Differential response to pharmacological intervention in ADHD furthers our understanding of the mechanisms of interference control.

The deficit in "interference control" found in children with Attention Deficit Hyperactivity Disorder (ADHD) could be due to two distinct processes, which are not disentangled in most studies: a larger susceptibility to activating prepotent response impulses and a deficit in suppressing them. Here, we investigated the effect of 1/ADHD and 2/ methylphenidate (MPH), on these two components of interference control. We compared interference control between untreated children with ADHD, children with ADHD under MPH, and typically developing children performing a Simon task. The main findings were that 1/ children with ADHD were more susceptible to reacting impulsively and less efficient at suppressing impulsive actions, and 2/ MPH improved the selective inhibition of impulsive actions but did not modify the strength of response impulse. This work provides an example of how pharmacological interventions and selective responses to them can be used to investigate and further our understanding of cognitive processing.

Two sides of the same coin: ADHD affects reactive but not proactive inhibition in children.

Children with attention-deficit/hyperactivity disorder (ADHD) present a deficit in inhibitory control. Still, it remains unclear whether it comes from a deficit in reactive inhibition (ability to stop the action in progress), proactive inhibition (ability to exert preparatory control), or both.We compared the performance of 39 children with ADHD and 42 typically developing children performing a Simon choice reaction time task. The Simon task is a conflict task that is well-adapted to dissociate proactive and reactive inhibition. Beyond classical global measures (mean reaction time, accuracy rate, and interference effect), we used more sophisticated dynamic analyses of the interference effect and accuracy rate to investigate reactive inhibition. We studied proactive inhibition through the congruency sequence effect (CSE).Our results showed that children with ADHD had impaired reactive but not proactive inhibition. Moreover, the deficit found in reactive inhibition seems to be due to both a stronger impulse capture and more difficulties in inhibiting impulsive responses. These findings contribute to a better understanding of how ADHD affects inhibitory control in children.

Targeting IgE in Severe Atopic Dermatitis with a Combination of Immunoadsorption and Omalizumab.

Patients with atopic dermatitis (AD) tend to have greatly elevated levels of serum immunoglobulin E (IgE). However, the role of IgE in the pathogenesis of AD is debated. This investigator-initiated open-label pilot study evaluates an anti-IgE-treatment approach by combining extracorporeal immunoadsorption and anti-IgE antibody omalizumab in 10 patients with severe, therapy-refractory AD. IgE levels decreased after immunoadsorption and decreased continuously in all patients during anti-IgE therapy. The reverse trend was observed during 6 months follow-up without treatment. In parallel with these observations, an improvement in AD was observed during the treatment period, with aggravation during follow-up. Further research is needed, based on the principle of reducing IgE levels in order to improve clinical symptoms, using a combination anti-IgE treatment approach, adjusted according to IgE levels.

The cognitive structure of time estimation impairments in adults with attention deficit hyperactivity disorder.

We compared the performance of 15 adults with attention deficit hyperactivity disorder (ADHD) and a group of 16 control adults on a temporal bisection task in auditory and visual modalities. The point of subjective equality (PSE) and the difference limen (DL) were computed to analyse performance. The main findings were that (a) individuals with ADHD overestimated the duration of both the auditory and visual stimuli in comparison to the control group, as evidenced by a shift in their mean PSE; (b) individuals with ADHD also showed less precision in their estimates than did the control group as evidenced by flatter psychometric functions; and (c) the degrees of overestimation and imprecision in subjects with ADHD were comparable across modalities. These results, discussed in the framework of the pacemaker-counter clock model of time estimation, suggest that temporal difficulties encountered by ADHD patients might be explained both by an alertness effect at the level of the switch that directs pulses into the accumulator and also by distortions of durations stored in reference memory.

The effect of reducing attentional resources on selective suppression in the Simon task.

Studies using reaction times (RTs) distribution methods find that the Simon effect is greater for fast RTs and becomes smaller or reversed for slow RTs. However, the exact mechanisms responsible for this reduction are under debate. This study addressed the issue of whether attentional resources play a role in reduction of the Simon effect over time by investigating whether it is influenced by attentional constraints in a dual-task paradigm. Participants were instructed to perform a Simon task concurrently with a secondary task. Secondary task characteristics were manipulated by varying the overlap between the secondary task and the Simon task. Specifically, secondary tasks varied in their stimulus modality (auditory or visual) and/or response type (verbal or manual and lateralised or not). Distribution analyses of RTs, in the form of delta-plot functions, were performed for both the single- and dual-task conditions. Results showed that the more attention the secondary task demanded, the less the Simon effect was reduced, even for slower RTs. This suggests that the mechanisms responsible for the reduction of Simon effect over time are under top-down control.

Dissociable effects of positive feedback on the capture and inhibition of impulsive behavior in adolescents with ADHD versus typically developing adolescents.

The present study investigated how enhancing motivation by delivering positive feedback (a smiley) after a successful trial could affect interference control in adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and in their typically developing (TD) peers. By using a Simon task within the theoretical framework of the "activation-suppression" model, we were able to separately investigate the expression and the inhibition of impulsive motor behavior. The experiment included 19 adolescents with ADHD and 20 TD adolescents in order to explore whether data found in adolescents with ADHD were similar to those found in TD adolescents. Participants performed the Simon task in two conditions: a condition with feedback delivered after each successful trial and a condition with no feedback. The main findings were that increasing motivation by delivering positive feedback increased impulsive response in both groups of adolescents. It also improved the efficiency of impulsive motor action inhibition in adolescents with ADHD but deteriorated it in TD adolescents. We suggest that 1/increased motivation could lead adolescents to favor fast responses even if incorrect, and 2/the differential effect of feedback on the selective suppression of impulsive motor action in both groups could be due to different baseline DA levels.

Detection of Horizontal Gene Transfer Mediated by Natural Conjugative Plasmids in E. coli.

Conjugation represents one of the main mechanisms facilitating horizontal gene transfer in Gram-negative bacteria. This work describes methods for the study of the mobilization of naturally occurring conjugative plasmids, using two naturally-occurring plasmids as an example. These protocols rely on the differential presence of selectable markers in donor, recipient, and conjugative plasmid. Specifically, the methods described include 1) the identification of natural conjugative plasmids, 2) the quantification of conjugation rates in solid culture, and 3) the diagnostic detection of the antibiotic resistance genes and plasmid replicon types in transconjugant recipients by polymerase chain reaction (PCR). The protocols described here have been developed in the context of studying the evolutionary ecology of horizontal gene transfer, to screen for the presence of conjugative plasmids carrying antibiotic-resistance genes in bacteria found in the environment. The efficient transfer of conjugative plasmids observed in these experiments in culture highlights the biological relevance of conjugation as a mechanism promoting horizontal gene transfer in general and the spread of antibiotic resistance in particular.

Prevalence and associations of metabolic syndrome in patients with alcohol use disorder.

Excessive alcohol consumption has been associated with different components of the metabolic syndrome (MetS) such as arterial hypertension, dyslipidemia, type 2 diabetes or obesity. We aimed to analyze the prevalence and associations of MetS in patients with Alcohol Use Disorder (AUD). Cross-sectional study in heavy drinkers admitted for the treatment of AUD between 2013 and 2017. Medical comorbidity, anthropometric data, alcohol use and biological parameters were obtained. MetS was established according to the harmonized definition. A total of 728 patients (22% women) were included; median age was 47 years (IQR: 40-53.5), median alcohol consumption was 160 g/day (IQR: 115-240) and prevalence of MetS was 13.9%. The multivariate analysis showed a significant dose-response effect of estimated glomerular filtration (eGFR) and MetS: relative to patients with eGFR > 90 mL/min, those with eGFR (60-90 mL/min) and those with eGFR < 60 mL/min were 1.93 times (95% CI 1.18-3.15) and 5.61 times (95% CI 1.66-19.0) more likely to have MetS, respectively. MetS was significantly associated with hyperuricemia (OR 2.28, 95% CI 1.36-3.82) and elevated serum GGT (OR 3.67, 95% CI 1.80-7.46). Furthermore, for every increase of 1 year in age, the probability of MetS increased significantly (OR 1.03, 95% CI 1.01-1.05). MetS in heavy drinkers is independently associated with reduced kidney function and metabolic risk factors including hyperuricemia and elevated serum GGT.

Cannabis hyperemesis syndrome: Incidence and treatment with topical capsaicin. / Síndrome de hiperémesis por cannabis: incidencia y tratamiento con capsaicina tópica.

There are few studies in Spain on cannabinoid hyperemesis syndrome (CHS), as well as on the use of topical capsaicin as a treatment. METHODS: Retrospective study of patients over 14 years of age seen in a hospital emergency department during 2018 and 2019 with a diagnosis of CHS based on the following criteria: compatible clinical picture, cannabis use less than 48h and positive urine cannabis test. Epidemiological and clinical variables, attendance times and treatment (including use of topical capsaicin 0.075%) were collected. RESULTS: Fifty-nine attendances were studied, from 29 patients (4.4 cases/10,000 visits, 95% CI 2.8-4.7). Fifty per cent returned for CHS, differing only in more tobacco (P=.01) and cocaine (P=.031) use. Capsaicin was used in 74.6% of visits. The mean time to resolution of vomiting after application was 17.87min. CONCLUSIONS: Although probably underdiagnosed, CHS has a low incidence in the emergency department in Spain, with high patient recurrence. The use of capsaicin ointment is efficient and safe.

Dynamic profiles and predictive values of some biochemical and haematological quantities in COVID-19 inpatients.

INTRODUCTION: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in some hospitalized patients has shown some important alterations in laboratory tests. The aim of this study was to establish the most relevant quantities associated with the worst prognosis related to COVID-19. MATERIALS AND METHODS: This was a descriptive, longitudinal, observational and retrospective study, in a cohort of 845 adult inpatients from Bellvitge University Hospital (L'Hospitalet de Llobregat, Barcelona, Spain). A multivariate regression analysis was carried out in demographic, clinical and laboratory data, comparing survivors (SURV) and non-survivors (no-SURV). A receiver operating characteristic analysis was also carried out to establish the cut-off point for poor prognostic with better specificity and sensibility. Dynamic changes in clinical laboratory measurements were tracked from day 1 to day 28 after the onset of symptoms. RESULTS: During their hospital stay, 18% of the patients died. Age, kidney disease, creatinine (CREA), lactate-dehydrogenase (LD), C-reactive-protein (CRP) and lymphocyte (LYM) concentration showed the strongest independent associations with the risk of death in the multivariate regression analysis. Established cut-off values for poor prognosis for CREA, LD, CRP and LYM concentrations were 75.0 µmol /L, 320 U/L, 80.9 mg/L and 0.69 x109/L. Dynamic profile of laboratory findings, were in agreement with the consequences of organ damage and tissue destruction. CONCLUSIONS: Age, kidney disease, CREA, LD, CRP and LYM concentrations in COVID-19 patients from the southern region of Catalonia provide important information for their prognosis. Measurement of LD has demonstrated to be very good indicator of poor prognosis at initial evaluation because of its stability over time.

Stronger impulse capture and impaired inhibition of prepotent action in children with ADHD performing a Simon task: An electromyographic study.

OBJECTIVE: A deficit in interference control is commonly reported in children with attention deficit hyperactivity disorder (ADHD). This has mainly been interpreted as a difficulty in inhibiting inappropriate responses. However, it could be due to at least two distinct and independent processes, which are often confounded: The activation or suppression of impulsive responses. The aim of the present study was to separate the contribution of these two processes. METHOD: We compared performance of 26 children with ADHD to that of 26 nonADHD children using a novel approach based on electromyographic activity (EMG) analysis. EMG allows two distinct indices to be computed: Incorrect activation rate, which is an index of the intensity of impulse capture and correction rate, which provides a direct measure of the ability to suppress automatic responses. RESULTS: Children with ADHD were slower, committed more errors, and had a larger interference effect than nonADHD children. Moreover, we observed a greater incorrect activation rate and a lower correction rate in the ADHD group. CONCLUSIONS: Our data suggest that the difficulties in interference control found in children with ADHD are explained by both impaired inhibitory processes and a greater propensity to activate automatic responses. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Impulsive and Omission Errors: Potential Temporal Processing Endophenotypes in ADHD.

Temporal processing (TP) is associated with functions such as perception, verbal skills, temporal perspective, and future planning, and is intercorrelated with working memory, attention, and inhibitory control, which are highly impaired in individuals with attention deficit hyperactivity disorder (ADHD). Here we evaluate TP measures as potential endophenotypes in Caribbean families ascertained from probands affected by ADHD. A total of 232 individuals were recruited and clinically evaluated using an extensive battery of neuropsychological tasks and reaction time (RT)-based task paradigms. Further, the heritability (genetic variance underpinning phenotype) was estimated as a measure of the genetics apportionment. A predictive framework for ADHD diagnosis was derived using these tasks. We found that individuals with ADHD differed from controls in neuropsychological tasks assessing mental control, visual-verbal memory, verbal fluency, verbal, and semantic fluency. In addition, TP measures such as RT, errors, and variability were also affected in individuals with ADHD. Moreover, we determined that only omission and commission errors had significant heritability. In conclusion, we have disentangled omission and commission errors as possible TP endophenotypes in ADHD, which can be suitable to assess the neurobiological and genetic basis of ADHD. A predictive model using these endophenotypes led to remarkable sensitivity, specificity, precision and classification rate for ADHD diagnosis, and may be a useful tool for patients' diagnosis, follow-up, and longitudinal assessment in the clinical setting.

How Is Temporal Processing Affected in Children with Attention-deficit/hyperactivity Disorder?

We compared the performance of children with ADHD and typically developing children on two temporal tasks, a bisection task and a reproduction task, in auditory and visual modalities. Children with ADHD presented a larger variability when performing auditory and visual temporal tasks. Moreover, they overestimated the durations in bisection tasks and underproduced duration intervals in the visual reproduction task. In the context of the pacemaker-accumulator model, these results suggest that temporal deficits might result from a dysfunction in the switch and/or memory impairment.

Induction of NOS and nitrotyrosine expression in the rat striatum following experimental hepatic encephalopathy.

Hepatic encephalopathy (HE) is a neurologic disease associated with hepatic dysfunction. Astroglial and neuronal alterations have been described in the basal ganglia in HE. Our study was performed to determine whether such alterations are mediated by nitric oxide (NO), by using an experimental model of HE (portacaval anastomosis [PCA]). The expression of the NO synthases (nNOS and iNOS) and the production of nitrotyrosine (NT) were evaluated in the striatum of rats exposed to PCA for 1 and 6 months. The expression of nNOS in the striatal neurons of PCA rats was increased compared to controls. nNOS expression was also detectable in astrocytes after 6 months of exposure to PCA. Whereas astroglial cells in the normal striatum showed no iNOS expression, iNOS was expressed in the astrocytes of PCA brains, mainly in perivascular processes at 6 months PCA exposure (demonstrated by colocalization with GFAP). The increased expression of both the nNOS and iNOS isoforms in PCA rats might indicate a critical role for NO in the pathomechanism of HE. To study the potential cell damage caused by NO, the deposition of NT in PCA-rats was analysed. Nitrotyrosine was detected in neurons although it was mainly seen in the astrocytes of PCA brains, in which double immunolabelling showed NT to be colocalized with GFAP. Thus, the present study shows the induction of iNOS and NT in astrocytes, which increases with the duration of PCA exposure. This suggests that the induced astroglial production of NO during PCA might be one of the main factors contributing to HE.

Clinical Management of Prostate Cancer Metastasis to Pineal Gland: Case Report and Review of Literature.

BACKGROUND: Prostate cancer is the most common cancer among American men, with an incidence of approximately 233,000 cases per year. Intracranial metastases are rare and, specifically, metastasis to the pineal gland has only been reported in 2 postmortem cases in the literature. CASE DESCRIPTION: We present the first documented case of confirmed prostate cancer metastasis to the pineal gland in a living patient. The patient underwent an endoscopic third ventriculostomy and pineal lesion biopsy with complete resolution of his hydrocephalus and presenting symptoms. His biopsy results confirmed the prostate origin of the metastasis, and he subsequently underwent stereotactic radiosurgery for treatment of this lesion. CONCLUSIONS: This is the first report of the clinical management of metastatic prostate cancer to the pineal region and description of the clinical outcome. Although prostate cancer is the most common cancer in American men, metastasis to the pineal has only been reported twice from autopsy examinations. Overall, pineal tumors in the geriatric population are exceedingly rare and the age and comorbidities in this patient made management quite unique.

Manipulating the Alpha Level Cannot Cure Significance Testing.

We argue that making accept/reject decisions on scientific hypotheses, including a recent call for changing the canonical alpha level from p = 0.05 to p = 0.005, is deleterious for the finding of new discoveries and the progress of science. Given that blanket and variable alpha levels both are problematic, it is sensible to dispense with significance testing altogether. There are alternatives that address study design and sample size much more directly than significance testing does; but none of the statistical tools should be taken as the new magic method giving clear-cut mechanical answers. Inference should not be based on single studies at all, but on cumulative evidence from multiple independent studies. When evaluating the strength of the evidence, we should consider, for example, auxiliary assumptions, the strength of the experimental design, and implications for applications. To boil all this down to a binary decision based on a p-value threshold of 0.05, 0.01, 0.005, or anything else, is not acceptable.

Effect of ammonia, glutamine, and serum on calcineurin, p38MAPK-diP, GADD153/CHOP10, and CNTF in primary rat astrocyte cultures.

Primary astrocyte cultures were subjected to different experimental schedules using several concentrations of ammonia (1, 3, and 5 mM ammonium chloride), serum (2.5%, 5%, and 12%), and glutamine (0.5, 1, and 3 mM) to analyze the involvement of calcineurin (CaN) in hyperammonemia and its relation with p38MAPK-diP and ciliary neurotrophic factor (CNTF). We demonstrated that exposure to ammonia affects CaN content, and confirmed the ammonia-induced reduction of CNTF expression; however, the involvement of CaN and p38MAPK-diP in CNTF reduction could not be confirmed. On the contrary, an inverse relationship between CaN and p38MAPK-diP contents was clearly demonstrated. GADD153/CHOP10 content was always higher under hyperammonemic conditions as well as under glutamine exposure, probably due to the osmotic stress provoked by glutamine accumulation, which was induced after exposure to ammonia. Statistical analysis demonstrated significant interactions of ammonia and serum for CaN, GADD153/CHOP10 and CNTF contents. The exposure to glutamine also induced changes in GADD153/CHOP10 and CaN; however, CNTF content was not affected. In conclusion, CaN content was affected by exposure to ammonia and glutamine; the serum content of the culture medium had a strong influence on the astroglial response to ammonium chloride, and glutamine exposure only reproduced some of the ammonia effects.

Reduced TH expression and α-synuclein accumulation contribute towards nigrostriatal dysfunction in experimental hepatic encephalopathy.

PURPOSE: The present work examines α-synuclein expression in the nigrostriatal system of a rat chronic hepatic encephalopathy model induced by portacaval anastomosis (PCA). There is evidence that dopaminergic dysfunction in disease conditions is strongly associated with such expression. Possible relationships among dopaminergic neurons, astroglial cells and α-synuclein expression were sought. METHODS: Brain tissue samples from rats at 1 and 6 months post-PCA, and controls, were analysed immunohistochemically using antibodies against tyrosine hydroxylase (TH), α-synuclein, glial fibrillary acidic protein (GFAP) and ubiquitin (Ub). RESULTS: In the control rats, TH immunoreactivity was detected in the neuronal cell bodies and processes in the substantia nigra pars compacta (SNc). A dense TH-positive network of neurons was also seen in the striatum. In the PCA-exposed rats, however, a reduction in TH-positive neurons was seen at both 1 and 6 months in the SNc, as well as a reduction in TH-positive fibres in the striatum. This was coincident with the appearance of α-synuclein-immunoreactive neurons in the SNc; some of the TH-positive neurons also showed α-synuclein immunoreactivity. In addition, α-synuclein accumulation was seen in the SNc and striatum at both 1 and 6 months post-PCA, whereas α-synuclein was only mildly expressed in the nigrostriatal pathway of the controls. Astrogliosis was also seen following PCA, as revealed by increased GFAP expression from 1 month to 6 months post-PCA in both the SN and striatum. The astroglial activation level in the SN paralleled the reduced neuronal expression of TH throughout PCA exposure. CONCLUSION: α-synuclein accumulation following PCA may induce dopaminergic dysfunction via the downregulation of TH, as well as astroglial activation.

Strongyloides hyperinfection syndrome in an immunocompetent host resulting in bandemia and death.

Strongyloides stercoralis infection is usually asymptomatic but can result in a hyperinfection syndrome, most commonly triggered by acquired or iatrogenic immunosuppression. Here, we present a case of a man aged 60 years originally from a strongyloides endemic area with a medical history of alcohol abuse who presents with strongyloides hyperinfection syndrome (SHS) complicated by partial small bowel obstruction, pulmonary haemorrhage, large bandemia without eosinophilia and cardiac arrest resulting in death. This case is notable for the presence of bandemia and absence of eosinophilia, lack of historical risk factors for hyperinfection, specifically corticosteroid immunosuppressants, and dramatic decline in clinical status which ultimately resulted in the patient's death. Clinicians should suspect SHS in immunocompetent patients who are from an endemic area and who have persistent gastrointestinal and/or pulmonary manifestations in the absence of a clear cause.

ACTN-3 and ECA genes expression do not influence the acute change in muscle mechanical and functional properties in youth handballers / Expresiones de los genes ACTN-3 y ECA no influyen en el cambio agudo de las propiedades musculares mecánicas y funcionales en jugadores juveniles de balonmano

The purpose of this study was to explore the potential relationship between ACTN-3 and ACE gene expression over the change in muscle mechanical and functional properties in youth handballers through a congested tournament. 30 players of the first handball division of Costa Rica participated in this study. The participants played a national tournament during three consecutive days (one match per day). The collection of genetic samples was through a mouth rinse with a 5% sucrose solution before the tournament. PCR tests were used to detect the alleles of the ACE and ACTN3 genes and the product ́s reaction was visualized by electrophoresis. Before and after each match, tensiomyography (TMG) and Countermovement jump (CMJ) tests were used to assess mechanical and functional properties respectively. Descriptive frequency analyses and a one-way analysis of variance of independent groups were the statistics test applied. The results showed that the most prevalent polymorphisms expression was ACTN-3 R-X (56.7%) and ECA I-D (43.3%). No significant differences (p> 0.050) were found between genes expressed in the mechanical responses (contraction time (TC), delay time (TD) and, maximum radial displacement (DM)) of the rectus femoral muscle of the dominant leg neither in performance in the test CMJ. Likewise, there was no significant change (p> 0.050) in muscle mechanical or functional properties post official matches. In conclusion, handball players have the genes ACE and ACTN. Nevertheless, it seems to have no influence of these genes on the mechanical or functional muscles acute responses. More investigations will be needed to explain and understand the real impact of this gene’s expression on muscle performance in handball players.(AU)

El propósito de este estudio fue explorar la relación potencial entre la expresión ACTN-3 y ACE sobre el cambio en las propiedades musculares mecánicas y funcionales de jugadores juveniles de balonmano a través de un torneo congestionado. Participaron 30 jugadores de la primera división de balonmano de Costa Rica. Los participantes jugaron un torneo nacional durante tres días consecutivos. La recolección de muestras genéticas se realizó mediante un enjuague bucal con una solución de sacarosa al 5% antes del inicio del torneo. Pruebas de PCR fueron usadas para detectar los aleros de los genes ACTN-3 y ACE y la reacción del producto fueron visualizadas por electroforesis. Antes y después de cada partido, se utilizaron las pruebas de tensiomiografía (TMG) y de salto contramovimiento (CMJ) para evaluar las propiedades mecánicas y funcionales respectivamente. Las pruebas estadísticas aplicadas fueron análisis descriptivo de frecuencias y un análisis de varianza de una vía para grupos independientes. Los resultados mostraron que la expresión de polimorfismos más prevalente fue ACTN-3 R-X (56,7%) y ECA I-D (43,3%). No se han encontrado diferencias significativas (p> 0,050) entre genes expresados en las respuestas mecánicas (tiempo de contracción (TC), tiempo de retardo (TD) and, máximo desplazamiento radial (DM)) del músculo recto femoral de la pierna dominante ni en el rendimiento en la prueba de CMJ. Asimismo, no hubo cambios significativos (p>0.050) en las propiedades mecánicas o funcionales de los músculos después de los partidos. En conclusión, los jugadores de balonmano tienen los genes ACE y ACTN, sin embargo, parece que estos genes no influyen en las respuestas agudas mecánicas o funcionales de los músculos. Se necesitan más investigaciones para explicar y comprender el impacto real de la expresión de estos genes en el rendimiento muscular de los jugadores de balonmano.(AU)