Inclusion of CYP3A5 genotyping in a nonparametric population model improves dosing of tacrolimus early after transplantation

Following organ engraftment, initial dosing of tacrolimus is based on recipient weight and adjusted by measured C₀ concentrations. The bioavailability and elimination of tacrolimus are affected by the patients CYP3A5 genotype. Prospective data of the clinical advantage of knowing patient's CYP3A5 genotype prior to transplantation are lacking. A nonparametric population model was developed for tacrolimus in renal transplant recipients. Data from 99 patients were used for model development and validation. A three‐compartment model with first‐order absorption and lag time from the dosing compartment described the data well. Clearances and volumes of distribution were allometrically scaled to body size. The final model included fat‐free mass, body mass index, hematocrit, time after transplantation, and CYP3A5 genotype as covariates. The bias and imprecision were 0.35 and 1.38, respectively, in the external data set. Patients with functional CYP3A5 had 26% higher clearance and 37% lower bioavailability. Knowledge of CYP3A5 genotype provided an initial advantage, but only until 3‐4 tacrolimus concentrations were known. After this, a model without CYP3A5 genotype predicted just as well. The present models seem applicable for clinical individual dose predictions but need a prospective evaluation.     

European Species of Hebeloma Section Theobromina

This paper addresses section Theobromina within the genus Hebeloma (Agaricales). We recognise seven European species within this section, three of which are described as new: Hebeloma alboerumpens, H. griseopruinatum and H. parvicystidiatum. The first two of these species appear to be ectomycorrhizal with Cistaceae: Cistus and Helianthemum. Hebeloma parvicystidiatum is more likely to be in mycorrhizal association with Quercus spp. We also provide a key to the European species within sect. Theobromina and an updated key of known Hebeloma associates of Cistus. Molecular analyses based on multiple loci further illustrate the distinctness of the newly described taxa and provide molecular evidence, supporting the morphological evidence, for the relationship that exists among species of this section. The ITS is the only one from the sequenced loci that, alongside with morphology, distinguishes among all of the species of sect. Theobromina. The section gains most of its molecular support from the MCM7 locus, followed by RPB2.     

Stability and Change of Psychopathology Symptoms Throughout Childhood and Adolescence

Child Psychiatry & Human Development - Assessing stability and change of children’s psychopathology symptoms can help elucidate whether specific behaviors are transient developmental...     

12 weeks of Brazilian jiu-jitsu training improves functional fitness in elderly men

Worldwide, there are up to 900 million people over 60 years old, of which more than half are physically inactive. Low physical fitness seems to be the major risk factor for cardiovascular diseases and mortality in this population. Alternative methods of exercise, such as martial arts, may be an option to improve physical fitness in the elderly. This study aimed to verify the effects of Brazilian jiu-jitsu (BJJ) training on the functional fitness of elderly men. Sixty-two elderly men were divided in two groups (experimental and control). The experimental group was submitted to a 12-week intervention of BJJ (2 times week^?1; 90-min session^?1). Physical fitness tests and anthropometric measurements were performed before and after intervention in both groups. No statistical differences were found between groups before and after the intervention. The experimental group improved in all performed physical fitness tests. Effect size showed that intervention had a small effect on upper body flexibility; a moderate effect for upper body strength, lower body flexibility, and motor agility/dynamic balance; and a large effect on lower body strength and aerobic endurance. BJJ seems to improve functional fitness in elderly men and may be an alternative method to enhance this population’s health and quality of life.     

Eight weeks of <Emphasis Type="Italic">Capoeira</Emphasis> progressive training program increases flexibility of beginners

Background

No study has investigated the alterations in the flexibility of beginners using an experimental protocol with basic techniques of Capoeira.

Purpose

To analyze the effects of 8 weeks of Capoeira progressive training program on the flexibility of beginners.

Methods

Twenty-one individuals divided in two groups (Capoeira: n = 13; 26.1 ± 7.2 years; 22.7 ± 2.7 kg m^2(?1) and control: n = 08; 27.1 ± 0.5 years; 24.3 ± 3.3 kg m^2(?1)) participated in the study. The Capoeira group performed 8 weeks of Capoeira progressive training program (two sessions per week lasting 60 min each). The experimental protocol used was exclusively based on the basic techniques of a programmed Capoeira training system. Before and after the intervention, measurements were performed aiming to analyze (1) trunk flexion flexibility through a sit-and-reach test using a Wells’ Bench (WB_tf), (2) passive tension (PT_hf), and (3) maximum amplitude of hip flexion (MA_hf) through goniometry.

Results

A two-way ANOVA revealed a main effect of group by time interaction to PT_hf (F = 11.797; P = 0.003; η _p ²  = 0.383) and MA_hf (F = 9.650; P = 0.006; η _p ²  = 0.337). No significant main effect of group by time interaction occurred to WB_tf (F = 3.320; P = 0.084; η _p ²  = 0.149). The relative changes (? %) before and after the intervention in both groups showed that the Capoeira group significantly differed to the control group in the PT_hf (Capoeira: 46.2 ± 29.9 % vs. control: 5.7 ± 27.6 %; P = 0.003) and MA_hf (Capoeira: 22.4 ± 24.5 % vs. control: ?6.1 ± 13.1 %; P = 0.006).

Conclusion

Eight weeks of Capoeira progressive training program resulted in a significant improvement in angular flexibility for beginners.

     

Surgical anterior cavoplasty for managing a case of early acute outflow obstruction after liver transplantation

HVOO following liver transplantation is rarely treated surgically because it tends to debut subacutely. However, acute HVOO is a surgical emergency that compromises the viability of the graft. We report a case of HVOO diagnosed intra‐operatively during surgical revision for a suspected arterial thrombosis in a 10‐month‐old male recipient of a second graft (segments II–III) for familial intrahepatic cholestasis. HVOO was related to a stenosis at the first transplant hepato‐caval anastomosis, left in place to obtain longer venous cuffs for retransplantation. An anterior cavoplasty was necessary to resolve the issue. The new anastomosis was created under total vascular exclusion after gaining control of the supradiaphragmatic vena cava, because the inferior vena cava was unsuitable for further surgery. This approach (normally used as a means to avoid sternotomy in patients with hepatic or renal tumours associated with venous thrombosis) allows adequate vascular control and, in selected cases, offers a surgical alternative for treating HVOO.     

Asymptomatic circulation of HEV71 in Norway

Widespread circulation of human enterovirus 71 was discovered in a prospective study of fecal samples obtained from healthy Norwegian children. Molecular characterization of the virus determined that it belonged to genotype C1. Complete sequencing of this strain, HEV71 804/NO/03, revealed differences in the 5'UTR and polymerase with respect to more pathogenic genotypes that may explain its reduced neurovirulence.     

Bone defect formation during implant placement following alveolar distraction

PURPOSE: This retrospective study was designed to evaluate the volume of hard tissue generated at the time of implant placement in distracted alveolar bone. MATERIALS AND METHODS: All patients who underwent distraction osteogenesis between 2000 and 2003 were included. The preoperative bone height, amount of distraction performed, and presence or absence of complications affecting implant placement were recorded. The augmentation achieved was correlated with insufficient bone formation using the Spearman correlation and the Fisher exact test. RESULTS: The study included 43 implants placed in 17 cases of alveolar distraction. Of the 34 implants placed in bone augmented by 4.5 to 6.5 mm, bone defects were observed with 12. All 9 implants placed in ridges augmented by 7 to 10.5 mm demonstrated a bone defect. The "defect" and "no-defect" implant groups differed significantly with respect to preoperative bone height and amount of distraction performed (P < .001 for both). Significantly more defects were formed in bone augmented by > 25% compared to bone augmented by < 25% (P < .001). CONCLUSIONS: When considering distraction osteogenesis, augmentation of up to 25% of the initial bone height seems more predictable and less likely to be associated with complications at the time of implant placement. In distractions greater than 25% of the original height, additional treatment should be considered.