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Tomlinson JL, Li B, Yang J, Loeuillard E, Stumpf HE, Kuipers H, Watkins R, Carlson DM, Willhite J, O'Brien DR, Graham RP, Chen X, Smoot RL, Dong H, Gores GJ, Ilyas SI. Syngeneic murine models with distinct immune microenvironments represent subsets of human intrahepatic cholangiocarcinoma. J Hepatol 2024; 80:892-903. [PMID: 38458319 DOI: 10.1016/j.jhep.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/19/2024] [Accepted: 02/09/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND & AIMS Cholangiocarcinoma (CCA) is a poorly immunogenic malignancy associated with limited survival. Syngeneic immunocompetent mouse models of CCA are an essential tool to elucidate the tumor immune microenvironment (TIME), understand mechanisms of tumor immune evasion, and test novel immunotherapeutic strategies. The scope of this study was to develop and characterize immunocompetent CCA models with distinct genetic drivers, and correlate tumor genomics, immunobiology, and therapeutic response. METHODS A multifaceted approach including scRNA-seq, CITE-seq, whole exome and bulk RNA sequencing was employed. FDA-approved PD-1/PD-L1 antibodies were tested in humanized PD-1/PD-L1 mice (HuPD-H1). RESULTS A genetic mouse model of intrahepatic CCA (iCCA) driven by intrabiliary transduction of Fbxw7ΔF/Akt that mimics human iCCA was generated. From the Fbxw7ΔF/Akt tumors, a murine cell line (FAC) and syngeneic model with genetic and phenotypic characteristics of human iCCA were developed. Established SB1 (YAPS127A/Akt) and KPPC (KrasG12Dp53L/L) models were compared to the FAC model. Although the models had transcriptomic similarities, they had substantial differences as well. Mutation patterns of FAC, SB1, and KPPC cells matched different mutational signatures in Western and Japanese CCA patient cohorts. KPPC tumors had a high tumor mutation burden. FAC tumors had a T cell-infiltrated TIME, while SB1 tumors had a preponderance of suppressive myeloid cells. FAC, SB1, and KPPC tumors matched different immune signatures in human iCCA cohorts. Moreover, FAC, SB1, and KPPC tumor-bearing HuPD-H1 mice displayed differential responses to nivolumab or durvalumab. CONCLUSIONS Syngeneic iCCA models display a correlation between tumor genotype and TIME phenotype, with differential responses to FDA-approved immunotherapies. This study underscores the importance of leveraging multiple preclinical models to understand responses to immunotherapy in different genetic subsets of human CCA. IMPACT AND IMPLICATIONS Understanding the relationship between tumor genotype and the phenotype of the immune microenvironment is an unmet need in cholangiocarcinoma (CCA). Herein, we use syngeneic murine models of intrahepatic CCA with different genetic drivers to demonstrate a correlation between tumor genotype and immune microenvironment phenotype in murine models, which is associated with differential responses to FDA-approved immunotherapies. This information will help guide other preclinical studies. Additionally, it emphasizes that immune checkpoint inhibition in patients with CCA is not a "one-size-fits-all" approach. Our observations suggest that, as for targeted therapies, patients should be stratified and selected for treatment according to their tumor genetics.
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Affiliation(s)
| | - Binbin Li
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jingchun Yang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Emilien Loeuillard
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Hannah E Stumpf
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
| | | | - Ryan Watkins
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Jessica Willhite
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Daniel R O'Brien
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Xin Chen
- Cancer Biology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Rory L Smoot
- Department of Surgery, Mayo Clinic, Rochester, MN, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Haidong Dong
- Department of Urology, Mayo Clinic, Rochester, MN, USA; Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Gregory J Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Sumera I Ilyas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA; Department of Immunology, Mayo Clinic, Rochester, MN, USA.
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2
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Hoogwater FJH, Kuipers H, de Meijer VE, Maulat C, Muscari F, Polak WG, van Hoek B, Jézéquel C, Alwayn IPJ, Ijzermans JNM, Mohkam K, Mabrut JY, Van Vilsteren FGI, Adam JP, Chiche L, Chebaro A, Boleslawski E, Dubbeld J, Murad SD, Rayar M, Porte RJ. Role of neoadjuvant chemoradiotherapy in liver transplantation for unresectable perihilar cholangiocarcinoma: multicentre, retrospective cohort study. BJS Open 2023; 7:7111385. [PMID: 37032423 PMCID: PMC10083139 DOI: 10.1093/bjsopen/zrad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND The Mayo protocol for liver transplantation in patients with unresectable perihilar cholangiocarcinoma is based on strict selection and neoadjuvant chemoradiotherapy. The role of neoadjuvant chemoradiotherapy in this scenario remains unclear. The aim of this study was to compare outcomes after transplantation for perihilar cholangiocarcinoma using strict selection criteria, either with or without neoadjuvant chemoradiotherapy. METHODS This was an international, multicentre, retrospective cohort study of patients who underwent transplantation between 2011 and 2020 for unresectable perihilar cholangiocarcinoma using the Mayo selection criteria and receiving neoadjuvant chemoradiotherapy or not receiving neoadjuvant chemoradiotherapy. Endpoints were post-transplant survival, post-transplant morbidity rate, and time to recurrence. RESULTS Of 49 patients who underwent liver transplantation for perihilar cholangiocarcinoma, 27 received neoadjuvant chemoradiotherapy and 22 did not. Overall 1-, 3-, and 5-year post-transplantation survival rates were 65 per cent, 51 per cent and 41 per cent respectively in the group receiving neoadjuvant chemoradiotherapy and 91 per cent, 68 per cent and 53 per cent respectively in the group not receiving neoadjuvant chemoradiotherapy (1-year hazards ratio (HR) 4.55 (95 per cent c.i. 0.98 to 21.13), P = 0.053; 3-year HR 2.07 (95 per cent c.i. 0.78 to 5.54), P = 0.146; 5-year HR 1.71 (95 per cent c.i. 0.71 to 4.09), P = 0.229). Hepatic vascular complications were more frequent in the group receiving neoadjuvant chemoradiotherapy compared with the group not receiving neoadjuvant chemoradiotherapy (nine of 27 versus two of 22, P = 0.045). In multivariable analysis, tumour recurrence occurred less frequently in the group receiving neoadjuvant chemoradiotherapy (HR 0.30 (95 per cent c.i. 0.09 to 0.97), P = 0.044). CONCLUSION In selected patients undergoing liver transplantation for perihilar cholangiocarcinoma, neoadjuvant chemoradiotherapy resulted in a lower risk of tumour recurrence, but was associated with a higher rate of early hepatic vascular complications. Adjustments in neoadjuvant chemoradiotherapy reducing the risk of hepatic vascular complications, such as omitting radiotherapy, may further improve the outcome in patients undergoing liver transplantation for perihilar cholangiocarcinoma.
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Affiliation(s)
- Frederik J H Hoogwater
- Department of Surgery, Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrien Kuipers
- Department of Surgery, Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vincent E de Meijer
- Department of Surgery, Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Charlotte Maulat
- Department of Digestive Surgery and Liver Transplantation, Toulouse-Rangueil University Hospital, Toulouse, France
| | - Fabrice Muscari
- Department of Digestive Surgery and Liver Transplantation, Toulouse-Rangueil University Hospital, Toulouse, France
| | - Wojciech G Polak
- Department of Surgery, Division of Hepato-Pancreato-Biliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Caroline Jézéquel
- Department of Hepatology, Rennes University Hospital, Rennes, France
| | - Ian P J Alwayn
- Department of Surgery, Division of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan N M Ijzermans
- Department of Surgery, Division of Hepato-Pancreato-Biliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kayvan Mohkam
- Department of Digestive Surgery and Liver Transplantation, Hôpital De La Croix Rousse, Lyon, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Liver Transplantation, Hôpital De La Croix Rousse, Lyon, France
| | - Frederike G I Van Vilsteren
- Department of Gastroenterology, Division of Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jean-Philippe Adam
- Department of Hepatobiliary and Pancreatic Surgery and Transplantation, University Hospital Bordeaux, Bordeaux, France
| | - Laurence Chiche
- Department of Hepatobiliary and Pancreatic Surgery and Transplantation, University Hospital Bordeaux, Bordeaux, France
| | - Alexandre Chebaro
- Department of Digestive Surgery and Transplantation, CHU Lille, University of Lille, Lille, France
| | - Emmanuel Boleslawski
- Department of Digestive Surgery and Transplantation, CHU Lille, University of Lille, Lille, France
| | - Jeroen Dubbeld
- Department of Surgery, Division of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michel Rayar
- Institut National de la Santé et de la Recherche Médicale (Inserm), Rennes, France
- Department of Hepatobiliary and Pancreatic Surgery and Transplantation, University Hospital Rennes, Rennes, France
| | - Robert J Porte
- Department of Surgery, Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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3
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Nooijen LE, Franssen S, Buis CI, Dejong CHC, den Dulk M, van Delden OM, Ijzermans JN, Groot Koerkamp B, Kazemier G, van Lienden K, Klümpen HJ, Kuipers H, Olij B, Porte RJ, Rauws EA, Voermans RP, van Gulik TM, Erdmann JI, Roos E, Coelen RJ. Long-term follow-up of a randomized trial of biliary drainage in perihilar cholangiocarcinoma. HPB (Oxford) 2023; 25:210-217. [PMID: 36376222 DOI: 10.1016/j.hpb.2022.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/02/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIMS The DRAINAGE trial was a randomized controlled trial comparing preoperative endoscopic (EBD) and percutaneous biliary drainage (PTBD) in patients with potentially resectable, perihilar cholangiocarcinoma (pCCA). The aim of this study was to compare the long-term outcomes. METHODS Patients were randomized in four tertiary referral centers. Follow-up data were available for all included patients. Primary outcome was overall survival (OS). Secondary outcomes were readmissions, and re-interventions not including in-trial interventions. RESULTS A total of 54 patients were randomized; 27 in both groups. Median follow-up for both groups was 62 months (95% CI 54-70). The median OS was 13 months (95% CI 7.9-18.1) in the EBD and 7 months (95% CI 0.0-17.2) in the PTBD group (P = 0.28). Twenty (37%, n = 8 EBD vs n = 12 PTBD, P = 0.43) of 54 patients were readmitted at least once, mostly due to drainage-related complications (n = 13, 24%). Of note, 14 out of the 54 patients died within the trial. A total of 76 drainage procedures (32 EBD and 44 PTBD) were performed in 28 patients. The median number of stent or drain placements was 2 (2-4) for the EBD group and 2 (1-3) for the PTBD group (P = 0.77). DISCUSSION Although this follow-up study represented a small cohort, no long-term differences in survival, readmissions, and drainage procedures for EBD and PTBD were found, even when comparing the resected and unresected group. However, this study demonstrates the complexity of biliary drainage for patients with potentially resectable pCCA, even in tertiary referral centers.
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Affiliation(s)
- Lynn E Nooijen
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Stijn Franssen
- Erasmus MC Cancer Institute, Department of Surgery, Rotterdam, the Netherlands
| | - Carlijn I Buis
- University Medical Center Groningen, University of Groningen, Department of Surgery, Groningen, the Netherlands
| | - Cornelis H C Dejong
- Maastricht University Medical Center, Department of Surgery, Maastricht, the Netherlands
| | - Marcel den Dulk
- Maastricht University Medical Center, Department of Surgery, Maastricht, the Netherlands
| | - Otto M van Delden
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC, Location University of Amsterdam, Department of Radiology and Nuclear Sciences, Amsterdam, the Netherlands
| | - Jan N Ijzermans
- Erasmus MC Cancer Institute, Department of Surgery, Rotterdam, the Netherlands
| | - Bas Groot Koerkamp
- Erasmus MC Cancer Institute, Department of Surgery, Rotterdam, the Netherlands
| | - Geert Kazemier
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Krijn van Lienden
- RAKU, Department of Radiology and Nuclear Sciences, Nieuwegein, the Netherlands
| | - Heinz-Josef Klümpen
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC, Location University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands
| | - Hendrien Kuipers
- University Medical Center Groningen, University of Groningen, Department of Surgery, Groningen, the Netherlands
| | - Bram Olij
- Maastricht University Medical Center, Department of Surgery, Maastricht, the Netherlands
| | - Robert J Porte
- University Medical Center Groningen, University of Groningen, Department of Surgery, Groningen, the Netherlands
| | - Erik A Rauws
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology, Amsterdam, the Netherlands
| | - Rogier P Voermans
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology, Amsterdam, the Netherlands
| | - Thomas M van Gulik
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Joris I Erdmann
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - E Roos
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Pathology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - R J Coelen
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
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Kuipers H, Hoogwater FJH, Holtman GA, van der Hoorn A, de Boer MT, de Haas RJ. Clinical value of diffusion-weighted MRI for differentiation between benign and malignant gallbladder disease: a systematic review and meta-analysis. Acta Radiol 2021; 62:987-996. [PMID: 32830511 DOI: 10.1177/0284185120950115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Radiological differentiation between benign and malignant gallbladder disease is important but remains challenging. Furthermore, the clinical value of diffusion-weighted imaging (DWI) remains unclear. PURPOSE To determine the value of DWI in discriminating benign from malignant gallbladder disease by conducting a systematic review and meta-analysis. MATERIAL AND METHODS The literature was systematically searched. Studies analyzing diagnostic value of DWI in gallbladder disease with histopathology or follow-up as reference standard were included. Study selection and data extraction were done by two reviewers independently. Methodological quality was assessed using the QUADAS-2 tool. Sensitivity and specificity were calculated and displayed in a forest plot. A sensitivity analysis was performed in case of outliers. Pooled sensitivity and specificity of DWI were plotted on a hierarchical summary receiver operating characteristic curve. If available, the added value of DWI to conventional magnetic resonance imaging (MRI) sequences was analyzed. RESULTS Out of 2456 articles, eight studies fulfilled the inclusion criteria; 592 patients with 221 malignant lesions were included. Pooled sensitivity and specificity rates were 0.87 and 0.84, respectively. In two studies, diagnostic accuracy rates improved after adding DWI to conventional MRI (64% and 75% for conventional MRI vs. 89% and 94% after combining conventional MRI with DWI). In another study, the area under the curve increased from 0.92 to 0.95. CONCLUSION DWI appears to be an accurate imaging technique in discriminating benign from malignant gallbladder disease. To achieve optimal patient care, it should be part of multiparametric MRI and should be combined with other imaging modalities.
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Affiliation(s)
- Hendrien Kuipers
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederik JH Hoogwater
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea A Holtman
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke T de Boer
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Kuipers H, Hoogwater FJH, Holtman GA, Slangen JJG, de Haas RJ, de Boer MT. Diagnostic performance of preoperative CT in differentiating between benign and malignant origin of suspicious gallbladder lesions. Eur J Radiol 2021; 138:109619. [PMID: 33676357 DOI: 10.1016/j.ejrad.2021.109619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/06/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine diagnostic performance of preoperative CT in differentiating between benign and malignant suspicious gallbladder lesions and to develop a preoperative risk score. METHOD All patients referred between January 2007 and September 2018 for suspicion of gallbladder cancer (GBC) or incidentally found GBC were retrospectively analyzed. Patients were excluded when preoperative CT or histopathologic examination was lacking. Two radiologists, blinded to histopathology results, independently reviewed CT images to differentiate benign disease from GBC. Multivariable analysis and internal validation were used to develop a risk score for GBC. Model discrimination, calibration, and diagnostic performance were assessed. RESULTS In total, 118 patients with 39 malignant (33 %) and 79 benign (67 %) lesions were included. Sensitivity of CT for diagnosing GBC was 90 % (95 % confidence interval [CI]: 76-97). Specificity rates were 61 % (95 % CI: 49-72) and 59 % (95 % CI: 48-70). Three predictors of GBC (irregular lesion aspect, absence of fat stranding, and locoregional lymphadenopathy) were included in the risk score ranging from -1 to 4. Adequate performance was found (AUC: 0.79, calibration slope: 0.89). In patients allocated >0 points, the model showed higher performance in excluding GBC than the radiologists (sensitivity 92 % [95 % CI: 79-98]). Moreover, when allocated >3 points, the risk score was superior in diagnosing GBC (specificity 99 % [95 % CI: 93-100]). CONCLUSIONS Sensitivity rates of CT for differentiation between benign and malignant gallbladder lesions are high, however specificity rates are relatively low. The proposed risk score may facilitate differentiation between benign and malignant suspicious gallbladder lesions.
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Affiliation(s)
- Hendrien Kuipers
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Frederik J H Hoogwater
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Gea A Holtman
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Jules J G Slangen
- Department of Radiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Marieke T de Boer
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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de Savornin Lohman EAJ, Kuipers H, van Dooren M, Verhoeven RHA, Erdmann JI, Groot Koerkamp B, Braat AE, Hagendoorn J, Daams F, van Dam R, van Gulik TM, de Boer MT, de Reuver PR. Should jaundice preclude resection in patients with gallbladder cancer? Results from a nation-wide cohort study. HPB (Oxford) 2020; 22:1686-1694. [PMID: 32340859 DOI: 10.1016/j.hpb.2020.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/08/2020] [Accepted: 03/16/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND It is controversial whether patients with gallbladder cancer (GBC) presenting with jaundice benefit from resection. This study re-evaluates the impact of jaundice on resectability and survival. METHODS Data was collected on surgically explored GBC patients in all Dutch academic hospitals from 2000 to 2018. Survival and prognostic factors were assessed. RESULTS In total 202 patients underwent exploration and 148 were resected; 124 non-jaundiced patients (104 resected) and 75 jaundiced patients (44 resected). Jaundiced patients had significantly (P < 0.05) more pT3/T4 tumors, extended (≥3 segments) liver- and organ resections, major post-operative complications and margin-positive resection. 90-day mortality was higher in jaundiced patients (14% vs. 0%, P < 0.001). Median overall survival (OS) was 7.7 months in jaundiced patients (2-year survival 17%) vs. 26.1 months in non-jaundiced patients (2-year survival 39%, P < 0.001). In multivariate analysis, jaundice (HR1.89) was a poor prognostic factor for OS in surgically explored but not in resected patients. Six jaundiced patients did not develop a recurrence; none had liver- or common bile duct (CBD) invasion on imaging. CONCLUSION Jaundice is associated with poor survival. However, jaundice is not an independent adverse prognostic factor in resected patients. Surgery should be considered in patients with limited disease and no CBD invasion on imaging.
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Affiliation(s)
| | - Hendrien Kuipers
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Groningen, P.O. Box 30001, 97700 RB, Groningen, the Netherlands
| | - Mike van Dooren
- Department of Surgery, Radboudumc, P.O. Box 9101, Internal Code 618, 6500 HB, Nijmegen, the Netherlands
| | - Rob H A Verhoeven
- Department of Surgery, Radboudumc, P.O. Box 9101, Internal Code 618, 6500 HB, Nijmegen, the Netherlands; Department of Research & Development, Netherlands Comprehensive Cancer Organization, P.O. Box 19079, 3501 DB, Utrecht, the Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam University Medical Centers, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmusmc, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - Andries E Braat
- Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - Jeroen Hagendoorn
- Department of Surgery, UMC Utrecht Cancer Center, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands; Department of Surgery, St Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam University Medical Centers, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - Ronald van Dam
- Department of Surgery, Maastricht University Medical Center +, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam University Medical Centers, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - Marieke T de Boer
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Groningen, P.O. Box 30001, 97700 RB, Groningen, the Netherlands
| | - Philip R de Reuver
- Department of Surgery, Radboudumc, P.O. Box 9101, Internal Code 618, 6500 HB, Nijmegen, the Netherlands.
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7
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Kuipers H, de Savornin Lohman EAJ, van Dooren M, Braat AE, Daams F, van Dam R, Erdmann JI, Hagendoorn J, Hoogwater FJH, Groot Koerkamp B, van Gulik TM, de Reuver PR, de Boer MT. Extended Resections for Advanced Gallbladder Cancer: Results from a Nationwide Cohort Study. Ann Surg Oncol 2020; 28:835-843. [PMID: 32696306 PMCID: PMC7801314 DOI: 10.1245/s10434-020-08858-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
Abstract
Background Extended resections (i.e., major hepatectomy and/or pancreatoduodenectomy) are rarely performed for gallbladder cancer (GBC) because outcomes remain inconclusive. Data regarding extended resections from Western centers are sparse. This Dutch, multicenter cohort study analyzed the outcomes of patients who underwent extended resections for locally advanced GBC. Methods Patients with GBC who underwent extended resection with curative intent between January 2000 and September 2018 were identified from the Netherlands Cancer Registry. Extended resection was defined as a major hepatectomy (resection of ≥ 3 liver segments), a pancreatoduodenectomy, or both. Treatment and survival data were obtained. Postoperative morbidity, mortality, survival, and characteristics of short- and long-term survivors were assessed. Results The study included 33 patients. For 16 of the patients, R0 resection margins were achieved. Major postoperative complications (Clavien Dindo ≥ 3A) occurred for 19 patients, and 4 patients experienced postoperative mortality within 90 days. Recurrence occurred for 24 patients. The median overall survival (OS) was 12.8 months (95% confidence interval, 6.5–19.0 months). A 2-year survival period was achieved for 10 patients (30%) and a 5-year survival period for 5 patients (15%). Common bile duct, liver, perineural and perivascular invasion and jaundice were associated with reduced survival. All three recurrence-free patients had R0 resection margins and no liver invasion. Conclusion The median OS after extended resections for advanced GBC was 12.8 months in this cohort. Although postoperative morbidity and mortality were significant, long-term survival (≥ 2 years) was achieved in a subset of patients. Therefore, GBC requiring major surgery does not preclude long-term survival, and a subgroup of patients benefit from surgery.
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Affiliation(s)
- H Kuipers
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | | | - M van Dooren
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A E Braat
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - F Daams
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - R van Dam
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J I Erdmann
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - J Hagendoorn
- Department of Surgery, Utrecht University Medical Center, Utrecht, The Netherlands.,Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - F J H Hoogwater
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B Groot Koerkamp
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - T M van Gulik
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - P R de Reuver
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M T de Boer
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Kuipers H, Hoogwater F, Slangen J, de Boer M, de Haas R. Diagnostic Performance of CT and MRI in The Characterization of Suspicious Gallbladder Lesions: A Large Single Center Study. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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9
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Hentzen JEKR, Rovers KP, Kuipers H, van der Plas WY, Been LB, Hoogwater FJH, van Ginkel RJ, Hemmer PHJ, van Dam GM, de Hingh IHJT, Kruijff S. Impact of Synchronous Versus Metachronous Onset of Colorectal Peritoneal Metastases on Survival Outcomes After Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Multicenter, Retrospective, Observational Study. Ann Surg Oncol 2019; 26:2210-2221. [PMID: 30877495 PMCID: PMC6545176 DOI: 10.1245/s10434-019-07294-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Indexed: 12/21/2022]
Abstract
Background Careful selection of patients with colorectal peritoneal metastases (PM) for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is crucial. It remains unknown whether the time of onset of colorectal PM (synchronous vs metachronous) influences surgical morbidity and survival outcomes after CRS with HIPEC. Methods Patients with histologically proven colorectal PM who underwent CRS with HIPEC between February 2006 and December 2017 in two Dutch tertiary referral hospitals were retrospectively included from a prospectively maintained database. The onset of colorectal PM was classified as synchronous (PM diagnosed at the initiational presentation with colorectal cancer) or metachronous (PM diagnosed after initial curative colorectal resection). Major postoperative complications (Clavien–Dindo grade ≥ 3), overall survival (OS), and disease-free survival (DFS) were compared between patients with synchronous colorectal PM and those with metachronous colorectal PM using Kaplan–Meier analyses, proportional hazard analyses, and a multivariate Cox regression analysis. Results The study enrolled 433 patients, of whom 231 (53%) had synchronous colorectal PM and 202 (47%) had metachronous colorectal PM. The major postoperative complication rate and median OS were similar between the patients with synchronous colorectal PM and those with metachronous colorectal PM (26.8% vs 29.7%; p = 0.693 and 34 vs 33 months, respectively; p = 0.819). The median DFS was significantly decreased for the patients with metachronous colorectal PM and those with synchronous colorectal PM (11 vs 15 months; adjusted hazard ratio, 1.63; 95% confidence interval, 1.18–2.26). Conclusions Metachronous onset of colorectal PM is associated with early recurrence after CRS with HIPEC compared with synchronous colorectal PM, without a difference in OS or major postoperative complications. Time to onset of colorectal PM should be taken into consideration to optimize patient selection for this major procedure. Electronic supplementary material The online version of this article (10.1245/s10434-019-07294-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Judith E K R Hentzen
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Koen P Rovers
- Department of Surgery, Division of Surgical Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Hendrien Kuipers
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Willemijn Y van der Plas
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lukas B Been
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frederik J H Hoogwater
- Department of Surgery, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert J van Ginkel
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Patrick H J Hemmer
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gooitzen M van Dam
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Nuclear Medicine and Molecular Imaging and Intensive Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ignace H J T de Hingh
- Department of Surgery, Division of Surgical Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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10
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Hentzen J, Rovers K, Kuipers H, van der Plas W, Been L, Hoogwater F, van Ginkel R, van Dam G, Hemmer P, de Hingh I, Kruijff S. The impact of synchronous versus metachronous peritonitis carcinomatosa on overall- and disease-free survival in colorectal patients scheduled for CRS and HIPEC. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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11
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Hop MJ, Stekelenburg C, Hiddingh J, Kuipers H, Goei H, Middelkoop E, Nieuwenhuis M, Polinder S, van BME. Cost-Effectiveness of Laser Doppler Imaging in Burn Care in The Netherlands; A Randomised Controlled Trial. Value Health 2014; 17:A608. [PMID: 27202115 DOI: 10.1016/j.jval.2014.08.2125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- M J Hop
- Association of Dutch Burn Centres, Rotterdam, The Netherlands
| | - C Stekelenburg
- Association of Dutch Burn Centres, Beverwijk, The Netherlands
| | - J Hiddingh
- Association of Dutch Burn Centres, Groningen, The Netherlands
| | - H Kuipers
- Association of Dutch Burn Centres, Groningen, The Netherlands
| | - H Goei
- Association of Dutch Burn Centres, Rotterdam, The Netherlands
| | - E Middelkoop
- VU University Medical Centre, Amsterdam, The Netherlands
| | - M Nieuwenhuis
- Association of Dutch Burn Centres, Groningen, The Netherlands
| | | | - Baar M E van
- Association of Dutch Burn Centres, Rotterdam, The Netherlands
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12
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Kuipers H, Dubravcic-Simunjak S, Moran J, Mitchell D, Shobe J, Sakai H, Ambartsumov R. Blood Testing in Sport: Hematological Profiling. Int J Sports Med 2010; 31:542-7. [DOI: 10.1055/s-0030-1254123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
This systematic review summarizes the research of previous studies that used resistance training in the post-treatment phase of cancer patients with a focus on methodological quality, training methods and physical outcome measures. We found twenty-four studies (10 RCTs, 4 controlled clinical trials and 10 uncontrolled trials) that met all inclusion criteria. The studies were of moderate methodological quality. The majority of studies involved breast cancer patients (54%), followed by prostate cancer patients (13%). Most studies used a combination of resistance and aerobic training, which was mostly supervised. Resistance training involved large muscle groups, with 1-3 sets of 8-12 repetitions. The duration of the resistance training programs varied from 3-24 weeks, with a training frequency of 1-5 sessions per week. The training intensity ranged from 25% to 85% of the one-repetition maximum. Overall, positive training effects were observed for cardiopulmonary and muscle function, with significant increases in peak oxygen uptake (range: 6-39%), and in the one-repetition maximum (range: 11-110%). In general, there were no effects of training on body composition, endocrine and immune function, and haematological variables. No adverse effects of the resistance training were reported. Based upon these results, we recommend to incorporate resistance training in cancer rehabilitation programmes.
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Affiliation(s)
- I C De Backer
- Maxima Medical Centre, Sports Medicine, De Run 4600, Veldhoven 5500MB, The Netherlands.
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Vos CC, Berry P, Opdam P, Baveco H, Nijhof B, O’Hanley J, Bell C, Kuipers H. Adapting landscapes to climate change: examples of climate-proof ecosystem networks and priority adaptation zones. J Appl Ecol 2008. [DOI: 10.1111/j.1365-2664.2008.01569.x] [Citation(s) in RCA: 224] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Praet SFE, van Rooij ESJ, Wijtvliet A, Boonman-de Winter LJM, Enneking T, Kuipers H, Stehouwer CDA, van Loon LJC. Brisk walking compared with an individualised medical fitness programme for patients with type 2 diabetes: a randomised controlled trial. Diabetologia 2008; 51:736-46. [PMID: 18297259 PMCID: PMC2292420 DOI: 10.1007/s00125-008-0950-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Accepted: 01/14/2008] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS Structured exercise is considered a cornerstone in type 2 diabetes treatment. However, adherence to combined resistance and endurance type exercise or medical fitness intervention programmes is generally poor. Group-based brisk walking may represent an attractive alternative, but its long-term efficacy as compared with an individualised approach such as medical fitness intervention programmes is unknown. We compared the clinical benefits of a 12-month exercise intervention programme consisting of either brisk walking or a medical fitness programme in type 2 diabetes patients. METHODS We randomised 92 type 2 diabetes patients (60 +/- 9 years old) to either three times a week of 60 min brisk walking (n = 49) or medical fitness programme (n = 43). Primary outcome was the difference in changes in HbA1c values at 12 months. Secondary outcomes were differences in changes in blood pressure, plasma lipid concentrations, insulin sensitivity, body composition, physical fitness, programme adherence rate and health-related quality of life. RESULTS After 12 months, 18 brisk walking and 19 medical fitness participants were still actively participating. In both programmes, 50 and 25% of the dropout was attributed to overuse injuries and lack of motivation, respectively. Intention-to-treat analyses showed no important differences between brisk walking and medical fitness programme in primary or secondary outcome variables. CONCLUSIONS/INTERPRETATION The prescription of group-based brisk walking represents an equally effective intervention to modulate glycaemic control and cardiovascular risk profile in type 2 diabetes patients when compared with more individualised medical fitness programmes. Future exercise intervention programmes should anticipate the high attrition rate due to overuse injuries and motivation problems.
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Affiliation(s)
- S F E Praet
- Department of Human Movement Sciences, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, the Netherlands.
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Abstract
Cardiac remodelling is commonly defined as a physiological or pathological state that may occur after conditions such as myocardial infarction, pressure overload, idiopathic dilated cardiomyopathy or volume overload. When training excessively, the heart develops several myocardial adaptations causing a physiological state of cardiac remodelling. These morphological changes depend on the kind of training and are clinically characterised by modifications in cardiac size and shape due to increased load. Several studies have investigated morphological differences in the athlete's heart between athletes performing strength training and athletes performing endurance training. Endurance training is associated with an increased cardiac output and volume load on the left and right ventricles, causing the endurance-trained heart to generate a mild to moderate dilatation of the left ventricle combined with a mild to moderate increase in left ventricular wall thickness. Strength training is characterised by an elevation of both systolic and diastolic blood pressure. This pressure overload causes an increase in left ventricular wall thickness. This may or may not be accompanied by a slight raise in the left ventricular volume. However, the development of an endurancetrained heart and a strength-trained heart should not be considered an absolute concept. Both forms of training cause specific morphological changes in the heart, dependent on the type of sport. (Neth Heart J 2008;16:129-33.).
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Affiliation(s)
- C Mihl
- Department of Cardiology, Maastricht University Hospital, Maastricht, the Netherlands
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17
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Janssen E, Kuipers H, Keizer H, Verstappen F. Plasma Enzyme Activities and Running Performance in a Maximal Treadmill Test before and after a 30 km Race or a Marathon. Int J Sports Med 2008. [DOI: 10.1055/s-2008-1025964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kuipers H, Geurten P, Verstappen F, van Kranenburg G, Keizer H. Inter-individual Variation in Heart Rate Response to Exercise and its Consequences for the Accuracy of Estimating VO2max. Int J Sports Med 2008. [DOI: 10.1055/s-2008-1025975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wijnen S, Verstappen F, Kuipers H. The Influence of Intravenous NaHCO3-Administration on Interval Exercise: Acid-base Balance and Endurance. Int J Sports Med 2008. [DOI: 10.1055/s-2008-1025976] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kuipers H, Van't Hullenaar GAC, Pluim BM, Overbeek SE, De Hon O, Van Breda EJ, Van Loon LC. Four weeks' corticosteroid inhalation does not augment maximal power output in endurance athletes. Br J Sports Med 2008; 42:868-71. [PMID: 18344386 DOI: 10.1136/bjsm.2007.042572] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess possible ergogenic properties of corticosteroid administration. DESIGN A balanced, double-blind, placebo-controlled design was used. PARTICIPANTS 28 well-trained cyclists and rowers. INTERVENTION 4 weeks' daily inhalation of 800 microg budesonide or placebo. MAIN OUTCOME MEASUREMENTS The subjects performed three incremental cycle ergometer tests until exhaustion, before and after 2 and 4 weeks of placebo or budesonide administration, to measure maximal power output (W(max)). Once a week they filled in a profile of mood state (POMS) questionnaire. RESULTS There was no significant difference in W(max) between the placebo (376 (SD 25) W) and the corticosteroid group (375 (36) W) during the preintervention test, and there were no significant changes in either group after 2 and 4 weeks of intervention. No effect of the intervention on mood state was found. CONCLUSION 4 weeks of corticosteroid or placebo inhalation in healthy, well-trained athletes did not affect maximal power output or mood state. Hence no ergogenic properties of 4 weeks' corticosteroid administration could be demonstrated, which corroborates previous studies of short-term corticosteroid administration.
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Affiliation(s)
- H Kuipers
- Department of Movement Sciences, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), University of Maastricht, Maastricht, The Netherlands.
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Praet SFE, Jonkers RAM, Schep G, Stehouwer CDA, Kuipers H, Keizer HA, van Loon LJ. Long-standing, insulin-treated type 2 diabetes patients with complications respond well to short-term resistance and interval exercise training. Eur J Endocrinol 2008; 158:163-72. [PMID: 18230822 DOI: 10.1530/eje-07-0169] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the feasibility and the benefits of combined resistance and interval exercise training on phenotype characteristics and skeletal muscle function in deconditioned, type 2 diabetes (T2D) patients with polyneuropathy. DESIGN Short-term, single-arm intervention trial. METHODS Eleven male T2D patients (age: 59.1+/-7.5 years; body mass index: 32.2+/-4.0 kg/m2) performed progressive resistance and interval exercise training thrice a week for 10 weeks. Besides primary diabetes outcome measures, muscle strength (MUST), maximal workload capacity (Wmax), whole-body peak oxygen uptake (VO2peak) and muscle oxidative capacity (MUOX), intramyocellular lipid (IMCL) and glycogen (IMCG) storage, and systemic inflammation markers were determined before and after training. Daily exogenous insulin requirements (EIR) and historic individualized EIR were gathered and analysed. RESULTS MUST and Wmax increased with 17% (90% confidence intervals 9-24%) and 14% (6-21) respectively. Furthermore, mean arterial blood pressure declined with 5.5 mmHg (-9.7 to -1.4). EIR dropped with 5.0 IU/d (-11.5 to 1.5) compared with baseline. A decline of respectively -0.7 mmol/l (-2.9 to 1.5) and -147 micromol/l (-296 to 2) in fasting plasma glucose and non-esterified fatty acids concentrations were observed following the intervention, but these were not accompanied by changes in VO2peak, MUOX, IMCL or IMCG, and blood glycolysated haemoglobin, adiponectin, tumor necrosis factor-alpha and/or cholesterol concentrations. CONCLUSION Short-term resistance and interval exercise training is feasible in deconditioned T2D patients with polyneuropathy and accompanied by moderate improvements in muscle function and blood pressure. Such a specific exercise regimen may provide a better framework for future exercise intervention programmes in the treatment of deconditioned T2D patients.
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Affiliation(s)
- S F E Praet
- Department of Movement Sciences, Nutrition and Toxicology Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
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Minetto MA, Lanfranco F, Baldi M, Termine A, Kuipers H, Ghigo E, Rainoldi A. Corticotroph axis sensitivity after exercise: comparison between elite athletes and sedentary subjects. J Endocrinol Invest 2007; 30:215-23. [PMID: 17505155 DOI: 10.1007/bf03347428] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Strenuous exercise activates the hypothalamic-pituitary-adrenal (HPA) axis. Several reports showed that physical training is associated with a decreased efficiency of the feedback control of HPA axis. The aims of the present study were: 1) to evaluate the differences in the mechanical, hormonal, and lactate responses to a high-intensity isokinetic exercise among different groups of competitive athletes (CA, no.=20) of power and endurance disciplines and sedentary controls (SED, no.=10); 2) to determine the effects of the training status on the HPA axis responsiveness following exercise, as indirectly evaluated by the rates of ACTH, cortisol, and DHEA recovery after exercise. CA and SED fulfilled eight sets of twenty concentric contractions of the knee extensors at 180 degrees/sec angular velocity throughout a constant range of motion (100 degrees). There was a rest period of 30 sec between each set and a 3-min rest period between the two legs. Before, immediately after the isokinetic exercise and at different times in the subsequent 120 min of recovery, blood and saliva were sampled to determine plasma ACTH, salivary cortisol, serum DHEA, and serum lactate concentrations. CA showed a higher cortisol response to exercise than SED, whereas no differences were found in the responses of ACTH, DHEA and lactate. In the athlete group the exercise-induced increases of ACTH, cortisol, and lactate were higher in power athletes with respect to endurance athletes. No differences were observed between athletes and SED in the rates of hormonal recovery after exercise: this finding does not support the concept that a reduced feedback control of HPA axis can represent a feature of trained individuals.
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Affiliation(s)
- M A Minetto
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, Turin, Italy.
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Kuipers H. Letter to the Editor. Int J Sports Med 2007; 28:178; author reply 178. [PMID: 17290310 DOI: 10.1055/s-2006-955957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kuipers H, Moran J, Dubravcic-Simunjak S, Mitchell DW, Shobe J, Sakai H, Ambartsumov R. Hemoglobin Level in Elite Speed Skaters from 2000 up to 2005, and its Relationship with Competitive Results. Int J Sports Med 2007; 28:16-20. [PMID: 16739092 DOI: 10.1055/s-2006-924055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We studied the mean hemoglobin (Hb) concentration in elite male and female long track junior and senior speed skaters from 2000 to 2005. In addition, the number of abnormal hematological findings observed over this period of time was investigated. We also studied whether there were differences in Hb concentration between top ranked and lower ranked skaters, and whether a relationship between Hb concentration and competitive results could be observed. The present study shows that the mean Hb level in male and female junior and senior long track speed skaters remained fairly stable and did not change from 2000 through 2005. The number and percentage of abnormal hematological findings were found to vary between 0 and 2 %, and failed to show a clear pattern or trend over the years. There was no difference in mean Hb levels between top ranked and lower ranked skaters, and no meaningful relationship between Hb concentration and ranking could be found.
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Affiliation(s)
- H Kuipers
- Department of Movement Sciences, University of Maastricht, Maastricht, The Netherlands.
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Praet SFE, De Feyter HMM, Jonkers RAM, Nicolay K, van Pul C, Kuipers H, van Loon LJC, Prompers JJ. 31P MR spectroscopy and in vitro markers of oxidative capacity in type 2 diabetes patients. MAGMA 2006; 19:321-31. [PMID: 17180611 DOI: 10.1007/s10334-006-0060-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Revised: 10/26/2006] [Accepted: 11/06/2006] [Indexed: 01/07/2023]
Abstract
BACKGROUND Skeletal muscle mitochondrial function in type 2 diabetes (T2D) is currently being studied intensively. In vivo (31)P magnetic resonance spectroscopy ((31)P MRS) is a noninvasive tool used to measure mitochondrial respiratory function (MIFU) in skeletal muscle tissue. However, microvascular co-morbidity in long-standing T2D can interfere with the (31)P MRS methodology. AIM To compare (31)P MRS-derived parameters describing in vivo MIFU with an in vitro assessment of muscle respiratory capacity and muscle fiber-type composition in T2D patients. METHODS (31)P MRS was applied in long-standing, insulin-treated T2D patients. (31)P MRS markers of MIFU were measured in the M. vastus lateralis. Muscle biopsy samples were collected from the same muscle and analyzed for succinate dehydrogenase activity (SDH) and fiber-type distribution. RESULTS Several (31)P MRS parameters of MIFU showed moderate to good correlations with the percentage of type I fibers and type I fiber-specific SDH activity (Pearson's R between 0.70 and 0.75). In vivo and in vitro parameters of local mitochondrial respiration also correlated well with whole-body fitness levels (VO (2peak)) in these patients (Pearson's R between 0.62 and 0.90). CONCLUSION Good correlations exist between in vivo and in vitro measurements of MIFU in long-standing insulin-treated T2D subjects, which are qualitatively and quantitatively consistent with previous results measured in healthy subjects. This justifies the use of (31)P MRS to measure MIFU in relation to T2D.
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Affiliation(s)
- S F E Praet
- Department of Movement Sciences, Nutrition and Toxicology Research Institute Maastricht, Maastricht University, 6200, MD, Maastricht, The Netherlands.
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Kuipers H. [Putative effects of doping in cycling]. Ned Tijdschr Geneeskd 2006; 150:2643-5. [PMID: 17205940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
After recent scandals in cycling involving doping, it has been asserted that top-level cycling is impossible without pharmacological support. An important prerequisite for successfully completing the Tour de France is maintaining energy balance. To compensate for the daily caloric expenditure of 23-25 MJ, conventional food must be supplemented with liquid food. Quick administration of liquid carbohydrates is essential for optimal recovery of glycogen stores in the liver and skeletal muscle. Androgenic anabolic steroids are a frequently used form of doping. In endurance sports, these drugs have not been shown to affect endurance performance, and there is little evidence to suggest that they enhance recovery. Although epoetin use can increase maximal oxygen uptake, its effects on maximal power output are less pronounced than what is generally assumed. A relationship between haemoglobin concentration and sport performance has not been proved. It has been found that growth hormone rather has a negative than a positive influence on the sport performance. The doping problem is due in part to superstition, hearsay and insufficient knowledge among the athlete's support personnel, which frequently leads to medical malpractice in sport. Education and quality control for sport professionals, including sports physicians, may help to control the doping problem.
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Affiliation(s)
- H Kuipers
- Universiteit Maastricht, vakgroep Bewegingswetenschappen, Postbus 616, 6200 MD Maastricht.
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Abstract
It has been suggested that minimally invasive surgery (MIS) in total hip replacement (THR) is less traumatic than standard techniques. This study was designed to address the question of whether an anterior MIS approach generates less inflammation and muscle damage than the standard posterolateral (PL) approach. Inflammation parameters such as interleukin-6 (IL-6), muscle damage parameters like heart type fatty acid binding protein (H-FABP), and haemoglobin (Hb) levels were determined pre-operatively and at five consecutive points post-operatively in 10 patients operated through a MIS anterior approach and in 10 patients operated through a PL approach. The mean IL-6 concentration increased from 3 pg/ml in both groups pre-operatively to 78.5 pg/ml (PL group) vs 74.8 pg/ml (MIS group) at 6 hours post-operatively and reached a maximum of 100 pg/ml (PL group) vs 90.5 pg/ml pg/ml (MIS group) after 24 hours. Up to this time point, there was a decrease in both groups. The post-operative mean H-FABP concentration increased to 10.7 microg/l in the PL group vs 15.8 microg/l in the MIS group. It formed a plateau and decreased after 24 hours post-operatively. The Hb levels were 14.5 g/dl before surgery and decreased to 10.7 g/dl (PL group) and 10.0 g/dl (MIS group) at 72 hours post-operatively. No significant differences were found between the two approaches either in inflammation and muscle damage or blood loss. Although the absence of a learning curve may explain the lack of a difference between both techniques, we speculate that the term MIS is at least doubtful in terms of being less traumatic.
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Affiliation(s)
- P Pilot
- Department of Orthopaedics, Reinier de Graaf Hospital, The Netherlands.
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Abstract
The average length of hospital stay after Total Hip Replacement (THR) has been decreasing over time. Recently, many hospitals have commenced rapid recovery programs such as Joint Care. In Joint Care the patients are usually discharged on the fifth post-operative day with relatively fresh surgical wounds. The aim of this study is to evaluate the Joint Care program after THR. Between February 2000 and February 2004, the Joint Care program was used in 611 patients after THR. The average age of the patients was 66.3 yrs (SD 9.3; range 24-86 yrs) and 68% (n= 415) of them were female. All clinical and outpatient charts as well as nursery records were evaluated. The follow up was from 6 months to 4 years (average: 2.5 years). At the planned fifth post-operative day, 92% (n = 562) of patients were discharged from hospital (SD 1.7 days; range 6-25 days). 3.8% (n= 23) of the remaining cases faced wound problems--prolonged wound drainage in 2.3% (n = 14) and potential superficial infection in 1.5% (n = 9) - causing a delay in their discharge. The readmission rate was 6.4% (n = 39) due to hip dislocation (3.4%; n = 21), re-evaluation of wound (1.5%; n= 9), deep infection (1.2%; n = 7)) and cardiac events (0.3%; n = 2). All the infection cases were treated effectively with debridement and antibiotics and no revision for any reason was reported. The Joint Care program seems to be effective after THR. Post-operative hip dislocation was the main reason for post-operative readmission. However, no clear signs that the intensive rehabilitation program caused more complications compared to previous regimens were evident. The above results encourage the application of rapid recovery programs in Orthopaedic surgery and joint replacement.
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Affiliation(s)
- P Pilot
- Department of Orthopaedics, Reinier de Graaf Hospital, The Netherlands.
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Abstract
Synchronized skating is a relatively new competitive sport and data about injuries in this discipline are lacking. Therefore the purpose of this study was to investigate the frequency and pattern of acute and overuse injuries in synchronized skaters. Before and during the World Synchronized Skating Championship 2004, a questionnaire inquiring about the frequency of injuries in this skating discipline was given to 23 participating teams. A total of 514 women and 14 men senior skaters completed the questionnaires (100 % response). Two hundred and eighteen (42.4 %) female and 6 (42.9 %) male skaters had suffered from acute injuries during their synchronized skating career. As some skaters had suffered from more than one injury, the total number of acute injuries in females was 398 and in males 14. In female skaters 19.8 % of acute injuries were head injuries, 7.1 % trunk, 33.2 % upper, and 39.9 % lower extremity injuries. In male skaters 14.3 % were head injuries, 28.6 % upper, and 57.1 % lower extremity injuries, with no report of trunk injuries. Sixty-nine female and 2 male skaters had low back problems and 112 female and 2 male skaters had one or more overuse syndromes during their skating career. Of 155 overuse injuries in female skaters, 102 (65.8 %) occurred during their figure skating career, while 53 injuries (34.2 %) only occurred when they skated in synchronized skating teams. In male skaters, out of 5 overuse injuries, 4 (80 %) occurred in their figure skating career, while 1 (20 %) occurred during their synchronized skating career. Out of the total of 412 injuries, 338 (82 %) occurred during on-ice practice, while 74 (18 %) happened during off-ice training. Ninety-one (26.9 %) acute injures occurred while practicing individual elements, and 247 (73.1 %) on-ice injuries occurred while practicing different team elements. We conclude that injuries in synchronized skating should be of medical concern due to an increasing number of acute injuries, especially those that go beyond the soft tissue and include head injuries and fractures. We feel that these more significant injuries MAY TO SOME EXTENT BE attributable to the increasing physical demands and technical difficulty required of the teams now participating in a more competitive environment over the last four years.
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Affiliation(s)
- S Dubravcic-Simunjak
- Department of Physical Medicine and Rehabilitation, General Hospital Sveti Duh, Zagreb, Croatia.
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Mayr A, Kuipers H, Falk M, Santer P, Wierer B. Comparison of hematologic data in world elite junior speed skaters and in non-athletic juniors. Int J Sports Med 2006; 27:283-8. [PMID: 16572370 DOI: 10.1055/s-2005-865676] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
During the world junior speed skating championship 2002 all athletes (60 males, 56 females) were subjected to hematologic blood testing one day before the competition as requested by International Skating Union--ISU. This study aimed to obtain hematological reference values for junior athletes, whilst the influence of endurance training on hematologic variables of young athletes was studied. Hematologic results of athletes were compared to results of non-athletes matched by age and gender (14 males, 17 females). The blood analysis was done on an ADVIA 120. To compare measurement of ferritin, erythropoietin, and soluble transferrin receptor in serum as well as in EDTA-plasma, serum and EDTA-blood was obtained from the control group. In hemoglobin and hematocrit we found no significant difference between the two groups, whereas the number of erythrocytes was lower in athletes. The mean corpuscular volume was higher in athletes, whilst the corpuscular hemoglobin content was only marginally higher in athletes than in non-athletes. Consequently corpuscular hemoglobin concentration mean was lower in athletes than in non-athletes. There was no difference of erythropoietin and soluble transferrin receptor, whilst in ferritin we found a difference between the groups. Endurance training does not change the values of hemoglobin and hematocrit. Increased mean corpuscular volume and decreased corpuscular hemoglobin concentration mean could be a result of changed properties of red blood cell-membrane caused by acidosis and higher osmolality during the training. In junior athletes we did not find an iron overload as described in some adult athletes.
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Affiliation(s)
- A Mayr
- Laboratory of Clinical Pathology, Hospital of Brunico, Italy, and Faculty of Health Sciences, University Maastricht, The Netherlands.
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Pluim BM, Ferrauti A, Broekhof F, Deutekom M, Gotzmann A, Kuipers H, Weber K. The effects of creatine supplementation on selected factors of tennis specific training. Br J Sports Med 2006; 40:507-11; discussion 511-2. [PMID: 16720886 PMCID: PMC2465117 DOI: 10.1136/bjsm.2005.022558] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Creatine supplementation is popular among tennis players but it is not clear whether it actually enhances tennis performance. OBJECTIVES To examine the effects of creatine supplementation on tennis specific performance indices. METHODS In a randomised, double blind design, 36 competitive male tennis players (24 creatine, mean (SD) age, 22.5 (4.9) years; 12 placebo, 22.8 (4.8) years) were tested at baseline, after six days of creatine loading, and after a maintenance phase of four weeks (14 creatine, 10 placebo). Serving velocity (10 serves), forehand and backhand velocity (three series of 5x8 strokes), arm and leg strength (bench press and leg press), and intermittent running speed (three series of five 20 metre sprints) were measured. RESULTS Compared with placebo, neither six days nor five weeks of creatine supplementation had a significant effect on serving velocity (creatine: +2 km/h; placebo: +2 km/h, p = 0.90); forehand velocity (creatine: +4 km/h; placebo: +4 km/h, p = 0.80), or backhand velocity (creatine: +3 km/h; placebo: +1 km/h, p = 0.38). There was also no significant effect of creatine supplementation on repetitive sprint power after 5, 10, and 20 metres, (creatine 20 m: -0.03 m/s; placebo 20 m: +0.01 m/s, p = 0.18), or in the strength of the upper and lower extremities. CONCLUSIONS Creatine supplementation is not effective in improving selected factors of tennis specific performance and should not be recommended to tennis players.
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Affiliation(s)
- B M Pluim
- Royal Netherlands Lawn Tennis Association (KNLTB), Amersfoort, The Netherlands
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Kuipers H, Brouwer T, Dubravcic-Simunjak S, Moran J, Mitchel D, Shobe J, Sakai H, Stray-Gundersen J, Vanhoutvin S. Hemoglobin and hematocrit values after saline infusion and tourniquet. Int J Sports Med 2005; 26:405-8. [PMID: 16037879 DOI: 10.1055/s-2004-821156] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study attempted to contribute to standardization of blood testing in sport, and to investigate the effect of artificial dilution with saline. In 10 healthy, physically active males and 3 healthy physically active females hemoglobin (Hb), hematocrit (Ht), and % reticulocytes (%retics) were measured at different time points to look for possible fluctuations during day time, while the subjects had regular coffee breaks and lunch. In 7 of the subjects in a separate experiment 500 ml of saline were infused around 8 am and Hb, Ht, and %retics were measured before and every hour thereafter until 7 hours after infusion. In addition Ht was measured on a hematological analyzer as well as with a centrifuge. In a separate experiment the effect of tourniquet duration on Hb and Ht was studied in 9 of the subjects. The results show that Hb, Ht, and %retics are stable from 8 am to 4 pm, but that infusion of 500 ml of saline induces an acute decrease in Hb and Ht within one hour (Hb decreased from 15.2+/-0.9 g/dl to 14.5+/-1.0 g/dl, and Ht from 45.6+/-2.8 % to 44.0+/-2.5 %). The decline in Hb and Ht was maintained during the 7-hour observation period. Ht values of the same samples measured with a hematological analyzer and a centrifuge were not different. Application of the tourniquet did significantly affect Hb and Ht values only from two minutes, and thereafter Hb and Ht remained stable during the rest of the 5-minute tourniquet. With blood testing in sport these results have to be taken into consideration.
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Affiliation(s)
- H Kuipers
- Department of Movement Sciences, University of Maastricht, Maastricht, The Netherlands.
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Somerville SJ, Lewis M, Kuipers H. Accidental breaches of the doping regulations in sport: is there a need to improve the education of sportspeople? Br J Sports Med 2005; 39:512-6; discussion 516. [PMID: 16046333 PMCID: PMC1725272 DOI: 10.1136/bjsm.2004.013839] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To identify educational needs of elite sportspeople with respect to the doping laws. METHODS A questionnaire survey of 196 Olympic level sportspeople from the fields of athletics, cycling, rowing, and sailing. The questionnaire addressed the date and source of the last doping educational update, the usefulness of current resources, sources of help, and possible ways of improving the system. The questionnaire also sought to estimate the use of nutritional supplements in these sports. RESULTS Seventy four (38%) athletes responded to the questionnaire. Over 90% of responders had received a doping educational update in the last six months, and most agreed with the statement "I have received the information I need to avoid getting into trouble with the doping laws". Despite this, more than half of responders agreed with the statements "I should receive reminders more often" and "The authorities should do more to educate sportspeople". In addition, there were four people who admitted taking a banned substance by accident. Forty one (55%) reported taking supplements. The team doctor was the most popular source if information on a substance or product was required, with 62% and 66% of subjects stating that they would contact their team doctor when based in the United Kingdom and abroad respectively. The UK Sports website was often suggested in relation to ways of improving knowledge. CONCLUSIONS There is a need to alter the educational process, particularly with respect to contingency planning for minor illness. The use of internet based resources for up to date information about banned substances needs to be promoted, and access to the internet improved. The educational needs of team doctors with respect to the doping laws need to be assessed.
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Affiliation(s)
- S J Somerville
- The John Kelso Practice, Park Medical Centre, Ball Hay Road, Leek ST13 6QR, UK.
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Rietjens GJWM, Kuipers H, Adam JJ, Saris WHM, van Breda E, van Hamont D, Keizer HA. Physiological, biochemical and psychological markers of strenuous training-induced fatigue. Int J Sports Med 2005; 26:16-26. [PMID: 15643530 DOI: 10.1055/s-2004-817914] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of the study was to investigate whether severe fatigue, possibly leading to overreaching, could be diagnosed at an early stage by a combination of parameters. Seven well-trained male subjects (age [mean +/- SD]: 25.3 +/- 4.7 yr; body mass: 76 +/- 6.6 kg; VO2max: 61.1 +/- 7 ml.kg(-1).min(-1)) increased their training load by doubling their training volume and increasing the intensity by 15 % over a period of two weeks. Before and after this intensified training period subjects underwent a series of tests including a maximal incremental cycle ergometer test (Wmax) with continuous ventilatory measurements and blood lactate values, time trial, basal blood parameter tests (red and white blood profile), hormones [growth hormone (GH), insulin-like growth factor 1(IGF-1), adreno-corticotropic hormone (ACTH), cortisol], neuro-endocrine stress test [short insulin tolerance test (SITT), combined anterior pituitary test (CAPT) and exercise], a shortened Profile of Mood State (POMS), the estimated rate of perceived exertion (RPE) and a cognitive reaction time test. The intensified training period resulted in a significant increase of the training load (p <0.01), training monotony (p <0.01) and training strain (p <0.01). The RPE during training increased significantly (p <0.01) during the intensified training period. Total mood score obtained from the POMS tended to increase (p=0.06), reflecting an increase in worse mood state. A novel finding was that reaction times increased significantly, indicating that overreaching might adversely affect speed of information processing by the brain, especially for the most difficult conditions. After the intensified training period, neither changes in exercise-induced plasma hormone values, nor SITT values were observed. During the CAPT only cortisol showed a significant decrease after the intensified training period. Hemoglobin showed a significant decrease after the intensified training period whereas hematocrit, red blood cell count (RBC) and MCV tended to decrease. The intensified training had no effect on physical performance (Wmax or time trial), maximal blood lactate, maximal heart rate and white blood cell profile. The most sensitive parameters for detecting overreaching are reaction time performance (indicative for cognitive brain functioning), RPE and to a lesser extend the shortened POMS. This strongly suggests, that central fatigue precedes peripheral fatigue. All other systems,including the neuro-endocrine, are more robust and react most likely at a later stage in exhaustive training periods.
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Affiliation(s)
- G J W M Rietjens
- Department of Movement Sciences, Maastricht University, Maastricht, The Netherlands
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Hartgens F, Rietjens G, Keizer HA, Kuipers H, Wolffenbuttel BHR. Effects of androgenic-anabolic steroids on apolipoproteins and lipoprotein (a). Br J Sports Med 2005; 38:253-9. [PMID: 15155420 PMCID: PMC1724824 DOI: 10.1136/bjsm.2003.000199] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To investigate the effects of two different regimens of androgenic-anabolic steroid (AAS) administration on serum lipid and lipoproteins, and recovery of these variables after drug cessation, as indicators of the risk for cardiovascular disease in healthy male strength athletes. METHODS In a non-blinded study (study 1) serum lipoproteins and lipids were assessed in 19 subjects who self administered AASs for eight or 14 weeks, and in 16 non-using volunteers. In a randomised double blind, placebo controlled design, the effects of intramuscular administration of nandrolone decanoate (200 mg/week) for eight weeks on the same variables in 16 bodybuilders were studied (study 2). Fasting serum concentrations of total cholesterol, triglycerides, HDL-cholesterol (HDL-C), HDL2-cholesterol (HDL2-C), HDL3-cholesterol (HDL3-C), apolipoprotein A1 (Apo-A1), apolipoprotein B (Apo-B), and lipoprotein (a) (Lp(a)) were determined. RESULTS In study 1 AAS administration led to decreases in serum concentrations of HDL-C (from 1.08 (0.30) to 0.43 (0.22) mmol/l), HDL2-C (from 0.21 (0.18) to 0.05 (0.03) mmol/l), HDL3-C (from 0.87 (0.24) to 0.40 (0.20) mmol/l, and Apo-A1 (from 1.41 (0.27) to 0.71 (0.34) g/l), whereas Apo-B increased from 0.96 (0.13) to 1.32 (0.28) g/l. Serum Lp(a) declined from 189 (315) to 32 (63) U/l. Total cholesterol and triglycerides did not change significantly. Alterations after eight and 14 weeks of AAS administration were comparable. No changes occurred in the controls. Six weeks after AAS cessation, serum HDL-C, HDL2-C, Apo-A1, Apo-B, and Lp(a) had still not returned to baseline concentrations. Administration of AAS for 14 weeks was associated with slower recovery to pretreatment concentrations than administration for eight weeks. In study 2, nandrolone decanoate did not influence serum triglycerides, total cholesterol, HDL-C, HDL2-C, HDL3-C, Apo-A1, and Apo-B concentrations after four and eight weeks of intervention, nor six weeks after withdrawal. However, Lp(a) concentrations decreased significantly from 103 (68) to 65 (44) U/l in the nandrolone decanoate group, and in the placebo group a smaller reduction from 245 (245) to 201 (194) U/l was observed. Six weeks after the intervention period, Lp(a) concentrations had returned to baseline values in both groups. CONCLUSIONS Self administration of several AASs simultaneously for eight or 14 weeks produces comparable profound unfavourable effects on lipids and lipoproteins, leading to an increased atherogenic lipid profile, despite a beneficial effect on Lp(a) concentration. The changes persist after AAS withdrawal, and normalisation depends on the duration of the drug abuse. Eight weeks of administration of nandrolone decanoate does not affect lipid and lipoprotein concentrations, although it may selectively reduce Lp(a) concentrations. The effect of this on atherogenesis remains to be established.
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Affiliation(s)
- F Hartgens
- Netherlands Centre for Doping Affairs, Capelle aan den IJssel, The Netherlands.
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Minnaard R, Drost MR, Wagenmakers AJM, van Kranenburg GP, Kuipers H, Hesselink MKC. Skeletal Muscle wasting and contractile performance in septic rats. Muscle Nerve 2005; 31:339-48. [PMID: 15751123 DOI: 10.1002/mus.20268] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We investigated the temporal effects of sepsis on muscle wasting and function in order to study the contribution of wasting to the decline in muscle function; we also studied the fiber-type specificity of this muscle wasting. Sepsis was induced by injecting rats intraperitoneally with a zymosan suspension. At 2 h and at 2, 6, and 11 days after injection, muscle function was measured using in situ electrical stimulation, Zymosan injection induced severe muscle wasting compared to pair-fed and ad libitum fed controls. At 6 days, isometric force-generating capacity was drastically reduced in zymosan-treated rats. We conclude that this was fully accounted fo by the reduction of muscle mas. At day 6, we also observed increased activity of the 20S proteasome in gastrocnemius but not soleus muscle from septic rats. In tibialis anterior but not in soleus, muscle wasting occurred in a fiber-type specific fashion, i.e., the reduction in cross-sectional area was significantly smaller in type 1 than type 2A and 2B/X fibers. These findings suggest that both the inherent function of a muscle and the muscle fiber-type distribution affect the responsiveness to catabolic signals.
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Affiliation(s)
- R Minnaard
- Nutrition and Toxicology Research Institute Maastricht, Depatment of Movement Sciencs, Maastricht University, 6200 MD Maastricht, The Netherlands.
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Hofman Z, van Drunen JDE, de Later C, Kuipers H. The effect of different nutritional feeds on the postprandial glucose response in healthy volunteers and patients with type II diabetes. Eur J Clin Nutr 2005; 58:1553-6. [PMID: 15173856 DOI: 10.1038/sj.ejcn.1602007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Assessment of postprandial glycaemic response to four nutritional feeds with different macronutrient and fibre composition. DESIGN A randomized, double-blind, crossover study. SETTING University of Maastricht, the Netherlands. SUBJECTS A total of 10 healthy volunteers and 10 patients with type II diabetes. INTERVENTIONS Subjects received 200 kcal of four enteral nutrition products (two standard products and two diabetes-specific products). Fasting and postprandial plasma glucose were measured for 2 h. Peak glucose level and area under the curve were calculated. RESULTS In healthy volunteers and diabetic patients, the feed with a low carbohydrate (CHO), high monounsaturated fatty acid (MUFA) and high fibre content significantly decreased peak glucose concentration and area under the curve compared to the feeds with standard composition. CONCLUSIONS Special feeds with a low CHO, high MUFA and high fibre content improve glycaemic balance and therefore should be considered in diabetic patients who are in need of nutritional support.
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Affiliation(s)
- Z Hofman
- Numico Research BV, Wageningen, The Netherlands.
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Abstract
Beta(2)-adrenergic agonists are important therapeutic agents for the prevention and treatment of (exercise-induced) asthma in athletes, but may have ergogenic effects. In this study we investigated whether inhalation of a supra-therapeutic dose of 800 microg salbutamol before exercise affects endurance performance during a cycling trial in non-asthmatic athletes. In a double-blind, randomized cross-over study, 16 athletes performed two trials, where they had to perform a certain amount of work as fast as possible on a cycle ergometer, 30 minutes after inhalation of 800 micro g salbutamol or placebo. Peak expiratory flow (PEF), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV(1)) were measured before and after exercise and blood samples were obtained before and during exercise. Cycling performance time was 4010.2 +/- 327.7 s after placebo inhalation and 3927.6 +/- 231.3 s after inhalation salbutamol (p < 0.05). Although salbutamol inhalation increased plasma free fatty acids, glycerol and lactate concentrations and decreased plasma potassium concentrations at rest, no differences between placebo and salbutamol in these variables were found during exercise. PEF and FEV(1) were increased after salbutamol inhalation at rest compared with placebo, but the difference between placebo and salbutamol after exercise was no longer significant. Inhalation of a supratherapeutic dose of 800 micro g salbutamol improved endurance cycling performance by 1.9 +/- 1.8 % in non-asthmatic athletes, which indicates that this route of administration does not exclude the possibility of an ergogenic effect of beta(2)-adrenergic agents in athletes. The increase in performance was not explained by changes in plasma concentrations of free fatty acids, glycerol, lactate, and potassium during exercise or by changes in ventilatory parameters at rest and after exercise. Therefore, the mechanism of the increase in performance remains to be determined.
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Affiliation(s)
- M A van Baak
- Department of Human Biology, Maastricht University, 6200 MD Maastricht, The Netherlands.
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Hoos MB, Westerterp KR, Kuipers H, Schuwirth L, Gerver WJM. Physical activity as measured by accelerometry in children receiving growth hormone. Acta Paediatr 2004; 93:1307-11. [PMID: 15499949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
AIM Parents of children treated with growth hormone (GH) frequently report to the paediatrician that their children have become more physically active. In the present study, activity patterns of GH-treated children were measured and compared to those of healthy controls. METHODS Subjects were 25 children at the start of GH treatment (age 8.4 +/- 2.6 y) and 19 age- and gender-matched controls (age 8.8 +/- 3.2 y). Physical activity was assessed with a tri-axial accelerometer for movement registration over two separate 2-wk intervals, one before the start of GH treatment and one 2 wk after the start of treatment. GH-treated subjects were categorized as poor responders (change in height over 1 y <0.7 SDS, n = 15) or good responders (change in height over 1 y >0.7 SDS, n = 10). RESULTS Before therapy, good responders showed a significantly lower physical activity compared to healthy controls, spending significantly less time on high-intensity activities. This difference disappeared 2 wk after the start of therapy. Physical activity in poor responders was not significantly different from controls before and after 2 wk of GH therapy. CONCLUSION Children who respond well to GH therapy (change in height >0.7 SDS) showed a reduced amount of physical activity before therapy, which was normalized after 2 wk of GH therapy.
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Affiliation(s)
- M B Hoos
- Department of Paediatrics, University of Maastricht, Maastricht, The Netherlands.
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Abstract
OBJECTIVES Accelerometry was used to assess the relationship between the physical activity level (PAL) and time spent on activities of various intensities in children. DESIGN A total of 20 children aged 8.6+/-3.3 y wore a triaxial accelerometer (Tracmor2) for 2 weeks. PAL was calculated with Tracmor2 output data. The fraction of time spent on activities with a given level of intensity (low, moderate, high) was calculated. The fractions of time spent on activities of different intensities were compared with previously obtained data for young adults and elderly persons. RESULTS PAL showed an inverse relation with the percentage of time spent on low-intensity activities (r = -0.76; P < 0.0001) and a positive relation with the percentage of time spent on high-intensity activities (r = 0.93; P < 0.0001). The fraction of time spent on low-intensity activities was smaller in children than in young adults (P < 0.05) and elderly persons (P < 0.0001), while the fraction spent on high-intensity activities (P < 0.0001) was larger. CONCLUSIONS The present data are important for a better understanding of physical activity in children, which is necessary for education and prevention about physical (in)activity in childhood. Our observations suggest that to obtain a higher PAL in children, they should be given the opportunities to perform high-intensity activities.
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Affiliation(s)
- M B Hoos
- Department of Pediatrics, University of Maastricht, The Netherlands.
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Hartgens F, Van Marken Lichtenbelt W, Ebbing S, Vollaard N, Rietjens G, Kuipers H. Body Composition and Anthropometry in Bodybuilders:Regional Changes due to Nandrolone Decanoate Administration. Int J Sports Med 2004. [DOI: 10.1055/s-2001-18679-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kuipers H, Rietjens G, Verstappen F, Schoenmakers H, Hofman G. Effects of stage duration in incremental running tests on physiological variables. Int J Sports Med 2003; 24:486-91. [PMID: 12968205 DOI: 10.1055/s-2003-42020] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To study the effect of stage duration on some physiological variables in an incremental running test, 8 well-trained runners underwent 3 running tests, with stage durations of 1, 3 and 6 min. To study maximal lactate steady state (maxLASS) and its corresponding speed, every subject underwent a 4th test with three 15-min stages at three speeds, based on the running speed at 4 mmol/l blood lactate (V4) in the 6 min per stage protocol. The first load in the 15 min per stage test was V4 - 0.5 km/h, the second at V4, and the third V4 + 0.5 km/h. To compare the maxLASS speed with outdoor performance, the subjects also ran 5 km at this speed on an outdoor track. Mean maximal running speed (V (max)) in the incremental test was significantly lower in the 6-min (15.1 km/h) and 3-min stage protocol (17.1 km/h), compared with the 1-min stage protocol (18.3 km/h). Mean peak VO (2) and mean peak heart rate were not different between the protocols with different stage duration. The mean V4 was significantly lower in the 6 min per stage protocol compared with the 3 min per stage protocol (12.9 vs. 14.4 km/h). Mean ventilatory threshold was not different between the 1, 3 and 6 min per stage protocols. No threshold behaviour was found in respiratory rate. MaxLASS can be estimated from V4 in the 6 min per stage protocol, and verified by three 15-min intensities being V4 - 0.5 km/h, at V4, and V4 + 0.5 km/h. The mean blood lactate concentration at the maxLASS speed was not different between treadmill running and outdoor running on a track. In conclusion, for measuring peak values of physiological variables in an incremental running test, the duration per stage is of less importance, however, when measuring blood lactate concentration as a function of running speed, the duration per stage should be at least 6 min.
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Affiliation(s)
- H Kuipers
- Department of Movement Sciences, University Maastricht, The Netherlands.
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van Breda E, Keizer H, Kuipers H, Kranenburg G. Effect of testosterone and endurance training on glycogen metabolism in skeletal muscle of chronic hyperglycaemic female rats. Br J Sports Med 2003; 37:345-50. [PMID: 12893722 PMCID: PMC1724656 DOI: 10.1136/bjsm.37.4.345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To investigate in glycolytic and oxidative muscles of trained (nine weeks) and untrained hyperglycaemic female rats the effect of hyperandrogenicity and/or endurance training on energy metabolic properties. METHODS Glycogen content and activity of muscle enzymes with regulatory functions in glycogen synthesis were examined. RESULTS Testosterone treatment increased glycogen content of extensor digitorum longus (EDL) and soleus muscles of hyperglycaemic sedentary (18% and 84% respectively) and hyperglycaemic trained (7% and 16% respectively) rats. In both types of muscle of the hyperglycaemic testosterone treated exercised subgroup, less depletion of glycogen was found than in the untreated group (38% and 87% for EDL and soleus respectively). CONCLUSIONS The mechanisms by which training and/or hyperandrogenism alone or in combination elicits their specific effects are complex. Differences in sex, surgery, levels of hormones administered, and exercise model used may be the main reasons for the observed discrepancies. Conclusions from the results: (a) hyperandrogenism is not a primary cause of the development of insulin resistance; (b) glycogen content of slow and fast twitch muscle is increased by training through increased glycogen synthase activity. The most plausible explanation for differences between different muscle fibre types is the different levels of expression of androgen receptors in these fibres. Hyperandrogenicity therefore acts on energy metabolic variables of hyperglycaemic animals by different mechanisms in glycolytic and oxidative muscle fibres.
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Affiliation(s)
- E van Breda
- Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, The Netherlands.
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Van Drunen J, Hofman Z, Kuipers H. Postprandial response and glycaemic index (GI) of diabetes-specific and standard clinical nutrition products. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80057-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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46
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Hartgens F, Cheriex EC, Kuipers H. Prospective echocardiographic assessment of androgenic-anabolic steroids effects on cardiac structure and function in strength athletes. Int J Sports Med 2003; 24:344-51. [PMID: 12868045 DOI: 10.1055/s-2003-40705] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Since the abuse of androgenic-anabolic steroids (AAS) has been associated with the occurrence of serious cardiovascular disease in young athletes, we performed two studies to investigate the effects of short-term AAS administration on heart structure and function in experienced male strength athletes, with special reference to dose and duration of drug abuse. In Study 1 the effects of AAS were assessed in 17 experienced male strength athletes (age 31 +/- 7 y) who self-administered AAS for 8 or 12 - 16 weeks and in 15 non-using strength athletes (age 33 +/- 5 y) in a non-blinded design. In Study 2 the effects of administration of nandrolone decanoate (200 mg/wk i. m.) for eight weeks were investigated in 16 bodybuilders in a randomised double blind, placebo controlled design. In all subjects M-mode and two-dimensional Doppler-echocardiography were performed at baseline and after 8 weeks AAS administration. In the athletes of Study 1 who used AAS for 12 - 16 weeks a third echocardiogram was also made at the end of the AAS administration period. Echocardiographic examinations included the determination of the aortic diameter (AD), left atrium diameter (LA), left ventricular end diastolic diameter (LVEDD), interventricular septum thickness (IVS), posterior wall end diastolic wall thickness (PWEDWT), left ventricular mass (LVM), left ventricular mass index (LVMI), ejection fraction (EF) and right ventricular diameter (RVD). For assessment of the diastolic function measurements of E and A peak velocities and calculation of E/A ratio were used. In addition, acceleration and deceleration times of the E-top (ATM and DT, respectively) were determined. For evaluation of factors associated with stroke volume the aorta peak flow (AV) and left ventricular ejection times (LVET) were determined. In Study 1 eight weeks AAS self-administration did not result in changes of blood pressure or cardiac size and function. Additionally, duration of AAS self-administration did not have any impact on these parameters. Study 2 revealed that eight weeks administration of nandrolone decanoate did not induce significant alterations in blood pressure and heart morphology and function. Short-term administration of AAS for periods up to 16 weeks did not lead to detectable echocardiographic alterations of heart morphology and systolic and diastolic function in experienced strength athletes. The administration regimen used nor the length of AAS abuse did influence the results. Moreover, it is concluded that echocardiographic evaluation may provide incomplete assessment of the actual cardiac condition in AAS users since it is not sensitive enough to detect alterations at the cellular level. Nevertheless, from the present study no conclusions can be drawn of the cardiotoxic effects of long term AAS abuse.
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Affiliation(s)
- F Hartgens
- Netherlands Centre for Doping Affairs, Capelle aan den IJssel, The Netherlands.
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47
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van Breda E, Keizer HA, Kuipers H, Wolffenbuttel BHR. Androgenic anabolic steroid use and severe hypothalamic-pituitary dysfunction: a case study. Int J Sports Med 2003; 24:195-6. [PMID: 12740738 DOI: 10.1055/s-2003-39089] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The data of the present case demonstrate that the abuse of androgenic anabolic steroids (AAS) may lead to serious health effects. Although most clinical attention is usually directed towards peripheral side effects, the most serious central side effect, hypothalamic-pituitary-dysfunction, is often overlooked in severe cases. Although this latter central side-effect usually recovers spontaneously when AAS intake is discontinued, the present case shows that spontaneous recovery does not always take place. We suggest that hypothalamic-pituitary dysfunction should always be considered in the differential diagnosis in athletes seen with typical presentation of anabolic steroid use. In order to regain normal hypothalamic-pituitary function, supraphysiological doses of 200 microg LH-RH should be considered when the physiological challenge test with LH-RH (50 microg) fails to show an acceptable response.
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Affiliation(s)
- E van Breda
- Department of Movement Sciences, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), University, PO Box 616, 6200 MD Maastricht, the Netherlands.
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Adam JJ, Backes W, Rijcken J, Hofman P, Kuipers H, Jolles J. Rapid visuomotor preparation in the human brain: a functional MRI study. Brain Res Cogn Brain Res 2003; 16:1-10. [PMID: 12589883 DOI: 10.1016/s0926-6410(02)00204-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
An important feature of human motor behaviour is anticipation and preparation. We report a functional magnetic resonance imaging study of the neuronal activation patterns in the human brain that are associated with the rapid visuomotor preparation of discrete finger responses. Our imaging results reveal a large-scale distributed network of neural areas involved in fast visuomotor preparation, including specific areas in the frontal cortex (middle frontal gyrus, premotor and supplementary motor cortex), the parietal cortex (intra-parietal sulcus, inferior and superior parietal lobe) and the basal ganglia. Our reaction time results demonstrate that it is easier to prepare two fingers on one hand than on two hands. This hand-advantage phenomenon was associated with relatively enhanced levels of activity in the basal ganglia and relatively reduced levels of activity in the parietal cortex. These findings provide direct evidence for differential activity in a distributed brain system associated with specific neuro-computational operations subserving fast visuomotor preparation.
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Affiliation(s)
- Jos J Adam
- Department of Movement Sciences, Maastricht University, Maastricht, The Netherlands.
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Abstract
OBJECTIVE To test the possible antipanic effects of acute exercise in healthy volunteers exposed to an inhalation of 35% CO2 challenge. METHOD Twenty healthy subjects in a randomized separate group design, performed exercise in a bicycle ergometer reaching >6 mm of blood lactate and a control condition of minimal activity in the same fashion with no lactate elevation. Immediately afterwards an inhalation of a vital capacity using a mixture of 35% CO2/65% O2 through a mask was given on both conditions. RESULTS Subjects under the exercise condition reported less panic symptoms than controls after a CO2 challenge on the diagnostic statistical manual-IV (DSM-IV) Panic Symptom List but no difference on the Visual Analogue Anxiety Scale. CONCLUSION Subjects under the exertion condition had lactate levels comparable with those of lactate infusions but an inhibitory rather than accumulative effect was seen when combined with a CO2 challenge.
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Affiliation(s)
- G Esquivel
- Department of Psychiatry and Neuropsychology and Academic Anxiety Center, Maastricht University, Maastricht, The Netherlands
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Abstract
The purpose of this study was to monitor general and individual changes in hematological variables during long-term endurance training, detraining and altitude training in elite Olympic distance triathletes. Over a period of three years, a total of 102 blood samples were collected in eleven (7-male and 4 female) elite Olympic distance triathletes (mean +/- SD; age = 26.4 +/- 5.1 yr; VO(2) max = 67.9 +/- 6.6 ml/min/kg) for determination of hemoglobin (Hb), hematocrit (Hct), red blood cell count (RBC), Mean corpuscular hemoglobin (MCH), Mean corpuscular hemoglobin content (MCHC), Mean corpuscular volume (MCV) and plasma ferritin. The data were pooled and divided into three periods; off-season, training season and race season. Blood samples obtained before and after altitude training were analyzed separately. Of all measured variables only RBC showed a significant decrease (p < 0.05) during the race season compared to the training season. Hematological values below the lower limit of the normal range were found in 46 % of the athletes during the off-season. This percentage increased from 55 % during the training season to 72 % of the athletes during the race season. Hemoglobin and ferritin values were most frequently below the normal range. There was a weak correlation between Hb levels and VO(2) max obtained during maximal cycling (r = 0.084) and running (r = 0.137) tests. Unlike training at 1500 m and 1850 m, training at an altitude of 2600 m for three weeks showed significant increases in Hb (+ 10 %; p < 0.05), Hct (+ 11 %; p < 0.05) and MCV (+ 5 %; p < 0.05). Long-term endurance training does not largely alter hematological status. However, regular screening of hematological variables is desirable as many athletes have values near or below the lower limit of the normal range. The data obtained from altitude training suggest that a minimum altitude (>2000 m) is necessary to alter hematological status.
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Affiliation(s)
- G J W M Rietjens
- Nutrition and Toxicology Research Institute Maastricht, Department of Movement Sciences, Maastricht University, Maastricht, The Netherlands.
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