Ultrasound Measurement of Femoral Articular Cartilage Thickness Before and After Marathon Running.

OBJECTIVE: The purpose of this study was to use ultrasonography to measure femoral articular cartilage thickness changes during marathon running, which could support MRI studies showing that deformation of knee cartilage during long-distance running is no greater than that for other weight-bearing activities. MATERIALS AND METHODS: Participants included 38 marathon runners with no knee pain or history of knee injury, aged 18-39. Ultrasound images of the femoral articular cartilage were taken two hours before and immediately after the race. Femoral articular cartilage thickness was measured at both the medial and lateral femoral condyles. RESULTS: The maximum change in femoral articular cartilage thickness, measured at the left outer lateral femoral condyle, was 6.94% (P=.006). All other femoral articular cartilage thickness changes were not significant. CONCLUSION: A change in femoral articular cartilage thickness of 6.94% supports our hypothesis that long-distance running does not induce deformational changes greater than that of regular daily activities. This study using ultrasonography supports MRI evidence that knee cartilage tolerates marathon running well.

Is There a Correlation Between Reported Knee Pain and Fluid at the Distal Insertion of the Iliotibial Band in Runners?

Objective To determine whether there is a correlation between pain and the amount of fluid present at the distal insertion of the iliotibial band (ITB) in runners, as measured by USG. Method Our retrospective cross-sectional study evaluated 100 male and female runners prior to the start of a race. A valid and reliable questionnaire collected demographic, pain, and training data. If a runner reported knee pain, a numeric pain rating scale was used to record the degree of pain. Participants then underwent USG on both knees to determine the presence or absence of fluid at the distal insertion of the ITB. Result We found no statistically significant correlations of fluid measurements with pain score, running experience in years, or age. In addition, we found no other differences in fluid measurements between those with and without knee pain or between the sexes. Conclusions Our findings indicate that the presence or absence of fluid at the distal insertion of the ITB does not correlate with knee pain in runners, regardless of age, running experience, or sex.

Isolation and Structure Elucidation of Additional Alkaloids from the Tropical Rainforest Tree Galbulimima baccata.

The structures of five new natural products (GB 27-GB 31, 1-5), isolated as minor components from the bark of Galbulimima baccata, have been determined by 2D NMR spectroscopy in combination with DFT calculations. Among the alkaloids, GB 31 (5) belongs to Class I, GB 27 (1) and 28 (2) belong to Class II, and GB 30 (4) belongs to Class III GB alkaloids. GB 31 is the first non-nitrogen-containing GB "alkaloid", being a biosynthetic oxidation product of himbacine, himandravine, or himbeline. GB 29 (3) has an entirely new natural product scaffold but belongs to Class IV (miscellaneous alkaloids). The isolation of a new Galbulimima scaffold has revealed a new pathway in the biosynthesis of the GB alkaloids. The new molecules isolated have shed further light on the biogenetic relationship among these structurally unique and complex groups of alkaloids. We present, for the first time, a unified biogenesis for the GB alkaloids that were first isolated in the 1950s and now number over 40 examples. This work also brings full circle the story of Galbulimima alkaloids. A life-long project of Wal Taylor involving one of his first students (Lew Mander) and one of his last students (Peter Karuso), a story stretching over six decades, has come to a final conclusion.

Factors Associated With Half- and Full-Marathon Race-Related Injuries: A 3-Year Review.

OBJECTIVE: To better evaluate the relationships between training, demographics, and injury, this study sought to define race-related injury risk factors for half- and full-marathon runners. DESIGN: This 3-year, observational cross-sectional study included adults who participated in a half or full marathon. Prerace and 2-week postrace surveys collected data on demographics, training factors, and injuries. SETTING: This study took place during a nationally recognized marathon affiliated with a local hospital. PARTICIPANTS: Runners were recruited during the Expo in the days before the race. Postrace surveys were returned by 1043 half marathoners and 624 full marathoners (response rate, 83%). INTERVENTIONS: This was an observational study; independent variables included demographic data and race year. MAIN OUTCOME MEASURE: The primary outcome was race-related injury that occurred during the race or within 2 weeks after the race. RESULTS: Race-related injuries were reported by 24% of half marathoners and 30% of full marathoners. For half and full marathoners, respectively, significant factors for injuries were previous injury, lower peak weekly training mileage, and lower weekly mileage before race training. Factors significant for only half-marathon injuries were younger age, female sex, shorter distance of longest training run, and no formal training program. Factors significant for only full-marathon injuries were higher body mass index, fewer days running per week, and fewer years of running experience. CONCLUSIONS: Previous running injuries, undertraining, and inexperience increased race-related injury risk; women had higher risk than men. Decreased risk of injury was associated with training loads of greater than 23 miles/week for half marathoners and 40 miles/week for full marathoners.

Considerations in the Care of Athletes With Attention Deficit Hyperactivity Disorder.

OBJECTIVES: Uncover literature pertaining to: (1) attention deficit hyperactivity disorder (ADHD) and how it impacts athletes; (2) ADHD medication effects; (3) regulations regarding ADHD medications; (4) approaches to conditions similar to, and occurring with, ADHD; and (5) use of stimulants. DATA SOURCES: MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Ovid interface. MAIN RESULTS: ADHD can have many effects on athletes and sports participation. Exercise has positive benefits on ADHD behaviors and players' attitudes. Athletes with ADHD can have worsened ADHD symptoms after concussions. Attention deficit hyperactivity disorder is a modifier of return to play; baseline ADHD symptoms should be used to guide management. Management should include medications, behavioral/psychosocial therapy, and academic accommodations. Behavioral therapy combined with medication is superior to behavioral treatment alone. Sustained exercise as ADHD treatment should be considered mainstay in management. Sports can increase thermogenic effects of stimulants, heat injury, and cardiac arrhythmias. Increased aggressiveness, improved pain tolerance, and decreased sense of fatigue are some attributes of stimulants that are presumed to impart some advantage to athletes, but evidence is uncertain. Attention deficit hyperactivity disorder medications may lead to myocardial infarctions, cerebrovascular accidents, paranoid psychoses, seizures, insomnia, tremors, anxiety, hypertension, and death. CONCLUSIONS: Athletes' performance and quality of life can be negatively affected by ADHD. Risks exist for those who take ADHD medications. More research is needed on the implications ADHD may have in specific sports, and on possible advantages of medication use. Potential deleterious effects of these medications should be addressed.

Structures of New Alkaloids from Rain Forest Trees Galbulimima belgraveana and Galbulimima baccata in Papua New Guinea, Indonesia, and Northern Australia.

Following on our 60-year research on the chemical constituents of the rain forest trees Galbulimima belgraveana and Galbulimima baccata, we report the isolation of seven new alkaloids: GB14 (14), GB22 (15), GB25 (16), GB21 (17), GB23 (18), GB24 (19), and GB26 (20). Their structures were elucidated by a combination of spectroscopic analyses and single-crystal X-ray crystallography, as well as structure degradation and interconversion. The newly isolated alkaloids are precursors or derivatives of the known family members from our early studies and could be intermediates in the biosynthesis of the Galbulimima alkaloids. Therefore, the present study has expanded the range of structures in this family of alkaloids and provided some missing links in the biosynthetic sequences.

Impact of a high body mass index on lower extremity injury in marathon/half-marathon participants.

BACKGROUND: To evaluate whether a high body mass index (BMI) predisposes marathon/half-marathon participants to lower extremity injuries. METHODS: Consenting adult participants at the 2008 National Marathon to Fight Breast Cancer were enrolled in this observational study. The primary outcome measure was prevalence of self-reported lower extremity injury, during both training and race participation, with respect to BMI. RESULTS: There were 194 subjects with complete data: 139 females (72%) and 55 males. Forty-six percent of females and 51% of males ran the full marathon (P = .63). Median BMI was 23.7 kg/m(2) for females and 26.2 kg/m(2) for males (P = .001). Eleven (24%) females in BMI tertile 1 (T1) suffered a training injury, while 9 (18%) from T2 and 4 (9%) from T3 suffered injuries (P = .072; OR 0.89; 95% CI 0.78 to 1.01). Twenty-six (19%) females suffered an injury during the race. Females in T1 were more likely to suffer a race-related injury (P = .038; OR 0.87; 95% CI 0.77 to 0.99). Females were 13% less likely to suffer a race-related injury with each 1-unit increase in BMI. Rates of injury did not differ by BMI tertile in males. CONCLUSIONS: A high BMI did not impart an increased risk of lower extremity injury during training or race participation.

Peroneal tendon subluxation: the other lateral ankle injury.

Ankle injuries are a frequent cause of patient visits to the emergency department and orthopaedic and primary care offices. Although lateral ligament sprains are the most common pathologic conditions, peroneal tendon subluxations occur with a similar inversion mechanism. Multiple grades of subluxation have been described with a recent addition of intrasheath subluxation. Magnetic resonance imaging is the best imaging modality to view the peroneal tendons at the retrofibular groove. Currently, point-of-care ultrasound is gaining clinical ground, especially for the dynamic viewing capability to capture an episodic subluxation. Although conservative treatment may be attempted for an acute injury, it has a low rate of success for the prevention of recurrent subluxation. Surgical procedures of various techniques have resulted in excellent recovery rates and faster return to play. The aim of this paper was to give a complete review of the current literature on peroneal tendon subluxation and to propose a clinical algorithm to help guide diagnosis and treatment. The goal of this study was to heighten clinical awareness to improve earlier detection and treatment of this sometimes elusive diagnosis.

Metabolites from the endophytic fungus Xylaria sp. PSU-D14.

Glucoside derivatives, xylarosides A (1) and B (2), were isolated from the broth extract of the endophytic fungus Xylaria sp. PSU-D14 along with two known compounds, sordaricin (3) and 2,3-dihydro-5-hydroxy-2-methyl-4H-1-benzopyran-4-one (4). The structures were assigned by spectroscopic methods. Sordaricin (3), one of the known metabolites, exhibited moderate antifungal activity against Candida albicans ATCC90028 with a MIC value of 32 microg/ml.

Echocardiographic characterisation of left ventricular geometry of professional male tennis players.

BACKGROUND: The cardiac characteristics of various types of athletes have been defined by echocardiography. Athletes involved in predominately static exercise, such as bodybuilders, have been found to have more concentric hypertrophy, whereas those involved in dynamic exercise, such as long distance runners, have more eccentric hypertrophy. Tennis at the elite level is a sport that is a combination of static and dynamic exercise. OBJECTIVE: To characterise left ventricular geometry including left ventricular hypertrophy by echocardiography in male professional tennis players. DESIGN: Retrospective study of screening echocardiograms that were performed on male professional tennis players. SETTING: All echocardiograms were performed at the Mayo Clinic (Jacksonville, Florida, USA) between 1998-2000. PARTICIPANTS: A total of 41 male professional tennis players, with a mean age of 23. RESULTS: Left ventricular hypertrophy was present in 30 of 41 subjects (73%, 95% CI: 57%-86%). The majority of players manifested eccentric hypertrophy (n = 22, 54%). Concentric hypertrophy (n = 9, 22%) and normal geometry (n = 7, 17%) were encountered with similar frequency. Only 7% (n = 3) manifested concentric remodelling. The mean thickness of both the interventricular septum and the posterior wall was 11.0 mm. The mean LVEDd was 55 mm. The mean RWT was 0.41. The mean LVMI was 130 gm/m2 and the mean EF was 64%. Five of the 41 subjects had an abnormal septal thickness of 13 mm. CONCLUSION: This was the first study to specifically describe the full range of echocardiographically-determined left ventricular geometry in professional male tennis players. The majority of subjects exhibited abnormal geometry, predominantly eccentric hypertrophy.

Constituents of the leaves of Holarrhena pubescens.

The leaves of Holarrhena pubescens yielded a new naringenin glycoside (1), together with naringin, naringenin 7-O-beta-D-glucoside, lupeol, lupeol beta-hydroxyhexadecanoate and ursolic acid. The structure of 1 was determined by spectral analysis.

Anti-inflammatory activity of 4-arylcoumarins from endophytic Streptomyces aureofaciens CMUAc130 in murine macrophage RAW 264.7 cells.

This research was undertaken to test the in vitro anti-inflammatory action of 5,7,4'-trimethoxy-4-phenylcoumarin and 5,7-dimethoxy-4-phenylcoumarin produced by Streptomyces aureofaciens CMUAc130. The effects of the two coumarins were investigated on the formation of NO, PGE2, and TNF-alpha and also on inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) in lipopolysaccharide (LPS)-induced murine macrophage RAW 264.7 cells. The data obtained were consistent with the modulation of iNOS enzyme expression. A similar effect was also observed when LPS-induced PGE2 release and COX-2 expression were tested. The inhibitory effects were shown in concentration-dependent manners. The 5,7,4'-Trimethoxy-4-phenylcoumarin and 5,7-dimethoxy-4-phenylcoumarin also mildly but significantly reduced the formation of TNF-alpha.

Update on exercise stress testing.

Exercise stress testing is an important diagnostic tool for the evaluation of suspected or known cardiac disease. In 2002, the American College of Cardiology (ACC) and the American Heart Association (AHA) revised their guidelines for exercise testing. Ten categories from the ACC/ AHA 1997 guidelines were modified: ST heart rate adjustment, unstable angina, older patients, acute coronary syndromes, chest pain centers, acute myocardial infarction, asymptomatic patients, valvular heart disease, rhythm disturbances, and hypertension. Adjustment of the ST heart rate can identify myocardial ischemia in asymptomatic patients with elevated cardiac risk. Intermediate- and low-risk patients with unstable angina, acute coronary syndromes, or chest pain should undergo exercise stress testing when clinically stable. Provided they are stable, patients who have had acute myocardial infarction can undergo a submaximal exercise test before discharge or a symptom-limited exercise stress test any time after two to three weeks have elapsed. In asymptomatic patients with cardiac risk factors, the exercise stress test may provide valuable prognostic information. Aortic regurgitation is the only valvular heart disorder in which there is significant evidence that exercise stress testing is useful in management decisions. The stress test also can be used in older patients to identify the presence of coronary artery disease. However, because of other comorbidities, a pharmacologic stress test may be necessary. Exercise stress testing can help physicians successfully evaluate arrhythmia in patients with syncope. The exercise stress test also can help identify patients at risk of developing hypertension if they show an abnormal hypertensive response to exercise.

Prenylated xanthones as potential antiplasmodial substances.

Mangostin, the major xanthone of Garcinia mangostana, and a series of synthetic derivatives were investigated for their in vitro antiplasmodial activity against Plasmodium falciparum. Mangostin itself showed moderate activity, but prenylated xanthones containing alkylamino functional groups exhibited quite potent antiplasmodial activity. Some structure-activity relationships are proposed.

Tetraoxygenated xanthones from the fruits of Garcinia cowa.

Tetraoxygenated xanthones, cowaxanthones A-E, together with 10 previously reported tetraoxygenated xanthones, were isolated from the crude hexane extract of the fruits of Garcinia cowa. Cowaxanthone B has previously been reported as a synthetic xanthone. Their structures were elucidated by analysis of spectroscopic data, especially by 1D and 2D NMR. The antibacterial activities of the isolated compounds were also evaluated.

NMR studies of darutoside, a rare ENT-pimarane glucoside.

NMR spectral data in various solvents (DMSO-d6, CD3OD, C5D5N) for the rare ent-pimar-8(14)-ene-15, 16-diol 3-O-beta-D-glucoside, darutoside, are reported. Complete assignments are made on the basis of 1D and 2D (COSY, HMQC, HMBC, NOESY) spectra.

Antibacterial caged-tetraprenylated xanthones from the stem bark of Garcinia scortechinii.

Five new caged-tetraprenylated xanthones, scortechinones L - P (1-5), together with six known scortechinones (A, B, D, F, I and J) and one known xanthone, 4 '',5 ''-dihydro-1,5-dihydroxy-6 ',6 '-dimethylpyrano(2 ',3 ':6,7)-4 '',4 '',5 ''-trimethylfurano(2 '',3 '':3,4)- xanthone, were isolated from the crude methanol extract of the stem bark of Garcinia scortechinii. The structures were elucidated by analysis of spectroscopic data and comparison of the NMR data with those reported previously. The antibacterial activity of all caged-polyprenylated xanthones, isolated from the latex and stem bark of G. scortechinii, was evaluated. Scortechinone B (6) exhibited significant antibacterial activity against a methicillin-resistant Staphylococcus aureus strain with an MIC value of 2 microg/mL. From the MIC values, some structure-antibacterial activity relationships were established.

A new ent-kaurane diterpenoid from Croton tonkinensis leaves.

A new ent-kaurane diterpenoid (1) was isolated from the leaves of Croton tonkinensis. The structure of 1 was determined as ent-7beta-hydroxy-15-oxokaur-16-en-18-ol from spectroscopic methods.