Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease

Copyright @ 2013 Janssens et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Introduction: Balance deficits are identified as important risk factors for falling in individuals with chronic obstructive pulmonary disease (COPD). However, the specific use of proprioception, which is of primary importance during balance control, has not been studied in individuals with COPD. The objective was to determine the specific proprioceptive control strategy during postural balance in individuals with COPD and healthy controls, and to assess whether this was related to inspiratory muscle weakness. Methods: Center of pressure displacement was determined in 20 individuals with COPD and 20 age/gender-matched controls during upright stance on an unstable support surface without vision. Ankle and back muscle vibration were applied to evaluate the relative contribution of different proprioceptive signals used in postural control. Results: Individuals with COPD showed an increased anterior-posterior body sway during upright stance (p=0.037). Compared to controls, individuals with COPD showed an increased posterior body sway during ankle muscle vibration (p=0.047), decreased anterior body sway during back muscle vibration (p=0.025), and increased posterior body sway during simultaneous ankle-muscle vibration (p=0.002). Individuals with COPD with the weakest inspiratory muscles showed the greatest reliance on ankle muscle input when compared to the stronger individuals with COPD (p=0.037). Conclusions: Individuals with COPD, especially those with inspiratory muscle weakness, increased their reliance on ankle muscle proprioceptive signals and decreased their reliance on back muscle proprioceptive signals during balance control, resulting in a decreased postural stability compared to healthy controls. These proprioceptive changes may be due to an impaired postural contribution of the inspiratory muscles to trunk stability. Further research is required to determine whether interventions such as proprioceptive training and inspiratory muscle training improve postural balance and reduce the fall risk in individuals with COPD.This work was supported by the Research Foundation – Flanders (FWO) grants 1.5.104.03, G.0674.09, G.0598.09N and G.0871.13N

Impaired Postural Control Reduces Sit-to-Stand-to-Sit Performance in Individuals with Chronic Obstructive Pulmonary Disease

Abstract Background: Functional activities, such as the sit-to-stand-to-sit (STSTS) task, are often impaired in individuals with chronic obstructive pulmonary disease (COPD). The STSTS task places a high demand on the postural control system, which has been shown to be impaired in individuals with COPD. It remains unknown whether postural control deficits contribute to the decreased STSTS performance in individuals with COPD. Methods: Center of pressure displacement was determined in 18 individuals with COPD and 18 age/gender-matched controls during five consecutive STSTS movements with vision occluded. The total duration, as well as the duration of each sit, sit-to-stand, stand and stand-to-sit phase was recorded. Results: Individuals with COPD needed significantly more time to perform five consecutive STSTS movements compared to healthy controls (1966 vs. 1364 seconds, respectively; p = 0.001). The COPD group exhibited a significantly longer stand phase (p = 0.028) and stand-to-sit phase (p = 0.001) compared to the control group. In contrast, the duration of the sit phase (p = 0.766) and sit-to-stand phase (p = 0.999) was not different between groups. Conclusions: Compared to healthy individuals, individuals with COPD needed significantly more time to complete those phases of the STSTS task that require the greatest postural control. These findings support the proposition that suboptimal postural control is an important contributor to the decreased STSTS performance in individuals with COPD

Oxygen saturation targets for children with respiratory distress:a systematic review

BACKGROUND: In children with respiratory distress, supplemental oxygen is indicated at peripheral oxygen saturation ( S pO 2 ) thresholds of 90-94%. However, these thresholds are poorly studied. We conducted a systematic review to summarise the existing evidence for S pO 2 thresholds in children with respiratory distress. METHODS: Electronic databases and registries were searched for original articles published from 1 January 2010 to 7 January 2022 comparing two or more S pO 2 thresholds in children with respiratory distress. Primary outcomes were safety, including mortality, neurocognitive outcomes and readmissions, and effectiveness, including admission rate and length of hospital stay. Methodological appraisal was performed using the Cochrane Risk of Bias 2 (RoB-2) or Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) tools. Results were narratively synthesised. RESULTS: We retrieved 3384 results; seven studies were included. Lower thresholds ranged from 80% to 92% and were compared with higher thresholds ranging from 92% to 94%. Studies were highly heterogeneous in setting, design, population and outcomes. Risk of bias varied from low to high. Lower S pO 2 thresholds had equivalent mortality, neurocognitive outcomes and readmissions or re-attendance to healthcare to higher thresholds. Lower S pO 2 thresholds showed a significant decrease in admission rates by up to 40% and shortened hospitalisation duration by 10-18 h. CONCLUSIONS: The current S pO 2 thresholds of 90-94% in children with respiratory distress may be too high, which could lead to unnecessary hospitalisations and prolonged hospitalisation duration. S pO 2 thresholds as low as 88% are potentially safe in children with respiratory distress and may reduce hospitalisation rates and length of stay. However, high-quality evidence is needed to support this. </p

Chest computed tomography in severe bronchopulmonary dysplasia:Comparing quantitative scoring methods

Purpose: Bronchopulmonary dysplasia (BPD) is the most common complication of extreme preterm birth and structural lung abnormalities are frequently found in children with BPD. To quantify lung damage in BPD, three new Hounsfield units (HU) based chest-CT scoring methods were evaluated in terms of 1) intra- and inter-observer variability, 2) correlation with the validated Perth-Rotterdam-Annotated-Grid-Morphometric-Analysis (PRAGMA)-BPD score, and 3) correlation with clinical data. Methods: Chest CT scans of children with severe BPD were performed at a median of 7 months corrected age. Hyper- and hypo-attenuated regions were quantified using PRAGMA-BPD and three new HU based scoring methods (automated, semi-automated, and manual). Intra- and inter-observer variability was measured using intraclass correlation coefficients (ICC) and Bland-Altman plots. The correlation between the 4 scoring methods and clinical data was assessed using Spearman rank correlation. Results: Thirty-five patients (median gestational age 26.1 weeks) were included. Intra- and inter-observer variability was excellent for hyper- and hypo-attenuation regions for the manual HU method and PRAGMA-BPD (ICCs range 0.80–0.97). ICC values for the semi-automated HU method were poorer, in particular for the inter-observer variability of hypo- (0.22–0.71) and hyper-attenuation (-0.06–0.89). The manual HU method was highly correlated with PRAGMA-BPD score for both hyper- (ρs0.92, p &lt; 0.001) and hypo-attenuation (ρs0.79, p &lt; 0.001), while automated and semi-automated HU methods showed poor correlation for hypo- (ρs &lt; 0.22) and good correlation for hyper-attenuation (ρs0.72–0.74, p &lt; 0.001). Several scores of hyperattenuation correlated with the use of inhaled bronchodilators in the first year of life; two hypoattenuation scores correlated with birth weight. Conclusions: PRAGMA-BPD and the manual HU method have the best reproducibility for quantification of CT abnormalities in BPD.</p

Optimizing care for children with difficult-to-treat and severe asthma through specialist paediatric asthma centres:expert practical experience and advice

Severe asthma in children carries an unacceptable treatment burden, yet its rarity means clinical experience in treating it is limited, even among specialists. Practical guidance is needed to support clinical decision-making to optimize treatment for children with this condition. This modified Delphi convened 16 paediatric pulmonologists and allergologists from northern Europe, all experienced in treating children with severe asthma. Informed by interviews with stakeholders involved in the care of children with severe asthma (including paediatricians, nurses and carers), and an analysis of European guidelines, the experts built a consensus focused on the gaps in existing guidance. Explored were considerations for optimizing care for patients needing biologic treatment, and for selecting home or hospital delivery of biologics. This consensus is aimed at clinicians in specialist centres, as well as general paediatricians, paediatric allergologists and paediatric pulmonologists who refer children with the most severe asthma to specialist care. Consensus is based on expert opinion and is intended for use alongside published guidelines. Our discussions revealed three key facets to optimizing care. Firstly, early asthma detection in children presenting with wheezing and/or dyspnoea is vital, with a low threshold for referral from primary to specialist care. Secondly, children who may need biologics should be referred to and managed by specialist paediatric asthma centres; we define principles for the specialist team members, tests, and expertise necessary at such centres, as well as guidance on when homecare biologics delivery is and is not appropriate. Thirdly, shared decision-making is essential at all stages of the patient’s journey: clear, concise treatment plans are vital for patient/carer self-management, and structured processes for transition from paediatric to adult services are valuable. The experts identified the potential for specialist paediatric asthma nurses to play a significant role in facilitating multidisciplinary working. Through this project is agreed a framework of practical advice to optimize the care of children with severe asthma. We encourage clinicians and policymakers to implement this practical advice to enhance patient care.</p

Lentiviral gene therapy with IGF2-tagged GAA normalizes the skeletal muscle proteome in murine Pompe disease

Pompe disease is a lysosomal storage disorder caused by deficiency of acid alpha-glucosidase (GAA), resulting in glycogen accumulation with profound pathology in skeletal muscle. We recently developed an optimized form of lentiviral gene therapy for Pompe disease in which a codon-optimized version of the GAA transgene (LV-GAAco) was fused to an insulin-like growth factor 2 (IGF2) peptide (LV-IGF2.GAAco), to promote cellular uptake via the cation-independent mannose-6-phosphate/IGF2 receptor. Lentiviral gene therapy with LV-IGF2.GAAco showed superior efficacy in heart, skeletal muscle, and brain of Gaa−/− mice compared to gene therapy with untagged LV-GAAco. Here, we used quantitative mass spectrometry using TMT labeling to analyze the muscle proteome and the response to gene therapy in Gaa−/− mice. We found that muscle of Gaa−/− mice displayed altered levels of proteins including those with functions in the CLEAR signaling pathway, autophagy, cytoplasmic glycogen metabolism, calcium homeostasis, redox signaling, mitochondrial function, fatty acid transport, muscle contraction, cytoskeletal organization, phagosome maturation, and inflammation. Gene therapy with LV-GAAco resulted in partial correction of the muscle proteome, while gene therapy with LV-IGF2.GAAco resulted in a near-complete restoration to wild type levels without inducing extra proteomic changes, supporting clinical development of lentiviral gene therapy for Pompe disease. Significance: Lysosomal glycogen accumulation is the primary cause of Pompe disease, and leads to a cascade of pathological events in cardiac and skeletal muscle and in the central nervous system. In this study, we identified the proteomic changes that are caused by Pompe disease in skeletal muscle of a mouse model. We showed that lentiviral gene therapy with LV-IGF2.GAAco nearly completely corrects disease-associated proteomic changes. This study supports the future clinical development of lentiviral gene therapy with LV-IGF2.GAAco as a new treatment option for Pompe disease.</p

Theory of Mind and social functioning among neuropsychiatric disorders:A transdiagnostic study

Social dysfunction is commonly present in neuropsychiatric disorders of schizophrenia (SZ) and Alzheimer's disease (AD). Theory of Mind (ToM) deficits have been linked to social dysfunction in disease-specific studies. Nevertheless, it remains unclear how ToM is related to social functioning across these disorders, and which factors contribute to this relationship. We investigated transdiagnostic associations between ToM and social functioning among SZ/AD patients and healthy controls, and explored to what extent these associations relate to information processing speed or facial emotion recognition capacity. A total of 163 participants were included (SZ: n=56, AD: n=50 and age-matched controls: n=57). Social functioning was assessed with the Social Functioning Scale (SFS) and the De Jong-Gierveld Loneliness Scale (LON). ToM was measured with the Hinting Task. Information processing speed was measured by the Digit Symbol Substitution Test (DSST) and facial emotion recognition capacity by the facial emotion recognition task (FERT). Case-control deficits in Hinting Task performance were larger in AD (rrb = -0.57) compared to SZ (rrb = -0.35). Poorer Hinting Task performance was transdiagnostically associated with the SFS (βHinting-Task = 1.20, p<0.01) and LON (βHinting-Task = -0.27, p<0.05). DSST, but not FERT, reduced the association between the SFS and Hinting Task performance, however the association remained significant (βHinting-Task = 0.95, p<0.05). DSST and FERT performances did not change the association between LON and Hinting Task performance. Taken together, ToM deficits are transdiagnostically associated with social dysfunction and this is partly related to reduced information processing speed

LISA pathfinder optical interferometry

The LISA Technology Package (LTP) aboard of LISA pathfinder mission is dedicated to demonstrate and verify key technologies for LISA, in particular drag free control, ultra-precise laser interferometry and gravitational sensor. Two inertial sensor, the optical interferometry in between combined with the dimensional stable Glass ceramic Zerodur structure are setting up the LTP. The validation of drag free operation of the spacecraft is planned by measuring laser interferometrically the relative displacement and tilt between two test masses (and the optical bench) with a noise levels of 10pm/[square root of]Hz and 10 nrad/[square root of]Hz between 3mHz and 30mHz. This performance and additionally overall environmental tests was currently verified on EM level. The OB structure is able to support two inertial sensors ([approximate]17kg each) and to withstand 25 g design loads as well as 0...40°C temperature range. Optical functionality was verified successfully after environmental tests. The engineering model development and manufacturing of the optical bench and interferometry hardware and their verification tests will be presented

Perceptions of institutional complexity and lobbyists’ decisions to join lobbying coalitions – evidence from the European Union context

YesWe use data from in-depth interviews with business lobbyists in Brussels to investigate why they choose to join lobbying coalitions. We find that lobbyists face two competing institutional incentives. First, they are confronted with incentives to ally with other European organisations, develop multilateral policy messages, and communicate messages to the Commission and the Parliament. Simultaneously, they face inducements to join narrower coalitions, develop bilateral policy messages, and direct those messages at the Council. Lobbyists’ receptivity to these incentives – and thus their choices of lobbying coalitions – differs with their age, educational background, and with the type and ownership structure of the organisations they represent. Combined, our findings contribute to the limited, mainly American literature on interest coalitions by demonstrating that lobbyists operate in complex institutional environments, and that their interpretations of and reactions to institutional complexity are shaped by individual- and organisational-level factors