Match Running Performance in Australian Football Is Related to Muscle Fiber Typology

PURPOSE

To examine the association between muscle fiber typology and match running performance in professional Australian football (AF) athletes.

METHODS

An observational time-motion analysis was performed on 23 professional AF athletes during 224 games throughout the 2020 competitive season. Athletes were categorized by position as hybrid, small, or tall. Athlete running performance was measured using Global Navigation Satellite System devices. Mean total match running performance and maximal mean intensity values were calculated for moving mean durations between 1 and 10 minutes for speed (in meters per minute), high-speed-running distance (HSR, >4.17 m·s-1), and acceleration (in meters per second squared), while intercept and slopes were calculated using power law. Carnosine content was quantified by proton magnetic resonance spectroscopy in the gastrocnemius and soleus and expressed as a carnosine aggregate z score (CAZ score) to estimate muscle fiber typology. Mixed linear models were used to determine the association between CAZ score and running performance.

RESULTS

The mean (range) CAZ score was -0.60 (-1.89 to 1.25), indicating that most athletes possessed a greater estimated proportion of type I muscle fibers. A greater estimated proportion of type I fibers (ie, lower CAZ score) was associated with a larger accumulation of HSR (>4.17 m·s-1) and an increased ability to maintain HSR as the peak period duration increased.

CONCLUSION

AF athletes with a greater estimated proportion of type I muscle fibers were associated with a greater capacity to accumulate distance running at high speeds, as well as a greater capacity to maintain higher output of HSR running during peak periods as duration increases.

Articular Cartilage-From Basic Science Structural Imaging to Non-Invasive Clinical Quantitative Molecular Functional Information for AI Classification and Prediction

This review presents the changes that the imaging of articular cartilage has undergone throughout the last decades. It highlights that the expectation is no longer to image the structure and associated functions of articular cartilage but, instead, to devise methods for generating non-invasive, function-depicting images with quantitative information that is useful for detecting the early, pre-clinical stage of diseases such as primary or post-traumatic osteoarthritis (OA/PTOA). In this context, this review summarizes (a) the structure and function of articular cartilage as a molecular imaging target, (b) quantitative MRI for non-invasive assessment of articular cartilage composition, microstructure, and function with the current state of medical diagnostic imaging, (c), non-destructive imaging methods, (c) non-destructive quantitative articular cartilage live-imaging methods, (d) artificial intelligence (AI) classification of degeneration and prediction of OA progression, and (e) our contribution to this field, which is an AI-supported, non-destructive quantitative optical biopsy for early disease detection that operates on a digital tissue architectural fingerprint. Collectively, this review shows that articular cartilage imaging has undergone profound changes in the purpose and expectations for which cartilage imaging is used; the image is becoming an AI-usable biomarker with non-invasive quantitative functional information. This may aid in the development of translational diagnostic applications and preventive or early therapeutic interventions that are yet beyond our reach.

What is the Prevalence of General Anxiety Disorder and Depression Symptoms in Semi-elite Australian Football Players: A Cross-Sectional Study

BACKGROUND

The prevalence of anxiety and depression symptoms in semi-elite Australian footballers is unknown. The primary objective of this study was to determine the prevalence of generalised anxiety disorder (GAD) and depressive symptoms in semi-elite Australian Football players. Our secondary objective was to explore the association between demographic and football-specific factors with GAD and depressive symptoms. A cross-sectional epidemiological study including 369 semi-elite Western Australian Football League (WAFL) players from the Men and Women's 2022 season (n = 337 men, 91%) was conducted. Symptoms of depression were measured using the Patient Health Questionnaire-9 scale (PHQ-9) and symptoms of GAD with the GAD-7 scale.

RESULTS

Our response rate was 82.9%. Thirteen players had missing data. The prevalence of GAD symptoms was 8.5% in men and 28.6% in women (10% overall). The prevalence of depressive symptoms was 20% in men and 57% in women (23% overall). Being a woman (gender) was associated with a sevenfold increased risk of GAD and/or depression symptoms [odds ratio (OR): 7.33, 95% confidence interval (CI): 3.18-16.92; p < 0.001]. Players of 'Aboriginal or Torres Strait Islander' ethnicity were two times more likely to report GAD and/or depression symptoms in comparison to players of 'Australian' ethnicity (OR: 2.13; 95% CI: 1.01-4.49; p = 0.048). Concussion history was not a significant risk factor for GAD or depression symptoms.

CONCLUSION

This study demonstrated that approximately 1 in 10 WAFL players met the diagnostic cut-off criteria for probable GAD, and 1 in 5 for probable depression. The prevalence for depression symptoms in this study were far higher than the national average in the comparative age bracket. WAFL women's players also reported a substantially higher prevalence of GAD and depressive symptoms than men, and should be further investigated as a priority by the WAFL.

Contextual factors associated with running demands in elite Australian football: a scoping review

OBJECTIVES

To identify and summarise the contextual factors associated with running demands in elite male Australian football (AF) gameplay that have been reported in the literature.

DESIGN

Scoping review.

METHODS

A contextual factor in sporting gameplay is a variable associated with the interpretation of results, yet is not the primary objective of gameplay. Systematic literature searches were performed in four databases to identify what contextual factors associated with running demands in elite male AF have been reported: Scopus, SPORTDiscus, Ovid Medline and CINAHL, for terms constructed around Australian football AND running demands AND contextual factors. The present scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and narrative synthesis was conducted.

RESULTS AND CONCLUSION

A total of 36 unique articles were identified by the systematic literature search, which included 20 unique contextual factors. The most studied contextual factors were position (n = 13), time in game (n = 9), phases of play (n = 8), rotations (n = 7) and player rank (n = 6). Multiple contextual factors, such as playing position, aerobic fitness, rotations, time within a game, stoppages, and season phase appear to correlate with running demands in elite male AF. Many identified contextual factors have very limited published evidence and thus additional studies would help draw stronger conclusions.

Laser microporation facilitates topical drug delivery: a comprehensive review about preclinical development and clinical application

INTRODUCTION

Topical drug delivery is highly attractive and yet faces tissue barrier challenges. Different physical and chemical methods have been explored to facilitate topical drug delivery.

AREAS COVERED

Ablative fractional laser (AFL) has been widely explored by the scientific community and dermatologists to facilitate topical drug delivery since its advent less than two decades ago. This review introduces the major efforts in exploration of AFL to facilitate transdermal, transungual, and transocular drug delivery in preclinical and clinical settings.

EXPERT OPINION

Most of the preclinical and clinical studies find AFL to be safe and highly effective to facilitate topical drug delivery with little restriction on physicochemical properties of drugs. Clinical studies support AFL to enhance drug efficacy, shorten treatment time, reduce pain, improve cosmetic outcomes, reduce systemic drug exposure, and improve safety. Considering most of the clinical trials so far involved a small sample size and were in early phase, future trials will benefit from enrolling a large group of patients for thorough evaluation of the safety and efficacy of AFL-assisted topical drug delivery. The manufacturing of small and less costly AFL devices will also facilitate the translation of AFL-assisted topical drug delivery.

Nordic strength and history of hamstring injury in Australian Football League players

OBJECTIVES

Compare hamstring strength between Australian Football League (AFL) players with and without a prior hamstring injury and determine the effect of the number of previous hamstring injuries, time since the last injury, and injury severity, on hamstring strength.

DESIGN

Cross-sectional, retrospective.

SETTING

AFL clubs.

PARTICIPANTS

124 AFL players.

MAIN OUTCOME MEASURES

Bilateral hamstring strength was assessed on a Nordbord (Vald Performance) during the Nordic Hamstring Exercise. Self-reported questionnaires were used to record previous hamstring injuries. Players were categorized into No Injury or Hamstring Injury groups. Previously injured players were subgrouped based on number of prior hamstring injuries (single or multiple), time since the last hamstring injury (≤1 or > 1-year ago), and hamstring injury severity (≤3 or > 3 matches missed).

RESULTS

19 hamstring injuries were reported. Hamstring strength was not different between players with and without a history of hamstring injury when assessed in absolute (N) or relative (i.e., N.kg-1) terms. No differences in strength were detected between hamstring injury subgroups when assessed in absolute or relative terms.

CONCLUSIONS

AFL players that experienced a previous hamstring injury did not exhibit deficits in hamstring strength relative to their uninjured limb or players without a previous hamstring injury.

Video Analysis of Pectoralis Major Injuries in Professional Australian Football Players

Background:

There is little evidence regarding the mechanisms of pectoralis major (PM) injury and player outcomes in Australian Football League (AFL) players.

Purposes/Hypothesis:

The study aims were to investigate (1) the mechanisms of PM muscle injury in elite AFL players via video analysis and (2) the player profile, method of management, and clinical outcomes of the PM injuries sustained. We hypothesized that the majority of PM tears would occur in outer-range PM positions (hyperextension of the glenohumeral joint).

Study Design:

Case series; Level of evidence, 4.

Methods:

We analyzed video of the precipitating event for traumatic PM injuries during AFL competition or training over a 20-year period (2002-2021). The footage was analyzed by 4 experienced assessors, and the following were evaluated: mechanism of injury, injury variables (arm position, initial contact point, visual awareness, and use of taping), player characteristics (age at the time of injury, hand dominance, and history of injury), injury profile (location and size of tear), method of management (operative vs nonoperative), patient outcomes (time to return to full senior training/match play), and complication rates.

Results:

The mean ± standard deviation age of the players was 26.5 ± 3.1 years (range, 21-32 years). Overall, 22 PM injuries were identified in the AFL injury database for a rate of 1.1 per year; 16 of these injuries had accompanying video footage. We identified 3 mechanisms for PM injury: horizontal hyperextension (62.5%), hyperflexion-abduction (25.0%), and horizontal adduction (sustained tackling; 12.5%). The most common site of the tear was the insertion point of the sternocostal head (91.0%). Twenty players (91.0%) required surgical repair, with 75% undergoing surgery within 1 week (range, 0-26 weeks). The mean return to competition for the surgical repair group was 11.1 weeks (range, 8-15 weeks). The rerupture rate was 5.0% (1 repair; <4 weeks postoperatively in 2004).

Conclusion:

PM tears in elite male AFL players were due to 1 of 3 distinct mechanisms: horizontal hyperextension, hyperflexion-abduction, and horizontal adduction (sustained tackling). Players returned to play on average 11 weeks after injury. Knowledge regarding mechanisms of injury, player profile, and return-to-sport timelines is important for appropriate medical management and provides potential areas to target for prevention of PM injuries.

Rev-erbα exacerbates hepatic steatosis in alcoholic liver diseases through regulating autophagy

Background and aims

Alcoholic fatty liver (AFL) is a liver disease caused by long-term excessive drinking and is characterized by hepatic steatosis. Understanding the regulatory mechanism of steatosis is essential for the treatment of AFL. Rev-erbα is a member of the Rev-erbs family of nuclear receptors, playing an important role in regulating lipid metabolism. However, its functional role in AFL and its underlying mechanism remains unclear.

Results

Rev-erbα was upregulated in the liver of EtOH-fed mice and EtOH-treated L-02 cells. Further, Rev-erbα activation exacerbates steatosis in L-02 cells. Inhibition/downexpression of Rev-erbα improved steatosis. Mechanistically, autophagy activity was inhibited in vivo and vitro. Interestingly, inhibition/downexpression of Rev-erbα enhanced autophagy. Furthermore, silencing of Rev-erbα up-regulated the nuclear expression of Bmal1. Autophagy activity was inhibited and steatosis was deteriorated after EtOH-treated L-02 cells were cotransfected with Rev-erbα shRNA and Bmal1 siRNA.

Conclusions

Rev-erbα induces liver steatosis, which promotes the progression of AFL. Our study reveals a novel steatosis regulatory mechanism in AFL and suggest that Rev-erbα might be a potential therapeutic target for AFL.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13578-021-00622-4.

Lower limb joint position sense and prospective hamstring injury

BACKGROUND

The hamstrings remain the most injured muscle group within the Australian Football League (AFL).

OBJECTIVE

To investigate preseason measures of hip and knee joint position sense (JPS) and prospective hamstring injury in AFL players.

DESIGN

Prospective cohort study.

METHODS

A total of 116 AFL players were recruited for this study. JPS was assessed with 3-D sensors using mono-articular hip (45° flexion and 0°) and knee (90° and 45° flexion) joint reproduction tests conducted in the preseason. Hamstring injury data were collected prospectively in the following AFL season. Wilcoxon-signed rank tests were used to assess between the subsequently injured and uninjured limbs. Mann-Whitney U tests were used to assess between group differences and odds ratio (OR) were used to predict players at risk of hamstring injury.

RESULTS

Eight players with JPS data sustained a season hamstring injury and 108 players did not. JPS was not significantly different between the subsequently injured and uninjured limbs (all P values > 0.05). No significant differences for any JPS measure were found between the subsequently injured and uninjured players (all p's > 0.05). ORs did not achieve significance for AE (2.7, p = 0.21) or for RMSE (OR = 1.9, p = 0.44).

CONCLUSION

Lower limb JPS measures were not predictive of hamstring injury in AFL players.

A League-Wide Evaluation of Factors Influencing Match Activity Profile in Elite Australian Football

Introduction: Accurate interpretation of activity profile data requires an understanding of the variables influencing player movement during matches.

Methods: Over 65,000 stints (player rotations) from all 207 matches of the 2018 Australian Football League (AFL) season were evaluated. The relative activity profile including total distance per minute (TD), high-speed running distance per minute (HSR) and Player Load^TM per minute (PL) was determined for each stint and analysed against a range of match-related, player-related and environment-related predictor variables using multivariate linear mixed modelling. Effect size statistics along with the uncertainty in the estimates (95% confidence interval) were used to interpret the findings.

Results: The smallest important effects on TD, HSR, and PL were calculated as 1.5%, 5.5%, and 2.4%, respectively. Stint duration had small to moderate negative effects on TD (−6%), PL (−7.7%), and HSR (−13%), while recovery duration between stints had a small positive effect on HSR (+7%). There were moderate reductions in TD (−8%), HSR (−23%), and PL (−9.6%) in the last quarter compared to the first quarter of matches, while similar reductions existed in subsequent stints compared to the first stint in each quarter. Moderate to large differences of up to 9% in TD, 48% in HSR and 12% in PL existed between positions. The TD of less experienced players was slightly higher than their more experienced counterparts (2–3%). A 5% increase in body mass was associated with a small reduction in HSR (−5.5%). There were small reductions in TD (−2%), HSR (−10%), and PL (−3%) during the Finals Series compared to the Premiership Season. Moderate levels of rainfall during matches and higher apparent temperatures had small negative effects on TD (−2%) and HSR (−6 and −9%). The number of days break between matches, score margin, match outcome, ground hardness, ground size, and traveling for the current or the previous match had trivial effects on the activity profile.

Conclusion: Player position and stage of the match (quarter) had the largest effects on match activity profile while stint duration, recovery duration, stint timing, professional experience, body mass, stage of the season, and weather conditions also had substantial effects.

Future Directions and Considerations for Talent Identification in Australian Football

As the focus on the elite Australian Football League competition becomes greater so too does the demand for success. Clubs are heavily scrutinized for their draft selections and as such are taking more interest in the younger levels of competition in an attempt to identify and monitor talent. Based on contemporary talent identification knowledge, this review examines the current talent identification process in Australian football, with a focus on areas to potentially improve or inform future developments. Currently, a significant gap exists between static and isolated assessment procedures used to identify talent in Australian football and the dynamic nature of match play. Future assessments should consider factors such as maturation, fatigue and ecological dynamics. The addition of a valid and reliable technical skill assessment (e.g., a small-sided game) to the current Australian Football League draft combine was recommended.

DXA-derived estimates of energy balance and its relationship with changes in body composition across a season in team sport athletes

This study examined the relationship between dual-energy x-ray absorptiometry (DXA)-derived estimates of energy balance (EB) and changes in body composition across various seasonal phases in team sport athletes. Forty-five Australian rules footballers underwent six DXA scans across a 12-month period (off-season [OS, Week 0-13], early [PS1, Week 13-22] and late pre-season [PS2, Week 22-31] and early [IS1, Week 3-42] and late in-season [IS2, Week 42-51]). EB (kcal·day^-1) was estimated from changes in fat free soft tissue mass (FFSTM) and fat mass (FM) between scans according to a validated formula. An EB threshold of ± 123 kcal·day^-1 for >60 days demonstrated a very likely (>95% probability) change in FFSTM (>1.0 kg) and FM (>0.7 kg). There were small to almost perfect relationships between EB and changes in FM (r = 0.97, 95% CI, 0.96-0.98), FFSTM (r = -0.41, -0.92 to -0.52) and body mass (r = 0.27, 0.14-0.40). EB was lowest during PS1 compared to all other phases (range, -265 to -142 kcal·day^-1), with no other changes at any time. Increases in FFSTM were higher during OS compared to PS2 (1.6 ± 0.4 kg), and higher during PS1 compared to PS2, IS1, and IS2 (range, 1.6-2.1 kg). There were no changes during in-season (-0.1-0.05 kg). FM decreased only in PS1 compared to all other seasonal phases (-1.8 to -1.0 kg). Assessments of body composition can be used as a tool to estimate EB, which practically can be used to indicate athlete's training and nutrition behaviours/practices.

Association Between Preseason Training and Performance in Elite Australian Football

PURPOSE

To examine the association between preseason training variables and subsequent in-season performance in an elite Australian football team.

METHODS

Data from 41 elite male Australian footballers (mean [SD] age = 23.4 [3.1] y, height =188.4 [7.1] cm, and mass = 86.7 [7.9] kg) were collected from 1 Australian Football League (AFL) club. Preseason training data (external load, internal load, fitness testing, and session participation) were collected across the 17-wk preseason phase (6 and 11 wk post-Christmas). Champion Data© Player Rank (CDPR), coaches' ratings, and round 1 selection were used as in-season performance measures. CDPR and coaches' ratings were examined over the entire season, first half of the season, and the first 4 games. Both Pearson and partial (controlling for AFL age) correlations were calculated to assess if any associations existed between preseason training variables and in-season performance measures. A median split was also employed to differentiate between higher- and lower-performing players for each performance measure.

RESULTS

Preseason training activities appeared to have almost no association with performance measured across the entire season and the first half of the season. However, many preseason training variables were significantly linked with performance measured across the first 4 games. Preseason training variables that were measured post-Christmas were the most strongly associated with in-season performance measures. Specifically, total on-field session rating of perceived exertion post-Christmas, a measurement of internal load, displayed the greatest association with performance.

CONCLUSION

Late preseason training (especially on-field match-specific training) is associated with better performance in the early season.

Association Between Pre-season Training and Performance in Elite Australian Football

PURPOSE

To examine the association between pre-season training variables and subsequent in-season performance in an elite Australian football team.

METHODS

Data from forty-one elite male Australian footballers (mean±SD: age=23.4±3.1y; height=188.4±7.1cm; mass=86.7±7.9kg) was collected from one Australian Football League (AFL) club. Pre-season training data (external load, internal load, fitness testing and session participation) were collected across the 17-week pre-season phase (6-weeks pre-Christmas, 11-weeks post-Christmas). Champion Data© Player Rank (CDPR), coaches' ratings (CR) and round one selection were used as in-season performance measures. CDPR and CR were examined over the entire season, first half of the season and the first four games. Both Pearson and partial (controlling for AFL age) correlations were calculated to assess if any associations existed between pre-season training variables and in-season performance measures. A median-split was also employed to differentiate between higher and lower performing players for each performance measure.

RESULTS

Pre-season training activities appeared to have almost no association with performance measured across the entire season and the first half of the season. However, many pre-season training variables were significantly linked with performance measured across the first four games. Pre-season training variables that were measured post-Christmas were the most strongly associated with in-season performance measures. Specifically, Total on-field session rating of perceived exertion (sRPE) post-Xmas, a measurement of internal load, displayed the greatest association with performance.

CONCLUSIONS

Late pre-season training (especially on-field match specific training) is associated with better performance in the early season.

The association of second trimester biomarkers in amniotic fluid and fetal outcome

Objective: To identify the level of amniotic fluid lactate (AFL), placental growth factor (PLGF), and vascular endothelial growth factor (VEGF) at second trimester amniocentesis, and to compare levels in normal pregnancies with pregnancies ending in a miscarriage, an intrauterine growth restricted fetus (IUGR) or decreased fetal movements. Study design: A prospective cohort study. Amniotic fluid was consecutively collected at amniocentesis in 106 pregnancies. Fetal wellbeing at delivery was evaluated from medical files and compared with the levels of AFL, VEGF, and PLGF at the time of amniocentesis. Results: The median level of AFL was 6.9 mmol/l, VEGF 0.088 pg/ml, and PLGF 0.208 pg/ml. The median levels of AFL in pregnancies ended in miscarriage were significantly higher (10.7 mmol/l) compared to those with a live new-born (6.9 mmol/L, p = .02). The levels of VEGF (p = .2) and PLGF (p = .7) were not affected. In pregnancies with an IUGR, the median level of AFL was higher compared to those with normal fetal growth (p = .003). No differences VEGF (p = .5), but significant lower PLGF were found in IUGR pregnancies (p = .03). Conclusions: Pregnancies ending in a miscarriage or with IUGR had significantly higher median values of AFL but lower values of PLGF in the amniotic fluid at the time of second trimester amniocentesis compared to normal pregnancies.

Optimizing Preseason Training Loads in Australian Football

PURPOSE

To investigate whether preseason training plans for Australian football can be computer generated using current training-load guidelines to optimize injury-risk reduction and performance improvement.

METHODS

A constrained optimization problem was defined for daily total and sprint distance, using the preseason schedule of an elite Australian football team as a template. Maximizing total training volume and maximizing Banister-model-projected performance were both considered optimization objectives. Cumulative workload and acute:chronic workload-ratio constraints were placed on training programs to reflect current guidelines on relative and absolute training loads for injury-risk reduction. Optimization software was then used to generate preseason training plans.

RESULTS

The optimization framework was able to generate training plans that satisfied relative and absolute workload constraints. Increasing the off-season chronic training loads enabled the optimization algorithm to prescribe higher amounts of "safe" training and attain higher projected performance levels. Simulations showed that using a Banister-model objective led to plans that included a taper in training load prior to competition to minimize fatigue and maximize projected performance. In contrast, when the objective was to maximize total training volume, more frequent training was prescribed to accumulate as much load as possible.

CONCLUSIONS

Feasible training plans that maximize projected performance and satisfy injury-risk constraints can be automatically generated by an optimization problem for Australian football. The optimization methods allow for individualized training-plan design and the ability to adapt to changing training objectives and different training-load metrics.

Functional Genomics and Seed Development in Medicago truncatula: An Overview

The study of seed development in the model species Medicago truncatula has made a significant contribution to our understanding of this process in crop legumes. Thanks to the availability of comprehensive proteomics and transcriptomics databases, coupled with exhaustive mutant collections, the roles of several regulatory genes in development and maturation are beginning to be deciphered and functionally validated. Advances in next-generation sequencing and the availability of a genomic sequence have made feasible high-density SNP genotyping, allowing the identification of markers tightly linked to traits of agronomic interest. A further major advance is to be expected from the integration of omics resources in functional network construction, which has been used recently to identify "hub" genes central to important traits.

Injuries in Australian Rules Football: An Overview of Injury Rates, Patterns, and Mechanisms Across All Levels of Play

CONTEXT

The nature of Australian rules football (Australian football) predisposes both unique and common injuries compared with those sustained in other football codes. The game involves a combination of tackling, kicking, high-speed running (more than other football codes), and jumping. Two decades of injury surveillance has identified common injuries at the professional level (Australian Football League [AFL]).

OBJECTIVE

To provide an overview of injuries in Australian rules football, including injury rates, patterns, and mechanisms across all levels of play.

STUDY DESIGN

A narrative review of AFL injuries, football injury epidemiology, and biomechanical and physiological attributes of relevant injuries.

RESULTS

The overall injury incidence in the 2015 season was 41.7 injuries per club per season, with a prevalence of 156.2 missed games per club per season. Lower limb injuries are most prevalent, with hamstring strains accounting for 19.1 missed games per club per season. Hamstring strains relate to the volume of high-speed running required in addition to at times having to collect the ball while running in a position of hip flexion and knee extension. Anterior cruciate ligament injuries are also prevalent and can result from contact and noncontact incidents. In the upper limb, shoulder sprains and dislocations account for 11.5 missed games per club per season and largely resulted from tackling and contact. Concussion is less common in AFL than other tackling sports but remains an important injury, which has notably become more prevalent in recent years, theorized to be due to a more conservative approach to management. Although there are less injury surveillance data for non-AFL players (women, community-level, children), many of these injuries appear to also be common across all levels of play.

CLINICAL RELEVANCE

An understanding of injury profiles and mechanisms in Australian football is crucial in identifying methods to reduce injury risk and prepare players for the demands of the game.

A randomized controlled trial of a new treatment for labor dystocia

OBJECTIVE

Labor dystocia is an intransigent, high-profile issue in obstetric care. Amniotic fluid lactate (AFL) reflects the uterine metabolic status. High levels associate with subsequent need for operative intervention due to dystocia. In sports medicine, it is known that lactic acid can affect muscular performance and can be decreased by bicarbonate given orally before physical activity.

MATERIAL AND METHODS

Two hundred dystocic deliveries were included. At the confirmation of dystocia, the AFL-level was analyzed. Deliveries were randomized to an intake of bicarbonate or not. In the "non-bicarbonate-group", stimulation with oxytocin was started immediately. In the "bicarbonate-group", bicarbonate was given; and oxytocin was started 1 hour after the intake. New sampling of AF was performed after 1 hour in both groups.

OUTCOME MEASURED

if an oral intake of bicarbonate changes the AFL levels and enhances delivery outcome in dystocic deliveries.

RESULTS

Bicarbonate decreases the AFL levels (p < .001). The spontaneous vaginal delivery rate after treatment with bicarbonate was increased (p = .007), without affecting the fetal outcome.

CONCLUSIONS

An increase of spontaneous vaginal deliveries resulted from bicarbonate ingestion by dystocic women. A decreased level of AFL-level was shown. This simple, low cost treatment has the potential to improve maternal morbidity and satisfaction worldwide.

Interchange rotation factors and player characteristics influence physical and technical performance in professional Australian Rules football

OBJECTIVES

To examine the effects of match-related and individual player characteristics on activity profile and technical performance during rotations in professional Australian football.

DESIGN

Longitudinal observational study.

METHODS

Global positioning system data and player rating scores were collected from 33 professional Australian football players during 15 Australian football League matches. Player rating scores were time aligned with their relative total and high-speed running (HSR) distance (>20kmh^-1) for each on ground rotation. Individual players' maximal aerobic running speed (MAS) was determined from a two-kilometre trial. A multilevel linear mixed model was used to examine the influence of rotations on physical activity profiles and skill execution during match play.

RESULTS

Rotation duration and accumulated distance resulted in a trivial-to-moderate reduction in relative total and HSR distances as well as relative rating points. The number of disposals in a rotation had a small positive effect on relative total and HSR distances and a large positive effect on relative rating points. MAS was associated with a moderate-to-large increase in relative total distance, but had a large negative effect on relative rating points. Previous rotation time, stoppages and the number of rotations in the quarter had a trivial-to-small negative effect on relative total and HSR distances. A greater speed (mmin^-1) was associated with a trivial increase in rating points during a rotation, while there was a trivial decrease in relative total distance as rating points increased.

CONCLUSION

The complex relationship between factors that influence activity profile and technical performance during rotations in Australian football needs to be considered when interpreting match performance.

Atypical flat lesions derive from pancreatic acinar cells

OBJECTIVES

Pancreatic ductal adenocarcinoma (PDAC) is thought to derive from different precursor lesions including the recently identified atypical flat lesions (AFL). While all precursor lesions and PDAC share ductal characteristics, there is an ongoing debate about the cellular origin of the different PDAC precursor lesions. In particular, pancreatic acinar cells have previously been shown to display a remarkable plasticity being able to undergo ductal dedifferentiation in the context of oncogenic stimuli.

METHODS

Histological analyses were performed in a murine PDAC model that specifically expresses oncogenic Kras in adult pancreatic acinar cells. Occurrence, characterization, and lineage tracing of AFLs were investigated.

RESULTS

Upon expression of oncogenic Kras in adult pancreatic acinar cells, AFLs with typical morphology and expression profile arise. Lineage tracing confirmed that the AFLs were of acinar origin.

CONCLUSIONS

Using a murine PDAC model, this study identifies pancreatic acinar cells as a cellular source for AFLs.

Corticosteroid use during pulmonary vein isolation is associated with a higher prevalence of dormant pulmonary vein conduction

BACKGROUND

Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is associated with PV to left atrium reconduction.

OBJECTIVE

The purpose of this study was to prospectively determine if the use of intraprocedural corticosteroids to limit the extent of tissue edema and/or inflammation alters the prevalence of spontaneous and adenosine-induced acute PV reconnection after PVI.

METHODS

Prior to wide circumferential PVI, 45 patients received a single intravenous (IV) bolus of hydrocortisone 250 mg immediately after transseptal access (steroid group). Another 45 consecutive patients underwent standard PVI without IV hydrocortisone (nonsteroid group). After PVI, all patients underwent adenosine testing to unmask dormant conduction. Patients were followed at 3, 6, and 12 months.

RESULTS

Dormant conduction was unmasked in a significantly higher proportion of PVs in the steroid group compared with the nonsteroid group (32.8% of PVs [60/183] vs 21.1% of PVs [37/175], P = .03). On multivariate generalized estimating equation analysis, steroid use remained independently associated with dormant PV conduction (P = .03). There was no difference in the segmental distribution of reconnection between the 2 groups. The 1-year freedom from recurrent AF did not differ between groups (P = .37). Radiofrequency time was significantly longer in the steroid group (58 ± 21 minutes vs 48 ± 18 minutes, P <.01), whereas procedure duration and fluoroscopy time were comparable (P = .55 and P = .44, respectively).

CONCLUSION

A single bolus of hydrocortisone 250 mg IV prior to PVI results in greater radiofrequency requirements for PVI and a higher prevalence of dormant PV conduction unmasked by adenosine. The utility of these approaches requires evaluation in a long-term prospective randomized study.

Survival after shock therapy in implantable cardioverter-defibrillator and cardiac resynchronization therapy-defibrillator recipients according to rhythm shocked. The ALTITUDE survival by rhythm study

OBJECTIVES

This study sought to determine if the risk of mortality associated with inappropriate implantable cardioverter-defibrillator (ICD) shocks is due to the underlying arrhythmia or the shock itself.

BACKGROUND

Shocks delivered from ICDs are associated with an increased risk of mortality. It is unknown if all patients who experience inappropriate ICD shocks have an increased risk of death.

METHODS

We evaluated survival outcomes in patients with an ICD and a cardiac resynchronization therapy defibrillator enrolled in the LATITUDE remote monitoring system (Boston Scientific Corp., Natick, Massachusetts) through January 1, 2010. First shock episode rhythms from 3,809 patients who acutely survived the initial shock were adjudicated by 7 electrophysiologists. Patients with a shock were matched to patients without a shock (n = 3,630) by age at implant, implant year, sex, and device type.

RESULTS

The mean age of the study group was 64 ± 13 years, and 78% were male. Compared with no shock, there was an increased rate of mortality in those who received their first shock for monomorphic ventricular tachycardia (hazard ratio [HR]: 1.65, p < 0.0001), ventricular fibrillation/polymorphic ventricular tachycardia (HR: 2.10, p < 0.0001), and atrial fibrillation/flutter (HR: 1.61, p = 0.003). In contrast, mortality after first shocks due to sinus tachycardia and supraventricular tachycardia (HR: 0.97, p = 0.86) and noise/artifact/oversensing (HR: 0.91, p = 0.76) was comparable to that in patients without a shock.

CONCLUSIONS

Compared with no shock, those who received their first shock for ventricular rhythms and atrial fibrillation had an increased risk of death. There was no significant difference in survival after inappropriate shocks for sinus tachycardia or noise/artifact/oversensing. In this study, the adverse prognosis after first shock appears to be more related to the underlying arrhythmia than to an adverse effect from the shock itself.

The effects of omega-3 polyunsaturated fatty acids on cardiac rhythm: a critical reassessment

Although epidemiological studies provide strong evidence for an inverse relationship between omega-3 polyunsaturated fatty acids (n-3 PUFAs) and cardiac mortality, inconsistent and often conflicting results have been obtained from both animal studies and clinical prevention trials. Despite these heterogeneous results, some general conclusions can be drawn from these studies: 1) n-PUFAs have potent effects on ion channels and calcium regulatory proteins that vary depending on the route of administration. Circulating (acute administration) n-3 PUFAs affect ion channels directly while incorporation (long-term supplementation) of these lipids into cell membranes indirectly alter cardiac electrical activity via alteration of membrane properties. 2) n-3 PUFAs reduce baseline HR and increase HRV via alterations in intrinsic pacemaker rate rather than from changes in cardiac autonomic neural regulation. 3) n-3 PUFAs may be only effective if given before electrophysiological or structural remodeling has begun and have no efficacy against atrial fibrillation. 5) Despite initial encouraging results, more recent clinical prevention and animal studies have not only failed to reduce sudden cardiac death but actually increased mortality in angina patients and increased rather than decreased malignant arrhythmias in animal models of regional ischemia. 6) Given the inconsistent benefits reported in clinical and experimental studies and the potential adverse actions on cardiac rhythm noted during myocardial ischemia, n-3 PUFA must be prescribed with caution and generalized recommendations to increase fish intake or to take n-3 PUFA supplements need to be reconsidered.

A probability based approach for the allocation of player draft selections in Australian rules football

Australian Rules Football, governed by the Australian Football League (AFL) is the most popular winter sport played in Australia. Like North American team based leagues such as the NFL, NBA and NHL, the AFL uses a draft system for rookie players to join a team's list. The existing method of allocating draft selections in the AFL is simply based on the reverse order of each team's finishing position for that season, with teams winning less than or equal to 5 regular season matches obtaining an additional early round priority draft pick. Much criticism has been levelled at the existing system since it rewards losing teams and does not encourage poorly performing teams to win matches once their season is effectively over. We propose a probability-based system that allocates a score based on teams that win 'unimportant' matches (akin to Carl Morris' definition of importance). We base the calculation of 'unimportance' on the likelihood of a team making the final eight following each round of the season. We then investigate a variety of approaches based on the 'unimportance' measure to derive a score for 'unimportant' and unlikely wins. We explore derivatives of this system, compare past draft picks with those obtained under our system, and discuss the attractiveness of teams knowing the draft reward for winning each match in a season. Key PointsDraft choices are allocated using a probabilistic approach that rewards teams for winning unimportant matches.The method is based upon Carl Morris' Importance and probabilistic calculations of making the finals.The importance of a match is calculated probabilistically to arrive at a DScore.Higher DScores are weighted towards teams winning unimportant matches which in turn lead to higher draft selections.Provides an alternative to current draft systems that are based on 'losing to win'.