Lung Volume Research Articles

Anorectal manometry and urodynamics in children with spina bifida: can we predict the colonic dysmotility from bladder dysfunction?

IntroductionSpina bifida is a condition that impacts the development of the neural tube leading to urological and gastrointestinal symptoms. Both systems are influenced together due to their shared innervation and embryological origin. Despite its impact on health and well-being there has been limited research on the relationship between manometry results and urodynamic tests, in this patient population. The aim of this study was to delineate the association of neurogenic bladder/bowel dysfunction with anorectal manometry and urodynamics.Materials and methodsUrodynamics and anorectal manometry were used to analyse the neurogenic bowel and bladder dysfunctions in 29 paediatric patients with spina bifida. Those children who had previous anorectal surgical interventions were excluded from the study. Patients were grouped according to the level of spinal defect to lower or upper defect. In this study, parameters such as bladder compliance, postvoid residual volume, detrusor activity, anorectal pressures, and rectal compliance were considered. Group comparison tests were performed using standardized paediatric protocols for data analysis as well as correlation tests. A p-value less than 0.05 was considered significant at all levels.ResultsA total of 29 patients with spina bifida were identified. Of these, 14 were male and 15 were female. Bladder function differed among the patients in the lower defect (LD, n:18) and upper defect (UD, n:11) groups. LD group exhibited lower bladder volumes (175.45 ± 106.19 mL) compared to the UD group (266.83 ± 102.54 mL, p < 0.05). All LD and 72.7% of UD had detrusor sphincter dyssynergia. There was positive correlation between functional bladder parameters and bowel dysfunction, such as rectoanal inhibitory reflex (RAIR) and maximum filling pressures of the bladder (rho = 0.569, p < 0.05). There was also a significant correlation between rectal compliance and bladder volumes.ConclusionsAssociation of neurogenic bowel and bladder dysfunction is a complex issue which requires personalized approach for managing the consequences. In children with neurogenic bladder dysfunction increased RAIR activity may be a sign for colonic dysmotility of neurogenic origin. This study may also pave the way for delineation of the mechanism under the generation of RAIR which is thought to be only intrinsic in origin. To optimize treatment modalities, full assessment with anorectal manometry and urodynamic studies should be done in patients with spina bifida.Clinical trial registrationThis study was not performed on volunteer patients. Clinical study enrolment is not required as this study was obtained from urodynamics and anorectal manometry performed in patients with neurogenic bladder/bowel and during clinical follow-up.

Gene Therapy With URO-902 (pVAX/hSlo) for the Treatment of Female Patients With Overactive Bladder and Urge Urinary Incontinence: Safety and Efficacy From a Randomized Phase 2a Trial.

To assess efficacy and safety of URO-902, an investigational gene therapy expressing the α subunit of the large-conductance Ca2+-activated K+ channel, in a phase 2a placebo-controlled trial in women with overactive bladder (OAB). Women, 40‒79 years, with OAB and urge urinary incontinence (UUI) who were refractory to OAB medications were randomized to single-dose URO-902 24 and 48 mg or placebo administered by intradetrusor injection via cystoscopy under local anesthesia. Efficacy endpoints included change from baseline to week 12 in mean daily micturitions, urgency episodes, UUI episodes, and patient-reported outcomes. Safety assessments included adverse events (AEs) and postvoid residual urine volume. Of 80 patients randomized (URO-902 24 mg, n=26; URO-902 48 mg, n=27; placebo, n=27), 74 received treatment, and 67 reached week 24. At week 12, URO-902 24 and 48 mg were associated with significant improvement vs placebo in daily micturitions (least squares mean change from baseline, -2.3 and -2.4 vs -0.8; least square mean difference [95% confidence interval], ‒1.5 [‒2.7 to ‒0.3] and ‒1.6 [‒2.8 to ‒0.4], nominal P=0.017 and P=0.009, respectively). URO-902 48 mg was associated with significant improvements vs placebo in urgency episodes (‒3.4 vs ‒1.1; ‒2.2 [‒4.0 to ‒0.4]; nominal P=0.016) and percentage of Patient Global Impression of Change responders (58% vs 31%; nominal P=0.026). Among patients receiving URO-902 24 mg, 48 mg, and placebo, 46%, 54%, and 54%, respectively, experienced ≥1 treatment-emergent AEs, most commonly urinary tract infection (0%, 15%, 4%) and hematuria (6%, 8%, 8%). In this phase 2a trial, treatment with URO-902 was associated with improvements vs placebo in efficacy and patient-reported outcomes and was safe and well tolerated.

Addressing lung truncation in 99mTc-MAA SPECT/CT for 90Y microsphere radioembolization treatment planning

BackgroundPrior studies have established that macroaggregated albumin (MAA)-SPECT/CT offers more robust lung shunt fraction (LSF) and lung mean absorbed dose (LMD) estimates in 90Y radioembolization in comparison to planar imaging. However, incomplete SPECT/CT coverage of the lungs is common due to clinical workflows, complicating its potential use for LSF and LMD calculations. In this work, lung truncation in MAA-SPECT/CT was addressed via correction strategies to improve 90Y treatment planning.MethodsLung truncation was simulated in 56 cases with adequate (> 90%, mean: 98%) lung coverage in MAA-SPECT/CT by removing slices in ~ 5 mm increments from the lung apices to the diaphragm. A wide range of lung coverages from 100% to < 1% in ~ 2% increments were created. LSF and LMD were calculated with four methods. (1) 2D planar imaging standard (not truncated), truncated lung SPECT/CT data was: (2) used with no corrections (SPECTTrunc), (3) uniformly extrapolated to full lung coverage (SPECTUniform), (4) fit with an empirical model to predict lung counts at full lung coverage (SPECTFit). To determine counts for LSF, full lung volumes, those modified at the lung/liver boundary (Lungs 2-cm), and those isolated to the left lung (Left Lung) were used. The correction methods were then applied to 31 independent cases without full lung coverage (< 90%, mean: 74%). The variations in LSF and LMD estimates from each correction method were analyzed.ResultsAveraged across simulated lung coverages from 40 to 80%, percent errors relative to non-truncated data for SPECTTrunc were (mean ± σ) − 22% ± 15% for LSF and 34% ± 29% for LMD. SPECTUniform had similar errors with 29% ± 26% for both LSF and LMD. SPECTFit yielded the most accurate and precise estimates for LSF and LMD, with errors of 11% ± 20% for both. The Left Lung approach equalized LMD errors in all three correction methods, with percent errors of 3% ± 17% (SPECTTrunc), 2% ± 17% (SPECTUniform), and 4% ± 13% (SPECTFit). In the 31 cases without ground truth LSF or LMD, Left Lung produced highly comparable LMD estimates, with a mean (max) coefficient of variation across the three correction methods of 4% (20%).ConclusionLSF and LMD can be estimated for 90Y radioembolization using truncated lung coverage data in MAA-SPECT/CT. Empirical models to predict lung counts at full lung coverage produced LSF and LMD estimates with minimal bias and uncertainty. With lung/liver boundary adjustments, all SPECT/CT methods assessed in this work yielded LMD estimates comparable to ground truth, even down to 50% lung coverage.

Under-Recognized Medication Loss With the Administration of Small-Volume Intermittent Infusions.

Background: Most antibiotics administered via intermittent IV infusion are diluted in 50 to 100 ml of diluent. The primary infusion set for the BD Alaris® pumps can hold 25 ml of volume in its tubing, potentially contributing up to a 50% drug loss if residual volume is present after administration is complete. In the case of antibiotics, this may lead to significant underdosing, potentially contributing to reduced therapeutic response and emergence of antimicrobial resistance. Many organizations lack departmental policies and procedures for the administration of small-volume intermittent infusions. Developing a clear policy and procedure can increase drug delivery efficiency. Previous studies propose several recommendations, such as using a secondary infusion set, adding carrier fluids, and flushing the line to account for overfill. Objective: Our aim was to implement pilot new guidance in 2 patient units (an ICU and a non-ICU) to address the administration of small-volume intermittent infusions and determine if this results in more complete medication administration. Methods: This was an observational quality improvement initiative assessing the new guidance established for the administration of small-volume intermittent infusions to current practices. The primary outcome of this study was the incidence of residual drug volume in the IV line before the air-detector, IV bag, or IV vial. This was done through observation, and data collected through a survey. Results: In total, 203 IV administrations were observed, 86% of which were antibiotics. There were 124 IV administrations being observed before policy guidance initiation and 79 after initiation. The results showed a statistically significant reduction in the incidence of fluid remaining in the IV line before the air-detector (85% vs 27%; P < .001), the IV bag (59% vs 7.6%; P < .001), and in the IV vial (47% vs 24%; P < .001.). Conclusion: The proposed interventions significantly decreased the incidence of fluid remaining in the IV line before the air detector in the BD Alaris Pump, IV bag, and IV vial, presumably decreasing medication loss.

Correction of hypoxic effects on target organs in pneumonia with phytotherapy.

This study aims to investigate the molecular mechanisms of the combination of stellasterin, quercetin, and kaempferol- components of the phytopreparation ginseng (trade name Panax)- in the treatment of tissue hypoxia occurring in patients with viral and bacterial pneumoni. An analytical single-center method of network pharmacology was utilized, involving 110 individuals divided into two subgroups: placebo and Panax phytopreparation. The therapy course lasted 2months, after which physical (forced vital capacity, respiratory volume, oxygen saturation) and laboratory (total ATPase, Na+/K+-ATPase, glucose, leukocytes) parameters were evaluated. The administration of kaempferol, stellasterin, and quercetin increased the activity of total ATPase compared to baseline measurements in pneumonia patients with respiratory insufficiency, as well as compared to the placebo group. Thus, phytopreparations capable of controlling or limiting inflammatory reactions in various types of pneumonia and accompanying hypoxia represent promising adjunctive therapy. Given the increasing incidence of viral and bacterial pneumonia, there is a growing need to develop new treatment strategies for patients and improve hypoxia outcomes.

Key spirometric parameters for post-tuberculosis sequelae in patients after new coronavirus infection

The study evaluated key spirometric parameters in patients with post-tuberculosis (post-TB) lung sequelae after recovery from a new coronavirus infection. The main group incliuded 14 patients with clinically cured respiratory tuberculosis who had recovered from the new coronavirus infection and, after recovery, were sent to the Glukhovskaya tuberculosis sanatorium for treatment in 2020-2021. The control group included 52 patients with residual post-TB sequelae, who did not have a new coronavirus infection and who were treated at the sanatorium during the same period. The groups were comparable in terms of epidemiological and clinical criteria, except for post-TB sequelae: the main group included 13 cases (92.9%) of minor post-TB sequelae, 1 case (7.1%) of major post-TB sequelae, and the control group included 36 (69.2%) and 16 (30.8%) cases, respectively. Pulmonary function tests included vital capacity, forced vital capacity, forced expiratory volume in 1 second, and forced expiratory volume in 1 second/forced vital capacity. Tests were performed at admission to the sanatorium and after 1 month. At stage 1 in the main group, vital capacity, forced vital capacity and forced expiratory volume in 1 second were on average below the predicted level (80%) compared with the control group, and after sanatorium treatment the same parameters improved slightly. In the control group, the initial indicators were significantly higher, the rates of recovery of vital capacity of the lungs and forced vital capacity of the lungs were comparable with the main group, during the 2nd examination, the average levels of recovery of vital capacity of the lungs and forced vital capacity of the lungs approached, and in terms of forced expiratory volume in the 1st second, they reached the norm. At baseline, low ventilatory lung capacity correlated with clinical symptoms, as 42.8% of patients in the main group and 55.7% of controls reported shortness of breath. However, after sanatorium treatment, the control group more often showed parameters below 60%: 7.7% of cases for vital capacity, 17.3% for forced vital capacity, 11.5% for forced expiratory volume in 1 second, while the main group showed mostly slight or moderate decrease of these parameters. Therefore, the new coronavirus infection has a negative impact on the functional capacity of the respiratory system, but major post-TB sequelae also contribute to the development of ventilatory disorders.

Prevalence and Clinical Implications of Pulmonary Vein Stenosis in Bronchiectasis: A 3D Reconstruction CT Study.

Recent studies on bronchiectasis have revealed significant structural abnormalities and pathophysiological changes. However, there is limited research focused on pulmonary venous variability and congenital variation. Through our surgical observations, we noted that coarctation of pulmonary veins and atrophied lung volume are relatively common in bronchiectasis patients. Therefore, we conducted a retrospective study to explore pulmonary venous variation and secondary manifestations in bronchiectasis cases, utilizing 3D reconstruction software (Mimics Innovation Suite 21.0, Materialise Dental, Leuven, Belgium) to draw conclusions supported by statistical evidence. This retrospective study included patients with bronchiectasis and healthy individuals who underwent CT examinations at Beijing Chao-Yang Hospital between January 2017 and July 2023. Chest CT data were reconstructed using Materialise Mimics. Pulmonary veins and lung lobes were segmented from surrounding tissue based on an appropriate threshold determined by local grey values and image gradients. Subsequently, venous cross-sectional areas and lung volumes were measured for statistical analysis. CT data from 174 inpatients with bronchiectasis and 75 cases from the health examination center were included. Three-dimensional reconstruction data revealed a significant reduction in cross-sectional areas of pulmonary veins in the left lower lobe (p < 0.001), the right lower lobe (p = 0.030), and the right middle lobe (p = 0.009) of bronchiectasis patients. Subgroup analyses indicated that approximately 73.5% of localized cases of the left lower lobe exhibited pulmonary vein stenosis, while in the diffuse group, this proportion was only 52.6%. Furthermore, the cross-sectional area of pulmonary veins had a gradually decreasing trend, based on a small sample. Lung function tests showed significant reductions in FEV1, FVC, and FEV1% in bronchiectasis patients, attributed to the loss of lung volume in the left lower lobe, which accounted for 60.9% of the included sample. Our recent findings suggest that pulmonary venous stenosis is a common variation in bronchiectasis and is often observed concurrently with reduced lung volume, particularly affecting the left lower lobe. Moreover, localized cases are more likely to suffer from pulmonary venous stenosis, with an ambiguous downtrend as the disease progresses. In conclusion, increased attention to pulmonary venous variation in bronchiectasis is warranted, and exploring new therapies to intervene in the early stages or alleviate obstruction may be beneficial.

Assessment of residual gastric volume by ultrasound prior to upper endoscopy: a prospective cohort study.

Pulmonary aspiration is an adverse event with high morbidity and mortality. Despite fasting for > 8hr, some patients still have residual gastric volume and are thus at risk of aspiration. We aimed to determine the accuracy of gastric ultrasound in assessing residual gastric content in patients undergoing upper gastrointestinal endoscopy. In a prospective cohort study, we performed gastric ultrasound immediately before upper gastrointestinal endoscopy in a sample of 294 patients. We categorized the ultrasound results as high risk of aspiration when the fluid volume was > 1.5mL·kg-1 or when there was thick/solid content. We applied Spearman's test to determine the correlation between aspirated volume and ultrasound-estimated volume using three mathematical models. We assessed the method's accuracy by calculating its sensitivity and specificity. We included 282 patients in the analysis. The incidence of residual gastric contents was 5%. There were no aspiration events. Prokinetic use (relative risk [RR], 7.5; 95% confidence interval [CI], 1.9 to 29.1; P < 0.01), previous stroke (RR, 4.0; 95% CI, 1.2 to 13.6; P = 0.02), and male sex (RR, 3.3; 95% CI, 1.2 to 9.4; P = 0.02) were significantly more frequent among those with residual gastric content. The ultrasonography's specificity and sensitivity to predict gastric content at risk of aspiration were 100% and 77%, respectively, with a positive predictive value of 100% and a negative predictive value of 99%. Ultrasonography was an effective way to assess residual gastric content, which can help improve patient safety.

AQUABEAM robotic system use-results survey: Aquablation for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia in the Japanese Population.

To evaluate the safety, efficacy, and patient-reported outcomes of Aquablation therapy using the AQUABEAM Robotic System for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) in a Japanese population. This post-market use-results survey included 103 Japanese men with BPH who underwent Aquablation across five centers with previously Aquablation naïve physicians. Data were collected at baseline, during the procedure, at discharge, and at 3 and 6 months post-procedure. Key outcomes included International Prostate Symptom Score (IPSS), quality of life (QoL), uroflowmetry parameters, and adverse events. The mean age of patients was 71.1 years, and the average prostate size was 82.3 mL. At 6 months, the mean IPSS significantly improved from 18.1 ± 9.0 to 6.1 ± 5.0 (p < 0.0001), and QoL scores improved from 4.9 ± 1.3 to 1.8 ± 1.3 (p < 0.0001). Uroflowmetry showed a significant increase in Qmax from 8.3 ± 4.4 to 15.5 ± 7.8 mL/s (p < 0.0001) and a decrease in post-void residual volume (PVR) from 85.6 ± 107.2 to 43.3 ± 60.0 mL (p = 0.0006). At the 30-day primary safety endpoint, there were no reported adverse events of pad-use incontinence, erectile dysfunction, or ejaculatory dysfunction reported, and no device-related serious adverse events were reported. One subject (0.97%) experienced a Clavien-Dindo grade 3 adverse event. Aquablation therapy using the AQUABEAM Robotic System is a reproducible, safe, and effective treatment for Japanese men with BPH, providing significant improvements in LUTS and QoL with a favorable safety profile.

Capnodynamic determination of end-expiratory lung volume in a porcine model of hypoxic pulmonary vasoconstriction.

The capnodynamic method, End Expiratory Lung Volume CO2 (EELV-CO2), utilizes exhaled carbon dioxide analysis to estimate End-Expiratory Lung Volume (EELV) and has been validated in both normal lungs and lung injury models. Its performance under systemic hypoxia and variations in CO2 elimination is not examined. This study aims to validate EELV-CO2 against inert gas wash in/wash out (EELV- SF6, sulfur hexafluoride) in a porcine model of stable hemodynamic conditions followed by hypoxic pulmonary vasoconstriction and inhaled nitric oxide (iNO). Ten mechanically ventilated piglets were exposed to a hypoxic gas mixture and selective pulmonary vasoconstriction. Inhalation of nitric oxide was used to reverse the pulmonary vasoconstriction. Paired recordings of EELV-CO2 and EELV-SF6, were conducted to assess their agreement of absolute values. EELV-CO2 showed a bias of + 5ml kg- 1 compared to EELV-SF6, upper limit of agreement of 11ml kg- 1 (95%CI: 9-13ml kg- 1), lower limit of agreement - 1ml kg- 1 (95%CI: -3- 0ml kg- 1), mean percentage error 34%. Agreement between EELV-CO2 and EELV-SF6 was largely constant but was affected by progressing hypoxia and reached maximum limit of agreement after iNO exposure. Re-introduction of normoxemia then stabilized bias and limits of agreement to baseline levels. EELV-CO2 generates absolute values in parallel with EELV -SF6. Stressing EELV-CO2 with hypoxic pulmonary vasoconstriction and iNO, transiently impairs the agreement which stabilizes once normoxemia is reestablished.

Establishment of a Rabbit Model of Rib Tethering-Induced Early-Onset Scoliosis: Insights into Lung Evaluation using Design-Based Stereology.

Experimental Study. To create an EOS rabbit model and use a design-based stereological method to quantitatively assess lung structure changes at 24 weeks of age. Scoliosis affects thoracic and lung development, impacting children's chest and lung growth. EOS was induced via rib tethering in 4-week-old rabbits with ongoing CT scans and weight measures. Lungs were extracted post-fixation for volume estimation and tissue sampling, followed by microscopic analysis of lung morphology. The mean Cobb angle increased with the rabbits' growth. The EOS group showed significant decreases in total and right lung volumes. Quantitative lung stereology revealed reduced volumes of lung parenchyma and nonparenchymal tissue in all lobes. Alveolar duct volumes decreased significantly in multiple lobes, and alveolar septal volume was notably reduced in the right upper, middle, and lower lobes. Alveolar septal area decreased, and septal thickness increased in the EOS group. Alveoli numbers dropped, with variable changes in mean alveolar volume across lobes. Vascular lumen volume decreased in the right middle and lower lobes, and blood vessel and perivascular tissue volumes were significantly reduced in the right lung. Vessel diameter changes varied across lobes, with significant decreases in the right middle and lower lobes and increases in the left upper and lower lobes. Vascular endothelial surface area decreased in the left lower, right middle, and right lower lobes, with increased vessel and perivascular tissue thickness in the left upper and lower lobes compared to the right lobes. The EOS rabbit model demonstrated reduced lung volume, impaired alveolarization, septal thickening, and vascular changes, indicating scoliosis's negative impact on thoracic and lung development, especially on the concave lung.

Fire needle therapy combined with bladder function training for neurogenic bladder caused by spinal cord injury: a randomized controlled trial

To observe the clinical effect and safety of fire needle therapy combined with bladder function training on neurogenic bladder (NB) caused by spinal cord injury. A total of 60 patients with NB caused by spinal cord injury were randomly divided into an observation group and a control group , with 30 cases in each group. On the basis of conventional treatment with western medicine, the bladder function training was adopted in the control group, once a day and for 4 weeks. In the observation group, on the basis of the interventions as the control group, fire needling was operated at bilateral Sanyinjiao (SP 6) and Guanyuan (CV 4) and Zhongji (CV 3), once every two days and for 4 weeks (14 interventions in total). Separately, at the baseline and in 2 and 4 weeks of interventions, the urination conditions (average daily urination frequency, average daily leakage frequency, average daily single urination volume) were recorded in the two groups; the urodynamic parameters (maximum flow rate [Qmax], maximum detrusor pressure at maximum flow rate [PdetQmax], residual urine volume [RUA], maximum cystometric capacity [MCC], and bladder pressure) were detected; the neurogenic bladder symptom score (NBSS), urinary symptom distress score (USDS) were observed. Before and after treatment, the score of World Health Organization quality of life assessment scale-brief (WHOQOL-BREF) was observed in the two groups. The therapeutic effect, the incidence of urinary infection, and the safety were evaluated. In 2 and 4 weeks of interventions, the average daily urination frequency, the average daily leakage frequency, RUA, and the scores of NBSS and USDS decreased in the two groups when compared with the baseline (P<0.05). In 4 weeks of interventions, the above-mention outcomes were lower than those in 2 weeks of interventions (P<0.05); and the results in the observation group were lower in 2 and 4 weeks of interventions when compared with the control group (P<0.05). In 2 and 4 weeks of interventions, the average daily single urination volume, Qmax, PdetQmax, MCC, and bladder pressure increased in the two groups compared with the baseline (P<0.05). In 4 weeks of interventions, the above-mention outcomes were elevated in comparison with those in 2 weeks of interventions (P<0.05); and except for bladder pressure, the results in the observation group in 2 and 4 weeks of interventions were higher when compared with the control group (P<0.05). In 4 weeks of interventions, the scores of each dimension and the total scores of WHOQOL-BREF increased in comparison with the baseline in the two groups (P<0.05), and the scores of the observation group were higher than those of the control group (P<0.05). The incidence of urinary infection was 0% (0/30) in the observation group and 10.0% (3/30) in the control group, without significant difference (P>0.05). The total effective rate of the observation group was 93.3% (28/30), which was higher than that (73.3%, 22/30) of the control group (P<0.05). No serious adverse reactions occurred in the patients of the observation group. Fire needle therapy combined with bladder function training can effectively relieve the clinical symptoms, ameliorate urination, restore bladder function and improve the quality of life in the patients with NB caused by spinal cord injury. This therapeutic regimen presents a high safety in practice.

Prediction of restrictive ventilation disorders after COVID-19

Introduction. The effect of SARS-COV-2 on the lung function remains relevant at the present time.Aim. Determination of the most important predictors of the restrictive ventilation disorder after COVID-19.Materials and methods. The retrospective study included 341 patients without underlying lung diseases (median age 48 years) survivors after COVID-19 with bilateral pneumonia. The median of the greatest extent of parenchymal involvement in the acute phase of COVID-19 (CTmax) was 50%. Spirometry, body plethysmography, and diffusion test were performed. Descriptive statistics, correlation analysis, one-dimensional logistic regression analysis with an assessment of odds ratios (OR) and multivariate logistic regression analysis were applied. ROC analysis was used to assess the quality of the binary classifier model.Results. The initial model for predicting reduced total lung capacity (TLC) (criterion 1: TLC &lt; 80% predicted, criterion 2: TLC&lt;predicted-1.645SD) included predictors: CTmax, time interval from the COVID-19 onset (TI), gender, age, body mass index. Backward stepwise regression was applied and a binary classifier model that includes CTmax and TI was obtained. Applying criterion 1 for reducing TLC, the sensitivity and specificity of the model were 70,5% and 89.3%, respectively, and criterion 2 - 96.6% and 67.3%, respectively. The analysis of OR for the obtained binary classifier models showed that OR&gt;1 is observed at CTmax &gt; 70%.Conclusions. The restrictive ventilation disorder after COVID-19 is caused by CTmax and TI. The risk of reducing TLC after COVID-19 increases significantly with CTmax 70% or more. The criterion of the low level of normal of TLC affects the sensitivity and specificity of the obtained models.

William Shakespeare’s Legacy in Vocal Pedagogy: Revolutionizing the Art of Singing Through Breathing Techniques

The article highlights the significant contributions of William Shakespeare (the vocal coach) to the art of singing in England. His approach reformed vocal pedagogy by focusing on natural breathing techniques, particularly intercostal and diaphragmatic breathing, which helped singers reduce tension and enhance lung capacity. Shakespeare's methods aimed to integrate vocal technique with the unique phonetic characteristics of the English language, ensuring clear diction and strong projection, especially in larger performance spaces like concert halls. His teachings emphasized the importance of breath control and tonal quality, which allowed singers to maintain vocal stamina during demanding performances. Shakespeare’s influence on vocal technique has left a lasting legacy, continuing to shape modern vocal pedagogy. His emphasis on natural breathing set a new standard for singers, blending technical mastery with expressive communication in vocal performance.

Pulmonary and Physical Virtual Reality Exercises for Patients With Blunt Chest Trauma: Randomized Clinical Trial.

Adequate pain relief, early restoration of breathing, and rapid mobilization pose a clinical challenge in patients with blunt chest trauma. Virtual reality (VR) has the potential to achieve these 3 interrelated treatment objectives with enhanced self-efficacy and autonomy of patients and limited support by clinicians. This study aimed to assess the effectivity of breathing and physical exercises using VR on the pulmonary recovery of patients with blunt chest trauma at the ward. A pilot randomized controlled trial was performed. The control group received usual physiotherapy consisting of protocolized breathing exercises (8 times daily for 10 minutes) and physical exercises (2 times daily for 10 minutes). The VR group was instructed to perform these exercises using VR. The primary outcome was vital lung capacity at day 5 or earlier at discharge. Secondary outcomes were patient mobility (time standing, lying, and sitting), clinical outcomes (length of hospital stay, pulmonary complications, transfer to intensive care unit, and readmission within 30 days), pain, activities of daily living, patient-reported outcome measures (satisfaction and quality of recovery). Patient experiences and barriers and facilitators toward implementation were assessed through interviews. The study was prematurely ended due to enrollment failure combined with poor protocol adherence to exercises in both groups. A total of 27 patients were included, of which 19 patients completed 3 or more days. Vital lung capacity at 5 days (or last measurement) was equal between groups with 1830 (SD 591) mL and 1857 (SD 435) mL in the control and VR groups, respectively. No marked differences were observed in secondary outcomes. Patient interviews showed positive attitudes toward the use of VR, describing that visualization of the exercises helped patients to perform the exercises correctly and to continue the exercises for a longer duration. Also, patients experienced the immersiveness of VR as an analgesic. However, patients did not experience added value over usual care and reported that better integration in treatment and the hectic hospital environment could improve the use of the VR exercises. The suitability of patients to use virtual reality therapy (VRx) in a hospital (trauma) ward setting is lower than generally expected. Effective application of VRx requires professional guidance and needs thorough alignment with clinical practice. For future research, we recommend to chart adherence to study protocol before designing a VR clinical trial. Patient-reported experiences need to be prioritized in evaluating VR acceptance, usability, and effectiveness. In line, we recommend performing a systematic analysis (eg, using the technology acceptance model) on the acceptance before pilot or main effectiveness studies. Finally, the eligibility of patients and exclusion of patients due to the inability to use VRx should be routinely reported. ClinicalTrials.gov NCT05194176; https://tinyurl.com/2bzh4tzx.

Perioperative bladder management: Assessment of residual pre-operative bladder volume to mitigate post-operative urinary retention

Perioperative bladder management: Assessment of residual pre-operative bladder volume to mitigate post-operative urinary retention

A Randomized Controlled Trial Assessing the Impact of Transcutaneous Electrical Acupoint Stimulation on Gastrointestinal Motility, Nutritional Status, and Immune Function in Patients Following Cerebrovascular Accident Surgery

Background Transcutaneous Electrical Acupoint Stimulation (TEAS) is a technique that involves stimulating specific acupoints on the body with electrical currents. It may regulate nerve excitability and improve nerve function. This study aimed to assess the impact of TEAS on gastrointestinal motility, nutrition, and immune function in patients post cerebrovascular accident surgery in the intensive care unit (ICU). Methods A randomized controlled trial included 300 post-cerebrovascular surgery patients at Lishui Central Hospital (January 2021–June 2023). Patients were randomly assigned to TEAS or control groups in a 1:1 ratio. The TEAS group received TEAS at bilateral Zusanli (ST36), Shangjuxu (ST37), Tianshu (ST25), Neiguan (PC6), and Hegu (LI4) according to the International Acupuncture Point Code, plus standard care. The control group received routine enteral nutrition and sham TEAS. Nutritional, immune, and gastrointestinal motility indicators were compared. Results A randomized controlled trial involving 300 post-surgery patients compared TEAS to sham TEAS, demonstrating significant enhancements (p < 0.05) in immune function and gastrointestinal motility. Compared to the control group, the TEAS group showed significant improvements in the patient’s serum nutritional levels (prealbumin, albumin, hemoglobin, and total protein), immune status (IgG, IgA, IgM, and CD4+/CD8+), gastrointestinal motility (daily gastric residual volume, time to achieve target feeding volume, time for nutritional fluid to meet standards, time to first bowel movement, time to first passage of activated charcoal stool, time to reach the defecation volume), and overall condition (the scores of clinical scales and ICU stay duration) (p < 0.05). The TEAS group also experienced a significantly lower incidence of adverse events (p < 0.05). Conclusions Early TEAS intervention positively impacted recovery, shortened ICU stay, and improved outcomes in patients post cerebrovascular accident surgery.

Neuro-Oncological Superiority of Supratotal Resection in Lower-Grade Gliomas.

Supratotal-Resection (SpTR) is a promising surgical strategy in Lower-grade gliomas (LGGs). SpTR assessment, feasibility and distinctive features, as well as clinical benefit at first and second surgery and on overall-survival must be better characterized. The critical percentage of resection exceeding FLAIR margins to obtain clinical benefit and its impact on long-term functional performance are also undefined. Included were 704 patients with primary and 439 with recurrent LGGs seen between 2010-2019, who underwent resection with Brain-Mapping-Technique (BMT) aimed at achieving a SpTR without any "a-priori" selection. Extent-Of-Resection, evaluated on 3D-FLAIR-MR and categorized according to residual tumor and cavity volume, was associated with Progression-Free-Survival (PFS) and Malignant(M)PFS at first and second surgery, and Overall-Survival by univariate, multivariate and propensity-score analysis. Functional performance was assessed by neuropsychological-NPS evaluation. SpTR evaluation requires volumetric assessment enhanced by brain deformation measurement in parietal tumors; SpTR rate accounts on average for 50.2% and 35.7% at first and second surgery, is higher in grade-2, frontal and temporal locations (at expenses of Total-Resection-TR). Compared to TR, SpTR reduces and postpones first and second recurrences in all molecular subtypes and grades, delays MPFS without difference in rate and prolongs Overall-Survival. A degree of SpTR>120% associates with the lowest recurrence risk. SpTR associates with the best NPS longitudinal course. This study supports feasibility of SpTR in LGGs, its benefit at first and second surgery regardless of molecular subtypes, and on Overall-Survival, significantly reducing recurrence when SpTR>120%; SpTR also associates with the best patients' functional outcome.

Effect of yoga exercises on lung volumes, vital capacity, and attention span in school going students

ObjectiveThe digital age has made children more dependent on digital sources for study and entertainment, which leads to increased physical inactivity that contributes to reduced work breathing and attention. Yoga Sana can be a promising form of physical activity that improves a child’s lung function and attention span if, started at a young age. To find out the effect of yoga exercises on lung volumes, vital capacity, and attention span in school-going children.MethodsA total of 56 children between the ages of 10–15 years were included using the chit method. The children were randomly divided into 2 groups: group A (yoga group, &lt;i&gt;n&lt;/i&gt; = 27) and group B (control group, &lt;i&gt;n&lt;/i&gt; = 27). The students of both groups were assessed for chest expansion, lung volumes, and attention span. Group A (yoga group) was trained to perform yoga exercises 3 days a week for 4 weeks. Group B (control group) children were asked to perform daily activities. At the end of the 4 weeks, post-assessment of both the groups was assessed, documented, and statistically analysed using Wilcoxon signed rank and Mann–Whitney &lt;i&gt;U&lt;/i&gt;-tests.ResultsRespiratory parameters (FEV1, FVC/FEV1, and PEFR), chest expansion, and the attention span of group A were statistically significant compared to group B with a &lt;i&gt;p&lt;/i&gt;-value &lt; 0.05.ConclusionsYoga exercises led to improvement in lung volumes, vital capacity, and attention in school-going students.

Iron enrichment and alumina recovery from bauxite residue through hydrogen reduction followed by alkaline leaching and CaO circulation

ABSTRACT The alumina industry faces a significant challenge in effectively utilising bauxite residue due to its hazardous nature. A potential solution involves recovering iron and alumina from the bauxite residue, leading to a substantial reduction in residue volume and also drawing some material value. This study involved the production of self-hardened calcite pellets from the bauxite residue, which were then subjected to hydrogen reduction and subsequently leached with a sodium carbonate solution for alumina extraction. In an effort to establish a circular material flow, the leaching residue, which contains most of calcium and metallic iron, was reintegrated into the process to produce self-hardened pellets. Analytical techniques such as X-ray diffraction, electron probe microanalysis, X-ray fluorescence, and inductively coupled plasma-mass spectroscopy were employed for comprehensive microstructural, chemical, and elemental evaluations of the samples. The integrated process yielded a final alumina recovery rate exceeding 62%, a substantial improvement compared to the process lacking calcium looping. The incorporation of leaching residue recycling played a crucial role in significantly reducing calcium consumption throughout the integrated process, reaching approximately 70%. This research signifies a promising approach to efficiently recover valuable components from bauxite residue while mitigating environmental concerns and optimising resource utilisation.