Pedro L. Valenzuela

Atypical Endometrial Hyperplasia: Grounds for Possible Misdiagnosis of Endometrial Adenocarcinoma

Objective: The diagnoses of atypical hyperplasia and well-differentiated adenocarcinoma imply totally different approaches because of clinical and patient-oriented ramifications, especially when morphological differences are not entirely conclusive. The purpose of this study was to examine the relationship between the diagnosis of atypical hyperplasia during curettage or endometrial biopsy and the definitive histological findings from hysterectomy material. Study Design: 23 patients were found fit for the current study and subsequently their clinical histories were reviewed for relevant clinical data, histopathological profiling and type of therapeutic interventions. Results: Adenocarcinoma was observed in 12 (52.17%) of 23 hysterectomy cases. The hyperplasia was found in 10 (43.47%) cases, although 4 of them lacked atypia and 1 case proved to be hyperplasia-free. Conclusion: Hysterectomy was prescribed as the next step in the diagnosis of atypical endometrial hyperplasia. Other wait-and-see approaches could have easily forfeited the chances of providing an adequate treatment for an operable and curable cancer in approximately half of the studied cases.

Multivariate analysis of determinants of fetal growth retardation

OBJECTIVEnTo analyse the relative effect of the risk factors related to fetal growth retardation (FGR) in the central area of Spain.nnnSTUDY DESIGNnThis is a case-control survey of 370 full-term gestations. Of the 370 women, 185 were diagnosed with intrauterine growth retardation, and 185 were in the normal group. All came from a central region of Spain. We took into account 25 possible risk factors.nnnRESULTSnIn the FGR group we found 12 risk factors with statistical significance in the univariate analysis (tobacco, drugs, low pre-pregnancy weight, low maternal height, little gestational weight gain, excessive physical activity during pregnancy, low socioeconomic status, low educational level, unmarried, urinary infection, mothers haematological changes, and previous infertility). After the multiple logistic regression analysis, five factors were shown to exist as independent risks (tobacco: OR, 23.50; 95% CI, 3.01-183.18; P < 0.01; low pre-pregnancy weight: OR, 4.01; 95% CI, 2.14-7.51; P < 0.001; low socioeconomic status: OR, 2.91; 95% CI, 1.72-4.90; P < 0.001; little gestational weight gain: OR, 2.52; 95% CI, 1.21-5.22; P < 0.05; and urinary infection: OR, 3.83; 95% CI, 1.49-9.87; P < 0.01).nnnCONCLUSIONSn(i) Tobacco, low pre-pregnancy weight and low socioeconomic status are the three main cause-effect factors of relative importance in our sanitary zone for FGR. (ii) Disproportionate FGR is related more to older mothers and maternal previous illness than to the proportionate FRG.

Intrauterine growth retardation: fluctuation of fetal pH measured between beginning and at the completion of labor

UNLABELLEDnThe aim of this study was to evaluate the fluctuation of fetal pH in blood samples taken at the beginning of labor and at the moment of birth as related to intrauterine growth retardation syndrome. This is a prospective follow-up of term gestations, of which 41 were diagnosed as intrauterine growth retardation (IUGR) and 61 as normal ones. pH was measured in scalp blood sample at the beginning of the labor and in umbilical artery right after birth in both groups respectively. The rate of decrease of pH value in relation to duration of labor was determined for each case. Our results are: 1) Lower baseline pH were found in the IUGR group (pH 7.32 vs 7.34, p < 0.01), lower arterial blood pH at birth/.23 +/- 0.08 vs 7.27 +/- 0.08, p < 0.05). 2) Faster decrease of the pH during the labor (0.019 unit/hour vs 0.012, p < 0.05) as related to IUGR.nnnCONCLUSIONnIUGR fetuses are more acidotic at the beginning of the labor, and the rate of decrease of the fetal pH per unit of time during the labor is faster at least in a theoretical situation nevertheless it will require more studies if any practical applications are thought of.

Relationship between skeletal muscle contractile properties and power production capacity in female Olympic rugby players

Abstract This study aimed to determine which contractile properties measured by tensiomyography (TMG) could better differentiate athletes with high- and low-power values, as well as to analyse the relationship between contractile properties and power production capacity. The contractile properties of the vastus medialis (VM), rectus femoris (RF) and vastus lateralis (VL) of an Olympic women’s Rugby Sevens team (nu2009=u200914) were analysed before a Wingate test in which their peak power output (PPO) was determined. Athletes were then divided into a high-power (HP) and a low-power (LP) group. HP presented an almost certainly higher PPO (9.8u2009±u20090.3 vs. 8.9u2009±u20090.4 W kg−1, ESu2009=u20093.00) than LP, as well as a very likely lower radial displacement (3.39u2009±u20091.16 vs. 5.65u2009±u20091.50u2005mm, ESu2009=u20091.68) and velocity of deformation (0.08u2009±u20090.02 vs. 0.13u2009±u20090.03 mm ms−1, ESu2009=u20091.87) of the VL. A likely lower time of delay was observed in HP for all analysed muscles (ESu2009>u20090.60). PPO was very largely related to the radial displacement (ru2009=u2009−0.75, 90% CIu2009=u2009−0.90 to −0.44) and velocity of deformation (ru2009=u2009−0.70, 90% CIu2009=u2009−0.87 to −0.34) of the VL. A large correlation was found between PPO and the time of delay of the VL (ru2009=u2009−0.61, 90% CIu2009=u2009−0.84 to −0.22). No correlations were found for the contractile properties of RF or VM. These results highlight the importance of VL contractile properties (but not so much those of RF and VM) for maximal power production and suggest TMG as a practical technique for its evaluation.

Comment on: “Drinking Strategies: Planned Drinking versus Drinking to Thirst”

We have read with interest the topical review article [1] entitled ‘‘Drinking strategies: planned drinking versus drinking to thirst’’, where Dr. Kenefick summarizes the evidence on pre-established drinking plans versus ad libitum drinking during exercise with a main focus on performance. Assessing an individual’s hydration pattern during exercise has received special attention in the sports science field based on the notion that dehydration dysregulates fluid homeostasis, thereby leading to physiological stress and impaired performance [2]. Kenefick [1] establishes a 2% body weight (BW) loss during exercise as a threshold for impairment of thermoregulatory and cardiovascular function, with subsequent decreases in exercise performance. His final advice is to avoid drinking to thirst in order to prevent BW losses[ 2% during activities of high intensity or long duration ([ 1–2 h), or when exercising in warm/hot environments. However, some aspects of the relationship between dehydration (understood as a BW loss[ 2%) and physiological stress or performance must be discussed. More importantly, certain health concerns should not be overlooked in the first instance. Although Kenefick [1] does highlight the importance of not consuming too much fluid (i.e. avoiding gaining BW after exertion), we believe more serious attention must be given to the potential risks of overdrinking [3]. The author describes cases of exercise-induced hyponatremia (EAH; defined as a plasma sodium level 135 mmol/L) as ‘rare’, when in fact a worrying prevalence of EAH has been reported in endurance events [4], notably 13% of Boston Marathon participants [5] and 11% of participants in the Ironman European Championship [6]. Importantly, the fact that EAH cases are usually asymptomatic or mildly symptomatic (e.g. nausea) does not rule out the possibility that this condition can lead to severe clinical manifestations, or even a fatal outcome [4]. By contrast, there is little evidence to support a cause–effect relationship between dehydration per se (in the absence of thirst) and onset of major health problems such as exertional muscle cramps, heat illnesses (including heat stroke), or cognitive impairment [2]. Therefore, special caution should be exercised when drinking beyond thirst. Furthermore, Dr. Kenefick’s specific recommendation to drink beyond thirst for exercise durations above 1–2 h is in disagreement with the finding that longer race times have been associated with a higher risk of developing EAH [5]. In fact, BW gain is not a good marker of EAH risk when drinking ad libitum; although this condition is commonly associated with an increased BW, it can also occur without associated gains in BW [7]. Health issues aside, some discussion is also needed on the performance effects of dehydration rates above the advocated 2% threshold. Dr. Kenefick [1] proposes a link & Pedro L. Valenzuela pedrol.valenzuela@edu.uah.es

Comment on: “Assessment of Skeletal Muscle Contractile Properties by Radial Displacement: The Case for Tensiomyography”

We have read with interest the recent review article by Macgregor et al. [1] in which the authors nicely discuss the physiological bases of tensiomyography (TMG) and summarize the evidence available regarding the reliability and validity of this tool in the field of sports medicine. TMG assesses muscle contractile properties in response to an evoked electrical twitch through several variables, including maximal radial displacement (Dm), time (Tc) and velocity of contraction (Vc), and delay time (Td). TMG assessment of these variables has proven to be overall reliable [2, 3]. There is a rationale to postulate a relationship between TMG-derived parameters and muscle performance. The TMG response reflects muscle fiber type composition [4–6], with longer Tc and Td values being related to a higher proportion of slow-twitch fibers [4]. In turn, the Dm of the muscle belly is an indicator of muscle stiffness [7, 8], with the latter playing a major role in the muscle capacity for torque production and force transmission and thereby in its capacity to generate power [9, 10]. Lower Tc, Td and Dm values have been reported in power compared with endurance athletes [11, 12]. Moreover, a recent study by our group [13], which was not cited in the review by Macgregor et al. [1], found that a higher TMG-determined stiffness in the vastus lateralis muscle (as reflected by a lower Dm) was strongly related to a greater power production capacity in Olympic rugby players [13]. To corroborate the potential of TMG as a non-invasive tool for the indirect assessment of muscle function, we recently conducted a preliminary analysis in 18 male elite ‘power’ (taekwondo, badminton) athletes. Their TMG properties (vastus lateralis muscle, dominant limb) were assessed with a jump squat using the TMG methodology reported elsewhere [13]. Briefly, an accurate pressure transducer (TMG Measurement System, TMG-BMC Ltd.; Ljubljana, Slovenia) was positioned perpendicular to the muscle belly and three single rectangular pulses (1 ms, 100 mA) interspersed with 30-s rest periods were generated with an electrical stimulator and two adhesive 5 × 5 cm electrodes (Compex Medical AS; Ecublens, Switzerland) placed on the muscle surface. We measured Dm, Tc, Td, and Vc. Thereafter, participants performed a jump squat incremental muscle power test in a Smith machine, as explained elsewhere [14], measuring bar velocity with a linear position transducer sampling at 1000 Hz (T-Force System, Ergotech; Murcia, Spain) connected to a 16-bit analog-to-digital converter (Biopac MP100 Systems; Goleta, CA, USA). Athletes were told to perform a downward movement until a knee flexion of ~ 90° was reached, wait at this position for 2 s, and then jump as quickly as possible. The initial weight was 25 kg (i.e., just the bar), and was increased by 5–10 kg until a constant decrease in mean propulsive power (MPP) was observed. During the incremental power test, we measured participants’ highest MPP, and analyzed its relationship with TMG variables (Pearson’s r). We found a significant relationship between MPP and both Tc (r = − 0.60, p = 0.008) and Td (− 0.58, p = 0.013). The nine athletes exhibiting the highest and lowest MPP were assigned to a high-power (HP) (mean ± standard deviation [SD] 13.0 ± 1.2 W·kg−1) and low-power (LP) (9.4 ± 0.8 W·kg−1) group, respectively, and This letter, its reply and the parent article available at doi:https :// doi.org/10.1007/s4027 9-018-0912-6.

Physical strategies to prevent disuse-induced functional decline in the elderly

Disuse situations can have serious adverse health consequences in the elderly, including mainly functional impairment with subsequent increase in the risk of falls or morbimortality. The present review provides clinicians and care givers with detailed and practical information on the feasibility and effectiveness of physical strategies that are currently available to prevent or attenuate the functional decline that occurs secondarily to disuse situations in the elderly, notably in the hospital setting. In this context, active approaches such as resistance exercises and maximal voluntary contractions, which can be performed both isometrically and dynamically, are feasible during most immobilization situations including in hospitalized old people and represent powerful tools for the prevention of muscle atrophy. Aerobic exercise should also be prescribed whenever possible to reduce the loss of cardiovascular capacity associated with disuse periods. Other feasible strategies for patients who are unwilling or unable to perform volitional exercise comprise neuromuscular electrical stimulation, vibration, and blood flow restriction. However, they should ideally be applied synchronously with voluntary exercise to obtain synergistic benefits.

Performance and physiological analysis of 500 km non-stop cycling: a case study

ABSTRACT Ultra-endurance sports have gained popularity over the last years. In this case, a well-trained cyclist completed 503.5 km non-stop (33.3 km.h−1). Speed and power output were reduced during the trial, being the reduction of power attributable to changes in pedal velocity rather than pedal forces. Heart rate (HR) showed an initial cardiovascular drift and progressively decreased independently of power. A decreased HR variability, a marked inflammatory response, signs of muscle damage and alterations of the haematological profile were observed after the trial. These adverse physiological effects were still present 24–48 h after exercise. A reduction in handgrip maximal voluntary contraction was observed immediately after the trial and 24 h later despite these muscles being minimally active during exercise. These findings show the high levels of stress to which the organism is subjected during ultra-endurance exercise even in the case of a trained cyclist.

Transcranial Direct Current Stimulation Enhances Mood But Not Performance in Elite Athletes

PURPOSEnTo determine if transcranial direct-current stimulation (tDCS) could be effective for the enhancement of swimming performance or mood state in elite athletes.nnnMETHODSnEight male elite triathletes (ageu2009=u200920 [2]xa0y, maximal oxygen uptakeu2009=u200971 [4]xa0mL·kg-1·min-1) participated in this crossover, counterbalanced, sham-controlled, double-blind study. Participants received either actual (20xa0min of anodal stimulation of the motor cortex at 2xa0mA) or sham tDCS and performed an 800-m swimming test in which rating of perceived exertion and blood lactate response were measured. Mood state (Brunel Mood Scale) was assessed before and after each tDCS session and after the swimming test. Heart-rate variability and central nervous system readiness were assessed before and after each tDCS session. The chances of finding differences between conditions were determined using magnitude-based inferences.nnnRESULTSnA significant and very likely higher Brunel Mood Scale-determined vigor self-perception was found with actual tDCS after the stimulation session (-0.1 [1.2] and 2.0 [2.3] for sham and actual tDCS, respectively; Pu2009=u2009.018, effect sizeu2009=u20091.14) and after exercise (-4.1 [2.9] and -0.9 [3.6] for sham and actual tDCS, respectively; Pu2009=u2009.022, effect sizeu2009=u20090.98). However, likely trivial and nonsignificant (Pu2009>u2009.05) differences were found between conditions in performance (599 [38]xa0s and 596 [39]xa0s, respectively). Unclear and nonsignificant differences were observed between conditions for the rest of the study end points.nnnCONCLUSIONSntDCS elicited a marked increase in vigor self-perception that was maintained after exercise but failed to improve swimming performance in elite triathletes.

Is the Functional Threshold Power (FTP) a Valid Surrogate of the Lactate Threshold

PURPOSEnTo analyze the relationship between functional threshold power (FTP) and the lactate threshold (LT).nnnMETHODSnA total of 20 male cyclists performed an incremental test in which LT was determined. At least 48xa0h later, they performed a 20-min time trial, and 95% of the mean power output was defined as FTP. Participants were divided into recreational (peak power outputu2009<u20094.5xa0W·kg-1; nu2009=u200911) or trained cyclists (peak power outputu2009>u20094.5xa0W·kg-1; nu2009=u20099) according to their fitness status.nnnRESULTSnThe FTP (240 [35]xa0W) was overall not significantly different (effect sizeu2009=u20090.20; limits of agreementu2009=u2009-2.4% [11.5%]) from the LT (246 [24]xa0W), and both markers were strongly correlated (ru2009=u2009.95; Pu2009<u2009.0001). Accounting for the participants fitness status, no significant differences were found between FTP and LT (effect sizeu2009=u20090.22; limits of agreementu2009=2.1% [7.8%]) in trained cyclists, but FTP was significantly lower than the LT (Pu2009=u2009.0004, effect sizeu2009=u20090.81; limits of agreementu2009=-6.5% [8.3%]) in recreational cyclists. A significant relationship was found between relative peak power output and the bias between FTP and the LT markers (ru2009=u2009.77; Pu2009<u2009.0001).nnnCONCLUSIONSnFTP is a valid field test-based marker for the assessment of endurance fitness. However, caution should be taken when using FTP interchangeably with LT, as the bias between markers seems to depend on the athletes fitness status. Whereas FTP provides a good estimate of LT in trained cyclists, in recreational cyclists, it may underestimate LT.