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      Athlete’s Passport: Prevention of Infections, Inflammations, Injuries and Cardiovascular Diseases

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          Abstract

          Laboratory medicine in sports medicine is taking on an ever-greater role in the assessment and monitoring of an athlete’s health condition. The acute or intense exercise practiced by elite athletes can lead to the appearance of infections, inflammations, muscle injuries or cardiovascular disorders, whose diagnosis is not always rapid and efficient, as there is no continuous monitoring of the athlete. The absence of such monitoring can have serious consequences in terms of recovery of the professional athlete. These imbalances can induce metabolic adaptations which translate into alterations of specific parameters in terms of concentration and activity. The aim of this study was to follow the variation of specific biochemical biomarkers in a basketball team participating to the maximum championship during different phases of the agonistic season. The evaluation of serum biomarkers can help doctors to safeguard the athlete’s health and sports trainers to adapt workouts, thus avoiding the appearance of diseases and injuries that in some cases can be underestimated by becoming irreversible ailments that do not allow the athlete to return to a healthy state. This information can be useful to create athlete biologic passports.

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          Most cited references52

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          Thyroid hormone action in the heart.

          The heart is a major target organ for thyroid hormone action, and marked changes occur in cardiac function in patients with hypo- or hyperthyroidism. T(3)-induced changes in cardiac function can result from direct or indirect T(3) effects. Direct effects result from T(3) action in the heart itself and are mediated by nuclear or extranuclear mechanisms. Extranuclear T(3) effects, which occur independent of nuclear T(3) receptor binding and increases in protein synthesis, influence primarily the transport of amino acids, sugars, and calcium across the cell membrane. Nuclear T(3) effects are mediated by the binding of T(3) to specific nuclear receptor proteins, which results in increased transcription of T(3)-responsive cardiac genes. The T(3) receptor is a member of the ligand-activated transcription factor family and is encoded by cellular erythroblastosis A (c-erb A) genes. T(3) also leads to an increase in the speed of diastolic relaxation, which is caused by the more efficient pumping of the calcium ATPase of the sarcoplasmic reticulum. This T(3) effect results from T(3)-induced increases in the level of the mRNA coding for the sarcoplasmic reticulum calcium ATPase protein, leading to an increased number of calcium ATPase pump units in the sarcoplasmic reticulum.
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            Metabolic markers in sports medicine.

            Physical exercise induces adaptations in metabolism considered beneficial for health. Athletic performance is linked to adaptations, training, and correct nutrition in individuals with genetic traits that can facilitate such adaptations. Intense and continuous exercise, training, and competitions, however, can induce changes in the serum concentrations of numerous laboratory parameters. When these modifications, especially elevated laboratory levels, result outside the reference range, further examinations are ordered or participation in training and competition is discontinued or sports practice loses its appeal. In order to correctly interpret commonly used laboratory data, laboratory professionals and sport physicians need to know the behavior of laboratory parameters during and after practice and competition. We reviewed the literature on liver, kidney, muscle, heart, energy, and bone parameters in athletes with a view to increase the knowledge about clinical chemistry applied to sport and to stimulate studies in this field. In liver metabolism, the interpretation of serum aminotransferases concentration in athletes should consider the release of aspartate aminotransferase (AST) from muscle and of alanine aminotransferase (ALT) mainly from the liver, when bilirubin can be elevated because of continuous hemolysis, which is typical of exercise. Muscle metabolism parameters such as creatine kinase (CK) are typically increased after exercise. This parameter can be used to interpret the physiological release of CK from muscle, its altered release due to rhabdomyolysis, or incomplete recovery due to overreaching or trauma. Cardiac markers are released during exercise, and especially endurance training. Increases in these markers should not simply be interpreted as a signal of cardiac damage or wall stress but rather as a sign of regulation of myocardial adaptation. Renal function can be followed in athletes by measuring serum creatinine concentration, but it should be interpreted considering the athlete's body-mass index (BMI) and phase of the competitive season; use of cystatin C could be a reliable alternative to creatinine. Exercise and training induce adaptations in glucose metabolism which improve glucose utilization in athletes and are beneficial for reducing insulin insensitivity in nonathletes. Glucose metabolism differs slightly for different sports disciplines, as revealed in laboratory levels. Sport activities induce a blood lipid profile superior to that of sedentary subjects. There are few reports for a definitive conclusion, however. The differences between athletes and sedentary subjects are mainly due to high-density lipoprotein cholesterol (HDLC) concentrations in physically active individuals, although some differences among sport disciplines exist. The effect of sports on serum and urinary markers for bone metabolism is not univocal; further studies are needed to establish the real and effective influence of sport on bone turnover and especially to establish its beneficial effect.
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              Vitamin D and athletes.

              While it is well recognized that vitamin D is necessary for optimal bone health, emerging evidence is finding that adequate vitamin D intake reduces risk for conditions such as stress fracture, total body inflammation, infectious illness, and impaired muscle function. Studies in athletes have found that vitamin D status is variable and is dependent on outdoor training time (during peak sunlight), skin color, and geographic location. Although research has found that athletes generally do not meet the U.S. dietary reference intake for vitamin D, inadequate endogenous synthesis is the most probable reason for insufficient/deficient status. Given the recent findings, it is imperative that sports dietitians and physicians routinely assess vitamin D status and make recommendations to help athletes achieve a serum 25(OH)D concentration of >or=32 and preferably >or=40 ng.mL(-1). Further research is needed to determine the effect of vitamin D status on injury, training, and performance in athletes.
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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                06 August 2020
                August 2020
                : 9
                : 8
                : 2540
                Affiliations
                [1 ]Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; cristinamennitti@ 123456libero.it (C.M.); cristina.mazzaccara@ 123456unina.it (C.M.); giulia.frisso@ 123456unina.it (G.F.)
                [2 ]Department of Biology and Evolution of Marine Organisms, Stazione Zoologica Anton Dohrn, Villa Comunale, 80121 Naples, Italy; mariarita.brancaccio@ 123456szn.it
                [3 ]Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; gentilelu@ 123456ceinge.unina.it (L.G.); ranieria@ 123456ceinge.unina.it (A.R.)
                [4 ]Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; daniela.terracciano@ 123456unina.it (D.T.); michelecennamo@ 123456unina.it (M.C.); evelina.lacivita@ 123456unina.it (E.L.C.); tonialiotti@ 123456virgilio.it (A.L.)
                [5 ]Department of Neuroscience and Rehabilitation, Center of Sports Medicine and Disability, AORN, Santobono-Pausillipon, 80122 Naples, Italy; ninodalicandro@ 123456libero.it
                [6 ]Task Force on Microbiome Studies, University of Naples Federico II, 80100 Naples, Italy
                Author notes
                [* ]Correspondence: pero@ 123456unina.it (R.P.); barbara.lombardo@ 123456unina.it (B.L.); olga.scudiero@ 123456unina.it (O.S.); Tel.: +39-339-459-6163 (R.P.); +39-339-360-7569 (B.L.); +39-339-613-9908 (O.S.)
                [†]

                These authors contributed equally to this work.

                Author information
                https://orcid.org/0000-0001-6355-5976
                https://orcid.org/0000-0002-4161-512X
                https://orcid.org/0000-0003-4296-429X
                https://orcid.org/0000-0001-7774-2799
                https://orcid.org/0000-0003-3487-7743
                https://orcid.org/0000-0003-3884-1043
                https://orcid.org/0000-0002-4916-4976
                Article
                jcm-09-02540
                10.3390/jcm9082540
                7465786
                32781561
                e7836102-44e9-49ee-98b9-5fa193b67e30
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 05 June 2020
                : 04 August 2020
                Categories
                Article

                sports medicine,elite athletes,serum biomarkers,prevention,infection,inflammation,muscle injuries,cardiovascular diseases

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