Acute effects of a 60‑min time trial on power‑related parameters in trained endurance runners

Background: The advent of power meters for running has raised the interest of athletes and coaches in new ways of assessing changes in running performance. The aim of this study is to determine the changes in power-related variables during and after a strenuous endurance running time trial. Methods: Twenty-one healthy male endurance runners, with a personal record of 37.2 ± 1.2 min in a 10-km race, completed a 1-h run on a motorized treadmill trying to cover as much distance as they could. Before and after the time trial the athletes were asked to perform a 3-min run at 12 km h− 1. Normalized mean power output, step frequency, form power and running effectiveness were calculated using the Stryd™ power meter. Heart rate (HR) and rating of perceived exertion (RPE) were monitored, and data averaged every 5 min. Results: Despite high levels of exhaustion were reached during the time trial (HRpeak = 176.5 ± 9.8 bpm; RPE = 19.2 ± 0.8), the repeated measures ANOVA resulted in no significant differences (p ≥ 0.05), between each pair of periods for any of the power-related variables. The pairwise comparison (T test) between the non-fatigued and fatigued constant 3-min runs showed an increase in step frequency (p = 0.012) and a decrease in form power (p < 0.001) under fatigue conditions, with no meaningful changes in normalized mean power output and running effectiveness. Conclusions: Trained athletes are able to maintain power output and running effectiveness during a high demanding extended run. However, they preferred to reduce the intensity of vertical impacts under fatigue conditions by increasing their step frequency

Hipertensión pulmonar estimada por ecocardiografía en prematuros con displasia broncopulmonar: frecuencia, evolución y factores de riesgo

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Pediatría. Fecha de lectura: 30-09-2016Trasfondo: La hipertensión pulmonar (HP) es una complicación evolutiva de los recién nacidos prematuros (RNPT) con displasia broncopulmonar (DBP). En nuestro medio, disponemos de escasa información epidemiológica sobre la HP asociada a DBP. Objetivos: Nuestro objetivo primario fue definir la frecuencia de HP asociada a DBP establecida por ecocardiografía durante el ingreso hospitalario neonatal. Los objetivos secundarios fueron establecer la asociación de HP con morbimortalidad, analizar potenciales factores de riesgo y describir los hallazgos obtenidos en otras pruebas complementarias de imagen. Pacientes y Métodos: Reclutamos prospectiva y consecutivamente, entre 2010 y 2012, recién nacidos prematuros (edad gestacional [EG] menor o igual a 30 sem+6 días y /o peso al nacimiento [PRN] menor o igual a 1500g) que desarrollaron DBP según los criterios de los Institutos Nacionales de la Salud de los Estados Unidos. Evaluamos la aparición de signos ecocardiográficos compatibles con HP a partir de los 2 meses de vida o antes del alta hospitalaria. Seguimos la evolución hasta el año de vida (persistencia o resolución de los signos de HP, mortalidad, duración de hospitalización, rehospitalización). Resultados: De 84 RNPT con DBP, encontramos 22 casos con signos ecográficos de HP, la mayoría en formas moderadas o graves de DBP. Los signos de HP persistieron al año de vida en 3 pacientes. En el seguimiento, hubo 3 fallecimientos en la cohorte global, todos en el grupo de HP durante el ingreso. Los pacientes con HP tuvieron más eventos adversos (mortalidad o estancia hospitalaria prolongada o reingresos tras el alta; 68% frente a 35%, p=0,01) que el grupo sin HP. El grupo de la cohorte con HP fue de PRN y EG medios menores que el grupo sin HP (806 g frente a 923g, p=0,03; 26 semanas frente a 27,3 semanas, p=0,005), precisó de mayor duración de ventilación mecánica (duración mediana de 41 días frente a 6 días, p<0,001), y estuvo más tiempo hospitalizado (126 días frente a 86 días, p<0,001). El cierre quirúrgico del ductus se asoció, de forma independiente a peso y EG, con el desarrollo de HP (odds ratio ajustada de 4,13 [1,34-12,77]). Encontramos malformaciones vasculares (colaterales sistémico-pulmonares, estenosis de venas pulmonares) potencialmente relevantes en pruebas adicionales de imagen torácica (angiotomografía computarizada torácica) que definieron la extensión de la afectación pulmonar de estos pacientes. Conclusiones: La HP fue un hallazgo ecocardiográfico frecuente (al menos uno de cada seis pacientes en la inferencia poblacional) en RNPT que desarrollaron DBP, y aunque se resolvió en la mayoría de los supervivientes durante el primer año de vida, se asoció con eventos adversos de morbimortalidad más frecuentes. El ductus que precisó cirugía fue un factor de riesgo de HP.Background: Pulmonary hypertension (PH) complicates the evolution of preterm infants who develop bronchopulmonary dysplasia (BPD). Epidemiological data about DBP-associated PH is scarce in Spain. Aims: We primarily aimed to define the frequency of DBP-associated PH, as established by echocardiography, during the neonatal admission. Secondarily, we aimed to assess the association of PH to morbidity and mortality, to analyse potential risk factors, and describe image findings in ancillary tests. Patients and Methods: Between 2010 and 2012, we prospectively, consecutively recruited preterm newborns (gestational age[GE] equal or under 30 weeks plus 6 days and/or birth weight [BW] equal or under 1500 grams) who developed BPD according to National Institutes of Health criteria. We assessed the presence of echo signs compatible with PH beyond two months of life of before discharge, following evolution until the first year of life (persistence of resolution of PH; mortality, length of hospital stay, or readmission). Results: 22 out of 84 preterm newborns with BPD showed echographic signs of PH, most with moderate or severe BPD. PH signs persisted in 3 patients at one year. At follow-up, there were 3 deaths in the full cohort, all in the PH group. Patients with PH had more adverse events (composite of death or prolonged hospital stay or readmission after neonatal discharge; 68% vs. 35%, p=0.01) than the group without PH. PH cohort had both lower mean birth weight and gestational age than the group without PH (806 g vs. 923 g, p=0.03; 26 weeks vs. 27.3 weeks, p=0.005, required longer support on mechanical ventilation (median duration of 41 days vs. 6 days, p<0.001), and had longer hospital stay (median stay of 126 days vs. 86 days, p<0,001). Surgical closure of a ductus arteriosus was associated with development of PH, independently of birth weight and gestational age (adjusted odds ratio of 4.13 [1.34-12.77]). We found vascular anomalies (systemic-to-pulmonary collaterals, pulmonary vein stenosis) in ancillary image testing (chest angio-computed tomography scan) defining the extent of lung damage. Conclusions: PH was a frequent echo finding (at least one in six patients, as inferable population-wide) in preterm newborns who developed BPD. Although PH resolved in most of the survivors in the first year of life, it was associated with more adverse events of morbidity and mortality. Surgical closure of a ductus arteriosus was a risk factor for PH

Cómo vive el paciente con EPOC las reagudizaciones : estudio cualitativo en medio hospitalario

47 páginasTrabajo de Curso de Experto Universitario en Medicina de Urgencias y Emergencias (2013). Director: Francisco Cabrera Franquelo ; Tutora: Francisca Muñoz Cobos. El objetivo de este trabajo es describir la visión de la enfermedad y las reagudizaciones del paciente con EPOC durante una reagudización

Factores relacionados con el cumplimiento terapéutico en EPOC. Análisis de la perspectiva de los pacientes

Resultados: o Perfil de los participantes: Hombre de 68 años de edad de bajo nivel cultural, con diagnóstico de EPOC de cinco años de evolución, nivel de gravedad medio, fenotipo no agudizador (75,9%< 2 reagudizaciones/año) y exfumador. Tiene pautado tratamiento anticolinérgico, beta 2 adrenérgico y corticoide inhalado pero no sigue correctamente la pauta de tratamiento; similar en otras investigaciones. o Percepción de la enfermedad: Los pacientes con EPOC carecen de un modelo mental definido sobre la enfermedad, siendo los aspectos más confusos: la identidad, la causa, la duración, las consecuencias )síntomas, exacerbaciones y sentimientos), el tratamiento y la relación médico-paciente. o Cumplimiento/Incumplimiento terapéutico: Para los pacientes cumplimiento e incumplimiento son dos conceptos diferentes: incumplir no es considerado lo contrario de cumplir. La base de ello es que el cumplimiento se asocia como una conducta propia, activa, voluntaria y flexible; mientras que la de incumplimiento lo hace como una conducta “de otros”, debida a: olvidos, efectos adversos y ausencia de efecto. o Análisis individual por criterios de segmentación: a. Mujeres: Se establecen dudas sobre la relación de la enfermedad con el tabaco, presencia mayor de beneficios con tratamientos no farmacológicos y una actitud activa frente a la enfermedad. El cumplimiento está basado en la necesidad (valoración positiva del efecto). En el incumplimiento destaca el rol de cuidadoras de la familia con olvido de sí mismas. b. Medio rural: destaca la relación médico-paciente en cuanto a la visión de la enfermedad. En cuanto al cumplimiento/incumplimiento este se basa en la necesidad, influenciado por el apoyo social y las falsas creencias. c. Fumadores: Visión confusa sobre la enfermedad con atribución a oras causas distintas del tabaco. Justifican seguir fumando. Cumplimiento/incumplimiento basado en la no necesidad y marcado por el escepticismo. d. Cumplidores: Reconocimiento de la cronicidad/incurabilidad y del efecto negativo del tabaco, con un modelo mental más claro en cuanto al papel del tabaco y a la cronicidad de la enfermedad. Actitudes activas frente al tabaquismo y la toma de la medicación inhalada. Cumplimiento/Incumplimiento: Actitud activa frente a la toma de la medicación inhalada. - Aplicación Práctica: o Contribuir a la formación de un modelo mental de la EPOC; es fundamental para la adopción de conductas que permitan el control de la enfermedad y mejora de la calidad de vida. o Favorecer el proceso cognitivo de valoración de la enfermedad como reto resaltando los recursos de la propia persona, fomentando el apoyo social y mostrando al propio sistema sanitario como parte de esa red de apoyo. o Incumplimiento: “De otros”: Reconocer el sesgo actor-observador, considerando las circunstancias situacionales que determinan gran parte de las conductas. “Propio”: Revertir la valoración dudosa o negativa del efecto del tratamiento: falta de efecto, creencias erróneas y efectos adversos. o Análisis de grupos específicos: Mujeres: • Incluir el grupo de mujeres EPOC entre las prioridades para la deshabituación tabáquica debido a la menor importancia que otorgan al tabaco como causa. • Reforzar y fomentar el potencial de afrontamiento activo que reflejan las mujeres, asociado a la alta percepción de autoeficacia. • Incluir la prevención y revisión periódica de la automedicación en los contactos de las mujeres con EPOC por su rol frecuente de cuidadoras. Medio Rural: Utilizar en la educación sanitaria el reconocimiento de los beneficios del campo y el aire libre mediante el fomento de la participación de asociaciones ciudadanas o iniciativas institucionales. Fumadores: • Identificación clara de la enfermedad y del tabaco como causa de su aparición y condicionante de su evolución. • Resolver las dudas sobre la eficacia del tratamiento inhalado y valorar a referencia de los fumadores a la “necesidad” como motivación para el cumplimiento. Aprovechando la disonancia cognitiva. • Favorecer un cambio de comportamiento mediante la entrevista motivacional. • Desenmascarar las creencias erróneas. Cumplidores: • Reforzar el modelo de enfermedad (que en estos pacientes es más claro) como forma de mejorar el control de la enfermedad. • Favorecer la motivación protectora parece ser un elemento positivo para el cumplimiento.Se presenta la tesis doctoral que lleva por título “Factores relacionados con el cumplimiento terapéutico en EPOC. Análisis de la perspectiva de los pacientes”. - Metodología: Se trata de un estudio cualitativo, exploratorio e interpretativo con metodología inductiva. Uso de la Teoría Fundamentada, un método de investigación, que busca derivar teorías sobre el comportamiento humano a nivel individual y social, con una base empírica. Aplicada a una investigación concreta se desarrolla en cinco fases: diseño de la investigación, recogida de datos, ordenar los datos, análisis de los datos y comparación con otras investigaciones. - Objetivos: o Principal: averiguar que factores que condicionan que los pacientes con EPOC cumplan o incumplan el tratamiento inhalado prescrito. o Específicos: Determinar el conocimiento general que tienen de su enfermedad y sus consecuencias. Conocer las declaraciones de los pacientes sobre cumplimiento/incumplimiento del tratamiento inhalado y determinar factores relacionados. Analizar los objetivos específicos en grupos determinados de pacientes: mujeres, pacientes de ámbito rural, pacientes fumadores activos, pacientes cumplidores. - Población de estudio: Tres Centros de Salud urbanos y uno rural. Grupo intervención del estudio ICEPOC. - Análisis de datos: o Mediante la entrevista grupal, se recogen los testimonios de los pacientes usando los criterios de transcripción de Jefferson, y posterior análisis con el apoyo de la herramienta informática Atlas.Ti. o Las etapas generales del análisis, se pueden clasificar a un nivel textual y otro conceptual. En un primer momento en el nivel textual tenemos: la preparación de datos primarios, la lectura y relectura, la segmentación del texto y la codificación), en cuanto al nivel conceptual tenemos: las redes, la recuperación de citas mediante operandos, la segmentación la saturación y la elaboración de la teoría

Is There a Relationship between the Morphology of Connective Tissue and Reactivity during a Drop Jump? Influence of Sex and Athletic Performance Level

The influence of the morphologic characteristics of connective tissue, which plays an essential role during sports activities, on sporting tasks needs further research given the controversial findings reported in the literature. This study aimed at examining the relationship between lower limb connective tissue morphology and drop jump reactivity and determining the influence of sex and athletic performance level. A total of 30 men and 14 women, runners, executed 6 drop jumps (3 20 cm and 30 cm height respectively) and their thickness and cross-sectional area were recorded for Achilles and patellar tendons and plantar fascia. No significant results were found in the relationship between the morphology of the connective tissue and reactivity strength index for both sexes. Significant sex differences were found, while women showed greater values (p < 0.005) for Achilles tendon and plantar fascia; men showed greater values for reactivity strength index and drop jump performance (p < 0.001). The present study shows a limited relationship between connective tissue morphology and drop jump reactivity. Additionally, women showed greater normalized values for Achilles tendon and plantar fascia, and men showed greater reactivity strength index and jumping performance values. No relationships between athletic performance level and connective tissue were found

Effects of a neuromuscular training program on physical performance and asymmetries in female soccer

Introduction: Women’s football require optimal neuromuscular system development for injury prevention and performance optimization. Standardized neuromuscular training programs have shown promising results in reducing injuries and functional asymmetries, but evidence on their impact on performance is limited. Methods: This research examined the effects of a 10-week neuromuscular training program on physical performance and asymmetries in female football players. Thirty-eight female players from two Spanish Second Division women’s football teams participated in the study. The physical performance tests used were: ankle dorsiflexion, bilateral and unilateral horizontal jump, bilateral and unilateral vertical countermovement jump, 40 m sprint including partial times at 10, 20 and 30 m and the 505 test for change of direction evaluation. For 10 weeks, players in the experimental group performed three weekly 24-min neuromuscular training sessions. Participants in the control group completed their normal 24-min strength and conditioning program. Results: The main results were that maximal linear velocity and change of direction skills showed the most notable improvements [effect size (ES), 0.46 to 0.59] after implementation of the training program, ankle dorsiflexion and jumping skills, also improved although, to a lesser extent (ES, <0.35) while asymmetries between limbs were reduced. Maximal running speed improved in the intervention group (p < 0.001) with a mean ES −0.59. Discussion: We conclude that a 10-week neuromuscular training program can be a sufficient stimulus to improve football-specific performance variables in highlevel female football players. Therefore, female players and coaches should be aware that weekly inclusion of strength, power and dynamic balance exercises following a neuromuscular paradigm is helpful for football-specific performance improvement

Mechanical Power in Endurance Running: A Scoping Review on Sensors for Power Output Estimation during Running

Mechanical power may act as a key indicator for physiological and mechanical changes during running. In this scoping review, we examine the current evidences about the use of power output (PW) during endurance running and the di erent commercially available wearable sensors to assess PW. The Boolean phrases endurance OR submaximal NOT sprint AND running OR runner AND power OR power meter, were searched in PubMed, MEDLINE, and SCOPUS. Nineteen studies were finally selected for analysis. The current evidence about critical power and both power-time and power-duration relationships in running allow to provide coaches and practitioners a new promising setting for PW quantification with the use of wearable sensors. Some studies have assessed the validity and reliability of di erent available wearables for both kinematics parameters and PW when running but running power meters need further research before a definitive conclusion regarding its validity and reliability

Relationship between Reactive Strength and Leg Stiffness at Submaximal Velocity: Effects of Age on Distance Runners

Background: Musculotendinous reactive strength is a key factor for the utilization of elastic energy in sporting activities such as running. AIM: To evaluate the relationship between musculotendinous reactive strength and lower-limb stiffness during running as well as to identify age-related differences in both variables. Methods: Fifty-nine amateur endurance runners performed three 20-cm drop jumps and a constant 3-min easy run on a motorized treadmill. Reactive strength index and dynamic lower-limb stiffness were calculated with a photoelectric cell system by jumping and running, respectively. Additionally, sit to stand difference in plantar arch height was assessed as a static lower-limb stiffness measure. The cluster analysis allows the comparison between younger and older runners. Results: No significant correlations were found between jumping reactive strength and running lower-limb stiffness. The younger group performed better at drop jumps (p = 0.023, ES = 0.82), whereas higher-but-no-significant results were found for reactive strength index and stiffness-related metrics. Conclusions: Musculotendinous vertical reactiveness may not be transferred to combined vertical and horizontal movements such as running

Exome array analysis identifies GPR35 as a novel susceptibility gene for anthracycline-induced cardiotoxicity in childhood cancer.

OBJECTIVES: Pediatric cancer survivors are a steadily growing population; however, chronic anthracycline-induced cardiotoxicity (AIC) is a serious long-term complication leading to considerable morbidity. We aimed to identify new genes and low-frequency variants influencing the susceptibility to AIC for pediatric cancer patients. PATIENTS AND METHODS: We studied the association of variants on the Illumina HumanExome BeadChip array in 83 anthracycline-treated pediatric cancer patients. In addition to single-variant association tests, we carried out a gene-based analysis to investigate the combined effects of common and low-frequency variants to chronic AIC. RESULTS: Although no single-variant showed an association with chronic AIC that was statistically significant after correction for multiple testing, we identified a novel significant association for G protein-coupled receptor 35 (GPR35) by gene-based testing, a gene with potential roles in cardiac physiology and pathology (P=7.0×10), which remained statistically significant after correction for multiple testing (PFDR=0.03). The greatest contribution to this observed association was made by rs12468485, a missense variant (p.Thr253Met, c.758C>T, minor allele frequency=0.04), with the T allele associated with an increased risk of chronic AIC and more severe symptomatic cardiac manifestations at low anthracycline doses. CONCLUSION: Using exome array data, we identified GPR35 as a novel susceptibility gene associated with chronic AIC in pediatric cancer patients.This work was supported by the Spanish Association against Cancer (AECC: Asociación Española contra el Cáncer). Human Genotyping lab is a member of CeGen, PRB2-ISCIII and is supported by grant PT13/0001, of the PE I+D+i 2013-2016, funded by ISCIII and FEDER (Fondo Europeo de Desarrollo Regional). Sara Ruiz-Pinto is a predoctoral fellow supported by the Severo Ochoa Excellence Programme (Project SEV-2011-0191)

Exome array analysis identifies ETFB as a novel susceptibility gene for anthracycline-induced cardiotoxicity in cancer patients.

PURPOSE: Anthracyclines are widely used chemotherapeutic drugs that can cause progressive and irreversible cardiac damage and fatal heart failure. Several genetic variants associated with anthracycline-induced cardiotoxicity (AIC) have been identified, but they explain only a small proportion of the interindividual differences in AIC susceptibility. METHODS: In this study, we evaluated the association of low-frequency variants with risk of chronic AIC using the Illumina HumanExome BeadChip array in a discovery cohort of 61 anthracycline-treated breast cancer patients with replication in a second independent cohort of 83 anthracycline-treated pediatric cancer patients, using gene-based tests (SKAT-O). RESULTS: The most significant associated gene in the discovery cohort was ETFB (electron transfer flavoprotein beta subunit) involved in mitochondrial β-oxidation and ATP production (P = 4.16 × 10-4) and this association was replicated in an independent set of anthracycline-treated cancer patients (P = 2.81 × 10-3). Within ETFB, we found that the missense variant rs79338777 (p.Pro52Leu; c.155C > T) made the greatest contribution to the observed gene association and it was associated with increased risk of chronic AIC in the two cohorts separately and when combined (OR 9.00, P = 1.95 × 10-4, 95% CI 2.83-28.6). CONCLUSIONS: We identified and replicated a novel gene, ETFB, strongly associated with chronic AIC independently of age at tumor onset and related to anthracycline-mediated mitochondrial dysfunction. Although experimental verification and further studies in larger patient cohorts are required to confirm our finding, we demonstrated that exome array data analysis represents a valuable strategy to identify novel genes contributing to the susceptibility to chronic AIC