Endurance exercise performance is impaired in a hot and humid environment. This study compared the effects of cold water immersion, with (CMWI) and without (CWI) menthol, on the recovery of cycling performance. Eight heat-acclimatized cyclists (age, 24.1 ± 4.4 years; mass, 65.3 ± 5.2 kg) performed 2 randomized sessions, each consisting of a 20-min cycling trial (T1) followed by 10 min of immersion during recovery and then a second 20-min cycling trial (T2). Mean power output and perceived exertion (RPE) were recorded for both trials. Rectal (T) and skin temperatures were measured before and immediately after T1, immersion, and T2. Perceived thermal sensation (TS) and comfort were measured immediately after T1 and T2. Power output was significantly improved in T2 compared with T1 in the CMWI condition (+15.6%). Performance did not change in the CWI condition. After immersion, T was lower in CWI (-1.17 °C) than in CMWI (-0.6 °C). TS decreased significantly after immersion in both conditions. This decline was significantly more pronounced in CMWI (5.9 ± 1 to 3.6 ± 0.5) than in CWI (5.6 ± 0.9 to 4.4 ± 1.2). In CMWI, RPE was significantly higher in T1 (6.57 ± 0.9) than in T2 (5.14 ± 1.25). However, there was no difference in TC. This study suggests that menthol immersion probably (i) improves the performance of a repeated 20-min cycling bout, (ii) decreases TS, and (iii) impairs thermoregulation processes.

The German government initiated the Network University Medicine (NUM) in early 2020 to improve national research activities on the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic. To this end, 36 German Academic Medical Centers started to collaborate on 13 projects, with the largest being the National Pandemic Cohort Network (NAPKON). The NAPKON’s goal is creating the most comprehensive Coronavirus Disease 2019 (COVID-19) cohort in Germany. Within NAPKON, adult and pediatric patients are observed in three complementary cohort platforms (Cross-Sectoral, High-Resolution and Population-Based) from the initial infection until up to three years of follow-up. Study procedures comprise comprehensive clinical and imaging diagnostics, quality-of-life assessment, patient-reported outcomes and biosampling. The three cohort platforms build on four infrastructure core units (Interaction, Biosampling, Epidemiology, and Integration) and collaborations with NUM projects. Key components of the data capture, regulatory, and data privacy are based on the German Centre for Cardiovascular Research. By April 01, 2022, 34 university and 40 non-university hospitals have enrolled 5298 patients with local data quality reviews performed on 4727 (89%). 47% were female, the median age was 52 (IQR 36–62-) and 50 pediatric cases were included. 44% of patients were hospitalized, 15% admitted to an intensive care unit, and 12% of patients deceased while enrolled. 8845 visits with biosampling in 4349 patients were conducted by April 03, 2022. In this overview article, we summarize NAPKON’s design, relevant milestones including first study population characteristics, and outline the potential of NAPKON for German and international research activities.Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04768998.https://clinicaltrials.gov/ct2/show/NCT04747366.https://clinicaltrials.gov/ct2/show/NCT04679584

The German government initiated the Network University Medicine (NUM) in early 2020 to improve national research activities on the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic. To this end, 36 German Academic Medical Centers started to collaborate on 13 projects, with the largest being the National Pandemic Cohort Network (NAPKON). The NAPKON’s goal is creating the most comprehensive Coronavirus Disease 2019 (COVID-19) cohort in Germany. Within NAPKON, adult and pediatric patients are observed in three complementary cohort platforms (Cross-Sectoral, High-Resolution and Population-Based) from the initial infection until up to three years of follow-up. Study procedures comprise comprehensive clinical and imaging diagnostics, quality-of-life assessment, patient-reported outcomes and biosampling. The three cohort platforms build on four infrastructure core units (Interaction, Biosampling, Epidemiology, and Integration) and collaborations with NUM projects. Key components of the data capture, regulatory, and data privacy are based on the German Centre for Cardiovascular Research. By December 01, 2021, 34 university and 34 non-university hospitals have enrolled 4,241 patients with local data quality reviews performed on 2,812 (66%). 47% were female, the median age was 53 (IQR: 38-63)) and 3 pediatric cases were included. 30% of patients were hospitalized, 11% admitted to an intensive care unit, and 4% of patients deceased while enrolled. 7,143 visits with biosampling in 3,595 patients were conducted by November 29, 2021. In this overview article, we summarize NAPKON’s design, relevant milestones including first study population characteristics, and outline the potential of NAPKON for German and international research activities.Trial registration:· https://clinicaltrials.gov/ct2/show/NCT04768998· https://clinicaltrials.gov/ct2/show/NCT04747366· https://clinicaltrials.gov/ct2/show/NCT04679584

Young athletes most often exceed the physical activity recommendations of the World Health Organization. Therefore, they are of special interest for investigating cardiovascular adaptions to exercise. This study aimed to examine the arterial structure and function of young athletes 12–17 years old and compare these parameters to reference values of healthy cohorts. Carotid intima-media thickness (cIMT), carotid diameter, cIMT÷carotid diameter-ratio (cIDR), arterial compliance (AC), elastic modulus (Ep), β stiffness index (β), and carotid pulse wave velocity (PWVβ) were determined using ultrasound in 331 young athletes (77 girls; mean age, 14.6 ± 1.30 years). Central systolic blood pressure (cSBP) and aortic PWV (aPWV) were measured using the oscillometric device Mobil-O-Graph. Standard deviation scores (SDS) of all parameters were calculated according to German reference values. The 75th and 90th percentiles were defined as the threshold for elevated cIMT and arterial stiffness, respectively. Activity behavior was assessed with the MoMo physical activity questionnaire, and maximum power output with a standard cardiopulmonary exercise test. One-sample t-tests were performed to investigate the significant deviations in SDS values compared to the value “0”. All subjects participated in competitive sports for at least 6 h per week (565.6 ± 206.0 min/week). Of the 331 young athletes, 135 (40.2%) had cIMT >75th percentile, 71 (21.5%) had cSBP >90th percentile, and 94 (28.4%) had aPWV>90th percentile. We observed higher cIMT SDS (p < 0.001), cIDR SDS (p = 0.009), and AC SDS (p < 0.001) but lower β SDS (p < 0.001), Ep SDS (p < 0.001), and PWVβ SDS (p < 0.001) compared to the reference cohort. The cSBP SDS (p < 0.001) and aPWV SDS (p < 0.001) were elevated. In conclusion, cIMT and cIDR were higher in young athletes than in a reference cohort. Furthermore, young athletes presented better carotid elasticity and lower arterial stiffness of the carotid artery. However, central arterial stiffness was higher compared to the reference cohort. The thickening of the carotid intima-media complex in combination with a reduction in arterial stiffness indicates a physiological adaptation to exercise in youth.

ZusammenfassungDie Prävalenz des Post-COVID-Syndroms (PCS) ist noch nicht abschließend geklärt. Die bisherigen Definitionen bilden vorrangig zeitliche Aspekte ab, lassen jedoch funktionelle Defizite sowie die Objektivierung von Symptomen außer Acht. Dies führt zu diagnostischen sowie therapeutischen Unklarheiten. In Pubmed wurde daher nach systematischen Reviews gesucht, die sich mit den Folgen einer SARS-CoV-2-Infektion befassten. Die zugrunde liegenden Definitionen sowie zeitlichen Einschlusskriterien wurden extrahiert. 16 systematische Reviews wurden eingeschlossen, davon 11 mit einer Definition des PCS. In 58 % der analysierten Einzelstudien wurden Patienten mit einer Symptomatik > 12 Wochen und damit entsprechend der Definition des PCS inkludiert. Fazit: Eine weitere Präzisierung der Definition des PCS ist notwendig, um Diagnostik und eine multimodale Behandlung zu erleichtern und die knappen therapeutischen Ressourcen entsprechend zu nutzen.

Objectives The use of remdesivir (RDV) as the first drug approved for coronavirus disease 2019 (COVID-19) remains controversial. Based on the Lean European Open Survey on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected patients (LEOSS), we aim to contribute timing-focused complementary real-world insights to its evaluation. Methods SARS-CoV-2 infected patients between January 2020 and December 2021 treated with RDV were matched 1:1 to controls considering sociodemographics, comorbidities and clinical status. Multiple imputations were used to account for missing data. Effects on fatal outcome were estimated using uni- and multivariable Cox regression models. Results We included 9,687 patients. For those starting RDV administration in the complicated phase, Cox regression for fatal outcome showed an adjusted hazard ratio (aHR) of 0.59 (95%CI 0.41–0.83). Positive trends could be obtained for further scenarios: an aHR of 0.51 (95%CI 0.16–1.68) when RDV was initiated in uncomplicated and of 0.76 (95% CI 0.55–1.04) in a critical phase of disease. Patients receiving RDV with concomitant steroids exhibited a further reduction in aHR in both, the complicated (aHR 0.50, 95%CI 0.29–0.88) and critical phase (aHR 0.63, 95%CI 0.39–1.02). Conclusion Our study results elucidate that RDV use, in particular when initiated in the complicated phase and accompanied by steroids is associated with improved mortality. However, given the limitations of non-randomized trials in estimating the magnitude of the benefit of an intervention, further randomized trials focusing on the timing of therapy initiation seem warranted.

ZUSAMMENFASSUNG Hintergrund Kardiopulmonale Belastungsuntersuchungen auf dem Fahrrad oder Laufband haben in der Erwachsenenmedizin einen hohen Stellenwert. Sie dienen einerseits zur Feststellung der körperlichen Leistungsfähigkeit, andererseits auch zum Beweis oder Ausschluss kardiopulmonaler Erkrankung. In der Kinder- und Jugendmedizin finden sie im Rahmen von wissenschaftlichen Untersuchungen etwa bei kongenitaler Herzerkrankung Anwendung, um den aktuellen Gesundheitszustand zu objektivieren. Dabei wird ihr Stellenwert bei der Behandlung von chronisch kranken Kindern und Jugendlichen gerade im niedergelassenen Bereich noch unterschätzt. Ziel der Arbeit war es, die Indikationen, die Durchführung und die Ergebnisse eines Kollektivs von 100 Patienten einer kinderkardiologischen Praxis darzustellen. Methodik Untersucht wurden 100 konsekutive Patienten (14,2 ± 3,8 Jahre) im Rahmen einer sportwissenschaftlichen Kooperation. Die Untersuchungen wurden standardisiert nach dem Godfrey-Protokoll auf dem Fahrradergometer durchgeführt. Neben der Leistungsfähigkeit in Watt/kg KG wurden die maximale Sauerstoffaufnahme, die respiratorische Austauschrate und die maximale Herzfrequenz erhoben. Ergebnisse 80 % der Patienten hatten eine kardiologische Indikation (26 % angeborene Herzfehler, 39 % erworbene Herzerkrankung, 15 % Rhythmusstörungen). 8 % der Patienten kamen wegen einer Sporttauglichkeit im Rahmen von Leistungssport zur Untersuchung, 6 % mit onkologischer Grunderkrankung, 6 % mit allgemeinpädiatrischen Vorerkrankungen. Alle Patienten konnten problemlos die Untersuchung beenden. Patienten mit angeborenem Herzfehler hatten die niedrigste Sauerstoffaufnahme, gefolgt von Patienten mit onkologischen Erkrankungen. Diskussion In unserem Kollektiv war die Gruppe der kardiologischen Indikation am größten, gefolgt von einem kleinen Anteil von leistungssportlich aktiven Kindern, onkologischen und allgemeinpädiatrischen Patienten. Es wäre ein wünschenswertes Ziel, auch einem größeren Kreis chronisch kranker Kinder basierend auf einer ergospirometrischen Untersuchung ein gezieltes Trainingsprogramm zur Verfügung zu stellen. Daten aus der Erwachsenen-Onkologie zeigen durchaus positive Effekte auf die Morbidität und Mortalität durch strukturierte Sportprogramme.

Purpose The adaptation process of the cardiovascular system to exercise and muscular strength in young athletes is unclear. Therefore, we investigated the influence of changes in muscular strength and weekly training load within one year on arterial stiffness in young male soccer players. Methods 30 male soccer players were examined twice (age t0: 13.3 ± 2.0 years, age t1: 14.2 ± 2.0 years). cSBP and aPWV were measured oscillometrically (Mobil-O-Graph®) and z-scores were calculated. The MoMo physical activity questionnaire recorded the weekly training load and the hand dynamometer measured muscular strength. Height and weight were examined and body surface area (BSA) was computed. Results The investigated parameters and the converted z-scores of cSBP and aPWV did not change over time, but handgrip strength (t0: 25.2 ± 10.2 kg, t1: 29.5 ± 10.2, p < 0.001) and training load (t0: 7.1 ± 1.5 hours/week, t1: 8.3 ± 2.4 hours/week, p = 0.005) increased significantly. 13.3% and 16.7% had cSBP >90th percentile at t0 and t1 respectively. The prevalence of aPWV >90th percentile was 26.7% at both times. Regardless of age and BSA, improvement in handgrip strength was significantly associated with higher values of cSBP (β = 1.66, p = 0.009, R2 = 0.42) and aPWV (β = 0.09, p = 0.001, R2 = 0.58) at t1. An improvement in weekly training load was not associated with cSBP and aPWV at t1. Conclusion cSBP and aPWV are negatively influenced by an improvement in muscular strength in young male soccer players within one year. Therefore, in addition to the recommended pre-participation screening, arterial stiffness in young athletes should be monitored annually to detect possible negative outcomes of exercise on vascular health.