European Journal of Applied Physiology

PurposeThe para-cycling classification system aims to minimize the impact of impairments on competition outcomes with the help of scientific evidence. This study investigated the impact of unilateral and bilateral ankle immobility on cycling performance, quantified by the maximal average mechanical power output (AMPO) over one revolution relative to that without ankle immobility. MethodsTen well-trained non-disabled cyclists performed all-out 6-second sprints on a cycle ergometer at 120 rpm under three conditions: without ankle foot orthoses (AFOs), with 1 AFO and with 2 AFOs immobilizing the ankle joint(s). Mechanical power output, pedal forces, cycling kinematics and surface-electromyography were measured. Maximal AMPO; ankle, knee and hip joint AMPO; and the amount of muscle excitation were calculated. ResultsWith 1 AFO and 2 AFOs, respectively, maximal AMPO was 96% (p<0.05) and 91% (p<0.001) of that without AFOs (1188 W). The decrease in maximal AMPO with ankle immobilization was less than the decrease in ankle joint AMPO (126 W decrease with 2 AFOs; p<0.001), due to an increase in hip joint AMPO (69 W increase with 2 AFOs; p<0.05). The amount of muscle excitation was not significantly different across conditions. ConclusionsThese findings provide a first quantitative and mechanistic indication of the impact of ankle immobility on cycling performance, which may offer valuable evidence to support the development of an evidence-based para-cycling classification system.

This study examined the utility of HRV detrended fluctuation analysis alpha-1 (DFA1) to assess readiness-to-train and exercise durability under varying acute training loads. Nineteen trained cyclists completed two 20-minute time-trials (TT) under rested and fatigued conditions. DFA1 was measured during a standardized warm-up (WU), 20-min TT, and standardized cool-down (CD). Power output (PO) and DFA1 responses were compared across conditions, and associations with performance and fitness (W/kg) were examined. DFA1 values declined with increasing WU and CD exercise intensity (p<0.001) and were significantly attenuated following the 20-min TT (p<0.001). While DFA1 profiles did not differ significantly between rested and fatigued conditions, lower pre-TT DFA1 was associated with reduced TT performance (p=0.022; r=0.55), suggesting relevance to training readiness. Additionally, an 18% decline in DFA1 between 10- and 20-min during the TT (p=0.031), and lower post-TT values at matched intensities were observed (p<0.001), indicating physiological perturbation from the 20-min TT. Fitter participants exhibited lower DFA1 values during the 20-min TT (p<0.001; r=-0.77), suggesting a greater capacity to sustain physiological stress. While DFA1 is responsive to exercise intensity and stress, offering potential to assess training readiness and durability, more robust fatigue protocols are needed to validate DFA1 as training load monitoring tool.

Abstract Purpose: MyotonPRO (MTP) and time-harmonic elastography (THE) are increasingly used to assess muscle mechanical properties, yet they operate on fundamentally different physical principles. MTP measures composite MTP stiffness (N/m) through surface oscillations, while THE quantifies intrinsic shear modulus (THE stiffness, kPa) via propagating shear waves. This study aimed at systematically compare MTP and THE measurements in the vastus lateralis muscle across different contraction intensities and examine how the skin layer and subcutaneous fat (SLSF) thickness influence their relationship. Methods: Twenty-six healthy adults (15 males, 11 females; age 25 [SD 4] years) underwent MTP and THE measurements of the vastus lateralis at rest and during isometric contractions at 15% and 30% maximal voluntary contraction (MVC). Effects of contraction intensities on tissue properties were assessed using univariate analyses of variance with repeated measures. Associations between the different outcomes of THE and MTP technologies were explored using Pearson's correlations and partial correlation coefficients separately for each contraction intensity with adjustment of the SLSF thickness of participants. Results: Both technologies detected contraction intensity-dependent stiffening across all outcomes (p < 0.001). THE stiffness increased from 5.3 [1.2] kPa at rest to 15.6 [6.1] kPa at 30% MVC; THE wave attenuation increased from 0.83 [0.19] to 1.42 [0.36] s/m while MTP stiffness increased from 337.3 [49.3] N/m at rest to 529.4 [160.7] N/m at 30% MVC. Correlations between modalities were weak and condition-dependent. THE wave attenuation did not significantly correlate with any MTP outcome across conditions. Conclusion: MTP and THE detect contraction-induced stiffening through fundamentally different physical mechanisms and should not be regarded as interchangeable. Their correlation is modest at rest and breaks down (or reverses) during active contraction, with subcutaneous fat as a key modifying factor. Clinical trial number: Not applicable.

Gait asymmetry is a common manifestation of walking impairment among clinical populations. We recently developed a novel treadmill walking approach called dynamic treadmill walking that can provide asymmetric gait training by changing the treadmill speed between fast and slow speeds within a single stride. Here, we studied the energy expenditure associated with a variety of dynamic treadmill walking conditions. We hypothesized that the metabolic power required for dynamic treadmill walking in all conditions would approximate the metabolic power associated with conventional walking at the mean of the fast and slow speeds employed in the task. Eleven young adults without gait impairment walked on an instrumented treadmill and breathed into a metabolic measurement system. During dynamic treadmill walking, the treadmill fluctuated between 0.75m/s and 1.50m/s, each for 50% of an individuals stride time. We used a metronome to synchronize participants right heel-strikes with four different timing conditions. Net metabolic power during dynamic treadmill walking was significantly greater than normal walking at the mean speed of the task (1.125m/s) and generally lower than walking at the fast speed (1.5m/s). We did not observe any significant associations between net metabolic power and several measures of gait asymmetry during dynamic treadmill walking. These findings establish dynamic treadmill walking as a promising technique for improving gait symmetry in individuals who cannot tolerate fast treadmill walking, a common gait rehabilitation approach. Future work will assess the feasibility, metabolic demands, and clinical efficacy of using dynamic treadmill walking to improve gait symmetry in clinical populations. Key Points SummaryO_LIDynamic treadmill walking (i.e., walking with oscillating treadmill speeds) has previously been shown to drive gait asymmetries, but little is known about the energy expenditure required to complete the task. C_LIO_LIOur hypothesis was that dynamic treadmill walking would have similar metabolic power requirements to normal walking at a speed that is intermediate between the two dynamic treadmill walking speeds. C_LIO_LIWe found that dynamic treadmill walking actually requires metabolic power that is greater than the average of the two belt speeds, but less than that used for fast walking. C_LIO_LIDynamic treadmill walking is a promising and clinically translatable technique for rehabilitating populations with gait asymmetries that is not more energetically costly than fast treadmill walking, a common gait rehabilitation approach. C_LI

Mass is a fundamental aspect of muscle contractile function, yet the inertial effects of inactive muscle mass is generally neglected in modeling and not quantified in studies on small muscles or isolated fibers. However, during submaximal contractions, inactive muscle tissue may take longer to be accelerated by active fibers, and may be subject to prolonged deceleration, both of which may potentially reduce force development and work output. We sought to test if inactive tissue mass imposes an inertial penalty on muscle performance, using in situ sinusoidal work-loop experiments on rat plantaris muscles. Regional fascicle dynamics, measured across supramaximal and submaximal levels of activation, showed that decreasing activation significantly reduced fascicle strain and increased both shortening and lengthening latency. Contrary to our predictions, however, reductions in work, beyond those explained by decreased fascicle strain, were negligible. Normalized work did not decline disproportionately relative to force, suggesting no clear inertial penalty on work at this muscle size. Our findings suggest that while inactive muscle mass influences the dynamics of submaximal contractions, its impact on work during submaximal contractions at small muscle sizes is limited.

Background: Quadriceps strength and landing mechanics are two modifiable factors associated with anterior cruciate ligament (ACL) injury risk. Collecting detailed biomechanical data is an arduous task. Identifying a relationship using more easily measured variables, such as quadriceps strength, would offer value for athlete counseling and injury prevention programs. Although quadriceps weakness has been associated with altered landing strategies in ACL-reconstructed (ACLR) individuals, this relationship is less clear in healthy athletes. Purpose: To investigate the association between isokinetic quadriceps strength and peak knee flexion angle during a vertical drop jump in healthy adolescent athletes. Study Design: Secondary analysis of previously collected data. Methods: Healthy adolescent athletes had their dominant leg quadriceps strength measured using an isokinetic dynamometer at 60{degrees}/s from 0-90{degrees} of knee flexion. Landing mechanics were assessed during a vertical drop jump using three-dimensional motion capture synchronized with force plates. Pearson correlation was used to evaluate the association between quadriceps strength and peak knee flexion angle during landing, with statistical significance defined as p < .05. Results: There was a weak negative correlation between quadriceps strength and peak knee flexion angle (p = .017, R = -.22 [-.04, -.38]), suggesting that stronger athletes achieved greater knee flexion angles. Discussion: Greater quadriceps strength was associated with increased peak knee flexion angles during landing; however, the weak correlation suggests that strength explains only a small portion of the variability in landing mechanics. These findings deviate slightly from prior literature in healthy populations but are consistent with studies demonstrating that greater quadriceps strength is associated with achieving greater peak knee flexion in ACLR patients. Accordingly, quadriceps strengthening should remain a key component of multifactorial ACL injury prevention programs.

ObjectivesThis study aimed to compare exercise-induced changes in serum and salivary concentrations of cardiac troponin-I (cTnI) in athletes during and after a marathon. MethodsThirty-six male runners were recruited. Eighteen participants in group 1 completed a marathon (42.195 km), while eighteen participants in group 2 did not undergo this exercise. Blood and saliva samples were collected at twelve different time points and then analyzed for cTnI using an immunoassay. ResultsBiphasic cTnI release into the circulation was observed during and after the marathon. Moreover, a similar pattern of biphasic cTnI elevation was found in saliva. In group 1, salivary and serum concentrations of cTnI first peaked after 60 min of exercise (0.67{+/-}0.08 ng/mL and 0.76{+/-}0.07 ng/mL), decreased slightly towards the end of the marathon (0.40{+/-}0.06 ng/mL and 0.46{+/-}0.06 ng/mL), and then reached a second, higher peak 4 h post-exercise (0.72{+/-}0.09 ng/mL and 0.82{+/-}0.09 ng/mL), returning to baseline by 48 h after marathon completion (0.16{+/-}0.04 ng/mL and 0.18{+/-}0.04 ng/mL). In group 2, there were no time-dependent changes in cTnI concentrations in both saliva and serum. Deming regression and Passing-Bablok regression demonstrated that there was proportional agreement between salivary and serum levels of cTnI in both groups at all twelve time points. The Bland-Altman method revealed that there was a negative differential bias but no proportional bias in the data. ConclusionsDocumenting a similar, biphasic pattern of cTnI elevations in saliva and serum during and after the marathon provides a reliable non-invasive alternative without requiring a blood draw.

Mental imagery is known to be accompanied by autonomic responses, traditionally viewed as merely downstream consequences of imagery. Recent theoretical work has challenged this view, proposing that mental imagery requires the integration of cortical sensory representations with ascending interoceptive signals supplied by the autonomic nervous system. These two views make opposite predictions: if autonomic activity is only a consequence of imagery, then the responsiveness of the autonomic nervous system should not predict imagery vividness. If instead autonomic input shapes the generation of mental images, individuals with greater autonomic responsiveness should experience more vivid imagery. The present study tested these competing predictions by examining whether individual differences in cardiac vagal reactivity (indexed by the magnitude of HRV change in response to a paced breathing manipulation) predict self-reported visual imagery vividness. Imagery vividness was assessed using the Vividness of Visual Imagery Questionnaire (VVIQ) at a separate time point from the paced breathing protocol, ensuring that any observed relationship between cardiac vagal capacity cannot reflect autonomic activation driven by imagery itself. The key result was that cardiac vagal reactivity (indexed by RMSSD change normalized by mean R-R interval), significantly predicted higher VVIQ scores (r = .30, p = .031). These findings demonstrate that vividness of mental imagery is not exclusively central in origin but also shaped by the capacity of the autonomic nervous system to enter a high-parasympathetic state. Imagery thus likely involves bidirectional autonomic-cortical interaction, with descending pathways triggering the intention to generate an image and ascending interoceptive signals contributing to its generation.

Introduction: Menstrual cycle phase has been proposed as a source of intra-individual variability in resting energy expenditure and the thermic effect of food in premenopausal females, yet studies examining the thermic effect of food across menstrual cycle phases report conflicting findings. Methods: This protocol describes a secondary analysis of prespecified outcomes from a non-randomized, two-period crossover trial primarily designed to assess postprandial plasma triglyceride concentrations across menstrual cycle phases (ClinicalTrials.gov: NCT07459465) in 12 premenopausal females aged 18-30 years, free of chronic disease and hormonal contraceptive use, recruited in Ottawa, Canada. Participants complete two experimental sessions: one in the early follicular phase and one in the mid-luteal phase, each involving consumption of a high-fat meal. Eleven secondary outcomes will be reported: fasting resting energy expenditure, thermic effect of food, respiratory exchange ratio, carbohydrate oxidation rate, lipid oxidation rate, desire to eat, hunger, fullness, prospective food consumption, serum beta-estradiol, and serum progesterone. Masked outcome analyses are performed using linear mixed-effects models. Results: Recruitment began on 26 March 2026; results will be reported in the Stage 2 manuscript. Discussion: Findings from this trial may help clarify whether menstrual cycle phase constitutes a meaningful source of intra-individual variability in energy metabolism, with implications for the design of metabolic research in premenopausal females.

Stress is a major risk factor for mental disorders, and urban living is a key environmental contributor. Nature exposure may promote stress recovery and mental health, but how physiological arousal and subjective stress change across green versus gray space during naturalistic urban mobility is poorly understood. This preregistered study (https://doi.org/10.17605/OSF.IO/HF4RW) employed geolocation-based ambulatory assessment to examine psychophysiological arousal and subjective stress during transitions between urban green and gray environments. Thirty-six healthy urban residents completed a counterbalanced circular walking route in Cologne, Germany, with continuous GPS, cardiovascular, and electrodermal recording alongside ecological momentary assessment of subjective stress, affect, and exertion. Green compared to gray spaces were associated with lower subjective stress and higher affective well-being, with cardiac indices reflecting reduced autonomic arousal during green space exposure. Autonomic changes surrounding environmental transitions persisted beyond the immediate transition window, suggesting that physiological benefits of green space exposure extend into subsequent gray environments. These findings underscore the public health potential of urban green infrastructure for preventing stress-related mental health conditions.

Background: Generative AI tools can support data-intensive research by writing code, drafting prose, searching analytical possibilities, and stress-testing claims. They can also produce false citations, drift between statistical specifications, and lose continuity across long investigations. This paper describes a practical workflow for using AI systems in empirical research while keeping discovery, verification, and accountability inspectable. Methods: We developed and applied a three-phase human-AI workflow to a case study of 14 elite Ethiopian distance runners. The dataset contained 22,605 GPS-segments collected across 97 consecutive days in late 2025, supplemented by venue and athlete metadata collected in the field. Phase 1 used an autonomous data-exploration tool to pre-filter the hypothesis space across five seeded research questions. Phase 2 used an AI system under direct human guidance to construct candidate findings into numerical claims, verification scripts, and draft text. Phase 3 used an independent AI system in an adversarial role to stress-test methods, statistics, prose, figures, and citations. The workflow was informed by Pearl's distinction between association, intervention, and counterfactual reasoning, with human judgement retained for research direction, interpretation, and final claims. Results: The workflow produced three empirical analyses and a documented correction process. The analyses estimated an altitude-to-sea-level pace correction of +0.10 min/km per 1,000 m at matched heart rate, showed why pooled altitude-surface regression was not identifiable within this venue system, documented method-dependence in heart-rate-based intensity classification, characterised within-venue route variation as a 64/36 path-fixed-to-trail-variable split with the Sululta label resolving into two functionally distinct sub-venues, and reframed the cohort's training through a 3x3x3 prescription lattice grounded in Ethiopian coaching practice. The adversarial phase identified several hallucinated citations, a terminology error between HC1 and cluster-robust standard errors, and several inconsistencies between prose, figures, and computed results. Verification scripts re-derived nearly all numerical claims from the cleaned lap-level data. Conclusions: The case study shows how researchers can organise AI-assisted empirical work so that candidate discovery, claim construction, independent stress-testing, and final accountability remain separated. The workflow did not remove the need for domain expertise or human judgement. Its value was in making the route from candidate finding to manuscript claim explicit, reproducible, and open to challenge. Trial registration: Not applicable.

Objectives To examine the acute effects of a single bout of high-intensity interval training (HIIT) on fetal blood flow distribution during the third trimester of pregnancy. Methods Thirty-four healthy pregnant participants (mean age 31.6 years, standard deviation (SD) 4.1; gestational week 33.8 (SD 0.4) completed eight 30-second high-intensity cycling work-bouts interspersed with 2-minute rest periods. Fetal heart rate (FHR), maternal blood pressure, and Doppler-derived blood flow indices in the middle cerebral artery, umbilical artery and vein, and ductus venosus were assessed before and after exercise. We estimated fetal liver blood flow and the ratio of umbilical vein flow to ductus venosus. Maternal heart rate (HR) and FHR were recorded throughout exercise. Paired t-tests compared pre- and post-exercise values. Results No significant changes were observed in fetal blood flow indices or distribution following exercise. Average maternal HR and FHR during the work-bouts were 158 bpm (SD 16) and 152 bpm (SD 12), respectively. Following HIIT, maternal systolic blood pressure increased by 5 mmHg (95% CI 1 to 8, p=.014), maternal HR by 22 bpm (95% CI 15 to 28, p<.001), and FHR by 13 bpm (95% CI 10 to 17, p<.001). We recorded 16 instances of FHR above normal range during HIIT. Conclusion A single HIIT session in late pregnancy increased maternal blood pressure and HR and transiently elevated FHR but did not affect fetal blood flow indices or distribution. Brief episodes of fetal tachycardia were observed but appeared to be clinically insignificant. Future research should investigate the effects of repeated HIIT exposure during pregnancy.

Background: Exercise-based cardiac rehabilitation (CR) improves peak oxygen uptake ([V]O2peak) in patients with coronary heart disease (CHD); however, whether women and men exhibit similar adaptations across the steps of O2 transport remains unknown. We aimed to compare the ventilatory and circulatory determinants of [V]O2peak changes between women and men with CHD following a structured exercise training program. Methods: A total of 28 women (27%) and 75 men (73%) with CHD, matched for age, body mass index, and [V]O2peak (% predicted), underwent maximal cardiopulmonary exercise testing (CPET) before and after 12 weeks of CR. [V]O2peak and minute ventilation ([V]E) were measured breath by breath. Heart rate and cardiac output ([Q]c)were assessed non-invasively using impedance cardiography. Exercise efficiency ({Delta}[V]O2/{Delta}W), alveolar ventilation ([V]A), ventilatory efficiency (OUES), O2 pulse, arteriovenous oxygen content difference (C(a-[v])O2) and gross muscular efficiency (W) were calculated using standard equations. Mixed model analyses (sex x time) were used to compare training-induced changes between sexes. Results: At baseline, values of [V]O2peak (absolute and normalized by fat free mass), [V]E, [V]A, O2 pulse, C(a-[v])O2, {Delta}[V]O2/{Delta}W, W were significantly lower in women than in men with CHD (group effect, p<0.01). [V]O2peak normalized by fat-free mass improved similarly in both sexes after CR (p<0.0001, no significant sex x time interaction). Pulmonary convection ([V]E, [V]A), ventilatory efficiency (OUES), circulatory convection ([Q]c, cardiac index, O2 pulse), and peripheral gross muscular efficiency (W) all improved similarly after CR in women and men (effect sizeXtime effect, p<0.05, no significant group x time interaction). The prevalence of responder categories did not differ between sexes (p=0.826). Conclusion: Women and men with CHD demonstrated equivalent O2 transport phenotype adaptations after CR, with comparable improvements across the O2 transport chain (pulmonary, circulatory, and peripheral determinants of [V]O2peak).

ObjectiveLoss of skeletal muscle mass and performance is a hallmark of ageing. Mitochondrial function has been suggested as a critical determinant of skeletal muscle performance. However, mixed results have been reported regarding mitochondrial function in older individuals. Therefore, the primary objective of this systematic review is to determine whether 31P-MRS-derived {tau}PCr, reflecting mitochondrial oxidative capacity, is reduced in ageing skeletal muscle. MethodsA preregistered systematic literature review was performed using the databases MEDLINE, EMBASE, SPORTDiscus, and Cochrane Central Register of Controlled Trials (CENTRAL). Papers were included if they reported {tau}PCr as measured by 31P-MRS; and studied individuals over 65 years of age in combination with a younger control group. Differences between young and older groups were assessed using random effects meta-analysis. ResultsWe included 20 papers in total, of which 2 measured 2 muscles, 5 focused on the tibialis anterior (TA) muscle, 11 on the calf muscles, 5 on the quadriceps, and 1 on the flexor digitorum longus. No statistically-significant differences were found in {tau}PCr between older and younger adults for all muscles combined (Hedges g=0.11 (p=0.487). Inter-study heterogeneity was high ({tau}2=0.36, I2=72.49%, H2=3.64). Sub-analyses for the individual muscles showed longer {tau}PCr in the quadriceps (g=0.65, p<0.001) in older adults, but shorter {tau}PCr in the TA muscle (g=-0.64, p<0.001). For the calf muscles, no differences were detected between older and young individuals (g=0.20, p=0.377). ConclusionNo uniform age-related decline was found for {tau}PCr when comparing all studies together. Substantial heterogeneity was observed between the individual muscles, with {tau}PCr being prolonged in the upper leg muscles in older adults, but shortened in the tibialis anterior. This suggests more work using standardised settings and well-defined cohorts is needed.

Voluntary contraction in one limb can facilitate motor output in a distant limb, a phenomenon commonly referred to as the remote effect. However, the neural mechanisms underlying this remote interlimb facilitation remain unclear. This study investigated cortical and spinal contributions to the remote effect in able-bodied participants. Transcranial magnetic stimulation (TMS) was applied over the hand area of the primary motor cortex using posterior-anterior (PA) and anterior-posterior (AP) current directions, which are sensitive to different cortical inputs. Cortical excitability was assessed using single- and paired-pulse paradigms to measure short-interval intracortical inhibition (SICI), short-interval intracortical facilitation (SICF), and short-latency afferent inhibition (SAI). Spinal motoneuron excitability was assessed from F-waves elicited by peripheral nerve stimulation. During voluntary lower-limb contractions, single-pulse TMS elicited larger motor evoked potentials in hand muscles across current directions, indicating a broad increase in net corticospinal output. However, only AP-sensitive paired-pulse measures showed reduced SICI and enhanced SICF during contraction, whereas PA-sensitive SICI and SICF were not significantly altered, suggesting that cortical modulation during the remote effect is expressed more clearly in AP-sensitive measures. SAI with PA stimulation was less consistently expressed during contraction, suggesting that afferent-related inhibitory modulation may also be influenced during the remote effect. In parallel, F-wave amplitude and persistence increased, consistent with enhanced spinal motoneuron excitability. Together, these results provide converging evidence that the remote effect in humans involves broad corticospinal and spinal facilitation, accompanied by current direction-dependent modulation of cortical excitability measures. KEY POINTS SUMMARYO_LIVoluntary contraction in one limb can facilitate motor output in a distant limb, but the mechanisms underlying this remote interlimb facilitation remain unclear. C_LIO_LIWe tested whether remote lower-limb contraction modulates corticospinal output, intracortical excitability, and spinal motoneuron excitability in a resting hand muscle. C_LIO_LISingle-pulse transcranial magnetic stimulation showed that motor evoked potentials in the hand were facilitated during remote lower-limb contraction across multiple current directions, indicating a broad increase in net corticospinal output. C_LIO_LIPaired-pulse measures were modulated preferentially with anterior-posterior stimulation, with reduced short-interval intracortical inhibition and increased short-interval intracortical facilitation, suggesting current direction-dependent modulation of cortical excitability measures. C_LIO_LIF-wave amplitude and persistence were also enhanced during remote lower-limb contraction, indicating increased spinal motoneuron excitability. These findings provide converging evidence that the remote effect involves both cortical and spinal contributions. C_LI

ObjectivesTo determine whether early functional severity at presentation explains variability in return to sport (RTS) after ankle sprain in young athletes, compared with sprain subtype and injury mechanism. DesignRetrospective cohort study. MethodsAthletes aged [&le;]22 years with acute ankle sprains were identified from a prospectively maintained institutional database. Surgically treated cases were excluded. Functional severity at presentation was classified into three grades based on the ability to continue sports participation and ambulate immediately after injury. Injury mechanisms were categorized as high-energy deceleration (HED) or non-HED. RTS was analyzed as time to return and as prolonged RTS ([&ge;]4 weeks). Multivariable logistic regression was performed to identify factors independently associated with prolonged RTS. ResultsA total of 437 cases were included. Median RTS was 2.0 weeks (interquartile range, 0.0-4.0), and prolonged RTS occurred in 33.0% of cases. RTS duration increased stepwise with greater functional severity (p < 0.001). In multivariable analysis, functional severity was strongly associated with prolonged RTS (Grade 2: adjusted odds ratio [OR], 3.58; 95% confidence interval [CI], 2.07-6.19; Grade 3: adjusted OR, 24.53; 95% CI, 10.67-56.43; p < 0.001), and age was also independently associated (adjusted OR, 1.19 per year; 95% CI, 1.11-1.27; p < 0.001). Sprain subtype and injury mechanism were not independently associated with RTS after adjustment. ConclusionsEarly functional severity at presentation is the primary determinant of RTS after ankle sprain in young athletes. Apparent differences related to sprain subtype and injury mechanism are largely explained by initial functional impairment.

ObjectivesTo investigate the epidemiology of acute sports-related upper-extremity injuries in young athletes, with a particular focus on the frequency, anatomical distribution, injury types, and mechanisms of digit injuries. MethodsThis single-center retrospective observational study included athletes aged [&le;]22 years who sustained acute sports-related upper-extremity injuries between January 2017 and November 2025. Digit injuries were defined as injuries involving the thumb and fingers at or distal to the metacarpophalangeal joint. Injury characteristics, mechanisms, and sports categories were analyzed using descriptive statistics. ResultsA total of 1,219 acute sports-related upper-extremity injuries were analyzed. Digit injuries were the most common injury location, accounting for 412 cases (33.8%), followed by shoulder (30.7%), elbow (17.5%), wrist (14.4%), and palm injuries (3.6%). Jammed finger was the most frequent injury type, comprising 64.8% of digit injuries, followed by fractures (20.1%) and dislocations (5.3%). Most injuries were caused by contact mechanisms (90.3%), with ball contact being the predominant cause (49.5%). Ball sports accounted for 85.4% of all digit injuries. ConclusionsDigit injuries represent the most frequent acute sports-related upper-extremity injuries in athletes aged [&le;]22 years, with jammed finger accounting for the majority of cases. Most injuries were associated with ball contact, highlighting the need for preventive strategies and appropriate initial management for digit injuries in young athletes.

Perinatal opioid exposure is a prevalent clinical concern linked to respiratory instability and adverse infant outcomes. The opioid buprenorphine is prescribed as a medication for opioid use disorder during pregnancy and used to treat neonatal opioid withdrawal syndrome, yet its direct effects on neonatal control of breathing have not been examined. Here, we asked how acute buprenorphine exposure affects breathing at rest, and during chemoreceptor stimulation. Using dual-chamber head-out plethysmography, we measured pulmonary ventilation rate ([V]I) and metabolic rate in awake male and female Sprague-Dawley neonatal rats on postnatal days 4-5 (P4-5) during eupnea and a hypoxic-hypercapnic (HH) challenge. The effects of buprenorphine and two opioid receptor antagonists, naloxone hydrochloride, or peripherally restricted naloxone methiodide, were assessed using a repeated measures design. [V]I during eupnea and HH were markedly depressed following buprenorphine administration. Buprenorphine reduced [V]O2 and [V]CO2 and produced ventilatory equivalents for O2 and CO2 consistent with frank hypoventilation, driven by reduced breathing frequency and tidal volume (VT). When administered after buprenorphine, neither naloxone hydrochloride nor naloxone methiodide could rescue the buprenorphine-mediated hypoventilation in eupnea or during HH. In contrast, pre-treatment with either naloxone hydrochloride or naloxone methiodide attenuated buprenorphine-induced hypoventilation by preserving VT. These findings demonstrate that neonatal protective chemoreceptor reflexes are depressed by buprenorphine and suggest that pre-treatment with a peripheral opioid receptor antagonist could mitigate buprenorphine-induced hypoventilation without inducing opioid withdrawal. Key PointsO_LIAcute buprenorphine exposure significantly depressed pulmonary ventilation rate ([V]I) during eupnea and hypoxic hypercapnia (HH) in awake neonatal rats. C_LIO_LIBuprenorphine-induced hypoventilation was driven by reduced tidal volume (VT) and breathing frequency. C_LIO_LIBuprenorphine also reduced oxygen consumption ([V]O2) and carbon dioxide production ([V]CO2). C_LIO_LINaloxone given after buprenorphine failed to reverse hypoventilation. C_LIO_LIIn contrast, pre-treatment with either naloxone hydrochloride or peripherally restricted naloxone methiodide mitigated buprenorphine-induced hypoventilation by preserving VT. C_LI

Clinically, burn severity is reported as the size (and depth) of burn wounds relative to total body surface area (TBSA). This nomenclature is also often used in rodent models of burns. Accordingly, accurate determination and reporting of rodent TBSA is required to ensure the rigor and reproducibility of preclinical burn research. Rodent TBSA is typically estimated indirectly as a function of body mass. Further, empirical quantification of rodent TBSA through pelt dissection does not consider differences in rodent and human anatomy, making comparison of relative burn size in rodents and humans a challenge. Here, we compared commonly used approaches to directly determine or indirectly estimate rodent TBSA to demonstrate the impact different approaches can have on the calculation of relative burn size. A total of n=48 C57BL/6J background mice (55% male) ranging from 4 to 45 weeks of age and 17 to 40 grams were used. Mice were weighed prior to euthanasia. After euthanasia, mouse length was measured from the nose to anus. Mice were then placed into clear polypropylene sheet protectors (21.6 x 27.9 cm) to trace the areas of both the dorsal and ventral surfaces as well as all four limbs (dorsal-ventral (DV) tracing). Next, the pelt was carefully excised from the body through cutting a lateral line from the mouth to the genitalia, then again proximally to distally on all four limbs. The pelt was gently placed on a sheet protector and traced when both relaxed and stretched. The ears and tail were removed and traced separately. Photographs were taken of all tracings next to a ruler for scale and analyzed in ImageJ. Stretched pelt measurements of TBSA were 34% (79.4{+/-}7.6 vs. 57.5{+/-}7.5 cm2, P<0.001) and 30% (70.6{+/-}10.9 vs. 52.7{+/-}8.1 cm2, P<0.001) greater than relaxed pelt TBSA measurements in male and female mice respectively. TBSA estimated by DV tracing was 9% greater in males (62.5{+/-}10.9 vs. 57.5{+/-}7.5 cm2) and 15% in females (60.6{+/-}12.3 vs. 52.7{+/-}8.1 cm2) compared to TBSA measurements made on relaxed pelts. Accordingly, empirically derived Meeh constants (k) from DV tracing were greater than those derived from relaxed pelt measurements for both males (7.14{+/-}0.59 vs. 6.58{+/-}0.72) and females (7.72{+/-}0.58 vs. 6.78{+/-}0.80). In contrast k values derived from stretched pelt measures of TBSA were significantly greater than those determined in relaxed pelts for males (8.91{+/-}0.87 vs. 6.58{+/-}0.72, P<0.001) and females (8.85{+/-}1.25 vs. 6.78{+/-}0.80, P>0.001). The combined ears and tail represent approximately 7% and 8% of the TBSA measured by the relaxed pelt approach, respectively. Exclusion of the tail and ears from the calculated TBSA results in derived k values that are [~]16-17% lower. The approach used to determine TBSA in mice significantly influences measured areas and thus derived k values. We suggest that stretching the pelt prior to tracing inflates TBSA values, where measurements made from relaxed pelts or by DV tracing likely provide more accurate estimates of actual TBSA. Further, exclusion of the tail and ears (the latter of which is not typically considered in estimates of TBSA in humans) may be a useful approach relating relative burn sizes of mice to those of humans.

Singing is an innate human behaviour present across cultures and the lifespan. Despite lacking direct biological advantages, its ubiquity suggests that it is intrinsically rewarding. This research aimed to investigate the underlying factors that explain variability in sensitivity to deriving reward and enjoyment from natural singing in the general population. In Study 1 (n = 606), an initial pool of items describing daily, non-professional singing behaviours were administered to an international adult sample. Exploratory factor analysis revealed a unidimensional structure of 20 items with acceptable model fit, organized into five facets representing distinct domains of singing-related rewards: 1) pleasure and emotional evocation, 2) social singing reward, 3) singing frequency, 4) mood regulation through singing, and 5) inattentional singing during routine tasks. In Study 2 (n = 430), confirmatory factor analysis in a new sample supported this structure. When both samples were combined (n = 1036), the unidimensional model defined by these five facets showed acceptable to excellent goodness-of-fit indices, supporting the conceptualization of singing reward as a multidimensional construct with differentiated facets. This led to the Barcelona-Aarhus Natural Singing Engagement Questionnaire (BANSEQ), which demonstrated excellent reliability ( = .94) and population-level stability. Study 3 (n = 1036) tested the convergent validity of BANSEQ with measures of music reward and engagement and identified sociodemographic and psychological correlates across the five facets of singing reward. Overall, these findings characterize the sources of individual differences in the hedonic experience of natural singing and propose BANSEQ as a robust psychometric tool for its assessment in the general population.