End Of Normal Expiration Research Articles

Ultrasound assessment of diaphragmatic excursion in chronic obstructive pulmonary disease patients with different severities

BackgroundChronic obstructive pulmonary disease (COPD) is associated with dysfunctional diaphragmatic breathing we assess the diaphragmatic excursion at different stages of COPD patients by transthoracic ultrasound.ObjectiveThe present study aimed to assess the diaphragmatic excursion at different stages of COPD patients by transthoracic ultrasound.Patients and methodsIn this observational case–control study, 80 COPD patients were included according to GOLD guidelines 2020 attending the Chest Clinic in Badr Hospital, Helwan University. All patients were divided equally into 5 groups according to FEV1 measured by spirometer: group (1) normal person; group (2) mild stage FEV1_80% predicted; group (3) moderate stage 50%_FEV1 < 80% predicted; group (4) severe stage 30%_FEV1 < 50% predicted; and group (5) very severe stage FEV1 < 30% predicted. We measured diaphragmatic movement in all these patients using ultrasound.ResultsThe outcomes result of normal, mild, moderate, severe, and very severe groups in terms of post-bronchodilator FEV1/FVC are 0.66 ± 0.05, 0.65 ± 0.05, 0.63 ± 0.04, 0.51 ± 0.068 respectively showed was a significant difference. There was a significant difference of FEV1 are 86.70 ± 5.62, 63.00 ± 13.81, 43.00 ± 6.78, 24.00 ± 4.17, respectively (P < 0.001). There was a significant difference in diaphragmatic thickness at the end of normal expiration are 0.49 ± 0.12, 0.51 ± 0.09, 0.47 ± 0.16, 0.37 ± 0.07, respectively (P < 0.001). There was a significant difference in the diaphragmatic thickness during maximum inspiration are 0.70 ± 0.16, 0.8 ± 0.17, 0.64 ± 0.19, and 0.47 ± 0.08, respectively (P < 0.001). There was a significant difference in the diaphragmatic excursion during normal breathing are 2.45 ± 0.39, 1.78 ± 0.67, 1.86 ± 0.67, 1.09 ± 0.16, respectively (P < 0.001). There was a significant difference in diaphragmatic Excursion during maximum inspiration are 4.41 ± 0.91, 3.83 ± 0.78, 3.36 ± 0.74, 2.36 ± 0.66 respectively (P < 0.001).ConclusionThe use of ultrasonography for assessing the diaphragmatic excursion. Sonographically determined diaphragmatic excursion strongly correlates with FEV1/FVC.

Current status of diagnosis and treatment of pulmonary hypertension in Chinese tertiary hospitals: A nationwide survey.

We intended to evaluate the diagnosis and treatment status of pulmonary hypertension (PH) in China and provide the basis for the design of the Chinese PH centers system.A questionnaire survey was conducted by sampling from Chinese Class A tertiary hospitals that have carried out the clinical work of PH, including the composition of PH clinical team, the current application of examinations related to PH diagnosis, the availability of PAH-specific medicine and the implementation of PH-related intervention and surgery.A total of 44 valid questionnaires from 20 provinces were collected in this survey. In the vast majority of centers (83.33%, n = 35), pulmonary artery catheterization was routinely performed under X-ray guidance. In 19.05% (n = 8) of centers, pressure measurements were determined at the right time (the end of normal expiration). Only 73.81% (n = 31) centers have carried out acute vasoreactivity testing. Prostacyclin analogues and prostaglandin receptor agonists were just prescribed in 45.45% (n = 20) of the centers. 19 centers (43.18%) were capable of performing balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA), while 25% (n = 11) were able to perform BPA, PEA, and lung transplantation. There was no significant difference in the diagnosis and treatment of PH between economic regions.The majority of Chinese tertiary hospitals were well equipped with the corresponding personnel, examinations and medicines related to PH, but the standardization and specialization of the management of PH need to be strengthened.

Effect of visual feedback aerobic exercise training on lung hyperinflation in chronic obstructive pulmonary disease patients – A randomized control trial

CONTEXT: Lung hyperinflation is defined as an abnormal increase in the volume of air remaining in the lungs at the end of normal expiration caused by the permanently destructive changes of emphysema and expiratory flow limitation. All the rehabilitation exercise programs have some reinforcement on hyperinflation mechanism directly or indirectly without any associated feedback. AIMS: This study aims to study the effect of visual biofeedback training on lung hyperinflation in chronic obstructive pulmonary disease (COPD) patients. SUBJECTS AND METHODS: 104 mild to moderate (global initiative for chronic obstructive lung disease) COPD patient of age group 40–60 years were recruited and randomly allocated to control and experimental group using random reviewer software 3.3 versions. The baseline and postoutcomes were analyzed by an external observer who is blinded. The visual training group receives biofeedback training on expiratory flow limitation. Both experimental and control group receives aerobic exercise training of 50%–60% of maximum heart rate intensity where all received cycling as a mode for 20–40 min with a warm and cool-down period. All the patients were trained for 4 days a week for 8 weeks. STATISTICAL ANALYSIS USED: Descriptive statistics, independent sample t-test, and repeated measures of analysis of variance. RESULTS: Residual volume and total lung capacity significantly reduced statistics F = 12.23 with P CONCLUSION: Visual feedback exercise training is one of the effective training methods to relieve the hyperinflation in stable COPD patients thereby improves exercise tolerance and quality of life.

SPINAL DISPLACEMENT DURING THORACIC SPINAL MANIPULATIVE THERAPY

Background: Vertebrae are linked together with facet and intervertebral joints. The application of a force to a spinal segment therefore impact adjacent areas of the spine. Objective: This study aimed to investigate the posteroanterior (PA) displacement of the thoracocervical spine during the application of thoracic PA mobilization. Methods: Forty-one healthy males were recruited. The participants were asked to lie prone and hold their breath at the end of normal expiration while a therapist applied a grade III of central PA mobilization to the T6 spinous process for 30[Formula: see text]s. The PA spinal displacements of C3, C5, C7, T2, T4 and T6 were investigated using a motion capture system. Descriptive statistics and Pearson’s correlation coefficient were used to analyze the PA spinal displacement and correlation between PA spinal displacement at T6 and the PA displacement of the thoracocervical spines, respectively. Results: The PA displacement of the T6 and the PA displacement of the marked spines (T4, T1, C7, C5 and C3) correlated well with [Formula: see text] being 0.83, 0.69, 0.63, 0.63 and 0.54 ([Formula: see text]), respectively. A trend toward a decrease in spinal displacement was noted when the distance from T6 spine increased. It showed that the mobilization force could be transferred from the local area to an adjacent area. Conclusions: These findings may provide plausible evidence that can explain the mechanism of how thoracic spinal manipulative therapy affects neck pain reduction.

Intra-rater Reliability of B-Mode Ultrasound Imaging of the Abdominal Muscles in Healthy Adolescents During the Active Straight Leg Raise Test

BackgroundTo date, the reliability of ultrasound imaging (USI) measures of the abdominal muscles in children and adolescents during the active straight leg raise (ASLR) test has not been confirmed. ObjectiveTo assess the intra-rater reliability of USI measures of the thickness and percentage thickness change of the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) on both sides of the body during the ASLR test in healthy adolescents. DesignSingle-group repeated-measures intra-rater reliability study. SettingSchool. ParticipantsThirty-nine adolescents between the ages of 13 and 16 years. MethodsThree repeated USI measurements were recorded in the supine resting position and during the ASLR test at 2 sessions, 6 to 8 days apart. In the supine position, measurements were collected at the end of normal expiration. In the case of ASLR, measurements were collected when the person undergoing examination touched the transverse delimiter with the distal part of their lower leg, that is, to a 30° flexion of the hip. Main Outcome MeasurementsUSI of abdominal muscle thickness. ResultsBy using the mean of 3 measures in the supine, resting position, intra-examiner reliability point estimates (intraclass correlation coefficient [ICC]3.3) ranged from 0.95 to 0.97 for EO, IO, and TrA. During the ASLR test, the ICC result of thickness measurements of all muscles was also above 0.90. In terms of percentage change of muscle thickness, the highest ICC3.3 result obtained for the TrA was 0.81-0.85; for EO the result ranged from 0.72-0.89, and the result for the IO was between 0.65 and 0.79. ConclusionUSI measurements of the thickness of the EO, IO, and TrA muscles at rest and during the ASLR test in healthy adolescents between 13 and 16 years of age are reliable. Because of an increase in the precision of measurements, we recommend using the mean of 3 consecutive measurements of the EO, IO, and TrA muscles in adolescents to ensure a good reliability level. Based on 3 consecutive measurements, good reliability for the percentage change in the TrA thickness was achieved.

Reliability of B-Mode Ultrasound Imaging of the Lateral Abdominal Muscles in Healthy Children During the Active Straight Leg Raise Test

Abstract Background: To date, reliability of ultrasound imaging (USI) measures of the abdominal muscles in children during the active straight leg raise (ASLR) test has not been confirmed. The aim of this study is to assess the intra-rater reliability of USI in measuring of the thickness and percent thickness change of the external oblique (EO), internal oblique (IO) and transversus abdominis (TrA) on both sides of the body during the ASLR test. Material/Methods: Thirty-two healthy children between 10-12 years old participated in the study. Three repeated USI measurements were recorded, in supine and resting positions and during the ASLR test. In supine position, measurements were collected at the end of normal expiration. In the case of ASLR, measurements were collected when the person undergoing examination touched the transverse delimiter with the distal part of the lower leg. A repeat session of the measurements was carried out 6 to 8 days later. Results: The use of mean value of the three repeated measurements showed that ICC3.3 fluctuated from 0.81 to 0.97 for OE, OI and TrA in resting position and during the ASLR test. In terms of percentage change of muscle thickness, the ICC3.3 result obtained for TrA, OE and IO were 0.86, 0.83 and 0.78, respectively. Conclusions: The USI evaluation of the lateral abdominal muscles thickness at rest has high reliability in children between 10-12 years old. The USI of the actual thickness and reflex activity of OE, OI and TrA during the ASLR test, based on three repeated measurements, is also reliable. It is recommended to perform three repeated measurements for children between 10-12 years old. There is still a need to seek solutions that will decrease the SDD value while evaluating the reflex activity of the lateral abdominal muscles during the ASLR test.

The Maternal Health Clinic: A New Window of Opportunity for Early Heart Disease Risk Screening and Intervention for Women with Pregnancy Complications

W cardiovascular health is a key national priority that should be addressed through improving cardiovascular awareness and prevention and reducing care inequities for women in general and younger women in particular.1–5 Given the costs of treating cardiovascular disease and screening for it, novel and innovative ways to identify women who should undergo cardiovascular risk screening, including biochemical testing, is critical to achieving this goal.

Effect of Breath Holding on Spleen Volume Measured by Magnetic Resonance Imaging

ObjectiveUltrasonographic studies have demonstrated transient reduction in spleen volume in relation to apnea diving. We measured spleen volume under various respiratory conditions by MR imaging to accurately determine the influence of ordinary breath holding on spleen volumetry.Materials and MethodsTwelve healthy adult volunteers were examined. Contiguous MR images of the spleen were acquired during free breathing and during respiratory manipulations, including breath holding at the end of normal expiration, breath holding at deep inspiration, and the valsalva maneuver, and spleen volume was measured from each image set based on the sum-of-areas method. Acquisition during free breathing was performed with respiratory triggering. The duration of each respiratory manipulation was 30 s, and five sets of MR images were acquired serially during each manipulation.ResultsBaseline spleen volume before respiratory manipulation was 173.0 ± 79.7 mL, and the coefficient of variance for two baseline measures was 1.4% ± 1.6%, suggesting excellent repeatability. Spleen volume decreased significantly just after the commencement of respiratory manipulation, remained constant during the manipulation, and returned to the control value 2 min after the cessation of the manipulation, irrespective of manipulation type. The percentages of volume reduction were 10.2% ± 2.9%, 10.2% ± 3.5%, and 13.3% ± 5.7% during expiration breath holding, deep-inspiration breath holding, and the valsalva maneuver, respectively, and these values did not differ significantly.ConclusionsSpleen volume is reduced during short breath-hold apnea in healthy adults. Physiological responses of the spleen to respiratory manipulations should be considered in the measurement and interpretation of spleen volume.

Advantages of simulating thoracic cancer patients in an upright position

PurposeTo compare lung volume and respiratory motion in supine and upright positions to assess the potential advantages of treating thoracic cancer patients in an upright position. Methods and MaterialsA multi-position MRI scanner (FONAR, Melville, NY) was used to take MRI images of 5 healthy volunteers in both supine and upright setup positions. In each case, a series of sagittal cine MR scans were acquired during normal respiration, followed by a volumetric scan taken during breath-hold at end of normal expiration. The trajectory of points inside the lung was automatically detected and tracked in the cine images and then analyzed using a deformable image registration technique together with a principal component analysis model. The exhale volume images were imported into a treatment planning system and lung volumes were delineated and compared for different setup positions. ResultsThe amplitude of motion for a set of landmark points in the lung volume ranged from 2 mm (distant from the diaphragm) to 29 mm (close to the diaphragm) in the superior-inferior direction. A linear regression to the amplitude of respiratory motion versus distance from the diaphragm for each volunteer showed that the motion was 3 mm less on average in the upright position than in the supine position, although there was variability among individuals. The average exhale lung volume was 27% (751 cm3) larger (range: 9%-53%, 250-1390 cm3) when volunteers were in the upright position compared with the supine position. ConclusionsThe magnitude of motion inside the lung was smaller and the absolute lung volumes were much larger in the upright position than in the supine position, which suggests that treating thoracic patients in the upright position may allow for a reduction in the mean lung dose.

SU-E-J-154: Advantages of Treating Thoracic Cancer Patients in an Upright Position.

To compare lung volume and respiratory motion in supine and upright positions to assess the potential advantages of treating thoracic cancer patients in an upright position. A multi-position MRI scanner (FONAR, Melville, NY) was used to take MRI images of 4 healthy volunteers in both supine and upright setup positions (expected total accrual: 15 volunteers). In each case, a volumetric scan was acquired during breath-hold at end of normal expiration, followed by a series of sagittal cine MR scans taken during normal respiration. The exhale volume images were imported into a treatment planning system and lung volumes were delineated and compared for different setup positions. The trajectory of points inside the lung were tracked in the cine images and analyzed using a deformable image registration technique and a principal component analysis (PCA) model. The average exhale lung volume was 38% (894cc) larger (range: 23%-57%, 570-121 1cc) when volunteers were in the upright position compared with the supine position. The amplitude of motion for a set of landmark points in the lung volume ranged from 〈2mm (distant from the diaphragm) to 29 mm (close to the diaphragm) in the superior-inferior direction. A linear fit to the amplitude of respiratory motion vs. distance from the diaphragm for all 4 volunteers indicated no difference on averagein the range of motion for the two setup positions, but there was variability between individuals. While the magnitude of motion was similar, the absolute lung volumes were much larger in the upright position than in the supine position, which suggests that treating thoracic patients in the upright position may allow for a reduction in the mean lung dose. The study was partially supported by a sponsored research grant from Varian Medical Systems.

SHA 39. Selected risk factors of cardiovascular diseases among adolescent in Ahad Rufeda southwestern region

Objectives: To study the selected cardiovascular disease risk factor among adolescent school boys in Ahad Rufeda, southwestern, Saudi Arabia. Methods: A cross sectional study was conducted on a sample of students covering 1249 from six secondary schools in Ahad Rufeda Region. the sample of six school was selected using proportional allocation to the of school (governmental or private) and geographical location (urban or rural) during March 2008. Two or three classes from each educational level were randomly chosen in the selected schools. The structured questionnaire was which was used to collect the data was the Arabic version of CDC adolescent health survey, validated and adopted in a previous study in Abha, having information on socio-demographic condition, family history of cardiovascular diseases, smoking habits, behaviors related to physical activity, food choices, as well as, direct measurement of weight, height, waist circumference, systolic and diastolic blood pressure. Waist and height measurement ; were taken to calculate the body mass index (BMI). BMI was classified into four categories: normal (BMI < 25) pre-obese (BMI 25 6 40) obese grade III (+40). Waist circumference was measured at the point of the trunk located midway between the lower costal margin (bottom of lower rib) and iliac crest (tap of pelvic bone) while the person was standing. It was measured to the nearest of the 0.5 cm, at the end of normal expiration. Standard techniques was used to measure the blood pressure. Two or more reading separated by at least 5 min were averaged. student having SBP (systolic blood pressure) over 130 or DBP (diastolic blood pressure) over 85 were considered as having high normal blood pressure. Results: Study shows that 23.4% of students has BMI above 25 and 14.1% has central obesity. About 21.5% of student had SBP over the normal while 19.7% had an increase in DPB – prevalence of smoking was eating found to 11.8% ; cigarette smoking account for 70.7% were 23.1% were shisha smoker ; and 18.4% had experience of smokingothermaterials. About 50%of the studentwere eating healthy food;whilemore than40%were eating junkor fast food. The assessment of physical activity revealed that 25%of the student were not engaged in any type of exercise activity. Family history of hypertensionwas highest among the father with 21.9%aswell as for diabetes mellitus, father were higher 25.6%. Regarding family history of hyperlipidemia it was highest among the father with 33.7% Conclusion: The study has brought out clearly the prevalent risk factors of cardiovascular disease among the student. A general health awareness should be organized at the school level. Tracks: Adult Cardiology.

The use of active breathing control (ABC) to reduce margin for breathing motion

Purpose: For tumors in the thorax and abdomen, reducing the treatment margin for organ motion due to breathing reduces the volume of normal tissues that will be irradiated. A higher dose can be delivered to the target, provided that the risk of marginal misses is not increased. To ensure safe margin reduction, we investigated the feasibility of using active breathing control (ABC) to temporarily immobilize the patient’s breathing. Treatment planning and delivery can then be performed at identical ABC conditions with minimal margin for breathing motion. Methods and Materials: An ABC apparatus is constructed consisting of 2 pairs of flow monitor and scissor valve, 1 each to control the inspiration and expiration paths to the patient. The patient breathes through a mouth-piece connected to the ABC apparatus. The respiratory signal is processed continuously, using a personal computer that displays the changing lung volume in real-time. After the patient’s breathing pattern becomes stable, the operator activates ABC at a preselected phase in the breathing cycle. Both valves are then closed to immobilize breathing motion. Breathing motion of 12 patients were held with ABC to examine their acceptance of the procedure. The feasibility of applying ABC for treatment was tested in 5 patients by acquiring volumetric scans with a spiral computed tomography (CT) scanner during active breath-hold. Two patients had Hodgkin’s disease, 2 had metastatic liver cancer, and 1 had lung cancer. Two intrafraction ABC scans were acquired at the same respiratory phase near the end of normal or deep inspiration. An additional ABC scan near the end of normal expiration was acquired for 2 patients. The ABC scans were also repeated 1 week later for a Hodgkin’s patient. In 1 liver patient, ABC scans were acquired at 7 different phases of the breathing cycle to facilitate examination of the liver motion associated with ventilation. Contours of the lungs and livers were outlined when applicable. The variation of the organ positions and volumes for the different scans were quantified and compared. Results: The ABC procedure was well tolerated in the 12 patients. When ABC was applied near the end of normal expiration, the minimal duration of active breath-hold was 15 s for 1 patient with lung cancer, and 20 s or more for all other patients. The duration was greater than 40 s for 2 patients with Hodgkin’s disease when ABC was applied during deep inspiration. Scan artifacts associated with normal breathing motion were not observed in the ABC scans. The analysis of the small set of intrafraction scan data indicated that with ABC, the liver volumes were reproducible at about 1%, and lung volumes to within 6%. The excursions of a “center of target” parameter for the livers were less than 1 mm at the same respiratory phase, but were larger than 4 mm at the extremes of the breathing cycle. The inter-fraction scan study indicated that daily setup variation contributed to the uncertainty in assessing the reproducibility of organ immobilization with ABC between treatment fractions. Conclusion: The results were encouraging; ABC provides a simple means to minimize breathing motion. When applied for CT scanning and treatment, the ABC procedure requires no more than standard operation of the CT scanner or the medical accelerator. The ABC scans are void of motion artifacts commonly seen on fast spiral CT scans. When acquired at different points in the breathing cycle, these ABC scans show organ motion in three-dimension (3D) that can be used to enhance treatment planning. Reproducibility of organ immobilization with ABC throughout the course of treatment must be quantified before the procedure can be applied to reduce margin for conformal treatment.

Perception of static respiratory forces in young and old subjects.

Respiratory sensations were measured by magnitude production in 15 young (23–33 years) and 15 old (61–85 years) healthy males to compare exponents for static respiratory muscle forces in the two age groups. Perceptions of static inspiratory and expiratory forces were scaled both at the end of normal expiration and at lung volume extremes. Exponents for young and old groups did not differ, and were independent of lung volume. The average exponent for perceived respiratory force was 1.7.

Positional Hypoxemia in Unilateral Lung Disease

BODY position may affect gas exchange by altering the matching of ventilation to perfusion within the lungs.1 2 3 In normal subjects breathing normally, both blood flow and ventilation are greater in the dependent lung zones. When subjects breathe deeply so that lung volume falls below that present at the end of normal expiration, the nondependent lung zones are preferentially ventilated.4 These considerations may assume clinical importance in unilateral lung disease, in which alterations in lung volume and regional perfusion complicate the predictability of the gravitational effects on gas exchange.5 We have encountered positionally related cardiac arrhythmias and dyspnea induced by lying . . .

Positional hypoxemia in unilateral lung disease.

BODY position may affect gas exchange by altering the matching of ventilation to perfusion within the lungs.1 2 3 In normal subjects breathing normally, both blood flow and ventilation are greater in the dependent lung zones. When subjects breathe deeply so that lung volume falls below that present at the end of normal expiration, the nondependent lung zones are preferentially ventilated.4 These considerations may assume clinical importance in unilateral lung disease, in which alterations in lung volume and regional perfusion complicate the predictability of the gravitational effects on gas exchange.5 We have encountered positionally related cardiac arrhythmias and dyspnea induced by lying . . .

Regional inhomogeneity of alveolar air and R. Q. differences in the lungs of the normal dog.

Regional inhomogeneity of alveolar air was studied by simultaneous sampling through catheters in primary or secondary bronchi, at the end of normal expiration in dogs under sodium pentobarbital anesthesia. With dogs lying on the back, the right lung usually had the lower Pco2, higher Po2 and higher R. P( t) &lt; .001 for each difference. In the side-lying position the ‘down’ lung usually had the higher Po2 and R unless the catheters were placed so deep as to differentially obstruct the airway in that lung. Submitted on July 3, 1958

STUDIES ON THE RESPIRATORY MECHANISM IN LOBAR PNEUMONIA

1. The functional residual air (defined as the lung volume at the end of normal expiration) has been determined in a series of normal individuals and in ten patients with lobar pneumonia at different stages of the disease. 2. The rate, depth, and minute volume of respirations were measured in the same individuals by a graphic method. 3. When appreciable cyanosis was present the oxygen content and capacity of the arterial blood were determined. 4. A constant relationship has been found to exist between the persistence and disappearance of symptoms (fever, accelerated heart rate, rapid and shallow breathing, cyanosis) and fluctuations of the functional residual air. When these symptoms persisted the functional residual air decreased; during their disappearance the volume of the functional residual air rose towards normal. The rise was detected soon after the crisis. 5. A close parallelism has been observed also between alterations in radiographic shadow, physical signs, and the volume of the functional residual air. The lung volume, measured at normal expiration, is diminished during the persistence of pathological signs in the lungs, and returns to normal as the pathological signs disappear. The average time required, in cases which recovered, for the functional residual air to become constant was 11 to 12 days, counting from the onset of the disease.