Sleep, training load and performance in elite female gymnasts.

Training load (TL) and recovery should be in optimal balance to obtain maximal performance gains. We aimed to study sleep as a recovery technique and its relationship with TL and performance in elite athletes. Twenty-six elite female artistic gymnasts were divided into an under 13 (n = 6), an under 14 (n = 6), a junior (n = 7; 14-15y) and a senior (=World Championship (WC) competitors, n = 7; ≥16y) category. Sleep, through sleep logs, and training parameters, using the session Rate of Perceived Exertion (sRPE) scale, were monitored to calculate total sleep time (TST), sleep efficiency (SE), TL, monotony and strain. Performance of WC competitors was evaluated through coach and WC qualification ranking. For the entire group, TST (effect sizes (ES) = -1.12, confidence intervals (CI) = -60:-47, P < .05) and SE (ES = -0.13, CI = -1.40:-0.10, P = .022) were shorter during week than weekend nights. TST and SE were highest in youngest gymnasts (P < .05). TL was lowest in under 13 and senior gymnasts (P < .05), while TL, monotony and strain were highest in junior gymnasts (P < .05). A negative regression was found between TST and TL the day after, while higher TL also led to lower TST the following night (P < .001). For the WC competitors, TST the night before the qualifications was shorter than the mean TST of the WC period (ES = -0.95, CI = -170:24, P = .030). TST correlated with coach ranking (r = -0.857, P = .014). Higher TL correlated with worse WC (r = 0.829, P = .042) and coach (r = 0.893, P = .007) ranking. This research in elite gymnasts indicated associations between decreased TST, augmented TL and inferior performance. Optimizing sleep and TL may therefore represent strategies to enhance performance.

A multidisciplinary network for the care of abnormal fatigue and chronic fatigue syndrome in the provinces of East and West Flanders in Belgium.

The organization of care for patients with the chronic fatigue syndrome (CFS) in tertiary care referral centres from 2002 onwards, was negatively evaluated by the Belgian Health Care Knowledge Centre on the endpoint of socio-professional reintegration. Subsequently, the federal health authorities asked for the elaboration of a new and innovative model of stepped care, aiming at improved integration of diagnosis and treatment into primary care and between levels of health care for patients with CFS. The reference centre of the University Hospital Ghent took the initiative of recruiting partners in the Belgian provinces of East and West Flanders to guarantee the care for patients with medically unexplained symptoms, in particular abnormal fatigue and CFS. A new and innovative care model, in which general practitioners play a central role, emphasizes the importance of early recognition of the patient 'at risk', correct diagnosis and timely referral. Early detection and intervention is essential in order to avoid or minimize illness progression towards chronicity, to safeguard opportunities for significant health improvement as well as to enhance successful socio-professional reintegration. This approach covers both the large sample of patients developing somatic complaints without obvious disease in an early phase as well as the more limited group of patients with chronic illness, including CFS. Cognitive behavioural therapy and graded exposure/exercise therapy are the evidence based main components of therapy in the latter. A biopsychosocial model underlies the proposed path of care.

Chordoid meningioma in an adult patient presenting with chronic fatigue and systemic inflammation.

We report a 27-year-old woman presenting with chronic fatigue and depressive symptoms. Aspecific neurologic symptoms and biochemical indices of inflammation and anaemia triggered an MRI, revealing a tumor with compression of the medulla oblongata. After neurosurgical resection, anatomopathologic examination showed a chordoid meningioma. All complaints disappeared and inflammatory parameters normalized, suggesting an association with Castleman syndrome. This case demonstrates the importance of a systematic diagnostic approach in patients presenting with unexplained chronic fatigue.

Interactions of virulent and avirulent Yersinia ruckeri strains with isolated gill arches and intestinal explants of rainbow trout Oncorhynchus mykiss.

Yersinia ruckeri is the causative agent of enteric redmouth disease leading to significant losses in salmonid aquaculture worldwide. Little information is available on the pathogenesis of this disease. Basic steps in the establishment of an infection include attachment to the epithelium followed by invasion at the portal of entry. In this study, the interactions of Y. ruckeri with the gills and the gut of rainbow trout Oncorhynchus mykiss (Walbaum, 1792) were studied using standardized perfusion models. Virulent and avirulent Y ruckeri isolates appeared to adhere to and invade both tissues without significant differences. For the first time, the gill and gut perfusion models are shown to be suitable to study bacterial invasiveness.

In vitro markers for virulence in Yersinia ruckeri.

In this study, different traits that have been associated with bacterial virulence were studied in Yersinia ruckeri. Two isolates that had been shown to cause disease and mortality in experimentally infected rainbow trout were compared with five avirulent isolates. Both virulent isolates showed high adhesion to gill and intestinal mucus of rainbow trout, whereas the majority of non-virulent strains demonstrated significantly lower adhesion. A decrease in adherence capability following bacterial treatment with sodium metaperiodate and proteolytic enzymes suggested the involvement of carbohydrates and proteins. All strains were able to adhere to and invade chinook salmon embryo cell line (CHSE-214), fathead minnow epithelial cell line (FHM) and rainbow trout liver cell line (R1). One non-virulent strain was highly adhesive and invasive in the three cell lines, whereas the virulent strains showed moderate adhesive and invasive capacity. The internalization of several isolates was inhibited by colchicine and cytochalasin-D, suggesting that microtubules and microfilaments play a role. For all strains, intracellular survival assays showed a decrease of viable bacteria in the cells 6 h after inoculation, suggesting that Y. ruckeri is not able to multiply or survive inside cultured cells. Analysis of the susceptibility to the bactericidal effect of rainbow trout serum demonstrated that virulent Y. ruckeri strains were serum resistant, whereas non-virulent strains were generally serum sensitive.

Route of entry and tissue distribution of Yersinia ruckeri in experimentally infected rainbow trout Oncorhynchus mykiss.

Yersinia ruckeri is the causative agent of enteric redmouth disease, which leads to significant losses in salmonid aquaculture worldwide. Despite the significance of the disease, little information is available on the pathogenesis. In this study, the portal of entry was investigated using a contact-exposure infection method in rainbow trout Oncorhynchus mykiss with 4 different Y. ruckeri strains. Bacteriological and histological examination revealed the presence of high numbers of bacteria in the gills immediately after infection resulting in a rapid spread of Y. ruckeri in the internal organs. However, only a virulent strain was able to survive and multiply in the host, causing septicaemia and death several days after infection. These findings indicate that gills may be an important site of entry and that Y. ruckeri virulence is related to immune evasion.

Yersinia ruckeri infections in salmonid fish.

Yersinia ruckeri is the causative agent of yersiniosis or enteric redmouth disease leading to significant economic losses in salmonid aquaculture worldwide. Infection may result in a septicaemic condition with haemorrhages on the body surface and in the internal organs. Despite the significance of the disease, very little information is available on the pathogenesis, hampering the development of preventive measures to efficiently combat this bacterial agent. This review discusses the agent and the disease it causes. The possibility of the presence of similar virulence markers and/or pathogenic mechanisms between the Yersinia species which elicit disease in humans and Y. ruckeri is also examined.