Effects of combined endurance and strength training on muscle strength, power and hypertrophy in 40-67-year-old men

Both strength and endurance training have several positive effects on aging muscle and physical performance of middle-aged and older adults, but their combination may compromise optimal adaptation. This study examined the possible interference of combined strength and endurance training on neuromuscular performance and skeletal muscle hypertrophy in previously untrained 40-67-year-old men. Maximal strength and muscle activation in the upper and lower extremities, maximal concentric power, aerobic capacity and muscle fiber size and distribution in the vastus lateralis muscle were measured before and after a 21-week training period. Ninety-six men [mean age 56 (SD 7) years] completed high-intensity strength training (S) twice a week, endurance training (E) twice a week, combined training (SE) four times per week or served as controls (C). SE and S led to similar gains in one repetition maximum strength of the lower extremities [22 (9)% and 21 (8)%, P<0.001], whereas E and C showed minor changes. Cross-sectional area of type II muscle fibers only increased in S [26 (22)%, P=0.002], while SE showed an inconsistent, non-significant change [8 (35)%, P=0.73]. Combined training may interfere with muscle hypertrophy in aging men, despite similar gains in maximal strength between the strength and the combined training groups.

[Laryngotracheal separation as treatment for severe bronchopulmonary aspiration]

We present the case of a patient with brain stem tumour and severe chronic aspiration. The bilateral dysfunction of lower cranial nerves and the severe gastroesophageal reflux contributed to the aspirations. Despite medical treatment and cuffed tracheotomy tube, she required almost constant hospitalization for a year and a half due to respiratory infections. Laryngotracheal separation dramatically reduced the infections and improved her quality of life.

Incidence and significance of K-RAS mutation in first line treatment of colorectal cancer (cc): Experience of a single institution (Hospital Universitario Central de Asturias (HUCA))

e15081

Background: Although the significance of K-RAS mutation and cetuximab/panitumumab has been established in first line (ASCO 08 abstract 2# and 4000#) and in previously treated patients (pts) (NEJM 2008; 359: 1757. JCO 2008; 26: 374. JCO 2008; 26: 1626), data of the significance of this mutation in relation to bevacizumab is scarcer (JNCI 2005; 97: 981). Methods: Sample tissue of alive patients diagnosed of stage IV colorectal cancer were analyzed for the presence of K-RAS mutation by PCR amplification and direct sequencing. Data regarding presence of K-RAS mutation were retrospectively analyzed in relation to clinical data. Results: From IV to XII 08 122 paraffin embedded samples were analyzed. The percentage of mutant cases were 41% (95% CI 32–51%). The most frequent mutant type was Gly12Asp (37%) followed by Gly12Val (25%) and Gly13Asp (19%). We have clinical data of 94 pts. 62 were men and 32 female. 25 pts had received previous complementary treatment; in 80 pts primary tumor was previously resected (85%); median number of affected organs was 1 (1–4); in first line 76 pts received bevacizumab and 18 did not received any biological agent. Response Rate (RR) between mutant and no mutant pts was 48% (95% CI 37–59%) vs 47.8% (95% CI 32–63%) (p=0.92). Median follow up was 15.4 months. Progression free survival was 15 months for mutant and native K-RAS. There were no differences in response or PFS in any subgroup studied. Multivariable Cox analysis did not find any significant difference between sex (p=0.78), primary resected organ (p=0.28), liver metastases (p=0.37), LDH value at diagnosis (p=0.0.43), employ of biological agents in first line (p=0.37) or mutation in K-RAS gene (p=0.68). Conclusions: The percentage of K-RAS mutants is coherent with the results of the literature; mutations Gly12Asp, Gly12Val, and Gly13Asp represents the majority of the cases (81%); no significant relation was found between responses or DFS and mutations in the gene.

No significant financial relationships to disclose.

[Functional capacity evaluation in a clinical and ambulatory setting: new challenges of accelerometry to assessment balance and muscle power in aging population]

If we consider a population of free-living individuals, who are 65 years old and even older, a substantial proportion (in the range of 6% to 25%) suffers from many of the elements of the syndrome of frailty. Although the syndrome is complex and still lacks a standard definition, there is a growing consensus about its signs and symptoms. Patients who are afflicted with frailty typically exhibit losses of muscle strength, fatigue easily, are physically inactive, with an increased risk (and fear) of falling, have undergone a recent, unintentional loss of weight, experience impaired cognition and depression, all of which is frequently complicated by a variety of coexistent illnesses. In this context, functional tests to predict disability and frailty are needed. Accelerometry offers a practical and low cost method of objectively monitoring human movements, and has particular applicability to the monitoring of disability in an aging population. Accelerometers have been used to monitor a range of different movements, including gait, sit to stand transfers and postural sway. This review focuses on methodological concepts in the evaluation of skeletal muscle function and monitoring systems (accelerometers and gyroscopes) in each of these areas. An integrated approach is described in which a combination of accelorometry and gyroscopy can be used to monitor a range of different parameters (muscle power, gait and balance) in an aging population in a clinical or out-patient setting.

Environmental, physical and structural characterisation of geopolymer matrixes synthesised from coal (co-)combustion fly ashes

The synthesis of geopolymer matrixes from coal (co-)combustion fly ashes as the sole source of silica and alumina has been studied in order to assess both their capacity to immobilise the potentially toxic elements contained in these coal (co-)combustion by-products and their suitability to be used as cement replacements. The geopolymerisation process has been performed using (5, 8 and 12 M) NaOH solutions as activation media and different curing time (6-48 h) and temperature (40-80 degrees C) conditions. Synthesised geopolymers have been characterised with regard to their leaching behaviour, following the DIN 38414-S4 [DIN 38414-S4, Determination of leachability by water (S4), group S: sludge and sediments. German standard methods for the examination of water, waste water and sludge. Institut für Normung, Berlin, 1984] and NEN 7375 [NEN 7375, Leaching characteristics of moulded or monolithic building and waste materials. Determination of leaching of inorganic components with the diffusion test. Netherlands Normalisation Institute, Delft, 2004] procedures, and to their structural stability by means of compressive strength measurements. In addition, geopolymer mineralogy, morphology and structure have been studied by X-ray diffraction (XRD), scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR), respectively. It was found that synthesised geopolymer matrixes were only effective in the chemical immobilisation of a number of elements of environmental concern contained in fly ashes, reducing (especially for Ba), or maintaining their leachable contents after the geopolymerisation process, but not for those elements present as oxyanions. Physical entrapment does not seem either to contribute in an important way, in general, to the immobilisation of oxyanions. The structural stability of synthesised geopolymers was mainly dependent on the glass content of fly ashes, attaining at the optimal activation conditions (12 M NaOH, 48 h, 80 degrees C) compressive strength values about 60 MPa when the fly ash glass content was higher than 90%.

Detección múltiple de SNPS relacionados con crecimiento y calidad de carne en porcino

Se describe un método basado en análisis por primer extension para genotipar simultáneamente 7 SNPs relacionados con el crecimiento y la calidad de la carne en porcino. Las muestras de ADN genómico fueron obtenidas de 193 animales pertenecientes a varias razas (54 Ibérico, 63 Duroc, 47 Large White-Landrace x Large White) y a jabalí (29). A partir de las secuencias de los genes H-FABP, MC4R y LEPR, se diseñaron 4 parejas de cebadores con el fin de amplificar las regiones del genoma porcino que contienen esos 7 SNPs. La reacción de minisecuenciación primer extension (ABI PRISM SNaPshot MultiplexTM kit. Applied Biosystem) se realizó con cebadores diseñados en las regiones flanqueantes de cada uno de los SNPs de interés. Los genotipos fueron identificados por mini-secuenciación con ABIPrism 3130 y GeneMapper 3.7 (Applied Biosystems) pudiéndose así discriminar, en una sola reacción, los diferentes alelos de los 7 SNPs de cada animal. Gracias a esta técnica han sido detectados los polimorfismos T221C y C233T del gen LEPR (Genbank AF092422), que no eran reconocibles por enzimas de restricción. Este método permite identificar los animales con genotipo más deseables para la selección.

Differences in Physical Fitness and Throwing Velocity Among Elite and Amateur Female Handball Players

This study compared physical characteristics (body height [BH], body mass [BM], body fat [BF], and fat free mass [FFM]), one repetition maximum bench press (1RM (BP)), jumping explosive power (VJ), handball throwing velocity, power-load relationship of the leg and arm extensor muscles, 5- and 15-m sprint running time, and running endurance in elite (n = 16; EF) and amateur (n = 15; AF) female handball players aged 17 - 38. Results revealed that, compared to AF, EF players presented similar values in body mass and percent body fat, but higher values (p < 0.001 - 0.05) in BH (6 %), FFM (10 %), 1RM (BP) (23 %), VJ (10 %), handball throwing velocity (11 %), power-load relationship of the arm (25 %) and leg (12 %) extensors, as well as 5- and 15-m sprint (3 - 4 %) and endurance running velocities (13 %). Univariate regression analyses showed that 1RM (BP) was associated with throwing velocity (R (2) = 0.64). The higher absolute values of maximal strength and muscle power, although explained by the differences in fat free mass, will give EF an advantage to sustain certain handball game actions. The association between 1RM (BP) and throwing velocity suggests that throwing velocity values in female handball players depend more on maximal strength than on the capacity to move low loads at high velocities, during elbow extension actions.

[Rare Diseases: chronic diseases that need a new approach]

The concept of Rare Diseases is relatively new. They are those processes "...that can be mortal or to cause a chronic weakening of the patient and who, due to its little prevalence, require combined efforts to treat them. For indicative purposes, a little prevalence is considered when is lesser than 5 cases per 10,000 people in the Community". The existence of these diseases is closely tied with orphan drugs, meaning all drugs, prosthesis, biological agents or dietetic preparations destined to the treatment of a Rare Disease. Besides, it is necessary to add two factors more: 1. The Primary Attention physicians do not feel very motivated in their knowledge and 2. These diseases need a complex sociosanitary attention, habitually more expensive than chronic diseases. By all exposed the Rare Diseases appear like a universe that requires a new sociosanitary approach from the health system.

T lymphocyte activation signals

Activation of T lymphocytes results in immediate biochemical changes including increases in intracellular calcium levels, activation of protein kinase C (PKC) and changes in tyrosine phosphorylation. In T cells recent studies have indicated that activation of the guanine nucleotide-binding proteins p21ras is mediated by PKC, which suggests that the p21ras proteins may regulate intracellular signalling events downstream of PKC. The p21ras proteins can be activated in T cells by signals generated by triggering of the T cell antigen receptor (TCR), the CD2 antigen and the interleukin 2 receptor. Experiments using a PKC pseudosubstrate inhibitor indicate that PKC does not mediate TCR-induced activation of p21ras. These results imply that an alternative signal transduction pathway not involving PKC can regulate the activity of p21ras proteins in T cells.

mTOR Inhibitors and Their Secondary Effects in Cardiac Trasplant Recipients: A Descriptive Study

BACKGROUND

Mammalian target of rapamycin (mTOR) inhibitors are relatively new drugs in the field of cardiac transplantation (HT), hence the need for further study of their secondary effects. We described the nature and incidence of secondary effects of these drugs in a group of HT recipients.

PATIENTS AND METHODS

We studied 23 HT recipients aged 52 +/- 9 years (Male: 91%, body mass index: 27 +/- 3.7, ischemic cardiopathy: 52%, dilated cardiomyopathy: 39%) who were started on an mTOR inhibitor (everolimus: 65%, sirolimus: 35%) as part of their treatment. We have described the secondary effects detected during a follow-up period of 10.7 +/- 6 months.

RESULTS

The reasons for starting the drug were renal impairment (65%), tumors (26%), and others (8%). During follow-up, 17% of patients required a dose reduction and 12% required drug withdrawal: edemas: 4%, recurrent infection: 4%, and hemolytic-uremic syndrome: 4%. Drug-attributable edemas presented in 26% of patients. Thirty nine percent suffered an infection that required hospital admission, 89% of which were lung and all bacterial two patients died due to the infection). The mean time to first infection was 5 +/- 6 months. In patients who had a treatment change due to tumors, 50% experienced improvement. We did not detect alterations in cholesterol, triglycerides, creatinine, or leukocytes. There was a nonsignificant trend toward decreased hemoglobin and platelet levels (P = .07 and P = .056, respectively).

CONCLUSIONS

Lung infection was the principal complication among our patients treated with mTOR inhibitors. A large percentage required dose reduction (17%) and even drug withdrawal (12%) due to secondary effects.

mTOR Inhibitors: Do They Help Preserve Renal Function?

BACKGROUND

Renal function deterioration is one of the main problems facing heart transplant recipients. The mammalian target of rapamycin (mTOR) inhibitors, in combination with or replacing calcineurin inhibitors, may help preserve renal function. The aim of this study was to evaluate the progression of renal function after switching the immunosuppressive regimen.

PATIENTS AND METHODS

We studied 23 heart transplant recipients (5.5 +/- 4.5 years since transplantation). An mTOR inhibitor was introduced to replace cyclosporine (everolimus, 65%; sirolimus, 35%). Patient clinical characteristics and renal function were studied after switching. The statistical analysis used Student t test for paired data.

RESULTS

The reason for the transplantation was ischemic cardiopathy (52%), dilated myocardiopathy (39%), or other causes (9%). Mean age at time of transplantation was 52 +/- 9 years. Comorbidities were as follows hypertension (43%), insulin-dependent diabetes (22%), hypercholesterolemia (39%), and ex-smokers (70%). The reason for the switch was increased creatinine (65%), appearance of tumors (26%), or others (8%). Previous creatinine level was 1.89 +/- 0.6 mg/dL with clearance of 61.7 +/- 23 mL/min and at the end of follow-up (mean follow-up, 11 +/- 6 months) creatinine level was 2.0 +/- 1.45 mg/dL with clearance of 68.3 +/- 35 mL/min, namely, no significant difference (P = .49 and P = .57, respectively). In the subgroup of patients who switched treatment due to renal dysfunction, initial creatinine level was 2.38 +/- 0.4 mg/dL with clearance of 42.3 +/- 10 mL/min and at the end of follow-up it was 2.28 +/- 0.2 mg/dL and 43.6 +/- 11 mL/min, respectively (P = .68 for creatinine and clearance).

CONCLUSIONS

The introduction of mTOR inhibitors to the immunosuppressant regimen may be useful to delay renal functional deterioration caused by calcineurin inhibitors.

Ezetimibe in Heart Transplantation: Initial Experience

Dyslipidemia is a common problem among heart transplant (HT) recipients; it is a frequent risk factor in these patients that is exacerbated by immunosuppressive drugs. Statins are effective drugs to treat dyslipidemia in HT recipients, but control is suboptimal in some patients. Ezetimibe acts through inhibition of the enterohepatic recirculation, a mechanism different from but complementary to statins. Our objective was to assess the effect of the addition of ezetimibe to statin therapy among a population of HT patients.

PATIENTS AND METHODS

We included 19 stable patients on statin therapy with suboptimal control of cholesterol. Determinations were performed at baseline on statins and at 6 months (statins + ezetimibe). The analyzed variables were total cholesterol and fractions, triglycerides, cyclosporine levels, CPK, SGOT/SGPT, and bilirubin. The statistics were Student's t test for paired samples.

RESULTS

The overall mean age was 59 +/- 9 years with 95% males and mean BMI 27.5 +/- 3.5. The time since HT was 7 +/- 3 years. The reason for HT included ischemic heart disease in 68%. Pre-HT risk factors included in arterial hypertension in 32% and insulin-dependent diabetes mellitus in 10%, Dyslipidemia occurred in 68%; hypertriglyceridemia in 16% and hyperuricemia in 21%. Immunosuppression was cyclosporine in 100% and steroids in 94%. Type of lipid-lowering agent was simvastatin in 5%; pravastatin, 32%; atorvastatin, 58%; fibrates, 10%. The ezetimibe dose was 10 mg/day in 95% of cases. When ezetimibe was added we observed differences in total cholesterol values (total cholesterol at baseline: 279 +/- 74, total cholesterol with ezetimibe: 198 +/- 47 mg/dL; P = .0001) and LDL-cholesterol values (LDL-cholesterol at baseline: 171 +/- 69, LDL-cholesterol with ezetimibe: 109 +/- 41 mg/dL; P = .001). The remaining variables did not show significant differences.

CONCLUSION

The addition of ezetimibe to statin therapy among heart transplant patients was effective to control dyslipidemia and showed an excellent safety profile.

Targeting c-Jun and JunB proteins as potential anticancer cell therapy

The activating protein-1 transcription factor, in particular the Jun proteins play critical roles in the regulation of cell proliferation and tumor progression. To study the potential clinical relevance of interfering with JunB expression, we generated retroviruses expressing short hairpin RNA. Reduction of JunB levels causes increased proliferation and tumorigenicity in wild-type murine fibroblasts, whereas in c-Jun knockout cells p53-independent cell cycle arrest and apoptosis are induced. Using melanoma-derived B16-F10 cancer cells the combination of JunB knockdown and c-Jun/JNK inactivation leads to cell cycle arrest and apoptosis-inducing factor-dependent apoptosis. Furthermore, the combined treatment extends survival of mice inoculated with the tumor cells. These results indicate that in the absence of c-Jun, JunB can act as a tumor promoter and inactivation of both, c-Jun and JunB, could provide a valuable strategy for antitumor intervention.

Flat and Uphill Climb Time Trial Performance Prediction in Elite Amateur Cyclists

The aim of this study was to determine physiological, anthropometric, biomechanical and hormonal variables related to road flat and uphill climb performance. Eighteen elite level amateur road cyclists (21.1 +/- 3.8 yrs), homogeneous with regard to time trial performance (coefficient of variation: 2.9-5.2 %), were measured for frontal area (FA), maximal strength, power, cross-sectional area of the quadriceps femoris muscle and basal serum concentrations of total testosterone (TT), free testosterone (FT) and cortisol (C). Maximal (W (max)) and submaximal workload were measured during a progressive discontinuous maximal cycling laboratory test, and two all-out time trial performance tests (duration range: 1049-1251 s) were also conducted outdoors on two separate days: a 14-km flat road (average gradient of 0.2 %) and a 6.7-km uphill climb (average gradient of 6 %). Significant negative correlations (p < 0.01-0.001) were observed between the individuals' 14-km flat time values and the individual values of W (max) (r = - 0.90) and FA (r = - 0.73). Regression analysis showed that the individual values of the 6.7-km uphill climb trial performance time correlated significantly (p < 0.05-0.001) with those of FT (r = - 0.75) and W (max) x kg (-1) (r = - 0.66). The present results suggest that flat time trial performance in highly elite amateur cyclists is mainly related to absolute maximal workload and anthropometric variables, whereas uphill climb time trial performance is associated with maximal workload normalized to body mass, as well as with an increased anabolic-androgenic activity.

Calcineurin inhibitors affect circulating regulatory T cells in stable renal transplant recipients

INTRODUCTION

Immunosuppression, although crucial for short-term management, has been described in renal transplantation to be a major hurdle for long-term graft survival. Efforts have been directed at achieving a true state of allotolerance, thereby reducing the load of immunosuppression. Recently, increased frequencies of CD4(+)CD25(high) regulatory T cells (Tregs) have been described as an additional mechanism to induce alloimmune tolerance.

MATERIALS AND METHODS

We assessed 64 renal transplant recipients with stable renal function for at least 1 year, divided into two groups: one composed of patients receiving rapamycin but not calcineurin inhibitors (CNIs), and another, of those receiving CNIs but not rapamycin.

RESULTS

We demonstrated that T cells with a regulatory phenotype were decreased in peripheral blood of renal transplant recipients under CNI therapy compared to those who were CNI-free. The Tregs in our patients showed a modest association with renal function as measured by the delta serum creatinine, which was not significant.

CONCLUSIONS

CNIs, but not rapamycin, reduce the frequencies of circulating Tregs in renal transplant recipients. The use of rapamycin might be further exploited in strategies reducing immunosuppression in renal transplantation. Furthermore, quantification of blood Tregs may be a suitable tool to identify those recipients who are candidates for reducing immunosuppression.

Pulmonary sarcoidosis in a patient with ankylosing spondylitis treated with infliximab

We present a case of a 34 year-old male diagnosed with ankylosing spondylitis. After two years of treatment with infliximab, the patient developed a clinical picture compatible with stage II thoracic sarcoidosis. These findings resulted in the interruption of infliximab therapy. The patient was not administered new treatment since respiratory function testing did not confirm harmful repercussions. After a follow-up of 1 year, the patient is asymptomatic and radiologic tests show complete resolution of pulmonary infiltrates and mediastinal and bilateral hilar lymphad- enopathy.

Exchange and correlation effects in electronic excitations of Cu(2)O

State-of-the-art theoretical methods fail in describing the optical absorption spectrum, band gap, and optical onset of Cu(2)O. We have extended a recently proposed self-consistent quasiparticle approach, based on the GW approximation, to the calculation of optical spectra, including excitonic effects. The band structure compares favorably with our present angle-resolved photoemission measurements. The excitonic effects based on these realistic band structure and screening provide a reliable optical absorption spectrum, which allows for a revised interpretation of its main structures.

Electromyostimulation and plyometric training effects on jumping and sprint time

This study compared the effects of four-week training periods of electromyostimulation (EMS), plyometric training (P), or combined EMS and P training of the knee extensor muscles on 20 m sprint time (ST), jumping ability (Squat jump [SJ] and Countermovement jump [CMJ]), maximal isometric strength (MVC), and muscle cross-sectional area (CSA). Forty subjects were randomly assigned to one of the four treatment groups: electromyostimulation (EG), plyometric (PG), combined EMG, and P (EPG), that took place 4 times per week, and a control group (CG). Subjects were tested before and after the training program, as well as once more after 2 wk of detraining. A significant improvement (p < 0.05) in ST was observed after training (2.4 %) in EG while a significant slowing (p < 0.05) was observed (- 2.3 %) in EPG. Significant increases in EPG (p < 0.05) were observed in SJ (7.5 %) and CMJ (7.3 %) after training, while no significant changes in both jumps were observed after training and detraining for EG. A significant increase (p < 0.05) in MVC was observed after training (9.1 %) and after detraining (8.1 %) in EG. A significant increase (p < 0.05) in MVC was observed after training (16.3 %) in EPG. A significant increase (p < 0.01) in CSA was observed after training in EG (9.0 %) and in EPG (7.1 %). EMS combined with plyometric training increased the jumping height and sprint run in physically active men. In addition, EMS alone or EMS combined with plyometric training leads to increase maximal strength and to some hypertrophy of trained muscles. However, EMS training alone did not result in any improvement in jumping explosive strength development or even interfered in sprint run.

[Gene therapy in neuro-oncology]

INTRODUCTION AND DEVELOPMENT

The concept of gene therapy implies the transfer of genetic material to a cell, a tissue or an organ with the aim to cure an illness or at least to improve the clinical status of a patient. The essential components of the therapy are: a vector able to enter efficiently and selectively the target cells; and the therapeutic gene competent to cure the pathology. In cancer therapies, retroviruses are preferentially used as vectors because they only infect dividing cells. Among the most popular and successful gene therapies against cancer we find the immunotherapy, the antiangiogenic strategies, the killer-suicide genes and RNA interference against specific oncogenes.

CONCLUSIONS

Each one of these therapies have proven successful in cancer cell lines and in experimental animals where it has been shown a clear antitumoral effect in the absence of appreciable secondary effects. At present, the majority of these procedures are in clinical phases but none as yet is considered a therapeutic option.

Variations in the Frequency and Type of Infections in Heart Transplantation According to the Immunosuppression Regimen

OBJECTIVE

To evaluate the frequency of infection according to the immunosuppressive regimens used in our center.

MATERIALS AND METHODS

From 259 consecutive heart transplants we excluded pediatric cases, retransplants, combined transplants (lung and kidney) and immunosuppressive regimens with fewer than 10 cases. The six groups analyzed were: (1) OKT3 (7 days) + cyclosporine (CsA) + mycophenolate mofetil (MMF) + steroids (S); (2) OKT3 (7 days) + CsA + azathioprine (AZA) + S; (3) OKT3 (10 days) + CsA + MMF + S; (4) OKT3 (10 days) + CsA + AZA + S; (5) interleukin-2 (IL-2) antagonists + CsA + MMF + S; (6) IL-2 antagonists + tacrolimus + MMF + S. Infection was considered significant when it causal hospital admission or prolonged hospitalization.

RESULTS

With a total mean follow-up of 54 +/- 43 months, the total percentage of infection-free patients at the end of follow-up was 45.5%. Infection-free survival was lower among patients administered induction with OKT3 antibodies for 10 days, combined with cyclosporine, either with MMF (10%, group 3) or with azathioprine (27%, group 4), compared to those given IL-2 antagonists (particularly in combination with tacrolimus and MMF-69.2%, group 6).

CONCLUSIONS

The results of this study showed that infection was frequent in heart transplantation. Furthermore, induction therapy with OKT3 monoclonal antibodies was associated with an important number of infections (particularly viral infections). Comparison of the treatment groups showed that the regimen associated with fever infections included an IL-2 receptor antagonist with tacrolimus, MMF, and S.