Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play

The Achilles tendon is the thickest, strongest and largest tendon in the human body, but despite its size and tensile strength, it frequently gets injured. Achilles tendon ruptures (ATRs) mainly occur during sports activities, and their incidence has increased over the last few decades. Achilles tendon tears necessitate a prolonged recovery time, sometimes leaving long-term functional limitations. Treatment options include conservative treatment and surgical repair. There is no consensus on which is the best treatment for ATRs, and their management is still controversial. Limited scientific evidence is available for optimized rehabilitation regimen and on the course of recovery after ATRs. Furthermore, there are no universally accepted outcomes regarding the return to play (RTP) process. Therefore, the aim of this narrative review is to give an insight into the mechanism of injuries of an ATR, related principles of rehabilitation, and RTP

External Responsiveness of the SuperOpTM Device to Assess Recovery After Exercise : A Pilot Study

Post-exercise recovery is a complex process involving a return of performance and a physiological or perceptual feeling close to pre-exercise status. The hypothesis of this study is that the device investigated here is effective in evaluating the recovery state of professional cyclists in order to plan effective training. Ten professional male cyclists belonging to the same team were enrolled in this study. Participants performed a 7-day exercise program [D1, D4, and D7: low-intensity training; D2 and D5: passive recovery; D3: maximum oxygen consumption (VO2Max) test (for maximum mechanical power assessment only); and D6: constant load test]. During the week of monitoring, each morning before getting up, the device assessed each participant's so-called Organic Readiness {OR [arbitrary unit (a.u.)]}, based on blood pressure (BP), heart rate (HR), features of past exercise session, and following self-perceived condition. Based on its readings and algorithm, the device graphically displayed four different colors/values, indicating general exercise recommendations: green/3 = \u201cyou can train hard,\u201d yellow/2 = \u201cyou can train averagely,\u201d orange/1 = \u201cyou can train lightly,\u201d or red/0 = \u201cyou should recover passively.\u201d During the week of research, morning OR values and Bonferroni post-hoc comparisons showed significant differences between days and, namely, values (1) D2 (after low intensity training) was higher than D4 (after VO2Max test; P = 0.033 and d = 1.296) and (2) D3 and D6 (after passive recovery) were higher than D4 (after VO2Max test; P = 0.006 and d = 2.519) and D5 (after low intensity training; P = 0.033 and d = 1.341). The receiver operating characteristic analysis area under curve (AUC) recorded a result of 0.727 and could differentiate between D3 and D4 with a sensitivity and a specificity of 80%. Preliminarily, the device investigated is a sufficiently effective and sensitive/specific device to assess the recovery state of athletes in order to plan effective training

Uphill walking at iso-efficiency speeds

Uphill walking gait has been extensively studied, but the optimal uphill speed able to enhance the metabolic demand without increasing fatigability has so far received little attention. Therefore, the aim of this study was to assess the metabolic/kinematic demand at constant speed (6 km\ub7h 121 G0 level, G2 2% uphill, G7 7% uphill) and at iso-efficiency speeds (G2IES 5.2 km\ub7h 121 2% uphill and G7IES 3.9 km\ub7h 121 7% uphill). For this aim, physically active women (n:24, Age 33.40 \ub1 4.97 years, BMI 21.62 \ub1 2.06 kg/m-2) after an 8-min warm-up were studied on a treadmill for 10\u2b9 for every walking condition with a 5\u2b9 rest in between. Average heart rate (AVG-HR), rating of perceived exertion (RPE) and kinematic variables (stance time, swing time, stride length, stride cycle, stride-length variability, stride-cycle variability and internal work) were studied. Modif\ufeffications in stance time, stride length and stride cycle (p<0.005), and lower internal-work values (p<0.001) occurred in G7IES in comparison to the other conditions. Swing time was significantly modified only in G7IES compared to G0 and G7 (p<0.001 and p<0.005, respectively). Stride-length variability and stride-cycle variability were higher in G7IES compared to the other conditions (p<0.001). G7 induced the highest AVG-HR (p<0.005) and RPE (p<0.001) compared to the other conditions. This study demonstrates that by applying the equation for uphill walking gait, it is possible to maintain a similar metabolic demand and RPE at iso-efficiency speeds during uphill compared to level walking, inducing at the same time a modification of the kinematic parameters of walking gait performed at the same slope condition

The Long and Winding Road to Cardiac Regeneration

Cardiac regeneration is a critical endeavor in the treatment of heart diseases, aimed at repairing and enhancing the structure and function of damaged myocardium. This review offers a comprehensive overview of current advancements and strategies in cardiac regeneration, with a specific focus on regenerative medicine and tissue engineering-based approaches. Stem cell-based therapies, which involve the utilization of adult stem cells and pluripotent stem cells hold immense potential for replenishing lost cardiomyocytes and facilitating cardiac tissue repair and regeneration. Tissue engineering also plays a prominent role employing synthetic or natural biomaterials, engineering cardiac patches and grafts with suitable properties, and fabricating upscale bioreactors to create functional constructs for cardiac recovery. These constructs can be transplanted into the heart to provide mechanical support and facilitate tissue healing. Additionally, the production of organoids and chips that accurately replicate the structure and function of the whole organ is an area of extensive research. Despite significant progress, several challenges persist in the field of cardiac regeneration. These include enhancing cell survival and engraftment, achieving proper vascularization, and ensuring the long-term functionality of engineered constructs. Overcoming these obstacles and offering effective therapies to restore cardiac function could improve the quality of life for individuals with heart diseases

Effect of Video Observation and Motor Imagery on Simple Reaction Time in Cadet Pilots

Neuromotor training can improve motor performance in athletes and patients. However, few data are available about their effect on reaction time (RT). We investigated the influence of video observation/motor imagery (VO/MI) on simple RT to visual and auditory stimuli. The experimental group comprised 21 cadets who performed VO/MI training over 4 weeks. Nineteen cadets completed a sham intervention as control. The main outcome measure was RT to auditory and visual stimuli for the upper and lower limbs. The RT to auditory stimuli improved significantly post-intervention in both groups (control vs. experimental mean change for upper limbs: −40 ms vs. −40 ms, p = 0.0008; for lower limbs: −50 ms vs. −30 ms, p = 0.0174). A trend towards reduced RT to visual stimuli was observed (for upper limbs: −30 ms vs. −20 ms, p = 0.0876; for lower limbs: −30 ms vs. −20 ms, p = 0.0675). The interaction term was not significant. Only the specific VO/MI training produced a linear correlation between the improvement in the RT to auditory and visual stimuli for the upper (r = 0.703) and lower limbs (r = 0.473). In conclusion, VO/MI training does not improve RT when compared to control, but it may be useful in individuals who need to simultaneously develop a fast response to different types of stimuli

Impact on ozone of high-speed stratospheric aircraft: effects of the emission scenario

A photochemical-transport two-dimensional model has been used to assess the impact of a projected fleet of high-speed stratospheric aircraft using different emissions scenarios. It is shown that the presence in the background atmosphere of nitric acid trihydrate aerosols is responsible for a lower stratospheric denoxification in addition to that caused by the sulfate aerosol layer. This has the effect of further decreasing the relative role of the odd nitrogen catalytic cycle for ozone destruction, so that the lower stratosphere is primarily controlled by chlorine species. The effect of aircraft injection of nitric oxides is that of decreasing the level of ClO, so that the lower stratospheric ozone (below about 20-25 km altitude) increases. The net effect on global ozone is that of a small increase even at Mach 2.4, and is enhanced by adopting emission scenarios including altitude restriction at 15 or 18 km. Reductions of the emission index (EI) of nitric oxides below relatively small values (about 15) are shown to reduce the aircraft-induced ozone increase, because of the associated smaller decrease of ClO. This conclusion is no more valid when the emission index is raised at the present values (about 45)

Impact on ozone of high-speed stratospheric aircraft: effects of the emission scenario

A photochemical-transport two-dimensional model has been used to assess the impact of a projected fleet of high-speed stratospheric aircraft using different emissions scenarios. It is shown that the presence in the background atmosphere of nitric acid trihydrate aerosols is responsible for a lower stratospheric denoxification in addition to that caused by the sulfate aerosol layer. This has the effect of further decreasing the relative role of the odd nitrogen catalytic cycle for ozone destruction, so that the lower stratosphere is primarily controlled by chlorine species. The effect of aircraft injection of nitric oxides is that of decreasing the level of ClO, so that the lower stratospheric ozone (below about 20-25 km altitude) increases. The net effect on global ozone is that of a small increase even at Mach 2.4, and is enhanced by adopting emission scenarios including altitude restriction at 15 or 18 km. Reductions of the emission index (EI) of nitric oxides below relatively small values (about 15) are shown to reduce the aircraft-induced ozone increase, because of the associated smaller decrease of ClO. This conclusion is no more valid when the emission index is raised at the present values (about 45)