The aim of this study was to investigate the effect of high-intensity plyometric training (PT) on central and peripheral fatigue during exercise performed at maximal intensity in prepubertal boys. ...The boys (n=13, age 10.3+/-0.3 years) performed continuous 2-min maximal voluntary contractions (MVC) before and after 16 high-intensity PT sessions (two training sessions per week, 30 jumps in each session, 20 s between jumps). The greatest effect of PT was on excitation-contraction coupling: twitch force increased by 323.2+/-210.8% and the height of a counter-movement jump increased by 36.7+/-11.7%, whereas quadriceps femoris (QF) muscle voluntary activation index, central activation ratio and MVC did not change significantly after PT. The thickness of QF increased by 8.8+/-7.9% after PT. Central fatigue increased significantly by about 15-20% after PT, whereas peripheral fatigue decreased significantly by about 10% during the 2-min MVC. Central fatigue and peripheral fatigue during the 2-min MVC were inversely related before PT, but this relationship disappeared after PT.
The prognostic factors and optimal therapy for invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT) remain poorly studied. We included in this multinational retrospective study ...112 recipients diagnosed with probable (75.0% of cases) or proven (25.0%) IPA between 2000 and 2013. The median interval from transplantation to diagnosis was 230 days. Cough, fever, and expectoration were the most common symptoms at presentation. Bilateral pulmonary involvement was observed in 63.6% of cases. Positivity rates for the galactomannan assay in serum and bronchoalveolar lavage samples were 61.3% and 57.1%, respectively. Aspergillus fumigatus was the most commonly identified species. Six‐ and 12‐week survival rates were 68.8% and 60.7%, respectively, and 22.1% of survivors experienced graft loss. Occurrence of IPA within the first 6 months (hazard ratio HR: 2.29; p‐value = 0.027) and bilateral involvement at diagnosis (HR: 3.00; p‐value = 0.017) were independent predictors for 6‐week all‐cause mortality, whereas the initial use of a voriconazole‐based regimen showed a protective effect (HR: 0.34; p‐value = 0.007). The administration of antifungal combination therapy had no apparent impact on outcome. In conclusion, IPA entails a dismal prognosis among KT recipients. Maintaining a low clinical suspicion threshold is key to achieve a prompt diagnosis and to initiate voriconazole therapy.
Invasive pulmonary aspergillosis presents a high mortality rate in kidney transplant recipients, with diagnosis within the first 6 months posttransplantation and bilateral lung involvement as independent risk factors for mortality.
Risk factors for invasive pulmonary aspergillosis (IPA) after kidney transplantation have been poorly explored. We performed a multinational case–control study that included 51 kidney transplant (KT) ...recipients diagnosed with early (first 180 posttransplant days) IPA at 19 institutions between 2000 and 2013. Control recipients were matched (1:1 ratio) by center and date of transplantation. Overall mortality among cases was 60.8%, and 25.0% of living recipients experienced graft loss. Pretransplant diagnosis of chronic pulmonary obstructive disease (COPD; odds ratio OR: 9.96; 95% confidence interval CI: 1.09–90.58; p = 0.041) and delayed graft function (OR: 3.40; 95% CI: 1.08–10.73; p = 0.037) were identified as independent risk factors for IPA among those variables already available in the immediate peritransplant period. The development of bloodstream infection (OR: 18.76; 95% CI: 1.04–339.37; p = 0.047) and acute graft rejection (OR: 40.73, 95% CI: 3.63–456.98; p = 0.003) within the 3 mo prior to the diagnosis of IPA acted as risk factors during the subsequent period. In conclusion, pretransplant COPD, impaired graft function and the occurrence of serious posttransplant infections may be useful to identify KT recipients at the highest risk of early IPA. Future studies should explore the potential benefit of antimold prophylaxis in this group.
A multinational case‐control study in kidney transplant recipients finds that pretransplant diagnosis of chronic obstructive pulmonary disease, delayed graft function, bloodstream infection and acute graft rejection identify patients at the highest risk for early invasive pulmonary aspergillosis.
Disorder of consciousness (DOC) is a consequence of severe brain injuries. Diagnosis of DOC is very challenging because it requires the patient collaboration. Research in hemodynamic brain activity ...in resting state conditions suggests that healthy brain is organized into large-scale resting state networks (RSNs) of sensory/cognitive relevance. Recently, relationships among these RSNs have been explored as a possible biomarker of loss of consciousness. The RSN functional connectivity is computed as the temporal relationship between pairs of RSNs time-courses. It results in the so called functional network of brain connectivity (FNC). The properties of this network in the DOC conditions remains poorly understood. In this work, we investigated some local complex network properties of the brain FNC,, during altered states of consciousness. For this, we characterized a population of 49 DOC patients and 27 healthy controls. fMRI data was acquired and processed for each subject to built a FNC for each one. Network characterization was performed by computing the strength and the clustering coefficient measurements at individual level on the corresponding FNC. These nodal measurements allows to understand brain alterations of single RSN in the FNC. Our results show that strength and clustering variations may reflect brain network reconfiguration, and they may be associated to loss of consciousness states in patients with DOCs.
In early estrogen receptor (ER)-positive/HER2-negative breast cancer, the decision to administer chemotherapy is largely based on prognostic criteria. The combined molecular/clinical EndoPredict test ...(EPclin) has been validated to accurately assess prognosis in this population. In this study, the clinical relevance of EPclin in relation to well-established clinical guidelines is assessed.
We assigned risk groups to 1702 ER-positive/HER2-negative postmenopausal women from two large phase III trials treated only with endocrine therapy. Prognosis was assigned according to National Comprehensive Cancer Center Network-, German S3-, St Gallen guidelines and the EPclin. Prognostic groups were compared using the Kaplan–Meier survival analysis.
After 10 years, absolute risk reductions (ARR) between the high- and low-risk groups ranged from 6.9% to 11.2% if assigned according to guidelines. It was at 18.7% for EPclin. EPclin reassigned 58%–61% of women classified as high-/intermediate-risk (according to clinical guidelines) to low risk. Women reclassified to low risk showed a 5% rate of distant metastasis at 10 years.
The EPclin score is able to predict favorable prognosis in a majority of patients that clinical guidelines would assign to intermediate or high risk. EPclin may reduce the indications for chemotherapy in ER-positive postmenopausal women with a limited number of clinical risk factors.
RESUMO É comum que o estado laico seja definido em termos da ideia da razão pública. De acordo com John Rawls, um dos seus principais defensores, a razão pública não permite que as razões religiosas ...sejam utilizadas como a única fonte de justificação do uso do poder estatal. Com frequência, assume-se que a exclusão das razões religiosas do universo justificatório do poder estatal implica que a laicidade deve ser entendida como um arranjo institucional que exclui o conteúdo religioso das instituições do estado. Neste artigo, essa tese é revisada. Defende-se que o projeto pluralista do liberalismo político de Rawls implica em aceitar a possibilidade de arranjos institucionais da laicidade que não demandam esse tipo de exclusão. Portanto, o liberalismo político, incluindo a ideia da razão pública, é indeterminado em relação ao arranjo institucional de laicidade a ser implementado numa democracia constitucional. Fatores contextuais serão cruciais para determinar qual regime de laicidade adotar.
ABSTRACT It is common to define the secular state in terms of public reason. According to one of its leading proponents, John Rawls, public reason does not allow religious reasons to be used as the sole source of justification for using state power. It is often assumed that excluding religious reasons from the justificatory universe of state power implies that secularism should be understood as an institutional arrangement that excludes religious content from state institutions. This article reviews this thesis. It argues that the pluralist project of Rawls’ political liberalism implies accepting the possibility of institutional arrangements of secularism that do not call for this kind of exclusion. Thus, political liberalism, including the idea of public reason, is not specific regarding the institutional arrangement of secularism implemented in a constitutional democracy. Contextual factors will be crucial in determining which secularism regime to adopt.
RESUMEN Es común que el estado laico sea defendido en términos de la idea de la razón pública. De acuerdo con John Rawls, uno de los principales defensores de la razón pública en la teoría política normativa, las razones religiosas no pueden ser utilizadas como la única fuente de justificación del uso del poder estatal. Es frecuente que se asuma que la exclusión de las razones religiosas del universo de justificación del poder estatal implique que la laicidad debe ser entendida como un diseño institucional que excluye todo el contenido religioso de las instituciones del estado. En este artigo, esta tesis es revisada. Se defiende que el proyecto pluralista del liberalismo político de Rawls involucra que diseños institucionales de laicidad que no requieren ese tipo de exclusión sean aceptados. Por lo tanto, el liberalismo político, incluyendo la idea de la razón pública, es indeterminado con relación al tipo de diseño institucional que debe ser implementado en una democracia constitucional. Elementos contextuales serán cruciales para determinar cuál régimen de laicidad adoptar.
RÉSUMÉ Il est courant que l’État laïc soit défini en fonction de l’idée de raison publique. Selon John Rawls, l’un de ses principaux défenseurs, la raison publique ne permet pas que les raisons religieuses soient utilisées comme seule source de justification de l’utilisation du pouvoir de l’État. On suppose souvent que l’exclusion des raisons religieuses de l’univers justificatif du pouvoir de l’État implique que la laïcité doit être comprise comme un arrangement institutionnel qui exclut le contenu religieux des institutions de l’État. Dans cet article, cette thèse est passée en revue. On soutient que le projet pluraliste du libéralisme politique de Rawls implique d’accepter la possibilité d’arrangements institutionnels de la laïcité qui n’exigent pas ce type d’exclusion. Dès lors, le libéralisme politique, y compris l’idée de raison publique, est indéterminé par rapport à l’agencement institutionnel de la laïcité à mettre en œuvre dans une démocratie constitutionnelle. Les facteurs contextuels seront cruciaux pour déterminer le régime laïc à adopter.
ER+/HER2- breast cancers have a proclivity for late recurrence. A personalised estimate of relapse risk after 5 years of endocrine treatment can improve patient selection for extended hormonal ...therapy.
A total of 1702 postmenopausal ER+/HER2- breast cancer patients from two adjuvant phase III trials (ABCSG6, ABCSG8) treated with 5 years of endocrine therapy participated in this study. The multigene test EndoPredict (EP) and the EPclin score (which combines EP with tumour size and nodal status) were predefined in independent training cohorts. All patients were retrospectively assigned to risk categories based on gene expression and on clinical parameters. The primary end point was distant metastasis (DM). Kaplan-Meier method and Cox regression analysis were used in an early (0-5 years) and late time interval (>5 years post diagnosis).
EP is a significant, independent, prognostic parameter in the early and late time interval. The expression levels of proliferative and ER signalling genes contribute differentially to the underlying biology of early and late DM. The EPclin stratified 64% of patients at risk after 5 years into a low-risk subgroup with an absolute 1.8% of late DM at 10 years of follow-up.
The EP test provides additional prognostic information for the identification of early and late DM beyond what can be achieved by combining the commonly used clinical parameters. The EPclin reliably identified a subgroup of patients who have an excellent long-term prognosis after 5 years of endocrine therapy. The side effects of extended therapy should be weighed against this projected outcome.
Higher body mass index (BMI) appears paradoxically associated with better outcomes in patients with chronic kidney disease. Whereas higher BMI reflects both increased visceral and subcutaneous fat ...and/or muscle mass, a combined assessment of BMI and waist circumference may enable differentiation of visceral adiposity from muscle and/or nonvisceral fat mass. We examined the association of BMI and waist circumference with all‐cause mortality in a prospective cohort of 993 kidney transplant recipients. Associations were examined in Cox models with adjustment for demographic and comorbid conditions and for inflammatory markers. Unadjusted death hazard ratios (95%CI) associated with one standard deviation higher BMI and waist circumference were 0.94 (0.78, 1.13), p = 0.5 and 1.20 (1.00, 1.45), p = 0.05, respectively. Higher BMI was associated with lower mortality after adjustment for waist circumference (0.48 0.34, 0.69, p < 0.001), and higher waist circumference was more strongly associated with higher mortality after adjustment for BMI (2.18 1.55–3.08, p < 0.001). The associations of waist circumference with mortality remained significant after additional multivariable adjustments. Higher BMI and waist circumference display opposite associations with mortality in kidney transplant recipients. Waist circumference appears to be a better prognostic marker for obesity than BMI.
The authors examine the association of waist circumference and of body mass index (BMI) with all‐cause mortality in a large prospective cohort of kidney transplant recipients, and find that higher waist circumference is associated with higher mortality, while higher BMI is associated with lower mortality.
Two quite different disc contents are used for antimicrobial susceptibility testing of two fluoroquinolone drugs, flumequine and enrofloxacin, in the disc diffusion test, 30 and 5 µg, respectively. ...Using the SRA method, single‐strain regression analysis, we studied the impact of disc content when testing two relevant bacterial species, Aeromonas sobria and Vibrio anguillarum. There were no major differences between the antimicrobial regression lines for the two species. Wild‐type strains produced acceptable zones of inhibition over a wide range of disc contents. The flumequine 30 µg disc should be lowered in its drug content. No rational reasons for choosing so different disc contents for the two antimicrobials were apparent. At present, the choice of disc content for new antimicrobials are outside the realm of clinical microbiologists. It is recommended that reference authorities, such as EUCAST, CLSI and USCAST, are consulted for the choice of disc contents in the future.
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