Assessment Of Respiratory Function Research Articles

Ultrasonographic measurement of diaphragm muscle activity for assessment of respiratory function in horses

Ultrasonographic imaging of the diaphragm is a non-invasive alternative for respiratory function evaluation in horses. This study aimed to measure diaphragm thickness, thickening (change in thickness with contraction) and thickening fraction in healthy adult horses during tidal breathing and forced vital capacity. Correlation between body weight (≤400 kg and >400 kg) and diaphragm thickness was investigated. To that purpose, 20 adult horses, weight 409±50 kg, height 1.47±0.05 m, and age 16±6 years were included in the study. Diaphragm thickness was measured at end-inspiration and end-expiration using B-mode and M-mode. The transducer was placed in the 10th, 11th and 12th intercostal spaces of both hemithoraces. Measurements obtained at end inspiration using M-mode during forced vital capacity were greater than for tidal breathing for diaphragm thickness (P=0.006), diaphragm thickening (P<0.001) and thickening fraction (P<0.001). The same was found for thickening (P<0.001) and thickening fraction (P<0.001). Diaphragm thickness at end-inspiration was greater in horses weighing >400kg than those ≤400kg at the inspiration (0.93±0.2 cm and 0.74±0 0.02 cm, P<0.001) and at the end of expiration (0.77±0.02 cm and 0.63±0, 02 cm, P<0.001). There was no difference in thickening fraction between horses weighing ≤400kg and >400kg (tidal breathing: 18±2 % and 16±2 %, P=0.609; forced vital capacity: 39±6 % and 31±5 %, P=0.301). Diaphragm assessment in horses is possible using both B-mode and M-mode. Breathing workload has a positive correlation between breathing workload and diaphragm contraction. Due to the relationship demonstrated between diaphragm thickness and weight, it is recommended that diaphragm thickening fraction is used to compare diaphragm measurements between horses.

The Significance of Selected Myokines in Predicting the Length of Rehabilitation of Patients after COVID-19 Infection.

In the context of the global COVID-19 pandemic, understanding the intricate mechanisms of the body's response to infection and inflammation has become a priority for the medical and research communities. It has been proven that during COVID-19 infection, molecules are secreted-namely organokines, which may directly or indirectly play a role in the pathophysiology of COVID-19. The objective of this study was to scrutinize the potential correlation between the levels of selected myokines (myostatin, agrin, irisin, and myonectin) and the duration of rehabilitation in post-COVID-19 patients. Additionally, the study aimed to investigate whether there is a correlation between the levels of these myokines and the length of hospitalization during COVID-19 treatment. The study was conducted at the Rehabilitation Hospital in Szczecin (Poland). Patients in the study participated in a comprehensive rehabilitation program following COVID-19 treatment. In order to assess the effectiveness of rehabilitation, the following tests were performed: a 6 min walk test with an assessment of exercise tolerance (Borg scale), an assessment of dyspnea severity (mMRC scale), a spirometric assessment of respiratory function, a measurement of arm strength, and an assessment of fatigue using the Fatigue Assessment Scale (FAS). Myokine levels were measured using commercially available enzyme-linked immunosorbent assays (ELISA) according to the manufacturer's instructions. Statistical analysis was performed using Statistica 13.1 software. Lower concentrations of irisin and myonectin and higher concentrations of myostatin correlated with longer rehabilitation time. Baseline levels of specific myokines in post-COVID-19 patients could play a crucial role in anticipating the duration of rehabilitation. The duration of hospitalization for the infection may influence myokine levels in patients recovering from COVID-19.

Effectiveness of comprehensive rehabilitation of patients with impaired respiratory muscle strength after coronavirus pneumonia

Aim. The study aims to evaluate the effectiveness of a comprehensive rehabilitation program for patients experiencing reduced respiratory muscle strength following coronavirus pneumonia.Materials and methods. This prospective, ran-domized study enrolled 55 individuals (average age 66.1±6.4 years; 21.8% males and 78.2% females) who had recovered from COVID-19. The rehabilitation regimen included 10 sessions of respiratory exercises, 10 chest massage treatments, and 3 sessions of osteopathic adjustment. Assessments of respiratory function and respiratory muscle strength were conducted both before the initiation of rehabilitation and upon its completion.Results. Initial complaints included rapid fatigue, dyspnea under physical strain, vertigo, headaches, chest pain during respiration, and disrupted sleep patterns. Participants were categorized into two groups: males and females. Both groups demonstrated a decrease in expiratory muscle strength by a factor of 1.2 and inspiratory muscle strength by 1.6, compared to normative values. Spirometry indicated impaired lung function across all participants. Post-rehabilitation, a marked improvement in overall health and a reduction in complaint severity were observed. Rehabilitation routing scales showed a decrease in condition severity from 2-3 points to 1-2 points, alongside a statistically significant increase in respiratory muscle strength, enhanced oxygen saturation, and restored lung function.Conclusion. Our proposed comprehensive rehabilitation program, incorporating osteopathic manipulation, respiratory exercises, and massage, successfully shifts the pathological breathing pattern to a physiological one, strengthens respiratory muscles, and reinstates lung function. This leads to improved exercise, reduced anxiety and depression levels, and enhanced quality of life for post-COVID-19 pneumonia patients.

Impulse oscillometry assessment of respiratory function in pediatric patients with a history of COVID-19.

While coronavirus disease 2019 (COVID-19) is generally considered to exhibit a less severe clinical course in children than in adults, studies have demonstrated that respiratory symptoms can endure for more than 3 months following infection in at least one-third of pediatric cases. The present study evaluates the respiratory functions of children aged 3-15 years within 3-6 months of their recovery from COVID-19 using impulse oscillometry (IOS) and compares them with the values of healthy children. Included in this prospective cross-sectional study were 63 patients (patient group) aged 3-15 years who contracted COVID-19 between December 2021 and May 2022, as well as 57 healthy children as a control group, matched for age and sex. The demographic, clinical, and laboratory data of the patients were recorded, and respiratory function was assessed based on airway resistance (zR5, zR20, R5-20) and reactance (zX5, zX20, reactance area[AX], resonant frequency [Fres]) using an IOS device. There were no significant differences in the age, weight, height, and body weight z score values of the two groups (p > .05). While the zR5 and R5-20 levels of the patient group were higher (p = .008 and p < .001, respectively) than those of the controls, the zR20, AX, and Fres values did not differ significantly between the groups (p > .05). The parameters indicating the reactance, including zX5 and zX20, were significantly lower in the patient group than in the control group (p = .028 and p < .001, respectively). Total and peripheral airway resistances were found to be elevated in children who had recovered from COVID-19 in the preceding 3-6 months.

Novel instruments for evaluating postoperative outcomes in MPS IVA patients: A confluence of AI for thematic quality of life analysis and Bayesian respiratory function assessment

Novel instruments for evaluating postoperative outcomes in MPS IVA patients: A confluence of AI for thematic quality of life analysis and Bayesian respiratory function assessment

Inspiratory Muscle Dysfunction Mediates and Predicts a Disease Continuum of Hypercapnic Failure in Chronic Obstructive Pulmonary Disease.

Advanced chronic obstructive pulmonary disease (COPD) is associated with chronic hypercapnic failure. The present work aimed to comprehensively investigate inspiratory muscle function as a potential key determinant of hypercapnic respiratory failure in patients with COPD. Prospective patient recruitment encompassed 61 stable subjects with COPD across different stages of respiratory failure, ranging from normocapnia to isolated nighttime hypercapnia and daytime hypercapnia. Arterialized blood gas analyses and overnight transcutaneous capnometry were used for patient stratification. Assessment of respiratory muscle function encompassed body plethysmography, maximum inspiratory pressure (MIP), diaphragm ultrasound, and transdiaphragmatic pressure recordings following cervical magnetic stimulation of the phrenic nerves (twPdi) and a maximum sniff manoeuvre (Sniff Pdi). Twenty patients showed no hypercapnia, 10 had isolated nocturnal hypercapnia, and 31 had daytime hypercapnia. Body plethysmography clearly distinguished patients with and without hypercapnia but did not discriminate patients with isolated nocturnal hypercapnia from those with daytime hypercapnia. In contrast to ultrasound parameters and transdiaphragmatic pressures, only MIP reflected the extent of hypercapnia across all three stages. MIP values below -48 cmH2O predicted nocturnal hypercapnia (area under the curve = 0.733, p = 0.052). In COPD, inspiratory muscle dysfunction contributes to progressive hypercapnic failure. In contrast to invasive tests of diaphragm strength only MIP fully reflects the pathophysiological continuum of hypercapnic failure and predicts isolated nocturnal hypercapnia.

Гіперсенситивний пневмоніт. Клінічний випадок

Abstract. Hypersensitivity pneumonitis (HP), or exogenous allergic alveolitis, is a complex and heterogeneous immune-mediated inflammatory and/or fibrotic disease of the lung parenchyma, small airways and interstitium that occurs in people with congenital or acquired hypersensitivity/ susceptibility to certain inhaled antigens. The disease can occur in acute/inflammatory form (duration of the disease is less than 6 months) or chronic form (duration of the disease is more than 6 months). According to the latter classification, HP is divided into fibrotic and non-fibrotic forms: non-fibrotic HP is a mild form of HP compared to fibrotic HP. However, non-fibrotic HP often progresses to fibrosis, i.e. it can be recurrent. The article describes a clinical case of acute HP induced by poultry antigens in the occupational environment. The clinical case study shows that the anamnesis data, namely the identification of a direct link between the occupational environment and the onset of symptoms of dyspnoea, cough, weakness, and headache, made it possible to suspect poultry antigen-induced HP. The characteristic picture of HP observed on computed tomography images, as well as auscultation and radiological findings, made it possible to confirm the diagnosis. The results of the respiratory function assessment showed the presence of pulmonary insufficiency, and the laboratory examination data showed the presence of inflammation, immunological imbalance, acid-base (alkaline) disorders and hypoxia.

PULMONARYFUNCTIONINNEUROMUSCULARDISEASES

Respiratory functional assessment in patients with neuromuscular diseases allows us to quantify lung volumes and capacities, cough flows and the effectiveness of of ventilation. Pulse oximetry and non-invasive monitoring of exhaled carbon dioxide are also essential for the non-invasive assessment of hypoventilation associated with ventilatory muscle and cough insufficiency. In this way, it is possible to detect the objective needs for therapeutic assistance and implement health policies appropriate to the needs of this population.

Maximum abdominal excursion assessment using an abdominal excursion measuring device: Reliability and validity of a new device for simple and quantitative assessment of respiratory function

This study aimed to verify the reliability and validity of abdominal expansion and respiratory function measurements. Forty healthy adult males underwent lung capacity, effort lung capacity, respiratory muscle strength, cough strength, diaphragm ultrasound, and abdominal expansion measurements. Abdominal expansion was measured using a device developed to accurately evaluate abdominal movements and calculate maximum abdominal expansion on the ventral side (AE-max: the difference between maximal abdominal contraction at the same time as maximal-effort expiration and maximal abdominal expansion at the same time as maximal-effort inspiration). Intra- and inter-rater reliabilities of the AE-max measurements were examined, the paired t-test was used for assessing the ratios of the expansion and contraction displacement components in AE-max, and regression analysis was used to obtain equations for predicting maximum inspiratory pressure (MIP) based on AE-max. Both intra- and inter-rater reliabilities were high. Criterion-related validity showed that AE-max was associated with all respiratory function parameters, especially MIP, and a high percentage of expansion displacement. Regression analysis showed that AE-max was significantly associated with MIP. Based on its association with MIP, the large proportion of expansion displacement in AE-max, and the results of the multiple regression analysis, we conclude that AE-max is a helpful measure for estimating MIP.

Assessment of Respiratory Functions, Activities of Daily Living, and Quality of Life of the Post-mechanical Ventilated Patients

Background: The fundamental goal of mechanical ventilation is to restore and improve respiratory functions and relieve respiratory distress, thus permitting lungs and airways to heal in acute and chronic respiratory failure conditions. Associated post-mechanical ventilation complications may increase the chance of re-intubation, poor quality of life, hospital stay and hospital costs, and so on. Objective: To assess the respiratory functions, activities of daily living, and quality of life of the post-mechanical ventilated patients. Methods: Using a purposive sampling technique, 72 patients after 24 h of weaning from the ventilator were enrolled in the study. Their socio-demographic profile, respiratory functions, activities of daily living, and quality of life were assessed using validated tools. Results: The mean respiratory rate per minute and oxygen saturation were 21.69 ± 4.10 and 93.58 ± 3.73, respectively. A total of 58.9% of the patients had dyspnea, 18.1% had abnormal breathing sound, 22.3% were using accessory muscles during breathing, 20.9% had pain during breathing, and 18.1% had cough with sputum production after extubation. Three fourth of the patients had complete dependency (75%) to perform activities of daily living. More than half (59.8%) of the patients had good quality of life scores as per the SF-36 item scale. Conclusion: There is a need to plan nursing interventions for patients in order to decrease post-mechanical ventilation complications.

Stenotic geometry effects on airflow dynamics and respiration for central airway obstruction

Background and ObjectiveThe quantitative relationship between tracheal anatomy and ventilation function can be analyzed by using engineering-derived methods, including mathematical modeling and numerical simulations. In order to provide quantitative functional evaluation for patients with tracheobronchial stenosis, we here propose an aerodynamics-based assessment method by applying computational fluid dynamics analysis on synthetic and patient-specific airway models. MethodsBy using 3D reconstruction of tracheobronchial tree and computational fluid dynamics simulations, the aerodynamic environment from the stenotic central airway down to the 4th-6th bifurcation of the tracheobronchial tree is examined in both synthetic and patient-derived models. The effects of stenotic anatomy (the degree of stenosis, stenotic length and location) on the aerodynamic parameters, including pressure drop, area-average velocity, volume flow rate, wall shear stress and airflow resistance, are investigated on three-dimensional models of tracheobronchial tree. ResultsThe results from 36 synthetic models demonstrate that 70% constriction marks the onset of a precipitous decrease in airflow relative to a normal airway. The analyses of simulation results of 8 patient-specific models indicate that the Myer-Cotton stenosis grading system can be interpreted in terms of aerodynamics-derived description, such as flow resistance. The tracheal stenosis significantly influences the resistance of peripheral bronchi, especially for patients with severe stenosis. ConclusionsThe present study forms a systematic framework for future development of more robust, bioengineering-informed evaluation methods for quantitative assessment of respiratory function of patients with central airway obstruction.

Norwegian Version of the Chelsea Critical Care Physical Assessment Tool (CPAx-NOR): Translation, Face Validity, Cross-Cultural Adaptation and Inter-Rater Reliability.

Assessment of physical and respiratory function in the intensive care unit (ICU) is useful for developing an individualized treatment plan and evaluating patient progress. There is a need for measurement tools that are culturally adapted, reliable and easy to use. The Chelsea Critical Care Physical Assessment Tool (CPAx) is a valid measurement tool with strong psychometric properties for the intensive care population. This study aims to translate, adapt and test face validity and inter-rater reliability of the Norwegian version of CPAx (CPAx-NOR) for use in critically ill adult patients receiving prolonged mechanical ventilation. CPAx-NOR was forward backward translated, culturally adapted and tested by experts and patients for face validity. Thereafter tested by 10 physiotherapists in five hospitals for inter-rater reliability. The experts and pilot testers reached consensus on the translation and face validity. Patients were tested at time point A (n = 57) and at time point B (n = 53). The reliability of CPAx-NOR at "A" was 0.990 (0.983-0.994) and at "B" 0.994 (0.990-0.997). Based on A+B combined and adjusted, the ICC was 0.990 (95% CI 0.996-0.998). Standard error of measurement (SEM) was 0.68 and the minimal detectable change (MDC) was 1.89. The Bland-Altman plot showed low bias and no sign of heteroscedasticity. CPAx-NOR changed with a mean score of 14.9, and showed a moderate floor effect at the start of physiotherapy and low ceiling effects at discharge. CPAx-NOR demonstrated good face validity and excellent inter-rater reliability. It can be used as an assessment tool for physical function in critically ill adults receiving prolonged mechanical ventilation in Norway.

Epidemiological and clinical profile of amyotrophic lateral sclerosis in Ethiopia: a 5-year multicenter retrospective study

Background Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that results in progressive weakness of skeletal muscles including respiratory muscles. Epidemiological and clinical aspects of ALS are derived from a few world regions with very little representation of low- and middle-income countries. We therefore set out to determine the epidemiological and clinical phenotype of individuals with ALS in Ethiopia. Methods Multicenter retrospective analysis was conducted using clinical records from ALS patients seen in Ethiopia at Tikur Anbessa Specialized Hospital and Yehuleshet specialty clinic between January 2016 and August 2021. The data collected included clinical characteristics, disease-related symptoms, a revised ALS functional rating scale, and medications. Results Patients in Ethiopia had a younger age of onset with a mean age of disease onset of 51.9 years. 2.9% of patients had juvenile ALS, and the male-to-female ratio was almost 2:1. 4.9% had a positive family history of the disease. 68% of patients had spinal region involvement at onset, while 32% had bulbar region involvement at onset. Riluzole was used by 31% of ALS patients. 20.6% of patients had some respiratory symptoms, but none received a standard respiratory function assessment. 33.3% of patients were wheelchair-bound. Conclusion In this retrospective study spanning 5 years, we examined the clinical phenotype of ALS in Ethiopian patients. Our findings suggest that most patients had clinically definite ALS with spinal region involvement. Further research, including genetic and epigenetic information, is necessary to understand the early onset of the disease in Ethiopia.

Effect of Compression Garments on the Ventilatory Function After Abdominoplasty.

The use of compression garments in the postoperative period of abdominoplasty seems to be a consensus, but the incidents of complications arising from this have been described, related to an increase in intraabdominal pressure and reduction of the femoral vein blood flow that may facilitate thromboembolic events. There are no studies that have evaluated the isolated effect of postoperative compression garments on respiratory function. The purpose of this study was to evaluate the effect of compression garments on respiratory function after abdominoplasty. Thirty-four female patients who underwent standard abdominoplasty were divided into 2 groups, the garment group (n = 18) and the no garment group (n = 16). Respiratory function assessment (with spirometry and manovacuometry) was performed in the preoperative and postoperative periods. Forced vital capacity assessment revealed a greater ventilatory restriction in the garment group. Forced expiratory volume in 1 second (FEV1) showed differences between the evaluation time points in the garment group; the intergroup comparisons showed that the no garment group had a lower FEV1. Slow vital capacity was evaluated with no significant differences found on both intergroup comparisons. The inspiratory capacity was reduced in the garment group, representing ventilatory restriction. Measurements of the maximum inspiratory pressure showed no significant differences between the groups. The maximum expiratory pressure showed significantly lower values on postoperative day 7 in the garment group. The use of compression garments after abdominoplasty impairs ventilatory function. Not wearing this type of garment can improve ventilation, decreasing the risk of pulmonary complications.

EXPERT ASSESSMENT OF DIAGNOSTIC DEFECTS IN TRAUMATIC BRAIN INJURY WITH DAILY FATALITY RATES DEPENDING ON THE DURATION OF TREATMENT AND PATIENTS' HOSPITAL STAY

One common diagnostic error in traumatic brain injury (TBI) assessment is the failure to recognize and properly evaluate the initial injury. The aim of our study was to find out diagnostic defects in traumatic brain injury with daily fatality rates depending on the duration of treatment and patients' hospital stay by analyzing the medical records of patients in Kyiv City Clinical Emergency Hospital. 102 cases of fatalities that occurred within 24 hours after admission to KCCEH (2012-2019 years) in cases of TBI were analyzed. Medical histories of the deceased and data from the forensic autopsy had been analyzed. It was found that the highest number of defects in diagnostic procedures, such as the absence of a complete description of the local status of head injuries, the lack of comprehensive assessment and objectification of hemodynamics and respiratory function, and the absence of neurovisualization, were found among patients who stayed in the hospital for up to 3 hours. There was a higher percentage of cases with discrepancies in diagnoses between forensic medical workers and clinicians as the duration of patients' hospital stay increased. The departments where the highest number of deaths occurred varied based on the duration of stay and treatment. The neurosurgical department had the highest number of deaths with a duration of 6 to 12 hours, while the polytrauma department had the highest number of deaths within the first 3 hours. The neurological department had the highest number of deaths with a duration of stay in the hospital from 6 to 12 hours.

93-LB: Discovery of ID110521156, a Small Molecule GLP-1 Receptor Agonist, for the Treatment of Type 2 Diabetes and Obesity

Glucagon-like peptide (GLP)-1 receptor agonists are widely used to treat type 2 diabetes and obesity by enhancing insulin release and suppressing appetite. Even semaglutide administrated orally has been developed, it still has limitation as a drug peptide, including high cost, less stability, and low bioavailability. This is the reason we aimed to discover a small molecule GLP-1 receptor agonist can be orally bioavailable. ID110521156 showed direct binding to GLP-1 receptor in a surface plasmon resonance assay. Treatment of ID110521156 induced a dose-dependent increase of intracellular cAMP levels in the human GLP-1 receptor expressed CHO cells with similar maximal efficacy with GLP-1 (7-36) amide. Partial agonism on the recruitment of β-arrestin was observed, whereas there are no effects on intracellular calcium levels, mitogen-activated protein kinase phosphorylation, and GLP-1 receptor internalization. Oral administration of ID110521156 demonstrated plasma glucose lowering and insulin secretion on intravenous glucose tolerance test using diabetic monkeys. In addition, we assured food intake reduction and body weight loss in a dose dependent manner by once daily dosing. Following oral administration, ID110521156 showed half-lives of 3.69-4.93 hours and bioavailability ranging 18-32% in normal cynomolgus monkeys. The no observed adverse effect level on the 28 days repeated dose toxicity study conducted in nonhuman primates was 100-fold margin with in vivo efficacy dose. ID110521156 demonstrated no liabilities when tested on a battery of safety pharmacology studies, including cardiovascular, respiratory, and neurobehavioral function assessment. No genotoxicity was observed on Ames, in vitro chromosomal aberration, and in vivo micronucleus test. From these nonclinical study results, ID110521156 might be considered as a potent candidate of small molecule selective GLP-1 receptor agonist to treat type 2 diabetes and obesity. Disclosure I. Je: None. K. An: None. H. Yoon: None. K. Kim: None. S. Choi: None. A. Im: None. D. Lee: None. W. Choi: None. E. Jang: None. J. Park: None. D. Kim: None. J. Lee: None. J. Park: None.

CO76 Switching Therapy from Alglucosidase Alfa to Avalglucosidase Alfa in Patients with Late Onset Pompe Disease (LOPD): Longitudinal Assessment of Respiratory Function from the Comet Trial

CO76 Switching Therapy from Alglucosidase Alfa to Avalglucosidase Alfa in Patients with Late Onset Pompe Disease (LOPD): Longitudinal Assessment of Respiratory Function from the Comet Trial

The facioscapulohumeral muscular dystrophy – health index: Italian validation of a disease-specific measure of symptomatic burden

Purpose The aim of this study was to adapt the Facioscapulohumeral Muscular Dystrophy – Health Index (FSHD-HI) to an Italian population affected by FSHD by translating, validating, and testing this instrument in an Italian cohort. Materials and methods Italian FSHD patients were interviewed regarding the form and content of the translated instrument. Subsequently, forty FSHD patients were recruited to test the reliability (Intraclass Correlation Coefficient, ICC for test-retest; and Cronbach’s Alpha for Internal consistency), known groups (Mann-Whitney U test and Area Under the Curve, AUC) and concurrent validity (Pearson’s and Spearman’s Rank Correlation Coefficient) of the instrument by serially completing the FSHD-HI and an extensive set of tests measuring the neuromotor, psychological and cognitive functions, and perceived quality of life (QoL) aspects. Results The Italian translation of the FSHD-HI and its subscales were highly relevant to patients, had a high internal consistency (Cronbach’s Alpha = 0.90), optimal test-retest reliability (ICC= 0.95), and was significantly associated with motor function, respiratory function, and QoL assessments. Conclusions Overall, the Italian FSHD-HI is a valid and well-suited measurement of the multi-dimensional aspects of disease burden in FSHD patients.

Respiratory muscle ultrasonography evaluation and its clinical application in stroke patients: A review.

Respiratory muscle ultrasound is a widely available, highly feasible technique that can be used to study the contribution of the individual respiratory muscles related to respiratory dysfunction. Stroke disrupts multiple functions, and the respiratory function is often significantly decreased in stroke patients. A search of the MEDLINE, Web of Science, and PubMed databases was conducted. We identified studies measuring respiratory muscles in healthy and patients by ultrasonography. Two reviewers independently extracted and documented data regarding to the criteria. Data were extracted including participant demographics, ultrasonography evaluation protocol, subject population, reference values, etc. A total of 1954 participants from 39 studies were included. Among them, there were 1,135 participants from 19 studies on diaphragm, 259 participants from 6 studies on extra-diaphragmatic inspiratory muscles, and 560 participants from 14 studies on abdominal expiratory muscles. The ultrasonic evaluation of diaphragm and abdominal expiratory muscle thickness had a relatively typically approach, while, extra-diaphragmatic inspiratory muscles were mainly used in ICU that lack of a consistent paradigm. Diaphragm and expiratory muscle ultrasound has been widely used in the assessment of respiratory muscle function. On the contrary, there is not enough evidence to assess extra-diaphragmatic inspiratory muscles by ultrasound. In addition, the thickness of the diaphragm on the hemiplegic side was lower than that on the non-hemiplegic side in stroke patients. For internal oblique muscle (IO), rectus abdominis muscle (RA), transversus abdominis muscle (TrA), and external oblique muscle (EO), most studies showed that the thickness on the hemiplegic side was lower than that on the non-hemiplegic side.Clinical Trial Registration: The protocol of this review was registered in the PROSPERO database (CRD42022352901).

Functional Outcome following Phrenic Nerve Transfer in Brachial Plexus Injury

BackgroundBrachial plexus injuries are debilitating injuries resulting in paralyzed shoulder to global paralysis of the upper extremity. Treatment strategies have evolved over the years with nerve transfer forming the mainstay of surgical management. Phrenic nerve provides certain advantages as donor over other options but has been less preferred due to fear of pulmonary complications. In this study, we assess the functional outcomes of phrenic nerve transfer in brachial plexus injuries. Materials and MethodsA retrospective study was performed on 18 patients operated between 2012 and 2017. The mean duration of injury to surgery was 4.56 months and mean follow-up was for 3.66 years. Phrenic nerve was used as donor to neurotize either biceps and brachialis branch of musculocutaneous nerve or suprascapular nerve. Assessment was done through Waikakul score for elbow flexion and Medical Research Council grading for shoulder abduction. Respiratory function assessment was done through questionnaire. ResultsTwelve (80%) patients recovered grade 3 and above elbow flexion with 6 patients having a positive endurance test according to Waikakul and a “very good” result. In phrenic to suprascapular transfer group (3 patients), all patients had more than grade 3 recovery of shoulder abduction. No patient complained of respiratory problems. ConclusionPhrenic nerve can be used as a reliable donor with suitable patient selection with good results in regaining muscle power without any anticipated effects on respiratory function.