The association between subjective anti-doping knowledge and objective knowledge among Japanese university athletes: a cross-sectional study

IntroductionThis study aimed to assess the association between subjective anti-doping knowledge (subjective ADK) and objective anti-doping knowledge (objective ADK) among Japanese university athletes, framed within the context of the Theory of Planned Behavior (TPB).MethodsEligible participants were 486 university athletes [320 men (65.8%), 166 women; mean age of 18.9 ± 1.0 years]. The participants categorized themselves in terms of the quality of their anti-doping knowledge. This assessment resulted in an independent variable coded as “(1) substantial lack of adequate knowledge,” “(2) some lack of adequate knowledge,” “(3) fair amount of knowledge” or “(4) good amount of knowledge.” Objective ADK was assessed using the Athlete Learning Program about Health and Anti-Doping (ALPHA) test, a set of questions derived from the ALPHA—a former World Anti-Doping Agency e-learning program. The test comprises 12 questions (four choices each; passing index: ≧10 points or 80% correct answer rate). ANCOVA was conducted using subjective ADK as an independent variable and ALPHA scores as a dependent variable, adjusting for confounding factors (anti-doping experience).ResultsThe ALPHA corrected answer rate across subjective ADK levels for the group were 73.10% for “(1) substantial lack of adequate knowledge,” 71.97% for “(2) some lack of adequate knowledge,” 75.18% for “(3) fair amount of knowledge” and 72.86% for “(4) good amount of knowledge.” Comparison between different levels of subjective ADK revealed no significant differences in ALPHA score considering the main effects or any of their interactions.DiscussionThe present results revealed that Japanese university athletes’ subjective ADK did not match their objective ADK. In the context of the TPB, there may be limitations in the perceived behavioral control in anti-doping knowledge. Even if athletes view doping as a wrongful act and have formed attitudes and subjective norms to comply with the rules, the results suggest that errors may occur in the composition of behavioral intentions due to a lack of knowledge. This could lead to the possibility of facing the risk of unintentional anti-doping rule violations. It highlights the need for targeted educational interventions to align subjective ADK of athletes with their objective ADK

Carnitine for Body Composition in Hemodialysis Patients

Background: Authors and colleagues have continued clinical research for hemodialysis patients. Currently, a pilot study presents intervention of carnitine for changes of the body composition. Subjects and Methods: Subjects were six patients on hemodialysis with intervention of carnitine (group 1). Average data were 74.3 years, 65.4 kg, 22.6 in BMI. As levocarnitine, L-Cartin FF injection 1000 mg was administered three times a week for six months. Group 2 has six control patients for age-, sex-, body weight, BMI-matched (group 2). Body composition of muscle and fat tissues were measured by InBody 770 on 0 and 6 months. Results: In group 1, muscle volume and skeletal muscle showed increasing tendency without statistical significance. In contrast, there were significant decreases of body fat volume (22.3 kg vs 20.5 kg, 39.0% vs 35.8%) (p<0.05). No significant differences were found in hemoglobin, total protein, albumin and Cardio-Thoracic Ratio (CTR) of chest X-ray. Group 2 showed no significant changes. Discussion and Conclusion: Hemodialysis patients often have muscular reduction. Previous reports showed improved lean body mass by carnitine administration, which may support our result. These results from current pilot study would be expected to become useful reference data in the pathophysiological investigation in patients on hemodialysis

Application of modified shrinking field radiation in RT-DeVIC chemoradiotherapy for treating localized extranodal natural killer/T-cell lymphoma

　Concurrent chemoradiotherapy (CRT) is the recommended treatment for localized extranodal natural killer/T-cell lymphoma, nasal type (ENKL). In 2009, the Japan Clinical Oncology Group first documented the safety and efficacy of a regimen involving radiotherapy (RT) plus dexamethasone, etoposide, ifosfamide, and carboplatin (DeVIC) in their phase I/II trials (JCOG0211 study). The application of this regimen has drastically improved outcomes of patients with localized ENKL. In 2013, the current guidelines were made to the cost in JCOG0211 study.　We retrospectively investigated the outcomes of three patients who received CRT for stage localized ENKL at the Kawasaki Medical School Hospital between August 2007 and March 2011. Our CRT protocol differed from that used in the JCOG0211 study as we used a different shrinking field RT method. A recent report on shrinking or extended-field RT raised questions regarding which fields are appropriate. Thus, we compared our clinical results with those of the JCOG0211 study and analyzed the effect of the differences in field size on clinical results. The median follow-up of the three patients in the present study was 9 months (range, 5-106 months), two and one of whom achieved complete and partial responses, respectively. Regarding adverse events, no severe acute side effects (e.g., mucositis) higher than Grade 4 were observed.　We reviewed cases and the JCOG0211 study which we experienced in the past about fields of the RT. The present study described our experiences with three patients receiving shrinking field RT

Investigation of Nerve Conduction in Patients with Diabetes and/or Hemodialysis

Diabetic peripheral neuropathy (DPN) has been clinically important, and nerve conduction studies (NCS) have been performed with rather complexity and high cost. By advances in technology, simple and useful DPN-Check device was developed obtaining NCS data as sural nerve conduction velocity (SNCV) and sural nerve action potential (SNAP). We enrolled 52 subjects classified into 4 groups according to the presence of hemodialysis (HD) and diabetes mellitus (DM) as follows: HD (+), DM (+) in group 1, HD (+), DM (-) in group 2, HD (-), DM (+) in group 3 and healthy controls in group 4. Average age was similar from 68 to 74 years in 4 groups. Median value of SNCV was 31, 48, 49, 54 m/sec, and median value of SNAP was 3, 9, 6, 22 μV, respectively, in 4 groups. These results might suggest some relationship between impaired states of HD and DM, and would become fundamental data for pathophysiological investigation of peripheral neuropathy of HD and/or DM in the future

Investigation of Nerve Conduction in Patients with Diabetes and/or Hemodialysis

Diabetic peripheral neuropathy (DPN) has been clinically important, and nerve conduction studies (NCS) have been performed with rather complexity and high cost. By advances in technology, simple and useful DPN-Check device was developed obtaining NCS data as sural nerve conduction velocity (SNCV) and sural nerve action potential (SNAP). We enrolled 52 subjects classified into 4 groups according to the presence of hemodialysis (HD) and diabetes mellitus (DM) as follows: HD (+), DM (+) in group 1, HD (+), DM (-) in group 2, HD (-), DM (+) in group 3 and healthy controls in group 4. Average age was similar from 68 to 74 years in 4 groups. Median value of SNCV was 31, 48, 49, 54 m/sec, and median value of SNAP was 3, 9, 6, 22 μV, respectively, in 4 groups. These results might suggest some relationship between impaired states of HD and DM, and would become fundamental data for pathophysiological investigation of peripheral neuropathy of HD and/or DM in the future

Influence of Diabetes and Hemodialysis Against Nerve Conduction Studies

Background: Diabetic peripheral neuropathy (DPN) has been prevalent and discussed, and nerve conduction studies (NCS) has been continued. We have checked NCS using recently introduced useful DPN-Check device. Subjects and Methods: The subjects were 66 patients (pts) classified into 4 groups according to existence of diabetes mellitus (DM) and hemodialysis (HD); Group1: DM (+), HD (+) in 15 pts, group 2: DM (-), HD (+) in 15 pts, group 3: DM (+), HD (-) in 20 pts, group 4: 16 healthy controls. Methods included measurements of sural nerve conduction velocity (SNCV) and sural nerve action potential (SNAP) using HDN-1000. Results: Average age in each group was 64.4 years to 72.6 years. SNCV value of 4 group in average was 37.1 m/sec, 46.3 m/sec, 49.3 m/sec, 53.2 m/sec, respectively, and value of group 1 was significantly lower than those of group 2,3,4 (p<0.01). Similarly, average SNAP was 4.1 μV, 8.7 μV, 8.0 μV, 21.6 μV, respectively, and group 1,2,3 were significantly lower than group 4 (p<0.01). There was significant correlation between SNCV and SNAP in all subjects (p<0.01). Significant correlations were shown between DM duration and SNCV, and DM duration and SNAP (p<0.01). Discussion and Conclusion: SNCV and SNAP were measured successfully and easily by HDN-1000, indicating clinical availability. Obtained data suggested that 1) SNCV is not significantly decreased due to only uremic neuropathy, 2) SNCV is significantly decreased in patients with both HD and DM, 3) SNAP is significantly decreased in patents with DM for years and 4) SNAP would be remarkably decreased when HD is in addition to DM. These results would become the basal data of future NCS for DM and HD

前立腺癌に対する高線量率組織内照射におけるアプリケーター刺入本数に関する検討

　前立腺癌に対する高線量率組織内照射において，アプリケーター針の刺入本数や刺入位置は線量分布に大きく影響する．刺入方法は各施設の経験やポリシー，使用装置に依存する部分があり，最適な刺入法として確立された普遍的な方法はない．今回我々はアプリケーター針の刺入本数と線量体積因子の関連を解析し，最適な刺入本数を検討した．対象は2010年６月１日から2012年10月31日の間に同治療を受けた初発前立腺癌135例．治療計画にはOncentra® を用いた．治療前エコーによる前立腺体積，治療計画CT により算出された線量体積因子（PTV のDmin%，D90%，dosenon-uniformity ratio：DNR，homogeneity index：HI，conformity index：CI，尿道最大線量，直腸最大線量），治療時期（一次解析として前期：～2011年１月，中期：2011年２月～９月，後期：2011年10月～2012年５月，さらに追加解析として直近：2012年６月〜），アプリケーター針刺入本数について，相互の関連をJMP 14，Student のｔ検定を用いて検討した．一次解析の結果，刺入本数は前立腺体積と相関せず，刺入本数が多い群は少ない群に比べ尿道最大線量が有意に低かった．他の線量体積因子では有意差はないものの，刺入本数が多い群でPTV のDmin% は高値，D90% は高値，DNR は低値，HI は高値，CI は高値と，本数が多いほど良好な線量分布であることを示していた．なお，治療時期が後期の症例で刺入本数が有意に増加していた．これらの結果が判明した後に治療された直近16例においては，さらに刺入本数が増加し，線量体積因子の改善が認められていた．今回の検討から，アプリケーター針の刺入本数が多いほど線量分布が改善し，とくに16-17本の刺入により良好な線量分布が得られることが示された．　In high-dose-rate brachytherapy (HDR-BT) for prostate cancer, the number and arrangement of applicator needles have a decisive impact on radiation dose distribution. Brachytherapy techniques largely depend on the operator’s experience, policy and devices. Furthermore, the procedures of needle insertion, dose prescription and plan optimization vary according to institutions. The aim of this study was to determine the optimal needle number for achieving the best quality of HDR-BT for prostate cancer by analyzing the relationship between needle number and dose-volume parameters. We included 135 patients with newly diagnosed prostate cancer who received HDR-BT between June 2010 and October 2012. Treatment planning was performed on Oncentra® using volume optimization, followed by manual graphical optimization. Dose-volume parameters, such as Dmin% and D90% of the planning target volume (PTV), dose non-uniformity ratio (DNR), homogeneity index (HI), conformity index (CI), and maximum dose to the urethra and rectum, were calculated on the treatment planning system. Student’s t-test was performed to determine the correlation of these parameters and prostate volume with needle number using the JMP® 14 software. We divided the treatment period into three phases: early, middle, and late; needle number and dose-volume parameters were analyzed according to these periods. Needle number was not correlated with prostate volume but showed correlations with several dose-volume parameters. Higher needle number was significantly correlated with lower maximum dose to the urethra; furthermore, higher needle number had a tendency to show correlations with higher Dmin% of PTV, higher D90%, lower DNR, higher HI, and higher CI. These results indicated that a higher needle number could achieve better radiation dose distribution. Concerning the treatment period, the number of needles used in patients was higher in the late period than in the earlier period. Based on these results, we started using the highest number of needles that could be inserted safely; this led to the achievement of better radiation dose distribution. In conclusion, our results show that a high needle number can achieve better quality of brachytherapy for prostate cancer. We think that using 16 or 17 needles is the most appropriate

Impact of anti-doping education and doping control experience on anti-doping knowledge in Japanese university athletes: a cross-sectional study

Abstract Background This study was conducted to elucidate the anti-doping (AD) education, doping control experience, and AD knowledge according to the World Anti-doping Code (Code) of Japanese university athletes. Methods We collected data from 514 male athletes (Mage = 19.53 years, SD = 1.13) and 629 female athletes (Mage = 20.99 years, SD = 1.07). We asked them about their experience undergoing doping control and the AD education they had received. Then, we assessed their AD knowledge using the World Anti-Doping Agency’s Athlete Learning Program about Health and AD (ALPHA) test. Results The results showed that 2.54% of the participants had undergone doping control. Further, 30.10% received AD education at least once, and 20.82% received AD education more than once. When comparing the ALPHA scores of athletes with/without doping test experience, we observed no significant difference. However, the ALPHA scores of athletes with/without AD education were significantly different; specifically, athletes who received AD education more than once had significantly higher ALPHA scores than non-educated athletes. Conclusion These results revealed that doping control experience was not related to AD knowledge and that AD education was associated with AD knowledge, suggesting that athletes who receive AD education more than once have more accurate AD knowledge than less educated athletes on this topic. The importance of AD education in promoting understanding of AD according to the Code in sports is highlighted in this study

The impact of doping risk perception on supplement avoidance: Mediating role of sports supplement beliefs

Aim: Sports supplement use by athletes can lead to unintentional anti-doping rule violations (ADRVs) due to the contamination of prohibited substances. This phenomenon underscores the need for athletes to reconsider their supplement use, assessing its safety, efficacy, and necessity—a process referred to as ‘reconsideration of supplement use’ in this study. Additionally, ingesting sports supplements may escalate to doping when athletes believe they improve performance, a notion measured by the Sports Supplement Belief Scale (SSBS), which assesses the degree to which athletes expect supplements to enhance their performance. Understanding the factors that may encourage and prevent an athlete from using supplements is crucial. This study explores the mediating influence of the perceived risk of ADRV due to supplements, reconsideration of supplement use, and sports supplement beliefs as factors influencing athletes’ decisions to use supplements as factors influencing athletes' decisions to use supplements. Methods: In Study 1, a Japanese version of the Sports Supplement Belief Scale (SSBS-J) was created using back-translation. In order to evaluate the reliability and validity of the scale, we utilized data from 356 university athletes, which were divided into two distinct cohorts. A two-step statistical analysis was implemented involving Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). The survey included questions about the frequency and number of supplements used. Internal consistency and fit of the SSBS-J were evaluated using EFA and CFA, and the scale’s ability to determine supplement use was assessed using linear regression analysis and t-tests. In Study 2, 525 university athletes (64.6% men, Mage = 18.7 ± 0.7 years) were asked to complete measures related to the perceived risk of committing an ADRV due to supplementation. Results: The SSBS-J showed high internal consistency (Cronbach’s α = 0.876), a one-factor structure similar to the original version in the EFA, and a good model fit in the CFA, thereby supporting construct validity. Linear regression results indicated that the SSBS-J scores were significantly associated with the frequency and number of supplements used. Significant differences were found between the scores of supplement users (21.51 ± 6.54) and non-users (16.48 ± 6.14) (p < 0.001). Next, discriminant analysis correctly classified 64.7% of supplement users and 61.0% of non-users. In examining the direct effect of ADRV awareness on supplement use, a significant negative path coefficient of -0.44 was observed (p < 0.001). The path coefficients from ADRV awareness to the reconsideration of supplement use and from a reconsideration of supplement use to supplement use through SSBS-J were all significant (p < 0.001), with an indirect effect path coefficient of 0.06. Conclusions: These findings suggest that ADRV awareness can influence reconsideration of supplement use and subsequently deter supplement use mediated by sport supplement beliefs. These insights emphasize the importance of promoting doping risk awareness, revisiting supplement use, and mitigating sport supplement beliefs to reduce inappropriate or unnecessary supplement use among athletes. From an anti-doping perspective, this insight could be valuable in guiding athlete education regarding supplement use