Inspiration Breath Research Articles

Efficacy of sevoflurane flush out and activated charcoal filtration—a bench study

PurposeA bench study to assess the elimination of sevoflurane from an anesthetic workstation using three different processing methods.MethodsSevoflurane concentrations from samples of the inspiratory breathing hose and air samples from within the investigation room were assessed during predetermined flush out intervals using Gas Chromatography-Ion Mobility Spectrometry. The primary objective was to determine the time to reach concentrations below 5 ppmv.ResultsReduction of sevoflurane volume concentrations below a threshold of 5 ppmv was achieved within the first minute after removal of the vaporizer and the complete exchange of the soda and the breathing system and within the 15 min measurement interval after inclusion of two activated charcoal filters without a 90 s of flushing and without changing of the breathing hoses as required by the manufacturer.ConclusionsComplete removal of the vaporizer and an exchange of the soda and the ventilation unit most quickly reduced sevoflurane concentrations, but the total processing interval may exceed 30 min. Inserted activated charcoal filters without a previous 90 s of flushing and without changing the breathing hoses followed by flushing only with raised fresh gas flow allow ventilation below trigger threshold to be reached within due time.

The Influence of Kinesiology Tape on Posture and Breathing Mechanics in Healthy Individuals: A Randomized Trial

Background and Purpose: Kinesiology tape (KT) has been used clinically to improve posture, mobility, and muscle strength. Limited research has investigated the effect of KT on respiratory function. The purpose of this study was to explore the effects of KT on posture and breathing in healthy individuals. Methods: Ninety-two adult participants were randomly assigned to a KT, sham tape (ST), or control group. Data collection occurred over 2 sessions. Baseline measurements included chest wall expansion (CWE) at the sternal angle (SA) and xiphoid process (Xi), maximal inspiratory pressure (MIP), and tragus (TWD) and acromion (AWD) to wall distances. Next, KT or ST was applied to the upper back and neck, or no tape was applied based on group assignment. Measurements were then repeated. Participants returned for a final round of measurements 48 hours later. Mixed-measures ANOVAs were used to determine the influence of tape at baseline (T0), immediately post-taping (T1), and 48 hours post-taping (T2). Post hoc analyses used the Tukey method. Results: Analysis showed significant differences between T0 and T1 (P = .004) and between T1 and T2 (P = .004) for AWD on the left. CWE-Xi data showed within group differences T0-T2 (P = .004) and T1-T2 (P = .004). MIP data showed within group differences between T0 and T1 (P = .001), T0 and T2 (P < .001), and T1 and T2 (P < .001). Discussion: KT had a limited and inconsistent impact on posture where there was a decrease in AWD on the left from T0 to T1 and then an increase from T1 to T2. No other changes in posture were found. Taping did not affect CWE at the SA. There was an evident training effect for CWE-Xi and MIP, where all groups saw increases over time. Conclusion: This method of KT application is not supported as an intervention for influencing posture and enhancing inspiratory breathing mechanics in healthy adults. Further investigation of KT in other populations is needed.

Dosimetric analysis of LAD dose in left-sided breast cancer radiotherapy with deep inspiratory breath hold

Objectives To analyze the dose to the left anterior descending artery (LAD) in patients who have received radiotherapy for left breast cancer with Deep Inspiratory Breath Hold (DIBH) technique and compare it with other cardiac dosimetric parameters, as well as the accepted dose constraints. Materials and Methods 20 patients (10 prospective and 10 retrospective) were selected for this study. All patients underwent 2 non-contrast radiation planning CT scans of 2.5 mm thickness - one with DIBH and one with free breathing. Contouring was done using the Radiation Therapy Oncology Group (RTOG) guidelines. LAD was delineated and given a PRV of 3 mm and 5 mm. Dose-volume histograms (DVH) were used to obtain the data from the approved plans. Results The lung volume receiving 17 Gy in percentage, Dmean of the heart, LAD Dmean and Dmax, and the Dmean and Dmax received by 3 mm and 5 mm PRVs were both very well achieved when compared to the dose constraints given by the DBCG HYPO trial. The study found a higher correlation between the mean heart dose and the 5 mm PRV dose (R2 = 0.81 and 0.71 respectively for the mean and max dose) than the 3 mm PRV, and a positive correlation between the heart dose and LAD making it a useful structure for predicting acute cardiac events. Conclusion The study of 20 patients found that DIBH is effective to minimize cardiac dose and potentially cardiac toxicity, with heart and LAD doses being comparable or lower compared to other studies. The LAD doses recorded were significantly less than those in non-DIBH studies, demonstrating the feasibility of routine contouring and recording LAD dose in left-sided breast radiation patients. Further research is needed to determine the dosimetry and clinical consequences of the Dmean and Dmax of the 5mm PRV to the LAD.

Evaluation of Inverse Planned and Forward Planned Intensity Modulated Radiotherapy Techniques in Breast Cancer

Introduction: The objective of this study is to compare the dosimetric parameters of radiation to the whole breast between the two intensity-modulated radiotherapy (IP IMRT) techniques, i.e. Inverse planned IMRT (IP IMRT) and Forward Planned IMRT (FP IMRT) with regard to target coverage (PTV) and irradiation of organs at risk (OAR). Material and Methods: Plain and Contrast enhanced computed tomography (CECT) datasets were created for 41 patients treated with whole breast radiation therapy. CT simulation and treatment is performed using deep inspiratory breath hold technique (DIBH). Radiotherapy treatment Planning is done using Eclipse Treatment Planning System (version 13.7) with a prescription dose of 40 Gy in 15#. The developed treatment plans were subjected to objective comparison of PTV and OARs using dose volume histograms (DVH). Results: IP IMRT plans provided better coverage (99.5% vs 97.6%), comparable though higher maximum dose (Dmax 45.0 VS 44.1 Gy), higher hot spot (PTV105% 49.2 vs 33), lower volumes receiving 20, 25, 30 Gy (V20, V25, V30) for heart, more homogeneous (homogeneity index 0.10 vs. 0.14) and conformal dose distribution (conformity Index 1.0 vs 0.98) compared to FP IMRT. Regarding OAR dosimetry it is observed that FP IMRT showed reduced mean dose to Coronary artery (LADCA), Contralateral Lung (CL), Contralateral breast (CB) along with reduction in low dose region (V5) to all OARs under study. It was also observed that Monitor units used and planning time were lower for FP IMRT. Conclusion: On weighing different dosimetric factors, both the techniques have displayed their own advantages and disadvantages. Choosing a planning technique needs to be customized taking into consideration various factors such as breast topography, size and volumes of breast, availability of expertise planning skills and resources.

Factors Affecting the Effectiveness of DIBH (Deep Inspiratory Breath Hold) in Patients with Left Breast Cancer: A Narrative Review

Deep Inspiratory Breath Hold (DIBH) has become a valuable technique in left-breast cancer radiotherapy, offering the possibility to reduce radiation exposure to organs at risks (OARs) and minimize the risk of cardiac complications. This treatment method involves stopping the breathing of patients during irradiation in order to temporarily distance the heart from the radiation field, which reduces potential cardiac risks and other complications. To identify factors that may affect the effectiveness of DIBH treatment, we analyzed the most important 5-year studies published in the PubMed database. Research shows that DIBH reduces the radiation dose to the heart and lungs. However, the effectiveness of DIBH is determined by a variety of factors, including the patient’s training, cooperation, anatomical features, age, and choice of radiotherapy technique. Additionally, cardiovascular risk factors, such as diabetes, smoking, and hypertension, can be impactful to the effectiveness and potential complications of DIBH. Moreover, if a patient has a substantial level of depression or anxiety, then they may be potentially disqualified from the DIBH treatment method. In addition to this, a lack of consent and/or fear may also disqualify a patient from DIBH treatment. Careful patient selection, comprehensive training, and optimization of treatment parameters are essential to maximize the benefits of DIBH whilst minimizing any potential side effects. DIBH enhancement techniques, such as IMRT and VMAT, also have an important role to play. The purpose of this narrative review article is to summarize the factors affecting the efficacy and side effects of DIBH in radiation therapy for left-breast cancer, with the aim of optimizing its clinical application while minimizing side effects. Patients who are likely to benefit most from DIBH are young women in good medical condition, able to cooperate with the procedure, and with smaller breasts. The increase in the estimated 10-year patient survival is significantly influenced by cardiovascular problems, so patients without diabetes and metabolic syndrome, and non-smokers, will benefit the most. An estimated 50–70% of breast cancer patients are likely to benefit from DIBH, and in the best case, it can result in a 50% reduction in the risk of cardiac problems after photodynamic therapy (PDT).

Effects of inspiratory muscle training on thoracoabdominal volume regulation in older adults: A randomised controlled trial

ObjectivesWe investigated the effect of inspiratory muscle training (IMT) on inspiratory muscle strength, functional capacity and respiratory muscle kinematics during exercise in healthy older adults. Methods24 adults were randomised into an IMT or SHAM-IMT group. Both groups performed 30 breaths, twice daily, for 8 weeks, at intensities of ∼50 % maximal inspiratory pressure (PImax; IMT) or <15 % PImax (SHAM-IMT). Measurements of PImax, breathing discomfort during a bout of IMT, six-minute walk distance, physical activity levels, and balance were assessed pre- and post-intervention. Respiratory muscle kinematics were assessed via optoelectronic plethysmography (OEP) during constant work rate cycling. ResultsPImax was significantly improved (by 20.0±11.9 cmH2O; p=0.001) in the IMT group only. Breathing discomfort ratings during IMT significantly decreased (from 3.5±0.9–1.7±0.8). Daily sedentary time was decreased (by 28.0±39.8 min; p=0.042), and reactive balance significantly improved (by 1.2±0.8; p<0.001) in the IMT group only. OEP measures showed a significantly greater contribution of the pulmonary and abdominal rib cage compartments to total tidal volume expansion post-IMT. ConclusionsIMT significantly improves inspiratory muscle strength and breathing discomfort in this population. IMT induces greater rib cage expansion and diaphragm descent during exercise, thereby suggesting a less restrictive effect on thoracic expansion and increased diaphragmatic power generation.

Automatic breathing phase identification based on the second derivative of the recorded lung sounds

This paper presents a new method for automatic identification of the inspiratory and expiratory breathing phases in lung sound recordings. Adventitious lung sounds (wheezes and crackles), superimposed on the breath sounds, are generally an early indication of the disease, and their timing in the breathing cycle (early/mid/late inspiratory or expiratory) has clinical significance for monitoring or diagnosing disease. Therefore, the identification of the phases of the breathing cycle is an essential step for clinical interpretation of pulmonary auscultation. The proposed algorithm is designed to be robust in the presence of adventitious lung sounds or where the breath sounds may be noisy compared to healthy lung sounds. The algorithm uses the Savitzky & Golay (SG) filter to estimate the second derivative of the lung sound signal then calculates its normalized absolute value. A threshold value is used to clip any large amplitude peaks and, following low-pas filtering, the breathing phases are visible in the plotted signal. A rule-based approach to locating peaks and troughs is then used to identify inspirations and expirations. The performance of the method is evaluated using four different datasets: (a) a longitudinal dataset recorded from 19 subjects with a diagnosis of idiopathic pulmonary fibrosis (IPF), (b) a cross-sectional dataset recorded from 55 subjects who were referred for high-resolution computed tomography (HRCT) scan of the chest for various clinical indications, (c) a longitudinal dataset recorded from 10 healthy subjects, and (d) an open access lung sounds dataset containing recordings from 41 subjects with wheeze (9 with chronic obstructive pulmonary fibrosis and 32 with asthma). On average for inspiratory phase identification the algorithm had a sensitivity of (mean (standard deviation)) 92.84 (12.88)%, positive predictive value of 90.64(15.96)%, and F1-score of 90.67 (12.53)%. For identification of the expiratory phase, the algorithm had an average sensitivity of 92.19 (13.44)%, an average positive predictive value of 91.55 (15.23)%, and an average F1-score of 90.89 (12.45)%. The method shows good potential for automatic identification of breathing phases in recorded lung sounds.

A comparative study in left-sided breast cancer treated with moderate deep inspiratory breath hold versus free breathing

BackgroundThe moderate deep inspiratory breath hold (mDIBH) is a modality famed for cardiac sparing. Prospective studies based on this are few from the eastern part of the world and India. We intend to compare the dosimetry between mDIBH and free-breathing (FB) plans.MethodsThirty-two locally advanced left breast cancer patients were taken up for the study. All patients received a dose of 50 Gy in 25 fractions to the chest wall/intact breast, followed by a 10-Gy boost to the lumpectomy cavity in the case of breast conservation surgery. All the patients were treated in mDIBH using active breath coordinator (ABC). The data from the two dose volume histograms were compared regarding plan quality and the doses received by the organs at risk. Paired t-test was used for data analysis.ResultsThe dose received by the heart in terms of V5, V10, and V30 (4.55% vs 8.39%) and mean dose (4.73 Gy vs 6.74 Gy) were statistically significant in the ABC group than that in the FB group (all p-values < 0.001). Also, the dose received by the LADA in terms of V30 (19.32% vs 24.87%) and mean dose (32.99 Gy vs 46.65 Gy) were significantly less in the ABC group. The mean treatment time for the ABC group was 20 min, while that for the free-breathing group was 10 min.ConclusionsIncorporating ABC-mDIBH for left-sided breast cancer radiotherapy significantly reduces the doses received by the heart, LADA, and left and right lung, with no compromise in plan quality but with an increase in treatment time.

Acute cardiac autonomic and hemodynamic responses to resistive breathing: Effect of loading type and intensity.

This study aimed to assess the acute impact of distinct loading breathing types and intensities on cardiac autonomic function and hemodynamic responses in healthy young adults. A randomized, crossover trial involved 28 participants who underwent inspiratory resistive breathing, expiratory resistive breathing (ERB) and combined resistive breathing, each at 30% and 60% of maximal respiratory pressures. Data on heart rate variability (HRV) and hemodynamic parameters were collected during each trial. The study revealed significant main and interaction effects for both the performed task and the intensity across all measured variables (all p < 0.001). ERB at 60% load demonstrated significantly higher HRV values in the standard deviation of normal-to-normal RR intervals, the square root of the mean squared difference of successive normal-to-normal RR intervals and high-frequency power, as well as significantly lower values in heart rate, stroke volume, stroke volume index, cardiac output, cardiac index, end-diastolic volume and end-diastolic volume index, compared to other loaded protocols (all p < 0.001). These findings highlight the acute effect of type-specific and load-dependent resistive breathing on cardiac autonomic and hemodynamic functions, where ERB at 60% intensity showed the most significant cardiovagal modulation while causing the least hemodynamic alterations.

Low-Impact Ampakine CX1739 Exerts Pro-Cognitive Effects and Reverses Opiate-Induced Respiratory Depression in Rodents

AMPA-glutamate receptors (AMPARs) are expressed throughout the CNS and mediate the majority of fast excitatory synaptic transmission. Ampakines are orally available small molecules that bind allosterically to AMPARs and enhance excitatory currents elicited by the endogenous agonist glutamate. In preclinical studies, ampakines are effective in ameliorating symptoms in a battery of neurodegenerative and neuropsychiatric diseases in which excitatory transmission is compromised. However, the development of ampakines as medicines was slowed by the emergence of neurotoxicity and seizures in rodents due to some ampakines. Here, we describe the preclinical pharmacology of a novel ampakine, N-methyl-N-(tetrahydro-2H-pyran-4-yl)benzo[c][1,2,5] oxadiazole-5-carboxamide (CX1739), that does not induce seizures in animals or humans at efficacious doses. CX1739 dose-dependently enhanced long-term potentiation in vivo in rats, a process thought to be a molecular substrate of learning and memory. Correspondingly, CX1739 dose-dependently enhanced performance in assays that probed multiple aspects of cognition—the novel object recognition test, the win shift radial arm maze, and the five-choice serial reaction time task in rats. CX1739 also abrogated amphetamine-induced locomotor activity, demonstrating that it may be given in conjunction with stimulants for pro-cognitive gains while mitigating the side effects of stimulant-based ADHD medications. CX1739 also rapidly reversed opioid-induced respiratory depression. While efficacy in these tests occurred at doses of 0.03–18 mg/kg, there were no adverse events detected in safety studies in rats up to 2000 mg/kg. These preclinical findings suggest that CX1739 can be translated safely into the clinical setting to potentially treat dementia, neuropsychiatric disorders, and the life-threatening complication of opiate-induced suppression of endogenous inspiratory breathing rhythms.

Inspiratory and sigh breathing rhythms depend on distinct cellular signalling mechanisms in the preBötzinger complex.

Breathing behaviour involves the generation of normal breaths (eupnoea) on a timescale of seconds and sigh breaths on the order of minutes. Both rhythms emerge in tandem from a single brainstem site, but whether and how a single cell population can generate two disparate rhythms remains unclear. We posit that recurrent synaptic excitation in concert with synaptic depression and cellular refractoriness gives rise to the eupnoea rhythm, whereas an intracellular calcium oscillation that is slower by orders of magnitude gives rise to the sigh rhythm. A mathematical model capturing these dynamics simultaneously generates eupnoea and sigh rhythms with disparate frequencies, which can be separately regulated by physiological parameters. We experimentally validated key model predictions regarding intracellular calcium signalling. All vertebrate brains feature a network oscillator that drives the breathing pump for regular respiration. However, in air-breathing mammals with compliant lungs susceptible to collapse, the breathing rhythmogenic network may have refashioned ubiquitous intracellular signalling systems to produce a second slower rhythm (for sighs) that prevents atelectasis without impeding eupnoea. KEY POINTS: A simplified activity-based model of the preBötC generates inspiratory and sigh rhythms from a single neuron population. Inspiration is attributable to a canonical excitatory network oscillator mechanism. Sigh emerges from intracellular calcium signalling. The model predicts that perturbations of calcium uptake and release across the endoplasmic reticulum counterintuitively accelerate and decelerate sigh rhythmicity, respectively, which was experimentally validated. Vertebrate evolution may have adapted existing intracellular signalling mechanisms to produce slow oscillations needed to optimize pulmonary function in mammals.

Can physical parameters from radiation simulation scan with deep inspiratory breath hold predict magnitude of heart dose reduction?

ABSTRACT Introduction: Deep inspiratory breath hold is one of the techniques for reducing the heart doses for left breast cancers. This study was conducted to confirm use of physical parameters from DIBH simulation CT scan like DIBH amplitude alongside several novel parameters to predict the heart dose reduction. Materials and Methods: Segmentation and planning of radiation to the left breast on the free breathing (FB) and DIBH simulation scan was performed for 50 left-sided breast cancer patients treated with DIBH technique. Physical parameters, namely DIBH amplitude, anterior sternal displacement, diaphragmatic excursion, ratio of lung volume (cc) in DIBH scan to lung volume in FB scan (cc), and delta heart volume in field (DHVIF), were extracted and were compared with magnitude of heart dose reduction (mean heart dose, V30Gy, and D5%). Results: Forty-eight (96%) patients achieved reduction in the mean heart dose with DIBH technique, while all patients had reduction in V30Gy. The median reduction was 41%, 89.7%, and 63% in the mean dose, V30Gy, and D5%, respectively. While DIBH did not correlate with heart dose reduction, ratio of lung volumes and DHVIF showed a strong positive correlation with heart dose reduction (P &lt; 0.05). Sternal displacement correlated weakly with heart dose reduction but strongly with DHVIF, demonstrating to be an indirect predictor. Conclusions: Physical parameters like anterior sternal displacement, ratio of lung volumes of DIBH to FB, and possibly diaphragmatic movement can predict the dose reduction before the dose calculations by the physicist. These parameters can be used to construct a model to predict heart dose reduction.

Within-breath oscillometry for identifying exercise-induced bronchoconstriction in pediatric patients reporting symptoms with exercise.

Evaluating oscillometry parameters separately for the inspiratory and expiratory breath phases and their within-breath differences can help to identify exercise-induced bronchoconstriction (EIB) in pediatric outpatients disclosing exercise-induced symptoms (EIS). To assess the response in impedance parameters following an exercise challenge in patients reporting EIS. Sixty-eight patients reporting EIS (34 asthmatics and 34 suspected of asthma, age mean = 10.8 years, range = 6.0-16.0) underwent an incremental treadmill exercise test. Spirometry was performed at baseline and 1, 5-, 10-, 15-, and 20-min post exercise. Oscillometry was performed at baseline and at 3- and 18-min post exercise. Bronchodilator response to 200 µg albuterol was then assessed. EIB was defined as a forced expiratory volume in 1 s (FEV1) fall ≥10% from baseline. Expiratory and inspiratory resistance (Rrs) and reactance (Xrs), their z-score (Ducharme et al. 2022), and their mean within-breath differences (ΔRrs = Rrsexp-Rrsinsp, ΔXrs = Xrsexp-Xrsinsp) were calculated. Receiver operating characteristic (ROC) curves and their areas (AUCs) were used to evaluate impedance parameters' performances in classifying EIB. Asthmatic patients developed EIB more frequently than those suspected of asthma [18/34 (52.9%) vs. 2/34 (5.9%), p < 0.001]. In the 20 subjects with EIB, Rrsinsp, Rrsexp, Xrsinsp, and Xrsexp peaked early (3'), and remained steady except for Xrsinsp, which recovered faster afterward. ΔXrs widened 18 min following the exercise and reversed sharply after bronchodilation (BD) (-1.81 ± 1.60 vs. -0.52 ± 0.80 cmH2O × s/L, p < 0.001). Cutoffs for EIB leading to the highest AUCs were a rise of 0.41 in z-score Rrsinsp (Se: 90.0%, Sp: 66.7%), and a fall of -0.64 in z-score Xrsinsp (Se: 90.0%, Sp: 75.0%). Accepting as having "positive" postexercise oscillometry changes those subjects who had both z-scores beyond respective cutoffs, sensitivity for EIB was 90.0% (18/20) and specificity, 83.3% (40/48). Oscillometry parameters and their within-breath differences changed markedly in pediatric patients presenting EIB and were restored after the bronchodilator. Strong agreement between z-scores of inspiratory oscillometry parameters and spirometry supports their clinical utility, though larger studies are required to validate these findings in a broader population.

Time-resolved characteristics of oscillatory particle-laden air flow in a realistic human airway model

Human airways represent a complex flow system with a spatially and temporally variable character of air flow during respiration. In this paper, we experimentally studied the oscillatory flow of air with monodispersed micron-sized liquid particles in a transparent, anatomically realistic model of human upper airways and several bronchi generations using phase-Doppler anemometry (PDA). The PDA provided point-wise high-frequency measurements of axial velocities of individual aerosol particles in multiple positions of the airways (in the trachea and the upper bronchi) for three breathing regimes with a sinusoidal course. Typical time-resolved velocity plots at several positions within the model were documented and analysed using dimensionless criteria. Local mean air velocity and turbulence time-lines disclosed specific flow dynamic features in the multiple bifurcation system, namely the transit of vortical structures, oscillations induced by flow reversals, and inspiratory flow separations behind bifurcations. The results elucidated the laminar, transitional and turbulent flows during inspiratory and expiratory breathing phases. The character of the flow varies significantly with position in the airways, while the breathing regime has a generally low effect on the flow character. Inspection of the flow in the terminal branches indicated the need to add further branches for more realistic results there.

Health-promoting effect for students from physical loads of speed and strength orientation.

Aim: To investigate the impact of speed and strength physical loads on promoting health and reducing the biological age of student youth. Materials and Methods: The research involved 180 students aged 18-19. The first stage provided for the study of the indicators of the biological age of 120 students, and the second stage covered substantiation of the methodology for martial arts training sessions, based on physical loads of speed and strength orientation. To test its effectiveness, 60 students were involved (30 were in the experimental group (EG), 30 - in the control group (CG)). Results: The methodology for martial arts training sessions was developed and tested. In the dynamics of the experiment, there is a tendency to a decrease in the difference between the biological and the passport age, but these changes were unreliable in the CG, while a statistically significant decrease in this difference was recorded in the EG. In addition, there were significant changes in the EG in the following indicators: inspiratory breath holding (11.6 %), subjective health assessment (38.5 %), and static balancing (20.0 %). Conclusions: The use of physical loads of speed and strength orientation in the course of martial arts training has established a health-promoting effect and positive dynamics of the biological age indicators of student youth. The results of the research can be implemented in physical education and the process of sports improvement of students in higher educational institutions.

Research regarding the impact of resistance training on swimming performance

The paper aims to bring to the fore some training methods and equipment that can improve sports performance in swimmers aged 12-14 years. The research, conducted at two swimming centres in Bucharest and Bacău, involved 32 athletes who were divided into two groups as follows: 16 in the experimental group and 16 in the control group. They were elite athletes practising swimming from the age of 5-6 years, 6 to 8 times a week. All of them performed the same in-water training for 14 weeks, but those in the experimental group also used a device to train their respiratory muscles before and after each workout, 3 x 30 inhalations. The research methods used were: literature review, pedagogical observation, experiment, mathematical statistics, and graphical method. The efficiency of the inspiratory muscles was measured using the PowerBreathe K-Series device, which recorded the values of lung capacity, inspiratory muscle strength and power, inspiratory pressure and breathing energy. The obtained results confirm the research hypotheses according to which there is a significant difference (of 36.7%) between the improved times of the two groups in favour of the experimental group, meaning 0.67 hundredths of a second for every 50 m swum in their preferred event after 14 weeks of using the device to train their respiratory muscles.

A Comparison of 3D Conformal and Deep Inspiratory Breath Holding vs. 4D-CT Intensity-Modulated Radiation Therapy for Patients with Left Breast Cancer.

Multimodality is required for the treatment of breast cancer. Surgery, radiation (RT), and systemic therapy were traditionally used. Pharmacotherapy includes different drug mechanisms, such as chemotherapy, hormone therapy, and targeted therapies, alone or in combination with radiotherapy. While radiation offers numerous benefits, it also has certain harmful risks. such as cardiac and pulmonary toxicity, lymphedema, and secondary cancer. Modern radiation techniques have been developed to reduce organs at risk (OAR) doses. This study is a prospective feasibility trial conducted at the Fayium Oncology Center on patients with left breast cancer receiving adjuvant locoregional radiotherapy after either breast conservative surgery (BCS) or modified radical mastectomy (MRM). This study aimed to assess the proportion of patients who are fit both physically and intellectually to undergo breast radiotherapy using the deep inspiratory breath-holding (DIBH) technique, comparing different dosimetric outcomes between the 3D dimensional conformal with DIBH and 4D-CT IMRT plans of the same patient. D95 of the clinical target volume (CTV) of the target is significantly higher in the 3D DIBH plan than in the IMRT plan, with an average of 90.812% vs. 86.944%. The dosimetry of the mean heart dose (MHD) in the 4D-CT IMRT plan was significantly lower than in the 3D conformal with the DIBH plan (2.6224 vs. 4.056 Gy, p < 0.0064), and no significant difference between the two plans regarding mean left anterior descending artery (LAD) (14.696 vs. 13.492 Gy, p < 0.58), maximum LAD (39.9 vs. 43.5 Gy, p < 0.35), and V20 of the ipsilateral lung (18.66% vs. 16.306%, p < 0.88) was observed. Internal mammary chain (IMC) irradiation was better in the 4D-CT IMRT plan. Radiotherapy of the breast and chest wall with the 4D-CT IMRT technique appears not to be inferior to the 3D conformal with the DIBH technique and can be used as an alternative to the 3D conformal with the DIBH technique in patients meeting the exclusion criteria for performing the DIBH maneuver concerning coverage to target volumes or unacceptably high doses to OAR.

Cognitive Improvement through Breathing Exercises in Post-Stroke Respiratory Sarcopenia: A Review

PURPOSE: The first purpose of this study is to investigate the relationship between Post-Stroke Respiratory Sarcopenia (PSRS) and Cognitive Impairment (CI) through Breathing Exercise (BE) as a respiratory rehabilitation after stroke (ST). The second purpose is to introduce a pilot study design set to investigate and compare the acute effects of each BE to develop a BE protocol for further studies.METHODS: Pubmed, Scopus, Web of Science and Google Scholar search engines were used to identify the definition and mechanism of ST, CI and respiratory sarcopenia (RS), and to find cases of application of BE in such conditions.RESULTS: Review; BEs that improve ST, RS, and CI symptoms are Box Breathing (Tactical Breathing), Fast-Breathing, Slow-paced Breathing, Inspiratory Diaphragmatic Breathing+Expiratory Pursed-lip Breathing Exercise. However, the effect is still unclear as post-stroke patients undergo multiple medical treatments other than BE. Pilot Study Prospective results; Inspiratory Diaphragmatic Breathing+Expiratory Pursed-lip Breathing Exercise, Slow-paced Breathing, Box Breathing (Tactical Breathing) and Fast-Breathing will be performed by 40 healthy college students through a randomized controlled trial for 4 weeks. Respiratory functions, exercise intensity, active oxygen level, blood lactate level, cerebral oxygen saturation and cognitive function will be measured pre- and post-intervention along with acute and 2 week mid-intervention. BEs are expected to improve respiratory function, cognitive performance and energy levels while reducing HR, BP, and stress. However, individual response to BE may vary according to health, physical fitness and life styles. All BE will be conducted in an evenly controlled and supervised environment for accurate data collection.CONCLUSIONS: Further study will be done to develop an appropriate BE protocol for PSRS patients per this review. Follow-up studies may also use this review as a reference for the application of BEs in PSRS patients with CI.

Breathing a low-density gas reduces respiratory muscle force development and marginally improves exercise performance in master athletes.

We tested the hypothesis that breathing heliox, to attenuate the mechanical constraints accompanying the decline in pulmonary function with aging, improves exercise performance. Fourteen endurance-trained older men (67.9 ± 5.9 year, [Formula: see text]O2max: 50.8 ± 5.8ml/kg/min; 151% predicted) completed two cycling 5-km time trials while breathing room air (i.e., 21% O2-79% N2) or heliox (i.e., 21% O2-79% He). Maximal flow-volume curves (MFVC) were determined pre-exercise to characterize expiratory flow limitation (EFL, % tidal volume intersecting the MFVC). Respiratory muscle force development was indirectly determined as the product of the time integral of inspiratory and expiratory mouth pressure (∫Pmouth) and breathing frequency. Maximal inspiratory and expiratory pressure maneuvers were performed pre-exercise and post-exercise to estimate respiratory muscle fatigue. Exercise performance time improved (527.6 ± 38 vs. 531.3 ± 36.9s; P = 0.017), and respiratory muscle force development decreased during inspiration (-22.8 ± 11.6%, P < 0.001) and expiration (-10.8 ± 11.4%, P = 0.003) with heliox compared with room air. EFL tended to be lower with heliox (22 ± 23 vs. 30 ± 23% tidal volume; P = 0.054). Minute ventilation normalized to CO2 production ([Formula: see text]E/[Formula: see text]CO2) increased with heliox (28.6 ± 2.7 vs. 25.1 ± 1.8; P < 0.001). A reduction in MIP and MEP was observed post-exercise vs. pre-exercise but was not different between conditions. Breathing heliox has a limited effect on performance during a 5-km time trial in master athletes despite a reduction in respiratory muscle force development.

Curietherapy User eXperience Pilot Study: A Novel Augmented Reality Educational Tool during Radiation Oncology Consultation for Patients with Breast Cancer

Improved communication and knowledge delivery by clinicians at initial consultation may reduce anxiety and psychological burdens associated with cancer treatment. Based on our pilot qualitative study which involved semi-structured interviews of breast cancer patients, we developed Curietherapy User eXperience (CurieUx), an educational tool integrating augmented reality display technology into radiation oncology consultations. We developed an interactive 3-dimensional hologram using a frictionless, augmented reality desktop display. Animated modules on patient-specific anatomy (breast, regional lymph nodes, organs-at-risk), linear accelerator, and positioning (prone and breath holding techniques) were created. Patients with newly diagnosed localized breast cancer undergoing radiation oncology treatment were prospectively enrolled in this IRB approved study to evaluate the impact of integrating augmented reality educational tools during radiation therapy consultation (n = 40). Likert scale surveys on anxiety (NIH PROMIS), radiation knowledge, and augmented reality experience (modified IBM technology usability survey) were administered to patients before and after radiation consultation. A total of 40 newly diagnosed breast cancer patients were enrolled in this study with a median age of 67 years. Majority were diagnosed with T1-T2N0 (75.0%), followed by Tis (17.5%) and N1+ (7.5%). Of the 36 patients who proceeded with radiation, prone technique was utilized in 83.3% and deep inspiratory breath holding technique in 16.7%. Patients reported decreases in multiple components of anxiety after consultation with the CurieUx platform, including in fearfulness (2.13 vs 1.78, p = 0.003), uneasiness (2.28 vs. 1.82, p = 0.008), nervousness (2.41 vs 2.06, p = 0.005), and tenseness (2.28 vs 1.87, p = 0.004). Patients reported significant increases in radiation knowledge across multiple domains, including treatment machine (2.35 vs 4.7, p<0.001), radiation (2.7 vs 4.58, p<0.001), positioning (2.49 vs 4.68, p<0.001), and confidence (2.4 vs 4.3, p<0.001). An overwhelming majority of patients had positive experiences (4 or 5 on Likert scale) with using the CurieUx hologram display as part of consultation, including its ease of understanding (97%), clarity (93%), comfort (100%), value (97%), and satisfaction (97%). Curietherapy User eXperience is a valuable educational tool that reduces patient anxiety and promotes radiation knowledge. CurieUx is easily incorporated into the existing radiation oncology consultation practice with the vast majority of patients believing it to be a valuable addition to the consultation process.