The Art and Science of Immunosuppression: The Fifth Annual American Society of Transplant Surgeon's State-of-the-Art Winter Symposium

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72057/1/j.1600-6143.2005.01187.x.pd

Effects of high-intensity interval training and plyometric exercise on the physical fitness of junior male handball players

OBJECTIVE This study analyzed the effects of high intensity interval training (HIIT) combined with plyometric exercise on the physical fitness of junior male handball players. PATIENTS AND METHODS Subjects (age ~17 years) were randomly divided between experimental (n=17) and control (n=15) groups. During the 8-week intervention, the experimental group replaced a part of their regular regimen by HIIT, combined with plyometric exercise. Assessments in both groups before and after the intervention included: squat jump (SJ), countermovement jump (CMJ), sprint performance (5 m, 10 m, 20 m and 30 m), change of direction tests (Illinois modified test [Illinois-MT] and T-half test), 20-m shuttle run, and repeated sprint T-test. RESULTS The two-way analyses of variance revealed significant group-time interactions (all p<0.05), favoring the intervention group in 5 m, 10 m, 20 m and 30 m sprint (d=0.33, 8.3%; d=0.52, 7.6%; d=0.57, 6.8%; and d=0.58, 8.8%, respectively), T-half (d=0.25, 5.1%), Illinois-MT (d=0.47, 4.2%), SJ and CMJ (d=0.34-0.39, 34-4-34.9%), repeated sprint T-test best time, mean time and total time (d=0.83, 6.9%; d=0.62, 7.4%; and d=0.61, 7.2%, respectively), 20 meter shuttle run test aerobic maximum speed and predicted maximal oxygen intake (d=0.36, 7.5%; d=0.19, 9.4%, respectively). CONCLUSIONS HIIT combined with plyometrics can aid in the development of physical fitness abilities, which are extremely important to junior male handball players

Effects of High-Intensity Warm-Up on 5000-Meter Performance Time in Trained Long-Distance Runners

Warm-up protocols with high intensities before continuous running provide potential benefits for middle-distance runners. Nevertheless, the effect of high-intensity warm-ups on long-distance runners remains unclear. The purpose of this study was to verify the effect of a high-intensity warm-up protocol on 5000 m performance in trained runners. Thirteen male runners (34 ± 10 years, 62 ± 6 kg, 62.7 ± 5.5 ml/kg/min) performed two 5000 m time trials, preceded by two different warm-ups. One high-intensity warm up (HIWU: 1x 500 m (70% of the running intensity) + 3x 250 m (100% of the running intensity) and one low-intensity warm up (LIWU: 1x 500 m (70% of the running intensity) + 3x 250 m (70% of the running intensity)), where the running intensities were calculated using the results obtained in the Cooper test. Physiological and metabolic responses, and endurance running performance parameters, were evaluated by the Counter Movement Jump (CMJ), running rating of perceived exertion (RPE), blood lactate concentration (BLa), and performance running. Total time for the 5000 m was lower using HIWU when compared to LIWU (1141.4 ± 110.4 s vs. 1147.8 ± 111.0 s; p = 0.03; Hedges' g = 0.66). The HIWU warm-up led to an improvement in pacing strategy during the time trial. After warm-up protocols, the performance on the CMJ was improved only when applying HIWU (p = 0.008). Post warm-up BLa was significantly higher for HIWU vs. LIWU (3.5 ± 1.0 mmol·L-1 vs. 2.3 ± 1.0 mmol·L-1; p = 0.02), with similar behavior for the RPE (p = 0.002), internal load of the session (p = 0.03). The study showed that a high-intensity warm-up protocol can improve performance in the 5000 m in trained endurance runners

The Performance, Physiology and Morphology of Female and Male Olympic-Distance Triathletes

Sex differences in triathlon performance have been decreasing in recent decades and little information is available to explain it. Thirty-nine male and eighteen female amateur triathletes were evaluated for fat mass, lean mass, maximal oxygen uptake (VO2 max), ventilatory threshold (VT), respiratory compensation point (RCP), and performance in a national Olympic triathlon race. Female athletes presented higher fat mass (p = 0.02, d = 0.84, power = 0.78) and lower lean mass (p &lt; 0.01, d = 3.11, power = 0.99). VO2 max (p &lt; 0.01, d = 1.46, power = 0.99), maximal aerobic velocity (MAV) (p &lt; 0.01, d = 2.05, power = 0.99), velocities in VT (p &lt; 0.01, d = 1.26, power = 0.97), and RCP (p &lt; 0.01, d = 1.53, power = 0.99) were significantly worse in the female group. VT (%VO2 max) (p = 0.012, d = 0.73, power = 0.58) and RCP (%VO2 max) (p = 0.005, d = 0.85, power = 0.89) were higher in the female group. Female athletes presented lower VO2 max value, lower lean mass, and higher fat mass. However, females presented higher values of aerobic endurance (%VO2 max), which can attenuate sex differences in triathlon performance. Coaches and athletes should consider that female athletes can maintain a higher percentage of MAV values than males during the running split to prescribe individual training. Keywords: VO2 max; female athlete; sports medicine; sports physiology; triathlo

The aspects of sex, age and nationality in winter swimming performance

OBJECTIVE Winter swimming is a new sport discipline. Very little is known, however, about the sex differences, origin, participation and performance of the world's best winter swimmers. Therefore, the study aimed to investigate sex differences in performance and age. Furthermore, it should be determined which country has the fastest swimmers, the highest numbers of participants and the most successful age group athletes in winter swimming. SUBJECTS AND METHODS A total of 6,477 results from the 25 m events of the IWSA (International Winter Swimming Association) World Cups from 2016-2020 was collected from the official website of IWSA. Data were analyzed using a generalized linear model (GLM) with a gamma probability distribution and identity link function. The 25 m events were carried out in head-up breaststroke style, freestyle and butterfly. The nationalities were grouped into six groups, the five nationalities with the highest number of participants in the 25 m competitions and one group with the other nationalities. The mean time of 25 m races by sex and country of the total sample was compared. For the top 10 comparisons, the best ten athletes from the six groups were selected. The mean time of each top 10 groups was compared by sex and nationality. RESULTS Men were faster than women for all categories. Swimmers in age group 15-29 years were the fastest, where females were the fastest in age group 15-19 years and males in age group 20-29 years. Women from both Russia and Estonia and men from both Russia and China were the fastest. Both Russian and Chinese males were the fastest in all water categories in the top 10 section in the 25 m events. CONCLUSIONS In summary, males were faster than females in the IWSA World Cups between 2016 and 2020. The age group of 15-29 years old athletes was the most successful while females had their age of peak performance earlier than males. Russian and Estonian males and Russian females were the overall fastest in the 25 m events in all water categories. Future studies should investigate the optimal anthropometric characteristics of male and female winter swimming sprint athletes and whether there are distinct areas in Russia, Estonia and China, where many international winter swimming athletes originate

Kidney after nonrenal transplantation-the impact of alemtuzumab induction

BACKGROUND.: Calcineurin inhibitor nephrotoxicity in nonrenal allograft recipients can lead to end-stage renal disease and the need for kidney transplantation. We sought to evaluate the role of alemtuzumab induction in this population. PATIENTS AND METHODS.: We evaluated 144 patients undergoing kidney transplantation after nonrenal transplantation between May 18, 1998, and October 8, 2007. Seventy-two patients transplanted between January 15, 2003, and October 8, 2007, received alemtuzumab induction and continued their pretransplant immunosuppression. Seventy-two patients transplanted between May 18, 1998, and July 21, 2007, did not receive alemtuzumab induction, but received additional steroids and maintenance immunosuppression. Donor and recipient demographics were comparable. RESULTS.: Overall, 1-and 3-year patient survival and renal function were comparable between the two groups. One-and 3-year graft survival was 93.0% and 75.3% in the alemtuzumab group and 83.3% and 68.7% in the no alemtuzumab group, respectively (P=0.051). The incidence of acute rejection was lower in the alemtuzumab group, 15.3%, than in the no alemtuzumab group, 41.7% (P=0.0001). The incidence of delayed graft function was lower in the alemtuzumab group, 9.7%, than in the no alemtuzumab group, 25.0% (P=0.003). The incidence of viral complications was comparable. CONCLUSION.: Alemtuzumab induction with simple resumption of baseline immunosuppression in patients undergoing kidney transplantation after nonrenal transplantation represents a reasonable immunosuppressive strategy. Copyright © 2009 by Lippincott Williams & Wilkins

Return to classes impact on mental health of university students during the COVID-19 pandemic

BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic and the necessary social isolation and distancing measures - that were adopted to prevent spreading the virus, including the suspension of university classes - negatively impacted the mental health of young adults. The aim of the current study was to investigate whether returning to online classes, even not presential, during the social isolation of the COVID-19 pandemic, affected the mental health of university students. METHODS Forty students (10 men and 30 women) (age, 22.3±3.8 years; body mass, 62.5±17.8 kg; height, 165.6±8.7cm) from undergraduate health courses participated in the study. The students answered a self-administered questionnaire designed to gather personal and quarantine information as well as information about the frequency of depression (PHQ-9) and anxiety (GAD-7) symptoms. The questionnaire was answered before and after the return to online classes. RESULTS There was a significantly lower frequency of depression symptoms after the return to online classes (Z = -2.27; p = 0.02). However, there was no difference in anxiety symptoms before and after returning to online classes (Z = -0.51; p = 0.61). CONCLUSIONS Return to online classes positively impacted the mental health (decrease of frequency of depression symptoms) of university students. Future studies are needed to observe whether the changes observed after returning to school are maintained over time

Comparison of the levels of depression and anxiety during the first and fourth waves of coronavirus disease-2019 pandemic in Brazil

OBJECTIVE To compare the levels of depression, anxiety, physical activity, and mobility restrictions between the first wave in June 2020 and the fourth wave in January 2022 of the coronavirus disease-2019 (COVID-19) pandemic in Brazil. PATIENTS AND METHODS Brazilian citizens answered a self-administered questionnaire that included questions related to personal information, mobility restriction levels, physical activity levels, and the status of mood disorders in June 2020 (n=1853) and January 2022 (n=728). RESULTS The levels of mobility restrictions (p<0.001), anxiety (p<0.001), and depression (p<0.001) significantly decreased from 2020 to 2022. In June 2020, 23.2% of the participants presented moderate to severe anxiety, and in January 2022, this percentage decreased to 14.8%. In June 2020, 29.6% of the participants presented moderate to severe depressive symptoms, and in January 2022 this percentage decreased to 19.3%. On the contrary, physical activity levels significantly increased between 2020 and 2022 (p<0.001). CONCLUSIONS During the fourth wave of the COVID-19 pandemic, participants were less restricted and more physically active than in the first wave. Furthermore, anxiety and depression levels were significantly lower in the fourth wave than in the first wave. Despite this reduction, levels of anxiety and depression remain high; therefore, the authors suggest measures to encourage physical activity and promote mental health

IL-21 Biased Alemtuzumab Induced Chronic Antibody-Mediated Rejection Is Reversed by LFA-1 Costimulation Blockade

Despite its excellent efficacy in controlling T cell mediated acute rejection, lymphocyte depletion may promote a humoral response. While T cell repopulation after depletion has been evaluated in many aspects, the B cell response has not been fully elucidated. We tested the hypothesis that the mechanisms also involve skewed T helper phenotype after lymphocytic depletion. Post-transplant immune response was measured from alemtuzumab treated hCD52Tg cardiac allograft recipients with or without anti-LFA-1 mAb. Alemtuzumab induction promoted serum DSA, allo-B cells, and CAV in humanized CD52 transgenic (hCD52Tg) mice after heterotopic heart transplantation. Additional anti-LFA-1 mAb treatment resulted in reduced DSA (Fold increase 4.75 ± 6.9 vs. 0.7 ± 0.5; p &lt; 0.01), allo-specific B cells (0.07 ± 0.06 vs. 0.006 ± 0.002 %; p &lt; 0.01), neo-intimal hyperplasia (56 ± 14% vs. 23 ± 13%; p &lt; 0.05), arterial disease (77.8 ± 14.2 vs. 25.8 ± 20.1%; p &lt; 0.05), and fibrosis (15 ± 23.3 vs. 4.3 ± 1.65%; p &lt; 0.05) in this alemtuzumab-induced chronic antibody-mediated rejection (CAMR) model. Surprisingly, elevated serum IL-21 levels in alemtuzumab-treated mice was reduced with LFA-1 blockade. In accordance with the increased serum IL-21 level, alemtuzumab treated mice showed hyperplastic germinal center (GC) development, while the supplemental anti-LFA-1 mAb significantly reduced the GC frequency and size. We report that the incomplete T cell depletion inside of the GC leads to a systemic IL-21 dominant milieu with hyperplastic GC formation and CAMR. Conventional immunosuppression, such as tacrolimus and rapamycin, failed to reverse AMR, while co-stimulation blockade with LFA-1 corrected the GC hyperplastic response. The identification of IL-21 driven chronic AMR elucidates a novel mechanism that suggests a therapeutic approach with cytolytic induction