Sport injuries in professional volleyball players.

Recently there has been a considerable surge in interest in volleyball by both physiotherapists and orthopaedic surgeons. Only few previous studies specified the nature, frequency, and demographics of volleyball injuries. The study was conducted during two league seasons. After the approvals of local bioethics committee and clubs` authorities, contact with the club's doctors was established. A special survey was designed to standardize the process of acquiring data on a weekly basis. One-hundred-and-ninety-eight women and 301 men were under supervision of the research group. On average, 45% of all players (56% males and 26% females) suffered from injuries and musculoskeletal disorders over two seasons. Relatively high incidence of injuries during matches was between 17.3 and 33.8 injuries per each 1000 hours of playing. Almost 50% of musculoskeletal problems occurred in the first phase of the season. Over 50% of musculoskeletal problems were reported during trainings. The blockers are the most affected players in both sex groups. Acute injuries mainly involved knee and ankle joints, while chronic problems affected knee, shoulder, spine and abdominal muscles. Professional volleyball is not a safe sport, especially during a league season. Attention should be especially paid to ankle, shoulder and knee joints, which are the most commonly injured structures. The study revealed that blockers were the most susceptible to injuries and should be protected by special training regime. These findings can help to prepare sports medicine personnel and to guide further related research to prevent injuries among volleyball professionals.

Expression of enzymes regulating placental ammonia homeostasis in human fetal growth restricted pregnancies.

Functional placental insufficiency results in impaired feto-placental exchange, and subsequently in fetal growth restriction (FGR). We hypothesized that reductions in placental amino acid transporter activities in FGR pregnancies may be accompanied by abnormal expression of placental ammonia-handling enzymes. Term placentas were obtained from growth restricted (N=11) and normal (N=17) human pregnancies, and examined for glutamate dehydrogenase (GDH), glutamine synthetase (GS) and glutaminase (GA) mRNA and protein expression. Northern and Western blots were normalized on human actin mRNA and protein expression. For GA, the presence of mRNA coding the kidney isoform, and the absence of mRNA coding the liver isoform of the enzyme were demonstrated in the human placenta. In FGR pregnancies, placental expression of GDH mRNA was reduced (P<0.05) compared to normal pregnancies (1.576+/-0.144 vs. 2.092+/-0.177, respectively; mean+/-SE), whereas GS and GA mRNA expression was not different between the two types of pregnancy. GDH protein expression were also reduced (P<0.05) in FGR placentas compared to normal placentas (1.055+/-0.079 vs. 1.322+/-0.053, respectively; mean+/-SE). The GS and GA protein expression was not different in FGR pregnancies. Our data indicate that in cases of FGR, glutamate-to-oxoglutarate transformation in the placenta is limited, yet glutamine synthesis from and decomposition to glutamate seems to be preserved. This may reflect down-regulation of GDH in response to decreased fetal liver output and reduced umbilical artery glutamate concentrations in human FGR pregnancies.

Influence of potent and selective beta-adrenoceptor agonist, CL 316243, on the contractile response of non-pregnant human myometrium.

UNLABELLED: The purpose of this study was to evaluate the effect of beta(3)-adrenoreceptor agonist, CL 316243 on human non-pregnant uterine contractility. The activity of myometrium strips was recorded by means of force transducers with digital output. Quantification of the response of myometrium strips was done by calculation of the area under the curve (AUC), as well as the amplitude and frequency of contractions. CL 316243 in a concentration - dependent manner (10(-10)-10(-4) mol/L) decreased the AUC value (logIC(50) -8.088+/-0.29; n=16). Decreased mean frequency of contractions and nearly 30% inhibition of spontaneous contractile activity were also observed. The inhibition of contractions by CL 316243 was not changed by either butoxamine (selective beta(2)-adrenoreceptor antagonist) or propranolol (beta(1)- and beta(2)-adrenoreceptor antagonist), and was partly antagonized by bupranolol (nonselective beta-adrenoreceptor antagonist), each antagonist at 10(-6) mol/L. IN CONCLUSION: CL 316243 causes inhibition of spontaneous contractile activity of human non-pregnant myometrium. Our findings also indicate that CL 316243 attenuates the contractile activity of human non-pregnant myometrium by the beta(3)-adrenoreceptors activation.

The activity of cancer procoagulant in cases of uterine leiomyomas.

PURPOSE: It is currently believed that cancer procoagulant (CP), an enzymatic protein, is a product of malignant neoplastic cells. The present study was designed to test whether it is also synthesized by benign neoplastic cells, namely uterine leiomyomas. MATERIALS AND METHODS: We determined the activity of CP in the blood serum of women with uterine leiomyomas (N = 24), normal women (N = 15), and genital cancer patients (N = 6) by the coagulative method according to Gordon and Benson. Also, the CP activity in 10% tissue homogenates of uterine leiomyomas, normal uterine muscle and tissues of cervical and endometrial carcinoma was determined by the chromogenic method according to Colucci et al. RESULTS: The mean CP activity in the sera of women with uterine leiomyomas was 181.1 seconds (s) +/- 19.9 s, in healthy women--293.2 s +/- 33.8 s, and in genital cancer patients--78.8 +/- 18.5 s (all differences: p < 0.001). Similarly, in homogenates of uterine leiomyomas the CP activity was 19.6 +/- 3.8 nmoles pNa/ml, in normal uterine muscle it was 13.2 +/- 2.2 nmoles pNa/ml, and in cancerous tissue--28.0 +/- 6.6 nmol pNa/ml (all values being significantly different from each other). There was a strong correlation (r = -0.8122; p < 0.001) between the CP activity in uterine leiomyomas and serum activity, suggesting that the source of the serum CP activity was from the leiomyoma. The coagulation time of 120 to 240 s by the Gordon and Benson method supported the diagnosis of uterine leiomyoma, and a value below 120 s--the suspicion of genital cancer. CONCLUSIONS: Uterine leiomyomas, representing benign genital neoplasia, synthesize CP and are the likely origin of CP activity in blood, as has been described for malignant tumors, but to a lesser degree. There may be a role for CP as a tumor marker of genital neoplasia.

The presence of sex hormone receptors in the vesicouterine fistula.

Although the traditional management of vesicouterine fistula is surgical, a recent review of world data showed high efficacy of hormonal manipulation by the induction of amenorrhea. The prerequisite for the action of sex hormones is the presence of target receptors in the given tissue. The current study examined the histology of the vesicouterine fistula in order to identify the possible cellular components containing sex hormone receptors. The presence of an epithelium similar to endometrium containing sex hormone receptors was demonstrated immunohistochemically and by hematoxylin-eosin staining, a finding in agreement with the definition of endometriosis. Our paper provides an explanation for the high efficacy of hormonal manipulation in the treatment of this relatively rare type of fistula.

Umbilical threonine uptake during maternal threonine infusion in sheep.

OBJECTIVE: The infusion into the maternal circulation of amino acid solutions failed to increase umbilical threonine (THR) uptake above normal even when THR was present in the infusate at a relatively high concentration. The purpose of the present study was to determine whether umbilical THR uptake can be increased by infusing a THR solution that does not contain any other amino acids. STUDY DESIGN: Five pregnant sheep (130+/-1.0 days after conception) were infused for 2h with a threonine solution (4.4+/-0.2 micromol.kg(-1).min(-1)). Plasma amino acids, glucose and lactate, hematocrit, blood O(2) content in maternal arterial, uterine venous, umbilical arterial and venous blood were measured. Uterine and umbilical blood flows were measured before and during the infusion and were used to calculate uterine and umbilical uptakes. Maternal and foetal plasma insulin and glucagon concentrations were also measured. RESULTS: The THR infusion increased maternal plasma THR (904 vs 236 microM, P< 0.001), foetal plasma THR (539 vs 334 microM, P< 0.01), and both uterine (20.4 vs 4.7 micromol.min(-1).kg(-1)(fetalweight), P< 0.05) and umbilical (8.6 vs 3.8 micromol.min(-1).kg(-1)(fetalweight), P< 0.001) THR uptakes. The uterine-umbilical THR uptake difference increased significantly (11.8 vs 0.9 micromol.min(-1).kg(-1)(fetalweight), P< 0.05). There were significant (P< 0.001) decreases in the foetal arterial plasma concentrations of tyrosine and the branched chain amino acids, as well as in isoleucine umbilical uptake (P< 0.05). There was a significant increase in maternal plasma glucagon (P< 0.01). CONCLUSION: A maternal THR infusion that causes a 3.8-fold increase in maternal plasma THR concentration above normal, with no significant increase in the concentration of other amino acids, leads to a 2.3-fold increase in umbilical THR uptake. This contrasts with the absence of a significant increase in umbilical THR uptake when THR was infused as part of an amino acid mixture in previous studies. The evidence supports the hypothesis that, in vivo, THR flux from placenta to foetus is mediated by a saturable, rate limiting transport system which is subject to inhibition by other neutral amino acids.

Effects of branched-chain amino acids on placental amino acid transfer and insulin and glucagon release in the ovine fetus.

OBJECTIVE: Competition for placental amino acid transporters can affect the fetal supply of amino acids. Specifically, the branched-chain amino acids-isoleucine, leucine, and valine-may inhibit the transfer of other amino acids. This study was undertaken to determine the effect of branched-chain amino acids on the umbilical uptake of amino acids. STUDY DESIGN: Six late-gestation ewes were infused sequentially for 2 hours with 3 different mixtures of amino acids: (1) one that was comparable to commercial parenteral nutrition preparations, (2) the same solution without branched-chain amino acids, and (3) branched-chain amino acids alone. Maternal and fetal blood samples were collected simultaneously for the determination of uterine and umbilical uptake values of amino acids, and for concentrations of arterial insulin, glucagon, glucose, and lactate before (control) and during (experimental) infusion. RESULTS: Umbilical uptake of branched-chain amino acids increased significantly when they were present in the infusates. The fetal uptake of several other amino acids could be increased by increasing their maternal concentrations. Inhibition of umbilical uptake by branched-chain amino acids could be shown for threonine and methionine. The infusion of branched-chain amino acids alone did not affect maternal and fetal insulin or glucagon concentrations. CONCLUSIONS: In late-gestation sheep, an increase in maternal plasma concentration of branched-chain amino acids led to increased branched-chain amino acid umbilical uptake, but branched-chain amino acids can also inhibit the transport of some amino acids to the fetus. Changes in fetal plasma concentration and uptake of branched-chain amino acid appear to have no significant effect on fetal insulin or glucagon.

Ammonia concentration in human preovulatory ovarian follicles.

OBJECTIVES: To determine ammonia concentrations in both the direct environment of the oocyte, ovarian follicular fluid, and peripheral blood. STUDY DESIGN: Samples of preovulatory follicular fluid and antecubital venous blood were obtained from 23 randomly selected women attending an in vitro fertilization program in an academic department. Ammonia concentrations were measured using the indophenol method. RESULTS: In every patient examined, the ratio of ammonia concentration in follicular fluid to that in blood exceeded 1.0. Mean ammonia concentration in follicular fluid (38.01+/-2.61 microM) was significantly higher than that in blood (22.70+/-1.35 microM; P<0.001 paired Student's t test). CONCLUSIONS: There is an ammonia gradient from follicular fluid to blood. The human preovulatory oocyte grows in an environment of a moderately increased ammonia concentration. This study suggests that the preovulatory follicle is a source of ammonia production.

[The effect of pelvic floor exercises in the antepartum and postpartum periods on occurrence of stress urinary incontinence: implications for health care provision]. / Wplyw okoloporodowych cwiczen dna miednicy na wystepowanie wysilkowego nietrzymania moczu: implikacje dla organizacji opieki zdrowotnej.

The aim of the present work was to review the existing evidence on the impact of pelvic floor exercises on the occurrence and the role in the treatment of stress urinary incontinence in the perinatal period. Our analysis indicates that pelvic floor exercises are a safe and highly effective measure in the prevention of occurrence and treatment of stress urinary incontinence, both antepartum and postpartum. Their performance in the inpatient setting during early puerperium can allow proper physiotherapeutic instruction and supervision without additional admission and costs. Poland has an opportunity to become the first country worldwide to implement peripartum pelvic floor exercises as a preventive method for urinary incontinence on a regular basis.

Clinical classification of vesicouterine fistula.

UNLABELLED: OBJECTIVE AND METHODSs: The aim of this paper is to propose a classification of vesicouterine fistula based on the routes of menstrual flow. RESULTS: Three types of the fistula are distinguished: type I - with menouria; type II - with dual flow via both the bladder and vagina; and type III - with normal vaginal menses. CONCLUSIONS: There is relevance of such division to both diagnosis and treatment. The simplicity and clinical utility of this classification warrant its widespread use.

[Use of oxygen therapy during labour and acid-base status in the newborn]. / Tlenoterapia stosowana w czasie porodu a parametry równowagi kwasowo-zasadowej u noworodka.

The effect of supplemental maternal oxygen therapy on acid-base status has for years been a subject of controversies. There is still no general agreement about oxygen administration in pregnancy or in labour. Many clinicians believe that in normal pregnancy maternal oxygen treatment has merely negligible, if any, influence on the foetus. Maternal oxygen therapy has frequently been suggested when oxygen supply to the foetus was insufficient, viz. in antepartum or intrapartum hypoxia. The aim of this study was to determine whether a brief maternal hyperoxygenation during caesarean section or during the second stage of normal delivery affects cord blood acid-base status measured at birth. Patients with uneventful term pregnancy admitted to the delivery room in spontaneous labour or indicated for elective caesarean section were matched and prospectively ascribed to the control or treatment group. The latter received 60% oxygen for ca. 10 min at 15 L/min by a face mask. We studied 41 normal term infants of healthy mothers (24 from caesarean sections, the remaining 17 delivered vaginally). The control group consisted of normal newborns chosen according to the same criteria except that their mothers had no oxygen supplementation. Immediately after delivery, umbilical cord paired blood samples were drawn. Arterial and venous specimens were analysed for blood gases and acid-base balance parameters. Statistical analysis assisted by computer software was performed using Mann-Whitney U test. A p value < 0.05 was considered significant. All tested parameters related to the acid-base status and blood gases were similar in the treatment and control groups. Concluding, a short period of maternal hyperoxygenation either in the second stage of vaginal spontaneous delivery or during caesarean section did not affect umbilical cord blood acid-base status measured at birth.

Umbilical vein blood flow determination in the ovine fetus: comparison of Doppler ultrasonographic and steady-state diffusion techniques.

OBJECTIVE: This study was undertaken to assess the accuracy of triplex ultrasonographic measurement of venous umbilical blood flow in comparison with the steady-state diffusion technique and to determine the impact of cotyledon weight and number on umbilical blood flow. STUDY DESIGN: Six late-gestation ewes with long-term catheter placement were studied for venous umbilical blood flow with the ethanol steady-state diffusion technique and with triplex-mode ultrasonography (color Doppler, pulsed-wave Doppler, and real-time ultrasonography). At necropsy the number and weight of the cotyledons serving each umbilical vein were recorded. RESULTS: Umbilical blood flow determined by triplex-mode ultrasonography (207. 5 +/- 8.6 mL. kg(-1) fetus. min(-1)) was virtually identical to that determined with the steady-state diffusion technique (208.1 +/- 7.3 mL. kg(-1) fetus. min(-1); P =.9). When values were normalized for the weight or number of cotyledons serving each vein, there was no difference in umbilical blood flow between small and large umbilical veins in all the sheep. CONCLUSIONS: Our study validates the accuracy of the triplex ultrasonographic method and provides justification for its use in future human investigations. In absolute terms umbilical blood flow frequently differs between the 2 veins. When expressed per number or mass of cotyledons, however, the umbilical blood flows are similar.

Spontaneous closure of vesicouterine fistula. Account for effective hormonal treatment.

OBJECTIVES: To analyze the incidence of spontaneous closure, or non-surgical resolution, of vesicouterine fistula and discuss the resultant implications for the management. METHODS: Review of the literature supplemented by case report of a young woman with spontaneous healing of vesicouterine fistula. RESULTS: This is the 41st patient with spontaneous closure of vesicouterine fistula reported to date. Her clinical course was suggestive of endocrine involvement in the lesion's formation. Spontaneous healing was observed in 5% of 796 vesicouterine fistula cases. Induction of amenorrhea was effective in 8 (89%) of the 9 patients treated, a rate significantly higher (p < 0.001) than that observed without hormonal manipulation (4%). CONCLUSIONS: Conservative management by means of hormonal treatment should be considered before surgical repair. We suggest the role of estrogens and the endometrium in the formation of vesicouterine fistulas.

Contribution of branched-chain amino acids to uteroplacental ammonia production in sheep.

The uteroplacental tissues are a principal site of ammonia production for the conceptus. The goal of this study was to examine the effect of the composition of maternal amino acid (AA) infusate on uteroplacental ammonia production. Seven pregnant ewes (126 +/- 1. 4 days gestation) were infused through the maternal femoral vein (duration 3.5 h, rate 240 ml per hour) with three solutions of AAs. The first infusate was comparable to commercial parenteral nutrition preparations, the second infusate contained the same solution without branched-chain AAs (BCAAs), and the third infusate contained only BCAAs. Blood samples were simultaneously collected from the maternal artery, uterine vein, fetal artery, and umbilical vein to determine plasma AA concentrations and whole blood ammonia concentrations, before (control) and 2 h after (experimental) the start of infusion. Uterine and umbilical blood flows were measured using the ethanol steady-state diffusion method. Results showed that fetal arterial and venous ammonia concentrations increased significantly after infusions with all AAs or only BCAAs, but not without BCAAs. Uteroplacental ammonia production increased in response to each of the three infusates. However, this increase was much greater when the BCAAs were present in infusates. We conclude that there is a significant contribution of BCAAs to the uteroplacental ammonia production. Maternal AA infusions containing BCAAs can result in increased fetal blood ammonia concentrations.

Relationship of umbilical vein blood flow to growth parameters in the human fetus.

OBJECTIVE: Our purposes were to determine the relationship of the growth of umbilical blood flow to growth in body measurements of human fetuses in uncomplicated pregnancies. The study also aimed to assess the relative contributions of growth in umbilical vein diameter and of increased velocity to the increase in umbilical blood flow. STUDY DESIGN: An animal study was conducted to assess the accuracy of umbilical vein blood flow measurements obtained by triplex mode ultrasonography. Seven pregnant ewes underwent triplex mode umbilical vein flow determination. These results were compared with historical flow data obtained by a steady-state diffusion technique in 34 ewes matched for gestational age and weight. In a separate study performed on human beings, reproducibility and precision of triplex mode flow determination were assessed, as were the relationships between umbilical vein flow and gestational age and head and abdominal circumferences. This cross-sectional study was performed with 70 healthy fetuses ranging from 20 weeks' gestation to term. Best-fit interpolating equations and confidence limits were calculated for blood flow measurements versus gestational age and head and abdominal circumferences. RESULTS: In the validation study performed on sheep there were no significant differences between triplex mode and steady-state measurement groups with respect to gestational age or weight. The umbilical vein flows were similar between triplex mode and steady-state measurement groups (P =.881). In the human study the intraobserver and interobserver coefficients of variation for the vein diameter, mean velocity, and absolute umbilical vein blood flow varied from 2.9% to 12.7%. The mean duration of examination was 3 +/- 1 minutes. The umbilical vein diameter and mean velocity increased throughout pregnancy. The absolute umbilical vein flow increased exponentially from 97.3 mL/min at midgestation to 529.1 mL/min at 38 weeks' gestation, whereas umbilical vein flow per kilogram of fetal weight did not change significantly with gestational age. There was a strong correlation between absolute umbilical vein flow and the fetal head and abdominal circumferences. CONCLUSIONS: The triplex mode ultrasonographic technique can play an innovative role in obtaining quick and reproducible measurements of umbilical vein blood flow. The approach was validated with a sheep model. Umbilical vein blood normalized for fetal weight (milliliters per minute per kilogram of fetal weight) and absolute flow (in milliliters per minute) are consistent with previous human studies. We have established new reference values of umbilical vein blood flow relative to head and abdominal circumferences. The growth of umbilical venous diameter accounted for most of the growth in umbilical vein flow.

[Monozygotic pregnancy after the treatment for infertility by transfer of frozen-thawed embryos]. / Ciaza mnoga monozygotyczna po leczeniu nieplodnosci metoda pozustrojowego zaplodnienia.

OBJECTIVES: It has been suggested that monozygotic pregnancies occur more frequently after in vitro fertilisation. This phenomenon is attributed to a number of factors including in vitro culture conditions, malformation of the zona pellucida due to manipulation on the oocytes and artificial opening of the zona pellucida. DESIGN: Retrospective analysis of monozygotic pregnancies in an IVF-ET procedures and obstetrical these pregnancies outcome. MATERIALS AND METHODS: A total of 2254 IVF-ET procedures were analysed. Three protocols were used for ovarian stimulation: short or long protocols with gonadotropins releasing hormone analogue or clomiphene citrate with hMG. In 811 cases male factor was diagnosed and intracitoplasmatic sperm injections were performed. RESULTS: 549 clinical pregnancies were achieved in analysed group. In six cases ultrasound examination 5 weeks after embryo transfer showed a greater number of foetus than the number of embryo transferred. In three of those cases the embryos were obtained after ICSI. Age and average thickness of zona pellucida were similar in group of patients with monozygotic pregnancies when compared with all pregnant patients after IVF treatment. CONCLUSIONS: The incidence of monozygotic pregnancy is increased in group pregnancies resulting from IVF ET. No single risk factor can explain this phenomena. This type of pregnancy needs special obstetrical attention.

Oxidative stress markers in preovulatory follicular fluid in humans.

Intensified peroxidation in the Graafian follicle may be a factor compromising the normal development of the oocyte. The aim of this study was to measure concentrations of three oxidative stress markers: conjugated dienes, lipid hydroperoxides and thiobarbituric acid-reactive substances, in preovulatory follicular fluids and sera of 145 women attending an in-vitro fertilization programme, and to correlate these concentrations with pregnancy outcome. Determinations were conducted either with or without an antioxidant (10 microM butylated hydroxytoluene) and an iron chelate (10 microM deferoxamine mesylate) to examine peroxidation associated with the methods used. Concentrations of conjugated dienes, lipid hydroperoxides and thiobarbituric acid-reactive substances in follicular fluid were all significantly lower than those in serum, both in the presence or absence of the antioxidant and iron chelate. These concentrations did not correlate with pregnancy outcome. In conclusion, the intensity of peroxidation in the Graafian follicle is much lower than that in serum. This gradient is the result of the lower rate of initiation of peroxidation in the follicular fluid, suggestive of the presence of efficient antioxidant defence systems in the direct milieu of the oocyte before ovulation. The concentrations of investigated oxidative stress markers in follicular fluid do not reflect the reproductive potential of oocytes.

Fetal supply of amino acids and amino nitrogen after maternal infusion of amino acids in pregnant sheep.

OBJECTIVE: The objective of the study was to determine whether a prolonged maternal infusion of amino acids would increase the umbilical uptake of amino acids and uteroplacental ammonia production. STUDY DESIGN: Six pregnant sheep (134.5 2.3 days after conception) were infused for 12 hours overnight with an amino acid solution. Uterine and umbilical blood flows were measured with the ethanol steady-state diffusion technique before (control) and during (experimental) infusion. Plasma amino acid and whole-blood ammonia concentrations were measured. RESULTS: After infusion, despite an increase in maternal arterial amino acid concentration, umbilical uptakes increased significantly only for branched-chain amino acids. Fetal ammonia concentrations and uteroplacental ammonia production increased moderately. Fetal nitrogen supply did not increase. Uterine nitrogen uptake represented 36% of the maternal nitrogen intake in the control period and 14% in the experimental period. CONCLUSION: Prolonged maternal infusion of an amino acid solution was a relatively ineffective method of increasing fetal amino acid supply.