Pressure Trajectories Research Articles

Identifying Parkinson’s disease and its stages using static standing balance

The current assessment of Parkinson’s disease (PD) relies on dynamic motor tasks, limiting accessibility. This study aimed to propose an innovative approach to identifying PD and its stages using static standing balance and machine learning. A total of 210 participants were recruited, including a control group and five PD groups categorized by stage. Each participant completed a 10-s static standing balance task in which center of pressure trajectory data in the medial-lateral and anterior-posterior directions were collected. Features were extracted from these trajectory data and the data derived from them using both representation learning and handcrafting methods. A Transformer encoder-based classifier was trained on these features and achieved an F1-score of 0.963 in classifying the six study groups. This approach enhances the accessibility of PD assessment, enabling earlier detection and timely intervention. The novel data mining framework introduced in this study heralds a new era of time-series data-driven digital healthcare.

Effect of long-term blood pressure trajectory on the future development of chronic kidney disease: an analysis of data from the Korean National Insurance Health Checkup Study.

Chronic kidney disease (CKD) is a prevalent health issue that causes the irreversible loss of functioning nephrons, end-stage renal disease, cardiovascular disease, and premature mortality. Hypertension is the leading cause of CKD. However, the effect of long-term blood pressure (BP) changes on the development of CKD is still unknown. Therefore, the current study investigated the association between BP trajectory and the future development of CKD. In this study, 246,874 individuals aged ≥40 years who underwent health examinations during the screening period (2002-2009) were evaluated. The systolic BP (SBP) trajectory was determined using latent-class mixture modeling. New-onset CKD was identified during the follow-up period (2010-2019). The association between SBP trajectories and new-onset CKD was assessed. In total, 111,900 adults (53,420 women, 51.9  6.4 years old) presented with 2 SBP trajectory classes: class 1 (n = 66,935) and class 2 (n = 44,965). During the follow-up period, patients with SBP trajectory class 2 had an approximately 2.1-fold increased risk of developing CKD (unadjusted hazard ratio [HR], 2.114; 95% confidence interval [CI], 1.989-2.246, p<0.001). In the multivariate analysis adjusted for other significant variables, SBP trajectory class 2 was significantly associated with CKD in men (HR, 1.093; 95% CI, 1.005-1.189; p=0.037), but not in women (HR, 1.059; 95% CI, 0.947-1.184; p=0.321). An elevated longitudinal BP was associated with a higher incidence of CKD in male participants aged ≥40 years. Nevertheless, further studies are needed to validate the clinical significance of an elevated SBP trajectory on CKD development.

Regional variation of age-related blood pressure trajectories and their association with blood pressure control rates, disability-adjusted life years and death

Abstract Background/Introduction While the relationship between blood pressure (BP) changes and increasing age is well described, age-related BP trajectories may vary substantially across different populations and associated with differential CV risk and outcomes. Purpose The dataset of the May Measurement Month (MMM) international campaigns enables a unique investigation of regional, socio-economic and sex differences in age-BP trajectories and their association with major public-health outcomes. Method Global BP data from more than 4,5 million adult (≥18 years) screenees obtained during the cross-sectional MMM campaigns in 2017, 2018, 2019, and 2021 were used for analysis. Average BP and slopes of BP changes across age groups were calculated within regional, socio-economic and sex strata. BP slopes of individuals between 30 and 70 years of age were derived from adjusted linear regression models, along with baseline BP estimates at young age. These BP slopes were correlated in regression models adjusted for baseline BP at young age with country-specific all-cause rates of DALYs (Disability-Adjusted Life Years), death (both from Global Burden of Disease Study 2019), life expectancy (World Bank data SP.DYN.LE00.IN 2019) and BP control rates (NCD Risk Factor Collaboration). Results Age-related BP changes differed distinctly across global geographic regions, income levels, and between sexes. The steepest increase in BP with age was observed in populations from Africa and Europe, whereas a more gradual rise in BP with increasing age was seen in South-East Asian populations. Women had lower BP levels than men at younger ages (twenties and thirties), but subsequently experienced a more pronounced age-related BP increase resulting in diminishing sex differences across older age groups. Geographically divergent age-related BP trajectories were significantly associated with major national public health indicators. Globally, the steeper the age-related BP slope, the stronger the association with poor BP control (β = -0.46 [95% CI: -0.74; -0.19], p=0.001), increased DALY’s (β = 66155.68 [95% CI: 44847.0; 87464.36], p&amp;lt;0.001) and death rates. (β = 1017.3 [95% CI: 351.72; 1682.89], p=0.003). Conclusion Age-related BP trajectories vary considerably across global populations and contribute considerably to the variability in BP-related risks and adverse outcomes across regions. Effective public health strategies may require region-specific targeting of lifestyle and other factors contributing to adverse BP trajectories to improve health outcomes.Average blood pressure by ageAssiciations with public health metrics

Association between trajectory of systolic blood pressure and outcomes in heart failure patients with preserved ejection fraction (HFpEF)

BackgroundThe optimal systolic blood pressure (SBP) in heart failure patients with preserved ejection fraction (HFpEF) remains controversial. We aim to assess the SBP trajectory and prognosis in HFpEF. Methods and ResultsPatients from Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT) were classified into three SBP trajectory groups according to the follow-up blood pressure using a latent category trajectory model. The primary outcome was composite of cardiovascular death, cardiac arrest, and hospital readmission for heart failure. A total of 3388 patients (mean age 68.6 years, 48.5 % men) were included. Mean SBP maintained 128 mmHg in the stable SBP trajectory group, declined from 129 to 125 mmHg in the decreasing SBP trajectory group and rose from 132 to 143 mmHg in the increasing SBP trajectory group within 6 years. During a mean follow-up of 3.4 years, 654 individuals had a primary outcome. Incidence for both primary and secondary outcomes were higher in increasing SBP trajectory group and decreasing SBP trajectory group compared with stable SBP trajectory group. After adjustments, the decreasing SBP trajectory group was associated with increased risk of all outcomes (hazard ratio ≥1.32), the increasing SBP trajectory group was associated with all-cause hospitalization and stroke (hazard ratio ≥ 1.28). ConclusionThe decreasing or increasing SBP trajectory is associated with a high risk of cardiovascular events in HFpEF, suggesting a stable SBP trajectory group (≈130 mmHg) have lower incidence of cardiovascular events and mortality. Trials are necessary to determine the optimal SBP in HFpEF.

Trajectories and management of vascular risk following the diagnosis of multiple sclerosis: A population-based matched cohort study between 1987 and 2018 in England

Background: People with multiple sclerosis (PwMS) have an increased cardiovascular and cerebrovascular disease burden, but this could be mitigated by vascular risk factor management. Objectives: We compared the trajectories of vascular risk factors, vascular comorbidities and clinical management in PwMS against the general population post-MS diagnosis while controlling for frailty. Methods: Retrospective longitudinal analysis using English data from the Clinical Practice Research Datalink between 1987 and 2018 comprising PwMS matched with up to six controls without MS by age, sex and general practice. Results: We compared 12,251 PwMS with 72,572 matched controls; 3.8% of PwMS had mild–moderate frailty, 1.2% more than matched controls. Compared to controls, PwMS had an elevated incidence of Type 2 diabetes (HR 1.18, 95% CI (1.04, 1.34)), and starting antihypertensive medications (HR 1.40, 95% CI (1.33, 1.47)). Among those with hypertension at baseline, blood pressure trajectories did not differ between PwMS and controls. PwMS had increased rates of meeting targets for hypertension management (HR 1.25, 95% CI (1.12, 1.41)). Conclusion: The observation that PwMS with hypertension are more likely to meet treatment targets than matched controls is encouraging, but the elevated rates of vascular comorbidities suggest that tighter vascular management may be needed in this population.

Epigenetic Clock at Birth and Childhood Blood Pressure Trajectory: A Prospective Birth Cohort Study.

The impact of methylation gestational age (GAmAge; a biomarker of fetal maturity) at birth on childhood blood pressure (BP) trajectories is unknown. This cohort study included 500 boys and 440 girls with data on cord blood DNA methylation and BP at 3 to 15 years of age. Systolic BP (SBP) and diastolic BP percentiles were calculated based on clinical guidelines. Time-series K-means clustering identified 4 distinct SBP and diastolic BP percentile trajectories: high-steady, high-decrease, normal-increase, and normal-steady. GAmAge was estimated using an existing pediatric epigenetic clock. Extrinsic age acceleration was calculated as residuals of associations between GAmAge and chronological gestational age. Intrinsic age acceleration was calculated using the same method adjusting for cord blood cell compositions. Extrinsic age acceleration and intrinsic age acceleration were inversely associated with repeated measures of BP percentiles. Significant inverse associations were observed between extrinsic age acceleration and SBP percentiles in boys (β=-2.02; P=0.02) but not in girls (β=-0.49; P=0.58). Both extrinsic age acceleration and intrinsic age acceleration were inversely associated with SBP percentiles in girls born preterm (<37 weeks; βEAA=-2.95; βIAA=-3.00; P<0.05). Compared with the normal-steady SBP trajectory, significant inverse associations were observed between intrinsic age acceleration and high-steady, high-decrease, and normal-increase SBP trajectories in boys (odds ratio, 0.73-0.81; P<0.03), and significant positive associations were observed for high-decrease and normal-increase SBP trajectories in girls (odds ratio, 1.26-1.38; P<0.01). Significant sex differences were observed (Psex-interaction<2×10-16). GAmAge acceleration at birth was inversely associated with child BP, and such association was more pronounced in boys than in girls. Our findings may shed new light on the developmental origins of high BP and sex differences in cardiovascular risk.

The role of diurnal variation in development of musculoskeletal pain during prolonged standing

BackgroundResearch suggests mechanical changes occur to the body over the course of the day including shrinking of the intervertebral disc height which can increase rotational stiffness and rigidity of the spinal column. Further, pain sensitivity has been observed to fluctuate throughout the day, suggesting variations in pain sensitivity. Previous work has identified biomechanical and neuromuscular features related to the development of musculoskeletal pain during prolonged standing; however, many protocols have not controlled for time of day. Research questionDoes the time of day (i.e., diurnal variation) have an effect on the common neuromuscular and biomechanical variables characterizing the development of standing musculoskeletal pain in a two-hour prolonged standing protocol? MethodsA convenience sample of 20 healthy young adults (10 female and 10 male) completed two 2-hour prolonged standing bouts (8:00 a.m. and 8:00 p.m.) on separate days. Visual analogue scales were used to measure pain perception of the low back, legs, and feet throughout each protocol. Neuromuscular control was measured using surface EMG on muscles of the trunk and lower extremities. Postural sway was captured using measures of joint range of motion, and the analysis of center of pressure trajectory data using a force plate. ResultsDiurnal variation was observed to influence the development of musculoskeletal pain. Specifically, pain perception was found to be increased in the evenings as more participants were classified as pain developers in the PM sessions, and mean leg and foot pain perceptions were higher in the evening. Reduced postural sway patterns, and elevated co-contraction indices were found to be associated with the development of pain. SignificanceThese results suggest that future research assessing standing-pain protocols should control for time of day. Additionally, further research is warranted to explore the mechanistic causes of the development of standing pain.

Education differences in blood pressure trajectories by sex through midlife: Findings from the National Health and Nutrition Examination Survey, 1999-2018.

Although it has long been established that age and sex play a role in blood pressure levels across the lifespan, the extent to which educational attainment moderates these relationships has been understudied. Thus, the purpose of this study was to assess educational differences in SBP, DBP, and pulse pressure (PP) trajectories among men and women through the midlife years. We conducted an analysis of pooled data from the 1999 to 2018 National Health and Nutrition Examination Survey to assess whether education moderates blood pressure measurements among men and women over the midlife years. Statistical analyses were performed using survey-weighted linear and quadratic regressions to assess these trajectories. During midlife, women with at least a college degree maintained the lowest average level of SBP compared to men at all education levels and women with a high school diploma or less. They also maintained the lowest level of PP, though not different from men with at least a college degree and women with less than a college degree. However, no educational differences were observed in DBP between men and women during the midlife years. Our study shows clear delineation in the trajectories of PP and SBP by education such that a 4-year education is more protective than some college and a high school degree, particularly among women. These results highlight the need to consider upstream policy interventions (education policy initiatives) that could reduce population-wide elevated blood pressure.

Latent Trajectories of Cerebral Perfusion Pressure and Risk Prediction Models Among Patients with Traumatic Brain Injury: Based on an Interpretable Artificial Neural Network

This study aimed to characterize long-term cerebral perfusion pressure (CPP) trajectory in traumatic brain injury (TBI) patients and construct an interpretable prediction model to assess the risk of unfavorable CPP evolution patterns. TBI patients with CPP records were identified from the Medical Information Mart for the Intensive Care (MIMIC)-IV 2.1, eICU Collaborative Research Database (eICU-CRD) 2.0 and HiRID dataset 1.1.1. The research process consisted of two stages. First, group-based trajectory modeling (GBTM) was used to identify different CPP trajectories. Second, different ANN algorithms were employed to predict the trajectories of CPP. A total of 331 eligible patients' records from MIMIC-IV 2.1 and eICU-CRD 2.0 were used for trajectory analysis and model development. Additionally, 310 patients' data from HiRID were used for external validation. The GBTM identified 5 CPP trajectory groups, group 1 and group 5 were merged into class 1 based on unfavorable in-hospital mortality. The best 6 predictors were invasive systolic blood pressure coefficient of variation (ISBPCV), venous blood chloride ion concentration, PaCO2, PT (Prothrombin Time), CPP coefficient of variation (CPPCV), and mean CPP. Compared with other algorithms, Scaled Conjugate Gradient (SCG) performed relatively better in identifying class 1. This study identified 2 CPP trajectory groups associated with elevated risk and 3 with reduced risk. PaCO2 might be a strong predictor for the unfavorable CPP class. The ANN model achieved the primary goal of risk stratification, which is conducive to early intervention and individualized treatment.

Abstract P167: Sex Dependent Associations of the Gut Microbiota with Hypertension – A Prospective Cohort

Background: Whilst there is emerging evidence that the associations of the gut microbiota (GM) with hypertension differ between sexes, it remains uncertain whether the GM 1) is altered with antihypertensive-use, 2) can predict blood pressure (BP) trajectories, and 3) whether these associations are also sex-dependent. We therefore aimed to determine the sex-dependent associations of the GM with baseline hypertensive state in untreated versus treated participants and BP changes over time. Methods: A total of 451 community-dwelling middle-aged Hong Kong Chinese without symptomatic cardiovascular diseases were recruited (50% men, 14% on antihypertensive agents, mean age, 54.6±6.5 years). Shotgun metagenomic sequencing of stool samples and 24-hour ambulatory blood pressure monitoring (ABPM) were performed. The 24hr-ABPM was repeated on 139 returned subjects after 4 years. Statistical analysis was conducted with 4 covariate models that include age, sex, menopause status, body mass index (BMI), smoking, fasting glucose, triglyceride, cholesterol, sodium intake, and fatty liver status. Results: Amongst the 389/451 subjects not on antihypertensive agents, 167/389 (42.9%) had newly diagnosed hypertension at baseline. Females drove the significantly different b-diversity of the GM composition ( p &lt;0.01) between the normotensives and hypertensives in the baseline study. Multiple GM species were significantly associated with hypertension. In sex stratified analysis, Faecalimonas umbilicate was significantly enriched in hypertensive females while Roseburia sp Am16-25 and Eubacterium ramulus were enriched in hypertensive males (all p &lt;0.05-0.01). When comparing the 62 treated and 167 nontreated hypertensive subjects, the GM abundance, a-, and b-diversity were not significantly different. However, there were significant GM species associated with the use of antihypertensive medication. Notably, Lachnospiraceae bacterium and Flavonifractor plautii were significantly enriched in treated and untreated individuals, respectively (all p &lt;0.05-0.001). During a mean follow up of 51.2±4.5 months, 73.2% of the 71 untreated subjects remained normotensive and were associated with enriched Bacteroides uniformis in their baseline metagenomic data under models adjusted for age, sex, and BMI. Conclusion: The GM displayed sex-dependent associations with hypertension within untreated and treated individuals and can potentially predict BP trajectory changes within a Chinese population.

Development and external validation of temporal fusion transformer models for continuous intraoperative blood pressure forecasting

During surgery, intraoperative hypotension is associated with postoperative morbidity and should therefore be avoided. Predicting the occurrence of hypotension in advance may allow timely interventions to prevent hypotension. Previous prediction models mostly use high-resolution waveform data, which is often not available. We utilised a novel temporal fusion transformer (TFT) algorithm to predict intraoperative blood pressure trajectories 7min in advance. We trained the model with low-resolution data (sampled every 15s) from 73,009 patients who were undergoing general anaesthesia for non-cardiothoracic surgery between January 1, 2017, and December 30, 2020, at the General Hospital of Vienna, Austria. The data set contained information on patient demographics, vital signs, medication, and ventilation. The model was evaluated using an internal (n=8113) and external test set (n=5065) obtained from the openly accessible Vital Signs Database. In the internal test set, the mean absolute error for predicting mean arterial blood pressure was 0.376 standard deviations-or 4mmHg-and 0.622 standard deviations-or 7mmHg-in the external test set. We also adapted the TFT model to binarily predict the occurrence of hypotension as defined by mean arterial blood pressure < 65mmHg in the next one, three, five, and 7min. Here, model discrimination was excellent, with a mean area under the receiver operating characteristic curve (AUROC) of 0.933 in the internal test set and 0.919 in the external test set. Our TFT model is capable of accurately forecasting intraoperative arterial blood pressure using only low-resolution data showing a low prediction error. When used for binary prediction of hypotension, we obtained excellent performance. No external funding.

Abstract P225: Persistent Vascular Dysfunction and Blood Pressure Elevation Over 12 Months After COVID-19 Recovery in Non-Hypertensive Adults – LOCHINVAR Study

Background: The potential long-term vascular consequences of COVID-19, particularly in relation to future hypertension risk, remain poorly understood. This study aims to elucidate the longitudinal blood pressure trajectories in individuals who have recovered from COVID-19 but were not hypertensive prior to their infection, over a 12-month observational period. Methods: This study enrolled participants who had recovered from a hospital-admitted COVID-19 infection at least 12 weeks prior and had no history of hypertension. A control group was established from individuals with no prior SARS-CoV-2 infection, confirmed by a negative antibody test. All participants underwent ambulatory blood pressure monitoring (ABPM), flow-mediated dilation (FMD), and 6-minute walk test (6MWT) both at baseline and after 12 months. RAAS phenotyping was conducted at baseline. Paired t-tests and multivariable adjusted regression models were employed in the analyses of the full-dataset and per-protocol subset (because of variation in participant characteristics due to changing COVID-19 landscape during the recruitment period). Results: The full dataset had 97 participants (SARS-CoV-2 Negative:Positive 60:37) and per protocol data set had 66 participants (SARS-CoV-2 Negative:Positive 51:15). The median age was 50 (IQR:42-54) years with majority females. Per-protocol analysis revealed the positive group showed an increase in systolic and diastolic blood pressure (SBP/DBP) by 4.6/4.5 mmHg, a decrease in FMD by 3.2%, and an improvement in the 6MWT distance by 145.6 meters over 12 months, compared to the negative group (Figure 1). Baseline RAAS phenotyping showed no significant differences between groups. Conclusions: Our study demonstrates a significant increase in diastolic blood pressure 12 months following COVID-19 recovery in previously non-hypertensive individuals, accompanied by a decline in FMD. These findings suggest a possible vascular basis for the development of hypertension post-COVID-19 recovery.

Plantar pressure in relation to hindfoot varus in people with unilateral upper motor neuron syndrome.

Hindfoot varus deformity is common in people with unilateral upper motor neuron syndrome (UMNS) and can be dynamic or persistent. The aims of this study were (1) to gain insight into plantar pressure characteristics of people with chronic UMNS in relation to hindfoot varus and (2) to propose a quantitative outcome measure, based on plantar pressure, for the scientific evaluation of surgical interventions. In this retrospective study, a cohort comprising plantar pressure data of 49 people with UMNS (22 "no hindfoot varus", 18 "dynamic hindfoot varus", and 9 "persistent hindfoot varus"), and 586 healthy controls was analyzed. As an indication of plantigrade foot contact, the ratio between the plantar contact area of the affected and the non-affected foot was calculated. To investigate spatial and temporal aspects of plantar pressure, normalized plantar pressure patterns and center of pressure trajectories were computed. People with UMNS had lower plantar pressure area ratios compared to healthy controls. Additionally, increased plantar pressure underneath the lateral foot was found in people with a persistent hindfoot varus. Center of pressure trajectories were more lateral during the first 26% of the stance phase in people with a dynamic hindfoot varus and during the first 82% of the stance phase in people with a persistent hindfoot varus compared to healthy controls. Spatial and temporal differences in plantar pressure were found in people with dynamic or persistent hindfoot varus deformity. We propose to primarily use the medio-lateral center of pressure trajectory as outcome measure for the scientific evaluation of surgical interventions targeting hindfoot varus.

Tracking of blood pressure levels from childhood.

The overall goal of this review is to summarize what is currently known regarding the tracking of blood pressure levels from early childhood into later adulthood and to describe the factors contributing to increased hypertension prevalence across the lifespan. This review describes 4 theoretical constructs of blood pressure trajectory across the lifespan: forward development, forward tracking, forward reversal, and maintenance of normal blood pressure levels.

Experimental study on combustion and emissions of an ammonia/diesel dual-fuel engine using split-injection strategy

Blending high-reactivity fuels is recognized as an effective way to improve poor combustion performance of ammonia (NH3). In this work, pressure trajectories, flame evolutions, and emission characteristics of ammonia/n-dodecane dual fuels were studied in an optical engine, addressing split-injection strategy. Synchronization measurement of in-cylinder pressure and high-speed photography was performed for combustion evolutions, and FT-IR spectroscopy was adopted for nitrogen-based emissions. Results demonstrate that pre-injection timing and its energy ratio play a significant role in improving engine thermal efficiency and pollution emissions. Specifically, compared to the single-injection strategy, split-injection strategy leads to a reduced peak in-cylinder pressure, optimized combustion phasing, and shortened combustion duration, achieving an increase in the indicated mean effective pressure by 15.8 %. An early pre-injection timing with an energy ratio of 40 %∼60 % yields superior thermal efficiency compared to single injection at the same injection timing. For the delayed pre-injection timing, increasing pre-injection energy ratio is required to achieve optimal engine performance. Combustion visualizations show that the improved flame development under split-injection conditions is attributed to high-reactivity fuel stratification and enhanced premixing processes. Regarding nitrogen-based emissions, unburned NH3 and N2O emissions are insignificantly reduced, and NOx emissions correlate with the sensitivity of flame development to in-cylinder temperature. On the premise of ensuring stable combustion, all nitrogen-based emissions are reduced at a pre-injection energy ratio of 40 %, and an energy ratio of 60 % reduces N2O and unburned NH3 emissions while increasing NO and NO2 emissions. The current work can provide useful insights into the optimization and control of ammonia/diesel dual-fuel engines in terms of combustion and emissions.

Nifedipine outperforms labetalol: A comparative analysis of hypertension management in black pregnancies

BackgroundNifedipine has previously exhibited superior efficacy to labetalol in managing hypertension in the non-pregnant Black population, establishing itself as a first-line treatment option. However, the unique challenges of hypertension during pregnancy, especially prevalent in Black individuals, remain underexplored in terms of effective medication choices. This gap highlights the need for targeted research on antihypertensive efficacy specifically within this population. ObjectiveThis study aims to evaluate the effectiveness of nifedipine versus labetalol in managing blood pressure in Black pregnancies. The primary measure is the mean systolic and diastolic blood pressure trajectories throughout pregnancy, determining the superiority of nifedipine in this context. Study designA retrospective cohort study was conducted at a multi-center institution in the metropolitan Detroit area, encompassing data from 1,235 Black pregnancies affected by chronic hypertension between 2015 and 2022. Mean blood pressure trajectories during pregnancy were fit by linear mixed effects model with a random intercept and time effect. ResultsPatients on nifedipine had an estimated 2.08 mmHg lower mean systolic and 1.60 mmHg lower mean diastolic blood pressure compared to those on labetalol, with significant p-values of 0.040 and 0.028. Additionally, nifedipine users were less likely to need increased doses, with an odds ratio of 0.28 (95 % CI: 0.19–0.40, p < 0.001) compared to labetalol users. ConclusionThis study provides compelling evidence that nifedipine outperforms labetalol in managing blood pressure during Black pregnancies. These findings suggest that the initiation of nifedipine should be considered in the management of chronic hypertension among Black pregnant individuals, offering a potentially more effective treatment option.

Multimodal training protocols on unstable rather than stable surfaces better improve dynamic balance ability in older adults

BackgroundThere has been growing interest in using unstable devices in training protocols. This study aimed to assess the effectiveness of two multimodal exercise interventions (i.e., on stable and unstable surfaces) on dynamic balance control and lower limb strength in older adults.MethodsSixty-two older adults were randomly assigned to two intervention groups (N = 20, stable group; N = 19, unstable group), and to a control group (N = 18). In this single-blinded randomized controlled study, the two intervention groups underwent a 12-week training program twice a week for 45 min, consisting of strength and balance exercises. The stable (ST) group performed the training program over stable surfaces, while the unstable (UNST) group over unstable surfaces. Dynamic balance was assessed by computing the center of pressure (CoP) trajectory while a driven movable platform induced an unexpected perturbation of the base of support. Specifically, we considered the following CoP-related parameters within a 2.5-s temporal window from the beginning of the perturbation: displacement (Area95), mean velocity (Unit Path), anterior–posterior first peak (FP), post perturbation variability (PPV), and maximal oscillations (ΔCoPMax). The dominant quadriceps strength was measured through an isometric maximal voluntary contraction on an instrumented chair.ResultsFour out of five CoP-related parameters (i.e., Area95, Unit Path, ΔCoPMax, and PPV) significantly improved in the UNST group from a minimum of 14.28% (d = 0.44) to a maximum of 52.82% (d = 0.58). The ST group significantly improved only in two (i.e., ΔCoPMax, and PPV) out of five CoP-related parameters with an enhancement of 12.48% (d = 0.68) and 19.10% (d = 1.06). Both intervention groups increased the maximal isometric quadriceps strength (UNST:17.27%, d = 0.69; ST:22.29%, d = 0.98). The control group did not show changes in any of the parameters considered.ConclusionsStable surfaces promoted faster increments of muscular strength. Unstable surfaces were more effective in enhancing dynamic balance efficiency. These findings suggested the employment of multimodal training on unstable rather than stable surfaces to potentially lower the incidence of falls in older adults.Trial registrationNCT 05769361, retrospectively registered 13 March 2023, https://clinicaltrials.gov/study/NCT05769361?lat=45.3661864&lng=11.8209139&locStr=Padova,%20Italy&distance=50&page=11&rank=107.

Postpartum Weight Change Association With Readmission and Blood Pressure Trend Among Individuals With Hypertensive Disorders of Pregnancy.

The aim of this study was to evaluate the association between early postpartum weight change and (1) hospital readmission and (2) 2-week blood pressure trajectory. This retrospective study cohort included 1365 individuals with a hypertensive disorder of pregnancy enrolled in a postpartum hypertension remote monitoring program. Exposure was percentage weight change from delivery to first weight recorded within 10 days postpartum. We first modeled likelihood of hospital readmission within 8 weeks postpartum using logistic regression adjusting for age, race, insurance, type of hypertensive disorder of pregnancy, early body mass index, gestational weight gain, mode of delivery, and any discharge antihypertensive medications. We then performed case-control analysis additionally matching in a 1:3 ratio on breastfeeding, early body mass index, discharge on antihypertensive medications, and days between weight measurements. Both analytic approaches were repeated, limiting to readmissions attributable to hypertension or heart failure. Finally, we compared blood pressure trajectories over first 2 weeks postpartum. Individuals who did not lose weight in the early postpartum period had more admissions compared with weight loss groups (group 3: 14.1% versus group 2: 5.8% versus group 1: 4.5%). These individuals had 4 times the odds of postpartum readmissions (adjusted odds ratio [aOR], 3.9 [95% CI, 1.8-8.6]) to 7 (aOR, 7.8 [95% CI, 2.3-26.5]) compared with those with the most weight loss. This association strengthened when limited to hypertension or heart failure readmissions. These individuals also had more adverse postpartum blood pressure trajectories, with significant differences by weight change group. Weight change is readily accessible and may identify individuals at high risk for postpartum readmission following a hypertensive disorder of pregnancy who could benefit from targeted interventions.

Weak magnetic vestibular stimulation decreases postural sway

BackgroundPerceptible galvanic vestibular stimulation (GVS) causes nystagmus and postural sway deterioration. Conversely, imperceptible GVS improves postural stability, suggesting the presence of stochastic resonance. Research questionSimilar to GVS, strong magnetic vestibular stimulation of 7 T induces nystagmus and increases body sway. Thus, a relatively small magnetic stimulation may improve postural stability. In this study, we measured the effect of a relatively small magnetic field on postural sway. MethodsPosturography was performed in eight healthy participants using a stabilometer with foam rubber on board. The center of pressure (COP) trajectories were recorded in both the anterior–posterior and medial–lateral directions for 60 s with the eye closed. Neodymium magnets (0.4 T) or aluminum disks of similar size (0 T) were placed bilaterally over the mastoid processes. ResultsBoth the trajectory length and envelopment area of the COP movement with 0.4 T were significantly smaller than those with 0 T. SignificanceThe relatively smaller magnetic vestibular stimulation decreased postural sway. This method may be useful for improving the vestibular function and related reflexes.

Influence of Different Breathing Strategies on Plantar Pressure Distribution in Ballet Movements

PURPOSE This study investigated the differences in plantar pressure distribution when using three breathing techniques during heel raises.METHODS The subjects were 29 professional dancers aged 20 to 30 years with more than 10 years of experience. Pressure distribution according to breathing method during heel raise was measured for 10 seconds while controlling the raise speed and gaze. The three breathing techniques were randomly ordered. Peak pressure, contact area and time, displacement, and absolute velocity of the center of pressure trajectory were measured using Emed&lt;sup&gt;®&lt;/sup&gt;-le from Novel GMBH. Plantar pressure was analyzed by dividing it into a total of 12 areas (masks): five toes, five metatarsals, the midfoot, and the hindfoot.RESULTS Using the teeth occlusion breathing technique, the peak pressure on the first metatarsal was significantly reduced, the contact time of the second metatarsal was significantly longer, and the displacement of the center of pressure trajectory was significantly shorter. Additionally, during the phase of the forefoot retainer, the velocity of the center of pressure trajectory was significantly reduced.CONCLUSIONS The teeth occlusion technique reduces peak pressure, increases contact time and area, and decreases the displacement and velocity of the center of pressure trajectory, demonstrating an efficient method for maintaining balance in ballet movements. This technique can potentially enhance stability and prevent injuries in ballet dancers.