Motor performance is not related to injury risk in growing elite-level male youth football players. A causal inference approach to injury risk assessment.

OBJECTIVE: To identify the causal relation between growth velocity and injury in elite-level youth football players, and to assess the mediating effects of motor performance in this causal pathway. DESIGN: Prospective cohort study. METHODS: We measured the body height of 378 male elite-level football players of the U13 to U15 age categories three to four months before and at the start of the competitive season. At the start of the season, players also performed a motor performance test battery, including motor coordination (Körperkoordinationstest für Kinder), muscular performance (standing broad jump, counter movement jump), flexibility (sit and reach), and endurance measures (YoYo intermittent recovery test). Injuries were continuously registered by the academies' medical staff during the first two months of the season. Based on the causal directed acyclic graph (DAG) that identified our assumptions about causal relations between growth velocity (standardized to cm/y), injuries, and motor performance, the causal effect of growth velocity on injury was obtained by conditioning on maturity offset. We determined the natural indirect effects of growth velocity on injury mediated through motor performance. RESULTS: In total, 105 players sustained an injury. Odds ratios (OR) showed a 15% increase in injury risk per centimetre/year of growth velocity (1.15, 95%CI: 1.05-1.26). There was no causal effect of growth on injury through the motor performance mediated pathways (all ORs were close to 1.0 with narrow 95%CIs). CONCLUSIONS: Growth velocity is causally related to injury risk in elite-level youth football players, but motor performance does not mediate this relation.

Factores de riesgo cardiovascular, estado nutricional e índices HOMA-IR, QUICKI y TG/c-HDL en adolescentes púberes / Cardiovascular risk factors, nutritional status on HOMA-IR, QUICKI and TG/c-HDL indexes in pubertal adolescents / Fatores de risco cardiovascular, estado nutricional e índices HOMA-IR, QUICKI e TG/c-HDL em adolescentes púberes

La coexistencia o agrupamiento de factores de riesgo cardiovascular (FRCV) en la adolescencia se asocia a un mayor riesgo de sufrir enfermedades cardiovasculares en la edad adulta. El objetivo de la presente investigación fue evaluar la prevalencia de FRCV y el efecto de la coexistencia o agrupación de dichos factores y del estado nutricional, sobre los índices HOMA-IR, QUICKI y TG/c-HDL, en adolescentes púberes del Estado Carabobo, Venezuela. El estudio fue descriptivo, correlacional, de campo y transversal. Participaron 147 adolescentes entre 12 y 15 años. Se evaluó el estado nutricional y el estadio de maduración sexual. Los FRCV estudiados fueron la actividad física (AF) deficiente, el tabaquismo, la circunferencia de cintura >percentil 90 (CC>p90), presión arterial sistólica y/o diastólica>p90 (PA>p90), glucosa alterada en ayuna (GAA>100 mg/dL), triglicéridos >p90 (TG>p90) y c-HDL<40 mg/dL. Se calcularon los índices HOMA-IR, QUICKI y TG/c-HDL. Las asociaciones entre variables se evaluaron utilizando el test de correlación de Pearson, las comparaciones de medias con las pruebas t de Student, U de Mann-Whitney, ANOVA y Kruskal-Wallis, mientras que la comparación de proporciones, se evaluó con el estadístico Z (a=0,05). Se encontraron las siguientes prevalencias para los FRCV estudiados: AF deficiente (63,3%), CC>p90 (41,5%), c-HDL<40 mg/ dL (40,3%), tabaquismo (6,8%), TG>p90 (4,1%) y PA>p90 (2,9%). El número de FRCV correlacionó con la insulina, HOMA-IR y QUICKI (p<0,001). El índice TG/c-HDL correlacionó significativamente con los índices HOMA-IR y QUICKI (p<0,001). Los índices HOMA-IR y TG/c-HDL fueron más elevados y el QUICKI más bajo en los adolescentes con exceso de peso y que presentaron tres o más FRCV, en comparación a los normopeso con el mismo número de FRCV (p<0,05). El exceso de peso y la coexistencia de los FRCV condicionaron un aumento de los índices HOMA-IR y TG/c-HDL, y una disminución del índice QUICKI en los adolescentes estudiados.

The coexistence or clustering of cardiovascular risk factors during adolescence is associated with an increased risk of cardiovascular disease in adulthood. The aim of the investigations was to evaluate the prevalence of cardiovascular risk factors and the effect of clustering of these factors and nutritional status on HOMA-IR, QUICKI and TG/c-HDL indexes, in pubertal adolescents from Carabobo State, Venezuela. A descriptive, correlational, and cross-sectional study was undertaken. It involved 147 adolescents aged 12 to 15 years. The nutritional status and sexual maturation stage of individuals was determined. The cardiovascular risk factors studied were: poor physical activity, smoking, waist circumference (>p90), systolic and/or diastolic blood pressure (>p90), impaired fasting glucose (IFG>100 mg/dL), triglycerides (>p90) and c-HDL (<40 mg/dL). HOMA-IR, QUICK and TG/c-HDL indexes were calculated. Associations between variables were evaluated using the Pearson correlation test and comparisons of means with the Student t test, Mann-Whitney U, ANOVA and Kruskal-Wallis test, while the comparison between proportions was evaluated with Z-score statistics (a=0.05). The following prevalences were found for the cardiovascular risk factors studied: Poor AF (63.3%), waist circumference> p90 (41.5%), HDL-C <40 mg/dL (40.3%), smoking (6.8%), TG>p90 (4.1%) and PA> p90 (2.9%). The number of cardiovascular risk factors correlated with insulin, HOMA-IR, QUICKI and TG/c-HDL (p<0.001). TG/c-HDL index correlated with HOMA-IR and QUICKI indexes (p<0.001). HOMA-IR and TG/c-HDL indexes were higher and the QUICKI index lower in overweight adolescents who presented three or more cardiovascular risk factors, compared to normal-weight adolescents with the same number of cardiovascular risk factors (p<0.05). Overweight and the clustering of cardiovascular risk factors determined an increase in HOMA-IR and TG/c-HDL indexes, and a decrease in the QUICKI index in the teenagers studied.

A coexistencia ou agrupamento de fatores de risco cardiovascular (FRCV) na adolescencia associa-se a um maior risco de sofrer doengas cardiovasculares na idade adulta. O objetivo desta investigagäo foi avaliar a prevalencia de FRCV e o efeito da coexistencia ou agrupamento desses fatores e do estado nutricional nos índices HOMA-IR, QUICKI e TG/c-HDL em adolescentes púberes do Estado Carabobo, Venezuela. O estudo foi descritivo, correlacional, de campo e transversal. Participaram 147 adolescentes entre 12 e 15 anos. Avaliou-se o estado nutricional e o estágio de maturidade sexual. Os FRCV estudados foram a atividade física (AF) deficiente, o tabagismo, a circunferencia da cintura > percentil 90 (CC >percentil 90), pressäo arterial sistólica e diastólica >p90 (PA>p90), glicemia de jejum alterada (GJA>100 mg/dL), triglicérides >p90 (TG>p90) e c-HDL<40mg/dL. Calcularam-se os índices HOMA-IR, QUICKI e TG/c-HDL. As asso-ciagöes entre variáveis avaliaram-se utilizando o teste de correlagäo de Pearson, as comparagöes de médias com os testes t de Student, U de Mann-Whitney, ANOVA e Kruskal-Wallis, enquanto que a comparagäo de proporgöes avaliou-se com o teste estatístico Z (a:0,05). Encontraram-se as seguintes prevalencias para os FCRV estudados: AF deficiente (63,3%), CC>p90 (41,5%), c-HDL<40 mg/dL (40,3%), tabagismo (6,8%), TG>p90 (4,1%) e PA>p90 (2,9%). O número de FCRV se correlacionou com a insulina, HOMA-IR e QUICKI (p<0,001). O índice TG/c-HDL correlacionou-se significativamente com os índices HOMA-IR e QUICKI (p<0,001). Os índices HOMA-IR e TG/c-HDL foram mais altos e o QUICKI mais baixo nos adolescentes com excesso de peso e que apresentaram tres ou mais FRCV, em comparagäo aos de peso normal com o mesmo número de FRCV (p<0,05). O excesso de peso e a coexistencia dos FRCV condicionaram um aumento dos índices HOMA-IR e TG/c-HDL e uma diminuigäo do índice QUICKI nos adolescentes estudados.

Factores de riesgo cardiovascular, estado nutricional e índices HOMA-IR, QUICKI y TG/c-HDL en adolescentes púberes / Cardiovascular risk factors, nutritional status on HOMA-IR, QUICKI and TG/c-HDL indexes in pubertal adolescents / Fatores de risco cardiovascular, estado nutricional e índices HOMA-IR, QUICKI e TG/c-HDL em adolescentes púberes

La coexistencia o agrupamiento de factores de riesgo cardiovascular (FRCV) en la adolescencia se asocia a un mayor riesgo de sufrir enfermedades cardiovasculares en la edad adulta. El objetivo de la presente investigación fue evaluar la prevalencia de FRCV y el efecto de la coexistencia o agrupación de dichos factores y del estado nutricional, sobre los índices HOMA-IR, QUICKI y TG/c-HDL, en adolescentes púberes del Estado Carabobo, Venezuela. El estudio fue descriptivo, correlacional, de campo y transversal. Participaron 147 adolescentes entre 12 y 15 años. Se evaluó el estado nutricional y el estadio de maduración sexual. Los FRCV estudiados fueron la actividad física (AF) deficiente, el tabaquismo, la circunferencia de cintura >percentil 90 (CC>p90), presión arterial sistólica y/o diastólica>p90 (PA>p90), glucosa alterada en ayuna (GAA>100 mg/dL), triglicéridos >p90 (TG>p90) y c-HDL<40 mg/dL. Se calcularon los índices HOMA-IR, QUICKI y TG/c-HDL. Las asociaciones entre variables se evaluaron utilizando el test de correlación de Pearson, las comparaciones de medias con las pruebas t de Student, U de Mann-Whitney, ANOVA y Kruskal-Wallis, mientras que la comparación de proporciones, se evaluó con el estadístico Z (a=0,05). Se encontraron las siguientes prevalencias para los FRCV estudiados: AF deficiente (63,3%), CC>p90 (41,5%), c-HDL<40 mg/ dL (40,3%), tabaquismo (6,8%), TG>p90 (4,1%) y PA>p90 (2,9%). El número de FRCV correlacionó con la insulina, HOMA-IR y QUICKI (p<0,001). El índice TG/c-HDL correlacionó significativamente con los índices HOMA-IR y QUICKI (p<0,001). Los índices HOMA-IR y TG/c-HDL fueron más elevados y el QUICKI más bajo en los adolescentes con exceso de peso y que presentaron tres o más FRCV, en comparación a los normopeso con el mismo número de FRCV (p<0,05). El exceso de peso y la coexistencia de los FRCV condicionaron un aumento de los índices HOMA-IR y TG/c-HDL, y una disminución del índice QUICKI en los adolescentes estudiados.(AU)

The coexistence or clustering of cardiovascular risk factors during adolescence is associated with an increased risk of cardiovascular disease in adulthood. The aim of the investigations was to evaluate the prevalence of cardiovascular risk factors and the effect of clustering of these factors and nutritional status on HOMA-IR, QUICKI and TG/c-HDL indexes, in pubertal adolescents from Carabobo State, Venezuela. A descriptive, correlational, and cross-sectional study was undertaken. It involved 147 adolescents aged 12 to 15 years. The nutritional status and sexual maturation stage of individuals was determined. The cardiovascular risk factors studied were: poor physical activity, smoking, waist circumference (>p90), systolic and/or diastolic blood pressure (>p90), impaired fasting glucose (IFG>100 mg/dL), triglycerides (>p90) and c-HDL (<40 mg/dL). HOMA-IR, QUICK and TG/c-HDL indexes were calculated. Associations between variables were evaluated using the Pearson correlation test and comparisons of means with the Student t test, Mann-Whitney U, ANOVA and Kruskal-Wallis test, while the comparison between proportions was evaluated with Z-score statistics (a=0.05). The following prevalences were found for the cardiovascular risk factors studied: Poor AF (63.3%), waist circumference> p90 (41.5%), HDL-C <40 mg/dL (40.3%), smoking (6.8%), TG>p90 (4.1%) and PA> p90 (2.9%). The number of cardiovascular risk factors correlated with insulin, HOMA-IR, QUICKI and TG/c-HDL (p<0.001). TG/c-HDL index correlated with HOMA-IR and QUICKI indexes (p<0.001). HOMA-IR and TG/c-HDL indexes were higher and the QUICKI index lower in overweight adolescents who presented three or more cardiovascular risk factors, compared to normal-weight adolescents with the same number of cardiovascular risk factors (p<0.05). Overweight and the clustering of cardiovascular risk factors determined an increase in HOMA-IR and TG/c-HDL indexes, and a decrease in the QUICKI index in the teenagers studied.(AU)

A coexistencia ou agrupamento de fatores de risco cardiovascular (FRCV) na adolescencia associa-se a um maior risco de sofrer doengas cardiovasculares na idade adulta. O objetivo desta investigagõo foi avaliar a prevalencia de FRCV e o efeito da coexistencia ou agrupamento desses fatores e do estado nutricional nos índices HOMA-IR, QUICKI e TG/c-HDL em adolescentes púberes do Estado Carabobo, Venezuela. O estudo foi descritivo, correlacional, de campo e transversal. Participaram 147 adolescentes entre 12 e 15 anos. Avaliou-se o estado nutricional e o estágio de maturidade sexual. Os FRCV estudados foram a atividade física (AF) deficiente, o tabagismo, a circunferencia da cintura > percentil 90 (CC >percentil 90), pressõo arterial sistólica e diastólica >p90 (PA>p90), glicemia de jejum alterada (GJA>100 mg/dL), triglicérides >p90 (TG>p90) e c-HDL<40mg/dL. Calcularam-se os índices HOMA-IR, QUICKI e TG/c-HDL. As asso-ciag÷es entre variáveis avaliaram-se utilizando o teste de correlagõo de Pearson, as comparag÷es de médias com os testes t de Student, U de Mann-Whitney, ANOVA e Kruskal-Wallis, enquanto que a comparagõo de proporg÷es avaliou-se com o teste estatístico Z (a:0,05). Encontraram-se as seguintes prevalencias para os FCRV estudados: AF deficiente (63,3%), CC>p90 (41,5%), c-HDL<40 mg/dL (40,3%), tabagismo (6,8%), TG>p90 (4,1%) e PA>p90 (2,9%). O número de FCRV se correlacionou com a insulina, HOMA-IR e QUICKI (p<0,001). O índice TG/c-HDL correlacionou-se significativamente com os índices HOMA-IR e QUICKI (p<0,001). Os índices HOMA-IR e TG/c-HDL foram mais altos e o QUICKI mais baixo nos adolescentes com excesso de peso e que apresentaram tres ou mais FRCV, em comparagõo aos de peso normal com o mesmo número de FRCV (p<0,05). O excesso de peso e a coexistencia dos FRCV condicionaram um aumento dos índices HOMA-IR e TG/c-HDL e uma diminuigõo do índice QUICKI nos adolescentes estudados.(AU)

Carcinoma diferenciado de tiroides (CDT) en niños y adolescentes: Evolución clínica y factores pronósticos / Differentiated thyroid carcinoma in children and adolescents: Clinial outcome and prognostic factors

Si bien la forma de presentación del CDT es más agresiva en la edad pediátrica que en los adultos, la tasa de sobrevida es superior al 90%.Objetivo: analizar retrospectivamente las características clínico-patológicas,la evolución y los factores pronósticos en pacientes prepuberales (PP) y puberales (P) con diagnostico de CDT controlados en nuestro servicio. Resultados se incluyeron 43 pacientes seguidos por un tiempo X (±DS) de 5.99 años(a) (3.57) a, rango 1 -14 a. El tratamiento consistió en tiroidectomía con vaciamiento ganglionar, Iodo131 y levotiroxina en dosis inhibitoria de TSH. Al diagnóstico: edad cronológica (EC) X (±DS)10.9 (3.84) a, rango: 4.7 -17a, relación femenino /masculino 2.9. Diecinueve PP y 24 P. El 53.5% (n:23) presentó nódulos confinados a la glándula con o sin extensión ganglionar y el 46.5% (n:20) tenia un estadío tumoral más avanzado con invasión local y metástasis (MTS) pulmonar. Treinta y ocho pacientes (88.4%) tenían MTS ganglionar cervical y 16(37.2%) MTS pulmonar. El grupo PP comparado con el P tenía EC significativamente menor X (±DS) 7.25 (2.03) a vs 13.83a (p <0.001), estadío tumoral más avanzado 84.2 vs16.8% (p<0.001) y mayor ocurrencia de MTS pulmonar 68.4 vs 12.5% (p<0.003). La sobrevida global fue de 92% y libre de enfermedad 78%.Las variables predictoras de persistencia de enfermedad más significativas fueron presencia de MTS pulmonar al diagnóstico y niveles séricos de tiroglobulina superiores a 8.5 ng/ml posterior al tratamiento inicial. Conclusión: el CDT pediátrico tiene una presentación agresiva especialmente en los pacientes prepuberales. El pediatra debería incorporar el examen clínico del cuello para realizar un diagnóstico y tratamiento precoz (AU)

Children-DTC has been found to behave differently than in adults. At diagnosis, children present in a more aggressive way. However the overall survival rates is greater than 90%. The aim of this study was to perform a retrospective analysis of clinicopathologycal features at diagnosis, evolution and prognostic factors for DTC in pre-pubertal (PP)and pubertal (P)children treated at our centre. Results: 43 CDT patients were included. Mean follow up was X (±DS) 5.99 (3.57) years (y) range: 1 -14 y. Treatment consisted on total thyroidectomy with lymph node dissection, radioiodine therapy, and TSH suppressive therapy with L-thyroxine. At diagnosis: chronological age (CA) was (±DS) :10.9 (3.84) y, range: 4.7 - 17y,sex: female/male ratio: 32/11,nineteen were PP and 24 P. Twentythree ( 53.5%) presented intrathyroidal nodes with or without lymph node MTS, Twenty patients (46.5%) had advanced disease, with adjacent tissue invasion and lung MTS. Thirty-eight patients (88.4%) had cervical lymph node MTS, 16 (37.2%) lung MTS.PP group had significant less CA X (±DS) 7.25 (2.03) y vs 13.83 (1.95)y (p <0.001),advanced tumor stage 84.2 vs16.8% (p<0.001) and more lung MTS occurrence 68.4 vs 12.5% (p<0.003). Global survival rate was 92% and disease free survival rate was 78%.Lung metastases (MTS) and serum thyroglobuline levels greater than 8.5 ng\ml post initial treatment were the most significant prognostic factor related to persistent disease. Conclusion: CDT had a more aggressive presentation in children; especially in PP children. Pediatricians should be aware of this in order to realize a precocious diagnosis and treatment (AU)

Seasonal Variations in the Morphometric Characteristics of the Pubertal West African Dwarf Buck in its Native Tropical Environment / Variaciones Estacionales en las Características Morfométricas de la Cabra Enana Púber Macho del Oeste Africano en su Medio Ambiente Nativo Tropical

The effects of season on the morphometric characteristics of the reproductive organs of the pubertal West African Dwarf buck in its native humid tropical environment were investigated. All morphometric characteristics as well as the derivations from both testicular and epididymal morphometry were unaffected by season (p<0.05). There were however, highly significant correlations (p<0.05, p<0.01, p<0.001) between body weight and testicular as well as epididymal morphometry. The results also showed that both testicular and epididymal morphometric characteristics in the pubertal buck are highly predictable from body weight and as such lend ground for the early selection of good sires from records of their growth rate. The non effect of season on both testicular and epididymal morphometry in this work generally demonstrates that there might be no restricted breeding season for the West African dwarf buck in its native humid tropical environment.

Se estudiaron los efectos que tiene la estación sobre las características morfométricas de los órganos reproductivos de la cabra enana macho del Oeste africano en su medio ambiente tropical húmedo. Todas las características morfométricas, como también las derivaciones de la morfología de ambos testículos y espidídimos, no fueron afectadas por la estación (p<0.05). Sin embargo, hubo, correlaciones altamente significativas (p<0.05, p<0.01 y p<0.01) entre el peso del cuerpo y del testículo así como la morfometría epididimaria. Los resultados también mostraron que las características morfométricas del testículo y epidídimo en la cabra enana macho púber son altamente predecibles, conociendo el peso del cuerpo, lo que permitiría una temprana selección de buenos padres sementales a partir del registro de sus rasgos de crecimiento. La ausencia de efectos estacionales sobre la morfometría del testículo y epidídimo que se observó en este trabajo, demostró que allí no debería restringirse la época de cría de la cabra enana del Oeste africano en su ambiente nativo tropical.