240 research outputs found
The measurement of proprioceptive accuracy: A systematic literature review
No full textBackground: Proprioceptive accuracy refers to the individual's ability to perceive proprioceptive information, that is, the information referring to the actual state of the locomotor system, which originates from mechanoreceptors located in various parts of the locomotor system and from tactile receptors located in the skin. Proprioceptive accuracy appears to be an important aspect in the evaluation of sensorimotor functioning; however, no widely accepted standard assessment exists. In this systematic review, our goal was to identify and categorize different methods that are used to assess different aspects of proprioceptive accuracy. Methods: A literature search was conducted in 5 different databases (PubMed, SPORTDiscus, PsycINFO, ScienceDirect, and SpringerLink). Results: Overall, 1139 scientific papers reporting 1346 methods were included in this review. The methods assess 8 different aspects of proprioception: (a) the perception of joint position, (b) movement and movement extent, (c) trajectory, (d) velocity, and the sense of (e) force, (f) muscle tension, (g) weight, and (h) size. They apply various paradigms of psychophysics (i.e., the method of adjustment, constant stimuli, and limits). Conclusion: As the outcomes of different tasks with respect to various body parts show no associations (i.e., proprioceptive accuracy is characterized by site-specificity and method-specificity), the appropriate measurement method for the task needs to be chosen based on theoretical considerations and/or ecological validity
Managing Patients With Short-Term Mechanical Circulatory Support <i>JACC</i> Review Topic of the Week
No full textThe use of mechanical circulatory support for patients presenting with cardiogenic shock is rapidly increasing. Currently, there is only limited and conflicting evidence available regarding the role of the Impella (a microaxial, continuous-flow, short-term, left or right ventricular assist device) in cardiogenic shock; further randomized trials are needed. Patient selection, timing of implantation, and post-implantation management in the cardiac intensive care unit are crucial elements for success. Particular challenges at the bedside include the practical management of anticoagulation, evaluation of correct device position, and the approach to use in a patient with signs of insufficient hemodynamic support. Profound knowledge of these issues is required to enable the maximal potential of the device. This review provides a comprehensive overview of the short-term assist device and describes a practical approach to optimize care for patients supported with the device.sponsorship: Drs. Balthazar, Vandenbriele, Engstrom, Meyns, Van Mieghem, and Price have reported receiving research and/or travel funding, as well as speaker fees, from Abiomed. Dr. Balthazar was supported by a grant from the Van De Werf fund for clinical research. Dr. Vandenbriele has reported being supported by a grant from University Hospitals Leuven (Klinische onderzoeks-en opleidingsraad). Dr. Verbrugge has reported being supported by a Fellowship of the Belgian American Educational Foundation and by the Special Research Fund of Hasselt University (BOF19PD04). Dr. Adriaenssens has received speaker fees from Abiomed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Abiomed, Van De Werf fund for clinical research, University Hospitals Leuven (Klinische onderzoeks-en opleidingsraad), Belgian American Educational Foundation, Special Research Fund of Hasselt University|BOF19PD04)status: Publishe
Mechanische ventriculaire ondersteuning bij chronisch hartfalen. Reversed remodeling en het renine-angiotensine-aldosterone systeem.
No full textCardiac failure is a common and progressive disease. Despite new developments in medical treatment the progression can only be delayed but not prevented and the failing heart cannot be cured. Many patients evolve to end)stage cardiac failure in which cardiac transplantation is the only curative option left. Donor hearts are sparse and not directly available to a transplant candidate. Therefore some patients awaiting transplantation need a mechanical assist device to support their failing heart when they are on a waiting list (bridge-to-transplantation). Recent clinical and experimental trails have shown that in some cases there is a functional recovery of the failing heart when supported even to a point where explantation of the assist device is feasible (bridge-to-recovery / reversed remodeling).In sheep we will create cardiac failure by means of an infarction. Biochemical and hemodynamic measurements we be done before creation of the infarction, 6 weeks after infarction. Subsequently some animals will receive a mechanical assist device(Synergy micro-pump, CircuLite Inc., partial support pump). A second group of animals will receive a mechanical assist device and ACE-inhibitors. A third group wont receive any treatment at all and will serve as a control. After 6 weeks of support the hemodynamic measurements will be repeated. Afterwards the hearts are explanted and histological investigated. The aim of the study is to examine the effect of partial mechanical support on the left ventricle in cardiac failure (reversed remodeling) and the effects of ACE-inhibitors on this reversed remodeling process.status: Publishe
Antiplatelet therapy abrogates platelet-assisted Staphylococcus aureus infectivity of biological heart valve conduits.
No full textAlthough recent advances in pulmonary valve replacement have enabled excellent hemodynamics, infective endocarditis remains a serious complication, particularly for implanted bovine jugular vein (BJV) conduits.
We investigated contributions by platelets and plasma fibrinogen to endocarditis initiation on various grafts used for valve replacement. Thus, adherence of Staphylococcus aureus and platelets to 5 graft tissues was studied quantitatively in perfusion chambers, assisted by microscopic analysis. We also evaluated standard antiplatelet therapy to prevent onset of S aureus endocarditis.
Of all tissues, bovine pericardium (BP) showed the greatest fibrinogen binding. Perfusion of all plasma-precoated tissues identified BP and BJV wall with the greatest affinity for S aureus. Perfusions of anticoagulated human blood over all tissues also triggered more platelet adhesion to BP and BJV wall as single platelets. Several controls confirmed that both S aureus and platelets were recruited on immobilized fibrinogen. In addition, perfusions (and controls) over plasma-coated tissues with whole blood, spiked with S aureus, revealed that bacteria exclusively bound to adhered platelets. Both the platelet adhesion and platelet-mediated S aureus recruitment required platelet α IIb β 3 and coated or soluble fibrinogen, respectively, interactions abrogated by the α IIb β 3 -antagonist eptifibatide. Also, standard antiplatelet therapy (aspirin/ticagrelor) reduced the adherence of S aureus in blood to BJV 3-fold.
Binding of plasma fibrinogen to especially BJV grafts enables adhesion of single platelets via α IIb β 3 . S aureus then attaches from blood to (activated) bound platelet α IIb β 3 via plasma fibrinogen. Dual antiplatelet therapy appears a realistic approach to prevent endocarditis and its associated mortality
Miniaturized implantable rotary blood pump in atrial–aortic position supports and unloads the failing heart
No full textExergaming improves balance in children with spastic cerebral palsy with low balance performance: results from a multicenter controlled trial
No full textPurpose: Previous studies investigating the effectiveness of exergame balance-training (using video-games) in children with cerebral palsy (CP) yielded inconsistent results that could be related to underpowered studies. Therefore, in this multicenter intervention study, we investigated whether exergaming improves balance clinically in spastic CP. Materials and methods: In total, 35 children with unilateral or bilateral spastic CP (GMFCS-level I–II) were included (age-range: 7–16 years); 16 at VUMC (trial: NTR6034), 19 at UHG (trial: NCT03219112). All participants received care as usual. The intervention group (n = 24) additionally performed exergame-training; 6–8 weeks home-based X-box One Kinect training focused on balance. Balance performance was assessed with the pediatric balance scale (PBS) and two subscales of the Bruininks–Oseretsky Test of Motor Proficiency-2nd edition (“balance” [BOTbal] and “running speed and agility” [BOTrsa]). Mixed model ANOVAs with between and within factors were used to test differences between and within groups. Results: On group level, no post-intervention differences were found between the intervention and control group (PBS: p = 0.248, ηp2 = 0.040; BOTbal: p = 0.374, ηp2 = 0.024; BOTrsa: p = 0.841, ηp2 = 0.001). Distribution of CP-symptoms (unilateral versus bilateral) did not affect training (PBS: p = 0.373, ηp2 = 0.036; BOTbal: p = 0.127, ηp2 = 0.103; BOTrsa: p = 0.474, ηp2 = 0.024). Children with low baseline balance performance (based on PBS) in the intervention group showed improvements in balance performance after training (PBS: p = 0.003, ηp2 = 0.304; BOTbal: p = 0.008, ηp2 = 0.258), whereas children with high baseline balance performance did not. Conclusions: This exergame-training resulted in balance improvements for the current population of CP that had a low baseline function.IMPLICATIONS FOR REHABILITATION Exergame-training (training using video-games) shows mixed results in children with cerebral palsy (CP). Children with spastic CP (GMFCS level I–II) with a high baseline balance-level did not show functional balance improvements after this home-based exergame-training, suggesting that these children should not be enrolled in this type of exergame-training protocol. Children with spastic CP (GMFCS level I–II) with a low baseline balance-level showed clinically relevant functional balance improvements after this home-based exergame-training, suggesting that these children can benefit from enrolment in this type of exergame-training protocol to improve their balance. The distribution of CP-symptoms did not affect the effectiveness of this balance exergame-training in children with spastic CP with GMFCS-level I and II
First human use of a wireless coplanar energy transfer coupled with a continuous-flow left ventricular assist device
No full textThe drive-line to power contemporary ventricular assist devices exiting the skin is associated with infection, and requires a holstered performance of the cardiac pump, which reduces overall quality of life. Attempts to eliminate the drive-line using transcutaneous energy transfer systems have been explored but have not succeeded in viable widespread application. The unique engineering of the coplanar energy transfer system is characterized by 2 large rings utilizing a coil-within-the-coil topology, ensuring robust resonance energy transfer while allowing for a substantial (>6 hours) unholstered circulatory support powered by an implantable battery source. Herein we report the first known human experience with this novel technology, coupled with a continuous-flow assist left ventricular assist device, in 2 consecutive patients evaluated with the primary end-point of system performance at 30 days post-implantation.sponsorship: CET system development, integration with prevalent commercially available LVADs, animal experiments, and the first human clinical trial were sponsored by Leviticus-Cardio, Ltd. This project was supported in part by the Office of the Chief Scientist of the Ministry of Industry, Israel (Grants 49639, 55065, 38675, 56638, and 63319). (Leviticus-Cardio, Ltd., Office of the Chief Scientist of the Ministry of Industry, Israel|49639, Office of the Chief Scientist of the Ministry of Industry, Israel|55065, Office of the Chief Scientist of the Ministry of Industry, Israel|38675, Office of the Chief Scientist of the Ministry of Industry, Israel|56638, Office of the Chief Scientist of the Ministry of Industry, Israel|63319)status: Publishe
Het gebruik van Xenon anesthesie bij patiënten met een hoog risico op postoperatieve orgaanstoornissen
No full textDespite being originally described to be chemically inert, noble gases including xenon, argon and helium have been repeatedly demonstrated to exhibit remarkable biological properties. The first use of xenon anaesthesia in humans was performed by Cullen and Gross in 1951. However, only the development of closed-circuit anaesthesia machines in the 1990'ies has made xenon available to a broader spectrum of patients. Unfortunately, the scarcity (air contains only 87 ppb xenon) and herewith-associated high costs of xenon have limited a wider use of this gas in clinical routine. Hence, strategies by which xenon consumption can be reduced without compromising its protective properties should significantly improve the cost-effectiveness of this noble gas.
Xenon has been repeatedly demonstrated to produce only minimal haemodynamic side effects when compared to volatile or intravenous anaesthetics. Moreover, recent evidence indicates that xenon - in contrast to the majority of conventionally used general anaesthetics - is virtually devoid of negative inotropic effects and improves recovery from post-ischemic contractile dysfunction. Furthermore, xenon was also found to induce both early and late pharmacological preconditioning in experimental models of myocardial ischemia.
The favourable haemodynamic profile of xenon anaesthesia as well as its cardioprotective properties could render this noble gas an attractive anaesthetic for patients undergoing cardiac surgery. These patients are known to carry a high risk for perioperative myocardial ischemia and perioperative haemodynamic instability. Up to now, there is a paucity of data regarding the safety and efficacy of xenon for cardiac anaesthesia.
Xenon is thought to induce its biological effects mainly through non-competitive inhibition of the N-methyl-D-aspartate (NMDA) receptor, a subtype of the excitatory glutamate receptors, with no or only minimal effects on the γ-aminobutyric acid A (GABAA) receptor and non-NMDA glutamatergic receptors. Xenon has also been demonstrated to offer neuroprotection in different animal models of neuronal injury, such as in traumatic brain injury, cardiopulmonary bypass-associated neuronal injury, hypoxia, neuronal ischemia, anaesthetic-induced neurotoxicity, and neonatal asphyxia.
All the above mentioned neuroprotective properties of xenon could make this gas attractive for the management of patients with a high risk for the development of postoperative neurological complications, specifically postoperative delirium (POD). Though, there is a lack of adequately powered studies on xenon related neuroprotection in humans.
In conclusion, an extensive body of evidence suggests that xenon might have the potential to prevent perioperative organ injury. However, this promise is mainly derived from preclinical findings, and clinical trials investigating the efficacy of xenon for perioperative organ protection are sparse. The overall aim of the current PhD project is to investigate the haemodynamic profile, safety, feasibility and organ protective effects (heart and brain) of xenon anaesthesia in patients with a particularly high risk for perioperative organ dysfunction.status: Publishe
Favourable mid-term outcome after heart transplantation for late Fontan failure
No full textOBJECTIVES: Fontan failure (FF) represents a growing and challenging indication for paediatric orthotopic heart transplantation (OHT). The
aim of this study was to identify predictors of the best mid-term outcome in OHT after FF.
METHODS: Twenty-year multi-institutional retrospective analysis on OHT for FF.
RESULTS: Between 1991 and 2011, 61 patients, mean age 15.0 ± 9.7 years, underwent OHT for failing atriopulmonary connection (17
patients = 27.8%) or total cavopulmonary connection (44 patients = 72.2%). Modality of FF included arrhythmia (14.8%), complex obstructions
in the Fontan circuit (16.4%), protein-losing enteropathy (PLE) (22.9%), impaired ventricular function (31.1%) or a combination of the
above (14.8%). The mean time interval between Fontan completion and OHT was 10.7 ± 6.6 years. Early FF occurred in 18%, requiring OHT
0.8 ± 0.5 years after Fontan. The hospital mortality rate was 18.3%, mainly secondary to infection (36.4%) and graft failure (27.3%). The
mean follow-up was 66.8 ± 54.2 months. The overall Kaplan–Meier survival estimate was 81.9 ± 1.8% at 1 year, 73 ± 2.7% at 5 years and
56.8 ± 4.3% at 10 years. The Kaplan-Meier 5-year survival estimate was 82.3 ± 5.9% in late FF and 32.7 ± 15.0% in early FF (P = 0.0007). Late
FF with poor ventricular function exhibited a 91.5 ± 5.8% 5-year OHT survival. PLE was cured in 77.7% of hospital survivors, but the 5-year
Kaplan-Meier survival estimate in PLE was 46.3 ± 14.4 vs 84.3 ± 5.5% in non-PLE (P = 0.0147). Cox proportional hazards identified early FF
(P = 0.0005), complex Fontan pathway obstruction (P = 0.0043) and PLE (P = 0.0033) as independent predictors of 5-year mortality.
CONCLUSIONS: OHT is an excellent surgical option for late FF with impaired ventricular function. Protein dispersion improves with OHT,
but PLE negatively affects the mid-term OHT outcome, mainly for early infective complications
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