Tight shoulders: A clinical, kinematic and strength comparison of symptomatic and asymptomatic male overhead athletes before and after stretching.

A tightness of the posterior structures of the throwing shoulder has been hypothesised to be associated with injuries and pain because of alterations of the scapular kinematics and muscular imbalances. The aims of this study were to identify the clinical and biomechanical profile of symptomatic and asymptomatic overhead athletes with a tight shoulder and to evaluate the efficiency of a self-applied stretching program. Twenty male overhead athletes were recruited. Half of them reported a painful shoulder at the beginning of the study. For four weeks, the volunteers performed daily stretching exercises. Before and after the stretching program, gleno-humeral mobility, scapular kinematics, rotator muscles strength and pain were evaluated. Before stretching, the main difference between the groups was more impingement syndrome and rotator cuff tendon lesion positive tests in the symptomatic group (p < 0.027, effect size = 0.51). After the program, pain reported by the symptomatic volunteers was reduced by approximately 40% and the gleno-humeral internal rotation bilateral difference was significantly reduced by 77.6% (p < 0.009, effect size = 0.84). In the symptomatic group, the scapula at rest was significantly more posteriorly tilted (p = 0.027, effect size = 0.69) after the stretching; a position that has been shown to limit the risk of impingement. The absence of significant differences of the profiles of the symptomatic and asymptomatic overhead athletes before stretching may indicate that the initiation of early prevention programs, including self-applied stretching, should not rely solely on biomechanical and clinical parameters and might be recommended to all players with a tight shoulder.

Comparison of longitudinal change in sST2 vs BNP to predict major adverse cardiovascular events in asymptomatic patients in the community.

Biomarker-based preventative and monitoring strategies are increasingly used for risk stratification in cardiovascular (CV) disease. The aim of this study was to investigate the utility of longitudinal change in B-type natriuretic peptide (BNP) and sST2 concentrations for predicting incident major adverse CV events (MACE) (heart failure, myocardial infarction, arrhythmia, stroke/transient ischaemic attack and CV death) in asymptomatic community-based patients with risk factors but without prevalent MACE at enrolment. The study population consisted of 282 patients selected from the longitudinal STOP-HF study of asymptomatic patients with risk factors for development of MACE. Fifty-two of these patients developed a MACE. The study was run in two phases comprising of an initial investigative cohort (n = 195), and a subsequent 2:1 (No MACE: MACE) propensity matched verification cohort (n = 87). BNP and sST2 were quantified in all patients at two time points a median of 2.5 years apart. Results highlighted that longitudinal change in sST2 was a statistically significant predictor of incident MACE, (AUC 0.60). A one-unit increment in sST2 change from baseline to follow up corresponded to approximately 7.99% increase in the rate of one or more incident MACE, independent of the baseline or follow-up concentration. In contrast, longitudinal change value of BNP was not associated with MACE. In conclusion, longitudinal change in sST2 but not BNP was associated with incident MACE in asymptomatic, initially event-free patients in the community. Further work is required to evaluate the clinical utility of change in sST2 in risk prediction and event monitoring in this setting.

Social Markers of Mild Cognitive Impairment: Proportion of Word Counts in Free Conversational Speech.

BACKGROUND: Detecting early signs of Alzheimer's disease (AD) and mild cognitive impairment (MCI) during the pre-symptomatic phase is becoming increasingly important for costeffective clinical trials and also for deriving maximum benefit from currently available treatment strategies. However, distinguishing early signs of MCI from normal cognitive aging is difficult. Biomarkers have been extensively examined as early indicators of the pathological process for AD, but assessing these biomarkers is expensive and challenging to apply widely among pre-symptomatic community dwelling older adults. Here we propose assessment of social markers, which could provide an alternative or complementary and ecologically valid strategy for identifying the pre-symptomatic phase leading to MCI and AD. METHODS: The data came from a larger randomized controlled clinical trial (RCT), where we examined whether daily conversational interactions using remote video telecommunications software could improve cognitive functions of older adult participants. We assessed the proportion of words generated by participants out of total words produced by both participants and staff interviewers using transcribed conversations during the intervention trial as an indicator of how two people (participants and interviewers) interact with each other in one-on-one conversations. We examined whether the proportion differed between those with intact cognition and MCI, using first, generalized estimating equations with the proportion as outcome, and second, logistic regression models with cognitive status as outcome in order to estimate the area under ROC curve (ROC AUC). RESULTS: Compared to those with normal cognitive function, MCI participants generated a greater proportion of words out of the total number of words during the timed conversation sessions (p=0.01). This difference remained after controlling for participant age, gender, interviewer and time of assessment (p=0.03). The logistic regression models showed the ROC AUC of identifying MCI (vs. normals) was 0.71 (95% Confidence Interval: 0.54 - 0.89) when average proportion of word counts spoken by subjects was included univariately into the model. CONCLUSION: An ecologically valid social marker such as the proportion of spoken words produced during spontaneous conversations may be sensitive to transitions from normal cognition to MCI.

International Work Group criteria for the diagnosis of Alzheimer disease.

Alzheimer-type biomarker changes are identifiable in asymptomatic and mildly symptomatic predementia phases of Alzheimer disease (AD) and AD dementia. The International Work Group (IWG) guidelines for diagnosis identify a unified spectrum of 3 phases. The classic clinical feature that indicates AD is an episodic memory defect of the amnestic type. IWG criteria require biomarker support for the diagnoses of AD at any clinical stage. Pathophysiologic and topographic biomarkers are recognized. These criteria are proposed to allow highly specific diagnosis of AD and assist in identifying patients for clinical trials of AD-related treatments and other types of AD research.