A Pilot Study Identifying Brain-Targeting Adaptive Immunity in Pediatric Extracorporeal Membrane Oxygenation Patients with Acquired Brain Injury

OBJECTIVES: Extracorporeal membrane oxygenation provides short-term cardiopulmonary life support, but is associated with peripheral innate inflammation, disruptions in cerebral autoregulation, and acquired brain injury. We tested the hypothesis that extracorporeal membrane oxygenation also induces CNS-directed adaptive immune responses which may exacerbate extracorporeal membrane oxygenation-associated brain injury. DESIGN: A single center prospective observational study. SETTING: Pediatric and cardiac ICUs at a single tertiary care, academic center. PATIENTS: Twenty pediatric extracorporeal membrane oxygenation patients (0-14 yr; 13 females, 7 males) and five nonextracorporeal membrane oxygenation Pediatric Logistic Organ Dysfunction score matched patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Venous blood samples were collected from the extracorporeal membrane oxygenation circuit at day 1 (10-23 hr), day 3, and day 7 of extracorporeal membrane oxygenation. Flow cytometry quantified circulating innate and adaptive immune cells, and CNS-directed autoreactivity was detected using an in vitro recall response assay. Disruption of cerebral autoregulation was determined using continuous bedside near-infrared spectroscopy and acquired brain injury confirmed by MRI. Extracorporeal membrane oxygenation patients with acquired brain injury (n = 9) presented with a 10-fold increase in interleukin-8 over extracorporeal membrane oxygenation patients without brain injury (p \u3c 0.01). Furthermore, brain injury within extracorporeal membrane oxygenation patients potentiated an inflammatory phenotype in adaptive immune cells and selective autoreactivity to brain peptides in circulating B cell and cytotoxic T cell populations. Correlation analysis revealed a significant relationship between adaptive immune responses of extracorporeal membrane oxygenation patients with acquired brain injury and loss of cerebral autoregulation. CONCLUSIONS: We show that pediatric extracorporeal membrane oxygenation patients with acquired brain injury exhibit an induction of pro-inflammatory cell signaling, a robust activation of adaptive immune cells, and CNS-targeting adaptive immune responses. As these patients experience developmental delays for years after extracorporeal membrane oxygenation, it is critical to identify and characterize adaptive immune cell mechanisms that target the developing CNS

Impact of the COVID-19 Pandemic on the Perceived Physical and Mental Health and Healthy Lifestyle Behaviors of People with Disabilities: Quantitative Analysis of the International Community Survey

This study aims to determine the perceived impact of the coronavirus pandemic on physical and mental health and healthy lifestyle behaviors in community-dwelling persons with disabilities, as compared to those without disabilities

Surveillance of stroke: WHO STEP-wise approach: A Chennai stroke unit report

Stroke is potentially the most devastating consequence of vascular disease, causing long-term disability and placing high medical, emotional, and financial burdens on the patient. WHO STEPS stroke surveillance study, provided the framework for our study of stroke patients in Chennai. In our center, we followed only the STEP 1 study and only hospital-based stroke data were collected. STEP 2 and 3 involved study of strokes in the community. We found that 78% of our patients were in the 6th to 8th decades of life; 72% had hypertension, either alone or in combination with other risk factors; 4 weeks after the stroke, 51% of our patients were independent with regard to mobility and the activities of daily living, while 14% had severe disability. We found a mortality rate of 14%. We concluded that the incidence of stroke in the community can be decreased further by effective risk factor modification. The admission delay needs to be shortened from> 48 h to less than 6 h. Our data also gave us fresh information about the recovery of motor function in stroke survivors at 28 days after the stroke

Access denied: the shortage of digitized fitness resources for people with disabilities

Purpose: The COVID-19 pandemic has drastically impacted every aspect of life, including how people exercise and access fitness resources. Prior to COVID-19, the global burden of disease attributable to sedentary behavior disproportionately affected the health of people with disabilities (PWD). This pre-existing gap has only widened during COVID-19 due to limited disability-friendly digital exercise resources. The purpose of this work is to examine this gap in accessibility to digital fitness resources, and re-frame the notion of accessibility to suit the contemporary context. Materials and methods: Using machine learning, video titles/descriptions about home exercise ordered by relevance populated on YouTube between 1 January 2020 and 30 June 2020 were examined. Results: Using the search terms, “home exercise,” “home-based exercise,” “exercise no equipment,” “workout no equipment,” “exercise at home,” or “at-home exercise,” 700 videos ordered by relevance included 28 (4%) that were inclusive of participants with disabilities. Unfortunately, most digital fitness resources are therefore inaccessible to PWD. The global pause the pandemic has induced may be the right moment to construct a comprehensive, indexed digital library of home-based fitness video content for the disabled. There is a further need for more nuanced understandings of accessibility as technological advancements continue. Implications for Rehabilitation: Physical activity is incredibly important to the quality of life and health of all people. Physical activity levels, however, remain lower among persons with disabilities. Access to disability-friendly resources remains a challenge and worsened by the circumstances of COVID-19 due to an apparent lack of digital fitness resources for persons with disabilities. A broader and comprehensive definition of accessibility must recognize digital advances and access to physical activity for persons with disabilities must feature digital resources

Global stakeholder perspectives on barriers and facilitators to community-based physical activity in adults living with disabilities: A systematic review protocol

The benefits of physical activity (PA) for health have been extensively studied; however, people with disabilities (PWDs) are more likely to be inactive compared to the general population. The topic of barriers and facilitators to PA for PWDs has been studied, but most reviews have focused on specific impairments, institution-based exercise programs, and/or persons who reside in high-income countries. A comprehensive review describing the barriers and facilitators to PA for community-dwelling PWDs (including developmental, intellectual, sensory, physical, and mental disabilities) from a global perspective has not been published. The aim of this paper is to describe the protocol used to conduct a systematic review concerning the socioenvironmental factors that encourage and discourage PA in PWDs around the world, by investigating the current knowledge, identifying gaps in the literature, and providing guidance for future research and guidelines. MEDLINE All, PsycINFO, and Web of Science Core Collection were searched. Gray literature sources included were extracted from the three main databases used for the literature search. A total of 6434 records were identified for the initial title/abstract screen. The following data were extracted from the final full-text articles: author, title, publication information (journal, year), study design, methodology, data collection instruments employed, language, country or countries where the study was conducted, subject characteristics, disabilities reported, disability characteristics, subjects' mobility level, a relation of stakeholder(s) to PWDs (self, family), PA mode, barriers, and facilitators