Endoscopic Technologies for Peripheral Pulmonary Lesions: From Diagnosis to Therapy

Peripheral pulmonary lesions (PPLs) are frequent incidental findings in subjects when performing chest radiographs or chest computed tomography (CT) scans. When a PPL is identified, it is necessary to proceed with a risk stratification based on the patient profile and the characteristics found on chest CT. In order to proceed with a diagnostic procedure, the first-line examination is often a bronchoscopy with tissue sampling. Many guidance technologies have recently been developed to facilitate PPLs sampling. Through bronchoscopy, it is currently possible to ascertain the PPL’s benign or malignant nature, delaying the therapy’s second phase with radical, supportive, or palliative intent. In this review, we describe all the new tools available: from the innovation of bronchoscopic instrumentation (e.g., ultrathin bronchoscopy and robotic bronchoscopy) to the advances in navigation technology (e.g., radial-probe endobronchial ultrasound, virtual navigation, electromagnetic navigation, shape-sensing navigation, cone-beam computed tomography). In addition, we summarize all the PPLs ablation techniques currently under experimentation. Interventional pulmonology may be a discipline aiming at adopting increasingly innovative and disruptive technologies

Physiological consequences of the work of breathing and of inspiratory muscle training

A reduced blood lactate concentration ([lac-]B) is commonly observed during whole-body exercise following inspiratory muscle training (IMT). However, whether the inspiratory muscles are, in part, the source of these reductions remains unknown. Accordingly, this thesis investigated: (I) the contribution of the respiratory muscles to the systemic [lac-]B and (II) the effects of IMT upon inspiratory muscle lactate exchange and clearance. In addition, the thesis also evaluated the determinants of inspiratory muscle strength (maximal inspiratory mouth pressure; MIP). All subjects were healthy, active and free of pulmonary and respiratory muscle disease. Under resting conditions, 10 min intense volitional hyperpnoea at 85% of maximal exercise minute ventilation (VE max) increased [lac-]B by 0.96 mmol.L-1. This was attenuated by 25% following 6 wks IMT. 8 min volitional hyperpnoea at 90% VE max imposed upon exercise at the maximal lactate steady state (MLSS) increased [lac-]B by 0.99 mmol.L-1. Following 6 wk IMT, the steady state and hyperpnoea-mediated increase in [lac-]B were lower by 8 and 26%, respectively. Relative to pre-IMT, loading the trained inspiratory muscles using a low-intensity pressure threshold resistance (15 cmH2O) immediately following maximal exercise accelerated both lactate exchange and clearance capacities by ~70%

Ultrasonography for the assessment of contractile properties of fresh and fatigued diaphragm muscle in healthy humans

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonContractile function of the diaphragm is characterised by its ability to shorten, generate force, produce power and perform work. Due to the diaphragm’s inaccessibility, these attributes are typically measured as the pressure difference across the diaphragm in response to twitch stimulation of phrenic nerves (i.e., twitch transdiaphragmatic pressure [ΔPdi,tw]). This technique, however, provides limited information concerning the muscle’s ability to shorten under load and to produce power. The overarching aim of this thesis was to determine whether ultrasound imaging could be used to elucidate the in vivo contractile properties of fresh and fatigued diaphragm muscle in healthy humans. Chapter 4 and 5 evaluated the feasibility, validity and intra-observer reliability of ultrasound-derived measures of crural diaphragm excursion, excursion velocity and power (i.e., kinetics) and costal diaphragm shortening in response to nerve stimulation, sniffs and hypercapnic hyperpnoea. Diaphragm kinetics and shortening exhibited good-to-excellent within-day reliability, with ultrasound acquisition during hyperpnoea unaffected by increasing tidal volume. Chapter 6 compared diaphragm contractile properties during CO2- vs. exercise-induced hyperpnoea, thereby elucidating the mechanisms that underpin postural-ventilatory modulation of the diaphragm. Compared to CO2-rebreathe, exercise evoked greater Pdi (17 ± 9 vs. 20 ± 8 cmH2O, p = 0.03; mean ± SD) but less diaphragm excursion (3.4 ± 1.1 vs. 2.5 ± 1.2 cm, p < 0.001), despite similar levels of ventilation. Thus, the diaphragm may be constrained during exercise due to quasi-isometric contractions required for modulating postural and ventilatory tasks. Chapter 7 assessed the effect of external loading (pressure and flow) on diaphragm kinetics and force to elucidate the mechanisms that underpin task-dependency of diaphragm fatigue. Pressure-loading, but not flow-loading, elicited a decline in ΔPdi,tw (–13%, p = 0.013) and excursion velocity (–39%; p = 0.043) with a subsequent decline in diaphragm power (–46%, p = 0.033). Chapter 8 was an exploratory study to assess the effect of external loading (pressure and flow) on costal diaphragm thickening. Despite a reduction in ΔPdi,tw (–11 ± 3%) after pressure loading, diaphragm thickening remained well-preserved in response to evoked contractions (fresh: 54 ± 27%; fatigued: 50 ± 33%), sniffs (fresh: 65 ± 25; fatigued: 78 ± 70%) and hypercapnic hyperpnoea (fresh: 130 ± 55%; fatigued: 86 ± 22%). Because measures of diaphragm thickening were highly variable, they may not be adequately sensitive to capture acute changes with fatigue. This body of work supports the use of subcostal ultrasonography in the assessment of in vivo diaphragm force-velocity-power relations, and suggests that ultrasound may be a useful tool to explore the effects of training interventions and healthy ageing on dynamic contractile properties of the human diaphragm

Nutrition, Health and Athletic Performance

Optimal nutrition is fundamental for enhancing training, recovery and performance in sport. Therefore, research has aimed to determine the efficacy of appropriate intake of nutrients, fluids, and supplements and their role in exercise performance. The purpose of this Special Issue entitled “Nutrition, Health and Athletic Performance” is to highlight recent research examining aspects of sports nutrition and exercise performance. Manuscript submissions of original research, meta-analyses, or reviews of the scientific literature, which targets nutritional strategies to benefit performance and health, are welcome. Studies performed in humans are preferred given the applied nature of this issue

Epidemiology of Injury in English Women's Super league Football: A Cohort Study

INTRODUCTION: The epidemiology of injury in male professional football has been well documented (Ekstrand, Hägglund, & Waldén, 2011) and used as a basis to understand injury trends for a number of years. The prevalence and incidence of injuries occurring in womens super league football is unknown. The aim of this study is to estimate the prevalence and incidence of injury in an English Super League Women’s Football squad. METHODS: Following ethical approval from Leeds Beckett University, players (n = 25) signed to a Women’s Super League Football club provided written informed consent to complete a self-administered injury survey. Measures of exposure, injury and performance over a 12-month period was gathered. Participants were classified as injured if they reported a football injury that required medical attention or withdrawal from participation for one day or more. Injuries were categorised as either traumatic or overuse and whether the injury was a new injury and/or re-injury of the same anatomical site RESULTS: 43 injuries, including re-injury were reported by the 25 participants providing a clinical incidence of 1.72 injuries per player. Total incidence of injury was 10.8/1000 h (95% CI: 7.5 to 14.03). Participants were at higher risk of injury during a match compared with training (32.4 (95% CI: 15.6 to 48.4) vs 8.0 (95% CI: 5.0 to 10.85)/1000 hours, p 28 days) of which there were three non-contact anterior cruciate ligament (ACL) injuries. The epidemiological incidence proportion was 0.80 (95% CI: 0.64 to 0.95) and the average probability that any player on this team will sustain at least one injury was 80.0% (95% CI: 64.3% to 95.6%) CONCLUSION: This is the first report capturing exposure and injury incidence by anatomical site from a cohort of English players and is comparable to that found in Europe (6.3/1000 h (95% CI 5.4 to 7.36) Larruskain et al 2017). The number of ACL injuries highlights a potential injury burden for a squad of this size. Multi-site prospective investigations into the incidence and prevalence of injury in women’s football are require

A Systematic Review and Meta-Analysis of the Incidence of Injury in Professional Female Soccer

The epidemiology of injury in male professional football is well documented and has been used as a basis to monitor injury trends and implement injury prevention strategies. There are no systematic reviews that have investigated injury incidence in women’s professional football. Therefore, the extent of injury burden in women’s professional football remains unknown. PURPOSE: The primary aim of this study was to calculate an overall incidence rate of injury in senior female professional soccer. The secondary aims were to provide an incidence rate for training and match play. METHODS: PubMed, Discover, EBSCO, Embase and ScienceDirect electronic databases were searched from inception to September 2018. Two reviewers independently assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement using a 22-item STROBE checklist. Seven prospective studies (n=1137 professional players) were combined in a pooled analysis of injury incidence using a mixed effects model. Heterogeneity was evaluated using the Cochrane Q statistic and I2. RESULTS: The epidemiological incidence proportion over one season was 0.62 (95% CI 0.59 - 0.64). Mean total incidence of injury was 3.15 (95% CI 1.54 - 4.75) injuries per 1000 hours. The mean incidence of injury during match play was 10.72 (95% CI 9.11 - 12.33) and during training was 2.21 (95% CI 0.96 - 3.45). Data analysis found a significant level of heterogeneity (total Incidence, X2 = 16.57 P < 0.05; I2 = 63.8%) and during subsequent sub group analyses in those studies reviewed (match incidence, X2 = 76.4 (d.f. = 7), P <0.05; I2 = 90.8%, training incidence, X2 = 16.97 (d.f. = 7), P < 0.05; I2 = 58.8%). Appraisal of the study methodologies revealed inconsistency in the use of injury terminology, data collection procedures and calculation of exposure by researchers. Such inconsistencies likely contribute to the large variance in the incidence and prevalence of injury reported. CONCLUSIONS: The estimated risk of sustaining at least one injury over one football season is 62%. Continued reporting of heterogeneous results in population samples limits meaningful comparison of studies. Standardising the criteria used to attribute injury and activity coupled with more accurate methods of calculating exposure will overcome such limitations