Utility of Brain Injury Biomarkers in Children With Congenital Heart Disease Undergoing Cardiac Surgery.

BACKGROUND: Congenital heart disease (CHD) affects roughly 40,000 children annually. Despite advancements, children undergoing surgery for CHD are at an increased risk for adverse neurological outcomes. At present, there is no gold standard for the diagnosis of cerebral injury during the perioperative period. OBJECTIVE: To determine the utility of brain injury biomarkers in children undergoing cardiac surgery. METHODS: We searched PUBMED, EMBASE, LILACS, EBSCO, ClinicalTrials.gov, Cochrane Databases, and OVID interface to search MEDLINE through July 2021 and assessed the literature following the snowball method. The search terms used were "congenital heart disease," "cardiopulmonary bypass," "biomarkers," "diagnosis," "prognosis," and "children." No language or publication date restrictions were used. Papers studying inflammatory and imaging biomarkers were excluded. The risk of bias, strengths, and limitations of the study were reported. Study was registered in PROSPERO ID: CRD42021258385. RESULTS: A total of 1449 articles were retrieved, and 27 were included. Eight neurological biomarkers were examined. Outcomes assessed included prognosis of poor neurological outcome, mortality, readmission, and diagnosis of brain injury. Results from these studies support that significant perioperative elevations in brain injury biomarkers in cerebrospinal fluid and serum, including S100B, GFAP, NSE, and activin A, may be diagnostic of real-time brain injury and serve as an independent predictor of adverse neurological outcomes in patients with CHD undergoing cardiopulmonary bypass. CONCLUSIONS: There are limited homogeneous data in the field, limiting the generalizability and comparability of the results. Further large-scale longitudinal studies addressing neurological biomarkers in children undergoing CHD corrective surgery are required to support the routine use of neuronal biomarkers in this population.

Ankle joint flexibility affects undulatory underwater swimming speed.

The movement of undulatory underwater swimming (UUS), a swimming technique adapted from whales, is mainly limited by human anatomy. A greater ankle joint flexibility could improve the imitation of the whale's flap of the fin and therefore enhance USS performance. The aim of this study was to investigate the impact of ankle joint flexibility on swimming velocity and kick efficiency during UUS by comparing kinematics of swimming trials with reduced, normal, and enhanced maximum angles of plantar flexion. Ten well trained swimmers (5m and 5f; 22 ± 4years; 177 ± 7cm; 74 ± 15kg), performed multiple trials of UUS with normal, restricted, and increased ankle joint flexibility on two separate days in randomized order. Kick frequency was controlled by a metronome. Plantar flexion (PF) was restricted by tape application on both feet and increased by passive-dynamic stretching. All trials were filmed. Kinematics were obtained with two-dimensional motion analysis. Tape application restricted maximum PF by 10.42% while stretching increased PF by 6.87% compared to normal PF. Swimming velocity and kick efficiency significantly decreased during swimming with restricted PF (1.13 ± 0.13m*s-1; 0.69 ± 0.09m) compared to normal (1.20 ± 0.14 m*s-1; 0.72 ± 0.10m) and increased (1.22 ± 0.15m*s-1; 0.73 ± 0.10m) PF. Swimming velocity and kick efficiency did not differ between normal and increased PF. Body height normalized swimming velocity correlated significantly with PF angle (r = 0.538). The results suggest that UUS velocity is affected by impaired PF. Particularly swimmers with low or average maximum PF angles may benefit from a long-term ankle joint flexibility program to improve their UUS performance.

Clinical application of genomic high-throughput data: Infrastructural, ethical, legal and psychosocial aspects.

Genomic high-throughput technologies (GHTT) such as next-generation sequencing represent a fast and cost-effective tool toward a more comprehensive understanding of the molecular background of complex diseases. However, technological advances contrast with insufficient application in clinical practice. Thus, patients, physicians, and other professionals are faced with tough challenges that forestall the efficient and effective implementation. With the increasing application of genetic testing, it is of paramount importance that physicians and other professionals in healthcare recognize the restrictions and potential of GHTT, in order to understand and interpret the complex data in the context of health and disease. At the same time, the growing volume and complexity of data is forever increasing the need for sustainable infrastructure and state-of-the-art tools for efficient data management, including their analysis and integration. The large pool of sensitive information remains difficult to interpret and fundamental questions spanning from billing to legal, social, and ethical issues have still not been resolved. Here we summarize and discuss these obstacles in an interdisciplinary context and suggest ways to overcome them. Continuous discussion with clinicians, data managers, biostatisticians, systems medicine experts, ethicists, legal scholars, and patients illuminates the strengths, weakness, and current practices in the pipeline from biomaterial to sequencing and data management. This discussion also highlights the new, cross-disciplinary working collaborations to realize the wide-ranging challenges in clinical genomics including the exceptional demands placed on the staff preparing and presenting the data, as well as the question as to how to report the data and results to patients.

Power vs strength training to improve muscular strength, power, balance and functional movement in individuals diagnosed with Parkinson's disease.

BACKGROUND: Declines in strength and power are cardinal symptoms of Parkinson's disease (PD), a progressive neuromuscular disorder. Progressive resistance training (PRT) has been shown to reduce a wide variety of PD-related motor deficits; however, no study has examined differences between the two most common RT methodologies utilized in this population, high-load, low velocity strength training (ST) and low-load, high-velocity power training (PT). The primary purpose of this study was to compare the effects of ST and PT on measures of strength, power, balance and functional movement in persons with PD. METHOD: Thirty-five persons with mild to moderate PD (Hoehm and Yahr Stages = 1-3; UPDRS Part III = 30.6 ±â€¯14.0) were randomized into either a ST or PT group involving 12 weeks of supervised PRT (2 visits per week). Leg press (LP) and chest press (CP) muscular strength (1RM) and muscular peak power (PP) were assessed before and after the twelve week training period as primary outcome measures. In addition, secondary measures of balance (Berg Balance Assessment (BBA), dynamic posturography (DMA), Modified Falls Efficacy Scale (MFES)), functional movement (timed up-and-go), and quality of life (PDQ-39 summary index and Mobility subscore) were obtained at the same time points, given the impact of PD symptoms on fall probability and independence. RESULTS: Repeated measures ANCOVA revealed significant improvements in LP 1RM (Mdiff = 54.89 kg, 95% CI: 43.38, 66.40; p < .05; d = 3.38) and CP 1RM (Mdiff = 7.33 kg, 95% CI: 4.75, 9.91; p < .05; d = 2.02). Additionally, significant improvements were seen in LPPP (Mdiff = 112.27 W, 95% CI: 56.03, 168.51; p < .05; d = 1.42) and CPPP (Mdiff = 52.1 W, 95% CI: 23.38, 80.86; p = .001; d = 1.29). No significant improvements were seen for any secondary outcome measures, however BBA scores were shown to significantly decrease following the intervention (Mdiff = -1.686, 95% CI: -2.89, -0.482; p = .007 d = -0.96), although this change did not reach clinical significance (clinically meaningful change = ±4.0). In addition, the ST group demonstrated significantly poorer PDQ-39SI scores (Mdiff = 4.96, 95% CI: 0.54, 9.38; p = .029), whereas the entire sample showed significantly poorer PDQ-39MOB scores (Mdiff = 4.80, 95% CI: 0.17, 9.43; p = .043; d = 0.71). CONCLUSIONS: Both ST and PT appear to be effective at reducing the neuromuscular deficits associated with PD; however, the use of these interventions for improving functional performance was not supported.