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Viemari JC. Isoproterenol modulates expiratory activities in the brainstem spinal cord preparation in neonatal mice in vitro. Respir Physiol Neurobiol 2024; 324:104241. [PMID: 38417565 DOI: 10.1016/j.resp.2024.104241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/12/2024] [Accepted: 02/23/2024] [Indexed: 03/01/2024]
Abstract
Motor behaviors such as breathing required temporal coordination of different muscle groups to insured efficient ventilation and provide oxygen to the body. This action is the result of interactions between neural networks located within the brainstem. Inspiration and expiration depend at least in part on interactions between two separate oscillators: inspiration is driven by a neural network located in the preBötzinger complex (PreBötC) and active expiration is driven by a network in the parafacial respiratory group (pFRG). Neurons of the pFRG are silent at rest and become active when the respiratory drive increased. This study investigated the temporal coordination between the brainstem respiratory network and the lumbar spinal network that generates spontaneous activities that is different of the induced fictive locomotion. The remaining question is how these activities coordinate early during the development. Results of this study show that brainstem networks contribute to the temporal coordination of the lumbar spontaneous activity during inspiration since lumbar motor activity occurs exclusively during the expiratory time. This study also investigated the role of the β-noradrenergic modulation on the respiratory activities. β-noradrenergic receptors activation increased the frequency of the double bursts and increased expiratory activity at the lumbar level. These results suggest interactions between brainstem and spinal networks and reveal a descending drive that may contribute to the coordination of the respiratory and lumbar spontaneous activities.
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Affiliation(s)
- Jean-Charles Viemari
- Aix-Marseille Univ, Inserm, MMG, Marseille, France; Aix-Marseille Univ, CNRS, INT, Marseille, France.
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Karunanethy M, Tripathi R, Panchagnula MV, Rengaswamy R. User authentication system based on human exhaled breath physics. PLoS One 2024; 19:e0301971. [PMID: 38648227 PMCID: PMC11034670 DOI: 10.1371/journal.pone.0301971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
This work, in a pioneering approach, attempts to build a biometric system that works purely based on the fluid mechanics governing exhaled breath. We test the hypothesis that the structure of turbulence in exhaled human breath can be exploited to build biometric algorithms. This work relies on the idea that the extrathoracic airway is unique for every individual, making the exhaled breath a biomarker. Methods including classical multi-dimensional hypothesis testing approach and machine learning models are employed in building user authentication algorithms, namely user confirmation and user identification. A user confirmation algorithm tries to verify whether a user is the person they claim to be. A user identification algorithm tries to identify a user's identity with no prior information available. A dataset of exhaled breath time series samples from 94 human subjects was used to evaluate the performance of these algorithms. The user confirmation algorithms performed exceedingly well for the given dataset with over 97% true confirmation rate. The machine learning based algorithm achieved a good true confirmation rate, reiterating our understanding of why machine learning based algorithms typically outperform classical hypothesis test based algorithms. The user identification algorithm performs reasonably well with the provided dataset with over 50% of the users identified as being within two possible suspects. We show surprisingly unique turbulent signatures in the exhaled breath that have not been discovered before. In addition to discussions on a novel biometric system, we make arguments to utilise this idea as a tool to gain insights into the morphometric variation of extrathoracic airway across individuals. Such tools are expected to have future potential in the area of personalised medicines.
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Affiliation(s)
- Mukesh Karunanethy
- Department of Applied Mechanics and Biomedical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Rahul Tripathi
- Department of Applied Mechanics and Biomedical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Mahesh V. Panchagnula
- Department of Applied Mechanics and Biomedical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Raghunathan Rengaswamy
- Department of Chemical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
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3
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Seeholzer LF, Julius D. Neuroendocrine cells initiate protective upper airway reflexes. Science 2024; 384:295-301. [PMID: 38669574 DOI: 10.1126/science.adh5483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 02/21/2024] [Indexed: 04/28/2024]
Abstract
Airway neuroendocrine (NE) cells have been proposed to serve as specialized sensory epithelial cells that modulate respiratory behavior by communicating with nearby nerve endings. However, their functional properties and physiological roles in the healthy lung, trachea, and larynx remain largely unknown. In this work, we show that murine NE cells in these compartments have distinct biophysical properties but share sensitivity to two commonly aspirated noxious stimuli, water and acid. Moreover, we found that tracheal and laryngeal NE cells protect the airways by releasing adenosine 5'-triphosphate (ATP) to activate purinoreceptive sensory neurons that initiate swallowing and expiratory reflexes. Our work uncovers the broad molecular and biophysical diversity of NE cells across the airways and reveals mechanisms by which these specialized excitable cells serve as sentinels for activating protective responses.
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Affiliation(s)
- Laura F Seeholzer
- Department of Physiology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - David Julius
- Department of Physiology, University of California, San Francisco, San Francisco, CA 94143, USA
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Dietsch AM, Krishnamurthy R, Young K, Barlow SM. Instrumental Assessment of Aero-Resistive Expiratory Muscle Strength Rehabilitation Devices. J Speech Lang Hear Res 2024; 67:729-739. [PMID: 38324264 DOI: 10.1044/2023_jslhr-23-00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE Expiratory muscle strength training (EMST) is increasingly being used to treat voice, cough, and swallowing deficits in a wide range of conditions. However, a multitude of aero-resistive EMST models are commercially available, and the absence of side-by-side comparative data interferes with clinicians' ability to assess which model is best suited to a particular client's needs. The primary aim of this research was to test and compare the pressure and flow parameters of six currently available EMST models to help inform clinical decision making. METHOD We identified and tested five devices of each of six different EMST models to generate benchmark data for minimum trigger pressures across settings. The reliability was tested within each device and between five devices of the same model across settings using coefficient of variation. RESULTS All six models required higher pressures to initiate flow at the highest setting compared to the lowest setting, as expected. Detailed descriptive statistics for each model/setting combination include average flow-triggering pressure for each model/setting and the variability across trials within a device and across devices of the same model. From these, ranked order of the least to most stable EMST model was derived. CONCLUSIONS Systematic testing of several commercially available expiratory resistance training devices yielded clinical benchmarks and reliability data to aid clinicians in selecting an appropriate therapy device and regimen for a client based on their available airflow and air pressure as well as reliability of the device. These findings allow clinicians to directly compare key parameters across EMST devices.
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Affiliation(s)
- Angela M Dietsch
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
- Center for Brain, Biology and Behavior, University of Nebraska-Lincoln
| | - Rahul Krishnamurthy
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
| | - Kelsey Young
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
| | - Steven M Barlow
- Department of Special Education and Communication Disorders, University of Nebraska-Lincoln
- Center for Brain, Biology and Behavior, University of Nebraska-Lincoln
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Nagata Y, Miki K, Kijima R, Mihashi Y, Miyamoto S, Hashimoto H, Nii T, Matsuki T, Tsujino K, Kida H. Body positioning-related laryngeal narrowing pattern and expiratory mechanical constraints in advanced chronic obstructive pulmonary disease: A case report. Respir Investig 2024; 62:258-261. [PMID: 38241959 DOI: 10.1016/j.resinv.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
We previously reported that laryngeal widening led to improved exercise tolerance in COPD. However, it is not clear whether laryngeal narrowing occurs as a compensatory response to tracheal movement or is affected by posture. Here, we report the case of an advanced COPD patient whose more prolonged expiration in a head-forward leaning position compared with that in a neck-extended position occurred with an excessive duration of severe laryngeal narrowing without tracheal obstruction, which led to exercise intolerance with expiratory mechanical constraints. This case provided useful insights into the regulation of the upper airway with body positioning for improving exercise tolerance.
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Affiliation(s)
- Yuka Nagata
- Department of Respiratory Medicine, NHO Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Keisuke Miki
- Department of Respiratory Medicine, NHO Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan.
| | - Ryo Kijima
- Department of Respiratory Medicine, NHO Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Yasuhiro Mihashi
- Department of Respiratory Medicine, NHO Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Satoshi Miyamoto
- Department of Respiratory Medicine, NHO Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Hisako Hashimoto
- Department of Respiratory Medicine, NHO Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Takuro Nii
- Department of Respiratory Medicine, NHO Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Takanori Matsuki
- Department of Respiratory Medicine, NHO Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, NHO Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Hiroshi Kida
- Department of Respiratory Medicine, NHO Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
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Ribeiro Fonseca Franco de Macedo J, Reychler G, Poncin W, Liistro G. Effects of the intermittent intrapulmonary deflation technique on expiratory flow limitation: an in vitro study. J Clin Monit Comput 2024; 38:69-75. [PMID: 37917211 DOI: 10.1007/s10877-023-01093-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 10/09/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION The intermittent intrapulmonary deflation (IID) technique is a recent airway clearance technique that intends to delay the onset of expiratory flow limitation (EFL) during exhalation. We showed in a previous study that IID increased the expiratory volume of COPD patients compared to quiet breathing and positive expiratory pressure (PEP) therapy. We hypothesized that it was due to the attenuation of the EFL. OBJECTIVES To verify the physiologic effects of IID and PEP techniques on EFL with a mechanical lung model. METHODS A mechanical lung model was created to assess the effects of IID and PEP techniques. The thorax was simulated by a plexiglas box in which an adult test lung was connected. A calibration syringe simulated the inspiratory phase. Later, with activation of the IID, the expiratory phase was driven by the deflation generated by the device. With PEP, the expiration occurred maintaining an expiratory pressure between 5 and 10 cmH2O. A pneumotachograph and a pressure transducer were placed in series for flow, volumes and pressure measurements. RESULTS The model reproduced physiological characteristics of EFL. However, the deflation of the model was slowed by IID and PEP, and flow remained almost constant, so flow limitation was reduced. CONCLUSION The IID and PEP attenuate EFL and increase exhaled volume in the in vitro model.
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Affiliation(s)
- Juliana Ribeiro Fonseca Franco de Macedo
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, 1200, Belgium.
- Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, 1200, Belgium.
- Department of Physical Medicine and Rehabilitation, Cliniques universitaires Saint-Luc, Avenue Hippocrate, Brussels, 10-1200, Belgium.
| | - Gregory Reychler
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, 1200, Belgium
- Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, 1200, Belgium
- Department of Physical Medicine and Rehabilitation, Cliniques universitaires Saint-Luc, Avenue Hippocrate, Brussels, 10-1200, Belgium
| | - William Poncin
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, 1200, Belgium
- Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, 1200, Belgium
- Department of Physical Medicine and Rehabilitation, Cliniques universitaires Saint-Luc, Avenue Hippocrate, Brussels, 10-1200, Belgium
| | - Giuseppe Liistro
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, 1200, Belgium
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, 1200, Belgium
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Mohamadbeigi N, Shooshtari L, Fardindoost S, Vafaiee M, Iraji Zad A, Mohammadpour R. Self-powered triboelectric nanogenerator sensor for detecting humidity level and monitoring ethanol variation in a simulated exhalation environment. Sci Rep 2024; 14:1562. [PMID: 38238422 PMCID: PMC10796746 DOI: 10.1038/s41598-024-51862-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
Respiration stands as a vital process reflecting physiological and pathological human health status. Exhaled breath analysis offers a facile, non-invasive, swift, and cost-effective approach for diagnosing and monitoring diseases by detecting concentration changes of specific biomarkers. In this study, we employed Polyethylene oxide/copper (I) oxide composite nanofibers (PCNFs), synthesized via the electrospinning method as the sensing material to measure ethanol levels (1-200 ppm) in an exhaled breath simulator environment. The integrated contact-separation triboelectric nanogenerator was utilized to power the self-powered PCNFs exhaled breath sensor. The PCNFs-based gas sensor demonstrates promising results with values of 0.9 and 3.2 for detecting 5 ppm and 200 ppm ethanol, respectively, in the presence of interfering gas at 90% relative humidity (RH). Notably, the sensor displayed remarkable ethanol selectivity, with ratios of 10:1 to methanol and 25:1 to acetone. Response and recovery times for 200 ppm ethanol at 90 RH% were rapid, at 2.7 s and 5.8 s, respectively. The PCNFs-based exhaled breath sensor demonstrated consistent and stable performance in practical conditions, showcasing its potential for integration into wearable devices. This self-powered breath sensor enabling continuous monitoring of lung cancer symptoms and facilitating compliance checks with legal alcohol consumption limits.
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Affiliation(s)
- Nima Mohamadbeigi
- Center for Nanoscience and Nanotechnology, Institute for Convergence Science and Technology, Sharif University of Technology, Tehran, Iran
| | - Leyla Shooshtari
- Center for Nanoscience and Nanotechnology, Institute for Convergence Science and Technology, Sharif University of Technology, Tehran, Iran
| | - Somayeh Fardindoost
- Center for Nanoscience and Nanotechnology, Institute for Convergence Science and Technology, Sharif University of Technology, Tehran, Iran
- Faculty of Engineering, Department of Mechanical Engineering, University of Victoria, P.O. Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Mohaddese Vafaiee
- Center for Nanoscience and Nanotechnology, Institute for Convergence Science and Technology, Sharif University of Technology, Tehran, Iran
| | - Azam Iraji Zad
- Center for Nanoscience and Nanotechnology, Institute for Convergence Science and Technology, Sharif University of Technology, Tehran, Iran.
- Department of Physics, Sharif University of Technology, Azadi Street, P.O. Box 11365-9161, Tehran, Iran.
| | - Raheleh Mohammadpour
- Center for Nanoscience and Nanotechnology, Institute for Convergence Science and Technology, Sharif University of Technology, Tehran, Iran.
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Larsson P, Holz O, Koster G, Postle A, Olin AC, Hohlfeld JM. Exhaled breath particles as a novel tool to study lipid composition of epithelial lining fluid from the distal lung. BMC Pulm Med 2023; 23:423. [PMID: 37924084 PMCID: PMC10623716 DOI: 10.1186/s12890-023-02718-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Surfactant phospholipid (PL) composition plays an important role in lung diseases. We compared the PL composition of non-invasively collected exhaled breath particles (PEx) with bronchoalveolar lavage (BAL) and induced sputum (ISP) at baseline and following endotoxin (LPS) challenges. METHODS PEx and BAL were collected from ten healthy nonsmoking participants before and after segmental LPS challenge. Four weeks later, PEx and ISP were sampled in the week before and after a whole lung LPS inhalation challenge. PL composition was analysed using mass spectrometry. RESULTS The overall PL composition of BAL, ISP and PEx was similar, with PC(32:0) and PC(34:1) representing the largest fractions in all three sample types (baseline PC(32:0) geometric mean mol%: 52.1, 56.9, and 51.7, PC(34:1) mol%: 11.7, 11.9 and 11.4, respectively). Despite this similarity, PEx PL composition was more closely related to BAL than to ISP. For most lipids comparable inter-individual differences in BAL, ISP, and PEx were found. PL composition of PEx was repeatable. The most pronounced increase following segmental LPS challenge was detected for SM(d34:1) in BAL (0.24 to 0.52 mol%) and following inhalation LPS challenge in ISP (0.45 to 0.68 mol%). An increase of SM(d34:1) following segmental LPS challenge was also detectable in PEx (0.099 to 0.103 mol%). The inhalation challenge did not change PL composition of PEx. CONCLUSION Our data supports the peripheral origin of PEx. The lack of PL changes in PEx after inhalation challenge might to be due to the overall weaker response of inhaled LPS which primarily affects the larger airways. Compared with BAL, which always contains lining fluid from both peripheral lung and central airways, PEx analysis might add value as a selective and non-invasive method to investigate peripheral airway PL composition. TRIAL REGISTRATION NCT03044327, first posted 07/02/2017.
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Affiliation(s)
- Per Larsson
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olaf Holz
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, 30625, Hannover, Germany.
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany.
| | - Grielof Koster
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anthony Postle
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jens M Hohlfeld
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, 30625, Hannover, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Hannover Medical School, Department of Respiratory Medicine, Hannover, Germany
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Haverkamp HC, Luu P, DeCato TW, Petrics G. Artificial neural network identification of exercise expiratory flow-limitation in adults. Sci Rep 2023; 13:17247. [PMID: 37821579 PMCID: PMC10567738 DOI: 10.1038/s41598-023-44331-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023] Open
Abstract
Identification of ventilatory constraint is a key objective of clinical exercise testing. Expiratory flow-limitation (EFL) is a well-known type of ventilatory constraint. However, EFL is difficult to measure, and commercial metabolic carts do not readily identify or quantify EFL. Deep machine learning might provide a new approach for identifying EFL. The objective of this study was to determine if a convolutional neural network (CNN) could accurately identify EFL during exercise in adults in whom baseline airway function varied from normal to mildly obstructed. 2931 spontaneous exercise flow-volume loops (eFVL) were placed within the baseline maximal expiratory flow-volume curves (MEFV) from 22 adults (15 M, 7 F; age, 32 yrs) in whom lung function varied from normal to mildly obstructed. Each eFVL was coded as EFL or non-EFL, where EFL was defined by eFVLs with expired airflow meeting or exceeding the MEFV curve. A CNN with seven hidden layers and a 2-neuron softmax output layer was used to analyze the eFVLs. Three separate analyses were conducted: (1) all subjects (n = 2931 eFVLs, [GRALL]), (2) subjects with normal spirometry (n = 1921 eFVLs [GRNORM]), (3) subjects with mild airway obstruction (n = 1010 eFVLs, [GRLOW]). The final output of the CNN was the probability of EFL or non-EFL in each eFVL, which is considered EFL if the probability exceeds 0.5 or 50%. Baseline forced expiratory volume in 1 s/forced vital capacity was 0.77 (94% predicted) in GRALL, 0.83 (100% predicted) in GRNORM, and 0.69 (83% predicted) in GRLOW. CNN model accuracy was 90.6, 90.5, and 88.0% in GRALL, GRNORM and GRLOW, respectively. Negative predictive value (NPV) was higher than positive predictive value (PPV) in GRNORM (93.5 vs. 78.2% for NPV vs. PPV). In GRLOW, PPV was slightly higher than NPV (89.5 vs. 84.5% for PPV vs. NPV). A CNN performed very well at identifying eFVLs with EFL during exercise. These findings suggest that deep machine learning could become a viable tool for identifying ventilatory constraint during clinical exercise testing.
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Affiliation(s)
- Hans Christian Haverkamp
- Department of Nutrition and Exercise Physiology, Washington State University-Spokane Health Sciences, Elson S. Floyd College of Medicine, 412 E. Spokane Falls Blvd., Spokane, WA, 99202-2131, USA.
| | - Peter Luu
- Department of Nutrition and Exercise Physiology, Washington State University-Spokane Health Sciences, Elson S. Floyd College of Medicine, 412 E. Spokane Falls Blvd., Spokane, WA, 99202-2131, USA
| | - Thomas W DeCato
- Department of Medical Education and Clinical Sciences, Washington State University-Spokane Health Sciences, Elson S. Floyd College of Medicine, Spokane, WA, USA
- Division of Respiratory & Critical Care Physiology & Medicine, Harbor-UCLA Medical Center and the Lundquist Institute for Biomedical Innovation, Torrance, CA, USA
| | - Gregory Petrics
- Department of Mathematics, Vermont State University-Johnson, Johnson, VT, USA
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10
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Duarte GP, Ferraz DD, Trippo KV, Novais MCM, Sales M, Ribeiro NMDS, Oliveira Filho J. Effects of three physical exercise modalities on respiratory function of older adults with Parkinson's disease: A randomized clinical trial. J Bodyw Mov Ther 2023; 36:425-431. [PMID: 37949595 DOI: 10.1016/j.jbmt.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/17/2023] [Accepted: 05/30/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Deficits in respiratory function of patients with Parkinson's disease contribute to aspiration pneumonia, one of the main causes of mortality in this population. The aim of this study was to evaluate the effects of functional training, bicycle exercise, and exergaming on respiratory function of elderly with Parkinson's disease. METHODS A randomized clinical trial with single blinding was conducted in a public reference outpatient clinic for the elderly. The participants were randomly assigned to three groups. Group 1 was submitted to functional training (n = 18); group 2 performed bicycle exercise (n = 20), and group 3 trained with Kinect Adventures exergames (n = 20). The sessions performed lasted 8 weeks with a frequency of three 50-min sessions per week. The primary outcome was the forced expiratory volume in the first second; and the secondary outcomes were forced vital capacity, peak expiratory flow, and maximum inspiratory and expiratory pressures. RESULTS The interventions performed did not improve the forced expiratory volume in the first second, forced vital capacity, and peak expiratory flow. However, group 2 improved (p = 0.03) maximum expiratory pressure (from 65.5cmH2O to 73.1cmH2O) (effect size 0.47), and group 3 increased (p = 0.03) maximum inspiratory pressure (from -61.3cmH2O to -71.6cmH2O) (effect size 0.53). CONCLUSIONS No effect was found on lung volume, forced respiratory flow and capacity of the participants with Parkinson's disease submitted to three different modalities of motor training. However, bicycle exercise and exergaming have improved expiratory and inspiratory muscle strength, respectively. NCT02622737.
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Affiliation(s)
| | | | | | | | - Matheus Sales
- Grupo de Pesquisa em Atenção Integral a Pessoas Com Doenças Raras e Doenças Crônicas, Complexo Hospitalar Universitário Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | - Nildo Manoel da Silva Ribeiro
- Department of Physical Therapy, Federal University of Bahia, Salvador, Brazil; Grupo de Pesquisa em Atenção Integral a Pessoas Com Doenças Raras e Doenças Crônicas, Complexo Hospitalar Universitário Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
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11
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Huff A, Karlen-Amarante M, Oliveira LM, Ramirez JM. Role of the postinspiratory complex in regulating swallow-breathing coordination and other laryngeal behaviors. eLife 2023; 12:e86103. [PMID: 37272425 PMCID: PMC10264072 DOI: 10.7554/elife.86103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023] Open
Abstract
Breathing needs to be tightly coordinated with upper airway behaviors, such as swallowing. Discoordination leads to aspiration pneumonia, the leading cause of death in neurodegenerative disease. Here, we study the role of the postinspiratory complex (PiCo) in coordinating breathing and swallowing. Using optogenetic approaches in freely breathing anesthetized ChATcre:Ai32, Vglut2cre:Ai32 and intersectional recombination of ChATcre:Vglut2FlpO:ChR2 mice reveals PiCo mediates airway protective behaviors. Activation of PiCo during inspiration or the beginning of postinspiration triggers swallow behavior in an all-or-nothing manner, while there is a higher probability for stimulating only laryngeal activation when activated further into expiration. Laryngeal activation is dependent on stimulation duration. Sufficient bilateral PiCo activation is necessary for preserving the physiological swallow motor sequence since activation of only a few PiCo neurons or unilateral activation leads to blurred upper airway behavioral responses. We believe PiCo acts as an interface between the swallow pattern generator and the preBötzinger complex to coordinate swallow and breathing. Investigating PiCo's role in swallow and laryngeal coordination will aid in understanding discoordination with breathing in neurological diseases.
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Affiliation(s)
- Alyssa Huff
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Marlusa Karlen-Amarante
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Luiz M Oliveira
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
- Department of Neurological Surgery, University of Washington School of MedicineSeattleUnited States
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12
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Mikołajowski G, Pałac M, Linek P. Automated ultrasound measurements of lateral abdominal muscles under controlled breathing phases. Comput Methods Programs Biomed 2022; 221:106936. [PMID: 35701251 DOI: 10.1016/j.cmpb.2022.106936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES A breathing phase during ultrasound measurements of the lateral abdominal muscles (LAMs) are usually indirectly controlled by visual inspection of the position of the transversus abdominis (TrA) muscle. This is due to the lack of devices to directly control airflow that are connected to the ultrasound in order to automatically and simultaneously freeze ultrasound images at the programmed breathing phase. Such indirect control may be related with potential measurement error because LAMs are respiratory muscles. Thus, the aim of this study was to present a newly developed and automatic measurement procedure to directly control airflow and at the same time automatically collect ultrasound images at the programed breathing phase. Additionally, it was decided to compare LAMs measurements obtained manually by the examiner and with an external device controlling the peak phase of tidal inspiration and expiration and compare the elasticity and thickness measurements between tidal inspiration and expiration in young participants. METHODS The study was carried out on 10 healthy youth. The thickness and shear modulus were measured by an Aixplorer ultrasound scanner. The measurements were obtained manually by the examiner and with a newly developed external device controlling the peak phases of tidal inspiration and expiration. RESULTS A significant difference in external/internal oblique thickness between the expiration and inspiration phases depended on the measurement procedure. The TrA thickness was similar during inspiration and expiration. During inspiration, the TrA shear modulus was higher than during expiration, and the TrA shear modulus depended on the measurement procedure. CONCLUSION Although the raw LAMs thickness and external/internal oblique thickness/shear modulus data were similar, the measurement procedure may affect the interpretation of the results. The TrA shear modulus is the most vulnerable to errors related to the measurement procedure. Construction of this study device controlling airflow and automatically collecting ultrasound images at the selected breathing phase seems to be promising in future studies considering measurements of respiratory muscles in a strictly defined breathing phase.
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Affiliation(s)
- Grzegorz Mikołajowski
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Mikolowska 72B, Katowice 40-065, Poland
| | - Małgorzata Pałac
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Mikolowska 72B, Katowice 40-065, Poland
| | - Paweł Linek
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Mikolowska 72B, Katowice 40-065, Poland.
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13
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Sol JA, Quindry JC. Application of a Novel Collection of Exhaled Breath Condensate to Exercise Settings. IJERPH 2022; 19:ijerph19073948. [PMID: 35409631 PMCID: PMC8997655 DOI: 10.3390/ijerph19073948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023]
Abstract
The collection of exhaled breath condensate (EBC) is a non-invasive method for obtaining biosamples from the lower respiratory tract, an approach amenable to exercise, environmental, and work physiology applications. The purpose of this study was to develop a cost-effective, reproducible methodology for obtaining larger volume EBC samples. Participants (male: n = 10; female: n = 6; 26 ± 8 yrs.) completed a 10 min EBC collection using a novel device (N-EBC). After initial collection, a 45 min bout of cycling at 75% HRmax was performed, followed by another N-EBC collection. In a subset of individuals (n = 5), EBC was obtained using both the novel technique and a commercially available EBC collection device (R-EBC) in a randomized fashion. N-EBC volume—pre- and post-exercise (2.3 ± 0.8 and 2.6 ± 0.9 mL, respectively)—and pH (7.4 ± 0.5 and 7.4 ± 0.5, respectively) were not significantly different. When normalized for participant body height, device comparisons indicated N-EBC volumes were larger than R-EBC at pre-exercise (+12%) and post-exercise (+48%). Following moderate-intensity exercise, no changes in the pre- and post-trial values of Pentraxin 3 (0.25 ± 0.04 and 0.26 ± 0.06 pg/mL, respectively) and 8-Isoprostrane (0.43 ± 0.33 and 0.36 ± 0.24 pg/mL, respectively) concentrations were observed. In a cost-efficient fashion, the N-EBC method produced larger sample volumes, both pre- and post-exercise, facilitating more biomarker tests to be performed.
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14
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Abstract
Face masks slow exhaled air flow and sequester exhaled particles. There are many types of face masks on the market today, each having widely varying fits, filtering, and air redirection characteristics. While particle filtration and flow resistance from masks has been well studied, their effects on speech air flow has not. We built a schlieren system and recorded speech air flow with 14 different face masks, comparing it to mask-less speech. All of the face masks reduced air flow from speech, but some allowed air flow features to reach further than 40 cm from a speaker's lips and nose within a few seconds, and all the face masks allowed some air to escape above the nose. Evidence from available literature shows that distancing and ventilation in higher-risk indoor environment provide more benefit than wearing a face mask. Our own research shows all the masks we tested provide some additional benefit of restricting air flow from a speaker. However, well-fitted mask specifically designed for the purpose of preventing the spread of disease reduce air flow the most. Future research will study the effects of face masks on speech communication in order to facilitate cost/benefit analysis of mask usage in various environments.
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Affiliation(s)
- Donald Derrick
- New Zealand Institute of Language, Brain, and Behaviour, University of Canterbury, Christchurch, 8041, New Zealand.
| | - Natalia Kabaliuk
- Department of Mechanical Engineering, University of Canterbury, Christchurch, 8041, New Zealand
| | - Luke Longworth
- Department of Mechanical Engineering, University of Canterbury, Christchurch, 8041, New Zealand
| | | | - Mark Jermy
- Department of Mechanical Engineering, University of Canterbury, Christchurch, 8041, New Zealand
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15
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Mizuhara K, Nittono H. Visual discrimination accuracy does not differ between nasal inhalation and exhalation when stimuli are voluntarily aligned to breathing phase. Int J Psychophysiol 2022; 173:1-8. [PMID: 35017027 DOI: 10.1016/j.ijpsycho.2021.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 11/19/2022]
Abstract
This study investigated the possible enhancement of visual discrimination accuracy by voluntarily adjusting the timing of stimulus presentation to a specific respiratory phase. Previous research has suggested that respiratory phases modulate perceptual and cognitive processing. For instance, a fearful face was identified faster when presented during nasal inhalation than during nasal exhalation, which could be related to changes in neural oscillatory activity synchronized with breathing in through one's nose. Based on such findings, the present study asked 40 young adults to perform an emotional discrimination task consisting of distinguishing fearful vs. neutral faces and a physical discrimination task consisting of distinguishing high- vs. low-contrast Gabor patches during nasal respiration. Participants presented themselves with the stimuli to be judged in a designated respiratory phase by pressing a button. It was hypothesized that fear discrimination accuracy would be higher during inhalation than exhalation if sensitivity to emotional stimuli increased during inhalation. Conversely, if overall visual sensitivity was enhanced during inhalation, the identical effect was expected for contrast discrimination. The results indicated that discrimination accuracy did not differ between inhalation and exhalation phases in either task. This result provided no evidence that the respiratory phase affected visual discrimination accuracy when people adjusted the timing of stimulus presentation to the onset of inhalation or exhalation.
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Affiliation(s)
- Keita Mizuhara
- Graduate School of Human Sciences, Osaka University, Osaka, Japan.
| | - Hiroshi Nittono
- Graduate School of Human Sciences, Osaka University, Osaka, Japan.
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16
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Ho KMA, Davies H, Epstein R, Bassett P, Hogan Á, Kabir Y, Rubin J, Shin GY, Reid JP, Torii R, Tiwari MK, Balachandran R, Lovat LB. Spatiotemporal droplet dispersion measurements demonstrate face masks reduce risks from singing. Sci Rep 2021; 11:24183. [PMID: 34921199 PMCID: PMC8683488 DOI: 10.1038/s41598-021-03519-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/03/2021] [Indexed: 12/02/2022] Open
Abstract
COVID-19 has restricted singing in communal worship. We sought to understand variations in droplet transmission and the impact of wearing face masks. Using rapid laser planar imaging, we measured droplets while participants exhaled, said 'hello' or 'snake', sang a note or 'Happy Birthday', with and without surgical face masks. We measured mean velocity magnitude (MVM), time averaged droplet number (TADN) and maximum droplet number (MDN). Multilevel regression models were used. In 20 participants, sound intensity was 71 dB for speaking and 85 dB for singing (p < 0.001). MVM was similar for all tasks with no clear hierarchy between vocal tasks or people and > 85% reduction wearing face masks. Droplet transmission varied widely, particularly for singing. Masks decreased TADN by 99% (p < 0.001) and MDN by 98% (p < 0.001) for singing and 86-97% for other tasks. Masks reduced variance by up to 48%. When wearing a mask, neither singing task transmitted more droplets than exhaling. In conclusion, wide variation exists for droplet production. This significantly reduced when wearing face masks. Singing during religious worship wearing a face mask appears as safe as exhaling or talking. This has implications for UK public health guidance during the COVID-19 pandemic.
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Affiliation(s)
- Kai Man Alexander Ho
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK.
| | - Hywel Davies
- Department of Mechanical Engineering, University College London, Malet Place, London, WC1E 6BT, UK
| | - Ruth Epstein
- Department of Otolaryngology, Royal National Ear Nose and Throat and Eastman Dental Hospital, University College London Hospitals NHS Foundation Trust, 47-49 Huntley Street, London, WC1E 6DG, UK
| | - Paul Bassett
- Statsconsultancy Ltd, 40 Longwood Lane, Amersham, Bucks, HP7 9EN, UK
| | - Áine Hogan
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Yusuf Kabir
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - John Rubin
- Department of Otolaryngology, Royal National Ear Nose and Throat and Eastman Dental Hospital, University College London Hospitals NHS Foundation Trust, 47-49 Huntley Street, London, WC1E 6DG, UK
| | - Gee Yen Shin
- Department of Virology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Jonathan P Reid
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, BS8 1TS, UK
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, Malet Place, London, WC1E 6BT, UK
| | - Manish K Tiwari
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
- Department of Mechanical Engineering, University College London, Malet Place, London, WC1E 6BT, UK
| | | | - Laurence B Lovat
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
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17
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van der Sar IG, Wijbenga N, Nakshbandi G, Aerts JGJV, Manintveld OC, Wijsenbeek MS, Hellemons ME, Moor CC. The smell of lung disease: a review of the current status of electronic nose technology. Respir Res 2021; 22:246. [PMID: 34535144 PMCID: PMC8448171 DOI: 10.1186/s12931-021-01835-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/26/2021] [Indexed: 02/08/2023] Open
Abstract
There is a need for timely, accurate diagnosis, and personalised management in lung diseases. Exhaled breath reflects inflammatory and metabolic processes in the human body, especially in the lungs. The analysis of exhaled breath using electronic nose (eNose) technology has gained increasing attention in the past years. This technique has great potential to be used in clinical practice as a real-time non-invasive diagnostic tool, and for monitoring disease course and therapeutic effects. To date, multiple eNoses have been developed and evaluated in clinical studies across a wide spectrum of lung diseases, mainly for diagnostic purposes. Heterogeneity in study design, analysis techniques, and differences between eNose devices currently hamper generalization and comparison of study results. Moreover, many pilot studies have been performed, while validation and implementation studies are scarce. These studies are needed before implementation in clinical practice can be realised. This review summarises the technical aspects of available eNose devices and the available evidence for clinical application of eNose technology in different lung diseases. Furthermore, recommendations for future research to pave the way for clinical implementation of eNose technology are provided.
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Affiliation(s)
- I G van der Sar
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - N Wijbenga
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - G Nakshbandi
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J G J V Aerts
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - O C Manintveld
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M S Wijsenbeek
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M E Hellemons
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - C C Moor
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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18
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Ogilvie LM, Edgett BA, Gray S, Al-Mufty S, Huber JS, Brunt KR, Simpson JA. A new approach to improve the hemodynamic assessment of cardiac function independent of respiratory influence. Sci Rep 2021; 11:17223. [PMID: 34446745 PMCID: PMC8390640 DOI: 10.1038/s41598-021-96050-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/19/2021] [Indexed: 01/06/2023] Open
Abstract
Cardiovascular and respiratory systems are anatomically and functionally linked; inspiration produces negative intrathoracic pressures that act on the heart and alter cardiac function. Inspiratory pressures increase with heart failure and can exceed the magnitude of ventricular pressure during diastole. Accordingly, respiratory pressures may be a confounding factor to assessing cardiac function. While the interaction between respiration and the heart is well characterized, the extent to which systolic and diastolic indices are affected by inspiration is unknown. Our objective was to understand how inspiratory pressure affects the hemodynamic assessment of cardiac function. To do this, we developed custom software to assess and separate indices of systolic and diastolic function into inspiratory, early expiratory, and late expiratory phases of respiration. We then compared cardiac parameters during normal breathing and with various respiratory loads. Variations in inspiratory pressure had a small impact on systolic pressure and function. Conversely, diastolic pressure strongly correlated with negative inspiratory pressure. Cardiac pressures were less affected by respiration during expiration; late expiration was the most stable respiratory phase. In conclusion, inspiration is a large confounding influence on diastolic pressure, but minimally affects systolic pressure. Performing cardiac hemodynamic analysis by accounting for respiratory phase yields more accuracy and analytic confidence to the assessment of diastolic function.
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Affiliation(s)
- Leslie M Ogilvie
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
- IMPART Investigator Team Canada, Saint John, Canada
| | - Brittany A Edgett
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- IMPART Investigator Team Canada, Saint John, Canada
| | - Simon Gray
- Cambridge Electronic Design Limited, Milton, Cambridge, England
| | - Sally Al-Mufty
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
- IMPART Investigator Team Canada, Saint John, Canada
| | - Jason S Huber
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
| | - Keith R Brunt
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- IMPART Investigator Team Canada, Saint John, Canada
| | - Jeremy A Simpson
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
- IMPART Investigator Team Canada, Saint John, Canada.
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19
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Hooker SK, Andrews RD, Arnould JPY, Bester MN, Davis RW, Insley SJ, Gales NJ, Goldsworthy SD, McKnight JC. Fur seals do, but sea lions don't - cross taxa insights into exhalation during ascent from dives. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200219. [PMID: 34121462 PMCID: PMC8200655 DOI: 10.1098/rstb.2020.0219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 11/12/2022] Open
Abstract
Management of gases during diving is not well understood across marine mammal species. Prior to diving, phocid (true) seals generally exhale, a behaviour thought to assist with the prevention of decompression sickness. Otariid seals (fur seals and sea lions) have a greater reliance on their lung oxygen stores, and inhale prior to diving. One otariid, the Antarctic fur seal (Arctocephalus gazella), then exhales during the final 50-85% of the return to the surface, which may prevent another gas management issue: shallow-water blackout. Here, we compare data collected from animal-attached tags (video cameras, hydrophones and conductivity sensors) deployed on a suite of otariid seal species to examine the ubiquity of ascent exhalations for this group. We find evidence for ascent exhalations across four fur seal species, but that such exhalations are absent for three sea lion species. Fur seals and sea lions are no longer genetically separated into distinct subfamilies, but are morphologically distinguished by the thick underfur layer of fur seals. Together with their smaller size and energetic dives, we suggest their air-filled fur might underlie the need to perform these exhalations, although whether to reduce buoyancy and ascent speed, for the avoidance of shallow-water blackout or to prevent other cardiovascular management issues in their diving remains unclear. This article is part of the theme issue 'Measuring physiology in free-living animals (Part I)'.
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Affiliation(s)
- Sascha K. Hooker
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, Fife KY16 8LB, UK
| | | | - John P. Y. Arnould
- School of Life and Environmental Sciences, Deakin University, Burwood, Victoria 3125, Australia
| | - Marthán N. Bester
- Mammal Research Institute, University of Pretoria, Hatfield 0028, Gauteng, South Africa
| | - Randall W. Davis
- Department of Marine Biology, Texas A&M University, Galveston, TX 77553, USA
| | - Stephen J. Insley
- Department of Biology, University of Victoria, Victoria, British Columbia, Canada, V8P 5C2
- Wildlife Conservation Society Canada, Whitehorse, Yukon Territory, Canada, Y1A 0E9
| | - Nick J. Gales
- Australian Antarctic Division, Kingston, Tasmania 7050, Australia
| | - Simon D. Goldsworthy
- South Australian Research and Development Institute, West Beach, South Australia 5024, Australia
- School of Biological Sciences, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - J. Chris McKnight
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, Fife KY16 8LB, UK
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20
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Jaeschke C, Padilla M, Glöckler J, Polaka I, Leja M, Veliks V, Mitrovics J, Leja M, Mizaikoff B. Modular Breath Analyzer (MBA): Introduction of a Breath Analyzer Platform Based on an Innovative and Unique, Modular eNose Concept for Breath Diagnostics and Utilization of Calibration Transfer Methods in Breath Analysis Studies. Molecules 2021; 26:3776. [PMID: 34205805 PMCID: PMC8235513 DOI: 10.3390/molecules26123776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
Exhaled breath analysis for early disease detection may provide a convenient method for painless and non-invasive diagnosis. In this work, a novel, compact and easy-to-use breath analyzer platform with a modular sensing chamber and direct breath sampling unit is presented. The developed analyzer system comprises a compact, low volume, temperature-controlled sensing chamber in three modules that can host any type of resistive gas sensor arrays. Furthermore, in this study three modular breath analyzers are explicitly tested for reproducibility in a real-life breath analysis experiment with several calibration transfer (CT) techniques using transfer samples from the experiment. The experiment consists of classifying breath samples from 15 subjects before and after eating a specific meal using three instruments. We investigate the possibility to transfer calibration models across instruments using transfer samples from the experiment under study, since representative samples of human breath at some conditions are difficult to simulate in a laboratory. For example, exhaled breath from subjects suffering from a disease for which the biomarkers are mostly unknown. Results show that many transfer samples of all the classes under study (in our case meal/no meal) are needed, although some CT methods present reasonably good results with only one class.
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Affiliation(s)
- Carsten Jaeschke
- Institute of Analytical and Bioanalytical Chemistry, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany; (C.J.); (J.G.)
| | - Marta Padilla
- JLM Innovation GmbH, Vor dem Kreuzberg 17, 72070 Tuebingen, Germany; (M.P.); (J.M.)
| | - Johannes Glöckler
- Institute of Analytical and Bioanalytical Chemistry, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany; (C.J.); (J.G.)
| | - Inese Polaka
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1079 Riga, Latvia; (I.P.); (M.L.); (V.V.); (M.L.)
| | - Martins Leja
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1079 Riga, Latvia; (I.P.); (M.L.); (V.V.); (M.L.)
| | - Viktors Veliks
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1079 Riga, Latvia; (I.P.); (M.L.); (V.V.); (M.L.)
| | - Jan Mitrovics
- JLM Innovation GmbH, Vor dem Kreuzberg 17, 72070 Tuebingen, Germany; (M.P.); (J.M.)
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1079 Riga, Latvia; (I.P.); (M.L.); (V.V.); (M.L.)
| | - Boris Mizaikoff
- Institute of Analytical and Bioanalytical Chemistry, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany; (C.J.); (J.G.)
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21
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Yamanaka HR, Cheung C, Mendoza JS, Oliva DJ, Elzey-Aberilla K, Perrault KA. Pilot Study on Exhaled Breath Analysis for a Healthy Adult Population in Hawaii. Molecules 2021; 26:molecules26123726. [PMID: 34207244 PMCID: PMC8234827 DOI: 10.3390/molecules26123726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 02/01/2023] Open
Abstract
Fast diagnostic results using breath analysis are an anticipated possibility for disease diagnosis or general health screenings. Tests that do not require sending specimens to medical laboratories possess capabilities to speed patient diagnosis and protect both patient and healthcare staff from unnecessary prolonged exposure. The objective of this work was to develop testing procedures on an initial healthy subject cohort in Hawaii to act as a range-finding pilot study for characterizing the baseline of exhaled breath prior to further research. Using comprehensive two-dimensional gas chromatography (GC×GC), this study analyzed exhaled breath from a healthy adult population in Hawaii to profile the range of different volatile organic compounds (VOCs) and survey Hawaii-specific differences. The most consistently reported compounds in the breath profile of individuals were acetic acid, dimethoxymethane, benzoic acid methyl ester, and n-hexane. In comparison to other breathprinting studies, the list of compounds discovered was representative of control cohorts. This must be considered when implementing proposed breath diagnostics in new locations with increased interpersonal variation due to diversity. Further studies on larger numbers of subjects over longer periods of time will provide additional foundational data on baseline breath VOC profiles of control populations for comparison to disease-positive cohorts.
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22
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Shinozaki K, Okuma Y, Saeki K, Miyara SJ, Aoki T, Molmenti EP, Yin T, Kim J, Lampe JW, Becker LB. A method for measuring the molecular ratio of inhalation to exhalation and effect of inspired oxygen levels on oxygen consumption. Sci Rep 2021; 11:12815. [PMID: 34140533 PMCID: PMC8211831 DOI: 10.1038/s41598-021-91246-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/17/2021] [Indexed: 01/15/2023] Open
Abstract
Using a new method for measuring the molecular ratio (R) of inhalation to exhalation, we investigated the effect of high fraction of inspired oxygen (FIO2) on oxygen consumption (VO2), carbon dioxide generation (VCO2), and respiratory quotient (RQ) in mechanically ventilated rats. Twelve rats were equally assigned into two groups by anesthetics: intravenous midazolam/fentanyl vs. inhaled isoflurane. R, VO2, VCO2, and RQ were measured at FIO2 0.3 or 1.0. R error was ± 0.003. R was 1.0099 ± 0.0023 with isoflurane and 1.0074 ± 0.0018 with midazolam/fentanyl. R was 1.0081 ± 0.0017 at an FIO2 of 0.3 and 1.0092 ± 0.0029 at an FIO2 of 1.0. There were no differences in VCO2 among the groups. VO2 increased at FIO2 1.0, which was more notable when midazolam/fentanyl was used (isoflurane-FIO2 0.3: 15.4 ± 1.1; isoflurane-FIO2 1.0: 17.2 ± 1.8; midazolam/fentanyl-FIO2 0.3: 15.4 ± 1.1; midazolam/fentanyl-FIO2 1.0: 21.0 ± 2.2 mL/kg/min at STP). The RQ was lower at FIO2 1.0 than FIO2 0.3 (isoflurane-FIO2 0.3: 0.80 ± 0.07; isoflurane-FIO2 1.0: 0.71 ± 0.05; midazolam/fentanyl-FIO2 0.3: 0.79 ± 0.03; midazolam/fentanyl-FIO2 1.0: 0.59 ± 0.04). R was not affected by either anesthetics or FIO2. Inspired 100% O2 increased VO2 and decreased RQ, which might be more remarkable when midazolam/fentanyl was used.
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Affiliation(s)
- Koichiro Shinozaki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Department of Emergency Medicine, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health, 300 Community Dr., Manhasset, NY, 11030, USA.
| | - Yu Okuma
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Kota Saeki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Nihon Kohden Innovation Center, Cambridge, MA, USA
| | - Santiago J Miyara
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
| | - Tomoaki Aoki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Ernesto P Molmenti
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Surgery, Medicine, and Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Tai Yin
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Junhwan Kim
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Joshua W Lampe
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- ZOLL Medical, Chelmsford, MA, USA
| | - Lance B Becker
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Emergency Medicine, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health, 300 Community Dr., Manhasset, NY, 11030, USA
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Dragonieri S, Quaranta VN, Carratù P, Ranieri T, Buonamico E, Carpagnano GE. Breathing Rhythm Variations during Wash-In Do Not Influence Exhaled Volatile Organic Compound Profile Analyzed by an Electronic Nose. Molecules 2021; 26:molecules26092695. [PMID: 34064506 PMCID: PMC8124182 DOI: 10.3390/molecules26092695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/21/2021] [Accepted: 05/03/2021] [Indexed: 11/24/2022] Open
Abstract
E-noses are innovative tools used for exhaled volatile organic compound (VOC) analysis, which have shown their potential in several diseases. Before obtaining a full validation of these instruments in clinical settings, a number of methodological issues still have to be established. We aimed to assess whether variations in breathing rhythm during wash-in with VOC-filtered air before exhaled air collection reflect changes in the exhaled VOC profile when analyzed by an e-nose (Cyranose 320). We enrolled 20 normal subjects and randomly collected their exhaled breath at three different breathing rhythms during wash-in: (a) normal rhythm (respiratory rate (RR) between 12 and 18/min), (b) fast rhythm (RR > 25/min) and (c) slow rhythm (RR < 10/min). Exhaled breath was collected by a previously validated method (Dragonieri et al., J. Bras. Pneumol. 2016) and analyzed by the e-nose. Using principal component analysis (PCA), no significant variations in the exhaled VOC profile were shown among the three breathing rhythms. Subsequent linear discriminant analysis (LDA) confirmed the above findings, with a cross-validated accuracy of 45% (p = ns). We concluded that the exhaled VOC profile, analyzed by an e-nose, is not influenced by variations in breathing rhythm during wash-in.
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Affiliation(s)
- Silvano Dragonieri
- Respiratory Diseases, University of Bari, 70121 Bari, Italy; (T.R.); (E.B.); (G.E.C.)
- Correspondence:
| | | | - Pierluigi Carratù
- Internal Medicine “A. Murri”, University of Bari, 70121 Bari, Italy;
| | - Teresa Ranieri
- Respiratory Diseases, University of Bari, 70121 Bari, Italy; (T.R.); (E.B.); (G.E.C.)
| | - Enrico Buonamico
- Respiratory Diseases, University of Bari, 70121 Bari, Italy; (T.R.); (E.B.); (G.E.C.)
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Ram S, Hoff BA, Bell AJ, Galban S, Fortuna AB, Weinheimer O, Wielpütz MO, Robinson TE, Newman B, Vummidi D, Chughtai A, Kazerooni EA, Johnson TD, Han MK, Hatt CR, Galban CJ. Improved detection of air trapping on expiratory computed tomography using deep learning. PLoS One 2021; 16:e0248902. [PMID: 33760861 PMCID: PMC7990199 DOI: 10.1371/journal.pone.0248902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/26/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Radiologic evidence of air trapping (AT) on expiratory computed tomography (CT) scans is associated with early pulmonary dysfunction in patients with cystic fibrosis (CF). However, standard techniques for quantitative assessment of AT are highly variable, resulting in limited efficacy for monitoring disease progression. OBJECTIVE To investigate the effectiveness of a convolutional neural network (CNN) model for quantifying and monitoring AT, and to compare it with other quantitative AT measures obtained from threshold-based techniques. MATERIALS AND METHODS Paired volumetric whole lung inspiratory and expiratory CT scans were obtained at four time points (0, 3, 12 and 24 months) on 36 subjects with mild CF lung disease. A densely connected CNN (DN) was trained using AT segmentation maps generated from a personalized threshold-based method (PTM). Quantitative AT (QAT) values, presented as the relative volume of AT over the lungs, from the DN approach were compared to QAT values from the PTM method. Radiographic assessment, spirometric measures, and clinical scores were correlated to the DN QAT values using a linear mixed effects model. RESULTS QAT values from the DN were found to increase from 8.65% ± 1.38% to 21.38% ± 1.82%, respectively, over a two-year period. Comparison of CNN model results to intensity-based measures demonstrated a systematic drop in the Dice coefficient over time (decreased from 0.86 ± 0.03 to 0.45 ± 0.04). The trends observed in DN QAT values were consistent with clinical scores for AT, bronchiectasis, and mucus plugging. In addition, the DN approach was found to be less susceptible to variations in expiratory deflation levels than the threshold-based approach. CONCLUSION The CNN model effectively delineated AT on expiratory CT scans, which provides an automated and objective approach for assessing and monitoring AT in CF patients.
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Affiliation(s)
- Sundaresh Ram
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biomedical Engineering, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Benjamin A. Hoff
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Alexander J. Bell
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Stefanie Galban
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Aleksa B. Fortuna
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Heidelberg (TLRC), German Lung Research Center (DZL), Heidelberg, Germany
| | - Mark O. Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Heidelberg (TLRC), German Lung Research Center (DZL), Heidelberg, Germany
| | - Terry E. Robinson
- Department of Pediatrics, Center of Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Beverley Newman
- Department of Pediatric Radiology, Lucile Packard Children’s Hospital at Stanford, Stanford, California, United States of America
| | - Dharshan Vummidi
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Aamer Chughtai
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Ella A. Kazerooni
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Timothy D. Johnson
- Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Michigan, United States of America
| | - MeiLan K. Han
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Charles R. Hatt
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Imbio LLC, Minneapolis, Minnesota, United States of America
| | - Craig J. Galban
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biomedical Engineering, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
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Zhang F, Zhong Y, Qin Z, Li X, Wang W. Effect of muscle training on dyspnea in patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e24930. [PMID: 33655957 PMCID: PMC7939163 DOI: 10.1097/md.0000000000024930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 02/04/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Rehabilitation training is beneficial for patients with chronic obstructive pulmonary disease (COPD). This study was aimed at evaluating the efficacy of muscle training on dyspnea. METHODS We used 5 common databases for conducting a meta-analysis included PubMed, the Cochrane Library, Science Direct, Web of Science and Clinical Trials.gov, and eligible randomized controlled trials (RCTs) were included. The main results of include studies were dyspnea of patients who had a clinical diagnosis of COPD measured using Borg score and Medical Research Council (MRC) or modified Medical Research Council (mMRC) scale as the criteria before and after intervention. The intervention measures included respiratory or expiratory muscles or upper limb (UL) or lower limb (LL) training. The mean differences (MD) with the 95% confidence interval (CI) were considered for summary statistics. We also assessed risk of bias using the Cochrane collaboration's tool, and the value of I2 was applied to evaluate the heterogeneity of the trials. RESULTS Fourteen RCTs with 18 interventions (n = 860 participants) were included. Muscle training significantly improved dyspnea during exercise and in the daily life of patients with COPD (MD, 95% CI: -0.58, -0.84 to -0.32, P < .0001 and -0.44, -0.65 to -0.24, P < .0001, respectively). In the subgroup analyses, the trials that used respiratory muscle and UL trainings significantly improved dyspnea during exercise (MD, 95% CI: -0.72, -1.13 to -0.31, P = .0005 and -0.53, -0.91 to -0.15, P = .007, respectively). The studies also showed that the participants in the rehabilitation group, who received respiratory muscle and UL trainings, had a significant improvement of dyspnea in daily life (MD, 95% CI: -0.38, -0.67 to -0.09, P = .01 and -0.51, -0.80 to -0.22, P = .0007, respectively). CONCLUSION There were some limitations that most of the subjects in this study were patients with moderate to severe COPD and were male, and the training period and duration were different. The analyses revealed that respiratory muscle and UL trainings can improve dyspnea in patients with COPD during exercise and in daily life.
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Affiliation(s)
- Fang Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital
| | - Yaping Zhong
- Department of Environmental Health, School of Public Health, China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Zheng Qin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital
| | - Xiaomeng Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital
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Gao Y, Xie J, Ye LS, Du J, Zhang QY, Hu B. Negative-Pressure Isolation Mask for Endoscopic Examination During the Coronavirus Disease 2019 Pandemic: A Randomized Controlled Trial. Clin Transl Gastroenterol 2021; 12:e00314. [PMID: 33620880 PMCID: PMC8345917 DOI: 10.14309/ctg.0000000000000314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION During the coronavirus disease 2019 (COVID-19) pandemic, endoscopists have high risks of exposure to exhaled air from patients during gastroscopy. To minimize this risk, we transformed the oxygen mask into a fully closed negative-pressure gastroscope isolation mask. This study aimed to evaluate the effectiveness, safety, and feasibility of use of this mask during gastroscopy. METHODS From February 28, 2020, to March 10, 2020, 320 patients undergoing gastroscopy were randomly assigned into the mask group (n = 160) or conventional group (n = 160). Patients in the mask group wore the isolation mask during gastroscopy, whereas patients in the conventional group did not wear the mask. The adenosine triphosphate fluorescence and carbon dioxide (CO2) concentration in patients' exhaled air were measured to reflect the degree of environmental pollution by exhaled air. Patients' vital signs, operation time, and adverse events during endoscopy were also evaluated. RESULTS Four patients were excluded because of noncooperation or incomplete data. A total of 316 patients were included in the final analysis. The difference between the highest CO2 concentration around patients' mouth and CO2 concentration in the environment was significantly decreased in the mask group compared with the conventional group. There was no significant difference in the adenosine triphosphate fluorescence, vital signs, and operation time between the 2 groups. No severe adverse events related to the isolation mask, endoscopy failure, or new coronavirus infection during follow-up were recorded. DISCUSSION This new isolation mask showed excellent feasibility of use and safety compared with routine gastroscopy during the COVID-19 pandemic.
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Affiliation(s)
- Yuan Gao
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China;
| | - Jia Xie
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China;
| | - Lian-Song Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China;
| | - Jiang Du
- Department of Endoscopy Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Qiong-Ying Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China;
- Department of Endoscopy Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China;
- Department of Endoscopy Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Weber J, Mißbach C, Schmidt J, Wenzel C, Schumann S, Philip JH, Wirth S. Prediction of expiratory desflurane and sevoflurane concentrations in lung-healthy patients utilizing cardiac output and alveolar ventilation matched pharmacokinetic models: A comparative observational study. Medicine (Baltimore) 2021; 100:e23570. [PMID: 33578509 PMCID: PMC7886476 DOI: 10.1097/md.0000000000023570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 11/04/2020] [Indexed: 01/05/2023] Open
Abstract
The Gas Man simulation software provides an opportunity to teach, understand and examine the pharmacokinetics of volatile anesthetics. The primary aim of this study was to investigate the accuracy of a cardiac output and alveolar ventilation matched Gas Man model and to compare its predictive performance with the standard pharmacokinetic model using patient data.Therefore, patient data from volatile anesthesia were successively compared to simulated administration of desflurane and sevoflurane for the standard and a parameter-matched simulation model with modified alveolar ventilation and cardiac output. We calculated the root-mean-square deviation (RMSD) between measured and calculated induction, maintenance and elimination and the expiratory decrement times during emergence and recovery for the standard and the parameter-matched model.During induction, RMSDs for the standard Gas Man simulation model were higher than for the parameter-matched Gas Man simulation model [induction (desflurane), standard: 1.8 (0.4) % Atm, parameter-matched: 0.9 (0.5) % Atm., P = .001; induction (sevoflurane), standard: 1.2 (0.9) % Atm, parameter-matched: 0.4 (0.4) % Atm, P = .029]. During elimination, RMSDs for the standard Gas Man simulation model were higher than for the parameter-matched Gas Man simulation model [elimination (desflurane), standard: 0.7 (0.6) % Atm, parameter-matched: 0.2 (0.2) % Atm, P = .001; elimination (sevoflurane), standard: 0.7 (0.5) % Atm, parameter-matched: 0.2 (0.2) % Atm, P = .008]. The RMSDs during the maintenance of anesthesia and the expiratory decrement times during emergence and recovery showed no significant differences between the patient and simulated data for both simulation models.Gas Man simulation software predicts expiratory concentrations of desflurane and sevoflurane in humans with good accuracy, especially when compared to models for intravenous anesthetics. Enhancing the standard model by ventilation and hemodynamic input variables increases the predictive performance of the simulation model. In most patients and clinical scenarios, the predictive performance of the standard Gas Man simulation model will be high enough to estimate pharmacokinetics of desflurane and sevoflurane with appropriate accuracy.
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Affiliation(s)
- Jonas Weber
- Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claudia Mißbach
- Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Schmidt
- Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christin Wenzel
- Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Schumann
- Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - James H. Philip
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Steffen Wirth
- Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Katsumata Y, Sano M, Okawara H, Sawada T, Nakashima D, Ichihara G, Fukuda K, Sato K, Kobayashi E. Laminar flow ventilation system to prevent airborne infection during exercise in the COVID-19 crisis: A single-center observational study. PLoS One 2021; 16:e0257549. [PMID: 34758032 PMCID: PMC8580245 DOI: 10.1371/journal.pone.0257549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
Particulate generation occurs during exercise-induced exhalation, and research on this topic is scarce. Moreover, infection-control measures are inadequately implemented to avoid particulate generation. A laminar airflow ventilation system (LFVS) was developed to remove respiratory droplets released during treadmill exercise. This study aimed to investigate the relationship between the number of aerosols during training on a treadmill and exercise intensity and to elucidate the effect of the LFVS on aerosol removal during anaerobic exercise. In this single-center observational study, the exercise tests were performed on a treadmill at Running Science Lab in Japan on 20 healthy subjects (age: 29±12 years, men: 80%). The subjects had a broad spectrum of aerobic capacities and fitness levels, including athletes, and had no comorbidities. All of them received no medication. The exercise intensity was increased by 1-km/h increments until the heart rate reached 85% of the expected maximum rate and then maintained for 10 min. The first 10 subjects were analyzed to examine whether exercise increased the concentration of airborne particulates in the exhaled air. For the remaining 10 subjects, the LFVS was activated during constant-load exercise to compare the number of respiratory droplets before and after LFVS use. During exercise, a steady amount of particulates before the lactate threshold (LT) was followed by a significant and gradual increase in respiratory droplets after the LT, particularly during anaerobic exercise. Furthermore, respiratory droplets ≥0.3 μm significantly decreased after using LFVS (2120800±759700 vs. 560 ± 170, p<0.001). The amount of respiratory droplets significantly increased after LT. The LFVS enabled a significant decrease in respiratory droplets during anaerobic exercise in healthy subjects. This study's findings will aid in exercising safely during this pandemic.
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Affiliation(s)
- Yoshinori Katsumata
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Motoaki Sano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Okawara
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomonori Sawada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Nakashima
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Genki Ichihara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kobayashi
- Department of Organ Fabrication, Keio University School of Medicine, Tokyo, Japan
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Wheelock CE, Hess HW, Stooks J, Schwob J, Johnson BD, Schlader ZJ, Clemency BM, St James E, Hostler D. Respiratory muscle training and exercise ventilation while diving at altitude. Undersea Hyperb Med 2021; 48:107-117. [PMID: 33975401 DOI: 10.22462/03.04.2021.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Pre-dive altitude exposure may increase respiratory fatigue and subsequently augment exercise ventilation at depth. This study examined pre-dive altitude exposure and the efficacy of resistance respiratory muscle training (RMT) on respiratory fatigue while diving at altitude. METHODS Ten men (26±5 years; VO2peak: 39.8±3.3 mL• kg-1•min-1) performed three dives; one control (ground level) and two simulated altitude dives (3,658 m) to 17 msw, relative to ground level, before and after four weeks of resistance RMT. Subjects performed pulmonary function testing (e.g., inspiratory [PI] and expiratory [PE] pressure testing) pre- and post-RMT and during dive visits. During each dive, subjects exercised for 18 minutes at 55% VO2peak, and ventilation (VE), breathing frequency (ƒb,), tidal volume (VT) and rating of perceived exertion (RPE) were measured. RESULTS Pre-dive altitude exposure reduced PI before diving (p=0.03), but had no effect on exercise VE, ƒb, or VT at depth. At the end of the dive in the pre-RMT condition, RPE was lower (p=0.01) compared to control. RMT increased PI and PE (p<0.01). PE was reduced from baseline after diving at altitude (p<0.03) and this was abated after RMT. RMT did not improve VE or VT at depth, but decreased ƒb (p=0.01) and RPE (p=0.048) during the final minutes of exercise. CONCLUSION Acute altitude exposure pre- and post-dive induces decrements in PI and PE before and after diving, but does not seem to influence ventilation at depth. RMT reduced ƒb and RPE during exercise at depth, and may be useful to reduce work of breathing and respiratory fatigue during dives at altitude.
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Affiliation(s)
- Courtney E Wheelock
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - Hayden W Hess
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - Jocelyn Stooks
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - Jacqueline Schwob
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - Blair D Johnson
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - Zachary J Schlader
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - Brian M Clemency
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - EriKa St James
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
| | - David Hostler
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S
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Hirabayashi G, Saito M, Terayama S, Akihisa Y, Maruyama K, Andoh T. Lung-protective properties of expiratory flow-initiated pressure-controlled inverse ratio ventilation: A randomised controlled trial. PLoS One 2020; 15:e0243971. [PMID: 33332454 PMCID: PMC7746151 DOI: 10.1371/journal.pone.0243971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022] Open
Abstract
Background Expiratory flow-initiated pressure-controlled inverse ratio ventilation (EF-initiated PC-IRV) reduces physiological dead space. We hypothesised that EF-initiated PC-IRV would be lung protective compared with volume-controlled ventilation (VCV). Methods Twenty-eight men undergoing robot-assisted laparoscopic radical prostatectomy were enrolled in this randomised controlled trial. The EF-initiated PC-IRV group (n = 14) used pressure-controlled ventilation with the volume guaranteed mode. The inspiratory to expiratory (I:E) ratio was individually adjusted by observing the expiratory flow-time wave. The VCV group (n = 14) used the volume control mode with a 1:2 I:E ratio. The Mann–Whitney U test was used to compare differences in the serum cytokine levels. Results There were no significant differences in serum IL-6 between the EF-initiated PC-IRV (median 34 pg ml-1 (IQR 20.5 to 63.5)) and VCV (31 pg ml-1 (24.5 to 59)) groups (P = 0.84). The physiological dead space rate (physiological dead space/expired tidal volume) was significantly reduced in the EF-initiated PC-IRV group as compared with that in the VCV group (0.31 ± 0.06 vs 0.4 ± 0.07; P<0.001). The physiological dead space rate was negatively correlated with the forced vital capacity (% predicted) in the VCV group (r = -0.85, P<0.001), but not in the EF-initiated PC-IRV group (r = 0.15, P = 0.62). Two patients in the VCV group had permissive hypercapnia with low forced vital capacity (% predicted). Conclusions There were no differences in the lung-protective properties between the two ventilatory strategies. However, EF-initiated PC-IRV reduced physiological dead space rate; thus, it may be useful for reducing the ventilatory volume that is necessary to maintain normocapnia in patients with low forced vital capacity (% predicted) during robot-assisted laparoscopic radical prostatectomy.
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Affiliation(s)
- Go Hirabayashi
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
- * E-mail:
| | - Minami Saito
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
| | - Sachiko Terayama
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
| | - Yuki Akihisa
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
| | - Koichi Maruyama
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
| | - Tomio Andoh
- Department of Anaesthesiology, Mizonokuchi Hospital Teikyo University School of Medicine, Kanagawa, Japan
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Korenbaum VI, Pochekutova IA, Kostiv AE, Malaeva VV, Safronova MA, Kabantsova OI, Shin SN. Human forced expiratory noise. Origin, apparatus and possible diagnostic applications. J Acoust Soc Am 2020; 148:3385. [PMID: 33379875 PMCID: PMC7857509 DOI: 10.1121/10.0002705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 05/02/2023]
Abstract
Forced expiratory (FE) noise is a powerful bioacoustic signal containing information on human lung biomechanics. FE noise is attributed to a broadband part and narrowband components-forced expiratory wheezes (FEWs). FE respiratory noise is composed by acoustic and hydrodynamic mechanisms. An origin of the most powerful mid-frequency FEWs (400-600 Hz) is associated with the 0th-3rd levels of bronchial tree in terms of Weibel [(2009). Swiss Med. Wkly. 139(27-28), 375-386], whereas high-frequency FEWs (above 600 Hz) are attributed to the 2nd-6th levels of bronchial tree. The laboratory prototype of the apparatus is developed, which includes the electret microphone sensor with stethoscope head, a laptop with external sound card, and specially developed software. An analysis of signals by the new method, including FE time in the range from 200 to 2000 Hz and band-pass durations and energies in the 200-Hz bands evaluation, is applied instead of FEWs direct measures. It is demonstrated experimentally that developed FE acoustic parameters correspond to basic indices of lung function evaluated by spirometry and body plethysmography and may be even more sensitive to some respiratory deviations. According to preliminary experimental results, the developed technique may be considered as a promising instrument for acoustic monitoring human lung function in extreme conditions, including diving and space flights. The developed technique eliminates the contact of the sensor with the human oral cavity, which is characteristic for spirometry and body plethysmography. It reduces the risk of respiratory cross-contamination, especially during outpatient and field examinations, and may be especially relevant in the context of the COVID-19 pandemic.
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Affiliation(s)
- Vladimir I Korenbaum
- Pacific Oceanological Institute, Russian Academy of Sciences, 43 Baltiiskaya str., Vladivostok 690041, Russia
| | - Irina A Pochekutova
- Pacific Oceanological Institute, Russian Academy of Sciences, 43 Baltiiskaya str., Vladivostok 690041, Russia
| | - Anatoly E Kostiv
- Pacific Oceanological Institute, Russian Academy of Sciences, 43 Baltiiskaya str., Vladivostok 690041, Russia
| | - Veronika V Malaeva
- Pacific Oceanological Institute, Russian Academy of Sciences, 43 Baltiiskaya str., Vladivostok 690041, Russia
| | - Maria A Safronova
- Pacific Oceanological Institute, Russian Academy of Sciences, 43 Baltiiskaya str., Vladivostok 690041, Russia
| | - Oksana I Kabantsova
- Pacific Oceanological Institute, Russian Academy of Sciences, 43 Baltiiskaya str., Vladivostok 690041, Russia
| | - Svetlana N Shin
- Pacific Oceanological Institute, Russian Academy of Sciences, 43 Baltiiskaya str., Vladivostok 690041, Russia
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Zannin E, Milesi I, Porta R, Cacciatore S, Barbano L, Trentin R, Fanfulla F, Vitacca M, Dellacà RL. Effect of nocturnal EPAP titration to abolish tidal expiratory flow limitation in COPD patients with chronic hypercapnia: a randomized, cross-over pilot study. Respir Res 2020; 21:301. [PMID: 33208164 PMCID: PMC7672935 DOI: 10.1186/s12931-020-01567-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/06/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Tidal expiratory flow limitation (EFLT) promotes intrinsic PEEP (PEEPi) in patients with chronic obstructive pulmonary disease (COPD). Applying non-invasive ventilation (NIV) with an expiratory positive airway pressure (EPAP) matching PEEPi improves gas exchange, reduces work of breathing and ineffective efforts. We aimed to evaluate the effects of a novel NIV mode that continuously adjusts EPAP to the minimum level that abolishes EFLT. METHODS This prospective, cross-over, open-label study randomized patients to one night of fixed-EPAP and one night of EFLT-abolishing-EPAP. The primary outcome was transcutaneous carbon dioxide pressure (PtcCO2). Secondary outcomes were: peripheral oxygen saturation (SpO2), frequency of ineffective efforts, breathing patterns and oscillatory mechanics. RESULTS We screened 36 patients and included 12 in the analysis (age 72 ± 8 years, FEV1 38 ± 14%Pred). The median EPAP did not differ between the EFLT-abolishing-EPAP and the fixed-EPAP night (median (IQR) = 7.0 (6.0, 8.8) cmH2O during night vs 7.5 (6.5, 10.5) cmH2O, p = 0.365). We found no differences in mean PtcCO2 (44.9 (41.6, 57.2) mmHg vs 54.5 (51.1, 59.0), p = 0.365), the percentage of night time with PtcCO2 > 45 mm Hg was lower (62(8,100)% vs 98(94,100)%, p = 0.031) and ineffective efforts were fewer (126(93,205) vs 261(205,351) events/hour, p = 0.003) during the EFLT-abolishing-EPAP than during the fixed-EPAP night. We found no differences in oxygen saturation and lung mechanics between nights. CONCLUSION An adaptive ventilation mode targeted to abolish EFLT has the potential to reduce hypercapnia and ineffective efforts in stable COPD patients receiving nocturnal NIV. TRIAL REGISTRATION ClicalTrials.gov, NCT04497090. Registered 29 July 2020-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04497090 .
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Affiliation(s)
- Emanuela Zannin
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy.
| | - Ilaria Milesi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Roberto Porta
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Simona Cacciatore
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Luca Barbano
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - R Trentin
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Function and Sleep Medicine Unit of the Institute of Pavia, Pavia, Italy
| | - Francesco Fanfulla
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Function and Sleep Medicine Unit of the Institute of Pavia, Pavia, Italy
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
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Liao SY, Showalter MR, Linderholm AL, Franzi L, Kivler C, Li Y, Sa MR, Kons ZA, Fiehn O, Qi L, Zeki AA, Kenyon NJ. l-Arginine supplementation in severe asthma. JCI Insight 2020; 5:137777. [PMID: 32497023 PMCID: PMC7406254 DOI: 10.1172/jci.insight.137777] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUNDDysregulation of l-arginine metabolism has been proposed to occur in patients with severe asthma. The effects of l-arginine supplementation on l-arginine metabolite profiles in these patients are unknown. We hypothesized that individuals with severe asthma with low fractional exhaled nitric oxide (FeNO) would have fewer exacerbations with the addition of l-arginine to their standard asthma medications compared with placebo and would demonstrate the greatest changes in metabolite profiles.METHODSParticipants were enrolled in a single-center, crossover, double-blind l-arginine intervention trial at UCD. Subjects received placebo or l-arginine, dosed orally at 0.05 mg/kg (ideal body weight) twice daily. The primary end point was moderate asthma exacerbations. Longitudinal plasma metabolite levels were measured using mass spectrometry. A linear mixed-effect model with subject-specific intercepts was used for testing treatment effects.RESULTSA cohort of 50 subjects was included in the final analysis. l-Arginine did not significantly decrease asthma exacerbations in the overall cohort. Higher citrulline levels and a lower arginine availability index (AAI) were associated with higher FeNO (P = 0.005 and P = 2.51 × 10-9, respectively). Higher AAI was associated with lower exacerbation events. The eicosanoid prostaglandin H2 (PGH2) and Nα-acetyl-l-arginine were found to be good predictors for differentiating clinical responders and nonresponders.CONCLUSIONSThere was no statistically significant decrease in asthma exacerbations in the overall cohort with l-arginine intervention. PGH2, Nα-acetyl-l-arginine, and the AAI could serve as predictive biomarkers in future clinical trials that intervene in the arginine metabolome.TRIAL REGISTRATIONClinicalTrials.gov NCT01841281.FUNDINGThis study was supported by NIH grants R01HL105573, DK097154, UL1 TR001861, and K08HL114882. Metabolomics analysis was supported in part by a grant from the University of California Tobacco-Related Disease Research Program program (TRDRP).
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Affiliation(s)
- Shu-Yi Liao
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, UCD, Sacramento, California, USA
- VA Northern California Health Care System (VANCHCS), Mather, California, USA
| | | | - Angela L. Linderholm
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, UCD, Sacramento, California, USA
| | - Lisa Franzi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, UCD, Sacramento, California, USA
| | | | - Yao Li
- Department of Public Health Sciences, UCD, Davis, California, USA
| | | | | | | | - Lihong Qi
- Department of Public Health Sciences, UCD, Davis, California, USA
| | - Amir A. Zeki
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, UCD, Sacramento, California, USA
- VA Northern California Health Care System (VANCHCS), Mather, California, USA
| | - Nicholas J. Kenyon
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, UCD, Sacramento, California, USA
- VA Northern California Health Care System (VANCHCS), Mather, California, USA
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Abstract
IMPORTANCE Individuals with asymptomatic or mild coronavirus disease 2019 (COVID-19) have been reported to frequently transmit the disease even without direct contact. The severe acute respiratory syndrome coronavirus 2 has been found at very high concentrations in swab and sputum samples from such individuals. OBJECTIVE To estimate the virus levels released from individuals with asymptomatic to moderate COVID-19 into different aerosol sizes by normal breathing and coughing, and to determine what exposure could result from this in a room shared with such individuals. DESIGN, SETTING, AND PARTICIPANTS This mathematical modeling study combined the size-distribution of exhaled breath microdroplets for coughing and normal breathing with viral swab and sputum concentrations as approximation for lung lining liquid to obtain an estimate of emitted virus levels. Viral data were obtained from studies published as of May 20, 2020. The resulting emission data fed a single-compartment model of airborne concentrations in a room of 50 m3, the size of a small office or medical examination room. MAIN OUTCOMES AND MEASURES Modeling was used to estimate the viral load emitted by individuals breathing normally or coughing, and the concentrations expected in the simulated room at different ventilation rates. RESULTS The mean estimated viral load in microdroplets emitted by simulated individuals while breathing regularly was 0.0000049 copies/cm3, with a range of 0.0000000049 to 0.637 copies/cm3. The corresponding estimates for simulated coughing individuals were a mean of 0.277 copies/cm3 per cough, with a range of 0.000277 to 36 030 copies/cm3 per cough. The estimated concentrations in a room with an individual who was coughing frequently were very high, with a maximum of 7.44 million copies/m3 from an individual who was a high emitter. However, regular breathing from an individual who was a high emitter was modeled to result in lower room concentrations of up to 1248 copies/m3. CONCLUSIONS AND RELEVANCE In this modeling study, breathing and coughing were estimated to release large numbers of viruses, ranging from thousands to millions of virus copies per cubic meter in a room with an individual with COVID-19 with a high viral load, depending on ventilation and microdroplet formation process. The estimated infectious risk posed by a person with typical viral load who breathes normally was low. The results suggest that only few people with very high viral load pose an infection risk in poorly ventilated closed environments. These findings suggest that strict respiratory protection may be needed when there is a chance to be in the same small room with an individual, whether symptomatic or not, especially for a prolonged period.
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Affiliation(s)
- Michael Riediker
- Swiss Centre for Occupational and Environmental Health, Winterthur, Switzerland
| | - Dai-Hua Tsai
- Swiss Centre for Occupational and Environmental Health, Winterthur, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
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Affiliation(s)
| | | | - Christina E Bax
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Leung NHL, Chu DKW, Shiu EYC, Chan KH, McDevitt JJ, Hau BJP, Yen HL, Li Y, Ip DKM, Peiris JSM, Seto WH, Leung GM, Milton DK, Cowling BJ. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med 2020. [PMID: 32371934 DOI: 10.21203/rs.3.rs-16836/v1] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
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Affiliation(s)
- Nancy H L Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Daniel K W Chu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Eunice Y C Shiu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kwok-Hung Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - James J McDevitt
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Benien J P Hau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Hui-Ling Yen
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Dennis K M Ip
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - J S Malik Peiris
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing-Hong Seto
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Pathology, Hong Kong Baptist Hospital, Hong Kong, China
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Tang B, Huang D, Wang J, Luo LL, Li QG. Relationship of Blood Eosinophils with Fractional Exhaled Nitric Oxide and Pulmonary Function Parameters in Chronic Obstructive Pulmonary Disease (COPD) Exacerbation. Med Sci Monit 2020; 26:e921182. [PMID: 32161254 PMCID: PMC7083088 DOI: 10.12659/msm.921182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/27/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The 2018 Global Initiative for Chronic Obstructive Lung Disease Report reveals that the blood eosinophil count could forecast the risk of flare-ups. This study explored the correlations of blood eosinophils with fractional exhaled nitric oxide (FeNO) and pulmonary function parameters in acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MATERIAL AND METHODS The data of patients with AECOPD at our hospital admitted between July 2018 and June 2019 were retrospectively analyzed. All patients were stratified into an eosinophilic group (≥2%) or a noneosinophilic group (<2%) based on the peripheral eosinophil count per centum. Cross-sectional analysis was performed to compare clinical characteristics, percentage of eosinophils, FeNO, and pulmonary function between the 2 groups. RESULTS After applying the inclusion/exclusion criteria, 247 patients were included. FeNO values were higher in eosinophilic group (n=97) than in noneosinophilic group (n=150) (P=0.005). The forced expiratory volume in 1 second% predicted (FEV1% predicted), FEV1, and forced vital capacity (FVC) were higher in the eosinophilic group than in the noneosinophilic group (P=0.043; P=0.040; and P=0.011, respectively). Blood eosinophilia showed positive correlations with FeNO (P=0.004) and spirometry variables (FEV₁ [% predicted], P=0.003; FEV₁, P<0.001; and FVC, P<0.001). An FeNO level of 22.5 ppb was the best cutoff value to predict blood eosinophilia (P=0.000). CONCLUSIONS Blood eosinophil count is a likely biomarker that can predict positive relationship with FeNO values and pulmonary function parameters.
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Affiliation(s)
- Bin Tang
- Department of Respiratory Medicine, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Dan Huang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Jun Wang
- Department of Respiratory Medicine, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Lin-lin Luo
- Department of Respiratory Medicine, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Qiu-gen Li
- Department of Respiratory Medicine, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, Jiangxi, P.R. China
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Asadi S, Wexler AS, Cappa CD, Barreda S, Bouvier NM, Ristenpart WD. Effect of voicing and articulation manner on aerosol particle emission during human speech. PLoS One 2020; 15:e0227699. [PMID: 31986165 PMCID: PMC6984704 DOI: 10.1371/journal.pone.0227699] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/24/2019] [Indexed: 12/30/2022] Open
Abstract
Previously, we demonstrated a strong correlation between the amplitude of human speech and the emission rate of micron-scale expiratory aerosol particles, which are believed to play a role in respiratory disease transmission. To further those findings, here we systematically investigate the effect of different 'phones' (the basic sound units of speech) on the emission of particles from the human respiratory tract during speech. We measured the respiratory particle emission rates of 56 healthy human volunteers voicing specific phones, both in isolation and in the context of a standard spoken text. We found that certain phones are associated with significantly higher particle production; for example, the vowel /i/ ("need," "sea") produces more particles than /ɑ/ ("saw," "hot") or /u/ ("blue," "mood"), while disyllabic words including voiced plosive consonants (e.g., /d/, /b/, /g/) yield more particles than words with voiceless fricatives (e.g., /s/, /h/, /f/). These trends for discrete phones and words were corroborated by the time-resolved particle emission rates as volunteers read aloud from a standard text passage that incorporates a broad range of the phones present in spoken English. Our measurements showed that particle emission rates were positively correlated with the vowel content of a phrase; conversely, particle emission decreased during phrases with a high fraction of voiceless fricatives. Our particle emission data is broadly consistent with prior measurements of the egressive airflow rate associated with the vocalization of various phones that differ in voicing and articulation. These results suggest that airborne transmission of respiratory pathogens via speech aerosol particles could be modulated by specific phonetic characteristics of the language spoken by a given human population, along with other, more frequently considered epidemiological variables.
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Affiliation(s)
- Sima Asadi
- Dept. of Chemical Engineering, University of California Davis, Davis, California, United States of America
| | - Anthony S. Wexler
- Dept. of Mechanical and Aerospace Engineering, University of California Davis, Davis, California, United States of America
- Air Quality Research Center, University of California Davis, Davis, California, United States of America
- Dept. of Civil and Environmental Engineering, University of California Davis, Davis, California, United States of America
- Dept. of Land, Air and Water Resources, University of California Davis, Davis, California, United States of America
| | - Christopher D. Cappa
- Dept. of Civil and Environmental Engineering, University of California Davis, Davis, California, United States of America
| | - Santiago Barreda
- Dept. of Linguistics, University of California Davis, Davis, California, United States of America
| | - Nicole M. Bouvier
- Div. of Infectious Diseases, Dept. of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Dept. of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - William D. Ristenpart
- Dept. of Chemical Engineering, University of California Davis, Davis, California, United States of America
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Kokelj S, Kim JL, Andersson M, Runström Eden G, Bake B, Olin AC. Intra-individual variation of particles in exhaled air and of the contents of Surfactant protein A and albumin. PLoS One 2020; 15:e0227980. [PMID: 31978133 PMCID: PMC6980535 DOI: 10.1371/journal.pone.0227980] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/04/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Particles in exhaled air (PEx) provide samples of respiratory tract lining fluid from small airways containing, for example, Surfactant protein A (SP-A) and albumin, potential biomarkers of small airway disease. We hypothesized that there are differences between morning, noon, and afternoon measurements and that the variability of repeated measurements is larger between days than within days. METHODS PEx was obtained in sixteen healthy non-smoking adults on 11 occasions, within one day and between days. SP-A and albumin were quantified by ELISA. The coefficient of repeatability (CR), intraclass correlation coefficient (ICC), and coefficient of variation (CV) were used to assess the variation of repeated measurements. RESULTS SP-A and albumin increased significantly from morning towards the noon and afternoon by 13% and 25% on average, respectively, whereas PEx number concentration and particle mean mass did not differ significantly between the morning, noon and afternoon. Between-day CRs were not larger than within-day CRs. CONCLUSIONS Time of the day influences the contents of SP-A and albumin in exhaled particles. The variation of repeated measurements was rather high but was not influenced by the time intervals between measurements.
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Affiliation(s)
- Spela Kokelj
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Jeong-Lim Kim
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marianne Andersson
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunilla Runström Eden
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Bake
- Unit of Respiratory Medicine and Allergy, Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Scherf G, Masseau I, Bua AS, Beauchamp G, Dunn ME. Fluoroscopic and radiographic assessment of variations in tracheal height during inspiration and expiration in healthy adult small-breed dogs. Can J Vet Res 2020; 84:24-32. [PMID: 31949326 PMCID: PMC6921987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/16/2019] [Indexed: 06/10/2023]
Abstract
The objective of this study was to document tidal variations in tracheal height during normal respiration in 19 healthy adult (> 1 y old) small-breed dogs (< 10 kg) using fluoroscopy and radiography. Each dog underwent tracheal fluoroscopic examination on inspiration and expiration while in a standing position (F-S) and in right lateral recumbency (F-RL), followed by radiographic projections obtained in right lateral recumbency. The percent variation in tracheal height during maximal inspiration and expiration was determined at 3 different locations [cervical region (CR), thoracic inlet (TI), and intrathoracic (IT) region]. When all imaging procedures and sites of measurement were considered, tracheal height varied during physiologic inspiration and expiration from 0% to 21.1%, with a mean of 4.5%. The mean percent variation in tracheal height was not significantly different among imaging modalities (F-S versus F-RL versus radiography) (P = 0.16) or measurement sites (CR versus TI versus IT) (P = 0.89). The body condition score (BCS) (P = 0.96), age (P = 0.95), and breed (P = 0.19) did not significantly influence the mean percent variation in tracheal height. The average variation in tracheal height during maximal physiological inspiration and expiration is small (< 6%) in most healthy adult small-breed dogs as assessed by fluoroscopy and radiography, although tracheal height may vary by as much as 21.1% in some healthy individuals. Inspiratory and expiratory radiographs acquired in right lateral recumbency provide an accurate assessment of tracheal height as an alternative to fluoroscopy.
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Affiliation(s)
- Grégoire Scherf
- Tufts University Cummings School of Veterinary Medicine, Clinical Sciences, 200 Westboro Road, North Grafton, Massachusetts 01536, USA (Scherf); Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, 3200 rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2 (Masseau, Bua, Beauchamp, Dunn)
| | - Isabelle Masseau
- Tufts University Cummings School of Veterinary Medicine, Clinical Sciences, 200 Westboro Road, North Grafton, Massachusetts 01536, USA (Scherf); Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, 3200 rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2 (Masseau, Bua, Beauchamp, Dunn)
| | - Anne-Sophie Bua
- Tufts University Cummings School of Veterinary Medicine, Clinical Sciences, 200 Westboro Road, North Grafton, Massachusetts 01536, USA (Scherf); Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, 3200 rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2 (Masseau, Bua, Beauchamp, Dunn)
| | - Guy Beauchamp
- Tufts University Cummings School of Veterinary Medicine, Clinical Sciences, 200 Westboro Road, North Grafton, Massachusetts 01536, USA (Scherf); Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, 3200 rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2 (Masseau, Bua, Beauchamp, Dunn)
| | - Marilyn E Dunn
- Tufts University Cummings School of Veterinary Medicine, Clinical Sciences, 200 Westboro Road, North Grafton, Massachusetts 01536, USA (Scherf); Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, 3200 rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2 (Masseau, Bua, Beauchamp, Dunn)
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Petitto L, Com G, Jackson R, Richter G, Jambhekar S. Catathrenia and Treatment With Positive Airway Pressure in the Pediatric Population. J Clin Sleep Med 2019; 15:1853-1857. [PMID: 31855170 PMCID: PMC7099177 DOI: 10.5664/jcsm.8100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 11/13/2022]
Abstract
None Catathrenia, also known as sleep-related groaning, is a relatively rare sleep disorder with characteristics consistent with loud groaning on expiration during sleep. Organic causes of catathrenia are unknown and the decision of whether or not to treat is unclear. Limited research is available concerning appropriate treatment and none of the literature focuses primarily on pediatrics. We report a series of three, male pediatric cases with catathrenia that were treated with continuous positive airway pressure (CPAP) while identifying and comparing clinical symptoms, polysomnogram findings, treatment, and patient response to treatment. Catathrenia may be associated with abnormal nocturnal oxygenation and ventilation and may lead to negative clinical daytime symptoms which may warrant treatment. If catathrenia leads to sleep disruption and negative daytime symptoms, treatment with CPAP should be considered.
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Affiliation(s)
- Lacie Petitto
- Arkansas Children’s Sleep Disorders Center, Little Rock, Arkansas
| | - Gulnur Com
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rithea Jackson
- Arkansas Children’s Sleep Disorders Center, Little Rock, Arkansas
| | - Gresham Richter
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Supriya Jambhekar
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Kim J, Hong UG, Choi Y, Hong S. Enhancing the evanescent field in TiO2/Au hybrid thin films creates a highly sensitive room-temperature formaldehyde gas biosensor. Colloids Surf B Biointerfaces 2019; 182:110303. [PMID: 31299539 DOI: 10.1016/j.colsurfb.2019.06.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Jina Kim
- Department of Biotechnology, CHA University, Gyeonggi 13488, Republic of Korea
| | - Ung Gi Hong
- R&D center, SK Gas, Gyeonggi 13493, Republic of Korea
| | - Youngbo Choi
- Department of Safety Engineering, Chungbuk National University, Chungbuk, 28644, Republic of Korea.
| | - Surin Hong
- Department of Biotechnology, CHA University, Gyeonggi 13488, Republic of Korea.
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Hoff IE, Hisdal J, Landsverk SA, Røislien J, Kirkebøen KA, Høiseth LØ. Respiratory variations in pulse pressure and photoplethysmographic waveform amplitude during positive expiratory pressure and continuous positive airway pressure in a model of progressive hypovolemia. PLoS One 2019; 14:e0223071. [PMID: 31560715 PMCID: PMC6764667 DOI: 10.1371/journal.pone.0223071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/12/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Respiratory variations in pulse pressure (dPP) and photoplethysmographic waveform amplitude (dPOP) are used for evaluation of volume status in mechanically ventilated patients. Amplification of intrathoracic pressure changes may enable their use also during spontaneous breathing. We investigated the association between the degree of hypovolemia and dPP and dPOP at different levels of two commonly applied clinical interventions; positive expiratory pressure (PEP) and continuous positive airway pressure (CPAP). METHODS 20 healthy volunteers were exposed to progressive hypovolemia by lower body negative pressure (LBNP). PEP of 0 (baseline), 5 and 10 cmH2O was applied by an expiratory resistor and CPAP of 0 (baseline), 5 and 10 cmH2O by a facemask. dPP was obtained non-invasively with the volume clamp method and dPOP from a pulse oximeter. Central venous pressure was measured in 10 subjects. Associations between changes were examined using linear mixed-effects regression models. RESULTS dPP increased with progressive LBNP at all levels of PEP and CPAP. The LBNP-induced increase in dPP was amplified by PEP 10 cmH20. dPOP increased with progressive LBNP during PEP 5 and PEP 10, and during all levels of CPAP. There was no additional effect of the level of PEP or CPAP on dPOP. Progressive hypovolemia and increasing levels of PEP were reflected by increasing respiratory variations in CVP. CONCLUSION dPP and dPOP reflected progressive hypovolemia in spontaneously breathing healthy volunteers during PEP and CPAP. An increase in PEP from baseline to 10 cmH2O augmented the increase in dPP, but not in dPOP.
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Affiliation(s)
- Ingrid Elise Hoff
- Norwegian Air Ambulance Foundation, Sentrum, Oslo, Norway
- Department of Anesthesiology, Oslo University Hospital, Nydalen, Oslo, Norway
- * E-mail:
| | - Jonny Hisdal
- Section of Vascular Investigations, Department of Vascular Surgery, Oslo University Hospital, Nydalen, Oslo, Norway
- Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
| | | | - Jo Røislien
- Norwegian Air Ambulance Foundation, Sentrum, Oslo, Norway
| | | | - Lars Øivind Høiseth
- Department of Anesthesiology, Oslo University Hospital, Nydalen, Oslo, Norway
- Section of Vascular Investigations, Department of Vascular Surgery, Oslo University Hospital, Nydalen, Oslo, Norway
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Silva IS, Pedrosa R, Azevedo IG, Forbes A, Fregonezi GAF, Dourado Junior MET, Lima SRH, Ferreira GMH. Respiratory muscle training in children and adults with neuromuscular disease. Cochrane Database Syst Rev 2019; 9:CD011711. [PMID: 31487757 PMCID: PMC6953358 DOI: 10.1002/14651858.cd011711.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neuromuscular diseases (NMDs) are a heterogeneous group of diseases affecting the anterior horn cell of spinal cord, neuromuscular junction, peripheral nerves and muscles. NMDs cause physical disability usually due to progressive loss of strength in limb muscles, and some NMDs also cause respiratory muscle weakness. Respiratory muscle training (RMT) might be expected to improve respiratory muscle weakness; however, the effects of RMT are still uncertain. This systematic review will synthesize the available trial evidence on the effectiveness and safety of RMT in people with NMD, to inform clinical practice. OBJECTIVES To assess the effects of respiratory muscle training (RMT) for neuromuscular disease (NMD) in adults and children, in comparison to sham training, no training, standard treatment, breathing exercises, or other intensities or types of RMT. SEARCH METHODS On 19 November 2018, we searched the Cochrane Neuromuscular Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase. On 23 December 2018, we searched the US National Institutes for Health Clinical Trials Registry (ClinicalTrials.gov), the World Health Organization International Clinical Trials Registry Platform, and reference lists of the included studies. SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs, including cross-over trials, of RMT in adults and children with a diagnosis of NMD of any degree of severity, who were living in the community, and who did not need mechanical ventilation. We compared trials of RMT (inspiratory muscle training (IMT) or expiratory muscle training (EMT), or both), with sham training, no training, standard treatment, different intensities of RMT, different types of RMT, or breathing exercises. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodological procedures. MAIN RESULTS We included 11 studies involving 250 randomized participants with NMDs: three trials (N = 88) in people with amyotrophic lateral sclerosis (ALS; motor neuron disease), six trials (N = 112) in Duchenne muscular dystrophy (DMD), one trial (N = 23) in people with Becker muscular dystrophy (BMD) or limb-girdle muscular dystrophy, and one trial (N = 27) in people with myasthenia gravis.Nine of the trials were at high risk of bias in at least one domain and many reported insufficient information for accurate assessment of the risk of bias. Populations, interventions, control interventions, and outcome measures were often different, which largely ruled out meta-analysis. All included studies assessed lung capacity, our primary outcome, but four did not provide data for analysis (1 in people with ALS and three cross-over studies in DMD). None provided long-term data (over a year) and only one trial, in ALS, provided information on adverse events. Unscheduled hospitalisations for chest infection or acute exacerbation of chronic respiratory failure were not reported and physical function and quality of life were reported in one (ALS) trial.Amyotrophic lateral sclerosis (ALS)Three trials compared RMT versus sham training in ALS. Short-term (8 weeks) effects of RMT on lung capacity in ALS showed no clear difference in the change of the per cent predicted forced vital capacity (FVC%) between EMT and sham EMT groups (mean difference (MD) 0.70, 95% confidence interval (CI) -8.48 to 9.88; N = 46; low-certainty evidence). The mean difference (MD) in FVC% after four months' treatment was 10.86% in favour of IMT (95% CI -4.25 to 25.97; 1 trial, N = 24; low-certainty evidence), which is larger than the minimal clinically important difference (MCID, as estimated in people with idiopathic pulmonary fibrosis). There was no clear difference between IMT and sham IMT groups, measured on the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALFRS; range of possible scores 0 = best to 40 = worst) (MD 0.85, 95% CI -2.16 to 3.85; 1 trial, N = 24; low-certainty evidence) or quality of life, measured on the EuroQol-5D (0 = worst to 100 = best) (MD 0.77, 95% CI -17.09 to 18.62; 1 trial, N = 24; low-certainty evidence) over the medium term (4 months). One trial report stated that the IMT protocol had no adverse effect (very low-certainty evidence).Duchenne muscular dystrophy (DMD)Two DMD trials compared RMT versus sham training in young males with DMD. In one study, the mean post-intervention (6-week) total lung capacity (TLC) favoured RMT (MD 0.45 L, 95% CI -0.24 to 1.14; 1 trial, N = 16; low-certainty evidence). In the other trial there was no clear difference in post-intervention (18 days) FVC between RMT and sham RMT (MD 0.16 L, 95% CI -0.31 to 0.63; 1 trial, N = 20; low-certainty evidence). One RCT and three cross-over trials compared a form of RMT with no training in males with DMD; the cross-over trials did not provide suitable data. Post-intervention (6-month) values showed no clear difference between the RMT and no training groups in per cent predicted vital capacity (VC%) (MD 3.50, 95% CI -14.35 to 21.35; 1 trial, N = 30; low-certainty evidence).Becker or limb-girdle muscular dystrophyOne RCT (N = 21) compared 12 weeks of IMT with breathing exercises in people with Becker or limb-girdle muscular dystrophy. The evidence was of very low certainty and conclusions could not be drawn.Myasthenia gravisIn myasthenia gravis, there may be no clear difference between RMT and breathing exercises on measures of lung capacity, in the short term (TLC MD -0.20 L, 95% CI -1.07 to 0.67; 1 trial, N = 27; low-certainty evidence). Effects of RMT on quality of life are uncertain (1 trial; N = 27).Some trials reported effects of RMT on inspiratory and/or expiratory muscle strength; this evidence was also of low or very low certainty. AUTHORS' CONCLUSIONS RMT may improve lung capacity and respiratory muscle strength in some NMDs. In ALS there may not be any clinically meaningful effect of RMT on physical functioning or quality of life and it is uncertain whether it causes adverse effects. Due to clinical heterogeneity between the trials and the small number of participants included in the analysis, together with the risk of bias, these results must be interpreted very cautiously.
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Affiliation(s)
- Ivanizia S Silva
- Federal University of Rio Grande do NorteDepartment of Physical TherapyAvenida Senador Salgado Filho 3000, Lagoa NovaBairro Lagoa NovaNatalRio Grande do NorteBrazil59072‐970
| | - Rafaela Pedrosa
- Federal University of ParaibaDepartment of Physical TherapyJoão PessoaParaibaBrazil
| | - Ingrid G Azevedo
- Ana Bezerra University HospitalPhysical TherapyAvenida Senador Salgado Filho, 3000Bairro Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
- Federal University of Rio Grande do NortePhD Program in Physical TherapyAvenida Senador Salgado Filho, 3000Bairro Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
| | - Anne‐Marie Forbes
- University of TasmaniaCreative Arts & Health ‐ School of Creative Arts & MediaPrivate Bag 63HobartTASAustralia7001
| | - Guilherme AF Fregonezi
- Federal University of Rio Grande do NorteDepartment of Physical TherapyAvenida Senador Salgado Filho 3000, Lagoa NovaBairro Lagoa NovaNatalRio Grande do NorteBrazil59072‐970
- Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH)PneumoCardioVascular LabNatalRio Grande do NorteBrazil59078‐970
| | - Mário ET Dourado Junior
- Federal University of Rio Grande do NorteIntegrated MedicineAv. Nilo Peçanha, 620PetrópolisNatalRio Grande do NorteBrazil59012‐300
| | - Suzianne RH Lima
- Federal University of Rio Grande do NorteIntegrated MedicineAv. Nilo Peçanha, 620PetrópolisNatalRio Grande do NorteBrazil59012‐300
| | - Gardenia MH Ferreira
- Federal University of Rio Grande do NortePhD Program in Physical TherapyAvenida Senador Salgado Filho, 3000Bairro Lagoa NovaNatalRio Grande do NorteBrazil59078‐970
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Liu F, Zhang C, Qian H, Zheng X, Nielsen PV. Direct or indirect exposure of exhaled contaminants in stratified environments using an integral model of an expiratory jet. Indoor Air 2019; 29:591-603. [PMID: 31025421 DOI: 10.1111/ina.12563] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 05/26/2023]
Abstract
The risk of cross-infection is high when the susceptible persons are exposed to the pathogen-laden droplets or droplet nuclei exhaled by infectors. This study proposes a jet integral model to predict the dispersion of exhaled contaminants, evaluating the exposure risk and determining a threshold distance to identify the direct and indirect exposures in both thermally uniform and stratified environments. The results show that the maximum concentration of contaminants exhaled by a bed-lying infector clearly decreases in a short distance (<1.8 m) in a uniform environment, while it maintains high values in a long distance in a stratified environment. The lock-up phenomenon largely weakens the decay of the concentration. The direct exposure of the receiver is determined primarily by the impact scope of the exhaled airflow, while the indirect exposure is mainly related to the ventilation rate and air distribution in the room. In particular, the distance of direct exposure is the longest (approximately 2 m) when the receiver's breathing height is at the lock-up layer in a stratified environment. Our study could be useful for developing effective prevention measures to control cross-infection in the initial stage of design of indoor layouts and ventilation systems.
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Affiliation(s)
- Fan Liu
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Chongyang Zhang
- School of Energy and Environment, Southeast University, Nanjing, China
- Shanghai Research Institute of Building Sciences (Group) Co., Ltd., Shanghai, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Xiaohong Zheng
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Peter V Nielsen
- Department of Civil Engineering, Aalborg University, Aalborg, Denmark
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Vena A, Howe M, Cao D, King A. The role of E-liquid vegetable glycerin and exhaled aerosol on cue reactivity to tank-based electronic nicotine delivery systems (ENDS). Psychopharmacology (Berl) 2019; 236:2083-2092. [PMID: 30796491 PMCID: PMC6626688 DOI: 10.1007/s00213-019-05202-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/13/2019] [Indexed: 01/02/2023]
Abstract
RATIONALE Electronic nicotine delivery systems (ENDS or e-cigarettes) share salient features of combustible smoking, such as inhalation and exhalation behaviors, and evidence indicates that first- and second-generation ENDS generalize as smoking cues. The present study examined whether newer, tank-based third-generation ENDS ("mods") also evoke smoking urges, and whether enhancing the visibility of exhaled aerosol clouds-by increasing the e-liquid vegetable glycerin (VG) content-strengthens the cue salience of ENDS. OBJECTIVES The objective was to assess the role of exhaled aerosol clouds on ENDS cue potency using a standardized laboratory paradigm designed to mimic real-world exposures. METHODS Using a mixed design, young adult smokers (n = 50; mean age 26.5 years; ≥ 5 cigarettes/day) observed a study confederate drinking bottled water (control cue) and vaping an ENDS mod containing e-liquid with either high (73%) or low (0%) VG. Participants completed the Brief Questionnaire on Smoking Urges (BQSU) and visual analog scales (VAS) assessing cigarette and e-cigarette desire pre- and post-cue exposure. RESULTS Increasing the e-liquid content of VG enhanced the size and visibility of the exhaled aerosol clouds and evoked a greater increase in smoking desire and a more sustained increase in e-cigarette desire relative to the low VG cue. Both cues elicited increases in smoking urges. These results remained after controlling for sex, prior ENDS experience, recent smoking behavior, and menthol preference. CONCLUSIONS Observation of tank-based ENDS use generalizes as a smoking cue and its cue salience is strengthened by increasing the e-liquid content of VG to enhance the visibility of the exhaled aerosol cloud.
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Affiliation(s)
- Ashley Vena
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Avenue (MC-3077), Chicago, IL, 60637, USA
| | - Meghan Howe
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Avenue (MC-3077), Chicago, IL, 60637, USA
| | - Dingcai Cao
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Andrea King
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Avenue (MC-3077), Chicago, IL, 60637, USA.
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Ai Z, Hashimoto K, Melikov AK. Airborne transmission between room occupants during short-term events: Measurement and evaluation. Indoor Air 2019; 29:563-576. [PMID: 30980555 DOI: 10.1111/ina.12557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/21/2019] [Accepted: 04/08/2019] [Indexed: 05/10/2023]
Abstract
This study experimentally examines and compares the dynamics and short-term events of airborne cross-infection in a full-scale room ventilated by stratum, mixing and displacement air distributions. Two breathing thermal manikins were employed to simulate a standing infected person and a standing exposed person. Four influential factors were examined, including separation distance between manikins, air change per hour, positioning of the two manikinsand air distribution. Tracer gas technique was used to simulate the exhaled droplet nuclei from the infected person and fast tracer gas concentration meters (FCM41) were used to monitor the concentrations. Real-time and average exposure indices were proposed to evaluate the dynamics of airborne exposure. The time-averaged exposure index depends on the duration of exposure time and can be considerably different during short-term events and under steady-state conditions. The exposure risk during short-term events may not always decrease with increasing separation distance. It changes over time and may not always increase with time. These findings imply that the control measures formulated on the basis of steady-state conditions are not necessarily appropriate for short-term events.
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Affiliation(s)
- Zhengtao Ai
- International Centre for Indoor Environment and Energy, Department of Civil Engineering, Technical University of Denmark, Copenhagen, Denmark
| | - Kaho Hashimoto
- International Centre for Indoor Environment and Energy, Department of Civil Engineering, Technical University of Denmark, Copenhagen, Denmark
- Department of Architecture, Faculty of Science and Engineering, Waseda University, Tokyo, Japan
| | - Arsen K Melikov
- International Centre for Indoor Environment and Energy, Department of Civil Engineering, Technical University of Denmark, Copenhagen, Denmark
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Abstract
The respiratory rhythm generator is spectacular in its ability to support a wide range of activities and adapt to changing environmental conditions, yet its operating mechanisms remain elusive. We show how selective control of inspiration and expiration times can be achieved in a new representation of the neural system (called a Boolean network). The new framework enables us to predict the behavior of neural networks based on properties of neurons, not their values. Hence, it reveals the logic behind the neural mechanisms that control the breathing pattern. Our network mimics many features seen in the respiratory network such as the transition from a 3-phase to 2-phase to 1-phase rhythm, providing novel insights and new testable predictions.
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Affiliation(s)
- Alona Ben-Tal
- School of Natural and Computational Sciences, Massey University, Auckland, New Zealand.
| | - Yunjiao Wang
- Department of Mathematics, Texas Southern University, Houston, TX, USA
| | - Maria C A Leite
- Mathematics and Statistics Unit, University of South Florida St Petersburg, St Petersburg, FL, USA
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Abstract
OBJECTIVE Disadvantaged socioeconomic circumstances in early life have the potential to impact lung function. Thus, this study aimed to summarise evidence on the association between socioeconomic circumstances and respiratory function from childhood to young adulthood. DESIGN Systematic review and meta-analysis. METHODS Following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, Medline, ISI-Web of Science and Scopus were searched from inception up to January 2018. Original studies on the association between socioeconomic circumstances and respiratory function in early ages (ie, participants younger than 25 years of age) were investigated. Two investigators independently evaluated articles, applied the exclusion criteria, extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale. A meta-analysis of the standardised mean difference and 95% CI in respiratory function between participants from different socioeconomic circumstances was conducted, using a random-effects model. RESULTS Thirty-three papers were included in this review and 23 showed that disadvantaged socioeconomic circumstances were significantly associated with reduced respiratory function. The meta-analysis including seven papers showed a significant difference of -0.31 (95% CI -0.42 to -0.21) litres in forced expiratory volume in the first second between children, adolescents and young adults from disadvantaged versus advantaged socioeconomic circumstances. Specifically a difference of -0.31 (95% CI -0.51 to -0.10) litres in girls and -0.43 (95% CI -0.51 to -0.35) litres in boys was observed. CONCLUSIONS Children, adolescents and young adults from disadvantaged socioeconomic circumstances had lower respiratory function, and boys presented higher respiratory health inequalities. This information contributes to explain the social patterning of respiratory diseases, and might enable health policy makers to tackle respiratory health inequalities at early ages.
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Affiliation(s)
- Vânia Rocha
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Sara Soares
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
- Population Epidemiology Unit, Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Sílvia Fraga
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Universidade do Porto Faculdade de Medicina, Porto, Portugal
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Saunoriene L, Siauciunaite V, Vainoras A, Bertasiute V, Navickas Z, Ragulskis M. The characterization of the transit through the anaerobic threshold based on relationships between RR and QRS cardiac intervals. PLoS One 2019; 14:e0216938. [PMID: 31091280 PMCID: PMC6519807 DOI: 10.1371/journal.pone.0216938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 05/01/2019] [Indexed: 11/18/2022] Open
Abstract
This paper aims to develop a novel computational technique for the detection of the transit through the anaerobic threshold. This technique uses only cardiac intervals derived from the electrocardiogram and is based on algebraic relationships between RR and QRS intervals. Electrocardiograms are measured during the load and the recovery processes. Algebraic relationships between cardiac intervals are used not only to identify the anaerobic threshold but also to characterise individual features of the person during the transit through the threshold. The ratio between carbon dioxide and oxygen in the exhaled air is used to validate the results. The algebraic relationship between cardiac intervals serves as a stand-alone indicator for both the determination of the anaerobic threshold and the characterization of the performance of the person during the load and the recovery processes.
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Affiliation(s)
- Loreta Saunoriene
- Center for Nonlinear Systems, Kaunas University of Technology, Studentu 50-146, Kaunas LT-51368, Lithuania
| | - Vaiva Siauciunaite
- Center for Nonlinear Systems, Kaunas University of Technology, Studentu 50-146, Kaunas LT-51368, Lithuania
| | - Alfonsas Vainoras
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu 17, Kaunas LT-50161, Lithuania
| | - Virginija Bertasiute
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu 17, Kaunas LT-50161, Lithuania
| | - Zenonas Navickas
- Center for Nonlinear Systems, Kaunas University of Technology, Studentu 50-146, Kaunas LT-51368, Lithuania
| | - Minvydas Ragulskis
- Center for Nonlinear Systems, Kaunas University of Technology, Studentu 50-146, Kaunas LT-51368, Lithuania
- * E-mail:
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