrotomy (economic aspects)]. / Arthroscopia és arthrotomia összehasonlítása (gazdasági szempontok).

On the Traumatological Orthopaedic Surgery Department of the Hungarian National Institute of Physical Education and Sports Hygiene 1629 arthroscopic operations of the knee joint were made between 1984-87. From these arthroscopic meniscectomy was made in 543 cases. A follow up study was performed in 302 arthroscopic meniscectomised and in 326 traditionally operated patients from the point of view of objective therapeutic results, hospitalization, convalescence and economic efficacy as well. The average follow up period was 8.2 months. The objective estimation of the therapeutic result was made by Lysholm score and Tapper-Hoover's functional classification. The mean hospitalization was 2 days after arthroscopic meniscectomy and 7 days following the traditional meniscectomy respectively. Twenty days shorter convalescence was observed in the arthroscopic meniscectomy cases. The patients were able to start regular physical activity 43 days earlier than traditionally operated athletes. The difference in Lysholm scores was 12 in favour of arthroscopic operations. On basis of the above considerable several millions reduction of expenses could be revealed what evidently proved the economic efficacy of arthroscopy.

A plaster containing DHEP and heparin for mild to moderate contusions and sprains with haematoma: a double-blind randomized study.

OBJECTIVE: This prospective, randomized, double-blind, three-arm study was performed to investigate the efficacy of a medicated plaster containing the combination of diclofenac epolamine (DHEP) 180 mg and heparin 5600 IU in the treatment of unilateral blunt soft tissue injuries involving the upper or lower limb, complicated by severe local haematoma. RESEARCH DESIGN AND METHODS: Patients with mild-to-moderate injuries complicated by local haematoma (< or =140 cm(2)) were included and randomly treated once daily with plasters containing DHEP/heparin, DHEP only, or placebo. Plasters were applied for at least 12 hours daily for 10 consecutive days. MAIN OUTCOME MEASURES: The time to complete haematoma dissolution was the primary efficacy endpoint; secondary endpoints were spontaneous pain reduction, pain on movement, muscle swelling and use of rescue analgesia. RESULTS: A total of 185 patients (90 males and 95 females, aged 18-80 years) were evaluated for efficacy. Baseline clinical and demographic characteristics were similar across the treatment groups. The time to complete haematoma dissolution was significantly shorter with the DHEP/heparin plaster compared with both the DHEP and placebo plasters (p < 0.05). Patients in the DHEP/heparin group had a 60% probability of achieving complete haematoma dissolution within the 10-day treatment period compared with patients receiving either DHEP or placebo plasters. Patient-rated reductions in pain on movement were significantly (p < 0.05) greater in the two active treatment groups compared with placebo. Overall, the DHEP/heparin, DHEP and placebo plasters were well-tolerated. While a reliance on patient self-reporting had the potential to limit the usefulness of some data obtained in this study, the investigators accounted for this accordingly. CONCLUSIONS: The plaster formulation combining DHEP and heparin relieves pain and induces faster dissolution of superficial haematomas, and may therefore contribute to a more rapid and complete recovery.

Changes in joint position sense after conservatively treated chronic lateral ankle instability.

Improvement of ankle proprioception through physiotherapy (a.k.a. proprioceptive training) is a widely accepted conservative treatment modality of chronic functional lateral ankle instability. Clinical studies provided controversial data on its proprioceptive effect. Aim of this study was to gain evidence on the efficacy of proprioceptive training on ankle joint position sense. Ten patients (five males and five females, aged 23.3+/-5.4 years) were treated conservatively for chronic lateral ankle instability with a special training programme over 6 weeks. For the assessment of joint position sense we used the slope-box test, first applied and described by Robbins et al. (Br J Sports Med 29:242-247, 1995). The test was performed before the start and after the end of the training programme, measuring joint position sense on 11 different slope amplitudes in four directions (anterior, posterior, lateral and medial) in random order each on both ankles. Comparisons were made between pre- and post-training results as well as versus a control-group of ten healthy athletes. Overall the proprioceptive sensory function of the studied group has improved, but this improvement was not significant in all directions. Only two patients have shown significant improvement of joint position sense in all directions (mean estimate error improvement: 2.47 degrees ), while conservative treatment was partially successful in five others (mean estimate error improvement: 0.73 degrees ). The follow-up results of these seven patients were comparable with the values measured in the control-group. Three patients did not show any improvements (mean estimate error improvement: -0.55 degrees ) (overall difference between improving and non-improving patients: P<0.0001). Mean absolute estimate error profiles of the seven improving patients became similar to the profiles of healthy athletes, while these changes could not be observed in the case of the three non-improving participants. Proprioceptive rehabilitation programme can be an effective method in order to improve impaired joint position sense function. After 6 weeks non-responding patients can be well identified, and considered for other treatment modalities. The determination of the effective length of the programme however needs further evaluation. Still, changes in the proprioceptive sensory function of the ankle plantarflectors indicate the preventive effect of the training programme. Furthermore, our results support the theory of simultaneous function of different mechanoreceptor-systems.

Surgical treatment of pectoralis major rupture in athletes.

Complete rupture of the pectoralis major muscle, first described by Patissier in 1822, is a rare sports injury. Less than 100 cases have been reported in the literature since 1822. In this study, we describe our surgical technique and summarize our results and experience of the surgical treatment of pectoralis major rupture. Seven athletes (4 wrestlers, 2 handball players, 1 body-builder) were surgically treated in our department from 1981 to 1996. During the follow-up examination, five patients had excellent and two had good results, and six athletes could return to sports activity at their preoperative level. Among our patients we emphasize that of a wrestler, who had suffered an acute rupture, and 3 months after the surgery he won an Olympic gold medal. According to the literature and our experience, we suggest that only surgical repair of the acute pectoralis major rupture will result in both complete recovery and restoration of the full strength of the muscle, essential for active athletes.

Kinetic assay of aldehyde oxidase with 2,2'-azino-di-(3-ethylbenzthiazoline-6-sulfonate) as chromogen.

A new kinetic method for the assay of aldehyde oxidase (EC 1.2.3.1) is described. By the oxidation of pyridoxal as a substrate, pyridoxic acid and hydrogen peroxide are formed. Hydrogen peroxide is subsequently reduced to water by the action of peroxidase, while the chromogen 2,2'-azino-di-(3-ethylbenzthiazoline-6-sulfonate) (ABTS) is oxidized to a blue-greenish-dyed product. The absorbance increase of the oxidized form of ABTS, registered every minute at 410 nm, is proportional to aldehyde oxidase activity.

The synthesis and chemical properties of 3-chloromercury-2-hydroxipropyl-urea.

A simple and rapid method for the synthesis of 3-chloromercury-2-hydroxipropyl-urea has been described. It has been concluded that highest yields are obtained by the synthesis of 197HgO and allyl urea in the ratio of 2.5 : 1. Stability of the final preparation was investigated after thermal sterilization and standing at room temperature. It has been proved that the inorganic mercury-197 is not released. Radiochemical purity was controlled by chromatographic method using pyridine, n-butanol and water (3 : 10 : 3 v/v) as a solvent. The results obtained indicate that the preparation is applicable for human use.

[Experience with the surgical correction of restricted movement of the knee joint]. / Tapasztalataink a térdízületi mozgáskorlátozottság mütéti kezelésében.

Authors treated 34 patients from 1989 to 1992 with restricted knee movements in the Department of Sport Medicine. The average age of the patients was 32 years, the youngest was 16 and the eldest was 54 years old, and the female male ratio was 14/20. 71% of the patients had some kind of ligament surgery in the past. Arthrolysis was performed in 24 cases. 13 cases out of 24 was performed arthroscopically and the rest was done following arthrotomy. Manipulation under anaesthesia was satisfactory in 5 cases, 4 patients had combined treatment and 1 had extraarticular intervention only. The range of motion was 0-11-81 degrees to start with, and it has improved up to 0-2-124 degrees in average 13 month time following the arthrolysis. There was correlation between the restriction and between the time of primary ligament reconstruction, the sex and the age of the patients. To perform the arthrolysis in time is important and the physiotherapist and the constant passive motion is inevitable.

[Relationship between the activity of alanine aminopeptidase and alkaline phosphatase in the blood of pregnant women]. / Odnos aktivnosti alaninaminopeptidaze i alkalne fosfataze u serumu trudnica.

The determination of the activity of alkaline phosphatase (AP)--orthophosphate-monoesterphosphohydrolase, EC.3.1.3.1.--and alanine-aminopeptidase (ANA)--alpha-aminoacyl-peptide hydrolase (microsomal), EC.3.4.11.2--in the serum of non-gravid and gravid women has shown that in non-gravid women normal ANA values range from 17.0 to 32.0 I. U. and normal AP values from 14.4 to 26.0 I. U., the ANA/AP quotient amounting to 1.28 (S = +/- 0.301 I. U., KV = 23.5%, n = 29). The determination of the activity of the above quoted enzymes has shown that in the course of pregnancy the values of both enzymes increased by the exponential curve which allowed the calculation of the ANA/AP quotient for each month of pregnancy. The ANA/AP quotient determined in this way is proposed to serve as a diagnostic parameter in the routine control of pregnant women.

Human red cell adenylate kinase polymorphism in Srbija, Yugoslavia.

Red cell adenylate kinase (AK) phenotypes were determined in 283 unrelated adults in Srbija (Yugoslavia). The gene frequencies observed were: AK1 0.961 and AK2 0.039. The adenylate kinase activity was estimated in all haemolysates; no significant differences were found between individuals of different phenotypes.

Super-marathon race increases serum and urinary nitrotyrosine and carbonyl levels.

BACKGROUND: In normal conditions, proteins are not present in the urine, however, exercise of long duration could result in proteinurea. Increased levels of reactive oxygen and nitrogen species (RONS) are formed during exhaustive physical exercise and causes alterations to cellular proteins. MATERIALS: In the present study serum and urinary nitrotyrosine and protein carbonyl levels were measured before and after each run of a 4-day super-marathon race. RESULT: Serum nitrotyrosine and protein carbonyl levels increased after the first (93 km) day running and reached a plateau on the second (120 km), third (56 km) and forth (59 km) days of the competition. A significant correlation was found between urinary and serum protein carbonyl and nitrotyrosine levels (r=0.78, r=0.71, respectively). A large percentage of urinary proteins were carbonylated and nitrated. Therefore, it appears that clearance of oxidized proteins in certain conditions occurs not only by the proteolytic pathways but also by filtration and urination. CONCLUSION: Data reveals that exhaustive aerobic exercise causes oxidative stress and increases the nitration and carbonylation of serum proteins. The presence of carbonyl and nitrotyrosine in proteins of the urine might reflect oxidative stress and could serve as a noninvasive diagnostic tool for exercise physiology.