Exercise-Induced Changes of Multimodal Interactions Within the Autonomic Nervous Network

Physical exercise has been shown to modulate activity within the autonomic nervous system (ANS). Considering physical exercise as a holistic stimulus on the nervous system and specifically the ANS, uni- and multimodal analysis tools were applied to characterize centrally driven interactions and control of ANS functions. Nineteen young and physically active participants performed treadmill tests at individually determined moderate and high intensities. Continuous electrodermal activity (EDA), heart rate (HR), and skin temperature at wrist (Temp) were recorded by wireless multisensor devices (Empatica® E4, Milan, Italy) before and 30 min after exercise. Artifact-free continuous 3 min intervals were analyzed. For unimodal analysis, mean values were calculated, for bimodal and multimodal analysis canonical correlation analysis (CCA) was performed. Unimodal results indicate that physical exercise affects ANS activity. More specifically, Temp increased due to physical activity (moderate intensity: from 34.15°C to 35.34°C and high intensity: from 34.11°C to 35.09°C). HR increased more for the high (from 60.76 bpm to 79.89 bpm) than for the moderate (from 64.81 bpm to 70.83 bpm) intensity. EDA was higher for the high (pre: 8.06 μS and post: 9.37 μS) than for the moderate (pre: 4.31 μS and post: 3.91 μS) intensity. Bimodal analyses revealed high variations in correlations before exercise. The overall correlation coefficient showed varying correlations in pretest measures for all modality pairs (EDA-HR, HR-Temp, Temp-EDA at moderate: 0.831, 0.998, 0.921 and high: 0.706, 0, 0.578). After exercising at moderate intensity coefficients changed little (0.828, 0.744, 0.994), but increased substantially for all modality pairs after exercising at high intensity (0.976, 0.898, 0.926). Multimodal analysis confirmed bimodal results. Exercise-induced changes in ANS activity can be found in multiple ANS modalities as well as in their interactions. Those changes are intensity-specific: with higher intensity the interactions increase. Canonical correlations between different ANS modalities may therefore offer a feasible approach to determine exercise induced modulations of ANS activity

Head injuries in professional football (soccer): Results of video analysis verified by an accident insurance registry

Background Video analysis is one of the most commonly applied methods for analysing football injuries. Purpose The objective of this study was to assess the accuracy of video analysis for recording head injuries in professional football from official matches in the four highest men’s professional football leagues in Germany. Methods In this cohort study, head injuries detected by means of video analysis of all official matches over one season (2017–18) were compared to head injuries registered with the German statutory accident insurance. Results Our video analysis yielded 359 head injuries of 287 players. The comparison of head injuries found in our video analysis to those registered with the accident insurance only yielded a match in 23.1% (n = 83), which presents a rather low verification rate. The verification rates varied between the leagues (7.0–30.8%). All injuries documented in the accident insurance registry were found in the video analysis (100%). The types of head injury most often verified by the accident insurance registry (n = 83) were contusion (43.4%), bone fractures (19.3%) and skin lacerations (18.1%). Only 66 of the 359 head injuries (18.4%) resulted in absence from at least one training session and involved a mean time loss of 18.5 days (1–87 days). Conclusion The mismatch between the number of head injuries found in the video analysis and head injuries registered with the accident insurance is an important methodological issue in scientific research. The low verification rate seems to be due to the unclear correlation between injury severity and clinical consequences of head injuries detected by means of video analysis and the failure of football clubs to register minor head injuries with the accident insurance

Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors

Objective New devices are needed for monitoring seizures, especially those associated with sudden unexpected death in epilepsy (SUDEP). They must be unobtrusive and automated, and provide false alarm rates (FARs) bearable in everyday life. This study quantifies the performance of new multimodal wrist-worn convulsive seizure detectors. Methods Hand-annotated video-electroencephalographic seizure events were collected from 69 patients at six clinical sites. Three different wristbands were used to record electrodermal activity (EDA) and accelerometer (ACM) signals, obtaining 5,928 h of data, including 55 convulsive epileptic seizures (six focal tonic–clonic seizures and 49 focal to bilateral tonic–clonic seizures) from 22 patients. Recordings were analyzed offline to train and test two new machine learning classifiers and a published classifier based on EDA and ACM. Moreover, wristband data were analyzed to estimate seizure-motion duration and autonomic responses. Results The two novel classifiers consistently outperformed the previous detector. The most efficient (Classifier III) yielded sensitivity of 94.55%, and an FAR of 0.2 events/day. No nocturnal seizures were missed. Most patients had <1 false alarm every 4 days, with an FAR below their seizure frequency. When increasing the sensitivity to 100% (no missed seizures), the FAR is up to 13 times lower than with the previous detector. Furthermore, all detections occurred before the seizure ended, providing reasonable latency (median = 29.3 s, range = 14.8–151 s). Automatically estimated seizure durations were correlated with true durations, enabling reliable annotations. Finally, EDA measurements confirmed the presence of postictal autonomic dysfunction, exhibiting a significant rise in 73% of the convulsive seizures. Significance The proposed multimodal wrist-worn convulsive seizure detectors provide seizure counts that are more accurate than previous automated detectors and typical patient self-reports, while maintaining a tolerable FAR for ambulatory monitoring. Furthermore, the multimodal system provides an objective description of motor behavior and autonomic dysfunction, aimed at enriching seizure characterization, with potential utility for SUDEP warning

Do cultured human skin explants elaborate coeliac antigen, possibly even Tissue-Transglutaminase?

To satisfy the demand for the most specific form of human tTG to use it as antigenic substrate in ELISA-tests, fibroblasts derived from skin biopsies of CD patients and healthy control patients were cultivated. Possible antigens in the medium that they produced and in sonicates of the fibroblasts themselves were seperated by SDS-Polyacrylamide gel electrophoresis with subsequent electrophoretic transfer to nitrocellulose membranes. In the following western blot they were exposed to serum of other untreated CD, treated CD and healthy control patients and the molecular weight of antigens was identified and compared to tTG. In conclusion cultured human skin explants do not secrete an antigen against CD antibodies into their environment. However the presence of such an antigen can be observed in fibroblast sonicates after the incubation with some CD sera. Whether this antigen of the molecular size of 20 - 25 kDa could be related to a fragment of tTG has to be evaluated in further studies

Home-Based Measurements of Nocturnal Cardiac Parasympathetic Activity in Athletes during Return to Sport after Sport-Related Concussion

Sport-related concussions (SRC) are characterized by impaired autonomic control. Heart rate variability (HRV) offers easily obtainable diagnostic approaches to SRC-associated dysautonomia, but studies investigating HRV during sleep, a crucial time for post-traumatic cerebral regeneration, are relatively sparse. The aim of this study was to assess nocturnal HRV in athletes during their return to sports (RTS) after SRC in their home environment using wireless wrist sensors (E4, Empatica, Milan, Italy) and to explore possible relations with clinical concussion-associated sleep symptoms. Eighteen SRC athletes wore a wrist sensor obtaining photoplethysmographic data at night during RTS as well as one night after full clinical recovery post RTS (>3 weeks). Nocturnal heart rate and parasympathetic activity of HRV (RMSSD) were calculated and compared using the Mann–Whitney U Test to values of eighteen; matched by sex, age, sport, and expertise, control athletes underwent the identical protocol. During RTS, nocturnal RMSSD of SRC athletes (Mdn = 77.74 ms) showed a trend compared to controls (Mdn = 95.68 ms, p = 0.021, r = −0.382, p adjusted using false discovery rate = 0.126) and positively correlated to “drowsiness” (r = 0.523, p = 0.023, p adjusted = 0.046). Post RTS, no differences in RMSSD between groups were detected. The presented findings in nocturnal cardiac parasympathetic activity during nights of RTS in SRC athletes might be a result of concussion, although its relation to recovery still needs to be elucidated. Utilization of wireless sensors and wearable technologies in home-based settings offer a possibility to obtain helpful objective data in the management of SRC

Altered structural connectome in temporal lobe epilepsy

PURPOSE: To study differences in the whole-brain structural connectomes of patients with left temporal lobe epilepsy (TLE) and healthy control subjects. MATERIALS AND METHODS: This study was approved by the institutional review board, and all individuals gave signed informed consent. Sixty-direction diffusion-tensor imaging and magnetization-prepared rapid acquisition gradient-echo (MP-RAGE) magnetic resonance imaging volumes were analyzed in 24 patients with left TLE and in 24 healthy control subjects. MP-RAGE volumes were segmented into 1015 regions of interest (ROIs) spanning the entire brain. Deterministic white matter tractography was performed after voxelwise tensor calculation. Weighted structural connectivity matrices were generated by using the pairwise density of connecting fibers between ROIs. Graph theoretical measures of connectivity networks were compared between groups by using linear models with permutation testing. RESULTS: Patients with TLE had 22%-45% reduced (P < .01) distant connectivity in the medial orbitofrontal cortex, temporal cortex, posterior cingulate cortex, and precuneus, compared with that in healthy subjects. However, local connectivity, as measured by means of network efficiency, was increased by 85%-270% (P < .01) in the medial and lateral frontal cortices, insular cortex, posterior cingulate cortex, precuneus, and occipital cortex in patients with TLE as compared with healthy subjects. CONCLUSION: This study suggests that TLE involves altered structural connectivity in a network that reaches beyond the temporal lobe, especially in the default mode network

Cortical thickness and neurocognitive performance in former high-level female soccer and non-contact sport athletes

Background: Long-term effects of playing soccer (football) on the brain structure and function of the brain are vividly debated. While some studies showed differences in neurocognitive performance and structural brain changes in retired male players, data on female players are scarce. The present study compares cortical thickness and neurocognitive performance in former high-level female soccer (SOC) and non-contact sport athletes (CON). Methods: 3 T T1-weighted 3D MPRAGE MRI was performed, and vertex-wise cortical thickness was analyzed using FreeSurfer (v. 6.0.0). Neurocognitive performance in seven domains of SOC and CON was assessed. A multivariate linear model was used to analyze interactions with respect to heading frequency and a history of concussion. Results: SOC (n = 15, mean age 38.3 ± 5.1 years) and CON (n = 16, mean age 36.6 ± 5.8 years) had a similar cortical thickness and performed similarly in the neurocognitive tests except for verbal memory and psychomotor speed, where SOC performed significantly worse than CON. Moderate headers had a significantly larger cortical thickness than rare headers in the right inferior parietal region. Visual memory and cortical thickness were positively correlated in the group of frequent headers and negatively correlated in CON, but not in the other header groups. Perspective: In contrast to previous reports in male soccer players, female players did not reveal cortical thinning in comparison with control athletes, whereas neurocognitive profiles of female soccer players might not significantly differ from male athletes. Small sample sizes, subjective header assessment, and the case–control study design require a cautious interpretation

Video analysis of 100 matches in male semi-professional football reveals a heading rate of 5.7 headings per field player and match

Introduction Heading is an integral part of football and frequent media reports and previous studies about potential danger of heading and head trauma in football fuelled discussions. Epidemiological data and video analyses regarding headings situation and associated head injuries are still missing in male adult professional football. Methods In a prospective cohort study in the male fourth German football league, 100 official matches of the 2015–2016 season were assessed by video analysis and a standardized protocol. Heading situations and concomitant circumstances as well as incidents with a propensity of injury (critical incidents) were analyzed. Critical incidents (CI) and seasonal reported head injuries were cross-referenced. Results Overall, 11,514 headings were analysed in detail. Video analysis yielded a mean of 5.7 headings per player and match (SD: 1.2; range 0–15). Heading was predominantly performed with the frontal part of the head (76.8%), and nearly two thirds of all headings occurred during defending (65.8%). 71.0% of all headings occured during tacklings, of which 71.9% involved body contact with the opponent player. Video analysis yielded 31 CI on the head due to heading (incidence: 1.02 per 1000 h match exposure and player). 29 CI occurred during heading duels (odds ratio: 5.91), 30 CI with body contact (odds ratio: 28.8) and 6 CI with elbow contact (odds ratio: 6.13). Conclusion Heading frequency in male semi-professional football could be determined with a rate of 5.7 headings per match and field player. Cross referencing CI and seasonal reported head injuries revealed a very low number of reported head injuries

Exercise and sports after COVID‐19—Guidance from a clinical perspective

SARS-CoV-2 infection has emerged as not only a pulmonary but also potentially multi-organ disease, which may cause long-term structural damage of different organ systems including the lung, heart, vasculature, brain, liver, kidney, or intestine. As a result, the current SARS-CoV-2/COVID-19 pandemic will eventually yield substantially increased numbers of chronically diseased patients worldwide, particularly suffering from pulmonary fibrosis, post-myocarditis, chronic heart failure, or chronic kidney disease. Exercise recommendations for rehabilitation are complex in these patients and should follow current guidelines including standards for pre-exercise medical examinations and individually tailored exercise prescription. It is of utmost importance to start exercise training at an early stage after COVID-19 infection, but at the same time paying attention to the physical barriers to ensure safe return to exercise. For exercise recommendations beyond rehabilitation programs particularly for leisure time and elite athletes, more precise advice is required including assessment of sports eligibility and specific return-to-sports exercise programs. Because of the current uncertainty of long-term course of SARS-CoV-2 infection or COVID disease, long-term follow-up seems to be necessary.Peer Reviewe

The effects of repetitive head impacts on postural control: A systematic review

Objectives: The purpose of our study was to investigate the association between repetitive head impact (RHI) exposure and postural control. Design: Systematic review. Methods: PubMed, Embase and PsycInfo were searched using a self-developed search term including the keywords balance OR postural control AND repetitive OR sub-concussive head impacts. Twenty-one studies excluding non-peer reviewed studies, secondary studies, cross-sectional studies, animal studies, and studies investigating concussion were included for further analyses. We rated Level of Evidence and quality using the Centre for Evidence-Based Medicine tool, the Quality Assessment for the Systematic Review of Effectiveness, and the Sub-concussion Specific Tool. Results: All included studies were grouped into Category I and II studies. Category I included trials investigating the effects of controlled soccer heading on postural control (n = 8) and Category II studies were cohort studies investigating on-the-field changes between preseason and postseason assessments on postural control measures (n = 13). Findings were heterogeneous, with a tendency towards no effects of RHI on clinical postural control measures. Most laboratory studies in Category I used instrumented assessments whereas on-the-field studies in Category II used both instrumented and non-instrumented assessments. Conclusions: Due to heterogeneous findings, future studies aiming to investigate the effects of RHI on different athlete populations are needed on other participant cohorts. Furthermore, the combination of objective clinical balance measures may be a promising approach to accurately measure how, and to what degree, postural control may be affected by RHI