Improving the Access of Highly Sensitized Patients to Kidney Transplantation From Deceased Donors: The Spanish PATHI Program With Allocation Based on the Virtual Crossmatch.

BACKGROUND: In 2015, the Spanish National Transplant Organization developed a prioritization system (Program for Access to Transplantation for Highly Sensitized Patients [PATHI]) to increase transplant options for patients with calculated panel-reactive antibodies (cPRAs) ≥98%, based on virtual crossmatch. We describe the experience with the implementation of PATHI and assess its efficacy. METHODS: PATHI registry was used to collect characteristics of donors and patients between June 15, 2015, and March 1, 2018. One-year graft and patient survival and acute rejection were also measured. A Cox model was used to identify factors related to patient death and graft loss and logistical regression for those associated with rejection. RESULTS: One thousand eighty-nine patients were included, and 272 (25%) were transplanted. Transplant rate by cPRA was 54.9%, 40.5%, and 12.8% in patients with cPRA98%, cPRA99%, and cPRA100%, respectively. One-year patient survival was 92.5%. Recipient age ≥60, time under dialysis >7 y, and delayed graft function were mortality risk factors. One-year graft survival was 88.7%. The factor related to graft loss was delayed graft function. The rejection rate was 22%. Factors related to rejection were sex, older recipients, and posttransplant donor-specific antibodies. CONCLUSIONS: A prioritization approach increases transplant options for highly sensitized patients with appropriate short-term postransplant outcomes. Along with other programs, PATHI may inspire other countries to adopt strategies to meet transplant needs of these patients.

Recommendations for living donor kidney transplantation.

This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes. Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor. Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations. This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors' health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors. Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.

Treatment with sotrovimab for SARS-CoV-2 infection in a cohort of high-risk kidney transplant recipients.

Background: Sotrovimab is a neutralizing monoclonal antibody (mAb) that seems to remain active against recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. The evidence on its use in kidney transplant (KT) recipients, however, is limited. Methods: We performed a multicenter, retrospective cohort study of 82 KT patients with SARS-CoV-2 infection {coronavirus disease 2019 [COVID-19]} treated with sotrovimab. Results: Median age was 63 years. Diabetes was present in 43.9% of patients, and obesity in 32.9% of patients; 48.8% of patients had an estimated glomerular filtration rate under 30 mL/minute/1.73 m2. Additional anti-COVID-19 therapies were administered to 56 patients, especially intravenous steroids (65.9%). Sotrovimab was administered early (<5 days from the onset of the symptoms) in 46 patients (56%). Early-treated patients showed less likely progression to severe COVID-19 than those treated later, represented as a lower need for ventilator support (2.2% vs 36.1%; P < .001) or intensive care admission (2.2% vs 25%; P = .002) and COVID-19-related mortality (2.2% vs 16.7%; P = .020). In the multivariable analysis, controlling for baseline risk factors to severe COVID-19 in KT recipients, early use of sotrovimab remained as a protective factor for a composite outcome, including need for ventilator support, intensive care, and COVID-19-related mortality. No anaphylactic reactions, acute rejection episodes, impaired kidney function events, or non-kidney side effects related to sotrovimab were observed. Conclusions: Sotrovimab had an excellent safety profile, even in high-comorbidity patients and advanced chronic kidney disease stages. Earlier administration could prevent progression to severe disease, while clinical outcomes were poor in patients treated later. Larger controlled studies enrolling KT recipients are warranted to elucidate the true efficacy of monoclonal antibody therapies.

Molecular bases for the association of FHR-1 with atypical hemolytic uremic syndrome and other diseases.

Factor H (FH)-related proteins are a group of partly characterized complement proteins thought to promote complement activation by competing with FH in binding to surface-bound C3b. Among them, FH-related protein 1 (FHR-1) is remarkable because of its association with atypical hemolytic uremic syndrome (aHUS) and other important diseases. Using a combination of biochemical, immunological, nuclear magnetic resonance, and computational approaches, we characterized a series of FHR-1 mutants (including 2 associated with aHUS) and unraveled the molecular bases of the so-called deregulation activity of FHR-1. In contrast with FH, FHR-1 lacks the capacity to bind sialic acids, which prevents C3b-binding competition between FH and FHR-1 in host-cell surfaces. aHUS-associated FHR-1 mutants are pathogenic because they have acquired the capacity to bind sialic acids, which increases FHR-1 avidity for surface-bound C3-activated fragments and results in C3b-binding competition with FH. FHR-1 binds to native C3, in addition to C3b, iC3b, and C3dg. This unexpected finding suggests that the mechanism by which surface-bound FHR-1 promotes complement activation is the attraction of native C3 to the cell surface. Although C3b-binding competition with FH is limited to aHUS-associated mutants, all surface-bound FHR-1 promotes complement activation, which is delimited by the FHR-1/FH activity ratio. Our data indicate that FHR-1 deregulation activity is important to sustain complement activation and C3 deposition at complement-activating surfaces. They also support that abnormally elevated FHR-1/FH activity ratios would perpetuate pathological complement dysregulation at complement-activating surfaces, which may explain the association of FHR-1 quantitative variations with diseases.

Eculizumab Modifies Outcomes in Adults with Atypical Hemolytic Uremic Syndrome with Acute Kidney Injury.

BACKGROUND: Atypical hemolytic uremic syndrome (aHUS) is a rare disease associated with congenital or acquired genetic abnormalities that result in uncontrolled complement activation, leading to thrombotic microangiopathy and kidney failure. Until recently, the only treatment was plasma exchange or plasma infusion (PE/PI), but 60% of patients died or had permanent kidney damage despite treatment. Eculizumab, a complement inhibitor, has shown promising results in aHUS. However, data are mainly extracted from case reports or studies of heterogeneous cohorts, and no direct comparison with PE/PI is available. METHODS: An observational retrospective study of adult, dialysis-dependent aHUS patients with acute kidney injury (AKI) who were treated with either PE/PI alone or with second-line eculizumab in our center. We compared the effect of PE/PI and eculizumab on kidney function, hypertension, proteinuria, hematologic values, relapse, and death. RESULTS: Thirty-one patients were included (females, 18; sporadic aHUS, 29; mean age, 46 ± 20 years). Twenty-six patients were treated with PE/PI alone, and 5 were deemed to be plasma-resistant and received eculizumab after stopping PE/PI. Among patients receiving eculizumab, 80% attained complete recovery of kidney function, 100% stopped dialysis, 20% had decreased proteinuria, and no patient relapsed (vs. 38.5, 50, 15.4, and 11.5%, respectively, of patients receiving only PE/PI). At 1-year of follow-up, no deaths had occurred in either group. CONCLUSION: Eculizumab shows greater efficacy than PE/PI alone for the treatment of adult aHUS patients with AKI. Prospective studies and meta-analyses are warranted to confirm our findings and set guidelines for treatment, monitoring, and maintenance.

Adaptacao do ABQ para a medida do burnout en jovens jogadores de futebol cabo-verdianos / Adaptación del ABQ para la medida del burnout en jóvenes jugadores de fútbol cabo-verdianos / Adaptation of ABQ for the burnout measurement burnout in young Cape Verdean soccer players

O ABQ é um questionário elaborado com amostras constituidas por atletas dos Estados Unidos com o propósito de medir a síndrome de burnout. Com o presente estudo pretendeu-se fazer urna adaptado para permitir que o instrumento passe a ser utilizado em Cabo Verde, país de língua oficial portuguesa. Foi administrado o questionário a urna amostra de 400 jogadores de futebol de ambos os sexos, com idades compreendidas entre 14 e 18 anos. Utilizando a aproximado da análise fatorial confirmatoria, foi definido um modelo de medida, á semelhan

El ABQ es un cuestionario elaborado con muestras de deportistas de los Estados Unidos para la medida del síndrome de burnout en deportistas. Con el presente estudio se pretendió hacer una adaptación para que pudiera ser utilizado en Cabo Verde de habla portuguesa. Se administró el cuestionario a una muestra de 400 futbolistas de ambos sexos y con edades comprendidas entre los 14 y los 18 años. Utilizando la aproximación del análisis factorial confirmatorio, se especificó un modelo de medida a semejanza del original tomando los ítems como indicadores de tres factores primarios: agotamiento físico/emocional (AFE), devaluación (D) y reducida sensación de logro (RSL). Los índices de ajustamiento fueron satisfactorios a nivel individual de cada parámetro y a nivel global. También fueron satisfactorios los indicadores de fiabilidad de los factores. Respecto al género de los deportistas, se obtuvo evidencia de invariancia del modelo en las cargas factoriales y en las correlaciones entre factores, pero no entre los errores de medida. En conclusión, la versión portuguesa del ABQ puede ser utilizada en Cabo Verde con las suficientes garantías psicométricas

The ABQ is a questionnaire to measurement of athlete burnout. It was elaborated with the responses of athletes of United States. The present study was the objective of adapt the ABQ to sport context of Cape Verde with Portuguese language. The Portuguese version of ABQ was administered to a sample of 400 soccer players of both sexes and with ages between 14 and 18 years old. A model with three factors as the original was specified using confirmatory factor analysis: physical/emotional exhaustion (PEE), sport devaluation (SD), reduced sense of accomplishment and (RSA). Overall fit of the model, fit individual parameters and values of reliability were satisfactory. Regarding to the gender of athletes, evidence of invariance model was confirmed in factorial loads and in correlations between factors, but not in measurement errors. In conclusion, this study shows that Portuguese version of ABQ can be used in Cape Verde with sufficient psychometric guarantees

Trasplante renal procedente de donante vivo HLA incompatible: Eficacia y pronóstico en 32 pacientes tras desensibilización / Kidney transplantation from HLA-incompatible live donors: Efficiency and outcome of 32 patients after desensitisation

La desensibilización es un método empleado en trasplante renal para tratar de trasplantar a pacientes que presentan una prueba cruzada positiva frente a su donante. El objetivo del estudio es mostrar los resultados de nuestro hospital en pacientes trasplantados renales con donantes vivos HLA incompatibles, tras un protocolo de desensibilización. Estudiamos a 32 pacientes de 46±14 años que presentaban una intensidad media de fluorescencia (MFI) frente a HLA de clase I de 7.979±4.089 y de 6.825±4.182 para MFI frente a clase II y relative intensity scale(RIS) de 8,9±7,6. La prueba cruzada fue positiva por citotoxicidad dependiente del complemento (CDC) en 18 pacientes, citometría de flujo (CF) en 7 y anticuerpos donante específicos (ADE) en 7. El protocolo empleado fue: rituximab, plasmaféresis/inmunoadsorción, inmunoglobulinas, tacrolimus, derivados ácido micofenólico y prednisona. Tras 8±3 sesiones de plasmaféresis/inmunoadsorción se trasplantó a 23 pacientes (71,9%) y resultó ineficaz en 9. Existían diferencias basales en MFI clase I (p<0,001), RIS (p=0,008) y cross-match por CDC, ADE o CF (p=0,05). El MFI de clase I y el RIS resultaron predictores de eficacia en curvas COR. Tras un seguimiento de 43±30 meses, 13 pacientes (56%) presentaron sangrado postoperatorio, 3 (13%) función retrasada injerto, 4 (17,4%) rechazo agudo, 6 (26%) viremia CMV y uno (4%) viremia BK. Al 5.° año, la supervivencia del paciente fue del 90% y la supervivencia renal del 86%. En ese mismo año, la creatinina fue de 1,5±0,4 y la proteinuria de 0,5±0,7. Conclusiones: El trasplante renal de donante vivo HLA incompatible tras la desensibilización fue posible en el 71,9% de los pacientes. MFI de clase I y RIS predicen ineficacia de la desensibilización. La supervivencia renal (86% al 5.° año) es aceptable con baja incidencia de rechazo agudo (17,4%), aunque con una mayor tendencia al sangrado postoperatorio (AU)

Desensitisation is a procedure undergone by the recipient of a kidney transplant from a donor who is cross-match positive. The aim of this study was to present the outcomes from our hospital of kidney transplant recipients from HLA-incompatible live donors after desensitisation. We studied 32 patients aged 46±14 years with a mean fluorescence intensity (MFI) versus class I HLA of 7979±4089 and 6825±4182 MFI versus class II and relative intensity scale (RIS) of 8.9±7.6. The complement-dependent cytotoxicity (CDC) cross-matching test was positive in 18 patients, flow cytometry was positive in 7 patients and donor-specific antibodies (DEA) were detected in 7. The protocol used was rituximab, plasmapheresis/immunoadsorption, immunoglobulins, tacrolimus, mycophenolic acid derivatives and prednisone. After 8±3 sessions of plasmapheresis/immunoadsorption, 23 patients were trasplanted (71.9%) and desensitisation was ineffective in 9. There were baseline differences in MFI class I (P<.001), RIS (P=.008), and CDC cross-matching, DSA and flow cytometry (P=.05). MFI class I and RIS were predictors of inefficiency in ROC curves. After follow-up of 43±30 months, 13 patients (56%) presented postoperative bleeding, 3 (13%) delayed graft function, 4 (17.4%) acute rejection, 6 (26%) CMV viraemia and 1 (4%) BK viraemia. Five-year patient survival was 90%, with 86% allograft survival. Five-year creatinine was 1.5±0.4 and proteinuria was 0.5±0.7. Conclusions: Kidney transplantation from HLA-incompatible live donors after desensitisation was possible in 71.9% of patients. MFI class I and RIS predict the inefficiency of desensitisation. Five-year allograft survival (86%) was acceptable with a low incidence of acute rejection (17.4%), although with a greater trend towards postoperative bleeding (AU)

Kidney transplantation from HLA-incompatible live donors: Efficiency and outcome of 32 patients after desensitisation. / Trasplante renal procedente de donante vivo HLA incompatible: Eficacia y pronóstico en 32 pacientes tras desensibilización.

Desensitisation is a procedure undergone by the recipient of a kidney transplant from a donor who is cross-match positive. The aim of this study was to present the outcomes from our hospital of kidney transplant recipients from HLA-incompatible live donors after desensitisation. We studied 32 patients aged 46±14 years with a mean fluorescence intensity (MFI) versus class I HLA of 7979±4089 and 6825±4182 MFI versus class II and relative intensity scale (RIS) of 8.9±7.6. The complement-dependent cytotoxicity (CDC) cross-matching test was positive in 18 patients, flow cytometry was positive in 7 patients and donor-specific antibodies (DEA) were detected in 7. The protocol used was rituximab, plasmapheresis/immunoadsorption, immunoglobulins, tacrolimus, mycophenolic acid derivatives and prednisone. After 8±3 sessions of plasmapheresis/immunoadsorption, 23 patients were trasplanted (71.9%) and desensitisation was ineffective in 9. There were baseline differences in MFI class I (P<.001), RIS (P=.008), and CDC cross-matching, DSA and flow cytometry (P=.05). MFI class I and RIS were predictors of inefficiency in ROC curves. After follow-up of 43±30 months, 13 patients (56%) presented postoperative bleeding, 3 (13%) delayed graft function, 4 (17.4%) acute rejection, 6 (26%) CMV viraemia and 1 (4%) BK viraemia. Five-year patient survival was 90%, with 86% allograft survival. Five-year creatinine was 1.5±0.4 and proteinuria was 0.5±0.7. CONCLUSIONS: Kidney transplantation from HLA-incompatible live donors after desensitisation was possible in 71.9% of patients. MFI class I and RIS predict the inefficiency of desensitisation. Five-year allograft survival (86%) was acceptable with a low incidence of acute rejection (17.4%), although with a greater trend towards postoperative bleeding.

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study) / Alteraciones del metabolismo mineral, fracturas vertebrales, y calcificaciones aórticas en receptores estables de trasplante renal: papel del género (estudio EMITRAL)

Antecedentes y objetivos: La relación entre las alteraciones del metabolismo mineral, las fracturas óseas y las calcificaciones vasculares en receptores de un trasplante renal no han sido establecidas. Método: Realizamos un estudio transversal en 727 receptores estables procedentes de 28 centros de trasplante españoles. Se determinaron de manera centralizada los parámetros del metabolismo mineral; también se centralizó la semicuantificación de las fracturas vertebrales y de las calcificaciones de la aorta abdominal. Resultados: La deficiencia de vitamina D (25OHD3 < 15ng/ml) fue más frecuente en mujeres y en los estadios CKD-T I-III (29,6 vs. 44,4%; p=0,003). La relación inversa y significativa observada entre los niveles de 25OHD3 y PTH fue modificada por el género de tal manera que la pendiente fue mayor en las mujeres que en los hombres (p=0,01). Un 15% de los receptores mostró alguna fractura vertebral (VFx) con un grado de deformidad ≥2. Los factores relacionados con la VFx diferían en función del género: en los hombres, la edad (OR: 1,04; IC 95%: 1,01-1,06) y el tratamiento con CsA (OR: 3,2; IC 95: 1,6-6,3); en las mujeres la edad (OR: 1,07; IC 95%: 1,03-1,12) y los niveles de PTH (OR per 100pg/ml increase: 1,27; IC 95%: 1,043-1,542). Las calcificaciones de la aorta abdominal fueron comunes (67,2%) y se relacionaron con los factores de riesgo clásicos, pero no con los parámetros del metabolismo mineral. Conclusiones: La deficiencia de vitamina D es más frecuente en las mujeres receptoras de un trasplante renal y en los estadios más tempranos de la CKD-T, y es un factor que contribuye al desarrollo de hiperparatiroidismo secundario. Las VFx prevalentes están relacionadas con unos niveles más elevados de PTH solamente en las mujeres (AU)

Background and objectives: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. Method: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. Results: Vitamin D deficiency (25OHD3 < 15 ng/ml) was more common in female recipients at CKD-T stages I–III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100 pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. Conclusions: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients (AU)

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study).

BACKGROUND AND OBJECTIVES: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. METHOD: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. RESULTS: Vitamin D deficiency (25OHD3<15ng/ml) was more common in female recipients at CKD-T stages I-III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. CONCLUSIONS: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients.

Perfiles de rendimiento de selecciones ganadoras y perdedoras en el Mundial de fútbol Sudáfrica 2010 / Performance profiles of winning and losing temas participating in the 2010 Fifa world cup in south Africa / Performance profiles of winning and losing teams participating in the 2010 fifa world cup in south africa / Perfis de rendimento de selecções ganhadoras e perdedoras no mundial de futebol da áfrica do sul 2010

El objetivo del presente estudio fue evaluar la prestación competitiva de equipos de fútbol de alto nivel, con el fin de diferenciar su perfil de rendimiento, tomando como criterio de agrupación el resultado final de los partidos (equipos ganadores vs equipos perdedores). Se aplicó una Batería Multidimensional de Indicadores de Rendimiento (BMIR) compuesta por seis índices: Índice de Iniciativa de Juego (IIJ), Índice de Progresión en el Juego Ofensivo (IPROJO), Índice de Precisión en el Juego Ofensivo (IPREJO), Índice de Volumen de Juego (IVJ), Índice de Carga Física1 (ICF1) e Índice de Carga Física2 (ICF2). Se analizaron 64 encuentros pertenecientes al Mundial de Fútbol celebrado en Sudáfrica 2010. Análisis estadísticos de comparaciones de medias entre ganadores y perdedores permitieron concluir que los equipos ganadores presentan valores estadísticamente más altos en cuatro de los seis índices de rendimiento utilizados: IIJ (p < .001), IPROJO (p = .002), IPREJO (p = .028) e IVJ (p = .001). No se obtuvieron, sin embargo, diferencias estadísticamente significativas entre ambos grupos en los índices ICF1 e ICF2 (p > .05). La utilización por parte de investigadores y entrenadores de la BMIR puede representar una herramienta muy útil para la evaluación del rendimiento y orientación de los contenidos de entrenamiento en fútbol de alto nivel

The aim of this study was to evaluate the competitive performance of elite football teams in order to differentiate their performance profiles, by taking the final result of the games (winning teams vs. losing teams) as a criterion. We applied a Multi-Dimensional Battery of Performance Indicators (MBPI) comprising six indices: Game Initiative Index (GII), Offensive Game Progression Index (OGPROI), Offensive Game Precision Index (OGPREI), Game Volume Index (GVI), Physical Load Index1 (PLI1) and Physical Load Index2 (PLI2). A total of 64 games from the 2010 FIFA World Cup in South Africa were analysed. Statistical analyses of comparisons of means between winners and losers made it possible to conclude that the winning teams showed statistically higher values in four of the six performance indices used: GII (p < .001), OGPROI (p =.002), OGPREI (p = .028) and GVI (p = .001). Nonetheless, no statistically significant differences were obtained between the two groups in the PLI1 and PLI2 indices (p > .05). The MBPI may prove to be a highly useful tool for researchers and coaches in evaluating performance, and orienting training content in elite football

O objectivo do presente estudo foi avaliar a prestação competitiva de equipas de futebol de alto rendimento, visando diferenciar o seu perfilde rendimento, adoptando como critério de agrupamento o resultado final dos jogos (equipas ganhadoras vs equipas perdedoras). Foi aplicada umaBateria Multidimensional de Indicadores de Rendimento(BMIR) composta por seis índices: Índice de Iniciativa de Jogo(IIJ), Índice de Progressão noJogo Ofensivo(IPROJO), Índice de Precisão no Jogo Ofensivo(IPREJO), Índice de Volume de Jogo(IVJ), Índice de Carga Física1(ICF1) e Índice deCarga Física2(ICF2). Foram analisados 64 jogos pertencentes ao Mundila de Futebol celebrado na África do Sul 2010. As análises estatísticas decomparações de médias entre ganhadores e perdedores permitiram concluir que as equipas ganhadoras apresentam valores estatisticamente mais elevadosem quatro dos seis índices de rendimento utilizados: IIJ (p< .001), IPROJO (p= .002), IPREJO (p= .028) e IVJ (p= .001). Contudo, não foram obtidasdiferenças estatisticamente significativas entre ambos os grupos nos índices ICF1 e ICF2 (p> .05). A BMIR pode ser uma ferramenta muito útil paratreinadores e investigadores no que concerne à avaliação do rendimento e da orientação de conteúdos do treino no futebol de alto rendimento

Estudio piloto comparativo de dos soluciones de sellado en catéteres de hemodiálisis: heparina sódica al 5 por ciento frente a fibrilin® / Comparative pilot study of two haemodialysis catheter lock solutions: 5 percent heparin sodium compared to fibrilin®

El sellado de catéteres en hemodiálisis suele ser motivo de controversia entre los distintos profesionales dedicados a la hemodiálisis. El objetivo del presente estudio es comparar dos soluciones de sellado de catéter para hemodiálisis: heparina al 5% y fibrilin (heparina 20ui/ml + metil y propilparaben). Estudiamos 8 pacientes (mujeres) de 69±12 años portadoras de catéter tunelizado de 17±7 meses de duración del catéter, estables y que habían dado su consentimiento para el estudio. Inicialmente se selló con fibrilin durante un mes (12 sesiones) y posteriormente con heparina al 5% el mismo periodo de tiempo. Se registró velocidad de bomba, flujo efectivo, presión venosa, KT, necesidad de utilizar fibrinolíticos, infecciones, nº de manipulaciones, hipotensiones, recirculación, KT/V, TP, TPTA. Se compararon los estudios mediante t student. Después de dos meses de estudio se observó mayor flujo efectivo 318±23 ml/m en catéteres sellados con heparina frente a 307±17 ml/m con fibrilin (p= 0,008), menor presión venosa 147±12 mm Hg en heparina frente a 168±17 en fibrilin (p=0,006), mayor KT en heparina 43±3 litros frente a 41±4 litros en fibrilin. A pesar de estas mejores condiciones, clínicamente no supusieron diferencias en la eficacia dialítica KT/V heparina 1,56±0,2 frente a 1,59 ±0,2 en fibrilin. Si se observó un mayor nº de manipulaciones del catéter en heparina 12±0,2 frente a 9,4±1,3 en fibrilin (p=0,001). No existieron diferencias en aparición de infecciones, recirculación, necesidad de fi brinoliticos o alteraciones de coagulación. Concluimos que el sellado de catéteres de Hemodiálisis con Fibrilin es una alternativa eficaz a la heparina al 5%. No se acompaña de un mayor grado de disfunción del catéter y si de un menor nº de manipulaciones, lo que podría condicionar un menor nº de infecciones asociado a catéteres(AU)

Catheter locks in haemodialysis are usually a source of controversy among the different professionals involved in haemodialysis. The aim of this study is to compare two haemodialysis catheter lock solutions: 5% heparin and fibrilin (heparin 20ui/ml + methyl and propyl paraben). We studied 8 patients (women) aged 69±12 years with tunnelled catheters of 17±7 months’ duration, whose condition was stable and who had given their consent to the study. Initially, the fibrilin lock solution was used with the catheters for one month (12 sessions) and then 5% heparin for the same length of time. Pump speed, effective flow, venous pressure, KT, the need to use fibrinolytics, infections, number of handlings, hypotension episodes, recirculation, KT/V, TP, TPTA were measured. The results were compared using student’s t-test. After two months of study, a greater effective flow 318±23 ml/m was observed in catheters with heparin lock compared to 307±17 ml/m with fibrilin (p= 0.008), lower venous pressure 147±12 mm Hg in heparin compared to 168±17 in fibrilin (p=0,006), higher KT in heparin 43±3 litres compared to 41±4 litres in fibrilin. Despite these better conditions, they did not represent clinical differences in dialysis efficacy, KT/V heparin 1.56±0.2 compared to 1.59 ±0.2 in fibrilin. A higher number of catheter handlings was observed in heparin 12±0.2 compared to 9.4±1.3 in fibrilin (p=0.001). There were no differences in the appearance of infections, recirculation, need for fi brinolytics or coagulation alterations. We conclude that the use of fibrilin lock solution for haemodialysis catheters is an effective alternative to 5% heparin. It is not accompanied by a higher degree of catheter dysfunction but does involve less handling, which could lead to fewer catheter-associated infections(AU)

Inventario de Burnout en Deportistas Revisado (IBD-R) / Burnout in Sport Revised Questionnaire (IBD-R)

La revisión del Inventario de Burnout en Deportistas (IBD) supone ofrecer una versión mejorada del primer instrumento de evaluación del síndrome que se utilizó en nuestro país. El IBD, que ha permitido profundizar en el conocimiento del burnout tanto desde una perspectiva investigadora como aplicada, requería mejores ajustes estadísticos que, entre otras cuestiones, garantizaran la mejor medida posible de este problema psicológico en deportistas. Se presenta en la introducción el estado actual de la medida del burnout, revisando la evolución de la misma. Se describe, en el apartado de metodología las características principales de los 460 deportistas que configuran la muestra, y a lo largo del apartado de resultados se da cuenta de una serie de indicadores psicométricos que nos hacen ser optimistas en cuanto a la evolución lograda con el IBD-R que ofrecemos, así como con la evaluación que ofrece del burnout a través de sus tres dimensiones: Agotamiento Emocional, Despersonalización y Reducida Realización Personal, discutiendo los mismos al final del trabajo (AU)

A review of the Athlete Burnout Inventory (ABI) offers an improved version of the first measurement tool of the syndrome that was used in our country. The ABI, which has made it possible to further knowledge of burnout from both a research and applied perspective, required best statistical fits which, among other issues, would ensure the best possible measurement of this psychological problem in athletes. The present state of the measurement of burnout appears in the introduction, reviewing its evolution. The basic characteristics of the 460 athletes forming the sample are described, in the section on methodology, and throughout the section on results, we find a series of psychometric indicators that lead us to be optimistic as to the developments achieved with ABI-R, as well as the burnout measurement it offers through its three dimensions: Emotional Exhaustion, Depersonalization, and Reduced Sense of Personal Accomplishment (AU)

Enteric-coated mycophenolate sodium in de novo and maintenance kidney-pancreas transplant recipients.

BACKGROUND: Our objective was to describe efficacy and safety of enteric-coated mycophenolate sodium (EC-MPS) in de novo and maintenance recipients of kidney-pancreas transplant in the clinical practice. METHODS: Observational, multicentre, prospective, 12-month study. RESULTS: We included 24 de novo and 24 maintenance patients. EC-MPS mean (± SD) doses at initiation in de novo patients were 1440 ± 0 vs. 1268 ± 263 mg/d at month 12 (M12). Patient and renal graft survival at one yr were 100%, and pancreatic graft survival was 83.3% (two losses owing to technical failure and two owing to rejection). In the maintenance cohort, EC-MPS was introduced at a median (P25-P75) of 30 (6-71) months after transplant. Baseline doses were 585 ± 310 vs. 704 ± 243 mg/d at M12. In this group, a significant increase in creatinine clearance was observed (65 ± 22 at baseline vs. 74 ± 20 mL/min at M12, p = 0.011). Patient, renal, and pancreatic graft survival were 100%, 95.8%, and 100%, respectively (one kidney graft loss owing to rejection). During follow-up, one patient from each group discontinued EC-MPS. CONCLUSIONS: The efficacy of EC-MPS in the clinical practice of kidney-pancreas transplantation is good, with high patient and grafts survival at 12 months, and good safety profile. The maintenance group displayed an improvement in renal function.

HIV infection and renal transplantation.

BACKGROUND: Some aspects of kidney transplant outcome in human immunodeficiency virus (HIV)-infected patients are still controversial. Besides, published experience is scarce in Europe. METHODS: A multicentre case-control study was designed to analyse the outcome of renal transplant in HIV + patients in Spain. Twenty HIV + patients were compared with a matched cohort of 40 HIV - recipients. RESULTS: Post-transplant follow-up period was 39.98 ± 36.51 months. Pre-transplant dialysis duration and the incidence of pre-transplant opportunistic infections were significantly higher for HIV + patients. Following transplantation, HIV + recipients presented lower incidence of immediate renal function and more acute rejection. Graft survival was lower although the difference was not significant (1 year: 85 vs 97.5%; 5 years: 74.4 vs 91%; log-rank P = 0.058). There was no difference in patient survival rates. Eight patients in each group presented hepatitis C (HCV) infection. Coinfected patients were compared with HIV +/HCV - and HIV -/HCV + recipients. Coinfected patients presented more time on dialysis, greater duration of delayed graft function and lower graft survival (HIV +/HCV + vs HIV +/HCV -: log-rank P = 0.009; HIV +/HCV + vs HIV -/HCV +: log-rank P = 0.02). Conversely, when excluding HCV + patients in both groups, graft survival in HIV + and HIV - patients was similar. CONCLUSIONS: The outcome was good, particularly in non-coinfected patients. Coinfected patients constitute an especially high-risk group for kidney transplantation.

[Psychometric properties of the Spanish version of the Revised Competitive State Anxiety Inventory-2 with athletes]. / Propiedades psicométricas de la versión española del Inventariode Ansiedad Competitiva CSAI-2R en deportistas.

The aim of this work was to develop a Spanish adaptation of the Revised Competitive State Anxiety Inventory-2. The scale was translated and its psychometric properties were analyzed with data from a sample of 149 athletes. Exploratory and confirmatory factor analyses were performed which supported a 16-item CSAI-2R assessing the three hypothesised dimensions of anxiety: Somatic anxiety, Cognitive anxiety, and Self-confidence. Overall fit of the model was good with a value of .97 for Comparative and Non-Normed Fit Indexes, and .045 for Root Mean Square Error of Approximation. Cronbach alpha coefficients for the factors ranged from .79 to .83. It is concluded that this version shows adequate properties, in terms of its dimensionality and internal consistency. Guidelines are also provided for future research on its validity as a measure of state anxiety in competitive situations.

Propiedades psicométricas de la versión española del Inventario de Ansiedad Competitiva CSAI-2R en deportistas / Psychometric properties of the Spanish version of the Revised Competitive State Anxiety Inventory-2 with athletes

El objetivo del presente trabajo consistió en obtener una versión adaptada al español del inventario de ansiedad competitiva CSAI-2, revisado recientemente. Se llevó a cabo la traducción de la escala y se estudiaron sus propiedades psicométricas con una muestra de 149 deportistas. Los datos se sometieron a procedimientos de análisis factorial exploratorio y confirmatorio. Como resultado se obtuvo una forma del CSAI-2R con 16 ítems, distribuidos en las tres subescalas hipotetizadas: Ansiedad somática, Ansiedad cognitiva y Autoconfianza. El ajuste del modelo fue satisfactorio, con índices CFI y NNFI de 0.97 y RMSEA igual a 0.045. Los valores de consistencia interna de los factores se situaron entre 0.79 y 0.83. Se concluye que esta versión posee propiedades, en términos de dimensionalidad y de consistencia interna, adecuadas, y se sugieren pautas para trabajos futuros sobre su validez como medida del estado de ansiedad en situaciones de competición

The aim of this work was to develop a Spanish adaptation of the Revised Competitive State Anxiety Inventory-2. The scale was translated and its psychometric properties were analyzed with data from a sample of 149 athletes. Exploratory and confirmatory factor analyses were performed which supported a 16-item CSAI-2R assessing the three hypothesised dimensions of anxiety: Somatic anxiety, Cognitive anxiety, and Self-confidence. Overall fit of the model was good with a value of .97 for Comparative and Non-Normed Fit Indexes, and .045 for Root Mean Square Error of Approximation. Cronbach alpha coefficients for the factors ranged from .79 to .83. It is concluded that this version shows adequate properties, in terms of its dimensionality and internal consistency. Guidelines are also provided for future research on its validity as a measure of state anxiety in competitive situations

Adaptación al español del cuestionario "Perfil de los Estados de Ánimo" en una muestra de deportistas / Adaptation of the profile of Mood States into Spanish with a sample of athletes

El POMS es un cuestionario para la medida del estadode ánimo, con aplicaciones en diferentes ámbitos, particularmente en el entorno deportivo. En un trabajo preliminar (Arce, Andrade y Seoane, 2000), el POMS fue traducido al castellano y administrado a una muestra formada por 374 estudiantes. Teniendo en cuenta criterios tanto psicométricos de la versión resultante, con 63 items, en una muestra de 216 deportistas. Mediante análisis de items y análisis factorial, el cuestionario fue reducido a 48 items, que abordan 6 estados de ánimo: Cólera, Depresión (estado deprimido), Tensión, Fatiga, Vigor y Amistad. Los coeficientes de consistencia interna de los factores oscilaron entre 0,76 (Amistad) y 0,91 (Cólera). Además, se han comparado las puntuaciones de deportistas con las obtenidas por una muestra de 268 estudiantes universitarios que no practicaban deporte. Se encontraron diferencias significativas entre deportistas y no deportistas en Cólera, Tensión, Vigor y Amistad. Las diferencias observadas entre ambos grupos en Depresión no resultaron significativas. Ambos mostraron también puntuaciones similares en Fatiga (AU)

The POMS is a questionnaire for the measurement of moods, that has shown to be useful in different settings, particularly in sports. In a preliminary work (Arce, Andrade & Seoane, 2000) the POMS was translated into Spanish and administered to a 374 students’ sample. Considering both psychometric and semantic criteria, some items had to be replaced and two of them were eliminated from the original scale. The present study examined the psychometric properties of the 63-item POMS version with a sample of 216 athletes. Using item and factor analyses the questionnaire was shortened to 48 items measuring six mood factors: Anger, Depression, Tension, Fatigue, Vigor, and Friendliness. Reliability coefficients (Cronbach’s Alphas) for the factors ranged from .76 (Friendliness) to .91 (Anger). Besides, athletes’ scores were compared with the scores obtained by a sample of 268 non-athletes. Significant differences were found between athletes and non-athletes on Anger, Tension, Vigor, and Friendliness. The observed differences between both samples on Depression were not significant. They also showed similar mean scores on Fatigue (AU)