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Lindy M. Castell, David C. Nieman, Stéphane Bermon and Peter Peeling

proteins increase chronically during recovery and are involved in the inflammatory acute phase response. In response to an acute immunological challenge, such as exercise stress, cells of the immune system must be able to grow and proliferate to generate effector cells producing specific molecules

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Jason P. Brandenburg and Luisa V. Giles

had an effect of salivary cortisol and CRP levels (increases in both have been shown to be associated with the inflammatory response to running [ Mohr et al., 2016 ; Tauler et al., 2014 ]), the blunted decrease in RSI was likely not due to the anti-inflammatory properties of blueberries. This

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Timothy D. Mickleborough

Increased muscle oxidative stress and inflammatory responses among athletes have been reported consistently. In addition, it is well known that exhaustive or unaccustomed exercise can lead to muscle fatigue, delayed-onset muscle soreness, and a decrement in performance. Omega-3 polyunsaturated fatty acids (PUFAs) have been shown to decrease the production of inflammatory eicosanoids, cytokines, and reactive oxygen species; have immunomodulatory effects; and attenuate inflammatory diseases. While a number of studies have assessed the efficacy of omega-3 PUFA supplementation on red blood cell deformability, muscle damage, inflammation, and metabolism during exercise, only a few have evaluated the impact of omega-3 PUFA supplementation on exercise performance. It has been suggested that the ingestion of EPA and DHA of approximately 1–2 g/d, at a ratio of EPA to DHA of 2:1, may be beneficial in counteracting exercise-induced inflammation and for the overall athlete health. However, the human data are inconclusive as to whether omega-3 PUFA supplementation at this dosage is effective in attenuating the inflammatory and immunomodulatory response to exercise and improving exercise performance. Thus, attempts should be made to establish an optimal omega-3 fatty-acid dosage to maximize the risk-to-reward ratio of supplementation. It should be noted that high omega-3 PUFA consumption may lead to immunosuppression and prolong bleeding time. Future studies investigating the efficacy of omega-3 PUFA supplementation in exercise-trained individuals should consider using an exercise protocol of sufficient duration and intensity to produce a more robust oxidative and inflammatory response.

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Zachary Y. Kerr, Andrew E. Lincoln, Shane V. Caswell, David A. Klossner, Nina Walker and Thomas P. Dompier

(21.4%, n = 104), sprains (18.1%, n = 88), and inflammatory conditions (15.8%, n = 77) were the highest. Concussions comprised the highest proportion of head/face injuries in competition (82.1%, n = 32) and practice (54.5%, n = 30). The remaining competition head/face injuries were mostly contusions

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Kevin M. Cross

Dimethyl sulfoxide (DMSO) was introduced to the medical community in the mid-1960s as a powerful anti-inflammatory agent. Clinical studies and subjective claims abounded about its healing effects on a variety of musculoskeletal injuries. Unfortunately, soon after the incorporation of DMSO into rehabilitation routines, the American Medical Association (AMA) denounced many of the studies of DMSO as being unscientific in nature, and the possibility of toxic effects on the optical lens was noted in an experiment using primates as subjects. As a result, the use of DMSOin the medical community was halted. The exact mechanisms by which DMSO affects the healing process are unknown; however, several studies from the 1980s noted specific effects during various phases of the inflammatory process, such as monocyte and fibroblast activity. Presently, DMSO is considered an investigational drag and has not been approved by the Food and Drag Administration for use with musculoskeletal disorders.

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Jeffrey B. Driban, Easwaran Balasubramanian, Mamta Amin, Michael R. Sitler, Marvin C. Ziskin and Mary F. Barbe

Context:

Joint trauma is a risk factor for osteoarthritis (OA), which is becoming an increasingly important orthopedic concern for athletes and nonathletes alike. For advances in OA prevention, diagnosis, and treatment to occur, a greater understanding of the biochemical environment of the affected joint is needed.

Objective:

To demonstrate the potential of a biochemical technique to enhance our understanding of and diagnostic capabilities for osteoarthritis.

Design:

Cross-sectional.

Setting:

Outpatient orthopedic practice.

Participants:

8 subjects: 4 OA-knee participants (65 ± 6 y of age) and 4 normal-knee participants (54 ± 10 y) with no history of knee OA based on bilateral standing radiographs.

Intervention:

The independent variable was group (OA knee, normal knee).

Main Outcome Measures:

16 knee synovial-protein concentrations categorized as follows: 4 as pro-inflammatory, or catabolic, cytokines; 5 as anti-inflammatory, or protective, cytokines; 3 as catabolic enzymes; 2 as tissue inhibitors of metalloproteinases [TIMPs]; and 2 as adipokines.

Results:

Two anti-inflammatory cytokines (interleukin [IL]-13 and osteoprotegerin) and a pro-inflammatory cytokine (IL-1β) were significantly lower in the OA knees. Two catabolic enzymes (matrix metalloproteinase [MMP]-2 and MMP-3) were significantly elevated in OA knees. TIMP-2, an inhibitor of MMPs, was significantly elevated in OA knees.

Conclusions:

Six of the 16 synovial-fluid proteins were significantly different between OA knees and normal knees in this study. Future research using a similar multiplex ELISA approach or other proteomic techniques may enable researchers and clinicians to develop more accurate biochemical profiles of synovial fluid to help diagnose OA, identify subsets of OA or individual characteristics, guide clinical decisions, and identify patients at risk for OA after knee injury.

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Milena Nasi, Alessandro Cristani, Marcello Pinti, Igor Lamberti, Lara Gibellini, Sara De Biasi, Alessandro Guazzaloca, Tommaso Trenti and Andrea Cossarizza

Purpose:

Exercise exerts various effects on the immune system, and evidence is emerging on its anti-inflammatory effects; the mechanisms on the basis of these modifications are poorly understood. Mitochondrial DNA (mtDNA) released from damaged cells acts as a molecule containing the so-called damage-associated molecular patterns and can trigger sterile inflammation. Indeed, high plasma levels of mtDNA are associated to several inflammatory conditions and physiological aging and longevity. The authors evaluated plasma mtDNA in professional male volleyball players during seasonal training and the possible correlation between mtDNA levels and clinical parameters, body composition, and physical performance.

Methods:

Plasma mtDNA was quantified by real-time PCR every 2 mo in 12 professional volleyball players (PVPs) during 2 consecutive seasons. As comparison, 20 healthy nonathlete male volunteers (NAs) were analyzed.

Results:

The authors found lower levels of mtDNA in plasma of PVPs than in NAs. However, PVPs showed a decrease of circulating mtDNA only in the first season, while no appreciable variations were observed during the second season. No correlation was observed among mtDNA, hematochemical, and anthropometric parameters.

Conclusions:

Regular physical activity appeared associated with lower levels of circulating mtDNA, further confirming the protective, anti-inflammatory effect of exercise.

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David B. Pyne, Joshua H. Guy and Andrew M. Edwards

Heat and immune stress can affect athletes in a wide range of sports and environmental conditions. The classical thermoregulatory model of heat stress has been well characterized, as has a wide range of practical strategies largely centered on cooling and heat-acclimation training. In the last decade evidence has emerged of an inflammatory pathway that can also contribute to heat stress. Studies are now addressing the complex and dynamic interplay between hyperthermia, the coagulation cascade, and a systemic inflammatory response occurring after transient damage to the gastrointestinal tract. Damage to the intestinal mucosal membrane increases permeability, resulting in leakage of endotoxins into the circulation. Practical strategies that target both thermoregulatory and inflammatory causes of heat stress include precooling; short-term heat-acclimation training; nutritional countermeasures including hydration, energy replacement, and probiotic supplementation; pacing strategies during events; and postevent cooling measures. Cooperation between international, national, and local sporting organizations is required to ensure that heat-management policies and strategies are implemented effectively to promote athletes’ well-being and performance.

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David J. Pezzullo

Plantar fasciitis is one of the most common foot injuries athletes sustain. The painful heel is the result of overloading and inflammation of the plantar fascia at its insertion into the medial process of the tuberosity of the calcaneus. Many different treatment approaches have been used to address this overuse problem. Treatment for plantar fasciitis has included decreased weight bearing, nonsteroidal anti-inflammatory drugs (NSAIDs), orthotics, arch taping, weight loss, steroid injections, ultrasound, ice, physical therapy, and surgical release. Clinically the use of night splints has been found to be very successful in the treatment of plantar fasciitis, as described in this case study.

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Edmund O. Acevedo and Aaron L. Slusher

The relationship between stress and disease, in particular cardiovascular disease, has long been recognized, whereas the study of the physiological mechanisms that explain this link has only more recently received attention. The acute response to stress is generally thought to be a critically important adaptation designed to activate the system in preparation to cope with the stressor. However, prolonged stimulation of the system (acute and chronic) can lead to deleterious adaptations including the release of inflammatory cytokines (small proteins important in cell signaling) that play a critical role in the development of atherosclerosis. Scientists have therefore used a breadth of protocols and methods to identify the complexity of our fight-or-flight response and demonstrate the synergy between perception, the stress response, physical activity, and health. In addition, the critical assessment of cellular health, the gut microbiome, and genetic polymorphisms have further advanced our understanding of additional therapeutic targets against CVD.