The world's most widely used comprehensive reference book of medicine has been updated 16 times since 1899. It took 5 years of work to bring out this 16th edition. The 12 physicians on the editorial board enlisted the aid of 29 distinguished consultants with outstanding qualifications to complete the volume. The manual has been expanded by 120 pages and includes 154 figures and 382 tables. New subjects include sports medicine, hospice medicine, human immunodeficiency virus infection in children, cardiopulmonary resuscitation in infants and children, genetic evaluation and counseling, anabolic steroid abuse, cultural issues in medicine, and cocaine withdrawal in newborns. A table of generic drugs with their trade names has been included and will be useful for the ophthalmologist as a reference. As in past editions, the contents are arranged by organ system on the basis of the origins of each disease. The pathologicand physiologic features of each disease are

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/640584/archopht_112_3_018.pdf

The Merck Manual of Diagnosis and Therapy

More than a decade ago it was reported in the journal Nature that the slope of improvement in the men's and women's running records, extrapolated from mean running velocity plotted against historical time, would eventually result in a performance intersection of the sexes across a variety of running distances. The first of these intersections was to occur for 42 000 m before the 21st century. Most of the error in this prediction is probably explained by the linear mathematical treatment and extrapolation of limited performance data, since including world record-setting running performances for women before and after 1985 results in a non-linear data fit. The reality of early, disproportionate improvements in women's running that gave the appearance of an impending convergence with men is best explained by an historical social sports bias. Women's times have now reached a plateau similar to that observed for men at comparative performance milestones in the marathon. Sex differences at distances from 100 to 10 000 m show similar trends. The remaining sex gaps in performance appear biological in origin. Success in distance running and sprinting is determined largely by aerobic capacity and muscular strength, respectively. Because men possess a larger aerobic capacity and greater muscular strength, the gap in running performances between men and women is unlikely to narrow naturally.

Running performance differences between men and women:an update.

While the crucial role of haemoglobin in aerobic exercise has been well accepted, there is still a great deal of controversy about the optimal haematological parameters in the athletic population. The initial part of this review will examine the question of anaemia in athletes. The most common finding in athletes is a dilutional pseudoanaemia that is caused by a plasma volume expansion, rather than an actual blood loss. It is not a pathological state and normalizes with training cessation in 3 to 5 days. This entity should be distinguished from conditions associated with lowered blood counts, such as intravascular haemolysis or iron deficiency anaemia. The evaluation of true anaemia states in the athlete must take into account not only blood losses secondary to exercise, such as foot strike haemolysis or iron losses through sweat, but non-athletic causes as well. Depending on the age and sex of the athlete, consideration must be given to evaluation of the gastrointestinal or genitourinary systems for blood loss. Finally, a comprehensive nutritional history must be taken, as athletes, especially women, are frequently not consuming adequate dietary iron.

Sports Haematology

This study was designed to examine the interrelationships between performance in endurance running events from 10 to 90 km, training volume 3–5 weeks prior to competition, and the fractional utilization of maximal aerobic capacity (%\(\dot V_{O_{2max} } \)) during each of the events. Thirty male subjects underwent horizontal treadmill testing to determine their\(\dot V_{O_{2max} } \), and steady-state\(\dot V_{O_2 }\) at specific speeds to allow for calculation of %\(\dot V_{O_{2max} } \) sustained during competition. Runners were divided into groups of ten according to their weekly training distance (group A trained less than 60 km · week−1, group B 60 to 100 km · week−1, and group C more than 100 km · week−1). Runners training more than 100 km · week−1 had significantly faster running times (average 19.2%) in all events than did those training less than 100 km · week−1.\(\dot V_{O_{2max} } \) or %\(\dot V_{O_{2max} } \) sustained during competition was not different between groups. The faster running speed of the more trained runners, running at the same %\(\dot V_{O_{2max} } \) during competition, was due to their superior running economy (19.9%). Thus all of the group differences in running performance could be explained on the basis of their differences in running economy. These findings suggest either that the main effect of training more than 100 km · week−1 may be to increase running economy, or that runners who train more than 100 km · week−1 may have inherited superior running economy. The finding that the maximal horizontal running speed reached during the progressive maximal treadmill test was a better predictor (r=0.72) of running performance at all distances than was the\(\dot V_{O_{2max} } \) (r=0.54) suggests that peak treadmill running speed can predict performance in endurance running events.

The influence of weekly training distance on fractional utilization of maximum aerobic capacity in marathon and ultramarathon runners

The effect of sodium bicarbonate and sodium citrate ingestion on cycling performance in three 30 s Wingate Anaerobic Tests separated by 6 min recovery periods has been studied using 6 male subjects. Subjects ingested either sodium bicarbonate (B), sodium bicarbonate plus sodium citrate (BC), sodium citrate (C) or sodium chloride (P) 2.5 h prior to exercise in a dose of 0.3 g kg-1 body weight. Pre-exercise blood pH was 7.44 +/- 0.06, 7.42 +/- 0.05, 7.41 +/- 0.05 and 7.38 +/- 0.04 in the C, BC, B and P conditions respectively. Mean and peak power output were significantly reduced by successive Wingate tests but not significantly affected by the treatments. Performance in the second and third tests was highest following C, BC and B ingestion. The total work done in the 3 tests was 103%, 102% and 101% of that achieved in the P condition after C, BC and B ingestion respectively. The increased alkali reserve recorded subsequent to bicarbonate and citrate treatment reduced mean post-exercise acidosis, although pH was significantly higher only in the C condition (p less than 0.05) compared to P after each exercise bout. No significant differences in plasma lactate concentration were recorded at any time. Citrate ingestion appears to be most effective in elevating blood pH and [HCO3-], and in enhancing performance in short-term intermittent exercise. This study demonstrates that alkali ingestion results in significant shifts in the acid-base balance of the blood and has a small, but non-significant, effect on anaerobic power and capacity as measured in a series of 3 Wingate Anaerobic Tests.

The effect of sodium bicarbonate and sodium citrate ingestion on anaerobic power during intermittent exercise.

This study was aimed at investigating the relationships between marathon performance time (MPT) and a set of variables wider in scope than that used to date in similar studies. Sixteen marathon runners of varying abilities were examined for the following variables prior to the start of a marathon race: age, weight (wt); height (ht); triceps, abdominal and subscapular (SSF) skinfolds; % fat; rectal temperature; average weekly training distance over the preceding 2–3 months and over the preceding year (ATD); hematocrit; creatine phosphokinase (CPK); aldosterone and cortisol. MPT's ranged between 2; 15:21 and 4; 54:31 h. The coefficients of the simple linear correlations with MPT were: age, 0.70; wt·ht−2, 0.57; SSF, 0.67; % fat, 0.61; ATD, −0,64; CPK, 0.52 and cortisol, −0.41. In order of relative strength, CPK, age, ATD, SSF and cortisol were found by a multiple linear regression analysis to be the best predictors of MPT (R=0.99; p<0.0001) — explaning 98% of its observed variance. The diversified approach may be supported by the high R value obtained. However, the significance of additional factors in determining MPT is expected and cannot be excluded.

Relationships of marathon running to physiological, anthropometric and training indices

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Relationships of marathon running to physiological, anthropometric and training indices