Examining the Impact of School Esports Program Participation on Student Health and Psychological Development.

This study examined the influence of 7 high school esports developmental programs on student self-regulation, growth mindset, positive youth development (PYD), perceived general health and physical activity (PA), and sport behaviour. A total of 188 students (male n = 120; female n = 68) originally participated (89 enrolled in an esports program in their school and 99 acted as aged-matched controls), with 58 participants (n = 19 esports group; n = 39 controls) completing both pre- and post-program information. At baseline, no significant differences were found between youth e-athletes and their aged-matched controls. The analysis for the observation period showed a significant interaction effect for the PYD confidence scale, with post-hoc comparisons showing a significant decrease in the control group from pre- to post assessment whereas the esports group remained the same. Time main effects showed a decrease in the self-regulation motivation factor, PYD connection factor and PA for all participants. Overall, this study showed that students enrolled in their respective school esports program did not differ from those who did not in self-regulation, growth mindset, PYD, perceived health and PA, and sport behaviour. It was likely that all participants showed a decrease in motivation, connection, and PA due to COVID19 lockdown during the study period. This study is the first to investigate the longitudinal impact of student involvement in high school esports and showed that esports participation did not have a negative impact on any health or psychological factors.

ACE2 and SARS-CoV-2 Infection Risk: Insights From Patients With Two Rare Genetic Tubulopathies, Gitelman's and Bartter's Syndromes.

COVID-19 is spreading globally with the angiotensin converting enzyme (ACE)-2 serving as the entry point of SARS-CoV-2 virus. This raised concerns how ACE2 and the Renin-Angiotensin (Ang)-System (RAS) are to be dealt with given their roles in hypertension and their involvement in COVID-19's morbidity and mortality. Specifically, increased ACE2 expression in response to treatment with ACE inhibitors (ACEi) and Ang II receptor blockers (ARBs) might theoretically increase COVID-19 risk by increasing SARS-CoV-2 binding sites. However, ACE2 is part of the protective counter-regulatory ACE2-Ang1-7-MasR axis, which opposes the classical ACE-AngII-AT1R regulatory axis. We used Gitelman's and Bartter's syndromes (GS/BS) patients, rare genetic tubulopathies that have endogenously increased levels of ACE2, to explore these issues. Specifically, 128 genetically confirmed GS/BS patients, living in Lombardia, Emilia Romagna and Veneto, the Northern Italy hot spots for COVID-19, were surveyed via telephone survey regarding COVID-19. The survey found no COVID-19 infection and absence of COVID-19 symptoms in any patient. Comparison analysis with the prevalence of COVID-19 in those regions showed statistical significance (p < 0.01). The results of the study strongly suggest that increased ACE2 does not increase risk of COVID-19 and that ACEi and ARBs by blocking excessive AT1R-mediated Ang II activation might favor the increase of ACE2-derived Ang 1-7. GS/BS patients' increased ACE2 and Ang 1-7 levels and their characteristic chronic metabolic alkalosis suggest a mechanism similar to that of chloroquine/hydroxychloroquine effect on ACE2 glycosylation alteration with resulting SARS-COV-2 binding inhibition and blockage/inhibition of viral entry. Studies from our laboratory are ongoing to explore GS/BS ACE2 glycosylation and other potential beneficial effects of BS/GS. Importantly, the absence of frank COVID-19 or of COVID-19 symptoms in the BS/GS patients cohort, given no direct ascertainment of COVID-19 status, suggest that elevated ACE2 levels as found in GS/BS patients at a minimum render COVID-19 infection asymptomatic and thus that COVID-19 symptoms are driven by ACE2 levels.

Are the Clinical Presentations (Phenotypes) of Gitelman's and Bartter's Syndromes Gene Mutations Driven by Their Effects on Intracellular pH, Their "pH" Enotype?

Gitelman's syndrome (GS) and Bartter's syndrome (BS) are rare inherited salt-losing tubulopathies whose variations in genotype do not correlate well with either clinical course or electrolyte requirements. Using GS/BS patients as nature's experiments, we found them to be a human model of endogenous Ang II antagonism with activated Renin-Angiotensin System (RAS), resulting in high Ang II levels with blunted cardiovascular effects. These patients are also characterized by increased and directly correlated levels of both Angiotensin Converting Enzyme 2 (ACE2) and Ang 1-7. Understanding the myriad of distinctive and frequently overlapping clinical presentations of GS/BS arises remains challenging. Efforts to find a treatment for COVID-19 has fueled a recent surge in interest in chloroquine/hydroxychloroquine and its effects. Of specific interest are chloroquine/hydroxychloroquine's ability to inhibit SARS-CoV infection by impairing ACE2, the SARS-CoV2 entry point, through terminal glycosylation via effects on TGN/post-Golgi pH homeostasis. Several different studies with a GS or a BS phenotype, along with a nonsyndromic form of X-linked intellectual disability linked to a mutated SLC9A7, provide additional evidence that specific gene defects can act via misregulation of TGN/post-Golgi pH homeostasis, which leads to a common mechanistic basis resulting in overlapping phenotypes. We suggest that linkage between the specific gene defects identified in GS and BS and the myriad of distinctive and frequently overlapping clinical findings may be the result of aberrant glycosylation of ACE2 driven by altered TGN/endosome system acidification caused by the metabolic alkalosis brought about by these salt-losing tubulopathies in addition to their altered intracellular calcium signaling due to a blunted second messenger induced intracellular calcium release that is, in turn, amplified by the RAS system.

Written Emotional Disclosure Can Promote Athletes' Mental Health and Performance Readiness During the COVID-19 Pandemic.

The widespread effects of the coronavirus disease 2019 (COVID-19) pandemic have negatively impacted upon many athletes' mental health and increased reports of depression as well as symptoms of anxiety. Disruptions to training and competition schedules can induce athletes' emotional distress, while concomitant government-imposed restrictions (e.g., social isolation, quarantines) reduce the availability of athletes' social and emotional support. Written Emotional Disclosure (WED) has been used extensively in a variety of settings with diverse populations as a means to promote emotional processing. The expressive writing protocol has been used to a limited extent in the context of sport and predominantly in support of athletes' emotional processing during injury rehabilitation. We propose that WED offers an evidence-based treatment that can promote athletes' mental health and support their return to competition. Research exploring the efficacy of the expressive writing protocol highlights a number of theoretical models underpinning the positive effects of WED; we outline how each of these potential mechanisms can address the multidimensional complexity of the challenging circumstances arising from the COVID-19 pandemic (e.g., loss of earnings, returning to training and competition). Considerations and strategies for using WED to support athletes during the COVID-19 pandemic are presented.