Case study: Resumption of eumenorrhea in parallel with high training load after 4 years of menstrual dysfunction: a 5-year follow-up of an elite female cyclist

The female athlete triad is a condition where low energy availability is typically observed together with menstrual dysfunction and/or low bone mineral density. How this condition affects maximal work capacity in endurance athletes is not clear and the recovery time-course of menses with increased energy availability with concomitant high training load is unknown. This case-study of an amenorrheic elite road-cyclist reports resumption of normal menstrual function after weight-gain during a 5-year period (2014-2019) while engaged in high training load and competition. The athlete (VO2max 3.54 L/min, 64 ml/min/kg, PPO 300 W, 5.4 W/kg) reported amenorrhea(2013-2015)/oligomenorrhea(2015-2018). Training load increased from 2014 to 2019 (584 to 818 h/year and 26707 to 41945 Training Stress Score/year). Regular menses (every 23-35 days) resumed in June 2018, ~5-6 months after a weight gain episode. During the period of menstrual dysfunction body mass was 51.3 ±2.25 kg (mean ±95% CL), and fat percentage 19% (Dual-energy X-ray Absorptiometry (DXA), 2016), and after weight gain, 56.8 ±2.63 kg and fat percentage 25% (DXA, 2019). Crank-based power-meter data showed absolute mean maximal power (MMP; watts) improvement over the 5s-4 h range through the 2014-2019 period, while relative MMP (watts/kg) likely peaked in the 2015-16 season for 5min, 20min and 30min but remained mostly unchanged across seasons. Results suggest that: 1)Best relative power-output associated with aerobic capacity (5min-1h) can be achieved during menstrual dysfunction, 2)High performance achieved despite an increase in body mass, and 3)Resumption of menses is achievable while maintaining high training loads when coupled with high energy availability

Optimizing protein delivery to promote skeletal muscle protein synthesis

Resistance exercise and protein ingestion are synergistic in their capacity to stimulate muscle protein synthesis. Previous research has examined the effect of various factors related to protein ingestion (e.g. amount, type, co-ingestion with carbohydrates and proximity to resistance exercise) and their capacity to modulate muscle protein synthesis. However, there are many deficiencies in our current knowledge regarding the effect of several modifiable factors related to amino acid provision that may alter muscle protein synthesis. Therefore, the aim of this thesis was to determine 1) the anabolic effect of leucine on skeletal muscle cells, 2) the capacity for differences in the timing and distribution of protein ingestion to modulate skeletal muscle protein synthesis after a bout of resistance exercise, and 3) the effect of resistance exercise and protein ingestion on the skeletal muscle anabolic response during dietary-induced energy deficit

Toxic Epidermal Necrolysis in an Irradiated Patient Treated with a Nanocrystalline Silver Dressing

Toxic epidermal necrolysis syndrome is a severe exfoliative condition, which may be triggered by anticonvulsant medication. We report a case of toxic epidermal necrolysis syndrome in a 43-year-old female who was receiving radiotherapy for brain metastases from a recurring breast cancer and phenytoin. She had 80% total body surface area involvement and recovered successfully with the application of a nanocrystalline silver dressing

Retraining and nutritional strategy of an endurance master athlete following hip arthroplasty: a case study

Retraining and resuming competition following surgery is challenging for athletes due to the prolonged period of reduced physical activity and subsequent alteration of body composition and physical performance. This is even more challenging for master athletes who endure the additional effect of aging. Within this context, the purpose of this study was to evaluate the feasibility and benefits that evidence-based nutritional and training recommendations could have on the time course of reconditioning and retraining following hip arthroplasty in an endurance master triathlete. During 38 weeks (from 6 weeks prior to surgery through to the return to competition in week 32), the athlete was provided with detailed training and nutritional recommendations. Dietary intake (via the remote food photographic method), body composition (via DXA), peak oxygen uptake (VO2peak), peak power output (PPO), cycling efficiency (GE), and energy availability (EA) were assessed 6 weeks pre- and 8, 12, 18, 21, and 25-weeks post-surgery. Training load was quantified (via TRIMP score and energy expenditure) daily during the retraining. Total body mass increased by 8.2 kg (attributable to a 3.5–4.6 kg increase in fat mass and lean mass, respectively) between week −6 and 8 despite a reduction in carbohydrate (CHO) intake post-surgery (<3.0 g/kg body mass/day). This was accompanied with a decrease in VO2peak, PPO, and GE due to a drop in training load. From week 7, the athlete resumed training and was advised to increase gradually CHO intake according to the demands of training. Eventually the athlete was able to return to competition in week 32 with a higher PPO, improved VO2peak, and GE. Throughout retraining, EA was maintained around 30 kcal/kg Lean Body Mass/day, protein intake was high (~2 g/kg/day) while CHO intake was periodized. Such dietary conditions allowed the athlete to maintain and even increase lean mass, which represents a major challenge with aging. Data reported in this study show, for the first time, the conditions required to recover and return to endurance competition following hip surgery

Continuous Gonadotropin-Releasing Hormone Infusion Stimulates Dramatic Gonadal Development in Hypogonadal Female Mice&apos;

ABSTRACT Adult hypogonadal (hpg) mice, lacking GnRH, have infantile reproductive systems and levels of pituitary gonadotropins that are lower than normal. The mutant mice respond to brain grafts containing GnRH neurons with gonadal development and increased production of gonadotropins. In view of the substantial literature regarding the nature and necessity of pulsatile GnRH stimulation of gonadotropins, we were not surprised in earlier studies to find that the majority of hpg mice with successful grafts have pulsatile LH secretion. It is not known, however, why LH pulsatility was undetectable in some animals with significant gonadal development. The present experiment was intended to determine the degree to which hpg mice respond to continuous infusion of GnRH via osmotic minipumps. Unexpectedly, female hpg mice exhibited dramatic ovarian and uterine growth after 15 or 30 days of continuous exposure to GnRH, with five-and eightfold increases in ovarian and uterine weights, respectively. Despite evidence of increased gonadotropin secretion in the treated hpg mice, pituitary stores of FSH and LH remained low. Similar treatment of normal female mice for 15 days also depleted pituitary concentrations of LH and FSH without significantly altering gonadal weights or plasma gonadotropin levels. It is clear from the present findings that inferences of pulsatile GnRH secretion based on stimulation of gonadal development in hpg mice should be made with caution

Tumores óseos de la pelvis

Se presenta la experiencia del Servicio de Ortopedia del Adulto del Hospital «Ramón y Cajal», en neoplasias de la pelvis, desde su creación hasta la actualidad, siendo 61 los pacientes recogidos y no se hace un trabajo estadístico, sino más bien se muestran las peculiaridades recogidas con la experiencia, que abarca desde la abstención en algunos casos de tumores secundarios, y el simple curetage hasta las grandes sustituciones con homoinjertos de banco, relacionándolo a su vez con publicaciones de aparición más o menos moderna sobre este tema, para concluir que se trata de una cirugía no exenta de complicaciones y problemas, pero necesaria a la hora de proporcionar a los enfermos curaciones, que le ofrezcan una salida a este difícil problema.The experience of Adult Orthopaedics Unit at the Hospital «Ramón y Cajal», Madrid, treating patients with malignant tumors of the pelvic bons is presented. In this paper, the results after surgery are not reported in terms of statistical analysis. The aún of this work is to comment the surgical experience covering from simple curettage to great bone replacement using bank allografts. The message is that surgical treatment of pelvic tumors is not exent of complications, but it seems to be worth in order to offer a better quality of Ufe for patients

Reliability of resting metabolic rate between and within day measurements using the Vyntus CPX system and comparison against predictive formulas

Background: To detect longitudinal changes of resting metabolic rate (RMR) resulting from the effects of energetic stress, reliable RMR measurements are crucial. The Vyntus CPX is a new automated indirect calorimetry system for which RMR reliability has not been determined. Additionally, its agreement with common predictive RMR formulas is unknown. Aim: To determine the within and between-day reliability of RMR measurements using the Vyntus CPX system and its agreement with predictive RMR formulas. Methods: Young (31 ± 7 years) healthy participants (n = 26, 12 females, 14 males) completed three measurements of RMR, two consecutive measures on the same day, one the day before/after, all under standardised conditions. Reliability was assessed with pairwise comparisons of between-day at the same time (BDST), within day consecutive measurements (WDCM) and between-day different time (BDDT), for parameters of reliability (mean change (MC), intraclass correlation (ICC) and typical error of measurement (TEM)). Measured RMR values (kcal/day) were compared against predictive values of 4 common formulas. Results: Parameters of reliability (mean, (95% confidence interval)) were: -BDST: MC, 0.2(-2.3—2.7)% (p = 0.67); ICC, 0.92(0.84—0.97); TEM, 4.5(3.5—6.2)%. -WDCM: MC, −2.5(-6.2—1.3)% (p = 0.21); ICC, 0.88(0.74—0.88); TEM, 7.0(5.4—9.8)%. -BDDT: MC, −1.5(-4.8—1.9)% (p = 0.57); ICC, 0.90(0.76—0.95); TEM, 6.1(4.8—8.5)%. RMRratios (measured/predicted) were: 1.04 ± 0.14 (Nelson, p = 0.13), 1.03 ± 0.10 (Mifflin, p = 0.21), 0.98 ± 0.09 (Harris-benedict, p = 0.30), 0.95 ± 0.11 (Cunningham1980, p = 0.01), 1.00 ± 0.12 (Cunningham1991, p = 0.90) and 0.96 ± 0.13 (DXA, p = 0.03). Conclusions: The Vyntus CPX is reliable and measured RMR values agreed with four predictive formulas but are lower than Cunningham1980 and DXA RMR estimates for this population

Direct and indirect impact of low energy availability on sports performance

Low energy availability (LEA) occurs inadvertently and purposefully in many athletes across numerous sports; and well planned, supervised periods with moderate LEA can improve body composition and power to weight ratio possibly enhancing performance in some sports. LEA however has the potential to have negative effects on a multitude of physiological and psychological systems in female and male athletes. Systems such as the endocrine, cardiovascular, metabolism, reproductive, immune, mental perception, and motivation as well as behaviors can all be impacted by severe (serious and/or prolonged or chronic) LEA. Such widely diverse effects can influence the health status, training adaptation, and performance outcomes of athletes leading to both direct changes (e.g., decreased strength and endurance) as well as indirect changes (e.g., reduced training response, increased risk of injury) in performance. To date, performance implications have not been well examined relative to LEA. Therefore, the intent of this narrative review is to characterize the effects of short-, medium-, and long-term exposure to LEA on direct and indirect sports performance outcomes. In doing so we have focused both on laboratory settings as well as descriptive athletic case-study-type experiential evidence