Immune Checkpoint Inhibitors and the Kidney: A Focus on Diagnosis and Management for Personalised Medicine.

Immunity plays a crucial role in fighting cancer, but tumours can evade the immune system and proliferate and metastasize. Enhancing immune responses is a new challenge in anticancer therapies. In this context, efficacy data are accumulating on immune checkpoint inhibitors and adjuvant therapies for various types of advanced-stage solid tumours. Unfortunately, immune-related adverse events are common. Although infrequent, renal toxicity may occur via several mechanisms and may require temporary or permanent drug suspension, renal biopsy, and/or immunosuppressive treatment. This short review aims to provide a practical approach to the multidisciplinary management of cancer patients with renal toxicity during treatment with immune checkpoint inhibitors.

Caffeine improves neuromuscular function during maximal dynamic exercise.

INTRODUCTION: In this study we tested the hypothesis that caffeine supplementation improves neuromuscular function, which has both nutritional and clinical relevance. METHODS: Fourteen male subjects (mean ± SD: 23.8 ± 2.8 years) volunteered in a double-blind, repeated-measures study with placebo (PLA) or caffeine (CAFF) (6 mg kg(-1)). Maximal voluntary isometric contractions (MVCs), evoked maximal twitch, and maximal isokinetic contractions during elbow flexion were assessed. Mechanical and electromyographic (EMG) signals from the biceps brachii muscle were recorded, and muscle fiber conduction velocity (CV) was calculated to evaluate changes in the muscle force-velocity relationship and muscle fiber recruitment. RESULTS: The torque-angular velocity curve was enhanced after CAFF supplementation. This was supported by a concomitant increase of CV values (8.7% higher in CAFF). CONCLUSIONS: Caffeine improves muscle performance during short-duration maximal dynamic contractions. The concomitant improvement of mean fiber CV supports the hypothesis of an effect of caffeine on motor unit recruitment.

Inter-limb coordination, strength, jump, and sprint performances following a youth men's basketball game.

This study aimed to verify whether basketball players are able to maintain strength (handgrip), jump (countermovement jump [CMJ]), sprint (10 m and 10 m bouncing the ball [10 mBB]), and interlimb coordination (i.e., synchronized hand and foot flexions and extensions at 80, 120, and 180 bpm) performances at the end of their game. Ten young (age 15.7 ± 0.2 years) male basketball players volunteered for this study. During the friendly game, heart rate (HR), rate of perceived exertion (RPE), and rate of muscle pain (RMP) were assessed to evaluate the exercise intensity. Overall, players spent 80% of the time playing at intensities higher than 85% HRmax. Main effects (p < 0.05) for game periods emerged for HR and the number of players involved in a single action, with lower occurrence of maximal efforts and higher involvement of teammates after the first 2 periods. At the end of the game, players reported high (p < 0.05) RPE (15.7 ± 2.4) and RMP (5.2 ± 2.3) values; decreased (p < 0.05) sprint capabilities (10 m: pre = 1.79 ± 0.09 seconds, post = 1.84 ± 0.08 seconds; 10 mBB: pre = 1.81 ± 0.11 seconds, post = 1.96 ± 0.08 seconds); increased (p < 0.05) interlimb coordination at 180 bpm (pre = 33.3 ± 20.2 seconds, post = 43.9 ± 19.8 seconds); and maintained jump (pre = 35.2 ± 5.2 cm, post = 35.7 ± 5.2 cm), handgrip (pre = 437 ± 73 N, post = 427 ± 55 N), and coordinative performances at lower frequencies of executions (80 bpm: pre = 59.7 ± 1.3 seconds, post = 60.0 ± 0.0 seconds; 120 bpm: pre = 54.7 ± 12.3 seconds, post = 57.3 ± 6.7 seconds). These findings indicate that the heavy load of the game exerts beneficial effects on the efficiency of executive and attentive control functions involved in complex motor behaviors. Coaches should structure training sessions that couple intense physical exercises with complex coordination tasks to improve the attentional capabilities of the players.

Neuromuscular control adaptations in elite athletes: the case of top level karateka.

This paper aimed at investigating the neuromuscular response of knee flexor and extensor muscles in elite karateka and karate amateurs (Amateurs) during isokinetic knee flexion/extensions and during the execution of a front kick (FK). Surface electromyograms (sEMG) were recorded from the right vastus lateralis (VL) and biceps femoris (BF) muscles with a four-array electrode during maximal isometric knee flexion and extension (maximal voluntary contraction), during isokinetic contractions (30 degrees , 90 degrees , 180 degrees , 270 degrees , 340 degrees , 400 degrees /s), and during the FK. The level of VL and BF agonist (ago) and antagonist (ant) activation during the isokinetic and FK protocols was quantified through normalized sEMG root mean square value (%RMS(ago/ant-ISOK/FK)). VL and BF average muscle fiber conduction velocity (CV) was computed for isokinetic and FK. Isokinetic flexion and extension torques and knee angular velocity during FK were also assessed. Analysis of variance was used to test the effect of group, angular velocity, and task on the assessed variables (P < 0.05). Elite karateka showed higher isokinetic knee flexion torque when compared with Amateurs. For all angular velocities, VL and BF %RMS(ant-isokinetic) were lower in elite karateka, while their BF-CV(isokinetic) BF-CV(front kick) and BF %RMS(ant-front kick) values were higher. For VL and BF, %RMS(ago-front kick) was lower than %RMS(ago-isokinetic) in both groups. Elite karateka demonstrated a typical neuromuscular activation strategy that seems task and skill level dependent. Knee flexion torque and CV results suggest the presence of an improved ability of elite karateka to recruit fast MUs as a part of training induced neuromuscular adaptation.

Effects of dynamic resistance training on heart rate variability in healthy older women.

Twenty healthy women aged between 65 and 74 years, trained three times a week, for 16 weeks, on a cycle ergometer, to determine the effects of dynamic resistance training on heart rate variability (HRV). Subjects were allocated to two training groups, high (HI, n=10) and low (LO, n=10) intensity. The HI group performed eight sets of 8 revolutions at 80% of the maximum resistance to complete 2 pedal revolutions (2RM); the LO group performed eight sets of 16 pedal revolutions at 40% of 2RM. Subjects were tested twice before, as control period (-4 weeks and 0 weeks) and once after training (16 weeks) for HRV, maximum voluntary contraction (MVC) of knee extensors and peak power (P(p)) of lower limbs by jumping on a force platform. HRV was measured using time and frequency domain parameters. Two-way ANOVA for repeated measures was performed on all variables (P<0.05). Results showed no differences between training groups. Following training HRV was not modified, while MVC and P(p) significantly increased. The two proposed forms of dynamic resistance training were appropriate to improve muscle power and strength in elderly females without affecting HRV. More research should verify the effects of an isometric and more prolonged training stimulus on HRV in older subjects.