Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type.

AIM: To investigate the putative modifying effect of dual antiplatelet therapy (DAPT) use on the incidence of stent thrombosis at 3 years in patients randomized to Endeavor zotarolimus-eluting stent (E-ZES) or Cypher sirolimus-eluting stent (C-SES). METHODS AND RESULTS: Of 8709 patients in PROTECT, 4357 were randomized to E-ZES and 4352 to C-SES. Aspirin was to be given indefinitely, and clopidogrel/ticlopidine for ≥3 months or up to 12 months after implantation. Main outcome measures were definite or probable stent thrombosis at 3 years. Multivariable Cox regression analysis was applied, with stent type, DAPT, and their interaction as the main outcome determinants. Dual antiplatelet therapy adherence remained the same in the E-ZES and C-SES groups (79.6% at 1 year, 32.8% at 2 years, and 21.6% at 3 years). We observed a statistically significant (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES  vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43). CONCLUSION: A strong interaction was observed between drug-eluting stent type and DAPT use, most likely prompted by the vascular healing response induced by the implanted DES system. These results suggest that the incidence of stent thrombosis in DES trials should not be evaluated independently of DAPT use, and the optimal duration of DAPT will likely depend upon stent type (Clinicaltrials.gov number NCT00476957).

A probable dual mode of action for both L- and D-lactate neuroprotection in cerebral ischemia.

Lactate has been shown to offer neuroprotection in several pathologic conditions. This beneficial effect has been attributed to its use as an alternative energy substrate. However, recent description of the expression of the HCA1 receptor for lactate in the central nervous system calls for reassessment of the mechanism by which lactate exerts its neuroprotective effects. Here, we show that HCA1 receptor expression is enhanced 24 hours after reperfusion in an middle cerebral artery occlusion stroke model, in the ischemic cortex. Interestingly, intravenous injection of L-lactate at reperfusion led to further enhancement of HCA1 receptor expression in the cortex and striatum. Using an in vitro oxygen-glucose deprivation model, we show that the HCA1 receptor agonist 3,5-dihydroxybenzoic acid reduces cell death. We also observed that D-lactate, a reputedly non-metabolizable substrate but partial HCA1 receptor agonist, also provided neuroprotection in both in vitro and in vivo ischemia models. Quite unexpectedly, we show D-lactate to be partly extracted and oxidized by the rodent brain. Finally, pyruvate offered neuroprotection in vitro whereas acetate was ineffective. Our data suggest that L- and D-lactate offer neuroprotection in ischemia most likely by acting as both an HCA1 receptor agonist for non-astrocytic (most likely neuronal) cells as well as an energy substrate.

A probable dual mode of action for both L- and D-lactate neuroprotection in cerebral ischemia.

Lactate has been shown to offer neuroprotection in several pathologic conditions. This beneficial effect has been attributed to its use as an alternative energy substrate. However, recent description of the expression of the HCA1 receptor for lactate in the central nervous system calls for reassessment of the mechanism by which lactate exerts its neuroprotective effects. Here, we show that HCA1 receptor expression is enhanced 24 hours after reperfusion in an middle cerebral artery occlusion stroke model, in the ischemic cortex. Interestingly, intravenous injection of L-lactate at reperfusion led to further enhancement of HCA1 receptor expression in the cortex and striatum. Using an in vitro oxygen-glucose deprivation model, we show that the HCA1 receptor agonist 3,5-dihydroxybenzoic acid reduces cell death. We also observed that D-lactate, a reputedly non-metabolizable substrate but partial HCA1 receptor agonist, also provided neuroprotection in both in vitro and in vivo ischemia models. Quite unexpectedly, we show D-lactate to be partly extracted and oxidized by the rodent brain. Finally, pyruvate offered neuroprotection in vitro whereas acetate was ineffective. Our data suggest that L- and D-lactate offer neuroprotection in ischemia most likely by acting as both an HCA1 receptor agonist for non-astrocytic (most likely neuronal) cells as well as an energy substrate.

Copy number variations of colorectal cancer by whole exome sequencing data

Colorectal cancer (CRC) is the third most common cancer and the fourth leading cause of cancer death worldwide. About 85% of the cases of CRC are known to have chromosomal instability, an allelic imbalance at several chromosomal loci, and chromosome amplification and translocation. The aim of this study is to determine the recurrent copy number variant (CNV) regions present in stage II of CRC through whole exome sequencing, a rapidly developing targeted next-generation sequencing (NGS) technology that provides an accurate alternative approach for accessing genomic variations. 42 normal-tumor paired samples were sequenced by Illumina Genome Analyzer. Data was analyzed with Varscan2 and segmentation was performed with R package R-GADA. Summary of the segments across all samples was performed and the result was overlapped with DEG data of the same samples from a previous study in the group1. Major and more recurrent segments of CNV were: gain of chromosome 7pq(13%), 13q(31%) and 20q(75%) and loss of 8p(25%), 17p(23%), and 18pq(27%). This results are coincident with the known literature of CNV in CRC or other cancers, but our methodology should be validated by array comparative genomic hybridisation (aCGH) profiling, which is currently the gold standard for genetic diagnosis of CNV.

Decay of linkage disequilibrium within genes across HGDP-CEPH human samples: most population isolates do not show increased LD

Background It is well known that the pattern of linkage disequilibrium varies between human populations, with remarkable geographical stratification. Indirect association studies routinely exploit linkage disequilibrium around genes, particularly in isolated populations where it is assumed to be higher. Here, we explore both the amount and the decay of linkage disequilibrium with physical distance along 211 gene regions, most of them related to complex diseases, across 39 HGDP-CEPH population samples, focusing particularly on the populations defined as isolates. Within each gene region and population we use r2 between all possible single nucleotide polymorphism (SNP) pairs as a measure of linkage disequilibrium and focus on the proportion of SNP pairs with r2 greater than 0.8. Results Although the average r2 was found to be significantly different both between and within continental regions, a much higher proportion of r2 variance could be attributed to differences between continental regions (2.8% vs. 0.5%, respectively). Similarly, while the proportion of SNP pairs with r2 > 0.8 was significantly different across continents for all distance classes, it was generally much more homogenous within continents, except in the case of Africa and the Americas. The only isolated populations with consistently higher LD in all distance classes with respect to their continent are the Kalash (Central South Asia) and the Surui (America). Moreover, isolated populations showed only slightly higher proportions of SNP pairs with r2 > 0.8 per gene region than non-isolated populations in the same continent. Thus, the number of SNPs in isolated populations that need to be genotyped may be only slightly less than in non-isolates. Conclusion The 'isolated population' label by itself does not guarantee a greater genotyping efficiency in association studies, and properties other than increased linkage disequilibrium may make these populations interesting in genetic epidemiology.

A Case-based reasoning approach to validate grammatical gender and number agreement in Spanish language

Across Latin America 420 indigenous languages are spoken. Spanish is considered a second language in indigenous communities and is progressively introduced in education. However, most of the tools to support teaching processes of a second language have been developed for the most common languages such as English, French, German, Italian, etc. As a result, only a small amount of learning objects and authoring tools have been developed for indigenous people considering the specific needs of their population. This paper introduces Multilingual–Tiny as a web authoring tool to support the virtual experience of indigenous students and teachers when they are creating learning objects in indigenous languages or in Spanish language, in particular, when they have to deal with the grammatical structures of Spanish. Multilingual–Tiny has a module based on the Case-based Reasoning technique to provide recommendations in real time when teachers and students write texts in Spanish. An experiment was performed in order to compare some local similarity functions to retrieve cases from the case library taking into account the grammatical structures. As a result we found the similarity function with the best performance

Panorama de propriedade intelectual, transferência de tecnologia e inovação da química brasileira e a comparação com os países do BRIC

Based on Science, Technology & Innovation (ST&I) indicators, Brazil is a competitive and interesting country from the point of view of technological foreign investment. However, it is still incipient with regard to national investments, production of technological knowledge, inbound mobility of scientists and technology transfer to the productive sector. Among many other factors, global patent production is considered as an important indicator of innovation. Likewise, the balance between revenue and expenses obtained through royalties and licensing fees of technologies is also critical in mapping the diffusion and absorption of knowledge. The understanding of intellectual property and its strategic management brings a significant advantage to the economic and technological development of nations, especially in the field of chemistry, which greatly contributes to biotechnology, new materials and microelectronics - three fundamental areas for innovation in developed countries. Therefore, this article aims to map out competencies in chemistry in Brazil and evaluate science, technology and innovation indicators in the country, comparing this dynamic to the one of other BRIC members (Russia, India and China). Chemistry is the fourth biggest field of interest in Brazil based on the number of researchers registered at the governmental platform for researchers, Plataforma Lattes/CNPq, and is preceded by education, medicine and agronomy. The majority of research groups are registered in the area of materials, followed by macromolecules and polymers, pharmaceutical products and basic materials chemistry. These groups represent approximately 77% of research groups analyzed, therefore, indicating a tendency in the country. The analyses of patents in different sub-areas of chemistry reveal that non-residents file most deposits in the country, a probable reflection of the low internal intellectual property culture. Pharmaceutics and Fine Chemistry are prominent areas in the country, in line with the global trend. Among BRIC countries, China has the highest number of patents and of requests for protection in international offices. On the other hand, Brazil has the lowest number of chemical patents published at USPTO, EPO and JPO. An analysis of the transfer of technology data indicates an increase in this activity in various sub-areas of chemistry in the country. Despite the great efforts made by the country to consolidate its national innovation system, more needs to be done to put Brazil in a competitive position. In a globalized world dominated by large players, Brazil needs a lot of progress on ownership and generation of chemistry technologies to strengthen its national sovereignty. It is essential to strengthen chemical research at all levels, from elementary school to university, as an inexhaustible source of knowledge and technology that, when properly protected, may generate real public achievement and social return.

Indoor air quality at a waste incineration plant in Finland

Waste has been incinerated for energy utilization for more than a hundred years, but the harmful emissions emitted from the incineration plants did not begin to cause concern until the 1980s. Many plants were shutdown and the waste incineration plant in Kyläsaari Helsinki was one of them. In later years, new landfill regulations have increased the interest in waste incineration. During the last year, four new plants were taken into operation in Finland, Westenergy in Vaasa among them. The presence of dust has been observed indoors at Westenergy waste incineration plant. Dust is defined as particles with a diameter above 10 μm, while fine particles have a diameter smaller than 2.5 μm, ultrafine under 0.1 μm and nanoparticles under 0.05 μm. In recent years, the focus of particle health research has been changed to investigate smaller particles. Ultrafine particles have been found to be more detrimental to health than larger particles. Limit values regulating the concentrations of ultrafine particles have not been determined yet. The objective of this thesis was to investigate dust and particles present inside the Westenergy waste incineration facility. The task was to investigate the potential pollutant sources and to give recommendations of how to minimize the presence of dust and particles in the power plant. The total particle number concentrations and size distributions where measured at 15 points inside the plant with an Engine Exhaust Particle Sizer (EEPS) Spectrometer. The measured particles were mainly in the ultrafine size range. Dust was only visually investigated, since the main purpose was to follow the dust accumulation. The measurement points inside the incineration plant were chosen according to investigate exposure to visitors and workers. At some points probable leakage of emissions were investigated. The measurements were carried out during approximately one month in March–April 2013. The results of the measurements showed that elevated levels of dust and particles are present in the indoor air at the waste incineration plant. The cleanest air was found in the control room, warehouse and office. The most polluted air was near the sources that were investigated due to possible leakage and in the bottom ash hall. However, the concentrations were near measured background concentrations in European cities and no leakage could be detected. The high concentrations were assumed to be a result of a lot of dust and particles present on surfaces that had not been cleaned in a while. The main source of the dust and particles present inside the waste incineration plant was thought to be particles and dust from the outside air. Other activities in the area around the waste incineration facility are ground work activities, stone crushing and traffic, which probably are sources of particle formation. Filtration of the outside air prior entering the facility would probably save personnel and visitors from nuisance and save in cleaning and maintenance costs.

Spontaneous Focusing on Quantitative Relations and the Development of Rational Number Conceptual Knowledge

The aim of the present set of studies was to explore primary school children’s Spontaneous Focusing On quantitative Relations (SFOR) and its role in the development of rational number conceptual knowledge. The specific goals were to determine if it was possible to identify a spontaneous quantitative focusing tendency that indexes children’s tendency to recognize and utilize quantitative relations in non-explicitly mathematical situations and to determine if this tendency has an impact on the development of rational number conceptual knowledge in late primary school. To this end, we report on six original empirical studies that measure SFOR in children ages five to thirteen years and the development of rational number conceptual knowledge in ten- to thirteen-year-olds. SFOR measures were developed to determine if there are substantial differences in SFOR that are not explained by the ability to use quantitative relations. A measure of children’s conceptual knowledge of the magnitude representations of rational numbers and the density of rational numbers is utilized to capture the process of conceptual change with rational numbers in late primary school students. Finally, SFOR tendency was examined in relation to the development of rational number conceptual knowledge in these students. Study I concerned the first attempts to measure individual differences in children’s spontaneous recognition and use of quantitative relations in 86 Finnish children from the ages of five to seven years. Results revealed that there were substantial inter-individual differences in the spontaneous recognition and use of quantitative relations in these tasks. This was particularly true for the oldest group of participants, who were in grade one (roughly seven years old). However, the study did not control for ability to solve the tasks using quantitative relations, so it was not clear if these differences were due to ability or SFOR. Study II more deeply investigated the nature of the two tasks reported in Study I, through the use of a stimulated-recall procedure examining children’s verbalizations of how they interpreted the tasks. Results reveal that participants were able to verbalize reasoning about their quantitative relational responses, but not their responses based on exact number. Furthermore, participants’ non-mathematical responses revealed a variety of other aspects, beyond quantitative relations and exact number, which participants focused on in completing the tasks. These results suggest that exact number may be more easily perceived than quantitative relations. As well, these tasks were revealed to contain both mathematical and non-mathematical aspects which were interpreted by the participants as relevant. Study III investigated individual differences in SFOR 84 children, ages five to nine, from the US and is the first to report on the connection between SFOR and other mathematical abilities. The cross-sectional data revealed that there were individual differences in SFOR. Importantly, these differences were not entirely explained by the ability to solve the tasks using quantitative relations, suggesting that SFOR is partially independent from the ability to use quantitative relations. In other words, the lack of use of quantitative relations on the SFOR tasks was not solely due to participants being unable to solve the tasks using quantitative relations, but due to a lack of the spontaneous attention to the quantitative relations in the tasks. Furthermore, SFOR tendency was found to be related to arithmetic fluency among these participants. This is the first evidence to suggest that SFOR may be a partially distinct aspect of children’s existing mathematical competences. Study IV presented a follow-up study of the first graders who participated in Studies I and II, examining SFOR tendency as a predictor of their conceptual knowledge of fraction magnitudes in fourth grade. Results revealed that first graders’ SFOR tendency was a unique predictor of fraction conceptual knowledge in fourth grade, even after controlling for general mathematical skills. These results are the first to suggest that SFOR tendency may play a role in the development of rational number conceptual knowledge. Study V presents a longitudinal study of the development of 263 Finnish students’ rational number conceptual knowledge over a one year period. During this time participants completed a measure of conceptual knowledge of the magnitude representations and the density of rational numbers at three time points. First, a Latent Profile Analysis indicated that a four-class model, differentiating between those participants with high magnitude comparison and density knowledge, was the most appropriate. A Latent Transition Analysis reveal that few students display sustained conceptual change with density concepts, though conceptual change with magnitude representations is present in this group. Overall, this study indicated that there were severe deficiencies in conceptual knowledge of rational numbers, especially concepts of density. The longitudinal Study VI presented a synthesis of the previous studies in order to specifically detail the role of SFOR tendency in the development of rational number conceptual knowledge. Thus, the same participants from Study V completed a measure of SFOR, along with the rational number test, including a fourth time point. Results reveal that SFOR tendency was a predictor of rational number conceptual knowledge after two school years, even after taking into consideration prior rational number knowledge (through the use of residualized SFOR scores), arithmetic fluency, and non-verbal intelligence. Furthermore, those participants with higher-than-expected SFOR scores improved significantly more on magnitude representation and density concepts over the four time points. These results indicate that SFOR tendency is a strong predictor of rational number conceptual development in late primary school children. The results of the six studies reveal that within children’s existing mathematical competences there can be identified a spontaneous quantitative focusing tendency named spontaneous focusing on quantitative relations. Furthermore, this tendency is found to play a role in the development of rational number conceptual knowledge in primary school children. Results suggest that conceptual change with the magnitude representations and density of rational numbers is rare among this group of students. However, those children who are more likely to notice and use quantitative relations in situations that are not explicitly mathematical seem to have an advantage in the development of rational number conceptual knowledge. It may be that these students gain quantitative more and qualitatively better self-initiated deliberate practice with quantitative relations in everyday situations due to an increased SFOR tendency. This suggests that it may be important to promote this type of mathematical activity in teaching rational numbers. Furthermore, these results suggest that there may be a series of spontaneous quantitative focusing tendencies that have an impact on mathematical development throughout the learning trajectory.

A comparative study of eleven protein systems in tamarins, genus Saguinus (Platyrrhini, Callitrichinae)

The genetic variability of six tamarin taxa, genus Saguinus, was analyzed comparatively using protein data from eleven systems coded by 15 loci. S. fuscicollis weddelli and S. midas midas were the most polymorphic taxa, and S. bicolor the least. The results of the phylogenetic analyses (UPGMA and neighbor-joining) and the genetic distances between taxa were generally consistent with their geographic and probable phylogenetic relationships. Analyses of the S. bicolor and S. midas populations suggested that they represent no more than three subspecies of a single species, S. midas, with the bicolor forms belonging to a single subspecies, S. midas bicolor. If supported by additional studies, this would have important implications for the conservation of the bicolor form, which is endangered with extinction. The genetic similarity of S. fuscicollis and S. mystax was also consistent with their geographical and morphological proximity, although more data from a larger number of taxa will be required before the taxonomic relationships within the genus can be defined.

Chromosome number in germplasm accessions of Paspalum notatum (Gramineae)

Chromosome numbers are reported for 127 germplasm accessions of Paspalum notatum maintained by EMBRAPA (Empresa Brasileira de Pesquisa Agropecuária) in two research centers in Brazil. Most accessions were collected in their natural habitats in Southern Brazil. Tetraploidy (2n = 40 chromosomes) was predominant (91% of the accessions studied), confirming previous reports for the species. Eleven accessions with 2n = 20 chromosomes, although collected in the wild, are possibly derived from 'Pensacola' bahiagrass, commonly cultivated in the area since its introduction from the United States in the 60's, for the establishment of permanent pastures.

Chromosome number and secondary constriction variation in 51 accessions of a citrus germplasm bank

The mitotic chromosomes of 51 citrus accessions from the Centro Nacional de Pesquisa em Mandioca e Fruticultura Tropical, Cruz das Almas, BA, Brazil, were analyzed. The sample included representatives of 20 Citrus species, one of Poncirus and seven hybrids. All accessions showed 2n = 18 without any evidence of numerical variation. The most clearly variable karyotype feature was the number and position of secondary constrictions (SECs). In 19 accessions the SECs were not identified, mainly due to the degree of chromatin condensation. In the remainder they varied in number from one to three per karyotype. They were found in the proximal region of one of the three largest chromosome pairs, in the terminal/subterminal region of a smaller chromosome or, more seldom, terminally in a larger chromosome. Only in a few cases were such constrictions observed simultaneously in both homologues of the same chromosome pair. The high variability of this karyotype feature may be due to the activation of this region in the previous interphase but may also indicate a high structural variability and heterozygosity of citrus germplasms

Axonal pathfinding mechanisms at the cortical midline and in the development of the corpus callosum

The corpus callosum is a large fiber tract that connects neurons in the right and left cerebral hemispheres. Agenesis of the corpus callosum (ACC) is associated with a large number of human syndromes but little is known about why ACC occurs. In most cases of ACC, callosal axons are able to grow toward the midline but are unable to cross it, continuing to grow into large swirls of axons known as Probst bundles. This phenotype suggests that in some cases ACC may be due to defects in axonal guidance at the midline. General guidance mechanisms that influence the development of axons include chemoattraction and chemorepulsion, presented by either membrane-bound or diffusible molecules. These molecules are not only expressed by the final target but by intermediate targets along the pathway, and by pioneering axons that act as guides for later arriving axons. Midline glial populations are important intermediate targets for commissural axons in the spinal cord and brain, including the corpus callosum. The role of midline glial populations and pioneering axons in the formation of the corpus callosum are discussed. Finally the differential guidance of the ipsilaterally projecting perforating pathway and the contralaterally projecting corpus callosum is addressed. Development of the corpus callosum involves the coordination of a number of different guidance mechanisms and the probable involvement of a large number of molecules.

Flow regime prediction via froude number calculation in a rock-bedded stream

Mathematical predictions of flow conditions along a steep gradient rock bedded stream are examined. Stream gage discharge data and Manning's Equation are used to calculate alternative velocities, and subsequently Froude Numbers, assuming varying values of velocity coefficient, full depth or depth adjusted for vertical flow separation. Comparison of the results with photos show that Froude Numbers calculated from velocities derived from Manning's Equation, assuming a velocity coefficient of 1.30 and full depth, most accurately predict flow conditions, when supercritical flow is defined as Froude Number values above 0.84. Calculated Froude Number values between 0.8 and 1.1 correlate well with observed transitional flow, defined as the first appearance of small diagonal waves. Transitions from subcritical through transitional to clearly supercritical flow are predictable. Froude Number contour maps reveal a sinuous rise and fall of values reminiscent of pool riffle energy distribution.

Investigation par les potentiels évoqués des effets de multiples commotions cérébrales chez les athlètes

Les commotions cérébrales subies en contexte sportif constituent un sujet préoccupant. Il est estimé qu’aux États-Unis, environ cinq pourcent de l’ensemble des athlètes subiront une commotion cérébrale. Celle-ci est considérée comme une blessure transitoire dans la majorité des cas. Dans le domaine de la commotion cérébrale sportive, le phénomène de risque accru chez des athlètes ayant subi préalablement des commotions cérébrales est bien documenté. Cet aspect remet en question l’aspect transitoire de la blessure. Les techniques d’imagerie fonctionnelle offrent un grand potentiel dans la compréhension de cette pathologie en montrant notamment les différences fonctionnelles chez des participants ayant subi un traumatisme crânio-cérébral léger en l’absence de résultats comportementaux. Il est probable que des altérations fonctionnelles persistent au-delà de la phase de récupération postsymptômes. L’électrophysiologie, en particulier les potentiels évoqués cognitifs sont un outil de choix pour étudier la question en raison de leur sensibilité et de la mesure fonctionnelle qu’ils permettent d’obtenir. Les potentiels évoqués cognitifs consistent en une réponse électrique cérébrale moyenne générée lors de l’accomplissement d’une tâche. Il est possible d’identifier différentes composantes dans le tracé d’un potentiel évoqué; ces composantes sont associées à différents aspects de l’activité électrique cérébrale durant le traitement perceptuel et cognitif.Les articles scientifiques inclus dans cette thèse se penchent sur les effets de commotions cérébrales multiples chez des athlètes plusieurs mois après la dernière commotion. Dans un premier temps, l’aspect temporel est évalué par le biais de la mesure de la P3a et la P3b dans différents groupes d’athlètes. Ces composantes sont liées aux processus de mémoire et d’attention. Les résultats suggèrent que, malgré un fonctionnement normal, les athlètes ayant subi des commotions cérébrales éprouveraient de probables changements cognitifs sous-cliniques persistants se traduisant par une atténuation des P3a et P3b. Des altérations seraient aussi présentes quelques années après la dernière commotion, mais de façon plus subtile. La deuxième étude soumise s’intéresse aux processus électrophysiologiques liés au maintien de l’information en mémoire de travail visuel chez des athlètes ayant subi plusieurs commotions cérébrales. La mesure utilisée est la SPCN (sustained posterior controlateral negativity), une composante ERP spécifique au processus cognitif étudié. Les résultats montrent non seulement une composante atténuée chez les athlètes ayant subi trois commotions cérébrales ou plus, mais aussi une modulation de la composante en fonction du nombre de commotions cérébrales subies. Ces résultats pourraient contribuer à expliquer le risque accru de subir des commotions cérébrales subséquentes observées chez ces athlètes. En lien avec la littérature, ces données pourraient s’expliquer par la présence de déficits cognitifs sous-cliniques ou encore par la mise en place de mécanismes compensatoires. Enfin, ces résultats invitent à une grande prudence dans la gestion des cas de commotions cérébrales ainsi qu’à un effort d’éducation plus poussé chez les jeunes athlètes afin qu’ils puissent prendre les meilleures décisions concernant leur avenir.