Xavier Iglesias

Acute Administration of Inorganic Nitrate Reduces V˙o2peak in Endurance Athletes

PURPOSE Humans can reduce inorganic nitrate (NO(3)(-)) to nitrite (NO(2)(-)), nitric oxide (NO), and other bioactive nitrogen oxides. The purpose of this study was to test the hypothesis that a single dose of inorganic nitrate before exercise might enhance the tolerance of endurance athletes to high intensity exercise. METHODS Eleven cyclists (age = 34.3 ± 4.8 yr, VO(2peak) = 65.1 ± 6.2 mL·kg(-1)·min(-1)) participated in this randomized, double-blind, crossover study. Subjects received dietary supplementation with nitrate (NaNO(3) 10 mg·kg(-1) of body mass) or a placebo (NaCl) 3 h before exercise. They then performed a cycle ergometer test that consisted of four 6-min submaximal workloads, corresponding to 2.0, 2.5, 3.0, and 3.5 W·kg(-1) of body mass, interspersed with 3 min of passive recovery. After a 5-min recovery period, subjects performed one incremental exercise test until exhaustion. RESULTS Plasma nitrate and nitrite were significantly higher (P < 0.05) 3 h after supplementation (nitrate = 250 ± 80 μM, nitrite = 2313 ± 157 nM) than after the placebo (nitrate = 29 ± 8 μM, nitrite = 1998 ± 206 nM) at resting conditions. Nitrate supplementation significantly reduced VO(2peak)(nitrate = 4.64 ± 0.35 L·min(-1), placebo = 4.82 ± 0.33 L·min(-1), P = 0.010) and the ratio between VO(2) and power at maximal intensity (nitrate = 11.2 ± 1.1 mL·min(-1)·W(-1), placebo = 11.8 ± 1.1 mL·min(-1)·W(-1), P = 0.031). This reduction of VO(2) occurred without changes in the time to exhaustion (nitrate = 416 ± 32 s, placebo = 409 ± 27 s) or in the maximal power (nitrate = 416 ± 29 W, placebo = 410 ± 28 W). CONCLUSIONS A single oral dose of inorganic nitrate acutely reduces VO(2peak)without compromising the maximal exercise performance.

Intraabdominal desmoplastic small round cell tumor with EWS/ERG fusion transcript.

This report describes an intraabdominal small cell tumor in a 37-year-old woman, with clinical, topographic, and morphologic features highly suggestive of the desmoplastic small round cell tumor. Immunohistochemical analysis revealed a polyphenotypic profile consistent with this tumor--positivity for keratin, epithelial membrane antigen, neuron-specific enolase, vimentin, and desmin--but, in addition, a strong membranous immunoreactivity for CD99 (MIC2 protein). Reverse transcription polymerase chain reaction revealed a EWS/ERG fusion transcript characteristic of the Ewings sarcoma/peripheral primitive neuroectodermal tumor group of tumors, rather than the EWS/WT1 chimeric transcript typical of the desmoplastic small round cell tumor. This is the third report of a hybrid tumor with features of the desmoplastic small round cell tumor and Ewings sarcoma/peripheral primitive neuroectodermal tumor, and the first one with the EWS/ERG fusion gene. Our case shows the existence of some overlap between these two groups of tumors, which are considered to be histogenetically different, and the need for further studies of molecular characterization of small cell tumors, especially in those with atypical morphologic or immunohistochemical features.

Is vascular and lymphatic space invasion a main prognostic factor in uterine neoplasms with a sarcomatous component? A retrospective study of prognostic factors of 60 patients stratified by stages

BACKGROUND Sarcomatous neoplasms of the uterine corpus are still a challenge in terms of obtaining prognostic factors and the most optimum complementary treatment to surgery. The most important prognostic factor is stage; relapses usually appear during the first 2 years, and most patients die within the first 3 years. We have performed a multivariate study of prognostic factors, stratifying patients by stage, to determine their impact on overall survival, disease-free survival, local relapse-free survival, and distant metastasis-free survival. Special emphasis has been given to vascular and lymphatic space invasion (VLSI). METHODS Sixty patients diagnosed with uterine neoplasms with a main sarcomatous component were treated at Hospital Clínic i Universitari of Barcelona between January 1975 and June 1999. Pathologic type: 32 carcinosarcomas, 14 leiomyosarcomas, 9 adenosarcomas, and 5 endometrial stromal sarcomas. TREATMENT 58/60 surgery, 35/60 postoperative radiotherapy, 2/60 exclusive chemotherapy, and 3/60 complementary chemotherapy. FIGO stages: 43 Stage I, 4 Stage II, 11 Stage III, and 2 Stage IV. Variables analyzed: age, stage, vascular and lymphatic space invasion, myometrial invasion, mitotic index, tumor size, unicentricity/multicentricity, necrosis, and radiotherapy. STATISTICS the S and Cox proportional risk models. The partial effect of each risk factor was calculated by hazard ratio (HR) with a confidence interval of 95%. RESULTS Early stages: Multivariate analysis showed that tumor size larger than 8 cm and VLSI had an impact on overall survival (HR = 4.01 and HR = 24.45, respectively). VLSI was present in 23% of the cases. Myometrial invasion greater than 50% had an impact on disease-free survival and local relapse-free survival (HR was 9.75 and 3.20, respectively). VLSI had an impact on distant metastasis-free survival (HR = 2.92). Advanced stages: VLSI was present in 89% of the cases. Only leiomyosarcoma type made the overall survival worse (HR = 10.54). CONCLUSIONS Vascular and lymphatic space invasion was a relevant prognostic factor in our series, with an impact on overall survival and distant metastasis-free survival in early stages. In advanced stages, VLSI had no impact on survival, but was present in 89% of cases. Myometrial invasion >50% had an impact on local relapse. Advanced stages had a more aggressive behavior, and there was a higher incidence of poor prognostic factors in these stages. Nevertheless, prospective studies are still needed on prognostic factors and on the best treatment option.

Physiological Responses in Relation to Performance during Competition in Elite Synchronized Swimmers

Purpose We aimed to characterize the cardiovascular, lactate and perceived exertion responses in relation to performance during competition in junior and senior elite synchronized swimmers. Methods 34 high level senior (21.4±3.6 years) and junior (15.9±1.0) synchronized swimmers were monitored while performing a total of 96 routines during an official national championship in the technical and free solo, duet and team competitive programs. Heart rate was continuously monitored. Peak blood lactate was obtained from serial capillary samples during recovery. Post-exercise rate of perceived exertion was assessed using the Borg CR-10 scale. Total competition scores were obtained from official records. Results Data collection was complete in 54 cases. Pre-exercise mean heart rate (beats·min−1) was 129.1±13.1, and quickly increased during the exercise to attain mean peak values of 191.7±8.7, with interspersed bradycardic events down to 88.8±28.5. Mean peak blood lactate (mmol·L−1) was highest in the free solo (8.5±1.8) and free duet (7.6±1.8) and lowest at the free team (6.2±1.9). Mean RPE (0–10+) was higher in juniors (7.8±0.9) than in seniors (7.1±1.4). Multivariate analysis revealed that heart rate before and minimum heart rate during the routine predicted 26% of variability in final total score. Conclusions Cardiovascular responses during competition are characterized by intense anticipatory pre-activation and rapidly developing tachycardia up to maximal levels with interspersed periods of marked bradycardia during the exercise bouts performed in apnea. Moderate blood lactate accumulation suggests an adaptive metabolic response as a result of the specific training adaptations attributed to influence of the diving response in synchronized swimmers. Competitive routines are perceived as very to extremely intense, particularly in the free solo and duets. The magnitude of anticipatory heart rate activation and bradycardic response appear to be related to performance variability.

On-Court Endurance and Performance Testing in Competitive Male Tennis Players

Abstract Baiget, E, Fernández-Fernández, J, Iglesias, X, Vallejo, L, and Rodríguez, FA. On-court endurance and performance testing in competitive male tennis players. J Strength Cond Res 28(1): 256–264, 2014—The aims of this study were (a) to establish a specific endurance test procedure for competitive tennis players, combining performance, physiological and technical parameters and (b) to determine the relationship between these parameters and their competitive levels. Thirty-eight competitive male tennis players (age, 18.2 ± 1.3 years; height, 180 ± 0.08 cm; body mass, 72.7 ± 8.6 kg; mean ± SD) performed a specific endurance field test. Performance (level achieved), physiological (heart rate, maximum oxygen uptake (V[Combining Dot Above]O2max), and ventilatory thresholds (VT1, VT2), and technical parameters (technical effectiveness [TE]) were assessed. Bivariate and multivariate models for predicting performance level were developed. Technical effectiveness was 63.1 ± 9.1%, with 3 identified phases throughout the test (adaptation, maximum effectiveness, and steady decline). Low to moderate correlations were found between performance (final stage), physiological (VT1, VT2) and TE, and competitive performance (r = 0.35–0.61; p = 0.038–0.000). Technical effectiveness explained 37% of variability in competitive performance (r = 0.61; p = 0.001). Using TE combined with VT2 or predictability increased explaining approximately 55% (p < 0.05) of the variance in competitive performance. The present study showed the usefulness of a field test including physiological and performance elements in high-caliber tennis players, and VT2 values combined with TE were good predictors of tennis performance.

Nutritional behavior of cyclists during a 24-hour team relay race: a field study report

BackgroundInformation about behavior of energy intake in ultra-endurance cyclists during a 24-hour team relay race is scarce. The nutritional strategy during such an event is an important factor which athletes should plan carefully before the race. The purpose of this study was to examine and compare the nutritional intake of ultra-endurance cyclists during a 24-hour team relay race with the current nutritional guidelines for endurance events. Additionally, we analyzed the relationship among the nutritional and performance variables.MethodsUsing a observational design, nutritional intake of eight males (mean ± SD: 36.7 ± 4.7 years; 71.6 ± 4.9 kg; 174.6 ± 7.3 cm; BMI 23.5 ± 0.5 kg/m2) participating in a 24-hour team relay cycling race was assessed. All food and fluid intake by athletes were weighed and recorded. Additionally, distance and speed performed by each rider were also recorded. Furthermore, before to the race, all subjects carried out an incremental exercise test to determine two heart rate-VO2 regression equations which were used to estimate the energy expenditure.ResultsThe mean ingestion of macronutrients during the event was 943 ± 245 g (13.1 ± 4.0 g/kg) of carbohydrates, 174 ± 146 g (2.4 ± 1.9 g/kg) of proteins and 107 ± 56 g (1.5 ± 0.7 g/kg) of lipids, respectively. This amount of nutrients reported an average nutrient intake of 22.8 ± 8.9 MJ which were significantly lower compared with energy expenditure 42.9 ± 6.8 MJ (P = 0.012). Average fluid consumption corresponded to 10497 ± 2654 mL. Mean caffeine ingestion was 142 ± 76 mg. Additionally, there was no relationship between the main nutritional variables (i.e. energy intake, carbohydrates, proteins, fluids and caffeine ingestion) and the main performance variables (i.e. distance and speed).ConclusionsA 24-hour hours cycling competition in a team relay format elicited high energy demands which were not compensated by energy intake of the athletes despite that dietary consumption of macronutrients did not differ to the nutritional guidelines for longer events.

Immediate maternal and neonatal effects of low-forceps delivery according to the new criteria of The American college of Obstetricians and Gynecologists compared with spontaneous vaginal delivery in term pregnancies

OBJECTIVE Our purpose was to investigate the maternal and neonatal effects of elective low-forceps delivery, as currently defined by the 1988 criteria of The American College of Obstetricians and Gynecologists. STUDY DESIGN During a 6-month period we conducted a prospective study that included 50 nulliparous term parturients who were randomly allocated to spontaneous or elective low-forceps delivery. Patients with either maternal or fetal disorders that could affect the outcome were excluded. All deliveries were attended by three experienced obstetricians. RESULTS Spontaneous and forceps delivery group were similar regarding maternal or gestational age, fetal scalp pH, antepartum maternal hemoglobin and hematocrit levels, maternal outcome, mean birth weight, and number of neonates with low Apgar scores or cord arterial pH < 7.20. In the spontaneous delivery group the time elapsed since randomization to delivery was significantly longer (18 vs 10.2 minutes, p < 0.001) and the mean cord arterial pH was significantly lower (7.23 vs 7.27, p = 0.01) than in the forceps delivery group. CONCLUSION Elective low forceps delivery may be used to shorten the second stage of labor without immediate maternal or neonatal side effects.

Altitude Training in Elite Swimmers for Sea Level Performance (Altitude Project)

INTRODUCTION This controlled, nonrandomized, parallel-groups trial investigated the effects on performance, V˙O2 and hemoglobin mass (tHbmass) of four preparatory in-season training interventions: living and training at moderate altitude for 3 and 4 wk (Hi-Hi3, Hi-Hi), living high and training high and low (Hi-HiLo, 4 wk), and living and training at sea level (SL) (Lo-Lo, 4 wk). METHODS From 61 elite swimmers, 54 met all inclusion criteria and completed time trials over 50- and 400-m crawl (TT50, TT400), and 100 (sprinters) or 200 m (nonsprinters) at best stroke (TT100/TT200). Maximal oxygen uptake (V˙O2max) and HR were measured with an incremental 4 × 200 m test. Training load was estimated using cumulative training impulse method and session RPE. Initial measures (PRE) were repeated immediately (POST) and once weekly on return to SL (PostW1 to PostW4). tHbmass was measured in duplicate at PRE and once weekly during the camp with CO rebreathing. Effects were analyzed using mixed linear modeling. RESULTS TT100 or TT200 was worse or unchanged immediately at POST, but improved by approximately 3.5% regardless of living or training at SL or altitude after at least 1 wk of SL recovery. Hi-HiLo achieved greater improvement 2 (5.3%) and 4 wk (6.3%) after the camp. Hi-HiLo also improved more in TT400 and TT50 2 (4.2% and 5.2%, respectively) and 4 wk (4.7% and 5.5%) from return. This performance improvement was not linked linearly to changes in V˙O2max or tHbmass. CONCLUSIONS A well-implemented 3- or 4-wk training camp may impair performance immediately but clearly improves performance even in elite swimmers after a period of SL recovery. Hi-HiLo for 4 wk improves performance in swimming above and beyond altitude and SL controls through complex mechanisms involving altitude living and SL training effects.

Carcinoma of the fallopian tube presenting as acute pelvic inflammatory disease

BACKGROUND Primary carcinomas of the fallopian tube are rare and their preoperative diagnosis is difficult due to the lack of specific symptoms. CASES We present two tumors diagnosed in women 74 and 77 years old. On examination both patients presented as acute pelvic peritonitis with abdominal pain and tenderness with guarding and rebound, as well as fever and leukocytosis. At surgery, a left tubal carcinoma was found in each patient. Marked inflammatory and purulent reaction involving the uterus, the adnexa, and the pelvic peritoneum, and no abnormalities in the digestive tract were identified. A total hysterectomy with bilateral salpingo-oophorectomy was performed in both patients. CONCLUSION Carcinoma of the fallopian tube should be considered in the differential diagnosis of pelvic peritonitis, a previously poorly reported clinical presentation.

Training load quantification in elite swimmers using a modified version of the training impulse method

Abstract Prior reports have described the limitations of quantifying internal training loads using hear rate (HR)-based objective methods such as the training impulse (TRIMP) method, especially when high-intensity interval exercises are performed. A weakness of the TRIMP method is that it does not discriminate between exercise and rest periods, expressing both states into a single mean intensity value that could lead to an underestimate of training loads. This study was designed to compare Banisters original TRIMP method (1991) and a modified calculation procedure (TRIMPc) based on the cumulative sum of partial TRIMP, and to determine how each model relates to the session rating of perceived exertion (s-RPE), a HR-independent training load indicator. Over four weeks, 17 elite swimmers completed 328 pool training sessions. Mean HR for the full duration of a session and partial values for each 50 m of swimming distance and rest period were recorded to calculate the classic TRIMP and the proposed variant (TRIMPc). The s-RPE questionnaire was self-administered 30 minutes after each training session. Both TRIMPc and TRIMP measures strongly correlated with s-RPE scores (r = 0.724 and 0.702, respectively; P < 0.001). However, TRIMPc was ∼9% higher on average than TRIMP (117 ± 53 vs. 107 ± 47; P < 0.001), with proportionally greater inter-method difference with increasing workload intensity. Therefore, TRIMPc appears to be a more accurate and appropriate procedure for quantifying training load, particularly when monitoring interval training sessions, since it allows weighting both exercise and recovery intervals separately for the corresponding HR-derived intensity.