Natriuretic Peptides as Biomarkers for Congestive States: The Cardiorenal Divergence

Congestion represents the primary reason for hospitalization of patients with heart failure and is associated with adverse outcomes. Fluid overload has been shown to be inadequately addressed in a significant subset of these patients in part due to lack of robust, reliable, and readily available biomarkers for objective assessment and monitoring of therapy. Natriuretic peptides have long been used in this setting, often in conjunction with other assessment tools such as imaging studies. Patients presenting with concomitant cardiac and renal dysfunction represent a unique population with regard to congestion in that the interactions between the heart and the kidney can affect the utility and performance of biomarkers of fluid overload. Herein, we provide an overview of the currently available evidence on the utility of natriuretic peptides in these patients and discuss the clinical conundrum associated with their use in the setting of renal dysfunction. We highlight the potential divergence in the role of natriuretic peptides for assessment of volume status in a subset of patients with renal dysfunction who receive renal replacement therapy and call for future research to elucidate the utility of the biomarkers in this setting.

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Concussion in para sport: the first position statement of the Concussion in Para Sport (CIPS) Group

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-103696 ◽

2021 ◽

pp. bjsports-2020-103696

Author(s):

Richard Weiler ◽

Cheri Blauwet ◽

David Clarke ◽

Kristine Dalton ◽

Wayne Derman ◽

...

Keyword(s):

Consensus Statement ◽

Assessment Tool ◽

Return To Sport ◽

Position Statement ◽

Assessment Tools ◽

Future Research ◽

Concussion Management ◽

Rule Changes ◽

Specific Rule ◽

And Performance

Concussion is a frequent injury in many sports and is also common in para athletes. However, there is a paucity of concussion research related to para sport, and prior International Concussion in Sport (CIS) consensus papers have not substantively addressed this population. To remedy this and to improve concussion care provided to para athletes, the concussion in para sport (CIPS) multidisciplinary expert group was created. This group analysed and discussed in-depth para athlete-specific issues within the established key clinical domains of the current (2017) consensus statement on CIS. Due to the onset of the COVID-19 pandemic, the group held all meetings by video conferencing. The existing Sport Concussion Assessment Tool 5 (SCAT5) for the immediate on-field and office-based off-field assessment of concussion was evaluated as part of this process, to identify any para athlete-specific concerns. Regular preparticipation and periodic health examinations are essential to determine a baseline reference point for concussion symptoms but pose additional challenges for the interpreting clinician. Further considerations for concussion management for the para athlete are required within the remove, rest, reconsider and refer consensus statement framework. Considering return to sport (RTS), the 2017 CIS consensus statement has limitations when considering the RTS of the para athlete. Case-by-case decision making related to RTS following concussion is imperative for para athletes. Additional challenges exist for the evaluation and management of concussion in para athletes. There is a need for greater understanding of existing knowledge gaps and attitudes towards concussion among athlete medical staff, coaches and para athletes. Future research should investigate the use and performance of common assessment tools in the para athlete population to better guide their clinical application and inform potential modifications. Concussion prevention strategies and sport-specific rule changes, such as in Para Alpine Skiing and Cerebral Palsy Football, also should be carefully considered to reduce the occurrence of concussion in para athletes.

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Definitions of Frailty in Qualitative Research: A Qualitative Systematic Review

Journal of Aging Research ◽

10.1155/2021/6285058 ◽

2021 ◽

Vol 2021 ◽

pp. 1-20

Author(s):

Deborah A. Lekan ◽

Susan K. Collins ◽

Audai A. Hayajneh

Keyword(s):

Systematic Review ◽

Older Adults ◽

Qualitative Research ◽

Objective Assessment ◽

Subjective Assessment ◽

Adverse Outcomes ◽

Older Age ◽

Future Research ◽

Qualitative Systematic Review ◽

Physical Limitations

The purpose of this qualitative systematic review was to examine how frailty was conceptually and operationally defined for participant inclusion in qualitative research focused on the lived experience of frailty in community-living frail older adults. Search of six electronic databases, 1994–2019, yielded 25 studies. Data collection involved extracting the definition of frailty from the study aim, background, literature review, methods, and sampling strategy in each research study. Quality appraisal indicated that 13 studies (52%) demonstrated potential researcher bias based on insufficient information about participant recruitment, sampling, and relationship between the researcher and participant. Content analysis and concept mapping were applied for data synthesis. Although frailty was generally defined as a multidimensional, biopsychosocial construct with loss of resilience and vulnerability to adverse outcomes, most studies defined the study population based on older age and physical impairments derived from subjective assessment by the researcher, a healthcare professional, or a family member. However, 13 studies (52%) used objective or performance-based quantitative measures to classify participant frailty. There was no consistency across studies in standardized measures or objective assessment of frailty. Synthesis of the findings yielded four themes: Time, Vulnerability, Loss, and Relationships. The predominance of older age and physical limitations as defining characteristics of frailty raises questions about whether participants were frail, since many older adults at advanced age and with physical limitations are not frail. Lack of clear criteria to classify frailty and reliance on subjective assessment introduces the risk for bias, threatens the validity and interpretation of findings, and hinders transferability of findings to other contexts. Clear frailty inclusion and exclusion criteria and a standardized approach in the reporting of how frailty is conceptually and operationally defined in study abstracts and the methodology used is necessary to facilitate dissemination and development of metasynthesis studies that aggregate qualitative research findings that can be used to inform future research and applications in clinical practice to improve healthcare.

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The physical and physiological effects of vacuum massage on the different skin layers: a current status of the literature

Burns & Trauma ◽

10.1186/s41038-016-0053-9 ◽

2016 ◽

Vol 4 ◽

pp. 1-12 ◽

Cited By ~ 4

Author(s):

Peter Moortgat ◽

Mieke Anthonissen ◽

Jill Meirte ◽

Ulrike Van Daele ◽

Koen Maertens

Keyword(s):

Objective Assessment ◽

Assessment Tools ◽

Current Status ◽

Future Research ◽

Physiological Effects ◽

Qualitative Synthesis ◽

Non Invasive ◽

Skin Fold ◽

Tissue Hardness ◽

Physical Effects

Abstract Vacuum massage is a non-invasive mechanical massage technique performed with a mechanical device that lifts the skin by means of suction, creates a skin fold and mobilises that skin fold. In the late 1970s, this therapy was introduced to treat traumatic or burn scars. Although vacuum massage was invented to treat burns and scars, one can find very little literature on the effects of this intervention. Therefore, the aim of this review is to present an overview of the available literature on the physical and physiological effects of vacuum massage on epidermal and dermal skin structures in order to find the underlying working mechanisms that could benefit the healing of burns and scars. The discussion contains translational analysis of the results and provides recommendations for future research on the topic. An extended search for publications was performed using PubMed, Web of Science and Google Scholar. Two authors independently identified and checked each study against the inclusion criteria. Nineteen articles were included in the qualitative synthesis. The two most reported physical effects of vacuum massage were improvement of the tissue hardness and the elasticity of the skin. Besides physical effects, a variety of physiological effects are reported in literature, for example, an increased number of fibroblasts and collagen fibres accompanied by an alteration of fibroblast phenotype and collagen orientation. Little information was found on the decrease of pain and itch due to vacuum massage. Although vacuum massage initially had been developed for the treatment of burn scars, this literature review found little evidence for the efficacy of this treatment. Variations in duration, amplitude or frequency of the treatment have a substantial influence on collagen restructuring and reorientation, thus implying possible beneficial influences on the healing potential by mechanotransduction pathways. Vacuum massage may release the mechanical tension associated with scar retraction and thus induce apoptosis of myofibroblasts. Suggestions for future research include upscaling the study design, investigating the molecular pathways and dose dependency, comparing effects in different stages of repair, including evolutive parameters and the use of more objective assessment tools.

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Vacuum Massage in the Treatment of Scars

Textbook on Scar Management ◽

10.1007/978-3-030-44766-3_54 ◽

2020 ◽

pp. 475-483

Author(s):

Peter Moortgat ◽

Jill Meirte ◽

Ulrike Van Daele ◽

Mieke Anthonissen ◽

Tine Vanhullebusch ◽

...

Keyword(s):

Objective Assessment ◽

Assessment Tools ◽

Future Research ◽

Molecular Pathways ◽

Physiological Effects ◽

Collagen Orientation ◽

Skin Fold ◽

Tissue Hardness ◽

Physical Effects ◽

Car Accident

AbstractVacuum massage is a noninvasive mechanical massage technique performed with a mechanical device that lifts the skin by means of suction to create and mobilize a skin fold. It was invented by a French engineer suffering from burn scars after a car accident and has since then been frequently used for the treatment of burn scars.The two most reported physical effects of vacuum massage were improvement of the tissue hardness and the elasticity of the skin. Besides physical effects, a variety of physiological effects are reported in the literature, for example, an increased number of fibroblasts and collagen fibers accompanied by an alteration of fibroblast phenotype and collagen orientation. Little information was found on the decrease of pain and itch due to vacuum massage.Although vacuum massage initially had been developed for the treatment of burn scars, a literature review found little evidence for the efficacy of this treatment. Variations in duration, amplitude, or frequency of the treatment have a substantial influence on collagen restructuring and reorientation, thus implying possible beneficial influences on the healing potential by mechanotransduction pathways. Vacuum massage may release the mechanical tension associated with scar retraction and thus induce apoptosis of myofibroblasts. Suggestions for future research include upscaling the study design, investigating the molecular pathways and dose dependency, comparing effects in different stages of repair, including evolutive parameters and the use of more objective assessment tools.

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Renal Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

PEDIATRICS ◽

10.1542/peds.2021-052888j ◽

2022 ◽

Vol 149 (Supplement_1) ◽

pp. S66-S73

Author(s):

Julie C. Fitzgerald ◽

Rajit K. Basu ◽

Dana Y. Fuhrman ◽

Stephen M. Gorga ◽

Amanda B. Hassinger ◽

...

Keyword(s):

Serum Creatinine ◽

Renal Dysfunction ◽

Critically Ill ◽

Urine Output ◽

Data Extraction ◽

Case Series ◽

Adverse Outcomes ◽

Assessment Tools ◽

Current Evidence ◽

Critically Ill Children

CONTEXT Renal dysfunction is associated with poor outcomes in critically ill children. OBJECTIVE To evaluate the current evidence for criteria defining renal dysfunction in critically ill children and association with adverse outcomes. To develop contemporary consensus criteria for renal dysfunction in critically ill children. DATA SOURCES PubMed and Embase were searched from January 1992 to January 2020. STUDY SELECTION Included studies evaluated critically ill children with renal dysfunction, performance characteristics of assessment tools for renal dysfunction, and outcomes related to mortality, functional status, or organ-specific or other patient-centered outcomes. Studies with adults or premature infants (≤36 weeks' gestational age), animal studies, reviews, case series, and studies not published in English with inability to determine eligibility criteria were excluded. DATA EXTRACTION Data were extracted from included studies into a standard data extraction form by task force members. RESULTS The systematic review supported the following criteria for renal dysfunction: (1) urine output <0.5 mL/kg per hour for ≥6 hours and serum creatinine increase of 1.5 to 1.9 times baseline or ≥0.3 mg/dL, or (2) urine output <0.5 mL/kg per hour for ≥12 hours, or (3) serum creatinine increase ≥2 times baseline, or (4) estimated glomerular filtration rate <35 mL/minute/1.73 m2, or (5) initiation of renal replacement therapy, or (6) fluid overload ≥20%. Data also support criteria for persistent renal dysfunction and for high risk of renal dysfunction. LIMITATIONS All included studies were observational and many were retrospective. CONCLUSIONS We present consensus criteria for renal dysfunction in critically ill children.

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Body Mass Index, Natriuretic Peptides, and Risk of Adverse Outcomes in Patients With Heart Failure and Preserved Ejection Fraction: Analysis From the TOPCAT Trial

Journal of the American Heart Association ◽

10.1161/jaha.118.009664 ◽

2018 ◽

Vol 7 (21) ◽

Cited By ~ 7

Author(s):

Ambarish Pandey ◽

Jarett D. Berry ◽

Mark H. Drazner ◽

James C Fang ◽

W. H. Wilson Tang ◽

...

Keyword(s):

Heart Failure ◽

Body Mass Index ◽

Ejection Fraction ◽

Body Mass ◽

Natriuretic Peptides ◽

Adverse Outcomes ◽

Preserved Ejection Fraction ◽

Patients With Heart Failure

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Improving Prognosis Estimation in Patients with Heart Failure and the Cardiorenal Syndrome

International Journal of Nephrology ◽

10.4061/2011/351672 ◽

2011 ◽

Vol 2011 ◽

pp. 1-11 ◽

Cited By ~ 4

Author(s):

Husam M. Abdel-Qadir ◽

Shaan Chugh ◽

Douglas S. Lee

Keyword(s):

Heart Failure ◽

Renal Dysfunction ◽

Cardiorenal Syndrome ◽

Left Ventricular ◽

High Risk Group ◽

Future Research ◽

Research Directions ◽

Patients With Heart Failure ◽

Future Research Directions

The coexistence of heart failure and renal dysfunction constitutes the “cardiorenal syndrome” which is increasingly recognized as a marker of poor prognosis. Patients with cardiorenal dysfunction constitute a large and heterogeneous group where individuals can have markedly different outcomes and disease courses. Thus, the determination of prognosis in this high risk group of patients may pose challenges for clinicians and for researchers alike. In this paper, we discuss the cardiorenal syndrome as it pertains to the patient with heart failure and considerations for further refining prognosis and outcomes in patients with heart failure and renal dysfunction. Conventional assessments of left ventricular function, renal clearance, and functional status can be complemented with identification of coexistent comorbidities, medication needs, microalbuminuria, anemia, biomarker levels, and pulmonary pressures to derive additional prognostic data that can aid management and provide future research directions for this challenging patient group.

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Machine Learning-Based Behavioral Diagnostic Tools for Depression: Advances, Challenges, and Future Directions

Journal of Personalized Medicine ◽

10.3390/jpm11100957 ◽

2021 ◽

Vol 11 (10) ◽

pp. 957

Author(s):

Thalia Richter ◽

Barak Fishbain ◽

Gal Richter-Levin ◽

Hadas Okon-Singer

Keyword(s):

Machine Learning ◽

Objective Assessment ◽

Clinical Information ◽

Assessment Tools ◽

Behavioral Data ◽

Diagnostic Tools ◽

Diagnostic Process ◽

Future Research ◽

Neuroimaging Data ◽

Future Research Directions

The psychiatric diagnostic procedure is currently based on self-reports that are subject to personal biases. Therefore, the diagnostic process would benefit greatly from data-driven tools that can enhance accuracy and specificity. In recent years, many studies have achieved promising results in detecting and diagnosing depression based on machine learning (ML) analysis. Despite these favorable results in depression diagnosis, which are primarily based on ML analysis of neuroimaging data, most patients do not have access to neuroimaging tools. Hence, objective assessment tools are needed that can be easily integrated into the routine psychiatric diagnostic process. One solution is to use behavioral data, which can be easily collected while still maintaining objectivity. The current paper summarizes the main ML-based approaches that use behavioral data in diagnosing depression and other psychiatric disorders. We classified these studies into two main categories: (a) laboratory-based assessments and (b) data mining, the latter of which we further divided into two sub-groups: (i) social media usage and movement sensors data and (ii) demographic and clinical information. The paper discusses the advantages and challenges in this field and suggests future research directions and implementations. The paper’s overarching aim is to serve as a first step in synthetizing existing knowledge about ML-based behavioral diagnosis studies in order to develop interventions and individually tailored treatments in the future.

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