Detailed Assessment of the "I Need Help" Criteria in Patients With Heart Failure: Insights From the HELP-HF Registry.

BACKGROUND: The "I Need Help" markers have been proposed to identify patients with advanced heart failure (HF). We evaluated the prognostic impact of these markers on clinical outcomes in a real-world, contemporary, multicenter HF population. METHODS: We included consecutive patients with HF and at least 1 high-risk "I Need Help" marker from 4 centers. The impact of the cumulative number of "I Need Help" criteria and that of each individual "I Need Help" criterion was evaluated. The primary end point was the composite of all-cause mortality or first HF hospitalization. RESULTS: Among 1149 patients enrolled, the majority had 2 (30.9%) or 3 (22.6%) "I Need Help" criteria. A higher cumulative number of "I Need Help" criteria was independently associated with a higher risk of the primary end point (adjusted hazard ratio for each criterion increase, 1.19 [95% CI, 1.11-1.27]; P<0.001), and patients with >5 criteria had the worst prognosis. Need of inotropes, persistently high New York Heart Association classes III and IV or natriuretic peptides, end-organ dysfunction, >1 HF hospitalization in the last year, persisting fluid overload or escalating diuretics, and low blood pressure were the individual criteria independently associated with a higher risk of the primary end point. CONCLUSIONS: In our HF population, a higher number of "I Need Help" criteria was associated with a worse prognosis. The individual criteria with an independent impact on mortality or HF hospitalization were need of inotropes, New York Heart Association class or natriuretic peptides, end-organ dysfunction, multiple HF hospitalizations, persisting edema or escalating diuretics, and low blood pressure.

On-Field Biomechanical Assessment of High and Low Dive in Competitive 16-Year-Old Goalkeepers through Wearable Sensors and Principal Component Analysis.

Diving saves are the main duty of football goalkeepers. Few biomechanical investigations of dive techniques have been conducted, none in a sport-specific environment. The present study investigated the characteristics of goalkeepers' dive in preferred (PS) and non-preferred (nPS) side through an innovative wearables-plus-principal-component analysis (PCA) approach. Nineteen competitive academy goalkeepers (16.5 ± 3.0 years) performed a series of high and low dives on their PS and nPS. Dives were performed in a regular football goal on the pitch. Full-body kinematics were collected through 17 wearable inertial sensors (MTw Awinda, Xsens). PCA was conducted to reduce data dimensionality (input matrix 310,878 datapoints). PCA scores were extracted for each kinematic variable and compared between PS and nPS if their explained variability was >5%. In high dive, participants exhibited greater hip internal rotation and less trunk lateral tilt (p < 0.047, ES > 0.39) in PS than nPS. In low dives, players exhibited greater ipsilateral hip abduction dominance and lower trunk rotation (p < 0.037, ES > 0.40) in PS than nPS. When diving on their nPS, goalkeepers adopted sub-optimal patterns with less trunk coordination and limited explosiveness. An ecological testing through wearables and PCA might help coaches to inspect relevant diving characteristics and improve training effectiveness.

Mobile-Bearing Total Ankle Replacement In Vivo Kinematic Assessment: A Prospective Study Protocol.

Total ankle prosthesis as a surgical solution in the case of end-stage osteoarthritis has seen a considerable increase in the last two decades. This study protocol arises from the need to understand the in vivo kinematics of mobile-bearing, flat tibial component total ankle replacement, evaluating the real range of motion and the reciprocal relationships between the components during normal motor tasks through the use of model-based radio-stereometric analysis (MB-RSA). In addition, pre- and post-operative evaluation of walking kinematics with inertial motion sensors, proprioception through a dedicated workstation, and clinical outcomes are discussed. We expect that based on our study protocol researchers will be able to improve future prosthetic designs and validate the setup of MB-RSA, as well as to understand "how an ankle prosthesis moves" once implanted in the patient.

Muscle Synergy Assessment During Single-Leg Stance.

In the study of muscle synergies during the maintenance of single-leg stance there are several methodological issues that must be taken into account before muscle synergy extraction. In particular, it is important to distinguish between epochs of surface electromyography (sEMG) signals corresponding to "well-balanced" and "unbalanced" single-leg stance, since different motor control strategies could be used to maintain balance. The aim of this work is to present and define a robust procedure to distinguish between "well-balanced" and "unbalanced" single-leg stance to be chosen as input for the algorithm used to extract muscle synergies. Our results demonstrate that the proposed approach for the selection of sEMG epochs relative to "well-balanced" and "unbalanced" single-leg stance is robust with respect to the selection of the segmentation threshold, revealing a high consistency in the number of muscle synergies and high similarity among the weight vectors (correlation values range from 0.75 to 0.97). Moreover, differences in terms of average recruitment levels and balance control strategies were detected, suggesting a slightly different modular organization between "well-balanced" and "unbalanced" single-leg stance. In conclusion, this approach can be successfully used as a pre-processing step before muscle synergy extraction, allowing for a better assessment of motor control strategies during the single-leg stance task.