Dietary Supplements and Sports Performance: Metabolites, Constituents, and Extracts

This is the fifth in a series of six articles to discuss the major classes of dietary supplements (vitamins; minerals; amino acids; herbs or botanicals; and metabolites/constituents/extracts). The major focus is on efficacy of such dietary supplements to enhance exercise or sports performance

Time to Surgery is an Important Factor for Acute Achilles Tendon Repair

Category: Ankle; Trauma Introduction/Purpose: Achilles tendon ruptures are a common ankle injury, predominantly affecting young, active, and athletic populations. Surgical repair is often favored in healthy and active individuals due to decreased re-rupture rates. Both open and minimally invasive percutaneous techniques have been described with excellent outcomes and reduced rates of re-rupture compared to non-surgical treatment. However, little research has focused on the impact of time-to-surgery on complications, re- rupture rates, and patient reported outcomes (PROs). The purpose of this study was to investigate outcomes following Achilles repair with respect to time-to-surgery and surgical technique. Outcomes were established both clinically and functionally, as indicated by complication rates and patient-reported outcomes, respectively. Methods: Patient records from a single institution were retrospectively reviewed from October 2016 to March 2022. Patients with an acute Achilles tendon rupture surgically treated within 6 weeks from injury and a minimum follow up of 3 months ± 14 days were eligible for inclusion. Injury and surgical variables included mechanism of injury, rupture grade and location, time-to- surgery, surgical technique, and operative time. Postoperative complications included deep vein thrombosis (DVT), major and minor wound complication, re-rupture, sural nerve injury, and postoperative neuropathic pain. PROs included PROMIS Physical Function CAT (PF), Pain Interference CAT, and Foot and Ankle SANE. Patients were stratified based both by operative technique and time-to-surgery (0-6 days, 7-13 days, and 14-42 days). Categorical variables were compared using Fischer exact tests, while numerical variables were evaluated using an unpaired t-test and ANOVA, depending on the number of groups compared. Results: 327 patients (79% male, mean age 40.4) were included. PRO data was available for 154 (47%). Average clinical and PRO follow-up was 155 days and 575 days, respectively. 149 were treated open, while 178 were percutaneously repaired. No significant differences were observed in complications between treatment groups; however, percutaneous repairs recorded shorter operative times (55.3 vs 65.8 minutes, p< 0.001). Stratifying by timepoints, follow-up physical function scores were significantly higher in patients repaired within 0-6 days (p < 0.05, Figure). There were 11 re-ruptures (3.3%), with 10/11 occurring within 3 months of surgery. Most re-ruptures were attributed to falls (4) and non-compliance (3), while 4 occurred following prescribed protocols. When stratified by time-to-surgery, the fewest re-ruptures (0) were observed for repairs performed 7-13 days following rupture. Conclusion: While no significant differences were observed in PROs or complications rates between open and percutaneous groups, our data suggests that time-to-surgery may play an important role in long-term patient reported physical function. Stratified by surgical timing, we also found significantly lower rates of re-rupture when surgical intervention occurred 7-13 days following injury. However, nearly all re-ruptures occurred within 3-months, with most occurring following postoperative falls or documented patient non-compliance with immobilization or protected weight-bearing instructions. The significance of surgical timing and re-rupture rates therefore requires additional investigation given the low failure rates and mechanisms of re-rupture

Does soccer participation lead to genu varum?

Little is known about the relationship between sport participation and body adaptations during growth. Our aim was to investigate whether soccer participation in youth is associated with the degree of genu varum. The design was a retrospective cohort study. Three hundred and thirty-six male soccer players, and 458 male non-soccer players (aged from 8 to 18) were recruited and included in the study. The intercondylar (IC) or intermalleolar (IM) distance were clinically measured with a specifically designed instrument. The results of this study revealed a statistically significant increase in degree of genu varum in both groups from the age of 14. However, at the age of 16-18 years a significant higher degree of genu varum was observed in the soccer players compared to the non-soccer players (P = 0.028). Intense soccer participation increases the degree of genu varum in males from the age of 16. Since genu varum predisposes to injuries, efforts to reduce the development of genu varum in male soccer players are warranted

Sensitivity of coccolithophores to carbonate chemistry and ocean acidification

About one-third of the carbon dioxide (CO(2)) released into the atmosphere as a result of human activity has been absorbed by the oceans(1), where it partitions into the constituent ions of carbonic acid. This leads to ocean acidification, one of the major threats to marine ecosystems(2) and particularly to calcifying organisms such as corals(3,4), foraminifera(5-7) and coccolithophores(8). Coccolithophores are abundant phytoplankton that are responsible for a large part of modern oceanic carbonate production. Culture experiments investigating the physiological response of coccolithophore calcification to increased CO(2) have yielded contradictory results between and even within species(8-11). Here we quantified the calcite mass of dominant coccolithophores in the present ocean and over the past forty thousand years, and found a marked pattern of decreasing calcification with increasing partial pressure of CO(2) and concomitant decreasing concentrations of CO(3)(2-). Our analyses revealed that differentially calcified species and morphotypes are distributed in the ocean according to carbonate chemistry. A substantial impact on the marine carbon cycle might be expected upon extrapolation of this correlation to predicted ocean acidification in the future. However, our discovery of a heavily calcified Emiliania huxleyi morphotype in modern waters with low pH highlights the complexity of assemblage-level responses to environmental forcing factors