Influence of population size, density, and proximity to talent clubs on the likelihood of becoming elite youth athlete.

Previous studies have found significant differences in the likelihood of becoming an elite athlete depending on community population sizes and densities, an effect known as the place of early development, or birthplace effect. However, the results have not been consistent between sports or European countries. As both professional and voluntary clubs are vital to the talent development systems in Europe, the proximity of an athlete's place of early development to the location of talent clubs may be an important predictor of the likelihood of becoming an elite athlete. Therefore, the primary purpose of this study was to investigate the place of early development effect and the effect of proximity to talent clubs. The samples included elite youth league athletes (579 football and 311 handball) and national youth athletes (85 football and 80 handball) and a comparison group of 147 221 football and 26 290 handball youth athletes. Odds ratios showed variations in the optimal community size and density across sports. Geospatial analyses of proximity to talent clubs highlighted a trend indicating that most national and elite youth league athletes in both sports had their place of early development in their sport near a talent club. The results suggest that proximity is an important predictor in the development of expertise across sports, but future studies need to clarify if proximity is important in other countries and sports.

The role of community in the development of elite handball and football players in Denmark.

The primary purpose of this study was to investigate the effect of the place of early development in a sample of Danish male elite and youth handball and football players. The sample included 366 handball and football players from the elite Danish league in the season 2011-2012 and a comparison sample of youth players under the age of 12 from 2003, including 147,221 football and 26,290 handball players. Odds ratio analysis showed that both population size and density significantly affected the proportional number of youth players per community and the odds of athletes reaching an elite level in football and handball. The odds for youth player registrations in both handball and football increased in rural in contrast to urban communities. However, elite football players primarily came from communities of high density (>1000 pop./km(2)), whereas elite handball players primarily came from less densely populated communities (100 to <250 pop./km(2)). Furthermore, there seems to be a relation between representation of elite and talent clubs in different communities and the probability of becoming an elite player in both sports. The limited number of elite players in both sports from rural communities may be due to national talent development strategies that do not incorporate development support for clubs in rural areas. Additionally, the results of the study clearly suggest the need to include the youth player population to advance research findings in birthplace effect studies.

Synergy between medical informatics and bioinformatics: facilitating genomic medicine for future health care.

In this paper, we review the results of BIOINFOMED, a study funded by the European Commission (EC) with the purpose to analyse the different issues and challenges in the area where Medical Informatics and Bioinformatics meet. Traditionally, Medical Informatics has been focused on the intersection between computer science and clinical medicine, whereas Bioinformatics have been predominantly centered on the intersection between computer science and biological research. Although researchers from both areas have occasionally collaborated, their training, objectives and interests have been quite different. The results of the Human Genome and related projects have attracted the interest of many professionals, and introduced new challenges that will transform biomedical research and health care. A characteristic of the 'post genomic' era will be to correlate essential genotypic information with expressed phenotypic information. In this context, Biomedical Informatics (BMI) has emerged to describe the technology that brings both disciplines (BI and MI) together to support genomic medicine. In recognition of the dynamic nature of BMI, institutions such as the EC have launched several initiatives in support of a research agenda, including the BIOINFOMED study.

Vascular toxicity and the mechanism underlying Raynaud's phenomenon in patients treated with cisplatin, vinblastine and bleomycin.

The vascular toxicity and the mechanism of Raynaud's phenomenon (RP) were investigated in 32 patients treated with cisplatin, vinblastine, and bleomycin. Sixteen patients had RP and sixteen patients were without finger symptoms. The results were compared with values obtained in 10 male controls. The following postural vasomotor functions were measured: (a) the vasomuscular, non-neurogenic autoregulation, tested by 133xenon flow during elevation of the finger 20 cm; (b) the local veno-arteriolar vasoconstrictor axon reflex, tested similarly by lowering the finger 40 cm; and (c) the central sympathetic vasoconstrictor reflex elicited by central baroreceptors and tested by changing the body posture from supine to sitting upright. The central sympathetic vasoconstrictor reflex was significantly increased in the group of patients with RP and/or cold provocation test positive (n = 16) when compared with the control group (p less than 0.05), and normal in patients without RP (n = 16). The local axon reflex functioned normally, whereas the autoregulation was impaired in both groups of patients compared with the control group (p less than 0.05). The results indicate a hyper-reactivity in the central sympathetic nervous system of the patients with RP, which also may explain their attacks of white fingers. The impaired autoregulation indicates a reduced function of the smooth muscle cells in the terminal arterioles, whereas the greater arterioles seem unaffected, as evidenced by the normal local axon reflex.

Pulmonary clearance of inhaled 99Tcm-DTPA: significance of site of aerosol deposition.

The aim of this study was to analyse how changes in the site of 99Tcm-DTPA aerosol deposition between central and peripheral parts of the lung influence routine measurement of pulmonary clearance of 99Tcm-DTPA (PCl). The study was performed in six 'never-smokers' and 10 smokers with bronchial hypersecretion. Changes in aerosol deposition was accomplished by changing the aerosol particle size and the velocity by which the subjects inhaled the particles. In the smokers with bronchial hypersecretion there was a significantly smaller PCl after central deposition (P less than 0.01), than after peripheral deposition, while in the never-smokers, significance was not reached. The smokers with bronchial hypersecretion had a significantly higher PCl than the never-smokers (P less than 0.01) when the 99Tcm-DTPA had been deposited in the peripheral parts of the lung, but at the examination of central deposition, the difference was no longer significant. It is concluded that in smokers with bronchial hypersecretion measurement of regional PCl is influenced by the site of 99Tcm-DTPA deposition in the lung.

Scintigraphy with nanocolloid Tc 99m in patients with small cell lung cancer, with special reference to bone marrow and hepatic metastasis.

Nineteen patients with newly diagnosed small cell lung cancer (SCLC) were examined with a nanocolloid Tc-99m bone marrow whole body imaging (scintigraphy) in order to detect bone marrow metastasis. Bilateral bone marrow biopsy taken from the posterior iliac crest was used as a reference. The scintigraphy was considered abnormal if a focal lesion was present and/or if the bone marrow activity expanded to more than one-third of the proximal part of the extremities. In 3 of the 19 patients, microscopical bone marrow metastasis and cold spots (focal lesions) on the scintigram were present. An additional 9 patients had expansion of the activity. Eight patients showed scintigraphic focal lesions in the liver. SCLC metastasis was confirmed in 4 patients, while 1 patient had focal necroses. The results indicate that cold spots rather than expansion of activity with bone marrow scintigraphy detected bone marrow involvement of the disease in patients with SCLC.

Bronchoscintigraphic visualization of the acute effect of tobacco exposure and terbutaline on mucociliary clearance in smokers.

The aim of this study was to examine the acute effect of tobacco smoke exposure and inhaled terbutaline on mucociliary clearance in 9 healthy smokers. It was based on a recently described method for scintigraphic visualization of the bronchi (bronchoscintigraphy). After an initial bronchoscintigram had been made by having the subjects inhale aerosolized 99mTc-albumin, they inhaled either terbutaline or placebo from a metered-dose inhaler. Subsequently, data acquisition for production of bronchoscintigrams was repeated at 10 min intervals for 120 min, and the mucociliary clearance was estimated from the movement of radioactivity in the series of bronchoscintigrams thus obtained. On two study days the subjects remained tobacco abstinent, while on two occasions they chain-smoked during the examination. Acute tobacco exposure resulted in an increased clearance rate in the lobar bronchi in 8 of the 9 smokers (p less than 0.03), while in the main bronchi and the trachea the effect was inconsistent. In all subjects terbutaline systematically increased the clearance rate in all visible bronchial structures compared to placebo (p less than 0.04). The combination of smoking and terbutaline caused a faster clearance rate in the lobar bronchi in most subjects than tobacco smoke or terbutaline alone. It is concluded that both acute tobacco exposure and terbutaline increase mucociliary clearance in healthy smokers.

Transitory postural vasomotor dysfunction in the finger after short term hand vibration.

The transitory effects of hand vibration (ah, w = 3.16 m/s2 during three minutes) on postural vasomotor functions of skin capillary blood flow rate in the finger were studied by the local 133xenon washout technique in ten men with vibration induced white finger (VWF), nine men professionally exposed to hand-arm vibration but without finger symptoms (HAV), and eight male controls (MC). The following postural vasomotor functions were measured: (a) the vasomuscular, non-neurogenic autoregulation, tested by raising the finger 20 cm; (b) the local venoarteriolar vasoconstrictor axon reflex, tested by lowering the finger 40 cm; and (c) the central sympathetic vasoconstrictor reflex elicited by central baroreceptors and tested by changing the body posture from supine to sitting upright. Before short term vibration the vasoconstriction elicited by central baroreceptors was increased in VWF (p less than 0.01) and normal in HAV (p greater than 0.10). The local axon reflex and the autoregulation functioned normally in VWF and HAV (p greater than 0.30). Three minutes after vibration, autoregulation was abolished and the functions of the central and local sympathetic vasoconstrictor reflexes were equally impaired in all three groups (p less than or equal to 0.01). All three vasomotor functions were completely restored 60 minutes after vibration in MC (p greater than 0.10) and also 30 minutes after vibration in one male control (p greater than 0.20). The results indicate a hyperreactivity of the central sympathetic nervous system in VWF, and a transitory, impaired function of digital arterioles after short term vibration in all groups.

Pulmonary permeability in never-smokers between 21 and 67 yr of age.

During the last 5-10 years, measurements of pulmonary clearance (PCl) of aerosolized 99mTc-labeled diethylenetriamine pentaacetic acid (99mTC-DTPA) have become increasingly used as an index of pulmonary epithelial injury. The aim of this study was to apply a carefully defined procedure for measurements of PCl in healthy nonsmoking individuals and analyze whether sex, age, and height are clinically relevant confounders contributing to the range of interindividual variation. Measurements of regional ventilation (V) and perfusion (Q) were included to analyze whether these indexes are influenced by the same confounders. We studied 39 males and females between 21 and 67 yr of age. Average PCl of the lungs was 0.85 +/- 0.25%.min-1. There was a significant difference between PCl of the central and peripheral parts of the lungs (P less than 0.01). Regional V and Q were greater in the lower than in the upper halves of the lungs (P less than 0.01). There was no relation between PCl, V, or Q and the sex, age, and height of the individuals. It is concluded that when measuring PCl in adult individuals anthropometric measurements need not be considered.

Effect of change in particle number on pulmonary clearance of aerosolized 99mTc-DTPA.

Pulmonary clearance (PCl) of inhaled aerosolized 99mTc-diethylenetriamine pentaacetic acid (DTPA) across the alveolocapillary membrane is diffusion limited. Therefore, if the mixing of the 99mTc-DTPA in the aqueous hypophase underlying surfactant is slow or incomplete or if there were no hypophase, an increase in the alveolar surface area occupied by 99mTc-DTPA particles would increase the absorption rate. The aim of this study was to examine whether there is an effect on PCl of changing the number of inhaled particles. The change in particle number was accomplished by a setup of four parallel jet nebulizers feeding a central delivery chamber of 400 cm3. We performed two kinds of experiments in eight healthy nonsmokers between 28 and 52 yr of age. In the first experiment, 99mTc-DTPA in saline was nebulized in one nebulizer, while saline was nebulized in the other three. In the second experiment the number of inhaled particles containing 99mTc-DTPA was increased by a factor of four by nebulizing 99mTc-DTPA in saline in all four nebulizers simultaneously. Increasing the number of inhaled 99mTc-DTPA particles caused an increase in PCl of 24.2% (P less than 0.01). We conclude that there is a slight but significant effect of changing the number of DTPA particles on PCl and that this is probably due to an uneven mixing of the 99mTc-DTPA in the aqueous hypophase underlying the surfactant lining and the alveoli.

Enhanced pulmonary toxicity in smokers with germ-cell cancer treated with cis-platinum, vinblastine and bleomycin: a long-term follow-up.

The long-term effects of bleomycin on pulmonary function were studied. Thirty-four patients with germ-cell cancer were followed for an average of 64 months (range 43-98 months). All had obtained complete remission during treatment and none had relapsed at the follow-up examination. Pulmonary function was tested by measurements of total lung capacity (TLC), vital capacity (VC), forced expiratory volume in one second (FEV1) and single breath diffusion capacity for carbon monoxide (TLCO). TLC and VC were significantly reduced by the treatment (P less than 0.05), but normalized during the follow-up. TLCO was initially reduced to a predicted median of 83%. In the smokers the initial TLCO was at a predicted median of 79%, while in non-smokers a median of 88% was predicted. During the first 2 months of treatment, TLCO increased both in smokers and non-smokers to predicted medians of 90% and 91%. Subsequently, however, a significant decrease to 72% was noted in the smokers, while the non-smokers had only an insignificant decrease to 84%. The decrease in TLCO was irreversible but not progressive. We conclude that bleomycin treatment is associated with a long-term sustained reduction in TLCO. The changes were most pronounced in the smokers.

[Bone scintigraphy in patients with hip joint prostheses. Use of bone scintigraphy in hip pain after total hip replacement]. / Knogleskintigrafi ved hofteledsprotese. Anvendelse af knogleskintigrafi ved hoftesmerter efter proteseindsaettelse.

A retrospective investigation was undertaken to assess the value of bone scintigraphy with 99mtechnetium methylene-diphosphonate in patients referred with hip pain after total hip replacement. The material comprized 68 patients with a total of 68 prostheses. This review revealed that 10/25 of the patients with pathological scintigrams and 6/28 of the patients with normal scintigrams were submitted to replacement of the prostheses. In the way in which it was carried out and interpreted in this department, scintigraphy was of limited value in selection of the patients who required replacement of the prostheses.

Technetium-99m DTPA does not break down during ultrasound nebulization.

For several years aerosolized 99Tcm-DTPA has been used for studies of pulmonary permeability. Comparable results have been obtained regardless of the 99Tcm-DTPA having been nebulized in an ultrasound nebulizer or a jet nebulizer. It was therefore surprising when in a recent study it was observed that more than 90% of a commercially available 99Tcm-DTPA (Squibb) was dissociated into 99TcmO4- and DTPA during ultrasound nebulization. To verify this observation we performed chromatography of seven commercially available DTPA-labelling kits (including that of Squibb). Four different test preparations of each of the kits were analysed: (1) stock solution of 99Tcm-DTPA; (2) heated (80 degrees C) 99Tcm-DTPA; (3) 99Tcm-DTPA nebulized by a DeVilbiss ultrasound nebulizer; (4) 99Tcm-DTPA nebulized by a Varic ultrasound nebulizer. In no case were we able to demonstrate more than 1.0% reduced pertechnetate (99TcmO2) or more than 0.9% free 99TcmO4- after either heating or ultrasound nebulization. A maximum of 5.6% 99TcmO2 could be demonstrated in the stock solution if chromatography was done immediately after the preparation, but only 15 min later no more than 0.9% 99TcmO2 was present. We conclude that there is no essential chemical breakdown of 99Tcm-DTPA during ultrasound nebulization. Caution should be taken not to use the 99Tcm-DTPA until 15 min after its preparation.

The effect of thoracic irradiation for cancer of the breast on ventilation, perfusion and pulmonary permeability. A one-year follow-up.

Regional and overall lung function was studied in 14 women during a one-year follow-up after postmastectomy irradiation for cancer of the breast. The dose was 40 Gy in the chest wall and 20-40 Gy in the apex of the lung. Immediately after irradiation there was a slight increase in pulmonary clearance of 99TCm-DTPA compared to baseline values. This increase, however, was not restricted to the field of irradiation. Three months after irradiation there were regional defects in the ventilation and perfusion scintigrams in 11 of the patients. At the same time there was a greater decrease in total lung capacity, vital capacity and diffusion capacity for CO than in ventilation and perfusion. One year after irradiation the lung function impairment had only insignificantly regressed. It is concluded that local lung irradiation may cause persistent regional and generalized lung function impairment. The early increase in pulmonary clearance of 99Tcm-DTPA could not be used as a predictor of subsequent lung function impairment.