Motor adaptations to unilateral quadriceps fatigue during a bilateral pedaling task.

This study was designed to investigate how motor coordination adapts to unilateral fatigue of the quadriceps during a constant-load bilateral pedaling task. We first hypothesized that this local fatigue would not be compensated within the fatigued muscles leading to a decreased knee extension power. Then, we aimed to determine whether this decrease would be compensated by between-joints compensations within the ipsilateral leg and/or an increased contribution of the contralateral leg. Fifteen healthy volunteers were tested during pedaling at 350 W before and after a fatigue protocol consisting of 15 minutes of electromyostimulation on the quadriceps muscle. Motor coordination was assessed from myoelectrical activity (22 muscles) and joint powers calculated through inverse dynamics. Maximal knee extension torque decreased by 28.3%±6.8% (P<.0005) immediately after electromyostimulation. A decreased knee extension power produced by the ipsilateral leg was observed during pedaling (-22.8±12.3 W, -17.0%±9.4%; P<.0005). To maintain the task goal, participants primarily increased the power produced by the non-fatigued contralateral leg during the flexion phase. This was achieved by an increase in hip flexion power confirmed by a higher activation of the tensor fascia latae. These results suggest no adjustment of neural drive to the fatigued muscles and demonstrate no concurrent ipsilateral compensation by the non-fatigued muscles involved in the extension pedaling phase. Although interindividual variability was observed, findings provide evidence that participants predominantly adapted by compensating with the contralateral leg during its flexion phase. Both neural (between legs) and mechanical (between pedals) couplings and the minimization of cost functions might explain these results.

Early Conversion to Prednisolone/Everolimus as an Alternative Weaning Regimen Associates With Beneficial Renal Transplant Histology and Function: The Randomized-Controlled MECANO Trial.

In renal transplantation, use of calcineurin inhibitors (CNIs) is associated with nephrotoxicity and immunosuppression with malignancies and infections. This trial aimed to minimize CNI exposure and total immunosuppression while maintaining efficacy. We performed a randomized controlled, open-label multicenter trial with early cyclosporine A (CsA) elimination. Patients started with basiliximab, prednisolone (P), mycophenolate sodium (MPS), and CsA. At 6 months, immunosuppression was tapered to P/CsA, P/MPS, or P/everolimus (EVL). Primary outcomes were renal fibrosis and inflammation. Secondary outcomes were estimated glomerular filtration rate (eGFR) and incidence of rejection at 24 months. The P/MPS arm was prematurely halted. The trial continued with P/CsA (N = 89) and P/EVL (N = 96). Interstitial fibrosis and inflammation were significantly decreased and the eGFR was significantly higher in the P/EVL arm. Cumulative rejection rates were 13% (P/EVL) and 19% (P/CsA), (p = 0.08). A post hoc analysis of HLA and donor-specific antibodies at 1 year after transplantation revealed no differences. An individualized immunosuppressive strategy of early CNI elimination to dual therapy with everolimus was associated with decreased allograft fibrosis, preserved allograft function, and good efficacy, but also with more serious adverse events and discontinuation. This can be a valuable alternative regimen in patients suffering from CNI toxicity.

Advantages and limitations of virtual reality for balance assessment and rehabilitation.

Virtual reality (VR) is now commonly used in many domains because of its ability to provide a standardized, reproducible and controllable environment. In balance assessment, it can be used to control stimuli presented to patients and thus accurately evaluate their progression or compare them to different populations in standardized situations. In balance rehabilitation, VR allows the creation of new generation tools and at the same time the means to assess the efficiency of each parameter of these tools in order to optimize them. Moreover, with the development of low-cost devices, this rehabilitation can be continued at home, making access to these tools much easier, in addition to their entertaining and thus motivating properties. Nevertheless, and even more with low-cost systems, VR has limits that can alter the results of the studies that use it: the latency of the system (the delay cumulated on each step of the process from data acquisition on the patients to multimodal outputs); and distance perception, which tends to be underestimated in VR. After having described why VR is an essential tool for balance assessment and rehabilitation and illustrated this statement with a case study, this review discusses the previous works in the domain with regards to the technological limits of VR.

[Use of BioRad plating agar MRSASelect for the daily detection of methicillin resistant staphylococci isolated from samples taken from blood culture bottles]. / Apport de l'utilisation de la gélose MRSASelect BioRad pour la détection de routine de la résistance à la méticilline des staphylocoques isolés de flacons d'hémoculture.

Within a medium size general biology laboratory, it is not always easy to set up rapid methods for detection of methicillin-resistant staphylococci (detection of the mecA gene or PLP2a). Since we already use BioRad chromogenic plating agar MRSASelect for the detection of carriers of methicillin resistant Staphylococcus aureus, we wanted to test its use on samples taken from blood culture bottles. Between December 2004 and October 2005, all the blood bottle cultures that detected positive by direct examination for Gram positive cocci and suspected to be staphylococci, that is 45 pairs of blood cultures and 3 joint aspirations, were inoculated on quarter plates of both MRSASelect and standard non-selective agar. After culture, they were screened by the disc method. No mismatch was observed between the cultures themselves or the highlighting of methicillin resistance in either Staphylococcus aureus isolates or for coagulase-negative staphylococci, regardless of species. Furthermore, the red colour of Staphylococcus aureus on the medium allowed visualisation of the colonies after only about ten hours incubation, thus giving the clinician rapid warning of suspected methicillin resistant Staphylococcus aureus. In addition, in polymicrobial cultures the different colour of the colonies of Staphylococcus aureus (red) and coagulase-negative staphylococci (white) is extremely useful.