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Purpose: This study aimed to quantify training and match-day (MD) load during 3-, 4-, and 5-day microcycles in professional adult football, as well as to analyze the effect of the microcycle length on training load produced the day after the match (MD + 1) and the day before the match (MD − 1). Methods: The study involved 20 male professional football players whose external and internal loads were monitored for a whole season. The training exposure, total distance covered, high-speed-running distance, sprint distance (SD), individual SD above 80% of the individual maximum velocity (D > 80%), and the number of accelerations and decelerations were quantified, as well as rating of perceived exertion and session rating of perceived exertion training load. Results: Microcycle length affected most of the variables of interest: high-speed-running distance (F = 9.04, P <.01), SD (F = 13.90, P <.01), D > 80% (F = 20.25, P <.01), accelerations (F = 10.12, P <.01), and decelerations (F = 6.01, P <.01). There was an interaction effect between the training day and microcycle type for SD (F = 5.46, P <.01), D > 80% (F = 4.51, P <.01), accelerations (F = 2.24, P =.06), and decelerations (F = 3.91, P <.01). Conclusions: Coaches seem to be influenced by shorter microcycles in their training proposal, preferring sessions with a reduced muscle impact during shorter microcycles. Independent of the length of the congested fixture microcycle, the daily load seems to decrease when MD approaches. [ABSTRACT FROM AUTHOR]

IntroductionTo effectively monitor post-match changes in physical performance, valid, reliable and practical measures which are sensitive to change are required. This study aimed to quantify test-retest reliability and sensitivity to change of a range of physical performance measures recorded during an isometric posterior chain (IPC) lower-limb muscle test and a countermovement jump (CMJ) test.MethodsEighteen Italian Serie A academy soccer players performed three IPC repetitions per limb and five CMJ trials in 4 testing sessions. Test-retest reliability was evaluated between two testing sessions seven days apart using typical error of measurement, coefficient of variation and intraclass correlation coefficient. Sensitivity to change was assessed on two additional testing sessions performed before and immediately after a soccer match through Hedges' g effect size (g) and comparisons to typical error.ResultsAbsolute reliability (coefficient of variations) ranged from 1.5 to 8.8%. IPC and CMJ measures demonstrated moderate to excellent relative reliability (intraclass correlation coefficients ranged from 0.70 to 0.98). A wide range of physical performance measures showed significant alterations post-match (p

Background Subgroup analyses of randomized trials suggest the superiority of immune checkpoint inhibitor-based therapy over chemotherapy in patients with mismatch-repair deficient (dMMR) and/or microsatellite instability-high (MSI-high) advanced gastric or gastroesophageal junction adenocarcinoma. However, these subgroups are small and studies examining prognostic features within dMMR/MSI-high patients are lacking.Methods We conducted an international cohort study at tertiary cancer centers and collected baseline clinicopathologic features of patients with dMMR/MSI-high metastatic or unresectable gastric cancer treated with anti-programmed cell death protein-1 (PD-1)-based therapies. The adjusted HRs of variables significantly associated with overall survival (OS) were used to develop a prognostic score.Results One hundred and thirty patients were included. At a median follow-up of 25.1 months, the median progression-free survival (PFS) was 30.3 months (95% CI: 20.4 to NA) and 2-year PFS rate was 56% (95% CI: 48% to 66%). Median OS was of 62.5 months (95% CI: 28.4 to NA) and 2-year OS rate was 63% (95% CI: 55% to 73%). Among the 103 Response Evaluation Criteria in Solid Tumors-evaluable patients, objective response rate was 66% and disease control rate 87% across lines of therapy. In the multivariable models, Eastern Cooperative Oncology Group Performance Status of 1 or 2, non-resected primary tumor, presence of bone metastases and malignant ascites were independently associated with poorer PFS and OS. These four clinical variables were used to build a three-category (ie, good, intermediate, and poor risk) prognostic score. Compared with patients with good risk, patients with intermediate risk score had numerically inferior PFS and OS (2-year PFS rate: 54.3% versus 74.5%, HR 1.90, 95% CI: 0.99 to 3.66; 2-year OS rate: 66.8% versus 81.2%, HR 1.86, 95% CI: 0.87 to 3.98), whereas patients with poor risk score had significantly inferior PFS and OS (2-year PFS rate: 10.6%, HR 9.65, 95% CI: 4.67 to 19.92; 2-year OS rate: 13.3%, HR 11.93, 95% CI: 5.42 to 26.23).Conclusions Overall outcomes with anti-PD-1-based therapies are favorable in MSI-high gastroesophageal adenocarcinomas. However, within this overall favorable subgroup a more accurate prognostication using baseline clinical characteristics might identify patients at higher risk of rapid disease progression who may deserve intensified immunotherapy combination strategies.

This study aimed to describe the distribution of training load (session rating of perceived exertion (sRPE), duration, and sRPE-training load) across weekly microcycles of an elite youth academy and assess the differences between four different age groups (U15-U16-U17-U19). Training load variables were recorded during in-season training weeks over 5 competitive seasons (from 2014–15 to 2018–19, evaluating new squads for each age group each season) for a total of 456 player observations. Mixed models assessed the variability of the three load variables across the different training days of a weekly microcycle and between the four different age groups. Estimated marginal means, 95% confidence intervals (CI), and effect sizes (d) were calculated for each training day of the microcycle. The main findings were significant differences in the training load variables three and four days before the next Match Day (i.e., MD-3 and MD-4, respectively), with U15 recording lower sRPE (−2.0 AU, d = 0.43–0.72) and U19 a lower duration (−35 min, d < -1.10). All age groups reduced sRPE-training load in the two days before a match, mainly due to a decrease in training duration (−160 AU & −17 min respectively). Match days provided the highest training loads within the weekly microcycle, with moderate-to-large differences between the four age groups (d = 0.77, 1.16 and 1.38 for U15 vs U16-U17-U19 respectively). The low variability in sRPE values in the three central sessions of a weekly microcycle indicates that training duration is an important factor to control when aiming to manipulate within-week training loads in elite youth soccer players. [ABSTRACT FROM AUTHOR]

Microcycles are fundamental structures for training prescription and load management, helping to optimise training effects and performance. This study quantified external and internal loads of Italian Serie A youth soccer players across competitive weeks and their periodisation within microcycles. Data were collected from 90 players belonging to four age groups (under-19, -17, -16, -15) across a season. Methods of monitoring external [duration and global navigation satellite systems (GNSS)] and internal load [heart rate (HR) and rating of perceived exertion (RPE)] were employed. Linear mixed models determined differences in training loads across age groups, training days and player positions. Under-19 and under-17 players trained five times per week, while younger players trained four times. Late-stage academy players (under-19 and -17) demonstrated higher weekly accumulated external and sRPE training load compared to their younger counterparts (p < 0.05 between groups). Weekly accumulated HR internal loads were higher in under-15 players (p < 0.05 between groups). Marked fluctuations of daily load were observed across microcycles in under-19 and under-17 groups (p < 0.05 between days). These findings highlight progressive increases in training load throughout the development pathway, with late-stage academy players training with higher frequency, volume and marked periodisation compared to younger players. [ABSTRACT FROM AUTHOR]

Antonello Nicolini,1 Bruna Grecchi,2 Maura Ferrari-Bravo,3 Cornelius Barlascini4 1Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Italy; 2Rehabilitation Unit, ASL4 Chiavarese, Chiavari, Italy; 3Statistics Unit, ASL4 Chiavarese, Chiavari, Italy; 4Health Medicine Unit, Hospital of Sestri Levante, Sestri Levante, Italy Purpose: Chest physiotherapy is an important tool in the treatment of COPD. Intrapulmonary percussive ventilation (IPV) and high-frequency chest wall oscillation (HFCWO) are techniques designed to create a global percussion of the lung which removes secretions and probably clears the peripheral bronchial tree. We tested the hypothesis that adding IPV or HFCWO to the best pharmacological therapy (PT) may provide additional clinical benefit over chest physiotherapy in patients with severe COPD. Methods: Sixty patients were randomized into three groups (20 patients in each group): IPV group (treated with PT and IPV), PT group with (treated with PT and HFCWO), and control group (treated with PT alone). Primary outcome measures included results on the dyspnea scale (modified Medical Research Council) and Breathlessness, Cough, and Sputum scale (BCSS), as well as an evaluation of daily life activity (COPD Assessment Test [CAT]). Secondary outcome measures were pulmonary function testing, arterial blood gas analysis, and hematological examinations. Moreover, sputum cell counts were performed at the beginning and at the end of the study. Results: Patients in both the IPV group and the HFCWO group showed a significant improvement in the tests of dyspnea and daily life activity evaluations (modified Medical Research Council scale, BCSS, and CAT) compared to the control group, as well as in pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory volume in 1 second/forced vital capacity%, total lung capacity, residual volume, diffusing lung capacity monoxide, maximal inspiratory pressure, maximal expiratory pressure) and arterial blood gas values. However, in the group comparison analysis for the same variables between IPV group and HFCWO group, we observed a significant improvement in the IPV group maximal inspiratory pressure, maximal expiratory pressure, BCSS, and CAT. Similar results were observed in changes of sputum cytology with reduction of inflammatory cells (neutrophils and macrophages). Conclusion: The two techniques improved daily life activities and lung function in patients with severe COPD. IPV demonstrated a significantly greater effectiveness in improving some pulmonary function tests linked to the small bronchial airways obstruction and respiratory muscle strength and scores on health status assessment scales (BCSS and CAT) as well as a reduction of sputum inflammatory cells compared with HFCWO. Keywords: severe COPD, intrapulmonary percussive ventilation, high-frequency chest wall oscillation, daily life activity

Background: Malnutrition, a very common condition in the elderly, is known to increase their vulnerability to adverse health events. This study aimed to estimate the prevalence of malnutrition in the over 75-yr-old community-dwelling population in the “Chiavarese” Local Health Unit district (North West Italy). Methods: The short version of the Mini Nutritional Assessment (MNA-SF) was used by General Practitioners (GP) as a screening tool to investigate the nutritional status of elderly people (1039 subjects). The study was conducted in 2012- 2013 in the Local Health Unit of Chiavari (Liguria Region), Italy. The malnutrition was subsequently confirmed by means of biochemical parameters. Subjects at risk of malnutrition or malnourished (n=22) received personalized dietary counseling by the GP. Results: The MNA-SF recognized 21% of the elderly people being at risk of malnutrition and biochemical tests confirmed a malnutrition prevalence of 3.5%. The dietary counseling improved the MNA-SF score and biochemical parameters, but the difference was statistically significant only for the MNA-SF score (P=0.00613). Conclusion: Malnutrition can be evaluated with a simple tool such as the MNA-SF, recognized at the earliest stage and successfully treated by the GP.

OBJECTIVE: Thoracentesis is one of the bedside procedures most commonly associated with iatrogenic complications, particularly pneumothorax. Various risk factors for complications associated with thoracentesis have recently been identified, including an inexperienced operator; an inadequate or inexperienced support team; the lack of a standardized protocol; and the lack of ultrasound guidance. We sought to determine whether ultrasound-guided thoracentesis can reduce the risk of pneumothorax and improve outcomes (fewer procedures without fluid removal and greater volumes of fluid removed during the procedures). In our comparison of thoracentesis with and without ultrasound guidance, all procedures were performed by a team of expert pulmonologists, using the same standardized protocol in both conditions. METHODS: A total of 160 participants were randomly allocated to undergo thoracentesis with or without ultrasound guidance (n = 80 per group). The primary outcome was pneumothorax following thoracentesis. Secondary outcomes included the number of procedures without fluid removal and the volume of fluid drained during the procedure. RESULTS: Pneumothorax occurred in 1 of the 80 patients who underwent ultrasound-guided thoracentesis and in 10 of the 80 patients who underwent thoracentesis without ultrasound guidance, the difference being statistically significant (p = 0.009). Fluid was removed in 79 of the 80 procedures performed with ultrasound guidance and in 72 of the 80 procedures performed without it. The mean volume of fluid drained was larger during the former than during the latter (960 ± 500 mL vs. 770 ± 480 mL), the difference being statistically significant (p = 0.03). CONCLUSIONS: Ultrasound guidance increases the yield of thoracentesis and reduces the risk of post-procedure pneumothorax. (Chinese Clinical Trial Registry identifier: ChiCTR-TRC-12002174 [http://www.chictr.org/en/])

Purpose: To define based on expert opinion and practical experience using a systematic and scientific approach, (1) the perceived most effective exercise-based strategies to prevent muscle injury in elite footballers; and, (2) when and how these exercise programs are prescribed based on the number of days between games i.e. implementation strategy. Methods: A Delphi survey obtained opinions and assessed for agreement. Delphi respondents consisted of 21 experienced sports practitioners (12 ± 5.3 years in elite football and with an academic background) belonging to 18 teams from the Big-5 European football leagues; England, France, Germany, Italy, Spain. Three teams were represented collaboratively by two experts. The Delphi process involves sequential rounds each evolving based on the responses from the previous. The number of rounds is not pre-defined and continues until an agreement is either achieved or it is clear that no agreement will be reached. Frequency of responses was recorded where the agreement was sought (i.e. in closed questions) and an agreement was achieved if ≥ 13/18 (70%) respondents agreed. For open-ended questions, a qualitative content analysis was performed to identify recurring themes and when themes were specified by ≥ 13 (70%), these were also considered as reaching an agreement. Practitioners had the opportunity to raise concerns if they disagreed with the 'agreement from recurrent themes'. Results: There were four Delphi rounds (100% response for each round). Sprinting and High-Speed Running (HSR) focused exercises were agreed as most effective (perceived) to prevent muscle injuries. Eccentric exercise was perceived as the next most effective. It was agreed that sprinting and HSR be integrated into coaches training, and target 100% of players worst-case match scenario (e.g. volume, intensity) based on individual maximum speeds. Eccentric exercise was recommended to be implemented according to the context of the main football session and planned/actual sprinting and HSR content. It was agreed that eccentrics can be performed before or after training, context dependent. The day to perform specific sprinting and HSR or eccentric exercises depended on the proximity of previous and upcoming matches. Other exercises reaching agreement as 'somewhat effective' included concentric and isometric, horizontal and vertical plyometrics, coordination, core and dynamic flexibility in addition to core stability. No agreement was reached for multi-joint, resisted sprinting, kicking or agility exercises nor simultaneous single-leg strength and stability. Finally, no agreement was reached regarding programming variables e.g. sets, repetitions as deemed too contextual. Conclusion: Regarding exercise-based strategies, particular importance agreed by the Delphi expert group was to focus on sprinting, HSR and eccentric exercises, integrated with a variety of other exercise modes which also carry some level of effectiveness in a multidimensional programme. Context was agreed to be key and decision-making about when to undertake/ how to prescribe exercise strategies to be made according to the content of normal football training and the proximity of matches. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: In chronic obstructive pulmonary disease (COPD) patients few modalities of airway clearance have demonstrated effectiveness in reducing hypersecretion and bronchial obstruction. Positive expiratory pressure (PEP) is one of these. Objective: Our goal was to compare the effectiveness of 2 devices Temporary PEP (T‐PEP) and Oscillatory PEP (O‐PEP) which use PEP applied at a low expiratory pressure of 1 cm H2O which creates oscillations that decrease bronchial obstruction in reducing COPD exacerbations and improving respiratory and health status assessment parameters. Each has different mechanism of action. Methods: A 26 week randomized controlled study evaluated their efficacy in reducing exacerbations and improving health status assessment tests as well as respiratory function parameters in severe to very severe COPD patients. One hundred‐twenty patients were enrolled: 40 patients received T‐PEP therapy; 40 underwent treatment with O‐PEP; 40 constituted the control group. The primary outcome was the reduction of exacerbations after 1, 3 and 6 months; secondary outcomes were improvement of lung function and health status assessment tests [Modified Medical Research Council (MMRC) scale, Breathlessness, Cough, and Sputum Scale (BCSS) scale, and COPD Assessment Test (CAT) score]. Results: Only T‐PEP statistically reduced the exacerbations after 1 and 3 months compared to the control group. Both the 2 devices improved dyspnea scale (MMRC), lung function parameters, and health status assessment (CAT) tests compared to the control group. Both interventions were well‐tolerated by our patients. Conclusions: O‐PEP and T‐PEP are useful for COPD treatment but only T‐PEP reduces exacerbations. Adding tools for airway clearance to medical therapy can help the management of COPD. [ABSTRACT FROM AUTHOR]