Exploring the Potential of Iminosugars as Antivirals for Crimean-Congo Haemorrhagic Fever Virus, Using the Surrogate Hazara Virus: Liquid-Chromatography-Based Mapping of Viral N-Glycosylation and In Vitro Antiviral Assays.

Crimean-Congo haemorrhagic fever virus (CCHFV) is a pathogen of increasing public health concern, being a widely distributed arbovirus and the causative agent of the potentially fatal Crimean-Congo haemorrhagic fever. Hazara virus (HAZV) is a genetically and serologically related virus that has been proposed as a surrogate for antiviral and vaccine testing for CCHFV. Glycosylation analysis of HAZV has been limited; first, we confirmed for the first time the occupation of two N-glycosylation sites in the HAZV glycoprotein. Despite this, there was no apparent antiviral efficacy of a panel of iminosugars against HAZV, as determined by quantification of the total secretion and infectious virus titres produced following infection of SW13 and Vero cells. This lack of efficacy was not due to an inability of deoxynojirimycin (DNJ)-derivative iminosugars to access and inhibit endoplasmic reticulum α-glucosidases, as demonstrated by free oligosaccharide analysis in uninfected and infected SW13 and uninfected Vero cells. Even so, iminosugars may yet have potential as antivirals for CCHFV since the positions and importance of N-linked glycans may differ between the viruses, a hypothesis requiring further evaluation.

Concurrent validity of the CORE wearable sensor with BodyCap temperature pill to assess core body temperature during an elite women's field hockey heat training camp.

Wearable temperature sensors offer the potential to overcome several limitations associated with current laboratory- and field-based methods for core temperature assessment; however, their ability to provide accurate data at elevated core temperatures (Tc) has been questioned. Therefore, this investigation aimed to determine the concurrent validity of a wearable temperature sensor (CORE) compared to a reference telemetric temperature pill (BodyCAP) during a team-sport heat training camp prior to the 2020 Olympic Games. Female field hockey players (n = 19) in the Australian national squad completed 4 sessions in hot conditions where their temperature was monitored via CORE and BodyCAP. Concurrent validity of the wearable CORE device was determined with reference to the ingested BodyCAP pill. Lin's Concordance Correlation Coefficients determined there was "poor" agreement between devices during all sessions. Mean bias demonstrated that CORE underestimated Tc in all sessions (-0.06°C to -0.34°C), with wide mean 95% confidence intervals (±0.35°C to ±0.56°C). Locally estimated scatterplot smoothing regression lines illustrated a non-linearity of error, with greater underestimation of Tc by the CORE device, as Tc increased. The two devices disagreed more than ±0.3°C for 41-60% of all data samples in each session. Our findings do not support the use of the CORE device as a valid alternative to telemetric temperature pills for Tc assessment, particularly during exercise in hot conditions where elevated Tc are expected.

The CORE wearable sensor is not a valid alternative to telemetric temperature pills for Tc assessment, particularly during exercise in hot conditions where elevated Tc are expected.Compared to reference Tc data provided by a validated, ingestible telemetric temperature pill, the CORE device demonstrated "poor" agreement between devices during all sessions in this investigation.There was a non-linear bias which tended to underestimate Tc to a greater extent as Tc increased (but with wide confidence intervals), with 41-60% of all data exceeding a threshold error of ±0.3°C.

What are the sleep characteristics of elite female athletes? A systematic review with meta-analysis.

With the recent growth in female sport, practitioners need to be able to provide specific support to female athletes to ensure their sleep, health and athletic performance are optimised. Examine the patterns, duration and quality of sleep among elite female athletes, and consider the impact of situational challenges and their effects on the sleep of elite female athletes. Data was located through a search of SPORTDiscus, MEDLINE and Scopus from inception up to May 2021. Studies needed to be peer-reviewed research reporting quantitative sleep outcomes for female athletes ≥ 18 years of age and competing at a predefined elite level. A meta-analysis was performed on habitual sleep outcomes (e.g. total sleep time [TST] and sleep efficiency [SE]) measured with actigraphy. A total of 38 studies were included. Meta-analysis showed habitual TST (n = 14) was 7.8 h [7.4, 8.2] (mean [95% CI]), and SE was 86.7% [84.7, 88.6], with high variability among studies (I2 = 97.8-98.2%). Subjective sleep complaints are common before a competition, as do post-training sleep disturbances (63% studies report TST decrease), and post-competition sleep disturbances (75% studies report TST decrease). Female athletes achieve satisfactory objective sleep quantity and quality during habitual periods, but experience sleep disturbances pre- and post-situational challenges. There is high variability of objective sleep outcomes, demonstrating the individual nature of habitual female athlete sleep. Overall, future research must focus on optimising the sleep appraisal methods and creating high-quality study designs in a broader number of sports.

Antiviral effects of deoxynojirimycin (DNJ)-based iminosugars in dengue virus-infected primary dendritic cells.

Dendritic cells (DCs) are important targets for dengue virus (DENV) infection and play a significant role in the early immune response. Antiviral effects of iminosugars against DENV in primary cells have been demonstrated previously in monocyte-derived macrophages (MDMΦs). Given the important role played by DCs in innate immune defense against DENV, the antiviral effects of three deoxynojirimycin (DNJ) derivatives (NN-DNJ, EOO-DNJ and 2THO-DNJ) and a deoxygalactonojirimycin (DGJ) negative control were evaluated in DENV-infected primary human monocyte-derived immature DCs (imDCs). DNJ- but not DGJ-derivatives elicited antiviral activity in DENV-infected imDCs, similar to that observed in MDMΦs. The DNJ-derivatives inhibited DENV secretion in a dose-dependent manner. Endoplasmic reticulum (ER) α-glucosidase I inhibition by DNJ-derived iminosugars, at concentrations of 3.16 µM, correlated with a reduction in the specific infectivity of virions that were still secreted, as well as a reduction in DENV-induced tumour necrosis factor alpha secretion. This suggests iminosugar-mediated ER α-glucosidase I inhibition may give rise to further benefits during DENV infection, beyond the reduction in viral secretion associated with ER α-glucosidase II inhibition.

How Do the Habitual Sleep Patterns of Elite Female Basketball and Soccer Athletes Compare With the General Population?

PURPOSE: To compare the habitual sleep of female basketball and soccer athletes to age- and sex-matched controls and to characterize the sleep of basketball and soccer athletes at different competition locations and on the days surrounding competition. METHODS: Using an observational case-control design, 41 female participants were recruited to participate, consisting of 11 basketball athletes (mean [SD]: age = 24.1 [4.9] y), 10 soccer athletes (24.8 [6.4] y), and 20 nonathletic controls (24.2 [2.8] y). Sleep was monitored using actigraphy for four 7-day periods throughout the preseason and subsequent competition season. Generalized linear models were used to analyze the effect of group and competition situation (eg, Home or Away) on sleep. RESULTS: During habitual conditions, basketball athletes had longer sleep durations (7.4 [1.5] h) than soccer athletes (7.0 [1.2] h, P < .001) and controls (7.3 [1.2] h, P = .002). During competition, basketball and soccer athletes had longer sleep durations following home (7.7 [1.7] and 7.2 ± 1.3 h) compared with away games (6.8 [1.8] and 7.0 [1.3] h). In addition, basketballers went to bed earlier (23:49 [01:25]) and woke earlier (07:22 [01:59]) following away games compared with soccer athletes (00:10 [01:45] and 08:13 [01:45]). CONCLUSIONS: Basketballers had longer habitual sleep durations compared with soccer athletes and nonathletic controls. During competition, basketballers had earlier bed and wake times compared with soccer athletes following away games, highlighting the need for individualized sleep strategies.

Efficacy of autologous mesenchymal stromal cell treatment for chronic degenerative musculoskeletal conditions in dogs: A retrospective study.

Introduction: The objective of this study was to retrospectively analyze clinical data from a referral regenerative medicine practice, to investigate the efficacy of autologous mesenchymal stromal cells (MSC) in 245 dogs deemed unresponsive to conventional treatment by their referring vet. Methods: Diagnostic imaging [radiology and musculoskeletal ultrasound (MSK-US)] identified musculoskeletal pathology holistically. MSCs, produced according to current guidelines, were initially administered with PRP by targeted injection to joints and/or tendons, with a second MSC monotherapy administered 12 weeks later to dogs with severe pathology and/or previous elbow arthroscopic interventions. Dogs with lumbosacral disease received epidural MSCs with additional intravenous MSCs administered to dogs with spondylosis of the cervical, thoracic and lumbar spine. All dogs received laser therapy at 10 J/cm2 at the time of treatment and for 5 sessions thereafter. Objective outcome measures (stance analysis, range of joint motion, pressure algometry) and validated subjective outcome measures (owner reported VetMetrica HRQL™ and veterinary pain and quality of life impact scores) were used to investigate short and long-term (6-104 weeks) efficacy. Outcome data were collected at predetermined time windows (0-6, 7-12, 13-18, 19-24, 25-48, 49-78, 79-104) weeks after initial treatment. Results: There were statistically significant improvements in post compared with pre-treatment measures at all time windows in stance analysis, shoulder and hip range of motion, lumbosacral pressure algometry, and to 49-78 weeks in carpus and elbow range of motion. Improvements in 4 domains of quality of life as measured by VetMetricaTM were statistically significant, as were scores in vet-assessed pain and quality of life impact. In dogs receiving one initial treatment the mean time before a second treatment was required to maintain improvements in objective measures was 451 days. Diagnostic imaging confirmed the regenerative effects of MSCs in tendinopathies by demonstrating resolution of abnormal mineralization and restoration of normal fiber patterns. Discussion: This represents the first study using "real-world" data to show that cell-based therapies, injected into multiple areas of musculoskeletal pathology in a targeted holistic approach, resulted in rapid and profound positive effects on the patient's pain state and quality of life which was maintained with repeat treatment for up to 2 years.

ɑ-Lactalbumin Improves Sleep and Recovery after Simulated Evening Competition in Female Athletes.

PURPOSE: This study aimed to determine the efficacy of α-lactalbumin (A-LAC) supplementation for improving sleep and performance recovery after simulated evening competition in female athletes. METHODS: Sixteen trained women (mean ± SD: age, 27 ± 7 yr; mass, 62 ± 10 kg; stature, 167 ± 8 cm) participated in this randomized double-blind three-arm crossover study. Participants completed a simulated evening competition before consuming either an A-LAC whey protein, whey protein placebo (PLA), or water control (CON) beverage. Sleep was monitored via polysomnography, and participants completed a series of physical, cognitive, and perceptual assessments before, and 14 and 24 h after simulated competition. RESULTS: Non-rapid eye movement stage 2 sleep increased after competition in A-LAC (pre, 199 ± 44 min; post, 212 ± 37 min) but decreased in CON (pre, 228 ± 43 min; post, 195 ± 40 min) and PLA (pre, 224 ± 25 min; post, 211 ± 35 min; P = 0.012). In addition, Yo-Yo Intermittent Recovery Test Level 1 distance improved over time in A-LAC (baseline, 664 ± 332 m; 14 h post, 667 ± 326 m; 24 h post, 781 ± 427 m) compared with CON (baseline, 741 ± 366 m; 14 h post, 648 ± 351 m; 24 h post, 720 ± 407 m) and PLA (baseline, 763 ± 394 m; 14 h post, 636 ± 366 m; 24 h post, 720 ± 396 m; P < 0.001). CONCLUSIONS: The findings indicate that A-LAC supplementation may be useful for retaining some sleep characteristics after evening competition, leading to improved physical performance in female athletes.

Pathogen-induced inflammation is attenuated by the iminosugar MON-DNJ via modulation of the unfolded protein response.

Sepsis is a life-threatening condition involving a dysregulated immune response to infectious agents that cause injury to host tissues and organs. Current treatments are limited to early administration of antibiotics and supportive care. While appealing, the strategy of targeted inhibition of individual molecules in the inflammatory cascade has not proved beneficial. Non-targeted, systemic immunosuppression with steroids has shown limited efficacy and raises concern for secondary infection. Iminosugars are a class of small molecule glycomimetics with distinct inhibition profiles for glycan processing enzymes based on stereochemistry. Inhibition of host endoplasmic reticulum resident glycoprotein processing enzymes has demonstrated efficacy as a broad-spectrum antiviral strategy, but limited consideration has been given to the effects on host glycoprotein production and consequent disruption of signalling cascades. This work demonstrates that iminosugars inhibit dengue virus, bacterial lipopolysaccharide and fungal antigen-stimulated cytokine responses in human macrophages. In spite of decreased inflammatory mediator production, viral replication is suppressed in the presence of iminosugar. Transcriptome analysis reveals the key interaction of pathogen-induced endoplasmic reticulum stress, the resulting unfolded protein response and inflammation. Our work shows that iminosugars modulate these interactions. Based on these findings, we propose a new therapeutic role for iminosugars as treatment for sepsis-related inflammatory disorders associated with excess cytokine secretion.

Extended post-exercise hyperthermia in athletes with a spinal cord injury.

OBJECTIVES: Determine the extent and underlying causes of post-exercise hyperthermia in athletes with a spinal cord injury following exercise. DESIGN: Observational. METHODS: Thirty-one males (8 with tetraplegia [TP; C5-C8], 7 with high paraplegia [HP; T1-T5], 8 with low paraplegia [LP; T6-L1] and 8 able-bodied [AB]), recovered in 35°C/50%RH for 45min after 30-min of exercise at a metabolic heat production (Hprod) of 4.0W/kg (AB vs TP) or 6.0W/kg (AB vs HP vs LP). Esophageal (Tes), gastrointestinal (Tgi) and skin temperatures, Hprod, local sweat rate (LSR) and mean arterial pressure were measured. RESULTS: TP maintained a higher Tes (38.05°C [95% CI: 37.83°C, 38.28°C], AB: 36.77°C [36.56°C, 36.98°C], p<0.001) and Tgi (TP: 38.36°C [38.15°C, 38.58°C], AB: 37.26°C [37.04°C, 37.47°C], p<0.001), with peak values observed 45min post-exercise. Core temperatures all declined in HP, LP and AB, but HP maintained a higher Tes than AB (p=0.030), and higher Tgi than LP and AB (p=0.019). No differences in post-exercise Hprod were observed between TP and AB (p=0.264), or HP, LP and AB (p=0.124). Evaporative heat loss was estimated to be zero in TP, while back LSR was greater in HP than LP (p=0.009). Minimal dry heat loss occurred in SCI groups (TP: 9W/m2 [6, 12], HP: 4W/m2 [1, 6], LP: 2W/m2 [0, 5]). CONCLUSIONS: Substantial post-exercise hyperthermia is evident in TP (∼1.4°C hotter than AB after 45min of post-exercise recovery) due to minimal evaporation. HP have delayed post-exercise thermoregulatory recovery whereas LP respond similarly to AB.

Influence of Electronic Devices on Sleep and Cognitive Performance During Athlete Training Camps.

ABSTRACT: Jones, MJ, Dawson, B, Eastwood, PR, Halson, SL, Miller, J, Murray, K, Dunican, IC, Landers, GJ, and Peeling, P. Influence of electronic devices on sleep and cognitive performance during athlete training camps. J Strength Cond Res 35(6): 1620-1627, 2021-This study investigated the effects of removing athletes' electronic devices in the evening on sleep and performance during training camps. Water polo athletes (n = 26) attending a 7-night training camp (study 1) and triathletes (n = 23) attending a 4-night training camp (study 2) were randomly allocated to a no-device group (no electronic devices could be used after dinner or overnight; ND) or control group (unrestricted electronic device use; CON). Sleep was monitored through wrist actigraphy. The ND group completed a questionnaire measuring anxiety related to being unable to use electronic devices ("nomophobia"). Triathletes also completed a psychomotor vigilance test (PVT) at the start and end of camp. Water polo ND athletes went to bed earlier and spent longer time in bed than CON on the first night, but not on other nights. In triathletes, sleep quantity was not different between groups on any night. No statistically significant differences were observed for changes in nomophobia from the first to the last night of camp. No differences in PVT performance were observed between ND and CON triathletes. In conclusion, removal of evening electronic devices does not improve sleep quantity or cognitive performance in athletes during short-duration (4-7 nights) training camps.

Sleep Hygiene and Light Exposure Can Improve Performance Following Long-Haul Air Travel.

PURPOSE: To assess the efficacy of a combined light exposure and sleep hygiene intervention to improve team-sport performance following eastward long-haul transmeridian travel. METHODS: Twenty physically trained males underwent testing at 09:00 and 17:00 hours local time on 4 consecutive days at home (baseline) and the first 4 days following 21 hours of air travel east across 8 time zones. In a randomized, matched-pairs design, participants traveled with (INT; n = 10) or without (CON; n = 10) a light exposure and sleep hygiene intervention. Performance was assessed via countermovement jump, 20-m sprint, T test, and Yo-Yo Intermittent Recovery Level 1 tests, together with perceptual measures of jet lag, fatigue, mood, and motivation. Sleep was measured using wrist activity monitors in conjunction with self-report diaries. RESULTS: Magnitude-based inference and standardized effect-size analysis indicated there was a very likely improvement in the mean change in countermovement jump peak power (effect size 1.10, ±0.55), and likely improvement in 5-m (0.54, ±0.67) and 20-m (0.74, ±0.71) sprint time in INT compared with CON across the 4 days posttravel. Sleep duration was most likely greater in INT both during travel (1.61, ±0.82) and across the 4 nights following travel (1.28, ±0.58) compared with CON. Finally, perceived mood and motivation were likely worse (0.73, ±0.88 and 0.63, ±0.87) across the 4 days posttravel in CON compared with INT. CONCLUSIONS: Combined light exposure and sleep hygiene improved speed and power but not intermittent-sprint performance up to 96 hours following long-haul transmeridian travel. The reduction of sleep disruption during and following travel is a likely contributor to improved performance.

Modular Orthopaedic Tissue Engineering With Implantable Microcarriers and Canine Adipose-Derived Mesenchymal Stromal Cells.

Mesenchymal stromal cells (MSC) hold significant potential for tissue engineering applications. Modular tissue engineering involves the use of cellularized "building blocks" that can be assembled via a bottom-up approach into larger tissue-like constructs. This approach emulates more closely the complexity associated hierarchical tissues compared with conventional top-down tissue engineering strategies. The current study describes the combination of biodegradable porous poly(DL-lactide-co-glycolide) (PLGA) TIPS microcarriers with canine adipose-derived MSC (cAdMSC) for use as implantable conformable building blocks in modular tissue engineering applications. Optimal conditions were identified for the attachment and proliferation of cAdMSC on the surface of the microcarriers. Culture of the cellularized microcarriers for 21 days in transwell insert plates under conditions used to induce either chondrogenic or osteogenic differentiation resulted in self-assembly of solid 3D tissue constructs. The tissue constructs exhibited phenotypic characteristics indicative of successful osteogenic or chondrogenic differentiation, as well as viscoelastic mechanical properties. This strategy paves the way to create in situ tissue engineered constructs via modular tissue engineering for therapeutic applications.

Profound Intraoperative Hypotension Associated With Transfusion via the Belmont Fluid Management System.

This retrospective observational case series conducted at 2 large academic centers over a 4-year period consists of 15 cases of profound hypotension in surgical patients immediately after initiation of the Belmont Fluid Management System for rapid transfusion of blood products. Halting the infusion and administering vasoactive agents led to resolution of hypotension. Repeat transfusion with the Belmont system resulted in repeat hypotension unless counteracted with vasopressors. No etiology was elucidated. This represents the largest documented association of acute hypotensive transfusion reaction with any rapid infusion system in surgical patients.

Iminosugars counteract the downregulation of the interferon γ receptor by dengue virus.

The antiviral mechanism of action of iminosugars against many enveloped viruses is hypothesized to be a consequence of misfolding of viral N-linked glycoproteins through inhibition of host endoplasmic reticulum α-glucosidase enzymes. Iminosugar treatment of dengue virus (DENV) infection results in reduced secretion of virions and hence lower viral titres in vitro and in vivo. We investigated whether iminosugars might also affect host receptors important in DENV attachment and uptake and immune responses to DENV. Using a primary human macrophage model of DENV infection, we investigated the effects of maturation with IL-4, DENV-infection and treatment with N-butyl-1-deoxynojirimycin (NB-DNJ) or N-(9-methoxynonyl)-1-DNJ (MON-DNJ) on expression of 11 macrophage receptors. Whereas iminosugars did not affect surface expression of any of the receptors examined, DENV infection significantly reduced surface IFNγ receptor amongst other changes to total receptor expression. This effect required infectious DENV and was reversed by iminosugar treatment. Treatment also affected signalling of the IFNγ receptor and TNFα receptor. In addition, iminosugars reduced ligand binding to the carbohydrate receptor-binding domain of the mannose receptor. This work demonstrates that iminosugar treatment of primary macrophages affects expression and functionality of some key glycosylated host immune receptors important in the dengue life cycle.

No association between Parkinson disease and autoantibodies against NMDA-type glutamate receptors.

BACKGROUND: IgG-class autoantibodies to N-Methyl-D-Aspartate (NMDA)-type glutamate receptors define a novel entity of autoimmune encephalitis. Studies examining the prevalence of NMDA IgA/IgM antibodies in patients with Parkinson disease with/without dementia produced conflicting results. We measured NMDA antibodies in a large, well phenotyped sample of Parkinson patients without and with cognitive impairment (n = 296) and controls (n = 295) free of neuropsychiatric disease. Detailed phenotyping and large numbers allowed statistically meaningful correlation of antibody status with diagnostic subgroups as well as quantitative indicators of disease severity and cognitive impairment. METHODS: NMDA antibodies were analysed in the serum of patients and controls using well established validated assays. We used anti-NMDA antibody positivity as the main independent variable and correlated it with disease status and phenotypic characteristics. RESULTS: The frequency of NMDA IgA/IgM antibodies was lower in Parkinson patients (13%) than in controls (22%) and higher than in previous studies in both groups. NMDA IgA/IgM antibodies were neither significantly associated with diagnostic subclasses of Parkinson disease according to cognitive impairment, nor with quantitative indicators of disease severity and cognitive impairment. A positive NMDA antibody status was positively correlated with age in controls but not in Parkinson patients. CONCLUSION: It is unlikely albeit not impossible that NMDA antibodies play a significant role in the pathogenesis or progression of Parkinson disease e.g. to Parkinson disease with dementia, while NMDA IgG antibodies define a separate disease of its own.

Independent Influence of Spinal Cord Injury Level on Thermoregulation during Exercise.

PURPOSE: This study aimed to establish the true influence of spinal cord injury (SCI) level on core temperature and sweating during exercise in the heat independently of biophysical factors. METHODS: A total of 31 trained males (8 with tetraplegia [TP; C5-C8], 7 with high paraplegia [HP; T1-T5], 8 with low paraplegia [LP; T6-L1], and 8 able bodied [AB]) performed 3 × 10 min of arm ergometry with 3-min rest at a metabolic heat production of (a) 4.0 W·kg (AB vs TP) or (b) 6.0 W·kg (AB vs HP vs LP), in 35°C, 50% relative humidity. Esophageal (Tes) and local skin temperatures and local sweat rate (LSR) on the forehead and upper back were measured throughout. RESULTS: Change in Tes was greatest in TP (1.86°C ± 0.32°C vs 0.29°C ± 0.07°C, P < 0.001) and greater in HP compared with LP and AB, reaching 1.20°C ± 0.50°C, 0.66°C ± 0.23°C, and 0.53°C ± 0.12°C, respectively (P < 0.001). Approximately half of the variability in end-trial ΔTes was described by SCI level in paraplegics (adjusted R = 0.490, P = 0.005). Esophageal temperature onset thresholds of sweating at the forehead and upper back were similar among HP, LP, and AB, whereas no sweating was observed in TP. Thermosensitivity (ΔTes vs ΔLSR) was also similar, except for LP demonstrating lower thermosensitivity than AB at the upper back (0.78 ± 0.26 vs 1.59 ± 0.89 mg·cm·min, P = 0.039). Change in skin temperature was greatest in denervated regions, most notably at the calf in all SCI groups (TP, 2.07°C ± 0.93°C; HP, 2.73°C ± 0.68°C; LP, 2.92°C ± 1.48°C). CONCLUSION: This study is the first to show the relationship between ΔTes and SCI level in athletes with paraplegia after removing variability arising from differences in metabolic heat production and mass. Individual variability in ΔTes is further reduced among athletes with TP because of minimal evaporative heat loss secondary to an absence of sweating.

Intrathecal Morphine Administration Does Not Affect Survival After Liver Resection for Hepatocellular Carcinoma.

Introduction. Opioids may influence tumor recurrence and cancer-free survival in hepatocellular carcinoma (HCC). The relationship between intrathecal morphine administration, tumor recurrence, and patient survival after hepatectomy for HCC is unknown. Patients and Methods. This single-center, retrospective study included 1837 liver resections between July 2002 and December 2012; 410 cases were incorporated in the final univariate and multivariate analysis. Confirmatory propensity matching yielded 65 matched pairs (intrathecal morphine vs none). Primary outcomes were recurrence of HCC and survival. Secondary outcomes included characterization of factors associated with recurrence and survival. Results. Groups were similar except for increased coronary artery disease in the no intrathecal morphine group. All patients received volatile anesthesia. Compared with no intrathecal morphine (N = 307), intrathecal morphine (N = 103) was associated with decreased intraoperative intravenous morphine administration (median difference = 12.5 mg; 95% confidence interval [CI] = 5-20 mg). There was no difference in blood loss, transfusion, 3- or 5-year survival, or recurrence in the univariate analysis. Multivariate analysis identified covariates that significantly correlated with 5-year survival: intrathecal morphine (hazard ratio [HR] = 0.527, 95% CI = 0.296-0.939), lesion diameter (HR = 1.099, 95% CI = 1.060-1.141), vascular invasion (HR = 1.658, 95% CI = 1.178-2.334), and satellite lesions (HR = 2.238, 95% CI = 1.447-3.463). Survival analysis on the propensity-matched pairs did not demonstrate a difference in 5-year recurrence or survival. Discussion and Conclusion. Multivariate analysis revealed a significant association between intrathecal morphine and 5-year survival. This association did not persist after propensity matching. The association between intrathecal morphine and HCC recurrence and survival remains unclear and prospective work is necessary to determine whether an association exists.

Sleep practices implemented by team sport coaches and sports science support staff: A potential avenue to improve athlete sleep?

OBJECTIVES: The primary aims of the present study were to assess the sleep hygiene knowledge of high performance team sport coaches and sports science support staff; the sleep practices these individuals implement with athletes; and the barriers to the more frequent use of these practices. DESIGN: Cross-sectional observational study. METHODS: A sample of 86 Australian coaches and sports science support staff working within high performance team sport volunteered to complete a four-part questionnaire, including the Sleep Beliefs Survey used to assess sleep hygiene knowledge. RESULTS: Overall sleep hygiene knowledge was adequate (15.3±2.9, score range 0-20; mean±SD), however knowledge of sleep-wake cycle behaviours (score 4.9±1.6 out of 7) and thoughts and attitudes about sleep (3.6±1.0 out of 5) were inadequate. Over half (56%) of coaches and support staff had monitored athlete sleep, while 43% had promoted sleep hygiene. Lack of resources (response range 44-60%) and knowledge (16-41%) were the two main barriers to the implementation of sleep monitoring and sleep hygiene practices. CONCLUSIONS: Team sport coaches and sports science support staff have adequate overall sleep hygiene knowledge, yet some specific areas (e.g. sleep-wake cycle behaviours) warrant improvement. There appear to be limited sleep practices implemented with athletes, particularly regarding the promotion of sleep hygiene. The development of educational sleep resources for coaches and support staff to implement with athletes may help address the identified barriers and improve sleep knowledge.