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Sample records for spontaneous breathing trials

  1. Changes in breathing variables during a 30-minute spontaneous breathing trial.

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    Figueroa-Casas, Juan B; Connery, Sean M; Montoya, Ricardo

    2015-02-01

    Spontaneous breathing trials (SBTs) are increasingly performed. Significant changes in monitored breathing variables and the timing of those changes during the trial have important implications for its outcome determination and supervision. We aimed to study the magnitude and timing of change in breathing variables during the course of a 30-min SBT. Breathing variables were continuously measured and averaged by minute during the SBT in 32 subjects with trial success and 8 subjects with trial failure from a general ICU population. Percentage changes in breathing variables during the trial and proportions of subjects showing a ≥20% change at different time points relative to the second minute of the trial were calculated. The commonly monitored breathing variables (frequency, tidal volume, their ratio, and minute ventilation) showed median coefficients of variation of breathing variables remain relatively constant, and potentially significant changes in these variables after 10 min into the trial are uncommon. These findings should be considered when addressing aspects of duration and supervision of SBTs in weaning protocols. Copyright © 2015 by Daedalus Enterprises.

  2. Different spontaneous breathing trials in patients with atrial fibrillation

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    Y.-H. Tseng

    2015-09-01

    Full Text Available Introduction: Weaning from mechanical ventilation is one of the most important and challenging problems for most intensive care unit (ICU patients. Spontaneous breathing trial (SBT is the most common method used to evaluate patients’ ability to breathe by themselves and plays an important role in decision making for weaning. The aim of our study was to investigate the effect of different methods of SBT in respiratory care unit (RCU patients with atrial fibrillation (AF on weaning outcome. Methods: We retrospectively analyzed different methods of SBT in patients with and without AF. We enrolled RCU patients who required mechanical ventilation and had undergone transthoracic echocardiography from January 2011 to January 2012. Results: There was a higher SBT passing rate among AF patients who received pressure support ventilation (PSV trial than in those who received T-piece trail (92.5% vs. 73.1%, p = 0.041. The weaning rates between these two groups were not significantly different (83.8% vs. 94.7%, p = 0.403. Total ventilator days were longer in T-piece group than in PSV group (median 40.0, IQR: 18.2–125.1 days vs. 33.0, IQR: 29.6–51.0 days respectively, p = 0.580, but this difference was not statistically significant. These results were not found in patients without AF. Conclusions: The use of PSV trial might be considered first instead of T-piece trial for SBT when AF patients were ready to wean. Keywords: Atrial fibrillation (AF, Intensive care unit (ICU, Mechanical ventilation, Spontaneous breathing trial (SBT, Ventilator weaning

  3. Effort to Breathe with Various Spontaneous Breathing Trial Techniques. A Physiologic Meta-analysis.

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    Sklar, Michael C; Burns, Karen; Rittayamai, Nuttapol; Lanys, Ashley; Rauseo, Michela; Chen, Lu; Dres, Martin; Chen, Guang-Qiang; Goligher, Ewan C; Adhikari, Neill K J; Brochard, Laurent; Friedrich, Jan O

    2017-06-01

    Spontaneous breathing trials (SBTs) are designed to simulate conditions after extubation, and it is essential to understand the physiologic impact of different methods. We conducted a systematic review and pooled measures reflecting patient respiratory effort among studies comparing SBT methods in a meta-analysis. We searched Medline, Excerpta Medica Database, and Web of Science from inception to January 2016 to identify randomized and nonrandomized clinical trials reporting physiologic measurements of respiratory effort (pressure-time product) or work of breathing during at least two SBT techniques. Secondary outcomes included the rapid shallow breathing index (RSBI), and effort measured before and after extubation. The quality of physiologic measurement and research design was appraised for each study. Outcomes were analyzed using ratio of means. Among 4,138 citations, 16 studies (n = 239) were included. Compared with T-piece, pressure support ventilation significantly reduced work by 30% (ratio of means [RoM], 0.70; 95% confidence interval [CI], 0.57-0.86), effort by 30% (RoM, 0.70; 95% CI, 0.60-0.82), and RSBI by 20% (RoM, 0.80; 95% CI, 0.75-0.86). Continuous positive airway pressure had significantly lower pressure-time product by 18% (RoM, 0.82; 95% CI, 0.68-0.999) compared with T-piece, and reduced RSBI by 16% (RoM, 0.84; 95% CI, 0.74-0.95). Studies comparing SBTs with the postextubation period demonstrated that pressure support induced significantly lower effort and RSBI; T-piece reduced effort, but not the work, compared with postextubation. Work, effort, and RSBI measured while intubated on the ventilator with continuous positive airway pressure of 0 cm H 2 O were no different than extubation. Pressure support reduces respiratory effort compared with T-piece. Continuous positive airway pressure of 0 cm H 2 O and T-piece more accurately reflect the physiologic conditions after extubation.

  4. Spontaneous Breathing Trials and Conservative Sedation Practices Reduce Mechanical Ventilation Duration in Subjects With ARDS.

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    Kallet, Richard H; Zhuo, Hanjing; Yip, Vivian; Gomez, Antonio; Lipnick, Michael S

    2018-01-01

    Spontaneous breathing trials (SBTs) and daily sedation interruptions (DSIs) reduce both the duration of mechanical ventilation and ICU length of stay (LOS). The impact of these practices in patients with ARDS has not previously been reported. We examined whether implementation of SBT/DSI protocols reduce duration of mechanical ventilation and ICU LOS in a retrospective group of subjects with ARDS at a large, urban, level-1 trauma center. All ARDS survivors from 2002 to 2016 ( N = 1,053) were partitioned into 2 groups: 397 in the pre-SBT/DSI group (June 2002-December 2007) and 656 in the post-SBT/DSI group (January 2009-April 2016). Patients from 2008, during the protocol implementation period, were excluded. An additional SBT protocol database (2008-2010) was used to assess the efficacy of SBT in transitioning subjects with ARDS to unassisted breathing. Comparisons were assessed by either unpaired t tests or Mann-Whitney tests. Multiple comparisons were made using either one-way analysis of variance or Kruskal-Wallis and Dunn's tests. Linear regression modeling was used to determine variables independently associated with mechanical ventilation duration and ICU LOS; differences were considered statistically significant when P mechanical ventilation duration (14 [6-29] vs 9 [4-17] d, respectively, P mechanical ventilation duration and ICU LOS. Among subjects with ARDS in the SBT performance database, most achieved unassisted breathing with a median of 2 SBTs. Evidenced-based protocols governing weaning and sedation practices were associated with both reduced mechanical ventilation duration and ICU LOS in subjects with ARDS. However, higher respiratory system compliance in the SBT/DSI cohort also contributed to these improved outcomes. Copyright © 2018 by Daedalus Enterprises.

  5. Comparison of Size 2 LMA-ProSeal™ and LMA-Supreme™ in Spontaneously Breathing Children: a Randomised Clinical Trial

    OpenAIRE

    Arslan, Zehra İpek; Balcı, Canan; Oysu, Duygu Akalın; Yılmaz, Mehmet; Gürbüz, Necla; İlce, Zekeriya

    2013-01-01

    Objective: The aim of this study was to compare size 2 Laryngeal Mask Airway ProSeal and size 2 Laryngeal Mask Airway Supreme in spontaneously breathing children undergoing lower abdominal elective surgery of <1 hour duration. Study Design: Randomized clinical trial. Material and Methods: Sixty children aged 1-7 years, weighing 10-20 kg, ASA I physical status were randomly allocated to the Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme. Results: There w...

  6. Comparison of Size 2 LMA-ProSeal™ and LMA-Supreme™ in Spontaneously Breathing Children: a Randomised Clinical Trial

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    Zehra İpek Arslan

    2013-03-01

    Full Text Available Objective: The aim of this study was to compare size 2 Laryngeal Mask Airway ProSeal and size 2 Laryngeal Mask Airway Supreme in spontaneously breathing children undergoing lower abdominal elective surgery of <1 hour duration. Study Design: Randomized clinical trial. Material and Methods: Sixty children aged 1-7 years, weighing 10-20 kg, ASA I physical status were randomly allocated to the Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme. Results: There were no differences in demographic variables, ease of gastric tube placement, ease of insertion and ventilation, number of insertion attempts, hemodynamic changes on insertion, postoperative complications and bloodstaining between the groups. Gastric insufflation was detected and gastric tube was placed in all patients except one in LMA Supreme. Postoperative cuff volumes were comparable with the preoperative values in group itself. Oropharyngeal leak pressures were higher in Laryngeal Mask Airway ProSeal (24.6±5.5 vs 21.3±4.2, respectively; p<0.01. Conclusion: As a result Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme can safely be used in spontaneously breathing pediatric population undergoing lower abdominal elective surgery.

  7. Development, implementation, and evaluation of an institutional daily awakening and spontaneous breathing trial protocol: a quality improvement project.

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    Kher, Sucharita; Roberts, Russel J; Garpestad, Erik; Kunkel, Chris; Howard, William; Didominico, Dorothy; Fergusson, Anne; Devlin, John W

    2013-01-01

    While one controlled trial found that a daily awakening and spontaneous breathing trial (DA-SBT) decreases time on mechanical ventilation (MV), there is a paucity of real-world data surrounding the development, implementation, and impact of DA-SBT protocols. We describe a multidisciplinary process improvement effort in 2, 10-bed medical intensive care units (MICUs) at a 330-bed academic medical center that focused on the development, implementation, and evaluation of a new DA-SBT protocol. A DA-SBT protocol, developed using results from a nursing survey literature and available institutional resources, was implemented after extensive clinician education and institution of quality reminders to boost use. Postprotocol compliance was evaluated. Use of sedation, DA and SBT practices, and clinical outcomes were retrospectively compared between the before and after DA-SBT protocol groups (ie, consecutive MICU patients requiring a continuously infused sedative [CIS] ≥24 hours). In the after group (n = 32), the DA and SBT compliances were 44% and 84%, respectively. Compared with the before group (n = 33), after group patients received CIS on fewer days of MV (100% vs 67%, P = .003) and had their CIS down-titrated by ≥25% on more days of CIS (40% vs 71%, P = .006). Neither total CIS dose (P = .49), total MV days (P = .75), days of MV where a SBT occurred (P = .38), nor episodes of self-extubation (15% vs 6%, P = .43) differed between the 2 groups. Despite the implementation of a DA-SBT protocol that was individualized to clinician preferences and institutional resources and accompanied by substantial education and reminders for use, compliance to the DA component of this protocol was low and duration of MV remained unchanged. Additional quality improvement strategies are needed to overcome barriers to DA-SBT protocol use that may not exist in controlled clinical trials.

  8. Spontaneous breathing trial in T-tube negatively impact on autonomic modulation of heart rate compared with pressure support in critically ill patients.

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    Güntzel Chiappa, Adriana M; Chiappa, Gaspar R; Cipriano, Gerson; Moraes, Ruy S; Ferlin, Elton L; Borghi-Silva, Audrey; Vieira, Silvia R

    2017-07-01

    Spontaneous breathing with a conventional T-piece (TT) connected to the tracheal tube orotraqueal has been frequently used in clinical setting to weaning of mechanical ventilation (MV), when compared with pressure support ventilation (PSV). However, the acute effects of spontaneous breathing with TT versus PSV on autonomic function assessed through heart rate variability (HRV) have not been fully elucidated. The purpose of this study was to examine the acute effects of spontaneous breathing in TT vs PSV in critically ill patients. Twenty-one patients who had received MV for ≥ 48 h and who met the study inclusion criteria for weaning were assessed. Eligible patients were randomized to TT and PSV. Cardiorespiratory responses (respiratory rate -ƒ, tidal volume-V T , mean blood pressure (MBP) and diastolic blood pressure (DBP), end tidal dioxide carbone (P ET CO 2 ), peripheral oxygen saturation (SpO 2 ) and HRV indices in frequency domain (low-LF, high frequency (HF) and LF/HF ratio were evaluated. TT increased ƒ (20 ± 5 vs 25 ± 4 breaths/min, P<0.05), MBP (90 ± 14 vs 94 ± 18 mmHg, P<0.05), HR (90 ± 17 vs 96 ± 12 beats/min, P<0.05), P ET CO 2 (33 ± 8 vs 48 ± 10 mmHg, P<0.05) and reduced SpO 2 (98 ± 1.6 vs 96 ± 1.6%, P<0.05). In addition, LF increased (47 ± 18 vs 38 ± 12 nu, P<0.05) and HF reduced (29 ± 13 vs 32 ± 16 nu, P<0.05), resulting in higher LF/HF ratio (1.62 ± 2 vs 1.18 ± 1, P<0.05) during TT. Conversely, V T increased with PSV (0.58 ± 0.16 vs 0.50 ± 0.15 L, P<0.05) compared with TT. Acute effects of TT mode may be closely linked to cardiorespiratory mismatches and cardiac autonomic imbalance in critically ill patients. © 2015 John Wiley & Sons Ltd.

  9. Weaning by gradual pressure support (PS reduction without an initial spontaneous breathing trial (SBT versus PS-supported SBT: A pilot study

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    K. Gnanapandithan

    2011-11-01

    Full Text Available Background and aim: Studies on weaning strategies have yielded conflicting results regarding the superiority of different methods. The aim of this RCT was to compare the efficacy of gradual pressure support (PS reduction without an initial spontaneous breathing trial (SBT with PS-supported SBT. Methods: Patients mechanically ventilated for >24 h were randomized to weaning by gradual reduction of PS without an initial SBT versus once daily SBT (PS 7 cm H2O. The primary outcomes were the rates of successful weaning trial and time to successful extubation. The secondary outcomes were the ICU and hospital length of stay, hospital mortality and the occurrence of ventilator-associated pneumonia (VAP. Results: Of the 120 patients (61 males, median age 35 years, 58 were assigned to PS and 62 to the SBT group. The median (IQR duration of ventilation prior to weaning was 80.2 (50.5–175.6 h. The baseline characteristics were similar in the two groups except the PaO2/FiO2 ratio, which was significantly higher in SBT group. The rates of successful weaning trial (89.7% versus 69.4% were significantly higher in the PS group. The median duration of weaning (66 h versus 81.5 h, P = 0.05 and the median duration of ICU stay (8 days versus 9.4 days, P = 0.027 were lower in the PS group. There was no difference in hospital stay, mortality rates or occurrence of VAP in the two arms. On multivariate analysis, the duration of ventilation prior to weaning, baseline SOFA score and the weaning method were predictors of successful extubation. Conclusions: Gradual reduction of PS without an initial SBT was found to be associated with better outcomes compared to once daily PS-supported SBT. Resumo: Antecedentes e objetivo: Os estudos sobre estratégias de desmame tiveram resultados controversos em relação à superioridade de métodos diferentes. O objetivo deste RCT foi comparar a eficácia da redução gradual da press

  10. Voluntary breath holding affects spontaneous brain activity measured by magnetoencephalography

    NARCIS (Netherlands)

    Schellart, N. A.; Reits, D.

    1999-01-01

    Spontaneous brain activity was measured by multichannel magnetoencephalography (MEG) during voluntary breath holds. Significant changes in the activity are limited to the alpha rhythm: 0.25 Hz frequency increase and narrowing of the peak. The area of alpha activity shifts slightly toward (fronto-)

  11. [A respiratory microvalve for spontaneously breathing anesthetized small animals].

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    Barnikol, W K; Hiller, B; Guth, S

    1994-03-01

    For the accurate functional analysis of the gas exchange in the lungs or evaluation of artificial oxygen carriers in spontaneously breathing anaesthetized small animals, we developed a new respiratory micro-valve. The body of the valve is made of aluminium, and the flaps are made of silicone rubber. The maximum flow rate in a rat measured with a pneumotachograph and the micro-valve was an average of 19.9 ml/s during inspiration, and 17.8 ml/s during expiration. The pressure measured in the tracheal tube was -0.85 during inspiration, and +0.39 cm H2O during expiration; the end-expiratory pressure in the tube was zero. In two experiments with anaesthetised rats lasting 4-5 hours, ventilation, oxygen uptake, carbon dioxide release and the respiratory exchange ratio were 638 ml/min/kg, 21.7 ml O2(STPD)/min/kg, 16.6 ml CO2(STPD)/min/kg, and 0.77, respectively. There was no significant change in any parameter during the experiment. The micro-valve increases the dead space by approximately 35%, but this is well tolerated by the rats, which compensate by increasing their tidal volume by about 10 to 15%. The major advantage of using the micro-valve in comparison with other methods is the fact that the true difference between inspiratory and mean mixed expiratory gas can be measured with great accuracy. The micro-valve can readily be adjusted for optimal use with a range of animals.

  12. Humidification performance of humidifying devices for tracheostomized patients with spontaneous breathing: a bench study.

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    Chikata, Yusuke; Oto, Jun; Onodera, Mutsuo; Nishimura, Masaji

    2013-09-01

    Heat and moisture exchangers (HMEs) are commonly used for humidifying respiratory gases administered to mechanically ventilated patients. While they are also applied to tracheostomized patients with spontaneous breathing, their performance in this role has not yet been clarified. We carried out a bench study to investigate the effects of spontaneous breathing parameters and oxygen flow on the humidification performance of 11 HMEs. We evaluated the humidification provided by 11 HMEs for tracheostomized patients, and also by a system delivering high-flow CPAP, and an oxygen mask with nebulizer heater. Spontaneous breathing was simulated with a mechanical ventilator, lung model, and servo-controlled heated humidifier at tidal volumes of 300, 500, and 700 mL, and breathing frequencies of 10 and 20 breaths/min. Expired gas was warmed to 37°C. The high-flow CPAP system was set to deliver 15, 30, and 45 L/min. With the 8 HMEs that were equipped with ports to deliver oxygen, and with the high-flow CPAP system, measurements were taken when delivering 0 and 3 L/min of dry oxygen. After stabilization we measured the absolute humidity (AH) of inspired gas with a hygrometer. AH differed among HMEs applied to tracheostomized patients with spontaneous breathing. For all the HMEs, as tidal volume increased, AH decreased. At 20 breaths/min, AH was higher than at 10 breaths/min. For all the HMEs, when oxygen was delivered, AH decreased to below 30 mg/L. With an oxygen mask and high-flow CPAP, at all settings, AH exceeded 30 mg/L. None of the HMEs provided adequate humidification when supplemental oxygen was added. In the ICU, caution is required when applying HME to tracheostomized patients with spontaneous breathing, especially when supplemental oxygen is required.

  13. The Lack, Magill and Bain anaesthetic breathing systems: a direct comparison in spontaneously-breathing anaesthetized adults.

    OpenAIRE

    Humphrey, D

    1982-01-01

    The performances of the Lack (Mapleson A), Magill (Mapleson A) and Bain (Mapleson D) anaesthetic breathing systems were compared in each of 20 anaesthetized adult patients breathing spontaneously with fresh gas flows of 70 ml kg-1 min-1. In every patient the Lack system caused the least rebreathing, as seen by the lowest inspired and end-expired CO2 tensions using capnography. The Magill caused more rebreathing than the Lack though less than the Bain. Comparative fresh gas flows for each syst...

  14. Time-varying respiratory system elastance: a physiological model for patients who are spontaneously breathing.

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    Chiew, Yeong Shiong; Pretty, Christopher; Docherty, Paul D; Lambermont, Bernard; Shaw, Geoffrey M; Desaive, Thomas; Chase, J Geoffrey

    2015-01-01

    Respiratory mechanics models can aid in optimising patient-specific mechanical ventilation (MV), but the applications are limited to fully sedated MV patients who have little or no spontaneously breathing efforts. This research presents a time-varying elastance (E(drs)) model that can be used in spontaneously breathing patients to determine their respiratory mechanics. A time-varying respiratory elastance model is developed with a negative elastic component (E(demand)), to describe the driving pressure generated during a patient initiated breathing cycle. Data from 22 patients who are partially mechanically ventilated using Pressure Support (PS) and Neurally Adjusted Ventilatory Assist (NAVA) are used to investigate the physiology relevance of the time-varying elastance model and its clinical potential. E(drs) of every breathing cycle for each patient at different ventilation modes are presented for comparison. At the start of every breathing cycle initiated by patient, E(drs) is 25 cmH2Os/l and thus can be used as an acute respiratory distress syndrome (ARDS) severity indicator. The E(drs) model captures unique dynamic respiratory mechanics for spontaneously breathing patients with respiratory failure. The model is fully general and is applicable to both fully controlled and partially assisted MV modes.

  15. Time-varying respiratory system elastance: a physiological model for patients who are spontaneously breathing.

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    Yeong Shiong Chiew

    Full Text Available BACKGROUND: Respiratory mechanics models can aid in optimising patient-specific mechanical ventilation (MV, but the applications are limited to fully sedated MV patients who have little or no spontaneously breathing efforts. This research presents a time-varying elastance (E(drs model that can be used in spontaneously breathing patients to determine their respiratory mechanics. METHODS: A time-varying respiratory elastance model is developed with a negative elastic component (E(demand, to describe the driving pressure generated during a patient initiated breathing cycle. Data from 22 patients who are partially mechanically ventilated using Pressure Support (PS and Neurally Adjusted Ventilatory Assist (NAVA are used to investigate the physiology relevance of the time-varying elastance model and its clinical potential. E(drs of every breathing cycle for each patient at different ventilation modes are presented for comparison. RESULTS: At the start of every breathing cycle initiated by patient, E(drs is 25 cmH2Os/l and thus can be used as an acute respiratory distress syndrome (ARDS severity indicator. CONCLUSION: The E(drs model captures unique dynamic respiratory mechanics for spontaneously breathing patients with respiratory failure. The model is fully general and is applicable to both fully controlled and partially assisted MV modes.

  16. Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants.

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    Göpel, Wolfgang; Kribs, Angela; Härtel, Christoph; Avenarius, Stefan; Teig, Norbert; Groneck, Peter; Olbertz, Dirk; Roll, Claudia; Vochem, Matthias; Weller, Ursula; von der Wense, Axel; Wieg, Christian; Wintgens, Jürgen; Preuss, Michael; Ziegler, Andreas; Roth, Bernhard; Herting, Egbert

    2015-03-01

    Providing less invasive surfactant administration (LISA) to spontaneously breathing preterm infants has been reported to reduce mechanical ventilation and bronchopulmonary dysplasia (BPD) in randomised controlled trials. This large cohort study compared these outcome measures between LISA-treated infants and controls. Infants receiving LISA, who were born before 32 gestational weeks and enrolled in the German Neonatal Network, were matched to control infants by gestational age, umbilical cord pH, Apgar-score at 5 min, small for gestational age status, antenatal treatment with steroids, gender and highest supplemental oxygen during the first 12 h of life. Outcome data were compared with chi-square and Mann-Whitney U-tests and adjusted for multiple comparisons. Between 2009 and 2012, 1103 infants were treated with LISA at 37 centres. LISA infants had lower rates of mechanical ventilation (41% versus 62%, p mechanical ventilation and BPD. Additional large-scale randomised controlled trials are needed to assess the possible long-term benefits of LISA. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  17. Extubation after breathing trials with automatic tube compensation, T-tube, or pressure support ventilation.

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    Haberthür, C; Mols, G; Elsasser, S; Bingisser, R; Stocker, R; Guttmann, J

    2002-09-01

    Automatic tube compensation (ATC) is a new option to compensate for the pressure drop across the endotracheal or tracheostomy tube (ETT), especially during ventilator-assisted spontaneous breathing. While several benefits of this mode have so far been documented, ATC has not yet been used to predict whether the ETT could be safely removed at the end of weaning, from mechanical ventilation. We undertook a systematic trial using a randomized block design. During a 2-year period, all eligible patients of a medical intensive care unit were treated with ATC, conventional pressure support ventilation (PSV, 5 cmH2O), or T-tube for 2-h. Tolerance of the breathing trial served as a basis for the decision to remove the endotracheal tube. Extubation failure was considered if reintubation was necessary or if the patient required non-invasive ventilatory assistance (both within 48 h). After the inclusion of 90 patients (30 per group) we did not observe significant differences between the modes. Twelve patients failed the initial weaning trial. However, half of the patients who appeared to fail the spontaneous breathing trial on the T-tube, PSV, or both, were successfully extubated after a succeeding trial with ATC. Extubation was thus withheld from four and three of these patients while breathing with PSV or the T-tube, respectively, but to any patient breathing with ATC. It seems that ATC can be used as an alternative mode during the final phase of weaning from mechanical ventilation. Furthermore, this study may promote a larger multicenter trial on weaning with ATC compared with standard modes.

  18. Can a central blood volume deficit be detected by systolic pressure variation during spontaneous breathing?

    DEFF Research Database (Denmark)

    Dahl, Michael; Hayes, Chris; Steen Rasmussen, Bodil

    2016-01-01

    BACKGROUND: Whether during spontaneous breathing arterial pressure variations (APV) can detect a volume deficit is not established. We hypothesized that amplification of intra-thoracic pressure oscillations by breathing through resistors would enhance APV to allow identification of a reduced...... resistors. A brachial arterial catheter was used to measure blood pressure and thus systolic pressure variation (SPV), pulse pressure variation and stroke volume variation . Pulse contour analysis determined stroke volume (SV) and CO and we evaluated whether APV could detect a 10 % decrease in CO. RESULTS...... (from 21 (±15)% to 30 (±13)%). Yet during head-up tilt, a SPV ≥ 37 % predicted a decrease in CO ≥ 10 % with a sensitivity and specificity of 78 % and 100 %, respectively. CONCLUSION: In spontaneously breathing healthy volunteers combined inspiratory and expiratory resistors enhance SPV during head...

  19. Spontaneous breathing during anaesthesia: first, do no harm

    OpenAIRE

    Drummond, Gordon B

    2007-01-01

    Controlled respiration and mechanical ventilation have long been part of anaesthetic practice. Modern surgery, anaesthetic techniques, and new agents require a reappraisal of this established habit. In many circumstances the adverse effects of mechanical ventilation can be avoided by the use of the laryngeal mask and allowing spontaneous ventilation. In addition to the more prominent advantages, such as less sore throat, reliable assessment of anaesthetic depth, and good recovery, there may b...

  20. An expiratory assist during spontaneous breathing can compensate for endotracheal tube resistance.

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    Uchiyama, Akinori; Chang, Cheng; Suzuki, Shinya; Mashimo, Takashi; Fujino, Yuji

    2009-08-01

    Although inspiratory assist of spontaneous breathing in intubated patients is common, expiratory assist functions have rarely been reported. Effective expiratory support (ES) could be used to compensate for endotracheal tube (ETT) resistance during spontaneous breathing. In this study, we examined the performance of a new system designed to provide both inspiratory support (IS) and ES during spontaneous breathing with the goal of reducing the effective resistance of the ETT. The ES system consisted of a ventilator demand valve and a computer-controlled piston cylinder, which aspirated gas from the respiratory circuit during the expiratory phase. The movement of the piston was synchronized with spontaneous breathing. We compared the pressures at the tip of the ETT and in the breathing circuit during spontaneous breathing through an ETT of internal diameter (ID) 5 mm with that of an ETT with ID 8 mm in nine healthy adult male volunteers. The ventilatory mode was set to maintain a continuous airway pressure of 0 cm H(2)O. Three ventilator settings (no support, IS only, and IS plus ES) were compared using ID 5 mm ETT. We monitored pressure in the breathing circuit (P(aw)), ETT tip pressure (P(tip)), and respiratory flow. The P(tip) of the ID 5 mm ETT showed a large negative deflection during inspiration and a positive deflection during expiration without support. IS alone did not improve the respiratory pattern through the small ETT. However, IS plus ES resulted in negative P(aw) during expiration in addition to positive deflection of P(aw) during inspiration, making the pressure characteristics of P(tip) similar to those of ID 8 mm ETT. Moreover, IS plus ES produced a respiratory pattern through the ID 5 mm ETT that was similar to that through the ID 8 mm ETT. In this study of healthy volunteers, IS plus ES compensated for the airway resistance imposed by a ID 5.0 mm ETT to create pressure changes at the tip of the ETT similar to those of an ID 8.0 mm ETT.

  1. The Lack, Magill and Bain anaesthetic breathing systems: a direct comparison in spontaneously-breathing anaesthetized adults.

    Science.gov (United States)

    Humphrey, D

    1982-01-01

    The performances of the Lack (Mapleson A), Magill (Mapleson A) and Bain (Mapleson D) anaesthetic breathing systems were compared in each of 20 anaesthetized adult patients breathing spontaneously with fresh gas flows of 70 ml kg-1 min-1. In every patient the Lack system caused the least rebreathing, as seen by the lowest inspired and end-expired CO2 tensions using capnography. The Magill caused more rebreathing than the Lack though less than the Bain. Comparative fresh gas flows for each system at the point where rebreathing started to occur were examined in 10 further patients. The Lack system required approximately 51 ml kg-1 min-1, the Magill 72 ml kg-1 min-1 while the Bain required 153 ml kg-1 min-1. Of the three systems the Lack is concluded to be the most efficient and economical system for spontaneous respiration in adults, with the additional advantages of convenient access to the exhaust valve, easy scavenging and low expiratory resistance. In addition, it also offers many useful advantages over the circle absorber system. Images Figure 1. PMID:6806473

  2. THE DIFFERENCE IN RESPIRATORY AND BLOOD GAS VALUES DURING RECOVERY AFTER EXERCISE WITH SPONTANEOUS VERSUS REDUCED BREATHING FREQUENCY

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    Jernej Kapus

    2009-09-01

    Full Text Available Extrapolation from post-exercise measurements has been used to estimate respiratory and blood gas parameters during exercise. This may not be accurate in exercise with reduced breathing frequency (RBF, since spontaneous breathing usually follows exercise. This study was performed to ascertain whether measurement of oxygen saturation and blood gases immediately after exercise accurately reflected their values during exercise with RBF. Eight healthy male subjects performed an incremental cycling test with RBF at 10 breaths per minute. A constant load test with RBF (B10 was then performed to exhaustion at the peak power output obtained during the incremental test. Finally, the subjects repeated the constant load test with spontaneous breathing (SB using the same protocol as B10. Pulmonary ventilation (VE, end-tidal oxygen (PETO2, and carbon dioxide pressures (PETCO2 and oxygen saturation (SaO2 were measured during both constant load tests. The partial pressures of oxygen (PO2 and carbon dioxide (PCO2 in capillary blood were measured during the last minute of exercise, immediately following exercise and during the third minute of recovery. At the end of exercise RBF resulted in lower PETO2, SaO2 and PO2, and higher PETCO2 and PCO2 when compared to spontaneous breathing during exercise. Lower SaO2 and PETO2 were detected only for the first 16s and 20s of recovery after B10 compared to the corresponding period in SB. There were no significant differences in PO2 between SB and B10 measured immediately after the exercise. During recovery from exercise, PETCO2 remained elevated for the first 120s in the B10 trial. There were also significant differences between SB and B10 in PCO2 immediately after exercise. We conclude that RBF during high intensity exercise results in hypoxia; however, due to post-exercise hyperpnoea, measurements of blood gas parameters taken 15s after cessation of exercise did not reflect the changes in PO2 and SaO2 seen during

  3. [Nursing outcomes for ineffective breathing patterns and impaired spontaneous ventilation in intensive care].

    Science.gov (United States)

    do Canto, Débora Francisco; Almeida, Miriam de Abreu

    2013-12-01

    This study aimed to validate the results of Nursing selected from the link NANDA-I-NOC (Nursing Outcomes Classification--NANDA--International) for diagnosis Ineffective Breathing Pattern and Impaired Spontaneous Ventilation in adult intensive care unit. This is a content validation study conducted in a university hospital in southern Brazil with 15 expert nurses with clinical experience and knowledge of the ratings. The instruments contained five-point Likert scales to rate the importance of each outcome (1st step) and indicator (Step 2) for the diagnoses studied. We calculated weighted averages for each outcome/indicator, considering) 1 = 0. 2 = 0.25, 3 = 0.50 4 = 0.75 and 5 = 1. The outcomes suggested by the NOC with averages above 0.8 were considered validated as well as the indicators. The results Respiratory State--airway permeability (Ineffective Breathing Patterns) and 11 indicators, and Response to mechanical ventilation: adult (Impaired Spontaneous Ventilation) with 26 indicators were validated.

  4. Randomised Comparison of the AMBU AuraOnce Laryngeal Mask and the LMA Unique Laryngeal Mask Airway in Spontaneously Breathing Adults

    OpenAIRE

    Williams, Daryl Lindsay; Zeng, James M.; Alexander, Karl D.; Andrews, David T.

    2012-01-01

    We conducted a randomised single-blind controlled trial comparing the LMA-Unique (LMAU) and the AMBU AuraOnce (AMBU) disposable laryngeal mask in spontaneously breathing adult patients undergoing general anaesthesia. Eighty-two adult patients (ASA status I–IV) were randomly allocated to receive the LMAU or AMBU and were blinded to device selection. Patients received a standardized anesthetic and all airway devices were inserted by trained anaesthetists. Size selection was guided by manufactur...

  5. In vitro evaluation of heat and moisture exchangers designed for spontaneously breathing tracheostomized patients.

    Science.gov (United States)

    Brusasco, Claudia; Corradi, Francesco; Vargas, Maria; Bona, Margherita; Bruno, Federica; Marsili, Maria; Simonassi, Francesca; Santori, Gregorio; Severgnini, Paolo; Kacmarek, Robert M; Pelosi, Paolo

    2013-11-01

    Heat and moisture exchangers (HMEs) are commonly used in chronically tracheostomized spontaneously breathing patients, to condition inhaled air, maintain lower airway function, and minimize the viscosity of secretions. Supplemental oxygen (O2) can be added to most HMEs designed for spontaneously breathing tracheostomized patients. We tested the efficiency of 7 HMEs designed for spontaneously breathing tracheostomized patients, in a normothermic model, at different minute ventilations (VE) and supplemental O2 flows. HME efficiency was evaluated using an in vitro lung model at 2 VE (5 and 15 L/min) and 4 supplemental O2 flows (0, 3, 6, and 12 L/min). Wet and dry temperatures of the inspiratory flow were measured, and absolute humidity was calculated. In addition, HME efficiency at 0, 12, and 24 h use was evaluated, as well as resistance to flow at 0 and 24 h. The progressive increase in O2 flow from 0 to 12 L/min was associated with a reduction in temperature and absolute humidity. Under the same conditions, this effect was greater at lower VE. The HME with the best performance provided an absolute humidity of 26 mg H2O/L and a temperature of 27.8 °C. No significant changes in efficiency or resistance were detected during the 24 h evaluation. The efficiency of HMEs in terms of temperature and absolute humidity is significantly affected by O2 supplementation and V(E).

  6. Comparison of trapezius squeeze test and jaw thrust as clinical indicators for laryngeal mask airway insertion in spontaneously breathing children

    Directory of Open Access Journals (Sweden)

    K K Dinesh Kumar

    2017-01-01

    Conclusion: Both JT and TPZ are equivalent clinical indicators in predicting the optimal conditions of LMA insertion in spontaneously breathing children; however, it takes a longer time to achieve a negative TPZ squeeze test.

  7. Respiratory variations in the photoplethysmographic waveform: acute hypovolaemia during spontaneous breathing is not detected

    International Nuclear Information System (INIS)

    Nilsson, Lena; Goscinski, Tomas; Lindenberger, Marcus; Länne, Toste; Johansson, Anders

    2010-01-01

    Recent studies using photoplethysmographic (PPG) signals from pulse oximeters have shown potential to assess hypovolaemia during spontaneous breathing. This signal is heavily filtered and reports are based on respiratory variations in the small pulse synchronous variation of PPG. There are stronger respiratory variations such as respiratory synchronous variation (PPGr) in the baseline of the unfiltered PPG signal. We hypothesized that PPGr would increase during hypovolaemia during spontaneous breathing. Hemodynamic and respiratory data were recorded together with PPG infrared signals from the finger, ear and forearm from 12 healthy male volunteers, at rest and during hypovolaemia created by the application of a lower body negative pressure (LBNP) of 15, 30 and 60 cmH 2 O. Hemodynamic and respiratory values changed significantly. From rest to the LBNP of 60 cmH 2 O systolic blood pressure fell from median (IQR) 116 (16) to 101 (23) mmHg, the heart rate increased from 58 (16) to 73 (16) beats min −1 , and the respiratory rate increased from 9.5 (2.0) to 11.5 (4.0) breaths min −1 . The amplitude of PPGr did not change significantly at any measurement site. The strongest effect was seen at the ear, where the LBNP of 60 cmH 2 O gave an amplitude increase from 1.0 (0.0) to 1.31 (2.24) AU. PPG baseline respiratory variations cannot be used for detecting hypovolaemia in spontaneously breathing subjects

  8. Whole body hyperthermia by extracorporeal circulation in spontaneously breathing sarcoma patients: hemodynamics and oxygen metabolism.

    Science.gov (United States)

    Locker, Gottfried J; Fuchs, Eva-Maria; Worel, Nina; Bojic, Andja; Heinrich, Gerhard; Brodowicz, Thomas; Clodi, Martin; Funk, Georg-Christian; Knöbl, Paul; Zielinski, Christoph C; Köstler, Wolfgang J

    2011-11-01

    This phase I study was performed to evaluate the feasibility and toxicity of a new method of extracorporeal perfusion-induced whole body hyperthermia (WBHT) in patients with advanced sarcoma avoiding the need of intubation and general anesthesia. One double-lumen femoral venous access was inserted by Seldinger's technique to obtain WBHT (41.8°C for 120 minutes) via an extracorporeal circuit. No concomitant chemotherapy was applied. Up to 4 treatments of WBHT were performed under moderate sedation in 6 spontaneously breathing patients. Invasive hemodynamic monitoring was performed by use of a pulmonary artery catheter. After their first WBHT session, 2 patients were excluded from further treatment due to transient liver toxicity or catheter-related complication, so a total of 12 cycles remained for analyses. In all patients, conscious sedation resulted in sufficient spontaneous respiration without the need for mandatory ventilation. Median time to reach the target temperature was 84 minutes (range 60-142). Hemodynamic changes revealed the expected hyperdynamic state: heart rate, cardiac index, and stroke volume index significantly increased (pmean; 0.062 µg·kg¹·min⁻¹) were necessary to maintain the mean arterial blood pressure >60 mmHg. Our data demonstrate the feasibility of this method of extracorporeal WBHT without mandatory ventilation. Hemodynamic side effects in spontaneously breathing patients during perfusion-induced WBHT seem less severe than those observed in radiant heat WBHT.

  9. The effects of passive humidifier dead space on respiratory variables in paralyzed and spontaneously breathing patients.

    Science.gov (United States)

    Campbell, R S; Davis, K; Johannigman, J A; Branson, R D

    2000-03-01

    Passive humidifiers have gained acceptance in the intensive care unit because of their low cost, simple operation, and elimination of condensate from the breathing circuit. However, the additional dead space of these devices may adversely affect respiratory function in certain patients. This study evaluates the effects of passive humidifier dead space on respiratory function. Two groups of patients were studied. The first group consisted of patients recovering from acute lung injury and breathing spontaneously on pressure support ventilation. The second group consisted of patients who were receiving controlled mechanical ventilation and were chemically paralyzed following operative procedures. All patients used 3 humidification devices in random order for one hour each. The devices were a heated humidifier (HH), a hygroscopic heat and moisture exchanger (HHME) with a dead space of 28 mL, and a heat and moisture exchanger (HME) with a dead space of 90 mL. During each measurement period the following were recorded: tidal volume, minute volume, respiratory frequency, oxygen consumption, carbon dioxide production, ratio of dead space volume to tidal volume (VD/VT), and blood gases. In the second group, intrinsic positive end-expiratory pressure was also measured. Addition of either of the passive humidifiers was associated with increased VD/VT. In spontaneously breathing patients, VD/VT increased from 59 +/- 13 (HH) to 62 +/- 13 (HHME) to 68 +/- 11% (HME) (p < 0.05). In these patients, constant alveolar ventilation was maintained as a result of increased respiratory frequency, from 22.1 +/- 6.6 breaths/min (HH) to 24.5 +/- 6.9 breaths/min (HHME) to 27.7 +/- 7.4 breaths/min (HME) (p < 0.05), and increased minute volume, from 9.1 +/- 3.5 L/min (HH) to 9.9 +/- 3.6 L/min (HHME) to 11.7 +/- 4.2 L/min (HME) (p < 0.05). There were no changes in blood gases or carbon dioxide production. In the paralyzed patient group, VD/VT increased from 54 +/- 12% (HH) to 56 +/- 10% (HHME

  10. Using an expiratory resistor, arterial pulse pressure variations predict fluid responsiveness during spontaneous breathing: an experimental porcine study.

    Science.gov (United States)

    Dahl, Michael K; Vistisen, Simon T; Koefoed-Nielsen, Jacob; Larsson, Anders

    2009-01-01

    Fluid responsiveness prediction is difficult in spontaneously breathing patients. Because the swings in intrathoracic pressure are minor during spontaneous breathing, dynamic parameters like pulse pressure variation (PPV) and systolic pressure variation (SPV) are usually small. We hypothesized that during spontaneous breathing, inspiratory and/or expiratory resistors could induce high arterial pressure variations at hypovolemia and low variations at normovolemia and hypervolemia. Furthermore, we hypothesized that SPV and PPV could predict fluid responsiveness under these conditions. Eight prone, anesthetized and spontaneously breathing pigs (20 to 25 kg) were subjected to a sequence of 30% hypovolemia, normovolemia, and 20% and 40% hypervolemia. At each volemic level, the pigs breathed in a randomized order either through an inspiratory and/or an expiratory threshold resistor (7.5 cmH2O) or only through the tracheal tube without any resistor. Hemodynamic and respiratory variables were measured during the breathing modes. Fluid responsiveness was defined as a 15% increase in stroke volume (DeltaSV) following fluid loading. Stroke volume was significantly lower at hypovolemia compared with normovolemia, but no differences were found between normovolemia and 20% or 40% hypervolemia. Compared with breathing through no resistor, SPV was magnified by all resistors at hypovolemia whereas there were no changes at normovolemia and hypervolemia. PPV was magnified by the inspiratory resistor and the combined inspiratory and expiratory resistor. Regression analysis of SPV or PPV versus DeltaSV showed the highest R2 (0.83 for SPV and 0.52 for PPV) when the expiratory resistor was applied. The corresponding sensitivity and specificity for prediction of fluid responsiveness were 100% and 100%, respectively, for SPV and 100% and 81%, respectively, for PPV. Inspiratory and/or expiratory threshold resistors magnified SPV and PPV in spontaneously breathing pigs during hypovolemia

  11. Ventilation and Haemodynamic Indicators in Spontaneously Breathing Pigs under General Anaesthesia

    Directory of Open Access Journals (Sweden)

    Jiří Kobr

    2010-01-01

    Full Text Available The aim of this study was to obtain ventilation and haemodynamic data of healthy piglets under general anaesthesia for future patho-physiological experimental studies. A total of 34 domestic piglets of the Czech Black Pied (Přeštice breed were used in the study. The animals (male to female ratio 8 : 9 were six weeks old and their average body mass was 22 kg. A general anaesthetic (fentanyl and azaperon was introduced via a pulmonary artery catheter and the spontaneously breathing animals were monitored for 60 min. Cardiac output and haemodynamic indicators were established using intermittent pulmonary artery thermodilution. Blood gas data were deduced using fan dynamic parameters of ventilation and ventilation indices. The study yielded reliable data of dynamic lung indicators (p 2O/kg, and haemodynamic indicators (p < 0.01 such as cardiac output 2.12 ± 0.75 l/min, pulmonary vascular resistance 3.92 ± 0.52 and systemic vascular resistance 15.8 ± 6.81 Woods units. Reliable data regarding lung dynamics, cardiac output, preload and afterload of both heart ventricles in spontaneously breathing healthy piglets under general anaesthesia were achieved.

  12. Spontaneous breathing test in the prediction of extubation failure in the pediatric population.

    Science.gov (United States)

    Nascimento, Milena Siciliano; Rebello, Celso Moura; Vale, Luciana Assis Pires Andrade; Santos, Érica; Prado, Cristiane do

    2017-01-01

    To assess whether the spontaneous breathing test can predict the extubation failure in pediatric population. A prospective and observational study that evaluated data of inpatients at the Pediatric Intensive Care Unit between May 2011 and August 2013, receiving mechanical ventilation for at least 24 hours followed by extubation. The patients were classified in two groups: Test Group, with patients extubated after spontaneous breathing test, and Control Group, with patients extubated without spontaneous breathing test. A total of 95 children were enrolled in the study, 71 in the Test Group and 24 in the Control Group. A direct comparison was made between the two groups regarding sex, age, mechanical ventilation time, indication to start mechanical ventilation and respiratory parameters before extubation in the Control Group, and before the spontaneous breathing test in the Test Group. There was no difference between the parameters evaluated. According to the analysis of probability of extubation failure between the two groups, the likelihood of extubation failure in the Control Group was 1,412 higher than in the Test Group, nevertheless, this range did not reach significance (p=0.706). This model was considered well-adjusted according to the Hosmer-Lemeshow test (p=0.758). The spontaneous breathing test was not able to predict the extubation failure in pediatric population. Avaliar se o teste de respiração espontânea pode ser utilizado para predizer falha da extubação na população pediátrica. Estudo prospectivo, observacional, no qual foram avaliados todos os pacientes internados no Centro de Terapia Intensiva Pediátrica, no período de maio de 2011 a agosto de 2013, que utilizaram ventilação mecânica por mais de 24 horas e que foram extubados. Os pacientes foram classificados em dois grupos: Grupo Teste, que incluiu os pacientes extubados depois do teste de respiração espontânea; e Grupo Controle, pacientes foram sem teste de respiração espont

  13. Liberation From Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: Inspiratory Pressure Augmentation During Spontaneous Breathing Trials, Protocols Minimizing Sedation, and Noninvasive Ventilation Immediately After Extubation.

    Science.gov (United States)

    Ouellette, Daniel R; Patel, Sheena; Girard, Timothy D; Morris, Peter E; Schmidt, Gregory A; Truwit, Jonathon D; Alhazzani, Waleed; Burns, Suzanne M; Epstein, Scott K; Esteban, Andres; Fan, Eddy; Ferrer, Miguel; Fraser, Gilles L; Gong, Michelle Ng; Hough, Catherine L; Mehta, Sangeeta; Nanchal, Rahul; Pawlik, Amy J; Schweickert, William D; Sessler, Curtis N; Strøm, Thomas; Kress, John P

    2017-01-01

    An update of evidence-based guidelines concerning liberation from mechanical ventilation is needed as new evidence has become available. The American College of Chest Physicians (CHEST) and the American Thoracic Society (ATS) have collaborated to provide recommendations to clinicians concerning liberation from the ventilator. Comprehensive evidence syntheses, including meta-analyses, were performed to summarize all available evidence relevant to the guideline panel's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, and the results were summarized in evidence profiles. The evidence syntheses were discussed and recommendations developed and approved by a multidisciplinary committee of experts in mechanical ventilation. Recommendations for three population, intervention, comparator, outcome (PICO) questions concerning ventilator liberation are presented in this document. The guideline panel considered the balance of desirable (benefits) and undesirable (burdens, adverse effects, costs) consequences, quality of evidence, feasibility, and acceptability of various interventions with respect to the selected questions. Conditional (weak) recommendations were made to use inspiratory pressure augmentation in the initial spontaneous breathing trial (SBT) and to use protocols to minimize sedation for patients ventilated for more than 24 h. A strong recommendation was made to use preventive noninvasive ventilation (NIV) for high-risk patients ventilated for more than 24 h immediately after extubation to improve selected outcomes. The recommendations were limited by the quality of the available evidence. The guideline panel provided recommendations for inspiratory pressure augmentation during an initial SBT, protocols minimizing sedation, and preventative NIV, in relation to ventilator liberation. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights

  14. Coupled and reduced dimensional modeling of respiratory mechanics during spontaneous breathing.

    Science.gov (United States)

    Ismail, M; Comerford, A; Wall, W A

    2013-11-01

    In this paper, we develop a total lung model based on a tree of 0D airway and acinar models for studying respiratory mechanics during spontaneous breathing. This model utilizes both computer tomography-based geometries and artificially generated lobe-filling airway trees to model the entire conducting region of the lung. Beyond the conducting airways, we develop an acinar model, which takes into account the alveolar tissue resistance, compliance, and the intrapleural pressure. With this methodology, we compare four different 0D models of airway mechanics and determine the best model based on a comparison with a 3D-0D coupled model of the conducting airways; this methodology is possible because the majority of airway resistance is confined to the lower generations, that is, the trachea and the first few bronchial generations. As an example application of the model, we simulate the flow and pressure dynamics under spontaneous breathing conditions, that is, at flow conditions driven purely by pleural space pressure. The results show good agreement, both qualitatively and quantitatively, with reported physiological values. One of the key advantages of this model is the ability to provide insight into lung ventilation in the peripheral regions. This is often crucial because this is where information, specifically for studying diseases and gas exchange, is needed. Thus, the model can be used as a tool for better understanding local peripheral lung mechanics without excluding the upper portions of the lung. This tool will be also useful for in vitro investigations of lung mechanics in both health and disease. Copyright © 2013 John Wiley & Sons, Ltd.

  15. Measurement of end-tidal carbon dioxide in spontaneously breathing children after cardiac surgery.

    Science.gov (United States)

    Rasera, Carmen Caroline; Gewehr, Pedro Miguel; Domingues, Adriana Maria Trevisan; Junior, Fernando Faria

    2011-09-01

    Respiratory monitoring is important after surgery to prevent pulmonary complications. End-tidal carbon dioxide (Petco(2)) measurement by capnometry is an indirect and noninvasive measurement of Pco(2) in blood and is accepted and recognized in critical care. To determine the correlation and level of agreement between Petco(2) and Paco(2) in spontaneously breathing children after cardiac surgery and to determine whether Petco(2) measured by using tidal volume (Vt-Petco(2)) or vital capacity (VC-Petco(2)) shows more or less significant correlation with Paco(2). Vt-Petco(2) and VC-Petco(2) by capnometry and Paco(2) by blood gas analysis were measured once a day after tracheal extubation. The determination coefficient and degree of bias between the methods were assessed in children with and without supplemental oxygen. A total of 172 Vt-Petco(2), VC-Petco(2), and Paco(2) values from 48 children were analyzed. The overall coefficients of determination were 0.84 (P breathing children, Vt-Petco(2) provided a more accurate estimate of Paco(2) than did VC-Petco(2), especially in children given little or no supplemental oxygen. The difference between the methods was significantly larger in the groups given 2 to 5 L of oxygen per minute.

  16. Model-based estimation of loop gain using spontaneous breathing: A validation study

    Science.gov (United States)

    Gederi, Elnaz; Nemati, Shamim; Edwards, Bradley A.; Clifford, Gari D.; Malhotra, Atul; Wellman, Andrew

    2014-01-01

    Non-invasive assessment of ventilatory control stability or loop gain (which is a key contributor in a number of sleep-related breathing disorders) has proven to be cumbersome. We present a novel multivariate autoregressive model that we hypothesize will enable us to make time-varying measurements of loop gain using nothing more than spontaneous fluctuations in ventilation and CO2. The model is adaptive to changes in the feedback control loop and therefore can account for system non-stationarities (e.g. changes in sleep state) and it is resistant to artifacts by using a signal quality measure. We tested this method by assessing its ability to detect a known increase in loop gain induced by proportional assist ventilation (PAV). Subjects were studied during sleep while breathing on continuous positive airway pressure (CPAP) alone (to stabilize the airway) or on CPAP + PAV. We show that the method tracked the PAV-induced increase in loop gain, demonstrating its time-varying capabilities, and it remained accurate in the face of measurement related artifacts. The model was able to detect a statistically significant increase in loop gain from 0.14 ± 10 on CPAP alone to 0.21 ± 0.13 on CPAP + PAV (p PAV-induced increase in loop gain was predominantly driven by an increase in controller gain. Taken together, these data provide compelling evidence for the validity of this technique. PMID:25038522

  17. Spontaneous breathing or mechanical ventilation alters lung compliance and tissue association of exogenous surfactant in preterm newborn rabbits.

    Science.gov (United States)

    Bohlin, Kajsa; Bouhafs, Rabea K L; Jarstrand, Connie; Curstedt, Tore; Blennow, Mats; Robertson, Bengt

    2005-05-01

    In preterm infants with respiratory distress syndrome, surfactant administration followed by immediate extubation to spontaneous breathing with nasal continuous positive airway pressure reduces the need for mechanical ventilation. With this treatment approach, repeated doses of surfactant are rarely indicated. We used a rabbit model to test the hypothesis that exogenous surfactant therapy followed by spontaneous breathing results in a more sustained initial treatment response compared with treatment followed by mechanical ventilation. Preterm rabbits (gestational age 28.5 d) were treated with pharyngeal deposition of 200 mg/kg radiolabeled surfactant (14C-Curosurf) and randomized to 4 h of spontaneous breathing or mechanical ventilation or to a control group, killed immediately after surfactant administration. With pharyngeal deposition, 46 +/- 10% (mean +/- SEM) of the administered surfactant reached the lungs. The dynamic lung-thorax compliance was higher in spontaneously breathing compared with mechanically ventilated animals (median, 9.9 and 0.75 ml x cm H2O(-1) x kg(-1), respectively; p mechanically ventilated animals (p mechanically ventilated animals. We conclude that the initial lung tissue association of exogenous surfactant is impaired by mechanical ventilation. This is associated with a reduction of dynamic compliance and evidence of increased surfactant inactivation.

  18. A nasal catheter for the measurement of end-tidal carbon dioxide in spontaneously breathing patients: a preliminary evaluation.

    Science.gov (United States)

    Raheem, Mohamed Samy Abdel; Wahba, Olaa M

    2010-04-01

    Several devices have been proposed to monitor end-tidal carbon dioxide tension (Petco(2)) in spontaneously breathing patients; however, many have been reported to be inaccurate. We designed this study to investigate the accuracy of a balloon-tipped nasal catheter in measuring Petco(2) in nontracheally intubated, spontaneously breathing patients. The catheter was assembled using a 14-F rubber Foley catheter, a tracheal tube pilot balloon, and the plastic sheath from an 18-gauge needle. The catheter was connected to the sampling tube of a gas analyzer. Petco(2) and Paco(2) were determined simultaneously in 20 otherwise healthy postsurgical patients while receiving oxygen. The mean Petco(2) - Paco(2) difference was -4.4 +/- 1.6 (SD) mm Hg with a correlation coefficient r = +0.87 (P breathing patients.

  19. Comparative study of minimal fresh gas flow used in Lack-Plus and Lack's circuit in spontaneously breathing anesthetized adults.

    Science.gov (United States)

    Theerapongpakdee, Sunchai; Sathitkarnmanee, Thepakorn; Tribuddharat, Sirirat; Sucher, Siwalai; Thananun, Maneerat; Nonlhaopol, Duangthida

    2016-01-01

    The Lack's circuit is a co-axial Mapleson A breathing system commonly used in spontaneously breathing anesthetized adults but still requires high fresh gas flow (FGF). The Lack-Plus circuit was invented with the advantage of lower FGF requirement. The authors compared the Lack-Plus and Lack's circuit for the minimal FGF requirement with no rebreathing in spontaneously breathing anesthetized adults. This was a randomized crossover study. We enrolled 24 adult patients undergoing supine elective surgery, with a body mass index ≤30 kg/m 2 and an American Society of Anesthesiologists physical status I-II. They were randomly allocated to group 1 (LP-L) starting with Lack-Plus then switching to Lack's circuit or group 2 (L-LP) (with the reverse pattern). After induction and intubation, anesthesia was maintained with 50% N 2 O/O 2 and desflurane (4%-6%) plus fentanyl titration to maintain an optimal respiratory rate between 10 and 16/min. Starting with the first circuit, all the patients were spontaneously breathing with a FGF of 4 L/min for 10 min, gradually decreased by 0.5 L/min every 5 min until FGF was 2.5 L/min. End-tidal CO 2 , inspired minimum CO 2 (ImCO 2 ), mean arterial pressure, and oxygen saturation were recorded until rebreathing (ImCO 2 >0 mmHg) occurred. The alternate anesthesia breathing circuit was used and the measurements were repeated. The respective minimal FGF at the point of rebreathing for the Lack-Plus and Lack's circuit was 2.7±0.8 and 3.3±0.5 L/min, respectively, p Lack-Plus circuit can be used safely and effectively, and it requires less FGF than Lack's circuit in spontaneously breathing anesthetized adults.

  20. Spontaneous sleep-like brain state alternations and breathing characteristics in urethane anesthetized mice.

    Directory of Open Access Journals (Sweden)

    Silvia Pagliardini

    Full Text Available Brain state alternations resembling those of sleep spontaneously occur in rats under urethane anesthesia and they are closely linked with sleep-like respiratory changes. Although rats are a common model for both sleep and respiratory physiology, we sought to determine if similar brain state and respiratory changes occur in mice under urethane. We made local field potential recordings from the hippocampus and measured respiratory activity by means of EMG recordings in intercostal, genioglossus, and abdominal muscles. Similar to results in adult rats, urethane anesthetized mice displayed quasi-periodic spontaneous forebrain state alternations between deactivated patterns resembling slow wave sleep (SWS and activated patterns resembling rapid eye movement (REM sleep. These alternations were associated with an increase in breathing rate, respiratory variability, a depression of inspiratory related activity in genioglossus muscle and an increase in expiratory-related abdominal muscle activity when comparing deactivated (SWS-like to activated (REM-like states. These results demonstrate that urethane anesthesia consistently induces sleep-like brain state alternations and correlated changes in respiratory activity across different rodent species. They open up the powerful possibility of utilizing transgenic mouse technology for the advancement and translation of knowledge regarding sleep cycle alternations and their impact on respiration.

  1. [Usefulness of monitoring anaesthesia with the bispectral index in upper gastrointestinal endoscopies with spontaneous breathing].

    Science.gov (United States)

    Alados-Arboledas, F J; Millán-Bueno, M P; Expósito-Montes, J F; Santiago-Gutierrez, C; Arévalo-Garrido, A; Pérez-Parras, A; Millán-Miralles, L; Martínez-Padilla, M C; de la Cruz-Moreno, J

    2013-08-01

    The objective of this investigation is to determine whether bispectral index (BIS®) monitoring during intravenous anaesthesia with spontaneous breathing for upper gastrointestinal endoscopy (UGE) in a pediatric population is useful for: a) decreasing the amount of drug, b) decreasing the time for awakening, and c) improving patient safety. A quasi-experimental case-control prospective study was conducted in the setting of a second level hospital pediatric intensive care unit. Children aged 1-13 years. ASA I patient who needed a diagnostic UGE; eligible, 36, participants, 30. historical cohort of patients who needed UGE (years 2008-2010): 50 patients. UGE performed with anaesthetic protocol, vital signs monitoring, sedation level (Ramsay scale) and BIS monitoring. propofol total dose (mg/kg), induction time, time in performing the UGE, awakening time (min); initial BIS (iBIS), and BIS during the UGE; adverse effects. There were no significant differences in sex, age or weight between case (B) and control (C) population. No significant differences in total propofol doses: (B 4.9 ± 1.4 mg/kg; C 5.2 ± 1.6 mg/kg, P=.492), awakening time (B 12.2 ± 4.6 min; C 12.8 ± 4.4 min, P=.402), time for execution of UGE (B 9.5 ± 4.8 min; C 11.3 ± 6.5 min, P=.335) and induction time (B 11.1 ± 2.6 min; C 10.1 ± 4.2 min, P=.059), iBIS 55.4 ± 6.9. There were no significant differences in adverse effects: 2 patients suffered from mild desaturation in the control group. BIS monitoring for diagnostic UGE in spontaneous breathing in a pediatric population is feasible, but does not appear to decrease awakening time or the amount of propofol needed. Furthermore, there was no statistically significant decrease in the number of adverse effects. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  2. Manual versus target-controlled infusion remifentanil administration in spontaneously breathing patients.

    Science.gov (United States)

    Moerman, Annelies T; Herregods, Luc L; De Vos, Martine M; Mortier, Eric P; Struys, Michel M R F

    2009-03-01

    The combination of propofol-remifentanil for procedural deep sedation in spontaneously breathing patients is characterized by the frequent incidence of side effects, especially respiratory depression. These side effects may be due to either the drug combination or the drug delivery technique. Target-controlled infusion (TCI) might optimize drug delivery. In this prospective, randomized, double-blind study in patients undergoing elective colonoscopy, we thus tried to answer two questions: first, if adding remifentanil to propofol surpasses the disadvantages of the combination of these two products, and second, if administration of remifentanil via TCI decreases the incidence of side effects, compared to manually controlled administration. Patients undergoing elective colonoscopy were randomly assigned to receive remifentanil via manually controlled continuous infusion (MCI) (0.125 microg x kg(-1) x min(-1) for 2 min followed by a continuous infusion of 0.05 microg x kg(-1) x min(-1)), TCI remifentanil (1 ng/mL), or placebo (normal saline either as TCI or manual infusion of equivalent rate). All patients received TCI propofol, adjusted to a target concentration level that provided deep sedation in which patients were not responsive to verbal commands, but maintained spontaneous ventilation without assistance. Significantly more patients in the placebo group showed movement, cough and hiccup, which transiently interfered with the examination. There were no clinically significant differences in hemodynamic or recovery variables among all groups. Remifentanil administered via TCI resulted in a decrease in propofol requirements. The incidence of hypopnea and apnea was less frequent when remifentanil was administered via TCI compared to MCI (TCI n = 7, MCI n = 16, P n = 7, MCI n = 16, P < 0.05), compared to manually controlled administration of remifentanil.

  3. Breathing

    Science.gov (United States)

    ... smaller structures called bronchi. The process of breathing (respiration) is divided into two distinct phases, inspiration (inhalation) and expiration (exhalation). During inspiration, the diaphragm contracts and pulls downward while the muscles between the ribs contract and pull upward. This ...

  4. Analysis of ineffective breathing pattern and impaired spontaneous ventilation of adults with oxygen therapy 1

    Science.gov (United States)

    Seganfredo, Deborah Hein; Beltrão, Beatriz Amorim; da Silva, Viviane Martins; Lopes, Marcos Venícios de Oliveira; Castro, Stela Maris de Jezus; Almeida, Miriam de Abreu

    2017-01-01

    ABSTRACT Objective: to analyze the manifestation of the defining characteristics of the nursing diagnoses of ineffective breathing pattern and impaired spontaneous ventilation, of the NANDA International and the defining characteristics identified in the literature for the concept of “ventilation” in adult patients hospitalized in an intensive care unit with use of oxygen therapy. Method: clinical diagnostic validation study, conducted with 626 patients in intensive care using oxygen therapy, in three different modalities. Multiple correspondence analysis was used to verify the discriminative capacity of the defining characteristics and latent class analysis to determine the diagnostic accuracy of them, based on the severity level defined by the ventilatory mode used. Results: in the multiple correspondence analysis, it was demonstrated that the majority of the defining characteristics presented low discriminative capacity and low percentage of explained variance for the two dimensions (diagnoses). Latent class models, separately adjusted for the two diagnoses, presented a worse fit, with sharing of some defining characteristics. Models adjusted by level of severity (ventilation mode) presented better fit and structure of the component defining characteristics. Conclusion: clinical evidence obtained in the present study seems to demonstrate that the set of defining characteristics of the two nursing diagnoses studied fit better in a single construct. PMID:29211196

  5. Transcutaneous carbon dioxide monitoring in spontaneously breathing, nonintubated patients in the early postoperative period.

    Science.gov (United States)

    Fanelli, G; Baciarello, M; Squicciarini, G; Malagutti, G; Zasa, M; Casati, A

    2008-01-01

    The authors investigated the accuracy of transcutaneous capnometry (TcPCO(2)) in estimating arterial blood carbon dioxide partial pressure (PaCO(2)) during spontaneous breathing in patients admitted to our surgical intensive care unit (ICU). Serial TcPCO(2) and PaCO(2) measurements were taken in stable patients undergoing postoperative monitoring after major abdominal, vascular, or thoracic surgery. Patients were enrolled 12 hours after extubation. Exclusion criteria were pulmonary dysfunction, hemodynamic instability, or anemia. Linear regression, mixed models, and Bland-Altman analyses were used to compare accuracy and correlation between the two variables. Data are presented as means (95% confidence intervals). PaCO(2) values ranged between 26 mmHg and 52 mmHg. Mean values for TcPCO(2) and PaCO(2) were 35.3 (33.8-36.8) mmHg and 39.2 (37.6-40.7) (Pbreathing, nonintubated patients in the early postoperative period.

  6. Analysis of ineffective breathing pattern and impaired spontaneous ventilation of adults with oxygen therapy

    Directory of Open Access Journals (Sweden)

    Deborah Hein Seganfredo

    2017-12-01

    Full Text Available ABSTRACT Objective: to analyze the manifestation of the defining characteristics of the nursing diagnoses of ineffective breathing pattern and impaired spontaneous ventilation, of the NANDA International and the defining characteristics identified in the literature for the concept of “ventilation” in adult patients hospitalized in an intensive care unit with use of oxygen therapy. Method: clinical diagnostic validation study, conducted with 626 patients in intensive care using oxygen therapy, in three different modalities. Multiple correspondence analysis was used to verify the discriminative capacity of the defining characteristics and latent class analysis to determine the diagnostic accuracy of them, based on the severity level defined by the ventilatory mode used. Results: in the multiple correspondence analysis, it was demonstrated that the majority of the defining characteristics presented low discriminative capacity and low percentage of explained variance for the two dimensions (diagnoses. Latent class models, separately adjusted for the two diagnoses, presented a worse fit, with sharing of some defining characteristics. Models adjusted by level of severity (ventilation mode presented better fit and structure of the component defining characteristics. Conclusion: clinical evidence obtained in the present study seems to demonstrate that the set of defining characteristics of the two nursing diagnoses studied fit better in a single construct.

  7. Quantifying Aerosol Delivery in Simulated Spontaneously Breathing Patients With Tracheostomy Using Different Humidification Systems With or Without Exhaled Humidity.

    Science.gov (United States)

    Ari, Arzu; Harwood, Robert; Sheard, Meryl; Alquaimi, Maher Mubarak; Alhamad, Bshayer; Fink, James B

    2016-05-01

    Aerosol and humidification therapy are used in long-term airway management of critically ill patients with a tracheostomy. The purpose of this study was to determine delivery efficiency of jet and mesh nebulizers combined with different humidification systems in a model of a spontaneously breathing tracheotomized adult with or without exhaled heated humidity. An in vitro model was constructed to simulate a spontaneously breathing adult (tidal volume, 400 mL; breathing frequency, 20 breaths/min; inspiratory-expiratory ratio, 1:2) with a tracheostomy using a teaching manikin attached to a test lung through a collecting filter (Vital Signs Respirgard II). Exhaled heat and humidity were simulated using a cascade humidifier set to deliver 37°C and >95% relative humidity. Albuterol sulfate (2.5 mg/3 mL) was administered with a jet nebulizer (AirLife Misty Max) operated at 10 L/min and a mesh nebulizer (Aeroneb Solo) using a heated pass-over humidifier, unheated large volume humidifier both at 40 L/min output and heat-and-moisture exchanger. Inhaled drug eluted from the filter was analyzed via spectrophotometry (276 nm). Delivery efficiency of the jet nebulizer was less than that of the mesh nebulizer under all conditions (P humidity decreased drug delivery up to 44%. The jet nebulizer was less efficient than the mesh nebulizer in all conditions tested in this study. Aerosol deposition with each nebulizer was lowest with the heated humidifier with high flow. Exhaled humidity reduced inhaled dose of drug compared with a standard model with nonheated/nonhumidified exhalation. Further clinical research is warranted to understand the impact of exhaled humidity on aerosol drug delivery in spontaneously breathing patients with tracheostomy using different types of humidifiers. Copyright © 2016 by Daedalus Enterprises.

  8. An evaluation of fresh gas flow rates for spontaneously breathing cats and small dogs on the Humphrey ADE semi-closed breathing system.

    Science.gov (United States)

    Gale, Elizabeth; Ticehurst, Kim E; Zaki, Sanaa

    2015-05-01

    To evaluate the fresh gas flow (FGF) rate requirements for the Humphrey ADE semi-closed breathing system in the Mapleson A mode; to determine the FGF at which rebreathing occurs, and compare the efficiency of this system to the Bain (Mapleson D) system in spontaneously breathing cats and small dogs. Prospective clinical study. Twenty-five healthy (ASA score I or II) client-owned cats and dogs (mean ± SD age 4.7 ± 5.0 years, and body weight 5.64 ± 3.26 kg) undergoing elective surgery or minor procedures. Anaesthesia was maintained with isoflurane delivered via the Humphrey ADE system in the A mode using an oxygen FGF of 100 mL kg(-1) minute(-1). The FGF was then reduced incrementally by 5-10 mL kg(-1) minute(-1) at approximately five-minute intervals, until rebreathing (inspired CO(2) >5 mmHg (0.7 kPa)) was observed, after which flow rates were increased. In six animals, once the minimum FGF at which rebreathing occurred was found, the breathing system was changed to the Bain, and the effects of this FGF delivery examined, before FGF was increased. Rebreathing did not occur at the FGF recommended by the manufacturer for the ADE. The mean ± SD FGF that resulted in rebreathing was 60 ± 20 mL kg(-1) minute(-1). The mean minimum FGF at which rebreathing did not occur with the ADE was 87 ± 39 mL kg(-1) minute(-1). This FGF resulted in significant rebreathing (inspired CO(2) 8.8 ± 2.6 mmHg (1.2 ± 0.3 kPa)) on the Bain system. The FGF rates recommended for the Humphrey ADE are adequate to prevent rebreathing in spontaneously breathing cats and dogs cats and small dogs. © 2014 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

  9. Slow breathing as a means to improve orthostatic tolerance: a randomized sham-controlled trial.

    Science.gov (United States)

    Lucas, Samuel J E; Lewis, Nia C S; Sikken, Elisabeth L G; Thomas, Kate N; Ainslie, Philip N

    2013-07-15

    Endogenous oscillations in blood pressure (BP) and cerebral blood flow have been associated with improved orthostatic tolerance. Although slow breathing induces such responses, it has not been tested as a therapeutic strategy to improve orthostatic tolerance. With the use of a randomized, crossover sham-controlled design, we tested the hypothesis that breathing at six breaths/min (vs. spontaneous breathing) would improve orthostatic tolerance via inducing oscillations in mean arterial BP (MAP) and cerebral blood flow. Sixteen healthy participants (aged 25 ± 4 yr; mean ± SD) had continuous beat-to-beat measurements of middle cerebral artery blood velocity (MCAv), BP (finometer), heart rate (ECG), and end-tidal carbon dioxide partial pressure during an incremental orthostatic stress test to presyncope by combining head-up tilt with incremental lower-body negative pressure. Tolerance time to presyncope was improved (+15%) with slow breathing compared with spontaneous breathing (29.2 ± 5.4 vs. 33.7 ± 6.0 min; P breathing) across time from baseline to presyncope. Our findings show that orthostatic tolerance can be improved within healthy individuals with a simple, nonpharmacological breathing strategy. The mechanisms underlying this improvement are likely mediated via the generation of negative intrathoracic pressure during slow and deep breathing and the related beneficial impact on cerebrovascular and autonomic function.

  10. Use of an Impedance Threshold Device in Spontaneously Breathing Patients with Hypotension Secondary to Trauma: An Observational Cohort Feasibility Study

    Science.gov (United States)

    2014-09-09

    hypotension due to multiple causes ; the patients of primary interest experienced a traumatic injury. Upon determination of hypotension (systolic blood...to vasovagal syncope , dehydration, and renal dialysis; (3) provide a treatment of right- sided heart failure after myocardial infarction; and (4...Research, the ITD has been used for treat- ment of hypotension due to multiple causes in spontaneously breathing patients.6,9 The US Army is specifically

  11. Extracorporeal Carbon Dioxide Removal Enhanced by Lactic Acid Infusion in Spontaneously Breathing Conscious Sheep.

    Science.gov (United States)

    Scaravilli, Vittorio; Kreyer, Stefan; Belenkiy, Slava; Linden, Katharina; Zanella, Alberto; Li, Yansong; Dubick, Michael A; Cancio, Leopoldo C; Pesenti, Antonio; Batchinsky, Andriy I

    2016-03-01

    The authors studied the effects on membrane lung carbon dioxide extraction (VCO2ML), spontaneous ventilation, and energy expenditure (EE) of an innovative extracorporeal carbon dioxide removal (ECCO2R) technique enhanced by acidification (acid load carbon dioxide removal [ALCO2R]) via lactic acid. Six spontaneously breathing healthy ewes were connected to an extracorporeal circuit with blood flow 250 ml/min and gas flow 10 l/min. Sheep underwent two randomly ordered experimental sequences, each consisting of two 12-h alternating phases of ALCO2R and ECCO2R. During ALCO2R, lactic acid (1.5 mEq/min) was infused before the membrane lung. Caloric intake was not controlled, and animals were freely fed. VCO2ML, natural lung carbon dioxide extraction, total carbon dioxide production, and minute ventilation were recorded. Oxygen consumption and EE were calculated. ALCO2R enhanced VCO2ML by 48% relative to ECCO2R (55.3 ± 3.1 vs. 37.2 ± 3.2 ml/min; P less than 0.001). During ALCO2R, minute ventilation and natural lung carbon dioxide extraction were not affected (7.88 ± 2.00 vs. 7.51 ± 1.89 l/min, P = 0.146; 167.9 ± 41.6 vs. 159.6 ± 51.8 ml/min, P = 0.063), whereas total carbon dioxide production, oxygen consumption, and EE rose by 12% each (223.53 ± 42.68 vs. 196.64 ± 50.92 ml/min, 215.3 ± 96.9 vs. 189.1 ± 89.0 ml/min, 67.5 ± 24.0 vs. 60.3 ± 20.1 kcal/h; P less than 0.001). ALCO2R was effective in enhancing VCO2ML. However, lactic acid caused a rise in EE that made ALCO2R no different from standard ECCO2R with respect to ventilation. The authors suggest coupling lactic acid-enhanced ALCO2R with active measures to control metabolism.

  12. Successful protocol of anaesthesia for measuring transepithelial nasal potential difference in spontaneously breathing mice.

    Science.gov (United States)

    Leal, T; Lebacq, J; Vanbinst, R; Lederman, Ch; De Kock, M; Wallemacq, P

    2006-01-01

    Numerous difficulties arise during in vivo measurements of transepithelial nasal potential difference (PD) in mice, such as inadequate duration and depth of anaesthesia, bronchoaspiration of solutions perfused in the nose, and respiratory and/or cardiovascular depression. Anaesthesia was induced in adult C57 mice with intraperitoneal injection of a combination of fentanyl, droperidol and medetomidine, each of these at either a small dose (0.20, 10 and 0.33 mg/kg, respectively) or at a large dose (0.40, 20 and 0.40 mg/kg, respectively), combined with a fixed dose of 0.375 microg clonidine. In order to establish a pharmacokinetic-pharmacodynamic relationship, blood concentrations of the first three drugs were measured in 24 animals by liquid-chromatography tandem mass spectrometry. At the end of the experiment, naloxone, a competitive morphinic antagonist, and atipamezole, an alpha-2 adrenergic antagonist, were administered. Bronchoaspiration was prevented by tilting the animal head downwards and by absorbing the excess fluid from the opposite nostril and from the oral cavity. Optimal assessment of anaesthesia associated with regular respiration, loss of blink, pupillary and pedal withdrawal reflexes was obtained with doses of fentanyl, droperidol and medetomidine corresponding to 0.20, 20 and 0.40 mg/kg, respectively. Blood concentrations of fentanyl around 17 ng/mL induced loss of respiratory efforts and were followed by death during the experiment. Integrity of ion transport was demonstrated under continuous perfusion by successive depolarization after amiloride and repolarization after chloride-free solution. The combination investigated in this study lead to adequate surgical anaesthesia (stage III, plane 2) for prolonged nasal PD measurements in spontaneously breathing mice.

  13. Comparison of objective methods to classify the pattern of respiratory sinus arrhythmia during mechanical ventilation and paced spontaneous breathing

    International Nuclear Information System (INIS)

    Carvalho, N C; Beda, A; Granja-Filho, P; Jandre, F C; Giannella-Neto, A; De Abreu, M G; Spieth, P M

    2009-01-01

    Respiratory sinus arrhythmia (RSA) is a fluctuation of heart period that occurs during a respiratory cycle. It has been suggested that inspiratory heart period acceleration and expiratory deceleration during spontaneous ventilation (henceforth named positive RSA) improve the efficiency of gas exchange compared to the absence or the inversion of such a pattern (negative RSA). During mechanical ventilation (MV), for which maximizing the efficiency of gas exchange is of critical importance, the pattern of RSA is still the object of debate. In order to gain a better insight into this matter, we compared five different methods of RSA classification using the data of five mechanically ventilated piglets. The comparison was repeated using the data of 15 volunteers undergoing a protocol of paced spontaneous breathing, which is expected to result in a positive RSA pattern. The results showed that the agreement between the employed methods is limited, suggesting that the lack of a consensus about the RSA pattern during MV is, at least in part, of methodological origin. However, independently of the method used, the pattern of RSA within the respiratory cycle was not consistent among the subjects and conditions of MV considered. Also, the outcomes showed that even during paced spontaneous breathing a negative RSA pattern might be present, when a low respiratory frequency is imposed

  14. Heart rate variability and stroke volume variability to detect central hypovolemia during spontaneous breathing and supported ventilation in young, healthy volunteers

    International Nuclear Information System (INIS)

    Elstad, Maja; Walløe, Lars

    2015-01-01

    Cardiovascular oscillations exist in many different variables and may give important diagnostic and prognostic information in patients. Variability in cardiac stroke volume (SVV) is used in clinical practice for diagnosis of hypovolemia, but currently is limited to patients on mechanical ventilation. We investigated if SVV and heart rate variability (HRV) could detect central hypovolemia in spontaneously breathing humans: We also compared cardiovascular variability during spontaneous breathing with supported mechanical ventilation.Ten subjects underwent simulated central hypovolemia by lower body negative pressure (LBNP) with >10% reduction of cardiac stroke volume. The subjects breathed spontaneously and with supported mechanical ventilation. Heart rate, respiratory frequency and mean arterial blood pressure were measured. Stroke volume (SV) was estimated by ModelFlow (Finometer). Respiratory SVV was calculated by: 1) SVV% = (SVmax − SVmin)/SVmean during one respiratory cycle, 2) SVIntegral from the power spectra (Fourier transform) at 0.15–0.4 Hz and 3) SVV-norm = (√SVIntegral)/SVmean. HRV was calculated by the same methods.During spontaneous breathing two measures of SVV and all three measures of HRV were reduced during hypovolemia compared to baseline. During spontaneous breathing SVIntegral and HRV% were best to detect hypovolemia (area under receiver operating curve 0.81). HRV% ≤ 11% and SVIntegral ≤ 12 ml 2 differentiated between hypovolemia and baseline during spontaneous breathing.During supported mechanical ventilation, none of the three measures of SVV changed and two of the HRV measures were reduced during hypovolemia. Neither measures of SVV nor HRV were classified as a good detector of hypovolemia.We conclude that HRV% and SVIntegral detect hypovolemia during spontaneous breathing and both are candidates for further clinical testing. (paper)

  15. Airway management in spontaneously breathing anaesthetized children: comparison of the Laryngeal Mask Airway with the cuffed oropharyngeal airway.

    Science.gov (United States)

    Mamaya, Biruta

    2002-06-01

    The efficacy and safety of the smallest size of the cuffed oropharyngeal airway (COPA) for school age, spontaneously breathing children was investigated and compared with the Laryngeal Mask Airway (LMA). Seventy children of school age (7-16 years) were divided into two groups: the COPA (n=35) and the LMA (n=35). Induction was with propofol i.v. or halothane, nitrous oxide, oxygen and fentanyl. After depression of laryngopharyngeal reflexes, a COPA size 8 cm or an LMA was inserted. Ventilation was manually assisted until spontaneous breathing was established. For maintenance, propofol i.v. and fentanyl or halothane with nitrous oxide were used. Local anaesthesia or peripheral blocks were also used. Both extratracheal airways had a highly successful insertion rate, but more positional manoeuvres to achieve a satisfactory airway were required with the COPA, 28.6% versus LMA 2.9%. The need to change the method of airway management was higher (8.6%) in the COPA group. After induction, the need for assisted ventilation was higher in the LMA group 54.3% versus 20% in the COPA group. Airway reaction to cuff inflation was higher in the LMA group 14.3% versus COPA 5.7%. Problems during surgery were similar, except continuous chin support to establish an effective airway was more frequent (11.4%) in the COPA group. In the postoperative period, blood on the device and incidence of sore throat were detected less in the COPA group. The COPA is a good extratracheal airway that provides new possibilities for airway management in school age children with an adequate and well sealed airway, during spontaneous breathing or during short-term assisted manual ventilation.

  16. Extracorporeal Gas Exchange and Spontaneous Breathing for the Treatment of Acute Respiratory Distress Syndrome: An Alternative to Mechanical Ventilation?

    Science.gov (United States)

    2014-03-01

    Alveolar minute ventilation (L/min) 5.7 ± 2.7 2.7 ± 1.5 0.003 Dead space fraction 0.44 ± 0.10 0.81 ± 0.10 < 0.001 Pulmonary shunt fraction 0.01 ± 0.01 0.25...ventilation expressed as % of control values, MVALV reduction = reduction in alveolar minute ventilation expressed as percentage of control values...Data are expressed as mean ± sd. Online Laboratory Investigations Critical Care Medicine www.ccmjournal.org e217 of spontaneous breathing: preserved

  17. Intermittent hypoxia-induced respiratory long-term facilitation is dominated by enhanced burst frequency, not amplitude, in spontaneously breathing urethane-anesthetized neonatal rats.

    Science.gov (United States)

    Reid, Inefta M; Solomon, Irene C

    2014-01-01

    Acute intermittent hypoxia (AIH) triggers a form of respiratory plasticity known as long-term facilitation (LTF), which is manifested as a progressive increase in respiratory motor activity that lasts for minutes to hours after the hypoxic stimulus is removed. Respiratory LTF has been reported in numerous animal models, but it appears to be influenced by a variety of factors (e.g., species, age, and gender). While most studies focusing on respiratory LTF have been conducted in adult (including young adult) rat preparations, little is known about the influence of postnatal maturation on AIH-induced respiratory LTF. To begin to address this issue, we examined diaphragm EMG activity in response to and at 5-min intervals for 60 min following three 5-min episodes of hypoxia (8% O2) in urethane-anesthetized spontaneously breathing P14-P15 neonatal rats (n=15). For these experiments, the hypoxic episodes were separated by hyperoxia (40% O2), and all rats were continuously supplied with ~4% CO2. During the AIH trials, burst frequency was increased by ~20-90% above baseline in each of the rats examined while changes in burst amplitude were highly variable. Following the AIH episodes, respiratory LTF was characterized by predominantly an increase in burst frequency (fLTF) ranging from ~10% to 55%, with most rats exhibiting a 20-40% increase. In seven rats, however, an increase in amplitude (ampLTF) (~10%, n=3; ~20%, n=3; ~30%, n=1) was also noted. These data suggest that in contrast to observations in anesthetized ventilated adult rats, in anesthetized spontaneously breathing P14-P15 neonatal rats, respiratory LTF is dominated by fLTF, not ampLTF. © 2014 Elsevier B.V. All rights reserved.

  18. Tracheostomy as a bridge to spontaneous breathing and awake-ECMO in non-transplant surgical patients.

    Science.gov (United States)

    Swol, J; Strauch, J T; Schildhauer, T A

    2017-05-01

    The tracheostomy is a frequently used procedure for the respiratory weaning of ventilated patients allows sedation free ECLS use in awake patient. The aim of this study is to assess the possibility and highlight the benefits of lowering the impact of sedation in surgical non-transplant patients on ECLS. The specific objective was to investigate the use of tracheostomy as a bridge to spontaneous breathing on ECLS. Of the 95 patients, 65 patients received a tracheostomy, and 5 patients were admitted with a tracheostoma. One patient was cannulated without intubation, one is extubated during ECLS course after 48 hours. 4 patients were extubated after weaning and the removal of ECLS. 19 patients died before the indication to tracheostomy was given. Tracheostomy can bridge to spontaneous breathing and awake-ECMO in non-transplant surgical patients. The "awake ECMO" strategy may avoid complications related to mechanical ventilation, sedation, and immobilization and provide comparable outcomes to other approaches for providing respiratory support. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  19. Albuterol Delivery via Facial and Tracheostomy Route in a Model of a Spontaneously Breathing Child.

    Science.gov (United States)

    Cooper, Brandy; Berlinski, Ariel

    2015-12-01

    Some pediatric patients receiving therapeutic aerosols undergo tracheostomy, and others who are tracheostomized continue requiring inhaled therapies upon decannulation. It is unknown whether a dose adjustment is required. Different devices are available for facial and tracheostomy delivery, and in some instances, the assisted technique is used. We hypothesized that the change from face mask to tracheostomy would result in a decrease in the lung dose. A breathing simulator connected in series to a filter holder and an anatomically correct head model of a child was used. The drug captured in the filter was termed the lung dose. Breathing patterns with tidal volumes of 50, 155, and 300 mL were tested. Albuterol hydrofluoroalkane (pressurized metered-dose inhaler [pMDI]) with an AeroChamber Mini (face and 4.5-mm tracheostomy), AeroTrach (4.5-mm tracheostomy), and AeroChamber (face) and albuterol (2.5 mg/3 mL) with a continuous output nebulizer (face and 4.5-mm tracheostomy) were tested. Masks were used for facial delivery. Four units of each device were tested. Particle size of the pMDI was measured by cascade impaction. Albuterol concentration was determined via spectrophotometry (276 nm). Switching from facial to tracheostomy delivery increased lung dose with nebulizer (all breathing patterns). When a pMDI was used, lung dose was unchanged or increased for the 50- and 155-mL and decreased for the 300-mL breathing pattern. The use of the assisted technique increased lung dose only during nebulization with the 300-mL breathing pattern. The particle size of the pMDI decreased by 19-23% when traveling through the tracheostomy tube, which retained tracheostomy was variable and depended on the delivery device and the breathing pattern. There is no advantage of using the assisted technique to enhance aerosol delivery. Copyright © 2015 by Daedalus Enterprises.

  20. Can transcutaneous carbon dioxide pressure be a surrogate of blood gas samples for spontaneously breathing emergency patients? The ERNESTO experience.

    Science.gov (United States)

    Peschanski, Nicolas; Garcia, Léa; Delasalle, Emilie; Mzabi, Lynda; Rouff, Edwin; Dautheville, Sandrine; Renai, Fayrouz; Kieffer, Yann; Lefevre, Guillaume; Freund, Yonathan; Ray, Patrick

    2016-05-01

    It is known that the arterial carbon dioxide pressure (PaCO2) is useful for emergency physicians to assess the severity of dyspnoeic spontaneously breathing patients. Transcutaneous carbon dioxide pressure (PtcCO2) measurements could be a non-invasive alternative to PaCO2 measurements obtained by blood gas samples, as suggested in previous studies. This study evaluates the reliability of a new device in the emergency department (ED). We prospectively included patients presenting to the ED with respiratory distress who were breathing spontaneously or under non-invasive ventilation. We simultaneously performed arterial blood gas measurements and measurement of PtcCO2 using a sensor placed either on the forearm or the side of the chest and connected to the TCM4 CombiM device. The agreement between PaCO2 and PtcCO2 was assessed using the Bland-Altman method. Sixty-seven spontaneously breathing patients were prospectively included (mean age 70 years, 52% men) and 64 first measurements of PtcCO2 (out of 67) were analysed out of the 97 performed. Nineteen patients (28%) had pneumonia, 19 (28%) had acute heart failure and 19 (28%) had an exacerbation of chronic obstructive pulmonary disease. Mean PaCO2 was 49 mm Hg (range 22-103). The mean difference between PaCO2 and PtcCO2 was 9 mm Hg (range -47 to +54) with 95% limits of agreement of -21.8 mm Hg and 39.7 mm Hg. Only 36.3% of the measurement differences were within 5 mm Hg. Our results show that PtcCO2 measured by the TCM4 device could not replace PaCO2 obtained by arterial blood gas analysis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. Agreement between values for arterial and end-tidal partial pressures of carbon dioxide in spontaneously breathing, critically ill dogs.

    Science.gov (United States)

    Kelmer, Efrat; Scanson, Lindsey C; Reed, Ann; Love, Lydia C

    2009-12-01

    To determine agreement between arterial partial pressures of carbon dioxide (PaCO(2)) and end-tidal partial pressures of carbon dioxide (PETCO(2)) measured with a nasal catheter in spontaneously breathing, critically ill dogs. Validation study. 26 client-owned dogs admitted to an intensive care unit for various conditions. PaCO(2) was measured with a commercial blood gas analyzer, and PETCO(2) was measured with a sidestream capnograph attached to a nasal catheter. Measurements were obtained twice (ie, with and without supplemental oxygen). Paired values were compared by means of the Pearson correlation method. Level of agreement was assessed by means of the Bland-Altman method. Mean difference between PaCO(2) and PETCO(2) when dogs did not receive supplemental oxygen (mean +/- SD, 3.95 +/- 4.92 mm Hg) was significantly lower than mean difference when dogs did receive supplemental oxygen (6.87 +/- 6.42 mm Hg). Mean difference in dogs with a condition affecting the respiratory system (8.55 +/- 5.43 mm Hg) was significantly higher than mean difference in dogs without respiratory tract disease (3.28 +/- 3.23 mm Hg). There was a significant linear correlation and good agreement between measured values of PaCO(2) and PETCO(2). Catheter size, ventilatory status, and outcome were not significantly associated with mean difference between PaCO(2) and PETCO(2). Results suggested that nasal capnography is a clinically relevant method of estimating PaCO(2) in spontaneously breathing, critically ill dogs, but that values should be interpreted with caution in dogs receiving supplemental oxygen and in dogs with conditions affecting the respiratory system.

  2. Imposed Work of Breathing and Breathing Comfort of Nonintubated Volunteers Breathing with Three Portable Ventilators and a Critical Care Ventilator

    National Research Council Canada - National Science Library

    Austin, Paul

    2001-01-01

    .... The purpose of this study was to assess the imposed inspiratory work of breathing and breathing comfort of nonintubated healthy volunteers breathing spontaneously through three portable ventilators...

  3. Delivery of helium–oxygen mixture during spontaneous breathing: evaluation of three high-concentration face masks.

    Science.gov (United States)

    Roche-Campo, Ferran; Vignaux, Laurence; Galia, Fabrice; Lyazidi, Aissam; Vargas, Frédéric; Texereau, Joëlle; Apiou-Sbirlea, Gabriela; Jolliet, Philippe; Brochard, Laurent

    2011-11-01

    To evaluate the efficacy of delivering a mixture of helium and oxygen gas (He–O2) in spontaneous ventilation. Three high oxygen flow reservoir masks were tested: the Heliox21, specifically designed for helium; the Hi-Ox80 mask, with an inspiratory and an expiratory valve; and a standard high-concentration face mask. This prospective randomized crossover study was performed in six healthy volunteers in a laboratory setting. Volunteers breathed a mixture of 78% He/22% O2 through each of the masks under two different breathing conditions (rest and hyperventilation: minute ventilation of 14.9 ± 6.1 and 26.7 ± 8.7 L min(−1), respectively) and four different He–O2 flow rates (7, 10, 12, and 15 L min(−1)). A nasopharyngeal catheter was used to estimate He pharyngeal concentration (Fp [He]) in the airways in order to determine the percentage of contamination with room air (% air cont) at end-expiration. Under all testing conditions, the Hi-Ox80 mask presented a significantly lower % air cont. During resting breathing pattern, a Fp [He] higher than 50% was achieved in 54% of the tests performed with the Hi-Ox80 mask compared to 29% for the Heliox21 mask and only 17% for the standard mask. At hyperventilation, a Fp [He] higher than 50% was achieved in 17% of the tests performed with the Hi-Ox mask compared to 4% for the other two masks. He–O2 administration via the usual high-concentration reservoir masks results in significant dilution by room air. The Hi-Ox80 mask minimized room air contamination and much more frequently achieved a pharyngeal He concentration higher than 50%.

  4. Can baroreflex measurements with spontaneous sequence analysis be improved by also measuring breathing and by standardization of filtering strategies?

    International Nuclear Information System (INIS)

    Hollow, M R; Parkes, M J; Clutton-Brock, T H

    2011-01-01

    Baroreflex sensitivity (BRS) is known to be attenuated by inspiration and all the original BRS methodologies took this into account by measuring only in expiration. Spontaneous sequence analysis (SSA) is a non-invasive clinical tool widely used to estimate BRS in Man but does not take breathing into account. We have therefore modified it to test whether it too can detect inspiratory attenuation. Traditional SSA is also entangled with issues of distinguishing causal from random relationships between blood pressure and heart period and of the optimum choice of data filter settings. We have also tested whether the sequences our modified SSA rejects do behave as random relationships and show the limitations of the absence of filter standardization. SSA was performed on eupneic data from 1 h periods in 20 healthy subjects. Applying SSA traditionally produced a mean BRS of 23 ± 3 ms mmHg −1 . After modification to measure breathing, SSA detected significant inspiratory attenuation (11 ± 1 ms mmHg −1 ), and the mean expiratory BRS was significantly higher (26 ± 5 ms mmHg −1 ). Traditional SSA therefore underestimates BRS by an amount (3 ms mmHg −1 ) as big as the major physiological and clinical factors known to alter BRS. We show that the sequences rejected by SSA do behave like random associations between pressure and period. We also show the minimal effect of the r 2 filter and the biases that some pressure and heart period filters can introduce. We discuss whether SSA might be improved by standardization of filter settings and by also measuring breathing

  5. The reliability and validity of passive leg raise and fluid bolus to assess fluid responsiveness in spontaneously breathing emergency department patients

    DEFF Research Database (Denmark)

    Duus, Nicolaj; Shogilev, Daniel J; Skibsted, Simon

    2015-01-01

    PURPOSE: We investigated the reproducibility of passive leg raise (PLR) and fluid bolus (BOLUS) using the Non-Invasive Cardiac Output Monitor (NICOM; Cheetah Medical, Tel Aviv, Israel) for assessment of fluid responsiveness (FR) in spontaneously breathing emergency department (ED) patients. METHO...

  6. Comparative study of minimal fresh gas flow used in Lack-Plus and Lack’s circuit in spontaneously breathing anesthetized adults

    Directory of Open Access Journals (Sweden)

    Theerapongpakdee S

    2016-11-01

    Full Text Available Sunchai Theerapongpakdee, Thepakorn Sathitkarnmanee, Sirirat Tribuddharat, Siwalai Sucher, Maneerat Thananun, Duangthida Nonlhaopol Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Background: The Lack’s circuit is a co-axial Mapleson A breathing system commonly used in spontaneously breathing anesthetized adults but still requires high fresh gas flow (FGF. The Lack-Plus circuit was invented with the advantage of lower FGF requirement. The authors compared the Lack-Plus and Lack’s circuit for the minimal FGF requirement with no rebreathing in spontaneously breathing anesthetized adults.Methods: This was a randomized crossover study. We enrolled 24 adult patients undergoing supine elective surgery, with a body mass index ≤30 kg/m2 and an American Society of Anesthesiologists physical status I–II. They were randomly allocated to group 1 (LP-L starting with Lack-Plus then switching to Lack’s circuit or group 2 (L-LP (with the reverse pattern. After induction and intubation, anesthesia was maintained with 50% N2O/O2 and desflurane (4%–6% plus fentanyl titration to maintain an optimal respiratory rate between 10 and 16/min. Starting with the first circuit, all the patients were spontaneously breathing with a FGF of 4 L/min for 10 min, gradually decreased by 0.5 L/min every 5 min until FGF was 2.5 L/min. End-tidal CO2, inspired minimum CO2 (ImCO2, mean arterial pressure, and oxygen saturation were recorded until rebreathing (ImCO2 >0 mmHg occurred. The alternate anesthesia breathing circuit was used and the measurements were repeated.Results: The respective minimal FGF at the point of rebreathing for the Lack-Plus and Lack’s circuit was 2.7±0.8 and 3.3±0.5 L/min, respectively, p<0.001. At an FGF of 2.5 L/min, the respective ImCO2 was 1.5±2.0 and 4.2±2.6 mmHg, respectively, p<0.001.Conclusion: The Lack-Plus circuit can be used safely and effectively, and it requires less FGF than Lack

  7. Completion report : Effect of Comprehensive Yogic Breathing program on type 2 diabetes: A randomized control trial

    Directory of Open Access Journals (Sweden)

    V P Jyotsna

    2014-01-01

    Full Text Available Background: Yoga has been shown to be benefi cial in diabetes in many studies, though randomized control trials are few. The aim of this randomized control trial was to see the effect of Sudarshan Kriya and related practices (comprehensive yogic breathing program on quality of life, glycemic control, and cardiac autonomic functions in diabetes. Diabetes mellitus is a risk factor for sudden cardiac death. Cardiac autonomic neuropathy has been implicated in the causation of sudden cardiac death. Therefore, a maneuver to prevent progression of cardiac autonomic neuropathy holds signifi cance. Materials and Methods: A total of 120 patients of diabetes on oral medication and diet and exercise advice were randomized into two groups: (1 Continued to receive standard treatment for diabetes. (2 Patients administered comprehensive yogic breathing program and monitored to regularly practice yoga in addition to standard treatment of diabetes. At 6 months, quality of life and postprandial plasma glucose signifi cantly improved in the group practicing yoga compared to baseline, but there was no significant improvement in the fasting plasma glucose and glycated hemoglobin. Results: On per protocol analysis, sympathetic cardiac autonomic functions signifi cantly improved from baseline in the group practicing comprehensive yogic breathing. Conclusion: This randomized control trial points towards the beneficial effect of yogic breathing program in preventing progression of cardiac neuropathy. This has important implications as cardiac autonomic neuropathy has been considered as one of the factors for sudden cardiac deaths.Keywords: comprehensive yogic breathing program, diabetes mellitus, cardiac autonomic function

  8. Aerosol delivery during spontaneous breathing with different types of nebulizers- in vitro/ex vivo models evaluation.

    Science.gov (United States)

    Lin, Hui-Ling; Fang, Tien-Pei; Cho, Hui-Sun; Wan, Gwo-Hwa; Hsieh, Meng-Jer; Fink, James B

    2018-02-01

    Nebulizers for spontaneous breathing have been evaluated through different study designs. There are limitations in simulated bench models related to patient and nebulizer factors. The aim of this study was to determine the correlation of inhaled drug mass between in vitro and ex vivo studies by testing aerosol deposition of various types of nebulizers. Ten healthy subjects were recruited to receive aerosol therapy with five nebulizers in random order: 1) a jet nebulizer (JN); 2) a breath-enhanced nebulizer (BEN); 3) a manually triggered nebulizer (MTN), 4) a breath-actuated nebulizer (BAN), and 5) a vibrating mesh nebulizer (VMN) with valved-adapter. A unit dose of salbutamol containing 5 mg in 2.5 mL was placed into the nebulizer and administered for 10 min. For the ex vivo study, minute ventilation of healthy subjects was recorded for 1 min. For the in vitro study a breathing simulator was utilized with adult breathing patterns. Aerosolized drug from the nebulizers and the accessory tubes was captured using inspiratory and expiratory collecting filters. Captured drug was eluted, measured and expressed as inhaled and exhaled mass using spectrophotometry at a wavelength of 276 nm. 10 healthy subjects were recruited, aged 20.8 ± 0.7 years old, with a mean height of 166.2 ± 9.2 cm and weight of 64.7 ± 12.4 kg. There was no significant difference in the inhaled drug dose between the JN and BEN (15.0 ± 1.94% and 17.74 ± 2.65%, respectively, p = .763), yet the inhaled doses were lower than the other three nebulizers (p vivo model (44.0 ± 0.9% and 35.5 ± 6.3% respectively, p = .003), whereas the JN in the ex vivo model resulted in a greater inhaled drug dose (15.0 ± 1.9% for ex vivo vs 11.6 ± 1.6% for in vitro, p = .008). These in vitro/ex vivo model comparisons of nebulizers performance indicated that breath-related nebulizers can be estimated using an in vitro model; however, the JN and VMN delivered

  9. [Is there an appropriate bispectral index for upper gastrointestinal endoscopy in spontaneous breathing in the pediatric patient?].

    Science.gov (United States)

    Alados-Arboledas, F J; Millán-Bueno, M P; Expósito-Montes, J F; Arévalo-Garrido, A; Pérez-Parras, A; de la Cruz-Moreno, J

    2015-03-01

    The bispectral index (BIS) values that predict appropriate anesthetic level to perform an upper gastrointestinal endoscopy in spontaneous breathing are not well established in Pediatrics. The objective of this study is to determine whether it is possible to find an appropriate, less profound, BIS level in the pediatric patient that would enable an upper gastrointestinal endoscopy (UGE) to be performed in spontaneous breathing without causing gag reflex or motor response. A prospective study was designed and included 61 patients from 12-167 months old, and an ASAI-II who needed a diagnostic UGE. The study was conducted from October 2011 to March 2013. UGE performed with an anesthetic protocol using propofol. The vital signs measured were heart and respiratory rate, pulse oximetry, non-invasive blood pressure. The sedation level score (Ramsay scale) and BIS values were also measured. The first attempt was performed at BIS level 60-69, and this was not feasible, then the anesthetic was deepened and a second attempt made at BIS level 50-59. If this was still not possible a deeper anesthetic level was then achieved and a third attempt made at BIS level 45-49. Variables of interest were: effective BIS level (eBIS), BIS level at which UGE was performed without gag reflex or motor response; propofol total dose (mgkg(-1)), induction time (time from onset of sedation to effective start of UGE). A logistic regression analysis was performed to obtain an equation to estimate the possibility of UGE success. The distribution of the patient was: male 40%, female 60%, with 11 (18%) patients under 36 months. The statistical values are expressed as mean and standard deviation, with following results; age (months): 95.9±45.86; weight (kg): 30.5±14.68; effective BIS: 56.41±4.63; induction time (minutes): 11.07±2.69; total propofol dose (per kg): 4.86±1.21. An additional intra-procedure propofol bolus was given in 38 patients (62%), with 7/38 of them (18%) due to movement, and 31

  10. Typical patterns of expiratory flow and carbon dioxide in mechanically ventilated patients with spontaneous breathing.

    Science.gov (United States)

    Rees, S E; Larraza, S; Dey, N; Spadaro, S; Brohus, J B; Winding, R W; Volta, C A; Karbing, D S

    2017-08-01

    Incomplete expiration of tidal volume can lead to dynamic hyperinflation and auto-PEEP. Methods are available for assessing these, but are not appropriate for patients with respiratory muscle activity, as occurs in pressure support. Information may exist in expiratory flow and carbon dioxide measurements, which, when taken together, may help characterize dynamic hyperinflation. This paper postulates such patterns and investigates whether these can be seen systematically in data. Two variables are proposed summarizing the number of incomplete expirations quantified as a lack of return to zero flow in expiration (IncExp), and the end tidal CO 2 variability (varETCO 2 ), over 20 breaths. Using these variables, three patterns of ventilation are postulated: (a) few incomplete expirations (IncExp  18) and small varETCO 2 . IncExp and varETCO 2 were calculated from data describing respiratory flow and CO 2 signals in 11 patients mechanically ventilated at 5 levels of pressure support. Data analysis showed that the three patterns presented systematically in the data, with periods of IncExp  18 having significantly lower variability in end-tidal CO 2 than periods with 2 ≤ IncExp ≤ 18 (p  18 to 2 ≤ IncExp ≤ 18 results in significant, rapid, change in the variability of end-tidal CO 2 p < 0.05. This study illustrates that systematic patterns of expiratory flow and end-tidal CO 2 are present in patients in supported mechanical ventilation, and that changes between these patterns can be identified. Further studies are required to see if these patterns characterize dynamic hyperinflation. If so, then their combination may provide a useful addition to understanding the patient at the bedside.

  11. Respiratory pattern and rebreathing in the Mapleson A, C and D breathing systems with spontaneous ventilation. A theory.

    Science.gov (United States)

    Cook, L B

    1996-04-01

    A theoretical analysis is presented of the Mapleson A, C and D breathing systems when used in spontaneous respiration. The influence of the respiratory pattern is explained diagrammatically. Simple equations are derived, predicting the fresh gas flow required to prevent rebreathing with different respiratory patterns. Further equations allow the degree of rebreathing caused by inadequate fresh gas flow to be quantified. These are used to examine the effects of different respiratory patterns on the efficiency of the three systems. It is demonstrated that the single most important determinant of efficiency is the duration of the expiratory pause. The nature of the inspiratory and expiratory waveforms is less important and the I:E ratio far less important. The analysis suggests that the Mapleson A system will always be the most efficient of the three systems. The Mapleson C system will be efficient if inspiration is long and the expiratory pause is minimal. The Mapleson D system will be efficient if the expiratory pause is sufficiently long.

  12. Comparison of trapezius squeeze test and jaw thrust as clinical indicators for laryngeal mask airway insertion in spontaneously breathing children.

    Science.gov (United States)

    Dinesh Kumar, K K; Bhardwaj, Neerja; Yaddanapudi, Sandhya

    2017-01-01

    It is not known whether trapezius squeeze test (TPZ) is a better clinical test than jaw thrust (JT) to assess laryngeal mask airway (LMA) insertion conditions in children under sevoflurane anesthesia. After the Institutional Ethics Committee approval and written informed parental consent, 124 American Society of Anesthesiologists I and II children of 2-8 years of age undergoing minor surgical procedures were randomized into TPZ and JT groups. The children were induced with 8% sevoflurane in oxygen at a fresh gas flow of 4 L/min. TPZ or JT was performed after 1 min of start of sevoflurane and then every 20 s till the test was negative, when end-tidal (ET) sevoflurane concentration was noted. Classic LMA of requisite size was inserted by a blinded anesthetist and conditions at the insertion of LMA, insertion time, and the number of attempts of LMA insertion were recorded. The mean LMA insertion time was significantly longer ( P insertion was comparable in the two groups. LMA insertion conditions were similar in the two groups. There was no difference between the two groups regarding total number of attempts of LMA insertion. Heart rate (HR) decreased in both groups after LMA insertion ( P insertion ( P = 0.03). Both JT and TPZ are equivalent clinical indicators in predicting the optimal conditions of LMA insertion in spontaneously breathing children; however, it takes a longer time to achieve a negative TPZ squeeze test.

  13. How to deal with morning bad breath: A randomized, crossover clinical trial

    Directory of Open Access Journals (Sweden)

    Jeronimo M Oliveira-Neto

    2013-01-01

    Full Text Available Context: The absence of a protocol for the treatment of halitosis has led us to compare mouthrinses with mechanical oral hygiene procedures for treating morning breath by employing a hand-held sulfide monitor. Aims: To compare the efficacy of five modalities of treatment for controlling morning halitosis in subjects with no dental or periodontal disease. Settings and Design: This is a five-period, randomized, crossover clinical trial. Materials and Methods: Twenty volunteers were randomly assigned to the trial. Testing involved the use of a conventional tongue scraper, a tongue scraper joined to the back of a toothbrush′s head, two mouthrinses (0.05% cetylpyridinium chloride and 0.12% chlorhexidine digluconate and a soft-bristled toothbrush and fluoride toothpaste for practicing oral hygiene. Statistical Analysis Used: Data analysis was performed using SPSS version 17 for Windows and NCSS 2007 software (P < 0.05. The products and the periods were compared with each other using the Friedman′s test. When significant differences (P < 0.05 were determined, the products and periods were compared in pairs by using the Wilcoxon′s test and by adjusting the original significance level (0.05 for multiple comparisons by using the Bonferroni′s method. Results: The toothbrush′s tongue scraper was able to significantly reduce bad breath for up to 2 h. Chlorhexidine reduced bad breath only at the end of the second hour, an effect that lasted for 3 h. Conclusions: Mechanical tongue cleaning was able to immediately reduce bad breath for a short period, whereas chlorhexidine and mechanical oral hygiene reduced bad breath for longer periods, achieving the best results against morning breath.

  14. Combination of intravenous dexmedetomidine with topicalization of airway for placement of double lumen tube in a spontaneously breathing patient of giant lung bullae

    Directory of Open Access Journals (Sweden)

    Vikas Karne

    2016-10-01

    Here we present a patient with giant lung bulla in left lower lobe with severely reduced pulmonary reserves and significant air-trapping posted for VAT assisted bullectomy. Anaesthesia challenges including pathological changes, its effects during induction of anaesthesia, and issues related to placement of double lumen tube in a spontaneously breathing patient are discussed with possible advantages of dexmedetomidine in this special group of patients.

  15. Comparative study of minimal fresh gas flow used in Lack-Plus and Lack’s circuit in spontaneously breathing anesthetized adults

    Science.gov (United States)

    Theerapongpakdee, Sunchai; Sathitkarnmanee, Thepakorn; Tribuddharat, Sirirat; Sucher, Siwalai; Thananun, Maneerat; Nonlhaopol, Duangthida

    2016-01-01

    Background The Lack’s circuit is a co-axial Mapleson A breathing system commonly used in spontaneously breathing anesthetized adults but still requires high fresh gas flow (FGF). The Lack-Plus circuit was invented with the advantage of lower FGF requirement. The authors compared the Lack-Plus and Lack’s circuit for the minimal FGF requirement with no rebreathing in spontaneously breathing anesthetized adults. Methods This was a randomized crossover study. We enrolled 24 adult patients undergoing supine elective surgery, with a body mass index ≤30 kg/m2 and an American Society of Anesthesiologists physical status I–II. They were randomly allocated to group 1 (LP-L) starting with Lack-Plus then switching to Lack’s circuit or group 2 (L-LP) (with the reverse pattern). After induction and intubation, anesthesia was maintained with 50% N2O/O2 and desflurane (4%–6%) plus fentanyl titration to maintain an optimal respiratory rate between 10 and 16/min. Starting with the first circuit, all the patients were spontaneously breathing with a FGF of 4 L/min for 10 min, gradually decreased by 0.5 L/min every 5 min until FGF was 2.5 L/min. End-tidal CO2, inspired minimum CO2 (ImCO2), mean arterial pressure, and oxygen saturation were recorded until rebreathing (ImCO2 >0 mmHg) occurred. The alternate anesthesia breathing circuit was used and the measurements were repeated. Results The respective minimal FGF at the point of rebreathing for the Lack-Plus and Lack’s circuit was 2.7±0.8 and 3.3±0.5 L/min, respectively, p<0.001. At an FGF of 2.5 L/min, the respective ImCO2 was 1.5±2.0 and 4.2±2.6 mmHg, respectively, p<0.001. Conclusion The Lack-Plus circuit can be used safely and effectively, and it requires less FGF than Lack’s circuit in spontaneously breathing anesthetized adults. PMID:27877068

  16. Spontaneous breathing with biphasic positive airway pressure attenuates lung injury in hydrochloric acid-induced acute respiratory distress syndrome.

    Science.gov (United States)

    Xia, Jingen; Zhang, Heng; Sun, Bing; Yang, Rui; He, Hangyong; Zhan, Qingyuan

    2014-06-01

    It has been proved that spontaneous breathing (SB) with biphasic positive airway pressure (BIPAP) can improve lung aeration in acute respiratory distress syndrome compared with controlled mechanical ventilation. The authors hypothesized that SB with BIPAP would attenuate lung injury in acute respiratory distress syndrome compared with pressure-controlled ventilation. Twenty male New Zealand white rabbits with hydrochloric acid aspiration-induced acute respiratory distress syndrome were randomly ventilated using the BIPAP either with SB (BIPAP plus SB group) or without SB (BIPAP minus SB group) for 5 h. Inspiration pressure was adjusted to maintain the tidal volume at 6 ml/kg. Both groups received the same positive end-expiratory pressure level at 5 cm H2O for hemodynamic goals. Eight healthy animals without ventilatory support served as the control group. The BIPAP plus SB group presented a lower ratio of dead space ventilation to tidal volume, a lower respiratory rate, and lower minute ventilation. No significant difference in the protein levels of interleukin-6 and interleukin-8 in plasma, bronchoalveolar lavage fluid, and lung tissue were measured between the two experimental groups. However, SB resulted in lower messenger ribonucleic acid levels of interleukin-6 (mean ± SD; 1.8 ± 0.7 vs. 2.6 ± 0.5; P = 0.008) and interleukin-8 (2.2 ± 0.5 vs. 2.9 ± 0.6; P = 0.014) in lung tissues. In addition, lung histopathology revealed less injury in the BIPAP plus SB group (lung injury score, 13.8 ± 4.6 vs. 21.8 ± 5.7; P hydrochloric acid-induced acute respiratory distress syndrome, SB with BIPAP attenuated lung injury and improved respiratory function compared with controlled ventilation with low tidal volume.

  17. A novel approach using time-frequency analysis of pulse-oximeter data to detect progressive hypovolemia in spontaneously breathing healthy subjects.

    Science.gov (United States)

    Selvaraj, Nandakumar; Shelley, Kirk H; Silverman, David G; Stachenfeld, Nina; Galante, Nicholas; Florian, John P; Mendelson, Yitzhak; Chon, K

    2011-08-01

    Accurate and early detection of blood volume loss would greatly improve intraoperative and trauma care. This study has attempted to determine early diagnostic and quantitative markers for blood volume loss by analyzing photoplethysmogram (PPG) data from ear, finger and forehead sites with our high-resolution time-frequency spectral (TFS) technique in spontaneously breathing healthy subjects (n = 11) subjected to lower body negative pressure (LBNP). The instantaneous amplitude modulations present in heart rate (AM HR) and breathing rate (AMBR) band frequencies of PPG signals were calculated from the high-resolution TFS. Results suggested that the changes (P signals, respectively. The mean percent increase in AMBR values at 100% LBNP tolerance was 99.4% and 19.6% for ear and finger sites, respectively; AMBR values were not attainable for forehead PPG signal. Even without baseline AMHR values, our results suggest that hypovolemia detection is possible with specificity and sensitivity greater than 90% for the ear and forehead locations when LBNP tolerance is 100%. Therefore, the TFS analysis of noninvasive PPG waveforms is promising for early diagnosis and quantification of hypovolemia at levels not identified by vital signs in spontaneously breathing subjects.

  18. Randomized controlled trial of the effect of amniotomy on the duration of spontaneous labor.

    Science.gov (United States)

    Vadivelu, Malarvizhi; Rathore, Swati; Benjamin, Santosh J; Abraham, Anuja; Belavendra, Antonisamy; Mathews, Jiji E

    2017-08-01

    To investigate the effect of amniotomy on the duration of spontaneous labor. In the present randomized controlled trial, women in spontaneous labor with singleton pregnancies presenting at a tertiary teaching hospital in South India between August 1, 2014, and October 31, 2015, were randomized in a 1:1 ratio to undergo amniotomy or conservative management. The primary outcome was the duration of labor. Per-protocol analyses were performed and the duration of labor was compared between the groups of patients. There were 144 patients randomized to each group. The median duration of labor was 235 minutes (interquartile range 117-355) in the amniotomy group and 364 minutes (interquartile range 201-580) in the conservative management group (Plabor in comparison with conservative management in patients with singleton pregnancies experiencing spontaneous labor. Clinical Trials Registry-India: (CTRI) (CTRI/2014/12/005264). © 2017 International Federation of Gynecology and Obstetrics.

  19. Vocal warm-up and breathing training for teachers: randomized clinical trial.

    Science.gov (United States)

    Pereira, Lílian Paternostro de Pina; Masson, Maria Lúcia Vaz; Carvalho, Fernando Martins

    2015-01-01

    OBJECTIVE To compare the effectiveness of two speech therapy interventions, vocal warm-up and breathing training, focusing on teachers' voice quality.METHODS A single-blind, randomized, parallel clinical trial was conducted. The research included 31 20 to 60-year old teachers from a public school in Salvador, BA, Northeasatern Brazil, with minimum workloads of 20 hours a week, who have or have not reported having vocal alterations. The exclusion criteria were the following: being a smoker, excessive alcohol consumption, receiving additional speech therapy assistance while taking part in the study, being affected by upper respiratory tract infections, professional use of the voice in another activity, neurological disorders, and history of cardiopulmonary pathologies. The subjects were distributed through simple randomization in groups vocal warm-up (n = 14) and breathing training (n = 17). The teachers' voice quality was subjectively evaluated through the Voice Handicap Index (Índice de Desvantagem Vocal, in the Brazilian version) and computerized voice analysis (average fundamental frequency, jitter, shimmer, noise, and glottal-to-noise excitation ratio) by speech therapists.RESULTS Before the interventions, the groups were similar regarding sociodemographic characteristics, teaching activities, and vocal quality. The variations before and after the intervention in self-assessment and acoustic voice indicators have not significantly differed between the groups. In the comparison between groups before and after the six-week interventions, significant reductions in the Voice Handicap Index of subjects in both groups were observed, as wells as reduced average fundamental frequencies in the vocal warm-up group and increased shimmer in the breathing training group. Subjects from the vocal warm-up group reported speaking more easily and having their voices more improved in a general way as compared to the breathing training group.CONCLUSIONS Both interventions were

  20. Prospective randomized controlled intervention trial: Comprehensive Yogic Breathing Improves Cardiac autonomic functions and Quality of life in Diabetes

    Directory of Open Access Journals (Sweden)

    V P Jyotsna

    2012-01-01

    Full Text Available Aims and Objectives: To assess the effect of Comprehensive Yogic Breathing Program on glycemic control, quality of life, and cardiac autonomic functions in diabetes. Material and Methods: This is a prospective randomized controlled intervention trial. Cardiac autonomic functions were assessed in 120 diabetics. Patients were randomized into two groups, one group receiving standard therapy for diabetes (n = 56 and the other group receiving standard therapy for diabetes and comprehensive yogic breathing program (n = 64. Standard therapy included advice on diet, walk, and oral antidiabetic drugs. Comprehensive yogic breathing program was an interactive session in which Sudarshan kriya yoga, a rhythmic cyclical breathing, preceded by Pranayam was taught under guidance of a certified teacher. Change in fasting, post prandial blood sugars, glycated hemoglobin, and quality of life were assessed. Cardiac autonomic function tests were done before and six months after intervention. Results: There was significant improvement in psychological (P = 0.006 and social domains (P = 0.04 and total quality of life (P = 0.02 in the group practicing comprehensive yogic breathing program as compared to the group following standard therapy alone. In the group following breathing program, the improvement in sympathetic cardiac autonomic functions was statistically significant (P = 0.01, while the change in the standard group was not significant (P = 0.17. When both parasympathetic and sympathetic cardiac autonomic functions were considered, there was a trend toward improvement in patients following comprehensive yogic breathing program (P = 0.07. In the standard therapy group, no change in cardiac autonomic functions was noted (P = 0.76. The parameters of glycemic control were comparable in both groups. Conclusion: There was significant improvement in quality of life and cardiac autonomic functions in the diabetes patients practicing comprehensive yogic breathing

  1. Wellness through a comprehensive Yogic breathing program – A controlled pilot trial

    Directory of Open Access Journals (Sweden)

    Norlander Torsten

    2007-12-01

    developed here is safe, compliance level is good, and a full scale trial is feasible. The data obtained suggest that adult participants may improve their wellness by learning and applying a program based on yoga and yogic breathing exercises; this can be conclusively assessed in a large-scale trial. Trial Registration Australian Clinical Trial Registry ACTRN012607000175471.

  2. Effects of Piracetam on Pediatric Breath Holding Spells: A Randomized Double Blind Controlled Trial

    Science.gov (United States)

    ABBASKHANIAN, Ali; EHTESHAMI, Sara; SAJJADI, Sadegh; REZAI, Mohammad Sadegh

    2012-01-01

    Objective Breath holding spells (BHS) are common paroxysmal non-epileptic events in the pediatric population which are very stressfull despite their harmless nature. There has been no specific treatment found for the spells yet. The aim of this study was to evaluate the efficacy of piracetam (2-oxo-l-pyrrolidine) on these children. Materials & Methods In this randomized double blind clinical trial study, 150 children with severe BHS referred to our pediatric outpatient service were enrolled from August 2011 to July 2012. The patients were randomized into two equal groups. One received 40mg/kg/day piracetam and the other group received placebo, twice daily. Patients were followed monthly for three months. The number of attacks/month before and after treatment were documented. Results Of the enrolled patients, 86 were boys. The mean age of the patients was 17 months (range, 6 to 24 months). In the piracetam group, 1 month after treatment an 81% response to treatment was found. In the placebo group, none of the patients had complete remission and 7% of the cases had partial remission. Overall, control of breath-holding spells was observed in 91% of the patients in the group taking piracetam as compared with 16% in the group taking placebo at the end of the study. There was no significant difference detected between the groups regarding the prevalence of drug side effects. Conclusion A significant difference was detected between piracetam and placebo in prevention and controlling BHS. Piracetam (40mg/kg/day) had a good effect on our patients. PMID:24665274

  3. A Controlled Trial of Chemoprevention Using COX-2 Inhibitors in an Avian Model of Spontaneous Ovarian Carcinogesis

    National Research Council Canada - National Science Library

    Barnes, Mack N

    2007-01-01

    The objective of this study was to determine in a controlled chemoprevention trial the ability of a COX-2 inhibitor to inhibit the development of spontaneously arising genital tract adenocarcinoma in the laying hen (Gall us Domesticus...

  4. Impact of different oral hygiene aids for the reduction of morning bad breath among dental students: a crossover clinical trial.

    Science.gov (United States)

    Godha, Shaijal; Dasar, Pralhad L; Sandesh, N; Mishra, Prashant; Kumar, Sandeep; Balsaraf, Swati; Bhadauria, Upendra Singh; Vyas, Shaleen

    2016-01-01

    To assess and compare the effects of different oral hygiene procedures on the reduction of morning bad breath, plaque and gingival status in healthy subjects. A four step cross-over trial was performed on 32 study subjects. They were allocated into four groups: Group I: tooth brushing; Group II: tooth brushing and tongue scraping; Group III: tooth brushing and mouth washing; and Group IV: tooth brushing, tongue scraping and use of mouthwash. A washout interval of 7 days was employed. At the beginning and at the end of all intervention periods, breath score was measured by hand held sulfide monitor (Breath Alert) at four time intervals. The Plaque and Gingival status was evaluated using Plaque and Gingival Index. The highest reduction in mean breath score (2.12±0.65), plaque score (0.75±0.47) and gingival score (0.67±0.41) were found in the Group IV followed by Group II and Group III. A significant positive correlation was observed between plaque scores and gingival scores before intervention (r=0.443; p value<0.001) and after intervention (r=0.846; p value<0.001). The study findings suggest that mechanical aids in conjunction with chemical regimens are considered as the most effective method for reducing the morning bad breath in healthy subjects and should be incorporated in daily oral hygiene practices.

  5. Improving assessment of paediatric acute breathing difficulties in medical education: a cluster randomized controlled trial.

    Science.gov (United States)

    Manikam, Logan; Blackwell, Nicholas; Banerjee, Jaydip; Nightingale, Peter; Lakhanpaul, Monica

    2013-05-01

    Impact assessment of an adjunct to standard teaching on knowledge gain and self-assessed confidence for students undertaking their paediatric attachment and evaluation of an acute breathing difficulties (ABDs) learning package. Pragmatic cluster randomized controlled trial involving 248 UK medical undergraduates within six paediatric clinical rotations. Intervention groups received an online ABD learning package consisting of symptom-based decision-making pathways underpinned by a ratified ABD evidence-based guideline. Control groups received an online dummy package. Outcome measures were a pre- and post-intervention multiple choice question assessment and confidence questionnaire utilising 5-point Likert scales. Significant knowledge gain in the intervention group (mean 6.84, 95% CI 5.56-8.12) versus no such difference in the control group, significant improvement in self-assessed confidence in intervention group versus no such difference in control group and significant confidence differences in ABD-specific statements were noted. In the satisfaction questionnaire, the learning content was noted to be new to only 16% participants. Supplementation of standard teaching with an interactive delivery method resulted in cognitive gain and self-assessed confidence improvement in interaction with children with ABDs. This indicates that a well-designed tool can help prepare students for direct interaction with sick children as a junior clinician. ISRCTN27499282. ©2013 The Author(s)/Acta Paediatrica ©2013 Foundation Acta Paediatrica.

  6. Effect of device-guided breathing exercises on blood pressure in patients with hypertension: a randomized controlled trial.

    Science.gov (United States)

    Altena, Mariette R; Kleefstra, Nanne; Logtenberg, Susan J; Groenier, Klaas H; Houweling, Sebastiaan T; Bilo, Henk J

    2009-01-01

    Hypertension is a chronic disorder with a high prevalence worldwide. Despite considerable efforts, it is sometimes hard to reach treatment goals for blood pressure (BP) with classical treatment options. Reducing breathing frequency has been advocated as a method to reduce BP. A randomized, single-blind, controlled trial was conducted in 30 non-diabetic patients with hypertension over a period of 9 weeks to evaluate the effect of a device that helps to slow breathing (Resperate) on BP and quality of life (QoL). The control group listened to music and used no other therapeutic device. There was no significant difference in change in BP between intervention and control; BP -4.2 mmHg (95% CI -12.4 to 3.9)/-2.6 mmHg (95% CI -8.4 to 3.3). This result did not alter in post hoc analyses, when patients not achieving target breathing frequency (<10 breaths/min) or non-compliant patients were excluded. QoL did not change over time. We found no effect of the Resperate on BP or QoL compared with the control group. We conclude that, at this moment, this device has no added value in the treatment of hypertension.

  7. Double blind randomised controlled trial of two different breathing techniques in the management of asthma

    Science.gov (United States)

    Slader, C A; Reddel, H K; Spencer, L M; Belousova, E G; Armour, C L; Bosnic‐Anticevich, S Z; Thien, F C K; Jenkins, C R

    2006-01-01

    Background Previous studies have shown that breathing techniques reduce short acting β2 agonist use and improve quality of life (QoL) in asthma. The primary aim of this double blind study was to compare the effects of breathing exercises focusing on shallow nasal breathing with those of non‐specific upper body exercises on asthma symptoms, QoL, other measures of disease control, and inhaled corticosteroid (ICS) dose. This study also assessed the effect of peak flow monitoring on outcomes in patients using breathing techniques. Methods After a 2 week run in period, 57 subjects were randomised to one of two breathing techniques learned from instructional videos. During the following 30 weeks subjects practised their exercises twice daily and as needed for relief of symptoms. After week 16, two successive ICS downtitration steps were attempted. The primary outcome variables were QoL score and daily symptom score at week 12. Results Overall there were no clinically important differences between the groups in primary or secondary outcomes at weeks 12 or 28. The QoL score remained unchanged (0.7 at baseline v 0.5 at week 28, p = 0.11 both groups combined), as did lung function and airway responsiveness. However, across both groups, reliever use decreased by 86% (p0.10 between groups). Peak flow monitoring did not have a detrimental effect on asthma outcomes. Conclusion Breathing techniques may be useful in the management of patients with mild asthma symptoms who use a reliever frequently, but there is no evidence to favour shallow nasal breathing over non‐specific upper body exercises. PMID:16517572

  8. Double blind randomised controlled trial of two different breathing techniques in the management of asthma.

    Science.gov (United States)

    Slader, C A; Reddel, H K; Spencer, L M; Belousova, E G; Armour, C L; Bosnic-Anticevich, S Z; Thien, F C K; Jenkins, C R

    2006-08-01

    Previous studies have shown that breathing techniques reduce short acting beta(2) agonist use and improve quality of life (QoL) in asthma. The primary aim of this double blind study was to compare the effects of breathing exercises focusing on shallow nasal breathing with those of non-specific upper body exercises on asthma symptoms, QoL, other measures of disease control, and inhaled corticosteroid (ICS) dose. This study also assessed the effect of peak flow monitoring on outcomes in patients using breathing techniques. After a 2 week run in period, 57 subjects were randomised to one of two breathing techniques learned from instructional videos. During the following 30 weeks subjects practised their exercises twice daily and as needed for relief of symptoms. After week 16, two successive ICS downtitration steps were attempted. The primary outcome variables were QoL score and daily symptom score at week 12. Overall there were no clinically important differences between the groups in primary or secondary outcomes at weeks 12 or 28. The QoL score remained unchanged (0.7 at baseline v 0.5 at week 28, p = 0.11 both groups combined), as did lung function and airway responsiveness. However, across both groups, reliever use decreased by 86% (p0.10 between groups). Peak flow monitoring did not have a detrimental effect on asthma outcomes. Breathing techniques may be useful in the management of patients with mild asthma symptoms who use a reliever frequently, but there is no evidence to favour shallow nasal breathing over non-specific upper body exercises.

  9. Hemorrhagic shock-induced endothelial cell activation in a spontaneous breathing and a mechanical ventilation hemorrhagic shock model is induced by a proinflammatory response and not by hypoxia.

    Science.gov (United States)

    van Meurs, Matijs; Wulfert, Francis M; Jongman, Rianne M; Schipper, Martin; Houwertjes, Martin C; Vaneker, Michiel; Scheffer, Gert Jan; Teppema, Luc J; Aarts, Leon P H J; Heeringa, Peter; Zijlstra, Jan G; Molema, Grietje

    2011-09-01

    The interaction between neutrophils and activated endothelium is essential for the development of multiple organ dysfunction in patients with hemorrhagic shock (HS). Mechanical ventilation frequently is used in patients with HS. The authors sought to investigate the consequences of mechanical ventilation of mice subjected to HS on microvascular endothelial activation in the lung and kidney. Anesthetized wild type C57BL/6 male mice were subjected to controlled hemorrhage; subgroups of mice were mechanically ventilated during the HS insult. To study the effect of acute hypoxia on the mice, the animals were housed in hypoxic cages. Gene expression levels was assessed by quantitative real-time polymerase chain reaction. Protein expression was assessed by immunohistochemistry and enzyme-linked immunosorbent assay. Ninety minutes after the shock induction, a vascular bed-specific, heterogeneous proinflammatory endothelial activation represented by E-selectin, vascular cell adhesion molecule 1, and intercellular adhesion molecule 1 expression was seen in kidney and lung. No differences in adhesion molecules between the spontaneously breathing and mechanically ventilated mice were found. Concentrations of the proinflammatory cytokines chemokine (C-X-C motif) ligand 1 (11.0-fold) and interleukin-6 (21.7-fold) were increased after 90 min of HS. Two hours of 6% oxygen did not induce the expression of E-selectin, vascular cell adhesion molecule 1, and intercellular adhesion molecule 1 in the kidneys and the lung. Hemorrhagic shock leads to an early and reversible proinflammatory endothelial activation in kidney and lung. HS-induced endothelial activation is not changed by mechanical ventilation during the shock phase. Hypoxia alone does not lead to endothelial activation. The observed proinflammatory endothelial activation is mostly ischemia- or reperfusion-dependent and not related to hypoxia.

  10. Enriched Air Nitrox Breathing Reduces Venous Gas Bubbles after Simulated SCUBA Diving: A Double-Blind Cross-Over Randomized Trial.

    Directory of Open Access Journals (Sweden)

    Vincent Souday

    Full Text Available To test the hypothesis whether enriched air nitrox (EAN breathing during simulated diving reduces decompression stress when compared to compressed air breathing as assessed by intravascular bubble formation after decompression.Human volunteers underwent a first simulated dive breathing compressed air to include subjects prone to post-decompression venous gas bubbling. Twelve subjects prone to bubbling underwent a double-blind, randomized, cross-over trial including one simulated dive breathing compressed air, and one dive breathing EAN (36% O2 in a hyperbaric chamber, with identical diving profiles (28 msw for 55 minutes. Intravascular bubble formation was assessed after decompression using pulmonary artery pulsed Doppler.Twelve subjects showing high bubble production were included for the cross-over trial, and all completed the experimental protocol. In the randomized protocol, EAN significantly reduced the bubble score at all time points (cumulative bubble scores: 1 [0-3.5] vs. 8 [4.5-10]; P < 0.001. Three decompression incidents, all presenting as cutaneous itching, occurred in the air versus zero in the EAN group (P = 0.217. Weak correlations were observed between bubble scores and age or body mass index, respectively.EAN breathing markedly reduces venous gas bubble emboli after decompression in volunteers selected for susceptibility for intravascular bubble formation. When using similar diving profiles and avoiding oxygen toxicity limits, EAN increases safety of diving as compared to compressed air breathing.ISRCTN 31681480.

  11. Breathing retraining for African-American adolescents with asthma: a pilot study of a school-based randomized controlled trial.

    Science.gov (United States)

    Bignall, Whitney Janee Raglin; Luberto, Christina Marie; Cornette, Adrianne Falkenberg; Haj-Hamed, Monzer; Cotton, Sian

    2015-01-01

    Asthma affects approximately seven million children/adolescents in the USA, with African-American children disproportionately affected. Breathing retraining techniques have been shown to improve asthma outcomes in adults, though research in youth is limited. The purpose of this pilot study was to test the feasibility and preliminary efficacy of a school-based randomized controlled trial of breathing retraining for asthma outcomes and anxiety symptoms in a sample of urban, African-American adolescents. Adolescents were randomized into either the intervention group (20-min breathing retraining plus education) or control group (20-min standard education). Participants completed two study visits, one month apart. Asthma control, asthma quality of life and lung functioning (FEV1 and peak flow) were the primary outcomes, and state anxiety (pre-post the intervention) and trait anxiety (over the one-month period) were the secondary outcomes. Thirty-three African-American adolescents participated in the study, with a 90% retention rate between visit 1 and visit 2. Asthma control and asthma quality of life, significantly improved over time (p ≤ 0.01) with no differences between intervention and control groups. State anxiety significantly decreased (p ≤ 0.01) immediately post intervention at both time points with no differences between groups. There were no significant differences found in lung functioning or trait anxiety over the one-month time period. These preliminary results suggest that breathing retraining is a feasible, acceptable and potentially efficacious intervention (although no significant differences between groups were found) for improving asthma symptoms in urban adolescents with asthma in a school-based setting.

  12. Effects of reduced rebreathing time, in spontaneously breathing patients, on respiratory effort and accuracy in cardiac output measurement when using a partial carbon dioxide rebreathing technique: a prospective observational study.

    Science.gov (United States)

    Tachibana, Kazuya; Imanaka, Hideaki; Takeuchi, Muneyuki; Nishida, Tomoyo; Takauchi, Yuji; Nishimura, Masaji

    2005-10-05

    New technology using partial carbon dioxide rebreathing has been developed to measure cardiac output. Because rebreathing increases respiratory effort, we investigated whether a newly developed system with 35 s rebreathing causes a lesser increase in respiratory effort under partial ventilatory support than does the conventional system with 50 s rebreathing. We also investigated whether the shorter rebreathing period affects the accuracy of cardiac output measurement. Once a total of 13 consecutive post-cardiac-surgery patients had recovered spontaneous breathing under pressure support ventilation, we applied a partial carbon dioxide rebreathing technique with rebreathing of 35 s and 50 s in a random order. We measured minute ventilation, and arterial and mixed venous carbon dioxide tension at the end of the normal breathing period and at the end of the rebreathing periods. We then measured cardiac output using the partial carbon dioxide rebreathing technique with the two rebreathing periods and using thermodilution. With both rebreathing systems, minute ventilation increased during rebreathing, as did arterial and mixed venous carbon dioxide tensions. The increases in minute ventilation and arterial carbon dioxide tension were less with 35 s rebreathing than with 50 s rebreathing. The cardiac output measures with both systems correlated acceptably with values obtained with thermodilution. When patients breathe spontaneously the partial carbon dioxide rebreathing technique increases minute ventilation and arterial carbon dioxide tension, but the effect is less with a shorter rebreathing period. The 35 s rebreathing period yielded cardiac output measurements similar in accuracy to those with 50 s rebreathing.

  13. Acute bag-valve breathing maneuvers plus manual chest compression is safe during stable septic shock: a randomized clinical trial.

    Science.gov (United States)

    Blattner, Clarissa Netto; Santos, Rafael Saldanha Dos; Dias, Fernando Suparregui; Dias, Alexandre Simões; Mestriner, Régis Gemerasca; Vieira, Silvia Regina Rios

    2017-01-01

    To evaluate the effects of bag-valve breathing maneuvers combined with standard manual chest compression techniques on safety, hemodynamics and oxygenation in stable septic shock patients. A parallel, assessor-blinded, randomized trial of two groups. A computer-generated list of random numbers was prepared by an independent researcher to allocate treatments. The Intensive Care Unit at Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul. Fifty-two subjects were assessed for eligibility, and 32 were included. All included subjects (n = 32) received the allocated intervention (n = 19 for the Experimental Group and n = 13 for the Control Group). Twenty minutes of bag-valve breathing maneuvers combined with manual chest compression techniques (Experimental Group) or chest compression, as routinely used at our intensive care unit (Control Group). Follow-up was performed immediately after and at 30 minutes after the intervention. Mean artery pressure. All included subjects completed the trial (N = 32). We found no relevant effects on mean artery pressure (p = 0.17), heart rate (p = 0.50) or mean pulmonary artery pressure (p = 0.89) after adjusting for subject age and weight. Both groups were identical regarding oxygen consumption after the data adjustment (p = 0.84). Peripheral oxygen saturation tended to increase over time in both groups (p = 0.05), and there was no significant association between cardiac output and venous oxygen saturation (p = 0.813). No clinical deterioration was observed. A single session of bag-valve breathing maneuvers combined with manual chest compression is hemodynamically safe for stable septic-shocked subjects over the short-term.

  14. Effect of body position on the arterial partial pressures of oxygen and carbon dioxide in spontaneously breathing, conscious dogs in an intensive care unit.

    Science.gov (United States)

    McMillan, Matthew W; Whitaker, Katie E; Hughes, Dez; Brodbelt, David C; Boag, Amanda K

    2009-12-01

    To evaluate the effect of body position on the arterial partial pressures of oxygen and carbon dioxide (PaO(2), PaCO(2)), and the efficiency of pulmonary oxygen uptake as estimated by alveolar-arterial oxygen difference (A-a difference). Prospective, randomized, crossover study. University teaching hospital, intensive care unit. Twenty-one spontaneously breathing, conscious, canine patients with arterial catheters placed as part of their management strategy. Patients were placed randomly into lateral or sternal recumbency. PaO(2) and PaCO(2) were measured after 15 minutes in this position. Patients were then repositioned into the opposite position and after 15 minutes the parameters were remeasured. Results presented as median (interquartile range). PaO(2) was significantly higher (P=0.001) when patients were positioned in sternal, 91.2 mm Hg (86.0-96.1 mm Hg), compared with lateral recumbency, 86.4 mm Hg (73.9-90.9 mm Hg). The median change was 5.4 mm Hg (1.1-17.9 mm Hg). All 7 dogs with a PaO(2)<80 mm Hg in lateral recumbency had improved arterial oxygenation in sternal recumbency, median increase 17.4 mm Hg with a range of 3.8-29.7 mm Hg. PaCO(2) levels when patients were in sternal recumbency, 30.5 mm Hg (27.3-32.7 mm Hg) were not significantly different from those in lateral recumbency, 32.2 mm Hg (28.3-36.0 mm Hg) (P=0.07). The median change was -1.9 mm Hg (-3.6-0.77 mm Hg). A-a differences were significantly lower (P=0.005) when patients were positioned in sternal recumbency, 21.7 mm Hg (17.3-27.7 mm Hg), compared with lateral recumbency, 24.6 mm Hg (20.4-36.3 mm Hg). The median change was -3.1 mm Hg (-14.6-0.9 mm Hg). PaO(2) was significantly higher when animals were positioned in sternal recumbency compared with lateral recumbency, predominantly due to improved pulmonary oxygen uptake (decreased A-a difference) rather than increased alveolar ventilation (decreased PaCO(2)). Patients with hypoxemia (defined as PaO(2)<80 mm Hg) in lateral recumbency may

  15. Effects of ultraprotective ventilation, extracorporeal carbon dioxide removal, and spontaneous breathing on lung morphofunction and inflammation in experimental severe acute respiratory distress syndrome.

    Science.gov (United States)

    Güldner, Andreas; Kiss, Thomas; Bluth, Thomas; Uhlig, Christopher; Braune, Anja; Carvalho, Nadja; Quast, Theresa; Rentzsch, Ines; Huhle, Robert; Spieth, Peter; Richter, Torsten; Saddy, Felipe; Rocco, Patricia R M; Kasper, Michael; Koch, Thea; Pelosi, Paolo; de Abreu, Marcelo Gama

    2015-03-01

    To investigate the role of ultraprotective mechanical ventilation (UP-MV) and extracorporeal carbon dioxide removal with and without spontaneous breathing (SB) to improve respiratory function and lung protection in experimental severe acute respiratory distress syndrome. Severe acute respiratory distress syndrome was induced by saline lung lavage and mechanical ventilation (MV) with higher tidal volume (VT) in 28 anesthetized pigs (32.8 to 52.5 kg). Animals (n = 7 per group) were randomly assigned to 6 h of MV (airway pressure release ventilation) with: (1) conventional P-MV with VT ≈6 ml/kg (P-MVcontr); (2) UP-MV with VT ≈3 ml/kg (UP-MVcontr); (3) UP-MV with VT ≈3 ml/kg and SB (UP-MVspont); and (4) UP-MV with VT ≈3 ml/kg and pressure supported SB (UP-MVPS). In UP-MV groups, extracorporeal carbon dioxide removal was used. The authors found that: (1) UP-MVcontr reduced diffuse alveolar damage score in dorsal lung zones (median[interquartile]) (12.0 [7.0 to 16.8] vs. 22.5 [13.8 to 40.8]), but worsened oxygenation and intrapulmonary shunt, compared to P-MVcontr; (2) UP-MVspont and UP-MVPS improved oxygenation and intrapulmonary shunt, and redistributed ventilation towards dorsal areas, as compared to UP-MVcontr; (3) compared to P-MVcontr, UP-MVcontr and UP-MVspont, UP-MVPS yielded higher levels of tumor necrosis factor-α (6.9 [6.5 to 10.1] vs. 2.8 [2.2 to 3.0], 3.6 [3.0 to 4.7] and 4.0 [2.8 to 4.4] pg/mg, respectively) and interleukin-8 (216.8 [113.5 to 343.5] vs. 59.8 [45.3 to 66.7], 37.6 [18.8 to 52.0], and 59.5 [36.1 to 79.7] pg/mg, respectively) in dorsal lung zones. In this model of severe acute respiratory distress syndrome, MV with VT ≈3 ml/kg and extracorporeal carbon dioxide removal without SB slightly reduced lung histologic damage, but not inflammation, as compared to MV with VT = 4 to 6 ml/kg. During UP-MV, pressure supported SB increased lung inflammation.

  16. Low dose aspirin in the prevention of recurrent spontaneous preterm labour - the APRIL study: a multicenter randomized placebo controlled trial.

    Science.gov (United States)

    Visser, Laura; de Boer, Marjon A; de Groot, Christianne J M; Nijman, Tobias A J; Hemels, Marieke A C; Bloemenkamp, Kitty W M; Bosmans, Judith E; Kok, Marjolein; van Laar, Judith O; Sueters, Marieke; Scheepers, Hubertina; van Drongelen, Joris; Franssen, Maureen T M; Sikkema, J Marko; Duvekot, Hans J J; Bekker, Mireille N; van der Post, Joris A M; Naaktgeboren, Christiana; Mol, Ben W J; Oudijk, Martijn A

    2017-07-14

    Preterm birth (birth before 37 weeks of gestation) is a major problem in obstetrics and affects an estimated 15 million pregnancies worldwide annually. A history of previous preterm birth is the strongest risk factor for preterm birth, and recurrent spontaneous preterm birth affects more than 2.5 million pregnancies each year. A recent meta-analysis showed possible benefits of the use of low dose aspirin in the prevention of recurrent spontaneous preterm birth. We will assess the (cost-)effectiveness of low dose aspirin in comparison with placebo in the prevention of recurrent spontaneous preterm birth in a randomized clinical trial. Women with a singleton pregnancy and a history of spontaneous preterm birth in a singleton pregnancy (22-37 weeks of gestation) will be asked to participate in a multicenter, randomized, double blinded, placebo controlled trial. Women will be randomized to low dose aspirin (80 mg once daily) or placebo, initiated from 8 to 16 weeks up to maximal 36 weeks of gestation. The primary outcome measure will be preterm birth, defined as birth at a gestational age (GA) aspirin is effective in preventing preterm birth, we expect that there will be cost savings, because of the low costs of aspirin. To evaluate this, a cost-effectiveness analysis will be performed comparing preventive treatment with aspirin with placebo. This trial will provide evidence as to whether or not low dose aspirin is (cost-) effective in reducing recurrence of spontaneous preterm birth. Clinical trial registration number of the Dutch Trial Register: NTR 5675 . EudraCT-registration number: 2015-003220-31.

  17. Mapleson's Breathing Systems

    OpenAIRE

    Kaul, Tej K; Mittal, Geeta

    2013-01-01

    Mapleson breathing systems are used for delivering oxygen and anaesthetic agents and to eliminate carbon dioxide during anaesthesia. They consist of different components: Fresh gas flow, reservoir bag, breathing tubes, expiratory valve, and patient connection. There are five basic types of Mapleson system: A, B, C, D and E depending upon the different arrangements of these components. Mapleson F was added later. For adults, Mapleson A is the circuit of choice for spontaneous respiration where...

  18. Enriched Air Nitrox Breathing Reduces Venous Gas Bubbles after Simulated SCUBA Diving: A Double-Blind Cross-Over Randomized Trial.

    Science.gov (United States)

    Souday, Vincent; Koning, Nick J; Perez, Bruno; Grelon, Fabien; Mercat, Alain; Boer, Christa; Seegers, Valérie; Radermacher, Peter; Asfar, Pierre

    2016-01-01

    To test the hypothesis whether enriched air nitrox (EAN) breathing during simulated diving reduces decompression stress when compared to compressed air breathing as assessed by intravascular bubble formation after decompression. Human volunteers underwent a first simulated dive breathing compressed air to include subjects prone to post-decompression venous gas bubbling. Twelve subjects prone to bubbling underwent a double-blind, randomized, cross-over trial including one simulated dive breathing compressed air, and one dive breathing EAN (36% O2) in a hyperbaric chamber, with identical diving profiles (28 msw for 55 minutes). Intravascular bubble formation was assessed after decompression using pulmonary artery pulsed Doppler. Twelve subjects showing high bubble production were included for the cross-over trial, and all completed the experimental protocol. In the randomized protocol, EAN significantly reduced the bubble score at all time points (cumulative bubble scores: 1 [0-3.5] vs. 8 [4.5-10]; P diving profiles and avoiding oxygen toxicity limits, EAN increases safety of diving as compared to compressed air breathing. ISRCTN 31681480.

  19. Omalizumab for the treatment of chronic spontaneous urticaria: A meta-analysis of randomized clinical trials.

    Science.gov (United States)

    Zhao, Zuo-Tao; Ji, Chun-Mei; Yu, Wen-Jun; Meng, Ling; Hawro, Tomasz; Wei, Ji-Fu; Maurer, Marcus

    2016-06-01

    Chronic spontaneous urticaria (CSU) is defined by itchy hives, angioedema, or both for at least 6 weeks. Omalizumab, an anti-IgE antibody that affects mast cell and basophil function, is a promising new treatment option. As of now, however, the efficacy and safety of different doses of omalizumab used in clinical trials for CSU have not been systematically analyzed and summarized. We sought to assess the efficacy and safety of different doses of omalizumab for the treatment of CSU in a meta-analysis of clinical trial results. Suitable trials were identified by searching PubMed, Medline, Embase, and Web of Science databases and with the help of omalizumab's manufacturers. Only double-blind, randomized, placebo-controlled studies with omalizumab-treated versus placebo-treated patients with CSU were included in this analysis. We identified 7 randomized, placebo-controlled studies with 1312 patients with CSU. Patients treated with omalizumab (75-600 mg every 4 weeks) had significantly reduced weekly itch and weekly wheal scores compared with the placebo group. Omalizumab's effects were dose dependent, with the strongest reduction in weekly itch and weekly wheal scores observed with 300 mg. Rates of complete response were significantly higher in the omalizumab group (relative risk, 4.55; P omalizumab and placebo groups. This meta-analysis provides high-quality evidence for the efficacy and safety of omalizumab in patients with CSU and for treating these patients with 300 mg of omalizumab every 4 weeks. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  20. Controlled breathing with or without peppermint aromatherapy for postoperative nausea and/or vomiting symptom relief: a randomized controlled trial.

    Science.gov (United States)

    Sites, Debra S; Johnson, Nancy T; Miller, Jacqueline A; Torbush, Pauline H; Hardin, Janis S; Knowles, Susan S; Nance, Jennifer; Fox, Tara H; Tart, Rebecca Creech

    2014-02-01

    With little scientific evidence to support use of aromatherapy for postoperative nausea and/or vomiting (PONV) symptoms, this study evaluated controlled breathing with peppermint aromatherapy (AR) and controlled breathing alone (CB) for PONV relief. A single blind randomized control trial design was used. On initial PONV complaint, symptomatic subjects received either CB (n = 16) or AR (n = 26) intervention based on randomization at enrollment. A second treatment was repeated at 5 minutes if indicated. Final assessment occurred 10 minutes post initial treatment. Rescue medication was offered for persistent symptoms. Among eligible subjects, PONV incidence was 21.4% (42/196). Gender was the only risk factor contributing to PONV symptoms (P = .0024). Though not statistically significant, CB was more efficacious than AR, 62.5% versus 57.7%, respectively. CB can be initiated without delay as an alternative to prescribed antiemetics. Data also support use of peppermint AR in conjunction with CB for PONV relief. Copyright © 2014 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  1. Prognostic value of the proliferation marker Ki-67 in laryngeal carcinoma : Results of the Accelerated Radiotherapy with Carbogen Breathing and Nicotinamide phase III randomized trial

    NARCIS (Netherlands)

    Rademakers, Saskia E.; Hoogsteen, Ilse J.; Rijken, Paul F.; Terhaard, Chris H.; Doornaert, Patricia A.; Langendijk, Johannes A.; van den Ende, Piet; van der Kogel, Albert J.; Bussink, Johan; Kaanders, Johannes H.

    BackgroundThe prognostic and predictive value of the proliferation marker Ki-67 was investigated in a randomized trial comparing accelerated radiotherapy with carbogen breathing and nicotinamide (ARCON) to accelerated radiotherapy in laryngeal carcinoma. MethodsLabeling index of Ki-67 (Li Ki-67) in

  2. Prognostic value of the proliferation marker Ki-67 in laryngeal carcinoma : Results of the Accelerated Radiotherapy with Carbogen Breathing and Nicotinamide phase III randomized trial

    NARCIS (Netherlands)

    Rademakers, Saskia E.; Hoogsteen, Ilse J.; Rijken, Paul F.; Terhaard, Chris H.; Doornaert, Patricia A.; Langendijk, Johannes A.; Van Den Ende, Piet; Van Der Kogel, Albert J.; Bussink, Johan; Kaanders, Johannes H.

    2015-01-01

    Background The prognostic and predictive value of the proliferation marker Ki-67 was investigated in a randomized trial comparing accelerated radiotherapy with carbogen breathing and nicotinamide (ARCON) to accelerated radiotherapy in laryngeal carcinoma. Methods Labeling index of Ki-67 (Li Ki-67)

  3. Effect of breathing technique of blowing on the extent of damage to the perineum at the moment of delivery: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Zohre Ahmadi

    2017-01-01

    Full Text Available Introduction: One of the important tasks in managing labor is the protection of perineum. An important variable affecting this outcome is maternal pushing during the second stage of labor. This study was done to investigate the effect of breathing technique on perineal damage extention in laboring Iranian women. Materials and Methods: This randomized clinical trial was performed on 166 nulliparous pregnant women who had reached full-term pregnancy, had low risk pregnancy, and were candidates for vaginal delivery in two following groups: using breathing techniques (case group and valsalva maneuver (control group. In the control group, pushing was done with holding the breath. In the case group, the women were asked to take 2 deep abdominal breaths at the onset of pain, then take another deep breath, and push 4–5 seconds with the open mouth while controlling exhalation. From the crowning stage onward, the women were directed to control their pushing, and do the blowing technique. Results: According to the results, intact perineum was more observed in the case group (P = 0.002. Posterior tears (Grade 1, 2, and 3 was considerably higher in the control group (P = 0.003. Anterior tears (labias and episiotomy were not significantly different in the two groups. Conclusions: It was concluded that breathing technique of blowing can be a good alternative to Valsalva maneuver in order to reduce perineal damage in laboring women.

  4. Breathing difficulty

    Science.gov (United States)

    Shortness of breath; Breathlessness; Difficulty breathing; Dyspnea ... There is no standard definition for difficulty breathing. Some people ... even though they don't have a medical condition. Others may ...

  5. Spontaneous pneumothorax in weightlifters.

    Science.gov (United States)

    Marnejon, T; Sarac, S; Cropp, A J

    1995-06-01

    Spontaneous pneumothorax is infrequently caused by strenuous exertion. To our knowledge there has only been one case of spontaneous pneumothorax associated with weightlifting reported in the medical literature. We describe three consecutive cases of spontaneous pneumothorax associated with weightlifting. We postulate that spontaneous pneumothorax in these patients may be secondary to improper breathing techniques. It is important that physicians and weight trainers be aware of the association between weight lifting and spontaneous pneumothorax and assure that proper instruction is given to athletes who work with weights.

  6. Operative hysteroscopy versus vacuum aspiration for incomplete spontaneous abortion (HY-PER): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Huchon, Cyrille; Koskas, Martin; Agostini, Aubert; Akladios, Cherif; Alouini, Souhail; Bauville, Estelle; Bourdel, Nicolas; Fernandez, Hervé; Fritel, Xavier; Graesslin, Olivier; Legendre, Guillaume; Lucot, Jean-Philippe; Matheron, Isabelle; Panel, Pierre; Raiffort, Cyril; Fauconnier, Arnaud

    2015-08-19

    Incomplete spontaneous abortions are defined by the intrauterine retention of the products of conception after their incomplete or partial expulsion. This condition may be managed by expectant care, medical treatment or surgery. Vacuum aspiration is currently the standard surgical treatment in most centers. However, operative hysteroscopy has the advantage over vacuum aspiration of allowing the direct visualization of the retained conception product, facilitating its elective removal while limiting surgical complications. Inadequately powered retrospective studies reported subsequent fertility to be higher in patients treated by operative hysteroscopy than in those treated by vacuum aspiration. These data require confirmation in a randomized controlled trial comparing fertility rates between women undergoing hysteroscopy and those undergoing vacuum aspiration for incomplete spontaneous abortion. After providing written informed consent, 572 women with incomplete spontaneous abortion recruited from 15 centers across France will undergo randomization by a centralized computer system for treatment by either vacuum aspiration or operative hysteroscopy. Patients will not be informed of the type of treatment that they receive and will be cared for during their hospital stay in accordance with standard practices at each center. The patients will be monitored for pregnancy or adverse effects by a telephone conversation or questionnaire sent by e-mail or post over a period of two years. In cases of complications, failure of the intervention or diagnosis of uterine cavity disease, patient care will be left to the discretion of the medical center team. If our hypothesis is confirmed, this study will provide evidence that the use of operative hysteroscopy can increase the number of pregnancies continuing beyond 22 weeks of gestation in the two-year period following incomplete spontaneous abortion without increasing the incidence of morbidity and peri- and postoperative

  7. Evaluating time between birth to cry or bag and mask ventilation using mobile delivery room timers in India: the NICHD Global Network's Helping Babies Breathe Trial.

    Science.gov (United States)

    Somannavar, Manjunath S; Goudar, Shivaprasad S; Revankar, Amit P; Moore, Janet L; McClure, Elizabeth M; Destefanis, Pablo; DeCain, Martha; Goco, Norman; Wright, Linda L

    2015-08-06

    The Golden Minute®, the first minute following birth of a newborn, is a critical period for establishing ventilation after delivery, as emphasized in the Helping Babies Breathe® and other resuscitation training programs. Previous studies have reinforced training through observers' evaluation of this time period; although observation is useful for research, it may not be a sustainable method to support resuscitation practice in low-resource settings where few birth attendants are available. In order to reinforce resuscitation within The Golden Minute®, we sought to develop a simple mobile delivery-room timer on an Android cell phone platform for birth attendants to use at the time of delivery. We developed and evaluated a mobile delivery room timer to document the time interval from birth to the initiation of newborn crying/spontaneous respiration or bag and mask ventilation in a convenience sample of women who delivered in five hospitals in Karnataka, India. The mobile delivery room timer is an Android cell phone-based application that recorded key events including crowning, delivery, and crying/spontaneous respiration or bag and mask ventilation. The mobile delivery room timer recorded the birth attendant verbally indicating the time of crowning, birth-(defined as when the entire baby was delivered), crying/spontaneous respiration or bag and mask ventilation. The mobile delivery room timer results were validated in a subsample by a trained observer (nurse) who independently recorded the time between delivery and initiation of crying/spontaneous respiration or bag and mask ventilation. Of the total 4,597 deliveries, 2,107 (46%) were timed; a sample (n = 438) of these deliveries was also observed by a trained nurse. There was high concordance between the mobile delivery room timer and observed time elapsed between birth and crying/spontaneous respiration or ventilation (correlation =0.94, p cried/breathed spontaneously or received bag and mask ventilation by 1

  8. Intravenous Gadoxetate Disodium Administration Reduces Breath-holding Capacity in the Hepatic Arterial Phase: A Multi-Center Randomized Placebo-controlled Trial.

    Science.gov (United States)

    McClellan, Taylor R; Motosugi, Utaroh; Middleton, Michael S; Allen, Brian C; Jaffe, Tracy A; Miller, Chad M; Reeder, Scott B; Sirlin, Claude B; Bashir, Mustafa R

    2017-02-01

    Purpose To determine, in a multicenter double-blinded placebo-controlled trial, whether maximal hepatic arterial phase breath-holding duration is affected by gadoxetate disodium administration. Materials and Methods Institutional review board approval was obtained for this prospective multi-institutional HIPAA-compliant study; written informed consent was obtained from all subjects. At three sites, a total of 44 volunteers underwent a magnetic resonance (MR) imaging examination in which images were acquired before and dynamically after bolus injection of gadoxetate disodium, normal saline, and gadoterate meglumine, administered in random order in a single session. The technologist and volunteer were blinded to the agent. Arterial phase breath-holding duration was timed after each injection, and volunteers reported subjective symptoms. Heart rate (HR) and oxygen saturation were monitored. Images were independently analyzed for motion artifacts by three radiologists. Arterial phase breath-holding duration and motion artifacts after each agent were compared by using the Mann-Whitney U test and the McNemar test. Factors affecting the above outcomes were assessed by using a univariate, multivariable model. Results Arterial phase breath holds were shorter after gadoxetate disodium (mean, 32 seconds ± 19) than after saline (mean, 40 seconds ± 17; P breath holds were shorter after gadoxetate disodium than after both saline and gadoterate meglumine. Three (7%) of 44 volunteers had severe arterial phase motion artifacts after gadoxetate disodium administration, one (2%; P = .62) had them after gadoterate meglumine administration, and none (P = .25) had them after saline administration. HR and oxygen saturation changes were not significantly associated with contrast agent. Conclusion Maximal hepatic arterial phase breath-holding duration is reduced after gadoxetate disodium administration in healthy volunteers, and reduced breath-holding duration is associated with motion

  9. A randomized placebo-controlled trial of an NMDA receptor antagonist in sleep-disordered breathing.

    Science.gov (United States)

    Torvaldsson, Stefan; Grote, Ludger; Peker, Yüksel; Basun, Hans; Hedner, Jan

    2005-06-01

    Hypoxemia is a powerful stimulus of glutamate release in the central nervous system (CNS) and a hallmark phenomenon in sleep disordered breathing (SDB). Glutamate effects that include neuronal damage and apoptosis following hypoxemia and apnea following microinjections in animal models are in part mediated via postjunctional N-methyl-D-aspartate (NMDA) receptors. This was a double blind, randomized, placebo-controlled single dose cross-over study of the NMDA receptor antagonist AR-R15896AR in 15 male patients with moderate to severe SDB. Seven patients received 120 mg and eight patients received 350 mg AR-R15896AR or corresponding placebo (given by 2 h infusion) starting half an hour before estimated sleep onset. AR-R15896AR concentrations were in line with the predicting kinetic model. A standard polysomnographic montage was applied. Repeated plasma samples were obtained in nine patients for analysis of plasma glutamate. Glutamate concentration in plasma did not change overnight and was unrelated to severity of SDB. Overall AHI (apnea-hypopnea index; primary efficacy variable) or investigated oxygen saturation variables were not significantly changed after AR-R15896AR at either dosage level. Side effects were mostly confined to the higher dose level and included vivid dreams, nightmares as well as in two cases mild hallucinations. The previously postulated role of glutamate in SDB could not be confirmed after AR-R15896AR induced NMDA-receptor blockade.

  10. Sleep-disordered breathing decreases after opioid withdrawal: results of a prospective controlled trial.

    Science.gov (United States)

    Schwarzer, Andreas; Aichinger-Hinterhofer, Marie; Maier, Christoph; Vollert, Jan; Walther, Jörg Werner

    2015-11-01

    An increased cardiovascular event rate in elderly patients under opioid medications was recently reported. One reason for this increase could be the occurrence of nocturnal apnea and hypoxia, as a consequence of sleep-disordered breathing (SDB). Using a controlled study, we prospectively analyzed SDB using polysomnography in a total of 18 patients before and after opioid withdrawal (opioid withdrawal group [OG]) and 14 patients before and after comprehensive pain management (without any strong-acting opioids) who served as the control group (CG). To analyze the differences, unpaired/paired t tests and Mann-Whitney U tests/Wilcoxon rank tests were used. At baseline, the OG presented more nocturnal apneas/hypopneas than the CG with an apnea-hypopnea index (AHI) of 41.4 ± 27.8 vs 21.8 ± 15.9 (P = 0.018). After treatment, the AHI decreased significantly only in the withdrawal group (OG: 16.7 ± 8.9; CG: 20.1 ± 12.9) (P opioid withdrawal and in none of the patients after withdrawal (P opioid intake; these findings may explain the opioid-associated cardiovascular morbidity. Thus, SDB may be a risk at lower opioid doses than hitherto described, and particular caution should be exercised in patients with comorbidities that might make them vulnerable to the consequences of SDB.

  11. A pilot feeding study for adults with asthma: The healthy eating better breathing trial.

    Directory of Open Access Journals (Sweden)

    Emily P Brigham

    Full Text Available Evidence from observational studies and to a lesser extent clinical trials suggest that a healthy diet may improve symptoms and lung function in patients with asthma. We conducted a pilot study to determine the feasibility of conducting a larger scale dietary trial and to provide preliminary evidence on the impact of a healthy diet on asthma outcomes.In a randomized, two period cross-over trial, participants with asthma received a 4-week dietary intervention followed by a usual diet (or vice versa, separated by a 4-week washout. The dietary intervention was a healthy diet rich in unsaturated fat. During the dietary intervention, participants ate three meals per week on site at the Johns Hopkins ProHealth Research Center. All remaining meals and snacks were provided for participants to consume off-site. During the control diet, participants were instructed to continue their usual dietary intake. Relevant biomarkers and asthma clinical outcomes were assessed at 0, 2, and 4 weeks after starting each arm of the study.Eleven participants were randomized, and seven completed the full study protocol. Among these seven participants, average age was 42 years, six were female, and six were African American. Participant self-report of dietary intake revealed significant increases in fruit, vegetable, and omega-3 fatty acid intake with the dietary intervention compared to usual diet. Serum carotenoids (eg. lutein and beta-cryptoxanthin increased in the intervention versus control. Total cholesterol decreased in the intervention versus control diet. There was no consistent effect on asthma outcomes.The findings suggest that a feeding trial in participants with asthma is feasible. Larger trials are needed to definitively assess the potential benefits of dietary interventions on pulmonary symptoms and function in patients with asthma.

  12. Lower Interbreath Interval Complexity Is Associated With Extubation Failure in Mechanically Ventilated Patients During Spontaneous Breathing Trials

    Science.gov (United States)

    2010-06-01

    literature ;10,21,58 however, the CV for VT in the success group of El-Khatib et al.6 was 9%.6 Using ApEn, Engoren7 investigated the regularity of RR and VT...surgery. Circulation. 1998;98:429–434. 50. Modarreszadeh M, Bruce EN, Gothe B. Nonrandom variability in respiratory cycle parameters of humans during

  13. The Breathe Easier through Weight Loss Lifestyle (BE WELL Intervention: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Buist A

    2010-03-01

    Full Text Available Abstract Background Obesity and asthma have reached epidemic proportions in the US. Their concurrent rise over the last 30 years suggests that they may be connected. Numerous observational studies support a temporally-correct, dose-response relationship between body mass index (BMI and incident asthma. Weight loss, either induced by surgery or caloric restriction, has been reported to improve asthma symptoms and lung function. Due to methodological shortcomings of previous studies, however, well-controlled trials are needed to investigate the efficacy of weight loss strategies to improve asthma control in obese individuals. Methods/Design BE WELL is a 2-arm parallel randomized clinical trial (RCT of the efficacy of an evidence-based, comprehensive, behavioral weight loss intervention, focusing on diet, physical activity, and behavioral therapy, as adjunct therapy to usual care in the management of asthma in obese adults. Trial participants (n = 324 are patients aged 18 to 70 years who have suboptimally controlled, persistent asthma, BMI between 30.0 and 44.9 kg/m2, and who do not have serious comorbidities (e.g., diabetes, heart disease, stroke. The 12-month weight loss intervention to be studied is based on the principles of the highly successful Diabetes Prevention Program lifestyle intervention. Intervention participants will attend 13 weekly group sessions over a four-month period, followed by two monthly individual sessions, and will then receive individualized counseling primarily by phone, at least bi-monthly, for the remainder of the intervention. Follow-up assessment will occur at six and 12 months. The primary outcome variable is the overall score on the Juniper Asthma Control Questionnaire measured at 12 months. Secondary outcomes include lung function, asthma-specific and general quality of life, asthma medication use, asthma-related and total health care utilization. Potential mediators (e.g., weight loss and change in physical

  14. Born not breathing: A randomised trial comparing two self-inflating bag-masks during newborn resuscitation in Tanzania.

    Science.gov (United States)

    Thallinger, Monica; Ersdal, Hege Langli; Francis, Fortunata; Yeconia, Anita; Mduma, Estomih; Kidanto, Hussein; Linde, Jørgen Erland; Eilevstjønn, Joar; Gunnes, Nina; Størdal, Ketil

    2017-07-01

    Effective ventilation is crucial to save non-breathing newborns. We compared standard equipment for newborn resuscitation to a new Upright bag, in an area with high neonatal mortality. Newborns requiring resuscitation at Haydom Lutheran Hospital, Tanzania, were ventilated with 230ml standard or 320ml Upright bag-mask by weekly non-blinded block randomisation. A Laerdal Newborn Resuscitation Monitor collected ventilation data through a flow sensor between mask and bag and heart rate with electrocardiography electrodes. Primary outcome was expiratory tidal volume per birth weight. Of 6110 babies born, 136 randomised to standard bag-mask and 192 to Upright, both groups had similar birth weight, gestational age, Apgar scores, gender, and mode of delivery. Compared to standard bag-mask, Upright gave higher median expiratory tidal volume (8.6ml/kg (IQR: 3.5-13.8) vs. 10.0ml/kg (IQR: 4.3-16.8) difference ratio 1.29, 95%CI 1.05, 1.58, p=0.014)), increased mean airway and peak inspiratory pressures, and higher early expired CO 2 (median at 20s 4.2% vs. 3.2%, p=0.0099). Clinical outcome 30min post-delivery was normal in 44% with standard versus 57% with Upright (p=0.016), but similar at 24h. Upright provided higher expired tidal volume, MAP, PIP and early ECO 2 than the standard bag. Clinical outcome differed at 30min, but not at 24h. Larger volume of Upright than standard bag can be an important factor. The results are relevant for low- and high-income settings as ventilatory and heart rate parameters during resuscitation of newborns are rarely reported. Trial registered at www.ClinicalTrials.gov, NCT01869582. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Breathing Problems

    Science.gov (United States)

    ... getting enough air. Sometimes you can have mild breathing problems because of a stuffy nose or intense ... panic attacks Allergies If you often have trouble breathing, it is important to find out the cause.

  16. Comparison between breathing and aerobic exercise on clinical control in patients with moderate-to-severe asthma: protocol of a randomized trial.

    Science.gov (United States)

    Evaristo, Karen B; Saccomani, Milene G; Martins, Milton A; Cukier, Alberto; Stelmach, Rafael; Rodrigues, Marcos R; Santaella, Danilo F; Carvalho, Celso R F

    2014-10-17

    Asthma is a chronic inflammatory airway disease characterized by reversible obstruction, inflammation and hyperresponsiveness to different stimulus. Aerobic and breathing exercises have been demonstrated to benefit asthmatic patients; however, there is no evidence comparing the effectiveness of these treatments. This is a prospective, comparative, blinded, and randomized clinical trial with 2 groups that will receive distinct interventions. Forty-eight asthmatic adults with optimized medical treatment will be randomly divided into either aerobic (AG) or breathing exercises (BG). Patients will perform breathing or aerobic exercise twice a week for 3 months, totalizing 24 sessions of 40 minutes each. Before intervention, both groups will complete an educational program consisting of 2 educational classes. Before and after interventions, the following parameters will be quantified: clinical control (main outcome), health related quality of life, levels of anxiety and depression, daily living physical activity and maximal exercise capacity (secondary outcome). Hyperventilation syndrome symptoms, autonomic nervous imbalance, thoracoabdominal kinematics, inflammatory cells in the sputum, fraction of exhaled nitric oxide (FENO) and systemic inflammatory cytokines will also be evaluated as possible mechanisms to explain the benefits of both interventions. Although the benefits of breathing and aerobic exercises have been extensively studied, the comparison between both has never been investigated. Furthermore, the findings of our results will allow us to understand its application and suitability to patients that will have more benefits for every intervention optimizing its effect. Clinicaltrials.gov; Identifier: NCT02065258.

  17. Basic and therapeutic trial results obtained in the spontaneous AK leukemia (lymphoma) model-end of 1971.

    Science.gov (United States)

    Skipper, H E; Schabel, F M; Trader, M W; Laster, W R; Simpson-Herren, L; Lloyd, H H

    1972-06-01

    Basic and therapeutic trial results obtained in the spontaneous AK leukemia (lymphoma) model have been brought together for comparison with available information on the much used transplanted murine leukemia models and human leukemias and lymphomas. The etiologic agent for "spontaneous" AK lymphoma is an RNA virus present at birth in AKR mice. Lymphoma cells first appear in the thymuses of animals at 5-->12 months of age. The time lapse between the first appearance of viable lymphoma cells in the thymus and clinical diagnosis (eg, with about 10(9) widely disseminated viable plus nonviable lymphoma cells in the host) is about 1 month. Thus, the overall doubling time of lymphoma cells before diagnosis is about 1 day. This estimate is compatible with the doubling time of relatively small numbers of first-passage lymphoma cells, assay data on the rate of repopulation of viable lymphoma cells after therapeutic reduction, and the median intermitotic time of dividing lymphoma cells (ie, 0.6 day). In general, the cytokinetic parameters of advanced spontaneous AK lymphoma cell populations are more like those observed in advanced human leukemias than are those of early L1210 leukemia. This paper presents assay data on the reduction in viable spontaneous AK lymphoma cells after treatment with a variety of agents, and the rate of cell repopulation after cessation of treatment. Extensive therapeutic trial data indicate that cyclophosphamide is presently the most effective single agent against spontaneous AK lymphoma, with arabinosylcytosine or palmO-ara-C a close second. Daunomycin, 5-fluorouracil, the nitrosoureas, vincristine, methotrexate, and dexamethasone provided moderate increases in host survival time. The combination of vincristine plus prednisone was a good remission inducer but the median survival time after cessation of treatment was shorter than that observed for cyclophosphamide or palmO-araC. The best responses observed to date with two-drug combinations appear

  18. The clinical utility of lung clearance index in early cystic fibrosis lung disease is not impacted by the number of multiple-breath washout trials

    Directory of Open Access Journals (Sweden)

    Rachel E. Foong

    2018-02-01

    Full Text Available The lung clearance index (LCI from the multiple-breath washout (MBW test is a promising surveillance tool for pre-school children with cystic fibrosis (CF. Current guidelines for MBW testing recommend that three acceptable trials are required. However, success rates to achieve these criteria are low in children aged <7 years and feasibility may improve with modified pre-school criteria that accepts tests with two acceptable trials. This study aimed to determine if relationships between LCI and clinical outcomes of CF lung disease differ when only two acceptable MBW trials are assessed. Healthy children and children with CF aged 3–6 years were recruited for MBW testing. Children with CF also underwent bronchoalveolar lavage fluid collection and a chest computed tomography scan. MBW feasibility increased from 46% to 75% when tests with two trials were deemed acceptable compared with tests where three acceptable trials were required. Relationships between MBW outcomes and markers of pulmonary inflammation, infection and structural lung disease were not different between tests with three acceptable trials compared with tests with two acceptable trials. This study indicates that pre-school MBW data from two acceptable trials may provide sufficient information on ventilation distribution if three acceptable trials are not possible.

  19. PTSD symptom reduction with mindfulness-based stretching and deep breathing exercise: randomized controlled clinical trial of efficacy.

    Science.gov (United States)

    Kim, Sang Hwan; Schneider, Suzanne M; Bevans, Margaret; Kravitz, Len; Mermier, Christine; Qualls, Clifford; Burge, Mark R

    2013-07-01

    Abnormal cortisol levels are a key pathophysiological indicator of post-traumatic stress disorder (PTSD). Endogenous normalization of cortisol concentration through exercise may be associated with PTSD symptom reduction. The aim of the study was to determine whether mindfulness-based stretching and deep breathing exercise (MBX) normalizes cortisol levels and reduces PTSD symptom severity among individuals with subclinical features of PTSD. A randomized controlled trial was conducted at the University of New Mexico Health Sciences Center. Twenty-nine nurses (28 female) aged 45-66 years participated in the study. Sixty-minute MBX sessions were conducted semiweekly for 8 weeks. Serum cortisol was measured, and the PTSD Checklist-Civilian version (PCL-C) was performed at baseline and weeks 4, 8, and 16. Twenty-nine participants completed the study procedures, 22 (79%) with PTSD symptoms (MBX, n = 11; control, n = 11), and 7 (21%) without PTSD (BASE group). Eight-week outcomes for the MBX group were superior to those for the control group (mean difference for PCL-C scores, -13.6; 95% confidence interval [CI], -25.6, -1.6; P = .01; mean difference for serum cortisol, 5.8; 95% CI, 0.83, 10.8; P = .01). No significant differences were identified between groups in any other items. The changes in the MBX group were maintained at the 16-week follow-up (P = .85 for PCL-C; P = .21 for cortisol). Our data show that improved PTSD scores were associated with normalization of cortisol levels (P PTSD-like symptoms in individuals exhibiting subclinical features of PTSD.

  20. Effect of device-guided breathing exercises on blood pressure in hypertensive patients with type 2 diabetes mellitus: a randomized controlled trial.

    Science.gov (United States)

    Logtenberg, Susan J; Kleefstra, Nanne; Houweling, Sebastiaan T; Groenier, Klaas H; Bilo, Henk J

    2007-01-01

    In patients with type 2 diabetes mellitus (DM2), it is hard to reach treatment objectives for blood pressure (BP) with classical treatment options. Recently, reducing breathing frequency has been advocated as a method to reduce BP. We examined if an electronic device such as Resperate, by reducing breathing frequency, would lead to BP reduction in a population of patients with DM2 and hypertension. Our secondary objective was to study the effect of this device on quality of life (QOL). A randomized, single-blind, controlled trial was conducted over a period of 8 weeks to evaluate the effect of this therapy on BP and QOL. The control group listened to music and used no other therapeutic device. BP and QOL changes were studied in 30 patients with DM2 and hypertension. There was no significant difference in change in BP between groups; -7.5 [95% confidence interval (CI) -12.7, -2.3]/-1.0 (95% CI -5.5, 3.6) mmHg in the intervention group and -12.2 (95% CI -17.4, -7.0)/-5.5 (95% CI -9.7, -1.4) mmHg in the control group. Whether or not the target breathing frequency of 10 breaths/min was reached did not affect BP. There were no significant changes in QOL. The effects of Resperate on BP and QOL were not significantly different from those found in the control group. Furthermore, 40% of patients did not reach the target breathing frequency, making this device less suitable for clinical practice in patients with DM2.

  1. Peripheral ARtery Atherosclerotic DIsease and SlEep disordered breathing (PARADISE) trial - protocol for an observational cohort study.

    Science.gov (United States)

    Szymański, Filip M; Gałązka, Zbigniew; Płatek, Anna E; Górko, Dariusz; Ostrowski, Tomasz; Adamkiewicz, Karolina; Łęgosz, Paweł; Ryś, Anna; Semczuk-Kaczmarek, Karolina; Celejewski, Krzysztof; Filipiak, Krzysztof J

    2017-01-01

    Peripheral arterial disease (PAD) is in fact a group of disease entities with different symptoms and course but a common underlying cause, i.e. atherosclerosis. Atherosclerosis is known to be aggravated by several cardiovascular risk factors, including obstructive sleep apnoea (OSA). Following paper is a protocol for the Peripheral ARtery Atherosclerotic DIsease and SlEep disordered breathing (PARADISE) trial, which aims to describe the prevalence of OSA in PAD patients scheduled for revascularisation, and to determine the effect of OSA on the procedure outcomes. The PARADISE study is an observational cohort trial. It plans to include 200 consecutive patients hospitalised for revascularisation due to PAD. In every patient an overnight sleep study will be performed to diagnose sleep disorders. Accord¬ing to the results of the test, patients will be divided into two groups: group A - patients with OSA, and group B - patients without OSA (control group). All patients will also be screened for classical and non-classical cardiovascular risk factors. In some of the patients, during surgery, a fragment of atherosclerotic plaque will be collected for further testing. Patients will be followed for one year for adverse events and end-points. Primary end-point of the study will be the failure of revascularisa¬tion defined as recurrence or new onset of the symptoms of ischaemia from the treated region, a need for re-operation or procedure revision, or recurrence of ischaemia signs on the imaging tests. The data obtained will help determine the incidence of OSA in the population of patients with PAD. The au¬thors expect to show that, as with other cardiovascular diseases associated with atherosclerosis, also in patients with PAD the incidence of undiagnosed OSA is high and its presence is associated with elevated cholesterol, inflammatory markers, and higher prevalence of arterial hypertension and poor control of other cardiovascular risk factors. In addition, due to

  2. Effectiveness of breathing through nasal and oral routes in unconscious apneic adult human subjects: a prospective randomized crossover trial.

    Science.gov (United States)

    Jiang, Yandong; Bao, Fang Ping; Liang, Yafen; Kimball, William R; Liu, Yanhong; Zapol, Warren M; Kacmarek, Robert M

    2011-07-01

    The authors hypothesized that mouth ventilation by a resuscitator via the nasal route ensures a more patent airway and more effective ventilation than does ventilation via the oral route and therefore would be the optimal manner to ventilate adult patients in emergencies, such as during cardiopulmonary resuscitation. They tested the hypothesis by comparing the effectiveness of mouth-to-nose breathing (MNB) and mouth-to-mouth breathing (MMB) in anesthetized, apneic, adult subjects without muscle paralysis. Twenty subjects under general anesthesia randomly received MMB and MNB with their heads placed first in a neutral position and then an extended position. A single operator performed MNB and MMB at the target breathing rate of 10 breaths/min, inspiratory:expiratory ratio 1:2 and peak inspiratory airway pressure 24 cm H₂O. A plethysmograph was used to measure the amplitude change during MMB and MNB. The inspiratory and expiratory tidal volumes during MMB and MNB were calculated retrospectively using the calibration curve. All data are presented as medians (interquartile ranges). The rates of effective ventilation (expired volume > estimated anatomic dead space) during MNB and MMB were 91.1% (42.4-100%) and 43.1% (42.5-100%) (P breathing technique during emergency situations will improve patient outcomes.

  3. Effect of relaxation-breathing training on anxiety and asthma signs/symptoms of children with moderate-to-severe asthma: a randomized controlled trial.

    Science.gov (United States)

    Chiang, Li-Chi; Ma, Wei-Fen; Huang, Jing-Long; Tseng, Li-Feng; Hsueh, Kai-Chung

    2009-08-01

    Emotional stress triggers and exacerbates asthma in children. Reducing anxiety in adults by relaxation-breathing techniques has been shown in clinical trials to produce good asthma outcomes. However, more evidence is needed on using this intervention with asthmatic children. To evaluate the effectiveness of combined self-management and relaxation-breathing training for children with moderate-to-severe asthma compared to self-management-only training. Two-group experimental design. Pediatric outpatient clinic of a medical center in central Taiwan. Participants were 48 children, ages 6-14 years, with moderate-to-severe asthma and their parents. Participants were randomly assigned to an experimental or comparison group and matched by gender, age, and asthma severity. Both groups participated in an asthma self-management program. Children in the experimental group were also given 30 min of training in a relaxation-breathing technique and a CD for home practice. Data on anxiety levels, self-perceived health status, asthma signs/symptoms, peak expiratory flow rate, and medication use were collected at baseline and at the end of the 12-week intervention. Effects of group, time, and group-time interaction were analyzed using the Mixed Model in SPSS (12.0). Anxiety (especially state anxiety) was significantly lower for children in the experimental group than in the comparison group. Differences in the other four physiological variables were also noted between pre- and post-intervention, but these changes did not differ significantly between groups. A combination of self-management and relaxation-breathing training can reduce anxiety, thus improving asthmatic children's health. These results can serve as an evidence base for psychological nursing practice with asthmatic children.

  4. Effect of device-guided breathing exercises on blood pressure in patients with hypertension : A randomized controlled trial

    NARCIS (Netherlands)

    Altena, Mariette R.; Kleefstra, Nanne; Logtenberg, Susan J.; Groenier, Klaas H.; Houweling, Sebastiaan T.; Bilo, Henk J.

    2009-01-01

    Objective. Hypertension is a chronic disorder with a high prevalence worldwide. Despite considerable efforts, it is sometimes hard to reach treatment goals for blood pressure (BP) with classical treatment options. Reducing breathing frequency has been advocated as a method to reduce BP. Methods. A

  5. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial

    Science.gov (United States)

    Mendelow, A David; Gregson, Barbara A; Rowan, Elise N; Murray, Gordon D; Gholkar, Anil; Mitchell, Patrick M

    2013-01-01

    Summary Background The balance of risk and benefit from early neurosurgical intervention for conscious patients with superficial lobar intracerebral haemorrhage of 10–100 mL and no intraventricular haemorrhage admitted within 48 h of ictus is unclear. We therefore tested the hypothesis that early surgery compared with initial conservative treatment could improve outcome in these patients. Methods In this international, parallel-group trial undertaken in 78 centres in 27 countries, we compared early surgical haematoma evacuation within 12 h of randomisation plus medical treatment with initial medical treatment alone (later evacuation was allowed if judged necessary). An automatic telephone and internet-based randomisation service was used to assign patients to surgery and initial conservative treatment in a 1:1 ratio. The trial was not masked. The primary outcome was a prognosis-based dichotomised (favourable or unfavourable) outcome of the 8 point Extended Glasgow Outcome Scale (GOSE) obtained by questionnaires posted to patients at 6 months. Analysis was by intention to treat. This trial is registered, number ISRCTN22153967. Findings 307 of 601 patients were randomly assigned to early surgery and 294 to initial conservative treatment; 298 and 291 were followed up at 6 months, respectively; and 297 and 286 were included in the analysis, respectively. 174 (59%) of 297 patients in the early surgery group had an unfavourable outcome versus 178 (62%) of 286 patients in the initial conservative treatment group (absolute difference 3·7% [95% CI −4·3 to 11·6], odds ratio 0·86 [0·62 to 1·20]; p=0·367). Interpretation The STICH II results confirm that early surgery does not increase the rate of death or disability at 6 months and might have a small but clinically relevant survival advantage for patients with spontaneous superficial intracerebral haemorrhage without intraventricular haemorrhage. Funding UK Medical Research Council. PMID:23726393

  6. Mapleson's Breathing Systems.

    Science.gov (United States)

    Kaul, Tej K; Mittal, Geeta

    2013-09-01

    Mapleson breathing systems are used for delivering oxygen and anaesthetic agents and to eliminate carbon dioxide during anaesthesia. They consist of different components: Fresh gas flow, reservoir bag, breathing tubes, expiratory valve, and patient connection. There are five basic types of Mapleson system: A, B, C, D and E depending upon the different arrangements of these components. Mapleson F was added later. For adults, Mapleson A is the circuit of choice for spontaneous respiration where as Mapleson D and its Bains modifications are best available circuits for controlled ventilation. For neonates and paediatric patients Mapleson E and F (Jackson Rees modification) are the best circuits. In this review article, we will discuss the structure of the circuits and functional analysis of various types of Mapleson systems and their advantages and disadvantages.

  7. Clinical Trials of Immunogene Therapy for Spontaneous Tumors in Companion Animals

    Science.gov (United States)

    Glikin, Gerardo Claudio; Finocchiaro, Liliana María Elena

    2014-01-01

    Despite the important progress obtained in the treatment of some pets' malignancies, new treatments need to be developed. Being critical in cancer control and progression, the immune system's appropriate modulation may provide effective therapeutic options. In this review we summarize the outcomes of published immunogene therapy veterinary clinical trials reported by many research centers. A variety of tumors such as canine melanoma, soft tissue sarcomas, osteosarcoma and lymphoma, feline fibrosarcoma, and equine melanoma were subjected to different treatment approaches. Both viral and mainly nonviral vectors were used to deliver gene products as cytokines, xenogeneic tumor associated antigens, specific ligands, and proapoptotic regulatory factors. In some cases autologous, allogenic, or xenogeneic transgenic cytokine producing cells were assayed. In general terms, minor or no adverse collateral effects appeared during this kind of therapies and treated patients usually displayed a better course of the disease (longer survival, delayed or suppressed recurrence or metastatic spread, and improvement of the quality of life). This suggests the utility of these methodologies as standard adjuvant treatments. The encouraging outcomes obtained in companion animals support their ready application in veterinary clinical oncology and serve as preclinical proof of concept and safety assay for future human gene therapy trials. PMID:25506617

  8. Double-blind, placebo-controlled trial on the effect of piracetam on breath-holding spells.

    Science.gov (United States)

    Sawires, Happy; Botrous, Osama

    2012-07-01

    Breath-holding spells (BHS) are apparently frightening events occurring in otherwise healthy children.The aim of this study was to evaluate the efficacy of piracetam in the treatment of breath-holding spells. Forty patients with BHS (who were classified into two groups)were involved in a double-blinded placebo-controlled prospective study. Piracetam was given to group A while group B received placebo. Patients were followed monthly for a total period of 4 months. The numbers of attacks/month before and monthly after treatment were documented, and the overall number of attacks/month after treatment was calculated in both groups. The median number of attacks/month before treatment in the two groups was 5.5 and 5,respectively, while after the first month of treatment, it was 2 and 5, respectively. The median overall number of attacks/month after treatment in both groups was 1 and 5, respectively.There was a significant decline of number of attacks after piracetam treatment compared to placebo (p valuepiracetam throughout the study period. In conclusion, piracetam is a safe and effective drug for the treatment of breath-holding spells in children.

  9. Breathing Difficulties

    Science.gov (United States)

    ... symptoms. Symptoms associated with weak respiratory muscles: Air “hunger” (gasping, labored breathing) with an without activity Fatigue ... Start your own fundraising event & help create a world without ALS Start an Event Site Map | Press ...

  10. Breath sounds

    Science.gov (United States)

    ... described as moist, dry, fine, and coarse. Rhonchi. Sounds that resemble snoring. They occur when air is blocked or air flow becomes rough through the large airways. Stridor. Wheeze-like sound heard when a person breathes. Usually it is ...

  11. Comparison the effect of two weaning methods from mechanical ventilation “spontaneous breathing trial” with “Synchronized Intermittent-Mandatory” on physiological indices

    Directory of Open Access Journals (Sweden)

    Mahmoudi Mokhtar

    2016-02-01

    Full Text Available Background and Objective: Weaning from mechanical ventilator due to the direct effect on patient’s physiologic indices is very risky action and if it is unsuccessful, it can lead to re-intubation of patient. The aim of the current study was to compare the effect of two weaning methods from mechanical ventilation “SBT” method with “SIMV” on physiological indices of ventilated patients. Materials and Method: In this clinical trial study, 44 intubated patients in intensive care units of one of the hospital in Arak in 2014 were selected through convenience sampling and then were randomly allocated into two intervention and control groups (each group 22 persons. In intervention group SBT method and in control group SIMV were used as weaning method from ventilation. Data collection was done thorugh using physiological indices and GCS score before, during and after the intervention Data were analyzed by using SPSS 20, paired T-test, independent T-test, repeated measures ANOVA and Greenhouse-Geisser. Results: In SBT group, the means of systolic blood pressure was (107.90 ± 5/2, heart rate (70.27 ± 7.2, respiration rate (14.90 ± 1.06 had significant reduction after intervention (from 9 to 12 Am (p < 0.001. Also, the mean of Pao2 (89.12 ± 1.16, mean of diastolic blood pressure (76.09 ± 4.6, O2 sat (93.09 ± 0.97 and  level of consciousness (14.90 ±0.21 had significant increase after intervention and physiologic status of patients was improved. In control group there was no significant difference among the measured indices. Conclusion: The results showed that “SBT” method leads to improvement of systolic and diastolic blood pressure, heart rate, Pao2, O2sat and level of consciousness of patients in intervention group. It is recommended to apply of this weaning method in intensive care unit.

  12. Intervening on spontaneous physical activity to prevent weight regain in older adults: design of a randomized, clinical trial.

    Science.gov (United States)

    Nicklas, Barbara J; Gaukstern, Jill E; Legault, Claudine; Leng, Iris; Rejeski, W Jack

    2012-03-01

    There is a need to identify evidenced-based obesity treatments that are effective in maintaining lost weight. Weight loss results in reductions in energy expenditure, including spontaneous physical activity (SPA) which is defined as energy expenditure resulting primarily from unstructured mobility-related activities that occur during daily life. To date, there is little research, especially randomized, controlled trials, testing strategies that can be adopted and sustained to prevent declines in SPA that occur with weight loss. Self-monitoring is a successful behavioral strategy to facilitate behavior change, so a provocative question is whether monitoring SPA-related energy expenditure would override these reductions in SPA, and slow weight regain. This study is a randomized trial in older, obese men and women designed to test the hypothesis that adding a self-regulatory intervention (SRI), focused around self-monitoring of SPA, to a weight loss intervention will result in less weight and fat mass regain following weight loss than a comparable intervention that lacks this self-regulatory behavioral strategy. Participants (n=72) are randomized to a 5-month weight loss intervention with or without the addition of a behavioral component that includes an innovative approach to promoting increased SPA. Both groups then transition to self-selected diet and exercise behavior for a 5-month follow-up. Throughout the 10-month period, the SRI group is provided with an intervention designed to promote a SPA level that is equal to or greater than each individual's baseline SPA level, allowing us to isolate the effects of the SPA self-regulatory intervention component on weight and fat mass regain. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. Effect of Cervical Pessary on Spontaneous Preterm Birth in Women With Singleton Pregnancies and Short Cervical Length: A Randomized Clinical Trial.

    Science.gov (United States)

    Saccone, Gabriele; Maruotti, Giuseppe Maria; Giudicepietro, Antonia; Martinelli, Pasquale

    2017-12-19

    Spontaneous preterm birth is a major cause of perinatal morbidity and mortality. It is unclear if a cervical pessary can reduce the risk of spontaneous preterm delivery. To test whether in asymptomatic women with singleton pregnancies and no prior spontaneous preterm birth but with short cervical length on transvaginal ultrasound, use of a cervical pessary would reduce the rate of spontaneous preterm birth at less than 34 weeks of gestation. Parallel-group, nonblinded, randomized clinical trial conducted from March 1, 2016, to May 25, 2017, at a single center in Italy. Asymptomatic women with singleton gestations, no previous spontaneous preterm births, and cervical lengths of 25 mm or less at 18 weeks 0 days to 23 weeks 6 days of gestation were eligible. Patients were randomized 1:1 to receive either cervical pessary (n = 150) or no pessary (n = 150). The pessary was removed between 37 weeks 0 days and 37 weeks 6 days of gestation or earlier if clinically indicated. The control group received standard care. For cervical length of 20 mm or shorter, women in both groups were prescribed vaginal progesterone, 200 mg/d, until 36 weeks 6 days of gestation. No bed rest or activity restriction was recommended. The primary end point was spontaneous preterm birth at less than 34 weeks of gestation. Secondary outcomes were adverse events. Among 300 women who were randomized (mean age, 29 [SD, 6.3] years; mean gestational age, 22 [SD, 1.3] weeks), 100% completed the trial. The primary end point occurred in 11 women (7.3%) in the pessary group and 23 women (15.3%) in the control group (between-group difference, -8.0% [95% CI, -15.7% to -0.4]; relative risk, 0.48 [95% CI, 0.24-0.95]). During follow-up, the pessary group had a higher rate of increased or new vaginal discharge (86.7% vs 46.0%; between-group difference, +40.7% [95% CI, +30.1%-+50.3%]; relative risk, 1.88 [95% CI, 1.57-2.27]). Among women without prior spontaneous preterm birth who had asymptomatic

  14. Improvement of spontaneous language in stroke patients with chronic aphasia treated with music therapy: a randomized controlled trial.

    Science.gov (United States)

    Raglio, Alfredo; Oasi, Osmano; Gianotti, Marta; Rossi, Agnese; Goulene, Karine; Stramba-Badiale, Marco

    2016-01-01

    The aim of this research is to evaluate the effects of active music therapy (MT) based on free-improvisation (relational approach) in addition to speech language therapy (SLT) compared with SLT alone (communicative-pragmatic approach: Promoting Aphasic's Communicative Effectiveness) in stroke patients with chronic aphasia. The experimental group (n = 10) was randomized to 30 MT individual sessions over 15 weeks in addition to 30 SLT individual sessions while the control group (n = 10) was randomized to only 30 SLT sessions during the same period. Psychological and speech language assessment were made before (T0) and after (T1) the treatments. The study shows a significant improvement in spontaneous speech in the experimental group (Aachener Aphasie subtest: p = 0.020; Cohen's d = 0.35); the 50% of the experimental group showed also an improvement in vitality scores of Short Form Health Survey (chi-square test = 4.114; p = 0.043). The current trial highlights the possibility that the combined use of MT and SLT can lead to a better result in the rehabilitation of patients with aphasia than SLT alone.

  15. Does the addition of deep breathing exercises to physiotherapy-directed early mobilisation alter patient outcomes following high-risk open upper abdominal surgery? Cluster randomised controlled trial.

    Science.gov (United States)

    Silva, Y R; Li, S K; Rickard, M J F X

    2013-09-01

    To investigate whether the inclusion of deep breathing exercises in physiotherapy-directed early mobilisation confers any additional benefit in reducing postoperative pulmonary complications (PPCs) when patients are treated once daily after elective open upper abdominal surgery. This study also compared postoperative outcomes following early and delayed mobilisation. Cluster randomised controlled trial. Single-centre study in a teaching hospital. Eighty-six high-risk patients undergoing elective open upper abdominal surgery. Three groups: early mobilisation (Group A), early mobilisation plus breathing exercises (Group B), and delayed mobilisation (mobilised from third postoperative day) plus breathing exercises (Group C). PPCs and postoperative outcomes [number of days until discharge from physiotherapy, physiotherapy input and length of stay (LOS)]. There was no significant difference in PPCs between Groups A and B. The LOS for Group A {mean 10.7 [standard deviation (SD) 5.0] days} was significantly shorter than the LOS for Groups B [mean 16.7 (SD 9.7) days] and C [mean 15.2 (SD 9.8) days; P=0.036]. The greatest difference was between Groups A and B (mean difference -5.93, 95% confidence interval -10.22 to -1.65; P=0.008). Group C had fewer smokers (26%) and patients with chronic obstructive pulmonary disease (0%) compared with Group B (53% and 14%, respectively). This may have led to fewer PPCs in Group C, but the difference was not significant. Despite Group C having fewer PPCs and less physiotherapy input, the number of days until discharge from physiotherapy and LOS were similar to Group B. The addition of deep breathing exercises to physiotherapy-directed early mobilisation did not further reduce PPCs compared with mobility alone. PPCs can be reduced with once-daily physiotherapy if the patients are mobilised to a moderate level of exertion. Delayed mobilisation tended to increase physiotherapy input and the number of days until discharge from physiotherapy

  16. Acetazolamide Reduces Blood Pressure and Sleep-Disordered Breathing in Patients With Hypertension and Obstructive Sleep Apnea: A Randomized Controlled Trial.

    Science.gov (United States)

    Eskandari, Davoud; Zou, Ding; Grote, Ludger; Hoff, Erik; Hedner, Jan

    2018-03-15

    The carbonic anhydrase inhibitor acetazolamide (AZT) modulates blood pressure at high altitude and reduces sleep-disordered breathing in patients with obstructive sleep apnea (OSA). We aimed to investigate the treatment effect of AZT and in combination with continuous positive airway pressure (CPAP) on blood pressure in patients with hypertension and OSA. In a prospective, randomized, three-way crossover study, 13 male patients with hypertension and moderate to severe OSA (age 64 ± 7 years, body mass index 29 ± 4 kg/m 2 , and mean apnea-hypopnea index 37 ± 23 events/h) received AZT, CPAP, or AZT plus CPAP for 2-week periods. Antihypertensive medication was washed out. Office and 24-hour blood pressure, arterial stiffness, polygraphic sleep study data, and blood chemistry were compared. AZT alone and AZT plus CPAP, but not CPAP alone, reduced office mean arterial pressure compared to baseline (-7 [95% CI -11 to -4], -7 [95% CI -11 to -4] and -1 [95% CI -5 to 4] mmHg, respectively; repeated- measures analysis of variance (RM-ANOVA; P = .015). Aortic systolic pressure and augmentation index, assessed by radial artery oscillatory tonometry, were unaffected by CPAP but decreased after AZT and AZT plus CPAP (RM-ANOVA P = .030 and .031, respectively). The apnea-hypopnea index was significantly reduced in all three treatment arms, most prominently by AZT plus CPAP (RM-ANOVA P = .003). The reduction of venous bicarbonate concentration following AZT was correlated with the change of apnea-hypopnea index ( r = 0.66, P = .013). AZT reduced blood pressure, vascular stiffness, and sleep-disordered breathing in patients with OSA and comorbid hypertension. Carbonic anhydrase inhibition may constitute a potential target for drug therapy in patients with sleep apnea and comorbid hypertension. Registry: ClinicalTrials.gov; Identifier: NCT02220803; Title: A Short Term Open, Randomized Cross-over Trial Exploring the Effect of Carbonic Anhydrase Inhibition by Acetazolamide on Sleep

  17. Effects of Prenatal Micronutrient Supplementation on Spontaneous Preterm Birth: A Double-Blind Randomized Controlled Trial in China.

    Science.gov (United States)

    Li, Zhiwen; Mei, Zuguo; Zhang, Le; Li, Hongtian; Zhang, Yali; Li, Nan; Ye, Rongwei; Ren, Aiguo; Liu, Jian-Meng; Serdula, Mary K

    2017-08-01

    In this secondary analysis of data from a double-blind randomized controlled trial carried out in northern China, we aimed to assess the effect of prenatal supplementation with multiple micronutrients (MMN) or iron + folic acid (IFA), versus folic acid (FA) alone, on risk of spontaneous preterm birth (SPB) and the impact of supplementation timing on SPB. A total of 18,775 nulliparous pregnant women enrolled between 2006 and 2009 were randomly assigned to receive daily FA, IFA, or MMN from the period before 20 weeks' gestation to delivery. The incidences of SPB for women consuming FA, IFA, and MMN were 5.7%, 5.6% and 5.1%, respectively. Compared with women given FA, the relative risks of SPB for those using MMN and IFA were 0.99 (95% confidence interval: 0.85, 1.16) and 0.89 (95% confidence interval: 0.79, 1.05), respectively. SPB incidence in women who started consuming FA, IFA, and MMN before the 12th week of gestation (4.6%, 4.2%, and 3.9%, respectively) was significantly reduced compared with starting supplement use on or after the 12th gestational week (6.9%, 7.2%, and 6.4%, respectively). Starting use of FA, IFA, or MMN supplements before the 12th week of gestation produced a 41%-45% reduction in risk of SPB. Early prenatal enrollment and micronutrient use during the first trimester of pregnancy appeared to be of particular importance for prevention of SPB, regardless of supplement group. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Prospective phase II trial of image-guided radiotherapy in Hodgkin lymphoma: benefit of deep inspiration breath-hold.

    Science.gov (United States)

    Petersen, Peter M; Aznar, Marianne C; Berthelsen, Anne K; Loft, Annika; Schut, Deborah A; Maraldo, Maja; Josipovic, Mirjana; Klausen, Thomas L; Andersen, Flemming L; Specht, Lena

    2015-01-01

    Long-term Hodgkin lymphoma (HL) survivors have an increased risk of late cardiac morbidity and secondary lung cancer after chemotherapy and mediastinal radiotherapy. In this prospective study we investigate whether radiotherapy with deep inspiration breath-hold (DIBH) can reduce radiation doses to the lungs, heart, and cardiac structures without compromising the target dose. Twenty-two patients (14 female, 8 male), median age 30 years (18-65 years), with supra-diaphragmatic HL were enrolled and had a thoracic PET/CT with DIBH in addition to staging FDG-PET/CT in free breathing (FB) and a planning CT in both FB and DIBH. For each patient an involved-node radiotherapy plan was done for both DIBH and FB, and the doses to the lungs, heart, and female breasts were recorded prospectively. Mean doses to the heart valves and coronary arteries were recorded retrospectively. Patients were treated with the technique yielding the lowest doses to normal structures. Nineteen patients were treated with DIBH and three with FB. DIBH reduced the mean estimated lung dose by 2.0 Gy (median: 8.5 Gy vs. 7.2 Gy) (p < 0.01) and the mean heart dose by 1.4 Gy (6.0 Gy vs. 3.9 Gy) (p < 0.01) compared to FB. The lung and heart V20Gy were reduced with a median of 5.3% and 6.3%. Mean doses to the female breasts were equal with FB and DIBH. DIBH can significantly decrease the estimated mean doses to the heart and lungs without lowering the dose to the target in radiotherapy for patients with mediastinal HL.

  19. Bad Breath

    Science.gov (United States)

    ... fresh and healthy. Tips for preventing bad breath: Brush your teeth (and tongue!) for at least two minutes twice ... and drinks. This helps prevent damage to your teeth and is great for your overall health. Brush after sweets. If you eat or drink sugary ...

  20. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials.

    Science.gov (United States)

    Fawcett, J W; Curt, A; Steeves, J D; Coleman, W P; Tuszynski, M H; Lammertse, D; Bartlett, P F; Blight, A R; Dietz, V; Ditunno, J; Dobkin, B H; Havton, L A; Ellaway, P H; Fehlings, M G; Privat, A; Grossman, R; Guest, J D; Kleitman, N; Nakamura, M; Gaviria, M; Short, D

    2007-03-01

    The International Campaign for Cures of Spinal Cord Injury Paralysis (ICCP) supported an international panel tasked with reviewing the methodology for clinical trials in spinal cord injury (SCI), and making recommendations on the conduct of future trials. This is the first of four papers. Here, we examine the spontaneous rate of recovery after SCI and resulting consequences for achieving statistically significant results in clinical trials. We have reanalysed data from the Sygen trial to provide some of this information. Almost all people living with SCI show some recovery of motor function below the initial spinal injury level. While the spontaneous recovery of motor function in patients with motor-complete SCI is fairly limited and predictable, recovery in incomplete SCI patients (American spinal injury Association impairment scale (AIS) C and AIS D) is both more substantial and highly variable. With motor complete lesions (AIS A/AIS B) the majority of functional return is within the zone of partial preservation, and may be sufficient to reclassify the injury level to a lower spinal level. The vast majority of recovery occurs in the first 3 months, but a small amount can persist for up to 18 months or longer. Some sensory recovery occurs after SCI, on roughly the same time course as motor recovery. Based on previous data of the magnitude of spontaneous recovery after SCI, as measured by changes in ASIA motor scores, power calculations suggest that the number of subjects required to achieve a significant result from a trial declines considerably as the start of the study is delayed after SCI. Trials of treatments that are most efficacious when given soon after injury will therefore, require larger patient numbers than trials of treatments that are effective at later time points. As AIS B patients show greater spontaneous recovery than AIS A patients, the number of AIS A patients requiring to be enrolled into a trial is lower. This factor will have to be balanced

  1. Endoscopic surgery versus conservative treatment for the moderate-volume hematoma in spontaneous basal ganglia hemorrhage (ECMOH: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Zan Xin

    2012-06-01

    Full Text Available Abstract Background Spontaneous intracerebral hemorrhage is a disease with high morbidity, high disability rate, high mortality, and high economic burden. Whether patients can benefit from surgical evacuation of hematomas is still controversial, especially for those with moderate-volume hematomas in the basal ganglia. This study is designed to compare the efficacy of endoscopic surgery and conservative treatment for the moderate-volume hematoma in spontaneous basal ganglia hemorrhage. Methods Patients meet the criteria will be randomized into the endoscopic surgery group (endoscopic surgery for hematoma evacuation and the best medical treatment or the conservative treatment group (the best medical treatment. Patients will be followed up at 1, 3, and 6 months after initial treatment. The primary outcomes include the Extended Glasgow Outcome Scale and the Modified Rankin Scale. The secondary outcomes consist of the National Institutes of Health Stroke Scale and the mortality. The Barthel Index(BI will also be evaluated. The sample size is 100 patients. Discussion The ECMOH trial is a randomized controlled trial designed to evaluate if endoscopic surgery is better than conservative treatment for patients with moderate-volume hematomas in the basal ganglia. Trial registration Chinese Clinical Trial Registry: ChiCTR-TRC-11001614 (http://www.chictr.org/en/proj/show.aspx?proj=1618

  2. Improvements in well-being and vagal tone following a yogic breathing-based life skills workshop in young adults: Two open-trial pilot studies.

    Science.gov (United States)

    Goldstein, Michael R; Lewis, Gregory F; Newman, Ronnie; Brown, Janice M; Bobashev, Georgiy; Kilpatrick, Lisa; Seppälä, Emma M; Fishbein, Diana H; Meleth, Sreelatha

    2016-01-01

    While efficacy of Sudarshan Kriya Yoga (SKY) has been demonstrated in a number of prior studies, little is known about the effects of SKY taught as part of the Your Enlightened Side (YES+) workshop designed for college students and other young adults. This study aimed to assess the effects of YES+, a yogic breathing-based life skills workshop, on multiple measures of well-being and physiological stress response. Two nonrandomized open-trial pilot studies were conducted with a total of 74 young adults (age 25.4 ± 6.6 years; 55% female). Study 1 collected a variety of self-report questionnaires at baseline, postworkshop, and 1-month follow-up. Study 2 collected self-report questionnaires in addition to electrocardiography with a stationary cycling challenge at baseline and 1-month follow-up. Study 1: Improvements in self-reported depression (P's ≤ 0.010), perceived stress (P's ≤ 0.002), life satisfaction (P's ≤ 0.002), social connectedness (P's ≤ 0.004), and gratitude (P's ≤ 0.090) were observed at postworkshop and 1-month after workshop relative to baseline. Study 2: Improvements in self-reported emotion regulation were observed at 1-month follow-up relative to baseline (P = 0.019). Positive and Negative Affect Schedule-Expanded Form positive affect increased (P = 0.021), while fatigue and sadness decreased (P's ≤ 0.005). During the stationary cycling challenge, rate to recovery of electrocardiography inter-beat interval also increased from baseline to 1-month follow-up (P = 0.077). These findings suggest that a life skills workshop integrating yogic breathing techniques may provide self-empowering tools for enhancing well-being in young adults. Future research is indicated to further explore these effects, particularly in regards to vagal tone and other aspects of stress physiology.

  3. Spontaneous improvement in randomised clinical trials: meta-analysis of three-armed trials comparing no treatment, placebo and active intervention

    DEFF Research Database (Denmark)

    Krogsbøll, Lasse Theis; Hróbjartsson, Asbjørn; Gøtzsche, Peter C

    2009-01-01

    uncertainty, as indicated by the confidence intervals for the three SMDs. The conditions that had the most pronounced spontaneous improvement were nausea (45%), smoking (40%), depression (35%), phobia (34%) and acute pain (25%). CONCLUSION: Spontaneous improvement and effect of placebo contributed importantly...

  4. Efficacy of a Brief Psychoeducational Intervention for Mothers of Children with Breath-Holding Spells: A Randomized Controlled Pilot Trial.

    Science.gov (United States)

    Bolat, Nurullah; Eliacik, Kayi; Sargin, Enis; Kanik, Ali; Baydan, Figen; Sarioglu, Berrak

    2016-08-01

    Objective Mothers of individuals with breath-holding spells (BHS) suffer more often from anxiety and experience more stressors in their everyday life. The purpose of this study was to examine the efficacy of psychoeducational intervention in reducing BHS and coping with these spells. Participants and Methods Mothers who have children with BHS were randomly assigned to one of the two groups: an intervention group receiving psychoeducational therapy in addition to the routine follow-up (n = 31) and a control group who did not receive psychoeducation in their routine follow-up (n = 28). The data collected at the beginning of the study and at the end of 3rd and 6th months about the frequency of the spells per month, maternal anxiety, and depression levels and mothers' perceived self-knowledge about coping BHS of both groups were compared. Results Mothers in psychoeducation group, compared with controls, improved significantly on state anxiety, depression, perceived anticipation anxiety level for BHS of their children and self-knowledge about coping with the spells. Conclusion The intervention program had a positive effect on anxiety-depression levels of the mothers and the frequency of BHS among the children. The possible link between emotional and autonomic dysregulation in children with BHS and maternal mental health were discussed. Georg Thieme Verlag KG Stuttgart · New York.

  5. Consumption of a dark roast coffee decreases the level of spontaneous DNA strand breaks: a randomized controlled trial.

    Science.gov (United States)

    Bakuradze, T; Lang, R; Hofmann, T; Eisenbrand, G; Schipp, D; Galan, J; Richling, E

    2015-02-01

    Coffee consumption has been reported to decrease oxidative damage in peripheral white blood cells (WBC). However, effects on the level of spontaneous DNA strand breaks, a well established marker of health risk, have not been specifically reported yet. We analyzed the impact of consuming a dark roast coffee blend on the level of spontaneous DNA strand breaks. Healthy men (n = 84) were randomized to consume daily for 4 weeks either 750 ml of fresh coffee brew or 750 ml of water, subsequent to a run in washout phase of 4 weeks. The study coffee was a blend providing high amounts of both caffeoylquinic acids (10.18 ± 0.33 mg/g) and the roast product N-methylpyridinium (1.10 ± 0.05 mg/g). Before and after the coffee/water consumption phase, spontaneous strand breaks were determined by comet assay. At baseline, both groups exhibited a similar level of spontaneous DNA strand breaks. In the intervention phase, spontaneous DNA strand breaks slightly increased in the control (water only) group whereas they significantly decreased in the coffee group, leading to a 27% difference within both arms (p = 0.0002). Food frequency questionnaires indicated no differences in the overall diet between groups, and mean body weight during the intervention phases remained stable. The consumption of the study coffee substantially lowered the level of spontaneous DNA strand breaks in WBC. We conclude that regular coffee consumption contributes to DNA integrity.

  6. Variability of exhaled breath condensate (EBC) volume and pH using a feedback regulated breathing pattern

    Science.gov (United States)

    Exhaled breath condensate (EBC) is a valuable biological medium for non-invasively measuring biomarkers with the potential to reflect organ systems responses to environmental and dietary exposures and disease processes. Collection of EBC has typically been with spontaneous breat...

  7. SPECT Analysis of Cardiac Perfusion Changes After Whole-Breast/Chest Wall Radiation Therapy With or Without Active Breathing Coordinator: Results of a Randomized Phase 3 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Zellars, Richard, E-mail: zellari@jhmi.edu [Johns Hopkins Medical Institution, Baltimore, Maryland (United States); Bravo, Paco E. [University of Washington Medical Center, Seattle, Washington (United States); Tryggestad, Erik [Mayo Clinic, Rochester, Minnesota (United States); Hopfer, Kari [Hahnemann University, Philadelphia, Pennsylvania (United States); Myers, Lee; Tahari, Abdel; Asrari, Fariba; Ziessman, Harvey [Johns Hopkins Medical Institution, Baltimore, Maryland (United States); Garrett-Mayer, Elizabeth [Medical University of South Carolina, Charleston, South Carolina (United States)

    2014-03-15

    Purpose: Cardiac muscle perfusion, as determined by single-photon emission computed tomography (SPECT), decreases after breast and/or chest wall (BCW) irradiation. The active breathing coordinator (ABC) enables radiation delivery when the BCW is farther from the heart, thereby decreasing cardiac exposure. We hypothesized that ABC would prevent radiation-induced cardiac toxicity and conducted a randomized controlled trial evaluating myocardial perfusion changes after radiation for left-sided breast cancer with or without ABC. Methods and Materials: Stages I to III left breast cancer patients requiring adjuvant radiation therapy (XRT) were randomized to ABC or No-ABC. Myocardial perfusion was evaluated by SPECT scans (before and 6 months after BCW radiation) using 2 methods: (1) fully automated quantitative polar mapping; and (2) semiquantitative visual assessment. The left ventricle was divided into 20 segments for the polar map and 17 segments for the visual method. Segments were grouped by anatomical rings (apical, mid, basal) or by coronary artery distribution. For the visual method, 2 nuclear medicine physicians, blinded to treatment groups, scored each segment's perfusion. Scores were analyzed with nonparametric tests and linear regression. Results: Between 2006 and 2010, 57 patients were enrolled and 43 were available for analysis. The cohorts were well matched. The apical and left anterior descending coronary artery segments had significant decreases in perfusion on SPECT scans in both ABC and No-ABC cohorts. In unadjusted and adjusted analyses, controlling for pretreatment perfusion score, age, and chemotherapy, ABC was not significantly associated with prevention of perfusion deficits. Conclusions: In this randomized controlled trial, ABC does not appear to prevent radiation-induced cardiac perfusion deficits.

  8. Spontaneous Pushing in Lateral Position versus Valsalva Maneuver During Second Stage of Labor on Maternal and Fetal Outcomes: A Randomized Clinical Trial.

    Science.gov (United States)

    Vaziri, Farideh; Arzhe, Amene; Asadi, Nasrin; Pourahmad, Saeedeh; Moshfeghy, Zeinab

    2016-10-01

    There are concerns about the harmful effects of the Valsalva maneuver during the second stage of labor. Comparing the effects of spontaneous pushing in the lateral position with the Valsalva maneuver during the second stage of labor on maternal and fetal outcomes. Inclusion criteria in this randomized clinical trial conducted in Iran were as follows: nulliparous mothers, live fetus with vertex presentation, gestational age of 37 - 40 weeks, spontaneous labor, and no complications. The intervention group pushed spontaneously while they were in the lateral position, whereas the control group pushed using Valsalva method while in the supine position at the onset of the second stage of labor. Maternal outcomes such as pain and fatigue severity and fetal outcomes such as pH and pO2 of the umbilical cord blood were measured. Data pertaining to 69 patients, divided into the intervention group (35 subjects) and control group (34 subjects), were analyzed statistically. The mean pain (7.80 ± 1.21 versus 9.05 ± 1.11) and fatigue scores (46.59 ± 21 versus 123.36 ± 43.20) of the two groups showed a statistically significant difference (P umbilical cord blood pO 2 levels of both groups showed a statistically significant difference (28.29 ± 11.76 versus 18.83 ± 9.86, P pain severity of the mothers. Also, it did not worsen fetal outcomes. Thus, it can be used as an alternative method for the Valsalva maneuver.

  9. Low dose aspirin in the prevention of recurrent spontaneous preterm labour the APRIL study : a multicenter randomized placebo controlled trial

    NARCIS (Netherlands)

    Visser, Laura; de Boer, Marjon A.; de Groot, Christianne J. M.; Nijman, Tobias A. J.; Hemels, Marieke A. C.; Bloemenkamp, Kitty W. M.; Bosmans, Judith E.; Kok, Marjolein; van Laar, Judith O.; Sueters, Marieke; Scheepers, Hubertina; van Drongelen, Joris; Franssen, Maureen T. M.; Sikkema, J. Marko; Duvekot, Hans J. J.; Bekker, Mireille N.; van der Post, Joris A. M.; Naaktgeboren, Christiana; Mol, Ben W. J.; Oudijk, Martijn A.

    2017-01-01

    Background: Preterm birth (birth before 37 weeks of gestation) is a major problem in obstetrics and affects an estimated 15 million pregnancies worldwide annually. A history of previous preterm birth is the strongest risk factor for preterm birth, and recurrent spontaneous preterm birth affects more

  10. Low dose aspirin in the prevention of recurrent spontaneous preterm labour - the APRIL study: a multicenter randomized placebo controlled trial

    NARCIS (Netherlands)

    Visser, L de; Boer, M.A. de; Groot, C.J. de; Nijman, T.A.; Hemels, M.A.C.; Bloemenkamp, K.W.; Bosmans, J.E.; Kok, M. de; Laar, J.O. van; Sueters, M.; Scheepers, H.; Drongelen, J. van; Franssen, M.T.; Sikkema, J.M.; Duvekot, H.J.; Bekker, M.N.; Post, J.A. van der; Naaktgeboren, C.; Mol, B.W.; Oudijk, M.A.

    2017-01-01

    BACKGROUND: Preterm birth (birth before 37 weeks of gestation) is a major problem in obstetrics and affects an estimated 15 million pregnancies worldwide annually. A history of previous preterm birth is the strongest risk factor for preterm birth, and recurrent spontaneous preterm birth affects more

  11. Low dose aspirin in the prevention of recurrent spontaneous preterm labour - the APRIL study : a multicenter randomized placebo controlled trial

    NARCIS (Netherlands)

    Visser, Laura; de Boer, Marjon A; de Groot, Christianne J M; Nijman, Tobias A J; Hemels, Marieke A C; Bloemenkamp, Kitty W M; Bosmans, Judith E; Kok, Marjolein; van Laar, Judith O; Sueters, Marieke; Scheepers, Hubertina; van Drongelen, Joris; Franssen, Maureen T M; Sikkema, J Marko; Duvekot, Hans J J; Bekker, Mireille N; van der Post, Joris A M; Naaktgeboren, Christiana; Mol, Ben W J; Oudijk, Martijn A

    2017-01-01

    BACKGROUND: Preterm birth (birth before 37 weeks of gestation) is a major problem in obstetrics and affects an estimated 15 million pregnancies worldwide annually. A history of previous preterm birth is the strongest risk factor for preterm birth, and recurrent spontaneous preterm birth affects more

  12. Low dose aspirin in the prevention of recurrent spontaneous preterm labour - the APRIL study: a multicenter randomized placebo controlled trial

    NARCIS (Netherlands)

    Visser, Laura; de Boer, Marjon A.; de Groot, Christianne J. M.; Nijman, Tobias A. J.; Hemels, Marieke A. C.; Bloemenkamp, Kitty W. M.; Bosmans, Judith E.; Kok, Marjolein; van Laar, Judith O.; Sueters, Marieke; Scheepers, Hubertina; van Drongelen, Joris; Franssen, Maureen T. M.; Sikkema, J. Marko; Duvekot, Hans J. J.; Bekker, Mireille N.; van der Post, Joris A. M.; Naaktgeboren, Christiana; Mol, Ben W. J.; Oudijk, Martijn A.

    2017-01-01

    Preterm birth (birth before 37 weeks of gestation) is a major problem in obstetrics and affects an estimated 15 million pregnancies worldwide annually. A history of previous preterm birth is the strongest risk factor for preterm birth, and recurrent spontaneous preterm birth affects more than 2.5

  13. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: a randomized controlled trial.

    Science.gov (United States)

    Brocki, Barbara Cristina; Andreasen, Jan Jesper; Langer, Daniel; Souza, Domingos Savio R; Westerdahl, Elisabeth

    2016-05-01

    The aim was to investigate whether 2 weeks of inspiratory muscle training (IMT) could preserve respiratory muscle strength in high-risk patients referred for pulmonary resection on the suspicion of or confirmed lung cancer. Secondarily, we investigated the effect of the intervention on the incidence of postoperative pulmonary complications. The study was a single-centre, parallel-group, randomized trial with assessor blinding and intention-to-treat analysis. The intervention group (IG, n = 34) underwent 2 weeks of postoperative IMT twice daily with 2 × 30 breaths on a target intensity of 30% of maximal inspiratory pressure, in addition to standard postoperative physiotherapy. Standard physiotherapy in the control group (CG, n = 34) consisted of breathing exercises, coughing techniques and early mobilization. We measured respiratory muscle strength (maximal inspiratory/expiratory pressure, MIP/MEP), functional performance (6-min walk test), spirometry and peripheral oxygen saturation (SpO2), assessed the day before surgery and again 3-5 days and 2 weeks postoperatively. Postoperative pulmonary complications were evaluated 2 weeks after surgery. The mean age was 70 ± 8 years and 57.5% were males. Thoracotomy was performed in 48.5% (n = 33) of cases. No effect of the intervention was found regarding MIP, MEP, lung volumes or functional performance at any time point. The overall incidence of pneumonia was 13% (n = 9), with no significant difference between groups [IG 6% (n = 2), CG 21% (n = 7), P = 0.14]. An improved SpO2 was found in the IG on the third and fourth postoperative days (Day 3: IG 93.8 ± 3.4 vs CG 91.9 ± 4.1%, P = 0.058; Day 4: IG 93.5 ± 3.5 vs CG 91 ± 3.9%, P = 0.02). We found no association between surgical procedure (thoracotomy versus thoracoscopy) and respiratory muscle strength, which was recovered in both groups 2 weeks after surgery. Two weeks of additional postoperative IMT, compared with standard physiotherapy alone, did not preserve

  14. Breath holding spell

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000967.htm Breath holding spell To use the sharing features on this page, please enable JavaScript. Some children have breath holding spells. This is an involuntary stop in breathing ...

  15. Deep breathing after surgery

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000440.htm Deep breathing after surgery To use the sharing features on ... way to do so is by doing deep breathing exercises. Deep breathing keeps your lungs well-inflated ...

  16. Breathing difficulty - lying down

    Science.gov (United States)

    ... short of breath; Paroxysmal nocturnal dyspnea; PND; Difficulty breathing while lying down; Orthopnea; Heart failure - orthopnea ... Heart failure Obesity (does not directly cause difficulty breathing while lying down but often worsens other conditions ...

  17. Apolo Ohno: Breathing Easier

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Breathing Easier Apolo Ohno: Breathing Easier Past Issues / Fall 2013 Table of Contents ... training, I started experiencing decreased exercise endurance, trouble breathing, and coughing. These symptoms affected my ability to ...

  18. Rapid shallow breathing

    Science.gov (United States)

    Tachypnea; Breathing - rapid and shallow; Fast shallow breathing; Respiratory rate - rapid and shallow ... Shallow, rapid breathing has many possible medical causes, including: Asthma Blood clot in an artery in the lung Choking Chronic obstructive ...

  19. Breathing and Relaxation

    Science.gov (United States)

    ... Home Health Insights Stress & Relaxation Breathing and Relaxation Breathing and Relaxation Make an Appointment Ask a Question ... level is often dependent on his or her breathing pattern. Therefore, people with chronic lung conditions may ...

  20. Breathing difficulties - first aid

    Science.gov (United States)

    Difficulty breathing - first aid; Dyspnea - first aid; Shortness of breath - first aid ... Breathing difficulty is almost always a medical emergency. An exception is feeling slightly winded from normal activity, ...

  1. Traveling with breathing problems

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000066.htm Traveling with breathing problems To use the sharing features on this page, please enable JavaScript. If you have breathing problems and you: Are short of breath most ...

  2. Efficacy of a mandibular advancement appliance on sleep-disordered breathing in children: a study protocol of a crossover randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Ghassan Idris

    2016-08-01

    Full Text Available Background: Sleep-Disordered Breathing (SDB varies from habitual snoring to partial or complete obstruction of the upper airway and can be found in up to 10% of children. SDB can significantly affect children’s wellbeing, as it can cause growth disorders, educational and behavioral problems, and even life-threatening conditions, such as cardiorespiratory failure. Adenotonsillectomy represents the primary treatment for pediatric SDB where adeno-tonsillar hypertrophy is indicated. For those with craniofacial anomalies, or for whom adenotonsillectomy or other treatment modalities have failed, or surgery is contra-indicated, mandibular advancement splints (MAS may represent a viable treatment option. Whilst the efficacy of these appliances has been consistently demonstrated in adults, there is little information about their effectiveness in children.Aims: To determine the efficacy of mandibular advancement appliances for the management of SDB and related health problems in children. Methods/design: The study will be designed as a single-blind crossover randomized controlled trial with administration of both an ‘Active MAS’ (Twin-block and a ‘Sham MAS’. Eligible participants will be children aged 8 to 12 years whose parents report they snore ≥ 3 nights per week. Sixteen children will enter the full study after confirming other inclusion criteria, particularly Skeletal class I or class II confirmed by lateral cephalometric radiograph. Each child will be randomly assigned to either a treatment sequence starting with the Active or the Sham MAS. Participants will wear the appliances for three weeks separated by a two-week washout period. For each participant, home-based polysomnographic data will be collected four times; once before and once after each treatment period. The Apnea Hypopnea Index (AHI will represent the main outcome variable. Secondary outcomes will include, snoring frequency, masseter muscle activity, sleep symptoms, quality

  3. Breathing - slowed or stopped

    Science.gov (United States)

    ... bradypnea. Labored or difficult breathing is known as dyspnea. ... Premature birth Seizures Common causes of breathing trouble (dyspnea) in adults include: Allergic reaction that causes tongue, ...

  4. IUD insertion following spontaneous abortion: a clinical trial of the TCu 220C, Liuppes loop D, and copper 7.

    Science.gov (United States)

    1983-04-01

    6 centers participated in a randomized comparison of the TCu 220C, Lippes Loop D, and Copper 7 intrauterine devices inserted immediately following spontaneous abortion. A total of 1060 insertions were performed with no perforations detected within the 1st 48 hours; only 9 subjects had complaints. At 390 and 750 days the continuation rates of all devices were equal. The expulsion rates were much lower than those with insertion immediately following the delivery of the placenta. There were no ectopic pregnancies reported and the incidence of pelvic inflammatory disease was low. It can be concluded that IUD insertion following spontaneous abortion in subjects with no signs of pelvic infection is safe and not associated with uterine perforation or a subsequent increased risk of pelvic inflammatory disease.

  5. Fast-starting for a breath: Air breathing in Hoplosternum littorale

    DEFF Research Database (Denmark)

    Domenici, Paolo; Norin, Tommy; Bushnell, Peter G.

    by the fall of a prey item on the water surface, and in tapping motions of goldfish, a behaviour that was interpreted to be food-related. Little is known about C-starts being used outside the context of escaping or feeding. Here, we test the hypothesis that air-breathing fish may use C-starts when gulping air...... at the surface. Air breathing is a common behaviour in many fish species when exposed to hypoxia, although certain species perform air-breathing in normoxia to fill their swim bladders for buoyancy control and/or sound transduction. Hoplosternum littorale is an air-breathing freshwater catfish found in South...... America. Field video observations reveal that their air-breathing behaviour consists of a fast air-gulping motion at the surface, followed by swimming towards the bottom. Using high-speed video in the laboratory, we compared the kinematics of spontaneous air-gulping performed by H. littorale in normoxia...

  6. Phase I clinical trial and pharmacodynamic evaluation of combination hydroxychloroquine and doxorubicin treatment in pet dogs treated for spontaneously occurring lymphoma.

    Science.gov (United States)

    Barnard, Rebecca A; Wittenburg, Luke A; Amaravadi, Ravi K; Gustafson, Daniel L; Thorburn, Andrew; Thamm, Douglas H

    2014-08-01

    Autophagy is a lysosomal degradation process that may act as a mechanism of survival in a variety of cancers. While pharmacologic inhibition of autophagy with hydroxychloroquine (HCQ) is currently being explored in human clinical trials, it has never been evaluated in canine cancers. Non-Hodgkin lymphoma (NHL) is one of the most prevalent tumor types in dogs and has similar pathogenesis and response to treatment as human NHL. Clinical trials in canine patients are conducted in the same way as in human patients, thus, to determine a maximum dose of HCQ that can be combined with a standard chemotherapy, a Phase I, single arm, dose escalation trial was conducted in dogs with spontaneous NHL presenting as patients to an academic, tertiary-care veterinary teaching hospital. HCQ was administered daily by mouth throughout the trial, beginning 72 h prior to doxorubicin (DOX), which was given intravenously on a 21-d cycle. Peripheral blood mononuclear cells and biopsies were collected before and 3 d after HCQ treatment and assessed for autophagy inhibition and HCQ concentration. A total of 30 patients were enrolled in the trial. HCQ alone was well tolerated with only mild lethargy and gastrointestinal-related adverse events. The overall response rate (ORR) for dogs with lymphoma was 93.3%, with median progression-free interval (PFI) of 5 mo. Pharmacokinetic analysis revealed a 100-fold increase in HCQ in tumors compared with plasma. There was a trend that supported therapy-induced increase in LC3-II (the cleaved and lipidated form of microtubule-associated protein 1 light chain 3/LC3, which serves as a maker for autophagosomes) and SQSTM1/p62 (sequestosome 1) after treatment. The superior ORR and comparable PFI to single-agent DOX provide strong support for further evaluation via randomized, placebo-controlled trials in canine and human NHL.

  7. Cut-off optimization for13C-urea breath test in a community-based trial by mathematic, histology and serology approach.

    Science.gov (United States)

    Li, Zhe-Xuan; Huang, Lei-Lei; Liu, Cong; Formichella, Luca; Zhang, Yang; Wang, Yu-Mei; Zhang, Lian; Ma, Jun-Ling; Liu, Wei-Dong; Ulm, Kurt; Wang, Jian-Xi; Zhang, Lei; Bajbouj, Monther; Li, Ming; Vieth, Michael; Quante, Michael; Zhou, Tong; Wang, Le-Hua; Suchanek, Stepan; Soutschek, Erwin; Schmid, Roland; Classen, Meinhard; You, Wei-Cheng; Gerhard, Markus; Pan, Kai-Feng

    2017-05-18

    The performance of diagnostic tests in intervention trials of Helicobacter pylori (H.pylori) eradication is crucial, since even minor inaccuracies can have major impact. To determine the cut-off point for 13 C-urea breath test ( 13 C-UBT) and to assess if it can be further optimized by serologic testing, mathematic modeling, histopathology and serologic validation were applied. A finite mixture model (FMM) was developed in 21,857 subjects, and an independent validation by modified Giemsa staining was conducted in 300 selected subjects. H.pylori status was determined using recomLine H.pylori assay in 2,113 subjects with a borderline 13 C-UBT results. The delta over baseline-value (DOB) of 3.8 was an optimal cut-off point by a FMM in modelling dataset, which was further validated as the most appropriate cut-off point by Giemsa staining (sensitivity = 94.53%, specificity = 92.93%). In the borderline population, 1,468 subjects were determined as H.pylori positive by recomLine (69.5%). A significant correlation between the number of positive H.pylori serum responses and DOB value was found (r s  = 0.217, P mathematical approach such as FMM might be an alternative measure in optimizing the cut-off point for 13 C-UBT in community-based studies, and a second method to determine H.pylori status for subjects with borderline value of 13 C-UBT was necessary and recommended.

  8. Mapleson′s breathing systems

    Directory of Open Access Journals (Sweden)

    Tej K Kaul

    2013-01-01

    Full Text Available Mapleson breathing systems are used for delivering oxygen and anaesthetic agents and to eliminate carbon dioxide during anaesthesia. They consist of different components: Fresh gas flow, reservoir bag, breathing tubes, expiratory valve, and patient connection. There are five basic types of Mapleson system: A, B, C, D and E depending upon the different arrangements of these components. Mapleson F was added later. For adults, Mapleson A is the circuit of choice for spontaneous respiration where as Mapleson D and its Bains modifications are best available circuits for controlled ventilation. For neonates and paediatric patients Mapleson E and F (Jackson Rees modification are the best circuits. In this review article, we will discuss the structure of the circuits and functional analysis of various types of Mapleson systems and their advantages and disadvantages.

  9. Slow Breathing and Hypoxic Challenge: Cardiorespiratory Consequences and Their Central Neural Substrates

    OpenAIRE

    Critchley, Hugo D.; Nicotra, Alessia; Chiesa, Patrizia A.; Nagai, Yoko; Gray, Marcus A.; Minati, Ludovico; Bernardi, Luciano

    2015-01-01

    Controlled slow breathing (at 6/min, a rate frequently adopted during yoga practice) can benefit cardiovascular function, including responses to hypoxia. We tested the neural substrates of cardiorespiratory control in humans during volitional controlled breathing and hypoxic challenge using functional magnetic resonance imaging (fMRI). Twenty healthy volunteers were scanned during paced (slow and normal rate) breathing and during spontaneous breathing of normoxic and hypoxic (13% inspired O2)...

  10. Stakeholder Engagement in Trial Design: Survey of Visitors to Critically Ill Patients Regarding Preferences for Outcomes and Treatment Options during Weaning from Mechanical Ventilation.

    Science.gov (United States)

    Burns, Karen E A; Jacob, Sonu Karottaiyamvelil; Aguirre, Valeria; Gomes, Janice; Mehta, Sangeeta; Rizvi, Leena

    2016-11-01

    Stakeholder engagement in research is expected to provide unique insights, make research investments more accountable and transparent, and ensure that future research is applicable to patients and family members. To inform the design of a trial of strategies for weaning from mechanical ventilation, we sought to identify preferences of patient visitors regarding outcome and treatment measures. We conducted an interviewer-administered questionnaire of visitors of critically ill patients in two family waiting rooms serving three intensive care units (ICUs) in Toronto, Canada. Respondents rated the importance of general and ventilation-related outcomes in two hypothetical scenarios (before a first spontaneous breathing trial, and after a failed spontaneous breathing trial) and selected a preferred technique for the breathing trials. With regard to the patient they were visiting, respondents identified the most important outcome to them at ICU admission, during the ICU stay, and at ICU discharge. We analyzed 322 questionnaires (95.5% response rate). All outcomes were highly rated (average range: 7.82-9.74). Across scenarios, outcomes rated as most important were ICU and hospital survival (9.72, 9.70), avoiding complications (9.45), quality of life (9.394), patient comfort (9.393), and returning to previous living arrangements (9.31). Overall, the most important ventilation-related outcomes were being ventilator-free (8.95), avoiding reintubation (8.905), and passing a spontaneous breathing trial (8.903). Passing a spontaneous breathing trial assumed greater importance after an initial failed attempt. "Time to event" outcomes were less important to visitors. We did not identify a preferred spontaneous breathing trial technique. Although ICU survival was the most important outcome at ICU admission and during the ICU stay, visitors rated quality of life higher than hospital survival at ICU discharge. Visitors to critically ill patients prioritized two general outcomes (ICU

  11. Spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Davari R

    1996-07-01

    Full Text Available A case with bilateral spontaneous pneumothorax was presented. Etiology, mechanism, and treatment were discussed on the review of literature. Spontaneous Pneumothorax is a clinical entity resulting from a sudden non traumatic rupture of the lung. Biach reported in 1880 that 78% of 916 patients with spontaneous pneumothorax had tuberculosis. Kjergaard emphasized 1932 the primary importance of subpleural bleb disease. Currently the clinical spectrum of spontaneous pneumothorax seems to have entered a third era with the recognition of the interstitial lung disease and AIDS as a significant etiology. Standard treatment is including: observation, thoracocentesis, tube thoracostomy. Chemical pleurodesis, bullectomy or wedge resection of lung with pleural abrasion and occasionally pleurectomy. Little information has been reported regarding the efficacy of such treatment in spontaneous pneumothorax secondary to non bleb disease

  12. Usage of a Generic Web-Based Self-Management Intervention for Breast Cancer Survivors: Substudy Analysis of the BREATH Trial

    Science.gov (United States)

    Peters, Esmee J; Kraaijeveld, J Frank; Gielissen, Marieke FM; Prins, Judith B

    2013-01-01

    Background Generic fully automated Web-based self-management interventions are upcoming, for example, for the growing number of breast cancer survivors. It is hypothesized that the use of these interventions is more individualized and that users apply a large amount of self-tailoring. However, technical usage evaluations of these types of interventions are scarce and practical guidelines are lacking. Objective To gain insight into meaningful usage parameters to evaluate the use of generic fully automated Web-based interventions by assessing how breast cancer survivors use a generic self-management website. Final aim is to propose practical recommendations for researchers and information and communication technology (ICT) professionals who aim to design and evaluate the use of similar Web-based interventions. Methods The BREAst cancer ehealTH (BREATH) intervention is a generic unguided fully automated website with stepwise weekly access and a fixed 4-month structure containing 104 intervention ingredients (ie, texts, tasks, tests, videos). By monitoring https-server requests, technical usage statistics were recorded for the intervention group of the randomized controlled trial. Observed usage was analyzed by measures of frequency, duration, and activity. Intervention adherence was defined as continuous usage, or the proportion of participants who started using the intervention and continued to log in during all four phases. By comparing observed to minimal intended usage (frequency and activity), different user groups were defined. Results Usage statistics for 4 months were collected from 70 breast cancer survivors (mean age 50.9 years). Frequency of logins/person ranged from 0 to 45, total duration/person from 0 to 2324 minutes (38.7 hours), and activity from opening none to all intervention ingredients. 31 participants continued logging in to all four phases resulting in an intervention adherence rate of 44.3% (95% CI 33.2-55.9). Nine nonusers (13%), 30 low users

  13. Success and spontaneous pregnancy rates following systemic methotrexate versus laparoscopic surgery for tubal pregnancies: A randomized trial

    DEFF Research Database (Denmark)

    Krag Moeller, Lars Bo; Moeller, Charlotte; Thomsen, Sten Grove

    2009-01-01

    . A total of 106 women diagnosed with ectopic pregnancy (EP). Methods. Between March 1997 and September 2000, 1,265 women were diagnosed with EP, 395 (31%) were eligible, 109 (9%) were randomized of whom 106 had an EP. The study was originally powered to a sample size of 422 patients. The women were......, subsequent intrauterine, and recurrent ectopic pregnancies. Results. The success rates were 74% following MTX treatment and 87% after surgery (n.s.); the subsequent spontaneous intrauterine pregnancy rate was 73% after MTX and 62% after surgery; and the EP rate was 9.6% after MTX and 17.3% following surgery......Objective. To determine which treatment should be offered to women with a non-ruptured tubal pregnancy: a single dose of methotrexate (MTX) or laparoscopic surgery. Design. Prospective, randomized, open multicenter study. Setting. Seven Danish departments of obstetrics and gynecology. Sample...

  14. Oral amoxicillin compared with injectable procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants with fast breathing when referral is not possible: a randomised, open-label, equivalence trial.

    Science.gov (United States)

    Tshefu, Antoinette; Lokangaka, Adrien; Ngaima, Serge; Engmann, Cyril; Esamai, Fabian; Gisore, Peter; Ayede, Adejumoke Idowu; Falade, Adegoke Gbadegesin; Adejuyigbe, Ebunoluwa A; Anyabolu, Chineme Henry; Wammanda, Robinson D; Ejembi, Clara L; Ogala, William N; Gram, Lu; Cousens, Simon

    2015-05-02

    WHO recommends referral to hospital for possible serious bacterial infection in young infants aged 0-59 days. We aimed to assess whether oral amoxicillin treatment for fast breathing, in the absence of other signs, is as efficacious as the combination of injectable procaine benzylpenicillin-gentamicin. In a randomised, open-label, equivalence trial at five sites in DR Congo, Kenya, and Nigeria, community health workers followed up all births in the community, identified unwell young infants, and referred them to study nurses. We randomly assigned infants with fast breathing as a single sign of illness or possible serious bacterial infection, whose parents did not accept referral to hospital, to receive either injectable procaine benzylpenicillin-gentamicin once per day or oral amoxicillin treatment twice per day for 7 days. A person who was off-site generated randomisation lists using computer software. Trained health professionals gave injections, but outcome assessors were masked to group allocations. The primary outcome was treatment failure by day 8 after enrolment, defined as clinical deterioration, development of a serious adverse event including death, persistence of fast breathing on day 4, or recurrence up to day 8. The primary analysis was per protocol and we used a prespecified similarity margin of 5% to assess equivalence between regimens. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12610000286044. From April 4, 2011, to March 29, 2013, we enrolled 2333 infants aged 0-59 days with fast breathing as the only sign of possible serious bacterial infection at the five study sites. We assigned 1170 infants to receive injectable procaine benzylpenicillin-gentamicin and 1163 infants to receive oral amoxicillin. In the per-protocol analysis, from which 137 infants were excluded, we included 1061 (91%) infants who fulfilled predefined criteria of adherence to treatment and adequate follow-up in the injectable

  15. Usage of a generic web-based self-management intervention for breast cancer survivors: substudy analysis of the BREATH trial.

    Science.gov (United States)

    van den Berg, Sanne W; Peters, Esmee J; Kraaijeveld, J Frank; Gielissen, Marieke F M; Prins, Judith B

    2013-08-19

    Generic fully automated Web-based self-management interventions are upcoming, for example, for the growing number of breast cancer survivors. It is hypothesized that the use of these interventions is more individualized and that users apply a large amount of self-tailoring. However, technical usage evaluations of these types of interventions are scarce and practical guidelines are lacking. To gain insight into meaningful usage parameters to evaluate the use of generic fully automated Web-based interventions by assessing how breast cancer survivors use a generic self-management website. Final aim is to propose practical recommendations for researchers and information and communication technology (ICT) professionals who aim to design and evaluate the use of similar Web-based interventions. The BREAst cancer ehealTH (BREATH) intervention is a generic unguided fully automated website with stepwise weekly access and a fixed 4-month structure containing 104 intervention ingredients (ie, texts, tasks, tests, videos). By monitoring https-server requests, technical usage statistics were recorded for the intervention group of the randomized controlled trial. Observed usage was analyzed by measures of frequency, duration, and activity. Intervention adherence was defined as continuous usage, or the proportion of participants who started using the intervention and continued to log in during all four phases. By comparing observed to minimal intended usage (frequency and activity), different user groups were defined. Usage statistics for 4 months were collected from 70 breast cancer survivors (mean age 50.9 years). Frequency of logins/person ranged from 0 to 45, total duration/person from 0 to 2324 minutes (38.7 hours), and activity from opening none to all intervention ingredients. 31 participants continued logging in to all four phases resulting in an intervention adherence rate of 44.3% (95% CI 33.2-55.9). Nine nonusers (13%), 30 low users (43%), and 31 high users (44%) were

  16. Noninvasive work of breathing improves prediction of post-extubation outcome.

    Science.gov (United States)

    Banner, Michael J; Euliano, Neil R; Martin, A Daniel; Al-Rawas, Nawar; Layon, A Joseph; Gabrielli, Andrea

    2012-02-01

    We hypothesized that non-invasively determined work of breathing per minute (WOB(N)/min) (esophageal balloon not required) may be useful for predicting extubation outcome, i.e., appropriate work of breathing values may be associated with extubation success, while inappropriately increased values may be associated with failure. Adult candidates for extubation were divided into a training set (n = 38) to determine threshold values of indices for assessing extubation and a prospective validation set (n = 59) to determine the predictive power of the threshold values for patients successfully extubated and those who failed extubation. All were evaluated for extubation during a spontaneous breathing trial (5 cmH(2)O pressure support ventilation, 5 cmH(2)O positive end expiratory pressure) using routine clinical practice standards. WOB(N)/min data were blinded to attending physicians. Area under the receiver operating characteristic curves (AUC), sensitivity, specificity, and positive and negative predictive values of all extubation indices were determined. AUC for WOB(N)/min was 0.96 and significantly greater (p indices. WOB(N)/min had a specificity of 0.83, the highest sensitivity at 0.96, positive predictive value at 0.84, and negative predictive value at 0.96 compared to all indices. For 95% of those successfully extubated, WOB(N)/min was ≤10 J/min. WOB(N)/min had the greatest overall predictive accuracy for extubation compared to traditional indices. WOB(N)/min warrants consideration for use in a complementary manner with spontaneous breathing pattern data for predicting extubation outcome.

  17. Effect of device-guided breathing exercises on blood pressure in hypertensive patients with type 2 diabetes mellitus : A randomized controlled trial

    NARCIS (Netherlands)

    Logtenberg, Susan J.; Kleefstra, Nanne; Houweling, Sebastlaan T.; Groenier, Klaas H.; Bilo, Henk J.

    Objective In patients with type 2 diabetes mellitus (DM2), it is hard to reach treatment objectives for blood pressure (BP) with classical treatment options. Recently, reducing breathing frequency has been advocated as a method to reduce BP. We examined if an electronic device such as Resperate, by

  18. Efficacy of device-guided breathing for hypertension in blinded, randomized, active-controlled trials : a meta-analysis of individual patient data

    NARCIS (Netherlands)

    Landman, Gijs W. D.; van Hateren, Kornelis J. J.; van Dijk, Peter R.; Logtenberg, Susan J. J.; Houweling, Sebastiaan T.; Groenier, Klaas H.; Bilo, Henk J. G.; Kleefstra, Nanne

    2014-01-01

    IMPORTANCE: Device-guided breathing (DGB) is recommended by the American Heart Association for its blood pressure-lowering effects. Most previous studies that showed beneficial effects on blood pressure had low methodological quality and only investigated short-term blood pressure effects.

  19. Improvements in well-being and vagal tone following a yogic breathing-based life skills workshop in young adults: Two open-trial pilot studies

    Directory of Open Access Journals (Sweden)

    Michael R Goldstein

    2016-01-01

    Conclusions: These findings suggest that a life skills workshop integrating yogic breathing techniques may provide self-empowering tools for enhancing well-being in young adults. Future research is indicated to further explore these effects, particularly in regards to vagal tone and other aspects of stress physiology.

  20. What Causes Bad Breath?

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español What Causes Bad Breath? KidsHealth / For Teens / What Causes Bad Breath? Print en español ¿Qué es lo ... through your mouth. Smoking is also a major cause of bad breath. There are lots of myths ...

  1. Breath-Holding Spells

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Breath-Holding Spells KidsHealth / For Parents / Breath-Holding Spells What's in ... Spells Print en español Espasmos de sollozo About Breath-Holding Spells Many of us have heard stories about stubborn ...

  2. Comparison of Diaphragmatic Breathing Exercise, Volume and Flow Incentive Spirometry, on Diaphragm Excursion and Pulmonary Function in Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Gopala Krishna Alaparthi

    2016-01-01

    Full Text Available Objective. To evaluate the effects of diaphragmatic breathing exercises and flow and volume-oriented incentive spirometry on pulmonary function and diaphragm excursion in patients undergoing laparoscopic abdominal surgery. Methodology. We selected 260 patients posted for laparoscopic abdominal surgery and they were block randomization as follows: 65 patients performed diaphragmatic breathing exercises, 65 patients performed flow incentive spirometry, 65 patients performed volume incentive spirometry, and 65 patients participated as a control group. All of them underwent evaluation of pulmonary function with measurement of Forced Vital Capacity (FVC, Forced Expiratory Volume in the first second (FEV1, Peak Expiratory Flow Rate (PEFR, and diaphragm excursion measurement by ultrasonography before the operation and on the first and second postoperative days. With the level of significance set at p<0.05. Results. Pulmonary function and diaphragm excursion showed a significant decrease on the first postoperative day in all four groups (p<0.001 but was evident more in the control group than in the experimental groups. On the second postoperative day pulmonary function (Forced Vital Capacity and diaphragm excursion were found to be better preserved in volume incentive spirometry and diaphragmatic breathing exercise group than in the flow incentive spirometry group and the control group. Pulmonary function (Forced Vital Capacity and diaphragm excursion showed statistically significant differences between volume incentive spirometry and diaphragmatic breathing exercise group (p<0.05 as compared to that flow incentive spirometry group and the control group. Conclusion. Volume incentive spirometry and diaphragmatic breathing exercise can be recommended as an intervention for all patients pre- and postoperatively, over flow-oriented incentive spirometry for the generation and sustenance of pulmonary function and diaphragm excursion in the management of

  3. A randomized clinical trial of salivary substitute as an adjunct to scaling and root planing for management of periodontal inflammation in mouth breathing patients.

    Science.gov (United States)

    Bhatia, Anu; Sharma, Rajinder K; Tewari, Shikha; Narula, Satish C

    2015-09-01

    We investigated the outcome of conventional periodontal treatment in mouth breathing patients with chronic periodontitis, and compared the efficacy of applying salivary substitute to the anterior sextants as an adjunct to conventional treatment in such patients. In this randomized, investigator-blind, clinical study involving parallel groups, 40 mouth breathing patients were divided into two groups: a control group (CG, n = 20) comprising patients who received scaling and root planing (SRP), and a test group (TG, n = 20) who received salivary substitute as an adjunct to SRP for treatment of chronic periodontitis. The patients were followed up at various time intervals, and improvement of the gingival index (GI) was examined as the primary outcome. Student's t-test, repeated-measures ANOVA and Mann-Whitney U test were applied for statistical analysis. Although periodontal parameters were improved in both groups after 8 weeks of follow-up, the test group showed better improvement in terms of GI and percentage bleeding on probing. Within the limits of this study, our results suggest that the use of salivary substitute has a beneficial adjunctive effect for improvement of periodontal parameters in mouth breathing patients with chronic periodontitis.

  4. Spontaneous deregulation

    NARCIS (Netherlands)

    Edelman, Benjamin; Geradin, Damien

    Platform businesses such as Airbnb and Uber have risen to success partly by sidestepping laws and regulations that encumber their traditional competitors. Such rule flouting is what the authors call “spontaneous private deregulation,” and it’s happening in a growing number of industries. The authors

  5. Simple Wound Irrigation in the Postoperative Treatment for Surgically Drained Spontaneous Soft Tissue Abscesses: Study Protocol for a Prospective, Single-Blinded, Randomized Controlled Trial.

    Science.gov (United States)

    Rühle, Annika; Oehme, Florian; Börnert, Katja; Fourie, Lana; Babst, Reto; Link, Björn-Christian; Metzger, Jürg; Beeres, Frank Jp

    2017-05-01

    Skin abscesses are a frequent encountered health care problem and lead to a significant source of morbidity. They consequently have an essential impact on the quality of life and work. To date, the type of aftercare for surgically drained abscesses remains under debate. This leads to undesirable practice variations. Many clinical standard protocols include sterile wound dressings twice a day by a home-care service to reduce the chance of a recurrent wound infection. It is unknown, however, whether reinfection rates are comparable to adequate wound irrigation with a nonsterile solution performed by the patient. Our hypothesis is that simple wound irrigation with nonsterile water for postoperative wound care after an abscess is surgically drained is feasible. We assume that in terms of reinfection and reintervention rates unsterile wound irrigation is equal to sterile wound irrigation. The primary aim of this study is therefore to investigate if there is a need for sterile wound irrigation after surgically drained spontaneous skin abscesses. In a prospective, randomized controlled, single-blinded, single-center trial based on a noninferiority design, we will enroll 128 patients randomized to either the control or the intervention group. The control group will be treated according to our current, standard protocol in which all patients receive a sterile wound irrigation performed by a home-care service twice a day. Patients randomized to the intervention group will be treated with a nonsterile wound irrigation (shower) twice a day. All patients will have a routine clinical control visit after 1, 3, 6, and 12 weeks in the outpatient clinic. Primary outcome is the reinfection and reoperation rate due to insufficient wound healing diagnosed either at the outpatient control visit or during general practitioner visits. Secondary outcome measures include a Short Form Health Survey, Visual Analog Scale, Patient and Observer Scar Assessment Scale, Vancouver Scar Scale, and

  6. Exhaled Carbon Dioxide and Neonatal Breathing Patterns in Preterm Infants after Birth.

    Science.gov (United States)

    Nicoll, Jessica; Cheung, Po-Yin; Aziz, Khalid; Rajani, Vishaal; O'Reilly, Megan; Pichler, Gerhard; Schmölzer, Georg M

    2015-10-01

    To examine the amount of exhaled carbon dioxide (ECO2) with different breathing patterns in spontaneously breathing preterm infants after birth. Preterm infants had a facemask attached to a combined carbon dioxide/flow sensor placed over their mouth and nose to record ECO2 and gas flow. A breath-by-breath analysis of the first 5 minutes of the recording was performed. Thirty spontaneously breathing preterm infants, gestational age (mean ± SD) 30 ± 2 weeks and birth weight 1635 ± 499 g were studied. ECO2 from normal breaths and slow expirations was significantly larger than with other breathing patterns (P breath also increased with gestational age P breathing pattern both during the first minute of recording and overall. Breathing pattern proportions also varied by gestational age. Finally, ECO2 from the fifth minute of recording was significantly greater than that produced during the first 4 minutes of recording (P ≤ .029). ECO2 varies with different breathing patterns and increases with gestational age and over time. ECO2 may be an indicator of lung aeration and that postnatal ECO2 monitoring may be useful in preterm infants in the delivery room. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Imposed work of breathing during high-frequency oscillatory ventilation : a bench study

    NARCIS (Netherlands)

    van Heerde, Marc; van Genderingen, Huib R.; Leenhoven, Tom; Roubik, Karel; Ploetz, Frans B.; Markhorst, Dick G.

    2006-01-01

    Introduction The ventilator and the endotracheal tube impose additional workload in mechanically ventilated patients breathing spontaneously. The total work of breathing (WOB) includes elastic and resistive work. In a bench test we assessed the imposed WOB using 3100 A/3100 B SensorMedics

  8. How to breathe when you are short of breath

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000053.htm How to breathe when you are short of breath ... Watch TV Use your computer Read a newspaper How to do Pursed lip Breathing The steps to ...

  9. Effect of omalizumab on angioedema in H1 -antihistamine-resistant chronic spontaneous urticaria patients: results from X-ACT, a randomized controlled trial.

    Science.gov (United States)

    Staubach, P; Metz, M; Chapman-Rothe, N; Sieder, C; Bräutigam, M; Canvin, J; Maurer, M

    2016-08-01

    Chronic spontaneous urticaria (CSU) severely impacts quality of life (QoL), especially in patients with wheals and angioedema. Omalizumab is approved as add-on therapy for CSU patients; however, its effect on patients who are double-positive for wheals and angioedema has not been systematically studied. The primary objective was to evaluate the efficacy of omalizumab vs placebo at week 28 using the Chronic Urticaria Quality of Life (CU-Q2oL) questionnaire. Number of angioedema-burdened days, time interval between successive angioedema episodes, disease activity, angioedema-specific and overall QoL impairment were secondary objectives. X-ACT was a phase III, randomized, double-blind study conducted in 24 centres (Germany), which selectively included CSU patients with angioedema and wheals. Patients were randomized (1 : 1) to omalizumab 300 mg or placebo (every 4 weeks up to week 24) (ClinicalTrials.gov number: NCT01723072). Of the 91 patients randomized to omalizumab (n = 44) or placebo (n = 47) at baseline, 68 completed the 28-week treatment phase (omalizumab, 35; placebo, 33). Omalizumab was superior to placebo in improving CU-Q2oL scores at week 28 (P omalizumab (0.3) vs placebo (1.1). The median time to first recurrence of angioedema was 57-63 days with omalizumab and Omalizumab significantly improved angioedema-specific QoL (P omalizumab. Omalizumab was an effective treatment option for patients with moderate-to-severe CSU symptoms and angioedema unresponsive to high doses of antihistamine treatment. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Breathing patterns and cardiovascular autonomic modulation during hypoxia induced by simulated altitude.

    Science.gov (United States)

    Bernardi, L; Passino, C; Wilmerding, V; Dallam, G M; Parker, D L; Robergs, R A; Appenzeller, O

    2001-05-01

    To assess the influence of different breathing patterns on autonomic cardiovascular modulation during acute exposure to altitude-induced hypoxia. We measured relative changes in minute ventilation (VE), oxygen saturation (%SaO2), spectral analysis of RR interval and blood pressure, and response to stimulation of carotid baroreceptors (neck suction) at baseline and after acute (1 h) hypobaric hypoxia (equivalent to 5,000 m, in a hypobaric chamber). We studied 19 human subjects: nine controls and 10 Western yoga trainees of similar age, while breathing spontaneously, at 15 breaths/min (controlled breathing) and during 'complete yogic breathing' (slow diaphragmatic + thoracic breathing, approximately 5 breaths/min) in yoga trainees, or simple slow breathing in controls. At baseline %SaO2, VE and autonomic pattern were similar in both groups; simulated altitude increased VE in controls but not in yoga trainees; %SaO2 decreased in all subjects (Pbreathing, controlled breathing and yogic or slow breathing, respectively). Simulated altitude decreased RR interval (from 879 +/- 45 to 770 +/- 39, P breathing. No effect of altitude was seen on stimulation of carotid baroreceptors in both groups. Well-performed slow yogic breathing maintains better blood oxygenation without increasing VE (i.e. seems to be a more efficient breathing) and reduces sympathetic activation during altitude-induced hypoxia.

  11. Eldercare at Home: Breathing Problems

    Science.gov (United States)

    ... Join our e-newsletter! Resources Eldercare at Home: Breathing Problems Caregiving How Tos Understanding the Problem As ... However, aging sometimes brings on other more serious breathing problems including incapacitating shortness of breath, chest discomfort, ...

  12. From breathing to respiration.

    Science.gov (United States)

    Fitting, Jean-William

    2015-01-01

    The purpose of breathing remained an enigma for a long time. The Hippocratic school described breathing patterns but did not associate breathing with the lungs. Empedocles and Plato postulated that breathing was linked to the passage of air through pores of the skin. This was refuted by Aristotle who believed that the role of breathing was to cool the heart. In Alexandria, breakthroughs were accomplished in the anatomy and physiology of the respiratory system. Later, Galen proposed an accurate description of the respiratory muscles and the mechanics of breathing. However, his heart-lung model was hampered by the traditional view of two non-communicating vascular systems - veins and arteries. After a period of stagnation in the Middle Ages, knowledge progressed with the discovery of pulmonary circulation. The comprehension of the purpose of breathing progressed by steps thanks to Boyle and Mayow among others, and culminated with the contribution of Priestley and the discovery of oxygen by Lavoisier. Only then was breathing recognized as fulfilling the purpose of respiration, or gas exchange. A century later, a controversy emerged concerning the active or passive transfer of oxygen from alveoli to the blood. August and Marie Krogh settled the dispute, showing that passive diffusion was sufficient to meet the oxygen needs. © 2014 S. Karger AG, Basel.

  13. Breath alcohol test (image)

    Science.gov (United States)

    The breath alcohol test measures the amount of alcohol in the blood by testing exhaled air. The test is performed by blowing ... breath machine 15 minutes after alcohol consumption. The test determines how much alcohol it takes to raise the blood-alcohol level ...

  14. Minimizing Shortness of Breath

    Science.gov (United States)

    ... is also placed on proper use of the abdominal muscles to better control episodes of shortness of breath, limit overuse of the accessory muscles and manage respiratory symptoms. Monitor Breathing During an activity, it is important to pause frequently to check ...

  15. Effects of inspiratory muscle training and yoga breathing exercises on respiratory muscle function in institutionalized frail older adults: a randomized controlled trial.

    Science.gov (United States)

    Cebrià i Iranzo, Maria dels Àngels; Arnall, David Alan; Igual Camacho, Celedonia; Tomás, José Manuel

    2014-01-01

    In older adults, respiratory function may be seriously compromised when a marked decrease of respiratory muscle (RM) strength coexists with comorbidity and activity limitation. Respiratory muscle training has been widely studied and recommended as a treatment option for people who are unable to participate in whole-body exercise training (WBET); however, the effects of inspiratory muscle training and yoga breathing exercises on RM function remain unknown, specifically in impaired older adults. To evaluate the effects of inspiratory threshold training (ITT) and yoga respiratory training (YRT) on RM function in institutionalized frail older adults. Eighty-one residents (90% women; mean age, 85 years), who were unable to perform WBET (inability to independently walk more than 10 m), were randomly assigned to a control group or one of the 2 experimental groups (ITT or YRT). Experimental groups performed a supervised interval-based training protocol, either through threshold inspiratory muscle training device or yoga breathing exercises, which lasted 6 weeks (5 days per week). Outcome measures were collected at 4 time points (pretraining, intermediate, posttraining, and follow-up) and included the maximum respiratory pressures (maximum inspiratory pressure [MIP] and maximum expiratory pressure [MEP]) and the maximum voluntary ventilation (MVV). Seventy-one residents completed the study: control (n = 24); ITT (n = 23); YRT (n = 24). The treatment on had a significant effect on MIP YRT (F(6,204) = 6.755, P training appears to be an effective and well-tolerated exercise regimen in frail older adults and may therefore be a useful alternative to ITT or no training, to improve RM function in older population, when WBET is not possible.

  16. Breath hydrogen analysis in patients with ileoanal pouch anastomosis

    DEFF Research Database (Denmark)

    Bruun, E; Meyer, J N; Rumessen, J J

    1995-01-01

    The possible influence on functional outcomes of hydrogen production in the ileoanal pouch after restorative proctocolectomy was investigated by means of lactulose H2 breath tests. Eight of 15 patients had significant increases in breath hydrogen after 10 g lactulose. One patient declined...... to participate in further investigations, the remaining seven responders had no evidence of small bowel bacterial overgrowth after glucose H2 breath tests. The ability to produce hydrogen by anaerobic fermentation of lactulose in the pouch was unrelated to the age of the patients or of the pouch. Seven of eight...... responders had successive breath tests after ingestion of lactulose 20 g and wheat starch 100 g. Five of seven had significant increases after lactulose but none after wheat starch. The overall function of the pouch continence, spontaneity of defecation, and 24 hour stool frequency was significantly better...

  17. White Grape Juice Elicits a Lower Breath Hydrogen Response Compared with Apple Juice in Healthy Human Subjects: A Randomized Controlled Trial.

    Science.gov (United States)

    Erickson, Jennifer; Wang, Qi; Slavin, Joanne

    2017-06-01

    Diets low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPS) are used to manage symptoms in individuals with irritable bowel syndrome. Although effective at reducing symptoms, the diet can be complex and restrictive. In addition, there are still large gaps in the literature and many foods with unclear effects in the gastrointestinal (GI) tract, like fruit juice. Although many fruits are allowable on a low-FODMAP diet, consumption of all fruit juice is generally cautioned due to the large fructose load contained in juice, regardless of the glucose concentration. Very little research exists regarding the importance of limiting fructose load during a low-FODMAP diet; therefore, individuals following a low-FODMAP diet may be unnecessarily restricting their diets. To determine whether there is a difference in GI tolerance between juice from a high-FODMAP fruit (apple juice) and juice from a low-FODMAP fruit (white grape juice) in healthy human subjects. The goal is to provide insight into the role of juice in a low-FODMAP diet. A double-blind, randomized, controlled crossover study was conducted with 40 healthy adults. Fasted subjects consumed 12 oz of either apple juice or white grape juice. Breath hydrogen measures were taken at baseline, 1, 2, and 3 hours. Subjective GI tolerance surveys were completed at the same time intervals and at 12 and 24 hours. Breath hydrogen and GI symptoms were assessed with area under the curve analysis. Significance was determined with a two-sided t test with a P value hydrogen area under the curve at 23.3 ppm/hour (95% CI 13.0 to 33.6) compared with white grape juice at 5.8 ppm/hour (95% CI -4.6 to 16.1) (Phydrogen, which may suggest excluding foods only because of the high fructose load could be unnecessarily restrictive. The results of this study suggest that the fructose-to-glucose ratio is likely more important than the total fructose load of the food when considering the acceptability of a food

  18. Shortness of Breath

    Science.gov (United States)

    ... enough air. Shortness of breath — known medically as dyspnea — is often described as an intense tightening in ... properly. Schwartzstein RM. Approach to the patient with dyspnea. http://www.uptodate.com/home. Accessed Feb. 4, ...

  19. Breathe Easier Online: evaluation of a randomized controlled pilot trial of an Internet-based intervention to improve well-being in children and adolescents with a chronic respiratory condition.

    Science.gov (United States)

    Newcombe, Peter A; Dunn, Tamara L; Casey, Leanne M; Sheffield, Jeanie K; Petsky, Helen; Anderson-James, Sophie; Chang, Anne B

    2012-02-08

    Chronic respiratory illnesses are the most common group of childhood chronic health conditions and are overrepresented in socially isolated groups. To conduct a randomized controlled pilot trial to evaluate the efficacy of Breathe Easier Online (BEO), an Internet-based problem-solving program with minimal facilitator involvement to improve psychosocial well-being in children and adolescents with a chronic respiratory condition. We randomly assigned 42 socially isolated children and adolescents (18 males), aged between 10 and 17 years to either a BEO (final n = 19) or a wait-list control (final n = 20) condition. In total, 3 participants (2 from BEO and 1 from control) did not complete the intervention. Psychosocial well-being was operationalized through self-reported scores on depression symptoms and social problem solving. Secondary outcome measures included self-reported attitudes toward their illness and spirometry results. Paper-and-pencil questionnaires were completed at the hospital when participants attended a briefing session at baseline (time 1) and in their homes after the intervention for the BEO group or a matched 9-week time period for the wait-list group (time 2). The two groups were comparable at baseline across all demographic measures (all F Children in the BEO group and their parents rated the online modules very favorably. Although there were no significant group differences on primary outcome measures, our pilot data provide tentative support for the feasibility (acceptability and user satisfaction) and initial efficacy of an Internet-based intervention for improving well-being in children and adolescents with a chronic respiratory condition. Australian New Zealand Clinical Trials Registry number: ACTRN12610000214033; http://www.anzctr.org.au/trial_view.aspx?ID=308074 (Archived by WebCite at http://www.webcitation.org/63BL55mXH).

  20. Log in and breathe out: internet-based recovery training for sleepless employees with work-related strain - results of a randomized controlled trial

    NARCIS (Netherlands)

    Thiart, H.; Lehr, D.; Ebert, D.D.; Berking, M.; Riper, H.

    2015-01-01

    Objectives The primary purpose of this randomized controlled trial (RCT) was to evaluate the efficacy of a guided internet-based recovery training for employees who suffer from both work-related strain and sleep problems (GET.ON Recovery). The recovery training consisted of six lessons, employing

  1. Ultrasound for critical care physicians: take a deep breath

    Directory of Open Access Journals (Sweden)

    Ling D

    2015-07-01

    Full Text Available No abstract available. Article truncated at 150 words. A 40 year old man with a past medical history of intravenous drug abuse presented to the emergency department with difficulty walking and lower extremity weakness. He did admit to recent heroin use. He became somnolent in the ED and was given naloxone. However, he did not improve his level of consciousness sufficiently and was intubated for hypercarbia. The patient was transferred to the MICU and was evaluated for respiratory failure. He later that day passed a spontaneous breathing trial after he awoke and was extubated. However, he was soon thereafter was re-intubated for poor respiratory efforts and a weak cough. With an unexplained etiology for the respiratory failure, CT of the head, MRI of the brain and lab evaluation were pursued but were negative. At that point, a bedside ultrasound of the right hemi-diaphragm in the zone of apposition was obtained and is shown below: Figure 1. Ultrasound of ...

  2. Asthma - A Disease of How We Breathe: Role of Breathing Exercises and Pranayam.

    Science.gov (United States)

    Sankar, Jhuma; Das, Rashmi Ranjan

    2017-12-16

    To describe the role of breathing exercises or yoga and/or pranayama in the management of childhood asthma. We conducted an updated literature search and retrieved relevant literature on the role of breathing exercises or yoga and/or pranayama in the management of childhood asthma. We found that the breathing exercises or yoga and/or pranayama are generally multi-component packaged interventions, and are described as follows: Papworth technique, Buteyko technique, Yoga and/or Pranayam. These techniques primarily modify the pattern of breathing to reduce hyperventilation resulting in normalisation of CO2 level, reduction of bronchospasm and resulting breathlessness. In addition they also change the behaviour, decrease anxiety, improve immunological parameters, and improve endurance of the respiratory muscles that may ultimately help asthmatic children. We found 10 clinical trials conducted in children with asthma of varying severity, and found to benefit children with chronic (mild and moderate) and uncontrolled asthma, but not acute severe asthma. Breathing exercises or yoga and/or pranayama may benefit children with chronic (mild and moderate) and uncontrolled asthma, but not acute severe asthma. Before these techniques can be incorporated into the standard care of asthmatic children, important outcomes like quality of life, medication use, and patient reported outcomes need to be evaluated in future clinical trials.

  3. Model-based characterization of ventilatory stability using spontaneous breathing

    OpenAIRE

    Nemati, Shamim; Edwards, Bradley A.; Sands, Scott A.; Berger, Philip J.; Wellman, Andrew; Verghese, George C.; Malhotra, Atul; Butler, James P.

    2011-01-01

    Cyclic ventilatory instabilities are widely attributed to an increase in the sensitivity or loop gain of the chemoreflex feedback loop controlling ventilation. A major limitation in the conventional characterization of this feedback loop is the need for labor-intensive methodologies. To overcome this limitation, we developed a method based on trivariate autoregressive modeling using ventilation, end-tidal Pco2 and Po2; this method provides for estimation of the overall “loop gain” of the resp...

  4. Iron supplementation for breath-holding attacks in children.

    Science.gov (United States)

    Zehetner, Anthony A; Orr, Nigel; Buckmaster, Adam; Williams, Katrina; Wheeler, Danielle M

    2010-05-12

    Breath-holding attacks are common during childhood. Iron supplementation has been claimed to reduce the frequency or severity, or both, of breath-holding attacks in children. To assess the effect of iron supplementation on the frequency and severity of breath-holding attacks in children. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, CINAHL and the metaRegister of Controlled Trials (up to April 2009). We scanned references of included trials. Pharmaceutical companies manufacturing oral iron supplements and some trial authors were contacted for any unpublished data or trials. Randomised and quasi-randomised controlled trials comparing iron supplementation with placebo or no therapy in children breath-holding episodes. These were reported by an observer. The primary outcome was reduction in the frequency (number over time) or severity (leading to cessation of loss of consciousness or convulsive movements), or both, of breath-holding attacks. Two authors (AZ and NO) independently selected studies and extracted data. Study authors were contacted for missing data, where necessary. Risk of bias was assessed using domain-based evaluation. In the presence of low heterogeneity, a fixed-effect meta-analysis was performed with pooled results presented as odds ratios (OR) and 95% confidence intervals (CIs). Two trials (87 children) fulfilled the inclusion criteria. In these trials, iron supplementation significantly reduced the frequency of breath-holding attacks in children (OR 76.48; 95% CI 15.65 to 373.72; P breath-holding attacks maintained this significance (OR 53.43; 95% CI 6.57 to 434.57; P = 0.0002). Iron supplementation (at 5 mg/kg/day of elemental iron for 16 weeks) appears to be useful in reducing the frequency and severity of breath-holding attacks. Supplementation is of particular benefit in children with iron deficiency anaemia, responses correlating with the improvements in haemoglobin

  5. Consciously controlled breathing decreases the high-frequency component of heart rate variability by inhibiting cardiac parasympathetic nerve activity.

    Science.gov (United States)

    Sasaki, Konosuke; Maruyama, Ryoko

    2014-07-01

    Heart rate variability (HRV), the beat-to-beat alterations in heart rate, comprises sympathetic and parasympathetic nerve activities of the heart. HRV analysis is used to quantify cardiac autonomic regulation. Since respiration could be a confounding factor in HRV evaluation, some studies recommend consciously controlled breathing to standardize the method. However, it remains unclear whether controlled breathing affects HRV measurement. We compared the effects of controlled breathing on HRV with those of spontaneous breathing. In 20 healthy volunteers, we measured respiratory frequency (f), tidal volume, and blood pressure (BP) and recorded electrocardiograms during spontaneous breathing (14.8 ± 0.7 breaths/min) and controlled breathing at 15 (0.25 Hz) and 6 (0.10 Hz) breaths/min. Compared to spontaneous breathing, controlled breathing at 0.25 Hz showed a higher heart rate and a lower high-frequency (HF) component, an index of parasympathetic nerve activity, although the f was the same. During controlled breathing at 0.10 Hz, the ratio of the low frequency (LF) to HF components (LF/HF), an index of sympathetic nerve activity, increased greatly and HF decreased, while heart rate and BP remained almost unchanged. Thus, controlled breathing at 0.25 Hz, which requires mental concentration, might inhibit parasympathetic nerve activity. During controlled breathing at 0.10 Hz, LF/HF increases because some HF subcomponents are synchronized with f and probably move into the LF band. This increment leads to misinterpretation of the true autonomic nervous regulation. We recommend that the respiratory pattern of participants should be evaluated before spectral HRV analysis to correctly understand changes in autonomic nervous regulation.

  6. The influence of the breathing action on net drag force production in front crawl swimming.

    Science.gov (United States)

    Formosa, D; Sayers, M G L; Burkett, B

    2014-12-01

    20 elite swimmers completed a total of 6 randomized net drag force trials in 2 conditions (i) 3 breathing and (ii) 3 non-breathing. Net drag force was measured using an assisted motorized dynamometer device mounted upon a Kistler force-platform. The male participants demonstrated no statistical differences in stroke rates between breathing and non-breathing trials. Female participants, however, demonstrated a statistical difference stroke rate. The male participants demonstrated that the breathing action caused a greater (26%) net drag force compared to the females (16%). To further understand the influence of breathing on swimming technique, each stroke was analyzed and comparisons were made between the breathing and non-breathing conditions. The male participants demonstrated a similar minimum net drag force when comparing the breathing and non-breathing conditions. Analysis showed that minimum net drag force and maximum net drag force for the males changed when integrating the breathing action, while female participants demonstrated similar swimming technique, regardless of condition or stroke. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Respiratory hypoalgesia? Breath-holding, but not respiratory phase modulates nociceptive flexion reflex and pain intensity.

    Science.gov (United States)

    Jafari, Hassan; Van de Broek, Karlien; Plaghki, Léon; Vlaeyen, Johan W S; Van den Bergh, Omer; Van Diest, Ilse

    2016-03-01

    Several observations suggest that respiratory phase (inhalation vs. exhalation) and post-inspiratory breath-holds could modulate pain and the nociceptive reflex. This experiment aimed to investigate the role of both mechanisms. Thirty-two healthy participants received supra-threshold electrocutaneous stimulations to elicit both the Nociceptive Flexion Reflex (NFR) and pain, either during spontaneous inhalations or exhalations, or during three types of instructed breath-holds: following exhalation, at mid-inhalation and at full-capacity inhalation. Whether the electrocutaneous stimulus was applied during inhalation or exhalation did not affect the NFR or pain. Self-reported pain was reduced and the NFR was increased during breath-holding compared to spontaneous breathing. Whereas the type of breath-hold did not impact on self-reported pain, breath-holds at full-capacity inhalation and following exhalation were associated with a lower NFR amplitude compared to breath-holds at mid-inhalation. The present findings confirm that breath-holding can modulate pain (sensitivity) and suggest that both attentional distraction and changes in vagal activity may underlie the observed effects. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. UNDERWATER STROKE KINEMATICS DURING BREATHING AND BREATH-HOLDING FRONT CRAWL SWIMMING

    Directory of Open Access Journals (Sweden)

    Nickos Vezos

    2007-03-01

    Full Text Available The aim of the present study was to determine the effects of breathing on the three - dimensional underwater stroke kinematics of front crawl swimming. Ten female competitive freestyle swimmers participated in the study. Each subject swam a number of front crawl trials of 25 m at a constant speed under breathing and breath-holding conditions. The underwater motion of each subject's right arm was filmed using two S-VHS cameras, operating at 60 Hz, which were positioned behind two underwater viewing windows. The spatial coordinates of selected points were calculated using the DLT procedure with 30 control points and after the digital filtering of the raw data with a cut-off frequency of 6 Hz, the hand's linear displacements and velocities were calculated. The results revealed that breathing caused significantly increases in the stroke duration (t9 = 2.764; p < 0.05, the backward hand displacement relative to the water (t9 = 2.471; p<0.05 and the lateral displacement of the hand in the X - axis during the downsweep (t9 = 2.638; p < 0.05. On the contrary, the peak backward hand velocity during the insweep (t9 = 2.368; p < 0.05 and the displacement of the hand during the push phase (t9 = -2.297; p < 0.05 were greatly reduced when breathing was involved. From the above, it was concluded that breathing action in front crawl swimming caused significant modifications in both the basic stroke parameters and the overall motor pattern were, possibly due to body roll during breathing

  9. Breathing Like a Fish

    Science.gov (United States)

    Katsioloudis, Petros J.

    2010-01-01

    Being able to dive and breathe underwater has been a challenge for thousands of years. In 1980, Fuji Systems of Tokyo developed a series of prototype gills for divers as a way of demonstrating just how good its membranes are. Even though gill technology has not yet reached the point where recipients can efficiently use implants to dive underwater,…

  10. Breathing, feeding, and neuroprotection

    National Research Council Canada - National Science Library

    Homma, Ikuo; Shioda, S

    2006-01-01

    ... of knowledge of brain functions and morphology. Akiyoshi Hosoyamada, M.D., Ph.D. President Showa University, Tokyo 142-8555, Japan December 2005Preface Brain research is on the march, with several advanced technical developments and new findings uncovered almost daily. Within the brain-research fields, we focus on breathing, neuroprotection, an...

  11. The Breath of Chemistry

    DEFF Research Database (Denmark)

    Josephsen, Jens

    The present preliminary text is a short thematic presentation in biological inorganic chemistry meant to illustrate general and inorganic (especially coordination) chemistry in biochemistry. The emphasis is on molecular models to explain features of the complicated mechanisms essential to breathing...

  12. Radon-in-breath measurement

    International Nuclear Information System (INIS)

    Leach, V.A.

    1981-01-01

    A review of literature on the area of radon breath measurements has shown that respiratory factors have been largely ignored. The history of breathing room-air radon concentrations and the variations in respiratory parameters for each individual have been the major contributing factors for poor reproducibility in radon breath measurements performed by past researchers

  13. Log in and breathe out: internet-based recovery training for sleepless employees with work-related strain - results of a randomized controlled trial.

    Science.gov (United States)

    Thiart, Hanne; Lehr, Dirk; Ebert, David Daniel; Berking, Matthias; Riper, Heleen

    2015-03-01

    The primary purpose of this randomized controlled trial (RCT) was to evaluate the efficacy of a guided internet-based recovery training for employees who suffer from both work-related strain and sleep problems (GET.ON Recovery). The recovery training consisted of six lessons, employing well-established methods from cognitive behavioral therapy for insomnia (CBT-I) such as sleep restriction, stimulus control, and hygiene interventions as well as techniques targeted at reducing rumination and promoting recreational activities. In a two-arm RCT (N=128), the effects of GET.ON Recovery were compared to a waitlist-control condition (WLC) on the basis of intention-to-treat analyses. German teachers with clinical insomnia complaints (Insomnia Severity Index ≥15) and work-related rumination (Irritation Scale, cognitive irritation subscale ≥15) were included. The primary outcome measure was insomnia severity. Analyses of covariance (ANCOVA) revealed that, compared to the WLC, insomnia severity of the intervention group decreased significantly stronger (F=74.11, Ptraining significantly reduces sleep problems and fosters mental detachment from work and recreational behavior among adult stressed employees at post-test and 6-months follow up. Given the low threshold access this training could reach out to a large group of stressed employees when results are replicated in other studies.

  14. EFFECTS OF ORAL IRON SUPPLEMENT ON BREATH-HOLDING SPELLS IN CHILDREN

    OpenAIRE

    S.H. TONEKABONI; S. ALAVI; F. MAHVELATI; Z. TABASI

    2006-01-01

    Objectives:Breath holding spells are one of the most frequent and important diagnostic challenges in pediatrics. The aim of this study, conducted on pediatric patients referring to the pediatric neurology clinic in Hormozgan province, was to evaluate therapeutic effects of iron on breath holding spellsMaterials and Methods:35 children (19 males and 16 females), aged between 3 to 60 months, with a history of breath-holding spells, were included in the trial. To obtain all relevant data a speci...

  15. The effects of embodied rhythm and robotic interventions on the spontaneous and responsive verbal communication skills of children with Autism Spectrum Disorder (ASD): A further outcome of a pilot randomized controlled trial.

    Science.gov (United States)

    Srinivasan, Sudha M; Eigsti, Inge-Marie; Gifford, Timothy; Bhat, Anjana N

    2016-07-01

    The current manuscript is the second in a mini-series of manuscripts reporting the effects of alternative, movement-based, rhythm and robotic interventions on the social communication skills of 36 school-age children with ASD. This pilot randomized controlled trial compared the effects of 8-weeks of rhythm and robotic interventions to those of a standard-of-care, comparison intervention. The first manuscript reported intervention effects on the spontaneous and responsive social attention skills of children. In this manuscript, we report intervention effects on the spontaneous and responsive verbal communication skills of children. Communication skills were assessed within a standardized test of responsive communication during the pretest and posttest as well as using training-specific measures of social verbalization during early, mid, and late training sessions. The rhythm and comparison groups improved on the standardized test in the posttest compared to the pretest. The rhythm and robot groups increased levels of social verbalization across training sessions. Movement-based and stationary contexts afforded different types and amounts of communication in children with ASD. Overall, movement-based interventions are a promising tool to enhance verbal and non-verbal communication skills in children with ASD.

  16. Fear of suffocation alters respiration during obstructed breathing.

    Science.gov (United States)

    Pappens, Meike; Smets, Elyn; Van Den Bergh, Omer; Van Diest, Ilse

    2012-06-01

    We aimed to investigate whether fear of suffocation predicts healthy persons' respiratory and affective responses to obstructed breathing as evoked by inspiratory resistive loads. Participants (N = 27 women, ages between 18 and 21 years) completed the Fear of Suffocation scale and underwent 16 trials in which an inspiratory resistive load of 15 cmH(2)O/l/s (small) or 40 cmH(2)O/l/s (large) was added to the breathing circuit for 40 s. Fear of suffocation was associated with higher arousal ratings for both loads. Loaded breathing was associated with a decrease in minute ventilation, but progressively less so for participants scoring higher on fear of suffocation when breathing against the large load. The present findings document a potentially panicogenic mechanism that may maintain and worsen respiratory discomfort in persons with fear of suffocation. Copyright © 2012 Society for Psychophysiological Research.

  17. Learn More Breathe Better

    Centers for Disease Control (CDC) Podcasts

    2011-11-16

    Chronic obstructive pulmonary disease (COPD) is a serious lung disease that makes breathing very difficult and can affect your quality of life. Learn the causes of COPD and what you can do to prevent it.  Created: 11/16/2011 by National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health (NCCDPHP, DACH).   Date Released: 11/16/2011.

  18. [TMJ, eating and breathing].

    Science.gov (United States)

    Cheynet, F

    2016-09-01

    The study of the relationship between temporomandibular joints (TMJ), mastication and ventilation and the involvement of these two functions in the genesis of primary Temporomandibular Disorders (TMD) and in some dentofacial deformities, was initiated in France, more than 30years, by Professor Raymond Gola. Once criticized the weakness of the scientific literature in this domain, the originality of the TMJ within the masticatory system is recalled with its huge adaptation potential to very different biomechanical constraints according to the age and masticatory activities during the day. But the biomechanics of the masticatory system does not stop at night and the positions of the mandible and head during sleep should be studied carefully. In case of nocturnal mouth breathing with open mouth, the predominant sleeping position (generating small but long-term strengths) may be deleterious to the condyle-disc complex, to the surrounding muscles and the occlusal relationships. Some condyle-disc displacements and asymmetric malocclusions occur in this long portion of life what sleep, especially as oral breathing leads to a lot of dysfunctions (low position of the tongue, labio-lingual dysfunctions, exacerbation of bruxism sleep…). The aim of this work was to share our multidisciplinary experience of the biomechanical consequences of the nocturnal mouth breathing on the face involving orthodontists, maxillofacial surgeons, ENT, allergists, speech therapists, physiotherapists and radiologists. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  19. Hemodinâmica de diferentes frações inspiradas de oxigênio em cães submetidos à infusão contínua de propofol sob ventilação espontânea Hemodyinamic effects of several inspired oxygen fractions in spontaneously breathing dogs submitted to continuous infusion of propofol

    Directory of Open Access Journals (Sweden)

    Newton Nunes

    2008-06-01

    Full Text Available Avaliaram-se os efeitos do fornecimento de diferentes frações inspiradas de oxigênio (FiO2 sobre os parâmetros hemodinâmicos em cães submetidos à infusão contínua de propofol e mantidos em ventilação espontânea. Foram utilizados oito cães, os quais foram empregados em cinco grupos com diferentes FiO2, G100 (FiO2 = 1, G80 (FiO2 = 0,8, G60 (FiO2 = 0,6, G40 (FiO2 = 0,4 e G20 (FiO2 = 0,21, respeitando-se um intervalo de dez dias entre cada procedimento anestésico. Os animais foram induzidos e mantidos sob anestesia com propofol na dose de 0,7mg kg-1 min-1 e, após a intubação orotraqueal, iniciou-se o fornecimento de oxigênio conforme a FiO2 determinada para cada grupo. As primeiras mensurações, da freqüência cardíaca (FC, das pressões arteriais sistólica, diastólica e média (PAS, PAD e PAM, da resistência vascular periférica e pulmonar (RPT e RPV, do débito cardíaco (DC; da pressão venosa central (PVC, da pressão média da artéria pulmonar (PMAP, da pressão média capilar pulmonar (PMCP, da pressão parcial de oxigênio (PaO2 e do dióxido de carbono (PaCO2 no sangue arterial, foram efetuadas 30 minutos após o início da infusão do anestésico (M0, seguidas de intervalos de 15 minutos (M15, M30, M45 e M60. Os dados numéricos obtidos foram submetidos à Análise de Variância, seguida pelo teste Tukey (PThe effects of several inspired oxygen fractions (FiO2 in hemodynamics parameters in spontaneously breathing dogs submitted to continuous infusion of propofol were evaluated. Eight adult mongrel dogs were studied and the animals underwent five anesthesias. In each procedure the patient was submitted to a different FiO2, thereby resulting in five groups, namely: G100 (FiO2 = 1, G80 (FiO2 = 0.8, G60 (FiO2 =0.6, G40 (FiO2 = 0.4, and G20 (FiO2 = 0.21. The dose of propofol was sufficient to abolish protector reflex and ensure endotracheal intubation, followed by immediate continuous infusion of that drug (0.7mg kg-1

  20. Device-guided breathing exercises for the treatment of hypertension : An overview

    NARCIS (Netherlands)

    van Hateren, Kornelis JJ; Landman, Gijs Wd; Logtenberg, Susan Jj; Bilo, Henk Jg; Kleefstra, Nanne

    2014-01-01

    The American Heart Association considers device-guided breathing as a reasonable treatment modality in their statement on non-pharmacological options for lowering blood pressure. This review discusses all randomized controlled trials that have investigated the effects of device-guided breathing on

  1. Data interpretation in breath biomarker research: pitfalls and directions.

    Science.gov (United States)

    Miekisch, Wolfram; Herbig, Jens; Schubert, Jochen K

    2012-09-01

    Most--if not all--potential diagnostic applications in breath research involve different marker concentrations rather than unique breath markers which only occur in the diseased state. Hence, data interpretation is a crucial step in breath analysis. To avoid artificial significance in breath testing every effort should be made to implement method validation, data cross-testing and statistical validation along this process. The most common data analysis related problems can be classified into three groups: confounding variables (CVs), which have a real correlation with both the diseased state and a breath marker but lead to the erroneous conclusion that disease and breath are in a causal relationship; voodoo correlations (VCs), which can be understood as statistically true correlations that arise coincidentally in the vast number of measured variables; and statistical misconceptions in the study design (SMSD). CV: Typical confounding variables are environmental and medical history, host factors such as gender, age, weight, etc and parameters that could affect the quality of breath data such as subject breathing mode, effects of breath sampling and effects of the analytical technique itself. VC: The number of measured variables quickly overwhelms the number of samples that can feasibly be taken. As a consequence, the chances of finding coincidental 'voodoo' correlations grow proportionally. VCs can typically be expected in the following scenarios: insufficient number of patients, (too) many measurement variables, the use of advanced statistical data mining methods, and non-independent data for validation. SMSD: Non-prospective, non-blinded and non-randomized trials, a priori biased study populations or group selection with unrealistically high disease prevalence typically represent misconception of study design. In this paper important data interpretation issues are discussed, common pitfalls are addressed and directions for sound data processing and interpretation

  2. SU-E-T-326: The Oxygen Saturation (SO2) and Breath-Holding Time Variation Applied Active Breathing Control (ABC)

    Energy Technology Data Exchange (ETDEWEB)

    Gong, G; Yin, Y [Shandong Cancer Hospital, Jinan, Shandong (China)

    2014-06-01

    Purpose: To study the oxygen saturation (SO2) and breath-holding time variation applied active breathing control (ABC) in radiotherapy of tumor. Methods: 24 volunteers were involved in our trials, and they all did breath-holding motion assisted by ELEKTA Active Breathing Coordinator 2.0 for 10 times respectively. And the patient monitor was used to observe the oxygen saturation (SO2) variation. The variation of SO2, and length of breath-holding time and the time for recovering to the initial value of SO2 were recorded and analyzed. Results: (1) The volunteers were divided into two groups according to the SO2 variation in breath-holding: A group, 14 cases whose SO2 reduction were more than 2% (initial value was 97% to 99%, while termination value was 91% to 96%); B group, 10 cases were less than 2% in breath-holding without inhaling oxygen. (2) The interfraction breath holding time varied from 8 to 20s for A group compared to the first breath-holding time, and for B group varied from 4 to 14s. (3) The breathing holding time of B group prolonged mean 8s, compared to A group. (4) The time for restoring to the initial value of SO2 was from 10s to 30s. And the breath-holding time shortened obviously for patients whose SO2 did not recover to normal. Conclusion: It is very obvious that the SO2 reduction in breath-holding associated with ABC for partial people. It is necessary to check the SO2 variation in breath training, and enough time should be given to recover SO2.

  3. A randomized controlled clinical trial comparing small buccal dehiscence defects around dental implants treated with guided bone regeneration or left for spontaneous healing.

    Science.gov (United States)

    Jung, Ronald E; Herzog, Milan; Wolleb, Karin; Ramel, Christian F; Thoma, Daniel S; Hämmerle, Christoph H F

    2017-03-01

    The aim of the present randomized controlled clinical study was to test whether small bony dehiscence defects (≤5 mm) left to heal spontaneously result in the same clinical and radiological outcome as defects treated with guided bone regeneration (GBR). Twenty-two patients who received at least one implant with a small bony dehiscence defect were enrolled in the study. If the defect height was ≤5 mm, the site was randomly assigned to either the spontaneous healing (SH) group or the GBR group. In the SH group, the defect was left without any treatment. In the GBR group, the defects around the implants were grafted with deproteinized bovine bone mineral (DBBM) and covered with a native collagen membrane. Clinical and radiographic measurements were performed 6 months after implant placement with a reentry surgery and at the time of crown insertion and the subsequent follow-up appointments at 3, 6, 12 and 18 months after loading. For statistical analyses, the mixed linear model was applied for the clinical and radiographic measurements observed around the implants. Simple comparisons of the location of the measurements in the two independent groups are performed with the Mann-Whitney U-test. In addition, the mixed model assumptions were checked. The implant and crown survival rate 18 months after loading was 100%, revealing no serious biologic or prosthetic complication. The mean changes of the buccal vertical bone height between implant placement and reentry surgery after 6 months revealed a small bone loss of -0.17 ± 1.79 mm (minimum -4 mm and maximum 2.5 mm) for the SH group and a bone gain of 1.79 ± 2.24 mm (minimum of -2.5 mm and maximum of 5 mm) for the GBR group, respectively (P = 0.017). Radiographic measurements demonstrated a slight bone loss of -0.39 ± 0.49 mm for the SH group and a stable bone level of 0.02 ± 0.48 mm for GBR group after 18 months. All peri-implant soft tissue parameters revealed healthy tissues with no

  4. Night-time sedating H1-antihistamine increases daytime somnolence but not treatment efficacy in chronic spontaneous urticaria: a randomized controlled trial

    Science.gov (United States)

    Staevska, M; Gugutkova, M; Lazarova, C; Kralimarkova, T; Dimitrov, V; Zuberbier, T; Church, MK; Popov, TA

    2014-01-01

    Background Many physicians believe that the most effective way to treat chronic urticaria is to take a nonsedating second-generation H1-antihistamine in the morning and a sedating first-generation H1-antihistamine, usually hydroxyzine, at night to enhance sleep. But is this belief well founded? Objectives To test this belief by comparing the effectiveness and prevalence of unwanted sedative effects when treating patients with chronic spontaneous urticaria (CSU) with levocetirizine 15 mg daily plus hydroxyzine 50 mg at night (levocetirizine plus hydroxyzine) vs. levocetirizine 20 mg daily (levocetirizine monotherapy). Methods In this randomized, double-blind, cross-over study, 24 patients with difficult-to-treat CSU took levocetirizine plus hydroxyzine or levocetirizine monotherapy for periods of 5 days each. At the end of each treatment period, assessments were made of quality of life (Chronic Urticaria Quality of Life Questionnaire, CU-Q2oL), severity of urticaria symptoms (Urticaria Activity Score, UAS), sleep disturbance during the night and daytime somnolence. Results Both treatments significantly decreased UAS, night-time sleep disturbances and CU-Q2oL scores (P urticaria guidelines, which state that first-line treatment for urticaria should be new-generation, nonsedating H1-antihistamines only. PMID:24472058

  5. 42 CFR 84.81 - Compressed breathing gas and liquefied breathing gas containers; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Compressed breathing gas and liquefied breathing... APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Self-Contained Breathing Apparatus § 84.81 Compressed breathing gas and liquefied breathing gas containers; minimum requirements. (a) Compressed breathing gas and...

  6. Long-term cardiovascular mortality after procedure-related or spontaneous myocardial infarction in patients with non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II, ICTUS, and RITA-3 trials (FIR).

    Science.gov (United States)

    Damman, Peter; Wallentin, Lars; Fox, Keith A A; Windhausen, Fons; Hirsch, Alexander; Clayton, Tim; Pocock, Stuart J; Lagerqvist, Bo; Tijssen, Jan G P; de Winter, Robbert J

    2012-01-31

    The present study was designed to investigate the long-term prognostic impact of procedure-related and spontaneous myocardial infarction (MI) on cardiovascular mortality in patients with non-ST-elevation acute coronary syndrome. Five-year follow-up after procedure-related or spontaneous MI was investigated in the individual patient pooled data set of the FRISC-II (Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Randomized Intervention Trial of Unstable Angina 3) non-ST-elevation acute coronary syndrome trials. The principal outcome was cardiovascular death up to 5 years of follow-up. Cumulative event rates were estimated by the Kaplan-Meier method; hazard ratios were calculated with time-dependent Cox proportional hazards models. Adjustments were made for the variables associated with long-term outcomes. Among the 5467 patients, 212 experienced a procedure-related MI within 6 months after enrollment. A spontaneous MI occurred in 236 patients within 6 months. The cumulative cardiovascular death rate was 5.2% in patients who had a procedure-related MI, comparable to that for patients without a procedure-related MI (hazard ratio 0.66; 95% confidence interval, 0.36-1.20, P=0.17). In patients who had a spontaneous MI within 6 months, the cumulative cardiovascular death rate was 22.2%, higher than for patients without a spontaneous MI (hazard ratio 4.52; 95% confidence interval, 3.37-6.06, P<0.001). These hazard ratios did not change materially after risk adjustments. Five-year follow-up of patients with non-ST-elevation acute coronary syndrome from the 3 trials showed no association between a procedure-related MI and long-term cardiovascular mortality. In contrast, there was a substantial increase in long-term mortality after a spontaneous MI.

  7. FMWC Radar for Breath Detection

    DEFF Research Database (Denmark)

    Suhr, Lau Frejstrup; Tafur Monroy, Idelfonso; Vegas Olmos, Juan José

    breathing through walls. Other remote breath tracking systems has been presented that are based on the Ultra-wideband radar technique. However, these systems have two drawbacks. Firstly, they penetrate walls. It is therefore harder to contain the emitted radiation and they could be used for unsolicited...

  8. Patient's breath controls comfort devices

    Science.gov (United States)

    Schrader, M.; Carpenter, B.; Nichols, C. D.

    1972-01-01

    Patient assist system for totally disabled persons was developed which permits a person, so paralyzed as to be unable to move, to activate by breathing, a call system to summon assistance, turn the page of a book, ajust his bed, or do any one of a number of other things. System consists of patient assist control and breath actuated switch.

  9. Investigation into breath meditation: Phenomenological ...

    African Journals Online (AJOL)

    This integral heuristic phenomenological investigation records participants' experiences of a single session of breath meditation with special reference to psychotherapy and sport psychology. There were 8 participants, 4 men and 4 women, with mean age of 45 years and age range from 31 to 62 years. Various breathing ...

  10. Cutaneous stimulation and generation of breathing in the fetus.

    Science.gov (United States)

    Scarpelli, E M; Condorelli, S; Cosmi, E V

    1977-01-01

    The generation of spontaneous regular breathing by cutaneous stimulation and by direct electrical stimulation of the sciatic nerve was examined in six previously apneic mature fetal lambs in utero. The fetuses were stable throughout the course of the experiments: PaO2 less than or equal to 27 mm Hg, PaCO2 less than 44 mm Hg, pH 7.29-7.34, blood pressure and heart rate steady and normal. It is shown that electrical stimulation of the fetal skin (66 cps, 4.0 msec, 6 V, 0.77 ma) can be as effective as direct stimulation of the sciatic nerve (66 cps, 4.0 msec, 1.5 V, 0.08 ma) when the higher voltage and current are used. Mechanical cutaneous stimulation also produced spontaneous breathing which, however, was short lived compared with that produced by electrical stimuli. The results are consonant with our concept of activation and recruitment of quiescent respiratory center neurones by somatic sensory stimulation, and they give fundamental support to the clinical observation of others that cutaneous stimulation is effective for the treatment of apnea of prematurity. Speculation Somatic sensory stimuli from the skin may be important determinants of the onset of breathing in the fetus and newborn.

  11. Quantifying stroke coordination during the breathing action in front-crawl swimming using an instantaneous net drag force profile.

    Science.gov (United States)

    Formosa, Danielle P; Sayers, Mark G L; Burkett, Brendan

    2014-01-01

    This study used both an instantaneous net drag force profile and a symmetry timing to evaluate the effect of the breathing action on stroke coordination. Twenty elite swimmers completed a total of six randomised front-crawl towing trials: (i) three breathing trials and (ii) three non-breathing trials. The net drag force was measured using an assisted towing device mounted upon a Kistler force platform, and this equipment towed the swimmer at a constant speed. The net drag force profile was used to create a stroke symmetry index for each swimming trial. Analysis using the symmetry indices identified that the majority of participants demonstrated an asymmetrical instantaneous net drag force stroke profile in both the breathing and non-breathing conditions, despite no significant differences in the time from finger-tip entry to finger-tip exit. Within the breathing condition, the faster swimmers compared to the slower swimmers demonstrated a lesser percentage of overlap between stroke phases on their breathing stroke side. During the non-breathing condition, the faster participants compared to the slower swimmers recorded a reduction in the percentage of overlap between stroke phases and less duration in the underwater stroke on their breathing stroke side. This study identified that the majority of participants demonstrated an asymmetrical net drag force profile within both conditions; however, asymmetry was less prevalent when examining with only the timing symmetry index.

  12. Breath of hospitality.

    Science.gov (United States)

    Škof, Lenart

    2016-12-01

    In this paper we outline the possibilities of an ethic of care based on our self-affection and subjectivity in the ethical spaces between-two. In this we first refer to three Irigarayan concepts - breath, silence and listening from the third phase of her philosophy, and discuss them within the methodological framework of an ethics of intersubjectivity and interiority. Together with attentiveness, we analyse them as four categories of our ethical becoming. Furthermore, we argue that self-affection is based on our inchoate receptivity for the needs of the other(s) and is thus dialectical in its character. In this we critically confront some epistemological views of our ethical becoming. We wind up this paper with a proposal for an ethics towards two autonomous subjects, based on care and our shared ethical becoming - both as signs of our deepest hospitality towards the other.

  13. Periodic breathing in healthy humans at exercise in hypoxia.

    Science.gov (United States)

    Hermand, Eric; Pichon, Aurélien; Lhuissier, François J; Richalet, Jean-Paul

    2015-01-01

    Periodic breathing is frequent in heart failure or ventilatory disorders during sleep, and common during sleep at high altitude, but has been rarely studied in wakefulness and during exercise. A retrospective analysis of ventilation from hypoxia exercise tests was realized in 82 healthy subjects separated into two groups with either high or low ventilatory response to hypoxia at exercise (HVRe). A fast Fourier transform spectral analysis of the breath-by-breath ventilation (V̇e) signal, O2 saturation, and end-tidal PCO2 evidenced a periodic pattern with a period of 11.1 to 12.0 s. The peak power of the V̇e spectrum was higher in the high HVRe group (P hypoxia (0 to 4,000 m altitude). The period of V̇e was shorter at exercise (vs. rest, P hypoxia (vs. normoxia, P hypoxia (P hypoxia was positively related with the ventilatory response to CO2 (HCVR). This novel observation suggests that healthy subjects demonstrate a spontaneous periodic breathing, not clearly observable at rest and in normoxia, but triggered by hypoxic exercise. The periodic pattern is enhanced in subjects with high HVRe and high HCVR, suggesting that oxygen and CO2 play synergistic roles in the modulation of these oscillations. Copyright © 2015 the American Physiological Society.

  14. Spontaneous uterine rupture

    African Journals Online (AJOL)

    ABSTRACT. Rupture of a gravid uterus is a surgical emergency. Predisposing factors include a scarred uterus. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. We hereby present the case of a spontaneous complete uterine rupture at a gestational age of 34 weeks in a 35 year old patient ...

  15. Spontaneous intracranial hypotension.

    LENUS (Irish Health Repository)

    Fullam, L

    2012-01-31

    INTRODUCTION: Spontaneous\\/primary intracranial hypotension is characterised by orthostatic headache and is associated with characteristic magnetic resonance imaging findings. CASE REPORT: We present a case report of a patient with typical symptoms and classical radiological images. DISCUSSION: Spontaneous intracranial hypotension is an under-recognised cause of headache and can be diagnosed by history of typical orthostatic headache and findings on MRI brain.

  16. Comparative effects of TV watching, recreational computer use, and sedentary video game play on spontaneous energy intake in male children. A randomised crossover trial.

    Science.gov (United States)

    Marsh, Samantha; Ni Mhurchu, Cliona; Jiang, Yannan; Maddison, Ralph

    2014-06-01

    To compare the effects of three screen-based sedentary behaviours on acute energy intake (EI) in children. Normal-weight males aged 9-13 years participated in a randomised crossover trial conducted in a laboratory setting between November 2012 and February 2013 in Auckland, New Zealand. EI during an ad libitum meal was compared for three 1-hour conditions: (1) television (TV) watching, (2) sedentary video game (VG) play, and (3) recreational computer use. The primary endpoint was total EI from food and drink. Mixed regression models were used to evaluate the treatment conditions adjusting for age, BMI, and appetite at baseline. A total of 20 participants were randomised and all completed the three conditions. Total EI from food and drink in the TV, computer, and VG conditions was estimated at 820 (SE 73.15), 685 (SE 73.33), and 696 (SE 73.16) kcal, respectively, with EI being significantly greater in the TV versus computer condition (+135; P = 0.04), a trend towards greater intake in the TV versus VG condition (+124; P = 0.06), but not significantly different between the computer and VG conditions (-10; P = 0.87). TV watching was associated with greater EI compared with computer use, and a trend towards greater EI compared with VG play. Copyright © 2014. Published by Elsevier Ltd.

  17. Diverse presentation of breath holding spells: two case reports with literature review.

    Science.gov (United States)

    Rathore, Geetanjali; Larsen, Paul; Fernandez, Cristina; Parakh, Manish

    2013-01-01

    Breath holding spells are a common and dramatic form of syncope and anoxic seizure in infancy. They are usually triggered by an emotional stimuli or minor trauma. Based on the color change, they are classified into 3 types, cyanotic, pallid, and mixed. Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breathholding spells are of more complex pathogenesis which is not completely understood. A detailed and accurate history is the mainstay of diagnosis. An EKG should be strongly considered to rule out long QT syndrome. Spontaneous resolution of breath-holding spells is usually seen, without any adverse developmental and intellectual sequelae. Rare cases of status epilepticus, prolonged asystole, and sudden death have been reported. Reassurance and education is the mainstay of therapy. Occasionally, pharmacologic intervention with iron, piracetam; atropine may be of benefit. Here we present 2 cases, one of each, pallid and cyanotic breath holding spells.

  18. Diverse Presentation of Breath Holding Spells: Two Case Reports with Literature Review

    Directory of Open Access Journals (Sweden)

    Geetanjali Rathore

    2013-01-01

    Full Text Available Breath holding spells are a common and dramatic form of syncope and anoxic seizure in infancy. They are usually triggered by an emotional stimuli or minor trauma. Based on the color change, they are classified into 3 types, cyanotic, pallid, and mixed. Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breathholding spells are of more complex pathogenesis which is not completely understood. A detailed and accurate history is the mainstay of diagnosis. An EKG should be strongly considered to rule out long QT syndrome. Spontaneous resolution of breath-holding spells is usually seen, without any adverse developmental and intellectual sequelae. Rare cases of status epilepticus, prolonged asystole, and sudden death have been reported. Reassurance and education is the mainstay of therapy. Occasionally, pharmacologic intervention with iron, piracetam; atropine may be of benefit. Here we present 2 cases, one of each, pallid and cyanotic breath holding spells.

  19. Diverse Presentation of Breath Holding Spells: Two Case Reports with Literature Review

    Science.gov (United States)

    Rathore, Geetanjali; Larsen, Paul; Fernandez, Cristina; Parakh, Manish

    2013-01-01

    Breath holding spells are a common and dramatic form of syncope and anoxic seizure in infancy. They are usually triggered by an emotional stimuli or minor trauma. Based on the color change, they are classified into 3 types, cyanotic, pallid, and mixed. Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breathholding spells are of more complex pathogenesis which is not completely understood. A detailed and accurate history is the mainstay of diagnosis. An EKG should be strongly considered to rule out long QT syndrome. Spontaneous resolution of breath-holding spells is usually seen, without any adverse developmental and intellectual sequelae. Rare cases of status epilepticus, prolonged asystole, and sudden death have been reported. Reassurance and education is the mainstay of therapy. Occasionally, pharmacologic intervention with iron, piracetam; atropine may be of benefit. Here we present 2 cases, one of each, pallid and cyanotic breath holding spells. PMID:24191206

  20. A randomized, double-blinded crossover trial testing the benefit of two hydrolysed poultry-based commercial diets for dogs with spontaneous pruritic chicken allergy.

    Science.gov (United States)

    Bizikova, Petra; Olivry, Thierry

    2016-08-01

    Hydrolysed protein diets are used to diagnose and treat dogs with cutaneous adverse food reactions (CAFR). Little is known about what proportion of dogs hypersensitive to the native protein would react to its hydrolysed form. To determine the clinical allergenicity of hydrolysed poultry feather (RCU) and chicken liver diets (HZD) in dogs with chicken induced CAFR. In this randomized, double-blinded, crossover trial, ten dogs with chicken induced CAFR were selected after a positive oral challenge to chicken meat and a negative one to corn. Test diets were fed for 14 days separated by a 14 day wash-out period. Owners rated pruritus daily with a Visual Analog Scale (PVAS). The challenge was ended if a flare in pruritus occurred (i.e. PVAS ≥5/10). The median PVAS scores before feeding RCU and HZD were 0.9 and 1.7, respectively (Wilcoxon signed rank test, P = 0.46). Pruritus scores increased significantly after feeding HZD (Friedman's test, P dogs fed RCU, but four dogs fed HZD (40%), were withdrawn after a flare in pruritus developed (Fisher's test, P = 0.04). The maximal PVAS score was significantly higher after HZD (median: 4.7) compared to RCU (2.5) (Wilcoxon signed rank test, P = 0.01). One dog in each group was withdrawn due to diarrhoea. The hydrolysed poultry feather diet did not induce pruritus flares in dogs allergic to chicken in contrast to the hydrolysed chicken liver diet that led to pruritus flares in 40% of these dogs. © 2016 ESVD and ACVD.

  1. Nonrigid registration method to assess reproducibility of breath-holding with ABC in lung cancer

    International Nuclear Information System (INIS)

    Sarrut, David; Boldea, Vlad; Ayadi, Myriam; Badel, Jean-Noel; Ginestet, Chantal; Clippe, Sebastien; Carrie, Christian

    2005-01-01

    Purpose: To study the interfraction reproducibility of breath-holding using active breath control (ABC), and to develop computerized tools to evaluate three-dimensional (3D) intrathoracic motion in each patient. Methods and materials: Since June 2002, 11 patients with non-small-cell lung cancer enrolled in a Phase II trial have undergone four CT scans: one during free-breathing (reference) and three using ABC. Patients left the room between breath-hold scans. The patient's breath was held at the same predefined phase of the breathing cycle (about 70% of the vital capacity) using the ABC device, then patients received 3D-conformal radiotherapy. Automated computerized tools for breath-hold CT scans were developed to analyze lung and tumor interfraction residual motions with 3D nonrigid registration. Results: All patients but one were safely treated with ABC for 7 weeks. For 6 patients, the lung volume differences were 300 cm 3 and displacements >10 mm, probably owing to atelectasia and emphysema. One patient was excluded, and two others had incomplete data sets. Conclusion: Breath-holding with ABC was effective in 6 patients, and discrepancies were clinically accountable in 2. The proposed 3D nonrigid registration method allows for personalized evaluation of breath-holding reproducibility with ABC. It will be used to adapt the patient-specific internal margins

  2. Practice It: Deep Conscious Breathing Exercise

    Science.gov (United States)

    No time to sit and breathe? No problem; take your breathing practice with you! Deep conscious breathing can also be done with the eyes open wherever you happen to be—simply pause and take two to three full deep breaths (inhale deeply and exhale completely).

  3. Thromboembolic events with recombinant activated factor VII in spontaneous intracerebral hemorrhage: results from the Factor Seven for Acute Hemorrhagic Stroke (FAST) trial.

    Science.gov (United States)

    Diringer, Michael N; Skolnick, Brett E; Mayer, Stephan A; Steiner, Thorsten; Davis, Stephen M; Brun, Nikolai C; Broderick, Joseph P

    2010-01-01

    Patients with intracerebral hemorrhage have a high risk of thromboembolic events (TEs) due to advanced age, hypertension, atherosclerosis, diabetes, and immobility. Use of recombinant activated factor VII (rFVIIa) could increase TEs in high-risk patients. Factor Seven for Acute Hemorrhagic Stroke (FAST) trial data were reviewed to define the frequency of and risk factors for TE with rFVIIa. Eight hundred forty-one patients presenting hemorrhage were randomized to 20 or 80 microg/kg of rFVIIa or placebo. Those with Glasgow Coma Scale score surgery, coagulopathy, or recent TE were excluded. Myocardial, cerebral, or venous TEs were subject to detailed reporting and expedited local review. Additionally, a blinded Data Monitoring Committee reviewed all electrocardiograms, centrally analyzed troponin I values, and CT scans. There were 178 arterial and 47 venous TEs. Venous events were similar across groups. There were 49 (27%) arterial events in the placebo group, 47 (26%) in the 20-microg/kg group, and 82 (46%) in the 80 microg/kg group (P=0.04). Of the myocardial events, 38 were investigator-reported and 103 identified by the Data Monitoring Committee. They occurred in 17 (6.3%) placebo and 57 (9.9%) rFVIIa patients (P=0.09). Arterial TEs were associated with: receiving 80 microg/kg rFVIIa (OR=2.14; P=0.031), signs of cardiac or cerebral ischemia at presentation (OR=4.19; P=0.010), age (OR=1.14/5 years; P=0.0123), and prior use of antiplatelet agents (OR=1.83; P=0.035). Ischemic strokes possibly related to study drug occurred in 7, 5, and 8 patients in the placebo, 20 microg/kg, and 80-microg/kg groups, respectively. Higher doses of rFVIIa in a high-risk population are associated with a small increased risk of what are usually minor cardiac events. Demonstration of the ability of rFVIIa to improve outcome in future studies should be driven by its effectiveness in slowing bleeding outweighting the risk of a small increase in arterial TEs.

  4. Sensors for breath testing: from nanomaterials to comprehensive disease detection.

    Science.gov (United States)

    Konvalina, Gady; Haick, Hossam

    2014-01-21

    The analysis of volatile organic compounds in exhaled breath samples represents a new frontier in medical diagnostics because it is a noninvasive and potentially inexpensive way to detect illnesses. Clinical trials with spectrometry and spectroscopy techniques, the standard volatile-compound detection methods, have shown the potential for diagnosing illnesses including cancer, multiple sclerosis, Parkinson's disease, tuberculosis, diabetes, and more via breath tests. Unfortunately, this approach requires expensive equipment and high levels of expertise to operate the necessary instruments, and the tests must be done quickly and use preconcentration techniques, all of which impede its adoption. Sensing matrices based on nanomaterials are likely to become a clinical and laboratory diagnostic tool because they are significantly smaller, easier-to-use, and less expensive than spectrometry or spectroscopy. An ideal nanomaterial-based sensor for breath testing should be sensitive at very low concentrations of volatile organic compounds, even in the presence of environmental or physiological confounding factors. It should also respond rapidly and proportionately to small changes in concentration and provide a consistent output that is specific to a given volatile organic compound. When not in contact with the volatile organic compounds, the sensor should quickly return to its baseline state or be simple and inexpensive enough to be disposable. Several reviews have focused on the methodological, biochemical, and clinical aspects of breath analysis in attempts to bring breath testing closer to practice for comprehensive disease detection. This Account pays particular attention to the technological gaps and confounding factors that impede nanomaterial-sensor-based breath testing, in the hope of directing future research and development efforts towards the best possible approaches to overcome these obstacles. We discuss breath testing as a complex process involving numerous

  5. Visualizing Breath using Digital Holography

    Science.gov (United States)

    Hobson, P. R.; Reid, I. D.; Wilton, J. B.

    2013-02-01

    Artist Jayne Wilton and physicists Peter Hobson and Ivan Reid of Brunel University are collaborating at Brunel University on a project which aims to use a range of techniques to make visible the normally invisible dynamics of the breath and the verbal and non-verbal communication it facilitates. The breath is a source of a wide range of chemical, auditory and physical exchanges with the direct environment. Digital Holography is being investigated to enable a visually stimulating articulation of the physical trajectory of the breath as it leaves the mouth. Initial findings of this research are presented. Real time digital hologram replay allows the audience to move through holographs of breath-born particles.

  6. Blue breath holding is benign.

    OpenAIRE

    Stephenson, J B

    1991-01-01

    In their recent publication in this journal, Southall et al described typical cyanotic breath holding spells, both in otherwise healthy children and in those with brainstem lesions and other malformations. Their suggestions regarding possible autonomic disturbances may require further study, but they have adduced no scientific evidence to contradict the accepted view that in the intact child blue breath holding spells are benign. Those families in which an infant suffers an 'apparently life t...

  7. Imposed Work of Breathing for Flow Meters with In-Line versus Flow-Through Technique during Simulated Neonatal Breathing.

    Directory of Open Access Journals (Sweden)

    Snorri Donaldsson

    Full Text Available The ability to determine airflow during nasal CPAP (NCPAP treatment without adding dead space or resistance would be useful when investigating the physiologic effects of different NCPAP systems on breathing. The aim of this study was to investigate the effect on pressure stability of different flow measuring devices at the in-line and flow-through position, using simulated neonatal breathing.Six different flow measure devices were evaluated by recording pressure changes and imposed work of breathing for breaths with 16 and 32 ml tidal volumes. The tests were performed initially with the devices in an in line position and with 5 and 10 L/min using flow through technique, without CPAP. The flow meters were then subsequently tested with an Infant Flow CPAP system at 3, 5 and 8 cm H2O pressure using flow through technique. The quality of the recorded signals was compared graphically.The resistance of the measuring devices generated pressure swings and imposed work of breathing. With bias flow, the resistance also generated CPAP pressure. Three of the devices had low resistance and generated no changes in pressure stability or CPAP pressure. The two devices intended for neonatal use had the highest measured resistance.The importance of pressure stability and increased work of breathing during non-invasive respiratory support are insufficiently studied. Clinical trials using flow-through technique have not focused on pressure stability. Our results indicate that a flow-through technique might be a way forward in obtaining a sufficiently high signal quality without the added effects of rebreathing and increased work of breathing. The results should stimulate further research and the development of equipment for dynamic flow measurements in neonates.

  8. Enhanced non-eupneic breathing following hypoxic, hypercapnic or hypoxic-hypercapnic gas challenges in conscious mice.

    Science.gov (United States)

    Getsy, Paulina M; Davis, Jesse; Coffee, Gregory A; May, Walter J; Palmer, Lisa A; Strohl, Kingman P; Lewis, Stephen J

    2014-12-01

    C57BL6 mice display non-eupneic breathing and spontaneous apneas during wakefulness and sleep as well as markedly disordered breathing following cessation of a hypoxic challenge. We examined whether (1) C57BL6 mice display marked non-eupneic breathing following hypercapnic or hypoxic-hypercapnic challenges, and (2) compared the post-hypoxia changes in non-eupneic breathing of C57BL6 mice to those of B6AF1 (57BL6 dam × A/J sire) and Swiss-Webster mice, which display different ventilatory responses than C57BL6 mice. C57BL6 mice displayed marked increases in respiratory frequency and non-eupneic breathing upon return to room-air after hypoxic (10% O2, 90% N2), hypercapnic (5% CO2, 21% O2 and 74% N2) and hypoxic-hypercapnic (10% O2, 5% CO2 and 85% N2) challenges. B6AF1 mice displayed less tachypnea and reduced non-eupneic breathing post-hypoxia, whereas Swiss-Webster mice displayed robust tachypnea with minimal increases in non-eupneic breathing post-hypoxia. These studies demonstrate that non-eupneic breathing increases after physiologically-relevant hypoxic-hypercapnic challenge in C57BL6 mice and suggest that further studies with these and B6AF1 and Swiss-Webster mice will help define the genetics of non-eupneic breathing. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Standardization of exhaled breath condensate (EBC) collection using a feedback regulated breathing pattern

    Science.gov (United States)

    Collection of exhaled breath condensate (EBC) fluid by cooling of expired breath is a potentially valuable approach for the detection of biomarkers associated with disease or exposure to xenobiotics. EBC is generally collected using unregulated breathing patterns, perceived to el...

  10. Vaginal progesterone vs intramuscular 17α-hydroxyprogesterone caproate for prevention of recurrent spontaneous preterm birth in singleton gestations: systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Saccone, G; Khalifeh, A; Elimian, A; Bahrami, E; Chaman-Ara, K; Bahrami, M A; Berghella, V

    2017-03-01

    Randomized controlled trials (RCTs) have recently compared intramuscular 17α-hydroxyprogesterone caproate (17-OHPC) with vaginal progesterone for reducing the risk of spontaneous preterm birth (SPTB) in singleton gestations with prior SPTB. The aim of this systematic review and meta-analysis was to evaluate the efficacy of vaginal progesterone compared with 17-OHPC in prevention of SPTB in singleton gestations with prior SPTB. Searches of electronic databases were performed to identify all RCTs of asymptomatic singleton gestations with prior SPTB that were randomized to prophylactic treatment with either vaginal progesterone (intervention group) or intramuscular 17-OHPC (comparison group). No restrictions for language or geographic location were applied. The primary outcome was SPTB EMBARAZOS CON FETO ÚNICO: REVISIÓN SISTEMÁTICA Y METAANÁLISIS DE ENSAYOS CONTROLADOS ALEATORIOS: RESUMEN OBJETIVO: Recientemente se han realizado varios ensayos controlados aleatorios (ECA) que comparaban el caproato de 17α-hidroxiprogesterona (17-OHPC, por sus siglas en inglés) por vía intramuscular con la progesterona por vía vaginal para la reducción del riesgo de parto pretérmino espontáneo (PPTE) en embarazos con feto único de gestantes con historial de PPTE. El objetivo de esta revisión sistemática y metaanálisis fue evaluar la eficacia de la progesterona vaginal en comparación con la 17-OHPC en la prevención de embarazos con feto único de gestantes con historial de PPTE. MÉTODOS: Se realizaron búsquedas en bases de datos electrónicas para identificar todos los ECA con embarazos de feto único asintomáticos con historial de PPTE antes de ser asignados al azar a un tratamiento profiláctico, ya fuera con progesterona vaginal (grupo de intervención) o con 17-OHPC intramuscular (grupo de control). No se aplicaron restricciones respecto al idioma o la ubicación geográfica. El resultado primario fue PPTE embarazos de feto único e historial de PPTE. Sin

  11. Active cycle of breathing technique for cystic fibrosis.

    Science.gov (United States)

    Mckoy, Naomi A; Wilson, Lisa M; Saldanha, Ian J; Odelola, Olaide A; Robinson, Karen A

    2016-07-05

    People with cystic fibrosis experience chronic airway infections as a result of mucus build up within the lungs. Repeated infections often cause lung damage and disease. Airway clearance therapies aim to improve mucus clearance, increase sputum production, and improve airway function. The active cycle of breathing technique (also known as ACBT) is an airway clearance method that uses a cycle of techniques to loosen airway secretions including breathing control, thoracic expansion exercises, and the forced expiration technique. This is an update of a previously published review. To compare the clinical effectiveness of the active cycle of breathing technique with other airway clearance therapies in cystic fibrosis. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of last search: 25 April 2016. Randomised or quasi-randomised controlled clinical studies, including cross-over studies, comparing the active cycle of breathing technique with other airway clearance therapies in cystic fibrosis. Two review authors independently screened each article, abstracted data and assessed the risk of bias of each study. Our search identified 62 studies, of which 19 (440 participants) met the inclusion criteria. Five randomised controlled studies (192 participants) were included in the meta-analysis; three were of cross-over design. The 14 remaining studies were cross-over studies with inadequate reports for complete assessment. The study size ranged from seven to 65 participants. The age of the participants ranged from six to 63 years (mean age 22.33 years). In 13 studies, follow up lasted a single day. However, there were two long-term randomised controlled studies with follow up of one to three years. Most of the studies did not report on key quality items, and therefore, have an unclear risk of

  12. Neostigmine Administration after Spontaneous Recovery to a Train-of-Four Ratio of 0.9 to 1.0: A Randomized Controlled Trial of the Effect on Neuromuscular and Clinical Recovery.

    Science.gov (United States)

    Murphy, Glenn S; Szokol, Joseph W; Avram, Michael J; Greenberg, Steven B; Shear, Torin D; Deshur, Mark A; Benson, Jessica; Newmark, Rebecca L; Maher, Colleen E

    2018-01-01

    When a muscle relaxant is administered to facilitate intubation, the benefits of anticholinesterase reversal must be balanced with potential risks. The aim of this double-blinded, randomized noninferiority trial was to evaluate the effect of neostigmine administration on neuromuscular function when given to patients after spontaneous recovery to a train-of-four ratio of 0.9 or greater. A total of 120 patients presenting for surgery requiring intubation were given a small dose of rocuronium. At the conclusion of surgery, 90 patients achieving a train-of-four ratio of 0.9 or greater were randomized to receive either neostigmine 40 μg/kg or saline (control). Train-of-four ratios were measured from the time of reversal until postanesthesia care unit admission. Patients were monitored for postextubation adverse respiratory events and assessed for muscle strength. Ninety patients achieved a train-of-four ratio of 0.9 or greater at the time of reversal. Mean train-of-four ratios in the control and neostigmine groups before reversal (1.02 vs. 1.03), 5 min postreversal (1.05 vs. 1.07), and at postanesthesia care unit admission (1.06 vs. 1.08) did not differ. The mean difference and corresponding 95% CI of the latter were -0.018 and -0.046 to 0.010. The incidences of postoperative hypoxemic events and episodes of airway obstruction were similar for the groups. The number of patients with postoperative signs and symptoms of muscle weakness did not differ between groups (except for double vision: 13 in the control group and 2 in the neostigmine group; P = 0.001). Administration of neostigmine at neuromuscular recovery was not associated with clinical evidence of anticholinesterase-induced muscle weakness. An online visual overview is available for this article.(Figure is included in full-text article.).

  13. Relationship between Musical Characteristics and Temporal Breathing Pattern in Piano Performance.

    Science.gov (United States)

    Sakaguchi, Yutaka; Aiba, Eriko

    2016-01-01

    Although there is growing evidence that breathing is modulated by various motor and cognitive activities, the nature of breathing in musical performance has been little explored. The present study examined the temporal breath pattern in piano performance, aiming to elucidate how breath timing is related to musical organization/events and performance. In the experiments, the respiration of 15 professional and amateur pianists, playing 10 music excerpts in total (from four-octave C major scale, Hanon's exercise, J. S. Bach's Invention, Mozart's Sonatas, and Debussy's Clair de lune), was monitored by capnography. The relationship between breathing and musical characteristics was analyzed. Five major results were obtained. (1) Mean breath interval was shortened for excerpts in faster tempi. (2) Fluctuation of breath intervals was reduced for the pieces for finger exercise and those in faster tempi. Pianists showing large within-trial fluctuation also exhibited large inter-excerpt difference. (3) Inter-trial consistency of the breath patterns depended on the excerpts. Consistency was generally reduced for the excerpts that could be performed mechanically (i.e., pieces for finger exercise), but interestingly, one third of the participant showed consistent patterns for the simple scale, correlated with the ascending/descending sequences. (4) Pianists tended to exhale just after the music onsets, inhale at the rests, and inhibit inhale during the slur parts. There was correlation between breathing pattern and two-voice polyphonic structure for several participants. (5) Respiratory patterns were notably different among the pianists. Every pianist showed his or her own characteristic features commonly for various musical works. These findings suggest that breathing in piano performance depends not only on musical parameters and organization written in the score but also some pianist-dependent factors which might be ingrained to individual pianists.

  14. Relationship between musical characteristics and temporal breathing pattern in piano performance

    Directory of Open Access Journals (Sweden)

    Yutaka Sakaguchi

    2016-07-01

    Full Text Available Although there is growing evidence that breathing is modulated by various motor and cognitive activities, the nature of breathing in musical performance has been little explored. The present study examined the temporal breath pattern in piano performance, aiming to elucidate how breath timing is related to musical organization/events and performance. In the experiments, the respiration of 15 professional and amateur pianists, playing 10 music excerpts in total (from four-octave C major scale, Hanon’s exercise, J. S. Bach’s Invention, Mozart’s Sonatas, and Debussy’s Clair de lune, was monitored by capnography. The relationship between breathing and musical characteristics was analyzed. Five major results were obtained. 1 Mean breath interval was shortened for excerpts in faster tempi. 2 Fluctuation of breath intervals was reduced for the pieces for finger exercise and those in faster tempi. Pianists showing large within-trial fluctuation also exhibited large inter-excerpt difference. 3 Inter-trial consistency of the breath patterns depended on the excerpts. Consistency was generally reduced for the excerpts that could be performed mechanically (i.e., pieces for finger exercise, but interestingly, one third of the participant showed consistent patterns for the simple scale, correlated with the ascending/descending sequences. 4 Pianists tended to exhale just after the music onsets, inhale at the rests, and inhibit inhale during the slur parts. There was correlation between breathing pattern and two-voice polyphonic structure for several participants. 5 Respiratory patterns were notably different among the pianists. Every pianist showed his or her own characteristic features commonly for various musical works. These findings suggest that breathing in piano performance depends not only on musical parameters and organization written in the score but also some pianist-dependent factors which might be ingrained to individual pianists.

  15. Slow Breathing and Hypoxic Challenge: Cardiorespiratory Consequences and Their Central Neural Substrates

    Science.gov (United States)

    Critchley, Hugo D.; Nicotra, Alessia; Chiesa, Patrizia A.; Nagai, Yoko; Gray, Marcus A.; Minati, Ludovico; Bernardi, Luciano

    2015-01-01

    Controlled slow breathing (at 6/min, a rate frequently adopted during yoga practice) can benefit cardiovascular function, including responses to hypoxia. We tested the neural substrates of cardiorespiratory control in humans during volitional controlled breathing and hypoxic challenge using functional magnetic resonance imaging (fMRI). Twenty healthy volunteers were scanned during paced (slow and normal rate) breathing and during spontaneous breathing of normoxic and hypoxic (13% inspired O2) air. Cardiovascular and respiratory measures were acquired concurrently, including beat-to-beat blood pressure from a subset of participants (N = 7). Slow breathing was associated with increased tidal ventilatory volume. Induced hypoxia raised heart rate and suppressed heart rate variability. Within the brain, slow breathing activated dorsal pons, periaqueductal grey matter, cerebellum, hypothalamus, thalamus and lateral and anterior insular cortices. Blocks of hypoxia activated mid pons, bilateral amygdalae, anterior insular and occipitotemporal cortices. Interaction between slow breathing and hypoxia was expressed in ventral striatal and frontal polar activity. Across conditions, within brainstem, dorsal medullary and pontine activity correlated with tidal volume and inversely with heart rate. Activity in rostroventral medulla correlated with beat-to-beat blood pressure and heart rate variability. Widespread insula and striatal activity tracked decreases in heart rate, while subregions of insular cortex correlated with momentary increases in tidal volume. Our findings define slow breathing effects on central and cardiovascular responses to hypoxic challenge. They highlight the recruitment of discrete brainstem nuclei to cardiorespiratory control, and the engagement of corticostriatal circuitry in support of physiological responses that accompany breathing regulation during hypoxic challenge. PMID:25973923

  16. The cerebral cost of breathing: an FMRI case-study in congenital central hypoventilation syndrome.

    Directory of Open Access Journals (Sweden)

    Mike Sharman

    Full Text Available Certain motor activities--like walking or breathing--present the interesting property of proceeding either automatically or under voluntary control. In the case of breathing, brainstem structures located in the medulla are in charge of the automatic mode, whereas cortico-subcortical brain networks--including various frontal lobe areas--subtend the voluntary mode. We speculated that the involvement of cortical activity during voluntary breathing could impact both on the "resting state" pattern of cortical-subcortical connectivity, and on the recruitment of executive functions mediated by the frontal lobe. In order to test this prediction we explored a patient suffering from central congenital hypoventilation syndrome (CCHS, a very rare developmental condition secondary to brainstem dysfunction. Typically, CCHS patients demonstrate efficient cortically-controlled breathing while awake, but require mechanically-assisted ventilation during sleep to overcome the inability of brainstem structures to mediate automatic breathing. We used simultaneous EEG-fMRI recordings to compare patterns of brain activity between these two types of ventilation during wakefulness. As compared with spontaneous breathing (SB, mechanical ventilation (MV restored the default mode network (DMN associated with self-consciousness, mind-wandering, creativity and introspection in healthy subjects. SB on the other hand resulted in a specific increase of functional connectivity between brainstem and frontal lobe. Behaviorally, the patient was more efficient in cognitive tasks requiring executive control during MV than during SB, in agreement with her subjective reports in everyday life. Taken together our results provide insight into the cognitive and neural costs of spontaneous breathing in one CCHS patient, and suggest that MV during waking periods may free up frontal lobe resources, and make them available for cognitive recruitment. More generally, this study reveals how the

  17. Breathing adapted radiotherapy for breast cancer: comparison of free breathing gating with the breath-hold technique

    DEFF Research Database (Denmark)

    Korreman, Stine Sofia; Pedersen, Anders N; Nøttrup, Trine Jakobi

    2005-01-01

    BACKGROUND AND PURPOSE: Adjuvant radiotherapy after breast-conserving surgery for breast cancer implies a risk of late cardiac and pulmonary toxicity. This is the first study to evaluate cardiopulmonary dose sparing of breathing adapted radiotherapy (BART) using free breathing gating......, and to compare this respiratory technique with voluntary breath-hold. PATIENTS AND METHODS: 17 patients were CT-scanned during non-coached breathing manoeuvre including free breathing (FB), end-inspiration gating (IG), end-expiration gating (EG), deep inspiration breath-hold (DIBH) and end-expiration breath......-hold (EBH). The Varian Real-time Position Management system (RPM) was used to monitor respiratory movement and to gate the scanner. For each breathing phase, a population based internal margin (IM) was estimated based on average chest wall excursion, and incorporated into an individually optimised three...

  18. Blue breath holding is benign.

    Science.gov (United States)

    Stephenson, J B

    1991-01-01

    In their recent publication in this journal, Southall et al described typical cyanotic breath holding spells, both in otherwise healthy children and in those with brainstem lesions and other malformations. Their suggestions regarding possible autonomic disturbances may require further study, but they have adduced no scientific evidence to contradict the accepted view that in the intact child blue breath holding spells are benign. Those families in which an infant suffers an 'apparently life threatening event' deserve immense understanding and help, and it behoves investigators to exercise extreme care and self criticism in the presentation of new knowledge which may bear upon their management and their morale. PMID:2001115

  19. Effect of repetitive end-inspiration breath holding on very short-term heart rate variability in healthy humans.

    Science.gov (United States)

    Chen, Xiang; Chen, Tianjun; Yun, Feng; Huang, Yuanyuan; Li, Jin

    2014-12-01

    Very short-term heart rate variability (HRV) is thought to reflect dynamic changes in autonomic nervous activity, which is helpful in understanding the role of autonomic nervous function (ANF) in the mechanisms underlying apnea-induced cardiac arrhythmias. The goal of this study was to investigate the effect of repetitive end-inspiration breath holding on very short-term HRV. A total of 32 young healthy participants took part in the experiments. Three trials were performed, each involving seven repetitive end-inspiration breath holding and a 30 s recovery period between breath holding. Durations of breath holding in the three trials were 1:2:3. The study first evaluated the effect of analyzed data lengths on the stability of HRV indices and determined three HRV indices suitable for very short-term analysis. The results showed that in most cases, during breath holding, the square root of the mean squared differences of successive normal RR intervals (rMSSD) was significantly lower, but normalized units of the power in the low frequency band ranging from 0.04 to 0.15 Hz (nLF) and LF/high frequency (HF) were significantly higher than those during corresponding durations under the normal breathing conditions. On the contrary, during recovery after breath holding, rMSSD was significantly higher but nLF and LF/HF were lower than normal. Moreover, the durations of breath holding had no significant influence on the variations of LF/HF. In addition, as participants repeated the breath holding, HRV indices varied non-linearly. HRV changes may indicate sympathetic activation during breath holding and parasympathetic activation during recovery after breath holding. In conjunction with the existing physiological interpretation based on changes in heart rate, the results may imply that breath holding leads to both cardiac sympathetic and parasympathetic activation simultaneously, which may be a possible pathogenic factor of apnea-induced arrhythmias.

  20. Effect of repetitive end-inspiration breath holding on very short-term heart rate variability in healthy humans

    International Nuclear Information System (INIS)

    Chen, Xiang; Huang, Yuanyuan; Li, Jin; Chen, Tianjun; Yun, Feng

    2014-01-01

    Very short-term heart rate variability (HRV) is thought to reflect dynamic changes in autonomic nervous activity, which is helpful in understanding the role of autonomic nervous function (ANF) in the mechanisms underlying apnea-induced cardiac arrhythmias. The goal of this study was to investigate the effect of repetitive end-inspiration breath holding on very short-term HRV. A total of 32 young healthy participants took part in the experiments. Three trials were performed, each involving seven repetitive end-inspiration breath holding and a 30 s recovery period between breath holding. Durations of breath holding in the three trials were 1:2:3. The study first evaluated the effect of analyzed data lengths on the stability of HRV indices and determined three HRV indices suitable for very short-term analysis. The results showed that in most cases, during breath holding, the square root of the mean squared differences of successive normal RR intervals (rMSSD) was significantly lower, but normalized units of the power in the low frequency band ranging from 0.04 to 0.15 Hz (nLF) and LF/high frequency (HF) were significantly higher than those during corresponding durations under the normal breathing conditions. On the contrary, during recovery after breath holding, rMSSD was significantly higher but nLF and LF/HF were lower than normal. Moreover, the durations of breath holding had no significant influence on the variations of LF/HF. In addition, as participants repeated the breath holding, HRV indices varied non-linearly. HRV changes may indicate sympathetic activation during breath holding and parasympathetic activation during recovery after breath holding. In conjunction with the existing physiological interpretation based on changes in heart rate, the results may imply that breath holding leads to both cardiac sympathetic and parasympathetic activation simultaneously, which may be a possible pathogenic factor of apnea-induced arrhythmias. (paper)

  1. Early abnormalities of post-sigh breathing in a mouse model of Rett syndrome.

    Science.gov (United States)

    Voituron, N; Zanella, S; Menuet, C; Lajard, A M; Dutschmann, M; Hilaire, G

    2010-02-28

    Rett syndrome is a neurodevelopmental disease accompanied by complex, disabling symptoms, including breathing symptoms. Because Rett syndrome is caused by mutations in the transcriptional repressor methyl-CpG-binding protein 2 (MeCP2), Mecp2-deficient mice have been generated as experimental model. Males of Mecp2-deficient mice (Mecp2(-/y)) breathe normally at birth but show abnormal respiratory responses to hypoxia and hypercapnia from postnatal day 25 (P25). After P30, Mecp2(-/y) mice develop breathing symptoms reminiscent of Rett syndrome, aggravating until premature death at around P60. Using plethysmography, we analyzed the sighs and the post-sigh breathing pattern of unrestrained wild type male mice (WT) and Mecp2(-/y) mice from P15 to P60. Sighs are spontaneous large inspirations known to prevent lung atelectasis and to improve alveolar oxygenation. However, Mecp2(-/y) mice show early abnormalities of post-sigh breathing, with long-lasting post-sigh apnoeas, reduced tidal volume when eupnoea resumes and lack of post-sigh bradypnoea which develop from P15, aggravate with age and possibly contribute to breathing symptoms to come. Copyright 2010 Elsevier B.V. All rights reserved.

  2. Spontaneous Atraumatic Mediastinal Hemorrhage

    Directory of Open Access Journals (Sweden)

    Morkos Iskander BSc, BMBS, MRCS, PGCertMedEd

    2013-04-01

    Full Text Available Spontaneous atraumatic mediastinal hematomas are rare. We present a case of a previously fit and well middle-aged lady who presented with acute breathlessness and an increasing neck swelling and spontaneous neck bruising. On plain chest radiograph, widening of the mediastinum was noted. The bruising was later confirmed to be secondary to mediastinal hematoma. This life-threatening diagnostic conundrum was managed conservatively with a multidisciplinary team approach involving upper gastrointestinal and thoracic surgeons, gastroenterologists, radiologists, intensivists, and hematologists along with a variety of diagnostic modalities. A review of literature is also presented to help surgeons manage such challenging and complicated cases.

  3. Oral breathing and speech disorders in children

    Directory of Open Access Journals (Sweden)

    Silvia F. Hitos

    2013-07-01

    Conclusion: Mouth breathing can affect speech development, socialization, and school performance. Early detection of mouth breathing is essential to prevent and minimize its negative effects on the overall development of individuals.

  4. Volatile sulphur compounds in morning breath of human volunteers

    NARCIS (Netherlands)

    Snel, Johannes; Burgering, Maurits; Smit, Bart; Noordman, Wouter; Tangerman, Albert; Winkel, Edwin G.; Kleerebezem, Michiel

    Objective: Morning breath contains elevated concentrations of volatile sulphur components (VSCs). Therefore, morning breath is recognised as a surrogate target for interventions on breath quality. Nevertheless, factors influencing morning breath are poorly understood. Our aim was to evaluate

  5. Volatile sulphur compounds in morning breath of human volunteers.

    NARCIS (Netherlands)

    Snel, J.; Burgering, M.; Smit, B.; Noordman, W.; Tangerman, A.; Winkel, E.G.; Kleerebezem, M.

    2011-01-01

    OBJECTIVE: morning breath contains elevated concentrations of volatile sulphur components (VSCs). Therefore, morning breath is recognised as a surrogate target for interventions on breath quality. Nevertheless, factors influencing morning breath are poorly understood. Our aim was to evaluate

  6. Trials

    Directory of Open Access Journals (Sweden)

    Michele Fornaro

    2010-01-01

    Full Text Available Mental Retardation (MR is a developmental disability characterized by impairments in adaptive daily life skills and difficulties in social and interpersonal functioning. Since multiple causes may contribute to MR, associated clinical pictures may vary accordingly. Nevertheless, when psychiatric disorders as Treatment Resistant Depression (TRD and/or alcohol abuse co-exist, their proper detection and management is often troublesome, essentially due to a limited vocabulary MR people could use to describe their symptoms, feelings and concerns, and the lack of reliable screening tools. Furthermore, MR people are among the most medicated subjects, with (over prescription of antidepressants and/or typical antipsychotics being the rule rather than exception. Thus, treatment resistance or even worsening of depression, constitute frequent occurrences. This report describes the case of a person with MR who failed to respond to repetitive trials of antidepressant monotherapies, finally recovering using aripiprazole to fluvoxamine augmentation upon consideration of a putative bipolar diathesis for “agitated” TRD. Although further controlled investigations are needed to assess a putative bipolar diathesis in some cases of MR associated to TRD, prudence is advised in the long-term prescription of antidepressant monotherapies in such conditions.

  7. The effect of inert gas choice on multiple breath washout in healthy infants: differences in lung function outcomes and breathing pattern.

    Science.gov (United States)

    Gustafsson, Per M; Bengtsson, Lovisa; Lindblad, Anders; Robinson, Paul D

    2017-12-01

    The detrimental effects on breathing pattern during multiple breath inert gas washout (MBW) have been described with different inhaled gases [100% oxygen (O 2 ) and sulfur hexafluoride (SF 6 )] but detailed comparisons are lacking. N 2 - and SF 6 -based tests were performed during spontaneous quiet sleep in 10 healthy infants aged 0.7-1.3 yr using identical hardware. Differences in breathing pattern pre and post 100% O 2 and 4% SF 6 exposure were investigated, and the results obtained were compared [functional residual capacity (FRC) and lung clearance index (LCI)]. During 100% O 2 exposure. mean inspiratory flow ("respiratory drive") decreased transiently by mean (SD) 28 (9)% ( P pattern of change reversed. No significant effect on breathing pattern was observed during SF 6 testing. In vitro testing confirmed that technical artifacts did not explain these changes. Mean (SD) FRC and LCI in vivo were significantly higher with N 2 vs. SF 6 washout: 216 (33) vs. 186 (22) ml ( P pattern during test performance and the functional residual capacity and lung clearance index values obtained. Data suggest the detrimental effect of breathing pattern of 100% O 2 and movement of O 2 across the alveolar capillary membrane, with direct effects on MBW outcomes. SF 6 MBW during infancy avoids this and can be further optimized by addressing the sources of technical artifact identified in this work.

  8. Teaching Spontaneous Responses to Young Children With Autism

    OpenAIRE

    Jones, Emily A; Feeley, Kathleen M; Takacs, Jennifer

    2007-01-01

    Using a multiple probe design across responses, we demonstrated the effectiveness of intensive intervention in establishing spontaneous verbal responses to 2 3-year-old children with autism with generalization to novel settings involving novel persons. Intervention involved discrete-trial instruction (i.e., repeated instructional opportunities presented in close proximity to high rates of reinforcement), specific prompts, and error correction. Spontaneous responses were defined as specific ve...

  9. Postural disorders in mouth breathing children: a systematic review.

    Science.gov (United States)

    Neiva, Patricia Dayrell; Kirkwood, Renata Noce; Mendes, Polyana Leite; Zabjek, Karl; Becker, Helena Gonçalves; Mathur, Sunita

    Mouth breathing syndrome can cause sleep disturbances that compromise the performance of children in school. It might also cause postural abnormalities involving the head and cervical spine; however, the association between postural abnormalities and mouth breathing in children is unclear. To assess the methodological quality of studies and determine if there is an association between mouth breathing and postural disorders in children. Databases comprised MEDLINE, CINAHL, PEDro, LILACS, EMBASE and Cochrane Central Registrar of Controlled Trials. Searches were until March 2016 and included studies that evaluated postural disorders in children diagnosed with mouth breathing. The Downs and Black checklist was used to evaluate the quality of the evidences. Ten studies were included totaling 417 children from 5 to 14 years. Two studies used the New York State Postural Rating Scale, seven used photography and one used motion capture to measure posture. The methods used to analyze the data included the Postural Analysis Software (SAPO), Fisiometer, ALCimagem and routines in MATLAB program. Quality assessment resulted in low scores (Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. 14CO2 in breath

    International Nuclear Information System (INIS)

    Rabinowitz, J.L.; Lopez-Majano, V.

    1981-01-01

    The diagnosis of metabolic disorders can be made by detecting 14 CO 2 in the breath. This is possible because 14 CO 2 can label any organic compound without any deteriorations in the nature of the compound. This type of analysis is dependable, noninvasive and simple to perform with a scintillation counter. (orig.)

  11. Submarines, Spacecraft, and Exhaled Breath

    Science.gov (United States)

    The International Association of Breath Research (IABR) meetings are an eclectic gathering of researchers in the medical, environmental and instrumentation fields; our focus is on human health as assessed by the measurement and interpretation of trace chemicals in human exhaled b...

  12. Breathing retraining: a rational placebo?

    NARCIS (Netherlands)

    Garssen, B.; de Ruiter, C.; van Dyck, R.

    1992-01-01

    Breathing retraining of patients with Hyperventilation Syndrome (HVS) and/or panic disorder is discussed to evaluate its clinical effectiveness and to examine the mechanism that mediates its effect. In relation to this theoretical question, the validity of HVS as a scientific model is discussed and

  13. Functional Analysis and Intervention for Breath Holding.

    Science.gov (United States)

    Kern, Lee; And Others

    1995-01-01

    A functional analysis of breath-holding episodes in a 7-year-old girl with severe mental retardation and Cornelia-de-Lange syndrome indicated that breath holding served an operant function, primarily to gain access to attention. Use of extinction, scheduled attention, and a picture card communication system decreased breath holding. (Author/SW)

  14. 21 CFR 868.5620 - Breathing mouthpiece.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Breathing mouthpiece. 868.5620 Section 868.5620...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5620 Breathing mouthpiece. (a) Identification. A breathing mouthpiece is a rigid device that is inserted into a patient's mouth and that...

  15. Relationships between breath ratios, spirituality and health ...

    African Journals Online (AJOL)

    The aim of this retrospective, quantitative study was to investigate relationships between breath ratios, spirituality perceptions and health perceptions, with special reference to breath ratios that best predict optimal health and spirituality. Significant negative correlations were found between breath ratios and spirituality ...

  16. Breath psychotherapy | Edwards | Inkanyiso: Journal of Humanities ...

    African Journals Online (AJOL)

    Breath psychotherapy is an approach that makes direct use of the breath in healing. There are many forms of breathbased healing: basic breathing and relaxation methods, with or without the practice of psychological skills such as imagery, centring and concentration; expressive physical and emotional techniques; ...

  17. Spontaneous Appendicocutaneous Fistula I

    African Journals Online (AJOL)

    M T0k0de* MB, BS and. Dr 0. A. AWOj0bi+ FMCS (Nig). ABSTRACT. Ruptured appendicitis is not a common cause of spontaneous enterocutaneous fistula. A case of ruptured retrocaecal appendicitis presenting as an enterocutaneous fistula in a Nigerian woman is presented. The literature on this disorder is also reviewed.

  18. [Spontaneous bacterial peritonitis].

    Science.gov (United States)

    Strauss, Edna; Caly, Wanda Regina

    2003-01-01

    Spontaneous bacterial peritonitis occurs in 30% of patients with ascites due to cirrhosis leading to high morbidity and mortality rates. The pathogenesis of spontaneous bacterial peritonitis is related to altered host defenses observed in end-stage liver disease, overgrowth of microorganisms, and bacterial translocation from the intestinal lumen to mesenteric lymph nodes. Clinical manifestations vary from severe to slight or absent, demanding analysis of the ascitic fluid. The diagnosis is confirmed by a number of neutrophils over 250/mm3 associated or not to bacterial growth in culture of an ascites sample. Enterobacteriae prevail and Escherichia coli has been the most frequent bacterium reported. Mortality rates decreased markedly in the last two decades due to early diagnosis and prompt antibiotic treatment. Third generation intravenous cephalosporins are effective in 70% to 95% of the cases. Recurrence of spontaneous bacterial peritonitis is common and can be prevented by the continuous use of oral norfloxacin. The development of bacterial resistance demands the search for new options in the prophylaxis of spontaneous bacterial peritonitis; probiotics are a promising new approach, but deserve further evaluation. Short-term antibiotic prophylaxis is recommended for patients with cirrhosis and ascites shortly after an acute episode of gastrointestinal bleeding.

  19. Spontaneous Grammar Explanations.

    Science.gov (United States)

    Tjoo, Hong Sing; Lewis, Marilyn

    1998-01-01

    Describes one New Zealand university language teacher's reflection on her own grammar explanations to university-level students of Bahasa Indonesian. Examines form-focused instruction through the teacher's spontaneous answers to students' questions about the form of the language they are studying. The teacher's experiences show that it takes time…

  20. EDITORIAL SPONTANEOUS BACTERIAL PERITONITIS ...

    African Journals Online (AJOL)

    hi-tech

    Spontaneous bacterial peritonitis (SBP) frequent]y occurs in patients with liver cirrhosis and ascites. It is defined as an infection of previously sterile ascitic fluid without any demonstrable intrabdominal source of infection. It is now internationally agreed that a polymorphonuclear (PMN) cell count in the ascitic fluid of over 250 ...

  1. Spontaneous dimensional reduction?

    Science.gov (United States)

    Carlip, Steven

    2012-10-01

    Over the past few years, evidence has begun to accumulate suggesting that spacetime may undergo a "spontaneous dimensional reduction" to two dimensions near the Planck scale. I review some of this evidence, and discuss the (still very speculative) proposal that the underlying mechanism may be related to short-distance focusing of light rays by quantum fluctuations.

  2. Teaching spontaneous responses to a young child with Down syndrome.

    Science.gov (United States)

    Feeley, Kathleen; Jones, Emily

    2008-10-01

    Children with Down syndrome experience significant communication impairments, particularly in expressive language. Although receiving little attention in the literature, deficiencies in expressive language are likely to affect spontaneous communicative responses in children with Down syndrome. In this study, using a multiple baseline design across responses, we demonstrated the effectiveness of discrete trial instruction in establishing spontaneous responses in a preschooler with Down syndrome. Spontaneous responses generalised to a novel setting involving a novel person and novel materials. Implications for the use of behaviourally based interventions to address the social-communicative needs of children with Down syndrome are discussed.

  3. Does the supplementary motor area keep patients with Ondine's curse syndrome breathing while awake?

    Directory of Open Access Journals (Sweden)

    Lysandre Tremoureux

    Full Text Available BACKGROUND: Congenital central hypoventilation syndrome (CCHS is a rare neuro-respiratory disorder associated with mutations of the PHOX2B gene. Patients with this disease experience severe hypoventilation during sleep and are consequently ventilator-dependent. However, they breathe almost normally while awake, indicating the existence of cortical mechanisms compensating for the deficient brainstem generation of automatic breathing. Current evidence indicates that the supplementary motor area plays an important role in modulating ventilation in awake normal humans. We hypothesized that the wake-related maintenance of spontaneous breathing in patients with CCHS could involve supplementary motor area. METHODS: We studied 7 CCHS patients (5 women; age: 20-30; BMI: 22.1 ± 4 kg.m(-2 during resting breathing and during exposure to carbon dioxide and inspiratory mechanical constraints. They were compared with 8 healthy individuals. Segments of electroencephalographic tracings were selected according to ventilatory flow signal, from 2.5 seconds to 1.5 seconds after the onset of inspiration. After artefact rejection, 80 or more such segments were ensemble averaged. A slow upward shift of the EEG signal starting between 2 and 0.5 s before inspiration (pre-inspiratory potential was considered suggestive of supplementary motor area activation. RESULTS: In the control group, pre-inspiratory potentials were generally absent during resting breathing and carbon dioxide stimulation, and consistently identified in the presence of inspiratory constraints (expected. In CCHS patients, pre-inspiratory potentials were systematically identified in all study conditions, including resting breathing. They were therefore significantly more frequent than in controls. CONCLUSIONS: This study provides a neurophysiological substrate to the wakefulness drive to breathe that is characteristic of CCHS and suggests that the supplementary motor area contributes to this phenomenon

  4. Does the supplementary motor area keep patients with Ondine's curse syndrome breathing while awake?

    Science.gov (United States)

    Tremoureux, Lysandre; Raux, Mathieu; Hudson, Anna L; Ranohavimparany, Anja; Straus, Christian; Similowski, Thomas

    2014-01-01

    Congenital central hypoventilation syndrome (CCHS) is a rare neuro-respiratory disorder associated with mutations of the PHOX2B gene. Patients with this disease experience severe hypoventilation during sleep and are consequently ventilator-dependent. However, they breathe almost normally while awake, indicating the existence of cortical mechanisms compensating for the deficient brainstem generation of automatic breathing. Current evidence indicates that the supplementary motor area plays an important role in modulating ventilation in awake normal humans. We hypothesized that the wake-related maintenance of spontaneous breathing in patients with CCHS could involve supplementary motor area. We studied 7 CCHS patients (5 women; age: 20-30; BMI: 22.1 ± 4 kg.m(-2)) during resting breathing and during exposure to carbon dioxide and inspiratory mechanical constraints. They were compared with 8 healthy individuals. Segments of electroencephalographic tracings were selected according to ventilatory flow signal, from 2.5 seconds to 1.5 seconds after the onset of inspiration. After artefact rejection, 80 or more such segments were ensemble averaged. A slow upward shift of the EEG signal starting between 2 and 0.5 s before inspiration (pre-inspiratory potential) was considered suggestive of supplementary motor area activation. In the control group, pre-inspiratory potentials were generally absent during resting breathing and carbon dioxide stimulation, and consistently identified in the presence of inspiratory constraints (expected). In CCHS patients, pre-inspiratory potentials were systematically identified in all study conditions, including resting breathing. They were therefore significantly more frequent than in controls. This study provides a neurophysiological substrate to the wakefulness drive to breathe that is characteristic of CCHS and suggests that the supplementary motor area contributes to this phenomenon. Whether or not this "cortical breathing" can be taken

  5. Analysis of Exhaled Breath for Disease Detection

    Science.gov (United States)

    Amann, Anton; Miekisch, Wolfram; Schubert, Jochen; Buszewski, Bogusław; Ligor, Tomasz; Jezierski, Tadeusz; Pleil, Joachim; Risby, Terence

    2014-06-01

    Breath analysis is a young field of research with great clinical potential. As a result of this interest, researchers have developed new analytical techniques that permit real-time analysis of exhaled breath with breath-to-breath resolution in addition to the conventional central laboratory methods using gas chromatography-mass spectrometry. Breath tests are based on endogenously produced volatiles, metabolites of ingested precursors, metabolites produced by bacteria in the gut or the airways, or volatiles appearing after environmental exposure. The composition of exhaled breath may contain valuable information for patients presenting with asthma, renal and liver diseases, lung cancer, chronic obstructive pulmonary disease, inflammatory lung disease, or metabolic disorders. In addition, oxidative stress status may be monitored via volatile products of lipid peroxidation. Measurement of enzyme activity provides phenotypic information important in personalized medicine, whereas breath measurements provide insight into perturbations of the human exposome and can be interpreted as preclinical signals of adverse outcome pathways.

  6. Tracking performance with two breathing oxygen concentrations after high altitude rapid decompression

    Science.gov (United States)

    Nesthus, Thomas E.; Schiflett, Samuel G.; Oakley, Carolyn J.

    1992-01-01

    Current military aircraft Liquid Oxygen (LOX) systems supply 99.5 pct. gaseous Aviator's Breathing Oxygen (ABO) to aircrew. Newer Molecular Sieve Oxygen Generation Systems (MSOGS) supply breathing gas concentration of 93 to 95 pct. O2. The margin is compared of hypoxia protection afforded by ABO and MSOGS breathing gas after a 5 psi differential rapid decompression (RD) in a hypobaric research chamber. The barometric pressures equivalent to the altitudes of 46000, 52000, 56000, and 60000 ft were achieved from respective base altitudes in 1 to 1.5 s decompressions. During each exposure, subjects remained at the simulated peak altitude breathing either 100 or 94 pct. O2 with positive pressure for 60 s, followed by a rapid descent to 40000 ft. Subjects used the Tactical Life Support System (TLSS) for high altitude protection. Subcritical tracking task performance on the Performance Evaluation Device (PED) provided psychomotor test measures. Overall tracking task performance results showed no differences between the MSOGS breathing O2 concentration of 94 pct. and ABO. Significance RMS error differences were found between the ground level and base altitude trials compared to peak altitude trials. The high positive breathing pressures occurring at the peak altitudes explained the differences.

  7. Spontaneous healing of spontaneous coronary artery dissection.

    Science.gov (United States)

    Almafragi, Amar; Convens, Carl; Heuvel, Paul Van Den

    2010-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and sudden cardiac death. It should be suspected in every healthy young woman without cardiac risk factors, especially during the peripartum or postpartum periods. It is important to check for a history of drug abuse, collagen vascular disease or blunt trauma of the chest. Coronary angiography is essential for diagnosis and early management. We wonder whether thrombolysis might aggravate coronary dissection. All types of treatment (medical therapy, percutaneous intervention or surgery) improve the prognosis without affecting survival times if used appropriately according to the clinical stability and the angiographic features of the involved coronary arteries. Prompt recognition and targeted treatment improve outcomes. We report a case of SCAD in a young female free of traditional cardiovascular risk factors, who presented six hours after thrombolysis for ST elevation myocardial infarction. Coronary angiography showed a dissection of the left anterior descending and immediate branch. She had successful coronary artery bypass grafting, with complete healing of left anterior descending dissection.

  8. Spontaneous spinal epidural abscess.

    LENUS (Irish Health Repository)

    Ellanti, P

    2011-10-01

    Spinal epidural abscess is an uncommon entity, the frequency of which is increasing. They occur spontaneously or as a complication of intervention. The classical triad of fever, back pain and neurological symptoms are not always present. High index of suspicion is key to diagnosis. Any delay in diagnosis and treatment can have significant neurological consequences. We present the case of a previously well man with a one month history of back pain resulting from an epidural abscess.

  9. [Stahl, Leibniz, Hoffmann and breathing].

    Science.gov (United States)

    Carvallo, Sarah

    2006-01-01

    At the beginning of the XVIII th century, Wilhelm Gottfried Leibniz and Friedrich Hoffmann criticize Georg Ernst Stahl's medical theory. They differenciate between unsound and true reasonings. Namely, they validate Stahl's definition of breath but extracting it from its animist basis and placing it in an epistemology obeying to the principle of sufficient reason and to the mechanical model. The stahlian discovery consists in understanding breath as a calorific ventilation against the ancient conception; the iatromechanists recognize its accuracy, but they try then to transpose it to a mechanical model of ventilation. Using it in a different epistemological context implies that they analyze the idea of discovery "true" in its contents, but "wrong" in its hypothesis. It impels to examine the epistemology of medical knowledge, as science and therapeutics, and in its links with the other scientific theories. Thus, if Leibniz as philosopher and Hoffmann as doctor consider Stahl's animism so important, it is because its discoveries question the fundamental principles of medicine.

  10. TR-BREATH: Time-Reversal Breathing Rate Estimation and Detection.

    Science.gov (United States)

    Chen, Chen; Han, Yi; Chen, Yan; Lai, Hung-Quoc; Zhang, Feng; Wang, Beibei; Liu, K J Ray

    2018-03-01

    In this paper, we introduce TR-BREATH, a time-reversal (TR)-based contact-free breathing monitoring system. It is capable of breathing detection and multiperson breathing rate estimation within a short period of time using off-the-shelf WiFi devices. The proposed system exploits the channel state information (CSI) to capture the miniature variations in the environment caused by breathing. To magnify the CSI variations, TR-BREATH projects CSIs into the TR resonating strength (TRRS) feature space and analyzes the TRRS by the Root-MUSIC and affinity propagation algorithms. Extensive experiment results indoor demonstrate a perfect detection rate of breathing. With only 10 s of measurement, a mean accuracy of can be obtained for single-person breathing rate estimation under the non-line-of-sight (NLOS) scenario. Furthermore, it achieves a mean accuracy of in breathing rate estimation for a dozen people under the line-of-sight scenario and a mean accuracy of in breathing rate estimation of nine people under the NLOS scenario, both with 63 s of measurement. Moreover, TR-BREATH can estimate the number of people with an error around 1. We also demonstrate that TR-BREATH is robust against packet loss and motions. With the prevailing of WiFi, TR-BREATH can be applied for in-home and real-time breathing monitoring.

  11. Thoracic radiotherapy and breath control: current prospects

    International Nuclear Information System (INIS)

    Reboul, F.; Mineur, L.; Paoli, J.B.; Bodez, V.; Oozeer, R.; Garcia, R.

    2002-01-01

    Three-dimensional conformal radiotherapy (3D CRT) is adversely affected by setup error and organ motion. In thoracic 3D CRT, breathing accounts for most of intra-fraction movements, thus impairing treatment quality. Breath control clearly exhibits dosimetric improvement compared to free breathing, leading to various techniques for gated treatments. We review benefits of different breath control methods -i.e. breath-holding or beam gating, with spirometric, isometric or X-ray respiration sensor- and argument the choice of expiration versus inspiration, with consideration to dosimetric concerns. All steps of 3D-CRT can be improved with breath control. Contouring of organs at risk (OAR) and target are easier and more accurate on breath controlled CT-scans. Inter- and intra-fraction target immobilisation allows smaller margins with better coverage. Lung outcome predictors (NTCP, Mean Dose, LV20, LV30) are improved with breath-control. In addition, inspiration breath control facilitates beam arrangement since it widens the distance between OAR and target, and leaves less lung normal tissue within the high dose region. Last, lung density, as of CT scan, is more accurate, improving dosimetry. Our institutions choice is to use spirometry driven, patient controlled high-inspiration breath-hold; this technique gives excellent immobilization results, with high reproducibility, yet it is easy to implement and costs little extra treatment time. Breath control, whatever technique is employed, proves superior to free breathing treatment when using 3D-CRT. Breath control should then be used whenever possible, and is probably mandatory for IMRT. (authors)

  12. Change of central hemodynamics of qualified athletes for testing the use of controlled breathing and evaluation

    Directory of Open Access Journals (Sweden)

    A.P. Romanchuk

    2013-11-01

    Full Text Available Using spiroarteriocardiorhythmography surveyed 174 qualified athletes (121 male and 53 female. The examination consisted of three consecutive two-minute registrations - spontaneous, controlled breathing 6 and 15 breaths per minute. Found that the hemodynamic change substantially when the respiratory tests in the first place, cardiac output, cardiac index, total peripheral vascular resistance and specific peripheral vascular resistance. To develop criteria for evaluation of hemodynamic changes carried percentile variance analysis of all indicators in the performance tests. Testing of the evaluation criteria for different types of hemodynamics in athletes allowed to establish that eukinetic type characteristic is the reduction in heart rate and pulse blood pressure under test with controlled breathing 6 times per minute for hypokinetic – pronounced increase in systolic blood pressure and pulse blood pressure during the breath tests 6 and 15 times per minute for hyperkinetic – reducing end-diastolic volume, end-systolic volume, stroke volume, in vivo performance of both tests and an increase in systemic vascular resistance during test 15 breaths per minute.

  13. Masticatory Changes in Oral Breath Secondary to Allergic Rhinitis: Integrative Review

    Directory of Open Access Journals (Sweden)

    Bezerra, Luciana Ângelo

    2014-04-01

    Full Text Available Introduction The III Brazilian Consensus on Rhinitis (2012 defines allergic rhinitis as a nasal mucosa inflammation, mediated by immunoglobulin E, after exposure to allergens. The classic signs and symptoms of allergic rhinitis are nasal obstruction, watery rhinorrhea, sneezing, and nasal itching, often reversible either spontaneously or with treatment, and mouth breathing (breathing predominantly through the mouth, regardless of the cause, due to a nasal breathing impairment in some cases. Objective To evaluate the literature on masticatory changes in children with mouth breathing due to allergic rhinitis. Methods We conducted a search of the past 10 years, at Bireme and MEDLINE databases, for articles that covered masticatory changes in children with mouth breathing secondary to allergic rhinitis. Results We found 1,986 articles, including 15 repeated in databases, but only two articles met the inclusion criteria fully. Discussion We found few studies to answer the question raised in this review, and those studies have some methodological limitations. Most articles claimed no have statistically significant differences in masticatory changes in this population. Conclusion A better controlled study (isolating diseases, exposure time, with a larger sample (sample calculation appropriate, would be necessary to examine such changes.

  14. Kidney motion during free breathing and breath hold for MR-guided radiotherapy

    Science.gov (United States)

    Stam, Mette K.; van Vulpen, Marco; Barendrecht, Maurits M.; Zonnenberg, Bernard A.; Intven, Martijn; Crijns, Sjoerd P. M.; Lagendijk, Jan J. W.; Raaymakers, Bas W.

    2013-04-01

    Current treatments for renal cell carcinoma have a high complication rate due to the invasiveness of the treatment. With the MRI-linac it may be possible to treat renal tumours non-invasively with high-precision radiotherapy. This is expected to reduce complications. To deliver a static dose distribution, radiation gating will be used. In this study the reproducibility and efficiency of free breathing gating and a breath hold treatment of the kidney was investigated. For 15 patients with a renal lesion the kidney motion during 2 min of free breathing and 10 consecutive expiration breath holds was studied with 2D cine MRI. The variability in kidney expiration position and treatment efficiency for gating windows of 1 to 20 mm was measured for both breathing patterns. Additionally the time trend in free breathing and the variation in expiration breath hold kidney position with baseline shift correction was determined. In 80% of the patients the variation in expiration position during free breathing is smaller than 2 mm. No clinically relevant time trends were detected. The variation in expiration breath hold is for all patients larger than the free breathing expiration variation. Gating on free breathing is, for gating windows of 1 to 5 mm more efficient than breath hold without baseline correction. When applying a baseline correction to the breath hold it increases the treatment efficiency. The kidney position is more reproducible in expiration free breathing than non-guided expiration breath hold. For small gating windows it is also more time efficient. Since free breathing also seems more comfortable for the patients it is the preferred breathing pattern for MRI-Linac treatments of the kidney.

  15. Kidney motion during free breathing and breath hold for MR-guided radiotherapy

    International Nuclear Information System (INIS)

    Stam, Mette K; Van Vulpen, Marco; Intven, Martijn; Crijns, Sjoerd P M; Lagendijk, Jan J W; Raaymakers, Bas W; Barendrecht, Maurits M; Zonnenberg, Bernard A

    2013-01-01

    Current treatments for renal cell carcinoma have a high complication rate due to the invasiveness of the treatment. With the MRI-linac it may be possible to treat renal tumours non-invasively with high-precision radiotherapy. This is expected to reduce complications. To deliver a static dose distribution, radiation gating will be used. In this study the reproducibility and efficiency of free breathing gating and a breath hold treatment of the kidney was investigated. For 15 patients with a renal lesion the kidney motion during 2 min of free breathing and 10 consecutive expiration breath holds was studied with 2D cine MRI. The variability in kidney expiration position and treatment efficiency for gating windows of 1 to 20 mm was measured for both breathing patterns. Additionally the time trend in free breathing and the variation in expiration breath hold kidney position with baseline shift correction was determined. In 80% of the patients the variation in expiration position during free breathing is smaller than 2 mm. No clinically relevant time trends were detected. The variation in expiration breath hold is for all patients larger than the free breathing expiration variation. Gating on free breathing is, for gating windows of 1 to 5 mm more efficient than breath hold without baseline correction. When applying a baseline correction to the breath hold it increases the treatment efficiency. The kidney position is more reproducible in expiration free breathing than non-guided expiration breath hold. For small gating windows it is also more time efficient. Since free breathing also seems more comfortable for the patients it is the preferred breathing pattern for MRI-Linac treatments of the kidney. (paper)

  16. Horses Auto-Recruit Their Lungs by Inspiratory Breath Holding Following Recovery from General Anaesthesia.

    Directory of Open Access Journals (Sweden)

    Martina Mosing

    Full Text Available This study evaluated the breathing pattern and distribution of ventilation in horses prior to and following recovery from general anaesthesia using electrical impedance tomography (EIT. Six horses were anaesthetised for 6 hours in dorsal recumbency. Arterial blood gas and EIT measurements were performed 24 hours before (baseline and 1, 2, 3, 4, 5 and 6 hours after horses stood following anaesthesia. At each time point 4 representative spontaneous breaths were analysed. The percentage of the total breath length during which impedance remained greater than 50% of the maximum inspiratory impedance change (breath holding, the fraction of total tidal ventilation within each of four stacked regions of interest (ROI (distribution of ventilation and the filling time and inflation period of seven ROI evenly distributed over the dorso-ventral height of the lungs were calculated. Mixed effects multi-linear regression and linear regression were used and significance was set at p<0.05. All horses demonstrated inspiratory breath holding until 5 hours after standing. No change from baseline was seen for the distribution of ventilation during inspiration. Filling time and inflation period were more rapid and shorter in ventral and slower and longer in most dorsal ROI compared to baseline, respectively. In a mixed effects multi-linear regression, breath holding was significantly correlated with PaCO2 in both the univariate and multivariate regression. Following recovery from anaesthesia, horses showed inspiratory breath holding during which gas redistributed from ventral into dorsal regions of the lungs. This suggests auto-recruitment of lung tissue which would have been dependent and likely atelectic during anaesthesia.

  17. Efficacy and tolerability of yoga breathing in patients with chronic obstructive pulmonary disease: a pilot study.

    Science.gov (United States)

    Pomidori, Luca; Campigotto, Federica; Amatya, Tara Man; Bernardi, Luciano; Cogo, Annalisa

    2009-01-01

    Yoga-derived breathing has been reported to improve gas exchange in patients with chronic heart failure and in participants exposed to high-altitude hypoxia. We investigated the tolerability and effect of yoga breathing on ventilatory pattern and oxygenation in patients with chronic obstructive pulmonary disease (COPD). Patients with COPD (N = 11, 3 women) without previous yoga practice and taking only short-acting beta2-adrenergic blocking drugs were enrolled. Ventilatory pattern and oxygen saturation were monitored by means of inductive plethysmography during 30-minute spontaneous breathing at rest (sb) and during a 30-minute yoga lesson (y). During the yoga lesson, the patients were requested to mobilize in sequence the diaphragm, lower chest, and upper chest adopting a slower and deeper breathing. We evaluated oxygen saturation (SaO2%), tidal volume (VT), minute ventilation (E), respiratory rate (i>f), inspiratory time, total breath time, fractional inspiratory time, an index of thoracoabdominal coordination, and an index of rapid shallow breathing. Changes in dyspnea during the yoga lesson were assessed with the Borg scale. During the yoga lesson, data showed the adoption of a deeper and slower breathing pattern (VTsb L 0.54[0.04], VTy L 0.74[0.08], P = .01; i>fsb 20.8[1.3], i>fy 13.8[0.2], P = .001) and a significant improvement in SaO2% with no change in E (SaO2%sb 91.5%[1.13], SaO2%y 93.5%[0.99], P = .02; Esb L/min 11.2[1.1], Ey L/min 10.2[0.9]). All the participants reported to be comfortable during the yoga lesson, with no increase in dyspnea index. We conclude that short-term training in yoga is well tolerated and induces favorable respiratory changes in patients with COPD.

  18. Relationships between hippocampal activity and breathing patterns

    DEFF Research Database (Denmark)

    Harper, R M; Poe, G R; Rector, D M

    1998-01-01

    Single cell discharge, EEG activity, and optical changes accompanying alterations in breathing patterns, as well as the knowledge that respiratory musculature is heavily involved in movement and other behavioral acts, implicate hippocampal regions in some aspects of breathing control. The control...... is unlikely to reside in oscillatory breathing movements, because such patterns emerge in preparations retaining only the medulla (and perhaps only the spinal cord). However, momentary changes in breathing patterns induced by affect, startle, whole-body movement changes, or compensatory ventilatory changes...... of hippocampal contributions to breathing control should be viewed in the context that significant interactions exist between blood pressure changes and ventilation, and that modest breathing challenges, such as exposure to hypercapnia or to increased resistive loads, bring into action a vast array of brain...

  19. Spontaneous Thigh Compartment Syndrome

    Directory of Open Access Journals (Sweden)

    Khan, Sameer K

    2011-02-01

    Full Text Available A young man presented with a painful and swollen thigh, without any history of trauma, illness, coagulopathic medication or recent exertional exercise. Preliminary imaging delineated a haematoma in the anterior thigh, without any fractures or muscle trauma. Emergent fasciotomies were performed. No pathology could be identified intra-operatively, or on follow-up imaging. A review of thigh compartment syndromes described in literature is presented in a table. Emergency physicians and traumatologists should be cognisant of spontaneous atraumatic presentations of thigh compartment syndrome, to ensure prompt referral and definitive management of this limb-threatening condition. [West J Emerg Med. 2011;12(1:134-138].

  20. Nucleosome breathing and remodeling constrain CRISPR-Cas9 function.

    Science.gov (United States)

    Isaac, R Stefan; Jiang, Fuguo; Doudna, Jennifer A; Lim, Wendell A; Narlikar, Geeta J; Almeida, Ricardo

    2016-04-28

    The CRISPR-Cas9 bacterial surveillance system has become a versatile tool for genome editing and gene regulation in eukaryotic cells, yet how CRISPR-Cas9 contends with the barriers presented by eukaryotic chromatin is poorly understood. Here we investigate how the smallest unit of chromatin, a nucleosome, constrains the activity of the CRISPR-Cas9 system. We find that nucleosomes assembled on native DNA sequences are permissive to Cas9 action. However, the accessibility of nucleosomal DNA to Cas9 is variable over several orders of magnitude depending on dynamic properties of the DNA sequence and the distance of the PAM site from the nucleosome dyad. We further find that chromatin remodeling enzymes stimulate Cas9 activity on nucleosomal templates. Our findings imply that the spontaneous breathing of nucleosomal DNA together with the action of chromatin remodelers allow Cas9 to effectively act on chromatin in vivo.

  1. Meigs′ syndrome in an elderly woman with short of breath

    Directory of Open Access Journals (Sweden)

    Wan-Chen Tsai

    2015-01-01

    Full Text Available The Meigs′ syndrome is a rare syndrome defined as the triad of benign solid ovarian tumors, ascites, and pleural effusion, which resolve spontaneously and permanently after tumor resection. Lung collapse due to a large amount of pleural effusion is a common mechanism of death. It always requires surgical treatment. We report an 84-year-old woman with a large ovarian fibroma associated with Meigs′ syndrome and short of breath. It is difficult to diagnose preoperatively and is usually misdiagnosed as an ovarian malignancy. Considering the patient′s serious clinical condition and assuming that she had Meigs′ syndrome with a large ovarian mass and possible lung collapse due to large amount of pleural effusion, we chose the most appropriate surgical treatment after pathologic examination, then enabled definitive diagnosis of the benign tumor and removed the huge ovarian fibroma. This resulted in a timely symptoms resolution, short hospitalization, and relatively low morbidity in elderly.

  2. 42 CFR 84.79 - Breathing gas; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing gas; minimum requirements. 84.79 Section...-Contained Breathing Apparatus § 84.79 Breathing gas; minimum requirements. (a) Breathing gas used to supply... respiratory tract irritating compounds. (c) Compressed, gaseous breathing air shall meet the applicable...

  3. 42 CFR 84.72 - Breathing tubes; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing tubes; minimum requirements. 84.72...-Contained Breathing Apparatus § 84.72 Breathing tubes; minimum requirements. Flexible breathing tubes used in conjunction with breathing apparatus shall be designed and constructed to prevent: (a) Restriction...

  4. 42 CFR 84.85 - Breathing bags; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing bags; minimum requirements. 84.85 Section...-Contained Breathing Apparatus § 84.85 Breathing bags; minimum requirements. (a) Breathing bags shall have.... (b) Breathing bags shall be constructed of materials which are flexible and resistant to gasoline...

  5. Spontaneous Tumor Lysis Syndrome

    Directory of Open Access Journals (Sweden)

    Alicia C. Weeks MD

    2015-08-01

    Full Text Available Tumor lysis syndrome (TLS is a known complication of malignancy and its treatment. The incidence varies on malignancy type, but is most common with hematologic neoplasms during cytotoxic treatment. Spontaneous TLS is thought to be rare. This case study is of a 62-year-old female admitted with multisystem organ failure, with subsequent diagnosis of aggressive B cell lymphoma. On admission, laboratory abnormalities included renal failure, elevated uric acid (20.7 mg/dL, and 3+ amorphous urates on urinalysis. Oliguric renal failure persisted despite aggressive hydration and diuretic use, requiring initiation of hemodialysis prior to chemotherapy. Antihyperuricemic therapy and hemodialysis were used to resolve hyperuricemia. However, due to multisystem organ dysfunction syndrome with extremely poor prognosis, the patient ultimately expired in the setting of a terminal ventilator wean. Although our patient did not meet current TLS criteria, she required hemodialysis due to uric acid nephropathy, a complication of TLS. This poses the clinical question of whether adequate diagnostic criteria exist for spontaneous TLS and if the lack of currently accepted guidelines has resulted in the underestimation of its incidence. Allopurinol and rasburicase are commonly used for prevention and treatment of TLS. Although both drugs decrease uric acid levels, allopurinol mechanistically prevents formation of the substrate rasburicase acts to solubilize. These drugs were administered together in our patient, although no established guidelines recommend combined use. This raises the clinical question of whether combined therapy is truly beneficial or, conversely, detrimental to patient outcomes.

  6. Environmental contamination and breathing disease

    International Nuclear Information System (INIS)

    Cardona A, Jose D

    2003-01-01

    The atmospheric contamination is the main component of the environmental contamination and it can be defined as the presence in the atmosphere of an or several substances in enough quantity to produce alterations of the health, it is presented in aerosol form, with its gassy and specific components, altering the quality of the population's life and the degradation of the ecosystems. The main pollutant, as much for the frequency as for the importance of its effects, is the smoke of cigarettes. The paper mentions other types of polluting agents and their effects in the breathing apparatus

  7. Sleep disordered breathing in pregnancy

    Directory of Open Access Journals (Sweden)

    Bilgay Izci Balserak

    2015-12-01

    Sleep disordered breathing (SDB is very common during pregnancy, and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, one of the major risk factors for SDB, together with physiological changes in pregnancy may predispose women to develop SDB. SDB has been associated with poor maternal and fetal outcomes. Thus, early identification, diagnosis and treatment of SDB are important in pregnancy. This article reviews the pregnancy-related changes affecting the severity of SDB, the epidemiology and the risk factors of SDB in pregnancy, the association of SDB with adverse pregnancy outcomes, and screening and management options specific for this population.

  8. Spontaneous Fluctuations of PO2 in the Rabbit Somatosensory Cortex.

    Science.gov (United States)

    Linsenmeier, Robert A; Aksenov, Daniil P; Faber, Holden M; Makar, Peter; Wyrwicz, Alice M

    2016-01-01

    In many tissues, PO2 fluctuates spontaneously with amplitudes of a few mmHg. Here we further characterized these oscillations. PO2 recordings were made from the whisker barrel cortex of six rabbits with acutely or chronically placed polarographic electrodes. Measurements were made while rabbits were awake and while anesthetized with isoflurane, during air breathing, and during 100% oxygen inspiration. In awake rabbits, 90% of the power was between 0 and 20 cycles per minute (cpm), not uniformly distributed over this range, but with a peak frequently near 10 cpm. This was much slower than heart or respiratory rhythms and is similar to the frequency content observed in other tissues. During hyperoxia, total power was higher than during air-breathing, and the dominant frequencies tended to shift toward lower values (0-10 cpm). These observations suggest that at least the lower frequency fluctuations represent efforts by the circulation to regulate local PO2. There were no consistent changes in total power during 0.5 or 1.5% isoflurane anesthesia, but the power shifted to lower frequencies. Thus, both hyperoxia and anesthesia cause characteristic, but distinct, changes in spontaneous fluctuations. These PO2 fluctuations may be caused by vasomotion, but other factors cannot be ruled out.

  9. The Cerebral Cost of Breathing: An fMRI Case-Study in Congenital Central Hypoventilation Syndrome

    Science.gov (United States)

    Sharman, Mike; Gallea, Cécile; Lehongre, Katia; Galanaud, Damien; Nicolas, Nathalie; Similowski, Thomas; Cohen, Laurent; Straus, Christian; Naccache, Lionel

    2014-01-01

    Certain motor activities - like walking or breathing - present the interesting property of proceeding either automatically or under voluntary control. In the case of breathing, brainstem structures located in the medulla are in charge of the automatic mode, whereas cortico-subcortical brain networks - including various frontal lobe areas - subtend the voluntary mode. We speculated that the involvement of cortical activity during voluntary breathing could impact both on the “resting state” pattern of cortical-subcortical connectivity, and on the recruitment of executive functions mediated by the frontal lobe. In order to test this prediction we explored a patient suffering from central congenital hypoventilation syndrome (CCHS), a very rare developmental condition secondary to brainstem dysfunction. Typically, CCHS patients demonstrate efficient cortically-controlled breathing while awake, but require mechanically-assisted ventilation during sleep to overcome the inability of brainstem structures to mediate automatic breathing. We used simultaneous EEG-fMRI recordings to compare patterns of brain activity between these two types of ventilation during wakefulness. As compared with spontaneous breathing (SB), mechanical ventilation (MV) restored the default mode network (DMN) associated with self-consciousness, mind-wandering, creativity and introspection in healthy subjects. SB on the other hand resulted in a specific increase of functional connectivity between brainstem and frontal lobe. Behaviorally, the patient was more efficient in cognitive tasks requiring executive control during MV than during SB, in agreement with her subjective reports in everyday life. Taken together our results provide insight into the cognitive and neural costs of spontaneous breathing in one CCHS patient, and suggest that MV during waking periods may free up frontal lobe resources, and make them available for cognitive recruitment. More generally, this study reveals how the active

  10. Surgical treatment versus conventional chest tube drainage in primary spontaneous pneumothorax

    DEFF Research Database (Denmark)

    Olesen, Winnie Hedevang; Katballe, Niels; Sindby, Jesper Eske

    2018-01-01

    OBJECTIVES: Primary spontaneous pneumothorax frequently recurs after chest tube management. Evidence is lacking whether patients may benefit from surgery following their first episode. METHODS: We performed a multicentre, randomized trial and enrolled young, otherwise healthy patients admitted wi...

  11. Log in and breathe out: efficacy and cost-effectiveness of an online sleep training for teachers affected by work-related strain - study protocol for a randomized controlled trial

    Science.gov (United States)

    2013-01-01

    Background Insomnia and work-related stress often co-occur. Both are associated with personal distress and diminished general functioning, as well as substantial socio-economic costs due to, for example, reduced productivity at the work place and absenteeism. Insomnia complaints by people experiencing work-related stress are correlated with a deficient cognitive detachment from work. Diffuse boundaries between work and private life can additionally complicate the use of recreational activities that facilitate cognitive detachment. Cognitive behavioral therapy for insomnia is effective but rarely implemented. Internet-based cognitive behavioral therapy for insomnia could potentially reduce this deficit given its demonstrated effectiveness. Less is known, however, about the efficacy of internet-based cognitive behavioral therapy for insomnia in populations affected by high work stress. Thus, the aim of the present study is to evaluate the efficacy and cost-effectiveness of a newly developed, guided online training which is based on Cognitive Behavioral Therapy for insomnia and tailored to teachers affected by occupational stress. Methods/Design In a two-arm randomized controlled trial (N = 128), the effects of a guided online sleep training will be compared to a waitlist-control condition. German teachers with significant clinical insomnia complaints (Insomnia Severity Index ≥15) and work-related rumination (Irritation Scale, subscale Cognitive Irritation ≥15) will be included in the study. The primary outcome measure will be insomnia severity. Additionally, an economic evaluation from a societal perspective will be conducted. Data from the intention-to-treat sample will be analyzed two and six months after randomization. Discussion To the best of our knowledge, this is the first study to evaluate an online sleep training tailored to a specific population with work stress, that is, teachers. If this type of intervention is effective, it could reduce the

  12. Submarines, spacecraft and exhaled breath.

    Science.gov (United States)

    Pleil, Joachim D; Hansel, Armin

    2012-03-01

    Foreword The International Association of Breath Research (IABR) meetings are an eclectic gathering of researchers in the medical, environmental and instrumentation fields; our focus is on human health as assessed by the measurement and interpretation of trace chemicals in human exhaled breath. What may have escaped our notice is a complementary field of research that explores the creation and maintenance of artificial atmospheres practised by the submarine air monitoring and air purification (SAMAP) community. SAMAP is comprised of manufacturers, researchers and medical professionals dealing with the engineering and instrumentation to support human life in submarines and spacecraft (including shuttlecraft and manned rockets, high-altitude aircraft, and the International Space Station (ISS)). Here, the immediate concerns are short-term survival and long-term health in fairly confined environments where one cannot simply 'open the window' for fresh air. As such, one of the main concerns is air monitoring and the main sources of contamination are CO(2) and other constituents of human exhaled breath. Since the inaugural meeting in 1994 in Adelaide, Australia, SAMAP meetings have been held every two or three years alternating between the North American and European continents. The meetings are organized by Dr Wally Mazurek (a member of IABR) of the Defense Systems Technology Organization (DSTO) of Australia, and individual meetings are co-hosted by the navies of the countries in which they are held. An overriding focus at SAMAP is life support (oxygen availability and carbon dioxide removal). Certainly, other air constituents are also important; for example, the closed environment of a submarine or the ISS can build up contaminants from consumer products, cooking, refrigeration, accidental fires, propulsion and atmosphere maintenance. However, the most immediate concern is sustaining human metabolism: removing exhaled CO(2) and replacing metabolized O(2). Another

  13. Spontaneous Intracranial Hypotension

    International Nuclear Information System (INIS)

    Joash, Dr.

    2015-01-01

    Epidemiology is not only rare but an important cause of new daily persistent headaches among young & middle age individuals. The Etiology & Pathogenesis is generally caused by spinal CSF leak. Precise cause remains largely unknown, underlying structural weakness of spinal meninges is suspected. There are several MR Signs of Intracranial Hypotension that include:- diffuse pachymeningeal (dural) enhancement; bilateral subdural, effusion/hematomas; Downward displacement of brain; enlargement of pituitary gland; Engorgement of dural venous sinuses; prominence of spinal epidural venous plexus and Venous sinus thrombosis & isolated cortical vein thrombosis. The sum of volumes of intracranial blood, CSF & cerebral tissue must remain constant in an intact cranium. Treatment in Many cases can be resolved spontaneously or by use Conservative approach that include bed rest, oral hydration, caffeine intake and use of abdominal binder. Imaging Modalities for Detection of CSF leakage include CT myelography, Radioisotope cisternography, MR myelography, MR imaging and Intrathecal Gd-enhanced MR

  14. Spontaneous wave packet reduction

    International Nuclear Information System (INIS)

    Ghirardi, G.C.

    1994-06-01

    There are taken into account the main conceptual difficulties met by standard quantum mechanics in dealing with physical processes involving macroscopic system. It is stressed how J.A.Wheeler's remarks and lucid analysis have been relevant to pinpoint and to bring to its extreme consequences the puzzling aspects of quantum phenomena. It is shown how the recently proposed models of spontaneous dynamical reduction represent a consistent way to overcome the conceptual difficulties of the standard theory. Obviously, many nontrivial problems remain open, the first and more relevant one being that of generalizing the model theories considered to the relativistic case. This is the challenge of the dynamical reduction program. 43 refs, 2 figs

  15. Log in and breathe out: efficacy and cost-effectiveness of an online sleep training for teachers affected by work-related strain--study protocol for a randomized controlled trial.

    Science.gov (United States)

    Thiart, Hanne; Lehr, Dirk; Ebert, David Daniel; Sieland, Bernhard; Berking, Matthias; Riper, Heleen

    2013-06-11

    Insomnia and work-related stress often co-occur. Both are associated with personal distress and diminished general functioning, as well as substantial socio-economic costs due to, for example, reduced productivity at the work place and absenteeism. Insomnia complaints by people experiencing work-related stress are correlated with a deficient cognitive detachment from work. Diffuse boundaries between work and private life can additionally complicate the use of recreational activities that facilitate cognitive detachment.Cognitive behavioral therapy for insomnia is effective but rarely implemented. Internet-based cognitive behavioral therapy for insomnia could potentially reduce this deficit given its demonstrated effectiveness. Less is known, however, about the efficacy of internet-based cognitive behavioral therapy for insomnia in populations affected by high work stress. Thus, the aim of the present study is to evaluate the efficacy and cost-effectiveness of a newly developed, guided online training which is based on Cognitive Behavioral Therapy for insomnia and tailored to teachers affected by occupational stress. In a two-arm randomized controlled trial (N = 128), the effects of a guided online sleep training will be compared to a waitlist-control condition. German teachers with significant clinical insomnia complaints (Insomnia Severity Index ≥ 15) and work-related rumination (Irritation Scale, subscale Cognitive Irritation ≥ 15) will be included in the study. The primary outcome measure will be insomnia severity. Additionally, an economic evaluation from a societal perspective will be conducted. Data from the intention-to-treat sample will be analyzed two and six months after randomization. To the best of our knowledge, this is the first study to evaluate an online sleep training tailored to a specific population with work stress, that is, teachers. If this type of intervention is effective, it could reduce the paucity of cognitive behavioral therapy for

  16. Method for breathing related ECG triggering

    Energy Technology Data Exchange (ETDEWEB)

    Waters, W.; Neeb, W.; Wellner, U.

    1984-02-01

    A method for breathing related ECG triggering has been developed. It can be applied in radionuclid-angiocardioscintigraphy promising new insights into the physiology and pathophysiology of breathing related heart function without invasive manipulations. High resolution images of the heart can be obtained using this method by steering the NMR (nuclear magnetic resonance) or the cine CT (ultrafast transmission computerized tomography) acquisition.

  17. How Does a Hopping Kangaroo Breathe?

    Science.gov (United States)

    Giuliodori, Mauricio J.; Lujan, Heidi L.; Janbaih, Hussein; DiCarlo, Stephen E.

    2010-01-01

    We developed a model to demonstrate how a hopping kangaroo breathes. Interestingly, a kangaroo uses less energy to breathe while hopping than while standing still. This occurs, in part, because rather than using muscle power to move air into and out of the lungs, air is pulled into (inspiration) and pushed out of (expiration) the lungs as the…

  18. Breathing Better with a COPD Diagnosis

    Science.gov (United States)

    ... out of the lungs. Normal luNg CoPD luNg breathiNg better with a CoPD DiagNosis 3 DiagNosis aND ... Using a machine called a spirometer, this noninvasive breathing test measures the amount of air a person ...

  19. The effect of breath freshener strips on two types of breath alcohol testing instruments.

    Science.gov (United States)

    Moore, Ronald L; Guillen, Jennifer

    2004-07-01

    The potential for breath freshener strips to interfere with the accuracy of a breath alcohol test was studied. Twelve varieties of breath freshener strips from five manufacturers were examined. Breath tests were conducted using the infrared based BAC DataMaster or the fuel cell based Alco-Sensor IV-XL, 30 and 150 seconds after placing a breath strip on the tongue. No effect was observed using the Alco-Sensor system. Some of the strips gave a small reading at 30 seconds (less than or equal to 0.010 g/210 L apparent alcohol) using the DataMaster. Readings on the DataMaster returned to zero by the 150 second test. A proper pre-test observation and deprivation period should prevent any interference from breath freshener strips on breath alcohol testing.

  20. Pattern of breathing in brachycephalic dogs.

    Science.gov (United States)

    Amis, T C; Kurpershoek, C

    1986-10-01

    The pattern of breathing was assessed in 19 brachycephalic dogs, using tidal breathing flow-volume loop (TBFVL) analysis. Fifteen dogs had TBFVL consistent with a fixed-type upper airway obstruction, whereas 4 dogs had a TBFVL indicative of a nonfixed upper airway obstruction. The dogs did not have a TBFVL shape the same as that considered normal for healthy nonbrachycephalic dogs. Tidal breathing flow-volume loops from brachycephalic dogs that were considered to have a normal respiratory tract (n = 11) were similar to those of dogs with clinical signs of upper airway obstruction (n = 8). Respiration was monitored continuously for short periods (20 to 50 minutes) in 3 brachycephalic dogs resting in a cage in a quiet, darkened laboratory; 2 of these dogs had periodic breathing patterns characterized by multiple episodes of alternating hypopnea and arousal. Brachycephalic dogs may be at risk for the development of disordered breathing during sleep.

  1. BREATH OF USE AND VOCAL TRAINING

    Directory of Open Access Journals (Sweden)

    Nuran ACAR

    2016-10-01

    Full Text Available Breathable, who escorted us in every aspect of our lives and our survival is our primary activity, allowing for quality of life in a healthy way. quality of breaths taken the right technique, you need both health professional sense should perhaps take advantage of individuals who want to achieve success in life is the primary rule. When the diaphragm is born with assisted breathing lungs of every person's life starts to grow to keep up with the flurry lose this special and important skills. First and foremost, which is important for our body health, including every aspect of proper breathing, especially correct use of the voice carries particular importance. In this article, breathing subject discussed, correct breathing and our lives have tried to give us information about the benefits of both vocal training.

  2. Rapid eye movement sleep in breath holders.

    Science.gov (United States)

    Kohyama, J; Hasegawa, T; Shimohira, M; Fukumizu, M; Iwakawa, Y

    2000-07-01

    One-night polysomnography was performed on seven subjects suffering from breath-holding spells, including one whose death was suggested to be a consequence of a breath-holding spell. The fatal case showed no rapid eye movements (REMs) during REM sleep, although he exhibited REMs during wakefulness. The average numbers of both REMs and bursts of REMs in REM sleep in the other six breath holders were significantly lower than those in age-matched controls. The breath holders showed no airway obstruction, desaturation, or sleep fragmentation. Since the rapid ocular activity in REM sleep is generated in the brain stem, we hypothesized that a functional brainstem disturbance is involved in the occurrence of breath-holding spells.

  3. Surgery for spontaneous intracerebral hemorrhage: Emerging trends

    Directory of Open Access Journals (Sweden)

    Girish Menon

    2017-01-01

    Full Text Available In spite of advances in imaging and surgical techniques, spontaneous intracerebral hemorrhage (SICH has defied attempts to find a scientifically proven effective therapy. The pathophysiology of SICH suggests that early removal of the clot with minimal additional surgical trauma should prove beneficial. Trials in this direction have been few, and for some unknown reason, surgery has not proved to be superior to best medical management in most of these trials. This has led to substantial variability in the management of ICH throughout the world, and the treatment of SICH remains a controversy. SICH encompasses spectra of possible clot locations with varying volumes. Surgery so far has been reserved only for patients with large hematomas and impending brain herniation. Critical analysis of the earlier studies has now shown that surgery does help in clots in certain locations and of particular volume and when done at an optimal time. Poor grade patients with large hematomas, earlier considered poor surgical candidates are being taken up for aggressive decompressive craniectomies with fair results. In addition, minimally invasive surgical techniques complemented by thrombolytic techniques seem to providing surprisingly good results. Overall surgery seems to be going through a period of renaissance with respect to primary spontaneous ICHs.

  4. Effect of probenecid on breathing movements and cerebral clearance of prostaglandin E2 in fetal sheep

    Science.gov (United States)

    Walker, David W; Pratt, Naomi

    1998-01-01

    Intravenous infusion of probencid (79-160 mg kg−1) into unanaesthetized fetal sheep (127-143 days gestation) in utero significantly decreased the incidence and amplitude of spontaneous breathing movements, but did not change the incidence of low voltage electrocortical (ECoG) activity, plasma prostaglandin E2 (PGE2) concentrations, blood gases or pH. In fetuses pretreated with paracetamol (350 mg kg−1) to inhibit PG synthase activity, infusion of probenecid did not change the mean incidence or amplitude of breathing movements, indicating that the inhibitory effect of probenecid on breathing movements required the presence of active PG synthesis. Probenecid infusion in four unanaesthetized fetuses significantly increased the PGE2 concentrations in cisternal cerebrospinal fluid (CSF) by 6.6 ± 1.5-fold (P probenecid infusion decreased the clearance of [3H]PGE2 from CSF during ventriculo-cisternal perfusion of artificial CSF containing [3H]PGE2. These results suggest that there is active transport of PGs from CSF to blood in fetal sheep from at least 127 days gestation. Inhibition of this transport results in the accumulation of PGs within interstitial fluid of the brain, one effect of which is to suppress the spontaneous activity of the respiratory centres. PMID:9481686

  5. Spontaneous compactification to homogeneous spaces

    International Nuclear Information System (INIS)

    Mourao, J.M.

    1988-01-01

    The spontaneous compactification of extra dimensions to compact homogeneous spaces is studied. The methods developed within the framework of coset space dimensional reduction scheme and the most general form of invariant metrics are used to find solutions of spontaneous compactification equations

  6. Screening for spontaneous preterm birth

    NARCIS (Netherlands)

    van Os, M.A.; van Dam, A.J.E.M.

    2015-01-01

    Preterm birth is the most important cause of perinatal morbidity and mortality worldwide. In this thesis studies on spontaneous preterm birth are presented. The main objective was to investigate the predictive capacity of mid-trimester cervical length measurement for spontaneous preterm birth in a

  7. Spontaneous Pneumomediastinum: Hamman Syndrome

    Directory of Open Access Journals (Sweden)

    Tushank Chadha, BS

    2018-04-01

    significant fat stranding. The image also showed an intraluminal stent traversing the gastric antrum and gastric pylorus with no indication of obstruction. Circumferential mural thickening of the gastric antrum and body were consistent with the patient’s history of gastric adenocarcinoma. The shotty perigastric lymph nodes with associated fat stranding, along the greater curvature of the distal gastric body suggested local regional nodal metastases and possible peritoneal carcinomatosis. The thoracic CT scans showed extensive pneumomediastinum that tracked into the soft tissues of the neck, which given the history of vomiting also raised concern for esophageal perforation. There was still no evidence of mediastinal abscess or fat stranding. Additionally, a left subclavian vein port catheter, which terminates with tip at the cavoatrial junction of the superior vena cava can also be seen on the image. Discussion: Spontaneous Pneumomediastinum, also known as Hamman syndrome, is defined by the uncommon incidence of free air in the mediastinum due to the bursting of alveoli, as a result of extended spells of shouting, coughing, or vomiting.1,2 The condition is diagnosed when a clear cause (aerodigestive rupture, barotrauma, infection secondary to gas-forming organisms3 for pneumomediastinum cannot be clearly identified on diagnostic studies. Macklin and Macklin were the first to note the pathogenesis of the syndrome and explained that the common denominator to spontaneous pneumomediastinum was that increased alveolar pressure leads to alveolar rupture.3 Common clinical findings for spontaneous pneumomediastinum include: chest pain, dyspnea, cough, and emesis.4 The condition is not always readily recognized on initial presentation in part for its rare incidence, estimated to be approximately 1 in every 44,500 ED patients3and also because of the non-specific presenting symptoms. For this patient, there was no clear singular cause, and therefore she received care for spontaneous

  8. Acceleration sensors in abdominal wall position as a non-invasive approach to detect early breathing alterations induced by intolerance of increased airway resistance.

    Science.gov (United States)

    Breuer, Thomas; Bruells, Christian S; Rossaint, Rolf; Steffen, Henning; Disselhorst-Klug, Catherine; Czaplik, Michael; Zoremba, Norbert

    2017-11-10

    Early detection of respiratory overload is crucial to mechanically ventilated patients, especially during phases of spontaneous breathing. Although a diversity of methods and indices has been established, there is no highly specific approach to predict respiratory failure. This study aimed to evaluate acceleration sensors in abdominal and thoracic wall positions to detect alterations in breathing excursions in a setting of gradual increasing airway resistance. Twenty-nine healthy volunteers were committed to a standardized protocol of a two-minutes step-down spontaneous breathing on a 5 mm, 4 mm and then 3 mm orally placed endotracheal tube. Accelerator sensors in thoracic and abdominal wall position monitored breathing excursions. 15 participants passed the breathing protocol ("completed" group), 14 individuals cancelled the protocol due to subjective intolerance to the increasing airway resistance ("abandoned" group). Gradual increased respiratory workload led to a significant decrease of acceleration in abdominal wall position in the "abandoned" group compared to the "completed" group (p breathing alterations prior to respiratory failure. EK 309-15; by the Ethics Committee of the Faculty of Medicine, RWTH Aachen, Aachen, Germany. Retrospectively registered 28th of December 2015.

  9. Horses Auto-Recruit Their Lungs by Inspiratory Breath Holding Following Recovery from General Anaesthesia.

    Science.gov (United States)

    Mosing, Martina; Waldmann, Andreas D; MacFarlane, Paul; Iff, Samuel; Auer, Ulrike; Bohm, Stephan H; Bettschart-Wolfensberger, Regula; Bardell, David

    2016-01-01

    This study evaluated the breathing pattern and distribution of ventilation in horses prior to and following recovery from general anaesthesia using electrical impedance tomography (EIT). Six horses were anaesthetised for 6 hours in dorsal recumbency. Arterial blood gas and EIT measurements were performed 24 hours before (baseline) and 1, 2, 3, 4, 5 and 6 hours after horses stood following anaesthesia. At each time point 4 representative spontaneous breaths were analysed. The percentage of the total breath length during which impedance remained greater than 50% of the maximum inspiratory impedance change (breath holding), the fraction of total tidal ventilation within each of four stacked regions of interest (ROI) (distribution of ventilation) and the filling time and inflation period of seven ROI evenly distributed over the dorso-ventral height of the lungs were calculated. Mixed effects multi-linear regression and linear regression were used and significance was set at pbreath holding until 5 hours after standing. No change from baseline was seen for the distribution of ventilation during inspiration. Filling time and inflation period were more rapid and shorter in ventral and slower and longer in most dorsal ROI compared to baseline, respectively. In a mixed effects multi-linear regression, breath holding was significantly correlated with PaCO2 in both the univariate and multivariate regression. Following recovery from anaesthesia, horses showed inspiratory breath holding during which gas redistributed from ventral into dorsal regions of the lungs. This suggests auto-recruitment of lung tissue which would have been dependent and likely atelectic during anaesthesia.

  10. Spontaneous sigh rates during sedentary activity: watching television vs reading.

    Science.gov (United States)

    Hark, William T; Thompson, William M; McLaughlin, Timothy E; Wheatley, Lisa M; Platts-Mills, Thomas A E

    2005-02-01

    Spontaneous sighs are thought to play an important role in preventing atelectasis and in regulating airway tone. Recent studies have provided a mechanism by which expansion of the lungs could cause relaxation of smooth muscle. To investigate breathing patterns during 2 forms of sedentary behavior: reading and watching television. Breathing patterns were monitored for 1 to 2 hours to document respiratory rates and sigh rates. Each participant was monitored while reading and while watching a movie on videotape. During the first experiment (17 controls), metabolic rates were also measured. In the second experiment (18 controls and 9 patients with mild-to-moderate asthma), only breathing patterns were monitored. There were no significant differences in respiratory or metabolic rates between the 2 activities. In contrast, in the first experiment, 13 of 17 controls had lower sigh rates while watching a videotape than while reading (P < .01). In the second experiment, the sigh rate was significantly lower overall while watching a videotape (mean, 13.7 sighs per hour; range, 1.8-26.0 sighs per hour) than while reading (mean, 19.3 sighs per hour; range, 7.7-30.0 sighs per hour) (P < .001). A similar decrease was observed in patients with asthma (P < .01). Given that many children and adults watch television for 5 or more hours per day, breathing patterns during this time may be relevant to lung function. Our results demonstrate that prolonged periods of watching a videotape are associated with lower sigh rates than while reading. Further research is needed to determine whether these changes are relevant to increased bronchial reactivity.

  11. Sleep disordered breathing in children.

    Science.gov (United States)

    Sinha, Deepti; Guilleminault, Christian

    2010-02-01

    Sleep disordered breathing (SDB) is increasingly being recognised as a cause of morbidity even in young children. With an estimated prevalence of 1 to 4 per cent, SDB results from having a structurally narrow airway combined with reduced neuromuscular tone and increased airway collapsibility. SDB in children differs from adults in a number of ways, including presenting symptoms and treatment. Presentation may differ according to the age of the child. Children have a more varied presentation from snoring and frequent arousals to enuresis to hyperactivity. Those with Down syndrome, midface hypoplasia or neuromuscular disorders are at higher risk for developing SDB. First line definitive treatment in children involves tonsillectomy and adenoidectomy. Rapid maxillary expansion, allergy treatment and continuous positive airway pressure (CPAP) are other options. As untreated SDB results in complications as learning difficulties, memory loss and a long term increase in risk of hypertension, depression and poor growth, it is important to diagnose SDB.

  12. Time Breath of Psychological Theories

    DEFF Research Database (Denmark)

    Tateo, Luca; Valsiner, Jaan

    2015-01-01

    Psychology as a self-aspiring, ambitious, developmental science faces the crucial limit of time—both theoretically and practically. The issue of time in constructing psychology’s theories is a major unresolved metatheoretical task. This raises several questions about generalization of knowledge......: which is the time length of breath of psychological theories? Which is the temporal dimension of psychological processes? In this article we discuss the role of different axiomatic assumptions about time in the construction of psychological theories. How could different theories include a concept...... of time—or fail to do that? How can they generalize with respect to time? The different conceptions of time often remain implicit, while shaping the concepts used in understanding psychological processes. Any preconception about time in human development will foster the generalizability of theory, as well...

  13. The indoor air we breathe.

    Science.gov (United States)

    Oliver, L C; Shackleton, B W

    1998-01-01

    Increasingly recognized as a potential public health problem since the outbreak of Legionnaire's disease in Philadelphia in 1976, polluted indoor air has been associated with health problems that include asthma, sick building syndrome, multiple chemical sensitivity, and hypersensitivity pneumonitis. Symptoms are often nonspecific and include headache, eye and throat irritation, chest tightness and shortness of breath, and fatigue. Air-borne contaminants include commonly used chemicals, vehicular exhaust, microbial organisms, fibrous glass particles, and dust. Identified causes include defective building design and construction, aging of buildings and their ventilation systems, poor climate control, inattention to building maintenance. A major contributory factor is the explosion in the use of chemicals in building construction and furnishing materials over the past four decades. Organizational issues and psychological variables often contribute to the problem and hinder its resolution. This article describes the health problems related to poor indoor air quality and offers solutions.

  14. Fast-starting after a breath: air-breathing motions are kinematically similar to escape responses in the catfish Hoplosternum littorale

    Directory of Open Access Journals (Sweden)

    Paolo Domenici

    2014-12-01

    Full Text Available Fast-starts are brief accelerations commonly observed in fish within the context of predator–prey interactions. In typical C-start escape responses, fish react to a threatening stimulus by bending their body into a C-shape during the first muscle contraction (i.e. stage 1 which provides a sudden acceleration away from the stimulus. Recently, similar C-starts have been recorded in fish aiming at a prey. Little is known about C-starts outside the context of predator–prey interactions, though recent work has shown that escape response can also be induced by high temperature. Here, we test the hypothesis that air-breathing fish may use C-starts in the context of gulping air at the surface. Hoplosternum littorale is an air-breathing freshwater catfish found in South America. Field video observations reveal that their air-breathing behaviour consists of air-gulping at the surface, followed by a fast turn which re-directs the fish towards the bottom. Using high-speed video in the laboratory, we compared the kinematics of the turn immediately following air-gulping performed by H. littorale in normoxia with those of mechanically-triggered C-start escape responses and with routine (i.e. spontaneous turns. Our results show that air-breathing events overlap considerably with escape responses with a large stage 1 angle in terms of turning rates, distance covered and the relationship between these rates. Therefore, these two behaviours can be considered kinematically comparable, suggesting that air-breathing in this species is followed by escape-like C-start motions, presumably to minimise time at the surface and exposure to avian predators. These findings show that C-starts can occur in a variety of contexts in which fish may need to get away from areas of potential danger.

  15. Voice function differences following resting breathing versus submaximal exercise.

    Science.gov (United States)

    Sandage, Mary J; Connor, Nadine P; Pascoe, David D

    2013-09-01

    There is little known about how physical exercise may alter physiological parameters of voice production. In this investigation, vocal function and upper airway temperature were examined following a bout of submaximal exercise and compared with a resting breathing condition. It was hypothesized that phonation threshold pressure (PTP) and perceived phonatory effort (PPE) would increase and pharyngeal temperature would decrease following an exercise bout. Using a within-participant repeated measures design, 18 consented participants (nine men and nine women) completed the study. A 20-minute equilibration task was immediately followed by 8 minutes of submaximal exercise on a stationary bike in a thermally neutral environment (25°C/40% RH). At the end of the equilibration trial and the exercise trial, measures were taken in the following order: pharyngeal temperature, PTP, and PPE. Data were analyzed using paired t tests with significance set at P function requires further study. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  16. Immediate effects of breath holding maneuvers onto composition of exhaled breath.

    Science.gov (United States)

    Sukul, Pritam; Trefz, Phillip; Schubert, Jochen K; Miekisch, Wolfram

    2014-09-01

    Rapid concentration changes due to physiological or pathophysiological effects rather than appearance of unique disease biomarkers are important for clinical application of breath research. Simple maneuvers such as breath holding may significantly affect breath biomarker concentrations. In this study, exhaled volatile organic compound (VOC) concentrations were assessed in real time before and after different breath holding maneuvers. Continuous breath-resolved measurements (PTR-ToF-MS-8000) were performed in 31 healthy human subjects in a side-stream sampling mode. After 1 min of tidal breathing participants held their breath for 10, 20, 40, 60 s and as long as possible. Afterwards they continued to breathe normally for another minute. VOC profiles could be monitored in real time by assigning online PTR-ToF-MS data to alveolar or inspired phases of breath. Sudden and profound changes of exhaled VOC concentrations were recorded after different breath holding maneuvers. VOC concentrations returned to base line levels 10-20 s after breath holding. Breath holding induced concentration changes depended on physico-chemical properties of the substances. When substance concentrations were normalized onto end-tidal CO2 content, variation of acetone concentrations decreased, whereas variations of isoprene concentrations were not affected. As the effects of breathing patterns on exhaled substance concentrations depend on individual substance properties, sampling procedures have to be validated for each compound by means of appropriate real-time analysis. Normalization of exhaled concentrations onto exhaled CO2 is only valid for substances having similar physico-chemical properties as CO2.

  17. Spontaneous breaking of supersymmetry

    Energy Technology Data Exchange (ETDEWEB)

    Zumino, B.

    1981-12-01

    There has been recently a revival of interest in supersymmetric gauge theories, stimulated by the hope that supersymmetry might help in clarifying some of the questions which remain unanswered in the so called Grand Unified Theories and in particular the gauge hierarchy problem. In a Grand Unified Theory one has two widely different mass scales: the unification mass M approx. = 10/sup 15/GeV at which the unification group (e.g. SU(5)) breaks down to SU(3) x SU(2) x U(1) and the mass ..mu.. approx. = 100 GeV at which SU(2) x U(1) is broken down to the U(1) of electromagnetism. There is at present no theoretical understanding of the extreme smallness of the ratio ..mu../M of these two numbers. This is the gauge hierarchy problem. This lecture attempts to review the various mechanisms for spontaneous supersymmetry breaking in gauge theories. Most of the discussions are concerned with the tree approximation, but what is presently known about radiative correction is also reviewed.

  18. Spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Haritanti, A.; Karacostas, D.; Drevelengas, A.; Kanellopoulos, V.; Paraskevopoulou, E.; Lefkopoulos, A.; Economou, I.; Dimitriadis, A.S.

    2009-01-01

    Spontaneous intracranial hypotension (SIH) is an uncommon but increasingly recognized syndrome. Orthostatic headache with typical findings on magnetic resonance imaging (MRI) are the key to diagnosis. Delayed diagnosis of this condition may subject patients to unnecessary procedures and prolong morbidity. We describe six patients with SIH and outline the important clinical and neuroimaging findings. They were all relatively young, 20-54 years old, with clearly orthostatic headache, minimal neurological signs (only abducent nerve paresis in two) and diffuse pachymeningeal gadolinium enhancement on brain MRI, while two of them presented subdural hygromas. Spinal MRI was helpful in detecting a cervical cerebrospinal fluid leak in three patients and dilatation of the vertebral venous plexus with extradural fluid collection in another. Conservative management resulted in rapid resolution of symptoms in five patients (10 days-3 weeks) and in one who developed cerebral venous sinus thrombosis, the condition resolved in 2 months. However, this rapid clinical improvement was not accompanied by an analogous regression of the brain MR findings that persisted on a longer follow-up. Along with recent literature data, our patients further point out that SIH, to be correctly diagnosed, necessitates increased alertness by the attending physician, in the evaluation of headaches

  19. Spontaneous lateral temporal encephalocele.

    Science.gov (United States)

    Tuncbilek, Gokhan; Calis, Mert; Akalan, Nejat

    2013-01-01

    A spontaneous encephalocele is one that develops either because of embryological maldevelopment or from a poorly understood postnatal process that permits brain herniation to occur. We here report a rare case of lateral temporal encephalocele extending to the infratemporal fossa under the zygomatic arch. At birth, the infant was noted to have a large cystic mass in the right side of the face. After being operated on initially in another center in the newborn period, the patient was referred to our clinic with a diagnosis of temporal encephalocele. He was 6 months old at the time of admission. Computerized tomography scan and magnetic resonance imaging studies revealed a 8 × 9 cm fluid-filled, multiloculated cystic mass at the right infratemporal fossa. No intracranial pathology or connection is seen. The patient was operated on to reduce the distortion effect of the growing mass. The histopathological examination of the sac revealed well-differentiated mature glial tissue stained with glial fibrillary acid protein. This rare clinical presentation of encephaloceles should be taken into consideration during the evaluation of the lateral facial masses in the infancy period, and possible intracranial connection should be ruled out before surgery to avoid complications.

  20. Breathing changes accompanying balance improvement during biofeedback.

    Science.gov (United States)

    Hirjaková, Zuzana; Neumannová, Kateřina; Kimijanová, Jana; Šuttová, Kristína; Janura, Miroslav; Hlavačka, František

    2017-06-09

    The aim of this study was to determine whether respiration would be altered during visual biofeedback condition while standing on a foam surface. Fifty young, healthy subjects (24 men, 26 women) were divided into a spirometry group, in which additional spirometry analysis was performed, and a control group. All subjects were tested in two conditions: 1) standing on a foam surface and 2) standing on a foam surface with visual biofeedback (VF) based on the centre of pressure (CoP). CoP amplitude and velocity in anterior-posterior (Aap, Vap) and medial-lateral (Aml, Vml) directions were measured by the force platform. Breathing movements were recorded by two pairs of 3D accelerometers attached on the upper chest (upper chest breathing - UCB) and the lower chest (lower chest breathing - LCB). Results showed that significant decreases of CoP amplitude and velocity in both directions were accompanied by a significant decrease of lower chest breathing, and an increase of LCB frequency was seen during VF condition compared to control condition in both groups. Moreover, a significant decrease in tidal volume and increased breathing frequency during VF condition were confirmed by spirometric analysis. Reduced breathing movements and volumes as well as increased breathing frequency are probably part of an involuntary strategy activated to maximize balance improvement during VF condition. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. A new co-axial breathing system. A combination of the benefits of Mapleson A, D and E systems.

    Science.gov (United States)

    Burchett, K R; Bennett, J A

    1985-02-01

    A new, simple, versatile co-axial breathing system combining the features of Mapleson A, D and E type systems is described. The change from an A system to a D/E system is effected by a single switch and without reversal of the gas flow. Fresh gas flows in the order of 70 ml/kg/min are required for both spontaneous ventilation in the Mapleson A mode and controlled ventilation in the Mapleson D mode. The co-axial configuration offers the advantages of a single, lightweight breathing system with easy scavenging of anaesthetic gases, while the ability to switch between the A and D or E configurations offers the economic advantages of low fresh gas flows and the need for a single anaesthetic breathing system for all situations.

  2. Air sampling unit for breath analyzers

    Science.gov (United States)

    Szabra, Dariusz; Prokopiuk, Artur; Mikołajczyk, Janusz; Ligor, Tomasz; Buszewski, Bogusław; Bielecki, Zbigniew

    2017-11-01

    The paper presents a portable breath sampling unit (BSU) for human breath analyzers. The developed unit can be used to probe air from the upper airway and alveolar for clinical and science studies. The BSU is able to operate as a patient interface device for most types of breath analyzers. Its main task is to separate and to collect the selected phases of the exhaled air. To monitor the so-called I, II, or III phase and to identify the airflow from the upper and lower parts of the human respiratory system, the unit performs measurements of the exhaled CO2 (ECO2) in the concentration range of 0%-20% (0-150 mm Hg). It can work in both on-line and off-line modes according to American Thoracic Society/European Respiratory Society standards. A Tedlar bag with a volume of 5 dm3 is mounted as a BSU sample container. This volume allows us to collect ca. 1-25 selected breath phases. At the user panel, each step of the unit operation is visualized by LED indicators. This helps us to regulate the natural breathing cycle of the patient. There is also an operator's panel to ensure monitoring and configuration setup of the unit parameters. The operation of the breath sampling unit was preliminarily verified using the gas chromatography/mass spectrometry (GC/MS) laboratory setup. At this setup, volatile organic compounds were extracted by solid phase microextraction. The tests were performed by the comparison of GC/MS signals from both exhaled nitric oxide and isoprene analyses for three breath phases. The functionality of the unit was proven because there was an observed increase in the signal level in the case of the III phase (approximately 40%). The described work made it possible to construct a prototype of a very efficient breath sampling unit dedicated to breath sample analyzers.

  3. Bilateral spontaneous carotid artery dissection.

    Science.gov (United States)

    Townend, Bradley Scott; Traves, Laura; Crimmins, Denis

    2005-06-01

    Bilateral internal carotid artery dissections have been reported, but spontaneous bilateral dissections are rare. Internal carotid artery dissection can present with a spectrum of symptoms ranging from headache to completed stroke. Two cases of spontaneous bilateral carotid artery dissection are presented, one with headache and minimal symptoms and the other with a stroke syndrome. No cause could be found in either case, making the dissections completely spontaneous. Bilateral internal carotid artery dissection (ICAD) should be considered in young patients with unexplained head and neck pain with or without focal neurological symptoms and signs. The increasing availability of imaging would sustain the higher index of suspicion.

  4. Effect of different breathing aids on ventilation distribution in adults with cystic fibrosis.

    Directory of Open Access Journals (Sweden)

    Markus Wettstein

    Full Text Available BACKGROUND AND OBJECTIVES: We investigated the effect of different breathing aids on ventilation distribution in healthy adults and subjects with cystic fibrosis (CF. METHODS: In 11 healthy adults and 9 adults with CF electrical impedance tomography measurements were performed during spontaneous breathing, continuous positive airway pressure (CPAP and positive expiratory pressure (PEP therapy randomly applied in upright and lateral position. Spatial and temporal ventilation distribution was assessed. RESULTS: The proportion of ventilation directed to the dependent lung significantly increased in lateral position compared to upright in healthy and CF. This effect was enhanced with CPAP but neutralised with PEP, whereas the effect of PEP was larger in the healthy group. Temporal ventilation distribution showed exactly the opposite with homogenisation during CPAP and increased inhomogeneity with PEP. CONCLUSIONS: PEP shows distinct differences to CPAP with respect to its impact on ventilation distribution in healthy adults and CF subjects EIT might be used to individualise respiratory physiotherapy.

  5. Is breath acetone a biomarker of diabetes? A historical review on breath acetone measurements.

    Science.gov (United States)

    Wang, Zhennan; Wang, Chuji

    2013-09-01

    Since the ancient discovery of the 'sweet odor' in human breath gas, pursuits of the breath analysis-based disease diagnostics have never stopped. Actually, the 'smell' of the breath, as one of three key disease diagnostic techniques, has been used in Eastern-Medicine for more than three thousand years. With advancement of measuring technologies in sensitivity and selectivity, more specific breath gas species have been identified and established as a biomarker of a particular disease. Acetone is one of the breath gases and its concentration in exhaled breath can now be determined with high accuracy using various techniques and methods. With the worldwide prevalence of diabetes that is typically diagnosed through blood testing, human desire to achieve non-blood based diabetic diagnostics and monitoring has never been quenched. Questions, such as is breath acetone a biomarker of diabetes and how is the breath acetone related to the blood glucose (BG) level (the golden criterion currently used in clinic for diabetes diagnostic, monitoring, and management), remain to be answered. A majority of current research efforts in breath acetone measurements and its technology developments focus on addressing the first question. The effort to tackle the second question has begun recently. The earliest breath acetone measurement in clearly defined diabetic patients was reported more than 60 years ago. For more than a half-century, as reviewed in this paper, there have been more than 41 independent studies of breath acetone using various techniques and methods, and more than 3211 human subjects, including 1581 healthy people, 242 Type 1 diabetic patients, 384 Type 2 diabetic patients, 174 unspecified diabetic patients, and 830 non-diabetic patients or healthy subjects who are under various physiological conditions, have been used in the studies. The results of the breath acetone measurements collected in this review support that many conditions might cause changes to breath

  6. SERS spectroscopy for detection of hydrogen cyanide in breath from children colonised with P. aeruginosa

    DEFF Research Database (Denmark)

    Lauridsen, Rikke Kragh; Skou, Peter Bæk; Rindzevicius, Tomas

    2017-01-01

    ) nanochip optimised for detection of trace amounts of the P. aeruginosa biomarker hydrogen cyanide (HCN) was mounted inside a Tedlar bag, which the patient breathed into. The SERS chip was then analysed in a Raman spectrometer, investigating the C≡N peak at 2131 cm-1 and correlated with sputum cultures. One...... new P. aeruginosa colonisation occurred during the trial period. The C≡N peak intensity was enhanced in this sample in contrast to the subject's 3 other samples. Three additional patients had intense C≡N SERS signals from their breath, but no P. aeruginosa was cultured from their sputum....... It is concluded that SERS spectroscopy can be developed into an easy to use hypersensitive clinical prescreening method for detection of HCN in human breath. ...

  7. A mass balance model for the Mapleson D anaesthesia breathing system.

    Science.gov (United States)

    Lovich, M A; Simon, B A; Venegas, J G; Sims, N M; Cooper, J B

    1993-06-01

    A mathematical model is described which calculates the alveolar concentration of CO2(FACO2) in a patient breathing through a Mapleson D anaesthesia system. The model is derived using a series of mass balances for CO2 in the alveolar space, dead space, breathing system limb volume and reservoir. The variables included in the model are tidal volume (VT), respiratory rate, fresh gas flow rate (Vf), dead space volume, I:E ratio, and expiratory limb volume (Vl) time constant of lung expiration, and carbon dioxide production rate. The model predictions are compared with measurements made using a mechanical lung simulator in both spontaneous and controlled ventilation. Both the model and the experimental data predict that at high fresh gas flow rates and low respiratory rates, FACO2 is independent of Vf; at low fresh gas flow rates and high respiratory rates, FACO2 is independent of respiratory rate. The model and the data show that the VT influences FACO2, independent of minute ventilation alone, during both partial re-breathing and non-rebreathing operation. Therefore, describing the operation in terms of minute ventilation is ambiguous. It is also shown that Vl influences FACO2 such that, for any combination of patient and breathing-system variables, there is a Vl that minimizes the Vf required to maintain FACO2. In addition, expiratory resistance can increase the fresh gas flow rate required to maintain a given FACO2. The respiratory patterns observed with spontaneous and controlled ventilation are responsible for the difference in Vf required with each mode of ventilation.

  8. 42 CFR 84.141 - Breathing gas; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing gas; minimum requirements. 84.141 Section... Respirators § 84.141 Breathing gas; minimum requirements. (a) Breathing gas used to supply supplied-air respirators shall be respirable breathing air and contain no less than 19.5 volume-percent of oxygen. (b...

  9. 14 CFR 25.1439 - Protective breathing equipment.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Protective breathing equipment. 25.1439... Protective breathing equipment. (a) Fixed (stationary, or built in) protective breathing equipment must be installed for the use of the flightcrew, and at least one portable protective breathing equipment shall be...

  10. 42 CFR 84.90 - Breathing resistance test; inhalation.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing resistance test; inhalation. 84.90...-Contained Breathing Apparatus § 84.90 Breathing resistance test; inhalation. (a) Resistance to inhalation airflow will be measured in the facepiece or mouthpiece while the apparatus is operated by a breathing...

  11. 42 CFR 84.91 - Breathing resistance test; exhalation.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing resistance test; exhalation. 84.91...-Contained Breathing Apparatus § 84.91 Breathing resistance test; exhalation. (a) Resistance to exhalation...-circuit apparatus with a breathing machine as described in § 84.88, and the exhalation resistance shall...

  12. 42 CFR 84.88 - Breathing bag test.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing bag test. 84.88 Section 84.88 Public... RESEARCH AND RELATED ACTIVITIES APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Self-Contained Breathing Apparatus § 84.88 Breathing bag test. (a) Breathing bags will be tested in an air atmosphere saturated with...

  13. 14 CFR 121.337 - Protective breathing equipment.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Protective breathing equipment. 121.337... Protective breathing equipment. (a) The certificate holder shall furnish approved protective breathing equipment (PBE) meeting the equipment, breathing gas, and communication requirements contained in paragraph...

  14. 21 CFR 868.5270 - Breathing system heater.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Breathing system heater. 868.5270 Section 868.5270...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5270 Breathing system heater. (a) Identification. A breathing system heater is a device that is intended to warm breathing gases before they enter...

  15. Oxygen breathing accelerates decompression from saturation at 40 msw in 70-kg swine.

    Science.gov (United States)

    Petersen, Kyle; Soutiere, Shawn E; Tucker, Kathryn E; Dainer, Hugh M; Mahon, Richard T

    2010-07-01

    Submarine disaster survivors can be transferred from a disabled submarine at a pressure of 40 meters of seawater (msw) to a new rescue vehicle; however, they face an inherently risky surface interval before recompression and an enormous decompression obligation due to a high likelihood of saturation. The goal was to design a safe decompression protocol using oxygen breathing and a trial-and-error methodology. We hypothesized that depth, timing, and duration of oxygen breathing during decompression from saturation play a role to mitigate decompression outcomes. Yorkshire swine (67-75 kg), compressed to 40 msw for 22 h, underwent one of three accelerated decompression profiles: (1) 13.3 h staged air decompression to 18 msw, followed by 1 h oxygen breathing, then dropout; (2) direct decompression to 18 msw followed by 1 h oxygen breathing then dropout; and (3) 1 h oxygen prebreathe at 40 msw followed by 1 h mixed gas breathing at 26 msw, 1 h oxygen breathing at 18 msw, and 1 h ascent breathing oxygen. Animals underwent 2-h observation for signs of DCS. Profile 1 (14.3 h total) resulted in no deaths, no Type II DCS, and 20% Type I DCS. Profile 2 (2.1 h total) resulted in 13% death, 50% Type II DCS, and 75% Type I DCS. Profile 3 (4.5 h total) resulted in 14% death, 21% Type II DCS, and 57% Type I DCS. No oxygen associated seizures occurred. Profile 1 performed best, shortening decompression with no death or severe DCS, yet it may still exceed emergency operational utility in an actual submarine rescue.

  16. [14C-urea breath test to diagnose gastric Helicobacter pylori colonization].

    Science.gov (United States)

    Coelho, L G; Chausson, Y; Passos, M C; Sadala, R U; Costa, E L; Sabino, C V; Queiroz, D M; Mendes, E N; Rocha, G A; Oliveira, C A

    1990-01-01

    Helicobacter pylori (H. pylori), ex-Campylobacter pylori, is now considered to be the causative agent of active chronic gastritis in humans and may be diagnosed by histology, gram-stain, culture, urease test or noninvasively by 14C-urea breath test. The aim of this study was to determine the sensitivity, specificity, and reproducibility of the breath test as compared with the microbiological (culture) "gold standard". Forty-one subjects were studied. Gastroscopy was performed in all participants and 2 antral mucosa biopsy specimens were taken for urease test and microbiological (gram-stain and culture) studies. The breath test was performed within one week after the gastroscopy. After fasting overnight, a control breath sample was obtained and a standard meal was offered to delay gastric emptying. Then, the participants drank 5 microCi of 14C-urea in 20 ml of water and breath samples were collected at 10, 15, 30 and 60 min in a hyamine-ethanol solution with a p-H indicator. A repeat test was performed in 9 subjects to assess test reproducibility. Twenty-nine subjects (71 percent) were Hp positive and 12 (29 percent) H. pylori negative. A highly significant difference (p less than 0.0001) was observed in 14CO2 exhalation in colonized and non-colonized subjects in samples collected at all times studied. As compared with culture we found that the breath test was 97 percent sensitive and 100 percent specific. We conclude that 14C-urea breath test is a simple, inexpensive, sensitive, and reliable method to detect H. pylori colonization. It is a useful test to epidemiologic and therapeutic trials.

  17. Cardiac autonomic function in patients with diabetes improves with practice of comprehensive yogic breathing program

    Directory of Open Access Journals (Sweden)

    Viveka P Jyotsna

    2013-01-01

    Full Text Available Background: The aim of this study was to observe the effect comprehensive yogic breathing (Sudarshan Kriya Yoga [SKY] and Pranayam had on cardiac autonomic functions in patients with diabetes. Materials and Methods: This is a prospective randomized controlled intervention trial. Cardiac autonomic functions were assessed in 64 diabetics. Patients were randomized into two groups, one group receiving standard therapy for diabetes and the other group receiving standard therapy for diabetes and comprehensive yogic breathing program. Standard therapy included dietary advice, brisk walking for 45 min daily, and administration of oral antidiabetic drugs. Comprehensive yogic breathing program was introduced to the participants through a course of 12 h spread over 3 days. It was an interactive session in which SKY, a rhythmic cyclical breathing, preceded by Pranayam is taught under the guidance of a certified teacher. Cardiac autonomic function tests were done before and after 6 months of intervention. Results: In the intervention group, after practicing the breathing techniques for 6 months, the improvement in sympathetic functions was statistically significant (P 0.04. The change in sympathetic functions in the standard therapy group was not significant (P 0.75.Parasympathetic functions did not show any significant change in either group. When both parasympathetic and sympathetic cardiac autonomic functions were considered, there was a trend toward improvement in patients following comprehensive yogic breathing program (P 0.06. In the standard therapy group, no change in cardiac autonomic functions was noted (P 0.99. Conclusion: Cardiac autonomic functions improved in patients with diabetes on standard treatment who followed the comprehensive yogic breathing program compared to patients who were on standard therapy alone.

  18. Spontaneous intraorbital hematoma: case report

    Directory of Open Access Journals (Sweden)

    Vinodan Paramanathan

    2010-12-01

    Full Text Available Vinodan Paramanathan, Ardalan ZolnourianQueen's Hospital NHS Foundation Trust, Burton on Trent, Staffordshire DE13 0RB, UKAbstract: Spontaneous intraorbital hematoma is an uncommon clinical entity seen in ophthalmology practice. It is poorly represented in the literature. Current evidence attributes it to orbital trauma, neoplasm, vascular malformations, acute sinusitis, and systemic abnormalities. A 65-year-old female presented with spontaneous intraorbital hematoma manifesting as severe ocular pains, eyelid edema, proptosis, and diplopia, without a history of trauma. Computer tomography demonstrated a fairly well defined extraconal lesion with opacification of the paranasal sinuses. The principal differential based on all findings was that of a spreading sinus infection and an extraconal tumor. An unprecedented finding of a spontaneous orbital hematoma was discovered when the patient was taken to theater. We discuss the rarity of this condition and its management.Keywords: hemorrhage, ophthalmology, spontaneous, intra-orbital, hematoma

  19. Design and Validation of a Breathing Detection System for Scuba Divers.

    Science.gov (United States)

    Altepe, Corentin; Egi, S Murat; Ozyigit, Tamer; Sinoplu, D Ruzgar; Marroni, Alessandro; Pierleoni, Paola

    2017-06-09

    Drowning is the major cause of death in self-contained underwater breathing apparatus (SCUBA) diving. This study proposes an embedded system with a live and light-weight algorithm which detects the breathing of divers through the analysis of the intermediate pressure (IP) signal of the SCUBA regulator. A system composed mainly of two pressure sensors and a low-power microcontroller was designed and programmed to record the pressure sensors signals and provide alarms in absence of breathing. An algorithm was developed to analyze the signals and identify inhalation events of the diver. A waterproof case was built to accommodate the system and was tested up to a depth of 25 m in a pressure chamber. To validate the system in the real environment, a series of dives with two different types of workload requiring different ranges of breathing frequencies were planned. Eight professional SCUBA divers volunteered to dive with the system to collect their IP data in order to participate to validation trials. The subjects underwent two dives, each of 52 min on average and a maximum depth of 7 m. The algorithm was optimized for the collected dataset and proved a sensitivity of inhalation detection of 97.5% and a total number of 275 false positives (FP) over a total recording time of 13.9 h. The detection algorithm presents a maximum delay of 5.2 s and requires only 800 bytes of random-access memory (RAM). The results were compared against the analysis of video records of the dives by two blinded observers and proved a sensitivity of 97.6% on the data set. The design includes a buzzer to provide audible alarms to accompanying dive buddies which will be triggered in case of degraded health conditions such as near drowning (absence of breathing), hyperventilation (breathing frequency too high) and skip-breathing (breathing frequency too low) measured by the improper breathing frequency. The system also measures the IP at rest before the dive and indicates with flashing light

  20. Design and Validation of a Breathing Detection System for Scuba Divers

    Directory of Open Access Journals (Sweden)

    Corentin Altepe

    2017-06-01

    Full Text Available Drowning is the major cause of death in self-contained underwater breathing apparatus (SCUBA diving. This study proposes an embedded system with a live and light-weight algorithm which detects the breathing of divers through the analysis of the intermediate pressure (IP signal of the SCUBA regulator. A system composed mainly of two pressure sensors and a low-power microcontroller was designed and programmed to record the pressure sensors signals and provide alarms in absence of breathing. An algorithm was developed to analyze the signals and identify inhalation events of the diver. A waterproof case was built to accommodate the system and was tested up to a depth of 25 m in a pressure chamber. To validate the system in the real environment, a series of dives with two different types of workload requiring different ranges of breathing frequencies were planned. Eight professional SCUBA divers volunteered to dive with the system to collect their IP data in order to participate to validation trials. The subjects underwent two dives, each of 52 min on average and a maximum depth of 7 m. The algorithm was optimized for the collected dataset and proved a sensitivity of inhalation detection of 97.5% and a total number of 275 false positives (FP over a total recording time of 13.9 h. The detection algorithm presents a maximum delay of 5.2 s and requires only 800 bytes of random-access memory (RAM. The results were compared against the analysis of video records of the dives by two blinded observers and proved a sensitivity of 97.6% on the data set. The design includes a buzzer to provide audible alarms to accompanying dive buddies which will be triggered in case of degraded health conditions such as near drowning (absence of breathing, hyperventilation (breathing frequency too high and skip-breathing (breathing frequency too low measured by the improper breathing frequency. The system also measures the IP at rest before the dive and indicates with

  1. Analysis for drugs in saliva and breath

    Science.gov (United States)

    1981-09-25

    Collection devices for saliva and breath that involved non-invasive techniques for sample collection were evaluated. Having subjects simply spit into a specially prepared glass vial was found to be an efficient, inexpensive and simple way to collect ...

  2. Analysis for drug in saliva and breath

    Science.gov (United States)

    1981-09-25

    Collection devices for saliva and breath that involved non-invasive : techniques for sample collection were evaluated. Having subjects simply : spit into a specially prepared glass vial was found to be an efficient, : inexpensive and simple way to co...

  3. Healthy Living: Helping Your Child Breathe Easier

    Science.gov (United States)

    ... Breathe Easier Font: Aerosol Delivery Oxygen Resources Immunizations Pollution Nutrition Exercise Coming Of Age Older Adults Allergy ... through these narrowed airways can produce a wheezing sound. Other forms the allergy may take are sneezing, ...

  4. Breath-holding spells in infants.

    Science.gov (United States)

    Goldman, Ran D

    2015-02-01

    I have children in my clinic who experience seizurelike episodes in which they cry and hold their breath to the point of cyanosis and loss of consciousness. Their examination or investigation findings are normal and referral to a pediatric specialist results in no further investigation. Are breath-holding spells common, and what type of investigation is needed? A breath-holding spell is a benign paroxysmal nonepileptic disorder occurring in healthy children 6 to 48 months of age. The episodes start with a provocation such as emotional upset or minor injury, and might progress to breath holding, cyanosis, and syncope. The episodes are extremely frightening to watch but have benign consequences. Once a clinical diagnosis is made, it is recommended to conduct an electrocardiogram and to rule out anemia, but no further investigation or referral is warranted. Copyright© the College of Family Physicians of Canada.

  5. Humidifiers: Air Moisture Eases Skin, Breathing Symptoms

    Science.gov (United States)

    Humidifiers: Air moisture eases skin, breathing symptoms Humidifiers can ease problems caused by dry air. But they need regular maintenance. Here ... that emit water vapor or steam to increase moisture levels in the air (humidity). There are several ...

  6. Alcohol breath test: gas exchange issues.

    Science.gov (United States)

    Hlastala, Michael P; Anderson, Joseph C

    2016-08-01

    The alcohol breath test is reviewed with a focus on gas exchange factors affecting its accuracy. The basis of the alcohol breath test is the assumption that alveolar air reaches the mouth during exhalation with no change in alcohol concentration. Recent investigations have shown that alcohol concentration is altered during its transit to the mouth. The exhaled alcohol concentration is modified by interaction with the mucosa of the pulmonary airways. Exhaled alcohol concentration is not an accurate indicator of alveolar alcohol concentration. Measuring alcohol concentration in the breath is very different process than measuring a blood level from air equilibrated with a blood sample. Airway exchange of alcohol leads to a bias against certain individuals depending on the anatomic and physiologic characteristics. Methodological modifications are proposed to improve the accuracy of the alcohol breath test to become fair to all. Copyright © 2016 the American Physiological Society.

  7. Seeking Allergy Relief: When Breathing Becomes Bothersome

    Science.gov (United States)

    ... Issues Subscribe June 2016 Print this issue Seeking Allergy Relief When Breathing Becomes Bothersome En español Send ... Preschoolers Benefit from Peanut Allergy Therapy Wise Choices Allergy Symptoms Runny or stuffy nose Sneezing Itchy nose, ...

  8. Atmospheric Breathing Electric Thruster for Planetary Exploration

    Data.gov (United States)

    National Aeronautics and Space Administration — This study will investigate the development of an atmosphere-breathing electric propulsion solar-powered vehicle to explore planets such as Mars. The vehicle would...

  9. Comparison of work of breathing using drawover and continuous flow anaesthetic breathing systems in children.

    Science.gov (United States)

    Bell, G T; McEwen, J P J; Beaton, S J; Young, D

    2007-04-01

    We compared the work of breathing under general anaesthesia in children using drawover and continuous flow anaesthetic systems. A pilot study was conducted in four children weighing > 20 kg in whom it would usually be considered appropriate to use breathing systems designed for adult anaesthesia. The pilot study compared work of breathing using the Mapleson D breathing system and the Triservice Anaesthetic Apparatus (TSAA). Work of breathing was calculated using the modified Campbell technique that calculates work using a pressure volume loop derived from oesophageal pressure and airway gas volume measurements. We found no difference in the work of breathing when comparing the Mapleson D and the TSAA in children > 20 kg. Following completion of the pilot study, we conducted a study on 10 children weighing between 10 and 20 kg comparing work of breathing using the Mapleson F breathing system and the TSAA. We found no significant difference in the work of breathing between the Mapleson F and the TSAA for these children. The TSAA can therefore be recommended for use down to a lower weight limit of 10 kg.

  10. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.

    2013-01-01

    Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....

  11. Spontaneity and international marketing performance

    OpenAIRE

    Souchon, Anne L.; Hughes, Paul; Farrell, Andrew M.; Nemkova, Ekaterina; Oliveira, Joao S.

    2016-01-01

    The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. Purpose – The purpose of this paper is to ascertain how today’s international marketers can perform better on the global scene by harnessing spontaneity. Design/methodology/approach – The authors draw on contingency theory to develop a model of the spontaneity – international marketing performance relationship, and identify three potential m...

  12. Long-term monitoring of breath methane.

    Science.gov (United States)

    Polag, Daniela; Keppler, Frank

    2018-05-15

    In recent years, methane as a component of exhaled human breath has been considered as a potential bioindicator providing information on microbial activity in the intestinal tract. Several studies indicated a relationship between breath methane status and specific gastrointestinal disease. So far, almost no attention has been given to the temporal variability of breath methane production by individual persons. Thus here, for the first time, long-term monitoring was carried out measuring breath methane of three volunteers over periods between 196 and 1002days. Results were evaluated taking into consideration the health status and specific medical intervention events for each individual during the monitoring period, and included a gastroscopy procedure, a vaccination, a dietary change, and chelate therapy. As a major outcome, breath methane mixing ratios show considerable variability within a person-specific range of values. Interestingly, decreased breath methane production often coincided with gastrointestinal complaints whereas influenza infections were mostly accompanied by increased breath methane production. A gastroscopic examination as well as a change to a low-fructose diet led to a dramatic shift of methane mixing ratios from high to low methane production. In contrast, a typhus vaccination as well as single chelate injections resulted in significant short-term methane peaks. Thus, this study clearly shows that humans can change from high to low methane emitters and vice versa within relatively short time periods. In the case of low to medium methane emitters the increase observed in methane mixing ratios, likely resulting from immune reactions and inflammatory processes, might indicate non-microbial methane formation under aerobic conditions. Although detailed reaction pathways are not yet known, aerobic methane formation might be related to cellular oxidative-reductive stress reactions. However, a detailed understanding of the pathways involved in human

  13. Swimming in air-breathing fishes.

    Science.gov (United States)

    Lefevre, S; Domenici, P; McKenzie, D J

    2014-03-01

    Fishes with bimodal respiration differ in the extent of their reliance on air breathing to support aerobic metabolism, which is reflected in their lifestyles and ecologies. Many freshwater species undertake seasonal and reproductive migrations that presumably involve sustained aerobic exercise. In the six species studied to date, aerobic exercise in swim flumes stimulated air-breathing behaviour, and there is evidence that surfacing frequency and oxygen uptake from air show an exponential increase with increasing swimming speed. In some species, this was associated with an increase in the proportion of aerobic metabolism met by aerial respiration, while in others the proportion remained relatively constant. The ecological significance of anaerobic swimming activities, such as sprinting and fast-start manoeuvres during predator-prey interactions, has been little studied in air-breathing fishes. Some species practise air breathing during recovery itself, while others prefer to increase aquatic respiration, possibly to promote branchial ion exchange to restore acid-base balance, and to remain quiescent and avoid being visible to predators. Overall, the diversity of air-breathing fishes is reflected in their swimming physiology as well, and further research is needed to increase the understanding of the differences and the mechanisms through which air breathing is controlled and used during exercise. © 2014 The Fisheries Society of the British Isles.

  14. Periodic breathing and apnea in preterm infants.

    Science.gov (United States)

    Barrington, K J; Finer, N N

    1990-02-01

    The relationship between periodic breathing and idiopathic apnea of prematurity was investigated. We recorded respiratory impedance, heart rate, pulse oximetry and end-tidal CO2 from 68 untreated infants of less than or equal to 34 wk gestation with a diagnosis of idiopathic apnea of prematurity. Mean birth wt was 1476 g (SD 420) and mean gestational age was 29.9 wk (SD 2.6). Apneas of more than 15 s duration that were associated with hypoxemia or bradycardia were identified by semiautomated analysis of computerized records. A total of 1116 significant apneic spells were identified, only one of which occurred during an epoch of periodic breathing, five others occurred within 2 min of the end of an epoch of periodic breathing. Less than 0.6% of significant apneic spells occur within 2 min of periodic breathing. In all of the 12 infants that were monitored starting in the first 12 h of life, significant apneic spells were identified before 36 h of age and no precipitating factors were identified. Periodic breathing did not occur during the first 48 h of life, a finding that supports the concept that the peripheral chemoreceptor is inactive in the first 48 h of life. Periodic breathing in the premature infant is not a precursor to significant apnea.

  15. Optoacoustic 13C-breath test analyzer

    Science.gov (United States)

    Harde, Hermann; Helmrich, Günther; Wolff, Marcus

    2010-02-01

    The composition and concentration of exhaled volatile gases reflects the physical ability of a patient. Therefore, a breath analysis allows to recognize an infectious disease in an organ or even to identify a tumor. One of the most prominent breath tests is the 13C-urea-breath test, applied to ascertain the presence of the bacterium helicobacter pylori in the stomach wall as an indication of a gastric ulcer. In this contribution we present a new optical analyzer that employs a compact and simple set-up based on photoacoustic spectroscopy. It consists of two identical photoacoustic cells containing two breath samples, one taken before and one after capturing an isotope-marked substrate, where the most common isotope 12C is replaced to a large extent by 13C. The analyzer measures simultaneously the relative CO2 isotopologue concentrations in both samples by exciting the molecules on specially selected absorption lines with a semiconductor laser operating at a wavelength of 2.744 μm. For a reliable diagnosis changes of the 13CO2 concentration of 1% in the exhaled breath have to be detected at a concentration level of this isotope in the breath of about 500 ppm.

  16. Effect of Continuous Promedol Infusion on Recovery of Spontaneous Breathing in Children in the Postoperative Period

    Directory of Open Access Journals (Sweden)

    E. V. Zilbert

    2011-01-01

    Full Text Available Objective: to study the impact of correcting immune disorders on the course of the disease in patients with abdominal sepsis. Subjects and methods. Ninety-five patients with abdominal sepsis were examined. APACHE III scores were 25—30. Humoral and cellular immunological parameters were studied in all the patients. The immunotropic drug Galavit was included into the combination treatment of 42 patients. Results. An immunodeficiency state was found in 74 (80% patients. The incorporation of targeted immunotherapy into the package of medical measures activated the immune system of patients and, in a number of cases, could elevate the level of T lymphocytes, reduced the rate of laparostomy wound suppurations by 1.9 times and the number of fatal outcomes by 10.1%. Conclusion. Incorporation of targeted immunotherapy into the package of medical measures activates cellular immunity and tissue regeneration processes and reduces the degree of endogenous intoxication, the rate of laparostomy wound suppurations, and the number of fatal outcomes. Key words: abdominal sepsis, immunomodulation, Galavit.

  17. [Weaning from prolonged mechanical ventilation at 72 hours of spontaneous breathing].

    Science.gov (United States)

    Villalba, Darío; Plotnikow, Gustavo; Feld, Viviana; Rivero Vairo, Noelia; Scapellato, José; Díaz Nielsen, Ernesto

    2015-01-01

    The aim of this study was to describe the population admitted to a weaning center (WC) to receive invasive mechanical ventilation (MV), analyze their evolution and identify weaning failure predictors. The medical records of 763 patients admitted to the respiratory care service in the period between May 2005 and January 2012 were reviewed; 372 were selected among 415 tracheotomized and mechanically ventilated. Different variables were analyzed as weaning failure predictors. The mean age of patients admitted was 69 years (SD 14.7), 57% were men. The median length of hospitalization in ICU was 33 days (IQR 26-46). Admission to ICU was due to medical causes in 86% of cases. During hospitalization in WC 186 (50%) patients achieved the successful weaning at a median of 13 days (interquartile range-IQR 5-38). A predictor of weaning failure was age. When we studied the subpopulation with partial disconnection of mechanical ventilation, we found a history of COPD and ageas predictors. Although 25% of the patients died, or required referral to a center of major complexity before 2 weeks of hospitalization, more than half of the patients were able to be removed permanently from the invasive mechanical ventilation (MV), this could support the care of chronic critical patients in MV and rehabilitation centers in Argentina because patients in these centers have a chance of weaning from MV, despite the high chances of developing complications.

  18. The Influence of the Thymine C5 Methyl Group on Spontaneous Base Pair Breathing in DNA

    Czech Academy of Sciences Publication Activity Database

    Wärmländer, S.; Šponer, Jiří; Leijon, M.; Šponer, Judit E.

    2002-01-01

    Roč. 277, č. 32 (2002), s. 28491-28497 ISSN 0021-9258 R&D Projects: GA MŠk LN00A016 Institutional research plan: CEZ:AV0Z4040901 Keywords : thymine * DNA * base pairs Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 6.696, year: 2002

  19. In vivo proton MRS of normal pancreas metabolites during breath-holding and free-breathing

    International Nuclear Information System (INIS)

    Su, T.-H.; Jin, E.-H.; Shen, H.; Zhang, Y.; He, W.

    2012-01-01

    Aim: To characterize normal pancreas metabolites using in vivo proton magnetic resonance spectroscopy ( 1 H MRS) at 3 T under conditions of breath-holding and free-breathing. Materials and methods: The pancreases of 32 healthy volunteers were examined using 1 H MRS during breath-holding and free-breathing acquisitions in a single-voxel point-resolved selective spectroscopy sequence (PRESS) technique using a 3 T MRI system. Resonances were compared between paired spectra of the two breathing modes. Furthermore, correlations between lipid (Lip) content and age, body-mass index (BMI), as well as choline (Cho) peak visibility of the normal pancreas were analysed during breath-holding. Results: Twenty-nine pairs of spectra were successfully obtained showing three major resonances, Lip, Cho, cholesterol and the unsaturated parts of the olefinic region of fatty acids (Chol + Unsat). Breath-hold spectra were generally better, with higher signal-to-noise ratios (SNR; Z=–2.646, p = 0.008) and Cho peak visible status (Z=–2.449, p = 0.014). Correlations were significant between spectra acquired by the two breathing modes, especially for Lip height, Lip area, and the area of other peaks at 1.9–4.1 ppm. However, the Lip resonance was significantly different between the spectra of the two breathing modes (p 1 H MRS of the normal pancreas at 3 T is technically feasible and can characterize several metabolites. 1 H MRS during breath-holding acquisition is superior to that during free-breathing acquisition.

  20. Objective vs. Subjective Evaluation of Cognitive Performance During 0.4-MPa Dives Breathing Air or Nitrox.

    Science.gov (United States)

    Germonpré, Peter; Balestra, Costantino; Hemelryck, Walter; Buzzacott, Peter; Lafère, Pierre

    2017-05-01

    Divers try to limit risks associated with their sport, for instance by breathing enriched air nitrox (EANx) instead of air. This double blinded, randomized trial was designed to see if the use of EANx could effectively improve cognitive performance while diving. Eight volunteers performed two no-decompression dry dives breathing air or EANx for 20 min at 0.4 MPa. Cognitive functions were assessed with a computerized test battery, including MathProc and Ptrail. Measurements were taken before the dive, upon arrival and after 15 min at depth, upon surfacing, and at 30 min postdive. After each dive subjects were asked to identify the gas they had just breathed. Identification of the breathing gas was not possible on subjective assessment alone, while cognitive assessments showed significantly better performance while breathing EANx. Before the dives, breathing air, mean time to complete the task was 1795 ms for MathProc and 1905 ms for Ptrail. When arriving at depth MathProc took 1616 ms on air and 1523 ms on EANx, and Ptrail took 1318 ms on air and and 1356 ms on EANx, followed 15 min later by significant performance inhibition while breathing air during the ascent and the postdive phase, supporting the concept of late dive/postdive impairment. The results suggest that EANx could protect against decreased neuro-cognitive performance induced by inert gas narcosis. It was not possible for blinded divers to identify which gas they were breathing and differences in postdive fatigue between air and EANx diving deserve further investigation.Germonpré P, Balestra C, Hemelryck W, Buzzacott P, Lafère P. Objective vs. subjective evaluation of cognitive performance during 0.4-MPa dives breathing air or nitrox. Aerosp Med Hum Perform. 2017; 88(5):469-475.

  1. Role of parafacial nuclei in control of breathing in adult rats.

    Science.gov (United States)

    Huckstepp, Robert T R; Cardoza, Kathryn P; Henderson, Lauren E; Feldman, Jack L

    2015-01-21

    Contiguous brain regions associated with a given behavior are increasingly being divided into subregions associated with distinct aspects of that behavior. Using recently developed neuronal hyperpolarizing technologies, we functionally dissect the parafacial region in the medulla, which contains key elements of the central pattern generator for breathing that are important in central CO2-chemoreception and for gating active expiration. By transfecting different populations of neighboring neurons with allatostatin or HM4D Gi/o-coupled receptors, we analyzed the effect of their hyperpolarization on respiration in spontaneously breathing vagotomized urethane-anesthetized rats. We identify two functionally separate parafacial nuclei: ventral (pFV) and lateral (pFL). Disinhibition of the pFL with bicuculline and strychnine led to active expiration. Hyperpolarizing pFL neurons had no effect on breathing at rest, or changes in inspiratory activity induced by hypoxia and hypercapnia; however, hyperpolarizing pFL neurons attenuated active expiration when it was induced by hypercapnia, hypoxia, or disinhibition of the pFL. In contrast, hyperpolarizing pFV neurons affected breathing at rest by decreasing inspiratory-related activity, attenuating the hypoxia- and hypercapnia-induced increase in inspiratory activity, and when present, reducing expiratory-related abdominal activity. Together with previous observations, we conclude that the pFV provides a generic excitatory drive to breathe, even at rest, whereas the pFL is a conditional oscillator quiet at rest that, when activated, e.g., during exercise, drives active expiration. Copyright © 2015 the authors 0270-6474/15/351052-16$15.00/0.

  2. Chemical sensors for breath gas analysis: the latest developments at the Breath Analysis Summit 2013.

    Science.gov (United States)

    Tisch, Ulrike; Haick, Hossam

    2014-06-01

    Profiling the body chemistry by means of volatile organic compounds (VOCs) in the breath opens exciting new avenues in medical diagnostics. Gas sensors could provide ideal platforms for realizing portable, hand-held breath testing devices in the near future. This review summarizes the latest developments and applications in the field of chemical sensors for diagnostic breath testing that were presented at the Breath Analysis Summit 2013 in Wallerfangen, Germany. Considerable progress has been made towards clinically applicable breath testing devices, especially by utilizing chemo-sensitive nanomaterials. Examples of several specialized breath testing applications are presented that are either based on stand-alone nanomaterial-based sensors being highly sensitive and specific to individual breath compounds over others, or on combinations of several highly specific sensors, or on experimental nanomaterial-based sensors arrays. Other interesting approaches include the adaption of a commercially available MOx-based sensor array to indirect breath testing applications, using a sample pre-concentration method, and the development of compact integrated GC-sensor systems. The recent trend towards device integration has led to the development of fully integrated prototypes of point-of-care devices. We describe and compare the performance of several prototypes that are based on different sensing technologies and evaluate their potential as low-cost and readily available next-generation medical devices.

  3. A case of spontaneous ventriculocisternostomy

    International Nuclear Information System (INIS)

    Yamane, Kanji; Yoshimoto, Hisanori; Harada, Kiyoshi; Uozumi, Tohru; Kuwabara, Satoshi.

    1983-01-01

    The authors experienced a case of spontaneous ventriculocisternostomy diagnosed by CT scan with metrizamide and Conray. Patient was 23-year-old male who had been in good health until one month before admission, when he began to have headache and tinnitus. He noticed bilateral visual acuity was decreased about one week before admission and vomiting appeared two days before admission. He was admitted to our hospital because of bilateral papilledema and remarkable hydrocephalus diagnosed by CT scan. On admission, no abnormal neurological signs except for bilateral papilledema were noted. Immediately, right ventricular drainage was performed. Pressure of the ventricle was over 300mmH 2 O and CSF was clear. PVG and PEG disclosed an another cavity behind the third ventricle, which was communicated with the third ventricle, and occlusion of aqueduct of Sylvius. Metrizamide CT scan and Conray CT scan showed a communication between this cavity and quadrigeminal and supracerebellar cisterns. On these neuroradiological findings, the diagnosis of obstructive hydrocephalus due to benign aqueduct stenosis accompanied with spontaneous ventriculocisternostomy was obtained. Spontaneous ventriculocisternostomy was noticed to produce arrest of hydrocephalus, but with our case, spontaneous regression of such symptoms did not appeared. By surgical ventriculocisternostomy (method by Torkildsen, Dandy, or Scarff), arrest of hydrocephalus was seen in about 50 to 70 per cent, which was the same results as those of spontaneous ventriculocisternostomy. It is concluded that VP shunt or VA shunt is thought to be better treatment of obstructive hydrocephalus than the various kinds of surgical ventriculocisternostomy. (J.P.N.)

  4. Optical antenna enhanced spontaneous emission.

    Science.gov (United States)

    Eggleston, Michael S; Messer, Kevin; Zhang, Liming; Yablonovitch, Eli; Wu, Ming C

    2015-02-10

    Atoms and molecules are too small to act as efficient antennas for their own emission wavelengths. By providing an external optical antenna, the balance can be shifted; spontaneous emission could become faster than stimulated emission, which is handicapped by practically achievable pump intensities. In our experiments, InGaAsP nanorods emitting at ∼ 200 THz optical frequency show a spontaneous emission intensity enhancement of 35 × corresponding to a spontaneous emission rate speedup ∼ 115 ×, for antenna gap spacing, d = 40 nm. Classical antenna theory predicts ∼ 2,500 × spontaneous emission speedup at d ∼ 10 nm, proportional to 1/d(2). Unfortunately, at d antenna efficiency drops below 50%, owing to optical spreading resistance, exacerbated by the anomalous skin effect (electron surface collisions). Quantum dipole oscillations in the emitter excited state produce an optical ac equivalent circuit current, I(o) = qω|x(o)|/d, feeding the antenna-enhanced spontaneous emission, where q|x(o)| is the dipole matrix element. Despite the quantum-mechanical origin of the drive current, antenna theory makes no reference to the Purcell effect nor to local density of states models. Moreover, plasmonic effects are minor at 200 THz, producing only a small shift of antenna resonance frequency.

  5. Spontaneous baroreflex by sequence and power spectral methods in humans.

    Science.gov (United States)

    Hughson, R L; Quintin, L; Annat, G; Yamamoto, Y; Gharib, C

    1993-11-01

    Beat-by-beat variations in blood pressure and RR-interval are interrelated by the actions of baroreflex and non-baroreflex responses. This study had two purposes: (1) to examine the spontaneous relationships between RR-interval and systolic blood pressure to determine the relative occurrence of baroreflex and non-baroreflex responses in humans, and (2) to compare the beat-sequence method with a cross spectral estimate of the baroreflex response slope. Eight healthy men were studied during 10 h of quiet, seated rest, and six men and three women were studied during rest, rest plus fixed pace breathing, and a cold pressor test. RR-interval and continuous, non-invasive arterial blood pressure were measured with a computerized system. A baroreflex sequence was defined by a series of at least three consecutive heart beats in which systolic pressure and the following RR-interval either both increased or both decreased. A non-baroreflex relationship was defined by sequences of at least three beats by opposite directional changes of RR-interval and systolic pressure of that beat. The results showed that there were approximately 30% as many non-baroreflex compared to baroreflex slopes. Individual subject mean baroreflex and non-baroreflex slopes were highly correlated (r = 0.72, P < 0.001). Absolute slope values were not different, and they were unaffected by time, fixed pace breathing, or cold pressor test. The data showed the relatively simple beat-by-beat sequence method to yield spontaneous baroreflex response slopes that were quantitatively similar to, and highly correlated with (r = 0.85-0.94), baroreflex response slopes calculated by spectral analysis methods.

  6. Autonomic breathing abnormalities in Rett syndrome: caregiver perspectives in an international database study.

    Science.gov (United States)

    Mackay, Jessica; Downs, Jenny; Wong, Kingsley; Heyworth, Jane; Epstein, Amy; Leonard, Helen

    2017-01-01

    Rett syndrome is a severe neurodevelopmental disorder associated with mutations in the MECP2 gene. Irregular breathing patterns and abdominal bloating are prominent but poorly understood features. Our aims were to characterize the abnormal breathing patterns and abdominal bloating, investigate the distribution of these by age and mutation type and examine their impact and management from a caregiver perspective. We invited previously recruited families from the International Rett Syndrome Study to complete a web-based questionnaire concerning their family member with Rett syndrome aged between 2 and 57 years. We used logistic regression to investigate presence, frequency and impact of breath-holding, hyperventilation, or abdominal bloating by age group and mutation type. Age of onset for both breathing abnormalities was investigated using time-to-onset analysis, and the Kaplan-Meier method was used to estimate the failure function for the study sample. Descriptive statistics were used to characterize the management of irregular breathing. Questionnaires were returned by 413/482 (85.7%) families. Breath-holding was reported for 68.8%, hyperventilation for 46.4% and abdominal bloating for 42.4%. Hyperventilation was more prevalent and frequent in those younger than 7 years of age and abdominal bloating in those aged over 20 years. Onset of breathing irregularities usually occurred during early childhood. Caregivers perceived that daily life was considerably impacted for almost half (44.1%) of those with abdominal bloating and in just over than a third of those with breath-holding (35.8%) or hyperventilation (35.1%). Although perceived impact was broadly comparable between age and mutation groups for breath-holding, hyperventilation and abdominal bloating, girls and women with a p.Arg294* mutation were considered to be more affected by all three conditions. Only 31 individuals had received medically prescribed treatments including 12 different medications, added

  7. Effects of ion channel noise on neural circuits: an application to the respiratory pattern generator to investigate breathing variability.

    Science.gov (United States)

    Yu, Haitao; Dhingra, Rishi R; Dick, Thomas E; Galán, Roberto F

    2017-01-01

    Neural activity generally displays irregular firing patterns even in circuits with apparently regular outputs, such as motor pattern generators, in which the output frequency fluctuates randomly around a mean value. This "circuit noise" is inherited from the random firing of single neurons, which emerges from stochastic ion channel gating (channel noise), spontaneous neurotransmitter release, and its diffusion and binding to synaptic receptors. Here we demonstrate how to expand conductance-based network models that are originally deterministic to include realistic, physiological noise, focusing on stochastic ion channel gating. We illustrate this procedure with a well-established conductance-based model of the respiratory pattern generator, which allows us to investigate how channel noise affects neural dynamics at the circuit level and, in particular, to understand the relationship between the respiratory pattern and its breath-to-breath variability. We show that as the channel number increases, the duration of inspiration and expiration varies, and so does the coefficient of variation of the breath-to-breath interval, which attains a minimum when the mean duration of expiration slightly exceeds that of inspiration. For small channel numbers, the variability of the expiratory phase dominates over that of the inspiratory phase, and vice versa for large channel numbers. Among the four different cell types in the respiratory pattern generator, pacemaker cells exhibit the highest sensitivity to channel noise. The model shows that suppressing input from the pons leads to longer inspiratory phases, a reduction in breathing frequency, and larger breath-to-breath variability, whereas enhanced input from the raphe nucleus increases breathing frequency without changing its pattern. A major source of noise in neuronal circuits is the "flickering" of ion currents passing through the neurons' membranes (channel noise), which cannot be suppressed experimentally. Computational

  8. Trained breathing-induced oxygenation acutely reverses cardiovascular autonomic dysfunction in patients with type 2 diabetes and renal disease.

    Science.gov (United States)

    Esposito, Pasquale; Mereu, Roberto; De Barbieri, Giacomo; Rampino, Teresa; Di Toro, Alessandro; Groop, Per-Henrik; Dal Canton, Antonio; Bernardi, Luciano

    2016-04-01

    Cardiovascular autonomic dysfunction, evaluated as baroreflex sensitivity (BRS), could be acutely corrected by slow breathing or oxygen administration in patients with type 1 diabetes, thus suggesting a functional component of the disorder. We tested this hypothesis in patients with the type 2 diabetes with or without renal impairment. Twenty-six patients with type 2 diabetes (aged 61.0 ± 0.8 years, mean ± SEM; duration of diabetes 10.5 ± 2 years, BMI 29.9 ± 0.7 kg/m(2), GFR 68.1 ± 5.6 ml/min) and 24 healthy controls (aged 58.5 ± 1.0 years) were studied. BRS was obtained from recordings of RR interval and systolic blood pressure fluctuations during spontaneous and during slow, deep (6 breaths/min) controlled breathing in conditions of normoxia or hyperoxia (5 l/min oxygen). During spontaneous breathing, diabetic patients had lower RR interval and lower BRS compared with the control subjects (7.1 ± 1.2 vs. 12.6 ± 2.0 ms/mmHg, p breathing and oxygen administration significantly increased arterial saturation, reduced RR interval and increased BRS in both groups (to 9.6 ± 1.8 and 15.4 ± 2.4 ms/mmHg, respectively, p breathing and hyperoxia (p breathing during normoxia). Autonomic dysfunction present in patients with type 2 diabetes can be partially reversed by slow breathing, suggesting a functional role of hypoxia, also in patients with DKD. Interventions known to relieve tissue hypoxia and improve autonomic function, like physical activity, may be useful in the prevention and management of complications in patients with diabetes.

  9. Spontaneous subcapsular and perirrenal hemorrhage

    International Nuclear Information System (INIS)

    Fuster, M.J.; Saez, J.; Perez-Paya, F.J.; Fernandez, F.

    1997-01-01

    To assess the role of CT in the etiologic diagnosis of spontaneous subcapsular and perirrenal hemorrhage. The CT findings are described in 13 patients presenting subcapsular and perirrenal hemorrhage. Those patients in whom the bleeding was not spontaneous were excluded. Surgical confirmation was obtained in nine cases. In 11 of the 13 cases (84.6%), involving five adenocarcinomas, five angiomyolipoma, two complicated cysts and one case of panarterities nodosa, CT disclosed the underlying pathology. In two cases (15.4%), it only revealed the extension of the hematoma, but gave no clue to its origin. CT is the technique of choice when spontaneous subcapsular and perirrenal hemorrhage is suspected since, in most cases, it reveals the underlying pathology. (Author)

  10. Decreased chewing activity during mouth breathing.

    Science.gov (United States)

    Hsu, H-Y; Yamaguchi, K

    2012-08-01

    This study examined the effect of mouth breathing on the strength and duration of vertical effect on the posterior teeth using related functional parameters during 3 min of gum chewing in 39 nasal breathers. A CO(2) sensor was placed over the mouth to detect expiratory airflow. When no airflow was detected from the mouth throughout the recording period, the subject was considered a nasal breather and enrolled in the study. Electromyographic (EMG) activity was recorded during 3 min of gum chewing. The protocol was repeated with the nostrils occluded. The strength of the vertical effect was obtained as integrated masseter muscle EMG activity, and the duration of vertical effect was also obtained as chewing stroke count, chewing cycle variation and EMG activity duration above baseline. Baseline activity was obtained from the isotonic EMG activity during jaw movement at 1.6 Hz without making tooth contact. The duration represented the percentage of the active period above baseline relative to the 3-min chewing period. Paired t-test and repeated analysis of variance were used to compare variables between nasal and mouth breathing. The integrated EMG activity and the duration of EMG activity above baseline, chewing stroke count and chewing cycle significantly decreased during mouth breathing compared with nasal breathing (Pbreathing was significantly greater than nasal breathing (Pbreathing reduces the vertical effect on the posterior teeth, which can affect the vertical position of posterior teeth negatively, leading to malocclusion. © 2012 Blackwell Publishing Ltd.

  11. Sudarshan kriya yoga: Breathing for health

    Directory of Open Access Journals (Sweden)

    Sameer A Zope

    2013-01-01

    Full Text Available Breathing techniques are regularly recommended for relaxation, stress management, control of psychophysiological states, and to improve organ function. Yogic breathing, defined as a manipulation of breath movement, has been shown to positively affect immune function, autonomic nervous system imbalances, and psychological or stress-related disorders. The aim of this study was to assess and provide a comprehensive review of the physiological mechanisms, the mind-body connection, and the benefits of Sudarshan Kriya Yoga (SKY in a wide range of clinical conditions. Various online databases searched were Medline, Psychinfo, EMBASE, and Google Scholar. All the results were carefully screened and articles on SKY were selected. The references from these articles were checked to find any other potentially relevant articles. SKY, a unique yogic breathing practice, involves several types of cyclical breathing patterns, ranging from slow and calming to rapid and stimulating. There is mounting evidence to suggest that SKY can be a beneficial, low-risk, low-cost adjunct to the treatment of stress, anxiety, post-traumatic stress disorder, depression, stress-related medical illnesses, substance abuse, and rehabilitation of criminal offenders.

  12. The clinical value of breath hydrogen testing.

    Science.gov (United States)

    Yao, Chu K; Tuck, Caroline J

    2017-03-01

    Breath hydrogen testing for assessing the presence of carbohydrate malabsorption is frequently applied to refine dietary restrictions on a low fermentable carbohydrate (FODMAP) diet. Its application has also been extended for the detection of small intestinal bacterial overgrowth. Recently, several caveats of its methodology and interpretation have emerged. A review of the evidence surrounding its application in the management of patients with a functional bowel disorder was performed. Studies were examined to assess limitations of testing methodology, interpretation of results, reproducibility, and how this relates to clinical symptoms. A wide heterogeneity in testing parameters, definition of positive/negative response, and the use of clinically irrelevant doses of test carbohydrate were common methodological limitations. These factors can subsequently impact the sensitivity, specificity, and false positive or negative detection rates. Evidence is also increasing on the poor intra-individual reproducibility in breath responses with repeated testing for fructose and lactulose. On the basis of these limitations, it is not surprising that the diagnosis of small intestinal bacterial overgrowth based on a lactulose breath test yields a wide prevalence rate and is unreliable. Finally, symptom induction during a breath test has been found to correlate poorly with the presence of carbohydrate malabsorption. The evidence suggests that breath hydrogen tests have limited clinical value in guiding clinical decision for the patient with a functional bowel disorder. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  13. Closed and open breathing circuit function in healthy volunteers during exercise at Mount Everest base camp (5300 m)

    NARCIS (Netherlands)

    McMorrow, R. C. N.; Windsor, J. S.; Hart, N. D.; Richards, P.; Rodway, G. W.; Ahuja, V. Y.; O'Dwyer, M. J.; Mythen, M. G.; Grocott, M. P. W.; Ahuja, V.; Aref-Adib, G.; Burnham, R.; Chisholm, A.; Clarke, K.; Coates, D.; Coates, M.; Cook, D.; Cox, M.; Dhillon, S.; Dougall, C.; Doyle, P.; Duncan, P.; Edsell, M.; Edwards, L.; Evans, L.; Gardiner, P.; Grocott, M.; Gunning, P.; Hart, N.; Harrington, J.; Harvey, J.; Holloway, C.; Howard, D.; Hurlbut, D.; Imray, C.; Ince, C.; Jonas, M.; van der Kaaij, J.; Khosravi, M.; Kolfschoten, N.; Levett, D.; Luery, H.; Luks, A.; Martin, D.; McMorrow, R.; Meale, P.; Mitchell, K.; Montgomery, H.; Morgan, G.; Morgan, J.; Murray, A.; Mythen, M.; Newman, S.; O'Dwyer, M.; Pate, J.; Plant, T.; Pun, M.; Richardson, A.; Rodway, G.; Simpson, J.; Stroud, C.; Stroud, M.; Stygal, J.; Symons, B.; Szawarski, P.; van Tulleken, A.; van Tulleken, C.; Vercueil, A.; Wandrag, L.; Wilson, M.; Windsor, J.; Basnyat, B.; Clarke, C.; Horn-Bein, T.; Milledge, J.; West, J.

    2012-01-01

    We present a randomised, controlled, crossover trial of the Caudwell Xtreme Everest (CXE) closed circuit breathing system vs an open circuit and ambient air control in six healthy, hypoxic volunteers at rest and exercise at Everest Base Camp, at 5300 m. Compared with control, arterial oxygen

  14. Comparing the Effects of Alcohol Mixed with Artificially-Sweetened and Carbohydrate Containing Beverages on Breath Alcohol Concentration

    Science.gov (United States)

    Irwin, Christopher; Shum, David; Desbrow, Ben; Leveritt, Michael

    2014-01-01

    This study investigated the impact of alcohol mixed with artificially sweetened or carbohydrate containing beverages on breath alcohol concentration s (BrAC) under various levels of hydration status. Two groups of males participated in 3 experimental trials where alcohol was consumed under three different levels of hydration status. One group…

  15. Training in multiple breath washout testing for respiratory physiotherapists.

    Science.gov (United States)

    O'Neill, Katherine; Elborn, J Stuart; Tunney, Michael M; O'Neill, Philip; Rowan, Stephen; Martin, Susan; Bradley, Judy M

    2018-03-01

    The development of multiple breath washout (MBW) testing in respiratory disease highlights the need for increased awareness amongst respiratory physiotherapists and a potential opportunity for professional development in the use of an important outcome measure for clinical trials. To rationalise how MBW may be a useful assessment tool for respiratory physiotherapists and to describe a local MBW training and certification programme for physiotherapists. The respiratory Multidisciplinary Team in the Belfast Health and Social Care Trust (BHSCT) identified a need for MBW testing to be available to facilitate clinical research and assessment. A 2day training programme consisting of prereading preparation, self-directed learning, theory presentations, practical demonstrations and hands-on practice was developed and delivered. All participants underwent a certification process. We have demonstrated the successful training and certification of clinical and research physiotherapists and encourage other respiratory physiotherapists to consider MBW test training. Copyright © 2017 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  16. Modelling nasal high flow therapy effects on upper airway resistance and resistive work of breathing.

    Science.gov (United States)

    Adams, Cletus F; Geoghegan, Patrick H; Spence, Callum J; Jermy, Mark C

    2018-04-07

    The goal of this paper is to quantify upper airway resistance with and without nasal high flow (NHF) therapy. For adults, NHF therapy feeds 30-60 L/min of warm humidified air into the nose through short cannulas which do not seal the nostril. NHF therapy has been reported to increase airway pressure, increase tidal volume (V t ) and decrease respiratory rate (RR), but it is unclear how these findings affect the work done to overcome airway resistance to air flow during expiration. Also, there is little information on how the choice of nasal cannula size may affect work of breathing. In this paper, estimates of airway resistance without and with different NHF flow (applied via different cannula sizes) were made. The breathing efforts required to overcome airway resistance under these conditions were quantified. NHF was applied via three different cannula sizes to a 3-D printed human upper airway. Pressure drop and flow rate were measured and used to estimate inspiratory and expiratory upper airway resistances. The resistance information was used to compute the muscular work required to overcome the resistance of the upper airway to flow. NHF raises expiratory resistance relative to spontaneous breathing if the breathing pattern does not change but reduces work of breathing if peak expiratory flow falls. Of the cannula sizes used, the large cannula produced the greatest resistance and the small cannula produced the least. The work required to cause tracheal flow through the upper airway was reduced if the RR and minute volume are reduced by NHF. NHF has been observed to do so in COPD patients (Bräunlich et al., 2013). A reduction in I:E ratio due to therapy was found to reduce work of breathing if the peak inspiratory flow is less than the flow below which no inspiratory effort is required to overcome upper airway resistance. NHF raises expiratory resistance but it can reduce the work required to overcome upper airway resistance via a fall in inspiratory work of

  17. [Efficacy of preoxygenation using tidal volume breathing: a comparison of Mapleson A, Bain's and Circle system].

    Science.gov (United States)

    Arora, Suman; Gupta, Priyanka; Arya, Virender Kumar; Bhatia, Nidhi

    Efficacy of preoxygenation depends upon inspired oxygen concentration, its flow rate, breathing system configuration and patient characteristics. We hypothesized that in actual clinical scenario, where breathing circuit is not primed with 100% oxygen, patients may need more time to achieve EtO 2 ≥90%, and this duration may be different among various breathing systems. We thus studied the efficacy of preoxygenation using unprimed Mapleson A, Bain's and Circle system with tidal volume breathing at oxygen flow rates of 5L.min -1 and 10L.min -1 . Patients were randomly allocated into one of the six groups, wherein they were preoxygenated using either Mapleson A, Bain's or Circle system at O 2 flow rate of either 5L.min -1 or 10L.min -1 . The primary outcome measure of our study was the time taken to achieve EtO 2 ≥90% at 5 and 10L.min -1 flow rates. At oxygen flow rate of 5L.min -1 , time to reach EtO 2 ≥90% was significantly longer with Bain's system (3.7±0.67min) than Mapleson A and Circle system (2.9±0.6, 3.3±0.97min, respectively). However at oxygen flow rate of 10L.min -1 this time was significantly shorter and comparable among all the three breathing systems (2.33±0.38min with Mapleson, 2.59±0.50min with Bain's and 2.60±0.47min with Circle system). With spontaneous normal tidal volume breathing at oxygen flow rate of 5L.min -1 , Mapleson A can optimally preoxygenate patients within 3min while Bain's and Circle system require more time. However at O 2 flow rate of 10L.min -1 all the three breathing systems are capable of optimally preoxygenating the patients in less than 3min. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  18. Spontaneous isolated celiac artery dissection

    Directory of Open Access Journals (Sweden)

    Tuba Cimilli Ozturk

    2011-01-01

    Full Text Available Dyspepsia with mild, stabbing epigastric discomfort without history of trauma is a very common symptom that emergency physicians see in their daily practice. Vascular emergencies, mostly the aortic dissection and aneurysm, are always described in the differential diagnosis with persistent symptoms. Isolated celiac artery dissection occurring spontaneously is a very rare diagnosis. The involvement of branch vessels is generally observed and patients show various clinical signs and symptoms according to the involved branch vessel. Here we are presenting a case with spontaneous isolated celiac artery dissection, without any branch vessel involvement or visceral damage, detected by computed tomography scans taken on admission.

  19. Spontaneous waves in muscle fibres

    Energy Technology Data Exchange (ETDEWEB)

    Guenther, Stefan; Kruse, Karsten [Department of Theoretical Physics, Saarland University, 66041 Saarbruecken (Germany); Max Planck Institute for the Physics of Complex Systems, Noethnitzer Street 38, 01187 Dresden (Germany)

    2007-11-15

    Mechanical oscillations are important for many cellular processes, e.g. the beating of cilia and flagella or the sensation of sound by hair cells. These dynamic states originate from spontaneous oscillations of molecular motors. A particularly clear example of such oscillations has been observed in muscle fibers under non-physiological conditions. In that case, motor oscillations lead to contraction waves along the fiber. By a macroscopic analysis of muscle fiber dynamics we find that the spontaneous waves involve non-hydrodynamic modes. A simple microscopic model of sarcomere dynamics highlights mechanical aspects of the motor dynamics and fits with the experimental observations.

  20. Clinical Applications of CO2 and H2 Breath Test

    Directory of Open Access Journals (Sweden)

    ZHAO Si-qian;CHEN Bao-jun;LUO Zhi-fu

    2016-08-01

    Full Text Available Breath test is non-invasive, high sensitivity and high specificity. In this article, CO2 breath test, H2 breath test and their clinical applications were elaborated. The main applications of CO2 breath test include helicobacter pylori test, liver function detection, gastric emptying test, insulin resistance test, pancreatic exocrine secretion test, etc. H2 breath test can be applied in the diagnosis of lactose malabsorption and detecting small intestinal bacterial overgrowth. With further research, the breath test is expected to be applied in more diseases diagnosis.

  1. Spontaneous perseverative turning in rats with radiation-induced hippocampal damage

    International Nuclear Information System (INIS)

    Mickley, G.A.; Ferguson, J.L.; Nemeth, T.J.; Mulvihill, M.A.; Alderks, C.E.

    1989-01-01

    This study found a new behavioral correlate of lesions specific to the dentate granule cell layer of the hippocampus: spontaneous perseverative turning. Irradiation of a portion of the neonatal rat cerebral hemispheres produced hypoplasia of the granule cell layer of the hippocampal dentate gyrus while sparing the rest of the brain. Radiation-induced damage to the hippocampal formation caused rats placed in bowls to spontaneously turn in long, slow bouts without reversals. Irradiated subjects also exhibited other behaviors characteristic of hippocampal damage (e.g., perseveration in spontaneous exploration of the arms of a T-maze, retarded acquisition of a passive avoidance task, and increased horizontal locomotion). These data extend previously reported behavioral correlates of fascia dentata lesions and suggest the usefulness of a bout analysis of spontaneous bowl turning as a measure of nondiscrete-trial spontaneous alternation and a sensitive additional indicator of radiation-induced hippocampal damage

  2. Lung volume reproducibility under ABC control and self-sustained breath-holding.

    Science.gov (United States)

    Kaza, Evangelia; Dunlop, Alex; Panek, Rafal; Collins, David J; Orton, Matthew; Symonds-Tayler, Richard; McQuaid, Dualta; Scurr, Erica; Hansen, Vibeke; Leach, Martin O

    2017-03-01

    An Active Breathing Coordinator (ABC) can be employed to induce breath-holds during CT imaging and radiotherapy of lung, breast and liver cancer, and recently during lung cancer MRI. The apparatus measures and controls respiratory volume, hence subject lung volume reproducibility is its principal measure of effectiveness. To assess ABC control quality, the intra-session reproducibility of ABC-induced lung volumes was evaluated and compared with that reached by applying the clinical standard of operator-guided self-sustained breath-holds on healthy volunteers during MRI. Inter-session reproducibility was investigated by repeating ABC-controlled breath-holds on a second visit. Additionally, lung volume agreement with ABC devices used with different imaging modalities in the same institution (MR, CT), or for a breast trial treatment, was assessed. Lung volumes were derived from three-dimensional (3D) T1-weighted MRI datasets by three observers employing semiautomatic lung delineation on a radiotherapy treatment planning system. Inter-observer variability was less than 6% of the delineated lung volumes. Lung volume agreement between the different conditions over all subjects was investigated using descriptive statistics. The ABC equipment dedicated for MR application exhibited good intra-session and inter-session lung volume reproducibility (1.8% and 3% lung volume variability on average, respectively). MR-assessed lung volumes were similar using different ABC equipment dedicated to MR, CT, or breast radiotherapy. Overall, lung volumes controlled by the same or different ABC devices agreed better than with self-controlled breath-holds, as suggested by the average ABC variation of 1.8% of the measured lung volumes (99 mL), compared to the 4.1% (226 mL) variability observed on average with self-sustained breath-holding. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in

  3. Helping Babies Breathe implementation in Zanzibar, Tanzania.

    Science.gov (United States)

    Wilson, Gina Marie; Ame, Ame Masemo; Khatib, Maimuna Mohamed; Rende, Elizabeth K; Hartman, Ann Michelle; Blood-Siegfried, Jane

    2017-08-01

    To assess the efficacy and feasibility of implementing Helping Babies Breathe, a neonatal resuscitation programme for resource-limited environments. This quality improvement project focused on training midwives on Helping Babies Breathe to address high rates of neonatal mortality secondary to birth asphyxia. The convenience sample was 33 midwives in Zanzibar, Tanzania. The train-the-trainer strategy with repeated measures design was used to assess knowledge and skills at 3 time points. Observations were completed during "real-time" deliveries, and a focused interview generated feedback regarding satisfaction and sustainability. Knowledge scores and resuscitation skills significantly improved and were sustained, P < .05. Of the 62 birth observations, 19% needed intervention. All were appropriately resuscitated and survived. Results indicate that participants retained knowledge and skills and used them in clinical practice. Observations demonstrated that participants took appropriate actions when presented with a baby who was not breathing. © 2017 John Wiley & Sons Australia, Ltd.

  4. Human Papillomavirus Infection as a Possible Cause of Spontaneous Abortion and Spontaneous Preterm Delivery

    DEFF Research Database (Denmark)

    Ambühl, Lea Maria Margareta; Baandrup, Ulrik; Dybkær, Karen

    2016-01-01

    , and 10.9% (95% CI; 10.1–11.7) for umbilical cord blood. Summary estimates for HPV prevalence of spontaneous abortions and spontaneous preterm deliveries, in cervix (spontaneous abortions: 24.5%, and pretermdeliveries: 47%, resp.) and placenta (spontaneous abortions: 24.9%, and preterm deliveries: 50......%, resp.), were identified to be higher compared to normal full-term pregnancies (푃 spontaneous abortion, spontaneous preterm...

  5. Acoustic signal classification of breathing movements to virtually aid breath regulation.

    Science.gov (United States)

    Abushakra, Ahmad; Faezipour, Miad

    2013-03-01

    Monitoring breath and identifying breathing movements have settled importance in many biomedical research areas, especially in the treatment of those with breathing disorders, e.g., lung cancer patients. Moreover, virtual reality (VR) revolution and their implementations on ubiquitous hand-held devices have a lot of implications, which could be used as a simulation technology for healing purposes. In this paper, a novel method is proposed to detect and classify breathing movements. The overall VR framework is intended to encourage the subjects regulate their breath by classifying the breathing movements in real time. This paper focuses on a portion of the overall VR framework that deals with classifying the acoustic signal of respiration movements. We employ Mel-frequency cepstral coefficients (MFCCs) along with speech segmentation techniques using voice activity detection and linear thresholding to the acoustic signal of breath captured using a microphone to depict the differences between inhale and exhale in frequency domain. For every subject, 13 MFCCs of all voiced segments are computed and plotted. The inhale and exhale phases are differentiated using the sixth MFCC order, which carries important classification information. Experimental results on a number of individuals verify our proposed classification methodology.

  6. Adaptive neuro-fuzzy inference system for breath phase detection and breath cycle segmentation.

    Science.gov (United States)

    Palaniappan, Rajkumar; Sundaraj, Kenneth; Sundaraj, Sebastian

    2017-07-01

    The monitoring of the respiratory rate is vital in several medical conditions, including sleep apnea because patients with sleep apnea exhibit an irregular respiratory rate compared with controls. Therefore, monitoring the respiratory rate by detecting the different breath phases is crucial. This study aimed to segment the breath cycles from pulmonary acoustic signals using the newly developed adaptive neuro-fuzzy inference system (ANFIS) based on breath phase detection and to subsequently evaluate the performance of the system. The normalised averaged power spectral density for each segment was fuzzified, and a set of fuzzy rules was formulated. The ANFIS was developed to detect the breath phases and subsequently perform breath cycle segmentation. To evaluate the performance of the proposed method, the root mean square error (RMSE) and correlation coefficient values were calculated and analysed, and the proposed method was then validated using data collected at KIMS Hospital and the RALE standard dataset. The analysis of the correlation coefficient of the neuro-fuzzy model, which was performed to evaluate its performance, revealed a correlation strength of r = 0.9925, and the RMSE for the neuro-fuzzy model was found to equal 0.0069. The proposed neuro-fuzzy model performs better than the fuzzy inference system (FIS) in detecting the breath phases and segmenting the breath cycles and requires less rules than FIS. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Rebreathing, resistance and external work of breathing in three different coaxial Mapleson D systems.

    Science.gov (United States)

    Jonsson, L O; Zetterström, H

    1989-01-01

    Using a lung model, rebreathing characteristics, resistance against gas flow and the external work of breathing were tested in three different coaxial Mapleson D systems: the Medicvent D system, the Bain original system and the Coax-II system. The rebreathing characteristics were found to be similar in all systems in both spontaneous and controlled ventilation. The Bain system was found to have the lowest resistance and work of breathing and the Coax-II system the highest. The differences were small and clinically insignificant. Both the resistance and the work of breathing increased with fresh gas flow. The resistance against expiration was found to be in the range 135-160 Pa at a total gas flow of 31 1.min-1, which is well within the acceptable level. The resulting end-expiratory pressure was never above 100 Pa (1 cmH2O) in any system. We concluded that there was no clinically significant difference among the three systems despite differences in design. The coaxial Mapleson D systems can also be used safely with high fresh gas flows with regard to resistance and end-expiratory pressures.

  8. 13C Urea Breath Testing to Diagnose Helicobacter pylori Infection in Children

    Directory of Open Access Journals (Sweden)

    Colette Deslandres

    1999-01-01

    Full Text Available The causal relationship between Helicobacter pylori colonization of the gastric mucosa and gastritis has been proven. Endoscopy and subsequent histological examination of antral biopsies have been regarded as the gold standard for diagnosing H pylori gastritis. The 13C urea breath test is a noninvasive test with a high specificity and sensitivity for H pylori colonization. Increasingly, it is becoming an important tool for use in diagnosing H pylori infection in paediatric populations. This test is particularly well suited for epidemiological studies evaluating reinfection rates, spontaneous clearance of infection and eradication rates after therapy. However, few groups have validated the test in the pediatric age group. The testing protocol has not yet been standardized. Variables include fasting state, dose of urea labelled with 13C, delta cutoff level of 13C carbon dioxide, choice of test meal and timing of collection of expired breath samples. Further studies are urgently needed to evaluate critically the impact of H pylori infection in children. The 13C urea breath test should prove very useful in such prospective studies.

  9. Spontaneous emission by moving atoms

    International Nuclear Information System (INIS)

    Meystre, P.; Wilkens, M.

    1994-01-01

    It is well known that spontaneous emission is not an intrinsic atomic property, but rather results from the coupling of the atom to the vacuum modes of the electromagnetic field. As such, it can be modified by tailoring the electromagnetic environment into which the atom can radiate. This was already realized by Purcell, who noted that the spontaneous emission rate can be enhanced if the atom placed inside a cavity is resonant with one of the cavity is resonant with one of the cavity modes, and by Kleppner, who discussed the opposite case of inhibited spontaneous emission. It has also been recognized that spontaneous emission need not be an irreversible process. Indeed, a system consisting of a single atom coupled to a single mode of the electromagnetic field undergoes a periodic exchange of excitation between the atom and the field. This periodic exchange remains dominant as long as the strength of the coupling between the atom and a cavity mode is itself dominant. 23 refs., 6 figs

  10. Spontaneous Development of Moral Concepts

    Science.gov (United States)

    Siegal, M.

    1975-01-01

    Moral competence is more difficult to attain than scientific competence. Since language comprehension plays a central role in conceptual development, and moral language is difficult to learn, there is a common deficiency in moral conceptual development. This suggests a theory of non-spontaneous solutions to moral problems. (Author/MS)

  11. Shell theorem for spontaneous emission

    DEFF Research Database (Denmark)

    Kristensen, Philip Trøst; Mortensen, Jakob Egeberg; Lodahl, Peter

    2013-01-01

    and therefore is given exactly by the dipole approximation theory. This surprising result is a spontaneous emission counterpart to the shell theorems of classical mechanics and electrostatics and provides insights into the physics of mesoscopic emitters as well as great simplifications in practical calculations....

  12. Prediction of Spontaneous Preterm Birth

    NARCIS (Netherlands)

    Dijkstra, Karolien

    2002-01-01

    Preterm birth is a leading cause of neonatal morbidity and mortality. It is a major goal in obstetrics to lower the incidence of spontaneous preterm birth (SPB) and related neonatal morbidity and mortality. One of the principal objectives is to discover early markers that would allow us to identify

  13. EAMJ Dec. Spontaneous.indd

    African Journals Online (AJOL)

    2008-12-12

    Dec 12, 2008 ... surgical abortion at one month gestation without any complication. The second pregnancy which was a year prior resulted in a spontaneous miscarriage at two months followed by evacuation of retained products of conception with no post abortion complications. Antibiotics were taken following both.

  14. Spontaneous fission of superheavy nuclei

    Indian Academy of Sciences (India)

    the Yukawa-plus-exponential potential. The microscopic shell and pairing corrections are obtained using the Strutinsky and BCS approaches and the cranking formulae yield the inertia tensor. Finally, the WKB method is used to calculate penetrabilities and spontaneous fission half-lives. Calculations are performed for the ...

  15. In vivo proton MRS of normal pancreas metabolites during breath-holding and free-breathing

    Energy Technology Data Exchange (ETDEWEB)

    Su, T.-H. [Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 Yong-An Road, Beijing (China); Jin, E.-H., E-mail: erhujin1@hotmail.com [Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 Yong-An Road, Beijing (China); Shen, H. [GE China Company Ltd, Healthcare, General Electric Company, Beijing (China); Zhang, Y.; He, W. [Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 Yong-An Road, Beijing (China)

    2012-07-15

    Aim: To characterize normal pancreas metabolites using in vivo proton magnetic resonance spectroscopy ({sup 1}H MRS) at 3 T under conditions of breath-holding and free-breathing. Materials and methods: The pancreases of 32 healthy volunteers were examined using {sup 1}H MRS during breath-holding and free-breathing acquisitions in a single-voxel point-resolved selective spectroscopy sequence (PRESS) technique using a 3 T MRI system. Resonances were compared between paired spectra of the two breathing modes. Furthermore, correlations between lipid (Lip) content and age, body-mass index (BMI), as well as choline (Cho) peak visibility of the normal pancreas were analysed during breath-holding. Results: Twenty-nine pairs of spectra were successfully obtained showing three major resonances, Lip, Cho, cholesterol and the unsaturated parts of the olefinic region of fatty acids (Chol + Unsat). Breath-hold spectra were generally better, with higher signal-to-noise ratios (SNR; Z=-2.646, p = 0.008) and Cho peak visible status (Z=-2.449, p = 0.014). Correlations were significant between spectra acquired by the two breathing modes, especially for Lip height, Lip area, and the area of other peaks at 1.9-4.1 ppm. However, the Lip resonance was significantly different between the spectra of the two breathing modes (p < 0.05). In the breath-holding spectra, there were significant positive correlations between Lip peak height, area, and age (r = 0.491 and 0.521, p = 0.007 and 0.004), but not between Lip peak area and BMI. There was no statistical difference in Cho resonances between males and females. The Lip peak height and area were significantly higher in the Cho peak invisible group than in the Cho peak visible group (t = 2.661 and 2.353, p = 0.030 and 0.043). Conclusion: In vivo{sup 1}H MRS of the normal pancreas at 3 T is technically feasible and can characterize several metabolites. {sup 1}H MRS during breath-holding acquisition is superior to that during free-breathing

  16. Self contained compressed air breathing apparatus to facilitate personnel decontamination

    International Nuclear Information System (INIS)

    McDonald, C.W.

    1963-11-01

    This report describes the modification of a Self Contained Compressed Air Breathing Apparatus to provide extended respiratory protection to grossly contaminated personnel during a decontamination period which may exceed the duration of the Breathing Apparatus air supply. (author)

  17. Iron and zinc levels in breath-holding spells

    OpenAIRE

    DEDA, Gülhis; AKAR, M. Nejat; CİN, Şükrü; GENÇGÖNÜL, Handan

    2002-01-01

    Breath-Holding spells are a dramatic and commonly observed clinical phenomenon in childhood. The underlyingpathophysiologic mechanisms in breath-holding spells are result from autonomic nervous system dysregulation.Cerebral anoxia is the ultimate factor responsible for the loss of consciousness observed in the severe forms of breath-holding spells.It’s known that, there is relationbetween breath-holding spells and iron-deficiency anemia, and the spells resolve after oral iron supplemantation....

  18. Spontaneous Retropharyngeal Emphysema: A Case Report | Chi ...

    African Journals Online (AJOL)

    ... is a rare clinical condition in pediatric otolaryngology. The predominant symptoms are sore throat, odynophagia, dysphagia, and neck pain. Here, we report a case of spontaneous retropharyngeal emphysema. Keywords: Iatrogenic injury, retropharyngeal emphysema, spontaneous retropharyngeal emphysem, trauma ...

  19. La maladie de Grisel : Spontaneous atlantoaxial subluxation

    NARCIS (Netherlands)

    Meek, MF; Robinson, PH; Hermens, RAEC

    Objective: "La maladie de Grisel" (Grisel's syndrome) is a spontaneously occurring atlantoaxial subluxation with torticollis. We present a case of atlantoaxial subluxation occurring in a 20-year period of pharyngoplasty surgery. The occurrence of a "spontaneous" atlantoaxial subluxation after oral

  20. Within-breath respiratory impedance and airway obstruction in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Karla Kristine Dames da Silva

    2015-07-01

    Full Text Available OBJECTIVE: Recent work has suggested that within-breath respiratory impedance measurements performed using the forced oscillation technique may help to noninvasively evaluate respiratory mechanics. We investigated the influence of airway obstruction on the within-breath forced oscillation technique in smokers and chronic obstructive pulmonary disease patients and evaluated the contribution of this analysis to the diagnosis of chronic obstructive pulmonary disease. METHODS: Twenty healthy individuals and 20 smokers were assessed. The study also included 74 patients with stable chronic obstructive pulmonary disease. We evaluated the mean respiratory impedance (Zm as well as values for the inspiration (Zi and expiration cycles (Ze at the beginning of inspiration (Zbi and expiration (Zbe, respectively. The peak-to-peak impedance (Zpp=Zbe-Zbi and the respiratory cycle dependence (ΔZrs=Ze-Zi were also analyzed. The diagnostic utility was evaluated by investigating the sensitivity, the specificity and the area under the receiver operating characteristic curve. ClinicalTrials.gov: NCT01888705. RESULTS: Airway obstruction increased the within-breath respiratory impedance parameters that were significantly correlated with the spirometric indices of airway obstruction (R=−0.65, p90%. CONCLUSIONS: We conclude the following: (1 chronic obstructive pulmonary disease introduces higher respiratory cycle dependence, (2 this increase is proportional to airway obstruction, and (3 the within-breath forced oscillation technique may provide novel parameters that facilitate the diagnosis of respiratory abnormalities in chronic obstructive pulmonary disease.

  1. Unconstrained monitoring of long-term heart and breath rates during sleep

    International Nuclear Information System (INIS)

    Chen, Wenxi; Zhu, Xin; Wei, Daming; Nemoto, Tetsu; Sugitani, Kayo; Kitamura, Kei-ichiro

    2008-01-01

    An unconstrained method for the long-term monitoring of heart and breath rates during sleep is proposed. The system includes a sensor unit and a web-based network module. The sensor unit is set beneath a pillow to pick up the pressure variations from the head induced by inhalation/exhalation movements and heart pulsation during sleep. The measured pressure signal was digitized and transferred to a remote database server via the network module. A wavelet-based algorithm was employed to detect the heart and breath rates, as well as body movement, during sleep. The overall system was utilized for a total six-month trial operation delivered to a female subject. The profiles of the heart and breath rates on a beat-by-beat and daily basis were obtained. Movements during sleep were also estimated. The results show that the daily average percentage of undetectable periods (UPs) during 881.6 sleep hours over a 180 day period was 17.2%. A total of 89.2% of sleep hours had a UP of not more than 25%. The profile of the heart rate revealed a periodic property that corresponded to the female monthly menstrual cycle. Our system shows promise as a long-term unconstrained monitor for heart and breath rates, and for other physiological parameters related to the quality of sleep and the regularity of the menstrual cycle. (note)

  2. Diabetes and the Metabolic Syndrome: Possibilities of a New Breath Test in a Dolphin Model

    Science.gov (United States)

    Schivo, Michael; Aksenov, Alexander A.; Yeates, Laura C.; Pasamontes, Alberto; Davis, Cristina E.

    2013-01-01

    Diabetes type-2 and the metabolic syndrome are prevalent in epidemic proportions and result in significant co-morbid disease. Limitations in understanding of dietary effects and cholesterol metabolism exist. Current methods to assess diabetes are essential, though many are invasive; for example, blood glucose and lipid monitoring require regular finger sticks and blood draws. A novel method to study these diseases may be non-invasive breath testing of exhaled compounds. Currently, acetone and lipid peroxidation products have been seen in small scale studies, though other compounds may be significant. As Atlantic bottlenose dolphins (Tursiops truncatus) have been proposed as a good model for human diabetes, applications of dietary manipulations and breath testing in this population may shed important light on how to design human clinical studies. In addition, ongoing studies indicate that breath testing in dolphins is feasible, humane, and yields relevant metabolites. By studying the metabolic and cholesterol responses of dolphins to dietary modifications, researchers may gain insight into human diabetes, improve the design of costly human clinical trials, and potentially discover biomarkers for non-invasive breath monitoring. PMID:24324455

  3. Oral breathing and speech disorders in children.

    Science.gov (United States)

    Hitos, Silvia F; Arakaki, Renata; Solé, Dirceu; Weckx, Luc L M

    2013-01-01

    To assess speech alterations in mouth-breathing children, and to correlate them with the respiratory type, etiology, gender, and age. A total of 439 mouth-breathers were evaluated, aged between 4 and 12 years. The presence of speech alterations in children older than 5 years was considered delayed speech development. The observed alterations were tongue interposition (TI), frontal lisp (FL), articulatory disorders (AD), sound omissions (SO), and lateral lisp (LL). The etiology of mouth breathing, gender, age, respiratory type, and speech disorders were correlated. Speech alterations were diagnosed in 31.2% of patients, unrelated to the respiratory type: oral or mixed. Increased frequency of articulatory disorders and more than one speech disorder were observed in males. TI was observed in 53.3% patients, followed by AD in 26.3%, and by FL in 21.9%. The co-occurrence of two or more speech alterations was observed in 24.8% of the children. Mouth breathing can affect speech development, socialization, and school performance. Early detection of mouth breathing is essential to prevent and minimize its negative effects on the overall development of individuals. Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  4. Application of stable isotope to breath test

    International Nuclear Information System (INIS)

    Sasaki, Yasuto

    1988-01-01

    Needles to say, radioisotopes have good characteristics as a tracer for examining biological functions. In fact, scyntigraphy is widely used over Japan. It is true, however, that there are some difficulties in applying radioisotopes to humans. Thus, greater attention began to be attracted to stable isotopes in the late 1960s, because these substances can be used for infants and pregnant women. They can be stored for a long period of time since they do not suffer damping as in the case of radioisotopes. In addition to serving as a tracer, stable isotopes can provide structural-chemical information including the position of isotope labels, and the mass and atomic composition of fragment ions. Such techniques as NMR spectroscopy is employed for this purpose. The method is currently used to perform examinations of congenital metabolic disorders. The carbon isotopes of 13 C and 14 C are used for breath test. Compounds labeled with these isotopes are administered and their ratio to the total CO 2 in breath is measured to diagnose diseases. In the early 1970s, 13 C has come into use for breath test. Similar breath test is applied to diagnosis of the bacterial overgrowth syndrome and ileal dysfunction syndrome. (Nogami, K.)

  5. Multi-layered breathing architectural envelope

    DEFF Research Database (Denmark)

    Lund Larsen, Andreas; Foged, Isak Worre; Jensen, Rasmus Lund

    2014-01-01

    A multi layered breathing envelope is developed as a method of natural ventilation. The two main layers consist of mineral wool and air permeable concrete. The mineral wool works as a dynamic insulation and the permeable concrete as a heat recovery system with a high thermal mass for heat storage...

  6. Extreme breathing excitations of atomic nuclei

    International Nuclear Information System (INIS)

    Antonov, A.N.; Nikolaev, V.A.; Petkov, I.Zh.

    1984-01-01

    In the present paper collective breathing nuclear states, that appear in the framework of the coherent density fluctuation model (CFM) are taken into consideration. Their excitation energies are large and comparable with the binding nuclear energies. The basic CFM equation obtain in the generator-coordinate method. The possible mechanisms for the excitations for the excitations of the breathing states are deeply inelastic interactions of particles (e - , p, etc.) with nuclei, the π - -absorbtion from nuclei. It should be noted, that the energy of the Roper-resonance is comparable with the breathing nuclear excitation energies. Therefore the decay of this resonance, in principle, can lead to the breathing nuclear vibrations. The results of this work, as well as the results of some papers, obtained by means of a similar method but related to different quantum-mechanical systems, give an evidence, that the structure in detail and the character of the forces between the particles are not decisive for the considered type of excitations

  7. Pulmonary Function Responses to Active Cycle Breathing ...

    African Journals Online (AJOL)

    Chronic heart failure patients experience restrictive respiratory dysfunction, resulting in alterations of FEV1, FVC and FEV /FVC as demonstrated in exercise 1 intolerance, dyspnoea and poor quality of life (QoL). Active Cycle of Breathing Techniques (ACBT) is traditionally used by Physiotherapists in the management of ...

  8. Practical recommendations for breathing-adapted radiotherapy

    International Nuclear Information System (INIS)

    Simon, L.; Giraud, P.; Rosenwald, J.C.; Dumas, J.L.; Lorchel, F.; Marre, D.; Dupont, S.; Varmenot, N.; Ginestet, C.; Caron, J.; Marchesi, V.; Ferreira, I.; Garcia, R.

    2007-01-01

    Respiration-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast and liver tumors. An increased conformality of irradiation fields leading to decreased complications rates of organs at risk (lung, heart) is expected. Respiratory gating is in line with the need for improved precision required by radiotherapy techniques such as 3D conformal radiotherapy or intensity modulated radiotherapy. Reduction of respiratory motion can be achieved by using either breath-hold techniques or respiration synchronized gating techniques. Breath-hold techniques can be achieved with active techniques, in which airflow of the patient is temporarily blocked by a valve, or passive techniques, in which the patient voluntarily holds his/her breath. Synchronized gating techniques use external devices to predict the phase of the respiration cycle while the patient breaths freely. This work summarizes the different experiences of the centers of the STIC 2003 project. It describes the different techniques, gives an overview of the literature and proposes a practice based on our experience. (authors)

  9. CONTINUOUS EXHALED BREATH ANALYSIS ON THE ICU

    International Nuclear Information System (INIS)

    Bos, Lieuwe D. J.; Sterk, Peter J.; Schultz, Marcus J.

    2011-01-01

    During admittance to the ICU, critically ill patients frequently develop secondary infections and/or multiple organ failure. Continuous monitoring of biological markers is very much needed. This study describes a new method to continuously monitor biomarkers in exhaled breath with an electronic nose.

  10. Breathing easier: Indonesia works towards cleaner air

    International Nuclear Information System (INIS)

    Madsen, Michael Amdi

    2015-01-01

    Indonesians can look forward to breathing cleaner air following upcoming changes in regulations introduced as a result of a study conducted using nuclear analytical techniques. Lead pollution and other fine particulate matter in the air is now, for the first time, being accurately monitored and is giving Indonesian officials a good understanding of their air pollution problem and how to manage it.

  11. ACTIVE CYCLE BREATHING TECHNIQUES IN HEART FAILURE ...

    African Journals Online (AJOL)

    RICHY

    47. Pulmonary Function Responses to Active Cycle. Breathing Techniques in Heart Failure Patients at the. University Teaching Hospital (UTH), Lusaka, Zambia. 1. 1. 2. 3. Charity Kapenda Muselema *, Methuselah Jere , Gershom Chongwe , Fastone M. Goma. 1Ministry of Community Development Mother and Child Health, ...

  12. A breath actuated dry powder inhaler

    NARCIS (Netherlands)

    de Boer, Anne; Frijlink, Henderik W.; Hagedoorn, Paul

    2015-01-01

    A breath actuated dry powder inhaler with a single air circulation chamber for de-agglomeration of entrained powdered medicament using the energy of the inspiratory air stream. The chamber has a substantially polygonal sidewall, a plurality of air supply channels entering the chamber substantially

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

    International Nuclear Information System (INIS)

    Wong, John W.; Sharpe, Michael B.; Jaffray, David A.; Kini, Vijay R.; Robertson, John M.; Stromberg, Jannifer S.; Martinez, Alavro A.

    1999-01-01

    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

  14. The cardiovascular and respiratory effects of medetomidine and thiopentone anaesthesia in dogs breathing at an altitude of 1486 m

    Directory of Open Access Journals (Sweden)

    K. E. Joubert

    2002-07-01

    Full Text Available The purpose of this study was to evaluate the cardio-respiratory effects of the combination of medetomidine and thiopentone followed by reversal with atipamezole as a combination for anaesthesia in 10 healthy German Shepherd dogs breathing spontaneously in a room at an altitude of 1486 m above sea level with an ambient air pressure of 651 mmHg. After the placement of intravenous and intra-arterial catheters, baseline samples were collected. Medetomidine (0.010 mg/kg was administered intravenously and blood pressure and heart rate were recorded every minute for 5 minutes. Thiopentone was then slowly administered until intubation conditions were ideal. An endotracheal tube was placed and the dogs breathed room air spontaneously. Blood pressure, pulse oximetry, respiratory and heart rate, capnography, blood gas analysis and arterial lactate were performed or recorded every 10 minutes for the duration of the trial. Thiopentone was administered to maintain anaesthesia. After 60 minutes, atipamezole (0.025 mg/kg was given intramuscularly. Data were recorded for the next 30 minutes. A dose of 8.7 mg/kg of thiopentone was required to anaesthetise the dogs after the administration of 0.010 mg/kg of medetomidine. Heart rate decreased from 96.7 at baseline to 38.5 5 minutes after the administration of medetomidine (P < 0.05. Heart rate then increased with the administration of thiopentone to 103.2 (P < 0.05. Blood pressure increased from 169.4/86.2 mmHg to 253.2/143.0 mmHg 5 minutes after the administration of medetomidine (P < 0.05. Blood pressure then slowly returned towards normal. Heart rate and blood pressure returned to baseline values after the administration of atipamezole. Arterial oxygen tension decreased from baseline levels (84.1 mmHg to 57.8 mmHg after the administration of medetomidine and thiopentone (P < 0.05. This was accompanied by arterial desaturation from 94.7 to 79.7 % (P < 0.05. A decrease in respiratory rate from 71.8 bpm to 12

  15. Human respiratory deposition of particles during oronasal breathing

    Science.gov (United States)

    Swift, David L.; Proctor, Donald F.

    Deposition of particles in the tracheobronchial and pulmonary airways is computed as a function of particle size, correcting for deposition in the parallel nasal and oral airways with oronasal breathing. Thoracic deposition is lower at all sizes for oronasal breathing than for mouth breathing via tube, and is negligible for aerodynamic equivalent diameters of 10 μm or larger.

  16. Oral Breathing Challenge in Participants with Vocal Attrition

    Science.gov (United States)

    Sivasankar, Mahalakshmi; Fisher, Kimberly V.

    2003-01-01

    Vocal folds undergo osmotic challenge by mouth breathing during singing, exercising, and loud speaking. Just 15 min of obligatory oral breathing, to dry the vocal folds, increases phonation threshold pressure (P[subscript th]) and expiratory vocal effort in healthy speakers (M. Sivasankar & K. Fisher, 2002). We questioned whether oral breathing is…

  17. 21 CFR 868.5240 - Anesthesia breathing circuit.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia breathing circuit. 868.5240 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5240 Anesthesia breathing circuit. (a) Identification. An anesthesia breathing circuit is a device that is intended to administer medical gases to a...

  18. 46 CFR 108.703 - Self-contained breathing apparatus.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Self-contained breathing apparatus. 108.703 Section 108... DESIGN AND EQUIPMENT Miscellaneous Equipment § 108.703 Self-contained breathing apparatus. (a) Each unit must be equipped with a self-contained breathing apparatus described in § 108.497(a) to use as...

  19. 46 CFR 197.340 - Breathing gas supply.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Breathing gas supply. 197.340 Section 197.340 Shipping... GENERAL PROVISIONS Commercial Diving Operations Equipment § 197.340 Breathing gas supply. (a) A primary breathing gas supply for surface-supplied diving must be sufficient to support the following for the...

  20. 21 CFR 868.5330 - Breathing gas mixer.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Breathing gas mixer. 868.5330 Section 868.5330...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5330 Breathing gas mixer. (a) Identification. A breathing gas mixer is a device intended for use in conjunction with a respiratory support...

  1. 46 CFR 197.450 - Breathing gas tests.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Breathing gas tests. 197.450 Section 197.450 Shipping....450 Breathing gas tests. The diving supervisor shall insure that— (a) The output of each air... or modification. (b) Purchased supplies of breathing mixtures supplied to a diver are checked before...

  2. 42 CFR 84.132 - Breathing tubes; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing tubes; minimum requirements. 84.132 Section 84.132 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL... Respirators § 84.132 Breathing tubes; minimum requirements. Flexible breathing tubes used in conjunction with...

  3. 42 CFR 84.1132 - Breathing tubes; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing tubes; minimum requirements. 84.1132 Section 84.1132 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL... Gas Masks § 84.1132 Breathing tubes; minimum requirements. (a) Flexible breathing tubes used in...

  4. 42 CFR 84.195 - Breathing tubes; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing tubes; minimum requirements. 84.195 Section 84.195 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL... Cartridge Respirators § 84.195 Breathing tubes; minimum requirements. Flexible breathing tubes used in...

  5. 46 CFR 169.736 - Self-contained breathing apparatus.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Self-contained breathing apparatus. 169.736 Section 169... VESSELS Vessel Control, Miscellaneous Systems, and Equipment Markings § 169.736 Self-contained breathing apparatus. Each locker or space containing self-contained breathing apparatus must be marked “SELF-CONTAINED...

  6. 46 CFR 154.1852 - Air breathing equipment.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Air breathing equipment. 154.1852 Section 154.1852... STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Operations § 154.1852 Air breathing equipment. (a) The master shall ensure that a licensed officer inspects the compressed air breathing...

  7. 42 CFR 84.172 - Breathing tubes; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing tubes; minimum requirements. 84.172... Air-Purifying Particulate Respirators § 84.172 Breathing tubes; minimum requirements. Flexible breathing tubes used in conjunction with respirators shall be designed and constructed to prevent: (a...

  8. 46 CFR 108.635 - Self-contained breathing apparatus.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Self-contained breathing apparatus. 108.635 Section 108... DESIGN AND EQUIPMENT Equipment Markings and Instructions § 108.635 Self-contained breathing apparatus. Each locker or space containing self-contained breathing apparatus must be marked: “SELF CONTAINED...

  9. The response of the vena cava to abdominal breathing.

    Science.gov (United States)

    Byeon, Kyeongmin; Choi, Jin-Oh; Yang, Jeong Hoon; Sung, Jidong; Park, Seung Woo; Oh, Jae K; Hong, Kyung Pyo

    2012-02-01

    Recently, abdominal-breathing or diaphragmatic-breathing methods have increased in popularity. Little is known how abdominal breathing affects the circulatory system. This study was designed to determine the impact of the respiratory pattern on central venous flow using echocardiography. The superior vena cava (SVC) and inferior vena cava (IVC) were observed in people who had practiced abdominal breathing for at least 2 years, while they were breathing in three different techniques: slow respiration, slow respiration with inspiratory pause, or normal respiration. In addition, the observation during normal respiration was compared with that of a control group. The abdominal-breathing group consisted of 20 people with mean duration of training of 9.6 years. The respiratory collapsibility index of IVC during slow respiration with inspiratory pause was 62±19% compared with 48±19% during normal respiration (p=0.012) in the abdominal-breathing group. The abdominal-breathing group had a higher IVC collapsibility index compared to the control group during normal respiration (48±19% versus 26±12%, pbreathing patterns or between groups. The IVC of people who practice abdominal breathing has a greater degree of collapse than those of normal people, suggesting that abdominal-breathing exercise can positively affect venous return via IVC. For those who practice abdominal breathing, the collapsibility of the IVC is the best during slow respiration with inspiratory pause. The SVC did not seem to be affected by abdominal-breathing training.

  10. 42 CFR 84.115 - Breathing tubes; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing tubes; minimum requirements. 84.115 Section 84.115 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL... § 84.115 Breathing tubes; minimum requirements. Flexible breathing tubes used in conjunction with gas...

  11. 42 CFR 84.152 - Breathing tube test; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing tube test; minimum requirements. 84.152... Respirators § 84.152 Breathing tube test; minimum requirements. (a)(1) Type A and Type B supplied-air respirators shall employ one or two flexible breathing tubes of the nonkinking type which extend from the...

  12. 14 CFR 29.1439 - Protective breathing equipment.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Protective breathing equipment. 29.1439... Protective breathing equipment. (a) If one or more cargo or baggage compartments are to be accessible in flight, protective breathing equipment must be available for an appropriate crewmember. (b) For...

  13. 42 CFR 84.122 - Breathing resistance test; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing resistance test; minimum requirements. 84... Masks § 84.122 Breathing resistance test; minimum requirements. (a) Resistance to airflow will be measured in the facepiece or mouthpiece of a gas mask mounted on a breathing machine both before and after...

  14. IMPLICATIONS OF MOUTH BREATHING AND ATYPICAL SWALLOWING IN BODY POSTURE

    Directory of Open Access Journals (Sweden)

    Veronique Sousa

    2017-07-01

    Conclusion: Statistically significant associations were established between the breathing pattern and the horizontal alignment of acromions, as well as the horizontal and vertical alignment of the head; between the pattern of breathing and swallowing with occlusal relationship anteroposterior and occlusal relationship vertical and also between breathing pattern and swallowing with digital sucking habits and pacifier use.

  15. 21 CFR 862.3050 - Breath-alcohol test system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Breath-alcohol test system. 862.3050 Section 862...) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Toxicology Test Systems § 862.3050 Breath-alcohol test system. (a) Identification. A breath-alcohol test system is a device intened...

  16. The best breathing command for abdominal PETCT

    International Nuclear Information System (INIS)

    Berthold, T.; Goerres, G.; Burger, C.

    2002-01-01

    Aim: To evaluate the best breathing command for combined PETCT scanning on a in-line system (Discovery LS, GEMS). Material and Methods: Eight patients underwent FDG PET and CT for attenuation correction and image co-registration on a combined PETCT scanner. CT was acquired during maximum inspiration (MaxInsp) with a starting point at the level of the head. Patients kept their breath for approximately 20 seconds. Then, a CT scan was acquired during normal expiration (NormExp), which corresponded to the respiratory level reached when the patient first inhaled and then exhaled without forcing expiration. Again, CT started at the head and patients kept their breath for approximately 20 seconds. In a third run, patients performed again the NormExp breathing manoeuvre but the breathing command was given after the start of the CT scan. Using this respiration protocol, the hold on time for the patients was between 10 and 15 seconds. All PET images were corrected for attenuation using the CT-based attenuation maps acquired with these three respiration protocols and then were reconstructed using an iterative algorithm. Results: In all patients, attenuation correction of the PET image using the CT scan acquired during MaxInsp caused mis-correction, which mimicked a decrease of FDG concentration in the base of the lungs. During MaxInsp the upper abdominal organs change their position and air filling of the lower lung zone is increased, thus, causing an underestimation of correction values. Subtraction images of the CT scans acquired during MaxInsp and NormExp illustrate the range of organ movements. Subtraction images of the attenuation corrected PET scans illustrate the deterioration of the final PET image. CT acquisition during NormExp provides better PET and co-registered PET/CT images. Using the shorter breath hold time the visual image quality was good in all patients. Conclusion: CT based attenuation correction can severely deteriorate PET image quality, if the CT scan

  17. Deep Breathing Improves End-Tidal Carbon Dioxide Monitoring of an Oxygen Nasal Cannula-Based Capnometry Device in Subjects Extubated After Abdominal Surgery.

    Science.gov (United States)

    Takaki, Shunsuke; Mizutani, Kenji; Fukuchi, Moeka; Yoshida, Tasuku; Idei, Masahumi; Matsuda, Yuko; Yamaguchi, Yoshikazu; Miyashita, Tetsuya; Nomura, Takeshi; Yamaguchi, Osamu; Goto, Takahisa

    2017-01-01

    Capnometry detects hypoventilation earlier than pulse oximetry while supplemental oxygen is being administered. We compared the end-tidal CO 2 (P ETCO 2 ) measured using a newly developed oxygen nasal cannula with a CO 2 -sampling port and the P aCO 2 in extubated subjects after abdominal surgery. We also investigated whether the difference between P aCO 2 and P ETCO 2 is affected by resting, by spontaneous breathing with the mouth consciously closed, and by deep breathing with the mouth closed. Adult post-abdominal surgery subjects admitted to the ICU were enrolled. After extubation, oxygen was supplied at 4 L/min using a capnometry-type oxygen cannula. The breathing frequency, P ETCO 2 , and P aCO 2 were measured after 30 min of oxygen supplementation. P ETCO 2 was continuously measured during rest, during breathing with the mouth consciously closed, and during deep breathing with the mouth closed. The difference between P ETCO 2 and P aCO 2 during various breathing patterns was analyzed using the Bland-Altman method. Twenty subjects were included. The bias ± SD (limits of agreement) for breathing frequency measured by capnometry compared with those obtained by direct measurement was 0.4 ± 3.6 (-6.7 to 7.4). In P ETCO 2 compared with P aCO 2 , the biases (limits of agreement) were 14.8 ± 8.2 (-1.3 to 30.9) at rest, 10.2 ± 6.4 (-2.3 to 22.7) with the mouth closed, and 7.7 ± 5.6 (-3.2 to 18.6) for deep breathing with the mouth closed. P ETCO 2 determined using the capnometry device yielded unreliable and widely ranging values under various breathing patterns. However, deep breathing with the mouth closed decreased the difference between P ETCO 2 and P aCO 2 , as compared with other breathing patterns. P ETCO 2 measurements under deep breathing with mouth closed with a capnometry-type oxygen cannula improved the prediction of the absolute value of P aCO 2 in extubated post-abdominal surgical subjects without respiratory dysfunction. Copyright © 2017 by

  18. Nocturnal breathing in cyanotic congenital heart disease.

    Science.gov (United States)

    Legault, Sylvie; Lanfranchi, Paola; Montplaisir, Jacques; Nielsen, Tore; Dore, Annie; Khairy, Paul; Marcotte, François; Mercier, Lise-Andrée

    2008-08-18

    Sleep disordered breathing is frequently observed in patients with cardiovascular disease. Even in the absence of heart disease, acute and chronic hypoxia have been shown to promote sleep-related periodic breathing with central apnea characterized by a repetitive reduction or lack of respiratory activity. Cyanotic congenital heart disease (CCHD) is associated with chronic hypoxia, regardless of whether an increase in pulmonary artery pressures coexists. Sleep aggravated hypoxia has been observed in many such patients, but it remains to be determined whether sleep disordered breathing is contributory. We, therefore, sought to assess sleep-related breathing pattern in patients with CCHD. Adults with CCHD, resting arterial oxygen saturation 40% were prospectively enrolled in a cross-sectional study. To assess sleep and respiratory indices, subjects underwent a standardized clinical appraisal that included arterial blood gas analysis and a comprehensive sleep study with an ambulatory device. An apnea-hypopnea index (AHI) >or=5/h was considered to indicate sleep apnea. Ten adults with CCHD, aged 38+/-11 years, completed the study. Seven patients had elevated pulmonary artery pressures, with a mean systolic pressure of 86.3+/-18.1 mm Hg. All patients demonstrated normal sleep parameters. Oxygen saturation further declined in 5 patients during sleep. However, no associated alteration in respiratory parameters was observed and no significant arrhythmia. The mean AHI was 1.1+/-1.0/h. No subject met the pre-defined criterion for sleep apnea. Although further oxygen desaturation may be observed during sleep in patients with CCHD, it occurs in the absence of sleep disordered breathing.

  19. Systematics of spontaneous positron lines

    International Nuclear Information System (INIS)

    Mueller, U.; Reus, T. de; Reinhardt, J.; Mueller, B.; Greiner, W.

    1985-08-01

    Dynamical and spontaneous positron emission are investigated for heavy-ion collisions with long time delay using a semiclassical description. Numerical results and analytical expressions for the characteristic quantities of the resulting spontaneous positron line, i.e., its position, width, and cross section, are compared. The expected behaviour of the line position and cross section and its visibility against the spectrum of dynamically created positrons is discussed in dependence of the united charge Zsub(u) of projectile and target nucleus in a range of systems from Zsub(u)=180 up to Zsub(u)=188. The results are confronted with presently available experimental data, and possible implications on further experiments are worked out. (orig.)

  20. Spontaneous Rotational Inversion in Phycomyces

    KAUST Repository

    Goriely, Alain

    2011-03-01

    The filamentary fungus Phycomyces blakesleeanus undergoes a series of remarkable transitions during aerial growth. During what is known as the stagea IV growth phase, the fungus extends while rotating in a counterclockwise manner when viewed from above (stagea IVa) and then, while continuing to grow, spontaneously reverses to a clockwise rotation (stagea IVb). This phase lasts for 24-48Ah and is sometimes followed by yet another reversal (stageAIVc) before the overall growth ends. Here, we propose a continuum mechanical model of this entire process using nonlinear, anisotropic, elasticity and show how helical anisotropy associated with the cell wall structure can induce spontaneous rotation and, under appropriate circumstances, the observed reversal of rotational handedness. © 2011 American Physical Society.

  1. Spontaneous regression of colon cancer.

    Science.gov (United States)

    Kihara, Kyoichi; Fujita, Shin; Ohshiro, Taihei; Yamamoto, Seiichiro; Sekine, Shigeki

    2015-01-01

    A case of spontaneous regression of transverse colon cancer is reported. A 64-year-old man was diagnosed as having cancer of the transverse colon at a local hospital. Initial and second colonoscopy examinations revealed a typical cancer of the transverse colon, which was diagnosed as moderately differentiated adenocarcinoma. The patient underwent right hemicolectomy 6 weeks after the initial colonoscopy. The resected specimen showed only a scar at the tumor site, and no cancerous tissue was proven histologically. The patient is alive with no evidence of recurrence 1 year after surgery. Although an antitumor immune response is the most likely explanation, the exact nature of the phenomenon was unclear. We describe this rare case and review the literature pertaining to spontaneous regression of colorectal cancer. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Management of intractable spontaneous epistaxis

    Science.gov (United States)

    Rudmik, Luke

    2012-01-01

    Background: Epistaxis is a common otolaryngology emergency and is often controlled with first-line interventions such as cautery, hemostatic agents, or anterior nasal packing. A subset of patients will continue to bleed and require more aggressive therapy. Methods: Intractable spontaneous epistaxis was traditionally managed with posterior nasal packing and prolonged hospital admission. In an effort to reduce patient morbidity and shorten hospital stay, surgical and endovascular techniques have gained popularity. A literature review was conducted. Results: Transnasal endoscopic sphenopalatine artery ligation and arterial embolization provide excellent control rates but the decision to choose one over the other can be challenging. The role of transnasal endoscopic anterior ethmoid artery ligation is unclear but may be considered in certain cases when bleeding localizes to the ethmoid region. Conclusion: This article will focus on the management of intractable spontaneous epistaxis and discuss the role of endoscopic arterial ligation and embolization as it pertains to this challenging clinical scenario. PMID:22391084

  3. Spontaneous baryogenesis in warm inflation

    OpenAIRE

    Brandenberger, Robert H.; Yamaguchi, Masahide

    2003-01-01

    We discuss spontaneous baryogenesis in the warm inflation scenario. In contrast with standard inflation models, radiation always exists in the warm inflation scenario, and the inflaton must be directly coupled to it. Also, the transition to the post-inflationary radiation dominated phase is smooth and the entropy is not significantly increased at the end of the period of inflation. In addition, after the period of warm inflation ends, the inflaton does not oscillate coherently but slowly roll...

  4. Differential Medical Aerosol Device and Interface Selection in Patients during Spontaneous, Conventional Mechanical and Noninvasive Ventilation.

    Science.gov (United States)

    Ari, Arzu; Fink, James B

    2016-04-01

    Many aerosol delivery devices are available on the market that have different features, characteristics, and operating requirements that need to be considered for the effective treatment of patients with pulmonary diseases. Device selection in aerosol medicine is largely patient dependent. Since there is no aerosol device that suits all patient populations, device selection and successful integration of the prescribed aerosol device to patients is essential. This article explores key issues in differential device selection in spontaneously breathing adults with or without artificial airways, as well as critically ill patients receiving invasive and noninvasive ventilation, with discussion of considerations for integration of aerosol devices to each of these patient populations.

  5. Spontaneous Splenic Rupture in Melanoma

    Directory of Open Access Journals (Sweden)

    Hadi Mirfazaelian

    2014-01-01

    Full Text Available Spontaneous rupture of spleen due to malignant melanoma is a rare situation, with only a few case reports in the literature. This study reports a previously healthy, 30-year-old man who came with chief complaint of acute abdominal pain to emergency room. On physical examination, abdominal tenderness and guarding were detected to be coincident with hypotension. Ultrasonography revealed mild splenomegaly with moderate free fluid in abdominopelvic cavity. Considering acute abdominal pain and hemodynamic instability, he underwent splenectomy with splenic rupture as the source of bleeding. Histologic examination showed diffuse infiltration by tumor. Immunohistochemical study (positive for S100, HMB45, and vimentin and negative for CK, CD10, CK20, CK7, CD30, LCA, EMA, and chromogranin confirmed metastatic malignant melanoma. On further questioning, there was a past history of a nasal dark skin lesion which was removed two years ago with no pathologic examination. Spontaneous (nontraumatic rupture of spleen is an uncommon situation and it happens very rarely due to neoplastic metastasis. Metastasis of malignant melanoma is one of the rare causes of the spontaneous rupture of spleen.

  6. Management of Sleep Disordered Breathing in Patients with Heart Failure.

    Science.gov (United States)

    Oates, Connor P; Ananthram, Manjula; Gottlieb, Stephen S

    2018-04-03

    This paper reviews treatment options for sleep disordered breathing (SDB) in patients with heart failure. We sought to identify therapies for SDB with the best evidence for long-term use in patients with heart failure and to minimize uncertainties in clinical practice by examining frequently discussed questions: what is the role of continuous positive airway pressure (CPAP) in patients with heart failure? Is adaptive servo-ventilation (ASV) safe in patients with heart failure? To what extent is SDB a modifiable risk factor? Consistent evidence has demonstrated that the development of SDB in patients with heart failure is a poor prognostic indicator and a risk factor for cardiovascular mortality. However, despite numerous available interventions for obstructive sleep apnea and central sleep apnea, it remains unclear what effect these therapies have on patients with heart failure. To date, all major randomized clinical trials have failed to demonstrate a survival benefit with SDB therapy and one major study investigating the use of adaptive servo-ventilation demonstrated harm. Significant questions persist regarding the management of SDB in patients with heart failure. Until appropriately powered trials identify a treatment modality that increases cardiovascular survival in patients with SDB and heart failure, a patient's heart failure management should remain the priority of medical care.

  7. Effect of cardiac pacing on sleep-related breathing disorders: a systematic review.

    Science.gov (United States)

    Anastasopoulos, Dimitrios L; Chalkias, Athanasios; Iakovidou, Nicoletta; Xanthos, Theodoros

    2016-09-01

    Sleep-related breathing disorders are commonly encountered in the middle-aged population, negatively affecting quality of life. Central sleep apnea is associated with congestive heart failure, whereas obstructive sleep apnea is related to different pathophysiologic mechanisms, such as the total or partial occlusion of upper airway tract. Both sleep-related disorders have been associated with increased morbidity, and hence, they have been a target of several treatment strategies. The aim of this systematic review is to evaluate the effect of different types of cardiac pacing on sleep-related breathing disorders in patients with or without heart failure. The PubMed and Cochrane Central Register of Controlled Trials were examined from April 2015 to January 2016. Of the initial 360 studies, 22 eligible trials were analyzed. The included studies were classified according to the type of sleep disorder and the intervention undertaken. The evidence shows that cardiac resynchronization therapy but not atrial overdrive pacing can reduce apneic events in central sleep apnea patients. However, their effect on obstructive sleep apnea is controversial. It can be assumed that pacing cannot be used alone as treatment of sleep-related breathing disorders. Further research is needed in order to elucidate the effect of these interventions in sleep apnea patients.

  8. Treatment of cyanotic breath-holding spells with oral theophylline in a 10-year-old boy.

    Science.gov (United States)

    Garg, Meenal; Goraya, Jatinder S

    2015-06-01

    Cyanotic breath-holding spells are generally benign and resolve spontaneously by 4 to 5 years of age. Treatment with iron and other drugs has been employed in selected cases with very frequent and severe episodes. We describe a 10-year-old boy with recent-onset cyanotic breath-holding spells that were activity limiting. He was unable to participate in physical activities with his peers as any argument or emotional upset provoked these spells. Treatment with oral iron and piracetam was ineffective. However, treatment with oral theophylline produced dramatic amelioration of symptoms, and he was once again able to participate in play activities with his peers. We believe that general central nervous system stimulant and respirogenic effects of theophylline were instrumental in control of symptoms in our child. © The Author(s) 2014.

  9. The importance of the expiratory pause. Comparison of the Mapleson A, C and D breathing systems using a lung model.

    Science.gov (United States)

    Cook, L B

    1996-05-01

    A physical lung model simulating spontaneous respiration was used to investigate the influence of the respiratory pattern on the efficiency of the Mapleson A, C and D breathing systems. It is shown that the Mapleson A system is always the most efficient breathing system and that its performance is relatively independent of the respiratory pattern. When the expiratory pause is minimal, the Mapleson C system is almost as efficient as the Mapleson A, but becomes ever less efficient as the expiratory pause increases. The Mapleson D system is very inefficient when the expiratory pause is short. With a longer expiratory pause, this system's efficiency approaches that of the Mapleson A. The experimental results are compared with predictions generated by a mathematical model. There is good agreement between the two, validating the mathematics used.

  10. The effects of breathing techniques training on the duration of labor and anxiety levels of pregnant women.

    Science.gov (United States)

    Cicek, Sevil; Basar, Fatma

    2017-11-01

    To assess the effects of breathing techniques training on anxiety levels of pregnant women and the duration of labor. The study utilizes a randomized controlled trial design. The pregnant women were divided into control (n = 35) or experimental group (n = 35) randomly. The experimental group received breathing techniques training in the latent phase and these techniques were applied in the following phases accordingly. The anxiety levels of pregnant women were evaluated three times in total. The duration of labor was considered as the duration of the first stage of labor and the duration of the second stage of labor. There were significant differences between the two groups regarding the mean State Anxiety Inventory (SAI) and the mean duration of labor. This study concludes that breathing techniques are an effective method in the reduction of anxiety and influence the duration of delivery during labor. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. [Irregular breathing during the cardiopulmonary exercise test - from mildly irregular breathing pattern to periodic breathing of oscillatory ventilation type].

    Science.gov (United States)

    Várnay, František; Mífková, Leona; Homolka, Pavel; Dobšák, Petr

    The fluctuating course of tidal volume (VT), breathing frequency (DF) and minute ventilation (VE) during the cardio-pulmonary exercise test using a ramp incremental protocol occurs not only in patients, but relatively frequently also in healthy individuals. It can account for a number of irregularities in the course of the curves VO2, VCO2 and in particular of those of ventilatory equivalents for O2 and CO2 (EQO2, EQCO2) as well as curves of partial pressure of end-tidal oxygen and partial pressure of end-tidal carbon dioxide (PETO2, PETCO2), which are also used, inter alia, to establish ventilatory thresholds. The presence of exercise oscillatory ventilation (EOV) reflects the severity of heart failure and it is an independent predictor of the increased morbidity, cardiac and total mortality and sudden death caused by heart failure. However there is not a generally accepted universal definition of EOV available at present, as different criteria are used. We have not found a comparison which would indicate whether and how the "strength" of the prognostic criteria for EOV - established according to different methods - differs. Therefore it is very important to specify what method, or what criteria were used in the establishment of EOV.Key words: breathing pattern - EOV - exercise oscillatory ventilation - periodic breathing.

  12. Breath Analysis Using Laser Spectroscopic Techniques: Breath Biomarkers, Spectral Fingerprints, and Detection Limits

    Directory of Open Access Journals (Sweden)

    Peeyush Sahay

    2009-10-01

    Full Text Available Breath analysis, a promising new field of medicine and medical instrumentation, potentially offers noninvasive, real-time, and point-of-care (POC disease diagnostics and metabolic status monitoring. Numerous breath biomarkers have been detected and quantified so far by using the GC-MS technique. Recent advances in laser spectroscopic techniques and laser sources have driven breath analysis to new heights, moving from laboratory research to commercial reality. Laser spectroscopic detection techniques not only have high-sensitivity and high-selectivity, as equivalently offered by the MS-based techniques, but also have the advantageous features of near real-time response, low instrument costs, and POC function. Of the approximately 35 established breath biomarkers, such as acetone, ammonia, carbon dioxide, ethane, methane, and nitric oxide, 14 species in exhaled human breath have been analyzed by high-sensitivity laser spectroscopic techniques, namely, tunable diode laser absorption spectroscopy (TDLAS, cavity ringdown spectroscopy (CRDS, integrated cavity output spectroscopy (ICOS, cavity enhanced absorption spectroscopy (CEAS, cavity leak-out spectroscopy (CALOS, photoacoustic spectroscopy (PAS, quartz-enhanced photoacoustic spectroscopy (QEPAS, and optical frequency comb cavity-enhanced absorption spectroscopy (OFC-CEAS. Spectral fingerprints of the measured biomarkers span from the UV to the mid-IR spectral regions and the detection limits achieved by the laser techniques range from parts per million to parts per billion levels. Sensors using the laser spectroscopic techniques for a few breath biomarkers, e.g., carbon dioxide, nitric oxide, etc. are commercially available. This review presents an update on the latest developments in laser-based breath analysis.

  13. Circadian rhythm of breath hydrogen in young women.

    Science.gov (United States)

    Kagaya, M; Iwata, M; Toda, Y; Nakae, Y; Kondo, T

    1998-08-01

    Breath hydrogen levels, which reflect colonic fermentation of undigested starches, are usually low in the fasted state. Fasting levels of breath hydrogen are important for estimation of oro-cecal transit time and diagnosis of lactase deficiency. In young women, however, fasting levels of breath hydrogen are high. To clarify the reason for this, we studied the circadian pattern of breath hydrogen and the effect of alpha-D-galactosidase on fasting breath hydrogen in one study, and the effect of sleep deprivation on fasting breath hydrogen in another study, in 13 women students aged 21-23 years. In the first study, two breath samples were collected, one in the evening and the other the next morning. On another occasion, alpha-D-galactosidase was given before dinner and breath samples were collected the next morning. In the second study, the circadian rhythm of breath hydrogen was assessed for 3 days and the subjects were deprived of sleep on the second night. Breath samples were collected every 30 min, except during the second night when samples were collected at 1-h intervals. Fasting breath hydrogen was 24 +/- 3.9 ppm (mean +/- SE), which did not differ from the value for the previous night. Alpha-D-galactosidase significantly decreased fasting breath hydrogen levels, to 17 +/- 2.4 ppm (P Sleep deprivation did not affect fasting levels of breath hydrogen. High fasting breath hydrogen levels in young women followed a circadian pattern and this may have been due, in part, to an high intake of dietary fiber on the previous day.

  14. Spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy.

    Science.gov (United States)

    Sheffield, Jeanne S; Andrews, Williams W; Klebanoff, Mark A; Macpherson, Cora; Carey, J Christopher; Ernest, J M; Wapner, Ronald J; Trout, Wayne; Moawad, Atef; Miodovnik, Menachem; Sibai, Baha; Varner, Michael W; Caritis, Steve N; Dombrowski, Mitchell; Langer, Oded; O'Sullivan, Mary J

    2005-03-01

    We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution. A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 16(0/7) and 23(6/7) weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow-up ligase chain reaction was performed between 24(0/7) and 29(6/7) weeks. A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79%) had ligase chain reaction performed both at randomization and follow-up. Women receiving antibiotics effective against Chlamydia between randomization and follow-up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9%) who were diagnosed as positive via the initial ligase chain reaction assay, 61 (44%) had spontaneous resolution of Chlamydia by the follow-up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow-up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater-than-5-week follow-up interval remained significant; for every 5-year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow-up decreased by 40% (odds ratio 0.6; 95% confidence interval 0.4-0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow-up also were not associated. The prevalence of asymptomatic C trachomatis in pregnancy was 9%; infection resolved spontaneously in almost half of these

  15. Universe out of a breathing bubble

    International Nuclear Information System (INIS)

    Guendelman, Eduardo I.; Sakai, Nobuyuki

    2008-01-01

    We consider the model of a false-vacuum bubble with a thin wall where the surface energy density is composed of two different components, 'domain-wall' type and 'dust' type, with opposite signs. We find stably oscillating solutions, which we call 'breathing bubbles'. By decay to a lower mass state, such a breathing bubble could become either (i) a child universe or ii) a bubble that 'eats up' the original universe, depending on the sign of the surface energy of the domain-wall component. We also discuss the effect of the finite-thickness corrections to the thin-wall approximation and possible origins of the energy contents of our model

  16. Coordination of Mastication, Swallowing and Breathing

    OpenAIRE

    Matsuo, Koichiro; Palmer, Jeffrey B.

    2009-01-01

    The pathways for air and food cross in the pharynx. In breathing, air may flow through either the nose or the mouth; it always flows through the pharynx. During swallowing, the pharynx changes from an airway to a food channel. The pharynx is isolated from the nasal cavity and lower airway by velopharyngeal and laryngeal closure during the pharyngeal swallow. During mastication, the food bolus accumulates in the pharynx prior to swallow initiation. The structures in the oral cavity, pharynx an...

  17. Breathing air trailer acceptance test report

    International Nuclear Information System (INIS)

    Kostelnik, A.J.

    1996-01-01

    This Acceptance Test Report documents compliance with the requirements of specification WHC-S-0251, Rev.0 and ECNs 613530 and 606113. The equipment was tested according to WHC-SD-WM-ATP-104. The equipment tested is a Breathing Air Supply Trailer purchased as a design and fabrication procurement activity. The ATP was written by the Seller and was performed by the Seller with representatives of the Westinghouse Hanford Company witnessing portions of the test at the Seller's location

  18. Breath tests and irritable bowel syndrome.

    Science.gov (United States)

    Rana, Satya Vati; Malik, Aastha

    2014-06-28

    Breath tests are non-invasive tests and can detect H₂ and CH₄ gases which are produced by bacterial fermentation of unabsorbed intestinal carbohydrate and are excreted in the breath. These tests are used in the diagnosis of carbohydrate malabsorption, small intestinal bacterial overgrowth, and for measuring the orocecal transit time. Malabsorption of carbohydrates is a key trigger of irritable bowel syndrome (IBS)-type symptoms such as diarrhea and/or constipation, bloating, excess flatulence, headaches and lack of energy. Abdominal bloating is a common nonspecific symptom which can negatively impact quality of life. It may reflect dietary imbalance, such as excess fiber intake, or may be a manifestation of IBS. However, bloating may also represent small intestinal bacterial overgrowth. Patients with persistent symptoms of abdominal bloating and distension despite dietary interventions should be referred for H₂ breath testing to determine the presence or absence of bacterial overgrowth. If bacterial overgrowth is identified, patients are typically treated with antibiotics. Evaluation of IBS generally includes testing of other disorders that cause similar symptoms. Carbohydrate malabsorption (lactose, fructose, sorbitol) can cause abdominal fullness, bloating, nausea, abdominal pain, flatulence, and diarrhea, which are similar to the symptoms of IBS. However, it is unclear if these digestive disorders contribute to or cause the symptoms of IBS. Research studies show that a proper diagnosis and effective dietary intervention significantly reduces the severity and frequency of gastrointestinal symptoms in IBS. Thus, diagnosis of malabsorption of these carbohydrates in IBS using a breath test is very important to guide the clinician in the proper treatment of IBS patients.

  19. Forced Air-Breathing PEMFC Stacks

    Directory of Open Access Journals (Sweden)

    K. S. Dhathathreyan

    2012-01-01

    Full Text Available Air-breathing fuel cells have a great potential as power sources for various electronic devices. They differ from conventional fuel cells in which the cells take up oxygen from ambient air by active or passive methods. The air flow occurs through the channels due to concentration and temperature gradient between the cell and the ambient conditions. However developing a stack is very difficult as the individual cell performance may not be uniform. In order to make such a system more realistic, an open-cathode forced air-breathing stacks were developed by making appropriate channel dimensions for the air flow for uniform performance in a stack. At CFCT-ARCI (Centre for Fuel Cell Technology-ARC International we have developed forced air-breathing fuel cell stacks with varying capacity ranging from 50 watts to 1500 watts. The performance of the stack was analysed based on the air flow, humidity, stability, and so forth, The major advantage of the system is the reduced number of bipolar plates and thereby reduction in volume and weight. However, the thermal management is a challenge due to the non-availability of sufficient air flow to remove the heat from the system during continuous operation. These results will be discussed in this paper.

  20. Current management of spontaneous coronary artery dissection.

    Science.gov (United States)

    Bastante, Teresa; Cuesta, Javier; García-Guimaraes, Marcos; Rivero, Fernando; Maruri, Ramon; Adlan, David; Alfonso, Fernando

    2017-08-01

    Spontaneous coronary artery dissection (SCAD) remains an infrequent and elusive clinical entity of unknown etiology. However, our knowledge of SCAD has been significantly enriched in recent years. Large and prospective contemporary series have increased the interest in this disease with fewer patients misdiagnosed and a growing number of cases recognized in daily clinical practice. Classically, SCAD was thought to present mainly in young women without traditional atherosclerotic risk factors but, actually, most patients are middle-aged and are not free from coronary risk factors. A high number of associated conditions have been reported. Of these, fibromuscular dysplasia emerges as a major association with intriguing pathophysiological implications. Areas covered: This review aims to present a contemporary update on SCAD. We concentrate on the clinical scenario, related conditions, practical management and treatment strategies. Expert commentary: Recognition of SCAD is currently much more frequent and accurate as a result of increased clinical awareness and the widespread use of intravascular imaging techniques. Hopefully, in the near future an improvement in the management of SCAD patients will come not only from empirical evidence but also from dedicated clinical trials.

  1. Bed Rest and Hypoxic Exposure Affect Sleep Architecture and Breathing Stability

    Directory of Open Access Journals (Sweden)

    Shawnda A. Morrison

    2017-06-01

    Full Text Available Objective: Despite over 50 years of research on the physiological effects of sustained bed rest, data characterizing its effects on sleep macrostructure and breathing stability in humans are scarce. This study was conducted to determine the effects of continuous exposure to hypoxia and sustained best rest, both individually and combined, on nocturnal sleep and breathing stability.Methods: Eleven participants completed three randomized, counter-balanced, 21-days trials of: (1 normoxic bed rest (NBR, PIO2 = 133.1 ± 0.3, (2 hypoxic ambulatory confinement (HAMB, PIO2 = 90.0 ± 0.4 and (3 hypoxic bed rest (HBR, PIO2 = 90.0 ± 0.4; ~4,000 m equivalent altitude. Full objective polysomnography was performed at baseline, on Night 1 and Night 21 in each condition.Results: In NBR Night 1, more time was spent in light sleep (10 ± 2% compared to baseline (8 ± 2%; p = 0.028; Slow-wave sleep (SWS was reduced from baseline in the hypoxic-only trial by 18% (HAMB Night 21, p = 0.028 and further reduced by 33% (HBR Night 1, p = 0.010, and 36% (HBR Night 21, p = 0.008 when combined with bed rest. The apnea-hypopnea index doubled from Night 1 to Night 21 in HBR (32–62 events·h−1 and HAMB (31–59 events·h−1; p = 0.002. Those who experienced greatest breathing instability from Night 1 to Night 21 (NBR were correlated to unchanged or higher (+1% night SpO2 concentrations (R2 = 0.471, p = 0.020.Conclusion: Bed rest negatively affects sleep macrostructure, increases the apnea-hypopnea index, and worsens breathing stability, each independently exacerbated by continuous exposure to hypoxia.

  2. Comparison of cephalometric patterns in mouth breathing and nose breathing children.

    Science.gov (United States)

    Chung Leng Muñoz, Isabel; Beltri Orta, Paola

    2014-07-01

    The aim of this study was to compare cephalometric values between nasal and oral breathing children and to measure the upper and lower airway space in both groups. The study was conducted on 118 pediatric patients, 51 girls and 67 boys, from the Dental Clinic of the Universidad Europea de Madrid. The age ranges of the sample were 6-12 years old. 53 of them were mouth breathers and 65 nose breathers. Lateral cephalometric radiographs were obtained for all of the subjects. The radiographs were analyzed and a cephalometric tracing was performed on each one. The mouth breathing children showed a more retruded mandible (SNB), and a greater inclination of the mandibular plane (NS-Go Gn) and occlusal plane (NS-O Pl.), than the nose breathing children (Pbreathing group also had a higher frequency of having the hyoid bone in a more elevated position and the nasopharyngeal air space significantly smaller than the nasal breathing group (Pbreathing children seem to have an increase in anterior lower facial height, the hyoid bone in a more elevated position and higher tendency towards having a class II malocclusion compared to nose breathing children. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. Spontaneous oscillations in microfluidic networks

    Science.gov (United States)

    Case, Daniel; Angilella, Jean-Regis; Motter, Adilson

    2017-11-01

    Precisely controlling flows within microfluidic systems is often difficult which typically results in systems being heavily reliant on numerous external pumps and computers. Here, I present a simple microfluidic network that exhibits flow rate switching, bistablity, and spontaneous oscillations controlled by a single pressure. That is, by solely changing the driving pressure, it is possible to switch between an oscillating and steady flow state. Such functionality does not rely on external hardware and may even serve as an on-chip memory or timing mechanism. I use an analytic model and rigorous fluid dynamics simulations to show these results.

  4. General features of spontaneous baryogenesis

    Science.gov (United States)

    Arbuzova, Elena

    2017-04-01

    The classical version of spontaneous baryogenesis is studied in details. It is shown that the relation between the time derivative of the (pseudo)goldstone field and the baryonic chemical potential essentially depends upon the representation chosen for the fermionic fields with non-zero baryonic number (quarks). The kinetic equation, used for the calculations of the cosmological baryon asymmetry, is generalized to the case of non-stationary background. The effects of the finite interval of the integration over time are also included into consideration.

  5. Spontaneous osteonecrosis of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Kattapuram, Taj M. [Department of Radiology, Massachusetts General Hospital (United States); Kattapuram, Susan V. [Department of Radiology, Massachusetts General Hospital (United States)], E-mail: skattapuram@partners.org

    2008-07-15

    Spontaneous osteonecrosis of the knee presents with acute onset of severe, pain in elderly patients, usually female and usually without a history of trauma. Originally described as idiopathic osteonecrosis, the exact etiology is still debated. Evidence suggests that an acute fracture occurs as a result of chronic stress or minor trauma to a weakened subchondral bone plate. The imaging characteristics on MR reflect the age of the lesion and the symptoms. More appropriate terminology may be ' subchondral insufficiency fracture of the knee' or 'focal subchondral osteonecrosis'.

  6. The patient inflating valve in anaesthesia and resuscitation breathing systems.

    Science.gov (United States)

    Fenton, P M; Bell, G

    2013-03-01

    Patient inflating valves combined with self-inflating bags are known to all anaesthetists as resuscitation devices and are familiar as components of draw-over anaesthesia systems. Their variants are also commonplace in transfer and home ventilators. However, the many variations in structure and function have led to difficulties in their optimal use, definition and classification. After reviewing the relevant literature, we defined a patient inflating valve as a one-way valve that closes an exit port to enable lung inflation, also permitting exhalation and spontaneous breathing, the actions being automatic. We present a new classification based on the mechanism of valve opening/closure; namely elastic recoil of a flexible flap/diaphragm, sliding spindle opened by a spring/magnet or a hollow balloon collapsed by external pressure. The evolution of these valves has been driven by the difficulties documented in critical incidents, which we have used along with information from modern International Organization for Standardization standards to identify 13 ideal properties, the top six of which are non-jamming, automatic, no bypass effect, no rebreathing or air entry at patient end, low resistance, robust and easy to service. The Ambu and the Laerdal valves have remained popular due to their simplicity and reliability. Two new alternatives, the Fenton and Diamedica valves, offer the benefits of location away from the patient while retaining a small functional dead space. They also offer the potential for greater use of hybrid continuous flow/draw-over systems that can operate close to atmospheric pressure. The reliable application of positive end-expiratory pressure/continuous positive airway pressure remains a challenge.

  7. Optimization of sampling parameters for standardized exhaled breath sampling.

    Science.gov (United States)

    Doran, Sophie; Romano, Andrea; Hanna, George B

    2017-09-05

    The lack of standardization of breath sampling is a major contributing factor to the poor repeatability of results and hence represents a barrier to the adoption of breath tests in clinical practice. On-line and bag breath sampling have advantages but do not suit multicentre clinical studies whereas storage and robust transport are essential for the conduct of wide-scale studies. Several devices have been developed to control sampling parameters and to concentrate volatile organic compounds (VOCs) onto thermal desorption (TD) tubes and subsequently transport those tubes for laboratory analysis. We conducted three experiments to investigate (i) the fraction of breath sampled (whole vs. lower expiratory exhaled breath); (ii) breath sample volume (125, 250, 500 and 1000ml) and (iii) breath sample flow rate (400, 200, 100 and 50 ml/min). The target VOCs were acetone and potential volatile biomarkers for oesophago-gastric cancer belonging to the aldehyde, fatty acids and phenol chemical classes. We also examined the collection execution time and the impact of environmental contamination. The experiments showed that the use of exhaled breath-sampling devices requires the selection of optimum sampling parameters. The increase in sample volume has improved the levels of VOCs detected. However, the influence of the fraction of exhaled breath and the flow rate depends on the target VOCs measured. The concentration of potential volatile biomarkers for oesophago-gastric cancer was not significantly different between the whole and lower airway exhaled breath. While the recovery of phenols and acetone from TD tubes was lower when breath sampling was performed at a higher flow rate, other VOCs were not affected. A dedicated 'clean air supply' overcomes the contamination from ambient air, but the breath collection device itself can be a source of contaminants. In clinical studies using VOCs to diagnose gastro-oesophageal cancer, the optimum parameters are 500mls sample volume

  8. The spontaneous breakdown of chiral symmetry in QCD

    International Nuclear Information System (INIS)

    Yoshida, K.

    1980-02-01

    It is suggested that the usual path integral representation of Euclidean vacuum amplitude (tunneling amplitude) in QCD must be supplemented by the explicit boundary condition corresponding to the spontaneous breaking of chiral SU(N) x SU(N). Adopting the trial wave function introduced by Nambu and Jona-Lasinio, one sees that such a path integral automatically breaks also the additional chiral U(1) symmetry of massless quarks. The catastrophe of semi-classical approach to QCD and 'U(1) problem' would be avoided in this way and one has, in principle, a better starting point for the self-consistent calculation

  9. Radiological evaluation of spontaneous pneumoperitoneum

    International Nuclear Information System (INIS)

    Kim, H. S.; Kim, J. D.; Rhee, H. S.

    1982-01-01

    112 cases of spontaneous penumoperitoneum, the causes of which were confirmed by clinical and surgical procedure at Presbyterian Medical Center from January, 1977 to July, 1981 were reviewed radiologically. The results were as follows: 1. Perforation of duodenal ulcer (46/112: 41.1%), stomach ulcer (22/112: 19.6%), and stomach cancer (11/112: 9.8%) were the three most common causes of spontaneous penumoperitoneum. These were 70.5% of all causes. 2. The most common site of free gas was both subdiaphragmatic areas (46: 41.1%). Others were Rt. subdiaphragmatic only (31: 27.7%), both subdiaphragmatic with subhepatic (16: 14.3%), Rt. subdiaphragmatic with subhepatic (7: 6.2%), Rt. subdiaphragmatic only (5: 4.4%), diffuse in abdomen (4: 3.6%), and subhepatic only (3: 2.7%). So 92.0% (103/112) were located in RUQ. 3. The radiological shape of free gas was classified: crescent (52: 46.4%) of small amount; half-moon (21: 18.8%) of moderate amount; large or diffuse (39: 34.8%) of large amount.4. The age between 31 and 60 occupied 69.1% (77/112), and male was predominant (5.2 times). 5. The patient's position showing free air most frequently was erect

  10. Estimation of tracheal pressure and imposed expiratory work of breathing by the endotracheal tube, heat and moisture exchanger, and ventilator during mechanical ventilation.

    Science.gov (United States)

    Uchiyama, Akinori; Yoshida, Takeshi; Yamanaka, Hidenori; Fujino, Yuji

    2013-07-01

    The resistance of the endotracheal tube (ETT), the heat and moisture exchanger (HME), and the ventilator may affect the patient's respiratory status. Although previous studies examined the inspiratory work of breathing (WOB), investigation of WOB in the expiratory phase is rare. We estimated tracheal pressure at the tip of the ETT (Ptrach) and calculated expiratory WOB imposed by the ETT, the HME, and the expiratory valve. We examined imposed expiratory WOB in patients under a continuous mandatory ventilation (CMV) mode and during spontaneous breathing trials (SBTs). We hypothesized that imposed expiratory WOB would increase with heightened ventilatory demand. We measured airway pressure (Paw) and respiratory flow (V). We estimated Ptrach using the equation Ptrach = Paw - K1 × V(K2) - 2.70 × V(L/s)(1.42). K1 and K2 were determined by the inner diameter (ID) of the ETT. Imposed expiratory WOB was calculated from the area of Ptrach above PEEP versus lung volume. We examined imposed expiratory WOB and imposed expiratory resistance in relation to mean expiratory flow. We examined 28 patients under CMV mode, and 29 during SBT. During both CMV and SBT, as mean expiratory flow increased, imposed expiratory WOB increased. The regression curves between mean expiratory flow (x) (L/s) and imposed expiratory WOB (y) (J/L) were y = 1.35x(0.83) (R(2) = 0.79) for 7 mm ID ETT under CMV, y = 1.12x(0.82) (R(2) = 0.73) for 8 mm ID ETT under CMV, y = 1.07x(1.04) (R(2) = 0.85) for 7 mm ID ETT during SBT, and y = 0.84x(0.93) (R(2) = 0.75) for 8 mm ID ETT during SBT. Levels of imposed expiratory WOB were affected by ETT diameter and ventilator mode. The reason for increasing imposed expiratory WOB was an increase in expiratory resistance imposed by the ETT and HME. Under mechanical ventilation, imposed expiratory WOB should be considered in patients with higher minute ventilation.

  11. A Case of Multiple Spontaneous Keloid Scars

    Directory of Open Access Journals (Sweden)

    Abdulhadi Jfri

    2015-07-01

    Full Text Available Keloid scars result from an abnormal healing response to cutaneous injury or inflammation that extends beyond the borders of the original wound. Spontaneous keloid scars forming in the absence of any previous trauma or surgical procedure are rare. Certain syndromes have been associated with this phenomenon, and few reports have discussed the evidence of single spontaneous keloid scar, which raises the question whether they are really spontaneous. Here, we present a 27-year-old mentally retarded single female with orbital hypertelorism, broad nasal bridge, repaired cleft lip and high-arched palate who presented with progressive multiple spontaneous keloid scars in different parts of her body which were confirmed histologically by the presence of typical keloidal collagen. This report supports the fact that keloid scars can appear spontaneously and are possibly linked to a genetic factor. Furthermore, it describes a new presentation of spontaneous keloid scars in the form of multiple large lesions in different sites of the body.

  12. Spontaneity of communication in individuals with autism.

    Science.gov (United States)

    Chiang, Hsu-Min; Carter, Mark

    2008-04-01

    This article provides an examination of issues related to spontaneity of communication in children with autism. Deficits relating to spontaneity or initiation are frequently reported in individuals with autism, particularly in relation to communication and social behavior. Nevertheless, spontaneity is not necessarily clearly conceptualized or measured. Several approaches to conceptualization of communicative spontaneity are examined with a particular focus on the continuum model and how it might be practically applied. A range of possible explanations for deficits in spontaneity of communication in children with autism is subsequently explored, including external factors (highly structured teaching programs, failure to systematically instruct for spontaneity) and intrinsic characteristics (intellectual disability, stimulus overselectivity, weak central coherence). Possible implications for future research are presented.

  13. An adverse drug event manager facilitates spontaneous reporting of adverse drug reactions

    DEFF Research Database (Denmark)

    Vinther, Siri; Klarskov, Pia; Borgeskov, Hanne

    2017-01-01

    reporting and helps raise awareness about ADRs, including how and why they should be reported. Hopefully, this will assist national and European spontaneous reporting systems in their work to increase patient safety nationally and abroad. FUNDING: none. TRIAL REGISTRATION: not relevant. ....

  14. Expert opinion : Defining response to omalizumab in patients with chronic spontaneous urticaria

    NARCIS (Netherlands)

    Ferrer, Marta; Boccon-Gibod, Isabelle; Gonçalo, Margarida; İnalöz, Hüseyin Serhat; Knulst, André; Lapeere, Hilde; Parthasaradhi, Anchala; Stingl, Georg; Tagka, Anna; Valenzuela, Fernando; Yeung, Jensen; Thomsen, Simon Francis

    2017-01-01

    Omalizumab (a recombinant, humanized anti-immunoglobulin-E antibody) has been shown in three pivotal Phase III trials (ASTERIA I, II and GLACIAL) and real-world studies to be effective and well-tolerated for the treatment of chronic spontaneous urticaria (CSU), and is the only licensed third-line

  15. IMMEDIATE EFFECTS OF INVERSE RATIO BREATHING VERSUS DIAPHRAGMATIC BREATHING ON INSPIRATORY VITAL CAPACITY AND THORACIC EXPANSION IN ADULT HEALTHY FEMALES

    Directory of Open Access Journals (Sweden)

    Kshipra Baban Pedamkar

    2016-04-01

    Full Text Available Background: The normal inspiratory to expiratory ratio is 1:2.However, the duration of inspiration can be increased voluntarily till the ratio becomes 2:1.This is called as inverse ratio breathing. The effects of inverse ratio ventilation have been studied on patients with respiratory failure and Acute Respiratory Distress Syndrome. No studies have been carried out to study the effects of inverse ratio breathing in voluntarily breathing individuals. Hence this study was carried out to find the immediate effects of inverse ratio breathing versus diaphragmatic breathing on inspiratory vital capacity and thoracic expansion. Methods: 30 healthy adult females in the age group 20-25 years were included in the study. Inspiratory vital capacity and thoracic expansion at 2nd, 4th and 6th intercostal space was measured using a digital spirometer and an inelastic inch tape respectively. Diaphragmatic breathing was administered for one minute and the same parameters were measured again. A washout period of one day was given and same outcome measures were measured before and after individuals performed inverse ratio breathing with the help of a visual feedback video for one minute. Results: Data was analysed using Wilcoxon test. There was extremely significant difference between the mean increase in the inspiratory vital capacity and thoracic expansion at the 2nd, 4th and 6th intercostals space after inverse ratio breathing as compared to diaphragmatic breathing (p < 0.0001. Conclusion: Inspiratory vital capacity and thoracic expansion increase significantly after inverse ratio breathing.

  16. Spontaneous cryptococcal peritonitis in cirrhotic patients.

    Directory of Open Access Journals (Sweden)

    Sungkanuparph S

    2002-07-01

    Full Text Available Spontaneous bacterial peritonitis is a common complication in patients with cirrhosis and ascites. However, spontaneous peritonitis caused by Cryptococcus neoformans is uncommon. Delayed diagnosis of cryptococcal peritonitis often results in death. We describe three cases of spontaneous cryptococcal peritonitis in patients with decompensated cirrhosis. One case had associated symptomatic human immunodeficiency virus infection. Clinical awareness of this entity may lead to the early diagnosis and proper treatment.

  17. Spontaneous Intracranial Hypotension without Orthostatic Headache

    Directory of Open Access Journals (Sweden)

    Tülay Kansu

    2009-03-01

    Full Text Available We report 2 cases of spontaneous intracranial hypotension that presented with unilateral abducens nerve palsy, without orthostatic headache. While sixth nerve palsies improved without any intervention, subdural hematoma was detected with magnetic resonance imaging. We conclude that headache may be absent in spontaneous intracranial hypotension and spontaneous improvement of sixth nerve palsy can occur, even after the development of a subdural hematoma

  18. Spontaneous renal hematoma - a case report

    International Nuclear Information System (INIS)

    Obrzut, M.; Obrzut, M.; Homa, J.; Obrzut, B.

    2006-01-01

    Spontaneous pararenal hematoma is a rare pathology most frequently coexisting with renal tumours, vascular anomalies and inflammatory processes. In some cases one cannot establish its etiology. The paper describes a case of a 58-year-old man with a spontaneous pararenal hematoma and presents a diagnostic algorithm. Ultrasonography and CT play an important role in diagnostics of spontaneous pararenal haemorrhages. These methods enable a precise evaluation of size and location of hematoma and its evolution. (author)

  19. Automated acoustic analysis in detection of spontaneous swallows in Parkinson's disease.

    Science.gov (United States)

    Golabbakhsh, Marzieh; Rajaei, Ali; Derakhshan, Mahmoud; Sadri, Saeed; Taheri, Masoud; Adibi, Peyman

    2014-10-01

    Acoustic monitoring of swallow frequency has become important as the frequency of spontaneous swallowing can be an index for dysphagia and related complications. In addition, it can be employed as an objective quantification of ingestive behavior. Commonly, swallowing complications are manually detected using videofluoroscopy recordings, which require expensive equipment and exposure to radiation. In this study, a noninvasive automated technique is proposed that uses breath and swallowing recordings obtained via a microphone located over the laryngopharynx. Nonlinear diffusion filters were used in which a scale-space decomposition of recorded sound at different levels extract swallows from breath sounds and artifacts. This technique was compared to manual detection of swallows using acoustic signals on a sample of 34 subjects with Parkinson's disease. A speech language pathologist identified five subjects who showed aspiration during the videofluoroscopic swallowing study. The proposed automated method identified swallows with a sensitivity of 86.67 %, a specificity of 77.50 %, and an accuracy of 82.35 %. These results indicate the validity of automated acoustic recognition of swallowing as a fast and efficient approach to objectively estimate spontaneous swallow frequency.

  20. Breath acetone analyzer: diagnostic tool to monitor dietary fat loss.

    Science.gov (United States)

    Kundu, S K; Bruzek, J A; Nair, R; Judilla, A M

    1993-01-01

    Acetone, a metabolite of fat catabolism, is produced in excessive amounts in subjects on restricted-calorie weight-loss programs. Breath acetone measurements are useful as a motivational tool during dieting and for monitoring the effectiveness of weight-loss programs. We have developed a simple, easy-to-read method that quantifies the amount of acetone in a defined volume of exhaled breath after trapping the sample in a gas-analyzer column. The concentration of acetone, as measured by the length of a blue color zone in the analyzer column, correlates with results obtained by gas chromatography. Using the breath acetone analyzer to quantify breath acetone concentrations of dieting subjects, we established a correlation between breath acetone concentration and rate of fat loss (slope 52.2 nmol/L per gram per day, intercept 15.3 nmol/L, n = 78, r = 0.81). We also discussed the possibility of using breath acetone in diabetes management.