Background: In 1992, the concept of female athlete triad was introduced to describe the interrelated problems of amenorrhea, eating disorders and osteoporosis seen in female athletes. To gain a clearer picture of amenorrhea/oligomenorrhea in Iran, one of the main components of the female athlete triad, we therefore established this study on the prevalence of amenorrhea/ oligomenorrhea in elite Iranian female athletes, also evaluating the risk factors of these disorders in the same population.
Context. Anti-Mullerian hormone (AMH) assay is becoming the best indicator of successful IVF treatment response to fertility drugs and could be a useful marker of embryo implantation potential. Various protocols are being used for controlled ovarian stimulation (COS), but there is an uncertainty regarding the implementation of the best protocol for endometriosis patients and also little evidence is available concerning the clinical value of AMH levels in endometriosis.Objective. This study aimed to evaluate the prognostic value of serum AMH levels for pregnancy in COS using GnRH-agonist(GnRH-a) and GnRHantagonist(GnRH-ant) protocols in endometriosis patients.Design. This is a cross-sectional study between March 2012 and November 2015.Subjects and Methods. Data were collected from 249 COS cycles of endometriosis patients, including 129 cycles with GnRH-a and 120 cycles with GnRH-ant. Patients in each group were classified into three subgroups based on their serum AMH levels. The outcomes of ICSI program were evaluated.Results. The ROC curve analysis showed that embryo and oocyte counts and AMH were equally predictive for pregnancy, as demonstrated by a similar area under the curve (AUC) of 0.69, 0.66 and 0.64, respectively. The sensitivity and specificity for prediction of positive pregnancy were 70.91% and 67.01% for embryo counts, 70.91% and 67.53% for oocyte counts at the cutoff values of 5 and 7, respectively, and 83.64% and 52.58% for AMH levels at the cutoff values of 1.3ng/mL.Conclusions. This study demonstrates that AMH as a single test has substantial accuracy in the prediction of pregnancy using the GnRH antagonist protocol for patients with endometriosis. In other words, AMH assay prior to ovarian stimulation initiation guides the clinicians to choose the antagonist stimulation protocol for the patients with two extreme AMH levels. AMH levels can be used to individualize control ovarian stimulation in endometriosis patients.
This study aimed to identify optimal sets of maximal voluntary isometric contractions (MVICs) for normalizing EMG data from anterior and posterior regions of the supraspinatus, and superior, middle and inferior regions of the infraspinatus. 31 right-handed young healthy individuals (15 males, 16 females) participated. EMG activity was obtained from two regions of supraspinatus and three regions of infraspinatus muscles via fine wire electrodes. Participants performed 15 MVIC tests against manual resistance. The EMG data were normalized to the maximum values. Optimal sets of MVIC combinations, defined as those which elicited >90% MVIC activation in the muscles of interest in >80% and >90% of the population, were obtained. EMG data from the inferior region of infraspinatus were removed from analysis due to technical problem. No single test achieved maximal activation of both regions of either the supraspinatus or infraspinatus. Instead, a combination of 6-8 MVICs were required to reach >90% MVIC activation in both parts of those muscles. In all regions of the rotator cuff muscles, the optimal combination was obtained with 8-10 MVICs. The proposed combinations can reduce inter-participant variability in generating maximal activation from different regions of the supraspinatus and infraspinatus muscles.
This study aimed to evaluate the effect of arm posture on activation of the anterior and posterior regions of supraspinatus and the superior and middle regions of infraspinatus during resisted isometric arm elevations.Thirty-one healthy participants performed eighteen isometric resistance exertions against a robotic arm in three elevation planes (flexion, scaption, abduction) and three elevation angles (30°, 90°, 150°) in maximal and sub-maximal resistance conditions. EMG data were obtained using fine wire electrodes. The mean activation of each region and the activation ratios were compared across postures using ANOVAs.Supraspinatus anterior was significantly more active during abduction and scaption, and in higher elevation angles, while the posterior region showed similar activation levels across postures. Infraspinatus regions were more active during flexion with more relative activation of the infraspinatus superior at 90° flexion.The results suggest that regional activation of supraspinatus and infraspinatus should be considered for assessment and rehabilitation purposes. In any clinical condition that less stress on the supraspinatus anterior is desired, isometric training in flexion or in lower elevation levels may strengthen the supraspinatus posterior while causing lower stress in the anterior region.Beside external rotation exertions, resisted flexion tests may be useful for evaluation of infraspinatus regions.
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