Effects of physical efforts on injury in elite soccer

In this study, the influence of physical efforts on occurrence of match injury in a professional soccer club was investigated. Computerised motion-analysis was used to measure the physical efforts of players during 10 injury situations. Total distance and those covered at different movement intensities were measured across the 5-min period preceding injury. If the final run preceding injury involved a high-intensity action (HIA), the distance, duration and speed of the effort and the recovery time between this and the penultimate HIA were measured. To determine the influence of these physical efforts, the results were compared to a normative profile for players computed from data across 5 games for the same variables; habitual distances covered over a 5-min period and characteristics of and recovery time between HIA. Compared to the normative profile, no differences were reported in physical characteristics during the period leading up to injury or for HIA although the latter were substantially higher in intensity (duration and distance). A lower than normal recovery time between HIA prior to injury was observed (35.6±16.8 s vs. 98.8±17.5 s, p=0.003). Within the limitations of the small sample, these findings may aid in further understanding injury and physical performance in elite soccer

Biomarker-guided antibiotic duration for hospitalized patients with suspected sepsis: the ADAPT-sepsis randomized clinical trial

Importance: For hospitalized critically ill adults with suspected sepsis, procalcitonin (PCT) and C-reactive protein (CRP) monitoring protocols can guide the duration of antibiotic therapy, but the evidence of the effect and safety of these protocols remains uncertain. Objective: To determine whether decisions based on assessment of CRP or PCT safely results in a reduction in the duration of antibiotic therapy. Design, Setting, and Participants: A multicenter, intervention-concealed randomized clinical trial, involving 2760 adults (≥18 years), in 41 UK National Health Service (NHS) intensive care units, requiring critical care within 24 hours of initiating intravenous antibiotics for suspected sepsis and likely to continue antibiotics for at least 72 hours. Intervention: From January 1, 2018, to June 5, 2024, 918 patients were assigned to the daily PCT-guided protocol, 924 to the daily CRP-guided protocol, and 918 assigned to standard care. Main Outcomes and Measures: The primary outcomes were total duration of antibiotics (effectiveness) and all-cause mortality (safety) to 28 days. Secondary outcomes included critical care unit data and hospital stay data. Ninety-day all-cause mortality was also collected. Results: Among the randomized patients (mean age 60.2 [SD, 15.4] years; 60.3% males), there was a significant reduction in antibiotic duration from randomization to 28 days for those in the daily PCT-guided protocol compared with standard care (mean duration, 10.7 [SD, 7.6] days for standard care and 9.8 [SD, 7.2] days for PCT; mean difference, 0.88 days; 95% CI, 0.19 to 1.58, P = .01). For all-cause mortality up to 28 days, the daily PCT-guided protocol was noninferior to standard care, where the noninferiority margin was set at 5.4% (19.4% [170 of 878] of patients receiving standard care; 20.9% [184 of 879], PCT; absolute difference, 1.57; 95% CI, −2.18 to 5.32; P = .02). No difference was found in antibiotic duration for standard care vs daily CRP-guided protocol (mean duration, 10.6 [7.7] days for CRP; mean difference, 0.09; 95% CI, −0.60 to 0.79; P = .79). For all-cause mortality, the daily CRP-guided protocol was inconclusive compared with standard care (21.1% [184 of 874] for CRP; absolute difference, 1.69; 95% CI, −2.07 to 5.45; P = .03). Conclusions and Relevance: Care guided by measurement of PCT reduces antibiotic duration safely compared with standard care, but CRP does not. All-cause mortality for CRP was inconclusive. Trial Registration: isrctn.org Identifier: ISRCTN4747324

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol�which is a marker of cardiovascular risk�changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95 credible interval 3.7 million�4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world. © 2020, The Author(s), under exclusive licence to Springer Nature Limited

Circadian rhythms and exercise

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN028652 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

A bright ultraluminous X-ray source in NGC 5907

We present a multimission X-ray analysis of a bright (peak observed 0.3–10 keV luminosity of ∼6 × 1040 erg s−1), but relatively highly absorbed ultraluminous X-ray source (ULX) in the edge-on spiral galaxy NGC 5907. The ULX is spectrally hard in X-rays (Γ ∼ 1.2–1.7, when fitted with an absorbed power law), and has a previously reported hard spectral break consistent with it being in the ultraluminous accretion state. It is also relatively highly absorbed for a ULX, with a column of ∼0.4–0.9 × 1022 atom cm−2 in addition to the line-of-sight column in our Galaxy. Although its X-ray spectra are well represented by accretion disc models, its variability characteristics argue against this interpretation. The ULX spectra instead appear dominated by a cool, optically thick Comptonizing corona. We discuss how the measured 9 per cent rms variability and a hardening of the spectrum as its flux diminishes might be reconciled with the effects of a very massive, radiatively driven wind and subtle changes in the corona, respectively. We speculate that the cool disc-like spectral component thought to be produced by the wind in other ULXs may be missing from the observed spectrum due to a combination of a low temperature (∼0.1 keV), and the high column to the ULX. We find no evidence, other than its extreme X-ray luminosity, for the presence of an intermediate mass black hole (MsBHs, ∼ 102−104 M⊙) in this object. Rather, the observations can be consistently explained by a massive (≳ 20 M⊙) stellar remnant black hole in a super-Eddington accretion state