Symptomatic Thoracic Disc Herniation in a 30-Year-Old Woman

Thoracic disc herniation is infrequent and presents a unique set of challenges for both diagnosis and treatment. It is an underdiagnosed entity, mainly due to the non-specific clinical manifestations. Different techniques are used for surgical treatment. This case describes a case of symptomatic thoracic disc herniation in a healthy young woman from diagnosis to surgical treatment, and it shows the importance of clinical integration and imaging studies of these cases.

Screening, Diagnosis and Management of Atrial Fibrillation in Cancer Patients: Current Evidence and Future Perspectives

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population, carrying a high morbimortality burden, and this also holds true in cancer patients. The association between AF and cancer goes even further, with some studies suggesting that AF can be a marker of occult cancer. There is, however, a remarkable paucity of data concerning specific challenges of AF management in cancer patients. AF prompt recognition and management in this special population can lessen the arrhythmia-related morbidity and have an important prognostic benefit. This review will focus on current AF diagnosis and management challenges in cancer patients, with special emphasis on AF screening strategies and devices, and anticoagulation therapy with non-vitamin K antagonist oral anti-coagulants (NOACs) for thromboembolic prevention in these patients. Some insights concerning future perspectives for AF prevention, diagnosis, and treatment in this special population will also be addressed.

Moderating effect of bone maturation on the relationship between body fat and insulin resistance

OBJECTIVES

The aim of the present study was to analyze the moderating effect of maturation on the relationship between body fat and insulin resistance, in children from 9 to 12 years.

METHODS

Maturity offset, homeostasis model assessment index of insulin resistance (HOMA-IR), and body fat percentage (BF%) were estimated in 127 children. Skeletal maturation indicator (SMI) was estimated in 105 participants. A moderation analysis based on a linear regression and on Johnson-Neyman technique was performed using a 95% confidence level.

RESULTS

BF%, insulin levels, and HOMA-IR values were lower in late maturers than on-time maturers (p<0.05). SMI moderated the relationship between BF% and HOMA-IR index in 11.1% of boys and in 32.5% of girls (p<0.05). Also, the highest values of HOMA-IR index were observed at -1 year to achieve the peak height velocity, in girls (p<0.05).

CONCLUSIONS

Maturation process has a moderation effect on the relationship BF% and insulin resistance, particularly in early maturers; furthermore, it was independently associated with HOMA-IR.

Sports injuries patterns in children and adolescents according to their sports participation level, age and maturation

Background

Growth can make young athletes more vulnerable to sports injuries. Increased knowledge about injury profile and its predictors is an important part of an overall risk management strategy but few studies have produced information.

Methods

Information about injury profile and sports participation (SP) level was obtained by LESADO and RAPIL II questionnaires. They were distributed to 651 participants aged between 10 and 18 years attending four schools. Maturity measures were evaluated through maturity offset (MO) and Tanner-Whitehouse III method. Bivariate analysis was used to identify the set of candidate predictors for multinomial logistic regression analysis that was used to determine significant predictors of injury type and body area injury location.

Results

Regarding injury type predictors recreative boys had more chances of having a sprain or a fracture than a strain. Also, recreative and scholar girls had more chances of having a sprain than a strain. As MO decreased, the chances of girls having a strain or a fracture when compared to sprains were higher. For body area location boys with 10–11 years were more likely to have upper limbs injuries than boys of other ages. This was also confirmed by MO. Spine and trunk injuries were more likely to occur in federate and no sports participation girls.

Conclusions

Injury type and body area injury location differed significantly by SP level, age group and MO.

Training Experience and Maturational, Morphological, and Fitness Attributes as Individual Performance Predictors in Male and Female Under-14 Portuguese Elite Basketball Players

ABSTRACT

Ramos, S, Volossovitch, A, Ferreira, AP, Fragoso, I, and Massuça, LM. Training experience and maturational, morphological, and fitness attributes as individual performance predictors in male and female under-14 Portuguese elite basketball players. J Strength Cond Res 35(7): 2025-2032, 2021-The association of the biological maturation, morphological attributes, and fitness attributes of 13- to 14-year-old players selected to regional basketball teams, which participated in the Portuguese Festival of Youth Basketball, was analyzed in the study. A total of 416 under-14 Portuguese elite basketball players (male, n = 224; female, n = 192) were evaluated in this cross-sectional study. Maturational parameters (maturity offset and predicted age at peak height velocity), morphological attributes (body mass, stature, skinfolds, and lengths), and fitness (sprint, agility, jump, and upper-body strength) attributes were measured. In addition, basketball game performance was assessed using technical statistics (rebounds and point averages) and the performance index rating (PIR). Correlation analyses indicated that male players with better PIR/minute were taller, had a longer hand span, had more free-fat mass, and demonstrated better results in all jumping tests, upper-body strength tests, 20-m speed test, and agility T-test. Female players with better PIR/minute were significantly older, more matured, heavier, taller, and had longer arm and hand span. They also demonstrated better results in jumping tests, medicine ball throw, had greater practice experience, and were subjected to higher training loads. Multiple regression analysis showed that combined stature, handgrip strength, agility, and countermovement jump (with arm swing power) can be considered strong predictors of PIR per time played for male players. The prediction model for female players indicated that maturity offset, practice experience, and agility were the strongest predictors of basketball performance. In conclusion, the results of this study indicate that around puberty, physical fitness attributes of elite basketball players of both sexes are associated with game performance parameters. Two regression models have been estimated to predict the performance of youth basketball players of both genders.

Morphological and Fitness Attributes of Young Male Portuguese Basketball Players: Normative Values According to Chronological Age and Years From Peak Height Velocity

The aims of the present study were: (i) to describe the structural and functional attributes of young male Portuguese basketball players aged 12-16 years and (ii) to generate normative data according to chronological age and years from peak height velocity. A total of 281 male Portuguese young basketball players between the ages of 12 and 16 years were assessed in this study. Chronological age, maturity parameters (maturity offset and predicted age at peak height velocity), morphological (body mass, height, and skinfolds and length), and fitness (sprint, change of direction ability, jump, and upper body strength) attributes were measured. Descriptive statistics were determined for the age and maturity status, and the 10th, 25th, 50th, 75th, and 90th percentiles were chosen as reference values. Descriptive and normative values of the players' morphological and fitness attributes, stratified by age and maturity status, are provided. The normative values of age at peak height velocity (category YAPHV = 0) showed that regional basketball players presented average values (50th percentile) of 169.8 cm for height, 173.3 cm for arm span, 55.6 kg for body mass, 3.34 s for the 20-m speed test, 10.31 s for the T-test, 4.75 m for the 2-kg medicine ball throw, 66.9 kg for the combined right and left handgrip strength, and 30.1 and 35.9 cm for jump height in the countermovement jump (CMJ) and CMJ with arm swing, respectively. In conclusion, these results may be helpful to quantify and control an athlete's performance over time and to adjust strength and conditioning programs to biological demands.

Energy intake and expenditure in children and adolescents, contributions of biological maturity

OBJECTIVE

The aim of this study was to examine the relationship between the ratio of energy intake (EI) and energy expenditure (EE) and body composition, physical activity and macronutrients intake, considering maturity as a moderator.

METHODS

The study involved 459 adolescents aged 10 to 17. Energy and macronutrients intake were estimated using a valid Food Frequency Questionnaire; basal metabolic rate (BMR) was predicted from Schofield equations and EE was estimated using BMR and physical activity level obtained through a Portuguese validated biosocial questionnaire. Body mass index, body composition, and bone age were objectively measured. Statistical analyses included independent samples t-tests, ANCOVA and Pearson correlations. All analyses were adjusted for chronological age, sex, and EI.

RESULTS

Body mass index, fat and fat-free mass, physical activity and protein intake were negatively correlated with EI/EE (P < .001). The study showed significant interactions between maturity and body mass index, fat-free mass and physical activity level. Maturity attenuated the negative relationships between EI/EE and body mass index, fat-free mass and physical activity, especially among early maturers. All categories of maturity showed implications in body mass index for values lower than 23.8 kg/m² . A significant EI/EE reduction was observed among late maturers with a fat-free mass above 39.8 kg.

CONCLUSIONS

Our findings suggest that maturity moderates the relationship between EI/EE and body mass index, fat-free mass and physical activity, especially evident among late maturers.

Differences in Maturity, Morphological, and Fitness Attributes Between the Better- and Lower-Ranked Male and Female U-14 Portuguese Elite Regional Basketball Teams

Ramos, S, Volossovitch, A, Ferreira, AP, Barrigas, C, Fragoso, I, and Massuça, L. Differences in maturity, morphological and fitness attributes between the better- and lower-ranked male and female U-14 Portuguese elite regional basketball teams. J Strength Cond Res 34(3): 878-887, 2020-During a national championship, the anthropometric, physiological, and maturation attributes of 13-14-year-old players of regional selection basketball teams and their association with team's final classification were analyzed. Body parameters (body mass, height, skinfolds, and lengths) were measured and physiological capacities assessed by sprint (20 m), agility, jump, and upper-body strength tests. Chronological age, maturity offset (years from age at peak height velocity; YAPHV), and predicted age at peak height velocity were calculated. In both sexes, no significant differences were found for maturity. Anthropometric and physiological analysis indicated that male players from finalist's teams were significantly faster, were more agile, threw the medicine ball longer, and showed lower percentages of body fat than players from lower-ranked teams. Further, semifinalists were faster than lower-ranked players. In the same sense, female players from semifinalist teams demonstrated to be significantly faster, more agile, and threw the medicine ball longer than female players from lower-ranked teams. In addition, discriminant analysis showed that speed (in boys) and the combination of speed and upper limb strength (in girls) could successfully discriminate players with different performances in a championship. In conclusion, speed and upper limb strength appear to be the physical attributes associated with better team performance in youth basketball. Coaches should be aware of the relationship between the improvement of these physical attributes and the teaching-learning process of the basketball game.

Differences in maturity, morphological and physical attributes between players selected to the primary and secondary teams of a Portuguese Basketball elite academy

The present study aims (i) to compare the maturational, morphological and fitness attributes of young basketball players of primary and secondary teams of an elite basketball academy, and (ii) to identify the set of morphological and fitness attributes which better discriminate the players from the two teams. A total of 116 male basketball players of an elite basketball academy were divided into primary (team A) and secondary (team B) teams in two age groups (U-14 and U-16). All the players were evaluated during two consecutive seasons and data related to players' practice experience, maturational, morphological and fitness attributes were collected at the beginning of the competition period. The results of the study suggest that: (i) in both age categories, team A players were older, more mature, bigger in size and had greater fitness profiles than team B players; (ii) stature and abdominal resistance were identified as discriminant attributes for youth basketball player performance; (iii) aerobic capacity for U-14 and agility for U-16 were identified as specific discriminant attributes for performance in youth basketball. Coaches are recommended to avoid premature talent identification and provide players with opportunities to progress through the talent pathway, at least until U-16 age category.

Health-related quality of life of Portuguese children and adolescents according to their biological maturation and volume of physical activity

PURPOSE

The purpose of this study was to analyze the relationship between biological maturation and health-related quality of life (HRQoL) in Portuguese children and adolescents of both sexes when the effect of chronological age (CA) and volume of physical activity (VPA) were removed.

METHODS

HRQoL, biological maturation, CA, and VPA were assessed in 750 children and adolescents, 11-17 years old, from 3 schools in Lisbon, Portugal. The KIDSCREEN-52 was used to assess HRQoL. Maturity indicator was bone age (BA), using Tanner-Whitehouse III method (TW3). The participants were classified into three different maturity categories: late, on time, and early maturers. VPA was assessed by questionnaire (RAPIL II). An analysis of covariance (ANCOVA), using the CA and the VPA as covariates was completed. The level of significance was set at p ≤ 0.05.

RESULTS

Analysis of covariance suggested an influence of biological maturation in physical well-being dimension in both sexes, with early-maturing girls and boys having worst perception. Maturity groups were also influent in moods and emotions for girls. CA seems to be particularly important in self-perception and parent relation and home life for girls and in school environment for boys.

CONCLUSION

Biological maturation and CA have relevant impact on some HRQoL dimensions. These variables, due to their nature and effect should be considered particularly when working with specific domains of HRQoL as physical well-being in both sexes, moods and emotions and self-perception and parent relation and home life for girls and in school environment for boys.

Prevalence and injury profile in Portuguese children and adolescents according to their level of sports participation

BACKGROUND

It is becoming increasingly apparent that sports can present danger in the form of injuries. The extent of this problem calls for preventive actions based on epidemiological research.

METHODS

Two questionnaires (LESADO and RAPIL II) were distributed in four schools to 651 subjects aged between 10 and 18 years, involved in different levels of physical activity (PA) - recreative sports, school sports, federated sports and no sports participation (except physical education classes). Bone age was evaluated through Tanner-Whitehouse III method and anthropometric measures according to ISAK.

RESULTS

From 247 subjects (37.9%) it was reported a sports injury during the previous six months. The most injured body areas were lower limbs (53.8%), followed by upper limbs (29.0%) and the type of injuries found was strains (33.7%), sprains (27.1%) and fractures (23.1%). The most frequent causes were direct trauma (51.9%), indirect trauma (29.5%) and overuse (12.7%). A high percentage was relapses and chronic injuries (40.9%). The OR for age group ≥16 years was 2.26 suggesting that those ≥16 years were 2.26 times more likely to have an injury than the younger subjects and concerning the PA level, school and federated sports subjects were 4.21 and 4.44 times more likely to have an injury than no sports participation subjects.

CONCLUSIONS

Sports injuries in school age subjects were predominantly minor conditions where sprains and strains were the major injuries. They resulted mostly of trauma situations and lower and upper limbs were the most affected areas. Injury occurrence increased with age and was higher in school and federated athletes.

Morphological characteristics of adult male handball players considering five levels of performance and playing position

This study aims 1--to describe and compare the anthropometric characteristics of male handball players from different levels of performance, and 2--to identify the morphological variables that allow differentiation of the level of performance for each individual playing position. A total of 212 male handball players (age, 23.6 ± 5.2 years) were included in this study, and divided into five levels of performance for comparison. The playing position of each player was recorded. All participants were tested during the 2008-2009 Portuguese handball season. Twenty-eight anthropometric measures were taken by a group of anthropometrics accredited by International Society of the Advance of Kinanthropometry. Body composition, fat mass and muscle mass were calculated from the equations proposed by Faulkner26, Yuhase28, Durnin and Womersley25, Jackson and Pollock29, Matiegka33, Heymsfield, McManus, Smith, Stevens and Nixon34, Martin, Spenst, Drinkwater and Clarys21, Doupe, Martin, Searle, Kriellaars and Giesbrecht35 and Lee, Wang, Heo, Ross, Janssen and Heymsfield36. The research findings showed that the morphological optimization is important to have success in handball.

Physical Fitness Attributes of Team-Handball Players are Related to Playing Position and Performance Level

Background:

Investigations have reported differences amongst player position groups in elite team-Handball (HB) players. Nevertheless, studies with normative physical fitness data of the HB playing positions at more than two different levels of male HB players have not been reported yet.

Objectives:

This study aimed: 1) to describe and compare the physical fitness (PF) attributes of male HB players in different playing positions, and 2) to determine which combination of PF measures best discriminate the performance level groups in each one of the individual HB playing position groups.

Materials and Methods:

One hundred and sixty-one male HB players participated in this study. The participants were divided into five playing position groups: 1) Goalkeeper (GK, n = 24), 2) Wing (W, n = 48), 3) Back left/right (BLR, n = 38), 4) Back center (BC, n = 29), 5) Pivot (Pi, n = 22), complementarily, performance level was recorded for each participant according to the national HB association, i.e. 1) Top Elite, 2) Moderate Elite, 3) Sub-Elite or, 4) Moderately Trained. Stature and body mass measures were taken from each HB player, and six fitness tests were performed (30 -m sprint, handgrip, vertical jumps-SJ and CMJ, sit-ups, and Yo-Yo IE2).

Results:

Significant differences were observed between HB playing position groups in body size, speed, and lower limb power and handgrip strength. Nevertheless, 1) the performance in Yo-Yo IE2 was the best measure to discriminate the performance level groups when considering the HB goalkeeper group, HB center back group, and HB pivot group; 2) the average leg power (in squat jump) and the number of executions in sit up test successfully discriminated HB wing performance level groups; and, 3) Stature, countermovement jump height and the position in the Yo-Yo IE2, successfully discriminated HB left/right back performance level groups.

Conclusions:

It can be concluded that HB players profile, 1) differs according to HB playing position group, and, 2) for the same playing position group, it differs according to HB performance level. This study also demonstrated the influence of aerobic capacity for HB excellence, and according to playing positions.

Effect of birth month on physical fitness of soccer players (Under-15) according to biological maturity

This study aims to clarify the relationship between the birth quarters, biological maturity and physical fitness (PF) in Under-15 youth soccer players. Each participant (n=133) was an Under-15 player from a top-elite soccer academy. The data collection period lasted 8 years (from Under-15 2002/2003 to 2009/2010 season). The athletes' birth dates were recorded and organized by birth quarters (Q1, first; Q2, second; Q3, third; Q4, fourth) and by semesters (S1, first; S2, second). Additionally recorded were each athlete's biological maturity (skeletal age, SA), anthropometric profile (stature; body mass; thigh, calf and upper arm girths), and fitness profile (10-m and 30-m sprint times; SJ; CMJ; shuttles in YYIR Test). Significant differences were found for (1) decimal age and SA by quarters (Q4-Q1, Q2) and semesters; and (2) stature (Q3-Q1, Q2, Q4; S1-S2), body mass (Q1-Q3; S1-S2), thigh girth (S1-S2), SJ (Q1-Q2) and sprint time (Q4-Q1, Q2; S1-S2). When maturity was considered as covariate all PF variables, with exception of SJ (Q1-Q2) and 10-m sprint time (S1-S2), were very similar among the studied groups. These findings suggest that (1) seasonal birth effect may result from the observed biological maturation differences, and (2) athletes may have been chosen due to their PF attributes.

The role of lean body mass and physical activity in bone health in children

In the context of physical education curricula, markers of physical fitness (e.g., aerobic capacity, muscular strength, flexibility, and body mass index or body fat) are usually evaluated in reference to health standards. Despite their possible mediating role in the relationship between weight-bearing or muscle forces and features of bone tissue, these attributes of fitness may not be the most relevant to predict skeletal health. It is therefore important to analyze the relative contribution of these factors to the variability in bone tissue of different parts of the skeleton, and to analyze it by gender, as sensitivity to mechanical loading can diverge for boys and girls. We compared the effects of habitual physical activity (PA) and lean mass, as surrogates of weight-bearing and muscle forces, and of physical fitness (aerobic and muscle capacity of lower and upper limbs) on bone mineral content (BMC) and size of total body, lumbar spine, femoral neck, and 1/3 radius in 53 girls and 64 boys from 7.9 to 9.7 years of age. After controlling for bone age, body mass, body height, and calcium intake, lean mass was the most important predictor of bone size and/or mineral in both genders (p < 0.05), while habitual weight-bearing PA positively influenced BMC in boys (p < 0.05). The effect of muscle in bone was not determined by PA and fitness score did not explain bone variability. Femoral neck was the bone site more closely associated with mechanical loading factors; boys with a PA > 608 counts/min/day (~105 min/day of moderate and vigorous intensity) showed 13-20% more BMC than those with less physical activity, and girls with a lean mass >19 kg showed 12-19% more BMC than those with less lean mass. These findings suggest that lean mass was the most important predictor of bone size and/or mineralization in both genders, while habitual weight-bearing PA appears to positively impact on bone mineral in prepubertal boys and that both lean mass and PA need to be considered in physical education curricula and other health-enhancing programs.

Reference data for bone speed of sound in Portuguese girls and boys aged 9-13 years

The objective of this study was to provide reference data for quantitative ultrasound (QUS, Sunlight Omnisense; BeamMed Ltd., Petach-Tikva, Israel) of the radius and tibia in Portuguese subjects. The evaluation was conducted with QUS in 430 healthy participants (213 girls and 217 boys) aged between 9 and 13yr. The results indicate that 13-yr-old girls had higher radial and tibial speed of sound (SOS) than younger girls and higher tibial SOS than boys of the same age (p<0.05). Regression analysis revealed positive associations between radial and tibial SOS and skeletal maturity in girls and negative association between tibial SOS and fat mass in both sexes and average intensity of physical activity in girls (p<0.01). The young Portuguese subjects showed an age-related variation in SOS similar to that seen in some of the eastern Mediterranean countries. Children with a history of fracture of lower (n=24) or upper limbs (n=43) did not show a significant decrease of SOS values in any of the bone sites evaluated (tibia Z-score: -0.23 standard deviations [SDs]; radius Z-score: -0.21 SDs; p>0.05).

Interaction of biomechanical and morphological factors on shoulder workload in industrial paint work

BACKGROUND

It is known that work-related musculoskeletal disorders are caused by multifactor operations of various risk factors. Among these, the association of these risk factors with pain symptoms and work-related musculoskeletal disorders have been reported in many studies in all typical manufacturing settings (Bernard, 1997). This study focuses on the automobile industry.

METHODS

Twenty-nine paint area production workers of an automobile industry plant took part (age 37.7+/-8.2 years; seniority 6.9+/-6.2 years). Musculoskeletal morbidity was assessed through a questionnaire-administered interview and a clinical exam. Each workplace exposure was assessed by the observational rapid upper limb assessment method. The quantification of the workload on shoulders and wrists during the actual work task accomplishment was obtained through surface EMG.

FINDINGS

Biomechanical exposure varied significantly between pain symptomatic and asymptomatic workers. It was the only estimator that could predict the risk of occurrence of musculoskeletal symptoms. Multifactor linear analysis showed that some linear and combined anthropometric characteristics could be associated to a higher workload on the shoulders and upper limbs.

INTERPRETATION

The rigid external working conditions for employees with different morphologic characteristics, combined with demanding force application associated with the adoption of awkward postures for long and continuous periods of work time, impose constraints in accomplishment of the paint tasks. Additionally our results suggest that the same work task could present different musculoskeletal mechanical load for people with different anthropometrics.

Morphologic and anthropometric characteristics of high level Dutch korfball players

In this study a morphologic and anthropometric characterisation of Dutch korfball players (N = 36) is performed. Data, compared with those of other sports populations, showed that (1) korfball athletes are smaller and lighter than basketball and volleyball players but heavier and taller than other team-sport players; (2) korfball players have less relative body fat, more lean body mass, more limb fat, and less or similar trunk fat than the other athletes. (3) Male korfball players presented a somatotype (1.9-4.4-3.4) similar to endurance athletes and an endomorphic value lower than or similar to the other athletes. (4) The only apparent similarity between female korfball somatotype (3.2-4.0-2.8) and other athletes' somatotypes is the dominance of mesomorphy.