The influence of the perceived requirements of the next match and motivation on the mental fatigue of soccer players.

The high cognitive and/or emotional demands of competition can lead to a state of mental fatigue which has shown to be detrimental to soccer performance. However, there is a need to further understand the true mental demands of soccer players. The aim of the present study was to analyze the influence of motivation and the perceived requirements of the next match on mental fatigue perceived by soccer players over the passing of a season. The combined effect of both variables on the perception of mental fatigue, as well as the influence of the time of the season on perceived mental fatigue, were also analyzed. Twenty-six semi-professional Spanish male players (M = 26.31 ± 5.18 years) participated in the present study, conducted during the 2020-2021 season. Perceived mental fatigue and motivation were measured at each training session. The perceived requirements of the next match were also measured in each of the competitive weeks. Linear mixed models were run with R Studio to examine the influence of motivation and the perceived difficulty of the next match on perceived mental fatigue, the combined effect of both variables on perceived mental fatigue, and the influence of the passing of the season on perceived mental fatigue. The results showed a negative and significant influence of motivation on perceived mental fatigue (p < 0.001) and a positive and significant influence of the perceived requirements of the next match on perceived mental fatigue (p < 0.001). Regarding the combined effect, there was a positive and significant effect (p < 0.01) of the perceived difficulty of the next match on the relation between motivation and perceived mental fatigue. A negative influence of season passage on perceived mental fatigue levels was found (p < 0.001). We recommended coaches to consider using the most motivating training tasks when higher next-match requirements are perceived and to be careful with avoidance strategies for mental fatigue, especially at the beginning of the season.

Enterovirus infection and type 1 diabetes: unraveling the crime scene.

Enteroviruses (EV) have been historically associated to type 1 diabetes. Definitive proof for their implication in disease development is lacking, but growing evidence suggests that they could be involved in beta cell destruction either directly by killing beta cells or indirectly by creating an exacerbated inflammatory response in the islets, capable of attracting autoreactive T cells to the 'scene of the crime'. Epidemiological and serological studies have been associated with the appearance of islet autoimmunity and EV RNA has been detected in prospective studies. In addition, the EV capsid protein has been detected in the islets of recent-onset type 1 diabetic donors, suggesting the existence of a low-grade EV infection that could become persistent. Increasing evidence in the field shows that a 'viral signature' exists in type 1 diabetes and involves interferon responses that could be sustained during prolonged periods. These include the up-regulation of markers such as protein kinase R (PKR), melanoma differentiation-associated protein 5 (MDA5), retinoic acid inducible gene I (RIG-I), myxovirus resistance protein (MxA) and human leukocyte antigen-I (HLA-I) and the release of chemokines able to attract immune cells to the islets leading to insulitis. In this scenario, the hyperexpression of HLA-I molecules would promote antigen presentation to autoreactive T cells, favoring beta cell recognition and, ultimately, destruction. In this review, an overview is provided of the standing evidence that implicates EVs in beta cell 'murder', the time-line of events is investigated from EV entry in the cell to beta cell death and possible accomplices are highlighted that might be involved in beta cell demise.

How Does Ball Possession Affect the Physical Demands in Spanish LaLiga? A Multilevel Approach.

Purpose: Using a multilevel approach, this study analyzed the relationship between ball possession and distance covered at different speed sections: total distance (TD), distance covered between 14.1-21 km·h-1 (MIRD), 21.1-24 km·h-1 (HIRD), and > 24.1 km·h-1 (VHIRD). Methods: The sample included 1,520 matches played by 80 Spanish professional soccer teams across four consecutive LaLiga seasons (from 2015/2016 to 2018/2019). Two observations were collected per match, one from each team, resulting in a total of 2,950 records (760 per season). Data were collected using Mediacoach®. Results: At match level (i.e., grand-mean centered), ball possession negatively predicted all distances covered. At team level (i.e., group-mean centered), ball possession negatively predicted total distance covered and distance covered between 14.1-21 km·h-1. Furthermore, cross-level interactions (Match X Team) in ball possession negatively predicted all distances covered at speeds above 14.1 km·h-1. Specifically, in high-possession teams, the negative relationship between match ball possession and distances traveled at all speed ranges above 14.1 km·h-1 was stronger than in teams with medium or low possession. Conversely, match ball possession was positively related todistance covered at low intensities, and negatively related at high intensities in low-possession teams. Conclusion: These findings show practitioners and researchers that the distances covered at different speed ranges depend on technical-tactical parameters such as ball possession.

The relationship between running distance and coaches' perception of team performance in professional soccer player during multiple seasons.

This study analyzed how the physical movement profile of soccer matches evolved throughout a season by assessing the variability of different metrics depending on the season phase. In addition, the evolution of running distances was investigated in the relation to the team performance based on the coaches' perception. Games from four consecutives Spanish LaLiga seasons (n = 1520) were recorded using an optical tracking system (i.e., ChyronHego). Total distance (TD), distance covered between 14 and 21 km h-1 (MIRD), 21-24 km h-1 (HIRD), and > 24 km h-1 (VHIRD) were analyzed, as well as the number of efforts between 21 and 24 km h-1 (Sp21) and > 24 km h-1 (Sp24). Seasons were divided into four phases (P): P1 (matches 1-10), P2 (11-19), P3 (20-29), and P4 (30-38). Linear mixed models revealed that soccer players covered significantly greater distances and completed a higher number of sprints in P2 and P3. Also, team performance evaluated by soccer coaches was positively related to TD, HIRD, VHIRD and Sp21 in P1. A negative relationship was observed between team performance and distance covered at speeds below 21 km h-1 in P2 and P3. Team performance was negatively related to TD, MIRD, and HIRD, and Sp21 in P4. As conclusion, the team performance perceived by coaches is related to the movement profile throughout a season, and it significantly influences the evolution of soccer players' movement profiles. Specifically, it seems that the players of the best teams have the best physical performance at the beginning of the season with respect to the rest of the phases.

The phenomenon of physical aggression against health service personnel: different perspectives.

The doctor-patient relationship has undergone important changes in recent years. Increasing levels of distrust, on the part of patients towards professionals and institutions, have led to an increase of conflicts resulting in violent actions against health service personnel. The aim of this study is to analyse this phenomenon in the public welfare services of the Region of Murcia (Spain), based on an analysis of accusations, as were presented by doctors in courts in the period between 2006 and April 2008. The conclusion reached can presumably be extrapolated to the rest of Spain. The violent reactions in question resulted from patients demanding drug prescriptions; the prolongation of sick leave and the demand for diagnostic tests. The Public Health Services provide directives to anticipate and avoid such situations, emphasize the training of professionals in communication skills, the promotion of skills of negotiation and emotional self-control. Other measures include the installation of alarms, intercoms and video cameras, contracting security companies, collaboration with the police and posters in health facilities warning that legal action will be taken. Nevertheless, given the obvious inadequacy of the above-mentioned measures, Plans of Prevention have been put in place. In addition legal defence has been granted to all such professionals. From the judicial point of view, these aggressions are judged as minor crimes of injury, insult and threat. The most recent view taken on such conduct is to consider it as a crime of attempt or offence against the authority, which has been confirmed in law by the recent judgment passed down by the Spanish High Court on 4th December, 2007.

Athletes' perceptions of coaching competency and team conflict in sport teams: A multilevel analysis.

The purpose of this study was to examine the relationship between coaching competency and team conflict, at individual and team levels, over the season. The participants were professional female and male soccer players, who participated in the First and Second Division. A longitudinal study was performed. At Time 1, the sample of participants consisted of 581 soccer players aged between 15 and 39 years. At Time 2, 549 players were recruited from the original sample aged between 15 and 37 years. Finally, at Time 3, the sample comprised 576 players aged between 15 and 37 years. All participants completed a multi-section questionnaire assessing coaching competency (motivation, game strategy, technique competency, and character-building competency) and team conflict (task conflict and relationship conflict). Results showed that both task and relationship conflict increased significantly over time. Multilevel modelling analysis showed that game strategy and character-building competencies negatively predicted both task and relationship conflicts at the individual level, whereas motivation competency was also added as a significant predictor of task conflict at the team level. Moreover, technique competency positively predicted task conflict at the team level. The current study suggests the importance of coaching competency in group dynamics in sport.

[Treatment of accidental dural puncture during obstetric epidural analgesia]. / Tratamiento de la punción dural accidental en la analgesia epidural del trabajo de parto.

OBJECTIVE: To assess the effectiveness of continuous intrathecal analgesia as prophylaxis for postdural puncture headache (PDPH) and for analgesia during labor in 12 patients who suffered accidental dural puncture. PATIENTS AND METHODS: A total of 920 patients who received spinal analgesia during labor were enrolled. Group A (no accidental dural puncture) received a single dose of 10 mL of 0.2% ropivacaine, and 5 minutes later continuous epidural infusion of 0.125% ropivacaine and 3 micromg mL(-1) was started at a rate of a 5 mL h(-1); a 5 mL bolus dose was allowed every 20 minutes if needed. In patients who suffered accidental dural puncture (Group B) we inserted an intrathecal catheter to administer an initial dose of 3 mL of 0.2% ropivacaine and the same analgesic mixture at the same dose as was administered in Group A. Patient characteristics, analgesic efficacy, duration of labor and delivery, motor blockade, analgesic volume, and incidence of PDPH were recorded. The Student t test was used for statistical comparisons. RESULTS: No significant differences in duration of labor and delivery, analgesic efficacy, or motor blockade were observed. The incidence of PDPH was 16.6% in Group B and 0.33% in Group A. The patients in Group B required more additional bolus doses: 10 (SD, 2) in Group B and 3 (1.25) in Group A (P<0.01). CONCLUSIONS: Continuous intrathecal analgesia after accidental dural puncture was a safe way to provide analgesia during labor and to reduce the expected incidence of PDPH.

Asthma control and exacerbations in patients with severe asthma treated with omalizumab in Portugal.

The analysis of outcomes from patients with severe asthma treated with omalizumab, using real-life prospective data, should contribute to future informed decisions about this treatment in Portugal. The aim of this study was to assess the clinical effect of omalizumab in Portuguese patients with severe persistent allergic asthma, considering specifically asthma control and exacerbations. This was an observational, prospective, multicentre study. Data were collected at routine care over a 12-month period. Disease control was defined by Control of Allergic Rhinitis and Asthma Test (CARAT) global score >24. All asthma patients already under treatment with omalizumab in 7 departments from 6 Portuguese hospitals were included (n=48). Most (77%) patients were female and the mean (SD) age was 51.9 (10.2) years old. During the study period, asthma was controlled in 34% of the visits and the 12-month exacerbation rate was 1.7 per patient (0.6 with unscheduled medical care). One-third of the patients needed unscheduled medical care because of asthma and 29% had to start or increase oral corticosteroid. There was still a 41% reduction in the total sum of oral corticosteroids usage from the first to the last trimester of the study. During routine treatment with omalizumab, Portuguese patients with severe asthma achieved asthma control in 1/3 of the visits and only 1/3 needed unscheduled or Emergency Room care because of asthma exacerbations. These outcomes support the maintenance of the clinical effect during treatment with omalizumab in routine care in Portugal.

Q fever mimicking herpetic encephalitis.

We describe a patient with temporal lobe encephalitis associated with primary Coxiella burnetii infection who presented with CT and MRI findings suggestive of herpes simplex encephalitis and an initial improvement during treatment with acyclovir. Q fever should be considered in the differential diagnosis of patients whose manifestations suggest herpes encephalitis.

Homozygous and heterozygous gly-188-Arg mutation of the rhodopsin gene in a family with autosomal dominant retinitis pigmentosa.

Autosomal dominant retinitis pigmentosa (adRP) may be caused by point mutations in the rhodopsin gene in up to 20% of Spanish families. Most of the rhodopsin mutations causing adRP have been reported in the heterozygous state. We describe a patient with adRP who is homozygous for a missense mutation at codon 188 in the second intradiscal domain of rhodopsin. All her sons are heterozygous for the mutation and show an RP phenotype suggesting complete penetrance for this mutation. The homozygous carrier of the mutation Gly-188-Arg in the rhodopsin gene showed a later subjective onset of symptoms than the heterozygotes, suggesting that the photoreceptor degeneration induced by the mutation is not dramatically influenced by mutant allele dosage.

Selection of European Union standard reference sera for use in the serological diagnosis of infectious bovine rhinotracheitis.

A study, consisting of three trials, was undertaken in order to find standard reference sera for use in serological diagnostic procedures for infectious bovine rhinotracheitis (IBR) in the European Union (EU). A total of forty-nine laboratories participated in the trials, in which panels of positive, weak positive, and negative candidate sera were tested blind by neutralisation, indirect and blocking enzyme-linked immunosorbent assay, indirect immunofluorescence and passive haemagglutination. A serum which scored positive in all tests in all laboratories was selected as a strong positive standard serum. The chosen negative standard serum gave negative results in virtually all tests. A 1/36 dilution of a positive serum was chosen as the weak positive standard serum and only very sensitive techniques were able to score it positive. Three EU reference sera are now available for the standardisation of serological tests for IBR.

PfGBP: una proteína de unión al telómero de Plasmodium falciparum / PfGBP: A Plasmodium falciparum telomere binding protein / PfGBP: uma proteína de ligação o telômero em Plasmodium falciparum

Los telómeros son estructuras complejas de ADN y proteína localizadas en el extremo de los cromosomas eucariotes. Su principal función es proteger el extremo cromosomal de ser reconocido y procesado como ADNs fracturado, evitando así eventos de recombinación y fusión que conducen a inestabilidad cromosomal. El ADN telomérico consta de secuencias cortas, repetidas una tras otra, ricas en guanina; la cadena rica en guanina se extiende formando una región de cadena sencilla denominada extremo 3' protuberante. Las proteínas por su parte, se pueden clasificar en: dsBPs, o proteínas de unión a la cadena doble, GBPs aquellas que reconocen específicamente el extremo protuberante y, proteínas que las interconectan mediante interacciones proteína-proteína. El gen PF3D7_1006800 de Plasmodium falciparum codifica para una proteína putativa similar a una GBP de Criptosporidium parvum, con el fin de establecer si esta proteína de P. falciparum presenta la capacidad de unión al ADN telomérico del parásito, se produjo una proteína recombinante a partir de la región codificante del gen, se purificó y se utilizó en ensayos de unión a ADN, y en la generación de anticuerpos policlonales específicos contra PfGBP. Nuestros resultados indican que la proteína de P. falciparum es una proteína nuclear con capacidad de unión al ADN telomérico in vitro, por lo que podría ser parte del complejo proteico encargado de proteger y/o mantener el telómero in vivo.

Telomeres are specialized structures at the end of chromosomes that consist of repetitive DNA sequences and associated proteins. The primary role of telomeres is to protect the end of linear chromosomes from recombination, fusion, and recognition as broken DNA ends. This protective function can be achieved through association with specific telomere binding proteins. Telomeric DNA consists of G-rich double-stranded arrays followed by a single-stranded G-rich overhang. The telomeric proteins can be classified in dsBPs, which bind double-stranded DNA, GBPs those that bind specifically to G-rich overhang, and proteins that interact with telomeric factors. Plasmodium falciparum gene PF3D7_1006800 codifies for a protein highly similar to Cryptosporidium parvum GBP. In order to investigate whether the P. falciparum protein binds telomeric DNA, a recombinant protein was produced, purified and DNA binding assays were performed. Polyclonal antibodies against rPfGBP were produced and tested in western blot. Our results indicate that PfGBP is a nuclear protein that binds telomeric DNA in vitro, which could be part of the protein complex responsible for protecting and/or maintaining the telomere in vivo.

Os telómeros são estruturas complexas de DNA e proteína localizadas no extremo dos cromossomas dos eucariotas. Sua principal função é proteger o extremo dos cromossomas para que não sejam reconhecidos e processados como DNAs fraturados. O anterior evita eventos de recombinação e fusão que conduzem à instabilidade nos cromossomas. O DNA telomérico tem sequencias curtas e repetidas, ricas em guanina. A cadeia rica em guanina estende-se para formar uma região de cadeia simples chamada extremo 3' protuberante. As proteínas podem-se classificar em: dsBPs ou proteínas de união à cadeia dupla, GBPs que são as que reconhecem especificamente o extremo protuberante e, as proteínas que interligam mediante interações proteína-proteína. O gene PF3D7_1006800 de Plasmodium falciparum codifica para uma proteína similar a uma GBP de Criptosporidium parvum. Com o objetivo de estabelecer se a proteína de P. falciparum presenta a capacidade de união ao DNA telomérico, foi produzida uma proteína recombinante partindo da região codificante do gene, purificou-se e utilizou-se nos ensaios de união ao DNA e na geração de anticorpos policlonais específicos contra PfGBP. Os nossos resultados indicam que a proteína de P. falciparum é uma proteína nuclear com capacidade de união ao DNA telomérico in vitro, pelo que poderia fazer parte do complexo proteico encarregado de proteger e/ou manter o telómero in vivo.

Brazilian medicinal plant acts on prostaglandin level and Helicobacter pylori.

Among the current treatment strategies for the peptic ulcer patient with Helicobacter pylori infection, the method of choice is triple therapy based on the concurrent use of proton inhibitors and two antibiotics. Alchornea triplinervia is a medicinal plant commonly used by people living in the Cerrado region of Brazil to treat gastrointestinal ulcers. In the present work we proposed therapy based on this medicinal plant that presents effective gastroprotective action with antibiotic effects. Oral pretreatment with methanolic extract (ME) of A. triplinervia in rats and mice decreased the gastric injuries induced by ethanol and HCl/ethanol. Increasing the dose reduced the gastroprotective effects of ME on the gastric lesions induced by nonsteroidal anti-inflammatory drug. After pylorus ligature of mice, oral administration of ME induced a decrease not only in total acid but also in the ulcer index. We also observed that ME displayed antibacterial activity against H. pylori. Liquid-liquid separation of ME indicated that active constituents responsible for the gastroprotective action are concentrated in the ethyl acetate fraction (EAF) (50% protection) rather than in the aqueous fraction, which did not induce significant gastroprotection at the same dose (100 mg/kg). EAF induced an increase of gastric mucosa prostaglandin (PG) E(2) levels, which remained high even after previous administration of indomethacin. The phytochemical profile of ME revealed that EAF contains mainly flavonoids. In conclusion, all these results suggest that ME did not show acute toxicity, but exhibited an antisecretory property, anti-H. pylori effect, and gastroprotective action. The observed effect did not involve the participation of nitric oxide or endogenous sulfhydryl groups. However, EAF showed a more efficient gastroprotective effect than ME at a lower dose and protected the gastric mucosa by increasing PGE(2).

Topical treatment of dermatophytosis and cutaneous candidosis with flutrimazole 1% cream: double-blind, randomized comparative trial with ketoconazole 2% cream.

In a double-blind, randomized study the efficacy and tolerance of flutrimazole 1% cream were compared with ketoconazole 2% cream, applied once daily for 4 weeks, in 60 patients with culturally proven dermatophytosis (47 patients) or cutaneous candidosis (13 patients). Both groups of patients and distribution of target lesions were similar. The sum of clinical scores had an even distribution in both groups at the end of treatment. The proportion of patients with negative microscopy and culture after 4 weeks of treatment was 70% in the flutrimazole group and 53% in the ketoconazole group; seven ketoconazole-treated patients (23%) compared with two flutrimazole-treated patients (6.6%) were asymptomatic carriers (clinically cured with positive cultures) at the end of treatment. At the assessment 6 weeks after the end of therapy the percentages of flutrimazole- and ketoconazole-treated patients with negative mycology were 57 and 70%, respectively. There were one relapse (3.3%) in the ketoconazole group and four (13.3%) in the flutrimazole group. One patient treated with ketoconazole (3%) had a premature termination due to adverse events attributable to the medication. The results of this study show that flutrimazole 1% cream is as effective and safe as ketoconazole 2% cream for Candida and dermatophyte skin infections.

Determination of the CH + O2 product channels.

The multichannel CH + O2 reaction was studied at room temperature, in a low-pressure fast-flow reactor. CH radical was obtained from the reaction of CHBr3 with potassium atoms. The overall rate constant was determined from the decay of CH with distance, O2 being introduced in excess. The result, after corrections for axial and radial diffusion, is k = (3.6 +/- 0.5) x 10(-11) cm3 molecule-1 s-1. The OH(A2 sigma +) chemiluminescence was observed, confirming the existence of the OH + CO channel. The vibrational population distribution of OH(A2 sigma +) is 32% in the v' = 1 level and 68% in the v' = 0 level (+/- 5%). The relative atomic concentrations were determined by resonance fluorescence in the vacuum ultraviolet. A ratio of 1.4 +/- 0.2 was found between the H atom density (H atoms being produced from the H + CO2 channel and from the HCO dissociation) and the O atom density (O + HCO). Ab initio calculations of the transition structures have been performed, associated with statistical estimations. The estimated branching ratios are: O + HCO, 20%; O + H + CO, 30%; H + CO2, 30%; and CO + OH, 20%.

[Study of in situ cancer of the uterine cervix in the Provincial Hospital of Madrid]. / Estudio del cáncer "in situ" de cuello uterino en el Hospital Provincial de Madrid.

Seventy nine cases of in situ cervical carcinoma (CIN III) treated between 1977 and 1985 are studied. CIN III appears ten years before invasive cervical carcinoma, at a mean age of 42.8 years. Parity may be a risk factor by itself or reflect the precocity and frequency of sexual intercourse. The study confirms that most of the times the combination of vaginal cytology and colposcopy attained the diagnosis. The best therapeutical methods are conization and then total hysterectomy, depending on lesion localization, patient age and early needs. Very young patients with lesions that do not reach the endocervical region may be treated by CO2 laser or cryotherapy.

Case reports. Transient colonization with Scedosporium prolificans. Report of four cases in Madrid.

Four cases of transient colonization of the respiratory tract by Scedosporium prolificans are presented, two in patients with cystic fibrosis, one in a liver transplant patient and one in a patient with AIDS. Colonization versus infection by S. prolificans is discussed.

Value of the preoperative detection of prostate-specific-antigen-positive circulating cells by nested RT-PCR in patients submitted to radical prostatectomy.

OBJECTIVE: To assess the value of the detection of circulating prostate cells [prostate-specific antigen (PSA) positive] by reverse-transcriptase nested polymerase chain reaction (nested RT-PCR) to improve the staging of clinically localized prostate cancer. METHODS: Nested PCR was performed on blood samples of 29 patients submitted to radical prostatectomy for clinically localized (T1-T2) prostate cancer. Nine patients with various benign urologic diseases comprised the negative control group. Incubation was for 25 cycles for each PCR, using beta 2-microglobulin to test the integrity of RNA samples. Each sample was tested in quadruplicate and analyzed by agarose gel electrophoresis, blotted and hybridized with specific internal primers. Nested PCR results were compared with the pT stage of the prostate specimen, processed according to the Stanford method. RESULTS: In 6 out of 29 patients (20.7%) with clinically localized prostate cancer, circulating prostate cells were detected by nested PCR. There was no relationship between pathologic stage and RT-PCR results. Eleven out of 14 pT2 patients (78.6%) were PCR negative and only 3 out of 15 pT3 patients (20%) were PCR positive. All control samples were PCR negative. CONCLUSIONS: In selected patients with T1-T2 prostate cancer, there was no relationship between pathologic stage and the presence of circulating PSA-positive cells detected by nested PCR. However, in 20.7% of patients with clinically localized prostate cancer, circulating prostate cancer cells were detected. A further follow-up based on PSA is necessary to clarify the clinical relevance of this biologic anomaly.

Erythropoietin plus granulocyte colony-stimulating factor in the treatment of myelodysplastic syndromes. Identification of a subgroup of responders. The Spanish Erythropathology Group.

BACKGROUND AND OBJECTIVE: Anemia leading to transfusion is probably the most important problem in patients with myelodysplastic syndromes (MDS). Human recombinant erythropoietin (rHuEpo) and granulocyte colony-stimulating factor (G-CSF) have been used to treat patients with anemia of MDS, but fewer than 50% respond. The aim of this work was to evaluate the benefit of rHuEpo +/- G-CSF treatment and to isolate the response predictive variables in a group of selected patients with MDS. DESIGN AND METHODS: A non-randomized multicenter trial was carried out in 32 patients with MDS. The inclusion criteria were age >= 18 years, refractory anemia (RA) or refractory anemia with ringed sideroblasts, Hb <= 100 g/L or receiving transfusions and serum erythropoietin <= 250 U/L. These patients were treated with subcutaneous rHuEpo (300 U/kg) three times a week for 8 weeks. In the case of partial response (PR) or no response (NR) subcutaneosly administered G-CSF (1 microg/kg) three times a week was added to the rHuEpo for 8 more weeks. If the patient achieved complete response (CR) or PR in the second phase, he was included in a follow-up phase of 24 weeks in which the dose of growth factors was tapered down. Several variables, including the score published by the Scandinavian-American group, were used as possible predictive variables. RESULTS: An erythroid response was observed in 16 patients (50%); in 12 it was a CR and in 4 it was a PR. During the period of rHuEpo administration, 7 CR and 4 PR (34.4%) were documented. Of the 14 patients in whom G-CSF was added to rHuEpo, 7 (50%) responded (3 CR and 4 PR). No major side-effects associated with growth factors were observed. The multivariate analysis showed that of the different variables evaluated only the Scandinavian-American response score was significant with a relative probability of response of 11.8 (95% confident intervals: 2.5-53) when this score was > +1 (77% of cases responded). In contrast, when this score was <= 1 only 15 % of the cases responded. INTERPRETATION AND CONCLUSIONS: Use of the Scandinavian-American response score is to be recommended in a patient-oriented approach to treating MDS cases with the Epo and G-CSF. Treatment with rHuEpo and G-CSF is safe, its main drawback being its cost. However, a long-term study evaluating the regimen's cost-benefit ratio is warranted.