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Background: After the increasingly common anterior cruciate ligament reconstruction (ACLR) procedure in competitive athletes, rehabilitation is crucial for facilitating a timely return to sports (RTS) and preventing re-injury. This pilot study investigates the patient-reported outcomes of postoperative rehabilitation in competitive athletes, comparing supervised rehabilitation (SVR) and home-based rehabilitation (HBR). Methods: After ACLR, 60 (out of 74 screened) athletes were recruited and equally divided into HBR and SVR groups using non-probability convenience sampling, with each group comprising 15 males and 15 females. The rehabilitation outcomes in the respective groups were evaluated at 8 months using measures (Tegner Activity Scale [TAS], International Knee Documentation Committee subjective knee form [IKDC-SKF], ACL Return to Sport after Injury [ACL-RSI]) and objective parameters (isometric muscle strength, hamstring/quadricep asymmetry). RTS was evaluated at 9 months, with ACL re-injury rates recorded approximately 6 months post-RTS. Results: Both groups exhibited decreased TAS scores (HBR: 8 to 6, SVR: 8 to 7), with the SVR group demonstrating superior postoperative IKDC-SKF scores (81.82 vs. 68.43) and lower ACL-RSI scores (49.46 vs. 55.25). Isometric and isokinetic muscle strength, along with asymmetry values, was higher in the SVR group 8 months post-ACLR ( p < 0.05). The SVR group showed a higher RTS rate to the same level (76.6% vs. 53.3%), while the re-injury rate was the same in both the rehabilitation groups (3.3%). Conclusions: Although both rehabilitation approaches yielded comparable outcomes, SVR may demonstrate some superior biomechanical improvements in athletes, resulting in a higher RTS rate. However, the psychological outcomes and re-injury rates did not significantly differ between the groups, emphasizing the need to address individual psychological needs during rehabilitation. Further investigation is recommended with a larger sample size to address the differences of gender among competitive athletes.

Let X 1 , X 2 , … be independent random variables with E X k = 0 and σ k 2 : = E X k 2 < ∞ ( k ≥ 1 ) . Set S k = X 1 + ⋯ + X k and assume that s k 2 : = E S k 2 → ∞ . We prove that under the Kolmogorov condition | X n | ≤ L n , L n = o ( s n / ( log log s n ) 1 / 2 ) we have 1 log s n 2 ∑ k = 1 n σ k + 1 2 s k 2 f S k s k → 1 2 π ∫ R f ( x ) e - x 2 / 2 d x a . s . for any almost everywhere continuous function f : R → R satisfying | f ( x ) | ≤ e γ x 2 , γ < 1 / 2 . We also show that replacing the o in (1) by O , relation (2) becomes generally false. Finally, in the case when (1) is not assumed, we give an optimal condition for (2) in terms of the remainder term in the Wiener approximation of the partial sum process { S n , n ≥ 1 } by a Wiener process., (© The Author(s) 2023.)

Random walks on the circle group R / Z whose elementary steps are lattice variables with span α ∉ Q or p / q ∈ Q taken mod Z exhibit delicate behavior. In the rational case, we have a random walk on the finite cyclic subgroup Z q , and the central limit theorem and the law of the iterated logarithm follow from classical results on finite state space Markov chains. In this paper, we extend these results to random walks with irrational span α , and explicitly describe the transition of these Markov chains from finite to general state space as p / q → α along the sequence of best rational approximations. We also consider the rate of weak convergence to the stationary distribution in the Kolmogorov metric, and in the rational case observe a phase transition from polynomial to exponential decay after ≈ q 2 steps. This seems to be a new phenomenon in the theory of random walks on compact groups. In contrast, the rate of weak convergence to the stationary distribution in the total variation metric is purely exponential., (© 2023 The Authors. Journal of the London Mathematical Society is copyright © London Mathematical Society.)

Unaccustomed or strenuous eccentric exercise is known to cause delayed-onset muscle soreness. A recent hypothesis postulated that mechano-energetic microinjury of the primary afferent sensory neuron terminals in the muscle spindles, namely a transient Piezo2 channelopathy, could be the critical cause of delayed-onset muscle soreness in the form of a bi-phasic non-contact injury mechanism. This theory includes that this microlesion could delay the medium-latency response of the stretch reflex. Our aim with this study was to investigate this hypothesis. According to our knowledge, no study has examined the effect of delayed-onset muscle soreness on the medium-latency response of the stretch reflex. Our findings demonstrated that a significant delay in the medium-latency stretch reflex could be observed right after a multi-stage fitness test in the quadriceps femoris muscles of Hungarian professional handball players who consequently experienced delayed-onset muscle soreness. The long-latency stretch reflex and most likely short-latency stretch reflex were unaffected by delayed-onset muscle soreness in our study, which is in line with earlier findings. We translate these findings as indicative of proprioceptive Type Ia terminal microdamage in the muscle spindle in line with the aforementioned new acute non-contact compression axonopathy theory of delayed-onset muscles soreness.

Anterior cruciate ligament injury occurs when the ligament fibers are stretched, partially torn, or completely torn. The authors propose a new injury mechanism for non-contact anterior cruciate ligament injury of the knee. Accordingly, non-contact anterior cruciate ligament injury could not happen without the acute compression microinjury of the entrapped peripheral proprioceptive sensory axons of the proximal tibia. This would occur under an acute stress response when concomitant microcracks-fractures in the proximal tibia evolve due to the same excessive and repetitive compression forces. The primary damage may occur during eccentric contractions of the acceleration and deceleration moments of strenuous or unaccustomed fatiguing exercise bouts. This primary damage is suggested to be an acute compression/crush axonopathy of the proprioceptive sensory neurons in the proximal tibia. As a result, impaired proprioception could lead to injury of the anterior cruciate ligament as a secondary damage, which is suggested to occur during the deceleration phase. Elevated prostaglandin E2, nitric oxide and glutamate may have a critical neuro-modulatory role in the damage signaling in this dichotomous neuronal injury hypothesis that could lead to mechano-energetic failure, lesion and a cascade of inflammatory events. The presynaptic modulation of the primary sensory axons by the fatigued and microdamaged proprioceptive sensory fibers in the proximal tibia induces the activation of N-methyl-D-aspartate receptors in the dorsal horn of the spinal cord, through a process that could have long term relevance due to its contribution to synaptic plasticity. Luteinizing hormone, through interleukin-1β, stimulates the nerve growth factor-tropomyosin receptor kinase A axis in the ovarian cells and promotes tropomyosin receptor kinase A and nerve growth factor gene expression and prostaglandin E2 release. This luteinizing hormone induced mechanism could further elevate prostaglandin E2 in excess of the levels generated by osteocytes, due to mechanical stress during strenuous athletic moments in the pre-ovulatory phase. This may explain why non-contact anterior cruciate ligament injury is at least three-times more prevalent among female athletes.

Regular exercise induces a wide range of redox system-associated molecular adaptive responses to the nervous system. The intermittent induction of reactive oxygen species (ROS) during acute exercise sessions and the related upregulation of antioxidant/repair and housekeeping systems are associated with improved physiological function. Exercise-induced proliferation and differentiation of neuronal stem cells are ROS dependent processes. The increased production of brain derived neurotrophic factor (BDNF) and the regulation by regular exercise are dependent upon redox sensitive pathways. ROS are causative and associative factors of neurodegenerative diseases and regular exercise provides significant neuroprotective effects against Alzheimer's disease, Parkinson's disease, and hypoxia/reperfusion related disorders. Regular exercise regulates redox homeostasis in the brain with complex multi-level molecular pathways., Competing Interests: Declaration of competing interest Authors state no conflict of interest., (Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.)

MicroRNAs (miRs) are small regulatory RNA transcripts capable of post-transcriptional silencing of mRNA messages by entering a cellular bimolecular apparatus called RNA-induced silencing complex. miRs are involved in the regulation of cellular processes producing, eliminating or repairing the damage caused by reactive oxygen species, and they are active players in redox homeostasis. Increased mitochondrial biogenesis, function and hypertrophy of skeletal muscle are important adaptive responses to regular exercise. In the present review, we highlight some of the redox-sensitive regulatory roles of miRs., (Copyright © 2020. Production and hosting by Elsevier B.V.)

The SARS-CoV-2-caused COVID-19 pandemic has resulted in a devastating threat to human society in terms of health, economy, and lifestyle. Although the virus usually first invades and infects the lung and respiratory track tissue, in extreme cases, almost all major organs in the body are now known to be negatively impacted often leading to severe systemic failure in some people. Unfortunately, there is currently no effective treatment for this disease. Pre-existing pathological conditions or comorbidities such as age are a major reason for premature death and increased morbidity and mortality. The immobilization due to hospitalization and bed rest and the physical inactivity due to sustained quarantine and social distancing can downregulate the ability of organs systems to resist to viral infection and increase the risk of damage to the immune, respiratory, cardiovascular, musculoskeletal systems and the brain. The cellular mechanisms and danger of this "second wave" effect of COVID-19 to the human body, along with the effects of aging, proper nutrition, and regular physical activity, are reviewed in this article., Competing Interests: The authors have no conflict of interest to report., (© 2020 Chengdu Sport University. Production and hosting by Elsevier B.V. on behalf of KeAi.)

According to our hypothesis, delayed onset muscle soreness (DOMS) is an acute compression axonopathy of the nerve endings in the muscle spindle. It is caused by the superposition of compression when repetitive eccentric contractions are executed under cognitive demand. The acute compression axonopathy could coincide with microinjury of the surrounding tissues and is enhanced by immune-mediated inflammation. DOMS is masked by sympathetic nervous system activity at initiation, but once it subsides, a safety mode comes into play to prevent further injury. DOMS becomes manifest when the microinjured non-nociceptive sensory fibers of the muscle spindle stop inhibiting the effects of the microinjured, hyperexcited nociceptive sensory fibers, therefore providing the 'open gate' in the dorsal horn to hyperalgesia. Reactive oxygen species and nitric oxide play a cross-talking role in the parallel, interlinked degeneration-regeneration mechanisms of these injured tissues. We propose that the mitochondrial electron transport chain generated free radical involvement in the acute compression axonopathy. 'Closed gate exercises' could be of nonpharmacological therapeutic importance, because they reduce neuropathic pain in addition to having an anti-inflammatory effect. Finally, DOMS could have an important ontogenetical role by not just enhancing ability to escape danger to survive in the wild, but also triggering muscle growth.

The decrease in cognitive/motor functions and physical abilities severely affects the aging population in carrying out daily activities. These disabilities become a burden on individuals, families and society in general. It is known that aging conditions are ameliorated with regular exercise, which attenuates the age-associated decline in maximal oxygen uptake (VO2max), production of reactive oxygen species (ROS), decreases in oxidative damage to molecules, and functional impairment in various organs. While benefits of physical exercise are well-documented, the molecular mechanisms responsible for functional improvement and increases in health span are not well understood. Recent findings imply that exercise training attenuates the age-related deterioration in the cellular housekeeping system, which includes the proteasome, Lon protease, autophagy, mitophagy, and DNA repair systems, which beneficially impacts multiple organ functions. Accumulating evidence suggests that exercise lessens the deleterious effects of aging. However, it seems unlikely that systemic effects are mediated through a specific biomarker. Rather, complex multifactorial mechanisms are involved to maintain homeostatic functions that tend to decline with age., (Copyright © 2018 Elsevier Inc. All rights reserved.)

We hypothesized that high altitude exposure and physical activity associated with the attack to Mt Everest could alter mRNA levels of DNA repair and metabolic enzymes and cause oxidative stress-related challenges in human skeletal muscle. Therefore, we have tested eight male mountaineers (25-40 years old) before and after five weeks of exposure to high altitude, which included attacks to peaks above 8000m. Data gained from biopsy samples from vastus lateralis revealed increased mRNA levels of both cytosolic and mitochondrial superoxide dismutase. On the other hand 8-oxoguanine DNA glycosylase (OGG1) mRNA levels tended to decrease while Ku70 mRNA levels and SIRT6 decreased with altitude exposure. The levels of SIRT1 and SIRT3 mRNA did not change significantly. However, SIRT4 mRNA level increased significantly, which could indicate decreases in fatty acid metabolism, since SIRT4 is one of the important regulators of this process. Within the limitations of this human study, data suggest that combined effects of high altitude exposure and physical activity climbing to Mt. Everest, could jeopardize the integrity of the particular chromosome., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Several methods are used to treat focal chondral and osteochondral defects on the weightbearing surfaces of synovial joints. Autologous osteochondral grafting is 1 option used to replace hyaline cartilage in the defect., Hypothesis: Mosaicplasty is effective in returning elite athletes to participation in sports., Study Design: Case series; Level of evidence, 4., Methods: In 3 institutes, 354 of 383 patients were followed from 2 to 17 years (average, 9.6 years). The results of mosaicplasty were prospectively evaluated at 6 weeks, 3 months, 6 months, and yearly with patient-reported outcomes measures and radiographs., Results: Slight or moderate degenerative changes (Fairbank grade I or II) were detected preoperatively in 27% of the cases and in 36% of the cases at follow-up. Fairbank grade III changes were observed in 5 cases. An average radiographic deterioration of 0.32 on the Fairbank scale was detected (preoperative, 0.34; postoperative, 0.66). Good to excellent results were found in 91% of femoral mosaicplasties, 86% of tibial, and 74% of patellofemoral; 92% of talar mosaicplasties had similar results (Hannover ankle scoring system). Patellofemoral pain related to graft harvest was observed in 5% of cases. Second-look arthroscopies revealed good, congruent, gliding surfaces of the transplants and acceptable fibrocartilage coverage of donor sites in 16 patients and degenerative changes of the transplants in 5 cases. Histological evaluation revealed good graft incorporation in all 11 cases. Two infections and 3 deep venous thromboses occurred., Conclusion: Despite a higher rate of preoperative osteoarthritic changes in the athletic patients, clinical outcomes of mosaicplasty in this group demonstrated a success rate similar to that of less athletic patients. Higher motivation resulted in better subjective evaluation. Slight deterioration in results occurred during the 9.6-year follow-up; thus, autologous osteochondral mosaicplasty may be a useful alternative for the treatment of 1.0- to 4.0-cm(2) focal chondral and osteochondral lesions in competitive athletes.

Background: A number of studies have shown that proprioception training can reduce the risk of injuries in pivoting sports, but the mechanism is not clearly understood., Aim: To determine the contributing effects of propioception on knee joint position sense among team handball players., Study Design: Prospective cohort study., Methods: Two professional female handball teams were followed prospectively for the 2005-6 season. 20 players in the intervention team followed a prescribed proprioceptive training programme while 19 players in the control team did not have a specific propioceptive training programme. The coaches recorded all exposures of the individual players. The location and nature of injuries were recorded. Joint position sense (JPS) was measured by a goniometer on both knees in three angle intervals, testing each angle five times. Assessments were performed before and after the season by the same examiner for both teams. In the intervention team a third assessment was also performed during the season. Complete data were obtained for 15 subjects in the intervention team and 16 in the control team. Absolute error score, error of variation score and SEM were calculated and the results of the intervention and control teams were compared., Results: The proprioception sensory function of the players in the intervention team was significantly improved between the assessments made at the start and the end of the season (mean (SD) absolute error 9.78-8.21 degrees (7.19-6.08 degrees ) vs 3.61-4.04 degrees (3.71-3.20 degrees ), p<0.05). No improvement was seen in the sensory function in the control team between the start and the end of the season (mean (SD) absolute error 6.31-6.22 degrees (6.12-3.59 degrees ) vs 6.13-6.69 degrees (7.46-6.49 degrees ), p>0.05)., Conclusion: This is the first study to show that proprioception training improves the joint position sense in elite female handball players. This may explain the effect of neuromuscular training in reducing the injury rate.

Introduction: According to data in the literature, the number of nosocomial infections in the ICU is far higher than in non-ICU patients. As a result of improving lifesaving technologies, the risk of nosocomial infections increases in ICUs. Utilization of epidemiological methods is recommended for the detection and follow up of nosocomial infections., Aims: Prospective surveillance to assess the epidemiology of nosocomial infections in an ICU., Methods: Kenézy Hospital is a country hospital with 1637 beds and a 16-bed central ICU. During the investigated period (01. 04. 2004-31. 03. 2006) 1490 patients, with a total 8058 ICU days, were hospitalised in the mixed medical-surgical ICU. The commonest primary diagnosis were respiratory failure, multiple trauma and head injury. Surveillance was performed by a trained infection control nurse and was supervised by an infection control physician and infectious disease physician. CDC definitions were used to define nosocomial infections., Results: A total of 194 nosocomial infections in 134 patients were detected during the study period. The overall incidence and incidence density of nosocomial infections were 13.0 per 100 patients and 24.0 per 1000 patient-days. Respiratory tract infections (44.3%) were the most frequent nosocomial infection, followed by urinary tract (21.1%) and bloodstream infections (20.1%)., Conclusions: Nosocomial surveillance is useful in detecting nosocomial infections in ICU. A multidisciplinary approach and partnership between the physicians and infection control nurses is needed. Patient-to-nurse ratio is an independent risk factor for nosocomial infections in intensive care, this must be kept in mind when planning rationalization of the number of nursing staff.

Improvement of ankle proprioception through physiotherapy (a.k.a. proprioceptive training) is a widely accepted conservative treatment modality of chronic functional lateral ankle instability. Clinical studies provided controversial data on its proprioceptive effect. Aim of this study was to gain evidence on the efficacy of proprioceptive training on ankle joint position sense. Ten patients (five males and five females, aged 23.3+/-5.4 years) were treated conservatively for chronic lateral ankle instability with a special training programme over 6 weeks. For the assessment of joint position sense we used the slope-box test, first applied and described by Robbins et al. (Br J Sports Med 29:242-247, 1995). The test was performed before the start and after the end of the training programme, measuring joint position sense on 11 different slope amplitudes in four directions (anterior, posterior, lateral and medial) in random order each on both ankles. Comparisons were made between pre- and post-training results as well as versus a control-group of ten healthy athletes. Overall the proprioceptive sensory function of the studied group has improved, but this improvement was not significant in all directions. Only two patients have shown significant improvement of joint position sense in all directions (mean estimate error improvement: 2.47 degrees ), while conservative treatment was partially successful in five others (mean estimate error improvement: 0.73 degrees ). The follow-up results of these seven patients were comparable with the values measured in the control-group. Three patients did not show any improvements (mean estimate error improvement: -0.55 degrees ) (overall difference between improving and non-improving patients: P<0.0001). Mean absolute estimate error profiles of the seven improving patients became similar to the profiles of healthy athletes, while these changes could not be observed in the case of the three non-improving participants. Proprioceptive rehabilitation programme can be an effective method in order to improve impaired joint position sense function. After 6 weeks non-responding patients can be well identified, and considered for other treatment modalities. The determination of the effective length of the programme however needs further evaluation. Still, changes in the proprioceptive sensory function of the ankle plantarflectors indicate the preventive effect of the training programme. Furthermore, our results support the theory of simultaneous function of different mechanoreceptor-systems.

Background: The security of the graft fixation is an important factor of anterior cruciate ligament reconstruction, especially in the early postoperative period., Hypothesis: The femoral press-fit fixation technique is a safe, alternative technique for the fixation of the bone-patellar tendon-bone graft., Study Design: Case series; Level of evidence, 4., Methods: Between January 1, 1998, and June 30, 2002, 285 patients, with a mean age of 29.1 years, underwent operation and observation in our department. All patients had arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft with femoral press-fit and tibial interference screw fixation. The mean follow-up period was 35.8 months (range, 24-77 months). During each patient's evaluation, a physical examination, a subjective evaluation, the International Knee Documentation Committee and Lysholm scores, KT-1000 arthrometer testing, and radiological evaluation were performed. The paired Student t test or chi(2) test was used for statistical analysis., Results: According to the International Knee Documentation Committee score, 241 patients (85%) had good (46 normal and 195 nearly normal) results, whereas 39 patients had abnormal and 5 patients had severely abnormal overall results. The preoperative mean Lysholm score was 63.5 +/- 12.7 points. At the final examination, the mean value was 93.5 +/- 7.8 points (P < .01). One hundred ninety-seven athletes could return to their previous sports activity level, whereas 13 patients gave up their sports career. The KT-1000 arthrometer results showed a side-to-side difference of 1.91 +/- 2.1 mm at the maximum manual strength tests., Conclusion: The femoral press-fit fixation is an alternative fixation method for the bone-patellar tendon-bone graft and provides good stability for the anterior cruciate ligament reconstruction. The use of press-fit fixation technique avoids most interference screw or other hardware-induced complications at the femoral side.

Background: None of the genetic markers are selectively associated with elite athletes, but potential candidates are found in the renin-angiotensin system, which plays a key role in the regulation of cardiovascular physiology. The most extensively examined gene in connection with the hemodynamics category is the angiotensin converting enzyme (ACE). This review paper has focused on ACE I/D allele polymorphism regarding the evidence of the effects of physiological and pathophysiological drugs and has completed with an original work in the exercise physiology., Methods: In this study we examined genetic polymorphisms of ACE in female (n=26) and male (n=24) athletes as well as in a well-trained control group (n=24). MVV(ex), VE and VO(2max) were determined at rest and during an exhaustive step test., Results: The frequency of the ACE I allele was significantly higher (p<0.041) in the group showing a higher intensity of breathing metabolism. The ACE D allele frequency was significantly higher in the excellent endurance athletes group than in unsuccessful athletes (p<0.054)., Conclusion: The ACE I allele is a genetic marker for higher endurance efficiency in acute physical activity and higher adaptation of the cardiovascular system. The measurement of acute physical status needs to be completed with examination of genotype, which is related to the athletic excellence also, because the D allele could be associated with good performance by endurance athletes in future world championships. Further studies are needed to assess the view that the ACE D allele has a significant role in athletic efficiency.

Background: A search of the literature shows that the effect of surgery on ankle proprioception has been hardly investigated., Objective: To examine the effect of anatomical reconstruction of the anterolateral capsuloligamentous complex on ankle joint position sense., Methods: A prospective study using the "slope box" test. Ten consecutive patients were included in the study, and 10 healthy athletes represented the control group., Results: Similar test-retest reliability rates (overall reliability 0.92; p = 0.0013) were obtained to those of the original designers of the method. There were no significant differences with respect to side dominance (p = 0.9216). Investigation of the characteristics of mean absolute estimate errors showed that the controls tested became error prone in the range of slope altitudes 7.5-25 degrees in every direction, compared with the range 0-5 degrees (range of p values 0.00003-0.00072). The results of the intervention group showed that, for the two main directions of interest (anterior and lateral), preoperative differences in mean absolute estimate errors between injured (anterior 3.91 (2.81) degrees ; lateral 4.06 (2.85) degrees ) and healthy (anterior 2.94 (2.21) degrees , lateral 3.19 (2.64) degrees ) sides (anterior, p = 0.0124; lateral, p = 0.0250) had disappeared (postoperative differences: anterior, p = 0.6906; lateral, p = 0.4491). The afflicted ankle had improved significantly after surgery in both important directions (anterior, p<0.0001; lateral, p = 0.0023)., Conclusions: The study shows that differences in joint position sense between healthy and injured ankles disappeared as the result of surgery. Preoperative data show that proprioceptive malfunction is a cause of functional instability. If treatment is by means of surgery, the retensioning of the original anterolateral structures is inevitable, even if other grafting or surgical techniques are used.

We have tested the hypothesis that training with moderate- (MT), strenuous- (ST), or over- (OT) load can cause alterations in memory, lipid peroxidation, protein oxidation, DNA damage, activity of 8-oxoG-DNA glycosylase (OGG1) and brain-derived neurotrophic factor (BDNF), in rat brain. Rat memory was assessed by a passive avoidance test and the ST and OT group demonstrated improved memory. The content of BDNF was increased only in the OT group. The oxidative damage of lipids and DNA, as measured by thiobarbituric acid reactive substances (TBARS), and 8-hydroxydeoxyguanosine (8-OHdG), did not change significantly with exercise. Similarly, the activity of DNA repair enzyme, 8-oxoguanine DNA glycosylase (OGG1), was not altered with exercise training. On the other hand, the content of reactive carbonyl derivatives (RCDs) decreased in all groups and the decrease reached significance levels in the ST and OT groups. The activity of the proteasome complex increased in the brain of OT. The findings of this study imply that over-training does not induce oxidative stress in the brain and does not cause loss of memory. The improved memory was associated with enhanced BDNF content.

Chronic swimming training and phytotherapeutic supplementation are assumed to alleviate oxidative damage, and support cell survival in the brain. The effect of forced, chronic swimming training, and enriched lab chow containing 1% (w/w) dried nettle (Urtica dioica) leaf were investigated for oxidative stress, inflammation and neurotrophic markers in Wistar rat brains. The rats were divided into groups subjected to swimming training (6 weeks) or to nettle supplementation (8 weeks) or to a combination of these two treatments. The level of oxidative stress was measured by electron spin resonance (EPR), and by the concentration of carbonylated proteins. Nettle supplementation resulted in a decreased concentration of free radicals in both cerebellum and frontal lobe. Swimming, however, did not influence significantly the oxidative damage nor was it reflected in the carbonyl content. The protein content of nerve growth factor (NGF), and brain-derived neurotrophic factors (BDNF) was evaluated by E-Max ImmunoAssay in the cerebellum. No changes occurred either with exercise or nettle diet treatments. On the other hand, nuclear factor kappa B (NF-kappaB) binding activity to DNA increased with the combined effect of swimming training and nettle diet, while the activator protein1 (AP-1) DNA binding activity showed a more profound elevation in the nettle treated animals. The amount of c-Jun decreased by swimming training. In conclusion, the results suggest that both exercise and nettle influenced physiological brain functions. Nettle supplementation reduces the free radical concentration and increases the DNA binding of AP-1 in the brain. Nettle was found to be an effective antioxidant and possible antiapoptotic supplement promoting cell survival in the brain. Exercise, as a downregulator of c-Jun and in combined group as an upregulator of NF-kappaB, may play also a role in antiapoptotic processes, which is important after brain injury.

Physical exercise above a certain load has been suggested as being a cause of oxidative stress. We have tested whether training with moderate (MT), strenuous (ST), or over (OT) load can cause alterations in the activities of antioxidant enzymes, lipid peroxidation, protein oxidation, DNA damage, or activity of 8-oxoG-DNA glycosylase (OGG1) in rat liver. The levels of corticosterone decreased in all exercising groups but the differences were not significant. Adrenocorticotrophin hormone (ACTH) levels decreased, not significantly, in MT and OT compared to C. Activity levels of antioxidant enzymes did not change significantly in the liver. The levels of reactive carbonyl derivative (RCD) content decreased in the liver of exercising animals, and the differences reached significance between control and moderately trained groups. The changes in the levels of lipid peroxidation (LIPOX) were not significant, but were lower in the exercised groups. The 8-hydroxydeoxyguanosine (8-OHdG) levels increased in the OT group, and the activity of OGG1 measured from crude cell extracts tended to increase in MT and ST. The findings of this study imply that overtraining induces oxidative damage to nuclear DNA, but not to liver lipids and proteins.

Introduction: The histological properties of the femoral press-fit fixation in anterior cruciate ligament reconstruction have not been extensively examined. The purpose of the study was to analyse the histological properties of the bone-patellar tendon graft in the bone tunnel area during the early stages of healing in an animal model. Furthermore the authors wanted to draw conclusions for the postoperative rehabilitation program on the basis of their data., Material and Methods: ACL reconstruction was performed in pigs using femoral press-fit fixation. After 3 and 6 weeks the incorporation of the bone block in the femur in 2 pigs was histological and radiological evaluated., Results: After 3 and 6 weeks the examination showed almost similar histology on the bony side the grafts except (1) a higher amount of fibrotic tissue in-between the lamellae of the inserted patellar bone after 6 weeks, (2) the presence of direct osseous unions between the two lamellar systems and (3) thicker lamellae at the base than toward the condylar tissue., Conclusions: Concerning the progression of graft healing by histological findings our study showed, that after 6 weeks the femoral press-fit fixation appear to have good incorporation after ACL reconstruction.

In this experimental study, the authors evaluated the biomechanical properties of the femoral press-fit graft fixation technique in ACL reconstruction. 20 fresh frozen distal femurs, patellae and patellar ligaments were used from 10 cadaver specimens. Three bone-patellar tendon grafts of 10 mm width were prepared from each sample; altogether 60 bone-patellar tendon grafts were prepared for the experiment. Three 9 mm wide tunnels were drilled in each distal femur at different angles (0, 15, 30, 45, and 60 degrees). This means that 60 tunnels were drilled into the 20 femurs, 12 at each angle. The trapezoid bone blocks were impacted into the holes. The primary stability and stiffness of this press-fit fixation method were measured with a Zwick 020 computer-controlled testing device using maximum-failure tensile-strength tests. The ultimate tensile strength was the greatest at 45 degrees (534+/-20 N, range 507-554), with 118+/-10 N/mm (range 99-126) stiffness, followed by 485+/-35 N (range 416-510) with 122+/-13 N/mm (range 104-136) stiffness at 30 degrees, 353+/-18 N (range 320-371) with 113+/-13 N/mm (range 83-124) stiffness at 15 degrees, and 312+/-30 N (range 261-343) with 89+/-14 N/mm (ranged:68-103) stiffness at 0 degrees. In the cases of 0, 15, 30 and 45 degrees the bone blocks were pulled out of the drilled holes, but at 60 degrees rupture of the patellar tendon or breakage of the bone block occurred more frequently. It can be seen that the ultimate tensile strength increased with the angle between the loading direction and the bone block. When compared to data in the literature, these data showed similar and satisfying biomechanical properties of femoral press-fit fixation. Because of the known advantages of an implantation-free fixation technique, the femoral press-fit fixation technique can be a good alternative in ACL surgery. These results provide the basis for future studies involving the postoperative healing process of this femoral press-fit fixation technique in porcine knees.

Introduction: Disorders around the patella are the most frequent knee complaints seen in adolescents. In the literature many intrinsic and extrinsic risk factors have been linked to Patellofemoral Pain Syndrome (PFPS), but the role of these risk factors is controversial., Aim: The goal of this study was to evaluate the prevalence of PFPS in a group of adolescents aged 12-20 years in Hungary, and to gain more information on the relationship between the biomechanical anomalies of the lower extremity and the PFPS., Material and Methods: In this epidemiological study the authors investigated the effect of sporting activity in the maturation of symptoms among 586 randomly selected students. Different physical examinations, anthropometric measurements, stability tests, footscan analysis were performed., Results: Concerning the prevalence of this syndrome they could not find any differences between males (n = 60, 20.41%) and females (n = 61, 20.89%). The authors could not identify any statistically significant intrinsic risk factors, although changes in the Q angle may be linked to increased prevalence of PFPS. The study supports the theory of the importance of "overload", for there was a significant correlation between the prevalence of PFPS and the different levels of sporting activities (competitive, recreational and non-athletes)., Conclusion: The authors concluded that the prevalence of PFPS among Hungarian students is 20.65%.

Background: Tegner and Lysholm described their generally acknowledged activity score in 1985. It was originally tested for knee ligament injuries, but for the past 17 years it has been used for other joint evaluations as well. The development of already existing and new kinds of sports, differences between knee and ankle loading, and different injury rates provided reasons for developing an ankle-specific activity score., Hypothesis: The new score should have a higher reliability, validity, and sensitivity than the Tegner score when evaluating ankle-related activity changes., Study Design: Methodological study., Methods: Fifty-three sports, 3 working activities, and 4 general activities were inserted into a 0-to-10 category system based on the rankings of a 7 x 2-point pre-evaluation system, followed by a direct comparison with the Tegner score and reliability, validity, and sensitivity testing on 2 different patient populations., Results: In direct comparison, there is a strong overall correlation of the 2 activity-scoring systems (r = 0.7565), but the ankle activity score proved to be different from the Tegner score in the higher categories, especially in the top 4 ankle score categories (r = 0.1450). Further tests demonstrated the high reliability (1.00) of the new score. Analysis of variance proved that activity changes measured by the ankle score correspond well to the difference between the patients' subjective results and their Karlsson functional scores (P =.0119). This is not the case when we measure ankle activity changes using the knee-specific Tegner score (P =.0987). Furthermore, ankle score differences spread over a wider range (-1.18 +/- 2.12) than did Tegner score differences (-0.68 +/- 1.29), which demonstrates the higher sensitivity of the new score., Conclusions: Based on these results, the new ankle activity score could be a better complement in the complex evaluation of ankle instability.

One hundred and fifty six patients were treated using the modified double suture technique for percutaneous Achilles tendon repair between 1994 and 1998. Endoscopy was used in 67 cases. The first ten cases were dropped (learning curve), 57 were followed (E-group). Percutaneous suture without endoscopy was performed in 89 patients. Two could not be followed (went abroad), so this group consists of 87 patients (P-group). Mean age: E-group 37.8 (22-60) years, P-group 38.9 (20-68) years. Male-female ratio: E 49/8, P 74/13. There were 54 and 83 athletes in groups E and P respectively. Follow-up period was 12-60 months. Overall re-rupture rate was 6/144 (4.2%). Two total and 3 partial re-ruptures were in the P-group, and 1 partial was in the E-group. Fusiform thickening of the tendon (delayed healing) occurred in 4 cases in each group. The mean plantar flexion strength compared with the non-affected side was 89% in the P-group and 86% in the E-group. The length of time before returning to sports activity ranged from 4 to 6 months after surgery in both groups. Subjective results were excellent to good in 88% (P-group) and in 89% (E-group) of the cases. On the basis of the results, the percutaneous double suture technique proved to be a simple and safe method for Achilles tendon repair with or without the use of an endoscope. The re-rupture rate was lower in the endoscopic controlled group. The basic goal of the endoscopy was to control the adaptation of the tendon ends. This method yielded further operative possibilities and benefits as well.

Background: In normal conditions, proteins are not present in the urine, however, exercise of long duration could result in proteinurea. Increased levels of reactive oxygen and nitrogen species (RONS) are formed during exhaustive physical exercise and causes alterations to cellular proteins., Materials: In the present study serum and urinary nitrotyrosine and protein carbonyl levels were measured before and after each run of a 4-day super-marathon race., Result: Serum nitrotyrosine and protein carbonyl levels increased after the first (93 km) day running and reached a plateau on the second (120 km), third (56 km) and forth (59 km) days of the competition. A significant correlation was found between urinary and serum protein carbonyl and nitrotyrosine levels (r=0.78, r=0.71, respectively). A large percentage of urinary proteins were carbonylated and nitrated. Therefore, it appears that clearance of oxidized proteins in certain conditions occurs not only by the proteolytic pathways but also by filtration and urination., Conclusion: Data reveals that exhaustive aerobic exercise causes oxidative stress and increases the nitration and carbonylation of serum proteins. The presence of carbonyl and nitrotyrosine in proteins of the urine might reflect oxidative stress and could serve as a noninvasive diagnostic tool for exercise physiology.

Reactive oxygen and nitrogen species generated either as products of aerobic metabolism or as a consequence of environmental mutagens, oxidatively modify DNA. Formamidopyrimidine-DNA glycosylase (Fpg) and endonuclease III (endo III) or their functional mammalian homologues repair 7,8-dihydro-8-oxoguanine (8-oxoG) and damaged pyrimidines, respectively, to curb the deleterious effects of oxidative DNA alterations. A single bout of physical exercise can induce oxidative DNA damage. However, its effect on the activity of repair enzymes is not known. Here we report that the activity of a functional homolog of Fpg, human 8-oxoG DNA glycosylase (hOGG1), is increased significantly, as measured by the excision of 32P labeled damaged oligonucleotide, in human skeletal muscle after a marathon race. The AP site repair enzyme did not change significantly. Despite the large individual differences among the six subjects measured, data suggest that a single-bout of aerobic exercise increases the activity of hOGG1 which is responsible for the excision of 8-oxoG. The up-regulation of DNA repair enzymes might be an important part of the regular exercise induced adaptation process.

Unlabelled: The authors have reported the experiences at femoral press-fit fixation technique used in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft. Their surgical technique have been described and early results have been compared with those from anterior cruciate ligament plasties with the interference screw fixation technique during a prospective study., Patients and Methods: 665 anterior cruciate ligament reconstructions were performed between September 1997 and August 1999 at the Department of Sports Surgery of the National Institute for Sports Medicine. 418 of them were operated on by transtibial technique using free bone--patellar tendon--bone autografts with 265 femoral press-fit and 153 interference screw fixations. 110 patients from the press-fit and 72 from the interference screw group could be followed-up (average follow-up period: 19 months). Physical examination, evaluation by International Knee Documentation Committee and Lysholm scores, radiology, and stability test by KT-1000 arthrometer were used as follow-up tests with statistical comparison., Results: According to the International Knee Documentation Committee score, 77% of the patients with the interference screw and 87% of the patients from the press-fit group turned out to get to the normal or nearly normal categories. Neither the Lachman, anterior drawer and pivot shift tests, nor the results of the KT-1000 measurements have shown statistically significant difference between the two groups of patients. Mild (3-5 degrees) extension deficit has been detected at 14% of the patients with interference screw and 8% of the patients in the press-fit group. Mild (6-15 degrees) flexion deficit has been observed at 22% of the patients with interference screw and 24% of the patients from press-fit group with moderate (16-25 degrees) of flexion deficit at 4% of the patients. The subjective opinions of more than 90% of the patients were that the operation proved to be excellent or good. Based on the functional and stability data of the follow-up study, 87% of the patients operated on with femoral press-fit autograft fixation technique for their anterior cruciate ligament have shown excellent or good results., Conclusions: When compared with the interference screw technique well-accepted in the literature, no statistically significant difference could be found, therefore this method can be recommended as alternative one for the femoral fixation of the anterior cruciate ligament graft.

The application of gene therapy to sports medicine is in its infancy, but it holds much promise as a novel procedure to improve the clinical management of sports injuries. Gene therapy will be particularly useful in initiating and accelerating the repair of cartilage, meniscus, tendon, and ligament. Several growth factors and other cytokines have been identified as important mediators of a successful healing process. Such molecules have promise as novel agents for the treatment of sports injuries, but there is presently no clinically useful way to deliver them. Gene transfer may be used to serve this purpose. Gene therapy functions as a type of local biological drug delivery system. Recent studies have shown the feasibility of transferring marker genes to synovium, chondrocytes, meniscal fibrochondrocytes, tenocytes and ligamental fibroblasts, prompting optimism about the eventual success of this approach.

Introduction: Based on the literature data in the last ten years the endoscopic carpal tunnel release seems to be an advantageous alternative method in the treatment of carpal tunnel syndrome., Aims: Based on minimum 5 year follow-up the authors report the long-term results of endoscopic surgery introduced since 1993., Patients and Methods: On 46 hand of 42 patients endoscopic procedure was performed. Thirty-two patients returned to follow-up, they filled out questionnaire, underwent physical examination and 15 patients had electrophysiological test., Results: Twenty-eight patients were without any complaints and symptoms, 3 patients had thenar atrophy. One patient was reoperated on because of residual symptoms. The authors make a comparison between their data and the great experienced Chow's results and they review the literature data of open procedure., Conclusions: They conclude that the long-term results of the endoscopic surgery are similar to the outcome of the open procedures. The electrophysiologic tests have not always any relationship with the patient's complaints and symptoms.

Complete rupture of the pectoralis major muscle, first described by Patissier in 1822, is a rare sports injury. Less than 100 cases have been reported in the literature since 1822. In this study, we describe our surgical technique and summarize our results and experience of the surgical treatment of pectoralis major rupture. Seven athletes (4 wrestlers, 2 handball players, 1 body-builder) were surgically treated in our department from 1981 to 1996. During the follow-up examination, five patients had excellent and two had good results, and six athletes could return to sports activity at their preoperative level. Among our patients we emphasize that of a wrestler, who had suffered an acute rupture, and 3 months after the surgery he won an Olympic gold medal. According to the literature and our experience, we suggest that only surgical repair of the acute pectoralis major rupture will result in both complete recovery and restoration of the full strength of the muscle, essential for active athletes.

Authors treated 34 patients from 1989 to 1992 with restricted knee movements in the Department of Sport Medicine. The average age of the patients was 32 years, the youngest was 16 and the eldest was 54 years old, and the female male ratio was 14/20. 71% of the patients had some kind of ligament surgery in the past. Arthrolysis was performed in 24 cases. 13 cases out of 24 was performed arthroscopically and the rest was done following arthrotomy. Manipulation under anaesthesia was satisfactory in 5 cases, 4 patients had combined treatment and 1 had extraarticular intervention only. The range of motion was 0-11-81 degrees to start with, and it has improved up to 0-2-124 degrees in average 13 month time following the arthrolysis. There was correlation between the restriction and between the time of primary ligament reconstruction, the sex and the age of the patients. To perform the arthrolysis in time is important and the physiotherapist and the constant passive motion is inevitable.

A new, simple kinetic method is described for the determination of serum cholesterol based on the oxidation of 2,2'-azino-di-3[ethyl-benzthiazolin sulfonic acid (6)] (ABTS) by use of a single aqueous reagent. This assay procedure is rapid, specific, reproducible and applicable to the measurement of free and esterified cholesterol in a continuous procedure. The method requires no prior treatment of sample and linear kinetics are obtained up to 13 mmol/l cholesterol. The use of ABTS permits the direct calculation of cholesterol concentrations from absorbance changes at 410 nm (A = epsilon - c - d).

A simple kinetic method for the determination of free and esterified serum cholesterol based on the oxidation of 2,2'-azino-di(3-ethyl-benzthiazoline-6-sulfonate) (ABTS) by use of choilesterol esterase, cholesterol oxidase and peroxidase has already been reported. Here the method is statistically examined. The method is very sensitive and precise (C.V. below 5%). The standard curve is linear up to 25.9 mmol/l. Comparison with results by Abell's method gave a linear regression of Yx = 0.2025 + 1.0043X with a correlation coefficient (r) of 0.983. Comparison with the enzymic methods of Roeschlau et al., Trinder, and Allain et al. gave Yx = 0.2037 + 0.9549X (r = 0.975), Yx = 0.4777 +0.8857X (r = 0.958) and Yx = 0.244 + 0.932X (r = 0.970), respectively. The effects of haemoglobin and bilirubin were studied and normal ranges for the method were determined on 150 healthy mature subjects of both sexes between 20 and 45 years of age. They are 3.375 to 6.948 mmol/l for total cholesterol, and 0.7196 to 2.089 mmol/l for free cholesterol.

A simple and rapid method for the synthesis of 3-chloromercury-2-hydroxipropyl-urea has been described. It has been concluded that highest yields are obtained by the synthesis of 197HgO and allyl urea in the ratio of 2.5 : 1. Stability of the final preparation was investigated after thermal sterilization and standing at room temperature. It has been proved that the inorganic mercury-197 is not released. Radiochemical purity was controlled by chromatographic method using pyridine, n-butanol and water (3 : 10 : 3 v/v) as a solvent. The results obtained indicate that the preparation is applicable for human use.

The chromogen ABTS is the di-ammonium salt of 2,2'-azino-di[3-ethyl-benzthiazolin-sulfonic acid (6)] routinely used in the "glucose-oxidase assay" with the peroxidase (GOD-Perid method, Boehringer). 1. The specific property of ABTS to give a stable radical cation by oxidation with hydrogen peroxide in the presence of peroxidase was used to design a kinetic method, for enzyme-activity determinations. 2. The assay is suitable for the specific oxido-reductase using oxygen as acceptor, known also as "aerobic transhydrogenases" which are H2O2 formers (EC 1.-.3.-). 3. L-Amino acid: oxygen oxidoreductase (deaminating) (EC 1.4.3.2), was used throughout, being a representative model for such determinations.

On the Traumatological Orthopaedic Surgery Department of the Hungarian National Institute of Physical Education and Sports Hygiene 1629 arthroscopic operations of the knee joint were made between 1984-87. From these arthroscopic meniscectomy was made in 543 cases. A follow up study was performed in 302 arthroscopic meniscectomised and in 326 traditionally operated patients from the point of view of objective therapeutic results, hospitalization, convalescence and economic efficacy as well. The average follow up period was 8.2 months. The objective estimation of the therapeutic result was made by Lysholm score and Tapper-Hoover's functional classification. The mean hospitalization was 2 days after arthroscopic meniscectomy and 7 days following the traditional meniscectomy respectively. Twenty days shorter convalescence was observed in the arthroscopic meniscectomy cases. The patients were able to start regular physical activity 43 days earlier than traditionally operated athletes. The difference in Lysholm scores was 12 in favour of arthroscopic operations. On basis of the above considerable several millions reduction of expenses could be revealed what evidently proved the economic efficacy of arthroscopy.

A spectrophotometric method for the determination of serum uric acid based on the oxidation of 2,2'-azino-di(3-ethylbenzthiazoline-6-sulphonate) by use of uricase and peroxidase has already been reported. The method is very precise (CV less than 4.7%). The standard curve is linear up to 4640 mumol/L. Comparison with other enzymatic methods gave good correlation. The method gave results 9% lower than the phosphotungstate method. The effects of bilirubin, haemoglobin, glucose, ascorbic acid, anticoagulants and purine compounds were studied. The reference values for this method are 140.8-407.8 mumol/L for female subjects and 145.6-514.7 mumol/L for male subjects.

The determination of the activity of alkaline phosphatase (AP)--orthophosphate-monoesterphosphohydrolase, EC.3.1.3.1.--and alanine-aminopeptidase (ANA)--alpha-aminoacyl-peptide hydrolase (microsomal), EC.3.4.11.2--in the serum of non-gravid and gravid women has shown that in non-gravid women normal ANA values range from 17.0 to 32.0 I. U. and normal AP values from 14.4 to 26.0 I. U., the ANA/AP quotient amounting to 1.28 (S = +/- 0.301 I. U., KV = 23.5%, n = 29). The determination of the activity of the above quoted enzymes has shown that in the course of pregnancy the values of both enzymes increased by the exponential curve which allowed the calculation of the ANA/AP quotient for each month of pregnancy. The ANA/AP quotient determined in this way is proposed to serve as a diagnostic parameter in the routine control of pregnant women.