Actualities on Nuclear Medicine Applications in Sports Medicine

Aims: This paper aims to address some of the main possible applications of actual Nuclear Medicine Imaging techniques and methodologies in the specific context of Sports Medicine, namely in two critical systems: musculoskeletal and cardiovascular. Discussion: At the musculoskeletal level, bone scintigraphy techniques proved to be a mean of diagnosis of functional orientation and high sensibility compared with other morphological imaging techniques in the detection and temporal evaluation of pathological situations, for instance allowing the acquisition of information of great relevance in athletes with stress fractures. On the other hand, infection/inflammation studies might be of an important added value to characterize specific situations, early diagnose of potential critical issues – so giving opportunity to precise, complete and fast solutions – while allowing the evaluation and eventual optimization of training programs. At cardiovascular system level, Nuclear Medicine had proved to be crucial in differential diagnosis between cardiac hypertrophy secondary to physical activity (the so called "athlete's heart") and hypertrophic cardiomyopathy, in the diagnosis and prognosis of changes in cardiac function in athletes, as well as in direct - and non-invasive - in vivo visualization of sympathetic cardiac innervation, something that seems to take more and more importance nowadays, namely in order to try to avoid sudden death episodes at intense physical effort. Also the clinical application of Positron Emission Tomography (PET) has becoming more and more widely recognized as promising. Conclusions: It has been concluded that Nuclear Medicine can become an important application in Sports Medicine. Its well established capabilities to early detection of processes involving functional properties allied to its high sensibility and the actual technical possibilities (namely those related with hybrid imaging, that allows to add information provided by high resolution morphological imaging techniques, such as CT and/or MRI) make it a powerful diagnostic tool, claiming to be used on an each day higher range of clinical applications related with all levels of sport activities. Since the improvements at equipment characteristics and detection levels allows the use of smaller and smaller doses, so minimizing radiation exposure it is believed by the authors that the increase of the use of NM tools in the Sports Medicine area should be considered.

Non-uniform printed antenna array for wireless communications in sports arenas

Wireless communications had a great development in the last years and nowadays they are present everywhere, public and private, being increasingly used for different applications. Their application in the business of sports events as a means to improve the experience of the fans at the games is becoming essential, such as sharing messages and multimedia material on social networks. In the stadiums, given the high density of people, the wireless networks require very large data capacity. Hence radio coverage employing many small sized sectors is unavoidable. In this paper, an antenna is designed to operate in the Wi-Fi 5GHz frequency band, with a directive radiation pattern suitable to this kind of applications. Furthermore, despite the large bandwidth and low losses, this antenna has been developed using low cost, off-the-shelf materials without sacrificing quality or performance, essential to mass production. © 2015 EurAAP.

Substance use among sportive adolescents in the French-speaking part of Switzerland

[Contents] Introduction. Objectives. Methodology. Results. Characteristics of the sample. Substance use (Psychoactive substances, Performance-enhancing substances). Profile of sportive adolescents using substances. Mixed substance use. Other factors related to substance use. Inactivity. Conclusions. References. Annexes. Annex 1. Questionnaire. Annex 2. Sample weighting procedure. Annex 3. Sports type.

Anti-doping testing at the 2008 European football championship.

Big sports events like the 2008 European Football Championship are a challenge for anti-doping activities, particularly when the sports event is hosted by two different countries and there are two laboratories accredited by the World Anti-Doping Agency. This challenges the logistics of sample collection as well as the chemical analyses, which must be carried out timeously. The following paper discusses the handling of whereabouts information for each athlete and the therapeutic use exemption system, experiences in sample collection and transportation of blood and urine samples, and the results of the chemical analysis in two different accredited laboratories. An overview of the analytical results of blood profiling and growth hormone testing in comparison with the distribution of the normal population is also presented.

Quantification of clenbuterol at trace level in human urine by ultra-high pressure liquid chromatography-tandem mass spectrometry.

Clenbuterol is a β2 agonist agent with anabolic properties given by the increase in the muscular mass in parallel to the decrease of the body fat. For this reason, the use of clenbuterol is forbidden by the World Anti-Doping Agency (WADA) in the practice of sport. This compound is of particular interest for anti-doping authorities and WADA-accredited laboratories due to the recent reporting of risk of unintentional doping following the eating of meat contaminated with traces of clenbuterol in some countries. In this work, the development and the validation of an ultra-high pressure liquid chromatography coupled to electrospray ionization tandem mass spectrometry (UHPLC-ESI-MS/MS) method for the quantification of clenbuterol in human urine is described. The analyte was extracted from urine samples by liquid-liquid extraction (LLE) in basic conditions using tert butyl-methyl ether (TBME) and analyzed by UHPLC-MS/MS with a linear gradient of acetonitrile in 9min only. The simple and rapid method presented here was validated in compliance with authority guidelines and showed a limit of quantification at 5pg/mL and a linearity range from 5pg/mL to 300pg/mL. Good trueness (85.8-105%), repeatability (5.7-10.6% RSD) and intermediate precision (5.9-14.9% RSD) results were obtained. The method was then applied to real samples from eighteen volunteers collecting urines after single oral doses administration (1, 5 and 10μg) of clenbuterol-enriched yogurts.

Endogenous steroid profiling in the athlete biological passport.

The Athlete Biological Passport (ABP) is an individual electronic document that collects data regarding a specific athlete that is useful in differentiating between natural physiologic variations of selected biomarkers and deviations caused by artificial manipulations. A subsidiary of the endocrine module of the ABP, that which here is called Athlete Steroidal Passport (ASP), collects data on markers of an altered metabolism of endogenous steroidal hormones measured in urine samples. The ASP aims to identify not only doping with anabolic-androgenic steroids, but also most indirect steroid doping strategies such as doping with estrogen receptor antagonists and aromatase inhibitors. Development of specific markers of steroid doping, use of the athlete's previous measurements to define individual limits, with the athlete becoming his or her own reference, the inclusion of heterogeneous factors such as the UDPglucuronosyltransferase B17 genotype of the athlete, the knowledge of potentially confounding effects such as heavy alcohol consumption, the development of an external quality control system to control analytical uncertainty, and finally the use of Bayesian inferential methods to evaluate the value of indirect evidence have made the ASP a valuable alternative to deter steroid doping in elite sports. The ASP can be used to target athletes for gas chromatography/combustion/ isotope ratio mass spectrometry (GC/C/IRMS) testing, to withdraw temporarily the athlete from competing when an abnormality has been detected, and ultimately to lead to an antidoping infraction if that abnormality cannot be explained by a medical condition. Although the ASP has been developed primarily to ensure fairness in elite sports, its application in endocrinology for clinical purposes is straightforward in an evidence-based medicine paradigm.

A one-year monitoring of nicotine use in sport: frontier between potential performance enhancement and addiction issues.

Tobacco consumption is a global epidemic responsible for a vast burden of disease. With pharmacological properties sought-after by consumers and responsible for addiction issues, nicotine is the main reason of this phenomenon. Accordingly, smokeless tobacco products are of growing popularity in sport owing to potential performance enhancing properties and absence of adverse effects on the respiratory system. Nevertheless, nicotine does not appear on the 2011 World Anti-Doping Agency (WADA) Prohibited List or Monitoring Program by lack of a comprehensive large-scale prevalence survey. Thus, this work describes a one-year monitoring study on urine specimens from professional athletes of different disciplines covering 2010 and 2011. A method for the detection and quantification of nicotine, its major metabolites (cotinine, trans-3-hydroxycotinine, nicotine-N'-oxide and cotinine-N-oxide) and minor tobacco alkaloids (anabasine, anatabine and nornicotine) was developed, relying on ultra-high pressure liquid chromatography coupled to triple quadrupole mass spectrometry (UHPLC-TQ-MS/MS). A simple and fast dilute-and-shoot sample treatment was performed, followed by hydrophilic interaction chromatography-tandem mass spectrometry (HILIC-MS/MS) operated in positive electrospray ionization (ESI) mode with multiple reaction monitoring (MRM) data acquisition. After method validation, assessing the prevalence of nicotine consumption in sport involved analysis of 2185 urine samples, accounting for 43 different sports. Concentrations distribution of major nicotine metabolites, minor nicotine metabolites and tobacco alkaloids ranged from 10 (LLOQ) to 32,223, 6670 and 538 ng/mL, respectively. Compounds of interest were detected in trace levels in 23.0% of urine specimens, with concentration levels corresponding to an exposure within the last three days for 18.3% of samples. Likewise, hypothesizing conservative concentration limits for active nicotine consumption prior and/or during sport practice (50 ng/mL for nicotine, cotinine and trans-3-hydroxycotinine and 25 ng/mL for nicotine-N'-oxide, cotinine-N-oxide, anabasine, anatabine and nornicotine) revealed a prevalence of 15.3% amongst athletes. While this number may appear lower than the worldwide smoking prevalence of around 25%, focusing the study on selected sports highlighted more alarming findings. Indeed, active nicotine consumption in ice hockey, skiing, biathlon, bobsleigh, skating, football, basketball, volleyball, rugby, American football, wrestling and gymnastics was found to range between 19.0 and 55.6%. Therefore, considering the adverse effects of smoking on the respiratory tract and numerous health threats detrimental to sport practice at top level, likelihood of smokeless tobacco consumption for performance enhancement is greatly supported.

Substance use among sportive adolescents in the French-speaking part of Switzerland

CONTEXTE: Pour diverses raisons, les adultes et en particulier les parents croient que la pratique sportive à l'adolescence est un facteur de protection contre les comportements à risque tels que la consommation de substances. Les preuves présentes à l'intérieur de la littérature ne sont toutefois pas concluantes à ce sujet. Le principal objectif de notre étude était donc de comparer la prévalence de la consommation de substances psychoactives (licites et illicites) et de substances ergogéniques et dopantes entre les jeunes de Suisse Romande pratiquant un sport et ceux n'en pratiquant pas.METHODES: À l'aide de plusieurs méthodes de recrutement, des adolescents sportifs et non sportifs âgés de 16 à 20 ans furent invités à répondre à un questionnaire anonyme en ligne sur leur consommation de substances. Les substances psychoactives étudiées furent principalement le tabac, l'alcool, et le cannabis. Le dopage a été limité à la volonté d'améliorer les performances tout en utilisant des produits interdits selon l'Agence Mondiale Antidopage (liste 2009). Plusieurs produits légaux liés à la pratique sportive ont également été étudiés. Sur une période de 10 mois, un total de 1303 questionnaires ont été complétés. De l'échantillon final pondéré, les réponses de 1247 sujets éligibles ont été analysées.RESULTATS ET CONCLUSIONS: Dans l'ensemble, l'effet protecteur d'une pratique sportive contre l'utilisation de substances psychoactives semble dépendre de la substance à l'étude.Les jeunes non-sportifs sont plus susceptibles de fumer que les sportifs, et, parmi ces derniers, ceux évoluant dans un contexte de loisir sont plus susceptibles de fumer que ceux en pratique compétitive. Au contraire, aucune différence concernant l'abus d'alcool n'a été observée entre les adolescents sportifs et non-sportifs, indiquant que la pratique sportive ne représente pas une protection contre l'abus d'alcool. Bien que les jeunes non-sportifs soient deux fois plus susceptibles d'être utilisateurs actuels de cannabis, un jeune sportif sur neuf en a néanmoins consommé dans le dernier mois.Les trois quarts des jeunes sportifs interrogés indiquent utiliser activement des produits pour améliorer leurs performances, confirmant la tendance actuellement perçue. Parmi les substances utilisées pour améliorer les performances sportives, les produits contenant de la caféine, les boissons sportives et les suppléments alimentaires sont les trois plus souvent signalés.Peu de jeunes sportifs en Suisse Romande semblent utiliser des substances bannies par l'Agence Mondiale Antidopage, le cannabis étant celui le plus fréquemment cité.Parmi les jeunes sportifs, ceux en pratique compétitive semblent plus susceptibles d'utiliser des produits pour améliorer leurs performances que ceux évoluant dans un contexte de loisir. En outre, Un lien entre les substances psychoactives et celles prises pour améliorer les performances sportives semblent exister: tous les jeunes sportifs signalant soit fumer, avoir abusé de l'alcool récemment ou consommer actuellement du cannabis ont démontré une consommation plus élevée de produits dopants. L'usage du cannabis comme un moyen d'améliorer les performances sportives semble assez fréquent chez les consommateurs récréatifs de cette substance.Les jeunes sportifs évoluant au niveau international ont montré des taux plus bas d'abus d'alcool et de cannabis.

Erythropoietin and blood doping.

OBJECTIVE AND METHOD: To outline the direct and indirect approaches in the fight against blood doping in sports, the different strategies that have been used and are currently being used to fight efficiently against blood doping are presented and discussed. RESULTS AND CONCLUSIONS: The paper outlines the different approaches and diagnostic tools that some federations have to identify and target sports people demonstrating abnormal blood profiles. Originally blood tests were introduced for medical reasons and for limiting misuse of recombinant human erythropoietin (rHuEPO). In this way it became possible to prevent athletes with haematocrit levels well above normal, and potentially dangerous for their health, competing in sport. Today, with nearly a decade of blood testing experience, sports authorities should be familiar with some of the limitations and specially the ability of blood tests performed prior to competitions to fight efficiently against the misuse of rHuEPO, blood transfusion, and artificial haemoglobin.

IEF pattern classification-derived criteria for the identification of epoetin-delta in urine.

Epoetin-delta (Dynepo Shire Pharmaceuticals, Basing stoke, UK) is a synthetic form of erythropoietin (EPO) whose resemblance with endogenous EPO makes it hard to identify using the classical identification criteria. Urine samples collected from six healthy volunteers treated with epoetin-delta injections and from a control population were immuno-purified and analyzed with the usual IEF method. On the basis of the EPO profiles integration, a linear multivariate model was computed for discriminant analysis. For each sample, a pattern classification algorithm returned a bands distribution and intensity score (bands intensity score) saying how representative this sample is of one of the two classes, positive or negative. Effort profiles were also integrated in the model. The method yielded a good sensitivity versus specificity relation and was used to determine the detection window of the molecule following multiple injections. The bands intensity score, which can be generalized to epoetin-alpha and epoetin-beta, is proposed as an alternative criterion and a supplementary evidence for the identification of EPO abuse.

Effects of exercise on the secondary blood markers commonly used to suspect erythropoietin doping.

Numerous trials have reported that some haematological and biochemical parameters could be put together and be used to detect and fight recombinant erythropoietin doping. Unfortunately, none of the studies mentioned the necessity of taking pre-analytical precautions to avoid possible suspicious results coming from major plasma volume changes caused notably by dehydration. Therefore we studied the behaviour of the most common secondary blood markers before and after a strenuous physical activity to find out how reliable these parameters were. The soluble transferrin receptor and the haemoglobin concentrations as well as the haematocrit level increased significantly after effort, whereas the plasma EPO concentration and the reticulocyte count remained constant. On the other hand, if the values were corrected for haemoconcentration, the soluble transferrin receptor concentration remained stable.

Total hemoglobin mass--a new parameter to detect blood doping?

PURPOSE: All kinds of blood manipulations aim to increase the total hemoglobin mass (tHb-mass). To establish tHb-mass as an effective screening parameter for detecting blood doping, the knowledge of its normal variation over time is necessary. The aim of the present study, therefore, was to determine the intraindividual variance of tHb-mass in elite athletes during a training year emphasizing off, training, and race seasons at sea level. METHODS: tHb-mass and hemoglobin concentration ([Hb]) were determined in 24 endurance athletes five times during a year and were compared with a control group (n = 6). An analysis of covariance was used to test the effects of training phases, age, gender, competition level, body mass, and training volume. Three error models, based on 1) a total percentage error of measurement, 2) the combination of a typical percentage error (TE) of analytical origin with an absolute SD of biological origin, and 3) between-subject and within-subject variance components as obtained by an analysis of variance, were tested. RESULTS: In addition to the expected influence of performance status, the main results were that the effects of training volume (P = 0.20) and training phases (P = 0.81) on tHb-mass were not significant. We found that within-subject variations mainly have an analytical origin (TE approximately 1.4%) and a very small SD (7.5 g) of biological origin. CONCLUSION: tHb-mass shows very low individual oscillations during a training year (<6%), and these oscillations are below the expected changes in tHb-mass due to Herythropoetin (EPO) application or blood infusion (approximately 10%). The high stability of tHb-mass over a period of 1 year suggests that it should be included in an athlete's biological passport and analyzed by recently developed probabilistic inference techniques that define subject-based reference ranges.

Validation and performance comparison of two carbon isotope ratio methods to control the misuse of androgens in humans.

Carbon isotope ratio of androgens in urine specimens is routinely determined to exclude an abuse of testosterone or testosterone prohormones by athletes. Increasing application of gas chromatography/combustion/isotope ratio mass spectrometry (GC/C/IRMS) in the last years for target and systematic investigations on samples has resulted in the demand for rapid sample throughput as well as high selectivity in the extraction process particularly in the case of conspicuous samples. For that purpose, we present herein the complimentary use of an SPE-based assay and an HPLC fractionation method as a two-stage strategy for the isolation of testosterone metabolites and endogenous reference compounds prior to GC/C/IRMS analyses. Assays validation demonstrated acceptable performance in terms of intermediate precision (range: 0.1-0.4 per thousand) and Bland-Altman analyses revealed no significant bias (0.2 per thousand). For further validation of this two-stage analyses strategy, all the specimens (n=124) collected during a major sport event were processed.