A case of vitamin B12 deficiency neurological syndrome in a young adult due to late-onset cobalamin C (CblC) deficiency: a diagnostic challenge

Vitamin B12 deficiency can present with neurologic and psychiatric symptoms without macrocytic anaemia. We describe a case of late-onset cobalamin C deficiency which typically presents with normal serum vitamin B12 concentrations, posing an additional diagnostic challenge. A 23-year-old woman with decreased muscle strength and hallucinations was diagnosed with ‘catatonic depression’ and admitted to a residential mental health facility. She was referred to our hospital for further investigation 3 months later. Heteroanamnesis revealed that the symptoms had been evolving progressively over several months. Magnetic resonance imaging (MRI) of the brain showed diffuse symmetrical white matter lesions in both hemispheres. Routine laboratory tests including vitamin B12 and folic acid were normal except for a slight normocytic, normochromic anaemia. Over the next 6 weeks her symptoms deteriorated, and she became unresponsive to stimuli. A new MRI scan showed progression of the white matter lesions. The neurologist requested plasma homocysteine (Hcys) which was more than 8 times the upper limit of normal. Further testing revealed increased methylmalonic acid and the patient was diagnosed with adult-onset cobalamin C deficiency. This case illustrates that Hcys and/or methylmalonic acid should be determined in patients presenting with neuropsychiatric symptoms suggestive of vitamin B12 deficiency with a normal serum vitamin B12 to rule out a late-onset cobalamin C deficiency.     

‘This could be our reality in the next five to ten years’: a blogpost platform as an expectation generation device on the future of insurance markets

William James (1919) characterises hypotheses as either live or dead. A hypothesis is live when it is taken into account as a ‘real possibility’. We follow James’ suggestion to not attribute intrinsic properties to hypotheses, but rather investigate how they came into being and look at the effects they generate. Expectations of digital technologies are a topic of vivid debate in the insurance industry. Before these expectations can become ‘live’, they have, in the first place, to be generated by market devices. We investigate how the reinsurance blogpost platform Open Minds functions as an ‘expectation generation device’ on the future of insurance markets. Combining Beckert’s work on the role of fictional expectations with the pragmatist turn in sociology of markets, we propose to study ‘expectation generation devices’, provoking expectations on economic markets. In our empirical analysis, we demonstrate the explicit fictional character of the Open Minds contributions, and analyse how a contained space of openness is generated to provoke expectations. We demonstrate how Open Minds can become live through circulation to other expectation generation sites in the insurance industry and beyond. We conclude by reflecting on the importance of expectation generation devices as a particular type of market devices.     

Maximizing recovery time between knock-out races improves sprint cross-country skiing performance

Background:In a sprint cross-country(XC)ski competition,the difference in recovery times separating the first and the second semi-final(SF)heats from the final(F)may affect performance.The aim of the current study was to compare the effects of longer vs.shorter recovery periods prescribed between the 3 knock-out races of a simulated sprint XC ski competition involving a prologue(P),quarter-final(QF),SF,and F.Methods:Eleven well-trained XC ski athletes completed 2 simulated sprint XC ski competitions on a treadmill involving 4×883-m roller-ski bouts at a 4°incline using the gear 3 ski-skating sub-technique.The first 3 bouts were completed at a fixed speed(PFIX,QFFIX,and SFFIX)corresponding to~96%of each individual’s previously determined maximal effort.The final bout was performed as a self-paced sprint time trial(FSTT).Test conditions differed by the time durations prescribed between the QFFIX,SFFIX,and FSTT,which simulated real-world XC ski competition conditions using maximum(MAX-REC)or minimum(MIN-REC)recovery periods.Results:The FSTT was completed 5.4±5.5 s faster(p=0.009)during MAX-REC(179.2±18.1 s)compared to MIN-REC(184.6±20.0 s),and this was linked to a significantly higher power output(p=0.010)and total metabolic rate(p=0.009).The pre FSTT blood lactate(BLa)concentration was significantly lower during MAX-REC compared to MIN-REC(2.5±0.8 mmol/L vs.3.6±1.6 mmol/L,respectively;p=0.027),and the pre-to-post FSTT increase in BLa was greater(8.8±2.1 mmol/L vs.7.1±2.3 mmol/L,respectively;p=0.024).No other differences for MAX-REC vs.MIN-REC reached significance(p>0.05).Conclusion:Performance in a group of well-trained XC skiers is negatively affected when recovery times between sprint heats are minimized which,in competition conditions,would occur when selecting the last QF heat.This result is combined with a higher pre-race BLa concentration and a reduced rise in BLa concentration under shorter recovery conditions.These findings may help inform decision making when XC skiers are faced with selecting a QF heat within a sprint competition.     

Is there really an eccentric action of the hamstrings during the swing phase of high-speed running? part I: A critical review of the literature

It is widely assumed that there is an eccentric hamstring muscle fibre action during the swing phase of high-speed running. However, animal and modelling studies in humans show that the increasing distance between musculotendinous attachment points during forward swing is primarily due to passive lengthening associated with the take-up of muscle slack. Later in the swing phase, the contractile element (CE) maintains a near isometric action while the series elastic (tendinous) element first stretches as the knee extends, and then recoils causing the swing leg to forcefully retract prior to ground contact. Although modelling studies showed some active lengthening of the contractile (muscular) element during the mid-swing phase of high-speed running, we argue that the increasing distance between the attachment points should not be interpreted as an eccentric action of the CE due to the effects of muscle slack. Therefore, there may actually be no significant eccentric, but rather predominantly an isometric action of the hamstrings CE during the swing phase of high-speed running when the attachment points of the hamstrings are moving apart. Based on this, we propose that isometric rather than eccentric exercises are a more specific way of conditioning the hamstrings for high-speed running.     

A novel sleep optimisation programme to improve athletes’ well-being and performance

Objectives: To improve well-being and performance indicators in a group of Australian Football League (AFL) players via a six-week sleep optimisation programme. Design: Prospective intervention study following observations suggestive of reduced sleep and excessive daytime sleepiness in an AFL group. Methods: Athletes from the Adelaide Football Club were invited to participate if they had played AFL senior-level football for 1–5 years, or if they had excessive daytime sleepiness (Epworth Sleepiness Scale [ESS] >10), measured via ESS. An initial education session explained normal sleep needs, and how to achieve increased sleep duration and quality. Participants (n?=?25) received ongoing feedback on their sleep, and a mid-programme education and feedback session. Sleep duration, quality and related outcomes were measured during week one and at the conclusion of the six-week intervention period using sleep diaries, actigraphy, ESS, Pittsburgh Sleep Quality Index, Profile of Mood States, Training Distress Scale, Perceived Stress Scale and the Psychomotor Vigilance Task. Results: Sleep diaries demonstrated an increase in total sleep time of approximately 20?min (498.8?±?53.8 to 518.7?±?34.3; p?<?.05) and a 2% increase in sleep efficiency (p?<?0.05). There was a corresponding increase in vigour (p?<?0.001) and decrease in fatigue (p?<?0.05). Conclusions: Improvements in measures of sleep efficiency, fatigue and vigour indicate that a sleep optimisation programme may improve athletes’ well-being. More research is required into the effects of sleep optimisation on athletic performance.     

Tribute to Dr Jacques Rogge: muscle activity and fatigue during hiking in Olympic dinghy sailing

‘A tribute to Dr J. Rogge’ aims to systematically review muscle activity and muscle fatigue during sustained submaximal quasi-isometric knee extension exercise (hiking) related to Olympic dinghy sailing as a tribute to Dr Rogge’s merits in the world of sports. Dr Jacques Rogge is not only the former President of the International Olympic Committee, he was also an orthopaedic surgeon and a keen sailor, competing at three Olympic Games. In 1972, in fulfilment of the requirements for the degree of Master in Sports Medicine, he was the first who studied a sailors’ muscle activity by means of invasive needle electromyography (EMG) during a specific sailing technique (hiking) on a self-constructed sailing ergometer. Hiking is a bilateral and multi-joint submaximal quasi-isometric movement which dinghy sailors use to optimize boat speed and to prevent the boat from capsizing. Large stresses are generated in the anterior muscles that cross the knee and hip joint, mainly employing the quadriceps at an intensity of 30–40% maximal voluntary contraction (MVC), sometimes exceeding 100% MVC. Better sailing level is partially determined by a lower rate of neuromuscular fatigue during hiking and for ≈60% predicted by a higher maximal isometric quadriceps strength. Although useful in exercise testing, prediction of hiking endurance capacity based on the changes in surface EMG in thigh and trunk muscles during a hiking maintenance task is not reliable. This could probably be explained by the varying exercise intensity and joint angles, and the great number of muscles and joints involved in hiking.

Highlights

• Dr Jacques Rogge, former president of the International Olympic Committee and Olympic Finn sailor, was the first to study muscle activity during sailing using invasive needle EMG to obtain his Master degree in Sports Medicine at the Ghent University.

• Hiking is a critical bilateral and multi-joint movement during dinghy racing, accounting for >60% of the total upwind leg time. Hiking generates large stresses in the anterior muscles that cross the knee and hip joint.

• Hiking is considered as a quasi-isometric bilateral knee extension exercise. Muscle activity measurements during sailing, recorded by means of EMG, show a mean contraction intensity of 30-40% maximal voluntary contraction with peaks exceeding 100%.

• Hiking performance is strongly related to the development of neuromuscular fatigue in the quadriceps muscle. Since maximal strength is an important determinant of neuromuscular fatigue during hiking, combined strength and endurance training should be incorporated in the training program of dinghy sailors.

     

Children's adaptive behavior scale: A new measure of adaptive functioning

This article describes a new instrument for the measurement of adaptive behavior that is administered directly to the child. It was designed for brief administration, to be educationally relevant, and to measure these five domains of adaptive behavior: Language Development, Independent Functioning, Family Role Performance and Economic-Vocational Activity, and Socialization. An initial study of test-retest reliability indicates the instrument has high reliability.