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Andreas Nikolis,1,2 Luiz Eduardo Toledo Avelar,3 Alessandra Haddad,4 Stephanie Chuk Kwan Lam,5 Andrei Metelitsa,6 Heidi B Prather,7 Frank Rosengaus,8 Kaitlyn M Enright,1 Desislava Ognyanova Lazarova,9 Inna Prygoya,10 Fabio Iachetti10 1Clinical Research Unit, Erevna Innovations Inc, Westmount, Quebec, Canada; 2Department of Plastic Surgery, McGill University, Montreal, Quebec, Canada; 3Clinica Domani Luiz Avelar, Belo Horizonte, Minas Gerais, Brazil; 4Federal University of São Paulo and Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; 5Central Health Medical Practice, Hong Kong, People’s Republic of China; 6Department of Dermatology, University of Calgary, Alberta, Canada; 7Westlake Dermatology, Austin, TX, USA; 8Dr. Rosengaus Clinic, Mexico City, Mexico; 9Galderma SA, Lausanne, Vaud, Switzerland; 10Galderma, Uppsala, SwedenCorrespondence: Andreas Nikolis, Email research@vicpark.comPurpose: Optimizing outcomes of aesthetic treatments with injectable products usually requires a consideration of the entire face to ensure balance, along with combination treatments that align with the patient’s goals. To help injectors, a method of assessing the patient and developing an individualized, holistic treatment plan was developed. This methodology is termed Assessment, Anatomy, Range, and Treatment (AART™) and Holistic Individualized Treatments (HITs™). This article aims to describe and evaluate the novel and systematic AART-HIT™ methodology.Methods: The AART-HIT™ methodology, including its associated diagnostic tool the Facial Assessment Scale (FAS™), were developed to aid injectors in completing a patient assessment in which the entire face is evaluated, the relevant anatomy is considered, the science behind the available range of products is understood, and the treatment plan is individualised for the patient. Specifically, the HITs™ are methodologic tools for practitioners to perform a standardized, full facial assessment and to create an individualized treatment approach to holistically address a patient’s aesthetic concerns. The use of this methodology in clinical practice was assessed via a survey, deployed to twenty-eight clinicians.Results: Over 85% of participants agreed that the AART-HIT™ methodology was adequate for their needs. Additionally, 100% of participants agreed that the temporal sequencing of HITs™ and the FAS™ diagnostic tool was useful in clinical practice. Furthermore, over 70% of participants agreed that the anatomical locations identified in each HIT™ were sufficient, while over 80% responded that the HITs™ adequately represented the range of products. Finally, over 85% of participants agreed that the HITs™ covered different ethnic skin types and various patient ages and, over 80% of participants responded that they would not add additional elements to any of the 5 HITs™.Conclusion: The AART-HIT™ methodology, including the FAS™ were comprehensive enough for clinical use in providing a personalised treatment plan for individual patients.Keywords: fillers, biostimulators, neuromodulators, hyaluronic acid, education, treatment techniques

An 8-wk study of the effects of CLA, rendered animal fats, and ractopamine, and their interactive effects on growth, fatty acid composition, and carcass quality of genetically lean pigs was conducted. Gilts (n = 228; initial BW of 59.1 kg) were assigned to a 2 x 2 x 3 factorial arrangement consisting of CLA, ractopamine, and fat treatments. The CLA treatment consisted of 1% CLA oil (CLA-60) or 1% soybean oil. Ractopamine levels were either 0 or 10 ppm. Fat treatments consisted of 0% added fat, 5% choice white grease (CWG), or 5% beef tallow (BT). The CLA and fat treatments were initiated at 59.1 kg of BW, 4 wk before the ractopamine treatments. The ractopamine treatments were imposed when the gilts reached a BW of 85.7 kg and lasted for the duration of the final 4 wk until carcass data were collected. Lipids from the belly, outer and inner layers of backfat, and LM were extracted and analyzed for fatty acid composition from 6 pigs per treatment at wk 4 and 8. Feeding CLA increased (P < 0.02) G:F during the final 4 wk. Pigs fed added fat as either CWG or BT exhibited decreased (P < 0.05) ADFI and increased (P < 0.01) G:F. Adding ractopamine to the diet increased (P < 0.01) ADG, G:F, and final BW. The predicted carcass lean percentage was increased (P < 0.05) in pigs fed CLA or ractopamine. Feeding either 5% fat or ractopamine increased (P < 0.05) carcass weight. Adding fat to the diets increased (P < 0.05) the 10th rib backfat depth but did not affect predicted percent lean. Bellies of gilts fed CLA were subjectively and objectively firmer (P < 0.01). Dietary CLA increased (P < 0.01) the concentration of saturated fatty acids and decreased (P < 0.01) the concentration of unsaturated fatty acids of the belly fat, both layers of backfat, and LM. Ractopamine decreased (P < 0.01) the i.m. fat content of the LM but had relatively little effect on the fatty acid profiles of the tissues compared with CLA. These results indicate that CLA, added fat, and ractopamine work mainly in an additive fashion to enhance pig growth and carcass quality. Furthermore, these results indicate that CLA results in more saturated fat throughout the carcass. Key words: conjugated linoleic acid, dietary fat, fatty acid, pig growth, ractopamine

Kaitlyn M Enright,1 Steven F Weiner,2 Kalpna K Durairaj,3 Mirko S Gilardino,4 Andreas Nikolis5 1Clinical Research Unit, Erevna Innovations Inc, Westmount, Quebec, Canada; 2The Aesthetic Clinique, New York, NY, USA; 3Beauty by Dr. Kay, Pasadena, CA, USA; 4Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada; 5Clinical Research Unit, Erevna Innovations Inc, Westmount, Quebec, Canada; Department of Plastic Surgery, McGill University, Montreal, Quebec, CanadaCorrespondence: Kaitlyn M Enright, Clinical Research Unit, Erevna Innovations Inc, 376 Victoria Ave., Suite 400A, Westmount, QC, H3Z 1C3, Canada, Tel +1 514-488-0163 Ext 256, Email research@vicpark.comBackground: Hyaluronic acid (HA) fillers are used to treat an array of aesthetic indications. Proper filler selection is paramount for successful patient outcomes. However, many important physiochemical and physical properties that impact HA gel behavior remain undefined.Purpose: To evaluate the hydrophilicity, cohesivity and particle size of eight commercial HA fillers manufactured by either Non-Animal Stabilized Hyaluronic Acid (NASHA) or Optimal Balance Technology (OBT) techniques.Methods and Materials: Three individual in vitro experiments were performed to assess HA swelling capacity, cohesion, and particle size. Image analyses, blinded evaluation using the Gavard-Sundaram Cohesivity Scale, and laser diffraction technology were utilized, respectively.Results: Compared to fillers manufactured with NASHA technology, OBT products demonstrated greater swelling capacity, cohesion, and wider particle size distributions. Strong positive correlations between swelling factor, degree of cohesivity, and increasing widths of the particle size distributions were observed.Conclusions: The hydrophilicity, cohesivity and particle size distributions vary among HA fillers manufactured with different techniques. The creation of new labels identifying products based on their unique combination of physiochemical and physical characteristics may help guide appropriate selection of HA fillers to optimize patient outcomes.Keywords: Optimal balance technology, OBT, Non-animal stabilized hyaluronic acid, NASHA, aesthetics

Andreas Nikolis,1,2 Luiz E Avelar,3,4 Kaitlyn M Enright2 1Division of Plastic Surgery, McGill University Health Center, Montreal, QC, Canada; 2Erevna Innovations Clinical Research Unit, Montreal, QC, Canada; 3Department of Forensic Anthropology, Civil Police Department, Minas Gerais, Brazil; 4Private Practice, Belo Horizonte, BrazilCorrespondence: Andreas NikolisErevna Innovations Clinical Research Unit, Montreal, QC, CanadaEmail anikolis@vicpark.comBackground and Objective: Poly-L-lactic acid (PLLA) has been used in various medical applications for decades, including aesthetic ones. The use of a cannula technique in injecting PLLA has been proposed in order to lower the incidence rate of adverse events (AEs) following treatment. Such AEs include nodule formation, which may occur less frequently by fanning the product with a cannula, thus creating a more uniform product placement compared to that resulting from the use of a needle. Currently, however, there is a lack of comparative research regarding the safety of cannulas versus needles for PLLA injections, as the selection of either remains highly subjective. Therefore, the objective of our study was to investigate the safety of cannula use in the administration of PLLA, in order to report safety outcomes.Materials and Methods: A single-center, retrospective chart review was conducted to examine the data of patients who had previously undergone treatment with PLLA in the form of Sculptra® Aesthetic™ in the face and/or neck regions. Twenty-seven subject charts met eligibility. Descriptive data regarding treatment and follow-up visits were collected and analyzed.Results: A total of seven AEs resulted from eighty-two treatment sessions (8.54%), with 6/27 patients having experienced at least one AE (22.22%). Mild bruising was the most commonly reported AE (57.14%). The majority of the AEs were mild and transient in nature, with one moderate AE being a nodule that was possibly related to a concomitant treatment. All AEs were resolved with follow-up care.Conclusion: Mild AEs such as bruising, swelling and pain should be expected following the use of a cannula for PLLA injections. However, the incidence rates of AEs following treatment can remain low if proper product preparation and treatment techniques are utilized.Keywords: poly-L-lactic acid, adverse events, cannula, injection techniques, antiaging

Background We used administrative health data to explore the impact of primary care physician (PCP) visits on acute-care service utilization by women receiving adjuvant chemotherapy for early-stage breast cancer (EBC). Methods Our population-based retrospective cohort study examined PCP visits and acute-care use [defined as an emergency room (ER) visit or hospitalization] by women diagnosed with EBC between 2007 and 2009 and treated with adjuvant chemotherapy. Multivariate regression analysis was used to identify the effect of PCP visits on the likelihood of experiencing an acute-care visit. Results Patients receiving chemotherapy visited a PCP significantly more frequently than they had before their diagnosis [relative risk (RR): 1.48; 95% confidence interval (ci): 1.44 to 1.53; p < 0.001] and significantly more frequently than control subjects without cancer (RR: 1.51; 95% ci: 1.46 to 1.57; p < 0.001). More than one third of PCP visits by chemotherapy patients were related to breast cancer or chemotherapy-related side effects. In adjusted multivariate analyses, the likelihood of experiencing an er visit or hospitalization increased in the days immediately after a PCP visit (RR: 1.92; 95% ci: 1.76 to 2.10; p < 0.001). Conclusions During chemotherapy treatment, patients visited their PCP more frequently than control subjects did, and they visited for reasons related to their breast cancer or to chemotherapy-related side effects. Visits to a PCP by patients receiving chemotherapy were associated with an increased frequency of ER visits or hospitalizations in the days immediately after the PCP visit. Those results suggest an opportunity to institute measures for early detection and intervention in chemotherapy side effects. [ABSTRACT FROM AUTHOR]

Andreas Nikolis,1–4 Kaitlyn M Enright1,3–5 1Victoria Park Medispa, Montreal, QC, Canada; 2Department of Plastic Surgery, Université de Montreal, Montreal, QC, Canada; 3VP Research Unit, Montreal, QC, Canada; 4Erevna Innovations Inc., Montreal, QC, Canada; 5Department of Experimental Surgery, McGill University, Montreal, QC, Canada Background: Loss of the viscoelastic properties of the skin is a primary sign of aging and contributes to the appearance of wrinkles. Hyaluronic acid (HA) fillers are one of the most commonly used treatments for age-related soft-tissue reduction and volume loss. Evidence is also emerging that HA fillers rejuvenate the skin.Methods: A retrospective chart review was completed on 20 subjects treated with small particle HA (SP-HA), to investigate its effects on skin properties. Subjects having received three treatments in the face, neck, and/or hands were considered in the analyses. Skin hydration, trans-epidermal water loss (TEWL), and pH were assessed at baseline (injection #1), Week 4 (injection #2), Week 8 (injection #3), and Week 12 (follow-up).Results: Treatment with SP-HA significantly improved hydration levels in the face, neck, and hands. Significant results were seen in the face following the first three treatments, with subjects moving up to the next hydration level (ie, hydration went from dry to moisturized) and by the second treatment in the neck and hands. TEWL scores on the face and neck remained within healthy values throughout all visits. At baseline, TEWL scores on the hands were within critical condition and after three injections they recuperated to healthy values, while pH values remained within the normal range throughout treatment.Conclusion: A treatment regimen consisting of three SP-HA injections was safe and well tolerated. SP-HA use demonstrated a hydrating effect while positively impacting the skin’s ability to retain moisture. Keywords: restylane, skinboosters, hyaluronic-acid, HA, skin, hydration

Andreas Nikolis,1–4 Kaitlyn M Enright,1,3–5 Sofia Masouri,5 Steven Bernstein,6 Christina Antoniou7 1Victoria Park Medispa, Westmount, 2Department of Plastic Surgery, University of Montreal, 3VP Research Unit, 4Erevna Innovations Inc., 5Department of Experimental Surgery, McGill University, Montreal, QC, Canada; 6Department of Dermatology, University of Montreal, Montreal, QC, Canada; 7Department of Dermatology, National and Kapodistrian University of Athens, Athens, Greece Background: IncobotulinumtoxinA (Xeomin Cosmetic®) has been used previously in the management of masseteric hypertrophy. However, a standardized injection technique has not been established. The goal of the present study was to evaluate the efficacy and safety of two injection techniques in the management of masseteric hypertrophy using incobotulinumtoxinA. Methods: Thirty female patients with masseteric hypertrophy were recruited and evenly randomized to receive bilateral treatments of either a single-injection technique (SIT) or a multiinjection technique (MIT). Improvement of masseteric hypertrophy was assessed at week 16 using standardized measurements and photographs. Patients completed a 5-point satisfaction questionnaire while physicians completed the Global Aesthetic Improvement Scale (GAIS) and 10-point photonumeric masseter prominence rating scale. Results: There were no significant differences in physician ratings on the photonumeric scale and GAIS between the SIT and MIT groups. Results of the standardized measurements also revealed no significant difference between injection techniques. Majority of patients at every visit reported being “satisfied” with treatment results. Clinically, the number and severity of adverse events were similar between groups. Conclusion: This study supports the noninferiority of both SIT and MIT with regard to efficacy and safety in the management of masseteric hypertrophy, using incobotulinumtoxinA. Keywords: Xeomin Cosmetic®, masseteric hypertrophy, noninferiority, botulinum toxin type A

Metals contaminants of the environment from mine waste have been implicated as contributing agents in autoimmune disease. The current study compares metals and autoimmunity in two Tribal communities residing in the Black Hills and the Bighorn Mountains geographical regions that are scattered with extant hard rock mines. With documented drinking water contamination in both communities, in vivo levels of more than half of the measured serum and urine metals differed between the two communities and were substantially different from their national median values. Serum autoantibodies associated with systemic autoimmune disease were rare or at low-level, but antibodies to denatured (single-stranded) DNA and thyroid-specific autoantibodies were commonly elevated, especially in women. A three-tier statistical modeling process was carried out to examine individual metals exposure as predictors of autoantibody levels. For the most part only weak positive associations between individual metals and systemic autoantibodies were found, although univariate quantile regression analysis showed positive statistical associations of serum lead and antimony with anti-chromatin and anti-histone autoantibodies. Using age and gender-adjusted multivariable statistical models, metals did not predict anti-thyroglobulin or -thyroid peroxidase significantly and metals were generally negative predictors of the other autoantibodies. Overall these results suggest that elevated levels of environmental metals and metalloids in these communities may result in suppression of autoantibodies associated with systemic autoimmune disease., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Focal intranasal drug delivery to the olfactory cleft is a promising avenue for pharmaceuticals targeting the brain. However, traditional nasal sprays often fail to deliver enough medication to this specific area. We present a laminar fluid ejection (LFE) method for precise delivery of medications to the olfactory cleft. Using a 3D-printed model of the nasal passages, we determined the precise velocity and angle of insertion needed to deposit fluid at the olfactory cleft. Then, we conducted three proof-of-concept in-vivo imaging studies to confirm olfactory delivery in humans. First, we used Technetium-99 (a radiolabeled tracer) and methylene blue (a laboratory-made dye) to visualize olfactory deposition. Both tracers showed successful deposition. In a separate study, we used functional MRI (fMRI), to compare our LFE method with a conventional nasal spray while delivering insulin. From the fMRI results, we qualitatively observed focal decreases in brain activity in prefrontal cortex following insulin delivery. Overall, these preliminary results suggest that LFE offers a targeted approach to olfactory drug delivery, opening opportunities for access to the brain.Clinical and Translational Impact Statement - Focal deposition at the olfactory cleft is a promising target for delivering medication to the brain. We present in-human tests of a laminar fluid ejection method for intranasal drug delivery and demonstrate improvements over conventional nasal spray., (© 2024 The Authors.)

The aim of this study was to achieve consensus from leading sport and exercise science practitioners in professional soccer academies surrounding (i) motivations for maturity-related data collection (ii) maturity-related injury risk factors (iii) how maturity-related data informs injury prevention practices and (iv) the use of bio-banding as an alternative injury prevention strategy. The study adopted an iterative three round online Delphi method, where a series of statements were rated by expert panellists. Consensus agreement was set at ≥70% for all statements. Nine panellists participated in all three rounds (69% response rate). Consensus was achieved for a total of sixteen statements. Panellists agreed that the period during and 12-months post peak height velocity, muscle strength/flexibility imbalances and maturity status (% predicted adult height) as the most important maturity-related injury risk factors. Panellists also agreed that maturity-related data collection is important for injury prevention as well as physical and performance-related purposes, but not for recruitment or retain/release purposes. It was also evident that variability and misunderstanding of key language terms used within the growth and maturation literature exists. It was agreed that practitioners who are responsible for conducting maturational assessments require additional training/education to enhance their application, delivery and outcomes. The findings indicate that maturity-related data collection is part of a multidisciplinary process, dedicated towards the long-term development of players. Greater training and education are required along with increased dissemination of research findings surrounding the full uses for bio-banding. This study provides guidance on maturity-related injury risks and prevention in youth soccer for practitioners., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sullivan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: The aim of this study was to survey Major League Soccer stakeholders' attitudes and perspectives on the youth-to-senior transition with a particular interest in the league's evolving club structures, specifically the reserve team and youth academy entities. The survey assessed various stakeholders' views on clubs' organisational aims and structure, the capabilities of club entities to prepare players for the first team, and the transition process to the first team within MLS., Methods: A total of 80 participants working in various 'player operation' roles for MLS clubs in the United States and Canada voluntarily completed the online survey., Results: The predominant aim for both reserve teams and academies in MLS is to develop players for the first team. The organisational structure and governance of reserve teams are varied across the league, but an overarching feature is their function as a development team. When players are transitioning, communication between staff may or may not be clear and effective. Finally, for players within an MLS club's talent pathway, a variety of support strategies are made available during the transition into the first team, but psychological support in particular may be limited or unavailable., Conclusion: Similar to European soccer, the aim of MLS reserve teams and youth academies is to develop first team players for the club. However, while players are transitioning into the first team, communication may or may not be clear and effective, and psychological support may be absent, which may impair player development initiatives.

Resistance exercise (RE) increases collagen synthesis in young and older men, whereas hydrolyzed collagen (HC) ingestion improves this response to RE in a dose-response manner in young men. However, the collagen synthesis response to RE with and without HC in middle-aged men is unknown. Eight resistance-trained men (age: 49 ± 8 yr; height: 1.78 ± 0.02 m; mass: 90 ± 4 kg) took part in this double-blind, crossover design study and undertook 4 × 10 repetitions of lower-limb RE at maximum load, after consuming 0 g, 15 g, or 30 g vitamin C-enriched HC. We analyzed venous blood samples for N-terminal propeptide of type 1 pro-collagen (PINP), β-isomerized C-terminal telopeptide of type 1 collagen (β-CTx), and 18 collagen amino acids throughout all three interventions. The serum PINP concentration × time area-under-the-curve (AUC) was higher following 30 g (169 ± 28 µg/mL × h) than 15 g (134 ± 23 µg/mL × h, P < 0.05) HC ingestion, and both 15 g and 30 g were higher than 0 g HC (96 ± 23 µg/mL × h, P < 0.05). RE with 0 g HC showed no change in serum PINP concentration. The AUCs for glycine, proline, hydroxyproline, alanine, arginine, lysine, serine, leucine, valine, and isoleucine were greater with 30 g than 15 g and 0 g HC ingestion ( P < 0.05) and greater with 15 g than 0 g HC ingestion ( P < 0.05). Plasma β-CTx concentration decreased after RE independently of HC dose. Our study suggests connective tissue anabolic resistance to RE in middle-aged men but ingesting 15 g HC rescues the collagen synthesis response and 30 g augments that response further. This dose response is associated with the increased bioavailability of collagen amino acids in the blood, which stimulate collagen synthesis. NEW & NOTEWORTHY This study is the first to document the dose-response effect of hydrolyzed collagen (HC) ingestion before resistance exercise (RE) on collagen turnover in middle-aged, resistance-trained men. Strikingly, RE alone did not increase collagen synthesis (suggesting connective tissue anabolic resistance), but ingesting 15 g HC rescued the collagen synthesis response and 30 g augmented that response further. These results were associated with the increased bioavailability of collagen amino acids in the blood, which stimulate collagen synthesis.

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.

Background: Resistance exercise (RE) stimulates collagen synthesis in skeletal muscle and tendon but there is limited and equivocal evidence regarding an effect of collagen supplementation and exercise on collagen synthesis. Furthermore, it is not known if a dose-response exists regarding the effect of hydrolyzed collagen (HC) ingestion and RE on collagen synthesis., Objective: To determine the HC dose-response effect on collagen synthesis after high-intensity RE in resistance-trained young men., Methods: Using a double-blind, randomized crossover design, 10 resistance-trained males (age: 26 ± 3 y; height: 1.77 ± 0.04 m; mass: 79.7 ± 7.0 kg) ingested 0 g, 15 g, or 30 g HC with 50 mg vitamin C 1 h before performing 4 sets' barbell back squat RE at 10-repetition maximum load, after which they rested for 6 h. Blood samples were collected throughout each of the 3 interventions to analyze procollagen type Ⅰ N-terminal propeptide (PINP) and β-isomerized C-terminal telopeptide of type I collagen (β-CTX) concentration, and the concentration of 18 collagen amino acids., Results: The serum PINP concentration × time area under the curve (AUC) was greater for 30 g (267 ± 79 μg·L -1 ·h) than for 15 g (235 ± 70 μg·L -1 ·h, P = 0.013) and 0 g HC (219 ± 88 μg·L -1 ·h, P = 0.002) but there was no difference between 0 and 15 g HC (P = 0.225). The AUCs of glycine and proline were greater for 30 g than for 15 and 0 g HC (P < 0.05). Plasma β-CTX concentration decreased from -1 to +6 h (P < 0.05), with no differences between interventions., Conclusions: Ingesting 30 g HC before high-intensity RE augments whole-body collagen synthesis more than 15 g and 0 g HC in resistance-trained young males., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

We investigated the effects of resistance exercise (RE), hydrolysed collagen (HC) ingestion and circulating oestrogen concentration on collagen synthesis in a naturally menstruating female CrossFit athlete. In a double-blind, randomised cross-over design, the participant (36 years; height 1.61 m; mass 82.6 kg) consumed 0 or 30 g HC prior to performing back-squat RE when endogenous circulating oestrogen concentration was low (onset of menses, OM) and high (late follicular phase, LF) during two consecutive menstrual cycles. Ten 5-mL blood samples were collected during each of the four interventions to analyse concentrations of serum 17β-oestradiol, and biomarkers of type I collagen turnover, that is serum procollagen type I N-terminal propeptide (PINP, a biomarker of collagen synthesis) and plasma β-isomerised C-terminal telopeptide of type I collagen (β-CTX, a biomarker of collagen breakdown), as well as the serum concentration of 18 collagen amino acids. 17β-Oestradiol concentration was 5-fold higher at LF (891 ± 116 pmol L -1 ) than OM (180 ± 13 pmol L -1 ). The PINP concentration × time area under the curve (AUC) was higher in the 30 g HC OM intervention (201 μg L -1  h) than the 30 g HC LF (144 μg L -1  h), 0 g HC OM (151 μg L -1  h) and 0 g HC LF (122 μg L -1  h) interventions. β-CTX concentration decreased 1.4-fold from pre-RE to 6 h post-RE in all interventions. Thus, high circulating oestrogen concentration was associated with lower collagen synthesis following RE in this female athlete. Ingesting 30 g HC, however, augmented the collagen synthesis response at LF and particularly at OM. HIGHLIGHTS: What is the central question of this study? Does resistance exercise-induced collagen synthesis vary according to circulating oestrogen concentration in a naturally menstruating female athlete, and if so, does hydrolysed collagen ingestion have any impact? What is the main finding and its importance? Exercise-induced collagen synthesis was low when circulating oestrogen concentration was high and vice versa. However, ingesting 30 g hydrolysed collagen prior to exercise reduced the negative effect of oestrogen on collagen synthesis. As high circulating oestrogen has been associated with greater injury risk in females, supplementing exercise with hydrolysed collagen may help protect these tissues from injury., (© 2024 The Authors. Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)

Guideline-directed medical therapies and guideline-directed nonpharmacological therapies improve quality of life and survival in patients with heart failure (HF), but eligible patients, particularly women and individuals from underrepresented racial and ethnic groups, are often not treated with these therapies. Implementation science uses evidence-based theories and frameworks to identify strategies that facilitate uptake of evidence to improve health. In this scientific statement, we provide an overview of implementation trials in HF, assess their use of conceptual frameworks and health equity principles, and provide pragmatic guidance for equity in HF. Overall, behavioral nudges, multidisciplinary care, and digital health strategies increased uptake of therapies in HF effectively but did not include equity goals. Few HF studies focused on achieving equity in HF by engaging stakeholders, quantifying barriers and facilitators to HF therapies, developing strategies for equity informed by theory or frameworks, evaluating implementation measures for equity, and titrating strategies for equity. Among these HF equity studies, feasibility was established in using various educational strategies to promote organizational change and equitable care. A couple include ongoing randomized controlled pragmatic trials for HF equity. There is great need for additional HF implementation trials designed to promote delivery of equitable guideline-directed therapy.

The aim of this review was to summarise the methods used to predict and assess maturity status and timing in adolescent, male, academy soccer players. A systematic search was conducted on PubMed, Scopus, Web of Science, CINAHL, Medline and SPORTDiscus. Only experimental studies including male, academy players aged U9-U18 years registered with a professional soccer club were included. The methodological quality of the included studies was assessed using guidelines from the Framework of Potential Biases. Fifteen studies fulfilled our inclusion criteria. Studies were mainly conducted in European countries (n = 12). In total, 4,707 players were recruited across all 15 studies, with an age range of 8-18 years. Five studies were longitudinal, two studies were mixed-method designs and eight studies were cross-sectional. Due to high heterogeneity within the studies, a meta-analysis was not performed. Our findings provided no equivalent estimations of adult height, skeletal age, or age at PHV. Discrepancies were evident between actual and predicted adult height and age at PHV. The Bayley-Pinneau [1952], Tanner-Whitehouse 2 [1983] and Khamis-Roche [1994] methods produced estimates of adult height within 1cm of actual adult height. For age at PHV, both Moore [2015] equations produced the closest estimates to actual age at PHV, and the Fransen [2018] equation correlated highly with actual age at PHV (>90%), even when the period between chronological age and age at PHV was large. Medical imaging techniques (e.g., Magnetic Resonance Imaging, X-Ray, Dual energy X-ray Absorptiometry) demonstrated high intra/inter-rater reliability (ICC = 0.83-0.98) for skeletal maturity assessments. The poor concordance between invasive and non-invasive methods, is a warning to practitioners to not use these methods interchangeably for assessing maturational status and timing in academy soccer players. Further research with improved study designs is required to validate these results and improve our understanding of these methods when applied in this target population., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Sullivan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study investigated the effects of an acute dose (900 mg) of New Zealand Blackcurrant (NZBC) extract on 5-km running performance, alongside associated physiological and metabolic responses. Sixteen trained male runners (age 26 ± 5 years, stature 173.4 ± 7.3 cm, body mass 73.7 ± 6.9 kg, maximal oxygen consumption [V˙O2max] 55.4 ± 6.1 ml·kg-1·min-1) ingested either capsules containing NZBC extract (3 × 300 mg CurraNZ, 315 mg anthocyanins) or a matched placebo (3 × 300 mg gluten-free flour) 2 hr before exercise in a double-blind, randomized, crossover design. Performance time, physiological, and metabolic responses were assessed in a 5-km time trial, preceded by 10-min exercise at the lactate threshold on a treadmill. NZBC extract did not alter the physiological or metabolic responses to exercise at the lactate threshold (oxygen uptake, respiratory exchange ratio, minute ventilation, carbohydrate oxidation, fat oxidation, heart rate, blood lactate, or rating of perceived exertion, p > .05). The 5-km time trial was completed in a faster time in the NZBC extract condition compared with placebo (NZBC: 1,308.96 ± 122.36 s, placebo: 1,346.33 ± 124.44, p = .001, d = -0.23, confidence interval range = [-0.46, 0.00 s]). No differences in physiological or metabolic responses were apparent between conditions for the 5-km time trial (p > .05). Ingesting 900 mg of NZBC extract as an acute dose improves performance in trained male runners without altering physiological or metabolic responses to exercise. Further research is needed to assess a wider range of possible mechanisms (e.g., cardiovascular function, metabolite profiles) to advance insight into improved performance following supplementation.

Introduction: To 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., Methods: Eighteen 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., Results: Absolute 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  < 0.05; g : small to moderate ). IPC peak force and torque, CMJ reactive strength index modified, CMJ eccentric forces (mean breaking force, mean deceleration force, peak force, force at zero velocity) and CMJ mean power measures had post-match changes greater than their typical variation, demonstrating acceptable sensitivity in detecting performance changes at post-match., Discussion: IPC peak force and torque, CMJ reactive strength index modified, CMJ eccentric phase forces and CMJ mean power were found to be both reliable and sensitive to change, and thus may be appropriate for monitoring post-match neuromuscular performance in youth soccer population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Franceschi, Robinson, Owens, Brownlee, Ferrari Bravo and Enright.)

In the United States (US), private-supply tapwater (TW) is rarely monitored. This data gap undermines individual/community risk-management decision-making, leading to an increased probability of unrecognized contaminant exposures in rural and remote locations that rely on private wells. We assessed point-of-use (POU) TW in three northern plains Tribal Nations, where ongoing TW arsenic (As) interventions include expansion of small community water systems and POU adsorptive-media treatment for Strong Heart Water Study participants. Samples from 34 private-well and 22 public-supply sites were analyzed for 476 organics, 34 inorganics, and 3 in vitro bioactivities. 63 organics and 30 inorganics were detected. Arsenic, uranium (U), and lead (Pb) were detected in 54%, 43%, and 20% of samples, respectively. Concentrations equivalent to public-supply maximum contaminant level(s) (MCL) were exceeded only in untreated private-well samples (As 47%, U 3%). Precautionary health-based screening levels were exceeded frequently, due to inorganics in private supplies and chlorine-based disinfection byproducts in public supplies. The results indicate that simultaneous exposures to co-occurring TW contaminants are common, warranting consideration of expanded source, point-of-entry, or POU treatment(s). This study illustrates the importance of increased monitoring of private-well TW, employing a broad, environmentally informative analytical scope, to reduce the risks of unrecognized contaminant exposures., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

Background: The term "exposome" describes the totality of exposures an individual is subjected to from conception to death. Both internal and external exposome factors affect skin health. External exposures that contribute to facial skin aging include solar radiation, air pollution, tobacco smoke, and unbalanced nutrition. The review explores scientific and clinical insights into the exposome impact on facial skin aging and topical mineralizing volcanic water use potential benefits., Methods: An expert panel of seven dermatologists and two clinical researchers specializing in aesthetic and dermatological indications reviewed and discussed the literature on the exposome and mineralizing volcanic water's role in relation to the exposome. Two virtual advisory boards were conducted between February and May 2021. Following the meetings, an additional systematic literature review explored publications relevant to the exposome, topical essential minerals, and skin health. The results of the two advisory boards, coupled with expert opinion and the outcome of the updated systematic literature review, informed the statements on which the advisors reached a consensus., Conclusions: A combination of in vivo, in vitro, and clinical data on topical mineralizing volcanic water application indicates that the serum supports the skin's antioxidant defenses and reduces skin inflammation. Additionally, the serum may have benefits as an adjunct for facial dermatoses and post-procedural skincare. J Drugs Dermatol. 2022;21:4(Suppl 1):s3-10.

Background: There is a significant emphasis on minimally invasive whole-body rejuvenation throughout the world. Recently, gluteal aesthetics have become an increasingly common patient concern. Although the application of poly-L-lactic acid (PLLA) to the face is already well known, there are relatively fewer publications on its use in other corporeal regions. This study aims to extend previous findings by evaluating the efficacy and safety of PLLA in the treatment of contour (including lifting) deformities of the buttock region., Methods: This was a prospective, multicenter (3 sites), single cohort, open-label clinical trial. Thirty female subjects were treated with PLLA in the bilateral buttocks, with three treatment sessions, each spaced one month apart and followed for six months after completion of the treatment regimen. At each visit, various safety and clinical efficacy parameters were collected, these included: Global Assessment of Improvement Scale (GAIS), subject satisfaction, skin hydration, elasticity, scaliness, roughness, and 3-dimensional imagery., Results: Six months following the last treatment, 84.00% of patients were rated as having &ldquo;improved&rdquo; or more on the physician assessed GAIS, accompanied by a 96.00% patient satisfaction rate. Approximately three vials of PLLA, per buttock and treatment were used. There were no serious adverse events throughout the duration of the trial, nor adverse events related to the investigational device. The most common subject-reported adverse events included pain during treatment (Mean: 70.97%) and bruising (Mean: 28.80%). Objective improvements were persistent after treatment in measurements of skin elasticity (improved 63.5% - 82.5% from weeks 16-32), hydration (increased ~11 Corneometer&reg; units by week 16), roughness (decreased 36.95% at week 32), and scaliness (desquamation; decreased 60.41% at week 32)., Conclusions: PLLA is safe and effective for the indication of buttock contouring and improving parameters of skin health. PLLA can provide long-lasting effects with a high level of patient and physician satisfaction. J Drugs Dermatol. 2022;21(3):304-308. doi:10.36849/JDD.5924.

Little is known about weight loss practices and eating behaviours in female physique athletes. This study investigated the weight loss history, practices, and key influences during the pre-competition period in a large cohort of female physique athletes stratified by division and experience level. Eating attitudes and behaviours were assessed to identify whether athletes were at risk of developing an eating disorder. Using a cross-sectional research design, female physique athletes (n = 158) were recruited and completed an anonymous online self-reported survey consisting of two validated questionnaires: Rapid Weight Loss Questionnaire and Eating Attitudes Test-26. Irrespective of division or experience, female physique athletes used a combination of weight loss practices during the pre-competition phase. Gradual dieting (94%), food restriction (64%) and excessive exercise (84%), followed by body water manipulation via water loading (73%) were the most commonly used methods. Overall, 37% of female physique athletes were considered at risk of developing an eating disorder. Additionally, 42% of female physique athletes used two pathogenic weight control methods with 34% of Figure novice athletes indicating binge eating once a week or more. The coach (89%) and another athlete (73%) were identified as key influences on athletes' dieting practices and weight loss. The prevalence of athletes identified with disordered eating symptoms and engaging in pathogenic weight control methods is concerning. In future, female physique athletes should seek advice from registered nutritionists to optimise weight management practices and minimise the risk of developing an eating disorder., Competing Interests: The authors have declared that no competing interests exist.

Objective: To evaluate the effectiveness of remote proactive management of toxicities during chemotherapy for early stage breast cancer., Design: Pragmatic, cluster randomised trial., Setting: 20 cancer centres in Ontario, Canada, allocated by covariate constrained randomisation to remote management of toxicities or routine care., Participants: All patients starting adjuvant or neoadjuvant chemotherapy for early stage breast cancer at each centre. 25 patients from each centre completed patient reported outcome questionnaires., Interventions: Proactive, standardised, nurse led telephone management of common toxicities at two time points after each chemotherapy cycle., Main Outcome Measures: The primary outcome, cluster level mean number of visits to the emergency department or admissions to hospital per patient during the whole course of chemotherapy treatment, was evaluated with routinely available administrative healthcare data. Secondary patient reported outcomes included toxicity, self-efficacy, and quality of life., Results: Baseline characteristics of participants were similar in the intervention (n=944) and control arms (n=1214); 22% were older than 65 years. Penetration (that is, the percentage of patients who received the intervention at each centre) was 50-86%. Mean number of visits to the emergency department or admissions to hospital per patient was 0.91 (standard deviation 0.28) in the intervention arm and 0.94 (0.40) in the control arm (P=0.94); 47% (1014 of 2158 patients) had at least one visit to the emergency department or a hospital admission during chemotherapy. Among 580 participants who completed the patient reported outcome questionnaires, at least one grade 3 toxicity was reported by 48% (134 of 278 patients) in the intervention arm and by 58% (163 of 283) in the control arm. No differences in self-efficacy, anxiety, or depression were found. Compared with baseline, the functional assessment of cancer therapy trial outcome index decreased by 6.1 and 9.0 points in the intervention and control participants, respectively., Conclusions: Proactive, telephone based management of toxicities during chemotherapy did not result in fewer visits to the emergency department or hospital admissions. With the rapid rise in remote care because of the covid-19 pandemic, identifying scalable strategies for remote management of patients during cancer treatment is particularly relevant., Trial Registration: ClinicalTrials.gov NCT02485678., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the Ontario Institute for Cancer Research (OICR) for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; CCE and EG hold appointments at the OICR Health Services Research Programme; no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)