Echocardiographic evaluation of left ventricular morphology and function in young male football players and runners

Background: Long-term physical exercise leads to left ventricular morphological adaptations, which vary with the kind of sport and the intensity and extent of the training. Although the echocardiographic changes related to exercise in athletes participating in various sports have been well described, changes associated with football players have been less well documented. The aim of this study was to investigate the morphological adaptations of the heart to athletic training and to compare by means of echocardiography the left ventricular dimensions, masses and systolic functions of runners and football players. Methods: A total of 40 male football players, 18 male long and middle-distance runners and 25 sedentary males were enrolled to the study and M-mode and two-dimensional echocardiograms with Doppler analysis were performed in all subjects. Results: The runners and football players were shown to have significantly greater left ventricular end-diastolic internal dimensions, left ventricular mass (corrected for body mass, height and body surface area), end-diastolic interventricular septum thicknesses and ejection fraction values than a control group. The present results show no significant difference between the left ventricular adaptations of runners and football players except when the left ventricular mass is indexed with body mass, the runners being thinner. Conclusions: The present results show that the echocardiographic findings of left ventricular adaptations in runners and football players are quite similar and lead to physiological enlargement of the heart. (Cardiol J 2007; 14: 37–43

Echokardiograficzna ocena morfologii oraz funkcji lewej komory u młodych piłkarzy i wyczynowych biegaczy

Wstęp: Długotrwały wysiłek fizyczny powoduje zmiany adaptacyjne w budowie i funkcji mięśnia lewej komory, zależne od rodzaju i intensywności uprawianego sportu. Choć przeprowadzono wiele badań opisujących echokardiograficzne odmienności serc sportowców, w dostępnym piśmiennictwie brakuje szczegółowej analizy zmian dotyczących zawodowego trenowania piłki nożnej. Celem przedstawionego badania była ocena morfologicznych zmian związanych z wyczynowym uprawianiem sportu oraz porównanie zmierzonych echokardiograficznie wymiarów, masy i funkcji skurczowej lewej komory u biegaczy i piłkarzy. Metody: Badaniami objęto 40 piłkarzy, 18 biegaczy długo- i średniodystansowych oraz 25 mężczyzn prowadzących siedzący tryb życia (grupa kontrolna). U wszystkich wykonano badanie echokardiograficzne z oceną wymiarów lewej komory w prezentacji jedno- (M-mode) i dwuwymiarowej (2-D) oraz analizę przepływów za pomocą techniki fali doplerowskiej. Wyniki: U osób uprawiających sport, w porównaniu z grupą kontrolną, stwierdzono statystycznie istotne zwiększenie wymiaru końcoworozkurczowego lewej komory, masy lewej komory (również po korekcji względem wzrostu, masy i powierzchni ciała), grubości przegrody międzykomorowej oraz frakcji wyrzutowej. Nie wykazano istotnych różnic w wartościach parametrów echochokardiograficznych (z wyjątkiem wskaźnika masy lewej komory) między biegaczami a piłkarzami. Wnioski: Przedstawione wyniki sugerują, że zwiększenie wymiarów lewej komory, podobne w obu grupach, stanowi fizjologiczną adaptację serca do wykonywanego wysiłku fizycznego

Percentile reference values for anthropometric body composition indices in European children from the IDEFICS study

INTRODUCTION: To characterise the nutritional status in children with obesity or wasting conditions, European anthropometric reference values for body composition measures beyond the body mass index (BMI) are needed. Differentiated assessment of body composition in children has long been hampered by the lack of appropriate references. OBJECTIVES: The aim of our study is to provide percentiles for body composition indices in normal weight European children, based on the IDEFICS cohort (Identification and prevention of Dietary-and lifestyle-induced health Effects in Children and infantS). METHODS: Overall 18 745 2.0-10.9-year-old children from eight countries participated in the study. Children classified as overweight/obese or underweight according to IOTF (N = 5915) were excluded from the analysis. Anthropometric measurements (BMI (N = 12 830); triceps, subscapular, fat mass and fat mass index (N = 11 845-11 901); biceps, suprailiac skinfolds, sum of skinfolds calculated from skinfold thicknesses (N = 8129-8205), neck circumference (N = 12 241); waist circumference and waist-to-height ratio (N = 12 381)) were analysed stratified by sex and smoothed 1st, 3rd, 10th, 25th, 50th, 75th, 90th, 97th and 99th percentile curves were calculated using GAMLSS. RESULTS: Percentile values of the most important anthropometric measures related to the degree of adiposity are depicted for European girls and boys. Age-and sex-specific differences were investigated for all measures. As an example, the 50th and 99th percentile values of waist circumference ranged from 50.7-59.2 cm and from 51.3-58.7 cm in 4.5-to < 5.0-year-old girls and boys, respectively, to 60.6-74.5 cm in girls and to 59.9-76.7 cm in boys at the age of 10.5-10.9 years. CONCLUSION: The presented percentile curves may aid a differentiated assessment of total and abdominal adiposity in European children

Burned-out testis tumour that metastasized to retroperitoneal lymph nodes: a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Phenotype, outcomes and natural history of early-stage non-ischaemic cardiomyopathy

Aims To characterize the phenotype, clinical outcomes and rate of disease progression in patients with early-stage non-ischaemic cardiomyopathy (early-NICM). Methods and results We conducted a prospective observational cohort study of patients with early-NICM assessed by late gadolinium enhancement cardiovascular magnetic resonance (CMR). Cases were classified into the following subgroups: isolated left ventricular dilatation (early-NICM H−/D+), non-dilated left ventricular cardiomyopathy (early-NICM H+/D−), or early dilated cardiomyopathy (early-NICM H+/D+). Clinical follow-up for major adverse cardiovascular events (MACE) included non-fatal life-threatening arrhythmia, unplanned cardiovascular hospitalization or cardiovascular death. A subset of patients (n = 119) underwent a second CMR to assess changes in cardiac structure and function. Of 254 patients with early-NICM (median age 46 years [interquartile range 36–58], 94 [37%] women, median left ventricular ejection fraction [LVEF] 55% [52–59]), myocardial fibrosis was present in 65 (26%). There was no difference in the prevalence of fibrosis between subgroups (p = 0.90), however fibrosis mass was lowest in early-NICM H−/D+, higher in early-NICM H+/D− and highest in early-NICM H+/D+ (p = 0.03). Over a median follow-up of 7.9 (5.5–10.0) years, 28 patients (11%) experienced MACE. Non-sustained ventricular tachycardia (hazard ratio [HR] 5.1, 95% confidence interval [CI] 2.36–11.00, p < 0.001), myocardial fibrosis (HR 3.77, 95% CI 1.73–8.20, p < 0.001) and diabetes mellitus (HR 5.12, 95% CI 1.73–15.18, p = 0.003) were associated with MACE in a multivariable model. Only 8% of patients progressed from early-NICM to dilated cardiomyopathy with LVEF <50% over a median of 16 (11–34) months. Conclusion Early-NICM is not benign. Fibrosis develops early in the phenotypic course. In-depth characterization enhances risk stratification and might aid clinical management

Selection of metastasis competent subclones in the tumour interior

The genetic evolutionary features of solid tumour growth are becoming increasingly well described, but the spatial and physical nature of subclonal growth remains unclear. Here, we utilize 102 macroscopic whole-tumour images from clear cell renal cell carcinoma patients, with matched genetic and phenotypic data from 756 biopsies. Utilizing a digital image processing pipeline, a renal pathologist marked the boundaries between tumour and normal tissue and extracted positions of boundary line and biopsy regions to X and Y coordinates. We then integrated coordinates with genomic data to map exact spatial subclone locations, revealing how genetically distinct subclones grow and evolve spatially. We observed a phenotype of advanced and more aggressive subclonal growth in the tumour centre, characterized by an elevated burden of somatic copy number alterations and higher necrosis, proliferation rate and Fuhrman grade. Moreover, we found that metastasizing subclones preferentially originate from the tumour centre. Collectively, these observations suggest a model of accelerated evolution in the tumour interior, with harsh hypoxic environmental conditions leading to a greater opportunity for driver somatic copy number alterations to arise and expand due to selective advantage. Tumour subclone growth is predominantly spatially contiguous in nature. We found only two cases of subclone dispersal, one of which was associated with metastasis. The largest subclones spatially were dominated by driver somatic copy number alterations, suggesting that a large selective advantage can be conferred to subclones upon acquisition of these alterations. In conclusion, spatial dynamics is strongly associated with genomic alterations and plays an important role in tumour evolution

Unusual cardiovascular complications of brucellosis presenting in two men: two case reports and a review of the literature

Introduction: Brucellosis is a zoonosis with worldwide distribution, which is particularly endemic in many countries of the Mediterranean basin. Cardiovascular complications of this disease, such as endocarditis, myocarditis and pericarditis, are very rare, with even fewer cases of myocarditis or asymptomatic pericardial effusion in the absence of concomitant endocarditis being reported. Case presentation: We report two cases of brucellosis in two Caucasian men, aged 17 and 34 years old, with myocarditis and asymptomatic pericardial effusion, respectively. Of note, neither patient had concomitant endocarditis. The disease was confirmed serologically and by blood cultures. Both patients recovered completely after receiving appropriate antibiotic treatment without any sign of relapse during a follow-up of 12 months. Conclusion: These two cases emphasize that in endemic areas Brucella can be considered as a potentially causative agent of idiopathic pericardial effusion or myocarditis, even in the absence of concomitant endocarditis. This possibility could be taken into account particularly in cases where contraction of brucellosis is possible, such as occupational exposure or consumption of unpasteurized dairy products. © 2011 Gatselis et al; licensee BioMed Central Ltd