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Sample records for breathing patients comparison

  1. Patient's breath controls comfort devices

    NASA Technical Reports Server (NTRS)

    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.

  2. FDG-PET-Based Radiotherapy Planning in Lung Cancer: Optimum Breathing Protocol and Patient Positioning-An Intraindividual Comparison

    SciTech Connect

    Grgic, Aleksandar

    2009-01-01

    Purpose: Fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) and PET/computed tomography (CT) are increasingly used for radiotherapy (RT) planning in patients with non-small-cell lung carcinoma. The planning process often is based on separately acquired FDG-PET/CT and planning CT scans. We compared intraindividual differences between PET acquired in diagnostic (D-PET) and RT treatment position (RT-PET) coregistered with planning CTs acquired using different breathing protocols. Methods and Materials: Sixteen patients with non-small-cell lung carcinoma underwent two PET acquisitions (D-PET and RT-PET) and three planning CT acquisitions (expiration [EXP], inspiration [INS], and mid-breath hold [MID]) on the same day. All scans were rigidly coregistered, resulting in six fused data sets: D-INS, D-EXP, D-MID, RT-INS, RT-EXP, and RT-MID. Fusion accuracy was assessed by three readers at eight anatomic landmarks, lung apices, aortic arch, heart, spine, sternum, carina, diaphragm, and tumor, by using an alignment score ranging from 1 (no alignment) to 5 (exact alignment). Results: The RT-PET showed better alignment with any CT than D-PET (p < 0.001). With regard to breathing, RT-MID showed the best mean alignment score (3.7 {+-} 1.0), followed by RT-EXP (3.5 {+-} 0.9) and RT-INS (3.0 {+-} 0.8), with all differences significant (p < 0.001). Comparing alignment scores with regard to anatomic landmarks, the largest deviations were found at the diaphragm, heart, and apices. Overall, there was fair agreement ({kappa} = 0.48; p < 0.001) among the three readers. Conclusions: Significantly better fusion of PET and planning CT can be reached with PET acquired in the RT position. The best intraindividual fusion results are obtained with the planning CT performed during mid-breath hold. Our data justify the acquisition of a separate planning PET in RT treatment position if only a diagnostic PET scan is available.

  3. 13C-methacetin breath test: isotope-selective nondispersive infrared spectrometry in comparison to isotope ratio mass spectrometry in volunteers and patients with liver cirrhosis.

    PubMed

    Adamek, R J; Goetze, O; Boedeker, C; Pfaffenbach, B; Luypaerts, A; Geypens, B

    1999-12-01

    The 13C-methacetin breath test (MBT) has been proposed for the noninvasive evaluation of the hepatic mixed function oxidase activity. Up to now, stable isotope analysis of carbon dioxide of the MBT has been carried out with isotope ratio mass spectrometry (IRMS). The aim of the present study was to test a recently developed isotope-selective nondispersive infrared spectrometer (NDIRS) in comparison to IRMS in healthy volunteers and patients with liver cirrhosis. Ten healthy volunteers (range 22 to 76 years) and ten patients with histologically proven liver cirrhosis (range 47 to 71 years; Child Pugh score A = 5, B = 3, C = 2) were studied. After an overnight fast each subject received 2 mg/kg BW of 13C-methacetin dissolved in 100 ml of tea. Breath samples were obtained before substrate administration and after 5, 10, 15, 20, 30, 40, 50, 60, 80, 100, 120, 150, 180 min. The 13C/12C-ratio was analyzed in each breath sample both by NDIRS (IRIS, Wagner Analysen Technik, Worpswede, Germany) and CF-IRMS (ABCA, Europa Scientific, Crewe, UK). Results were expressed as delta over baseline (DOB [/1000]) and as cumulative percentage doses of 13C recovered (cPDR [%]) at each time interval. Correlations between IRMS and NDIRS were tested by linear regression correlation. For measuring agreement an Altman-Bland-plot was performed. Applying correlation analysis a linear correlation was found (DOB: y = 1.068 +/- 0.0012.x + 2.088 +/- 0.2126, r = 0.98, p < 0.0001; cPDR: y = 1.148 +/- 0.0109.x + 0.569 +/- 0.172; r = 0.99, p < 0.0001). For DOB the mean difference (d) was 2.9/1000 and the standard deviation (SD) of the difference was 2.7/1000. The limits of agreement (d +/- SD) were -2.5/1000 and 8.3/1000. The comparison of DOB- and cPDR-values by NDIRS and IRMS shows a high linear correlation. However, the distance of the limits of agreement is wide. Consequently, the validity of the MBT could be influenced which could make MBT by NDIRS unprecise for exact evaluation of hepatocellular

  4. 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

    PubMed Central

    Anand, R.

    2016-01-01

    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 laparoscopic

  5. 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.

    PubMed

    Alaparthi, Gopala Krishna; Augustine, Alfred Joseph; Anand, R; Mahale, Ajith

    2016-01-01

    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 laparoscopic

  6. Comparison of urinary 5-hydroxytryptophol, breath ethanol, and self-report for detection of recent alcohol use during outpatient treatment: a study on methadone patients.

    PubMed

    Helander, A; von Wachenfeldt, J; Hiltunen, A; Beck, O; Liljeberg, P; Borg, S

    1999-08-01

    This study compared urinary 5-hydroxytryptophol (5HTOL) with breath-ethanol testing as objective ways to disclose recent drinking by outpatients attending a methadone maintenance treatment clinic. Information about quantity and frequency of alcohol use was obtained by confidential self-reports. Random screening was performed on Mondays-Fridays in connection with routine clinic visits for methadone dosing. An observed urine sample for monitoring of illicit drug use and determination of 5HTOL, expressed as a ratio to 5-hydroxyindole-3-acetic acid (5HIAA), was obtained from 202 patients (59 women and 143 men), 16 of whom refused to complete the self-report and/or do a breath-ethanol test. Patients taking disulfiram or calcium carbimide for alcohol detoxification were excluded. Among the 177 subjects remaining, 47 (26.6%) reported intake of any alcohol on the previous day (range, 10-230 g ethanol; median, 40). Only four of those could be identified by a positive breath-test, while 17 showed a urinary 5HTOL/5HIAA ratio above the cutoff limit. Their alcohol consumption (median, 60 g) was significantly higher compared with those showing ratios within the reference interval (median, 35 g). The sensitivity of 5HTOL/5HIAA testing for detecting self-reported drinking in excess of 50 g ethanol was 77%. An additional nine patients who claimed abstinence still showed abnormal 5HTOL/5HIAA ratios, and so did three of the patients who refused to do a breath-ethanol test and/or complete the self-report. Altogether, 59 of 190 methadone-maintained patients (31.1%) had been drinking any alcohol on the previous day (i.e. Sunday-Thursday) according to self-report and/or urinalysis data, 29 (49.2%) of whom were identified by the urinary 5HTOL/5HIAA ratio and only four (6.8%) by utilizing breathalyzer. PMID:10462090

  7. SU-E-J-32: Calypso(R) and Laser-Based Localization Systems Comparison for Left-Sided Breast Cancer Patients Using Deep Inspiration Breath Hold

    SciTech Connect

    Robertson, S; Kaurin, D; Sweeney, L; Kim, J; Fang, L; Tran, A; Holloway, K

    2014-06-01

    Purpose: Our institution uses a manual laser-based system for primary localization and verification during radiation treatment of left-sided breast cancer patients using deep inspiration breath hold (DIBH). This primary system was compared with sternum-placed Calypso(R) beacons (Varian Medical Systems, CA). Only intact breast patients are considered for this analysis. Methods: During computed tomography (CT) simulation, patients have BB and Calypso(R) surface beacons positioned sternally and marked for free-breathing and DIBH CTs. During dosimetry planning, BB longitudinal displacement between free breathing and DIBH CT determines laser mark (BH mark) location. Calypso(R) beacon locations from the DIBH CT are entered at the Tracking Station. During Linac simulation and treatment, patients inhale until the cross-hair and/or lasers coincide with the BH Mark, which can be seen using our high quality cameras (Pelco, CA). Daily Calypso(R) displacement values (difference from the DIBH-CT-based plan) are recorded.The displacement mean and standard deviation was calculated for each patient (77 patients, 1845 sessions). An aggregate mean and standard deviation was calculated weighted by the number of patient fractions.Some patients were shifted based on MV ports. A second data set was calculated with Calypso(R) values corrected by these shifts. Results: Mean displacement values indicate agreement within 1±3mm, with improvement for shifted data (Table). Conclusion: Both unshifted and shifted data sets show the Calypso(R) system coincides with the laser system within 1±3mm, demonstrating either localization/verification system will Resultin similar clinical outcomes. Displacement value uncertainty unilaterally reduces when shifts are taken into account.

  8. Patient-specific simulation of tidal breathing

    NASA Astrophysics Data System (ADS)

    Walters, M.; Wells, A. K.; Jones, I. P.; Hamill, I. S.; Veeckmans, B.; Vos, W.; Lefevre, C.; Fetitia, C.

    2016-03-01

    Patient-specific simulation of air flows in lungs is now straightforward using segmented airways trees from CT scans as the basis for Computational Fluid Dynamics (CFD) simulations. These models generally use static geometries, which do not account for the motion of the lungs and its influence on important clinical indicators, such as airway resistance. This paper is concerned with the simulation of tidal breathing, including the dynamic motion of the lungs, and the required analysis workflow. Geometries are based on CT scans obtained at the extremes of the breathing cycle, Total Lung Capacity (TLC) and Functional Residual Capacity (FRC). It describes how topologically consistent geometries are obtained at TLC and FRC, using a `skeleton' of the network of airway branches. From this a 3D computational mesh which morphs between TLC and FRC is generated. CFD results for a number of patient-specific cases, healthy and asthmatic, are presented. Finally their potential use in evaluation of the progress of the disease is discussed, focusing on an important clinical indicator, the airway resistance.

  9. Pressure control to accommodate patient breathing efforts during volume ventilation.

    PubMed

    Stawitcke, F A; Ream, A K; Piziali, R L

    1987-04-01

    Intermittent positive-pressure ventilation is used to support patients whose unassisted breathing is inadequate. Mechanical ventilators deliver pressurized gas to the patient's lungs by using a pattern of volume and timing that is preset by the clinician. A weakness of existing control methods is their emphasis on maintaining adequate gas exchange while poorly accommodating the patient's efforts to reassume control of the delivery pattern. A method is proposed to control airway pressure within a breath by making it respond to measurements of volume. This method using pressure as a function of volume, or P(V) method, permits the patient to have transient control over flow rate and delivered volume. In addition, an adaptive controller is included that modifies the applied pressure during subsequent breaths; it assures an average flow rate and delivered volume at the levels prescribed by the clinician, when sustained changes occur in airway resistance, lung-thorax compliance, or breathing efforts. Analyses and computer simulations suggest that the P(V) method will be better than conventional volume ventilation in accommodating, within a breath, transient breathing efforts without long-term degradation of the prescribed delivery pattern. The P(V) method can restore the delivery pattern, using the adaptive controller, within a few breaths after changes occur in the patient's lung mechanics. We conclude that the P(V) method is feasible, that it may represent an improved method of patient ventilation, particularly during fighting or weaning from the ventilator, and that it warrants further investigation.

  10. Influence of Continuous Table Motion on Patient Breathing Patterns

    SciTech Connect

    Wilbert, Juergen; Baier, Kurt; Richter, Anne; Herrmann, Christian; Ma Lei; Flentje, Michael; Guckenberger, Matthias

    2010-06-01

    Purpose: To investigate the influence of continuous table motion on patient breathing patterns for compensation of moving targets by a robotic treatment couch. Methods and Materials: Fifteen volunteers were placed on a robotic treatment couch, and the couch was moved on different breathing-correlated and -uncorrelated trajectories. External abdominal breathing motion of the patients was measured using an infrared camera system. The influence of table motion on breathing range and pattern was analyzed. Results: Continuous table motion was tolerated well by all test persons. Volunteers reacted differently to table motion. Four test persons showed no change of breathing range and pattern. Increased irregular breathing was observed in 4 patients; however, irregularity was not correlated with table motion. Only 4 test persons showed an increase in mean breathing amplitude of more than 2mm during motion of the couch. The mean cycle period decreased by more than 1 s for 2 test persons only. No abrupt changes in amplitude or cycle period could be observed. Conclusions: The observed small changes in breathing patterns support the application of motion compensation by a robotic treatment couch.

  11. Effect of tracheostomy tube on work of breathing: Comparison of pre- and post-decannulation

    PubMed Central

    Villalba, Darío; Feld, Viviana; Leiva, Valeria; Scrigna, Mariana; Distéfano, Eduardo; Pratto, Romina; Rodriguez, Matías; Collins, Jesica; Rocco, Ana; Matesa, Amelia; Rossi, Damián; Areas, Laura; Virgilio, Sacha; Golfarini, Nicolás; Gil-Rosetti, Gregorio; Diaz-Ballve, Pablo; Planells, Fernando

    2016-01-01

    Objective: To describe and compare the work of breathing (WOB) during spontaneous breathing under four conditions: (1) breathing through a tracheostomy tube with an inflated cuff, (2) breathing through the upper airway (UA) with a deflated cuff and occluded tube, (3) breathing through the UA with an occluded cuffless tube, and (4) postdecannulation. Patients and Methods: Patients who tolerated an occluded cuffless tube were included. Ventilatory variables and esophageal pressure were recorded. The pressure-time product (PTP), PTP/min, and PTP/min/tidal volume (PTP/min/VT) were measured. Each condition was measured for 5 min with a 15 min time interval between evaluations. Quantitative data are expressed as mean ± standard deviation. Single-factor analysis of variance was used, and the Games-Howell test was used for post hoc analysis of comparisons between group means (P ≤ 0.05). Results: Eight patients were studied under each of the four conditions described above. Statistically significant differences were found for PTP, PTP/min, and PTP/min/VT. In the post hoc analysis for PTP, significant differences among all conditions were found. For PTP/min, there was no significant difference between Conditions 2 and 4 (P = 0.138), and for PTP/min/VT, there was no significant difference between Conditions 1 and 2 (P = 0.072) or between Conditions 2 and 3 (P = 0.106). A trend toward a higher PTP, PTP/min, and PTP/min/VT was observed when breathing through a cuffless tracheostomy tube. Conclusion: The four conditions differed with respect to WOB. Cuff inflation could result in a reduced WOB because there is less dead space. Cuffless tracheostomy tubes generate increased WOB, perhaps due to the material deformity caused by body temperature. PMID:27722109

  12. A Ringdown Breath Analyzer for Diabetes Monitoring: Breath Acetone in Diabetic Patients.

    NASA Astrophysics Data System (ADS)

    Wang, Chuji; Mbi, Armstrong; Shepherd, Mark

    2008-03-01

    It is highly desirable for millions of diabetic patients to have a non-blood, non-invasive, point-of-care device for monitoring daily blood glucose (BG) levels and the adequacy of diabetic treatment and control. Cavity ringdown spectroscopy, due to its unique capability of high sensitivity, fast-response, and relatively low cost for instrumentation, has the potential for medical application through non-invasive analysis of breath biomarkers. We report the first ringdown acetone breath analyzer for clinic testing with diabetic outpatients. The instrument was set in a clinic center and 34 outpatients (24 T1D and 10 T2D) were tested during a four-day period. 10 T1D subjects and 15 nondiabetic persons were tested in our laboratory. Three juvenile-onset T1D subjects were selected for a 24-hr monitoring on the variations of breath acetone and simultaneous BG level. In this talk, we present our research findings including the correlations of breath acetone with BG level and A1C.

  13. Silicon Nanowire Sensors Enable Diagnosis of Patients via Exhaled Breath.

    PubMed

    Shehada, Nisreen; Cancilla, John C; Torrecilla, Jose S; Pariente, Enrique S; Brönstrup, Gerald; Christiansen, Silke; Johnson, Douglas W; Leja, Marcis; Davies, Michael P A; Liran, Ori; Peled, Nir; Haick, Hossam

    2016-07-26

    Two of the biggest challenges in medicine today are the need to detect diseases in a noninvasive manner and to differentiate between patients using a single diagnostic tool. The current study targets these two challenges by developing a molecularly modified silicon nanowire field effect transistor (SiNW FET) and showing its use in the detection and classification of many disease breathprints (lung cancer, gastric cancer, asthma, and chronic obstructive pulmonary disease). The fabricated SiNW FETs are characterized and optimized based on a training set that correlate their sensitivity and selectivity toward volatile organic compounds (VOCs) linked with the various disease breathprints. The best sensors obtained in the training set are then examined under real-world clinical conditions, using breath samples from 374 subjects. Analysis of the clinical samples show that the optimized SiNW FETs can detect and discriminate between almost all binary comparisons of the diseases under examination with >80% accuracy. Overall, this approach has the potential to support detection of many diseases in a direct harmless way, which can reassure patients and prevent numerous unpleasant investigations. PMID:27383408

  14. Sleep disordered breathing in patients with chronic obstructive pulmonary disease.

    PubMed

    Aoki, Takuya; Akinori, Ebihara; Yogo, Yurika; Sakamaki, Fumio; Suzuki, Yukio; Suemasu, Keiichi

    2005-06-01

    Sleep-related disordered breathing (SDB) and its influence on desaturation were examined in stable COPD patients with waking SpO2 > 90%. With respiratory inductance plethysmography, thoracic-abdominal respiratory movements for all events with more than 4% desaturation were analyzed in 26 patients. Types of SDB were confirmed by full polysomnography. Irregular breathing induced desaturation, while stable respiration continued during some desaturation events. Three types of altered ventilation were observed: hypoventilation, paradoxical movement and periodic breathing. An unusual type of paradoxical movement, with normal airflow despite progressive desaturation, was observed in REM sleep. Patients were divided into desaturation (15 patients) and non-desaturation (11 patients) groups. Daytime arterial blood gas, lung function values, and 6-min walking distance did not differ. Awake, mode, maximum and minimum nocturnal SpO2 were lower in the desaturation group. SDB-induced desaturation events in the desaturation group were more frequent (9.2+/-3.5 vs. 1.8+/-2.2 times), a greater SpO2 decrease (11.4+/-7.1% vs. 5.2+/-2.1%) and longer duration (73.2+/-34.8 vs. 18.8+/-39.0 min). Patterns of SDB in the desaturation group were hypoventilation (74.4+/-23.4%), paradoxical movement (10.2+/-14.5%), periodic breathing (12.1+/-18.3%) and unclassified (5.8+/-11.2%). These results reveal that lower SpO2 and SDB influence nocturnal desaturation in stable COPD patients. PMID:17136951

  15. Volatile Biomarkers in Breath Associated With Liver Cirrhosis — Comparisons of Pre- and Post-liver Transplant Breath Samples

    PubMed Central

    Fernández del Río, R.; O'Hara, M.E.; Holt, A.; Pemberton, P.; Shah, T.; Whitehouse, T.; Mayhew, C.A.

    2015-01-01

    Background The burden of liver disease in the UK has risen dramatically and there is a need for improved diagnostics. Aims To determine which breath volatiles are associated with the cirrhotic liver and hence diagnostically useful. Methods A two-stage biomarker discovery procedure was used. Alveolar breath samples of 31 patients with cirrhosis and 30 healthy controls were mass spectrometrically analysed and compared (stage 1). 12 of these patients had their breath analysed after liver transplant (stage 2). Five patients were followed longitudinally as in-patients in the post-transplant period. Results Seven volatiles were elevated in the breath of patients versus controls. Of these, five showed statistically significant decrease post-transplant: limonene, methanol, 2-pentanone, 2-butanone and carbon disulfide. On an individual basis limonene has the best diagnostic capability (the area under a receiver operating characteristic curve (AUROC) is 0.91), but this is improved by combining methanol, 2-pentanone and limonene (AUROC curve 0.95). Following transplant, limonene shows wash-out characteristics. Conclusions Limonene, methanol and 2-pentanone are breath markers for a cirrhotic liver. This study raises the potential to investigate these volatiles as markers for early-stage liver disease. By monitoring the wash-out of limonene following transplant, graft liver function can be non-invasively assessed. PMID:26501124

  16. Determination of breath acetone in 149 type 2 diabetic patients using a ringdown breath-acetone analyzer.

    PubMed

    Sun, Meixiu; Chen, Zhuying; Gong, Zhiyong; Zhao, Xiaomeng; Jiang, Chenyu; Yuan, Yuan; Wang, Zhennang; Li, Yingxin; Wang, Chuji

    2015-02-01

    Over 90% of diabetic patients have Type 2 diabetes. Although an elevated mean breath acetone concentration has been found to exist in Type 1 diabetes (T1D), information on breath acetone in Type 2 diabetes (T2D) has yet to be obtained. In this study, we first used gas chromatography-mass spectrometry (GC-MS) to validate a ringdown breath-acetone analyzer based on the cavity-ringdown-spectroscopy technique, through comparing breath acetone concentrations in the range 0.5-2.5 ppm measured using both methods. The linear fitting of R = 0.99 suggests that the acetone concentrations obtained using both methods are consistent with a largest standard deviation of ±0.4 ppm in the lowest concentration of the range. Next, 620 breath samples from 149 T2D patients and 42 healthy subjects were collected and tested using the breath analyzer. Four breath samples were taken from each subject under each of four different conditions: fasting, 2 h post-breakfast, 2 h post-lunch, and 2 h post-dinner. Simultaneous blood glucose levels were also measured using a standard diabetic-management blood-glucose meter. For the 149 T2D subjects, their exhaled breath acetone concentrations ranged from 0.1 to 19.8 ppm; four different ranges of breath acetone concentration, 0.1-19.8, 0.1-7.1, 0.1-6.3, and 0.1-9.5 ppm, were obtained for the subjects under the four different conditions, respectively. For the 42 healthy subjects, their breath acetone concentration ranged from 0.1 to 2.6 ppm; four different ranges of breath acetone concentration, 0.3-2.6, 0.1-2.6, 0.1-1.7, and 0.3-1.6 ppm, were obtained for the four different conditions. The mean breath acetone concentration of the 149 T2D subjects was determined to be 1.5 ± 1.5 ppm, which was 1.5 times that of 1.0 ± 0.6 ppm for the 42 healthy subjects. No correlation was found between the breath acetone concentration and the blood glucose level of the T2D subjects and the healthy volunteers. This study using a relatively large number of

  17. Ethylene and ammonia traces measurements from the patients' breath with renal failure via LPAS method

    NASA Astrophysics Data System (ADS)

    Popa, C.; Dutu, D. C. A.; Cernat, R.; Matei, C.; Bratu, A. M.; Banita, S.; Dumitras, D. C.

    2011-11-01

    The application of laser photoacoustic spectroscopy (LPAS) for fast and precise measurements of breath biomarkers has opened up new promises for monitoring and diagnostics in recent years, especially because breath test is a non-invasive method, safe, rapid and acceptable to patients. Our study involved assessment of breath ethylene and breath ammonia levels in patients with renal failure receiving haemodialysis (HD) treatment. Breath samples from healthy subjects and from patients with renal failure were collected using chemically inert aluminized bags and were subsequently analyzed using the LPAS technique. We have found out that the composition of exhaled breath in patients with renal failure contains not only ethylene, but also ammonia and gives valuable information for determining efficacy and endpoint of HD. Analysis of ethylene and ammonia traces from the human breath may provide insight into severity of oxidative stress and metabolic disturbances and may ensure optimal therapy and prevention of pathology at patients on continuous HD.

  18. Comparison of craniofacial morphology, head posture and hyoid bone position with different breathing patterns

    PubMed Central

    Ucar, Faruk Izzet; Ekizer, Abdullah; Uysal, Tancan

    2012-01-01

    Objectives The aim of this study was to evaluate differences in craniofacial morphology, head posture and hyoid bone position between mouth breathing (MB) and nasal breathing (NB) patients. Methods Mouth breathing patients comprised 34 skeletal Class I subjects with a mean age of 12.8 ± 1.5 years (range: 12.0–15.2 years). Thirty-two subjects with skeletal Class I relationship were included in the NB group (mean 13.5 ± 1.3 years; range: 12.2–14.8 years). Twenty-seven measurements (15 angular and 12 linear) were used for the craniofacial analysis. Additionally, 12 measurements were evaluated for head posture (eight measurements) and hyoid bone position (four measurements). Student’s t-test was used for the statistical analysis. Probability values <0.05 were accepted as significant. Results Statistical comparisons showed that sagittal measurements including SNA (p < 0.01), ANB (p < 0.01), A to N perp (p < 0.05), convexity (p < 0.05), IMPA (p < 0.05) and overbite (p < 0.05) measurements were found to be lower in MB patients compared to NB. Vertical measurements including SN-MP (p < 0.01) and PP-GoGn (p < 0.01), S-N (p <0.05) and anterior facial height (p < 0.05) were significantly higher in MB patients, while the odontoid proses and palatal plane angle (OPT-PP) was greater and true vertical line and palatal plane angle (Vert-PP) was smaller in MB patients compared to NB group (p < 0.05 for both). No statistically significant differences were found regarding the hyoid bone position between both groups. Conclusions The maxilla was more retrognathic in MB patients. Additionally, the palatal plane had a posterior rotation in MB patients. However, no significant differences were found in the hyoid bone position between MB and NB patients. PMID:23960542

  19. Electronic Nose To Detect Patients with COPD From Exhaled Breath

    NASA Astrophysics Data System (ADS)

    Velásquez, Adriana; Durán, Cristhian M.; Gualdron, Oscar; Rodríguez, Juan C.; Manjarres, Leonardo

    2009-05-01

    To date, there is no effective tool analysis and detection of COPD syndrome, (Chronic Obstructive Pulmonary Disease) which is linked to smoking and, less frequently to toxic substances such as, the wood smoke or other particles produced by noxious gases. According to the World Health Organization (WHO) estimates of this disease show it affects more than 52 million people and kills more than 2.7 million human beings each year. In order to solve the problem, a low-cost Electronic Nose (EN) was developed at the University of Pamplona (N. S) Colombia, for this specific purpose and was applied to a sample group of patients with COPD as well as to others who were healthy. From the exhalation breath samples of these patients, the results were as expected; an appropriate classification of the patients with the disease, as well as from the healthy group was obtained.

  20. Evaluation of tracheal cuff pressure variation in spontaneously breathing patients

    PubMed Central

    Plotnikow, Gustavo A; Roux, Nicolas; Feld, Viviana; Gogniat, Emiliano; Villalba, Dario; Ribero, Noelia Vairo; Sartore, Marisa; Bosso, Mauro; Quiroga, Corina; Leiva, Valeria; Scrigna, Mariana; Puchulu, Facundo; Distéfano, Eduardo; Scapellato, Jose Luis; Intile, Dante; Planells, Fernando; Noval, Diego; Buñirigo, Pablo; Jofré, Ricardo; Nielsen, Ernesto Díaz

    2013-01-01

    Background: Most of the studies referring cuff tubes’ issues were conducted on intubated patients. Not much is known about the cuff pressure performance in chronically tracheostomized patients disconnected from mechanical ventilation. Objective: To evaluate cuff pressure (CP) variation in tracheostomized, spontaneously breathing patients in a weaning rehabilitation center. Materials and Methods: Experimental setup to test instruments in vitro, in which the gauge (TRACOE) performance at different pressure levels was evaluated in six tracheostomy tubes, and a clinical setupin which CP variation over 24 h, every 4 h, and for 6 days was measured in 35 chronically tracheostomized clinically stable, patients who had been disconnected from mechanical ventilation for at least 72 h. The following data were recorded: Tube brand, type, and size; date of the tube placed; the patient's body position; the position of the head; axillary temperature; pulse and respiration rates; blood pressure; and pulse oximetry. Results: In vitro difference between the initial pressure (IP) and measured pressure (MP) was statistically significant (P < 0.05). The difference between the IP and MP was significant when selecting for various tube brands (P < 0.05). In the clinical set-up, 207 measurements were performed and the CP was >30 cm H2O in 6.28% of the recordings, 20-30 cm H2O in 42.0% of the recordings, and <20 cm H2O in 51.69% of the recordings. Conclusion: The systematic CP measurement in chronically tracheostomized, spontaneously breathing patients showed high variability, which was independent of tube brand, size, type, or time of placement. Consequently, measurements should be made more frequently. PMID:24459624

  1. Exhaled breath condensate collection in the mechanically ventilated patient.

    PubMed

    Carter, Stewart R; Davis, Christopher S; Kovacs, Elizabeth J

    2012-05-01

    Collection of exhaled breath condensate (EBC) is a non-invasive means of sampling the airway-lining fluid of the lungs. EBC contains numerous measurable mediators, whose analysis could change the management of patients with certain pulmonary diseases. While initially popularized in investigations involving spontaneously breathing patients, an increasing number of studies have been performed using EBC in association with mechanical ventilation. Collection of EBC in mechanically ventilated patients follows basic principles of condensation, but is influenced by multiple factors. Effective collection requires selection of a collection device, adequate minute ventilation, low cooling temperatures, and sampling times of greater than 10 min. Condensate can be contaminated by saliva, which needs to be filtered. Dilution of samples occurs secondary to distilled water in vapors and humidification in the ventilator circuit. Dilution factors may need to be employed when investigating non-volatile biomarkers. Storage and analysis should occur promptly at -70 °C to -80 °C to prevent rapid degradation of samples. The purpose of this review is to examine and describe methodologies and problems of EBC collection in mechanically ventilated patients. A straightforward and safe framework has been established to investigate disease processes in this population, yet technical aspects of EBC collection still exist that prevent clinical practicality of this technology. These include a lack of standardization of procedure and analysis of biomarkers, and of normal reference ranges for mediators in healthy individuals. Once these procedural aspects have been addressed, EBC could serve as a non-invasive alternative to invasive evaluation of lungs in mechanically ventilated patients.

  2. Mechanics of breathing in patients with atrial septal defect.

    PubMed

    Troyer, A D; Yernault, J C; Englert, M

    1977-03-01

    Mechanics of breathing and pulmonary diffusing properties were investigated in 24 adult patients with atrial septal defect. The patients were divided into 3 groups according to mean pulmonary artery pressure: less than 19 mm Hg (group I), 20 to 24 mm Hg (group II), and greater than 25 mm Hg (group III). The only change observed in group I was a marked increase in diffusing capacity. Patients of group II showed not only an increase in diffusing capacity, but also an overt decrease in maximal expiratory flow at all lung volumes and at any given driving pressure. For these two groups, a highly significant inverse correlation was found between changes in diffusing and elastic lung properties (r = -0.71; P less than 0.001). In patients of group III, the expiratory flow remained clearly decreased; furthermore, lung compliance and lung volumes were sharply reduced, airway resistance was elevated, and diffusing capacity was normal. Finally, from group I to group III, the lung elastic recoil became progressively diminished at small lung volumes. These results suggest that an increased pulmonary blood volume induces an increase in diffusing capacity and a slight decrease in lung compliance. Simultaneous existance of high intravascular pressure strengthens the effects of increased pulmonary blood volume on lung mechanics and results in significant abnormalities in the lung mechanical behavior. It is postulated that these effects are due to a competition for space between vessels and airways within the bronchovascular sheaths, with a subsequent compression of small airways. PMID:842953

  3. The patient inflating valve in anaesthesia and resuscitation breathing systems.

    PubMed

    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. PMID:23530783

  4. Evaluation of oxygen saturation by pulse-oximetry in mouth breathing patients.

    PubMed

    Niaki, Esfandiar Akhavan; Chalipa, Javad; Taghipoor, Elahe

    2010-01-01

    Mouth breathing might not always result in hypoxia, but can contribute to it. The aim of the present study was to determine the effect of mouth breathing on hypoxia. Based on a pilot study, 323 patients with mouth breathing were selected. Assessment of mouth breathing was based on clinical examination and questionnaires filled out by patients and their companions. The patients were also examined for further oral findings that could be attributable to mouth breathing. Oxygen saturation of each case was measured by means of a pulse oximetry device. The level of 95% saturation was set as the limit, under which the patient was considered hypoxemic. Acquired data was analyzed for descriptive data and frequency and also by means of the Chi-square and Spearman's correlation coefficient tests. 34.6% of the cases had normal O2 saturation. 65.4% of cases were hypoxemic (saturation level was below 95% in 42.8% and 95% in 22.6%). Most of the mouth breathing patients were male who were also more hypoxemic. A weak inverse relationship existed between the age of the patients and Oxygen saturation. Deep palatal vaults (29.4%) and gingival hyperplasia (29.2%) were the most frequent intraoral findings. Concerning the effects of hypoxia on body systems, the use of pulse oximetry in suspected mouth breathing patients could be recommended in routine oral and dental examinations.

  5. (13) C Breath Tests Are Feasible in Patients With Extracorporeal Membrane Oxygenation Devices.

    PubMed

    Bednarsch, Jan; Menk, Mario; Malinowski, Maciej; Weber-Carstens, Steffen; Pratschke, Johann; Stockmann, Martin

    2016-07-01

    Temporary extracorporeal membrane oxygenation (ECMO) has been established as an essential part of therapy in patients with pulmonary or cardiac failure. As physiological gaseous exchange is artificially altered in this patient group, it is debatable whether a (13) C-breath test can be carried out. In this proof of technical feasibility report, we assess the viability of the (13) C-breath test LiMAx (maximum liver function capacity) in patients on ECMO therapy. All breath probes for the test device were obtained directly via the membrane oxygenator. Data of four patients receiving liver function assessment with the (13) C-breath test LiMAx while having ECMO therapy were analyzed. All results were compared with validated scenarios of the testing procedures. The LiMAx test could successfully be carried out in every case without changing ECMO settings. Clinical course of the patients ranging from multiorgan failure to no sign of liver insufficiency was in accordance with the results of the LiMAx liver function test. The (13) C-breath test is technically feasible in the context of ECMO. Further evaluation of (13) C-breath test in general would be worthwhile. The LiMAx test as a (13) C-breath test accessing liver function might be of particular predictive interest if patients with ECMO therapy develop multiorgan failure. PMID:26527580

  6. Piezoresistive Membrane Surface Stress Sensors for Characterization of Breath Samples of Head and Neck Cancer Patients.

    PubMed

    Lang, Hans Peter; Loizeau, Frédéric; Hiou-Feige, Agnès; Rivals, Jean-Paul; Romero, Pedro; Akiyama, Terunobu; Gerber, Christoph; Meyer, Ernst

    2016-01-01

    For many diseases, where a particular organ is affected, chemical by-products can be found in the patient's exhaled breath. Breath analysis is often done using gas chromatography and mass spectrometry, but interpretation of results is difficult and time-consuming. We performed characterization of patients' exhaled breath samples by an electronic nose technique based on an array of nanomechanical membrane sensors. Each membrane is coated with a different thin polymer layer. By pumping the exhaled breath into a measurement chamber, volatile organic compounds present in patients' breath diffuse into the polymer layers and deform the membranes by changes in surface stress. The bending of the membranes is measured piezoresistively and the signals are converted into voltages. The sensor deflection pattern allows one to characterize the condition of the patient. In a clinical pilot study, we investigated breath samples from head and neck cancer patients and healthy control persons. Evaluation using principal component analysis (PCA) allowed a clear distinction between the two groups. As head and neck cancer can be completely removed by surgery, the breath of cured patients was investigated after surgery again and the results were similar to those of the healthy control group, indicating that surgery was successful. PMID:27455276

  7. Piezoresistive Membrane Surface Stress Sensors for Characterization of Breath Samples of Head and Neck Cancer Patients

    PubMed Central

    Lang, Hans Peter; Loizeau, Frédéric; Hiou-Feige, Agnès; Rivals, Jean-Paul; Romero, Pedro; Akiyama, Terunobu; Gerber, Christoph; Meyer, Ernst

    2016-01-01

    For many diseases, where a particular organ is affected, chemical by-products can be found in the patient’s exhaled breath. Breath analysis is often done using gas chromatography and mass spectrometry, but interpretation of results is difficult and time-consuming. We performed characterization of patients’ exhaled breath samples by an electronic nose technique based on an array of nanomechanical membrane sensors. Each membrane is coated with a different thin polymer layer. By pumping the exhaled breath into a measurement chamber, volatile organic compounds present in patients’ breath diffuse into the polymer layers and deform the membranes by changes in surface stress. The bending of the membranes is measured piezoresistively and the signals are converted into voltages. The sensor deflection pattern allows one to characterize the condition of the patient. In a clinical pilot study, we investigated breath samples from head and neck cancer patients and healthy control persons. Evaluation using principal component analysis (PCA) allowed a clear distinction between the two groups. As head and neck cancer can be completely removed by surgery, the breath of cured patients was investigated after surgery again and the results were similar to those of the healthy control group, indicating that surgery was successful. PMID:27455276

  8. Association between the rapid shallow breathing index and extubation success in patients with traumatic brain injury

    PubMed Central

    dos Reis, Helena França Correia; Almeida, Mônica Lajana Oliveira; da Silva, Mário Ferreira; Moreira, Julião Oliveira; Rocha, Mário de Seixas

    2013-01-01

    Objective To investigate the association between the rapid shallow breathing index and successful extubation in patients with traumatic brain injury. Methods This study was a prospective study conducted in patients with traumatic brain injury of both genders who underwent mechanical ventilation for at least two days and who passed a spontaneous breathing trial. The minute volume and respiratory rate were measured using a ventilometer, and the data were used to calculate the rapid shallow breathing index (respiratory rate/tidal volume). The dependent variable was the extubation outcome: reintubation after up to 48 hours (extubation failure) or not (extubation success). The independent variable was the rapid shallow breathing index measured after a successful spontaneous breathing trial. Results The sample comprised 119 individuals, including 111 (93.3%) males. The average age of the sample was 35.0±12.9 years old. The average duration of mechanical ventilation was 8.1±3.6 days. A total of 104 (87.4%) participants achieved successful extubation. No association was found between the rapid shallow breathing index and extubation success. Conclusion The rapid shallow breathing index was not associated with successful extubation in patients with traumatic brain injury. PMID:24213084

  9. Comparison of spectroscopically measured tissue alcohol concentration to blood and breath alcohol measurements

    NASA Astrophysics Data System (ADS)

    Ridder, Trent D.; Ver Steeg, Benjamin J.; Laaksonen, Bentley D.

    2009-09-01

    Alcohol testing is an expanding area of interest due to the impacts of alcohol abuse that extend well beyond drunk driving. However, existing approaches such as blood and urine assays are hampered in some testing environments by biohazard risks. A noninvasive, in vivo spectroscopic technique offers a promising alternative, as no body fluids are required. The purpose of this work is to report the results of a 36-subject clinical study designed to characterize tissue alcohol measured using near-infrared spectroscopy relative to venous blood, capillary blood, and breath alcohol. Comparison of blood and breath alcohol concentrations demonstrated significant differences in alcohol concentration [root mean square of 9.0 to 13.5 mg/dL] that were attributable to both assay accuracy and precision as well as alcohol pharmacokinetics. A first-order kinetic model was used to estimate the contribution of alcohol pharmacokinetics to the differences in concentration observed between the blood, breath, and tissue assays. All pair-wise combinations of alcohol assays were investigated, and the fraction of the alcohol concentration variance explained by pharmacokinetics ranged from 41.0% to 83.5%. Accounting for pharmacokinetic concentration differences, the accuracy and precision of the spectroscopic tissue assay were found to be comparable to those of the blood and breath assays.

  10. Speech-language pathology findings in patients with mouth breathing: multidisciplinary diagnosis according to etiology.

    PubMed

    Junqueira, Patrícia; Marchesan, Irene Queiroz; de Oliveira, Luciana Regina; Ciccone, Emílio; Haddad, Leonardo; Rizzo, Maria Cândida

    2010-11-01

    The purpose of this study was to identify and compare the results of the findings from speech-language pathology evaluations for orofacial function including tongue and lip rest postures, tonus, articulation and speech, voice and language, chewing, and deglutition in children who had a history of mouth breathing. The diagnoses for mouth breathing included: allergic rhinitis, adenoidal hypertrophy, allergic rhinitis with adenoidal hypertrophy; and/or functional mouth breathing. This study was conducted with on 414 subjects of both genders, from 2 to 16-years old. A team consisting of 3 speech-language pathologists, 1 pediatrician, 1 allergist, and 1 otolaryngologist, evaluated the patients. Multidisciplinary clinical examinations were carried out (complete blood counting, X-rays, nasofibroscopy, audiometry). The two most commonly found etiologies were allergic rhinitis, followed by functional mouth breathing. Of the 414 patients in the study, 346 received a speech-language pathology evaluation. The most prevalent finding in this group of 346 subjects was the presence of orofacial myofunctional disorders. The most frequently orofacial myofunctional disorder identified in these subjects who also presented mouth breathing included: habitual open lips rest posture, low and forward tongue rest posture and lack of adequate muscle tone. There were also no statistically significant relationships identified between etiology and speech-language diagnosis. Therefore, the specific type of etiology of mouth breathing does not appear to contribute to the presence, type, or number of speech-language findings which may result from mouth breathing behavior.

  11. Exhaled Breath Analysis for the Monitoring of Elderly COPD Patients Health-state

    NASA Astrophysics Data System (ADS)

    Pennazza, Giorgio; Scarlata, Simone; Santonico, Marco; Chiurco, Domenica; D'Amico, Arnaldo; Incalzi, Raffaele Antonelli

    2011-09-01

    This pilot study assesses how effectively a gas sensors array can follow the evolution of elderly patients with COPD, the most common chronic respiratory disease. In particular, reproducibility of breath analysis (calculated for each subject along three weekly measurements) resulted comparable to spirometry, except for a larger spread for breath analysis, whose patterns was significantly correlated with other heath status parameters (such as eosinophiles and Barthel index).

  12. Comparison of the analytical capabilities of the BAC Datamaster and Datamaster DMT forensic breath testing devices.

    PubMed

    Glinn, Michele; Adatsi, Felix; Curtis, Perry

    2011-11-01

    The State of Michigan uses the Datamaster as an evidential breath testing device. The newest version, the DMT, will replace current instruments in the field as they are retired from service. The Michigan State Police conducted comparison studies to test the analytical properties of the new instrument and to evaluate its response to conditions commonly cited in court defenses. The effects of mouth alcohol, objects in the mouth, and radiofrequency interference on paired samples from drinking subjects were assessed on the DMT. The effects of sample duration and chemical interferents were assessed on both instruments, using drinking subjects and wet-bath simulators, respectively. Our testing shows that Datamaster and DMT results are essentially identical; the DMT gave accurate readings as compared with measurements made using simulators containing standard ethanol solutions and that the DMT did not give falsely elevated breath alcohol results from any of the influences tested.

  13. Variability of within-breath reactance in COPD patients and its association with dyspnoea.

    PubMed

    Aarli, Bernt B; Calverley, Peter M A; Jensen, Robert L; Eagan, Tomas M L; Bakke, Per S; Hardie, Jon A

    2015-03-01

    The forced oscillation technique can identify expiratory flow limitation (EFL) when a large difference in inspiratory and expiratory reactance (ΔXrs) occurs. However, flow limitation can vary from breath to breath, and so we compared a multiple-breath ΔXrs approach to the traditional breath-by-breath assessment of EFL. We investigated the within- and between-day reproducibility and the factors that affect the size of ΔXrs when used as a continuous measurement over multiple breaths. In addition, we examined how multiple-breath ΔXrs relates to the sensation of breathlessness. 425 moderate to very severe chronic obstructive pulmonary disease (COPD) patients and 229 controls were included. Spirometry and impedance measurements were performed on a MasterScope CT Impulse Oscillation System. Median ΔXrs approached zero in healthy controls with little variation between measurements. COPD patients generally had higher ΔXrs and higher variability. The COPD patients with ΔXrs >0.1 kPa · L(-1) · s(-1) were prone to be more breathless and had a higher modified Medical Research Council dyspnoea scale score. In controls, the 95th percentile of ΔXrs was as low as 0.07 kPa · L(-1) · s(-1). We describe a new method to assess EFL at a patient level and propose a cut-off, mean ΔXrs >0.1 kPa · L(-1) · s(-1), as a way to identify COPD patients who are more likely to report dyspnoea.

  14. Variability of within-breath reactance in COPD patients and its association with dyspnoea.

    PubMed

    Aarli, Bernt B; Calverley, Peter M A; Jensen, Robert L; Eagan, Tomas M L; Bakke, Per S; Hardie, Jon A

    2015-03-01

    The forced oscillation technique can identify expiratory flow limitation (EFL) when a large difference in inspiratory and expiratory reactance (ΔXrs) occurs. However, flow limitation can vary from breath to breath, and so we compared a multiple-breath ΔXrs approach to the traditional breath-by-breath assessment of EFL. We investigated the within- and between-day reproducibility and the factors that affect the size of ΔXrs when used as a continuous measurement over multiple breaths. In addition, we examined how multiple-breath ΔXrs relates to the sensation of breathlessness. 425 moderate to very severe chronic obstructive pulmonary disease (COPD) patients and 229 controls were included. Spirometry and impedance measurements were performed on a MasterScope CT Impulse Oscillation System. Median ΔXrs approached zero in healthy controls with little variation between measurements. COPD patients generally had higher ΔXrs and higher variability. The COPD patients with ΔXrs >0.1 kPa · L(-1) · s(-1) were prone to be more breathless and had a higher modified Medical Research Council dyspnoea scale score. In controls, the 95th percentile of ΔXrs was as low as 0.07 kPa · L(-1) · s(-1). We describe a new method to assess EFL at a patient level and propose a cut-off, mean ΔXrs >0.1 kPa · L(-1) · s(-1), as a way to identify COPD patients who are more likely to report dyspnoea. PMID:25359342

  15. The classification of the patients with pulmonary diseases using breath air samples spectral analysis

    NASA Astrophysics Data System (ADS)

    Kistenev, Yury V.; Borisov, Alexey V.; Kuzmin, Dmitry A.; Bulanova, Anna A.

    2016-08-01

    Technique of exhaled breath sampling is discussed. The procedure of wavelength auto-calibration is proposed and tested. Comparison of the experimental data with the model absorption spectra of 5% CO2 is conducted. The classification results of three study groups obtained by using support vector machine and principal component analysis methods are presented.

  16. Particle size concentration distribution and influences on exhaled breath particles in mechanically ventilated patients.

    PubMed

    Wan, Gwo-Hwa; Wu, Chieh-Liang; Chen, Yi-Fang; Huang, Sheng-Hsiu; Wang, Yu-Ling; Chen, Chun-Wan

    2014-01-01

    Humans produce exhaled breath particles (EBPs) during various breath activities, such as normal breathing, coughing, talking, and sneezing. Airborne transmission risk exists when EBPs have attached pathogens. Until recently, few investigations had evaluated the size and concentration distributions of EBPs from mechanically ventilated patients with different ventilation mode settings. This study thus broke new ground by not only evaluating the size concentration distributions of EBPs in mechanically ventilated patients, but also investigating the relationship between EBP level and positive expiratory end airway pressure (PEEP), tidal volume, and pneumonia. This investigation recruited mechanically ventilated patients, with and without pneumonia, aged 20 years old and above, from the respiratory intensive care unit of a medical center. Concentration distributions of EBPs from mechanically ventilated patients were analyzed with an optical particle analyzer. This study finds that EBP concentrations from mechanically ventilated patients during normal breathing were in the range 0.47-2,554.04 particles/breath (0.001-4.644 particles/mL). EBP concentrations did not differ significantly between the volume control and pressure control modes of the ventilation settings in the mechanically ventilated patients. The patient EBPs were sized below 5 µm, and 80% of them ranged from 0.3 to 1.0 µm. The EBPs concentrations in patients with high PEEP (> 5 cmH₂O) clearly exceeded those in patients with low PEEP (≤ 5 cmH₂O). Additionally, a significant negative association existed between pneumonia duration and EBPs concentration. However, tidal volume was not related to EBPs concentration.

  17. SU-E-J-175: Comparison of the Treatment Reproducibility of Tumors Affected by Breathing Motion

    SciTech Connect

    Adamczyk, M; Piotrowski, T; Adamczyk, S

    2015-06-15

    Purpose: The aim of the dose distribution simulations was to form a global idea of intensity-modulated radiation therapy (IMRT) realization, by its comparison to three-dimensional conformal radiation therapy (3DCRT) delivery for tumors affected by respiratory motion. Methods: In the group of 10patients both 3DCRT and IMRT plans were prepared.For each field the motion kernel was generated with the largest movement amplitude of 4;6 and 8mm.Additionally,the sets of reference measurements were made in no motion conditions(0 mm).The evaluation of plan delivery,using a diode array placed on moving platform,was based on the Gamma Index analysis with distance to agreement of 3mm and dose difference of 3%. Results: IMRT plans tended to spare doses delivered to lungs compared to 3DCRT.Nonetheless,analyzed volumes showed no significant difference between the static and dynamic techniques,except for the volumes of both lungs receiving 10 and 15Gy.After adding the components associated with the respiratory movement,all IMRT lung parameters evaluated for the ipsilateral,contralateral and both lungs together,revealed considerable differences between the 0vs.6, 0vs.8 and 4vs.8-mm amplitudes.Similar results were obtained for the 3DCRT lung measurements,but without significance between the 0vs.6-mm amplitude.Taking into account the CTV score parameter in 3DCRT and IMRT plans,there was no statistically significant difference between the motion patterns with the smallest amplitudes.The differences were found for the 8-mm amplitude when it was compared both with static conditions and 4-mm amplitude (for 3DCRT) and between 0vs.6, 0vs.8 and 4vs.8-mm amplitudes (for IMRT).All accepted and measured 3DCRT and IMRT doses to spinal cord,esophagus and heart were always below the QUANTEC limits. Conclusion: The application of IMRT technique in lung radiotherapy affords possibilities for reducing the lung doses.For maximal amplitudes of breathing trajectory below 4mm,the disagreement between CTV

  18. Bicycle endurance performance of patients with interstitial lung disease breathing air and oxygen.

    PubMed

    Bye, P T; Anderson, S D; Woolcock, A J; Young, I H; Alison, J A

    1982-12-01

    The effect of supplemental oxygen breathing on bicycle exercise performance was studied in 16 patients in the assessment of their extent of impairment with interstitial lung disease (ILD). The mean maximal working capacity (W-Max) +/- 1 SD with incremental exercise breathing air was 107 +/- 43 W (60% predicted). There was no significant increase in W-Max with oxygen breathing (p less than 0.10, n = 12). On a separate day each patient performed 2 endurance studies at a constant submaximal work load (80% W-Max) inspiring air and 60% oxygen. The mean fall in arterial oxyhemoglobin saturation (SaO2%) during exercise in air was 8% (range, 1 to 23%). There was a significant improvement in exercise time (p less than 0.001) when patients exercised with oxygen. This increase in endurance was significantly correlated with the fall in SaO2% during the air study. The improvement in exercise time with oxygen was greatest in those with the most marked lung restriction. Blood lactic acid was reduced with oxygen breathing.

  19. Biochemical pathways of breath ammonia (NH3) generation in patients with end-stage renal disease undergoing hemodialysis.

    PubMed

    Chen, W; Laiho, S; Vaittinen, O; Halonen, L; Ortiz, F; Forsblom, C; Groop, P-H; Lehto, M; Metsälä, M

    2016-01-01

    Breath ammonia (NH3) has been proposed as a potential biomarker in monitoring hemodialysis (HD) adequacy, since a strong correlation between blood urea and mouth-exhaled breath NH3 has been observed in patients with end-stage renal disease (ESRD) undergoing HD. However, the biochemical pathways for breath NH3 generation from blood urea have not been demonstrated. In this study, we show a strong correlation (r s  =  0.77, p  <  0.001) between blood and salivary urea, indicating that salivary urea levels reflect blood urea levels. Salivary urea is in turn strongly correlated to salivary ammonia ([Formula: see text] + NH3) in most of the patients. This confirms that the hydrolysis of urea by urease generates ammonia in the oral cavity. A further strong correlation between salivary ammonia and breath NH3 indicates that salivary ammonia evaporates into gas phase and turns to breath NH3. Therefore, blood urea is a major biochemical source of breath NH3. Since breath NH3 is generated predominantly in the oral cavity, the levels of breath NH3 are influenced significantly by the patient's oral condition including urease activity and salivary pH. Our results agree with previous studies that have shown a connection between salivary urea and breath NH3. PMID:27516572

  20. Noninvasive Estimation of Respiratory Mechanics in Spontaneously Breathing Ventilated Patients: A Constrained Optimization Approach.

    PubMed

    Vicario, Francesco; Albanese, Antonio; Karamolegkos, Nikolaos; Wang, Dong; Seiver, Adam; Chbat, Nicolas W

    2016-04-01

    This paper presents a method for breath-by-breath noninvasive estimation of respiratory resistance and elastance in mechanically ventilated patients. For passive patients, well-established approaches exist. However, when patients are breathing spontaneously, taking into account the diaphragmatic effort in the estimation process is still an open challenge. Mechanical ventilators require maneuvers to obtain reliable estimates for respiratory mechanics parameters. Such maneuvers interfere with the desired ventilation pattern to be delivered to the patient. Alternatively, invasive procedures are needed. The method presented in this paper is a noninvasive way requiring only measurements of airway pressure and flow that are routinely available for ventilated patients. It is based on a first-order single-compartment model of the respiratory system, from which a cost function is constructed as the sum of squared errors between model-based airway pressure predictions and actual measurements. Physiological considerations are translated into mathematical constraints that restrict the space of feasible solutions and make the resulting optimization problem strictly convex. Existing quadratic programming techniques are used to efficiently find the minimizing solution, which yields an estimate of the respiratory system resistance and elastance. The method is illustrated via numerical examples and experimental data from animal tests. Results show that taking into account the patient effort consistently improves the estimation of respiratory mechanics. The method is suitable for real-time patient monitoring, providing clinicians with noninvasive measurements that could be used for diagnosis and therapy optimization.

  1. Replacement of missing anterior teeth in a patient with chronic mouth breathing and tongue thrusting.

    PubMed

    Haralur, Satheesh B; Al-Qahtani, Ali Saad

    2013-01-01

    The loss of anterior teeth has serious functional, esthetic disabilities, in addition to compromising the patients' quality of life. Various etiologies can be attributed to the anterior tooth loss, including trauma, caries, and periodontal diseases. The chronic mouth breathing due to nasal adenoids is known to enhance the gingival and periodontal diseases. The dental literature proves the association of nasal breathing, tongue thrusting, and anterior open bite. Arch shape and tooth position are primarily determined by the equilibrium of the forces from tongue and perioral musculature. Increased force from tongue musculature in the tongue thrusting patient leads to flaring of anterior teeth, making them susceptible for periodontal and traumatic tooth loss. Replacement of the anterior teeth in this patient will also help in restoration of anterior guidance, which is critical for the health of temporomandibular joint, posterior teeth, and musculature.

  2. Replacement of Missing Anterior Teeth in a Patient with Chronic Mouth Breathing and Tongue Thrusting

    PubMed Central

    Haralur, Satheesh B.; Al-Qahtani, Ali Saad

    2013-01-01

    The loss of anterior teeth has serious functional, esthetic disabilities, in addition to compromising the patients' quality of life. Various etiologies can be attributed to the anterior tooth loss, including trauma, caries, and periodontal diseases. The chronic mouth breathing due to nasal adenoids is known to enhance the gingival and periodontal diseases. The dental literature proves the association of nasal breathing, tongue thrusting, and anterior open bite. Arch shape and tooth position are primarily determined by the equilibrium of the forces from tongue and perioral musculature. Increased force from tongue musculature in the tongue thrusting patient leads to flaring of anterior teeth, making them susceptible for periodontal and traumatic tooth loss. Replacement of the anterior teeth in this patient will also help in restoration of anterior guidance, which is critical for the health of temporomandibular joint, posterior teeth, and musculature. PMID:24490091

  3. Time series analyses of breathing patterns of lung cancer patients using nonlinear dynamical system theory

    NASA Astrophysics Data System (ADS)

    Tewatia, D. K.; Tolakanahalli, R. P.; Paliwal, B. R.; Tomé, W. A.

    2011-04-01

    The underlying requirements for successful implementation of any efficient tumour motion management strategy are regularity and reproducibility of a patient's breathing pattern. The physiological act of breathing is controlled by multiple nonlinear feedback and feed-forward couplings. It would therefore be appropriate to analyse the breathing pattern of lung cancer patients in the light of nonlinear dynamical system theory. The purpose of this paper is to analyse the one-dimensional respiratory time series of lung cancer patients based on nonlinear dynamics and delay coordinate state space embedding. It is very important to select a suitable pair of embedding dimension 'm' and time delay 'τ' when performing a state space reconstruction. Appropriate time delay and embedding dimension were obtained using well-established methods, namely mutual information and the false nearest neighbour method, respectively. Establishing stationarity and determinism in a given scalar time series is a prerequisite to demonstrating that the nonlinear dynamical system that gave rise to the scalar time series exhibits a sensitive dependence on initial conditions, i.e. is chaotic. Hence, once an appropriate state space embedding of the dynamical system has been reconstructed, we show that the time series of the nonlinear dynamical systems under study are both stationary and deterministic in nature. Once both criteria are established, we proceed to calculate the largest Lyapunov exponent (LLE), which is an invariant quantity under time delay embedding. The LLE for all 16 patients is positive, which along with stationarity and determinism establishes the fact that the time series of a lung cancer patient's breathing pattern is not random or irregular, but rather it is deterministic in nature albeit chaotic. These results indicate that chaotic characteristics exist in the respiratory waveform and techniques based on state space dynamics should be employed for tumour motion management.

  4. Evaluation of Waste Anesthetic Gas in the Postanesthesia Care Unit within the Patient Breathing Zone

    PubMed Central

    Hiller, Kenneth N.; Altamirano, Alfonso V.; Cai, Chunyan; Tran, Stephanie F.; Williams, George W.

    2015-01-01

    Potential health hazards from waste anesthetic gases (WAGs) have been a concern since the introduction of inhalational anesthetics into clinical practice. The potential to exceed recommended exposure levels (RELs) in the postanesthesia care unit (PACU) exists. The aim of this pilot study was to assess sevoflurane WAG levels while accounting for factors that affect inhalational anesthetic elimination. In this pilot study, 20 adult day surgery patients were enrolled with anesthesia maintained with sevoflurane. Following extubation, exhaled WAG from the patient breathing zone was measured 8 inches from the patient's mouth in the PACU. Maximum sevoflurane WAG levels in the patient breathing zone exceeded National Institute for Occupational Safety and Health (NIOSH) RELs for every 5-minute time interval measured during PACU Phase I. Observed WAGs in our study were explained by inhalational anesthetic pharmacokinetics. Further analysis suggests that the rate of washout of sevoflurane was dependent on the duration of anesthetic exposure. This study demonstrated that clinically relevant inhalational anesthetic concentrations result in sevoflurane WAG levels that exceed current RELs. Evaluating peak and cumulative sevoflurane WAG levels in the breathing zone of PACU Phase I and Phase II providers is warranted to quantify the extent and duration of exposure. PMID:26693222

  5. Sleep-disordered breathing in patients with cystic fibrosis *

    PubMed Central

    Veronezi, Jefferson; Carvalho, Ana Paula; Ricachinewsky, Claudio; Hoffmann, Anneliese; Kobayashi, Danielle Yuka; Piltcher, Otavio Bejzman; Silva, Fernando Antonio Abreu e; Martinez, Denis

    2015-01-01

    Abstract Objective: To test the hypothesis that disease severity in patients with cystic fibrosis (CF) is correlated with an increased risk of sleep apnea. Methods: A total of 34 CF patients underwent clinical and functional evaluation, as well as portable polysomnography, spirometry, and determination of IL-1β levels. Results: Mean apnea-hypopnea index (AHI), SpO2 on room air, and Epworth Sleepiness Scale score were 4.8 ± 2.6, 95.9 ± 1.9%, and 7.6 ± 3.8 points, respectively. Of the 34 patients, 19 were well-nourished, 6 were at nutritional risk, and 9 were malnourished. In the multivariate model to predict the AHI, the following variables remained significant: nutritional status (β = −0.386; p = 0.014); SpO2 (β = −0.453; p = 0.005), and the Epworth Sleepiness Scale score (β = 0.429; p = 0.006). The model explained 51% of the variation in the AHI. Conclusions: The major determinants of sleep apnea were nutritional status, SpO2, and daytime sleepiness. This knowledge not only provides an opportunity to define the clinical risk of having sleep apnea but also creates an avenue for the treatment and prevention of the disease. PMID:26398755

  6. Within-breath respiratory impedance and airway obstruction in patients with chronic obstructive pulmonary disease

    PubMed Central

    da Silva, Karla Kristine Dames; Faria, Alvaro Camilo Dias; Lopes, Agnaldo José; de Melo, Pedro Lopes

    2015-01-01

    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, p<0.0001). In contrast to the control subjects and the smokers, the chronic obstructive pulmonary disease patients presented significant expiratory-inspiratory differences (p<0.002). The adverse effects of moderate airway obstruction were detected based on the Zpp with an accuracy of 83%. Additionally, abnormal effects in severe and very severe patients were detected based on the Zm, Zi, Ze, Zbe, Zpp and ΔZrs with a high degree of accuracy (>90%). 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

  7. Comparative Analysis of VOCs in Exhaled Breath of Amyotrophic Lateral Sclerosis and Cervical Spondylotic Myelopathy Patients

    PubMed Central

    Wang, Changsong; Li, Mingjuan; Jiang, Hongquan; Tong, Hongshuang; Feng, Yue; Wang, Yue; Pi, Xin; Guo, Lei; Nie, Maomao; Feng, Honglin; Li, Enyou

    2016-01-01

    Amyotrophic lateral sclerosis (ALS) is an incurable neurological degenerative disease. It can cause irreversible neurological damage to motor neurons; typical symptoms include muscle weakness and atrophy, bulbar paralysis and pyramidal tract signs. The ALS-mimicking disease cervical spondylotic myelopathy (CSM) presents similar symptoms, but analysis of breath volatile organic compounds (VOCs) can potentially be used to distinguish ALS from CSM. In this study, breath samples were collected from 28 ALS and 13 CSM patients. Subsequently, gas chromatography/mass spectrometry (GCMS) was used to analyze breath VOCs. Principal component analysis (PCA) and orthogonal partial least-squares discriminant analysis (OPLSDA) were the statistical methods used to process the final data. We identified 4 compounds with significantly decreased levels in ALS patients compared with CSM controls: (1) carbamic acid, monoammonium salt; (2) 1-alanine ethylamide, (S)-; (3) guanidine, N,N-dimethyl-; and (4) phosphonic acid, (p-hydroxyphenyl)-. Currently, the metabolic origin of the VOCs remains unclear; however, several pathways might explain the decreasing trends observed. The results of this study demonstrate that there are specific VOC profiles associated with ALS and CSM patients that can be used to differentiate between the two. In addition, these metabolites could contribute to a better understanding of the underlying pathophysiological mechanisms of ALS. PMID:27212435

  8. The resistive and elastic work of breathing during exercise in patients with chronic heart failure

    PubMed Central

    Cross, Troy J.; Sabapathy, Surendan; Beck, Kenneth C.; Morris, Norman R.; Johnson, Bruce D.

    2014-01-01

    Patients with heart failure (HF) display numerous derangements in ventilatory function, which together serve to increase the work of breathing (Wb) during exercise. However, the extent to which the resistive and elastic properties of the respiratory system contribute to the higher Wb in these patients is unknown. We quantified the resistive and elastic Wb in patients with stable HF (n=9; New York Heart Association functional class I–II) and healthy control subjects (n=9) at standardised levels of minute ventilation (V′E) during graded exercise. Dynamic lung compliance was systematically lower for a given level of V′E in HF patients than controls (p<0.05). HF patients displayed slightly higher levels of inspiratory elastic Wb with greater amounts of ventilatory constraint and resistive Wb than control subjects during exercise (p<0.05). Our data indicates that the higher Wb in HF patients is primarily due to a greater resistive, rather than elastic, load to breathing. The greater resistive Wb in these patients probably reflects an increased hysteresivity of the airways and lung tissues. The marginally higher inspiratory elastic Wb observed in HF patients appears related to a combined decrease in the compliances of the lungs and chest wall. The clinical and physiological implications of our findings are discussed. PMID:22034652

  9. Lactose malabsorption testing in daily clinical practice: a critical retrospective analysis and comparison of the hydrogen/methane breath test and genetic test (c/t-13910 polymorphism) results.

    PubMed

    Enko, Dietmar; Rezanka, Erwin; Stolba, Robert; Halwachs-Baumann, Gabriele

    2014-01-01

    The aim of this study was to establish a retrospective evaluation and comparison of the hydrogen/methane (H2/CH4) breath test and genetic test (C/T-13910 polymorphism) results in lactose malabsorption testing. In total 263 consecutive patients with suspected lactose malabsorption were included in this study. They underwent the H2/CH4 breath test following the ingestion of 50 g lactose and were tested for the C/T-13910 polymorphism. In total 51 patients (19.4%) had a C/C-13910 genotype, indicating primary lactose malabsorption. Only 19 patients (7.2%) also had a positive H2/CH4 breath test. All in all 136 patients (51.69%) had a C/T-13910 and 76 patients (28.91%) a T/T-13910 genotype, indicating lactase persistence. Four patients (1.5%) with the C/T-13910 genotype and one patient (0.4%) with the T/T-13910 genotype had a positive H2/CH4 breath test result, indicating secondary lactose malabsorption. Cohen's Kappa measuring agreement between the two methods was 0.44. Twenty patients (7.6%) with a positive H2/CH4 peak within 60 minutes after lactose ingestion were classified as patients with lactose-dependent small intestinal bacterial overgrowth (SIBO). In conclusion, only moderate agreement between the breath test and the genetic test was shown. Secondary lactose malabsorption as well as preanalytical limitations of the combined H2/CH4 breath test procedure can cause discrepant results. This trial is registered with K-42-13. PMID:24829570

  10. Lactose Malabsorption Testing in Daily Clinical Practice: A Critical Retrospective Analysis and Comparison of the Hydrogen/Methane Breath Test and Genetic Test (C/T−13910 Polymorphism) Results

    PubMed Central

    Rezanka, Erwin; Stolba, Robert; Halwachs-Baumann, Gabriele

    2014-01-01

    The aim of this study was to establish a retrospective evaluation and comparison of the hydrogen/methane (H2/CH4) breath test and genetic test (C/T−13910 polymorphism) results in lactose malabsorption testing. In total 263 consecutive patients with suspected lactose malabsorption were included in this study. They underwent the H2/CH4 breath test following the ingestion of 50 g lactose and were tested for the C/T−13910 polymorphism. In total 51 patients (19.4%) had a C/C−13910 genotype, indicating primary lactose malabsorption. Only 19 patients (7.2%) also had a positive H2/CH4 breath test. All in all 136 patients (51.69%) had a C/T−13910 and 76 patients (28.91%) a T/T−13910 genotype, indicating lactase persistence. Four patients (1.5%) with the C/T−13910 genotype and one patient (0.4%) with the T/T−13910 genotype had a positive H2/CH4 breath test result, indicating secondary lactose malabsorption. Cohen's Kappa measuring agreement between the two methods was 0.44. Twenty patients (7.6%) with a positive H2/CH4 peak within 60 minutes after lactose ingestion were classified as patients with lactose-dependent small intestinal bacterial overgrowth (SIBO). In conclusion, only moderate agreement between the breath test and the genetic test was shown. Secondary lactose malabsorption as well as preanalytical limitations of the combined H2/CH4 breath test procedure can cause discrepant results. This trial is registered with K-42-13. PMID:24829570

  11. Comparison of breath gases, including acetone, with blood glucose and blood ketones in children and adolescents with type 1 diabetes.

    PubMed

    Blaikie, Tom P J; Edge, Julie A; Hancock, Gus; Lunn, Daniel; Megson, Clare; Peverall, Rob; Richmond, Graham; Ritchie, Grant A D; Taylor, David

    2014-11-25

    Previous studies have suggested that breath gases may be related to simultaneous blood glucose and blood ketone levels in adults with type 2 and type 1 diabetes. The aims of this study were to investigate these relationships in children and young people with type 1 diabetes in order to assess the efficacy of a simple breath test as a non-invasive means of diabetes management. Gases were collected in breath bags and measurements were compared with capillary blood glucose and ketone levels taken at the same time on a single visit to a routine hospital clinic in 113 subjects (59 male, age 7 years 11 months-18 years 3 months) with type 1 diabetes. The patients were well-controlled with relatively low concentrations of the blood ketone measured (β hydroxybutyrate, 0-0.4 mmol l(-1)). Breath acetone levels were found to increase with blood β hydroxybutyrate levels and a significant relationship was found between the two (Spearman's rank correlation ρ = 0.364, p < 10(-4)). A weak positive relationship was found between blood glucose and breath acetone (ρ = 0.16, p = 0.1), but led to the conclusion that single breath measurements of acetone do not provide a good measure of blood glucose levels in this cohort. This result suggests a potential to develop breath gas analysis to provide an alternative to blood testing for ketone measurement, for example to assist with the management of type 1 diabetes.

  12. Preoxygenation in the elderly: a comparison of the four-maximal-breath and three-minute techniques.

    PubMed

    Valentine, S J; Marjot, R; Monk, C R

    1990-11-01

    To compare the effectiveness of two routinely used methods of preoxygenation in protecting against hypoxia in the elderly, the arterial O2 saturation was measured using an oximeter. Twenty-four elderly patients (greater than or equal to 65 yr) presenting for elective orthopedic surgery were randomly allocated to receive either 3-min or four-maximal-breaths of 100% O2 via a Bain circuit. After preoxygenation, anesthesia was induced, tracheal intubation performed with patients kept apneic, and the endotracheal tube left open to air. The arterial O2 saturation was measured before preoxygenation and continually recorded during desaturation. Although attaining similar arterial O2 saturation values after preoxygenation, patients in the four-maximal-breath group had significantly shorter times (P less than 0.0001) to all levels of desaturation. We suggest that preoxygenation with 3-min breathing of 100% O2 offers more protection against hypoxia due to prolonged apnea after induction of anesthesia in the elderly than does four maximal breaths of 100% O2. PMID:2221412

  13. Comparison of impedance and inductance ventilation sensors on adults during breathing, motion, and simulated airway obstruction.

    PubMed

    Cohen, K P; Ladd, W M; Beams, D M; Sheers, W S; Radwin, R G; Tompkins, W J; Webster, J G

    1997-07-01

    The goal of this study was to compare the relative performance of two noninvasive ventilation sensing technologies on adults during artifacts. We recorded changes in transthoracic impedance and cross-sectional area of the abdomen (abd) and rib cage (rc) using impedance pneumography (IP) and respiratory inductance plethysmography (RIP) on ten adult subjects during natural breathing, motion artifact, simulated airway obstruction, yawning, snoring, apnea, and coughing. We used a pneumotachometer to measure air flow and tidal volume as the standard. We calibrated all sensors during natural breathing, and performed measurements during all maneuvers without changing the calibration parameters. No sensor provided the most-accurate measure of tidal volume for all maneuvers. Overall, the combination of inductance sensors [RIP(sum)] calibrated during an isovolume maneuver had a bias (weighted mean difference) as low or lower than all individual sensors and all combinations of sensors. The IP(rc) sensor had a bias as low or lower than any individual sensor. The cross-correlation coefficient between sensors was high during natural breathing, but decreased during artifacts. The cross correlation between sensor pairs was lower during artifacts without breathing than it was during maneuvers with breathing for four different sensor combinations. We tested a simple breath-detection algorithm on all sensors and found that RIP(sum) resulted in the fewest number of false breath detections, with sensitivity of 90.8% and positive predictivity of 93.6%.

  14. Inspired humidity in anaesthesia breathing circuits: comparison and examination of effect of Revell circulator.

    PubMed

    Flynn, P J; Morris, L E; Askill, S

    1984-11-01

    Humidity levels of respired gases in spontaneously breathing patients were measured with a quadrupole mass spectrometer (Medishield Model MS-2) and compared between various anaesthetic systems during clinical anaesthesia. In studies of high flow rebreathing non-absorption systems the mean inspired absolute humidity averaged approximately 16 mg X l-1 (range 14.7 to 16.1 mg X l-1) compared to a semiclosed circle absorption system (BOC MK III) in which values for absolute humidity varied from 6.8 +/- 5.1 mg X l-1 for children through 9.5 +/- 3.0 mg X l-1 for adults), and the closed circle absorption system in which values of 20.5 +/- 2.3 mg X l-1 were only gradually reached. Addition of a functioning Revell circulator to the circle absorption system provided immediately markedly higher levels of inspired humidity during clinical use, either semiclosed (15.4 +/- 5.1 mg X l-1 in children to 18.8 +/- 2.4 mg X l-1 in adults), or closed (23.3 +/- 1.8 mg X l-1 in adults). These markedly higher inspired levels of absolute humidity were attained during forced circulation of respired gas provided by the Revell circulator without the concomitant disadvantages of rebreathing or the potential hazards associated with some humidifying devices.

  15. [Pulmonary function results in healthy subjects breathing through external stenoses compared to patients with airway obstruction].

    PubMed

    Schäfer, Thorsten; Schätt, Dieter; Schläfke, Marianne E; Ulmer, Wolfgang T

    2004-01-01

    We compared body plethysmographic data, flow-volume curves during spontaneous breathing, P0.1 and PETCO2 in healthy subjects breathing through external stenoses (ES) of varying magnitude to the results in patients suffering from chronic obstructive pulmonary disease (COPD). Inspiratory vital capacity (IVC) remained unchanged by experimental airway stenoses. IVC is mainly determined by the end-expiratory closure of the airways, which only weakly correlates with airway resistance in patients. External stenoses had no effect on the physiological end-expiratory closure of the airways. For the other spirometric parameters the available force of the respiratory muscles and the degree of the experimental stenosis played the major role. The mouth occlusion pressure (P0.1) showed considerably lower variation during ES as well as in COPD patients than total resistance (Rt). There was no increase in intrathoracic gas volume (IGV) causing increased tension of the lungs and the thorax during ES. The well-known correlation between Rt and IGV is attributed to the end-expiratory closure of the airways during increased flow resistance and to "trapped air". It remains open, if and how the expiratory muscles act to overcome the increased resistance. With consideration of the underlying factors of the different lung function measures, the combination and the analysis of the correlation between different values may lead to far-reaching results in lung function testing. PMID:15518089

  16. Detection of chaotic determinism in lung cancer patients' breathing patterns and tracking of lung tumors using dMLC

    NASA Astrophysics Data System (ADS)

    Tewatia, Dinesh Kumar

    The aim of the thesis is to investigate two techniques for tracking moving lung tumors, develop a model for numerical phantom for moving tumors and analyze breathing pattern of lung cancer patients using nonlinear dynamics and chaos theory. The clinical implementation will require an electronic interface to radiation delivery machines to trigger the beam ON and hold OFF the beam once tumor goes out of the threshold window. A breathing synchronized delivery (BSD) was developed using Eclipse TM treatment planning system (Varian Medical Systems). Delivered dose calculation on 50% (maximum exhalation) phase and using shaperTM application was performed to superimpose the instantaneous average tumor displacement on the dynamic Multileaf collimator position at corresponding phase. BSD technique assumed a constant dose rate and patient is guided to reproduce the breathing pattern that was acquired during 4D CT acquisition. As BSD technique cannot directly be adapted to moving tumors in case of volumetric modulated arc therapy, we have developed a novel technique for arc-based treatments. We have demonstrated the implementation of this technique on the ADAC Pinnacle3 TM (Philips Medical Systems) treatment planning system. This technique does not require breath-hold or breath synchronization and has nearly 100% duty cycle without major hardware changes. The variation in dose accumulation due to changes in breathing pattern was studied on numerical phantom. Stereotactic body radiotherapy treatment was investigated to see the effect of changes in breathing patterns on five days of the treatment. If variation in breathing pattern is not substantial, then the total accumulated dose on that treatment day would not be significantly different from the planned dose distribution. If breathing pattern on a given day changes beyond some threshold we may partially miss the target on that day. Lung tumor motion is mainly due to breathing. No matter how robust the tumor tracking

  17. Breath Analysis Based on Surface-Enhanced Raman Scattering Sensors Distinguishes Early and Advanced Gastric Cancer Patients from Healthy Persons.

    PubMed

    Chen, Yunsheng; Zhang, Yixia; Pan, Fei; Liu, Jie; Wang, Kan; Zhang, Chunlei; Cheng, Shangli; Lu, Lungen; Zhang, Wei; Zhang, Zheng; Zhi, Xiao; Zhang, Qian; Alfranca, Gabriel; de la Fuente, Jesús M; Chen, Di; Cui, Daxiang

    2016-09-27

    Fourteen volatile organic compound (VOC) biomarkers in the breath have been identified to distinguish early gastric cancer (EGC) and advanced gastric cancer (AGC) patients from healthy persons by gas chromatography-mass spectrometry coupled with solid phase microextraction (SPME). Then, a breath analysis approach based on a surface-enhanced Raman scattering (SERS) sensor was developed to detect these biomarkers. Utilizing hydrazine vapor adsorbed in graphene oxide (GO) film, the clean SERS sensor is facilely prepared by in situ formation of gold nanoparticles (AuNPs) on reduced graphene oxide (RGO) without any organic stabilizer. In the SERS sensor, RGO can selectively adsorb and enrich the identified biomarkers from breath as an SPME fiber, and AuNPs well dispersed on RGO endow the SERS sensor with an effective detection of adsorbed biomarkers. Fourteen Raman bands associated with the biomarkers are selected as the fingerprints of biomarker patterns to distinguish persons in different states. The approach has successfully analyzed and distinguished different simulated breath samples and 200 breath samples of clinical patients with a sensitivity of higher than 83% and a specificity of more than 92%. In conclusion, the VOC biomarkers and breath analysis approach in this study can not only diagnose gastric cancer but also distinguish EGC and AGC. This work has great potential for clinical translation in primary screening diagnosis and stage determination of stomach cancer in the near future.

  18. Comparative analysis between the alveolar recruitment maneuver and breath stacking technique in patients with acute lung injury

    PubMed Central

    Porto, Elias Ferreira; Tavolaro, Kelly Cristiani; Kumpel, Claudia; Oliveira, Fernanda Augusta; Sousa, Juciaria Ferreira; de Carvalho, Graciele Vieira; de Castro, Antonio Adolfo Mattos

    2014-01-01

    Objective To compare the effectiveness of the alveolar recruitment maneuver and the breath stacking technique with respect to lung mechanics and gas exchange in patients with acute lung injury. Methods Thirty patients were distributed into two groups: Group 1 - breath stacking; and Group 2 - alveolar recruitment maneuver. After undergoing conventional physical therapy, all patients received both treatments with an interval of 1 day between them. In the first group, the breath stacking technique was used initially, and subsequently, the alveolar recruitment maneuver was applied. Group 2 patients were initially subjected to alveolar recruitment, followed by the breath stacking technique. Measurements of lung compliance and airway resistance were evaluated before and after the use of both techniques. Gas analyses were collected before and after the techniques were used to evaluate oxygenation and gas exchange. Results Both groups had a significant increase in static compliance after breath stacking (p=0.021) and alveolar recruitment (p=0.03), but with no significant differences between the groups (p=0.95). The dynamic compliance did not increase for the breath stacking (p=0.22) and alveolar recruitment (p=0.074) groups, with no significant difference between the groups (p=0.11). The airway resistance did not decrease for either groups, i.e., breath stacking (p=0.91) and alveolar recruitment (p=0.82), with no significant difference between the groups (p=0.39). The partial pressure of oxygen increased significantly after breath stacking (p=0.013) and alveolar recruitment (p=0.04), but there was no significant difference between the groups (p=0.073). The alveolar-arterial O2 difference decreased for both groups after the breath stacking (p=0.025) and alveolar recruitment (p=0.03) interventions, and there was no significant difference between the groups (p=0.81). Conclusion Our data suggest that the breath stacking and alveolar recruitment techniques are effective in

  19. Small Intestinal Bacterial Overgrowth Diagnosed by Glucose Hydrogen Breath Test in Post-cholecystectomy Patients

    PubMed Central

    Sung, Hea Jung; Paik, Chang-Nyol; Chung, Woo Chul; Lee, Kang-Moon; Yang, Jin-Mo; Choi, Myung-Gyu

    2015-01-01

    Background/Aims Patients undergoing cholecystectomy may have small intestinal bacterial overgrowth (SIBO). We investigated the prevalence and characteristics of SIBO in patients with intestinal symptoms following cholecystectomy. Methods Sixty-two patients following cholecystectomy, 145 with functional gastrointestinal diseases (FGIDs), and 30 healthy controls undergoing hydrogen (H2)-methane (CH4) glucose breath test (GBT) were included in the study. Before performing GBT, all patients were interrogated using bowel symptom questionnaire. The positivity to GBT indicating the presence of SIBO, gas types and bowel symptoms were surveyed. Results Post-cholecystectomy patients more often had SIBO as evidenced by a positive (+) GBT than those with FGID and controls (29/62, 46.8% vs 38/145, 26.2% vs 4/30, 13.3%, respectively; P = 0.010). In the gas types, the GBT (H2) + post-cholecystectomy patients was significantly higher than those in FGIDs patients (P = 0.017). Especially, positivity to fasting GBT (H2) among the GBT (H2)+ post-cholecystectomy patients was high, as diagnosed by elevated fasting H2 level. The GBT+ group had higher symptom scores of significance or tendency in abdominal discomfort, bloating, chest discomfort, early satiety, nausea, and tenesmus than those of the GBT negative group. The status of cholecystectomy was the only significant independent factor for predicting SIBO. Conclusions The SIBO with high levels of baseline H2 might be the important etiologic factor of upper GI symptoms for post-cholecystectomy patients. PMID:26351251

  20. Endothelin-1 in exhaled breath condensate of allergic asthma patients with exercise-induced bronchoconstriction

    PubMed Central

    Zietkowski, Ziemowit; Skiepko, Roman; Tomasiak, Maria M; Bodzenta-Lukaszyk, Anna

    2007-01-01

    Background Exercise-induced bronchoconstriction (EIB) is a highly prevalent condition, whose pathophysiology is not well understood. Endothelins are proinflammatory, profibrotic, broncho- and vasoconstrictive peptides which play an important role in the development of airway inflammation and remodeling in asthma. The aim of the study was to evaluate the changes in endothelin-1 levels in exhaled breath condensate following intensive exercise in asthmatic patients. Methods The study was conducted in a group of 19 asthmatic patients (11 with EIB, 8 without EIB) and 7 healthy volunteers. Changes induced by intensive exercise in the concentrations of endothelin-1 (ET-1) in exhaled breath condensate (EBC) during 24 hours after an exercise challenge test were determined. Moreover, the possible correlations of these measurements with the results of other tests commonly associated with asthma and with the changes of airway inflammation after exercise were observed. Results In asthmatic patients with EIB a statistically significant increase in the concentration of ET-1 in EBC collected between 10 minutes and 6 hours after an exercise test was observed. The concentration of ET-1 had returned to its initial level 24 hours after exercise. No effects of the exercise test on changes in the concentrations of ET-1 in EBC in either asthmatic patients without EIB or healthy volunteers were observed. A statistically significant correlation between the maximum increase in ET-1 concentrations in EBC after exercise and either baseline FENO and the increase in FENO or BHR to histamine 24 hours after exercise in the groups of asthmatics with EIB was revealed. Conclusion The release of ET-1 from bronchial epithelium through the influence of many inflammatory cells essential in asthma and interactions with other cytokines, may play an important role in increase of airway inflammation which was observed after postexercise bronchoconstriction in asthmatic patients. PMID:17973986

  1. Individuality of breathing patterns in patients under noninvasive mechanical ventilation evidenced by chaotic global models

    NASA Astrophysics Data System (ADS)

    Letellier, Christophe; Rodrigues, Giovani G.; Muir, Jean-François; Aguirre, Luis A.

    2013-03-01

    Autonomous global models based on radial basis functions were obtained from data measured from patients under noninvasive mechanical ventilation. Some of these models, which are discussed in the paper, turn out to have chaotic or quasi-periodic solutions, thus providing a first piece of evidence that the underlying dynamics of the data used to estimate the global models are likely to be chaotic or, at least, have a chaotic component. It is explicitly shown that one of such global models produces attractors characterized by a Horseshoe map, two models produce toroidal chaos, and one model produces a quasi-periodic regime. These topologically inequivalent attractors evidence the individuality of breathing profiles observed in patient under noninvasive ventilation.

  2. Exhaled Breath Analysis Using Electronic Nose in Cystic Fibrosis and Primary Ciliary Dyskinesia Patients with Chronic Pulmonary Infections

    PubMed Central

    Joensen, Odin; Paff, Tamara; Haarman, Eric G.; Skovgaard, Ib M.; Jensen, Peter Ø.; Bjarnsholt, Thomas; Nielsen, Kim G.

    2014-01-01

    The current diagnostic work-up and monitoring of pulmonary infections may be perceived as invasive, is time consuming and expensive. In this explorative study, we investigated whether or not a non-invasive exhaled breath analysis using an electronic nose would discriminate between cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) with or without various well characterized chronic pulmonary infections. We recruited 64 patients with CF and 21 with PCD based on known chronic infection status. 21 healthy volunteers served as controls. An electronic nose was employed to analyze exhaled breath samples. Principal component reduction and discriminant analysis were used to construct internally cross-validated receiver operator characteristic (ROC) curves. Breath profiles of CF and PCD patients differed significantly from healthy controls p = 0.001 and p = 0.005, respectively. Profiles of CF patients having a chronic P. aeruginosa infection differed significantly from to non-chronically infected CF patients p = 0.044. We confirmed the previously established discriminative power of exhaled breath analysis in separation between healthy subjects and patients with CF or PCD. Furthermore, this method significantly discriminates CF patients suffering from a chronic pulmonary P. aeruginosa (PA) infection from CF patients without a chronic pulmonary infection. Further studies are needed for verification and to investigate the role of electronic nose technology in the very early diagnostic workup of pulmonary infections before the establishment of a chronic infection. PMID:25542036

  3. Effects of yoga breathing exercises on pulmonary function in patients with Duchenne muscular dystrophy: an exploratory analysis*, **

    PubMed Central

    Rodrigues, Marcos Rojo; Carvalho, Celso Ricardo Fernandes; Santaella, Danilo Forghieri; Lorenzi-Filho, Geraldo; Marie, Suely Kazue Nagahashi

    2014-01-01

    OBJECTIVE: Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in children, and children with DMD die prematurely because of respiratory failure. We sought to determine the efficacy and safety of yoga breathing exercises, as well as the effects of those exercises on respiratory function, in such children. METHODS: This was a prospective open-label study of patients with a confirmed diagnosis of DMD, recruited from among those followed at the neurology outpatient clinic of a university hospital in the city of São Paulo, Brazil. Participants were taught how to perform hatha yoga breathing exercises and were instructed to perform the exercises three times a day for 10 months. RESULTS: Of the 76 patients who entered the study, 35 dropped out and 15 were unable to perform the breathing exercises, 26 having therefore completed the study (mean age, 9.5 ± 2.3 years; body mass index, 18.2 ± 3.8 kg/m2). The yoga breathing exercises resulted in a significant increase in FVC (% of predicted: 82.3 ± 18.6% at baseline vs. 90.3 ± 22.5% at 10 months later; p = 0.02) and FEV1 (% of predicted: 83.8 ± 16.6% at baseline vs. 90.1 ± 17.4% at 10 months later; p = 0.04). CONCLUSIONS: Yoga breathing exercises can improve pulmonary function in patients with DMD. PMID:24831396

  4. Comparison between UWB and CW radar sensors for breath activity monitoring

    NASA Astrophysics Data System (ADS)

    Pisa, Stefano; Bernardi, Paolo; Cicchetti, Renato; Giusto, Roberto; Pittella, Erika; Piuzzi, Emanuele; Testa, Orlandino

    2014-05-01

    In this paper the ability of four radar sensors in detecting breath activity has been tested. In particular, range gating UWB, CMOS UWB, CW phase detecting, and FMCW radars have taken into account. Considering a realistic scenario, the radar antenna has been pointed towards the thorax of a breathing subject and the recorded signals have been compared with those of a piezoelectric belt placed around the thorax. Then the ability of the radars in detecting small movements has been tested by means of an oscillating copper plate placed at various distances from the radar antenna. All the considered radars were able to detect the plate movements with a distance-dependent resolution.

  5. Characteristics of sleep-disordered breathing in Japanese patients with acromegaly.

    PubMed

    Kashine, Susumu; Kishida, Ken; Funahashi, Tohru; Shimomura, Iichiro

    2012-01-01

    Sleep-disordered breathing (SDB), especially sleep apnea-hypopnea syndrome (SAS), is often observed in patients with active acromegaly. This complication is a risk factor for cardiovascular disease and associated with increased morbidity and mortality in acromegaly. However there is little information on SDB in Japanese patients with acromegaly. We investigated the prevalence of SDB and association between the severity of SDB and various features and biomarkers in Japanese patients with acromegaly. Twenty-four Japanese patients with active acromegaly underwent overnight cardiorespiratory monitoring, hormonal assays and cephalometric measurements on X-ray. A high prevalence of SDB was detected in acromegaly (87.5%). Log apnea-hypopnea index (AHI) correlated positively with soft palate length / body height (X-ray) (r=0.44, p=0.043), but not with log growth hormone levels and insulin-like growth factor type-1 standard deviation scores, size of pituitary adenoma, disease duration, body mass index, waist circumference, estimated visceral fat area, heel pad thickness / height, tongue thickness/ height, or oropharyngeal dimension/ height. In conclusion, our study demonstrated a high prevalence of SDB in Japanese patients with acromegaly, and its severity correlated with soft palate length. Based on the high incidence of SDB identified in the present study, we recommend that all patients with acromegaly are routinely screened for SDB for early diagnosis and treatment.

  6. Bad Breath

    MedlinePlus

    ... habits, like brushing and flossing regularly, help fight bad breath. Mouthwashes, mints or chewing gum may make your breath fresher. If you have an underlying disorder, treating it may help eliminate the breath odor.

  7. Hemodynamic Changes during a Deep Inspiration Maneuver Predict Fluid Responsiveness in Spontaneously Breathing Patients

    PubMed Central

    Préau, Sébastien; Dewavrin, Florent; Soland, Vincent; Bortolotti, Perrine; Colling, Delphine; Chagnon, Jean-luc; Durocher, Alain; Saulnier, Fabienne

    2012-01-01

    Objective. We hypothesized that the hemodynamic response to a deep inspiration maneuver (DIM) indicates fluid responsiveness in spontaneously breathing (SB) patients. Design. Prospective study. Setting. ICU of a general hospital. Patients. Consecutive nonintubated patients without mechanical ventilation, considered for volume expansion (VE). Intervention. We assessed hemodynamic status at baseline and after VE. Measurements and Main Results. We measured radial pulse pressure (PP) using an arterial catheter and peak velocity of femoral artery flow (VF) using continuous Doppler. Changes in PP and VF induced by a DIM (ΔPPdim and ΔVFdim) were calculated in 23 patients. ΔPPdim and ΔVFdim ≥12% predicted responders to VE with sensitivity of 90% and specificity of 100%. Conclusions. In a restricted population of SB patients with severe sepsis or acute pancreatitis, ΔPPdim and ΔVFdim are accurate indices for predicting fluid responsiveness. These results should be confirmed in a larger population before validating their use in current practice. PMID:22195286

  8. Single Breath-Hold Physiotherapy Technique: Effective tool for T2* magnetic resonance imaging in young patients with thalassaemia major.

    PubMed

    Mevada, Surekha T; Al-Mahruqi, Najma; El-Beshlawi, Ismail; El-Shinawy, Mohamed; Zachariah, Mathew; Al-Rawas, Abdul H; Daar, Shahina; Wali, Yasser

    2016-02-01

    Magnetic resonance imaging using T2* (MRI T2*) is a highly sensitive and non-invasive technique for the detection of tissue iron load. Although the single breath-hold multi-echo T2* technique has been available at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, since 2006, it could not be performed on younger patients due to their inability to hold their breath after expiration. This study was carried out between May 2007 and May 2015 and assessed 50 SQUH thalassaemic patients aged 7-17 years old. Seven of these patients underwent baseline and one-year follow-up MRI T2* scans before receiving physiotherapy training. Subsequently, all patients were trained by a physiotherapist to hold their breath for approximately 15-20 seconds at the end of expiration before undergoing baseline and one-year follow-up MRI T2* scans. Failure rates for the pre- and post-training groups were 6.0% and 42.8%, respectively. These results indicate that the training of thalassaemic patients in breath-hold techniques is beneficial and increases rates of compliance for MRI T2* scans.

  9. Sampling and analyzing alveolar exhaled breath condensate in mechanically ventilated patients: a feasibility study.

    PubMed

    Vaschetto, Rosanna; Corradi, Massimo; Goldoni, Matteo; Cancelliere, Laura; Pulvirenti, Simone; Fazzini, Ugo; Capuzzi, Fabio; Longhini, Federico; Mutti, Antonio; Della Corte, Francesco; Navalesi, Paolo

    2015-12-01

    Recent studies in spontaneously breathing subjects indicate the possibility of obtaining the alveolar fraction of exhaled breath condensate (aEBC). In critically ill mechanically ventilated patients, in whom microbial colonization of the upper airways is constant, collection of aEBC could considerably add to the ability of monitoring alveolar inflammation. We designed this study to test the feasibility of collecting aEBC in mechanically ventilated critically ill patients through a dedicated apparatus, i.e. a CO2 valve combined with a condenser placed in the expiratory limb of the ventilator circuit. We also aimed to assess the adequacy of the samples obtained by measuring different markers of oxidative stress and inflammation. We enrolled 40 mechanically ventilated patients, 20 with and 20 without acute respiratory distress syndrome (ARDS). Measurements of respiratory mechanics, gas exchange and hemodynamics were obtained with a standard ventilator circuit after 30 min of aEBC collection and after inserting the dedicated collecting apparatus. Data showed that intrinsic positive end-expiratory pressure, peak and plateau pressure, static compliance and airway resistance (Raw) were similar before and after adding the collecting apparatus in both ARDS and controls. Similarly, gas exchange and hemodynamic variables did not change and 30 min collection provided a median aEBC volume of 2.100 and 2.300 ml for ARDS and controls, respectively. aEBC pH showed a trend toward a slight reduction in the ARDS group of patients, as opposed to controls (7.83 (7.62-8.03) versus 7.98 (7.87-8.12), respectively, p  =  0.055)). H2O2 was higher in patients with ARDS, compared to controls (0.09 (0.06-0.12) μM versus 0.03 (0.01-0.09) μM, p  =  0.043), while no difference was found in proteins content, 8-isoprostane, 4-hydroxy-2-nonhenal. In conclusion, we demonstrate, in patients receiving controlled mechanical ventilation, that aEBC collection is feasible without

  10. Sampling and analyzing alveolar exhaled breath condensate in mechanically ventilated patients: a feasibility study.

    PubMed

    Vaschetto, Rosanna; Corradi, Massimo; Goldoni, Matteo; Cancelliere, Laura; Pulvirenti, Simone; Fazzini, Ugo; Capuzzi, Fabio; Longhini, Federico; Mutti, Antonio; Della Corte, Francesco; Navalesi, Paolo

    2015-11-19

    Recent studies in spontaneously breathing subjects indicate the possibility of obtaining the alveolar fraction of exhaled breath condensate (aEBC). In critically ill mechanically ventilated patients, in whom microbial colonization of the upper airways is constant, collection of aEBC could considerably add to the ability of monitoring alveolar inflammation. We designed this study to test the feasibility of collecting aEBC in mechanically ventilated critically ill patients through a dedicated apparatus, i.e. a CO2 valve combined with a condenser placed in the expiratory limb of the ventilator circuit. We also aimed to assess the adequacy of the samples obtained by measuring different markers of oxidative stress and inflammation. We enrolled 40 mechanically ventilated patients, 20 with and 20 without acute respiratory distress syndrome (ARDS). Measurements of respiratory mechanics, gas exchange and hemodynamics were obtained with a standard ventilator circuit after 30 min of aEBC collection and after inserting the dedicated collecting apparatus. Data showed that intrinsic positive end-expiratory pressure, peak and plateau pressure, static compliance and airway resistance (Raw) were similar before and after adding the collecting apparatus in both ARDS and controls. Similarly, gas exchange and hemodynamic variables did not change and 30 min collection provided a median aEBC volume of 2.100 and 2.300 ml for ARDS and controls, respectively. aEBC pH showed a trend toward a slight reduction in the ARDS group of patients, as opposed to controls (7.83 (7.62-8.03) versus 7.98 (7.87-8.12), respectively, p  =  0.055)). H2O2 was higher in patients with ARDS, compared to controls (0.09 (0.06-0.12) μM versus 0.03 (0.01-0.09) μM, p  =  0.043), while no difference was found in proteins content, 8-isoprostane, 4-hydroxy-2-nonhenal. In conclusion, we demonstrate, in patients receiving controlled mechanical ventilation, that aEBC collection is feasible without

  11. Rapid Automated Treatment Planning Process to Select Breast Cancer Patients for Active Breathing Control to Achieve Cardiac Dose Reduction

    SciTech Connect

    Wang Wei; Purdie, Thomas G.; Rahman, Mohammad; Marshall, Andrea; Liu Feifei; Fyles, Anthony

    2012-01-01

    Purpose: To evaluate a rapid automated treatment planning process for the selection of patients with left-sided breast cancer for a moderate deep inspiration breath-hold (mDIBH) technique using active breathing control (ABC); and to determine the dose reduction to the left anterior descending coronary artery (LAD) and the heart using mDIBH. Method and Materials: Treatment plans were generated using an automated method for patients undergoing left-sided breast radiotherapy (n = 53) with two-field tangential intensity-modulated radiotherapy. All patients with unfavorable cardiac anatomy, defined as having >10 cm{sup 3} of the heart receiving 50% of the prescribed dose (V{sub 50}) on the free-breathing automated treatment plan, underwent repeat scanning on a protocol using a mDIBH technique and ABC. The doses to the LAD and heart were compared between the free-breathing and mDIBH plans. Results: The automated planning process required approximately 9 min to generate a breast intensity-modulated radiotherapy plan. Using the dose-volume criteria, 20 of the 53 patients were selected for ABC. Significant differences were found between the free-breathing and mDIBH plans for the heart V{sub 50} (29.9 vs. 3.7 cm{sup 3}), mean heart dose (317 vs. 132 cGy), mean LAD dose (2,047 vs. 594 cGy), and maximal dose to 0.2 cm{sup 3} of the LAD (4,155 vs. 1,507 cGy, all p <.001). Of the 17 patients who had a breath-hold threshold of {>=}0.8 L, 14 achieved a {>=}90% reduction in the heart V{sub 50} using the mDIBH technique. The 3 patients who had had a breath-hold threshold <0.8 L achieved a lower, but still significant, reduction in the heart V{sub 50}. Conclusions: A rapid automated treatment planning process can be used to select patients who will benefit most from mDIBH. For selected patients with unfavorable cardiac anatomy, the mDIBH technique using ABC can significantly reduce the dose to the LAD and heart, potentially reducing the cardiac risks.

  12. Effect of posture on 13C-urea breath test in partial gastrectomy patients

    PubMed Central

    Yin, Shu-Ming; Zhang, Fan; Shi, Dong-Mei; Xiang, Ping; Xiao, Li; Huang, Yi-Qin; Zhang, Gan-Sheng; Bao, Zhi-Jun

    2015-01-01

    AIM: To investigate whether posture affects the accuracy of 13C-urea breath test (13C-UBT) for Helicobacter pylori (H. pylori) detection in partial gastrectomy patients. METHODS: We studied 156 consecutive residual stomach patients, including 76 with H. pylori infection (infection group) and 80 without H. pylori infection (control group). H. pylori infection was confirmed if both the rapid urease test and histology were positive during gastroscopy. The two groups were divided into four subgroups according to patients’ posture during the 13C-UBT: subgroup A, sitting position; subgroup B, supine position; subgroup C, right lateral recumbent position; and subgroup D, left lateral recumbent position. Each subject underwent the following modified 13C-UBT: 75 mg of 13C-urea (powder) in 100 mL of citric acid solution was administered, and a mouth wash was performed immediately; breath samples were then collected at baseline and at 5-min intervals up to 30 min while the position was maintained. Seven breath samples were collected for each subject. The cutoff value was 2.0‰. RESULTS: The mean delta over baseline (DOB) values in the subgroups of the infection group were similar at 5 min (P > 0.05) and significantly higher than those in the corresponding control subgroups at all time points (P < 0.01). In the infection group, the mean DOB values in subgroup A were higher than those in other subgroups within 10 min and peaked at the 10-min point (12.4‰ ± 2.4‰). The values in subgroups B and C both reached their peaks at 15 min (B, 13.9‰ ± 1.5‰; C, 12.2‰ ± 1.7‰) and then decreased gradually until the 30-min point. In subgroup D, the value peaked at 20 min (14.7‰ ± 1.7‰). Significant differences were found between the values in subgroups D and B at both 25 min (t = 2.093, P = 0.043) and 30 min (t = 2.141, P = 0.039). At 30 min, the value in subgroup D was also significantly different from those in subgroups A and C (D vs C: t = 6.325, P = 0.000; D vs A: t

  13. [Effect of mouth breathing on the severity of morphological and functional changes of dental system in patients with otolaryngologic pathology].

    PubMed

    Arsenina, O I; Piksaikina, K G; Popova, A V; Popova, N V

    2014-01-01

    The study included 282 patients aged 5 to 14 years with pathology of the pharyngeal tonsil. Diagnostic algorithm is presented. The study results allowed elaboration of complex rehabilitation of nasal breathing and miodynamic equilibrium in the maxillofacial region by means of elastopositioner.

  14. Effects of ozone exposure: a comparison between oral and nasal breathing

    SciTech Connect

    Hynes, B.; Silverman, F.; Cole, P.; Corey, P.

    1988-09-01

    Mode of inhalation, by nose or by mouth, as a determinant of pulmonary toxicity to acute inhalant exposure has been investigated incompletely. This communication addresses whether there are significant differences in toxic pulmonary responses to acute ozone (O/sub 3/) exposure between differing modes of inhalation (nasal vs. oral breathing). Changes in the results of pulmonary function tests and symptomatology of healthy young adults were compared following both exclusive nose and exclusive mouth breathing during a 30-min exposure to approximately 0.4 ppm O/sub 3/ under conditions of moderate continuous exercise. In this single-blind, randomized, crossover study, no significant differences in either the results of pulmonary function tests or in symptomatology were found between the two modes of inhalation.

  15. 13C-methacetin breath test correlates with clinical indices of liver disease severity in patients with primary biliary cirrhosis.

    PubMed

    Kochel-Jankowska, A; Hartleb, M; Jonderko, K; Kaminska, M; Kasicka-Jonderko, A

    2013-02-01

    This prospective study intended to ascertain if cytochrome P450 dependent liver function is affected in early and late histological stages of primary biliary cirrhosis (PBC). The study included 32 female PBC patients (mean age 55.4 years, range 33-70) and 16 aged-matched healthy women (mean age 52.6 years, range 38-65). In every subject a 13(C)-methacetin breath test (13(C)-MBT) was applied, and the results were related to histological Ludwig's staging system and several indices of liver disease severity comprising the MAYO-1, MAYO-2, MELD, and Child-Pugh score. The 13(C)-MBT differentiated healthy controls from the patients with Ludwig IV and Ludwig III histopathological stages of PBC. The most significant relationships (i.e. explaining >50% of the variance) were found between measurements of the momentary breath 13(C) elimination from 6 to 18 minutes as well as the 15-min or 30-min cumulative elimination and the MAYO-1 or MAYO-2 scores. The breath test poorly correlated with histopathological features of PBC, however, it accurately discriminated cirrhotic from non-cirrhotic patients (momentary breath 13(C) elimination at 40 min, AUROC 0,958). In conclusion, 13(C)-MBT correlates with clinical scoring systems, especially those specifically designed for PBC (Mayo model) and accurately recognizes the disease at the stage of cirrhosis up to 40 minutes of the test duration.

  16. Clinical comparison of a new manual toothbrush on breath volatile sulfur compounds.

    PubMed

    Williams, Malcolm I; Vazquez, Joe; Cummins, Diane

    2004-10-01

    The objective of this randomized, crossover study was to compare the effectiveness of a newly designed manual toothbrush (Colgate 360 degrees) to two commercially available manual toothbrushes (Oral-B Indicator and Oral-B CrossAction) and a battery-powered toothbrush (Crest SpinBrush PRO) for their ability to reduce overnight volatile sulfur compounds (VSC) associated with oral malodor. The study followed a four-period crossover design. Following a washout period, prospective subjects arrived at the testing facility without eating, drinking, or performing oral hygiene for baseline evaluation of breath VSC levels. For each phase of the study, subjects were given one of the test tooth-brushes and a tube of regular toothpaste to take home, and they were instructed to brush their teeth in their customary manner for 1 minute. When using the Colgate 360 degrees toothbrush, subjects were instructed to clean their tongue with the implement on the back of the brush head for 10 seconds. The following morning, subjects reported to the testing facility, again without performing oral hygiene, eating, or drinking, for the overnight evaluation. After a minimum 2-day washout period, subjects repeated the same regimen using the other toothbrushes. The levels of breath VSC were evaluated instrumentally using a gas chromatograph equipped with a flame photometric detector. Measurements were taken in duplicate and then averaged. The levels of VSC were expressed as parts per billion (ppb) in mouth air. Sixteen men and women completed the study. At baseline, the mean levels of VSC in mouth air for the 4 toothbrushes were 719.8 ppb+/-318.4 ppb, 592.8 ppb+/-264.6 ppb, 673.8 ppb+/-405.9 ppb, and 656.2 ppb+/-310.2 ppb for the Colgate 360 degrees, Oral-B Indicator, Crest SpinBrush PRO, and Oral-B CrossAction, respectively. Overnight, the mean breath VSC levels after using the four toothbrushes were lower than those observed at baseline. The respective mean levels of breath VSC were 266.5 ppb

  17. Clinical comparison of a new manual toothbrush on breath volatile sulfur compounds.

    PubMed

    Williams, Malcolm I; Vazquez, Joe; Cummins, Diane

    2004-10-01

    The objective of this randomized, crossover study was to compare the effectiveness of a newly designed manual toothbrush (Colgate 360 degrees) to two commercially available manual toothbrushes (Oral-B Indicator and Oral-B CrossAction) and a battery-powered toothbrush (Crest SpinBrush PRO) for their ability to reduce overnight volatile sulfur compounds (VSC) associated with oral malodor. The study followed a four-period crossover design. Following a washout period, prospective subjects arrived at the testing facility without eating, drinking, or performing oral hygiene for baseline evaluation of breath VSC levels. For each phase of the study, subjects were given one of the test tooth-brushes and a tube of regular toothpaste to take home, and they were instructed to brush their teeth in their customary manner for 1 minute. When using the Colgate 360 degrees toothbrush, subjects were instructed to clean their tongue with the implement on the back of the brush head for 10 seconds. The following morning, subjects reported to the testing facility, again without performing oral hygiene, eating, or drinking, for the overnight evaluation. After a minimum 2-day washout period, subjects repeated the same regimen using the other toothbrushes. The levels of breath VSC were evaluated instrumentally using a gas chromatograph equipped with a flame photometric detector. Measurements were taken in duplicate and then averaged. The levels of VSC were expressed as parts per billion (ppb) in mouth air. Sixteen men and women completed the study. At baseline, the mean levels of VSC in mouth air for the 4 toothbrushes were 719.8 ppb+/-318.4 ppb, 592.8 ppb+/-264.6 ppb, 673.8 ppb+/-405.9 ppb, and 656.2 ppb+/-310.2 ppb for the Colgate 360 degrees, Oral-B Indicator, Crest SpinBrush PRO, and Oral-B CrossAction, respectively. Overnight, the mean breath VSC levels after using the four toothbrushes were lower than those observed at baseline. The respective mean levels of breath VSC were 266.5 ppb

  18. Noninvasive Mechanical Ventilation Improves Breathing-Swallowing Interaction of Ventilator Dependent Neuromuscular Patients: A Prospective Crossover Study

    PubMed Central

    Garguilo, Marine; Lejaille, Michèle; Vaugier, Isabelle; Orlikowski, David; Terzi, Nicolas; Lofaso, Frédéric; Prigent, Hélène

    2016-01-01

    Background Respiratory involvement in neuromuscular disorders may contribute to impaired breathing-swallowing interactions, swallowing disorders and malnutrition. We investigated whether the use of non-invasive ventilation (NIV) controlled by the patient could improve swallowing performances in a population of neuromuscular patients requiring daytime NIV. Methods Ten neuromuscular patients with severe respiratory failure requiring extensive NIV use were studied while swallowing without and with NIV (while ventilated with a modified ventilator allowing the patient to withhold ventilation as desired). Breathing-swallowing interactions were investigated by chin electromyography, cervical piezoelectric sensor, nasal flow recording and inductive plethysmography. Two water-bolus sizes (5 and 10ml) and a textured yogurt bolus were tested in a random order. Results NIV use significantly improved swallowing fragmentation (defined as the number of respiratory interruption of the swallowing of a single bolus) (p = 0.003) and breathing-swallowing synchronization (with a significant increase of swallows followed by an expiration) (p <0.0001). Patient exhibited piecemeal swallowing which was not influenced by NIV use (p = 0.07). NIV use also significantly reduced dyspnea during swallowing (p = 0.04) while preserving swallowing comfort, regardless of bolus type. Conclusion The use of patient controlled NIV improves swallowing parameters in patients with severe neuromuscular respiratory failure requiring daytime NIV, without impairing swallowing comfort. Trial Registration ClinicalTrials.gov NCT01519388 PMID:26938617

  19. The analysis of components that lead to increased work of breathing in chronic obstructive pulmonary disease patients

    PubMed Central

    Chen, Sibei; Li, Ying; Zheng, Zeguang; Luo, Qun

    2016-01-01

    Background This study is to explore the components and related mechanism responsible for the increase of work of breathing (WB) in chronic obstructive pulmonary disease (COPD) patients. Methods Eight COPD patients and eight healthy volunteers were recruited in the study. The rebreathing method was used to increase end-tidal CO2 partial pressure (PetCO2) and stimulate the increase in ventilation (VE). The increase in VE, WB, and changes in the compositions of WB were observed and analyzed. The WB and its components were calculated using the Campbell diagram. Results The inspiratory work (Wi) of breathing, a major component of total work of breathing (Wtot), in the COPD group was significantly higher than the control group during quiet breathing (P<0.05). As the minute VE increased, Wtot and Wi increased in a linear manner, and the slope of increase was significantly higher in the COPD group as compared to the normal group (P<0.05). The analyses of changes in overcoming airway resistance (Wrs) and lung/chest-wall elastance (Wel) indicated that the slope of increase (response to VE increase) of Wrs was not significantly different between the two groups (P>0.05) although the Wrs in the COPD group was always higher than the normal group (P<0.05). However, as the VE increased, the slope of the increase in Wel was significantly higher in the COPD group than the normal group. Work done to overcome the intrinsic PEEP (WPEEPi), a component of the Wel, was not observed in the control group. However, WPEEPi increased gradually as VE increased and accounted for 56% of Wel at the end of rebreathing trial in COPD group. Conclusions Airway resistance was the main cause for increased WB during quiet breathing. As the VE increased, an increase of WPEEPi became an important part of increased WB in COPD patients, so it is important to reduce dynamic hyperinflation in COPD patients. PMID:27621878

  20. The analysis of components that lead to increased work of breathing in chronic obstructive pulmonary disease patients

    PubMed Central

    Chen, Sibei; Li, Ying; Zheng, Zeguang; Luo, Qun

    2016-01-01

    Background This study is to explore the components and related mechanism responsible for the increase of work of breathing (WB) in chronic obstructive pulmonary disease (COPD) patients. Methods Eight COPD patients and eight healthy volunteers were recruited in the study. The rebreathing method was used to increase end-tidal CO2 partial pressure (PetCO2) and stimulate the increase in ventilation (VE). The increase in VE, WB, and changes in the compositions of WB were observed and analyzed. The WB and its components were calculated using the Campbell diagram. Results The inspiratory work (Wi) of breathing, a major component of total work of breathing (Wtot), in the COPD group was significantly higher than the control group during quiet breathing (P<0.05). As the minute VE increased, Wtot and Wi increased in a linear manner, and the slope of increase was significantly higher in the COPD group as compared to the normal group (P<0.05). The analyses of changes in overcoming airway resistance (Wrs) and lung/chest-wall elastance (Wel) indicated that the slope of increase (response to VE increase) of Wrs was not significantly different between the two groups (P>0.05) although the Wrs in the COPD group was always higher than the normal group (P<0.05). However, as the VE increased, the slope of the increase in Wel was significantly higher in the COPD group than the normal group. Work done to overcome the intrinsic PEEP (WPEEPi), a component of the Wel, was not observed in the control group. However, WPEEPi increased gradually as VE increased and accounted for 56% of Wel at the end of rebreathing trial in COPD group. Conclusions Airway resistance was the main cause for increased WB during quiet breathing. As the VE increased, an increase of WPEEPi became an important part of increased WB in COPD patients, so it is important to reduce dynamic hyperinflation in COPD patients.

  1. Clinical comparison of Colgate Total Advanced Fresh vs a commercially available fluoride breath-freshening toothpaste in reducing breath odor overnight: a multiple-use study.

    PubMed

    Niles, Hollandra P; Hunter, Catherine M; Vazquez, Joe; Williams, Malcolm I; Cummins, Diane

    2003-09-01

    The objective of this randomized, crossover study was to compare the effectiveness of Colgate Total Advanced Fresh toothpaste to a commercially available breath-freshening dentifrice containing fluoride for its ability to reduce volatile sulfur compounds (VSC) responsible for breath odor overnight. The study followed a two-treatment, two-period crossover design. Subjects were given a test product, along with a soft-bristled toothbrush, and instructed to brush their teeth for 1 minute, twice daily (once in the morning and the evening) using the assigned dentifrice for 7 consecutive days. After their evening brushing on the seventh day, subjects reported to the testing facility without oral hygiene, eating, or drinking for the overnight evaluation. After a washout period, subjects repeated the same regimen, now using the other test product. The levels of breath VSC were evaluated instrumentally using a gas chromatograph equipped with a flame photometric detector.

  2. Methods for Assessing Expiratory Flow Limitation during Tidal Breathing in COPD Patients.

    PubMed

    Koulouris, Nickolaos G; Kaltsakas, Georgios; Palamidas, Anastasios F; Gennimata, Sofia-Antiopi

    2012-01-01

    Patients with severe COPD often exhale along the same flow-volume curve during quite breathing as during forced expiratory vital capacity manoeuvre, and this has been taken as indicating expiratory flow limitation at rest (EFL(T)). Therefore, EFL(T), namely, attainment of maximal expiratory flow during tidal expiration, occurs when an increase in transpulmonary pressure causes no increase in expiratory flow. EFL(T) leads to small airway injury and promotes dynamic pulmonary hyperinflation with concurrent dyspnoea and exercise limitation. In fact, EFL(T) occurs commonly in COPD patients (mainly in GOLD III and IV stage) in whom the latter symptoms are common. The existing up-to-date physiological methods for assessing expiratory flow limitation (EFL(T)) are reviewed in the present work. Among the currently available techniques, the negative expiratory pressure (NEP) has been validated in a wide variety of settings and disorders. Consequently, it should be regarded as a simple, non invasive, most practical, and accurate new technique.

  3. Methods for Assessing Expiratory Flow Limitation during Tidal Breathing in COPD Patients.

    PubMed

    Koulouris, Nickolaos G; Kaltsakas, Georgios; Palamidas, Anastasios F; Gennimata, Sofia-Antiopi

    2012-01-01

    Patients with severe COPD often exhale along the same flow-volume curve during quite breathing as during forced expiratory vital capacity manoeuvre, and this has been taken as indicating expiratory flow limitation at rest (EFL(T)). Therefore, EFL(T), namely, attainment of maximal expiratory flow during tidal expiration, occurs when an increase in transpulmonary pressure causes no increase in expiratory flow. EFL(T) leads to small airway injury and promotes dynamic pulmonary hyperinflation with concurrent dyspnoea and exercise limitation. In fact, EFL(T) occurs commonly in COPD patients (mainly in GOLD III and IV stage) in whom the latter symptoms are common. The existing up-to-date physiological methods for assessing expiratory flow limitation (EFL(T)) are reviewed in the present work. Among the currently available techniques, the negative expiratory pressure (NEP) has been validated in a wide variety of settings and disorders. Consequently, it should be regarded as a simple, non invasive, most practical, and accurate new technique. PMID:23008769

  4. Utility of wireless motility capsule and lactulose breath testing in the evaluation of patients with chronic functional bloating

    PubMed Central

    Triadafilopoulos, George

    2016-01-01

    Background The precise aetiology of chronic bloating remains poorly understood and underlying gastroparesis, small bowel bacterial overgrowth and colonic inertia may, individually or collectively, play a role. Aims In this retrospective cohort analysis of symptomatic patients with chronic persistent bloating, we determined the clinical utility of wireless motility capsule and lactulose breath test in further defining the underlying aetiology for functional bloating. Methods Consecutive patients with chronic bloating underwent clinical assessment, wireless motility capsule testing and lactulose breath testing using standard protocols. Results 52 patients qualified for inclusion in this analysis, fulfilling Rome III criteria for functional bloating. Most patients (54%) had an abnormal wireless motility capsule study; of those, 11.5% had evidence of gastroparesis, 7.7% had small bowel transit delay, 15.8% had colonic inertia, 3.8% had delayed gastric and small bowel transit, 5.6% had combined gastric and colonic transit delay, 3.8% had delayed small bowel and colonic transit, and 5.6% had delayed gastric, small bowel and colon transit times. Using clinical questionnaires the median scores for bloating, constipation and eructation were not significantly different. Neither constipation nor eructation was specific to gastroparesis or colonic inertia but bloating was numerically more prevalent and severe in patients with delayed small bowel transit. 40% of patients had positive lactulose breath test but had no distinguishing clinical characteristics. Conclusions Chronic functional bloating may reflect underlying gastroparesis, small intestinal bacterial overgrowth or colonic inertia. Wireless motility capsule and lactulose breath test are useful in the assessment of patients with bloating and should be considered during evaluation. PMID:27648298

  5. Utility of wireless motility capsule and lactulose breath testing in the evaluation of patients with chronic functional bloating

    PubMed Central

    Triadafilopoulos, George

    2016-01-01

    Background The precise aetiology of chronic bloating remains poorly understood and underlying gastroparesis, small bowel bacterial overgrowth and colonic inertia may, individually or collectively, play a role. Aims In this retrospective cohort analysis of symptomatic patients with chronic persistent bloating, we determined the clinical utility of wireless motility capsule and lactulose breath test in further defining the underlying aetiology for functional bloating. Methods Consecutive patients with chronic bloating underwent clinical assessment, wireless motility capsule testing and lactulose breath testing using standard protocols. Results 52 patients qualified for inclusion in this analysis, fulfilling Rome III criteria for functional bloating. Most patients (54%) had an abnormal wireless motility capsule study; of those, 11.5% had evidence of gastroparesis, 7.7% had small bowel transit delay, 15.8% had colonic inertia, 3.8% had delayed gastric and small bowel transit, 5.6% had combined gastric and colonic transit delay, 3.8% had delayed small bowel and colonic transit, and 5.6% had delayed gastric, small bowel and colon transit times. Using clinical questionnaires the median scores for bloating, constipation and eructation were not significantly different. Neither constipation nor eructation was specific to gastroparesis or colonic inertia but bloating was numerically more prevalent and severe in patients with delayed small bowel transit. 40% of patients had positive lactulose breath test but had no distinguishing clinical characteristics. Conclusions Chronic functional bloating may reflect underlying gastroparesis, small intestinal bacterial overgrowth or colonic inertia. Wireless motility capsule and lactulose breath test are useful in the assessment of patients with bloating and should be considered during evaluation.

  6. Sleep disordered breathing and post-discharge mortality in patients with acute heart failure

    PubMed Central

    Khayat, Rami; Jarjoura, David; Porter, Kyle; Sow, Angela; Wannemacher, Jacob; Dohar, Robert; Pleister, Adam; Abraham, William T.

    2015-01-01

    Background Hospitalizations for heart failure are associated with a high post-discharge risk for mortality. Identification of modifiable predictors of post-discharge mortality during hospitalization may improve outcome. Sleep disordered breathing (SDB) is the most common co-morbidity in heart failure patients. Design, setting, and participants Prospective cohort study of patients hospitalized with acute heart failure (AHF) in a single academic heart hospital. Between January 2007 and December 2010, all patients hospitalized with AHF who have left ventricular ejection fraction (LVEF) ≤ 45% and were not already diagnosed with SDB were the target population. Main outcomes and measures Patients underwent in-hospital attended polygraphy testing for SDB and were followed for a median of 3 years post-discharge. Mortality was recorded using national and state vital statistics databases. Results During the study period, 1117 hospitalized AHF patients underwent successful sleep testing. Three hundred and forty-four patients (31%) had central sleep apnoea (CSA), 525(47%) patients had obstructive sleep apnoea (OSA), and 248 had no or minimal SDB (nmSDB). Of those, 1096 patients survived to discharge and were included in the mortality analysis. Central sleep apnoea was independently associated with mortality. The multivariable hazard ratio (HR) for time to death for CSA vs. nmSDB was 1.61 (95% CI: 1.1, 2.4, P = 0.02). Obstructive sleep apnoea was also independently associated with mortality with a multivariable HR vs. nmSDB of 1.53 (CI: 1.1, 2.2, P = 0.02). The Cox proportional hazards model adjusted for the following covariates: LVEF, age, BMI, sex, race, creatinine, diabetes, type of cardiomyopathy, coronary artery disease, chronic kidney disease, discharge systolic blood pressure <110, hypertension, discharge medications, initial length of stay, admission sodium, haemoglobin, and BUN. Conclusions This is the largest study to date to evaluate the effect of SDB on post

  7. Assessment of antibacterial effect of garlic in patients infected with Helicobacter pylori using urease breath test

    PubMed Central

    Zardast, Mahmoud; Namakin, Kokab; Esmaelian Kaho, Jamil; Hashemi, Sarira Sadat

    2016-01-01

    Objective: Helicobacter pylori (H. pylori) is the most common pathogenic bacteria in the stomach. The aim of the current study was to explore the effect of oral garlic administration on bacterial urease activity inside the stomach and its contribution to the treatment of H. pylori infection. Materials and Methods: In this clinical trial, 15 patients were studied quantitatively with Urease Breath Test (UBT). The patients with gastrointestinal symptoms and a positive serum H. pylori IgG were enrolled. UBT was performed for each patient in three sessions as follows: at the beginning of the study, an initial UBT was performed based on which, the positive cases entered the study and the negative ones were excluded. Second UBT was done three days later in patients who were not receiving any treatment and were considered as the control, whereas the third UBT was performed three days after prescribing two medium-sized cloves of garlic (3 g) with their meal, twice a day (at noon and in the evening). The collected data were analyzed using ANOVA and Bonferroni tests and the significance level was set at p<0.05. Results: the mean UBT significantly differed before and after treatment with garlic cloves, being significantly lower after garlic consumption. No meaningful difference was observed in the mean UBT without garlic consumption between the first and second steps. Conclusion: Raw garlic has anti-bacterial effects against H. pylori residing in the stomach and may be prescribed along with routine drugs for the treatment of gastric H. pylori infection. PMID:27761418

  8. Comparison of sampling bags for the analysis of volatile organic compounds in breath.

    PubMed

    Ghimenti, S; Lomonaco, T; Bellagambi, F G; Tabucchi, S; Onor, M; Trivella, M G; Ceccarini, A; Fuoco, R; Di Francesco, F

    2015-12-01

    Nalophan, Tedlar and Cali-5-Bond polymeric bags were compared to determine the most suitable type for breath sampling and storage when volatile organic compounds are to be determined. Analyses were performed by thermal desorption gas chromatography mass spectrometry. For each bag, the release of contaminants and the chemical stability of a gaseous standard mixture containing eighteen organic compounds, as well as the CO2 partial pressure were assessed. The selected compounds were representative of breath constituents and belonged to different chemical classes (i.e. hydrocarbons, ketones, aldehydes, aromatics, sulfurs and esters). In the case of Nalophan, the influence of the surface-to-volume ratio, related to the bag's filling degree, on the chemical stability was also evaluated. Nalophan bags were found to be the most suitable in terms of contaminants released during storage (only 2-methyl-1,3-dioxalane), good sample stability (up to 24 h for both dry and humid samples), and very limited costs (about 1 € for a 20 liter bag). The (film) surface-to-(sample) volume ratio was found to be an important factor affecting the stability of selected compounds, and therefore we recommended to fill the bag completely. PMID:26654981

  9. Comparison of sampling bags for the analysis of volatile organic compounds in breath.

    PubMed

    Ghimenti, S; Lomonaco, T; Bellagambi, F G; Tabucchi, S; Onor, M; Trivella, M G; Ceccarini, A; Fuoco, R; Di Francesco, F

    2015-12-14

    Nalophan, Tedlar and Cali-5-Bond polymeric bags were compared to determine the most suitable type for breath sampling and storage when volatile organic compounds are to be determined. Analyses were performed by thermal desorption gas chromatography mass spectrometry. For each bag, the release of contaminants and the chemical stability of a gaseous standard mixture containing eighteen organic compounds, as well as the CO2 partial pressure were assessed. The selected compounds were representative of breath constituents and belonged to different chemical classes (i.e. hydrocarbons, ketones, aldehydes, aromatics, sulfurs and esters). In the case of Nalophan, the influence of the surface-to-volume ratio, related to the bag's filling degree, on the chemical stability was also evaluated. Nalophan bags were found to be the most suitable in terms of contaminants released during storage (only 2-methyl-1,3-dioxalane), good sample stability (up to 24 h for both dry and humid samples), and very limited costs (about 1 € for a 20 liter bag). The (film) surface-to-(sample) volume ratio was found to be an important factor affecting the stability of selected compounds, and therefore we recommended to fill the bag completely.

  10. Comparison between in-phase and opposed-phase T1-weighted breath-hold FLASH sequences for hepatic imaging

    SciTech Connect

    Rofsky, N.M.; Weinreb, J.C.; Ambrosino, M.M.; Safir, J.; Krinsky, G.

    1996-03-01

    Our goal was to compare in-phase (IP) and opposed-phase (OP) sequences for GRE breath-hold hepatic imaging. Non-contrast-enhanced IP and OP GRE breath-hold images were obtained in 104 consecutive patients referred for abdominal MRI at 1.0 T. For both sequences, the TR, FA, matrix, FOV, slice thickness, interslice gap, and measurements were kept constant. Images were compared quantitatively [liver/spleen and liver/lesion signal difference/noise ratio, (SD/N)] and qualitatively (artifacts, lesion detection and conspicuity, and intrahepatic anatomy). There was no statistically significant difference when comparing IP and OP sequences for liver/spleen and liver/lesion SD/N or for the qualitative parameters. In patients with fatty infiltration, the OP sequences yielded substantially lower values for liver/spleen and liver/lesion SD/N (0.9 and - 1.2, respectively) than the IP sequences (20 and 17, respectively). Furthermore, in several cases with fatty infiltration, many more lesions were identified using IP images. The use of IP and OP GRE sequences provides complementary diagnostic information. Focal liver lesions may be obscured in the setting of fatty infiltration if only OP sequences are employed. A complete assessment of the liver with MR should include both IP and OP imaging. 11 refs., 3 figs., 1 tab.

  11. Right Atrial Pressure Affects the Interaction between Lung Mechanics and Right Ventricular Function in Spontaneously Breathing COPD Patients

    PubMed Central

    Boerrigter, Bart; Trip, Pia; Bogaard, Harm Jan; Groepenhoff, Herman; Oosterveer, Frank; Westerhof, Nico; Vonk Noordegraaf, Anton

    2012-01-01

    Introduction It is generally known that positive pressure ventilation is associated with impaired venous return and decreased right ventricular output, in particular in patients with a low right atrial pressure and relative hypovolaemia. Altered lung mechanics have been suggested to impair right ventricular output in COPD, but this relation has never been firmly established in spontaneously breathing patients at rest or during exercise, nor has it been determined whether these cardiopulmonary interactions are influenced by right atrial pressure. Methods Twenty-one patients with COPD underwent simultaneous measurements of intrathoracic, right atrial and pulmonary artery pressures during spontaneous breathing at rest and during exercise. Intrathoracic pressure and right atrial pressure were used to calculate right atrial filling pressure. Dynamic changes in pulmonary artery pulse pressure during expiration were examined to evaluate changes in right ventricular output. Results Pulmonary artery pulse pressure decreased up to 40% during expiration reflecting a decrease in stroke volume. The decline in pulse pressure was most prominent in patients with a low right atrial filling pressure. During exercise, a similar decline in pulmonary artery pressure was observed. This could be explained by similar increases in intrathoracic pressure and right atrial pressure during exercise, resulting in an unchanged right atrial filling pressure. Conclusions We show that in spontaneously breathing COPD patients the pulmonary artery pulse pressure decreases during expiration and that the magnitude of the decline in pulmonary artery pulse pressure is not just a function of intrathoracic pressure, but also depends on right atrial pressure. PMID:22272306

  12. Synchronized imaging and acoustic analysis of the upper airway in patients with sleep-disordered breathing.

    PubMed

    Chang, Yi-Chung; Huon, Leh-Kiong; Pham, Van-Truong; Chen, Yunn-Jy; Jiang, Sun-Fen; Shih, Tiffany Ting-Fang; Tran, Thi-Thao; Wang, Yung-Hung; Lin, Chen; Tsao, Jenho; Lo, Men-Tzung; Wang, Pa-Chun

    2014-12-01

    Progressive narrowing of the upper airway increases airflow resistance and can produce snoring sounds and apnea/hypopnea events associated with sleep-disordered breathing due to airway collapse. Recent studies have shown that acoustic properties during snoring can be altered with anatomic changes at the site of obstruction. To evaluate the instantaneous association between acoustic features of snoring and the anatomic sites of obstruction, a novel method was developed and applied in nine patients to extract the snoring sounds during sleep while performing dynamic magnetic resonance imaging (MRI). The degree of airway narrowing during the snoring events was then quantified by the collapse index (ratio of airway diameter preceding and during the events) and correlated with the synchronized acoustic features. A total of 201 snoring events (102 pure retropalatal and 99 combined retropalatal and retroglossal events) were recorded, and the collapse index as well as the soft tissue vibration time were significantly different between pure retropalatal (collapse index, 2 ± 11%; vibration time, 0.2 ± 0.3 s) and combined (retropalatal and retroglossal) snores (collapse index, 13 ± 7% [P ≤ 0.0001]; vibration time, 1.2 ± 0.7 s [P ≤ 0.0001]). The synchronized dynamic MRI and acoustic recordings successfully characterized the sites of obstruction and established the dynamic relationship between the anatomic site of obstruction and snoring acoustics.

  13. Occurrence of sleep-related breathing disorders in patients with chronic urticaria at its asymptomatic or oligosymptomatic stages

    PubMed Central

    Kruszewski, Jerzy; Gutkowski, Piotr; Chciałowski, Andrzej; Kłos, Krzysztof

    2016-01-01

    Introduction Chronic urticaria (CU), in view of its manifestations (pruritus, wheals), chronic and recurrent nature is very bothersome for patients and significantly influences their quality of life. Aim To assess the importance of sleep problems and sleep-related breathing disorders (SRBDs) declared by CU patients, for their quality of life. Material and methods Twenty-eight patients with CU at an asymptomatic stage or with minimal symptoms and signs were qualified for the study. In these patients, assessment of urticaria severity, QoL and SRBDs incidence was carried out. Results In a questionnaire study (CU-Q2oL), about 54% of the patients with CU complained of sleeping problems, about 80% reported significant fatigue and lack of concentration in the daytime. Respiratory polygraphy, an objective measure of sleep-related breathing disorders (SRBDs) demonstrated their higher incidence in patients with CU than in the general population, but these disorders were mild and had no influence on the reduced quality of life of the study patients, compared with a group of patients without SRBDs. Conclusions The occurrence of SRBDs was found in 25% of patients with CU at asymptomatic or oligosymptomatic stages. The SRBDs in those patients were mild, required no treatment and their occurrence did not cause any significant reduction in their quality of life. PMID:26985182

  14. Breathing Problems

    MedlinePlus

    ... re not getting enough air. Sometimes mild breathing problems are from a stuffy nose or hard exercise. ... emphysema or pneumonia cause breathing difficulties. So can problems with your trachea or bronchi, which are part ...

  15. Survey of otorhinolaryngologists on their clinical examinations performed in patients with suspected sleep-disordered breathing.

    PubMed

    Plößl, Sebastian; Herzog, Beatrice; Glien, Alexander; Plontke, Stefan; Herzog, Michael

    2016-04-01

    There is currently no standardized ear, nose, and throat (ENT) clinical examination for patients with sleep-disordered breathing (SDB). As a result, there are large inter-individual differences in the examinations due to an inadequate estimation of the relevance of certain anatomic sites. We aimed to identify which examinations/dynamic tests are considered most relevant by German ENT physicians. A questionnaire was designed, evaluating 23 anatomic sites/dynamic tests of the upper aero-digestive tract. The questionnaire was sent to all German ENT departments (n = 153), including universities and other tertiary or secondary referral centers, by postal mail. In addition, almost all private ENT specialists registered with the German professional association (n = 2496) were contacted via e-mail. Participants assessed how often they examined the sites/dynamic tests, subjective importance, and the impact on the therapeutic procedure. A mean score of relevance (mSOR) was generated (minimum score 1; maximum score 75) from these three items. The response rate for hospitals was 58.8 %; while, it was 4.1 % for ENT specialists in private practice. Therefore, the total response rate was 7.3 %. Of the 23 assessed items, some showed a high overall relevance, such as the tonsils (mSOR 64.75), webbing (mSOR 58.14), uvula (mSOR 55.12), or tongue base (mSOR 53.99). Other examinations, such as simulated snoring (mSOR 19.34) or the Mueller maneuver (mSOR 18.98), were estimated as less relevant. Our data reflect the assessment of German otorhinolaryngologists on the clinical examination of SDB patients. The results should be considered as a basis for compiling a standardized procedure.

  16. The association of annual air pollution exposure with blood pressure among patients with sleep-disordered breathing.

    PubMed

    Liu, Wen-Te; Lee, Kang-Yun; Lee, Hsin-Chien; Chuang, Hsiao-Chi; Wu, Dean; Juang, Jer-Nan; Chuang, Kai-Jen

    2016-02-01

    While sleep-disordered breathing (SDB), high blood pressure (BP) and air pollution exposure have separately been associated with increased risk of cardiopulmonary mortality, the association linking air pollution exposure to BP among patients with sleep-disordered breathing is still unclear. We collected 3762 participants' data from the Taipei Medical University Hospital's Sleep Center and air pollution data from the Taiwan Environmental Protection Administration. Associations of 1-year mean criteria air pollutants [particulate matter with aerodynamic diameters ≤10 μm (PM10), particulate matter with aerodynamic diameters ≤2.5 μm (PM2.5), nitrogen dioxide (NO2) and ozone (O3)] with systolic BP (SBP) and diastolic BP (DBP) were investigated by generalized additive models. After controlling for age, sex, body mass index (BMI), temperature and relative humidity, we observed that increases in air pollution levels were associated with decreased SBP and increased DBP. We also found that patients with apnea-hypopnea index (AHI) ≥30 showed a stronger BP response to increased levels of air pollution exposure than those with AHI<30. Stronger effects of air pollution exposure on BP were found in overweight participants than in participants with normal BMI. We concluded that annual exposure to air pollution was associated with change of BP among patients with sleep-disordered breathing. The association between annual air pollution exposure and BP could be modified by AHI and BMI.

  17. Detection of p53 gene mutations in exhaled breath condensate of non-small cell lung cancer patients.

    PubMed

    Gessner, Christian; Kuhn, Hartmut; Toepfer, Katja; Hammerschmidt, Stefan; Schauer, Joachim; Wirtz, Hubert

    2004-02-01

    Early diagnosis of lung carcinoma is greatly desired. A potential source of early information regarding the process of cancerisation in the airways is exhaled breath condensate (EBC). The direct approach to detecting cancerisation is examining DNA from the area of chronic damage, i.e. airways and lung parenchyma. We therefore investigated DNA in EBC of patients with NSCLC and healthy volunteers. Human DNA was amplified by PCR in exhaled breath condensate and used to detect p53 mutations. A PCR of the beta-actin gene fragment was used to detect human DNA in each of the EBC samples. In 65.7% of the samples, the beta-actin gene was found. Extracted DNA as well as native EBC were equally suited as starting material for amplification. Mutations of the p53 gene were investigated in all EBC samples of NSCLC patients. p53 exons 5-8 were amplified using nested PCR and subsequently sequenced. Mutations were found in four of the patients (n=11; 36.4%) while no mutation was found in volunteers (n=10). Mutations detected in EBC were also compared with those of corresponding tumor tissue. Different point mutations in EBC and tumor tissue were revealed in all cases. Our findings demonstrate that exhaled breath condensate may be used for analysis of somatic gene mutations in an area of direct tobacco-related DNA damage. PMID:14739043

  18. Factors Influencing Continuous Breath Signal in Intubated and Mechanically-Ventilated Intensive Care Unit Patients Measured by an Electronic Nose

    PubMed Central

    Leopold, Jan Hendrik; Abu-Hanna, Ameen; Colombo, Camilla; Sterk, Peter J.; Schultz, Marcus J.; Bos, Lieuwe D. J.

    2016-01-01

    Introduction: Continuous breath analysis by electronic nose (eNose) technology in the intensive care unit (ICU) may be useful in monitoring (patho) physiological changes. However, the application of breath monitoring in a non-controlled clinical setting introduces noise into the data. We hypothesized that the sensor signal is influenced by: (1) humidity in the side-stream; (2) patient-ventilator disconnections and the nebulization of medication; and (3) changes in ventilator settings and the amount of exhaled CO2. We aimed to explore whether the aforementioned factors introduce noise into the signal, and discuss several approaches to reduce this noise. Methods: Study in mechanically-ventilated ICU patients. Exhaled breath was monitored using a continuous eNose with metal oxide sensors. Linear (mixed) models were used to study hypothesized associations. Results: In total, 1251 h of eNose data were collected. First, the initial 15 min of the signal was discarded. There was a negative association between humidity and Sensor 1 (Fixed-effect β: −0.05 ± 0.002) and a positive association with Sensors 2–4 (Fixed-effect β: 0.12 ± 0.001); the signal was corrected for this noise. Outliers were most likely due to noise and therefore removed. Sensor values were positively associated with end-tidal CO2, tidal volume and the pressure variables. The signal was corrected for changes in these ventilator variables after which the associations disappeared. Conclusion: Variations in humidity, ventilator disconnections, nebulization of medication and changes of ventilator settings indeed influenced exhaled breath signals measured in ventilated patients by continuous eNose analysis. We discussed several approaches to reduce the effects of these noise inducing variables. PMID:27556467

  19. Effects of Exogenous Lactase Administration on Hydrogen Breath Excretion and Intestinal Symptoms in Patients Presenting Lactose Malabsorption and Intolerance

    PubMed Central

    Ibba, Ivan; Gilli, Agnese; Boi, Maria Francesca; Usai, Paolo

    2014-01-01

    Objective. To establish whether supplementation with a standard oral dose of Beta-Galactosidase affects hydrogen breath excretion in patients presenting with lactose malabsorption. Methods. Ninety-six consecutive patients positive to H2 Lactose Breath Test were enrolled. Mean peak H2 levels, the time to reach the peak H2, the time to reach the cut-off value of 20 ppm, the cumulative breath H2 excretion, the areas under the curve, and a Visual Analogical 10-point Scale for symptoms were calculated. Genotyping of the C/T-13910 variant was carried out. Results. Following the oral administration of Beta-Galactosidase, in 21.88% of the cases, H2 Lactose Breath Test became negative (Group A), while mean peak H2 levels (74.95 ppm versus 7.85), P < 0.0000, in 17.71% (Group B) were still positive, with the H2 level 20 ppm above the baseline, but the peak H2 levels were significantly lower than those observed at the baseline test (186.7 ppm versus 66.64), P < 0.0000, while in 60.41% (Group C) they were still positive with the peak H2 levels similar to those observed at the baseline test (94.43 versus 81.60 ppm). All 96 individuals tested presented the C/C-13910 genotype nonpersistence. Conclusions. The response to oral administration of Beta-Galactosidase in patients with symptoms of lactose malabsorption presents a significant variability. PMID:24967391

  20. Shortness-of-Breath

    MedlinePlus

    ... can lead to shortness of breath include anxiety, panic attacks, anemia and even constipation. The experience of shortness ... are used to treat patients with anxiety or panic attacks. Other commonly used drugs include bronchodilators to widen ...

  1. Habitual Alcohol Consumption and Metabolic Syndrome in Patients with Sleep Disordered Breathing

    PubMed Central

    Joo, Eun Yeon

    2016-01-01

    To investigate the associations between amount of habitual alcohol consumption (HAC) and prevalence of metabolic syndrome (MetS), sleep, and sleep-disordered breathing (SDB). We enrolled 683 untreated SDB male patients (age: 54.4 ± 7.80 y, apnea-hypopnea index (AHI): 29.0 ± 21.53/h). HAC was assessed as the average number of drinks consumed per week during the past 12 months. Anthropometric and biochemical markers were used to diagnose MetS. Clinical data and MetS components were compared according to the reported amounts of HAC (no drinking, light drinking <13, heavy drinking ≥13 drinks/week). As reported, 78.9% of the participants (n = 539) were regular drinkers; 33.7% (n = 230) were habitually heavy drinkers (mean: 30.7 drinks/week), and 45.2% (n = 309) were light drinkers (5.1 drinks/week). The overall prevalence of MetS was 36.9% (n = 252) and was most common in heavy drinkers (40.5%). Compared to non-drinkers and light drinkers, heavy drinkers had the greatest body mass index (BMI) and waist circumference. Central obesity, hypertension, and hyperglycemia were most prevalent in heavy drinkers. Sleep quality and severity of SDB were the worst in heavy drinkers. After adjusting for age, AHI, and BMI, heavy drinkers had a 1.71 times greater risk of MetS when compared with non-drinkers, and light and heavy drinkers had a 2.06 and 2.11 times higher risk of severe SDB than non-drinkers. HAC may increase the prevalence of MetS and deteriorate sleep in relation to amount of alcohol intake. Even light drinkers had more than twice higher risk of severe SDB than non-drinkers. PMID:27536782

  2. Habitual Alcohol Consumption and Metabolic Syndrome in Patients with Sleep Disordered Breathing.

    PubMed

    Choi, Su Jung; Lee, Sung Ik; Joo, Eun Yeon

    2016-01-01

    To investigate the associations between amount of habitual alcohol consumption (HAC) and prevalence of metabolic syndrome (MetS), sleep, and sleep-disordered breathing (SDB). We enrolled 683 untreated SDB male patients (age: 54.4 ± 7.80 y, apnea-hypopnea index (AHI): 29.0 ± 21.53/h). HAC was assessed as the average number of drinks consumed per week during the past 12 months. Anthropometric and biochemical markers were used to diagnose MetS. Clinical data and MetS components were compared according to the reported amounts of HAC (no drinking, light drinking <13, heavy drinking ≥13 drinks/week). As reported, 78.9% of the participants (n = 539) were regular drinkers; 33.7% (n = 230) were habitually heavy drinkers (mean: 30.7 drinks/week), and 45.2% (n = 309) were light drinkers (5.1 drinks/week). The overall prevalence of MetS was 36.9% (n = 252) and was most common in heavy drinkers (40.5%). Compared to non-drinkers and light drinkers, heavy drinkers had the greatest body mass index (BMI) and waist circumference. Central obesity, hypertension, and hyperglycemia were most prevalent in heavy drinkers. Sleep quality and severity of SDB were the worst in heavy drinkers. After adjusting for age, AHI, and BMI, heavy drinkers had a 1.71 times greater risk of MetS when compared with non-drinkers, and light and heavy drinkers had a 2.06 and 2.11 times higher risk of severe SDB than non-drinkers. HAC may increase the prevalence of MetS and deteriorate sleep in relation to amount of alcohol intake. Even light drinkers had more than twice higher risk of severe SDB than non-drinkers. PMID:27536782

  3. Four-sample lactose hydrogen breath test for diagnosis of lactose malabsorption in irritable bowel syndrome patients with diarrhea

    PubMed Central

    Yang, Jian-Feng; Fox, Mark; Chu, Hua; Zheng, Xia; Long, Yan-Qin; Pohl, Daniel; Fried, Michael; Dai, Ning

    2015-01-01

    AIM: To validate 4-sample lactose hydrogen breath testing (4SLHBT) compared to standard 13-sample LHBT in the clinical setting. METHODS: Irritable bowel syndrome patients with diarrhea (IBS-D) and healthy volunteers (HVs) were enrolled and received a 10 g, 20 g, or 40 g dose lactose hydrogen breath test (LHBT) in a randomized, double-blinded, controlled trial. The lactase gene promoter region was sequenced. Breath samples and symptoms were acquired at baseline and every 15 min for 3 h (13 measurements). The detection rates of lactose malabsorption (LM) and lactose intolerance (LI) for a 4SLHBT that acquired four measurements at 0, 90, 120, and 180 min from the same data set were compared with the results of standard LHBT. RESULTS: Sixty IBS-D patients and 60 HVs were studied. The genotype in all participants was C/C-13910. LM and LI detection rates increased with lactose dose from 10 g, 20 g to 40 g in both groups (P < 0.001). 4SLHBT showed excellent diagnostic concordance with standard LHBT (97%-100%, Kappa​​ 0.815-0.942) with high sensitivity (90%-100%) and specificity (100%) at all three lactose doses in both groups. CONCLUSION: Reducing the number of measurements from 13 to 4 samples did not significantly impact on the accuracy of LHBT in health and IBS-D. 4SLHBT is a valid test for assessment of LM and LI in clinical practice. PMID:26140004

  4. Do linear logistic model analyses of volatile biomarkers in exhaled breath of cystic fibrosis patients reliably indicate Pseudomonas aeruginosa infection?

    PubMed

    Španěl, Patrik; Sovová, Kristýna; Dryahina, Kseniya; Doušová, Tereza; Dřevínek, Pavel; Smith, David

    2016-01-01

    Non-invasive breath analysis has been used to search for volatile biomarkers of lungs and airways infection by Pseudomonas aeruginosa, PA, in cystic fibrosis patients. The exhaled breath of 20 PA-infected patients and 38 PA-negative patients was analysed using selected ion flow tube mass spectrometry, SIFT-MS. Special attention was given to the positive identification and accurate quantification of 16 volatile compounds (VOCs) as assured by the detailed consideration of their analytical ion chemistry occurring in the SIFT-MS reactor. However, the diagnostic sensitivity and specificity of the concentrations of any of the 16 compounds taken individually were found to be low. But when a linear combination of the concentrations of all 16 VOCs was used to construct an optimised receiver operating characteristics (ROC) curve using a linear logistic model, the diagnostic separation of PA-infected patients relative to the PA-negative patients was apparently good in terms of the derived sensitivity (89%), specificity (86%), and the area under the ROC curve is 0.91. Four compounds were revealed by the linear logistic model as significant, viz. malondialdehyde, isoprene, phenol and acetoin. The implications of these results to PA detection in the airways are assessed. Whilst such a metabolomics approach to optimise the ROC curve is widely used in breath analysis, it can lead to misleading indications. Therefore, we conclude that the results of the linear logistic model analyses are of limited immediate clinical value. The identified compounds should rather be considered as a stimulus for further independent studies involving larger patient cohorts. PMID:27532768

  5. 13C-Breath Tests for Sucrose Digestion in Congenital Sucrase Isomaltase Deficient and Sacrosidase Supplemented Patients

    PubMed Central

    Robayo-Torres, Claudia C.; Opekun, Antone R.; Quezada-Calvillo, Roberto; Xavier, Villa; Smith, E. O’Brian; Navarrete, Marilyn; Baker, S. Susan; Nichols, Buford L

    2008-01-01

    Congenital sucrase-isomaltase deficiency (CSID) is characterized by absence or deficiency of the mucosal sucrase-isomaltase enzyme. Specific diagnosis requires upper gastrointestinal biopsy with evidence of low to absent sucrase enzyme activity and normal histology. The hydrogen breath test (BT) is useful but is not specific for confirmation of CSID. We investigated a more specific 13C-sucrose labeled BT. Objectives were to determine if CSID can be detected with the 13C-sucrose BT without duodenal biopsy sucrase assay and if the 13C-sucrose BT can document restoration of sucrose digestion by CSID patients after oral supplementation with sacrosidase (Sucraid®). Methods Ten CSID patients were diagnosed by low biopsy sucrase activity. Ten controls were children who underwent endoscopy and biopsy because of dyspepsia or chronic diarrhea with normal mucosal enzymes activity and histology. Uniformly-labeled 13C-glucose and 13C-sucrose loads were orally administered. 13CO2 breath enrichments were assayed using an infrared spectrophotometer. In CSID patients the 13C-sucrose load was repeated adding Sucraid®. Sucrose digestion and oxidation were calculated as a mean % coefficient of glucose oxidation (% CGO) averaged between 30 and 90 minutes. Results Classification of patients by 13C-sucrose BT % CGO agreed with biopsy sucrase activity. The breath test also documented the return to normal of sucrose digestion and oxidation after supplementation of CSID patients with Sucraid®. Conclusion 13C-sucrose BT is an accurate and specific non-invasive confirmatory test for CSID and for enzyme replacement management. PMID:19330928

  6. Transition from acute to chronic hypercapnia in patients with periodic breathing: predictions from a computer model.

    PubMed

    Norman, Robert G; Goldring, Roberta M; Clain, Jeremy M; Oppenheimer, Beno W; Charney, Alan N; Rapoport, David M; Berger, Kenneth I

    2006-05-01

    Acute hypercapnia may develop during periodic breathing from an imbalance between abnormal ventilatory patterns during apnea and/or hypopnea and compensatory ventilatory response in the interevent periods. However, transition of this acute hypercapnia into chronic sustained hypercapnia during wakefulness remains unexplained. We hypothesized that respiratory-renal interactions would play a critical role in this transition. Because this transition cannot be readily addressed clinically, we modified a previously published model of whole-body CO2 kinetics by adding respiratory control and renal bicarbonate kinetics. We enforced a pattern of 8 h of periodic breathing (sleep) and 16 h of regular ventilation (wakefulness) repeated for 20 days. Interventions included varying the initial awake respiratory CO2 response and varying the rate of renal bicarbonate excretion within the physiological range. The results showed that acute hypercapnia during periodic breathing could transition into chronic sustained hypercapnia during wakefulness. Although acute hypercapnia could be attributed to periodic breathing alone, transition from acute to chronic hypercapnia required either slowing of renal bicarbonate kinetics, reduction of ventilatory CO2 responsiveness, or both. Thus the model showed that the interaction between the time constant for bicarbonate excretion and respiratory control results in both failure of bicarbonate concentration to fully normalize before the next period of sleep and persistence of hypercapnia through blunting of ventilatory drive. These respiratory-renal interactions create a cumulative effect over subsequent periods of sleep that eventually results in a self-perpetuating state of chronic hypercapnia.

  7. Transition from acute to chronic hypercapnia in patients with periodic breathing: predictions from a computer model.

    PubMed

    Norman, Robert G; Goldring, Roberta M; Clain, Jeremy M; Oppenheimer, Beno W; Charney, Alan N; Rapoport, David M; Berger, Kenneth I

    2006-05-01

    Acute hypercapnia may develop during periodic breathing from an imbalance between abnormal ventilatory patterns during apnea and/or hypopnea and compensatory ventilatory response in the interevent periods. However, transition of this acute hypercapnia into chronic sustained hypercapnia during wakefulness remains unexplained. We hypothesized that respiratory-renal interactions would play a critical role in this transition. Because this transition cannot be readily addressed clinically, we modified a previously published model of whole-body CO2 kinetics by adding respiratory control and renal bicarbonate kinetics. We enforced a pattern of 8 h of periodic breathing (sleep) and 16 h of regular ventilation (wakefulness) repeated for 20 days. Interventions included varying the initial awake respiratory CO2 response and varying the rate of renal bicarbonate excretion within the physiological range. The results showed that acute hypercapnia during periodic breathing could transition into chronic sustained hypercapnia during wakefulness. Although acute hypercapnia could be attributed to periodic breathing alone, transition from acute to chronic hypercapnia required either slowing of renal bicarbonate kinetics, reduction of ventilatory CO2 responsiveness, or both. Thus the model showed that the interaction between the time constant for bicarbonate excretion and respiratory control results in both failure of bicarbonate concentration to fully normalize before the next period of sleep and persistence of hypercapnia through blunting of ventilatory drive. These respiratory-renal interactions create a cumulative effect over subsequent periods of sleep that eventually results in a self-perpetuating state of chronic hypercapnia. PMID:16384839

  8. Role of CO2 responsiveness and breathing efficiency in determining exercise capacity of patients with chronic airway obstruction.

    PubMed

    Chonan, T; Hida, W; Kikuchi, Y; Shindoh, C; Takishima, T

    1988-12-01

    We examined the role of CO2 responsiveness and breathing efficiency in limiting exercise capacity in 15 patients with chronic airway obstruction (FEV1 = 0.88 +/- 0.25 L, mean +/- SD). Responses of minute ventilation and P0.1 (mouth pressure 0.1 s after the onset of occluded inspiration) to hypercapnia (delta VE/delta PCO2, delta P0.1/delta PCO2) were measured by rebreathing, and the ratio of the two (delta VE/delta P0.1) was defined as an index of breathing efficiency during hyperventilation. Exercise capacity was measured as symptom-limited, maximal oxygen consumption (VO2max/BW) in an incremental treadmill test and also as the 12-min walking distance (TMD). All patients discontinued the treadmill test because of dyspnea, and the exercise capacity correlated with the degree of airway obstruction, although there was a wide variability among patients with comparable FEV1. There were no significant correlations between the responses to CO2 and exercise capacity. However, there was a significant correlation between delta VE/delta P0.1 and VO2max/BW (r = 0.87, p less than 0.001) or TMD (r = 0.78, p less than 0.001), and these correlations remained significant even when the relational effects of FEV1 were taken out. These results support the hypothesis that airway obstruction and breathing efficiency are important, but that CO2 responsiveness is not a major factor in determining the exercise capacity of patients with chronic airway obstruction.

  9. Levels of cytokines in broncho-alveolar lavage fluid, but not in plasma, are associated with levels of markers of lipid peroxidation in breath of ventilated ICU patients.

    PubMed

    Boshuizen, Margit; Leopold, Jan Hendrik; Zakharkina, Tetyana; Knobel, Hugo H; Weda, Hans; Nijsen, Tamara M E; Vink, Teunis J; Sterk, Peter J; Schultz, Marcus J; Bos, Lieuwe D J

    2015-09-03

    Alkanes and alkenes in the breath are produced through fatty acid peroxidation, which is initialized by reactive oxygen species. Inflammation is an important cause and effect of reactive oxygen species. We aimed to evaluate the association between fatty acid peroxidation products and inflammation of the alveolar and systemic compartment in ventilated intensive care unit (ICU) patients.Volatile organic compounds were measured by gas chromatography and mass spectrometry in the breath of newly ventilated ICU patients within 24 h after ICU admission. Cytokines were measured in non-directed bronchial lavage fluid (NBL) and plasma by cytometric bead array. Correlation coefficients were calculated and presented in heatmaps.93 patients were included. Peroxidation products in exhaled breath were not associated with markers of inflammation in plasma, but were correlated with those in NBL. IL-6, IL-8, IL-1β and TNF-α concentration in NBL showed inverse correlation coefficients with the peroxidation products of fatty acids. Furthermore, NBL IL-10, IL-13, GM-CSF and IFNγ demonstrated positive associations with breath alkanes and alkenes. Correlation coefficients for NBL cytokines were high regarding peroxidation products of n-6, n-7 and particularly in n-9 fatty acids.Levels of lipid peroxidation products in the breath of ventilated ICU patients are associated with levels of inflammatory markers in NBL, but not in plasma. Alkanes and alkenes in breath seems to be associated with an anti-inflammatory, rather than a pro-inflammatory state in the alveoli.

  10. Cardiac functional analysis by free-breath real-time cine CMR with a spatiotemporal filtering method, TSENSE: comparison with breath-hold cine CMR.

    PubMed

    Yamamuro, Masaki; Tadamura, Eiji; Kanao, Shotaro; Okayama, Satoshi; Okamoto, Jun; Urayama, Shinichi; Kimura, Takeshi; Komeda, Masashi; Kita, Toru; Togashi, Kaori

    2006-01-01

    The aim of this study was to assess the accuracy of cardiac functional values obtained from free-breathing real-time cine CMR with the temporal sensitivity encoding (TSENSE) technique by comparing them with values obtained from conventional cine CMR. For the real-time cine CMR, two protocols were employed, one with good temporal resolution and one with good spatial resolution. The functional values obtained from the high temporal resolution real-time cine CMR agreed and correlated well with those of cine CMR. On the other hand, statistically significant but clinically slight overestimation of ESV (p < .05) and underestimation of EF (p < .01) were observed with the other protocol. Real-time cine CMR with TSENSE can provide acceptable cardiac functional values.

  11. Adaptive Servoventilation (ASV) in Patients with Sleep Disordered Breathing Associated with Chronic Opioid Medications for Non-Malignant Pain

    PubMed Central

    Farney, Robert J.; Walker, James M.; Boyle, Kathleen M.; Cloward, Tom V.; Shilling, Kevin C.

    2008-01-01

    Background: Adaptive servoventilation (ASV) can be effective therapy for specific types of central apnea such as Cheyne-Stokes respiration (CSR). Patients treated chronically with opioids develop central apneas and ataxic breathing patterns (Biot's respiration), but therapy with CPAP is usually unsuccessful. There are no published studies of ASV in patients with sleep apnea complicated by chronic opioid therapy. Methods: Retrospective analysis of 22 consecutive patients referred for evaluation and treatment of sleep apnea who had been using opioid medications for at least 6 months, had an apnea-hypopnea index (AHI) >20/h, and had been tested with ASV. Baseline polysomnography was compared with CPAP and ASV. Outcome variables: AHI, central apnea index (CAI), obstructive apnea index (OAI), hypopnea index (HI), desaturation index, mean SpO2, lowest SpO2, time SpO2 <90%, and degree of Biot's respiration. Results: Mean (SD) AHI measured 66.6/h (37.3) at baseline, 70.1/h (32.6) on CPAP, and 54.2/h (33.0) on ASV. With ASV, the mean OAI was significantly decreased to 2.4/h (p < 0.0001), and the mean HI increased significantly to 35.7/h (p < 0.0001). The decrease of CAI from 26.4/h to 15.6/h was not significant (p = 0.127). Biot's breathing persisted, and oxygenation parameters were unimproved with ASV. Conclusions: Due to residual respiratory events and hypoxemia, ASV was considered insufficient therapy in these patients. Persistence of obstructive events could be due to suboptimal pressure settings (end expiratory and/or maximal inspiratory). Residual central events could be related to fundamental differences in the pathophysiology of CSR compared to opioid induced breathing disturbances. Citation: Farney RJ; Walker JM; Boyle KM; Cloward TV; Shilling KC. Adaptive servoventilation (ASV) in patients with sleep disordered breathing associated with chronic opioid medications for non-malignant pain. J Clin Sleep Med 2008;4(4):311-319. PMID:18763421

  12. Minimizing Late Effects for Patients With Mediastinal Hodgkin Lymphoma: Deep Inspiration Breath-Hold, IMRT, or Both?

    SciTech Connect

    Aznar, Marianne C.; Maraldo, Maja V.; Schut, Deborah A.; Lundemann, Michael; Brodin, N Patrik; Vogelius, Ivan R.; Berthelsen, Anne K.; Specht, Lena; Petersen, Peter M.

    2015-05-01

    Purpose: Hodgkin lymphoma (HL) survivors have an increased risk of cardiovascular disease (CD), lung cancer, and breast cancer. We investigated the risk for the development of CD and secondary lung, breast, and thyroid cancer after radiation therapy (RT) delivered with deep inspiration breath-hold (DIBH) compared with free-breathing (FB) using 3-dimensional conformal RT (3DCRT) and intensity modulated RT (IMRT). The aim of this study was to determine which treatment modality best reduced the combined risk of life-threatening late effects in patients with mediastinal HL. Methods and Materials: Twenty-two patients with early-stage mediastinal HL were eligible for the study. Treatment plans were calculated with both 3DCRT and IMRT on both DIBH and FB planning computed tomographic scans. We reported the estimated dose to the heart, lung, female breasts, and thyroid and calculated the estimated life years lost attributable to CD and to lung, breast, and thyroid cancer. Results: DIBH lowered the estimated dose to heart and lung regardless of delivery technique (P<.001). There was no significant difference between IMRT-FB and 3DCRT-DIBH in mean heart dose, heart V20Gy, and lung V20Gy. The mean breast dose was increased with IMRT regardless of breathing technique. Life years lost was lowest with DIBH and highest with FB. Conclusions: In this cohort, 3DCRT-DIBH resulted in lower estimated doses and lower lifetime excess risks than did IMRT-FB. Combining IMRT and DIBH could be beneficial for a subgroup of patients.

  13. Reduced cardiac autonomic response to deep breathing: A heritable vulnerability trait in patients with schizophrenia and their healthy first-degree relatives.

    PubMed

    Liu, Yu-Wen; Tzeng, Nian-Sheng; Yeh, Chin-Bin; Kuo, Terry B J; Huang, San-Yuan; Chang, Chuan-Chia; Chang, Hsin-An

    2016-09-30

    Reduced resting heart rate variability (HRV) has been observed in patients with schizophrenia and their relatives, suggesting genetic predispositions. However, findings have not been consistent. We assessed cardiac autonomic response to deep breathing in first-degree relatives of patients with schizophrenia (n=45; 26 female; aged 39.69±14.82 years). Data were compared to healthy controls (n=45; 26 female; aged 38.27±9.79 years) matched for age, gender, body mass index and physical activity as well as to unmedicated patients with acute schizophrenia (n=45; 25 female; aged 37.31±12.65 years). Electrocardiograms were recorded under supine resting and deep-breathing conditions (10-12breaths/min). We measured HRV components including variance, low-frequency (LF) power, which may reflect baroreflex function, high-frequency (HF) power, which reflects cardiac parasympathetic activity, and LF/HF ratio, which may reflect sympatho-vagal balance. Patients rather than relatives exhibited lower resting-state HRV (variance, LF, and HF) than controls. As expected, deep breathing induced an increase in variance and HF-HRV in controls. However, such a response was significantly reduced in both patients and their relatives. In conclusion, the diminished cardiac autonomic reactivity to deep breathing seen in patients and their unaffected relatives indicates that this pattern of cardiac autonomic dysregulation may be regarded as a genetic trait marker for schizophrenia. PMID:27442977

  14. Reduced cardiac autonomic response to deep breathing: A heritable vulnerability trait in patients with schizophrenia and their healthy first-degree relatives.

    PubMed

    Liu, Yu-Wen; Tzeng, Nian-Sheng; Yeh, Chin-Bin; Kuo, Terry B J; Huang, San-Yuan; Chang, Chuan-Chia; Chang, Hsin-An

    2016-09-30

    Reduced resting heart rate variability (HRV) has been observed in patients with schizophrenia and their relatives, suggesting genetic predispositions. However, findings have not been consistent. We assessed cardiac autonomic response to deep breathing in first-degree relatives of patients with schizophrenia (n=45; 26 female; aged 39.69±14.82 years). Data were compared to healthy controls (n=45; 26 female; aged 38.27±9.79 years) matched for age, gender, body mass index and physical activity as well as to unmedicated patients with acute schizophrenia (n=45; 25 female; aged 37.31±12.65 years). Electrocardiograms were recorded under supine resting and deep-breathing conditions (10-12breaths/min). We measured HRV components including variance, low-frequency (LF) power, which may reflect baroreflex function, high-frequency (HF) power, which reflects cardiac parasympathetic activity, and LF/HF ratio, which may reflect sympatho-vagal balance. Patients rather than relatives exhibited lower resting-state HRV (variance, LF, and HF) than controls. As expected, deep breathing induced an increase in variance and HF-HRV in controls. However, such a response was significantly reduced in both patients and their relatives. In conclusion, the diminished cardiac autonomic reactivity to deep breathing seen in patients and their unaffected relatives indicates that this pattern of cardiac autonomic dysregulation may be regarded as a genetic trait marker for schizophrenia.

  15. Comparison of exhaled nitric oxide and cardiorespiratory indices between nasal and oral breathing during submaximal exercise in humans.

    PubMed

    Yasuda, Y; Itoh, T; Miyamura, M; Nishino, H

    1997-10-01

    In order to examine the origin and role of nitric oxide (NO) in exhaled air during exercise, exhaled NO outputs of 8 healthy human subjects were compared using different breathing methods, through the mouth or nose, at two intensities of bicycle exercise. The concentration of NO in the exhaled air and ventilatory gas exchange variables were measured by a chemiluminescence analyzer and a mixing chamber method, respectively. The concentration and total output of NO in the expired air was significantly higher under nasal breathing than under oral breathing for both exercise intensities, whereas no significant difference was observed in cardiorespiratory variables between them. NO output increased significantly when exercise intensity was increased from unloaded (0 W) to 60 W under nasal breathing, but not under oral breathing. A negative correlation among subjects was found between NO output and minute ventilation in both breathing methods only for unloaded exercise. Data indicate that nasal airways have a large contribution, at least 50% of total NO output in the exhaled air during nasal breathing, but this nasal NO may have no further modulation on respiratory function during submaximal exercise by healthy humans.

  16. Comparison of Energy Expenditure and Oxygen Consumption of Spontaneous Breathing Trial Conducted With and Without Automatic Tube Compensation

    PubMed Central

    Lago, Alessandra Fabiane; Goncalves, Elaine Cristina; Silva, Elaine Caetano; Menegueti, Mayra Goncalves; Nicolini, Edson Antonio; Auxiliadora-Martins, Maria; Martinez, Edson Zangiacomi; Gastaldi, Ada Clarice; Basile-Filho, Anibal

    2015-01-01

    Background Weaning from mechanical ventilation is defined as the process of release of ventilatory support and how the evaluation of this phase is conducted in the spontaneous breathing trial (SBT). One of the most used modes of SBT is the continuous positive airway pressure (CPAP), which applies a continuous positive pressure in both inspiration and expiration. However, together with the mechanical ventilation modes, the automatic tube compensation (ATC) can be used, which compensates the resistance imposed by the endotracheal tube. The objective of this study was to compare oxygen consumption (VO2) and energy expenditure (EE) during SBT conducted with and without ATC. Methods The study was prospective, randomized and crossover. Forty mechanically ventilated patients were admitted to an intensive care unit of a university tertiary hospital. The participants were randomly allocated in group 1, in which SBT was initiated with CPAP and ATC, followed by CPAP without ATC or in group 2, in which SBT was initiated with CPAP without ATC, followed by CPAP with ATC. Indirect calorimetry helped to measure VO2 and EE during SBT. Results The differences between VO2 and EE obtained during SBT with ATC and without ATC were -1.6 mL/kg/min (95% CI: -4.36 - 1.07) and 5.4 kcal/day (95% CI: -21.67 - 10.79), respectively. Conclusions We concluded that VO2 and EE obtained during SBT with and without ATC were not different. PMID:26251685

  17. Comparison of active cycle of breathing and high-frequency oscillation jacket in children with cystic fibrosis.

    PubMed

    Phillips, Gillian E; Pike, Sarah E; Jaffé, Adam; Bush, Andrew

    2004-01-01

    High-frequency chest compressions (HFCC) have been suggested as an alternative to conventional chest physiotherapy to aid sputum clearance in patients with cystic fibrosis (CF). We aimed to compare the active cycle of breathing techniques (ACBT) with the Hayek Oscillator Cuirass, performing HFCC on secretion clearance in children with CF during an exacerbation. Ten children (7 males; median age, 14 years; range, 9-16) received either two supervised sessions using HFCC or two self-treatment ACBT sessions in random order on successive days. Baseline pulmonary function was similar prior to treatments. Sputum weight increased significantly with ACBT compared with HFCC during treatment (5.2 g vs. 1.1 g, P < 0.005, morning; 4.1 g vs. 0.7 g, P < 0.01, afternoon). Pulmonary function improved significantly after morning ACBT (forced vital capacity (FVC): 2.67 l to 2.76 l, P < 0.03; forced expiratory volume in 1 sec (FEV1): 1.59 l to 1.62 l, P < 0.03). Following afternoon ACBT, there was a significant increase in FVC (2.64 to 2.79, P < 0.02), but no significant change in FEV1. Pulmonary function did not change at any time following HFCC. Compared with ACBT, HFCC by Hayek Cuirass is not an effective airway clearance treatment modality for children with CF during an infective exacerbation.

  18. A cohort study to identify simple clinical tests for chronic respiratory failure in obese patients with sleep-disordered breathing

    PubMed Central

    Mandal, S; Suh, E S; Boleat, E; Asher, W; Kamalanathan, M; Lee, K; Douiri, A; Murphy, P B; Steier, J; Hart, N

    2014-01-01

    Background Chronic respiratory failure complicating sleep-disordered breathing in obese patients has important adverse clinical implications in terms of morbidity, mortality and healthcare utilisation. Screening strategies are essential to identify obese patients with chronic respiratory failure. Method Prospective data were collected from patients with obesity-related sleep-disordered breathing admitted for respiratory assessment at a UK national sleep and ventilation centre. Hypercapnia was defined as an arterial partial pressure of carbon dioxide of >6kPa. Results 245 obese patients (56±13 years) with a body mass index of 48±12 kg/m2, forced vital capacity (FVC) of 2.1±1.1 L, daytime oximetry (SpO2) of 91±6% and abnormal overnight oximetry were included in the analysis. Receiver operator curve analysis for the whole group showed that an FVC ≤3 L had a sensitivity of 90% and a specificity of 41% in predicting hypercapnia, and an SpO2 ≤95% had a sensitivity of 83% and a specificity of 63% in predicting hypercapnia. Gender differences were observed and receiver operator curve analysis demonstrated ‘cut-offs’ for (1) SpO2 of ≤95% for men and ≤93% for women and (2) FVC of ≤3.5 L for men and ≤2.3 L for women, in predicting hypercapnia. Conclusions The measurement of FVC and clinic SpO2 in obese patients with abnormal overnight limited respiratory studies predicted hypercapnia. This may have clinical utility in stratifying patients attending sleep clinics. PMID:25478174

  19. Efficacy evaluation of retrospectively applying the Varian normal breathing predictive filter for volume definition and artifact reduction in 4D CT lung patients.

    PubMed

    Malone, Ciaran; Rock, Luke; Skourou, Christina

    2014-05-08

    Phase-based sorting of four-dimensional computed tomography (4D CT) datasets is prone to image artifacts due to patient's breathing irregularities that occur during the image acquisition. The purpose of this study is to investigate the effect of the Varian normal breathing predictive filter (NBPF) as a retrospective phase-sorting parameter in 4D CT. Ten 4D CT lung cancer datasets were obtained. The volumes of all tumors present, as well as the total lung volume, were calculated on the maximum intensity projection (MIP) images as well as each individual phase image. The NBPF was varied retrospectively within the available range, and changes in volume and image quality were recorded. The patients' breathing trace was analysed and the magnitude and location of any breathing irregularities were correlated to the behavior of the NBPF. The NBPF was found to have a considerable effect on the quality of the images in MIP and single-phase datasets. When used appropriately, the NBPF is shown to have the ability to account for and correct image artifacts. However, when turned off (0%) or set above a critical level (approximately 40%), it resulted in erroneous volume reconstructions with variations in tumor volume up to 26.6%. Those phases associated with peak inspiration were found to be more susceptible to changes in the NBPF. The NBPF settings selected prior to exporting the breathing trace for patients evaluated using 4D CT directly affect the accuracy of the targeting and volume estimation of lung tumors. Recommendations are made to address potential errors in patient anatomy introduced by breathing irregularities, specifically deep breath or cough irregularities, by implementing the proper settings and use of this tool.

  20. Effect of different breathing patterns in the same patient on stereotactic ablative body radiotherapy dosimetry for primary renal cell carcinoma: A case study

    SciTech Connect

    Pham, Daniel; Kron, Tomas; Foroudi, Farshad; Siva, Shankar

    2013-10-01

    Stereotactic ablative body radiotherapy (SABR) for primary renal cell carcinoma (RCC) targets requires motion management strategies to verify dose delivery. This case study highlights the effect of a change in patient breathing amplitude on the dosimetry to organs at risk and target structures. A 73-year-old male patient was planned for receiving 26 Gy of radiation in 1 fraction of SABR for a left primary RCC. The patient was simulated with four-dimensional computed tomography (4DCT) and the tumor internal target volume (ITV) was delineated using the 4DCT maximum intensity projection. However, the initially planned treatment was abandoned at the radiation oncologist's discretion after pretreatment cone-beam CT (CBCT) motion verification identified a greater than 50% reduction in superior to inferior diaphragm motion as compared with the planning 4DCT. This patient was resimulated with respiratory coaching instructions. To assess the effect of the change in breathing on the dosimetry to the target, each plan was recalculated on the data set representing the change in breathing condition. A change from smaller to larger breathing showed a 46% loss in planning target volume (PTV) coverage, whereas a change from larger breathing to smaller breathing resulted in an 8% decrease in PTV coverage. ITV coverage was similarly reduced by 8% in both scenarios. This case study highlights the importance of tools to verify breathing motion prior to treatment delivery. 4D image guided radiation therapy verification strategies should focus on not only verifying ITV margin coverage but also the effect on the surrounding organs at risk.

  1. Bad Breath

    MedlinePlus

    ... hygiene leads to bad breath because when food particles are left in your mouth, they can rot ... Flossing once a day helps get rid of particles wedged between your teeth. Also, visit your dentist ...

  2. Spontaneously breathing anesthetized patients with a laryngeal mask airway: positive end-expiratory pressure does not improve oxygen saturation.

    PubMed

    Froessler, B; Brommundt, J; Anton, J; Khanduja, R; Kuhlen, R; Rossaint, R; Coburn, M

    2010-11-01

    Spontaneous ventilation is a popular mode of ventilation for patients with the laryngeal mask airway (LMA). Studies have shown, however, that spontaneous ventilation impairs gas exchange and that assisting or controlling ventilation results in higher oxygen saturation. Atelectasis during general anesthesia is a well described mechanism which impacts on gas exchange. Positive end-expiratory pressure (PEEP) increases the lung volume available for gas exchange. This study investigated whether the application of PEEP leads to an improvement of oxygen saturation in unassisted spontaneously breathing patients with a LMA. A total of 80 adult patients under general anesthesia were prospectively randomized into two groups. Both groups were left to breathe spontaneously. In group 1 the adjustable pressure limiting (APL) valve was opened resulting in zero end-expiratory pressure. In group 2 the valve was set to a PEEP of +7 cm H₂O. Oxygen saturation was measured by pulse oxymetry at four different phases: pre-induction, after induction and insertion of the LMA, during maintenance and in recovery. The application of PEEP did not improve oxygen saturation. In both groups the mean oxygen saturation was similar (97.2±1.8% in group 1 versus 97.2±1.9% in group 2, p=0.941) during maintenance. No effect on oxygen saturation in recovery could be found either (96.0±1.8% in group 1 versus 96.1±2.0% in group 2, p=0.952) and hemodynamics were unaffected by the application of PEEP. The application of a PEEP of +7 cm H₂O with a LMA under spontaneous ventilation cannot be recommended. Limitations of our study were the selection of healthy patients and omitting pre-oxygenation before induction which might have limited the development of atelectasis. In addition arterial partial pressure of oxygen (p(a)O₂) measurements could have revealed subtle changes in oxygenation.

  3. Comparison of breath-alcohol screening test results with venous blood alcohol concentration in suspected drunken drivers.

    PubMed

    Kriikku, Pirkko; Wilhelm, Lars; Jenckel, Stefan; Rintatalo, Janne; Hurme, Jukka; Kramer, Jan; Jones, A Wayne; Ojanperä, Ilkka

    2014-06-01

    Hand-held electronic breath-alcohol analyzers are widely used by police authorities in their efforts to detect drunken drivers and to improve road-traffic safety. Over a three month period, the results of roadside breath-alcohol tests of drivers apprehended in Finland were compared with venous blood alcohol concentration (BAC). The mean (median) time between sampling blood and breath was 0.71h (0.58h) with a range from 0 to 6h. Some hand-held instruments gave results as the concentration of alcohol in breath and were converted into BAC assuming a blood-breath alcohol ratio (BBR) of 2260. The mean venous BAC (1.82g/kg) in traffic offenders was higher than the result predicted by the hand-held breath analyzers (1.72g/kg). In 1875 roadside tests, the relationship between venous BAC (x) and BrAC (y) was defined by the regression equation y=0.18+0.85x. The coefficients show both a constant bias (y-intercept 0.18g/kg) and a proportional bias (slope=0.85). The residual standard deviation (SD), an indicator of random variation, was ±0.40g/kg. After BAC results were corrected for the time elapsed between sampling blood and breath, the y-intercept decreased to 0.10g/kg and 0.004g/kg, respectively, when low (0.1g/kg/h) and high (0.25g/kg/h) rates of alcohol elimination were used. The proportional bias of 0.85 shows that the breath-alcohol test result reads lower than the actual BAC by 15% on average. This suggests that the BBR of 2260 used for calibration should be increased by about 15% to give closer agreement between BAC and BrAC. Because of the large random variation (SD±0.40g/kg), there is considerable uncertainty if and when results from the roadside screening test are used to estimate venous BAC. The roadside breath-alcohol screening instruments worked well for the purpose of selecting drivers above the statutory limit of 0.50g/kg.

  4. Specific Metabolome Profile of Exhaled Breath Condensate in Patients with Shock and Respiratory Failure: A Pilot Study

    PubMed Central

    Fermier, Brice; Blasco, Hélène; Godat, Emmanuel; Bocca, Cinzia; Moënne-Loccoz, Joseph; Emond, Patrick; Andres, Christian R.; Laffon, Marc; Ferrandière, Martine

    2016-01-01

    Background: Shock includes different pathophysiological mechanisms not fully understood and remains a challenge to manage. Exhaled breath condensate (EBC) may contain relevant biomarkers that could help us make an early diagnosis or better understand the metabolic perturbations resulting from this pathological situation. Objective: we aimed to establish the metabolomics signature of EBC from patients in shock with acute respiratory failure in a pilot study. Material and methods: We explored the metabolic signature of EBC in 12 patients with shock compared to 14 controls using LC-HRMS. We used a non-targeted approach, and we performed a multivariate analysis based on Orthogonal Partial Least Square-Discriminant Analysis (OPLS-DA) to differentiate between the two groups of patients. Results: We optimized the procedure of EBC collection and LC-HRMS detected more than 1000 ions in this fluid. The optimization of multivariate models led to an excellent model of differentiation for both groups (Q2 > 0.4) after inclusion of only 6 ions. Discussion and conclusion: We validated the procedure of EBC collection and we showed that the metabolome profile of EBC may be relevant in characterizing patients with shock. We performed well in distinguishing these patients from controls, and the identification of relevant compounds may be promising for ICC patients. PMID:27598216

  5. Effects of breathing training on voluntary hypo- and hyperventilation in patients with panic disorder and episodic anxiety.

    PubMed

    Wollburg, Eileen; Roth, Walton T; Kim, Sunyoung

    2011-06-01

    Anxiety disorders are associated with respiratory abnormalities. Breathing training (BT) aimed at reversing these abnormalities may also alter the anxiogenic effects of biological challenges. Forty-five Panic Disorder (PD) patients, 39 Episodic Anxiety patients, and 20 non-anxious controls underwent voluntary hypoventilation and hyperventilation tests twice while psychophysiological measures were recorded. Patients were randomized to one of two BT therapies (Lowering vs. Raising pCO(2)) or to a waitlist. Before treatment panic patients had higher respiration rates and more tidal volume instability and sighing at rest than did non-anxious controls. After the Lowering therapy, patients had lower pCO(2) during testing. However, neither reactivity nor recovery to either test differed between patients and controls, or were affected by treatment. Although the two treatments had their intended opposite effects on baseline pCO(2), other physiological measures were not affected. We conclude that baseline respiratory abnormalities are somewhat specific to PD, but that previously reported greater reactivity and slower recovery to respiratory challenges may be absent. PMID:21373936

  6. Dosimetric comparison of treatment plans based on free breathing, maximum, and average intensity projection CTs for lung cancer SBRT

    SciTech Connect

    Tian Yuan; Wang Zhiheng; Ge Hong; Zhang Tian; Cai Jing; Kelsey, Christopher; Yoo, David; Yin Fangfang

    2012-05-15

    Purpose: To determine whether there is a CT dataset may be more favorable for planning and dose calculation by comparing dosimetric characteristics between treatment plans calculated using free breathing (FB), maximum and average intensity projection (MIP and AIP, respectively) CTs for lung cancer patients receiving stereotactic body radiation therapy (SBRT). Methods: Twenty lung cancer SBRT patients, treated on a linac with 2.5 mm width multileaf-collimator (MLC), were analyzed retrospectively. Both FB helical and four-dimensional CT scans were acquired for each patient. Internal target volume (ITV) was delineated based on MIP CTs and modified based on both ten-phase datasets and FB CTs. Planning target volume (PTV) was then determined by adding additional setup margin to ITV. The PTVs and beams in the optimized treatment plan based on FB CTs were copied to MIP and AIP CTs, with the same isocenters, MLC patterns and monitor units. Mean effective depth (MED) of beams, and some dosimetric parameters for both PTVs and most important organ at risk (OAR), lung minus PTV, were compared between any two datasets using two-tail paired t test. Results: The MEDs in FB and AIP plans were similar but significantly smaller (Ps < 0.001) than that in MIP plans. Minimum dose, mean dose, dose covering at least 90% and 95% of PTVs in MIP plans were slightly higher than two other plans (Ps < 0.008). The absolute volume of lung minus PTV receiving greater than 5, 10, and 20 Gy in MIP plans were significantly smaller than those in both FB and AIP plans (Ps < 0.008). Conformity index for FB plans showed a small but statistically significantly higher. Conclusions: Dosimetric characteristics of AIP plans are similar to those of FB plans. Slightly better target volume coverage and significantly lower low-dose region ({<=}30 Gy) in lung was observed in MIP plans. The decrease in low-dose region in lung was mainly caused by the change of lung volume contoured on two datasets rather than the

  7. Applications of Hadamard transform-gas chromatography/mass spectrometry to the detection of acetone in healthy human and diabetes mellitus patient breath.

    PubMed

    Fan, Gang-Ting; Yang, Chien-Lin; Lin, Cheng-Huang; Chen, Chien-Chung; Shih, Chung-Hung

    2014-03-01

    The Hadamard transform-gas chromatography/mass spectrometry (HT-GC/MS) technique was successfully employed to detect acetone, a biomarker for diabetes mellitus (DM) prediction, in human breath. Samples of exhaled breath were collected from four DM patients (one type-I and three type-II) and eight volunteers (nondiabetic healthy subjects), respectively. The gas samples, without any pretreatment, were simultaneously injected into a GC column through a Hadamard-injector based on Hadamard codes. Under optimized conditions, when cyclic S-matrix orders of 255, 1023 and 2047 were used, the S/N ratios of the acetone signals were substantially improved by 8.0-, 16.0- and 22.6-fold, respectively; these improvements are in good agreement with theoretically calculated values. We found that the breath acetone concentration levels in the four DM patients and the eight volunteers ranged from 1 to 10 ppmv and 0.1 to 1 ppmv, respectively.

  8. Diagnosing Lung Nodules on Oncologic MR/PET Imaging: Comparison of Fast T1-Weighted Sequences and Influence of Image Acquisition in Inspiration and Expiration Breath-Hold

    PubMed Central

    Schwenzer, Nina F.; Seith, Ferdinand; Gatidis, Sergios; Brendle, Cornelia; Schmidt, Holger; Pfannenberg, Christina A.; laFougère, Christian; Nikolaou, Konstantin

    2016-01-01

    Objective First, to investigate the diagnostic performance of fast T1-weighted sequences for lung nodule evaluation in oncologic magnetic resonance (MR)/positron emission tomography (PET). Second, to evaluate the influence of image acquisition in inspiration and expiration breath-hold on diagnostic performance. Materials and Methods The study was approved by the local Institutional Review Board. PET/CT and MR/PET of 44 cancer patients were evaluated by 2 readers. PET/CT included lung computed tomography (CT) scans in inspiration and expiration (CTin, CTex). MR/PET included Dixon sequence for attenuation correction and fast T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences (volume interpolated breath-hold examination acquired in inspiration [VIBEin], volume interpolated breath-hold examination acquired in expiration [VIBEex]). Diagnostic performance was analyzed for lesion-, lobe-, and size-dependence. Diagnostic confidence was evaluated (4-point Likert-scale; 1 = high). Jackknife alternative free-response receiver-operating characteristic (JAFROC) analysis was performed. Results Seventy-six pulmonary lesions were evaluated. Lesion-based detection rates were: CTex, 77.6%; VIBEin, 53.3%; VIBEex, 51.3%; and Dixon, 22.4%. Lobe-based detection rates were: CTex, 89.6%; VIBEin, 58.3%; VIBEex, 60.4%; and Dixon, 31.3%. In contrast to CT, inspiration versus expiration did not alter diagnostic performance in VIBE sequences. Diagnostic confidence was best for VIBEin and CTex and decreased in VIBEex and Dixon (1.2 ± 0.6; 1.2 ± 0.7; 1.5 ± 0.9; 1.7 ± 1.1, respectively). The JAFROC figure-of-merit of Dixon was significantly lower. All patients with malignant lesions were identified by CTex, VIBEin, and VIBEex, while 3 patients were false-negative in Dixon. Conclusion Fast T1-weighted VIBE sequences allow for identification of patients with malignant pulmonary lesions. The Dixon sequence is not recommended for lung nodule evaluation in oncologic MR

  9. How to breathe when you are short of breath

    MedlinePlus

    Pursed lip breathing; COPD - pursed lip breathing; Emphysema - pursed lip breathing; Chronic bronchitis - pursed lip breathing; Pulmonary fibrosis - pursed lip breathing; Interstitial lung disease - pursed lip breathing; Hypoxia - pursed lip breathing; ...

  10. [COMPARATIVE EVALUATION OF THE EFFECTIVENESS OF THE USE OF 13C-LABELED MIXED TRIGLYCERIDE AND 13C-STARCH BREATH TESTS IN PATIENTS WITH CHRONIC PANCREATITIS AFTER CHOLECYSTECTOMY].

    PubMed

    Sirchak, Ye S

    2015-01-01

    The results of a comprehensive study of 96 patients after cholecystectomy are provided. The higher sensitivity and informativeness of the 13C-labeled mixed triglyceride breath .test compared with 13C-starch breath test for determining functional pancreatic insufficiency in patients after cholecystectomy in early stages of its formation was set. PMID:27491156

  11. The Effects of Game-Based Breathing Exercise on Pulmonary Function in Stroke Patients: A Preliminary Study

    PubMed Central

    Joo, Sunghee; Shin, Doochul; Song, Changho

    2015-01-01

    Background Reduction of respiratory function along with hemiparesis leads to decreased endurance, dyspnea, and increased sedentary behavior, as well as to an increased risk of stroke. The main purpose of this study was to investigate the preliminary effects of game-based breathing exercise (GBE) on pulmonary function in stroke patients. Material/Methods Thirty-eight in-patients with stroke (22 men, 16 women) were recruited for the study. Participants were randomly allocated into 2 groups: patients assigned to the GBE group (n=19), and the control group (n=19). The GBE group participated in a GBE program for 25 minutes a day, 3 days a week, during a 5 week period. For the same period, both groups participated in a conventional stroke rehabilitation program. Forced vital capacity (FVC), forced expiratory volume at 1 second (FEV1), FEV1/FVC, and maximum voluntary ventilation (MVV) were measured by a spirometer in pre- and post-testing. Results The GBE group had significantly improved FVC, FEV1, and MVV values compared with the control group (p<0.05), although there was no significant difference in FEV1/FVC value between groups. Significant short-term effects of the GBE program on pulmonary function in stroke patients were recorded in this study. Conclusions These findings gave some indications that it may be feasible to include GBE in rehabilitation interventions with this population. PMID:26098853

  12. [A clinical investigation of pediatric patients with sleep-disordered breathing who suffered perioperative respiratory complications of adenotonsillectomy].

    PubMed

    Ogawa, Makoto; Hosokawa, Kiyohito; Inohara, Hidenori

    2014-03-01

    The aim of this study was to investigate the clinical background and identify the risk factors for perioperative respiratory complication in pediatric patients with sleep-disordered breathing (SDB) who underwent adenotonsillectomy (AT). Of the 186 pediatric subjects (male: 131, female: 55) undergoing AT as the first surgical treatment for SDB, 14 patients (male: 9, female: 5) fulfilled the following criteria: 1) disturbed ventilation, 2) cyanosis with an oxygen saturation of less than 90% on pulse oximetry during the perioperative period and 3) the subsequent need for medical intervention, including immediate intubation, continuous positive airway pressure (CPAP) or airway insertion. Among these 14 patients, nine were less than 3 years of age. In addition, 5 and 3 patients had hypotonia due to cerebral paralysis and metabolic disturbances, respectively. Seven had a short stature with an SD of worse than - 1.5. A statistical analysis showed that cases with either an age of less than 3 years, hypotonia or a short stature had a high risk for suffering from respiratory complications, and suggested that low body weight and a high value for preoperative apnea-hypopnea index were additional risk factors. However, a chart review exhibited that, of the 14 cases with respiratory complications, the 8 cases whose age was under 3 years had either of hypotonia or a short stature. In thirteen of the 14 cases, respiratory complications were associated with the process of general anesthesia, and ten patients exhibited pharyngeal collapse. After surgery, 7 and 3 patients required intensive care in the ICU and the pediatric recovery unit, respectively. Based on these results, it is suggested that pediatric SDB cases under 3 years of age and either with hypotonia or a short stature have a high risk for respiratory complications associated with AT, and therefore AT for such patients should only be performed in medical facilities with an ICU or an equivalent department. PMID:24783453

  13. Nasopharyngeal chordoma in a patient with a severe form of sleep-disordered breathing: A case report

    PubMed Central

    RADZIKOWSKA, JOANNA; GRONKIEWICZ, ZUZANNA; KUKWA, ANDRZEJ; LISIK, WOJCIECH; CZARNECKA, ANNA M.; KRZESKI, ANTONI; KUKWA, WOJCIECH

    2015-01-01

    Nasopharyngeal chordoma is a rare type of malignant neoplasm that originates in the remnants of the notochord, a primitive tissue of embryonic origin preserved outside the axial skeleton. Approximately one-third of chordomas are located in the base of the skull, in the midline of the body. The slow growth rate of the tumor, which gradually fills the nasopharyngeal cavity, contributes to a delayed oncological diagnosis. Among its isolated and non-specific symptoms, the obstruction of the nasopharynx is dominant, thus, sleep-disordered breathing (SDB) may occur. The current study presents the case of a 32-year-old female patient who was incidentally diagnosed with a nasopharyngeal chordoma during a diagnostic examination for SDB. The diagnostic examination was performed as a part of a research program for pathologically obese patients who qualified for bariatric surgery. Following tumor resection, a significant improvement in various polysomnographic parameters occurred, including a decrease in the apnea hypopnea index from 53.5 to 6.4 and an increase in the mean saturation rate from 92.5 to 95%, confirming that an association exists between tumor obstruction of the nasopharynx and SDB. The incidental diagnosis of this rare type of neoplasm drew attention to diagnostic and therapeutic problems associated with nasopharyngeal chordomas. Furthermore, it indicated the necessity for the accurate laryngological examination of patients with SDB. PMID:26622754

  14. Comparison of ethanol concentrations in venous blood and end-expired breath during a controlled drinking study.

    PubMed

    Jones, A W; Andersson, L

    2003-03-12

    Concentration-time profiles of ethanol were determined for venous whole blood and end-expired breath during a controlled drinking experiment in which healthy men (n=9) and women (n=9) drank 0.40-0.65 g ethanol per kg body weight in 20-30 min. Specimens of blood and breath were obtained for analysis of ethanol starting at 50-60 min post-dosing and then every 30-60 min for 3-6 h. This protocol furnished 130 blood-breath pairs for statistical evaluation. Blood-ethanol concentration (BAC, mg/g) was determined by headspace gas chromatography and breath-ethanol concentration (BrAC, mg/2l) was determined with a quantitative infrared analyzer (Intoxilyzer 5000S), which is the instrument currently used in Sweden for legal purposes. In 18 instances the Intoxilyzer 5000S gave readings of 0.00 mg/2l whereas the actual BAC was 0.08 mg/g on average (range 0.04-0.15 mg/g). The remaining 112 blood- and breath-alcohol measurements were highly correlated (r=0.97) and the regression relationship was BAC=0.10+0.91BrAC and the residual standard deviation (S.D.) was 0.042 mg/g (8.4%). The slope (0.91+/-0.0217) differed significantly from unity being 9% low and the intercept (0.10+/-0.0101) deviated from zero (t=10.2, P<0.001), indicating the presence of both proportional and constant bias, respectively. The mean bias (BAC - BrAC) was 0.068 mg/g and the 95% limits of agreement were -0.021 and 0.156 mg/g. The average BAC/BrAC ratio was 2448+/-540 (+/-S.D.) with a median of 2351 and 2.5th and 97.5th percentiles of 1836 and 4082. We found no significant gender-related differences in BAC/BrAC ratios, being 2553+/-576 for men and 2417+/-494 for women (t=1.34, P>0.05). The mean rate of ethanol disappearance from blood was 0.157+/-0.021 mg/(g per hour), which was very close to the elimination rate from breath of 0.161+/-0.021 mg/(2l per hour) (P>0.05). Breath-test results obtained with Intoxilyzer 5000S (mg/2l) were generally less than the coexisting concentrations of ethanol in venous blood

  15. Comparison of assisted ventilator modes on triggering, patient effort, and dyspnea.

    PubMed

    Leung, P; Jubran, A; Tobin, M J

    1997-06-01

    In 11 ventilator-dependent patients, we undertook a head-to-head comparison of patient-ventilator interaction during four ventilator modes: assist-control ventilation (ACV), intermittent mandatory ventilation (IMV), pressure support (PS), and a combination of IMV and PS. Progressive increases in IMV rate and PS level each decreased inspiratory pressure-time product (PTP) (p < 0.0001). These reductions in PTP were greater with PS than with IMV at lower but proportional levels of maximal assistance (p < 0.005). When PS 10 cm H2O was added to a given level of IMV, greater reductions in PTP were achieved not only during intervening (PS) breaths (p < 0.001), but also during mandatory (volume-assisted) breaths (p < 0.0005); this additional unloading during mandatory breaths was proportional to the decrease in respiratory drive (dP/dt) during intervening breaths (r = 0.67, p < 0.0001). Maximal unloading occurred with ACV, achieving more than a fivefold decrease in PTP compared with unassisted breathing. Decreases in PTP were confined to the post-trigger phase, and PTP of the post-trigger phase correlated with dP/dt (r = 0.78, p < 0.0001). Effort during the trigger phase remained constant despite marked changes in drive and intrinsic positive end-expiratory pressure (PEEPi). Ineffective triggering occurred with all modes, and wasted PTP increased with increasing levels of assistance as a result of the accompanying decrease in drive and increase in volume. Breaths preceding nontriggering efforts had shorter respiratory cycle times (p < 0.0005) and expiratory times (p < 0.0001) and higher PEEPi (p < 0.0001), indicating that neural-mechanical asynchrony resulted from inspiratory activity commencing prematurely before elastic recoil pressure had fallen to a level that could be overcome by a patient's muscular effort. Thus, increases in the level of ventilator assistance produced progressive decreases in inspiratory muscle effort and dyspnea,which were accompanied by increases

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

    PubMed

    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.

  17. Breath Testing for Small Intestinal Bacterial Overgrowth: Should We Bother?

    PubMed

    Pimentel, Mark

    2016-03-01

    The hydrogen breath test is based on following breath hydrogen levels after the administration of a carbohydrate (most commonly lactulose) to a patient with suspected small intestinal bacterial overgrowth. The test is based on the interaction between the administered carbohydrate and the intestinal bacteria. The resulting fermentation produces hydrogen. A positive breath test is based on a breath hydrogen rise prior to the expected arrival time in the highly microbial cecum. Despite renewed enthusiasm for breath testing in recent years due to associations with conditions such as irritable bowel syndrome, breath testing poses many challenges. In this argument against breath testing, several pitfalls that complicate breath testing will be described. PMID:26902227

  18. Prognostic value of 13C-phenylalanine breath test on predicting survival in patients with chronic liver failure

    PubMed Central

    Gallardo-Wong, I; Morán, S; Rodríguez-Leal, G; Castañeda-Romero, B; Mera, R; Poo, J; Uribe, M; Dehesa, M

    2007-01-01

    AIM: To evaluate the prognostic value of percentage of 13C-phenylalanine oxidation (13C-PheOx) obtained by 13C-phenylalanine breath test (13C-PheBT) on the survival of patients with chronic liver failure. METHODS: The hepatic function was determined by standard liver blood tests and the percentage of 13C-PheOx in 118 chronic liver failure patients. The follow-up period was of 64 mo. Survival analysis was performed by the Kaplan-Meier method and variables that were significant (P < 0.10) in univariate analysis and subsequently introduced in a multivariate analysis according to the hazard model proposed by Cox. RESULTS: Forty-one patients died due to progressive liver failure during the follow-up period. The probability of survival at 12, 24, 36, 48 and 64 mo was 0.88, 0.78, 0.66, 0.57 and 0.19, respectively. Multivariate analysis demonstrated that Child-Pugh classes, age, creatinine and the percentage of 13C-PheOx (HR 0.338, 95% CI: 0.150-0.762, P = 0.009) were independent predictors of survival. When Child-Pugh classes were replaced by all the parameters of the score, only albumin, bilirubin, creatinine, age and the percentage of 13C-PheOx (HR 0.449, 95% CI: 0.206-0.979, P = 0.034) were found to be independent predictors of survival. CONCLUSION: Percentage of 13C-PheOx obtained by 13C-PheBT is a strong predictor of survival in patients with chronic liver disease. PMID:17729409

  19. Effect of Inhaled Budesonide on Interleukin-4 and Interleukin-6 in Exhaled Breath Condensate of Asthmatic Patients

    PubMed Central

    Chi, Chun-Hua; Liao, Ji-Ping; Zhao, Yan-Ni; Li, Xue-Ying; Wang, Guang-Fa

    2016-01-01

    Background: Studies of interleukin (IL)-4 and IL-6 in the exhaled breath condensate (EBC) of asthmatic patients are limited. This study was to determine the effect of inhaled corticosteroid (ICS) treatment on IL-4 and IL-6 in the EBC of asthmatic patients. Methods: In a prospective, open-label study, budesonide 200 μg twice daily by dry powder inhaler was administered to 23 adult patients with uncontrolled asthma (mean age 42.7 years) for 12 weeks. Changes in asthma scores, lung function parameters (forced expiratory volume in 1 s [FEV1], peak expiratory flow [PEF], forced expiratory flow at 50% of forced vital capacity [FEF50], forced expiratory flow at 75% of forced vital capacity, maximum mid-expiratory flow rate) and the concentrations of IL-4 and IL-6 in EBC were measured. Results: Both asthma scores and lung function parameters were significantly improved by ICS treatment. The mean IL-4 concentration in the EBC was decreased gradually, from 1.92 ± 0.56 pmol/L before treatment to 1.60 ± 0.36 pmol/L after 8 weeks of treatment (P < 0.05) and 1.54 ± 0.81 pmol/L after 12 weeks of treatment (P < 0.01). However, the IL-6 concentration was not significantly decreased. The change in the IL-4 concentration was correlated with improvements in mean FEV1, PEF and FEF50 values (correlation coefficients −0.468, −0.478, and −0.426, respectively). Conclusions: The concentration of IL-4 in the EBC of asthmatic patients decreased gradually with ICS treatment. Measurement of IL-4 in EBC could be useful to monitor airway inflammation in asthmatics. PMID:26996478

  20. Effects of the combined PNF and deep breathing exercises on the ROM and the VAS score of a frozen shoulder patient: Single case study

    PubMed Central

    Lee, Byung-Ki

    2015-01-01

    This study was conducted to examine the influence of combined exercise using proprioceptive neuromuscular facilitation (PNF) and deep breathing exercise on range of motion (ROM) and visual analog scale (VAS) score in acute frozen shoulder patient. The subject of this study was woman complained disabilities in daily routine due as a frozen left shoulder. The exercise program was composed of 11 sessions and continued four weeks. The program was composed of PNF and deep breathing exercise, and the subject was compared by passive ROM (shoulder flexion, abduction, and internal and external rotation) test and VAS score in shoulder movement before and after the exercise. The results showed that patient who practiced this program, the ROM of the shoulder joint increased and the VAS score decreased. Thus, this program was shown to be effective in suppressing pain and increasing the ROM of the shoulder joint in acute frozen shoulder patient. PMID:26535219

  1. A preliminary randomized trial of the mechanical insufflator-exsufflator versus breath-stacking technique in patients with amyotrophic lateral sclerosis.

    PubMed

    Rafiq, Muhammad K; Bradburn, Michael; Proctor, Alison R; Billings, Catherine G; Bianchi, Stephen; McDermott, Christopher J; Shaw, Pamela J

    2015-01-01

    A major problem faced by patients with amyotrophic lateral sclerosis (ALS) in respiratory failure is the inability to cough effectively. Forty eligible ALS patients were randomized to the breath-stacking technique using a lung volume recruitment bag (n = 21) or mechanical insufflator-exsufflator MI-E (n = 19) and followed up at three-monthly intervals for at least 12 months or until death. Results showed that there were 13 episodes of chest infection in the breath-stacking group and 19 episodes in the MI-E group (p = 0.92), requiring 90 and 95 days of antibiotics, respectively (p = 0.34). The mean duration of symptoms per chest infection was 6.9 days in the breath-stacking group and 3.9 days in MI-E group (p = 0.16). There were six episodes of hospitalization in each group (p = 0.64). The chance of hospitalization, in the event of a chest infection, was 0.46 in the breath-stacking group and 0.31 in MI-E group (p = 0.47). Median survival in the breath-stacking group was 535 days and 266 days in the MI-E group (p = 0.34). The QoL was maintained above 75% of baseline for a median of 329 days in the breath-stacking group and 205 days in the MI-E group (p = 0.41). In conclusion, lack of statistically significant differences due to sub-optimal power and confounders precludes a definitive conclusion with respect to the relative efficacy of one cough augmentation technique over the other. This study however, provides useful lessons and informative data, needed to strengthen the power calculation, inclusion criteria and randomization factors for a large scale definitive trial. Until such a definitive trial can be undertaken, we recommend the breath-stacking technique as a low-cost, first-line intervention for volume recruitment and cough augmentation in patients with ALS who meet the criteria for intervention with non-invasive ventilation.

  2. Breathing hot humid air induces airway irritation and cough in patients with allergic rhinitis.

    PubMed

    Khosravi, Mehdi; Collins, Paul B; Lin, Ruei-Lung; Hayes, Don; Smith, Jaclyn A; Lee, Lu-Yuan

    2014-07-01

    We studied the respiratory responses to an increase in airway temperature in patients with allergic rhinitis (AR). Responses to isocapnic hyperventilation (40% of maximal voluntary ventilation) for 4min of humidified hot air (HA; 49°C) and room air (RA; 21°C) were compared between AR patients (n=7) and healthy subjects (n=6). In AR patients, cough frequency increased pronouncedly from 0.10±0.07 before to 2.37±0.73 during, and 1.80±0.79coughs/min for the first 8min after the HA challenge, but not during the RA challenge. In contrast, neither HA nor RA had any significant tussive effect in healthy subjects. The HA challenge also caused respiratory discomfort (mainly throat irritation) measured by the handgrip dynamometry in AR patients, but not in healthy subjects. Bronchoconstriction was not detected after the HA challenge in either group of subjects. In conclusion, hyperventilation of HA triggered vigorous cough response and throat irritation in AR patients, indicating the involvement of sensory nerves innervating upper airways.

  3. Lipidic last breath of life in patients with alcoholic liver disease.

    PubMed

    Raszeja-Wyszomirska, Joanna; Safranow, Krzysztof; Milkiewicz, Małgorzata; Milkiewicz, Piotr; Szynkowska, Agnieszka; Stachowska, Ewa

    2012-10-01

    Alcoholic liver disease (ALD) begins with the accumulation of lipid droplets in the liver. Lipids which accumulate in the liver can stimulate inflammation, and the fatty acid derivatives, hydroxyeicosatetraenoic acids (HETEs) and hydroxyoctadecadienoic acids (HODEs), may play an important role in this process. We evaluated the concentrations of linoleic and arachidonic acid derivatives in the plasma of patients with ALD, non-alcoholic fatty liver disease (NAFLD) and healthy individuals. The groups consisted of 173 subjects: 63 patients with ALD, 90 with NAFLD and 20 healthy volunteers. Plasma 12-, 15-, and 5-HETE as well as 9- and 13-HODE were assessed using HPLC and isoprostane 8-epi-PGF 2α III was evaluated with an ELISA. In addition the mRNA expression of lipoxygenases (5-LOX, 15-LOX-1, 15-LOX-2) in the liver samples of patients with ALD cirrhosis was measured. A significant difference between the plasma concentrations of the analyzed derivatives was found when divided according to gender. The most significant differences were found between healthy individuals and ALD patients, as well as ALD and NAFLD individuals regardless of gender. The increased plasma HODEs and HETEs concentrations were in line with the increase in 5- and 15-LOX-1 and 15-LOX-2 mRNA in liver samples from ALD cirrhosis patients. LOXs expression and peroxidation of polyunsaturated fatty acids by free radical-propagated chemical oxidation may be contributing factors in liver necroinflammatory injury in ALD. PMID:22706383

  4. Arrhythmogenic properties of disordered breathing during sleep in patients with cardiovascular disorders.

    PubMed

    Otsuka, K; Sadakane, N; Ozawa, T

    1987-12-01

    The purpose of this study was twofold: to establish an ECG respiration monitoring system, and to evaluate the clinical usefulness of this system. Our purpose was to determine how many patients with cardiovascular disorders may have unrecognized sleep apnea and whether such apneic episodes are an important cause of cardiac arrhythmias. The study group included 81 patients, age range 40-95 years, and 13 healthy males, age range 52-72 years. The 24-h ECG respiration recordings were obtained with the two-channel holter recorder. Airflow at the nose using a nasal thermister or chest wall movement by impedance pneumography was recorded as respiration record on the second channel. Sleep apnea was observed 69% and 77-100% in the control subjects and patients with cardiovascular disorders, respectively. Episodes of sleep apnea were most frequent in the patients with old myocardial infarction. Grading of apneas was defined according to the length of apnea. Short duration apneas were observed only in the control subjects, but longer apneic episodes were observed in patients with cardiovascular disorders. Bradyarrhythmias observed were to be relative to apneic episodes longer than 20 s, while ventricular arrhythmias were observed only in the patients with old myocardial infarction, coincident with apneas lasting longer than 40 s. Atrioventricular conduction disturbances were also observed to be related to the occurrence of sleep apnea. These results suggest that 24-h ECG respiration monitoring is useful not only for the observation of sleep apneic episodes, but also in clarifying the relationship between cardiac arrhythmias and apneic episodes.

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

    NASA Astrophysics Data System (ADS)

    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.

  6. Can chest trauma patients provide breath sample with Lion SD-400 Alcometer?

    PubMed

    Rathinam, Sridhar; Luke, David; Nanjaiah, Prakash; Kalkat, Maninder S; Steyn, Richard S

    2009-06-01

    Various investigators have addressed the minimum lung function required to activate breathalyzers, and the impact of comorbid respiratory illness. We postulated that subjects with significant chest trauma may have difficulty in providing an adequate breathalyzer sample. A prospective self-controlled study of 20 patients who underwent thoracotomy was conducted between August 2005 and December 2005, using a Lion Alcometer SD-400. The mean age of the patients was 69.3 years (range, 37-83 years). Preoperatively, their mean forced expiratory volume was 1.97 L (range, 1.19-2.46 L), and peak expiratory flow rate was 240 L min(-1) (range, 126-520 L min(-1)). Postoperatively, mean forced expiratory volume was 1.14 L (range, 0.34-2.2 L) and peak expiratory flow rate was 179 L min(-1) (range, 36-492 L min(-1)). These decreases were highly significant. All patients activated the breathalyzer device preoperatively, but only 2 (10%) could activate it postoperatively. Extrapolating this to patients with chest injury, most may find it impossible to activate breathalyzers. PMID:19643853

  7. Last Breath: Art Therapy with a Lung Cancer Patient Facing Imminent Death

    ERIC Educational Resources Information Center

    Furman, Lisa R.

    2011-01-01

    Art therapy can be an effective way to focus on end of life issues with cancer patients facing imminent death. This viewpoint discusses ethical challenges in the treatment of a 63-year-old man with terminal lung cancer who was participating in short-term individual art therapy. Difficult issues that often surface in the final days of life may…

  8. Pathology Image of the Month:Cough and Shortness of Breath in a Noncompliant Patient with HIV/AIDS.

    PubMed

    Thomasson, Reggie; Dewenter, Tracy; McGoey, Robin R

    2015-01-01

    A 37- year-old man with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) was admitted to the intensive care unit following a four month history of progressive shortness of breath, productive cough, and flu-like symptoms. His HIV/AIDS was diagnosed at the age of 19 (CD4 count =15; viral load = 294,436 copies/ mL) and was complicated by hemodialysis-dependent, HIV-associated nephropathy, prior Pneumocystis pneumonia and known noncompliance with prescribed antiretroviral therapy. Chest film at admission was interpreted as diffuse bilateral interstitial and airspace opacities with a right sided layering density representative of laminar pleural effusion. Bacterial blood cultures were subsequently negative. A bronchoalveolar lavage was performed and an image from the cytologic cell block is seen above in Figure 1. The patient's respiratory status continued to deteriorate and he was converted to comfort care. Following death, an unlimited autopsy examination was requested by the family and authorized by the coroner. At autopsy, additional gross pathologic findings included 350ml of chylous appearing pleural fluid and serous ascites (700ml). Histopathology revealed intra-alveolar acute fibrinopurulent exudate, chronic pericarditis and end-stage nephropathy. Similar cells to those shown above in Figure 1 were identified in lung epithelium and in pancreatic acinar cells. Special stain for Pneumocystis was negative. PMID:27159517

  9. Pathology Image of the Month:Cough and Shortness of Breath in a Noncompliant Patient with HIV/AIDS.

    PubMed

    Thomasson, Reggie; Dewenter, Tracy; McGoey, Robin R

    2015-01-01

    A 37- year-old man with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) was admitted to the intensive care unit following a four month history of progressive shortness of breath, productive cough, and flu-like symptoms. His HIV/AIDS was diagnosed at the age of 19 (CD4 count =15; viral load = 294,436 copies/ mL) and was complicated by hemodialysis-dependent, HIV-associated nephropathy, prior Pneumocystis pneumonia and known noncompliance with prescribed antiretroviral therapy. Chest film at admission was interpreted as diffuse bilateral interstitial and airspace opacities with a right sided layering density representative of laminar pleural effusion. Bacterial blood cultures were subsequently negative. A bronchoalveolar lavage was performed and an image from the cytologic cell block is seen above in Figure 1. The patient's respiratory status continued to deteriorate and he was converted to comfort care. Following death, an unlimited autopsy examination was requested by the family and authorized by the coroner. At autopsy, additional gross pathologic findings included 350ml of chylous appearing pleural fluid and serous ascites (700ml). Histopathology revealed intra-alveolar acute fibrinopurulent exudate, chronic pericarditis and end-stage nephropathy. Similar cells to those shown above in Figure 1 were identified in lung epithelium and in pancreatic acinar cells. Special stain for Pneumocystis was negative.

  10. The impact of breathing guidance and prospective gating during thoracic 4DCT imaging: an XCAT study utilizing lung cancer patient motion.

    PubMed

    Pollock, Sean; Kipritidis, John; Lee, Danny; Bernatowicz, Kinga; Keall, Paul

    2016-09-01

    Two interventions to overcome the deleterious impact irregular breathing has on thoracic-abdominal 4D computed tomography (4DCT) are (1) facilitating regular breathing using audiovisual biofeedback (AVB), and (2) prospective respiratory gating of the 4DCT scan based on the real-time respiratory motion. The purpose of this study was to compare the impact of AVB and gating on 4DCT imaging using the 4D eXtended cardiac torso (XCAT) phantom driven by patient breathing patterns. We obtained simultaneous measurements of chest and abdominal walls, thoracic diaphragm, and tumor motion from 6 lung cancer patients under two breathing conditions: (1) AVB, and (2) free breathing. The XCAT phantom was used to simulate 4DCT acquisitions in cine and respiratory gated modes. 4DCT image quality was quantified by artefact detection (NCCdiff), mean square error (MSE), and Dice similarity coefficient of lung and tumor volumes (DSClung, DSCtumor). 4DCT acquisition times and imaging dose were recorded. In cine mode, AVB improved NCCdiff, MSE, DSClung, and DSCtumor by 20% (p  =  0.008), 23% (p  <  0.001), 0.5% (p  <  0.001), and 4.0% (p  <  0.003), respectively. In respiratory gated mode, AVB improved NCCdiff, MSE, and DSClung by 29% (p  <  0.001), 34% (p  <  0.001), 0.4% (p  <  0.001), respectively. AVB increased the cine acquisitions by 15 s and reduced respiratory gated acquisitions by 31 s. AVB increased imaging dose in cine mode by 10%. This was the first study to quantify the impact of breathing guidance and respiratory gating on 4DCT imaging. With the exception of DSCtumor in respiratory gated mode, AVB significantly improved 4DCT image analysis metrics in both cine and respiratory gated modes over free breathing. The results demonstrate that AVB and respiratory-gating can be beneficial interventions to improve 4DCT for cancer radiation therapy, with the biggest gains achieved when these interventions are used

  11. The impact of breathing guidance and prospective gating during thoracic 4DCT imaging: an XCAT study utilizing lung cancer patient motion

    NASA Astrophysics Data System (ADS)

    Pollock, Sean; Kipritidis, John; Lee, Danny; Bernatowicz, Kinga; Keall, Paul

    2016-09-01

    Two interventions to overcome the deleterious impact irregular breathing has on thoracic-abdominal 4D computed tomography (4DCT) are (1) facilitating regular breathing using audiovisual biofeedback (AVB), and (2) prospective respiratory gating of the 4DCT scan based on the real-time respiratory motion. The purpose of this study was to compare the impact of AVB and gating on 4DCT imaging using the 4D eXtended cardiac torso (XCAT) phantom driven by patient breathing patterns. We obtained simultaneous measurements of chest and abdominal walls, thoracic diaphragm, and tumor motion from 6 lung cancer patients under two breathing conditions: (1) AVB, and (2) free breathing. The XCAT phantom was used to simulate 4DCT acquisitions in cine and respiratory gated modes. 4DCT image quality was quantified by artefact detection (NCCdiff), mean square error (MSE), and Dice similarity coefficient of lung and tumor volumes (DSClung, DSCtumor). 4DCT acquisition times and imaging dose were recorded. In cine mode, AVB improved NCCdiff, MSE, DSClung, and DSCtumor by 20% (p  =  0.008), 23% (p  <  0.001), 0.5% (p  <  0.001), and 4.0% (p  <  0.003), respectively. In respiratory gated mode, AVB improved NCCdiff, MSE, and DSClung by 29% (p  <  0.001), 34% (p  <  0.001), 0.4% (p  <  0.001), respectively. AVB increased the cine acquisitions by 15 s and reduced respiratory gated acquisitions by 31 s. AVB increased imaging dose in cine mode by 10%. This was the first study to quantify the impact of breathing guidance and respiratory gating on 4DCT imaging. With the exception of DSCtumor in respiratory gated mode, AVB significantly improved 4DCT image analysis metrics in both cine and respiratory gated modes over free breathing. The results demonstrate that AVB and respiratory-gating can be beneficial interventions to improve 4DCT for cancer radiation therapy, with the biggest gains achieved when these interventions are used

  12. Patient-ventilator interaction during acute lung injury, and the role of spontaneous breathing: part 1: respiratory muscle function during critical illness.

    PubMed

    Kallet, Richard H

    2011-02-01

    Since the early 1970s there has been an ongoing debate regarding the wisdom of promoting unassisted spontaneous breathing throughout the course of critical illness in patients with severe respiratory failure. The basis of this debate has focused on the clinical relevance of opposite problems. Historically, the term "disuse atrophy" has described a situation wherein sustained inactivity of the respiratory muscles (ie, passive ventilation) results in deconditioning and weakness. More recently it has been referred to as "ventilator-induced diaphragmatic dysfunction." In contrast, "use atrophy" describes a situation where chronic high-tension inspiratory work causes structural damage to the diaphragm and weakness. Both laboratory and clinical studies demonstrated that relatively brief periods of complete respiratory muscle inactivity, as well as intense muscle loading, result in acute inflammation, loss of muscle mass, and weakness. Yet in critical illness other factors also affect respiratory muscle function, including prolonged use of neuromuscular blocking agents, administration of corticosteroids, and sepsis. This makes the attribution of acquired respiratory muscle weakness and ventilator-dependence to either ventilator-induced diaphragmatic dysfunction or loaded breathing extremely difficult. Regardless, the clinical implications of this research strongly suggest that passive mechanical ventilation should be avoided whenever possible. However, promotion of unassisted spontaneous breathing in the acute phase of critical illness also may carry a substantial risk of respiratory muscle injury and weakness. Use of mechanical ventilation modes in a manner that induces spontaneous breathing effort, while simultaneously reducing the work load on the respiratory muscles, is probably sufficient to minimize both problems.

  13. Sleep-Disordered Breathing in Patients with Polycystic Liver and Kidney Disease Referred for Transcatheter Arterial Embolization

    PubMed Central

    Hoshino, Junichi; Suwabe, Tatsuya; Kasai, Takatoshi; Hayami, Noriko; Mise, Koki; Kawada, Masahiro; Imafuku, Aya; Hiramatsu, Rikako; Hasegawa, Eiko; Yamanouchi, Masayuki; Sawa, Naoki; Narui, Koji; Takaichi, Kenmei; Ubara, Yoshifumi

    2015-01-01

    Background and objectives Sleep-disordered breathing (SDB) is prevalent among patients with CKD, but its prevalence among patients with symptomatic autosomal dominant polycystic kidney disease (ADPKD) and its association with total liver and kidney volume remain unclear. Design, setting, participants, & measurements This study examined the association between height-adjusted total liver and kidney volume (htTLKV) and SDB in a cross-sectional study of 304 adult patients with symptomatic ADPKD who were hospitalized at Toranomon Hospital for transcatheter arterial embolization and who underwent pulse oximetry between April 2008 and November 2013. SDB was defined as having a 3% oxygen desaturation index of ≥15 events per hour of sleep. Logistic regression was performed with sex-specific quartiles of htTLKV as the main predictor, using patient data and comorbidities as covariates. Results Overall (54.6% women, mean age 56.2±9.4 years, 83.5% on hemodialysis), 177 of 304 patients (58.2%) had SDB. SDB was strongly associated with htTLKV quartiles, demonstrating that odds ratios (ORs) and 95% confidence intervals (95% CIs) for SDB were 1.63 (0.76 to 3.48), 2.35 (1.09 to 5.06), and 4.61 (1.98 to 10.7) for htTLKV quartiles 2–4 (P for trend, P=0.003), respectively. Older age (OR, 1.81 per 10 years; 95% CI, 1.29 to 2.55), male sex (OR, 3.87; 95% CI, 1.96 to 7.66), receiving hemodialysis (OR, 3.46; 95% CI, 1.62 to 12.1), and higher body mass index (≥25 kg/m2) (OR, 3.03; 95% CI, 1.08 to 8.52) were also associated with SDB. Conclusions In this highly selected population of patients with symptomatic ADPKD referred for transcatheter arterial embolization, SDB was highly prevalent and independently associated with higher htTLKV. PMID:25825485

  14. Breath analysis for noninvasively differentiating Acinetobacter baumannii ventilator-associated pneumonia from its respiratory tract colonization of ventilated patients.

    PubMed

    Gao, Jianping; Zou, Yingchang; Wang, Yonggang; Wang, Feng; Lang, Lang; Wang, Ping; Zhou, Yong; Ying, Kejing

    2016-06-01

    A number of multiresistant pathogens including Acinetobacter baumannii (A. baumannii) place a heavy burden on ventilator-associated pneumonia (VAP) patients in intensive care units (ICU). It is critically important to differentiate between bacterial infection and colonization to avoid prescribing unnecessary antibiotics. Quantitative culture of lower respiratory tract (LRT) specimens, however, requires invasive procedures. Nowadays, volatile organic compounds (VOCs) have been studied in vitro and in vivo to identify pathogen-derived biomarkers. Therefore, an exploratory pilot study was conceived for a proof of concept that the appearance and level of A. baumannii-derived metabolites might be correlated with the presence of the pathogen and its ecological niche (i.e. the infection and colonization states) in ICU ventilated patients. Twenty patients with A. baumannii VAP (infection group), 20 ventilated patients with LRT A. baumannii colonization (colonization group) and 20 ventilated patients with neurological disorders, but without pneumonia or A. baumannii colonization (control group) were enrolled in the in vivo pilot study. A clinical isolate of A. baumannii strains was used for the in vitro culture experiment. The adsorptive preconcentration (solid-phase microextraction fiber and Tenax(®) TA) and analysis technique of gas chromatography-mass spectrometry were applied in the studies. Breath profiles could be visually differentiated between A. baumannii cultivation in vitro and culture medium, and among in vivo groups. In the in vitro experiment, nine compounds of interest (2,5-dimethyl-pyrazine, 1-undecene, isopentyl 3-methylbutanoate, decanal, 1,3-naphthalenediol, longifolene, tetradecane, iminodibenzyl and 3-methyl-indene) in the headspace were found to be possible A. baumannii derivations. While there were eight target VOCs (1-undecene, nonanal, decanal, 2,6,10-trimethyl-dodecane, 5-methyl-5-propyl-nonane, longifolene, tetradecane and 2-butyl-1-octanol

  15. Breathe easy at home: a web-based referral system linking clinical sites with housing code enforcement for patients with asthma.

    PubMed

    Reid, Margaret; Fiffer, Melissa; Gunturi, Nivedita; Ali, Amanda; Irish, Dion; Sandel, Megan

    2014-03-01

    Asthma, the most significant cause of pediatric morbidity and mortality, is exacerbated by adverse environmental conditions, especially substandard housing. The clinical care provider is often unable to address housing and environmental trigger issues. In Boston, Massachusetts, a web-based referral system called Breathe Easy At Home has been put in place, through which clinicians can refer patients to have their homes inspected for housing code violations that may be contributing to their asthma. Violations will then be brought to the attention of the landlord, who then has the option of redressing the issue or be taken to housing court. By bringing the local public health department, the city's inspectional services department, and the clinical care provider together with the help of a program coordinator, Breathe Easy At Home is able to provide comprehensive care to asthma patients. This program also serves as a replicable model for other cities and jurisdictions to follow.

  16. [pH values in the pharynx of the patients presenting with compromised nasal breathing of inflammatory and non-inflammatory genesis concomitant with gastroesophageal reflux disease].

    PubMed

    Subbotina, M V; Temnikova, I V; Onuchina, E V

    2015-01-01

    The objective of the present study was to estimate the influence of gastroesophageal reflux disease (GERD) on the pH values in the pharynx and nose. It included 87 patients at the age varying from 18 to 81 years admitted to the Irkutsk-based Railway Clinical Hospital and allocated to four groups. Group 1 was comprised of 25 patients presenting with gastroesophageal reflux disease and chronic rhinosinusitis (CRS), group 2 consisted of 29 patients with CRS in the absence of GERD, group 3 included 22 patients with nasal septum deformations (NSD) and GERD, group 4 included 11 patients with NSD and motor rhinitis without GERD. The control group was formed from 10 volunteers. pH was measured by the contact method with the use ofEkokhim indicator paper. Gastroesophageal reflux disease was diagnosed following the recommendations of the Montreal consensus. It was shown that pH values in the pharynx of the patients with compromised nasal breathing of any origin in combination with GERD were lower than in the absence of GERD and in the healthy volunteers. The study groups did not differ in terms of pH values in the nasal cavity. It is concluded that pH values 4 or lower may serve as the criterion for pharyngo-laryngeal reflux (PLR) concomitant with HERD while pH 5 occurs more frequently in the patients with compromised nasal breathing of any etiology, regardless of the presence or absence of GERD.Disordered nasal breathing of any genesis in the patients presenting with gastroesophageal reflux disease was associated with the feeling of the lump in the throat, congestion of the respiratory tract and the nose, pain in the ears, cardialgia, and irregular heartbeat. It isrecommended to use pH measurements as a criterion for diagnostics of pharyngo-laryngeal reflux in the patients presenting with gastroesophageal reflux disease.

  17. Manikin model with breathing tube for wire-guided percutaneous cricothyrotomy in patients applying an intermaxillary fixation.

    PubMed

    Hwang, Kun; Kim, Han Joon; Kim, Yoo Chan; Choi, Yong Soon; Hwang, Se Won

    2014-09-01

    Jaw fracture surgery or orthognathic surgery usually involves the application of an intermaxillary fixation (IMF). Obstructions that cannot be relieved by suction require an immediate release of IMF wires, but releasing the IMF may damage the surgical alignment of the facial bones. The mean time taken to release the jaws was an average of 2 minutes 9 seconds by hospital staff involved in caring for these patients. The aims of this study were to introduce a training model for wire-guided percutaneous cricothyrotomy in the patients applying an IMF and to perform the procedure for medical students. Our model consisted of a facial mannequin, a plastic breathing tube, 2 rolls of tapes, and a reservoir bag. The inner parts of the 2 used rolls of tape represent tracheal/cricoid rings (1-inch width for thyroid and half-inch width for cricoid), and the space between them represents the cricothyroid membrane, which is wrapped with Peha-Haft. A surgeon demonstrated the technique on the model, and then, 60 medical students who had never attended airway-training courses applied the Melker cricothyrotomy kit on the model. All 60 students completed the procedure successfully. The mean (SD) time needed to insert a cricothyrotomy catheter of the medical students was 175 (50) seconds (range, 76-297 s). Most of the students (54; 90%) performed it within 4 minutes; more than half (33; 55%), within 3 minutes. With our manikin model and Melker cricothyrotomy kit, 60 medical students completed the procedure successfully. This model can be useful to cricothyrotomy training for medical personnel.

  18. SU-E-J-185: A Systematic Review of Breathing Guidance in Radiation Oncology and Radiology

    SciTech Connect

    Pollock, S; Keall, P; Keall, R

    2015-06-15

    Purpose: The advent of image-guided radiation therapy (IGRT) has led to dramatic improvements in the accuracy of treatment delivery in radiotherapy. Such advancements have highlighted the deleterious impact tumor motion can have on both image quality and radiation treatment delivery. One approach to reducing tumor motion is the use of breathing guidance systems during imaging and treatment. A review of such research had not yet been performed, it was therefore our aim to perform a systematic review of breathing guidance interventions within the fields of radiation oncology and radiology. Methods: Results of online database searches were filtered in accordance to a set of eligibility criteria. The search, filtration, and analysis of articles were conducted in accordance with the PRISMAStatement reporting standard (Preferred Reporting Items for Systematic reviews and Meta-Analyses) utilizing the PICOS approach (Participants, Intervention, Comparison, Outcome, Study design). Participants: Cancer patients, healthy volunteers. Intervention: Biofeedback breathing guidance systems. Comparison: No breathing guidance of the same breathing type. Outcome: Regularity of breathing signal and anatomic/tumor motion, medical image quality, radiation treatment margins and coverage, medical imaging and radiation treatment times. Study design: Quantitative and controlled prospective or retrospective trials. Results: The systematic search yielded a total of 479 articles, which were filtered down to 27 relevant articles in accordance to the eligibility criteria. The vast majority of investigated outcomes were significantly positively impacted by the use of breathing guidance; however, this was dependent upon the nature of the breathing guidance system and study design. In 25/27 studies significant improvements from the use of breathing guidance were observed. Conclusion: The results found here indicate that further clinical studies are warranted which quantify more comprehensively the

  19. Phosgene- and chlorine-induced acute lung injury in rats: comparison of cardiopulmonary function and biomarkers in exhaled breath.

    PubMed

    Luo, Sa; Trübel, Hubert; Wang, Chen; Pauluhn, Jürgen

    2014-12-01

    This study compares changes in cardiopulmonary function, selected endpoints in exhaled breath, blood, and bronchoalveolar lavage fluid (BAL) following a single, high-level 30-min nose-only exposure of rats to chlorine and phosgene gas. The time-course of lung injury was systematically examined up to 1-day post-exposure with the objective to identify early diagnostic biomarkers suitable to guide countermeasures to accidental exposures. Chlorine, due to its water solubility, penetrates the lung concentration-dependently whereas the poorly water-soluble phosgene reaches the alveolar region without any appreciable extent of airway injury. Cardiopulmonary endpoints were continually recorded by telemetry and barometric plethysmography for 20h. At several time points blood was collected to evaluate evidence of hemoconcentration, changes in hemostasis, and osteopontin. One day post-exposure, protein, osteopontin, and cytodifferentials were determined in BAL. Nitric oxide (eNO) and eCO2 were non-invasively examined in exhaled breath 5 and 24h post-exposure. Chlorine-exposed rats elaborated a reflexively-induced decreased respiratory rate and bradycardia whereas phosgene-exposed rats developed minimal changes in lung function but a similar magnitude of bradycardia. Despite similar initial changes in cardiac function, the phosgene-exposed rats showed different time-course changes of hemoconcentration and lung weights as compared to chlorine-exposed rats. eNO/eCO2 ratios were most affected in chlorine-exposed rats in the absence of any marked time-related changes. This outcome appears to demonstrate that nociceptive reflexes with changes in cardiopulmonary function resemble typical patterns of mixed airway-alveolar irritation in chlorine-exposed rats and alveolar irritation in phosgene-exposed rats. The degree and time-course of pulmonary injury was reflected best by eNO/eCO2 ratios, hemoconcentration, and protein in BAL. Increased fibrin in blood occurred only in chlorine

  20. Phosgene- and chlorine-induced acute lung injury in rats: comparison of cardiopulmonary function and biomarkers in exhaled breath.

    PubMed

    Luo, Sa; Trübel, Hubert; Wang, Chen; Pauluhn, Jürgen

    2014-12-01

    This study compares changes in cardiopulmonary function, selected endpoints in exhaled breath, blood, and bronchoalveolar lavage fluid (BAL) following a single, high-level 30-min nose-only exposure of rats to chlorine and phosgene gas. The time-course of lung injury was systematically examined up to 1-day post-exposure with the objective to identify early diagnostic biomarkers suitable to guide countermeasures to accidental exposures. Chlorine, due to its water solubility, penetrates the lung concentration-dependently whereas the poorly water-soluble phosgene reaches the alveolar region without any appreciable extent of airway injury. Cardiopulmonary endpoints were continually recorded by telemetry and barometric plethysmography for 20h. At several time points blood was collected to evaluate evidence of hemoconcentration, changes in hemostasis, and osteopontin. One day post-exposure, protein, osteopontin, and cytodifferentials were determined in BAL. Nitric oxide (eNO) and eCO2 were non-invasively examined in exhaled breath 5 and 24h post-exposure. Chlorine-exposed rats elaborated a reflexively-induced decreased respiratory rate and bradycardia whereas phosgene-exposed rats developed minimal changes in lung function but a similar magnitude of bradycardia. Despite similar initial changes in cardiac function, the phosgene-exposed rats showed different time-course changes of hemoconcentration and lung weights as compared to chlorine-exposed rats. eNO/eCO2 ratios were most affected in chlorine-exposed rats in the absence of any marked time-related changes. This outcome appears to demonstrate that nociceptive reflexes with changes in cardiopulmonary function resemble typical patterns of mixed airway-alveolar irritation in chlorine-exposed rats and alveolar irritation in phosgene-exposed rats. The degree and time-course of pulmonary injury was reflected best by eNO/eCO2 ratios, hemoconcentration, and protein in BAL. Increased fibrin in blood occurred only in chlorine

  1. Comparison of three humidifiers during high-frequency percussive ventilation using the VDR-4® Fail-safe Breathing Circuit Hub.

    PubMed

    Tiffin, Norman H; Short, Kathy A; Jones, Samuel W; Cairns, Bruce A

    2011-01-01

    The VDR-4® high-frequency percussive ventilator (HFPV) has been shown to be beneficial in the management of inhalation injury by improving secretion clearance while maintaining oxygenation and ventilation. Delivery of gas flow during HFPV could lack adequate humidification delivered to the patient because a major portion of the delivered gas flow would bypass the humidifier when using the original VDR-4® ventilator circuit. The authors tested a novel inline vaporizing humidifier and two gas-water interface humidifiers during HFPV using the new VDR-4® Fail-safe Breathing Circuit Hub® to determine whether delivered humidification could be improved. This new humidification system, the Hydrate Omni™, delivers water vapor into the gas flow of the ventilator circuit rather than water droplets as delivered by the gas-water interface humidifiers. Measurements of absolute humidity and gas temperature were made on the three different humidification systems using a test lung model under standard ambient conditions. The authors found that when using the novel inline vaporizer, it provided better humidification when compared with the standard gas-water interface humidifier during HFPV using the new VDR-4® breathing circuit.

  2. What Controls Your Breathing?

    MedlinePlus

    ... To a limited degree, you can change your breathing rate, such as by breathing faster or holding your ... oxygen levels in your blood and change your breathing rate as needed. Sensors in the airways detect lung ...

  3. Breath alcohol test

    MedlinePlus

    Alcohol test - breath ... There are various brands of breath alcohol tests. Each one uses a different method to test the level of alcohol in the breath. The machine may be electronic or manual. One ...

  4. Breath-Holding Spells

    MedlinePlus

    ... less than a minute before a child regains consciousness and resumes breathing normally. Breath-holding spells can ... spells cause kids to stop breathing and lose consciousness for up to a minute. In the most ...

  5. Analysis of Exhaled Breath for Disease Detection

    NASA Astrophysics Data System (ADS)

    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. Interactive Visualization for Patient-to-Patient Comparison.

    PubMed

    Nguyen, Quang Vinh; Nelmes, Guy; Huang, Mao Lin; Simoff, Simeon; Catchpoole, Daniel

    2014-03-01

    A visual analysis approach and the developed supporting technology provide a comprehensive solution for analyzing large and complex integrated genomic and biomedical data. This paper presents a methodology that is implemented as an interactive visual analysis technology for extracting knowledge from complex genetic and clinical data and then visualizing it in a meaningful and interpretable way. By synergizing the domain knowledge into development and analysis processes, we have developed a comprehensive tool that supports a seamless patient-to-patient analysis, from an overview of the patient population in the similarity space to the detailed views of genes. The system consists of multiple components enabling the complete analysis process, including data mining, interactive visualization, analytical views, and gene comparison. We demonstrate our approach with medical scientists on a case study of childhood cancer patients on how they use the tool to confirm existing hypotheses and to discover new scientific insights.

  7. Breathing difficulty - lying down

    MedlinePlus

    ... Paroxysmal nocturnal dyspnea; PND; Difficulty breathing while lying down; Orthopnea ... does not directly cause difficulty breathing while lying down but often worsens other conditions that lead to ...

  8. Tidal breathing parameters in young children: comparison of measurement by respiratory inductance plethysmography to a facemask pneumotachograph system.

    PubMed

    Manczur, T; Greenough, A; Hooper, R; Allen, K; Latham, S; Price, J F; Rafferty, G F

    1999-12-01

    The ratio of expiratory time at tidal peak flow to total expiratory time (t(ptef)/t(e)) correlates with conventional measures of airway obstruction. It is usually assessed using a facemask and pneumotachograph system which may be poorly tolerated in young children and hence limits the usefulness of this technique. We therefore determined in young asthmatic children the accuracy of t(ptef)/t(e), using an uncalibrated respiratory inductance plethysmograph (RIP), and compared the results with those from a facemask-pneumotachograph system. We also assessed whether age influenced the agreement between measurements using the two devices. Forty-seven children aged between 1 month and 12 years were recruited: 39 were inpatients recovering from an acute wheezy episode, and 8 were recruited from the asthma clinic. All were receiving bronchodilators. Tidal breathing parameters t(ptef)/t(e), the duty cycle (t(i)/t(tot)), and respiratory rate were initially measured using the Respitrace alone and then simultaneously with both the Respitrace and the facemask-pneumotachograph system. Eight children did not tolerate the facemask, and in two others it was impossible to analyze the Respitrace trace due to artefacts. In the remaining 37 children, the reliability coefficients and coefficients of variation of the two techniques were similar. Similar values of t(i)/t(tot) and respiratory rate were obtained using the two devices. The mean t(ptef)/t(e) obtained using the Respitrace was lower than with the facemask-pneumotachograph system (P < 0.01), although this was age group-dependent (P < 0.05), as the difference was less apparent in the 1 to 2-year-old children than in other age groups. Application of the facemask-pneumotachograph system did not significantly influence the results obtained using the Respitrace. We conclude that uncalibrated respiratory inductance plethysmography can measure tidal breathing parameters as reliably as a facemask-pneumotachograph system in young asthmatic

  9. Amplitude gating for a coached breathing approach in respiratory gated 10 MV flattening filter-free VMAT delivery.

    PubMed

    Viel, Francis; Lee, Richard; Gete, Ermias; Duzenli, Cheryl

    2015-01-01

    The purpose of this study was to investigate amplitude gating combined with a coached breathing strategy for 10 MV flattening filter-free (FFF) volumetric-modulated arc therapy (VMAT) on the Varian TrueBeam linac. Ten patient plans for VMAT SABR liver were created using the Eclipse treatment planning system (TPS). The verification plans were then transferred to a CT-scanned Quasar phantom and delivered on a TrueBeam linac using a 10 MV FFF beam and Varian's real-time position management (RPM) system for respiratory gating based on breathing amplitude. Breathing traces were acquired from ten patients using two kinds of breathing patterns: free breathing and an interrupted (~ 5 s pause) end of exhale coached breathing pattern. Ion chamber and Gafchromic film measurements were acquired for a gated delivery while the phantom moved under the described breathing patterns, as well as for a nongated stationary phantom delivery. The gate window was set to obtain a range of residual target motion from 2-5 mm. All gated deliveries on a moving phantom have been shown to be dosimetrically equivalent to the nongated deliveries on a static phantom, with differences in point dose measurements under 1% and average gamma 2%/2 mm agreement above 98.7%. Comparison with the treatment planning system also resulted in good agreement, with differences in point-dose measurements under 2.5% and average gamma 3%/3 mm agreement of 97%. The use of a coached breathing pattern significantly increases the duty cycle, compared with free breathing, and allows for shorter treatment times. Patients' free-breathing patterns contain considerable variability and, although dosimetric results for gated delivery may be acceptable, it is difficult to achieve efficient treatment delivery. A coached breathing pattern combined with a 5 mm amplitude gate, resulted in both high-quality dose distributions and overall shortest gated beam delivery times.

  10. Amplitude gating for a coached breathing approach in respiratory gated 10 MV flattening filter-free VMAT delivery.

    PubMed

    Viel, Francis; Lee, Richard; Gete, Ermias; Duzenli, Cheryl

    2015-01-01

    The purpose of this study was to investigate amplitude gating combined with a coached breathing strategy for 10 MV flattening filter-free (FFF) volumetric-modulated arc therapy (VMAT) on the Varian TrueBeam linac. Ten patient plans for VMAT SABR liver were created using the Eclipse treatment planning system (TPS). The verification plans were then transferred to a CT-scanned Quasar phantom and delivered on a TrueBeam linac using a 10 MV FFF beam and Varian's real-time position management (RPM) system for respiratory gating based on breathing amplitude. Breathing traces were acquired from ten patients using two kinds of breathing patterns: free breathing and an interrupted (~ 5 s pause) end of exhale coached breathing pattern. Ion chamber and Gafchromic film measurements were acquired for a gated delivery while the phantom moved under the described breathing patterns, as well as for a nongated stationary phantom delivery. The gate window was set to obtain a range of residual target motion from 2-5 mm. All gated deliveries on a moving phantom have been shown to be dosimetrically equivalent to the nongated deliveries on a static phantom, with differences in point dose measurements under 1% and average gamma 2%/2 mm agreement above 98.7%. Comparison with the treatment planning system also resulted in good agreement, with differences in point-dose measurements under 2.5% and average gamma 3%/3 mm agreement of 97%. The use of a coached breathing pattern significantly increases the duty cycle, compared with free breathing, and allows for shorter treatment times. Patients' free-breathing patterns contain considerable variability and, although dosimetric results for gated delivery may be acceptable, it is difficult to achieve efficient treatment delivery. A coached breathing pattern combined with a 5 mm amplitude gate, resulted in both high-quality dose distributions and overall shortest gated beam delivery times. PMID:26219000

  11. New optical analyzer for 13C-breath test

    NASA Astrophysics Data System (ADS)

    Harde, Hermann; Dressler, Matthias; Helmrich, Günther; Wolff, Marcus; Groninga, Hinrich

    2008-04-01

    Medical breath tests are well established diagnostic tools, predominantly for gastroenterological inspections, but also for many other examinations. Since the composition and concentration of exhaled volatile gases reflect the physical condition of a patient, a breath analysis allows one 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 is based on photoacoustic spectroscopy and uses a DFB diode laser at 2.744 μm. The concentration ratio of the CO II isotopologues is determined by measuring the absorption on a 13CO II line in comparison to a 12CO II line. In the specially selected spectral range the lines have similar strengths, although the concentrations differ by a factor of 90. Therefore, the signals are well comparable. Due to an excellent signal-noise-ratio isotope variations of less than 1% can be resolved as required for the breath test.

  12. 13C-breath tests for sucrose digestion in congenital sucrase isomaltase-deficient and sacrosidase-supplemented patients

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Congenital sucrase-isomaltase deficiency (CSID) is characterized by absence or deficiency of the mucosal sucrase-isomaltase enzyme. Specific diagnosis requires upper gastrointestinal biopsy with evidence of low to absent sucrase enzyme activity and normal histology. The hydrogen breath test (BT) is ...

  13. SU-E-J-183: Quantifying the Image Quality and Dose Reduction of Respiratory Triggered 4D Cone-Beam Computed Tomography with Patient- Measured Breathing

    SciTech Connect

    Cooper, B; OBrien, R; Kipritidis, J; Keall, P

    2014-06-01

    Purpose: Respiratory triggered four dimensional cone-beam computed tomography (RT 4D CBCT) is a novel technique that uses a patient's respiratory signal to drive the image acquisition with the goal of imaging dose reduction without degrading image quality. This work investigates image quality and dose using patient-measured respiratory signals for RT 4D CBCT simulations instead of synthetic sinusoidal signals used in previous work. Methods: Studies were performed that simulate a 4D CBCT image acquisition using both the novel RT 4D CBCT technique and a conventional 4D CBCT technique from a database of oversampled Rando phantom CBCT projections. A database containing 111 free breathing lung cancer patient respiratory signal files was used to create 111 RT 4D CBCT and 111 conventional 4D CBCT image datasets from realistic simulations of a 4D RT CBCT system. Each of these image datasets were compared to a ground truth dataset from which a root mean square error (RMSE) metric was calculated to quantify the degradation of image quality. The number of projections used in each simulation is counted and was assumed as a surrogate for imaging dose. Results: Based on 111 breathing traces, when comparing RT 4D CBCT with conventional 4D CBCT the average image quality was reduced by 7.6%. However, the average imaging dose reduction was 53% based on needing fewer projections (617 on average) than conventional 4D CBCT (1320 projections). Conclusion: The simulation studies using a wide range of patient breathing traces have demonstrated that the RT 4D CBCT method can potentially offer a substantial saving of imaging dose of 53% on average compared to conventional 4D CBCT in simulation studies with a minimal impact on image quality. A patent application (PCT/US2012/048693) has been filed which is related to this work.

  14. Respiratory monitoring system based on the nasal pressure technique for the analysis of sleep breathing disorders: Reduction of static and dynamic errors, and comparisons with thermistors and pneumotachographs

    NASA Astrophysics Data System (ADS)

    Alves de Mesquita, Jayme; Lopes de Melo, Pedro

    2004-03-01

    Thermally sensitive devices—thermistors—have usually been used to monitor sleep-breathing disorders. However, because of their long time constant, these devices are not able to provide a good characterization of fast events, like hypopneas. Nasal pressure recording technique (NPR) has recently been suggested to quantify airflow during sleep. It is claimed that the short time constants of the devices used to implement this technique would allow an accurate analysis of fast abnormal respiratory events. However, these devices present errors associated with nonlinearities and acoustic resonance that could reduce the diagnostic value of the NPR. Moreover, in spite of the high scientific and clinical potential, there is no detailed description of a complete instrumentation system to implement this promising technique in sleep studies. In this context, the purpose of this work was twofold: (1) describe the development of a flexible NPR device and (2) evaluate the performance of this device when compared to pneumotachographs (PNTs) and thermistors. After the design details are described, the system static accuracy is evaluated by a comparative analysis with a PNT. This analysis revealed a significant reduction (p<0.001) of the static error when system nonlinearities were reduced. The dynamic performance of the NPR system was investigated by frequency response analysis and time constant evaluations and the results showed that the developed device response was as good as PNT and around 100 times faster (τ=5,3 ms) than thermistors (τ=512 ms). Experimental results obtained in simulated clinical conditions and in a patient are presented as examples, and confirmed the good features achieved in engineering tests. These results are in close agreement with physiological fundamentals, supplying substantial evidence that the improved dynamic and static characteristics of this device can contribute to a more accurate implementation of medical research projects and to improve the

  15. Quantifying the image quality and dose reduction of respiratory triggered 4D cone-beam computed tomography with patient-measured breathing

    NASA Astrophysics Data System (ADS)

    Cooper, Benjamin J.; O'Brien, Ricky T.; Kipritidis, John; Shieh, Chun-Chien; Keall, Paul J.

    2015-12-01

    Respiratory triggered four dimensional cone-beam computed tomography (RT 4D CBCT) is a novel technique that uses a patient’s respiratory signal to drive the image acquisition with the goal of imaging dose reduction without degrading image quality. This work investigates image quality and dose using patient-measured respiratory signals for RT 4D CBCT simulations. Studies were performed that simulate a 4D CBCT image acquisition using both the novel RT 4D CBCT technique and a conventional 4D CBCT technique. A set containing 111 free breathing lung cancer patient respiratory signal files was used to create 111 pairs of RT 4D CBCT and conventional 4D CBCT image sets from realistic simulations of a 4D CBCT system using a Rando phantom and the digital phantom, XCAT. Each of these image sets were compared to a ground truth dataset from which a mean absolute pixel difference (MAPD) metric was calculated to quantify the degradation of image quality. The number of projections used in each simulation was counted and was assumed as a surrogate for imaging dose. Based on 111 breathing traces, when comparing RT 4D CBCT with conventional 4D CBCT, the average image quality was reduced by 7.6% (Rando study) and 11.1% (XCAT study). However, the average imaging dose reduction was 53% based on needing fewer projections (617 on average) than conventional 4D CBCT (1320 projections). The simulation studies have demonstrated that the RT 4D CBCT method can potentially offer a 53% saving in imaging dose on average compared to conventional 4D CBCT in simulation studies using a wide range of patient-measured breathing traces with a minimal impact on image quality.

  16. Pitfalls in the evaluation of shortness of breath.

    PubMed

    Wills, Charlotte Page; Young, Megann; White, Douglas W

    2010-02-01

    This article illustrates the challenges practitioners face evaluating shortness of breath, a common emergency department complaint. Through a series of patient encounters, pitfalls in the evaluation of shortness of breath are reviewed and discussed. PMID:19945605

  17. Noninvasive detection of lung cancer by analysis of exhaled breath

    PubMed Central

    2009-01-01

    -MS measurements). A comparison of the GCMS-results of 65 lung cancer patients with those of 31 healthy volunteers revealed differences in concentration for more than 50 compounds. Sensitivity for detection of lung cancer patients based on presence of (one of) 4 different compounds not arising in exhaled breath of healthy volunteers was 52% with a specificity of 100%. Using 15 (or 21) different compounds for distinction, sensitivity was 71% (80%) with a specificity of 100%. Potential marker compounds are alcohols, aldehydes, ketones and hydrocarbons. Conclusion GCMS-SPME is a relatively insensitive method. Hence compounds not appearing in exhaled breath of healthy volunteers may be below the limit of detection (LOD). PTR-MS, on the other hand, does not need preconcentration and gives much more reliable quantitative results then GCMS-SPME. The shortcoming of PTR-MS is that it cannot identify compounds with certainty. Hence SPME-GCMS and PTR-MS complement each other, each method having its particular advantages and disadvantages. Exhaled breath analysis is promising to become a future non-invasive lung cancer screening method. In order to proceed towards this goal, precise identification of compounds observed in exhaled breath of lung cancer patients is necessary. Comparison with compounds released from lung cancer cell cultures, and additional information on exhaled breath composition in other cancer forms will be important. PMID:19788722

  18. 13C-tryptophan breath test detects increased catabolic turnover of tryptophan along the kynurenine pathway in patients with major depressive disorder

    PubMed Central

    Teraishi, Toshiya; Hori, Hiroaki; Sasayama, Daimei; Matsuo, Junko; Ogawa, Shintaro; Ota, Miho; Hattori, Kotaro; Kajiwara, Masahiro; Higuchi, Teruhiko; Kunugi, Hiroshi

    2015-01-01

    Altered tryptophan–kynurenine (KYN) metabolism has been implicated in major depressive disorder (MDD). The l-[1-13C]tryptophan breath test (13C-TBT) is a noninvasive, stable-isotope tracer method in which exhaled 13CO2 is attributable to tryptophan catabolism via the KYN pathway. We included 18 patients with MDD (DSM-IV) and 24 age- and sex-matched controls. 13C-tryptophan (150 mg) was orally administered and the 13CO2/12CO2 ratio in the breath was monitored for 180 min. The cumulative recovery rate during the 180-min test (CRR0–180; %), area under the Δ13CO2-time curve (AUC; %*min), and the maximal Δ13CO2 (Cmax; %) were significantly higher in patients with MDD than in the controls (p = 0.004, p = 0.008, and p = 0.002, respectively). Plasma tryptophan concentrations correlated negatively with Cmax in both the patients and controls (p = 0.020 and p = 0.034, respectively). Our results suggest that the 13C-TBT could be a novel biomarker for detecting a subgroup of MDD with increased tryptophan–KYN metabolism. PMID:26524975

  19. Slow breathing influences cardiac autonomic responses to postural maneuver: Slow breathing and HRV.

    PubMed

    Vidigal, Giovanna Ana de Paula; Tavares, Bruna S; Garner, David M; Porto, Andrey A; Carlos de Abreu, Luiz; Ferreira, Celso; Valenti, Vitor E

    2016-05-01

    Chronic slow breathing has been reported to improve Heart Rate Variability (HRV) in patients with cardiovascular disorders. However, it is not clear regarding its acute effects on HRV responses on autonomic analysis. We evaluated the acute effects of slow breathing on cardiac autonomic responses to postural change manoeuvre (PCM). The study was conducted on 21 healthy male students aged between 18 and 35 years old. In the control protocol, the volunteer remained at rest seated for 15 min under spontaneous breathing and quickly stood up within 3 s and remained standing for 15 min. In the slow breathing protocol, the volunteer remained at rest seated for 10 min under spontaneous breath, then performed slow breathing for 5 min and rapidly stood up within 3 s and remained standing for 15 min. Slow breathing intensified cardiac autonomic responses to postural maneuver. PMID:27157952

  20. Active breathing control (ABC): Determination and reduction of breathing-induced organ motion in the chest

    SciTech Connect

    Gagel, Bernd . E-mail: BGagel@UKAachen.de; Demirel, Cengiz M.P.; Kientopf, Aline; Pinkawa, Michael; Piroth, Marc; Stanzel, Sven; Breuer, Christian; Asadpour, Branka; Jansen, Thomas; Holy, Richard; Wildberger, Joachim E.; Eble, Michael J.

    2007-03-01

    Purpose: Extensive radiotherapy volumes for tumors of the chest are partly caused by interfractional organ motion. We evaluated the feasibility of respiratory observation tools using the active breathing control (ABC) system and the effect on breathing cycle regularity and reproducibility. Methods and Materials: Thirty-six patients with unresectable tumors of the chest were selected for evaluation of the ABC system. Computed tomography scans were performed at various respiratory phases starting at the same couch position without patient movement. Threshold levels were set at minimum and maximum volume during normal breathing cycles and at a volume defined as shallow breathing, reflecting the subjective maximal tolerable reduction of breath volume. To evaluate the extent of organ movement, 13 landmarks were considering using commercial software for image coregistration. In 4 patients, second examinations were performed during therapy. Results: Investigating the differences in a normal breathing cycle versus shallow breathing, a statistically significant reduction of respiratory motion in the upper, middle, and lower regions of the chest could be detected, representing potential movement reduction achieved through reduced breath volume. Evaluating interfraction reproducibility, the mean displacement ranged between 0.24 mm (chest wall/tracheal bifurcation) to 3.5 mm (diaphragm) for expiration and shallow breathing and 0.24 mm (chest wall) to 5.25 mm (diaphragm) for normal inspiration. Conclusions: By modifying regularity of the respiratory cycle through reduction of breath volume, a significant and reproducible reduction of chest and diaphragm motion is possible, enabling reduction of treatment planning margins.

  1. Dosimetric Benefits of Intensity-Modulated Radiotherapy Combined With the Deep-Inspiration Breath-Hold Technique in Patients With Mediastinal Hodgkin's Lymphoma

    SciTech Connect

    Paumier, Amaury; Ghalibafian, Mithra; Gilmore, Jennifer; Beaudre, Anne; Blanchard, Pierre; El Nemr, Mohammed; Azoury, Farez; Al Hamokles, Hweej; Lefkopoulos, Dimitri; Girinsky, Theodore

    2012-03-15

    Purpose: To assess the additional benefits of using the deep-inspiration breath-hold (DIBH) technique with intensity-modulated radiotherapy (IMRT) in terms of the protection of organs at risk for patients with mediastinal Hodgkin's disease. Methods and Materials: Patients with early-stage Hodgkin's lymphoma with mediastinal involvement were entered into the study. Two simulation computed tomography scans were performed for each patient: one using the free-breathing (FB) technique and the other using the DIBH technique with a dedicated spirometer. The clinical target volume, planning target volume (PTV), and organs at risk were determined on both computed tomography scans according to the guidelines of the European Organization for Research and Treatment of Cancer. In both cases, 30 Gy in 15 fractions was prescribed. The dosimetric parameters retrieved for the statistical analysis were PTV coverage, mean heart dose, mean coronary artery dose, mean lung dose, and lung V20. Results: There were no significant differences in PTV coverage between the two techniques (FB vs. DIBH). The mean doses delivered to the coronary arteries, heart, and lungs were significantly reduced by 15% to 20% using DIBH compared with FB, and the lung V20 was reduced by almost one third. The dose reduction to organs at risk was greater for masses in the upper part of the mediastinum. IMRT with DIBH was partially implemented in 1 patient. This combination will be extended to other patients in the near future. Conclusions: Radiation exposure of the coronary arteries, heart, and lungs in patients with mediastinal Hodgkin's lymphoma was greatly reduced using DIBH with IMRT. The greatest benefit was obtained for tumors in the upper part of the mediastinum. The possibility of a wider use in clinical practice is currently under investigation in our department.

  2. Limitations in the use of /sup 14/C-glycocholate breath and stool bile acid determinations in patients with chronic diarrhea

    SciTech Connect

    Ferguson, J.; Walker, K.; Thomson, A.B.

    1986-06-01

    Analysis of a modified /sup 14/C-glycocholate breath test on 165 consecutive in-patients being investigated for chronic diarrhea showed that the measurement of /sup 14/CO/sub 2/ between 3 and 6 h after oral dosing of 5 microCi of /sup 14/C-glycocholic acid was of only limited use to distinguish between patients with Crohn's disease (CD), idiopathic bile salt wastage (IBW), or ileal resection (IR) from those with the irritable bowel syndrome (IBS). Continuing /sup 14/CO/sub 2/ collections for up to 24 h was of little more help in establishing the presence of bacterial overgrowth syndrome (BOS) and in distinguishing between BOS and CD. Stool bile acid measurements were of use in differentiating between IBW and IBS, but did not distinguish between CD and BOS or between CD and IR. Since the range of normal values was defined by measurements in the IBS group, a positive test was specific for an organic cause of chronic diarrhea. Even so, the sensitivity of the test was relatively low: CD, 53%; IR, 23%; IBW, /sup 14/%; and BOS, 10%. We believe that the 24-h /sup 14/C-glycocholic breath test combined with the measurement of stool bile acids represents a screening test of only limited use for the identification of organic causes of chronic diarrhea.

  3. Minimizing Shortness of Breath

    MedlinePlus

    ... Top Doctors in the Nation Departments & Divisions Home Health Insights Stress & Relaxation Breathing and Relaxation Minimizing Shortness of Breath ... Management Assess Your Stress Coping Strategies Identifying ... & Programs Health Insights Doctors & Departments Research & Science Education & Training Make ...

  4. Breathing and Relaxation

    MedlinePlus

    ... Top Doctors in the Nation Departments & Divisions Home Health Insights Stress & Relaxation Breathing and Relaxation Breathing and Relaxation Make ... Management Assess Your Stress Coping Strategies Identifying ... & Programs Health Insights Doctors & Departments Research & Science Education & Training Make ...

  5. Radiobiological evaluation of breast cancer radiotherapy accounting for the effects of patient positioning and breathing in dose delivery. A meta analysis.

    PubMed

    Tzikas, A; Komisopoulos, G; Ferreira, B C; Hyodynmaa, S; Axelsson, S; Papanikolaou, N; Lavdas, E; Lind, B K; Mavroidis, P

    2013-02-01

    In breast cancer radiotherapy, significant discrepancies in dose delivery can contribute to underdosage of the tumor or overdosage of normal tissue, which is potentially related to a reduction of local tumor control and an increase of side effects. To study the impact of these factors in breast cancer radiotherapy, a meta analysis of the clinical data reported by Mavroidis et al. (2002) in Acta Oncol (41:471-85), showing the patient setup and breathing uncertainties characterizing three different irradiation techniques, were employed. The uncertainties in dose delivery are simulated based on fifteen breast cancer patients (5 mastectomized, 5 resected with negative node involvement (R-) and 5 resected with positive node involvement (R1)), who were treated by three different irradiation techniques, respectively. The positioning and breathing effects were taken into consideration in the determination of the real dose distributions delivered to the CTV and lung in each patient. The combined frequency distributions of the positioning and breathing distributions were obtained by convolution. For each patient the effectiveness of the dose distribution applied is calculated by the Poisson and relative seriality models and a set of parameters that describe the dose-response relations of the target and lung. The three representative radiation techniques are compared based on radiobiological measures by using the complication-free tumor control probability, P(+) and the biologically effective uniform dose, (BEUD)concepts. For the Mastectomy case, the average P(+) values of the planned and delivered dose distributions are 93.8% for a (BEUD)(CTV) of 51.8 Gy and 85.0% for a (BEUD)(CTV) of 50.3 Gy, respectively. The respective total control probabilities, P(B) values are 94.8% and 92.5%, whereas the corresponding total complication probabilities, P(1) values are 0.9% and 7.4%. For the R- case, the average P(+) values are 89.4% for a (BEUD)(CTV) of 48.9 Gy and 88.6% for a

  6. Breath Tests to Assess Alcoholic Liver Disease.

    PubMed

    Furnari, Manuele; Ahmed, Iftikhar; Erpecum, Karel J van; Savarino, Vincenzo; Giannini, Edoardo G

    2016-01-01

    The prevalence of Alcohol related Liver Disease (ALD) continues to rise all over the world due to changing drinking behaviour of the population. Liver disease due to excessive alcohol consumption causes significant morbidity and mortality, and poses a substantial economic burden to the health care resources. Early diagnosis and treatment of ALD may help prevent progression to cirrhosis and hepatocellular carcinoma. The last decade has seen a rising interest in potential use of non-invasive tests in clinical practice, including diagnosis and monitoring of chronic liver diseases. Over the past few decades, breath testing has been investigated extensively in the diagnosis of ALD, and has shown promising results in predicting the early stages of ALD. A variety of breath tests have been utilised in this regard including the13Clabelled breath tests, aminopyrine breath test , galactose breath test , methacetin breath test, and keto-isocaproic acid breath test. These tests have demonstrated good results in identification of both significant and severe liver disease among patients with ALD. Volatile Organic Compounds (VOC) are chemicals, which can be quantified in breath and other biological fluids, and represent physio-pathological activities within an individual. Alteration in the pattern of breath VOCs can be correlated with a number of diseases including ALD. Early stages of ALD can be detected using these breath tests, which can lead to adoption of preventive measures to reduce the progression of liver disease. This review focuses on the clinical utility of current and future breath tests, including breath VOC, as a non-invasive means of predicting early stages of ALD. PMID:27515960

  7. A convenient and reliable method for carbogen breathing in man.

    PubMed

    Kaanders, J H; van der Maazen, R W

    1993-12-01

    The feasibility of carbogen breathing and the intake of nicotinamide in combination with radiation therapy is currently being tested for clinical application. A dependable and convenient system for carbogen breathing is presented which can be easily combined with techniques for immobilization of the patient. The proposed method ensures adequate breathing of carbogen.

  8. Study on the sampling of methadone from exhaled breath.

    PubMed

    Beck, Olof; Sandqvist, Sören; Böttcher, Michael; Eriksen, Paul; Franck, Johan; Palmskog, Göran

    2011-06-01

    This study aimed at develop and validate the procedure for collecting exhaled breath for drug testing. Patients receiving methadone maintenance treatment were recruited for the study. Methadone levels were measured using liquid chromatography- electrospray-tandem mass spectrometry. The sampling device was based on a 47-mm C(18) filter and used under pressure to aid flow through the filter. The mouth was rinsed before sampling, and the device was constructed to protect against any saliva contamination. Methadone was present in breath samples before and after the daily intake of methadone. The mean (± SD) pre-dose level was found to be 135 ± 109 pg/min (n = 48, median 121). The exhaled methadone increased after dose intake. Saliva levels of methadone were high in comparison with exhaled breath levels. Saliva contamination was suspected in about 10% of the collected samples. Similar results were obtained using 1, 3, and 10 min sampling times. The inter- and intraindividual variability were found to be similar and in the order of 50%. Alternative sampling using XAD-2 beads and solid-phase microextraction fiber was found to be possible and enables sampling with low back pressure and with no need for pump assistance. The presented results confirm that breath testing is a new possibility for the detection of drugs of abuse.

  9. Effect of Early Intervention With Positive Airway Pressure Therapy for Sleep Disordered Breathing on Six-Month Readmission Rates in Hospitalized Patients With Heart Failure.

    PubMed

    Sharma, Sunil; Mather, Paul; Gupta, Ankit; Reeves, Gordon; Rubin, Sharon; Bonita, Raphael; Chowdhury, Anindita; Malloy, Raymond; Willes, Leslee; Whellan, David

    2016-03-15

    Rehospitalization for congestive heart failure (CHF) is high within 6 months of discharge. Sleep disordered breathing (SDB) is common and underdiagnosed condition in patients with CHF. We hypothesized that early recognition and treatment of SDB in hospitalized patients with CHF will reduce hospital readmissions and emergency room visits. Patients admitted for CHF underwent overnight polysomnography within 4 weeks of discharge. Patients diagnosed with SDB were provided therapy with positive airway pressure therapy. Patients were identified as having good compliance if the device use was for a minimum of 4 hours 70% of the time for a minimum of 4 weeks during the first 3 months of therapy. Hospital admissions for 6 months before therapy were compared with readmission within 6 months after therapy in patients with good and poor compliance. A total of 70 patients were diagnosed with SDB after discharge. Of the 70 patients, 37 (53%) were compliant with positive airway pressure therapy. Compliant patients were more likely to be older (64 ± 12 vs 58 ± 11 years) and women (54% vs 33%) and less likely to be patient with diabetes (40% vs 67%) versus noncompliant patients. Although both groups experienced a decrease in total readmissions, compliant patients had a significant reduction (mean ± SE: -1.5 ± 0.2 clinical events vs -0.2 ± 0.3; p <0.0001). In this single-center analysis, identification and treatment of SDB in admitted patients with CHF with SDB is associated with reduced readmissions over 6 months after discharge. Adherence to the treatment was associated with a greater reduction in clinical events. PMID:26830259

  10. Impact of predischarge nocturnal pulse oximetry (sleep-disordered breathing) on postdischarge clinical outcomes in hospitalized patients with left ventricular systolic dysfunction after acute decompensated heart failure.

    PubMed

    Ohmura, Takayasu; Iwama, Yoshitaka; Kasai, Takatoshi; Kato, Takao; Suda, Shoko; Takagi, Atsutoshi; Daida, Hiroyuki

    2014-02-15

    Stratifying patients at a high risk for readmission and mortality before their discharge after acute decompensated heart failure (ADHF) is important. Although sleep-disordered breathing (SDB) is prevalent in patients with chronic heart failure, only few studies have investigated the impact of SDB on hospitalized patients with left ventricular (LV) systolic dysfunction after ADHF. Thus, we assessed the prevalence of SDB using nocturnal pulse oximetry and the relation between SDB and clinical events in this patient group. One hundred consecutive patients with LV systolic dysfunction who were hospitalized for ADHF were enrolled in the study. Predischarge nocturnal oximetry was performed to determine if they had SDB (defined as an oxygen desaturation index of ≥5 events/hour with ≥4% decrease in saturation level). Data on death and readmission for ADHF were collected. Forty-one patients had SDB. Complete outcome data were collected in the mean follow-up period of 14.2 months during which 33 events occurred. On multivariate Cox proportional hazards regression analysis, the presence of SDB was a significant independent predictor of postdischarge readmission and mortality (hazard ratio 2.93, p = 0.006). In conclusion, SDB, as determined by predischarge nocturnal oximetry, is prevalent and is an independent predictor of the combined end point of readmission and mortality in hospitalized patients with LV systolic dysfunction after ADHF.

  11. Rapid shallow breathing index

    PubMed Central

    Karthika, Manjush; Al Enezi, Farhan A.; Pillai, Lalitha V.; Arabi, Yaseen M.

    2016-01-01

    Predicting successful liberation of patients from mechanical ventilation has been a focus of interest to clinicians practicing in intensive care. Various weaning indices have been investigated to identify an optimal weaning window. Among them, the rapid shallow breathing index (RSBI) has gained wide use due to its simple technique and avoidance of calculation of complex pulmonary mechanics. Since its first description, several modifications have been suggested, such as the serial measurements and the rate of change of RSBI, to further improve its predictive value. The objective of this paper is to review the utility of RSBI in predicting weaning success. In addition, the use of RSBI in specific patient populations and the reported modifications of RSBI technique that attempt to improve the utility of RSBI are also reviewed. PMID:27512505

  12. Rapid shallow breathing index.

    PubMed

    Karthika, Manjush; Al Enezi, Farhan A; Pillai, Lalitha V; Arabi, Yaseen M

    2016-01-01

    Predicting successful liberation of patients from mechanical ventilation has been a focus of interest to clinicians practicing in intensive care. Various weaning indices have been investigated to identify an optimal weaning window. Among them, the rapid shallow breathing index (RSBI) has gained wide use due to its simple technique and avoidance of calculation of complex pulmonary mechanics. Since its first description, several modifications have been suggested, such as the serial measurements and the rate of change of RSBI, to further improve its predictive value. The objective of this paper is to review the utility of RSBI in predicting weaning success. In addition, the use of RSBI in specific patient populations and the reported modifications of RSBI technique that attempt to improve the utility of RSBI are also reviewed. PMID:27512505

  13. Breathing evaluation and retraining in manual therapy.

    PubMed

    McLaughlin, Laurie

    2009-07-01

    Patients with back and neck pain commonly seek body work yet there are some who do not experience full recovery with the typical tool kit of manual therapy, education and exercise, suggesting the need for additional clinical approaches. Epidemiological literature linking back pain with breathing difficulties suggests one possibility. Altered motor control associated with back and neck pain appears to negatively impact breathing mechanics, which may have negative consequences on respiratory chemistry. Changes in respiratory chemistry can have profound effects on body system function. Altered breathing has been recognized for many years as a potential source of a wide variety of unexplained symptoms. There has been controversy around accurate diagnosis with symptoms and questionnaires often being the only methods used. Capnography, which is routinely used in critical care settings, offers an objective measure of respiratory chemistry providing physiological data on which to base a diagnosis of poor breathing. Capnography can also be used as biofeedback to guide breathing retraining.

  14. Comparisons between written and computerised patient histories.

    PubMed Central

    Quaak, M J; Westerman, R F; van Bemmel, J H

    1987-01-01

    Patient histories were obtained from 99 patients in three different ways: by a computerised patient interview (patient record), by the usual written interview (medical record), and by the transcribed record, which was a computerised version of the medical record. Patient complaints, diagnostic hypotheses, observer and record variations, and patients' and doctors' opinions were analysed for each record, and records were compared with the final diagnosis. About 40% of the data in the patient record were not present in the medical record. Two thirds of the patients said that they could express all or most of their complaints in the patient record. The doctors found that the medical record expressed the main complaints better (52%) than the patient record (15%) but that diagnostic hypotheses were more certain in the patient record (38%) than in the medical one (26%). The number of diagnostic hypotheses in the patient record was about 20% higher than that in the medical record. Intraobserver agreement (51%) was better than interobserver agreement (32%), while the inter-record agreement varied from 25% (between the medical and patient records) to 35% (between the transcribed and patient records). One third of final diagnoses were seen in the medical record, with 29% and 22% for the transcribed and patient records, respectively. Interobserver agreement in the final diagnosis was 35%. The results of the study suggest that computerised history taking is suitable for certain patients in addition to, and not as a substitute for, the oral interview with a doctor. PMID:3115371

  15. Comparison of the 13C-urea breath test and the endoscopic phenol red mucosal pH test in the quantification of Helicobacter pylori infection loading

    PubMed Central

    Cho, Young-Seok; Jang, Se Na; Kim, Jin-Soo; Son, Hye Suk; Kim, Hyung-Keun; Kim, Byung-Wook; Han, Sok-Won; Choi, Kyu-Yong; Lee, Hae Kyung; Chang, Eun Deok

    2008-01-01

    Background/Aims The 13C-urea breath test (UBT) is a semiquantitative test for measuring Helicobacter pylori infection loading. H. pylori produces ammonia, which elevates the pH of the gastric mucosa and is detectable via endoscopy using a phenol red indicator. We evaluated whether this test could be used to diagnose H. pylori infection and whether phenol red staining was correlated with 13C-UBT results. Methods One hundred and twenty-three patients participated. The UBT was performed after ingestion of a capsule containing urea. A change in 13C-UBT >2‰ was selected as the cutoff value for diagnosing infection. After spraying evenly with a 0.1% phenol red solution, the pH of the gastric mucosal surface was measured using an antimony electrode through the biopsy channel. Results The pH of stained mucosa (6.9±0.4) was significantly higher than that of unstained mucosa (1.9±0.8; p<0.001), and the H. pylori detection rate confirmed via histology was higher in stained versus unstained mucosa (p<0.01). Extensive mucosal staining resulted in a higher detection rate (p<0.001). The UBT produced results were very similar to those obtained via histological detection in stained mucosa (p<0.001). The extent of staining, expressed as a staining score, was positively correlated with the change in 13C-UBT (r=0.426, p<0.001). A significant correlation was also observed between the histologically determined H. pylori density and 13C-UBT results (r=0.674, p<0.001). Conclusions H. pylori infection elevates gastric mucosal surface pH, and endoscopic phenol red staining may be an alternative method for the diagnosis of H. pylori infection. PMID:18787366

  16. News from the Breath Analysis Summit 2011.

    PubMed

    Corradi, Massimo; Mutti, Antonio

    2012-05-23

    (oxygen, nitrogen, water vapour and CO(2)) in patient respiratory monitoring have served as a platform for technological growth in clinical breath-testing applications. A few exhaled breath tests have demonstrated clinical utility and are in widespread use, and several FDA-approved devices are available. These widely used exhaled breath tests include detection of blood alcohol concentration and exhaled CO(2). Other clinical applications of exhaled breath analysis include testing for H. pylori infection, lactose intolerance, heart transplant rejection and, more recently, monitoring of airway inflammation by means of exhaled NO. Examination of exhaled breath has the potential to change the existing routine approaches in human medicine. The rapidly developing new analytical and computer technologies along with novel, unorthodox ideas are prerequisites for future advances in this field. Scientists who participated in the Breath Analysis Summit 2011 were invited to submit a full length paper to the Journal of Breath Research and this issue includes eight articles which describe the different applications of breath analysis. We thank all the authors for their valuable contribution and we trust that this collection will provide useful information and an update to this rapidly evolving field, giving an example of integration among scientists who address the same topic-breath analysis-from different and complementary perspectives, from basic to clinical research.

  17. Gated CT imaging using a free-breathing respiration signal from flow-volume spirometry

    SciTech Connect

    D'Souza, Warren D.; Kwok, Young; Deyoung, Chad; Zacharapoulos, Nicholas; Pepelea, Mark; Klahr, Paul; Yu, Cedric X.

    2005-12-15

    Respiration-induced tumor motion is known to cause artifacts on free-breathing spiral CT images used in treatment planning. This leads to inaccurate delineation of target volumes on planning CT images. Flow-volume spirometry has been used previously for breath-holds during CT scans and radiation treatments using the active breathing control (ABC) system. We have developed a prototype by extending the flow-volume spirometer device to obtain gated CT scans using a PQ 5000 single-slice CT scanner. To test our prototype, we designed motion phantoms to compare image quality obtained with and without gated CT scan acquisition. Spiral and axial (nongated and gated) CT scans were obtained of phantoms with motion periods of 3-5 s and amplitudes of 0.5-2 cm. Errors observed in the volume estimate of these structures were as much as 30% with moving phantoms during CT simulation. Application of motion-gated CT with active breathing control reduced these errors to within 5%. Motion-gated CT was then implemented in patients and the results are presented for two clinical cases: lung and abdomen. In each case, gated scans were acquired at end-inhalation, end-exhalation in addition to a conventional free-breathing (nongated) scan. The gated CT scans revealed reduced artifacts compared with the conventional free-breathing scan. Differences of up to 20% in the volume of the structures were observed between gated and free-breathing scans. A comparison of the overlap of structures between the gated and free-breathing scans revealed misalignment of the structures. These results demonstrate the ability of flow-volume spirometry to reduce errors in target volumes via gating during CT imaging.

  18. Quantifying the Reproducibility of Heart Position During Treatment and Corresponding Delivered Heart Dose in Voluntary Deep Inhalation Breath Hold for Left Breast Cancer Patients Treated With External Beam Radiotherapy

    SciTech Connect

    McIntosh, Alyson; Shoushtari, Asal N.; Benedict, Stanley H.; Read, Paul W.; Wijesooriya, Krishni

    2011-11-15

    Purpose: Voluntary deep inhalation breath hold (VDIBH) reduces heart dose during left breast irradiation. We present results of the first study performed to quantify reproducibility of breath hold using bony anatomy, heart position, and heart dose for VDIBH patients at treatment table. Methods and Materials: Data from 10 left breast cancer patients undergoing VDIBH whole-breast irradiation were analyzed. Two computed tomography (CT) scans, free breathing (FB) and VDIBH, were acquired to compare dose to critical structures. Pretreatment weekly kV orthogonal images and tangential ports were acquired. The displacement difference from spinal cord to sternum across the isocenter between coregistered planning Digitally Reconstructed Radiographs (DRRs) and kV imaging of bony thorax is a measure of breath hold reproducibility. The difference between bony coregistration and heart coregistration was the measured heart shift if the patient is aligned to bony anatomy. Results: Percentage of dose reductions from FB to VDIBH: mean heart dose (48%, SD 19%, p = 0.002), mean LAD dose (43%, SD 19%, p = 0.008), and maximum left anterior descending (LAD) dose (60%, SD 22%, p = 0.008). Average breath hold reproducibility using bony anatomy across the isocenter along the anteroposterior (AP) plane from planning to treatment is 1 (range, 0-3; SD, 1) mm. Average heart shifts with respect to bony anatomy between different breath holds are 2 {+-} 3 mm inferior, 1 {+-} 2 mm right, and 1 {+-} 3 mm posterior. Percentage dose changes from planning to delivery: mean heart dose (7%, SD 6%); mean LAD dose, ((9%, SD 7%)S, and maximum LAD dose, (11%, SD 11%) SD 11%, p = 0.008). Conclusion: We observed excellent three-dimensional bony registration between planning and pretreatment imaging. Reduced delivered dose to heart and LAD is maintained throughout VDIBH treatment.

  19. Exhaled breath condensate detects baseline reductions in chloride and increases in response to albuterol in cystic fibrosis patients.

    PubMed

    Wheatley, Courtney M; Morgan, Wayne J; Cassuto, Nicholas A; Foxx-Lupo, William T; Daines, Cori L; Morgan, Mary A; Phan, Hanna; Snyder, Eric M

    2013-01-01

    Impaired ion regulation and dehydration is the primary pathophysiology in cystic fibrosis (CF) lung disease. A potential application of exhaled breath condensate (EBC) collection is to assess airway surface liquid ionic composition at baseline and in response to pharmacological therapy in CF. Our aims were to determine if EBC could detect differences in ion regulation between CF and healthy and measure the effect of the albuterol on EBC ions in these populations. Baseline EBC Cl(-), DLCO and SpO2 were lower in CF (n = 16) compared to healthy participants (n = 16). EBC Cl(-) increased in CF subjects, while there was no change in DLCO or membrane conductance, but a decrease in pulmonary-capillary blood volume in both groups following albuterol. This resulted in an improvement in diffusion at the alveolar-capillary unit, and removal of the baseline difference in SpO2 by 90-minutes in CF subjects. These results demonstrate that EBC detects differences in ion regulation between healthy and CF individuals, and that albuterol mediates increases in Cl(-) in CF, suggesting that the benefits of albuterol extend beyond simple bronchodilation.

  20. Exhaled Breath Condensate Detects Baseline Reductions in Chloride and Increases in Response to Albuterol in Cystic Fibrosis Patients

    PubMed Central

    Wheatley, Courtney M.; Morgan, Wayne J.; Cassuto, Nicholas A.; Foxx-Lupo, William T.; Daines, Cori L.; Morgan, Mary A.; Phan, Hanna; Snyder, Eric M.

    2013-01-01

    Impaired ion regulation and dehydration is the primary pathophysiology in cystic fibrosis (CF) lung disease. A potential application of exhaled breath condensate (EBC) collection is to assess airway surface liquid ionic composition at baseline and in response to pharmacological therapy in CF. Our aims were to determine if EBC could detect differences in ion regulation between CF and healthy and measure the effect of the albuterol on EBC ions in these populations. Baseline EBC Cl−, DLCO and SpO2 were lower in CF (n = 16) compared to healthy participants (n = 16). EBC Cl− increased in CF subjects, while there was no change in DLCO or membrane conductance, but a decrease in pulmonary-capillary blood volume in both groups following albuterol. This resulted in an improvement in diffusion at the alveolar-capillary unit, and removal of the baseline difference in SpO2 by 90-minutes in CF subjects. These results demonstrate that EBC detects differences in ion regulation between healthy and CF individuals, and that albuterol mediates increases in Cl− in CF, suggesting that the benefits of albuterol extend beyond simple bronchodilation. PMID:24367235

  1. Hydrogen breath tests in gastrointestinal diseases.

    PubMed

    Rana, Satya Vati; Malik, Aastha

    2014-10-01

    Hydrogen breath tests are widely used to explore pathophysiology of functional gastrointestinal (GI) disorders. Small intestinal bacterial overgrowth (SIBO) and carbohydrate malabsorption are disorders detected by these tests that have been proposed to be of great importance for symptoms of GI diseases. Glucose hydrogen breath test is more acceptable for diagnosis of SIBO whereas lactose and fructose hydrogen breath tests are used for detection of lactose and fructose maldigestion respectively. Lactulose hydrogen breath test is also used widely to measure the orocecal transit time for GI motility. These methods are noninvasive and inexpensive. Many patients with functional gut disorders are unaware of the relationship between diet and GI symptoms they present. In particular, patients with chronic symptoms may regard their condition as normal and may not be aware that their symptoms can be effectively managed following a proper diagnosis. Patients with symptoms of abdominal pain, bloating, flatulence and altered bowel movements (diarrhea and constipation), or with a medical diagnosis of irritable bowel syndrome or celiac disease, may have undiagnosed carbohydrate malabsorption or SIBO. Hydrogen breath tests are specific and sensitive diagnostic tests that can be used to either confirm or eliminate the possibility of carbohydrate malabsorption or SIBO in such patients. Breath tests, though valuable tools, are underutilized in evaluating dyspepsia and functional bloating and diarrhea as well as suspected malabsorption. However, because of their simplicity, reproducibility and safety of procedure they are now being substituted to more uncomfortable and expensive techniques that were traditionally used in gastroenterology. PMID:25298621

  2. Simulated breath waveform control

    NASA Technical Reports Server (NTRS)

    Bartlett, R. G.; Hendricks, C. M.; Morison, W. B.

    1972-01-01

    Subsystem was developed which provides twelve waveform controls to breath drive mechanism. Twelve position, magnetically actuated rotary switch is connected to one end of crankshaft drive, such that it makes one complete revolution for each simulated breath. Connections with common wired point are included in modifications made to standard motor speed controller.

  3. From breathing to respiration.

    PubMed

    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.

  4. From breathing to respiration.

    PubMed

    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. PMID:25532022

  5. Detection of inner tube defects in co-axial circle and Bain breathing systems: a comparison of occlusion and Pethick tests.

    PubMed

    Szypula, K A; Ip, J K; Bogod, D; Yentis, S M

    2008-10-01

    The performance of the occlusion and Pethick tests in detecting faulty inner tubes in co-axial circle and Bain systems was compared. Twelve co-axial circle and 12 Bain anaesthetic breathing systems were tested using the occlusion and the Pethick tests. For each system, three tubes were intact, and the remaining nine had a defect deliberately created in the inner tube (three proximal, three middle and three distal). The investigators were blinded to which of the tubes were defective, and to each other's results. The results showed 100% specificity for both tests. The sensitivity of the occlusion test for detecting faulty breathing systems was found to be good (98%). Our results suggest that the occlusion test should be performed in preference to the Pethick test when testing co-axial circle and Bain systems.

  6. Comparison of PCR and common clinical tests for the diagnosis of H. pylori in dyspeptic patients.

    PubMed

    Pacheco, N; Mago, V; Gómez, I; Gueneau, P; Guelrud, M; Reyes, N; Pericchi, L R; Domínguez-Bello, M G

    2001-04-01

    Helicobacter pylori has been recognized as a major gastric pathogen. The objective of this study was to assess the diagnostic value of common clinical tests to detect H. pylori infection, by comparison with PCR. Serum and gastric biopsy specimens from 106 dyspeptic patients were examined. Serology was performed with Pyloriset Dry test, and biopsies were examined histologically, for rapid urease activity and PCR amplification of an ureA gene segment of H. pylori. PCR primers were specific for H. pylori and required at least 1.47 pg of H. pylori DNA, corresponding to about 800 bacterial cells. According to serology, histology, rapid urease, and PCR, positive results were respectively found in 56%, 86%, 64%, and 85% of dyspeptic patients, primarily with gastritis. Relative to PCR, the sensitivity (and specificity) was 55% (38%) for serology, 86% (13%) for histology, 70% (69%) for urease. When combining histology and urease, Bayesian analysis of data indicated no advantage of using combined methods over rapid urease test alone. Histology should not any longer be considered a gold standard test for Helicobacter pylori. Urea breath test still seems the first option for non invasive diagnostic. If an invasive diagnostic is justified, highly specific and sensitive molecular methods should be used to examine specimens. PMID:11404061

  7. Whole left ventricular functional assessment from two minutes free breathing multi-slice CINE acquisition

    NASA Astrophysics Data System (ADS)

    Usman, M.; Atkinson, D.; Heathfield, E.; Greil, G.; Schaeffter, T.; Prieto, C.

    2015-04-01

    Two major challenges in cardiovascular MRI are long scan times due to slow MR acquisition and motion artefacts due to respiratory motion. Recently, a Motion Corrected-Compressed Sensing (MC-CS) technique has been proposed for free breathing 2D dynamic cardiac MRI that addresses these challenges by simultaneously accelerating MR acquisition and correcting for any arbitrary motion in a compressed sensing reconstruction. In this work, the MC-CS framework is combined with parallel imaging for further acceleration, and is termed Motion Corrected Sparse SENSE (MC-SS). Validation of the MC-SS framework is demonstrated in eight volunteers and three patients for left ventricular functional assessment and results are compared with the breath-hold acquisitions as reference. A non-significant difference (P > 0.05) was observed in the volumetric functional measurements (end diastolic volume, end systolic volume, ejection fraction) and myocardial border sharpness values obtained with the proposed and gold standard methods. The proposed method achieves whole heart multi-slice coverage in 2 min under free breathing acquisition eliminating the time needed between breath-holds for instructions and recovery. This results in two-fold speed up of the total acquisition time in comparison to the breath-hold acquisition.

  8. Applying dynamic parameters to predict hemodynamic response to volume expansion in spontaneously breathing patients with septic shock.

    PubMed

    Lanspa, Michael J; Grissom, Colin K; Hirshberg, Eliotte L; Jones, Jason P; Brown, Samuel M

    2013-02-01

    Volume expansion is a mainstay of therapy in septic shock, although its effect is difficult to predict using conventional measurements. Dynamic parameters, which vary with respiratory changes, appear to predict hemodynamic response to fluid challenge in mechanically ventilated, paralyzed patients. Whether they predict response in patients who are free from mechanical ventilation is unknown. We hypothesized that dynamic parameters would be predictive in patients not receiving mechanical ventilation. This is a prospective, observational, pilot study. Patients with early septic shock and who were not receiving mechanical ventilation received 10-mL/kg volume expansion (VE) at their treating physician's discretion after initial resuscitation in the emergency department. We used transthoracic echocardiography to measure vena cava collapsibility index and aortic velocity variation before VE. We used a pulse contour analysis device to measure stroke volume variation (SVV). Cardiac index was measured immediately before and after VE using transthoracic echocardiography. Hemodynamic response was defined as an increase in cardiac index 15% or greater. Fourteen patients received VE, five of whom demonstrated a hemodynamic response. Vena cava collapsibility index and SVV were predictive (area under the curve = 0.83, 0.92, respectively). Optimal thresholds were calculated: vena cava collapsibility index, 15% or greater (positive predictive value, 62%; negative predictive value, 100%; P = 0.03); SVV, 17% or greater (positive predictive value 100%, negative predictive value 82%, P = 0.03). Aortic velocity variation was not predictive. Vena cava collapsibility index and SVV predict hemodynamic response to fluid challenge patients with septic shock who are not mechanically ventilated. Optimal thresholds differ from those described in mechanically ventilated patients.

  9. Patient access to pharmaceuticals: an international comparison.

    PubMed

    Cohen, Joshua; Faden, Laura; Predaris, Susan; Young, Brian

    2007-09-01

    We have identified eight sub-dimensions of patient access to pharmaceuticals: marketing approvals, time of marketing approval, coverage, cost sharing, conditions of reimbursement, speed from marketing approval to reimbursement, extent to which beneficiaries control choice of their drug benefit, and evenness of the availability of drugs to the population. For a sample of commonly used best-selling drugs in the United States (US), we measured these eight access sub-dimensions across four health systems: France, the Netherlands, the United Kingdom (UK), and the US. Although the US approved between 15 and 18% more drugs than the other three countries, the US was slower than France and the UK to approve drugs licensed in all four countries. The percentage of drugs covered is approximately the same for all four countries. For covered drugs, we observe the least cost sharing by patients in the Netherlands. The Netherlands imposes conditions of reimbursement on a much larger percentage of drugs. France seems to be the slowest in respect of speed from marketing approval to reimbursement. The US is the most flexible in terms of the extent to which beneficiaries control their choice of drug benefit but it is the least universal in terms of evenness of the availability of drugs to the population. Our study confirms the frequently cited problems of access in European countries: lag between marketing approval and reimbursement, and inflexibility in respect of the extent to which beneficiaries control their choice of drug benefit. At the same time, our study confirms, qualitatively, different kinds of access problems in the US: relatively high patient cost sharing for pharmaceuticals, and wide variation in coverage. PMID:17279403

  10. [SLEEP DISORDERED BREATHING AND EPILEPSY: RELATIONSHIPS AND THERAPEUTIC CONSIDERATIONS].

    PubMed

    Faludi, Béla; Bóné, Beáta; Komoly, Sámuel; Janszky, József

    2015-11-30

    The importance of the sleep related breathing disorders (obstructive sleep apnea syndrome, central sleep apnea, and Cheyne-Stokes breathing) in the pathophysiology crebro- and cardiovascular disorders is well known. The relationship of sleep related breathing abnormalities and epilepsy is also important but underestimated in the daily practice. The relation is bidirectional. The breathing abnormalities in sleep may play important role in generating epileptic seizure, but the adverse effect of seizure and antiepileptic therapy (generation of apneas and hypopneas) may worsen the seizure control. The effect of new therapies (vagal nerve and deep brain stimulation) on the sleep architecture and sleep disordered breathing must be examined and discussed. Here we present a brief case of epileptic patient with deep brain stimulation therapy on sleep as well. The examination of the sleep related breathing abnormalities in epilepsy patient may help improve the effectiveness of antiepileptic therapy.

  11. Stop, Breathe & Think app.

    PubMed

    Shaw, Natalie

    2014-07-15

    The Stop, Breathe & Think app is free, thanks to underwriting from Tools for Peace, the non-profit organisation that teaches people of all ages how to develop and apply kindness and compassion in their daily lives.

  12. Breath holding spell

    MedlinePlus

    ... such as Riley-Day syndrome or Rett syndrome Iron deficiency anemia A family history of breath holding spells ( ... tests may be done to check for an iron deficiency. Other tests that may be done include: EKG ...

  13. Shortness of Breath

    MedlinePlus

    ... deep breath, which usually results in retention of carbon dioxide and not enough oxygen in blood (obesity hypoventilation ... for anemia), and oximetry or blood oxygen or carbon dioxide levels. Your doctor also may obtain a chest ...

  14. Additional work of breathing imposed by endotracheal tubes, breathing circuits, and intensive care ventilators.

    PubMed

    Bersten, A D; Rutten, A J; Vedig, A E; Skowronski, G A

    1989-07-01

    A disadvantage of spontaneous breathing through an endotracheal tube (ETT) and connector attached to a breathing circuit and/or ventilator (breathing device) is an increase in the work of breathing. The work of breathing associated with ETT of 6 to 9-mm diameter and eight breathing devices was determined, using a lung simulator to mimic spontaneous inspiration at flow rates of 20 to 100 L/min and a tidal volume of 500 ml, at both zero end-expiratory pressure (ZEEP) and 10 cm H2O continuous positive airway pressure (CPAP). Work associated with the breathing devices alone (WCIR) ranged from -0.002 kg.m/L (Servo 900-C ventilator, 7-mm ETT, 20 L/min, ZEEP) to 0.1 kg.m/L (continuous flow circuit, 7-mm ETT, 100 L/min, CPAP), the latter representing 196% of the work of normal breathing. When the devices were attached to ETT, total apparatus work (WAPP) ranged from 0.009 kg.m/L (Mapleson-D circuit, 9-mm ETT, 20 L/min, ZEEP) to 0.25 kg.m/L (Drager EV-A, 6-mm ETT, 100 L/min, ZEEP), the latter representing 490% of the work of normal breathing. This additional work imposed by the ETT varied considerably among devices. Spontaneous breathing through modern ventilators, circuits and ETT imposes a burden of increased work, most of which is associated with the presence of the ETT and connector. Whether this burden represents an impediment to the weaning patient, or has training value for the ultimate resumption of unassisted spontaneous ventilation, remains to be determined.

  15. Chronic Intermittent Hypoxia Is Independently Associated with Reduced Postoperative Opioid Consumption in Bariatric Patients Suffering from Sleep-Disordered Breathing

    PubMed Central

    Turan, Alparslan; You, Jing; Egan, Cameron; Fu, Alex; Khanna, Ashish; Eshraghi, Yashar; Ghosh, Raktim; Bose, Somnath; Qavi, Shahbaz; Arora, Lovkesh; Sessler, Daniel I.; Doufas, Anthony G.

    2015-01-01

    Background Evidence suggests that recurrent nocturnal hypoxemia may affect pain response and/or the sensitivity to opioid analgesia. We tested the hypothesis that nocturnal hypoxemia, quantified by sleep time spent at an arterial saturation (SaO2) < 90% and minimum nocturnal SaO2 on polysomnography, are associated with decreased pain and reduced opioid consumption during the initial 72 postoperative hours in patients having laparoscopic bariatric surgery. Methods With Institutional Review Board approval, we examined the records of all patients who underwent laparoscopic bariatric surgery between 2004 and 2010 and had an available nocturnal polysomnography study. We assessed the relationships between the time-weighted average of pain score and total opioid consumption during the initial 72 postoperative hours, and: (a) the percentage of total sleep time spent at SaO2 < 90%, (b) the minimum nocturnal SaO2, and (c) the number of apnea/hypopnea episodes per hour of sleep. We used multivariable regression models to adjust for both clinical and sleep-related confounders. Results Two hundred eighteen patients were included in the analysis. Percentage of total sleep time spent at SaO2 < 90% was inversely associated with total postoperative opioid consumption; a 5-%- absolute increase in the former would relatively decrease median opioid consumption by 16% (98.75% CI: 2% to 28%, P = 0.006). However, the percentage of total sleep time spent at SaO2 < 90% was not associated with pain. The minimum nocturnal SaO2 was associated neither with total postoperative opioid consumption nor with pain. In addition, neither pain nor total opioid consumption was significantly associated with the number of apnea/hypopnea episodes per hour of sleep. Conclusions Preoperative nocturnal intermittent hypoxia may enhance sensitivity to opioids. PMID:26010491

  16. Monitoring breath markers under controlled conditions.

    PubMed

    Righettoni, Marco; Ragnoni, Alessandro; Güntner, Andreas T; Loccioni, Claudio; Pratsinis, Sotiris E; Risby, Terence H

    2015-12-01

    Breath analysis has the potential to detect and monitor diseases as well as to reduce the corresponding medical costs while improving the quality of a patient's life. Herein, a portable prototype, consisting of a commercial breath sampler modified to work as a platform for solid-state gas sensors was developed. The sensor is placed close to the mouth (<10 cm) and minimizes the mouth-to-sensor path to avoid contamination and dilution of the target breath marker. Additionally with an appropriate cooling concept, even high sensor operating temperatures (e.g. 350 °C) could be used. Controlled sampling is crucial for accurate repeatable analysis of the human breath and these concerns have been addressed by this novel prototype. The device helps a subject control their exhaled flow rate which increases reproducibility of intra-subject breath samples. The operation of this flame-made selective chemo-resistive gas sensor is demonstrated by the detection of breath acetone. PMID:26469378

  17. Optoacoustic 13C-breath test analyzer

    NASA Astrophysics Data System (ADS)

    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.

  18. Comparison of cardiorespiratory variables in dorsally recumbent horses anesthetized with guaifenesin-ketamine-xylazine spontaneously breathing 50% or maximal oxygen concentrations.

    PubMed

    Karrasch, Nicole M; Hubbell, John A E; Aarnes, Turi K; Bednarski, Richard M; Lerche, Phillip

    2015-04-01

    This study compared cardiorespiratory variables in dorsally recumbent horses anesthetized with guaifenesin-ketamine-xylazine and spontaneously breathing 50% or maximal (> 90%) oxygen (O2) concentrations. Twelve healthy mares were randomly assigned to breathe 50% or maximal O2 concentrations. Horses were sedated with xylazine, induced to recumbency with ketamine-diazepam, and anesthesia was maintained with guaifenesin-ketamine-xylazine to effect. Heart rate, arterial blood pressures, respiratory rate, lithium dilution cardiac output (CO), inspired and expired O2 and carbon dioxide partial pressures, and tidal volume were measured. Arterial and mixed-venous blood samples were collected prior to sedation (baseline), during 30 minutes of anesthesia, 10 minutes after disconnection from O2, and 30 minutes after standing. Shunt fraction, O2 delivery, and alveolar-arterial O2 partial pressures difference [P(A-a)O2] were calculated. Recovery times were recorded. There were no significant differences between groups in cardiorespiratory parameters or in P(A-a)O2 at baseline or 30 minutes after standing. Oxygen partial pressure difference in the 50% group was significantly less than in the maximal O2 group during anesthesia. PMID:25829559

  19. Comparison of cardiorespiratory variables in dorsally recumbent horses anesthetized with guaifenesin-ketamine-xylazine spontaneously breathing 50% or maximal oxygen concentrations

    PubMed Central

    Karrasch, Nicole M.; Hubbell, John A.E.; Aarnes, Turi K.; Bednarski, Richard M.; Lerche, Phillip

    2015-01-01

    This study compared cardiorespiratory variables in dorsally recumbent horses anesthetized with guaifenesin-ketamine-xylazine and spontaneously breathing 50% or maximal (> 90%) oxygen (O2) concentrations. Twelve healthy mares were randomly assigned to breathe 50% or maximal O2 concentrations. Horses were sedated with xylazine, induced to recumbency with ketamine-diazepam, and anesthesia was maintained with guaifenesin-ketamine-xylazine to effect. Heart rate, arterial blood pressures, respiratory rate, lithium dilution cardiac output (CO), inspired and expired O2 and carbon dioxide partial pressures, and tidal volume were measured. Arterial and mixed-venous blood samples were collected prior to sedation (baseline), during 30 minutes of anesthesia, 10 minutes after disconnection from O2, and 30 minutes after standing. Shunt fraction, O2 delivery, and alveolar-arterial O2 partial pressures difference [P(A-a)O2] were calculated. Recovery times were recorded. There were no significant differences between groups in cardiorespiratory parameters or in P(A-a)O2 at baseline or 30 minutes after standing. Oxygen partial pressure difference in the 50% group was significantly less than in the maximal O2 group during anesthesia. PMID:25829559

  20. Variability of the breathing pattern before and after extubation.

    PubMed

    Krieger, B P; Chediak, A; Gazeroglu, H B; Bizousky, F P; Feinerman, D

    1988-04-01

    A stable breathing pattern during unassisted ventilation through an endotracheal tube (ETT) prior to extubation is an important factor in determining whether a patient can be successfully extubated. Proper interpretation of changes in the breathing pattern requires knowledge of the normal variability of the breathing pattern in critically ill, intubated patients. To establish these guidelines, 50 spontaneously breathing patients who were being weaned from mechanical ventilation were monitored with respiratory inductive plethysmography for one hour immediately prior to and following successful extubation. Immediately after extubation, respiratory rate (f), tidal volume (VT), minute ventilation, and mean inspiratory flow increased slightly. By 30 minutes postextubation, these parameters were similar to preextubation values. There was no significant change in variability of f or VT. Although the breathing pattern of these relatively stable, intensive care patients differed from values of normal ambulatory subjects, values were similar in the preextubation and postextubation periods.

  1. Predicting clinical physiology: a Markov chain model of heart rate recovery after spontaneous breathing trials in mechanically ventilated patients.

    PubMed

    Lu, Yan; Burykin, Anton; Deem, Michael W; Buchman, Timothy G

    2009-09-01

    Analysis of heart rate (HR) dynamics before, during, and after a physiologic stress has clinical importance. For example, the celerity of heart rate recovery (HRR) after a cardiac stress test (eg, treadmill exercise test) has been shown to be an independent predictor of all-cause mortality. Heart rate dynamics are modulated, in part, by the autonomic nervous system. These dynamics are commonly abstracted using metrics of heart rate variability (HRV), which are known to be sensitive to the influence of the autonomic nervous system on HR. The patient-specific modulators of HR should be reflected both in the response to stress as well as in the recovery from stress. We therefore hypothesized that the patient-specific HR response to stress could be used to predict the HRR after the stress. We devised a Markov chain model to predict the poststress HRR dynamics using the parameters (transition matrix) calculated from HR data during the stress. The model correctly predicts the exponential shape of poststress HRR. This model features a simple analytical relationship linking poststress HRR time constant (T(off)) with a standard measure of HRV, namely the correlation coefficient of the Poincaré plot (first return map) of the HR recorded during the stress. A corresponding relationship exists between the time constant (T(on)) of R-R interval decrease at the onset of stress and the correlation coefficient of the Poincaré plot of prestress R-R intervals. Consequently, the model can be used for the prediction of poststress HRR using the HRV measured during the stress. This direct relationship between the event-to-event microscopic fluctuations (HRV) during the stress and the macroscopic response (HRR) after the stress terminates can be interpreted as an instance of a fluctuation-dissipation relationship. We have thus applied the fluctuation-dissipation theorem to the analysis of heart rate dynamics. The approach is specific neither to cardiac physiology nor to transitions

  2. Comparison of Bystander Cardiopulmonary Resuscitation (BCPR) Performance in the Absence and Presence of Timing Devices for Coordinating Delivery of Ventilatory Breaths and Cardiac Compressions in a Model of Adult Cardiopulmonary Arrest

    NASA Technical Reports Server (NTRS)

    Hurst, Victor, IV; West, Sarah; Austin, Paul; Branson, Richard; Beck, George

    2006-01-01

    Astronaut crew medical officers (CMO) aboard the International Space Station (ISS) receive 40 hours of medical training during the 18 months preceding each mission. Part of this training ilncludes twoperson cardiopulmonary resuscitation (CPR) per training guidelines from the American Heart Association (AHA). Recent studies concluded that the use of metronomic tones improves the coordination of CPR by trained clinicians. Similar data for bystander or "trained lay people" (e.g. CMO) performance of CPR (BCPR) have been limited. The purpose of this study was to evailuate whether use of timing devices, such as audible metronomic tones, would improve BCPR perfomance by trained bystanders. Twenty pairs of bystanders trained in two-person BCPR performled BCPR for 4 minutes on a simulated cardiopulmonary arrest patient using three interventions: 1) BCPR with no timing devices, 2) BCPR plus metronomic tones for coordinating compression rate only, 3) BCPR with a timing device and metronome for coordinating ventilation and compression rates, respectively. Bystanders were evaluated on their ability to meet international and AHA CPR guidelines. Bystanders failed to provide the recommended number of breaths and number of compressions in the absence of a timing device and in the presence of audible metronomic tones for only coordinating compression rate. Bystanders using timing devices to coordinate both components of BCPR provided the reco number of breaths and were closer to providing the recommended number of compressions compared with the other interventions. Survey results indicated that bystanders preferred to use a metronome for delivery of compressions during BCPR. BCPR performance is improved by timing devices that coordinate both compressions and breaths.

  3. Using acoustic sensors to discriminate between nasal and mouth breathing.

    PubMed

    Curran, Kevin; Yuan, Peng; Coyle, Damian

    2012-01-01

    The recommendation to change breathing patterns from the mouth to the nose can have a significantly positive impact upon the general well being of the individual. We classify nasal and mouth breathing by using an acoustic sensor and intelligent signal processing techniques. The overall purpose is to investigate the possibility of identifying the differences in patterns between nasal and mouth breathing in order to integrate this information into a decision support system which will form the basis of a patient monitoring and motivational feedback system to recommend the change from mouth to nasal breathing.

  4. A multicomponent yoga-based, breath intervention program as an adjunctive treatment in patients suffering from generalized anxiety disorder with or without comorbidities

    PubMed Central

    Katzman, Martin A; Vermani, Monica; Gerbarg, Patricia L; Brown, Richard P; Iorio, Christina; Davis, Michele; Cameron, Catherine; Tsirgielis, Dina

    2012-01-01

    Objectives: The aim of this study is to evaluate the efficacy and tolerability of Sudarshan Kriya Yoga (SKY) course in generalized anxiety disorder (GAD) outpatients, who after eight weeks of an appropriate dose of traditional therapy had not yet achieved remission. Subjects: The adult participants (18-65 years) were outpatients with a primary diagnosis of GAD with or without comorbidities on the Mini-International Neuropsychiatric Interview (MINI). Participants had a minimum of eight weeks standard treatment with an appropriate dose of a standard prescription anxiolytic, a clinician global impression-severity (CGI-S) score of 5-7, a Hamilton anxiety scale (HAM-A) total score ≥20 including a score of >2 on the anxious mood and tension items. Materials and Methods: Forty-one patients were enrolled in an open-label trial of the SKY course as an adjunct to standard treatment of GAD at the START Clinic for Mood and Anxiety Disorders, a tertiary care mood and anxiety disorder clinic in Toronto. The SKY course was administered over five days (22 h total). Subjects were encouraged to practice the yoga breathing techniques at home for 20 min per day after the course and were offered group practice sessions for 2 h once a week led by certified yoga instructors. The primary outcome measure was the mean change from pre-treatment on the HAM-A scale. Psychological measures were obtained at baseline and four weeks after completing the intervention. Results: Thirty-one patients completed the program (mean age 42.6 ± 13.3 years). Among completers, significant reductions occurred in the pre- and post-intervention mean HAM-A total score (t=4.59; P<0.01) and psychic subscale (t=5.00; P≤0.01). The response rate was 73% and the remission rate 41% as measured on the HAM-A. Conclusion: The results of this small pilot trial suggest that the SKY course represents a potentially valuable adjunct to standard pharmacotherapy in patients with GAD or treatment-resistant GAD, and warrants

  5. Utility of a Novel Biofeedback Device for Within-Breath Modulation of Heart Rate in Rats: A Quantitative Comparison of Vagus Nerve vs. Right Atrial Pacing.

    PubMed

    O'Callaghan, Erin L; Chauhan, Ashok S; Zhao, Le; Lataro, Renata M; Salgado, Helio C; Nogaret, Alain; Paton, Julian F R

    2016-01-01

    In an emerging bioelectronics era, there is a clinical need for physiological devices incorporating biofeedback that permits natural and demand-dependent control in real time. Here, we describe a novel device termed a central pattern generator (CPG) that uses cutting edge analog circuitry producing temporally controlled, electrical stimulus outputs based on the real time integration of physiological feedback. Motivated by the fact that respiratory sinus arrhythmia (RSA), which is the cyclical changes in heart rate every breath, is an essential component of heart rate variability (HRV) (an indicator of cardiac health), we have explored the versatility and efficiency of the CPG for producing respiratory modulation of heart rate in anesthetized, spontaneously breathing rats. Diaphragmatic electromyographic activity was used as the input to the device and its output connected to either the right cervical vagus nerve or the right atrium for pacing heart rate. We found that the CPG could induce respiratory related heart rate modulation that closely mimicked RSA. Whether connected to the vagus nerve or right atrium, the versatility of the device was demonstrated by permitting: (i) heart rate modulation in any phase of the respiratory cycle, (ii) control of the magnitude of heart rate modulation, and (iii) instant adaptation to changes in respiratory frequency. Vagal nerve pacing was only possible following transection of the nerve limiting its effective use chronically. Pacing via the right atrium permitted better flexibility and control of heart rate above its intrinsic level. This investigation now lays the foundation for future studies using this biofeedback technology permitting closer analysis of both the function and dysfunction of RSA. PMID:26869940

  6. Utility of a Novel Biofeedback Device for Within-Breath Modulation of Heart Rate in Rats: A Quantitative Comparison of Vagus Nerve vs. Right Atrial Pacing

    PubMed Central

    O'Callaghan, Erin L.; Chauhan, Ashok S.; Zhao, Le; Lataro, Renata M.; Salgado, Helio C.; Nogaret, Alain; Paton, Julian F. R.

    2016-01-01

    In an emerging bioelectronics era, there is a clinical need for physiological devices incorporating biofeedback that permits natural and demand-dependent control in real time. Here, we describe a novel device termed a central pattern generator (CPG) that uses cutting edge analog circuitry producing temporally controlled, electrical stimulus outputs based on the real time integration of physiological feedback. Motivated by the fact that respiratory sinus arrhythmia (RSA), which is the cyclical changes in heart rate every breath, is an essential component of heart rate variability (HRV) (an indicator of cardiac health), we have explored the versatility and efficiency of the CPG for producing respiratory modulation of heart rate in anesthetized, spontaneously breathing rats. Diaphragmatic electromyographic activity was used as the input to the device and its output connected to either the right cervical vagus nerve or the right atrium for pacing heart rate. We found that the CPG could induce respiratory related heart rate modulation that closely mimicked RSA. Whether connected to the vagus nerve or right atrium, the versatility of the device was demonstrated by permitting: (i) heart rate modulation in any phase of the respiratory cycle, (ii) control of the magnitude of heart rate modulation, and (iii) instant adaptation to changes in respiratory frequency. Vagal nerve pacing was only possible following transection of the nerve limiting its effective use chronically. Pacing via the right atrium permitted better flexibility and control of heart rate above its intrinsic level. This investigation now lays the foundation for future studies using this biofeedback technology permitting closer analysis of both the function and dysfunction of RSA. PMID:26869940

  7. Utility of a Novel Biofeedback Device for Within-Breath Modulation of Heart Rate in Rats: A Quantitative Comparison of Vagus Nerve vs. Right Atrial Pacing.

    PubMed

    O'Callaghan, Erin L; Chauhan, Ashok S; Zhao, Le; Lataro, Renata M; Salgado, Helio C; Nogaret, Alain; Paton, Julian F R

    2016-01-01

    In an emerging bioelectronics era, there is a clinical need for physiological devices incorporating biofeedback that permits natural and demand-dependent control in real time. Here, we describe a novel device termed a central pattern generator (CPG) that uses cutting edge analog circuitry producing temporally controlled, electrical stimulus outputs based on the real time integration of physiological feedback. Motivated by the fact that respiratory sinus arrhythmia (RSA), which is the cyclical changes in heart rate every breath, is an essential component of heart rate variability (HRV) (an indicator of cardiac health), we have explored the versatility and efficiency of the CPG for producing respiratory modulation of heart rate in anesthetized, spontaneously breathing rats. Diaphragmatic electromyographic activity was used as the input to the device and its output connected to either the right cervical vagus nerve or the right atrium for pacing heart rate. We found that the CPG could induce respiratory related heart rate modulation that closely mimicked RSA. Whether connected to the vagus nerve or right atrium, the versatility of the device was demonstrated by permitting: (i) heart rate modulation in any phase of the respiratory cycle, (ii) control of the magnitude of heart rate modulation, and (iii) instant adaptation to changes in respiratory frequency. Vagal nerve pacing was only possible following transection of the nerve limiting its effective use chronically. Pacing via the right atrium permitted better flexibility and control of heart rate above its intrinsic level. This investigation now lays the foundation for future studies using this biofeedback technology permitting closer analysis of both the function and dysfunction of RSA.

  8. Heat and moisture exchangers and breathing system filters: their use in anaesthesia and intensive care. Part 2 - practical use, including problems, and their use with paediatric patients.

    PubMed

    Wilkes, A R

    2011-01-01

    Heat and moisture exchangers and breathing system filters are intended to replace the normal warming, humidifying and filtering functions of the upper airways. The first part of this review considered the history, principles of operation and efficiency of these devices. The aim of this part of the review is to summarise recent guidelines on the use of these devices and outline the problems that can occur. In particular, the effect of these devices on gas analysis, dead space, resistance to gas flow and blockage of the breathing system is considered. In children, it is important to consider the addition of dead space and resistance to gas flow. A body weight of 2.5 kg is probably the lower weight limit for use with heat and moisture exchangers, and 3 kg for filters. The resistance to gas flow of a heat- and moisture-exchanging filter added to a Mapleson F breathing system can cause a delay in the induction of anaesthesia.

  9. Detection of malignant pleural mesothelioma in exhaled breath by multicapillary column/ion mobility spectrometry (MCC/IMS).

    PubMed

    Lamote, Kevin; Vynck, Matthijs; Van Cleemput, Joris; Thas, Olivier; Nackaerts, Kristiaan; van Meerbeeck, Jan P

    2016-01-01

    Malignant pleural mesothelioma (MPM) is predominantly caused by previous asbestos exposure. Diagnosis often happens in advanced stages restricting any therapeutic perspectives. Early stage detection via breath analysis was explored using multicapillary column/ion mobility spectrometry (MCC/IMS) to detect volatile organic compounds (VOCs) in the exhaled breath of MPM patients in comparison to former occupational asbestos-exposed and non-exposed controls. Breath and background samples of 23 MPM patients, 22 asymptomatic former asbestos (AEx) workers and 21 healthy non-asbestos exposed persons were taken for analysis. After background correction, we performed a logistic least absolute shrinkage and selection operator (lasso) regression to select the most important VOCs, followed by receiver operating characteristic (ROC) analysis. MPM patients were discriminated from both controls with 87% sensitivity, 70% specificity and respective positive and negative predictive values of 61% and 91%. The overall accuracy was 76% and the area under the ROC-curve was 0.81. AEx individuals could be discriminated from MPM patients with 87% sensitivity, 86% specificity and respective positive and negative predictive values of 87% and 86%. The overall accuracy was 87% with an area under the ROC-curve of 0.86. Breath analysis by MCC/IMS allows MPM patients to be discriminated from controls and holds promise for further investigation as a screening tool for former asbestos-exposed persons at risk of developing MPM. PMID:27669062

  10. Comparison of Multi-Echo Dixon Methods with Volume Interpolated Breath-Hold Gradient Echo Magnetic Resonance Imaging in Fat-Signal Fraction Quantification of Paravertebral Muscle

    PubMed Central

    Yoo, Yeon Hwa; Kim, Hak-Sun; Lee, Young Han; Yoon, Choon-Sik; Paek, Mun Young; Yoo, Hanna; Kannengiesser, Stephan; Chung, Tae-Sub; Song, Ho-Taek; Suh, Jin-Suck

    2015-01-01

    Objective To assess whether multi-echo Dixon magnetic resonance (MR) imaging with simultaneous T2* estimation and correction yields more accurate fat-signal fraction (FF) measurement of the lumbar paravertebral muscles, in comparison with non-T2*-corrected two-echo Dixon or T2*-corrected three-echo Dixon, using the FF measurements from single-voxel MR spectroscopy as the reference standard. Materials and Methods Sixty patients with low back pain underwent MR imaging with a 1.5T scanner. FF mapping images automatically obtained using T2*-corrected Dixon technique with two (non-T2*-corrected), three, and six echoes, were compared with images from single-voxel MR spectroscopy at the paravertebral muscles on levels L4 through L5. FFs were measured directly by two radiologists, who independently drew the region of interest on the mapping images from the three sequences. Results A total of 117 spectroscopic measurements were performed either bilaterally (57 of 60 subjects) or unilaterally (3 of 60 subjects). The mean spectroscopic FF was 14.3 ± 11.7% (range, 1.9-63.7%). Interobserver agreement was excellent between the two radiologists. Lin's concordance correlation between the spectroscopic findings and all the imaging-based FFs were statistically significant (p < 0.001). FFs obtained from the T2*-corrected six-echo Dixon sequences showed a significantly better concordance with the spectroscopic data, with its concordance correlation coefficient being 0.99 and 0.98 (p < 0.001), as compared with two- or three-echo methods. Conclusion T2*-corrected six-echo Dixon sequence would be a better option than two- or three-echo methods for noninvasive quantification of lumbar muscle fat quantification. PMID:26357503

  11. Breathing: Rhythmicity, Plasticity, Chemosensitivity

    PubMed Central

    Feldman, Jack L.; Mitchell, Gordon S.; Nattie, Eugene E.

    2010-01-01

    Breathing is a vital behavior that is particularly amenable to experimental investigation. We review recent progress on three problems of broad interest. (i) Where and how is respiratory rhythm generated? The preBötzinger Complex is a critical site, whereas pacemaker neurons may not be essential. The possibility that coupled oscillators are involved is considered. (ii) What are the mechanisms that underlie the plasticity necessary for adaptive changes in breathing? Serotonin-dependent long-term facilitation following intermittent hypoxia is an important example of such plasticity, and a model that can account for this adaptive behavior is discussed. (iii) Where and how are the regulated variables CO2 and pH sensed? These sensors are essential if breathing is to be appropriate for metabolism. Neurons with appropriate chemosensitivity are spread throughout the brainstem; their individual properties and collective role are just beginning to be understood. PMID:12598679

  12. Analysis of volatile organic compounds in exhaled breath to diagnose ventilator-associated pneumonia

    PubMed Central

    Schnabel, Ronny; Fijten, Rianne; Smolinska, Agnieszka; Dallinga, Jan; Boumans, Marie-Louise; Stobberingh, Ellen; Boots, Agnes; Roekaerts, Paul; Bergmans, Dennis; van Schooten, Frederik Jan

    2015-01-01

    Ventilator-associated pneumonia (VAP) is a nosocomial infection occurring in the intensive care unit (ICU). The diagnostic standard is based on clinical criteria and bronchoalveolar lavage (BAL). Exhaled breath analysis is a promising non-invasive method for rapid diagnosis of diseases and contains volatile organic compounds (VOCs) that can differentiate diseased from healthy individuals. The aim of this study was to determine whether analysis of VOCs in exhaled breath can be used as a non-invasive monitoring tool for VAP. One hundred critically ill patients with clinical suspicion of VAP underwent BAL. Before BAL, exhaled air samples were collected and analysed by gas chromatography time-of-flight mass spectrometry (GC-tof-MS). The clinical suspicion of VAP was confirmed by BAL diagnostic criteria in 32 patients [VAP(+)] and rejected in 68 patients [VAP(−)]. Multivariate statistical comparison of VOC profiles between VAP(+) and VAP(−) revealed a subset of 12 VOCs that correctly discriminated between those two patient groups with a sensitivity and specificity of 75.8% ± 13.5% and 73.0% ± 11.8%, respectively. These results suggest that detection of VAP in ICU patients is possible by examining exhaled breath, enabling a simple, safe and non-invasive approach that could diminish diagnostic burden of VAP. PMID:26608483

  13. Analysis of volatile organic compounds in exhaled breath to diagnose ventilator-associated pneumonia.

    PubMed

    Schnabel, Ronny; Fijten, Rianne; Smolinska, Agnieszka; Dallinga, Jan; Boumans, Marie-Louise; Stobberingh, Ellen; Boots, Agnes; Roekaerts, Paul; Bergmans, Dennis; van Schooten, Frederik Jan

    2015-11-26

    Ventilator-associated pneumonia (VAP) is a nosocomial infection occurring in the intensive care unit (ICU). The diagnostic standard is based on clinical criteria and bronchoalveolar lavage (BAL). Exhaled breath analysis is a promising non-invasive method for rapid diagnosis of diseases and contains volatile organic compounds (VOCs) that can differentiate diseased from healthy individuals. The aim of this study was to determine whether analysis of VOCs in exhaled breath can be used as a non-invasive monitoring tool for VAP. One hundred critically ill patients with clinical suspicion of VAP underwent BAL. Before BAL, exhaled air samples were collected and analysed by gas chromatography time-of-flight mass spectrometry (GC-tof-MS). The clinical suspicion of VAP was confirmed by BAL diagnostic criteria in 32 patients [VAP(+)] and rejected in 68 patients [VAP(-)]. Multivariate statistical comparison of VOC profiles between VAP(+) and VAP(-) revealed a subset of 12 VOCs that correctly discriminated between those two patient groups with a sensitivity and specificity of 75.8% ± 13.5% and 73.0% ± 11.8%, respectively. These results suggest that detection of VAP in ICU patients is possible by examining exhaled breath, enabling a simple, safe and non-invasive approach that could diminish diagnostic burden of VAP.

  14. Improving estimation of cardiac vagal tone during spontaneous breathing using a paced breathing calibration.

    PubMed

    Wilhelm, Frank H; Grossman, Paul; Coyle, Michael A

    2004-01-01

    Respiratory sinus arrhythmia (RSA) is a commonly employed non-invasive measure of cardiac vagal control. It has been demonstrated that respiratory parameters such as tidal volume and respiratory frequency can change RSA without altering tonic vagal activity. Thus, within-individual comparisons of cardiac vagal control across different behavioral tasks might benefit from an adjustment for respiratory confounds. We tested an adjustment method using transfer function analysis and paced breathing at 3 different respiratory frequencies as the basis for regressing out respiratory related RSA changes in a task where breathing was not controlled. Electrocardiogram and calibrated respiration were recorded with the LifeShirt system from 15 young adult participants. Time series of RR intervals and lung volume change were computed and the respiration-to-RR-interval transfer-function magnitude (RSA-TF, in ms/liter) estimated. Mean (SD) of RSA-TF was 142 (68) at 9 breaths/min, 78 (52) at 13.5 breaths/min, 57 (43) at 18 breaths/min, and 121 (56) during baseline, with a respiratory frequency of 12.5 (3.8) breaths/min. At baseline, measured and predicted RSA-TF values (mean 94 +/- 82) differed significantly and correlated only moderately (r = 0.67). Factors contributing to a less than perfect correlation included slightly elevated subjective anxiety levels and hyperventilation during paced breathing, both of which may have affected cardiac vagal tone. This study demonstrates a novel procedure for computing a respiratory unrelated RSA index. Results provide some support for the utility of this adjustment method for improving the estimation of cardiac vagal tone from RSA, but also indicate that the paced breathing procedure may need to be further refined.

  15. External work output and force generation during synchronized intermittent mechanical ventilation. Effect of machine assistance on breathing effort.

    PubMed

    Marini, J J; Smith, T C; Lamb, V J

    1988-11-01

    We measured the mechanical work performed by 12 acutely ill patients during synchronized intermittent mandatory ventilation to determine the influence of volume-cycled machine assistance on inspiratory timing, respiratory muscle force development, and external work output. The frequency and tidal volume of spontaneous breaths increased at lower levels of mechanical ventilation, but inspiratory time fraction did not vary across the spectrum of machine support. As machine support was withdrawn, inspiratory work and pressure-time product increased progressively for both spontaneous and assisted breathing cycles. On a per cycle basis, work output was greater for assisted than for spontaneous breaths at all levels of comparison. Although the mean pressure developed by the patient during assisted cycles averaged approximately equal to 20% less than during adjacent unassisted cycles, contraction time averaged approximately equal to 20% longer, so that the pressure-time products were nearly equivalent for both types of cycle. Two indices of force reserve indicated that our patients taxed their maximal ventilatory capability at all but the highest levels of support. We conclude that under the conditions of this study the ventilatory pump continued to be active at all levels of machine assistance. Although work per liter related linearly to the proportion of minute ventilation borne by the patient, force generation differed little for spontaneous and machine-aided breaths at any specified level of support. Whether judged on the basis of mean developed pressure (work per liter of ventilation) or pressure-time product, little effort adaptation to volume-cycled machine assistance appears to occur on a breath-by-breath basis.

  16. Association between halitosis and mouth breathing in children

    PubMed Central

    Motta, Lara Jansiski; Bachiega, Joanna Carolina; Guedes, Carolina Cardoso; Laranja, Lorena Tristão; Bussadori, Sandra Kalil

    2011-01-01

    OBJECTIVE: To determine whether there is a correlation between halitosis and mouth breathing in children. STUDY DESIGN: Fifty-five children between 3 and 14 years of age were divided into two groups (nasal and mouth breathing) for the assessment of halitosis. A descriptive analysis was conducted on the degree of halitosis in each group. The chi-square test was used for comparison between groups, with a 5% level of significance. RESULTS: There was a significantly greater number of boys with the mouth-breathing pattern than girls. A total of 23.6% of the participants had no mouth odor, 12.7% had mild odor, 12.7% had moderate odor and 50.9% had strong odor. There was a statistically significant association between halitosis and mouth breathing. CONCLUSIONS: The occurrence of halitosis was high among the children evaluated, and there was a statistically significant association between halitosis and mouth breathing. PMID:21808855

  17. Predisposing factors for positive D-Xylose breath test for evaluation of small intestinal bacterial overgrowth: A retrospective study of 932 patients

    PubMed Central

    Schatz, Richard A; Zhang, Qing; Lodhia, Nilesh; Shuster, Jonathan; Toskes, Phillip P; Moshiree, Baharak

    2015-01-01

    AIM: To investigate, in the largest cohort to date, patient characteristics and associated risk factors for developing small intestinal bacterial overgrowth (SIBO) using the D-Xylose breath test (XBT). METHODS: We performed a retrospective cross-sectional study to analyze patient characteristics who underwent the XBT for evaluation of SIBO. Diagnostic testing with the XBT was performed based on a clinical suspicion for SIBO in patients with symptoms of bloating, abdominal pain, abdominal distension, weight loss, diarrhea, and/or constipation. Consecutive electronic medical records of 932 patients who completed the XBT at the University of Florida between 2005 and 2009 were reviewed. A two-way Analysis of Variance (ANOVA) was used to test for several associations including age, gender, and body mass index (BMI) with a +XBT. A two-way ANOVA was also performed to control for the differences and interaction with age and between genders. A similar analysis was repeated for BMI. Associations between medical conditions and prior surgical histories were conducted using the Mantel-Haenszel method for 2 by 2 contingency tables, stratified for gender. Reported odds ratio estimates reflect the odds of the prevalence of a condition within the +XBT group to that of the -XBT group. P values of less than 0.05 (two-sided) were considered statistically significant. RESULTS: In the 932 consecutive eligible subjects studied, 513 had a positive XBT. A positive association was found between female gender and a positive XBT (P = 0.0025), and females with a positive test were, on average, greater than 5 years older than those with a negative test (P = 0.024). The mean BMI of positive XBT subjects was normal (24.5) and significantly lower than the subjects with a negative XBT (29.5) (P = 0.0050). A positive XBT was associated with gastroesophageal reflux disease (GERD) (OR = 1.35; 95%CI: 1.02-1.80, P = 0.04), peptic ulcer disease (PUD) (OR = 2.61; 95%CI: 1.48-4.59, P < 0.01), gastroparesis

  18. Sleep-Disordered Breathing and Cardiac Arrhythmias.

    PubMed

    Bitter, Thomas; Fox, Henrik; Gaddam, SaiPrassad; Horstkotte, Dieter; Oldenburg, Olaf

    2015-07-01

    Over the past few years sleep-disordered breathing has been identified as an important factor in arrhythmogenesis and a potential target of therapy to prevent cardiac arrhythmias in selected patients. In this review we highlight the role of obstructive sleep apnea and Cheyne-Stokes respiration in the pathophysiology of arrhythmias, address their clinical effect in supraventricular and ventricular tachyarrhythmias, and in conduction disturbances, and address the role of current treatment options for sleep-disordered breathing in the primary and secondary prevention of arrhythmic events.

  19. Medication effects on sleep and breathing.

    PubMed

    Seda, Gilbert; Tsai, Sheila; Lee-Chiong, Teofilo

    2014-09-01

    Sleep respiration is regulated by circadian, endocrine, mechanical and chemical factors, and characterized by diminished ventilatory drive and changes in Pao2 and Paco2 thresholds. Hypoxemia and hypercapnia are more pronounced during rapid eye movement. Breathing is influenced by sleep stage and airway muscle tone. Patient factors include medical comorbidities and body habitus. Medications partially improve obstructive sleep apnea and stabilize periodic breathing at altitude. Potential adverse consequences of medications include precipitation or worsening of disorders. Risk factors for adverse medication effects include aging, medical disorders, and use of multiple medications that affect respiration.

  20. Comparison of changes in the contraction of the lateral abdominal muscles between the abdominal drawing-in maneuver and breathe held at the maximum expiratory level.

    PubMed

    Ishida, Hiroshi; Hirose, Ryohei; Watanabe, Susumu

    2012-10-01

    The abdominal drawing-in maneuver (ADIM) is commonly used as a fundamental component of lumbar stabilization training programs. One potential limitation of lumbar stabilization programs is that it can be difficult and time consuming to train people to perform the ADIM. The transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles are the most powerful muscles involved in expiration. However, little is known about the differences in the recruitment of the abdominal muscles between the ADIM and breathe held at maximum expiratory level (maximum expiration). The thickness of the TrA and IO muscles was measured by ultrasound imaging, and the activity of the EO muscle was measured by electromyography (EMG) in 33 healthy male performing the ADIM and maximum expiration. Maximum expiration produced a significant increase in the thickness of the TrA and IO muscles compared to the ADIM (p < 0.001). The EMG activity of the EO muscle was significantly higher during maximum expiration than during the ADIM (p < 0.001). The intensity of the EMG activity of the EO muscle was approximately 30% of the maximal voluntary contraction during maximum expiration. Thus, maximum expiration may be an effective method for training of co-activation of the lateral abdominal muscles.

  1. Breath tests in diagnosis of pulmonary tuberculosis.

    PubMed

    Cheepsattayakorn, Attapon; Cheepsattayakorn, Ruangrong

    2014-01-01

    Since the time of Hippocrates, physicians have known that the odour of human breath can provide clues to diagnosis. In the past, hydrogen peroxide which is a marker of inflammatory diseases and oxidative stress was the most studied substance in the exhaled breath which was detectable in the liquid that obtained by condensing or cooling. The advantages of breath analysis are that it is convenient, non-invasive, and could be performed with children as well as mechanically ventilated patients. Today, exhaled nitric oxide has been studied extensively, especially in relation to asthma. More than a thousand different volatile organic compounds have been observed in low concentrations in normal human breath. Alkanes and methylalkanes have been increasingly used by physicians as a novel method to diagnose many diseases without discomforts of invasive procedures. Although the limitations of measurement of exhaled nitric oxide in direct diagnosis of infectious pulmonary TB, it may have potential development as a cost-effective replacement of chest radiological examination in screening algorithms. None of the individual exhaled volatile organic compound alone is specific for disease. Exhaled breath analysis techniques may be available to diagnose and monitor the diseases in home setting when their sensitivity and specificity are expected to improve in the future. Here, we also discussed some patents related to the topic. PMID:25185981

  2. Life and Breath

    ERIC Educational Resources Information Center

    Ellis, Helen D.

    1974-01-01

    This article describes a public education program combining the screening process and a follow-up program for teaching victims of emphysema and other respiratory diseases how to better their living condition through proper breathing, avoidance of air pollutants and cigarette smoking, and taking better care of themselves physically. (PD)

  3. Metabolic breath analyzer

    NASA Technical Reports Server (NTRS)

    Perry, C. L.

    1971-01-01

    Instrument measures metabolic breathing rate and dynamics of human beings in atmospheres ranging from normal air to 100 percent oxygen at ambient pressures from 14.7 to 3.0 psia. Measurements are made at rest or performing tasks up to maximum physical capacity under either zero or normal gravity.

  4. Breathing Like a Fish

    ERIC Educational Resources Information Center

    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,…

  5. Breathing metabolic simulator

    NASA Technical Reports Server (NTRS)

    Bartlett, R. G., Jr.; Hendricks, C. M.; Morison, W. B.

    1972-01-01

    A description is given of an automatic computer controlled second generation breathing metabolic simulator (BMS). The simulator is used for evaluating and testing respiratory diagnostic, monitoring, support, and resuscitation equipment. Any desired sequence of metabolic activities can be simulated on the device for up to 15 hours. The computer monitors test procedures and provides printouts of test results.

  6. Classification of Asthma Based on Nonlinear Analysis of Breathing Pattern

    PubMed Central

    Raoufy, Mohammad Reza; Ghafari, Tara; Darooei, Reza; Nazari, Milad; Mahdaviani, Seyed Alireza; Eslaminejad, Ali Reza; Almasnia, Mehdi; Gharibzadeh, Shahriar; Mani, Ali R.; Hajizadeh, Sohrab

    2016-01-01

    Normal human breathing exhibits complex variability in both respiratory rhythm and volume. Analyzing such nonlinear fluctuations may provide clinically relevant information in patients with complex illnesses such as asthma. We compared the cycle-by-cycle fluctuations of inter-breath interval (IBI) and lung volume (LV) among healthy volunteers and patients with various types of asthma. Continuous respiratory datasets were collected from forty age-matched men including 10 healthy volunteers, 10 patients with controlled atopic asthma, 10 patients with uncontrolled atopic asthma, and 10 patients with uncontrolled non-atopic asthma during 60 min spontaneous breathing. Complexity of breathing pattern was quantified by calculating detrended fluctuation analysis, largest Lyapunov exponents, sample entropy, and cross-sample entropy. The IBI as well as LV fluctuations showed decreased long-range correlation, increased regularity and reduced sensitivity to initial conditions in patients with asthma, particularly in uncontrolled state. Our results also showed a strong synchronization between the IBI and LV in patients with uncontrolled asthma. Receiver operating characteristic (ROC) curve analysis showed that nonlinear analysis of breathing pattern has a diagnostic value in asthma and can be used in differentiating uncontrolled from controlled and non-atopic from atopic asthma. We suggest that complexity analysis of breathing dynamics may represent a novel physiologic marker to facilitate diagnosis and management of patients with asthma. However, future studies are needed to increase the validity of the study and to improve these novel methods for better patient management. PMID:26824900

  7. Cultural comparison of symptoms in patients on maintenance hemodialysis.

    PubMed

    Weisbord, Steven D; Bossola, Maurizio; Fried, Linda F; Giungi, Stefania; Tazza, Luigi; Palevsky, Paul M; Arnold, Robert M; Luciani, Giovanna; Kimmel, Paul L

    2008-10-01

    Although symptoms are common and frequently severe in patients on maintenance hemodialysis, little is known about the relationship between cultural background and symptom burden. The aim of this study was to explore differences in the prevalence and severity of symptoms between American and Italian hemodialysis patients. We administered the 30-item Dialysis Symptom Index to American and Italian patients receiving maintenance hemodialysis during routine dialysis sessions. The prevalence and severity of individual symptoms were compared between patient populations, adjusting for multiple comparisons. Multivariable logistic regression and ordinal logistic regression were used to assess the independent associations of cultural background with the prevalence and severity of symptoms, respectively. We enrolled 75 American and 61 Italian patients. American patients were more likely to be black (36% vs. 0%, P<0.001) and diabetic (53% vs. 13%, P<0.001). Italian patients were more likely to report decreased interest in sex, decreased sexual arousal, feeling nervous, feeling irritable, and worrying (P<0.001, respectively). Adjustment for demographic and clinical variables had no impact on these cultural differences in symptom prevalence. The median severity of 11 symptoms including muscle soreness, muscle cramps, and itching was greater among Americans (P<0.001, respectively), although nearly all of these differences were rendered nonstatistically significant with adjustment for race, diabetes, and/or Kt/V. Italian patients receiving chronic hemodialysis report a greater burden of symptoms than American patients, particularly those related to sexual dysfunction and psychosocial distress. These findings suggest that cultural background may affect adaptation to chronic hemodialysis therapy.

  8. 21 CFR 862.3080 - Breath nitric oxide test system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... fractional nitric oxide concentration in expired breath aids in evaluating an asthma patient's response to anti-inflammatory therapy, as an adjunct to established clinical and laboratory assessments of...

  9. 21 CFR 862.3080 - Breath nitric oxide test system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... fractional nitric oxide concentration in expired breath aids in evaluating an asthma patient's response to anti-inflammatory therapy, as an adjunct to established clinical and laboratory assessments of...

  10. 21 CFR 862.3080 - Breath nitric oxide test system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... fractional nitric oxide concentration in expired breath aids in evaluating an asthma patient's response to anti-inflammatory therapy, as an adjunct to established clinical and laboratory assessments of...

  11. 21 CFR 862.3080 - Breath nitric oxide test system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... fractional nitric oxide concentration in expired breath aids in evaluating an asthma patient's response to anti-inflammatory therapy, as an adjunct to established clinical and laboratory assessments of...

  12. 21 CFR 862.3080 - Breath nitric oxide test system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... fractional nitric oxide concentration in expired breath aids in evaluating an asthma patient's response to anti-inflammatory therapy, as an adjunct to established clinical and laboratory assessments of...

  13. Emergency Response Breathing Apparatus

    NASA Technical Reports Server (NTRS)

    2000-01-01

    Aerospace Design & Development, Inc.'s (ADD's) SCAMP was developed under an SBIR contract through Kennedy Space Center. SCAMP stands for Supercritical Air Mobility Pack. The technology came from the life support fuel cell support systems used for the Apollo and Space Shuttle programs. It uses supercritical cryogenic air and is able to function in microgravity environments. SCAMP's self-contained breathing apparatus(SCBA) systems are also ground-based and can provide twice as much air than traditional SCBA's due to its high-density capacity. The SCAMP system was designed for use in launch pad emergency rescues. ADD also developed a protective suit for use with SCAMP that is smaller and lighter system than the old ones. ADD's SCAMP allows for body cooling and breathing from the supercritical cryogenic air, requiring no extra systems. The improvement over the traditional SCBA allows for a reduction of injuries, such as heat stress, and makes it easier for rescuers to save lives.

  14. Evaluation of Fractional Regional Ventilation Using 4D-CT and Effects of Breathing Maneuvers on Ventilation

    SciTech Connect

    Mistry, Nilesh N.; Diwanji, Tejan; Shi, Xiutao; Pokharel, Sabin; Feigenberg, Steven; Scharf, Steven M.; D'Souza, Warren D.

    2013-11-15

    Purpose: Current implementations of methods based on Hounsfield units to evaluate regional lung ventilation do not directly incorporate tissue-based mass changes that occur over the respiratory cycle. To overcome this, we developed a 4-dimensional computed tomography (4D-CT)-based technique to evaluate fractional regional ventilation (FRV) that uses an individualized ratio of tidal volume to end-expiratory lung volume for each voxel. We further evaluated the effect of different breathing maneuvers on regional ventilation. The results from this work will help elucidate the relationship between global and regional lung function. Methods and Materials: Eight patients underwent 3 sets of 4D-CT scans during 1 session using free-breathing, audiovisual guidance, and active breathing control. FRV was estimated using a density-based algorithm with mass correction. Internal validation between global and regional ventilation was performed by use of the imaging data collected during the use of active breathing control. The impact of breathing maneuvers on FRV was evaluated comparing the tidal volume from 3 breathing methods. Results: Internal validation through comparison between the global and regional changes in ventilation revealed a strong linear correlation (slope of 1.01, R{sup 2} of 0.97) between the measured global lung volume and the regional lung volume calculated by use of the “mass corrected” FRV. A linear relationship was established between the tidal volume measured with the automated breathing control system and FRV based on 4D-CT imaging. Consistently larger breathing volumes were observed when coached breathing techniques were used. Conclusions: The technique presented improves density-based evaluation of lung ventilation and establishes a link between global and regional lung ventilation volumes. Furthermore, the results obtained are comparable with those of other techniques of functional evaluation such as spirometry and hyperpolarized-gas magnetic

  15. Effect of breathing pattern on arm coordination symmetry in front crawl.

    PubMed

    Seifert, Ludovic; Chehensse, Amelie; Tourny-Chollet, Claire; Lemaitre, Frederic; Chollet, Didier

    2008-09-01

    This study analyzed the relationship between breathing pattern and arm coordination symmetry in 11 expert male swimmers who performed the front crawl at their 100-m race pace using seven randomized breathing patterns. Two indexes of coordination (IdCP and IdCNP) and a symmetry index (SI) based on the difference of IdCP - IdCNP were calculated. IdCP calculated the lag time between the beginning of arm propulsion on the nonpreferential breathing side and the end of arm propulsion on the preferential breathing side; IdCNP did the converse. The IdCP and IdCNP comparisons and the SI showed coordination asymmetries among the seven breathing patterns. Specifically, breathing to the preferential side led to an asymmetry, in contrast to the other breathing patterns, and the asymmetry was even greater when the swimmer breathed to his nonpreferential side. These findings highlight the effect of breathing laterality in that coordination was symmetric in patterns with breathing that was bilateral, axed (as in breathing with a frontal snorkel), or removed (as in apnea). One practical application is that arm coordination asymmetry can be prevented or reduced by using breathing patterns that balance the coordination. PMID:18714216

  16. [TMJ, eating and breathing].

    PubMed

    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.

  17. [TMJ, eating and breathing].

    PubMed

    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. PMID:27554491

  18. [Specific variability of teicoplanin protein binding in patients receiving continuous hemodiafiltration-comparison with hypoalbuminemia patients].

    PubMed

    Yanagimoto, Hiromi; Teramatsu, Tsuyoshi; Goto, Junko; Yanagisawa, Masahiko; Harii, Norikazu; Suzuki, Masahiko; Hanawa, Takehisa; Matsuda, Kenichi; Oguchi, Toshio

    2013-01-01

    Variation in protein binding ratio (PBR) of teicoplanin (TEIC) was investigated in continuous hemodiafiltration (CHDF) patients. TEIC is classified as a high PBR drug (≧90%), and it was reported that the PBR of TEIC decreased with an decrease in the serum albumin level in hypoalbuminemia patients. However, few reports can be found about the variation of PBR of TEIC for CHDF patient. An antibiotic activity is directly determined by the level of unbound antibiotics species (Cfree) in the target site, namely, an increase in the Cfree enhances the risks of TEIC as well as the therapeutic effect against Methicillin-resistant Staphylococcus aureus (MRSA). In this study, both the total concentration (Ctotal) and Cfree of TEIC were determined and the PBRs were compared between a patient with normal albumin level, hypoalbuminemia patients and CHDF patients. Similarly to the previous report, the lowering of PBR of TEIC was demonstrated in the hypoalbuminemia patients. On the other hand, the CHDF patients showed lower value of PBR suggesting some change in the protein binding ability, although showed higher values of serum albumin level in comparison with the hypoalbuminemia patients. It was not necessary to measure the Cfree value for the hypoalbuminemia patient routinely, but the monitoring of Cfree as well as Ctotal for the CHDF patients can be important for the proper TEIC use because of the potential specialty of PBR.

  19. Cardiovascular Biomarkers In Exhaled Breath

    PubMed Central

    Cikach, Frank S.; Dweik, Raed A.

    2014-01-01

    With each breath we exhale, thousands of molecules are expelled in our breath giving individuals a “breath-print” that can tell a lot about them and their state of health. Breath analysis is rapidly evolving as the new frontier in medical testing. The end of the 20th century and the beginning of the 21st century have arguably witnessed a revolution in our understanding of the constituents of exhaled breath and the development of the field of breath analysis and testing. Thanks to major breakthroughs in new technologies (infrared, electrochemical, chemiluminescence, and others) and the availability of mass spectrometers, the field of breath analysis has made considerable advances in the 21st century. Several methods are now in clinical use or nearly ready to enter that arena. Breath analysis has the potential to offer relatively inexpensive, rapid, noninvasive methods for detecting and/or monitoring a variety of diseases. Breath analysis also has applications in fields beyond medicine, including environmental monitoring, security and others. This review will focus on exhaled breath as a potential source of biomarkers for medical applications with specific attention to applications (and potential applications) in cardiovascular disease. PMID:22824108

  20. Breath Analysis in Pulmonary Arterial Hypertension

    PubMed Central

    Cikach, Frank S.; Tonelli, Adriano R.; Barnes, Jarrod; Paschke, Kelly; Newman, Jennie; Grove, David; Dababneh, Luma; Wang, Sihe

    2014-01-01

    Background: Pulmonary arterial hypertension (PAH) is a progressive and devastating condition characterized by vascular cell proliferation and is associated with several metabolic derangements. We hypothesized that metabolic derangements in PAH can be detected by measuring metabolic by-products in exhaled breath. Methods: We collected breath and blood samples from patients with PAH at the time of right-sided heart catheterization (n = 31) and from healthy control subjects (n = 34). Breath was analyzed by selected ion flow tube-mass spectrometry in predetermined training and validation cohorts. Results: Patients with PAH were 51.5 ± 14 years old, and 27 were women (85%). Control subjects were 38 ± 13 years old, and 22 were women (65%). Discriminant analysis in the training set identified three ion peaks (H3O+29+, NO+56+, and O2+98+) and the variable age that correctly classified 88.9% of the individuals. In an independent validation cohort, 82.8% of the individuals were classified correctly. The concentrations of the volatile organic compounds 2-propanol, acetaldehyde, ammonia, ethanol, pentane, 1-decene, 1-octene, and 2-nonene were different in patients with PAH compared with control subjects. Exhaled ammonia was higher in patients with PAH (median [interquartile range]: 94.7 parts per billion (ppb) [70-129 ppb] vs 60.9 ppb [46-77 ppb], P < .001) and was associated with right atrial pressure (ρ = 0.57, P < .001), mean pulmonary artery pressure (ρ = 0.43, P = .015), cardiac index by thermodilution (ρ = −0.39, P = .03), pulmonary vascular resistance (ρ = 0.40, P = .04), mixed venous oxygen (ρ = −0.59, P < .001), and right ventricular dilation (ρ = 0.42, P = .03). Conclusions: Breathprint is different between patients with PAH and healthy control subjects. Several specific compounds, including ammonia, were elevated in the breath of patients with PAH. Exhaled ammonia levels correlated with severity of disease. PMID:24091389

  1. Breath Powered Nasal Delivery: A New Route to Rapid Headache Relief

    PubMed Central

    Djupesland, Per G; Messina, John C; Mahmoud, Ramy A

    2013-01-01

    The nose offers an attractive noninvasive alternative for drug delivery. Nasal anatomy, with a large mucosal surface area and high vascularity, allows for rapid systemic absorption and other potential benefits. However, the complex nasal geometry, including the narrow anterior valve, poses a serious challenge to efficient drug delivery. This barrier, plus the inherent limitations of traditional nasal delivery mechanisms, has precluded achievement of the full potential of nasal delivery. Breath Powered bi-directional delivery, a simple but novel nasal delivery mechanism, overcomes these barriers. This innovative mechanism has now been applied to the delivery of sumatriptan. Multiple studies of drug deposition, including comparisons of traditional nasal sprays to Breath Powered delivery, demonstrate significantly improved deposition to superior and posterior intranasal target sites beyond the nasal valve. Pharmacokinetic studies in both healthy subjects and migraineurs suggest that improved deposition of sumatriptan translates into improved absorption and pharmacokinetics. Importantly, the absorption profile is shifted toward a more pronounced early peak, representing nasal absorption, with a reduced late peak, representing predominantly gastrointestinal (GI) absorption. The flattening and “spreading out” of the GI peak appears more pronounced in migraine sufferers than healthy volunteers, likely reflecting impaired GI absorption described in migraineurs. In replicated clinical trials, Breath Powered delivery of low-dose sumatriptan was well accepted and well tolerated by patients, and onset of pain relief was faster than generally reported in previous trials with noninjectable triptans. Interestingly, Breath Powered delivery also allows for the potential of headache-targeted medications to be better delivered to the trigeminal nerve and the sphenopalatine ganglion, potentially improving treatment of various types of headache. In brief, Breath Powered bi

  2. Breath powered nasal delivery: a new route to rapid headache relief.

    PubMed

    Djupesland, Per G; Messina, John C; Mahmoud, Ramy A

    2013-09-01

    The nose offers an attractive noninvasive alternative for drug delivery. Nasal anatomy, with a large mucosal surface area and high vascularity, allows for rapid systemic absorption and other potential benefits. However, the complex nasal geometry, including the narrow anterior valve, poses a serious challenge to efficient drug delivery. This barrier, plus the inherent limitations of traditional nasal delivery mechanisms, has precluded achievement of the full potential of nasal delivery. Breath Powered bi-directional delivery, a simple but novel nasal delivery mechanism, overcomes these barriers. This innovative mechanism has now been applied to the delivery of sumatriptan. Multiple studies of drug deposition, including comparisons of traditional nasal sprays to Breath Powered delivery, demonstrate significantly improved deposition to superior and posterior intranasal target sites beyond the nasal valve. Pharmacokinetic studies in both healthy subjects and migraineurs suggest that improved deposition of sumatriptan translates into improved absorption and pharmacokinetics. Importantly, the absorption profile is shifted toward a more pronounced early peak, representing nasal absorption, with a reduced late peak, representing predominantly gastrointestinal (GI) absorption. The flattening and "spreading out" of the GI peak appears more pronounced in migraine sufferers than healthy volunteers, likely reflecting impaired GI absorption described in migraineurs. In replicated clinical trials, Breath Powered delivery of low-dose sumatriptan was well accepted and well tolerated by patients, and onset of pain relief was faster than generally reported in previous trials with noninjectable triptans. Interestingly, Breath Powered delivery also allows for the potential of headache-targeted medications to be better delivered to the trigeminal nerve and the sphenopalatine ganglion, potentially improving treatment of various types of headache. In brief, Breath Powered bi

  3. Breath-by-breath measurement of particle deposition in the lung of spontaneously breathing rats.

    PubMed

    Karrasch, S; Eder, G; Bolle, I; Tsuda, A; Schulz, H

    2009-10-01

    A number of deposition models for humans, as well as experimental animals, have been described. However, no breath-by-breath deposition measurement in rats has been reported to date. The objective of this study is to determine lung deposition of micrometer-sized particles as a function of breathing parameters in the adult rat lung. A new aerosol photometry system was designed to measure deposition of nonhygroscopic, 2-mum sebacate particles in anesthetized, intubated, and spontaneously breathing 90-day-old Wistar-Kyoto rats placed in a size-adjusted body plethysmograph box. Instrumental dead space of the system was minimized down to 310 microl (i.e., approximately 20% of respiratory dead space). The system allows continuous monitoring of particle concentration in the respired volume. Breathing parameters, such as respiratory rate (f), tidal volume (Vt), as well as inspiration/expiration times, were also monitored at different levels of anesthesia. The results showed that Vt typically varied between 1.5 and 4.0 ml for regular breathing and between 4.0 and 10.0 ml for single-sigh breaths; f ranged from 40 to 200 breaths/min. Corresponding deposition values varied between 5 and 50%, depending on breath-by-breath breathing patterns. The best fit of deposition (D) was achieved by a bilinear function of Vt and f and found to be D = 11.0 - 0.09.f + 3.75.Vt. We conclude that our approach provides more realistic conditions for the measurement of deposition than conventional models using ventilated animals and allows us to analyze the correlation between breath-specific deposition and spontaneous breathing patterns.

  4. Comparative effects of pressure support ventilation and intermittent positive pressure breathing (IPPB) in non-intubated healthy subjects.

    PubMed

    Mancebo, J; Isabey, D; Lorino, H; Lofaso, F; Lemaire, F; Brochard, L

    1995-11-01

    We compared the efficacy of three devices delivering assisted non-invasive ventilation with different working mechanisms, during room air breathing and during CO2-induced hyperventilation. In seven healthy volunteers, breathing pattern, respiratory muscle activity and comfort were assessed: during unassisted spontaneous breathing through a mouth-piece (SB); during assisted breathing with a device delivering inspiratory pressure support (IPS); and with two devices delivering intermittent positive pressure breathing (IPPB), the Monaghan 505 (IPPB1), and the CPU 1 ventilator (IPPB2). All three devices were set at 10 cmH2O of maximal pressure. During room air breathing, the work of breathing expressed as power, was significantly greater with the two IPPB devices than with the two other modes (IPPB1 and IPPB2 7.3 +/- 5.2 and 7.2 +/- 6.2 J.min-1, respectively, versus SB and IPS 2.4 +/- 0.7 and 2.3 +/- 3.3 J.min-1, respectively). The difference did not reach the statistical significance for the pressure-time product (PTP). Discomfort was also greater during the IPPB modes. During CO2-induced hyperventilation, considerable differences in power of breathing were found between the two IPPB devices and the other two modes. The PTP was also much higher with IPPB. Transdiaphragmatic pressure was significantly smaller during IPS than during the three other modes (IPS 18 +/- 2.6 cmH2O versus SB 22 +/- 2.6, IPPB1 32 +/- 5.2, and IPPB2: 28 +/- 5.2). Maximal discomfort was observed during the IPPB modes and was correlated with the magnitude of transdiaphragmatic pressure (r = 0.60). Despite similarities in their operational principles, IPS and IPPB had very different effects on respiratory muscle activity in healthy non-intubated subjects. IPPB machines not only failed to reduce patient's effort but also induced a significant level of extra work by comparison to spontaneous ventilation at ambient pressure. Great caution is, therefore, needed in the use of patient-triggered devices

  5. Probing plasmonic breathing modes optically

    SciTech Connect

    Krug, Markus K. Reisecker, Michael; Hohenau, Andreas; Ditlbacher, Harald; Trügler, Andreas; Hohenester, Ulrich; Krenn, Joachim R.

    2014-10-27

    The confinement of surface plasmon modes in flat nanoparticles gives rise to plasmonic breathing modes. With a vanishing net dipole moment, breathing modes do not radiate, i.e., they are optically dark. Having thus escaped optical detection, breathing modes were only recently revealed in silver nanodisks with electron energy loss spectroscopy in an electron microscope. We show that for disk diameters >200 nm, retardation induced by oblique optical illumination relaxes the optically dark character. This makes breathing modes and thus the full plasmonic mode spectrum accessible to optical spectroscopy. The experimental spectroscopy data are in excellent agreement with numerical simulations.

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

    PubMed

    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.

  7. Feasibility of Free-breathing CCTA using 256-MDCT.

    PubMed

    Liu, Zhuo; Sun, Ye; Zhang, Zhuolu; Chen, Lei; Hong, Nan

    2016-07-01

    Usually, coronary computed tomography angiography (CCTA) is performed during breath-holding to reduce artifact caused by respiration. The objective of this study was to evaluate the feasibility of free-breathing CCTA compared to breath-holding using CT scanner with wide detector. To evaluate the feasibility of CCTA during free-breathing using a 256-MDCT. In 80 patients who underwent CCTA, 40 were performed during breath-holding (group A), and the remaining 40 during free-breathing (group B). The quality scores for coronary arteries were analyzed and defined as: 3 (excellent), 2 (good), and 1 (poor). The image noise, signal-to-noise ratio and effective radiation dose as well as the heart rate variation were compared. The noise, signal-to-noise ratio, and effective radiation dose were not significantly different between the 2 groups. The mean heart rate variation between planning and scanning for group A was 7 ± 7.6 bpm, and larger than 3 ± 2.6 bpm for group B (P = 0.012). Quality scores of the free-breathing group were better than those of the breath-holding group (group A: 2.55 ± 0.64, group B: 2.85 ± 0.36, P = 0.018). Free-breathing CCTA is feasible on wide detector CT scanner to provide acceptable image quality with reduced heart rate variation and better images for certain patients. PMID:27399104

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

    SciTech Connect

    Gong, G; Yin, Y

    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.

  9. BREATHE to Understand©

    ERIC Educational Resources Information Center

    Swisa, Maxine

    2015-01-01

    BREATHE is an acronym for Breathe, Reflect, Empathize, Accept, Thank, Hearten, Engage. The addition of Understand allows for a holistic approach to living a healthy and balanced life both inside and outside the classroom. This paper took form as a result of my personal, spiritual journey, as well as my teaching practice. I noticed that the…

  10. Breath tests and irritable bowel syndrome.

    PubMed

    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. PMID:24976698

  11. Breath tests and irritable bowel syndrome

    PubMed Central

    Rana, Satya Vati; Malik, Aastha

    2014-01-01

    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. PMID:24976698

  12. Yoga breathing, meditation, and longevity.

    PubMed

    Brown, Richard P; Gerbarg, Patricia L

    2009-08-01

    Yoga breathing is an important part of health and spiritual practices in Indo-Tibetan traditions. Considered fundamental for the development of physical well-being, meditation, awareness, and enlightenment, it is both a form of meditation in itself and a preparation for deep meditation. Yoga breathing (pranayama) can rapidly bring the mind to the present moment and reduce stress. In this paper, we review data indicating how breath work can affect longevity mechanisms in some ways that overlap with meditation and in other ways that are different from, but that synergistically enhance, the effects of meditation. We also provide clinical evidence for the use of yoga breathing in the treatment of depression, anxiety, post-traumatic stress disorder, and for victims of mass disasters. By inducing stress resilience, breath work enables us to rapidly and compassionately relieve many forms of suffering.

  13. Sensitivity of bile acid breath test in the diagnosis of bacterial overgrowth in the small intestine with and without the stagnant (blind) loop syndrome.

    PubMed

    Farivar, S; Fromm, H; Schindler, D; Schmidt, F W

    1979-01-01

    The bile acid breath test was studied to examine its sensitivity for establishing the diagnosis of bacterial overgrowth in comparison to that of the Schilling test and small-intestinal cultures in 12 patients with a stagnant (blind) loop syndrome, as well as in 38 patients who had other conditions with suspected bacterial contamination of the small intestine. The presence of bile acid malabsorption was excluded in all 50 patients by studies of fecal excretion of radioactively labeled bile acids. The bile acid breath test was positive in 100% (12/12) of the patients with a stagnant (blind) loop syndrome, whereas 92% (11/12) had a positive Schilling test and 75% (9/12) a positive small-intestinal culture. The abnormal tests improved only in 2 of 4 patients treated with tetracycline. In the group of 38 patients without demonstrable dilated or blind loops of small bowel who were suspected of having bacterial contamination of small bowel, the bile acid breath test was positive in 53% (20/38), the Schilling test in 39% (15/38), and the small-intestinal culture in 45% (17/38). The difference in the incidence of positive results between the tests in the two patient groups was statistically not significant. The findings of these studies have the following diagnostic implications: (1) Bile acid breath test, Schilling test, and cultures of aspirates from the upper small bowel are of comparable sensitivity in the detection of bacterial overgrowth in the small intestine. (2) A negative bile acid breath test makes the diagnosis of a stagnant (blind) loop syndrome very unlikely.

  14. Breathing zone air sampler

    DOEpatents

    Tobin, John

    1989-01-01

    A sampling apparatus is provided which comprises a sampler for sampling air in the breathing zone of a wearer of the apparatus and a support for the sampler preferably in the form of a pair of eyeglasses. The sampler comprises a sampling assembly supported on the frame of the eyeglasses and including a pair of sample transport tubes which are suspended, in use, centrally of the frame so as to be disposed on opposite sides of the nose of the wearer and which each include an inlet therein that, in use, is disposed adjacent to a respective nostril of the nose of the wearer. A filter holder connected to sample transport tubes supports a removable filter for filtering out particulate material in the air sampled by the apparatus. The sample apparatus is connected to a pump for drawing air into the apparatus through the tube inlets so that the air passes through the filter.

  15. Growth of breath figures

    NASA Astrophysics Data System (ADS)

    Beysens, D.; Knobler, C. M.

    1986-09-01

    Measurements are reported of the growth of breath figures, the patterns that form when a vapor is condensed onto a cold surface. Water vapor was condensed on glass slides and the pattern was studied by direct observation and light scattering as a function of the contact angle theta, flux F, degree of supersaturation ΔT, and time t. When theta=0°, a uniform layer forms whose thickness grows as t at constant F and ΔT. For theta=90°, droplets are formed; at constant F and T, the radius of an isolated droplet grows as t0.23, but, as a result of coalescences, the average droplet radius grows as t0.75. The droplet growth process is self-similar-coalescences simply rescale the distances and leave the basic droplet pattern unaltered.

  16. Deodorization of garlic breath volatiles by food and food components.

    PubMed

    Munch, Ryan; Barringer, Sheryl A

    2014-04-01

    The ability of foods and beverages to reduce allyl methyl disulfide, diallyl disulfide, allyl mercaptan, and allyl methyl sulfide on human breath after consumption of raw garlic was examined. The treatments were consumed immediately following raw garlic consumption for breath measurements, or were blended with garlic prior to headspace measurements. Measurements were done using a selected ion flow tube-mass spectrometer. Chlorophyllin treatment demonstrated no deodorization in comparison to the control. Successful treatments may be due to enzymatic, polyphenolic, or acid deodorization. Enzymatic deodorization involved oxidation of polyphenolic compounds by enzymes, with the oxidized polyphenols causing deodorization. This was the probable mechanism in raw apple, parsley, spinach, and mint treatments. Polyphenolic deodorization involved deodorization by polyphenolic compounds without enzymatic activity. This probably occurred for microwaved apple, green tea, and lemon juice treatments. When pH is below 3.6, the enzyme alliinase is inactivated, which causes a reduction in volatile formation. This was demonstrated in pH-adjusted headspace measurements. However, the mechanism for volatile reduction on human breath (after volatile formation) is unclear, and may have occurred in soft drink and lemon juice breath treatments. Whey protein was not an effective garlic breath deodorant and had no enzymatic activity, polyphenolic compounds, or acidity. Headspace concentrations did not correlate well to breath treatments.

  17. Sleep-disordered breathing and psychiatric disorders.

    PubMed

    Naqvi, Haider A; Wang, David; Glozier, Nicholas; Grunstein, Ronald R

    2014-12-01

    Sleep-disordered breathing, the commonest form of which is obstructive sleep apnoea (OSA) is increasingly recognised as a treatable cause of morbidity. It shares many risk factors with psychiatric disorders including behaviours such as smoking and physical comorbidity. Many symptoms of the two overlap, leaving OSA often undetected and undertreated. In the few studies that assess the two, OSA is commonly comorbid with depression (17-45%) and schizophrenia (up to 55%) and possibly bipolar. There is some limited evidence that treating OSA can ameliorate psychiatric symptoms. Some psychotropics, such as narcotics, cause sleep-disordered breathing (SDB), whilst weight-inducing neuroleptics may exacerbate it. An extreme form of SDB, sudden infant death syndrome (SIDS), is a risk in mothers with substance abuse. Being aware of these common comorbidities may help improve psychiatric patient's treatment and quality of life. PMID:25308389

  18. Noninvasive Electrocardiographic Imaging (ECGI): Comparison to intraoperative mapping in patients

    PubMed Central

    Ghanem, Raja N.; Jia, Ping; Ramanathan, Charulatha; Ryu, Kyungmoo; Markowitz, Alan; Rudy, Yoram

    2007-01-01

    OBJECTIVES/BACKGROUND Cardiac arrhythmias are a leading cause of death and disability. Electrocardiographic imaging (ECGI) is a noninvasive imaging modality that reconstructs potentials, electrograms, and isochrones on the epicardial surface from body surface measurements. We previously demonstrated in animal experiments through comparison with simultaneously measured epicardial data the high accuracy of ECGI in imaging cardiac electrical events. Here, images obtained by noninvasive ECGI are compared to invasive direct epicardial mapping in open heart surgery patients. METHODS Three patients were studied during sinus rhythm and right ventricular endocardial and epicardial pacing (total of five datasets). Body surface potentials were acquired preoperatively or postoperatively using a 224-electrode vest. Heart-torso geometry was determined preoperatively using computed tomography. Intraoperative mapping was performed with two 100-electrode epicardial patches. RESULTS Noninvasive potential maps captured epicardial breakthrough sites and reflected general activation and repolarization patterns, localized pacing sites to ∼1 cm and distinguished between epicardial and endocardial origin of activation. Noninvasively reconstructed electrogram morphologies correlated moderately with their invasive counterparts (cross correlation = 0.72 ± 0.25 [sinus rhythm], 0.67 ± 0.23 [endocardial pacing], 0.71 ± 0.21 [epicardial pacing]). Noninvasive isochrones captured the sites of earliest activation, areas of slow conduction, and the general excitation pattern. CONCLUSIONS Despite limitations due to nonsimultaneous acquisition of the surgical and noninvasive data under different conditions, the study demonstrates that ECGI can capture important features of cardiac electrical excitation in humans noninvasively during a single beat. It also shows that general excitation patterns and electrogram morphologies are largely preserved in open chest conditions. PMID:15851333

  19. Care strategies for schizophrenic patients in a transcultural comparison.

    PubMed

    von Zerssen, D; León, C A; Möller, H J; Wittchen, H U; Pfister, H; Sartorius, N

    1990-01-01

    This study was conducted in order to test the hypothesis derived from the International Pilot Study of Schizophrenia (IPSS) that the existence of extended families in developing countries contributes to the more favorable course and outcome of schizophrenia in these countries in comparison with industrial countries. For this purpose, we compared data from the 5- and 10-year follow-up obtained within the IPSS at Cali, Colombia with data from two 5- to 8-year follow-up studies of former schizophrenic inpatients of the Max Planck Institute of Psychiatry (MPIP) in Munich, FRG. Although, in Cali, schizophrenics are hospitalized and treated with drugs only during acute episodes of the psychosis and no facilities exist for long-term treatment, the psychopathological outcome was, on the whole, not worse than in Munich. Furthermore, the duration of hospitalization during the follow-up period was much lower at Cali and a significantly lower number of Colombian than of German patients was not separated from their families. However, contrary to the hypothesis, family size did not predict course and outcome at both centers.

  20. Perioperative issues and sleep-disordered breathing.

    PubMed

    Wood, Karen L; Besecker, Beth Y

    2015-07-01

    Sleep-disordered breathing in the perioperative setting poses an increase in both perceived and demonstrated challenges for health care providers. Some of these challenges relate to identifying patients at high risk for obstructive sleep apnea prior to surgery. Other management challenges include identifying the proper monitoring techniques, using the correct mix of pharmacologic and nonpharmacologic strategies to manage these patients, and identifying the proper and safe disposition strategy after surgery. Additional populations, such as pediatrics and the morbidly obese, are also highlighted, which may help address questions in populations that are frequently managed in the critical care setting postoperatively.

  1. The effects of slow breathing on affective responses to pain stimuli: an experimental study.

    PubMed

    Zautra, Alex J; Fasman, Robert; Davis, Mary C; Craig, Arthur D Bud

    2010-04-01

    This study examined whether breathing rate affected self-reported pain and emotion following thermal pain stimuli in women with fibromyalgia syndrome (FM: n=27) or age-matched healthy control women (HC: n=25). FM and HC were exposed to low and moderate thermal pain pulses during paced breathing at their normal rate and one-half their normal rate. Thermal pain pulses were presented in four blocks of four trials. Each block included exposure to both mild and moderate pain trials, and periods of both normal and slow paced breathing. Pain intensity and unpleasantness were recorded immediately following each pain trial, and positive and negative affect were assessed at the end of each block of trials. Compared to normal breathing, slow breathing reduced ratings of pain intensity and unpleasantness, particularly for moderately versus mildly painful thermal stimuli. The effects of slow breathing on pain ratings were less reliable for FM patients than for HCs. Slow versus normal breathing decreased negative affect ratings following thermal pain pulses for both groups, and increased positive affect reports, but only for healthy controls with high trait negative affect. Participants who reported higher levels of trait positive affect prior to the experiment showed greater decreases in negative affect as a result of slow versus normal breathing. These experimental findings provide support for prior reports on the benefits of yogic breathing and mindful Zen meditation for pain and depressed affect. However, chronic pain patients may require more guidance to obtain therapeutic benefit from reduced breathing rates.

  2. Genetics and early disturbances of breathing control.

    PubMed

    Gaultier, Claude; Amiel, Jeanne; Dauger, Stéphane; Trang, Ha; Lyonnet, Stanislas; Gallego, Jorge; Simonneau, Michel

    2004-05-01

    Early disturbances in breathing control, including apneas of prematurity and apparently life-threatening events, account for some cases of sudden infant death syndrome and for a rare disorder called congenital central hypoventilation syndrome (CCHS). Data suggesting a genetic basis for CCHS have been obtained. Recently, we found heterozygous de novo mutations of the PHOX2B gene in 18 of 29 individuals with CCHS. Most mutations consisted of five to nine alanine expansions within a 20-residue polyalanine tract, probably resulting from nonhomologous recombination. Other mutations, generally inherited from one of the parents, in the coding regions of genes involved in the endothelin and RET signaling pathways and in the brain-derived-neurotrophic factor (BDNF) gene have been found in a few CCHS patients. Interestingly, all these genes are involved in the development of neural crest cells. Targeted disruption of these genes in mice has provided information on the pathophysiological mechanisms underlying CCHS. Despite the identification of these genes involved in breathing control, none of the genetically engineered mice developed to date replicate the full human CCHS respiratory phenotype. Recent insights into the genetic basis for CCHS may shed light on the genetics of other early disturbances in breathing control, such as apnea of prematurity and sudden infant death syndrome. PMID:14739359

  3. A wireless breathing-training support system for kinesitherapy.

    PubMed

    Tawa, Hiroki; Yonezawa, Yoshiharu; Maki, Hiromichi; Ogawa, Hidekuni; Ninomiya, Ishio; Sada, Kouji; Hamada, Shingo; Caldwell, W Morton

    2009-01-01

    We have developed a new wireless breathing-training support system for kinesitherapy. The system consists of an optical sensor, an accelerometer, a microcontroller, a Bluetooth module and a laptop computer. The optical sensor, which is attached to the patient's chest, measures chest circumference. The low frequency components of circumference are mainly generated by breathing. The optical sensor outputs the circumference as serial digital data. The accelerometer measures the dynamic acceleration force produced by exercise, such as walking. The microcontroller sequentially samples this force. The acceleration force and chest circumference are sent sequentially via Bluetooth to a physical therapist's laptop computer, which receives and stores the data. The computer simultaneously displays these data so that the physical therapist can monitor the patient's breathing and acceleration waveforms and give instructions to the patient in real time during exercise. Moreover, the system enables a quantitative training evaluation and calculation the volume of air inspired and expired by the lungs.

  4. SU-E-J-62: Breath Hold for Left-Sided Breast Cancer: Visually Monitored Deep Inspiration Breath Hold Amplitude Evaluated Using Real-Time Position Management

    SciTech Connect

    Conroy, L; Quirk, S; Smith, WL; Yeung, R; Phan, T; Hudson, A

    2015-06-15

    Purpose: We used Real-Time Position Management (RPM) to evaluate breath hold amplitude and variability when gating with a visually monitored deep inspiration breath hold technique (VM-DIBH) with retrospective cine image chest wall position verification. Methods: Ten patients with left-sided breast cancer were treated using VM-DIBH. Respiratory motion was passively collected once weekly using RPM with the marker block positioned at the xiphoid process. Cine images on the tangent medial field were acquired on fractions with RPM monitoring for retrospective verification of chest wall position during breath hold. The amplitude and duration of all breath holds on which treatment beams were delivered were extracted from the RPM traces. Breath hold position coverage was evaluated for symmetric RPM gating windows from ± 1 to 5 mm centered on the average breath hold amplitude of the first measured fraction as a baseline. Results: The average (range) breath hold amplitude and duration was 18 mm (3–36 mm) and 19 s (7–34 s). The average (range) of amplitude standard deviation per patient over all breath holds was 2.7 mm (1.2–5.7 mm). With the largest allowable RPM gating window (± 5 mm), 4 of 10 VM-DIBH patients would have had ≥ 10% of their breath hold positions excluded by RPM. Cine verification of the chest wall position during the medial tangent field showed that the chest wall was greater than 5 mm from the baseline in only 1 out of 4 excluded patients. Cine images verify the chest wall/breast position only, whether this variation is acceptable in terms of heart sparing is a subject of future investigation. Conclusion: VM-DIBH allows for greater breath hold amplitude variability than using a 5 mm gating window with RPM, while maintaining chest wall positioning accuracy within 5 mm for the majority of patients.

  5. SU-E-J-178: A Normalization Method Can Remove Discrepancy in Ventilation Function Due to Different Breathing Patterns

    SciTech Connect

    Qu, H; Yu, N; Stephans, K; Xia, P

    2014-06-01

    Purpose: To develop a normalization method to remove discrepancy in ventilation function due to different breathing patterns. Methods: Twenty five early stage non-small cell lung cancer patients were included in this study. For each patient, a ten phase 4D-CT and the voluntarily maximum inhale and exhale CTs were acquired clinically and retrospectively used for this study. For each patient, two ventilation maps were calculated from voxel-to-voxel CT density variations from two phases of the quiet breathing and two phases of the extreme breathing. For the quiet breathing, 0% (inhale) and 50% (exhale) phases from 4D-CT were used. An in-house tool was developed to calculate and display the ventilation maps. To enable normalization, the whole lung of each patient was evenly divided into three parts in the longitude direction at a coronal image with a maximum lung cross section. The ratio of cumulated ventilation from the top one-third region to the middle one-third region of the lung was calculated for each breathing pattern. Pearson's correlation coefficient was calculated on the ratios of the two breathing patterns for the group. Results: For each patient, the ventilation map from the quiet breathing was different from that of the extreme breathing. When the cumulative ventilation was normalized to the middle one-third of the lung region for each patient, the normalized ventilation functions from the two breathing patterns were consistent. For this group of patients, the correlation coefficient of the normalized ventilations for the two breathing patterns was 0.76 (p < 0.01), indicating a strong correlation in the ventilation function measured from the two breathing patterns. Conclusion: For each patient, the ventilation map is dependent of the breathing pattern. Using a regional normalization method, the discrepancy in ventilation function induced by the different breathing patterns thus different tidal volumes can be removed.

  6. Breathing-Synchronized Delivery: A Potential Four-Dimensional Tomotherapy Treatment Technique

    SciTech Connect

    Zhang Tiezhi . E-mail: tiezhi.zhang@beaumont.edu; Lu Weiguo; Olivera, Gustavo H.; Keller, Harry; Jeraj, Robert; Manon, Rafael; Mehta, Minesh; Mackie, Thomas R.; Paliwal, Bhudatt

    2007-08-01

    Purpose: To introduce a four-dimensional (4D) tomotherapy treatment technique with improved motion control and patient tolerance. Methods and Materials: Computed tomographic images at 10 breathing phases were acquired for treatment planning. The full exhalation phase was chosen as the planning phase, and the CT images at this phase were used as treatment-planning images. Region of interest delineation was the same as in traditional treatment planning, except that no breathing motion margin was used in clinical target volume-planning target volume expansion. The correlation between delivery and breathing phases was set assuming a constant gantry speed and a fixed breathing period. Deformable image registration yielded the deformation fields at each phase relative to the planning phase. With the delivery/breathing phase correlation and voxel displacements at each breathing phase, a 4D tomotherapy plan was obtained by incorporating the motion into inverse treatment plan optimization. A combined laser/spirometer breathing tracking system has been developed to monitor patient breathing. This system is able to produce stable and reproducible breathing signals representing tidal volume. Results: We compared the 4D tomotherapy treatment planning method with conventional tomotherapy on a static target. The results showed that 4D tomotherapy can achieve dose distributions on a moving target similar to those obtained with conventional delivery on a stationary target. Regular breathing motion is fully compensated by motion-incorporated breathing-synchronized delivery planning. Four-dimensional tomotherapy also has close to 100% duty cycle and does not prolong treatment time. Conclusion: Breathing-synchronized delivery is a feasible 4D tomotherapy treatment technique with improved motion control and patient tolerance.

  7. The control of breathing during weaning from mechanical ventilation.

    PubMed

    Dunn, W F; Nelson, S B; Hubmayr, R D

    1991-09-01

    Using the recruitment threshold technique, we measured the CO2 responsiveness of the unloaded respiratory pump in 14 mechanically ventilated patients prior to weaning. The CO2 recruitment threshold (CO2RT) was compared with the arterial CO2 tension during unassisted breathing (CO2SB) and with the PaCO2 during mechanical ventilation (CO2MV) at machine settings determined by the primary physician. Based on these comparisons, we tested the hypotheses that (1) patients without weaning-induced respiratory distress (group 1) maintain CO2SB near CO2RT, (2) patients with weaning-induced respiratory distress (group 2) retain CO2SB above CO2RT, thereby manifesting incomplete load compensation, and (3) CO2MV is ventilator setting dependent and provides insufficient information about the ventilatory requirement during weaning. Respiratory distress was prospectively defined as sustained tachypnea (rate greater than or equal to 30) or intense dyspnea (Borg scale rating) and limited weaning in nine of 14 patients. The average CO2RT was 40 mm Hg in both groups. All patients in group 1 maintained CO2SB near CO2RT (p greater than 0.1). Seven of nine patients in group 2 retained CO2 by greater than or equal to 3 mm Hg above CO2RT (p less than 0.01). There was no significant difference between CO2MV and CO2SB in either group. We conclude that CO2RT provides a better reference of the adequacy of ventilatory load compensation during weather than CO2MV.

  8. Dysfunctional breathing: a review of the literature and proposal for classification.

    PubMed

    Boulding, Richard; Stacey, Rebecca; Niven, Rob; Fowler, Stephen J

    2016-09-01

    Dysfunctional breathing is a term describing breathing disorders where chronic changes in breathing pattern result in dyspnoea and other symptoms in the absence or in excess of the magnitude of physiological respiratory or cardiac disease. We reviewed the literature and propose a classification system for the common dysfunctional breathing patterns described. The literature was searched using the terms: dysfunctional breathing, hyperventilation, Nijmegen questionnaire and thoraco-abdominal asynchrony. We have summarised the presentation, assessment and treatment of dysfunctional breathing, and propose that the following system be used for classification. 1) Hyperventilation syndrome: associated with symptoms both related to respiratory alkalosis and independent of hypocapnia. 2) Periodic deep sighing: frequent sighing with an irregular breathing pattern. 3) Thoracic dominant breathing: can often manifest in somatic disease, if occurring without disease it may be considered dysfunctional and results in dyspnoea. 4) Forced abdominal expiration: these patients utilise inappropriate and excessive abdominal muscle contraction to aid expiration. 5) Thoraco-abdominal asynchrony: where there is delay between rib cage and abdominal contraction resulting in ineffective breathing mechanics.This review highlights the common abnormalities, current diagnostic methods and therapeutic implications in dysfunctional breathing. Future work should aim to further investigate the prevalence, clinical associations and treatment of these presentations. PMID:27581828

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

    EPA Science Inventory

    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. Sleep-disordered breathing and stroke.

    PubMed

    Ali, Latisha K; Avidan, Alon Y

    2008-01-01

    Sleep and stroke have an important and fascinating interaction. Patients with sleep-disordered breathing present with cardiovascular heart disease, cognitive decline, and increased risk of stroke. Stroke adversely affects sleep and factors such as prolonged immobilization, chronic pain, nocturnal hypoxia, and depression, which can also adversely impact sleep quality. Obstructive sleep apnea (OSA), one of the most common and serious sleep disturbances, manifests itself in almost 50% of all stroke patients. Sleep apnea patients who experience a stroke may be at a greater impairment in their rehabilitation potential and have increased risk of secondary stroke and mortality. Given these factors, the practicing neurologist should possess the skills to appropriately recognize, rapidly diagnose, and properly manage stroke patients with OSA.

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

    SciTech Connect

    Sarrut, David . E-mail: dsarrut@univ-lyon2.fr; Boldea, Vlad; Ayadi, Myriam; Badel, Jean-Noel; Ginestet, Chantal; Clippe, Sebastien; Carrie, Christian

    2005-02-01

    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 <5%. The mean 3D displacement inside the lungs was between 2.3 mm (SD 1.4) and 4 mm (SD 3.3), and the gross tumor volume residual motion was 0.9 mm (SD 0.4) to 5.9 mm (SD 0.7). The residual motion was slightly greater in the inferior part of the lung than the superior. For 2 patients, we detected volume changes >300 cm{sup 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.

  12. Comparison of Sun Protection Behaviors among Physicians and Patients.

    ERIC Educational Resources Information Center

    Sciamanna, Christopher N.; Zampi, Amy; Weinstock, Martin A.

    2002-01-01

    Compared the sun protection behaviors (SPBs) of physicians and patients from a Rhode Island teaching hospital. Survey data indicated that physicians and patients did not differ in their overall use of SPBs, though they differed in their regular use of specific SPBs (physicians were more likely to use sunscreen, while patients were more likely to…

  13. Comparison of end-tidal carbon dioxide and arterial blood bicarbonate levels in patients with metabolic acidosis referred to emergency medicine

    PubMed Central

    Taghizadieh, Ali; Pouraghaei, Mahboub; Moharamzadeh, Payman; Ala, Alireza; Rahmani, Farzad; Basiri Sofiani, Karim

    2016-01-01

    Introduction: The routine and gold standard method to diagnose of acid – base disturbance is arterial blood gas (ABG) sampling. Capnography could be used to measure the end-tidal carbon dioxide (ETCO2) levels and ETco2 has a close correlation with the PaCo2. The aim of this study was comparison the ETco2 and arterial blood bicarbonate levels in patients with metabolic acidosis. Methods: In a descriptive-analytical study that performed in Emergency Department of Emam Reza Medical Research and Training Hospital of Tabriz on patients with metabolic acidosis, ETco2 level and blood bicarbonate levels in 262 patients were evaluated. Results: Mean of ETco2 and Hco3 levels in patients with metabolic acidosis were 22.29 ± 4.15 and 12.78 ± 3.83, respectively. In all patients, the significant direct linear relationship was found between ETco2 with Hco3 (r = 0.553, P < 0.001). We had 4 groups of patients with metabolic acidosis, also there is a significant direct linear relationship between the ETCo2 and the Hco3 level of arterial blood in patients with renal failure (P < 0.001 and r = 0.551), sepsis (P < 0.001 and r = 0.431), drug toxicity (P < 0.001 and r = 0.856), and ketoacidosis (DKA) (P < 0.001 and r = 0.559). Conclusion: According to the results of this study, capnography can be used for primary diagnosis of metabolic acidosis in spontaneously breathing patients who referred to the emergency wards, however, the ABG must be considered as the gold standard tool for diagnosis and guiding the treatment. PMID:27777693

  14. 21 CFR 868.5965 - Positive end expiratory pressure breathing attachment.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... in a patient's lungs above atmospheric pressure at the end of exhalation. (b) Classification. Class... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Positive end expiratory pressure breathing... Positive end expiratory pressure breathing attachment. (a) Identification. A positive end...

  15. 21 CFR 868.5965 - Positive end expiratory pressure breathing attachment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... in a patient's lungs above atmospheric pressure at the end of exhalation. (b) Classification. Class... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Positive end expiratory pressure breathing... Positive end expiratory pressure breathing attachment. (a) Identification. A positive end...

  16. 21 CFR 868.5965 - Positive end expiratory pressure breathing attachment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... in a patient's lungs above atmospheric pressure at the end of exhalation. (b) Classification. Class... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Positive end expiratory pressure breathing... Positive end expiratory pressure breathing attachment. (a) Identification. A positive end...

  17. 21 CFR 868.5965 - Positive end expiratory pressure breathing attachment.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... in a patient's lungs above atmospheric pressure at the end of exhalation. (b) Classification. Class... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Positive end expiratory pressure breathing... Positive end expiratory pressure breathing attachment. (a) Identification. A positive end...

  18. A Study of the Effects of Breath Management Instruction on the Breathing Mode, Knowledge of Breathing, and Performance Skills of College-Level Brass Players.

    ERIC Educational Resources Information Center

    Phillips, Kenneth H.; Sehmann, Karin Harfst

    1990-01-01

    Investigates the effectiveness of breathing instruction on the breath management, performance, and knowledge of breathing among college-level brass musicians. Finds that breathing instruction significantly improved the breath management and knowledge of the breathing for the experimental groups and the musical range of the trombone players in the…

  19. Comparison of preoperative anxiety in reconstructive and cosmetic surgery patients.

    PubMed

    Sönmez, Ahmet; Bişkin, Nurdan; Bayramiçli, Mehmet; Numanoğlu, Ayhan

    2005-02-01

    Surgery is a serious stressor and a cause of anxiety for the patients. Reconstructive surgery patients are mostly operated on because of certain functional impairment or disability; on the contrary, cosmetic surgery patients do not have any physical impairment and they are operated on because of mostly psychologic reasons. The aim of this study was to compare the anxiety levels in the reconstructive surgery patients and cosmetic surgery patients preoperatively. Thirty-two patients in the reconstructive surgery group and 30 patients in the cosmetic surgery group were included in the study. State Trait Anxiety Inventory was used to measure the anxiety levels in these 2 groups preoperatively. The 2 groups were similar in characteristics such as age, gender distribution, number of previous operations, and trait anxiety scores. Mean state anxiety scores obtained for the reconstructive surgery group was 38.0 +/- 8.7, while it was 44.2 +/- 10.79 for the cosmetic surgery group (t test, degrees of freedom = 60, P = 0.015). This study reveals that preoperative anxiety levels in the cosmetic surgery patients are higher than those of the reconstructive surgery patients. Therefore, adequate preoperative preparation for cosmetic surgery should include attempts to cope with anxiety. Anxiolytics may be used more liberally and professional psychologic assistance may be required.

  20. Comparison of packages for suppositories by patients with rheumatoid arthritis.

    PubMed

    Verheggen-Laming, B N; Phiferons, H; Mulder, E F; van der Meij, N T; van Harten, R P; Dijkmans, B A

    1988-01-01

    Ninety-four patients with rheumatoid arthritis were asked via a questionnaire about the convenience of packages containing tablets, capsules, or suppositories for home use. Almost half of the patients stated that they had difficulty in opening packages containing capsules or tablets, and two-thirds had difficulty with the packages used for suppositories. The characteristics of six packages used for suppositories were also compared. Patients were given the packages in random order and were asked to open them and remove a suppository. Many of them were unable to open three of the packages with their hands. The evaluation of the six packages by the patients differed widely.

  1. Bacterial contamination of anesthesia machines’ internal breathing-circuit-systems

    PubMed Central

    Spertini, Verena; Borsoi, Livia; Berger, Jutta; Blacky, Alexander; Dieb-Elschahawi, Magda; Assadian, Ojan

    2011-01-01

    Background: Bacterial contamination of anesthesia breathing machines and their potential hazard for pulmonary infection and cross-infection among anesthetized patients has been an infection control issue since the 1950s. Disposable equipment and bacterial filters have been introduced to minimize this risk. However, the machines’ internal breathing-circuit-system has been considered to be free of micro-organisms without providing adequate data supporting this view. The aim of the study was to investigate if any micro-organisms can be yielded from used internal machines’ breathing-circuit-system. Based on such results objective reprocessing intervals could be defined. Methods: The internal parts of 40 anesthesia machines’ breathing-circuit-system were investigated. Chi-square test and logistic regression analysis were performed. An on-site process observation of the re-processing sequence was conducted. Results: Bacterial growth was found in 17 of 40 machines (43%). No significant difference was ascertained between the contamination and the processing intervals. The most common contaminants retrieved were coagulase negative Staphylococci, aerobe spore forming bacteria and Micrococcus species. In one breathing-circuit-system, Escherichia coli, and in one further Staphylococcus aureus were yielded. Conclusion: Considering the availability of bacterial filters installed on the outlet of the breathing-circuit-systems, the type of bacteria retrieved and the on-site process observation, we conclude that the contamination found is best explained by a lack of adherence to hygienic measures during and after re-processing of the internal breathing-circuit-system. These results support an extension of the re-processing interval of the anesthesia apparatus longer than the manufacturer’s recommendation of one week. However, the importance of adherence to standard hygienic measures during re-processing needs to be emphasized. PMID:22242095

  2. Employing components-of-variance to evaluate forensic breath test instruments.

    PubMed

    Gullberg, Rod G

    2008-03-01

    The evaluation of breath alcohol instruments for forensic suitability generally includes the assessment of accuracy, precision, linearity, blood/breath comparisons, etc. Although relevant and important, these methods fail to evaluate other important analytical and biological components related to measurement variability. An experimental design comparing different instruments measuring replicate breath samples from several subjects is presented here. Three volunteers provided n = 10 breath samples into each of six different instruments within an 18 minute time period. Two-way analysis of variance was employed which quantified the between-instrument effect and the subject/instrument interaction. Variance contributions were also determined for the analytical and biological components. Significant between-instrument and subject/instrument interaction were observed. The biological component of total variance ranged from 56% to 98% among all subject instrument combinations. Such a design can help quantify the influence of and optimize breath sampling parameters that will reduce total measurement variability and enhance overall forensic confidence.

  3. Respiration-correlated treatment delivery using feedback-guided breath hold: A technical study

    SciTech Connect

    Nelson, Christopher; Starkschall, George; Balter, Peter; Fitzpatrick, Mathew J.; Antolak, John A.; Tolani, Naresh; Prado, Karl

    2005-01-01

    Respiratory motion causes movement of internal structures in the thorax and abdomen, making accurate delivery of radiation therapy to tumors in those areas a challenge. To reduce the uncertainties caused by this motion, we have developed feedback-guided breath hold (FGBH), a novel delivery technique in which radiation is delivered only during a voluntary breath hold that is sustained for as long as the patient feels comfortable. Here we present the technical aspects of FGBH, which involve (1) fabricating the hardware so the respiratory trace can be displayed to the patient, (2) assembling a delay box to be used as a breath-hold detector, and (3) performing quality control tests to ensure that FGBH can be delivered accurately and safely. A commercial respiratory tracking system that uses an external fiducial to monitor abdominal wall motion generates and displays the breathing trace and specific positions in the breathing cycle where a breath hold needs to occur. Hardware was developed to present this display to the patient in the treatment position. Patients view the presentation either on a liquid crystal display or through a pair of virtual reality goggles. Using the respiratory trace as a visual aid, the patient performs a breath hold so that the position representing the location of a fiducial is held within a specified gating window. A delay box was fabricated to differentiate between gating signals received during free breathing and those received during breath hold, allowing radiation delivery only when the fiducial was within the breath-hold gating window. A quality control analysis of the gating delay box and the integrated system was performed to ensure that all of the hardware and components were ready for clinical use.

  4. Cardiovascular disease risk profiles comparison among dialysis patients.

    PubMed

    Sharabas, Islam; Siddiqi, Nauman

    2016-01-01

    This study was performed to assess the cardiovascular disease (CVD) risk factors in the prevalent peritoneal dialysis (PD) and hemodialysis (HD) patients and their association with cardiovascular events (CVEs) in a Saudi end-stage renal disease cohort. This was a prospective, observational, single-center study. A total of 192 patients were screened of which 157 patients were eligible (HD = 121, PD = 36). All patients underwent assessment of cardiovascular risk factors at the time of enrollment including electrocardiogram and echocardiography, lipid profile, homocysteine, and insulin levels. Patients were followed for one year and CVE [acute myocardial infarction, cerebrovascular accident (CVA), and congestive heart failure] and mortality were recorded. SPSS ® Version 16 was used for the analysis. T-test and ANOVA were used for continuous data; categorical data were analyzed using Chi-square and Mann-Whitney tests. The primary end-point of CVE and all-cause mortality was compared in the two groups using Kaplan-Meier survival analysis. HD patients were older and had been longer on dialysis. While PD patients had higher urine output and better Kt/V values, they were more edematous and using more antihypertensive medications. PD patients also had a lower ejection fraction (EF). Age >57 years and the use of more than one antihypertensive medication were associated with higher risk of CVE, while EF >53 was found to be protective. Age >57 years and EF <53 at enrollment were predictive of all-cause mortality. Saudi patients undergoing PD have worse CVD risk profiles compared to HD patients. Age less than 57 years and an EF >53 were cardioprotective.

  5. Cardiovascular disease risk profiles comparison among dialysis patients.

    PubMed

    Sharabas, Islam; Siddiqi, Nauman

    2016-01-01

    This study was performed to assess the cardiovascular disease (CVD) risk factors in the prevalent peritoneal dialysis (PD) and hemodialysis (HD) patients and their association with cardiovascular events (CVEs) in a Saudi end-stage renal disease cohort. This was a prospective, observational, single-center study. A total of 192 patients were screened of which 157 patients were eligible (HD = 121, PD = 36). All patients underwent assessment of cardiovascular risk factors at the time of enrollment including electrocardiogram and echocardiography, lipid profile, homocysteine, and insulin levels. Patients were followed for one year and CVE [acute myocardial infarction, cerebrovascular accident (CVA), and congestive heart failure] and mortality were recorded. SPSS ® Version 16 was used for the analysis. T-test and ANOVA were used for continuous data; categorical data were analyzed using Chi-square and Mann-Whitney tests. The primary end-point of CVE and all-cause mortality was compared in the two groups using Kaplan-Meier survival analysis. HD patients were older and had been longer on dialysis. While PD patients had higher urine output and better Kt/V values, they were more edematous and using more antihypertensive medications. PD patients also had a lower ejection fraction (EF). Age >57 years and the use of more than one antihypertensive medication were associated with higher risk of CVE, while EF >53 was found to be protective. Age >57 years and EF <53 at enrollment were predictive of all-cause mortality. Saudi patients undergoing PD have worse CVD risk profiles compared to HD patients. Age less than 57 years and an EF >53 were cardioprotective. PMID:27424685

  6. Quantitative Analysis of the Shape of the Corpus Callosum in Patients with Autism and Comparison Individuals

    ERIC Educational Resources Information Center

    Casanova, Manuel F.; El-Baz, Ayman; Elnakib, Ahmed; Switala, Andrew E.; Williams, Emily L.; Williams, Diane L.; Minshew, Nancy J.; Conturo, Thomas E.

    2011-01-01

    Multiple studies suggest that the corpus callosum in patients with autism is reduced in size. This study attempts to elucidate the nature of this morphometric abnormality by analyzing the shape of this structure in 17 high-functioning patients with autism and an equal number of comparison participants matched for age, sex, IQ, and handedness. The…

  7. Breathing challenges in Rett Syndrome: Lessons learned from humans and animal models✩,✩✩

    PubMed Central

    Ramirez, Jan-Marino; Ward, Christopher Scott; Neul, Jeffrey Lorenz

    2013-01-01

    Breathing disturbances are a major challenge in Rett Syndrome (RTT). These disturbances are more pronounced during wakefulness; but irregular breathing occurs also during sleep. During the day patients can exhibit alternating bouts of hypoventilation and irregular hyperventilation. But there is significant individual variability in severity, onset, duration and type of breathing disturbances. Research in mouse models of RTT suggests that different areas in the ventrolateral medulla and pons give rise to different aspects of this breathing disorder. Pre-clinical experiments in mouse models that target different neuromodulatory and neurotransmitter receptors and MeCP2 function within glia cells can partly reverse breathing abnormalities. The success in animal models raises optimism that one day it will be possible to control or potentially cure the devastating symptoms also in human patients with RTT. PMID:23816600

  8. Lifestyle of Hemodialysis Patients in Comparison with Outpatients

    PubMed Central

    Moghadasian, Sima; Sahebi Hagh, Mohammad Hasan; Aghaallah Hokmabadi, Leila

    2012-01-01

    Introduction: Nowadays, the chronic diseases are known to be associated with lifestyle risk factors. Hemodialysis patients encounter considerable amount of physical, mental and social pressure. Lifestyle is important because it affects quality of life and has important role in prevention. This study aimed to compare the lifestyle of hemodialysis patients and outpatients in health clinics of Tabriz. Methods: This was a case-control study on 155 hemodialysis patients and 155 outpatients referring to five dialysis centers and clinics, who met the inclusion criteria. Demographic data and some questions about lifestyle in nutrition, stress, physical activity and smoking were asked. Results: The history of hypertension among hemodialysis patients was 34.6% greater than outpatients. High daily salt consumption (more than two tablespoons a day) was 40.5% higher among hemodialysis patients than outpatients. In terms of saturated oil intake, it was 30.8%higher among hemodialysis patients. Problem in communicating with family members was 69.8% higher in hemodialysis patients. In terms of physical activity, 46.4% of outpatients had higher physical activity like walking. Conclusion: Lifestyle in different dimensions was associated with chronic kidney disease (CKD); therefore, the officials of health system are recommended to develop a program to combat chronic diseases and integrate it with providing the first-level health services. It seems that public education can have a major role in life-style modification and in chronic kidney diseases prevention. PMID:25276683

  9. [The influence of breathing mode on the oral cavity].

    PubMed

    Surtel, Anna; Klepacz, Robert; Wysokińska-Miszczuk, Joanna

    2015-12-01

    Nose breathing is one of the key factors in the proper development and functioning of the oral cavity. The air passing through the nasal cavity is warmed and humidified while dust and other particulate matter is removed. It is also important as far as bone formation is concerned. The obstruction or congestions of the upper respiratory tract may negatively affect the correct and most optimal (nasal) respiratory tract. The switch from nasal to mouth breathing may lead to serious clinical consequences. Children with the clinical diagnosis of mouth breathing are usually pale, apathetic and they lack concentration and often get tired. Disorders resulting from hypoxy may also be the reason from sleep disturbances, such as frequent waking-up, nocturia, difficulties falling aslee. The main clinical manifestations of mouth breathing appear in the craniofacial structures. Mouth breathers frequently suffer from dental malocclusions and craniofacial bone abnormalities. Chronic muscle tension around the oral cavity could result in the widening of cranio-vertebral angle, posterior position of mandibula and narrow maxillary arch. Among dental alterations the most common are class II malocclusion (total or partial) with the protrusion of the anterior teeth, cross bite (unilateral or bilateral), anterior open bite and primary crowded teeth. Apart from malocclusion, chronic gingivitis, periodontitis, candida infections and halitosis are frequently present in mouth--breathing patients. PMID:26802697

  10. [The influence of breathing mode on the oral cavity].

    PubMed

    Surtel, Anna; Klepacz, Robert; Wysokińska-Miszczuk, Joanna

    2015-12-01

    Nose breathing is one of the key factors in the proper development and functioning of the oral cavity. The air passing through the nasal cavity is warmed and humidified while dust and other particulate matter is removed. It is also important as far as bone formation is concerned. The obstruction or congestions of the upper respiratory tract may negatively affect the correct and most optimal (nasal) respiratory tract. The switch from nasal to mouth breathing may lead to serious clinical consequences. Children with the clinical diagnosis of mouth breathing are usually pale, apathetic and they lack concentration and often get tired. Disorders resulting from hypoxy may also be the reason from sleep disturbances, such as frequent waking-up, nocturia, difficulties falling aslee. The main clinical manifestations of mouth breathing appear in the craniofacial structures. Mouth breathers frequently suffer from dental malocclusions and craniofacial bone abnormalities. Chronic muscle tension around the oral cavity could result in the widening of cranio-vertebral angle, posterior position of mandibula and narrow maxillary arch. Among dental alterations the most common are class II malocclusion (total or partial) with the protrusion of the anterior teeth, cross bite (unilateral or bilateral), anterior open bite and primary crowded teeth. Apart from malocclusion, chronic gingivitis, periodontitis, candida infections and halitosis are frequently present in mouth--breathing patients.

  11. A Portable Real-Time Ringdown Breath Acetone Analyzer: Toward Potential Diabetic Screening and Management.

    PubMed

    Jiang, Chenyu; Sun, Meixiu; Wang, Zhennan; Chen, Zhuying; Zhao, Xiaomeng; Yuan, Yuan; Li, Yingxin; Wang, Chuji

    2016-07-30

    Breath analysis has been considered a suitable tool to evaluate diseases of the respiratory system and those that involve metabolic changes, such as diabetes. Breath acetone has long been known as a biomarker for diabetes. However, the results from published data by far have been inconclusive regarding whether breath acetone is a reliable index of diabetic screening. Large variations exist among the results of different studies because there has been no "best-practice method" for breath-acetone measurements as a result of technical problems of sampling and analysis. In this mini-review, we update the current status of our development of a laser-based breath acetone analyzer toward real-time, one-line diabetic screening and a point-of-care instrument for diabetic management. An integrated standalone breath acetone analyzer based on the cavity ringdown spectroscopy technique has been developed. The instrument was validated by using the certificated gas chromatography-mass spectrometry. The linear fittings suggest that the obtained acetone concentrations via both methods are consistent. Breath samples from each individual subject under various conditions in total, 1257 breath samples were taken from 22 Type 1 diabetic (T1D) patients, 312 Type 2 diabetic (T2D) patients, which is one of the largest numbers of T2D subjects ever used in a single study, and 52 non-diabetic healthy subjects. Simultaneous blood glucose (BG) levels were also tested using a standard diabetic management BG meter. The mean breath acetone concentrations were determined to be 4.9 ± 16 ppm (22 T1D), and 1.5 ± 1.3 ppm (312 T2D), which are about 4.5 and 1.4 times of the one in the 42 non-diabetic healthy subjects, 1.1 ± 0.5 ppm, respectively. A preliminary quantitative correlation (R = 0.56, p < 0.05) between the mean individual breath acetone concentration and the mean individual BG levels does exist in 20 T1D subjects with no ketoacidosis. No direct correlation is observed in T1D subjects, T2D

  12. A Portable Real-Time Ringdown Breath Acetone Analyzer: Toward Potential Diabetic Screening and Management.

    PubMed

    Jiang, Chenyu; Sun, Meixiu; Wang, Zhennan; Chen, Zhuying; Zhao, Xiaomeng; Yuan, Yuan; Li, Yingxin; Wang, Chuji

    2016-01-01

    Breath analysis has been considered a suitable tool to evaluate diseases of the respiratory system and those that involve metabolic changes, such as diabetes. Breath acetone has long been known as a biomarker for diabetes. However, the results from published data by far have been inconclusive regarding whether breath acetone is a reliable index of diabetic screening. Large variations exist among the results of different studies because there has been no "best-practice method" for breath-acetone measurements as a result of technical problems of sampling and analysis. In this mini-review, we update the current status of our development of a laser-based breath acetone analyzer toward real-time, one-line diabetic screening and a point-of-care instrument for diabetic management. An integrated standalone breath acetone analyzer based on the cavity ringdown spectroscopy technique has been developed. The instrument was validated by using the certificated gas chromatography-mass spectrometry. The linear fittings suggest that the obtained acetone concentrations via both methods are consistent. Breath samples from each individual subject under various conditions in total, 1257 breath samples were taken from 22 Type 1 diabetic (T1D) patients, 312 Type 2 diabetic (T2D) patients, which is one of the largest numbers of T2D subjects ever used in a single study, and 52 non-diabetic healthy subjects. Simultaneous blood glucose (BG) levels were also tested using a standard diabetic management BG meter. The mean breath acetone concentrations were determined to be 4.9 ± 16 ppm (22 T1D), and 1.5 ± 1.3 ppm (312 T2D), which are about 4.5 and 1.4 times of the one in the 42 non-diabetic healthy subjects, 1.1 ± 0.5 ppm, respectively. A preliminary quantitative correlation (R = 0.56, p < 0.05) between the mean individual breath acetone concentration and the mean individual BG levels does exist in 20 T1D subjects with no ketoacidosis. No direct correlation is observed in T1D subjects, T2D

  13. A Portable Real-Time Ringdown Breath Acetone Analyzer: Toward Potential Diabetic Screening and Management

    PubMed Central

    Jiang, Chenyu; Sun, Meixiu; Wang, Zhennan; Chen, Zhuying; Zhao, Xiaomeng; Yuan, Yuan; Li, Yingxin; Wang, Chuji

    2016-01-01

    Breath analysis has been considered a suitable tool to evaluate diseases of the respiratory system and those that involve metabolic changes, such as diabetes. Breath acetone has long been known as a biomarker for diabetes. However, the results from published data by far have been inconclusive regarding whether breath acetone is a reliable index of diabetic screening. Large variations exist among the results of different studies because there has been no “best-practice method” for breath-acetone measurements as a result of technical problems of sampling and analysis. In this mini-review, we update the current status of our development of a laser-based breath acetone analyzer toward real-time, one-line diabetic screening and a point-of-care instrument for diabetic management. An integrated standalone breath acetone analyzer based on the cavity ringdown spectroscopy technique has been developed. The instrument was validated by using the certificated gas chromatography-mass spectrometry. The linear fittings suggest that the obtained acetone concentrations via both methods are consistent. Breath samples from each individual subject under various conditions in total, 1257 breath samples were taken from 22 Type 1 diabetic (T1D) patients, 312 Type 2 diabetic (T2D) patients, which is one of the largest numbers of T2D subjects ever used in a single study, and 52 non-diabetic healthy subjects. Simultaneous blood glucose (BG) levels were also tested using a standard diabetic management BG meter. The mean breath acetone concentrations were determined to be 4.9 ± 16 ppm (22 T1D), and 1.5 ± 1.3 ppm (312 T2D), which are about 4.5 and 1.4 times of the one in the 42 non-diabetic healthy subjects, 1.1 ± 0.5 ppm, respectively. A preliminary quantitative correlation (R = 0.56, p < 0.05) between the mean individual breath acetone concentration and the mean individual BG levels does exist in 20 T1D subjects with no ketoacidosis. No direct correlation is observed in T1D subjects, T

  14. Submarines, Spacecraft, and Exhaled Breath

    EPA Science Inventory

    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...

  15. Conspicuous effect on treatment of mild-to-moderate COPD by combining deep-breathing exercise with oxygen inhalation

    PubMed Central

    Liu, Yong-Qiang; Yan, Ling-Xian; Zhang, Li-Yan; Song, Qing-Hua; Xu, Rong-Mei

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) can lead to respiratory failure, but current pharmacological treatments focus on symptom relief or slowing disease progression. Here, the effectiveness of an alternative therapy combining deep-breathing exercises and oxygen inhalation therapy was assessed in mild-to-moderate COPD patients. Forty-two male mild-to-moderate COPD patients were randomly divided into a deep-breathing training group, an oxygen inhalation group, and a combination group (n=14 in each). In the deep-breathing training group, the patients were treated only by the deep-breathing exercise; in the oxygen inhalation group, the patients were treated only by oxygen inhalation; in the combination group, the patients were treated by combining the deep-breathing exercises with oxygen inhalation. Before treatment, there were no statistical differences in the general characteristics or lung function indexes between the three groups of patients (P > 0.05). However, after treatment, patients in the combination group had significantly better lung function indexes than they did before treatment, and their improvement was also superior to that of patients from the deep-breathing training group and the oxygen inhalation group (P < 0.01 and P < 0.05, respectively). Thus, a treatment method combining deep-breathing exercise with oxygen inhalation offers more significant lung function improvement in COPD patients than either the deep-breathing exercise or oxygen inhalation alone. This approach should be further explored for use in the clinic. PMID:26309676

  16. Detection of response to command using voluntary control of breathing in disorders of consciousness

    PubMed Central

    Charland-Verville, Vanessa; Lesenfants, Damien; Sela, Lee; Noirhomme, Quentin; Ziegler, Erik; Chatelle, Camille; Plotkin, Anton; Sobel, Noam; Laureys, Steven

    2014-01-01

    Background: Detecting signs of consciousness in patients in a vegetative state/unresponsive wakefulness syndrome (UWS/VS) or minimally conscious state (MCS) is known to be very challenging. Plotkin et al. (2010) recently showed the possibility of using a breathing-controlled communication device in patients with locked in syndrome. We here aim to test a breathing-based “sniff controller” that could be used as an alternative diagnostic tool to evaluate response to command in severely brain damaged patients with chronic disorders of consciousness (DOC). Methods: Twenty-five DOC patients were included. Patients’ resting breathing-amplitude was measured during a 5 min resting condition. Next, they were instructed to end the presentation of a music sequence by sniffing vigorously. An automated detection of changes in breathing amplitude (i.e., >1.5 SD of resting) ended the music and hence provided positive feedback to the patient. Results: None of the 11 UWS/VS patients showed a sniff-based response to command. One out of 14 patients with MCS was able to willfully modulate his breathing pattern to answer the command on 16/19 trials (accuracy 84%). Interestingly, this patient failed to show any other motor response to command. Discussion: We here illustrate the possible interest of using breathing-dependent response to command in the detection of residual cognition in patients with DOC after severe brain injury. PMID:25566035

  17. Comparison of patients with orofacial pain of different diagnostic categories.

    PubMed

    Karibe, Hiroyuki; Goddard, Greg; McNeill, Charles; Shih, Sandy Thai

    2011-04-01

    The authors compared the pain intensity and difficulty experienced in performing activities of daily living (ADL) among 237 patients with orofacial pain. The patients underwent comprehensive examinations and recorded their subjective symptoms on a form (five items for pain intensity and six for ADL-related difficulty). On the basis of the primary diagnosis, the patients were divided into the temporomandibular joint dysfunction (TMJ), myofascial pain (MP), neuropathic pain (NP), and fibromyalgia (FM) groups. The intensity of pain in the jaw/face, tightness in the jaw/face, pain in the neck, and toothache significantly differed among the groups (p < 0.01, Kruskal-Wallis test). Compared to other patients, the FM and NP groups reported greater pain intensity, whereas those in the TMJ group reported lesser pain intensity. The ADL-related difficulty was not significantly different among the groups. Thus, compared to pain due to joint-related disorders, myalgic and neuropathic pain seem to be of higher intensity.

  18. A comparison of governance types and patient satisfaction outcomes.

    PubMed

    Stumpf, L R

    2001-04-01

    Given our dynamic healthcare marketplace, it is imperative to examine the context in which nurses function. A unit level study was conducted to investigate the influence of governance type on organizational culture, nurse work satisfaction, nurse retention, and patient satisfaction. The results of the study will be of value to nurse executives wanting to redesign the context for nursing service to improve outcomes, including nurse and patient satisfaction.

  19. Cost comparison of mechanically ventilated patients across the age span

    PubMed Central

    Hayman, William R.; Leuthner, Steven R.; Laventhal, Naomi T.; Brousseau, David; Lagatta, Joanne M.

    2016-01-01

    Objective to compare use of mechanical ventilation and hospital costs across ventilated patients of all ages, preterm through adults, in a nationally-representative sample. Study Design secondary analysis of the 2009 Agency for Healthcare Research and Quality National Inpatient Sample. Results 1,107,563 (2.8%) patients received mechanical ventilation. For surviving ventilated patients, median costs for infants ≤32 weeks’ gestation were $51,000–$209,000, whereas median costs for older patients were lower, from $17,000–$25,000. For non-surviving ventilated patients, median costs were $27,000–$39,000 except at the extremes of age; the median cost was $10,000 for <24 week newborns, and $14,000 for 91+ year adults. Newborns of all gestational ages had a disproportionate share of hospital costs relative to their total volume. Conclusions Most ICU resources at the extremes of age are not directed toward non-surviving patients. From a perinatal perspective, attention should be directed toward improving outcomes and reducing costs for all infants, not just at the earliest gestational ages. PMID:26468935

  20. Functional analysis and intervention for breath holding.

    PubMed

    Kern, L; Mauk, J E; Marder, T J; Mace, F C

    1995-01-01

    We conducted a functional analysis of breath-holding episodes in a 7-year-old girl with severe mental retardation and Cornelia-de-Lange syndrome. The results showed that breath holding served an operant function, primarily to gain access to attention. The intervention, consisting of extinction, scheduled attention, and use of a picture card communication system, resulted in decreased breath holding.

  1. Emptying patterns of the lung studied by multiple-breath N2 washout

    NASA Technical Reports Server (NTRS)

    Lewis, S. M.

    1978-01-01

    Changes in the nitrogen concentration seen during the single-breath nitrogen washout reflect changes in relative flow (ventilation) from units with differing ventilation/volume ratios. The multiple-breath washout provides sufficient data on ventilation for units with varying ventilation/volume ratios to be plotted as a function of the volume expired. Flow from the dead space may also be determined. In young normals the emptying patterns are narrow and unimodal throughout the alveolar plateau with little or no flow from the dead space at the end of the breath. Older normals show more flow from the dead space, particularly toward the end of the breath, and some show a high ventilation/volume ratio mode early in the breath. Patients with obstructive lung disease have a high flow from the dead space which is present throughout the breath. A well ventilated mode at the end of the breath is seen in some obstructed subjects. Patients with cystic fibrosis showed a poorly ventilated mode appearing at the end of the breath as well as a very high dead space.

  2. Drive mechanism for production of simulated human breath

    NASA Technical Reports Server (NTRS)

    Bartlett, R. G.; Hendricks, C. M.; Lambert, J. W.; Morison, W. B.

    1972-01-01

    Simulated breath drive mechanism was developed as subsystem to breathing metabolic simulator. Mechanism reproduces complete range of human breath rate, breath depth, and breath waveform, as well as independently controlled functional residual capacity. Mechanism was found capable of simulating various individual human breathing characteristics without any changes of parts.

  3. A comparison of pain measures used with patients with fibromyalgia.

    PubMed

    Bigatti, Silvia M; Cronan, Terry A

    2002-01-01

    The objective of the present study was to evaluate instruments used to assess pain in patients with fibromyalgia (FMS). Participants were 602 patients with FMS. Pain was measured with five scales: a visual analog scale (VAS), the Pain Rating, Present Pain, and Number of Words Chosen Indexes from the McGill Pain Questionnaire; and intensity of pain obtained from a manual tender point exam. The VAS had the highest correlations with other measures of pain and with self-efficacy for pain, physical functioning, fatigue, and stiffness. The correlations between the VAS and fatigue and stiffness were significantly higher than those of other pain measures (p < .01). Our findings suggest that the easy-to-administer VAS may be the most useful measure of pain with patients with FMS. PMID:12048970

  4. Patients' rights in England and the United States of America: The Patient's Charter and the New Jersey Patient Bill of Rights: a comparison.

    PubMed

    Silver, M H

    1997-08-01

    The Patient's Charter has been in effect for nearly five years. This article considers the purpose and value of the document through a comparison with the New Jersey Patient Bill of Rights. Patient rights statements have been posted in American hospitals for more than twenty years. However, the New Jersey document and the patient rights programme it established seven years ago, have proven to be economically effective, successful in their representation of patients and enforceable, due to the adoption of state legislation and regulation to oversee the process. Several examples of how the programme works are included in the comparison, with a similar review of The Patient's Charter. In the comparison the author argues that for the programme to succeed as it has done in New Jersey, the government will need to develop legislative backing to ensure enforcement, and an efficient system for monitoring compliance. The programme will need to become credible in the eyes of the health service user. The author suggests this may be best achieved by developing an efficient, accessible and user-friendly means of redress, should the patient consider his or her rights have been violated. A "mish-mash" of quality assurance standards and levels of care which patients can "expect" from the health service providers only serves to distract the health service user from the government's failure to commit the resources that would empower the patients rights portion of The Patient's Charter.

  5. Reproducibility of liver position using active breathing coordinator for liver cancer radiotherapy

    SciTech Connect

    Eccles, Cynthia; Brock, Kristy K.; Bissonnette, Jean-Pierre; Hawkins, Maria; Dawson, Laura A. . E-mail: laura.dawson@rmp.uhn.on.ca

    2006-03-01

    Purpose: To measure the intrabreath-hold liver motion and the intrafraction and interfraction reproducibility of liver position relative to vertebral bodies using an active breathing coordinator (ABC) in patients with unresectable liver cancer treated with hypofractionated stereotactic body radiation therapy (SBRT). Methods: Tolerability of ABC and organ motion during ABC was assessed using kV fluoroscopy in 34 patients. For patients treated with ABC, repeat breath-hold CT scans in the ABC breath-hold position were acquired at simulation to estimate the volumetric intrafraction reproducibility of the liver relative to the vertebral bodies. In addition, preceding each radiation therapy fraction, with the liver immobilized using ABC, repeat anteroposterior (AP) megavoltage verification images were obtained. Off-line alignments were completed to determine intrafraction reproducibility (from repeat images obtained before one treatment) and interfraction reproducibility (from comparisons of the final image for each fraction with the AP) of diaphragm position relative to vertebral bodies. For each image set, the vertebral bodies were aligned, and the resultant craniocaudal (CC) offset in diaphragm position was measured. Liver position during ABC was also evaluated from kV fluoroscopy acquired at the time of simulation, kV fluoroscopy at the time of treatment, and from MV beam's-eye view movie loops acquired during treatment. Results: Twenty-one of 34 patients were screened to be suitable for ABC. The average free breathing range of these patients was 13 mm (range, 5-1 mm). Fluoroscopy revealed that the average maximal diaphragm motion during ABC breath-hold was 1.4 mm (range, 0-3.4 mm). The MV treatment movie loops confirmed diaphragm stability during treatment. For a measure of intrafraction reproducibility, an analysis of 36 repeat ABC computed tomography (CT) scans in 14 patients was conducted. The average mean difference in the liver surface position was -0.9 mm, -0

  6. Biomechanical interpretation of a free-breathing lung motion model

    NASA Astrophysics Data System (ADS)

    Zhao, Tianyu; White, Benjamin; Moore, Kevin L.; Lamb, James; Yang, Deshan; Lu, Wei; Mutic, Sasa; Low, Daniel A.

    2011-12-01

    The purpose of this paper is to develop a biomechanical model for free-breathing motion and compare it to a published heuristic five-dimensional (5D) free-breathing lung motion model. An ab initio biomechanical model was developed to describe the motion of lung tissue during free breathing by analyzing the stress-strain relationship inside lung tissue. The first-order approximation of the biomechanical model was equivalent to a heuristic 5D free-breathing lung motion model proposed by Low et al in 2005 (Int. J. Radiat. Oncol. Biol. Phys. 63 921-9), in which the motion was broken down to a linear expansion component and a hysteresis component. To test the biomechanical model, parameters that characterize expansion, hysteresis and angles between the two motion components were reported independently and compared between two models. The biomechanical model agreed well with the heuristic model within 5.5% in the left lungs and 1.5% in the right lungs for patients without lung cancer. The biomechanical model predicted that a histogram of angles between the two motion components should have two peaks at 39.8° and 140.2° in the left lungs and 37.1° and 142.9° in the right lungs. The data from the 5D model verified the existence of those peaks at 41.2° and 148.2° in the left lungs and 40.1° and 140° in the right lungs for patients without lung cancer. Similar results were also observed for the patients with lung cancer, but with greater discrepancies. The maximum-likelihood estimation of hysteresis magnitude was reported to be 2.6 mm for the lung cancer patients. The first-order approximation of the biomechanical model fit the heuristic 5D model very well. The biomechanical model provided new insights into breathing motion with specific focus on motion trajectory hysteresis.

  7. Applications of principal component analysis to breath air absorption spectra profiles classification

    NASA Astrophysics Data System (ADS)

    Kistenev, Yu. V.; Shapovalov, A. V.; Borisov, A. V.; Vrazhnov, D. A.; Nikolaev, V. V.; Nikiforova, O. Y.

    2015-12-01

    The results of numerical simulation of application principal component analysis to absorption spectra of breath air of patients with pulmonary diseases are presented. Various methods of experimental data preprocessing are analyzed.

  8. Qualitative assessment of contrast-enhanced magnetic resonance angiography using breath-hold and non-breath-hold techniques in the portal venous system

    NASA Astrophysics Data System (ADS)

    Goo, Eun-Hoe; Kim, Sun-Ju; Dong, Kyung-Rae; Kim, Kwang-Choul; Chung, Woon-Kwan

    2016-09-01

    The purpose of this study is to evaluate the image quality in delineation of the portal venous systems with two different methods, breath-hold and non-breath-hold by using the 3D FLASH sequence. We used a 1.5 T system to obtain magnetic resonance(MR)images. Arterial and portal phase 3D FLASH images were obtained with breath-hold after a bolus injection of GD-DOTA. The detection of PVS on the MR angiograms was classified into three grades. First, the angiograms of the breath-hold method showed well the portal vein, the splenic vein and the superior mesenteric vein systems in 13 of 15 patients (86%) and the inferior mesenteric vein system in 6 of 15 patients (40%), Second, MR angiograms of the non-breath-hold method demonstrated the PVS and the SMV in 12 of 15 patients (80%) and the IMV in 5 of 15 patients (33%). Our study showed contrast-enhanced 3D FLASH MR angiography, together with the breath-hold technique, may provide reliable and accurate information on the portal venous system.

  9. Case report of successful treatment of pallid breath-holding spells with glycopyrrolate.

    PubMed

    Williams, Jason; Cain, Nicole

    2015-05-01

    Breath-holding spells are a common childhood disorder that typically present before 12 months of age. Whereas most cases are benign, some patients have very severe cases associated with bradycardia that can progress from asystole to syncope and seizures. Treatment studies have implicated the use of several therapies, such as oral iron, fluoxetine, and pacemaker implantation. This is a retrospective study of patients treated with glycopyrrolate for pallid breath-holding spells. Clinical data from 4 patients referred to pediatric cardiology who saw therapeutic benefit from treatment using glycopyrrolate were reviewed to evaluate for clinical response to the drug. Two twin patients, whose symptoms began at 5 months of age, experienced a decrease in breath-holding frequency after 1 month. A patient diagnosed at 7 months of age experienced a decrease in frequency of spells. A patient diagnosed at 10 months of age reported cessation of syncope shortly after initiation of glycopyrrolate and complete resolution of breath-holding spells during prolonged treatment. This case study of 4 patients with pallid breath-holding offers evidence that glycopyrrolate may be beneficial in treating breath-holding spells and has a safer side-effect profile than pacemaker implantation.

  10. Comparison of elastography methods in patients with pancreatic masses

    PubMed Central

    Rustemovic, N.; Opacic, D.; Ostojic, Z.; Opacic, M.; Ledinsky, I.; Višijić, A.; Ravić, K. Grubelić; Iveković, H.; Markoš, P.

    2014-01-01

    Introduction: Endoscopic ultrasonography (EUS) quantitative elastography methods are developed for non-invasive differentiation of pancreatic masses. Aims: First: To evaluate the diagnostic value of strain ratio (SR) and hue histogram (HH) in patients with pancreatic masses and to determine the cut-off value between pancreatic cancer and focal pancreatitis using a pancreatic tissue close to the mass as a reference area. Second: To calculate new variable HH ratio (HHR) in an attempt to improve sensitivity, specificity and accuracy of the method. Methods: In a prospective single center study, 149 patients were examined: 105 with the pancreatic masses and 44 controls using Pentax EUS linear probes in combination with Hitachi platforms. SR and HH were automatically calculated by machine software. Finally, two groups were formed: Pancreatic cancer group (58 patients) and focal pancreatitis group (47 patients). All statistical analysis has been made in SPSS 14.0 (SPSS Inc., Chicago, USA). Conclusion: Statistical analysis in our study showed that SR with a cut-off value of 7.59 reaches 100% sensitivity and 95% specificity with overall accuracy of 97% (confidence intervals [CI]: 92-97%) in detection of pancreatic cancer. Statistical analysis also showed that HH with a cut-off value of ≥86 reaches 100% sensitivity and just 45% specificity with overall accuracy of 66% (CI: 61-66%) in detection of pancreatic cancer. New variable HHR with cut-off ≥1.153 was slightly better with 98% sensitivity and 50% specificity, with overall accuracy of 69% (CI: 63-70%). SR showed significantly higher specificity compared with HH and HHR. More HH studies on Hitachi platforms are needed. PMID:26425528

  11. A comparison of two patient-friendly ERG electrodes.

    PubMed

    Hidajat, R R; McLay, J L; Elder, M J; Goode, D H; Morton, J P; Burley, C D

    2003-03-01

    The ideal electroretinography (ERG) electrode does not exist. In deciding which electrode should be used in clinical practice the capacity to provide reproducible waveforms, maximal amplitudes and minimal irritation to the patient's eyes are the most important characteristics. This study tested two patient friendly electrodes, the gold foil (CH Electrodes, UK) and the H-K loop (Avanta, Slovenia). Seventeen normal volunteers were subjected to three standard measurements namely flash ERGs under photopic and scotopic conditions and the transient pattern ERG (PERG). Each test followed the guidelines set by the International Society for Clinical Electrophysiology of Vision (ISCEV). It was found that the mean values of the flash ERG a and b wave amplitudes and the PERG P50 and N95 amplitudes from the gold foil electrodes were approximately a factor of two larger than those from the H-K loop. In addition most of the subjects (13/17) felt less discomfort with the gold foil electrodes. We reached the conclusion that gold foil electrodes are the electrode of choice because they provide good patient comfort, reasonably high amplitudes and relatively reproducible results. PMID:12854623

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

    PubMed

    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.

  13. Self-contained breathing apparatus

    NASA Technical Reports Server (NTRS)

    Sullivan, J. L.; Giorgini, E. A.; Simmonds, M. R. (Inventor)

    1976-01-01

    A self-contained breathing apparatus with automatic redundant fluid pressure controls and a facemask mounted low pressure whistle alarm is described. The first stage of the system includes pair of pressure regulators connected in parallel with different outlet pressures, both of which reduce the pressure of the stored supply gas to pressures compatible with the second stage breathing demand regulator. A primary regulator in the first stage delivers a low output pressure to the demand regulator. In the event of a failure closed condition of the primary regulator an automatic transfer valve switches on the backup regulator. A warning that the supply pressure has been depleted is also provided by a supply pressure actuated transfer valve which transfers the output of the first stage pressure regulators from the primary to the backup regulator. The alarm is activated in either the failure closed condition or if the supply pressure is reduced to a dangerously low level.

  14. Force oscillations simulating breathing maneuvers do not prevent force adaptation.

    PubMed

    Pascoe, Chris; Jiao, Yuekan; Seow, Chun Y; Paré, Peter D; Bossé, Ynuk

    2012-07-01

    Airway inflammation in patients with asthma exposes the airway smooth muscle (ASM) to a variety of spasmogens. These spasmogens increase ASM tone, which can lead to force adaptation. Length oscillations of ASM, which occur in vivo due to breathing maneuvers, can attenuate force adaptation. However, in the presence of tone, the force oscillations required to achieve these length oscillations may be unphysiologic (i.e., magnitude greater than the ones achieved due to the swings in transpulmonary pressure required for breathing). In the present study, we applied force oscillations simulating the tension oscillations experienced by the wall of a fourth-generation airway during tidal breathing with or without deep inspirations (DI) to ASM. The goal was to investigate whether force adaptation occurs in conditions mimicking breathing maneuvers. Tone was induced by carbachol (average, 20 nM), and the force-generating capacity of the ASM was assessed at 5-minute intervals before and after carbachol administration using electrical field stimulations (EFS). The results show that force oscillations applied before the introduction of tone had a small effect on the force produced by EFS (declined to 96.8% [P > 0.05] and 92.3% [P < 0.05] with and without DI, respectively). The tone induced by carbachol transiently decreased after a DI and declined significantly (P < 0.05) due to tidal breathing oscillations (25%). These force oscillations did not prevent force adaptation (gain of force of 11.2 ± 2.2 versus 13.5 ± 2.7 and 11.2 ± 3.0% in static versus dynamic conditions with or without DI, respectively). The lack of effect of simulated breathing maneuvers on force adaptation suggests that this gain in ASM force may occur in vivo and could contribute to the development of airway hyperresponsiveness. PMID:22323367

  15. Sensitivity and specificity of an abbreviated 13C-mixed triglyceride breath test for measurement of pancreatic exocrine function

    PubMed Central

    Meier, Viola; Wolfram, Kristina U; Rosien, Ulrich; Layer, Peter

    2014-01-01

    Background A modified 13C-mixed triglyceride breath test (13C -MTGT) detects moderate pancreatic exocrine insufficiency noninvasively and reliably, but it requires prolonged breath sampling (6 hours (hr)). Objective We aimed to investigate whether 13C -MTGT can be abbreviated, to optimize clinical usability. Methods We analyzed the 13C-MTGT of 200 consecutive patients, retrospectively. Cumulative 1–5 hr 13C-exhalation values were compared with the standard parameter (6-hr cumulative 13C-exhalation). We determined the sensitivity and specificity of shortened breath sampling periods, by comparison with the normal values from 10 healthy volunteers, whom also underwent a secretin test to quantitate pancreatic secretion. Moreover, we evaluated the influence of gastric emptying (GE), using a 13C-octanoic acid breath test in a subset (N = 117). Results The 1–5 hr cumulative 13C-exhalation tests correlated highly and significantly with the standard parameter (p < 0.0001). Sensitivity for detection of impaired lipolysis was high (≥77%), but the specificity was low (≥38%) for the early measurements. Both parameters were high after 4 hrs (88% and 94%, respectively) and 5 hrs (98% and 91%, respectively). Multivariate linear correlation analysis confirmed that GE strongly influenced early postprandial 13C-exhalation during the 13C-MTGT. Conclusion Shortening of the 13C -MTGT from 6 to 4 hrs of duration was associated with similar diagnostic accuracy, yet increased clinical usability. The influence of GE on early postprandial results of the 13C-MTGT precluded further abbreviation of the test. PMID:25083286

  16. Running and Breathing in Mammals

    NASA Astrophysics Data System (ADS)

    Bramble, Dennis M.; Carrier, David R.

    1983-01-01

    Mechanical constraints appear to require that locomotion and breathing be synchronized in running mammals. Phase locking of limb and respiratory frequency has now been recorded during treadmill running in jackrabbits and during locomotion on solid ground in dogs, horses, and humans. Quadrupedal species normally synchronize the locomotor and respiratory cycles at a constant ratio of 1:1 (strides per breath) in both the trot and gallop. Human runners differ from quadrupeds in that while running they employ several phase-locked patterns (4:1, 3:1, 2:1, 1:1, 5:2, and 3:2), although a 2:1 coupling ratio appears to be favored. Even though the evolution of bipedal gait has reduced the mechanical constraints on respiration in man, thereby permitting greater flexibility in breathing pattern, it has seemingly not eliminated the need for the synchronization of respiration and body motion during sustained running. Flying birds have independently achieved phase-locked locomotor and respiratory cycles. This hints that strict locomotor-respiratory coupling may be a vital factor in the sustained aerobic exercise of endothermic vertebrates, especially those in which the stresses of locomotion tend to deform the thoracic complex.

  17. Comparison of energy expenditure measurement techniques in severely burned patients.

    PubMed

    Schane, J; Goede, M; Silverstein, P

    1987-01-01

    The degree of accuracy of existing formulas for calculating energy expenditure can be determined by comparing them to the measured energy expenditure via indirect calorimetry. As a result, one can modify traditional predicted recommendations for nutrition alimentation of the burn patient with real-time data. In this study, 21 sequential adult admissions with second- and third-degree total body surface area (TBSA) burn wounds (range 21%-81% TBSA) underwent serial assessments of energy expenditure by indirect calorimetry. On admission, maximum, and discharge, measured energy expenditure (MEE) was compared with the calculations for predicted energy expenditure by the Curreri (CEE) and modified Harris-Benedict (MBEE) equations. The mean energy expenditure calculated from the Curreri equation on admission (CEEA) overestimated the mean MEE on admission (MEEA) by 25% (P less than 0.001) and on discharge (MEED) by 36% (P less than 0.0005). The mean modified Harris-Benedict equation overestimated the mean MEEA by 32% (P less than 0.0005) and the mean MEED by 39% (P less than 0.0005). No significant difference was noted between the mean MEE at maximum (MEEM) and the mean CEEA or the mean MBEEA. This indicates excessive overfeeding of the burn patient from admission to discharge by both standard formulas. Actual measured data provide a better indicator of varying nutritional needs throughout the hospital course than the standard formulas, and their use would result in significant savings in the expenses of enteral/parenteral nutritional supplements. PMID:3667663

  18. A comparison of eating disorder patients in India and Australia

    PubMed Central

    Lal, Maala; Abraham, Suzanne; Parikh, Samir; Chhibber, Kamna

    2015-01-01

    Background: Eating disorders (EDs) are an emerging concern in India. There are few studies comparing clinical samples in western and nonwestern settings. Aim: The aim was to compare females aged 16–26 years being treated for an ED in India (outpatients n = 30) and Australia (outpatients n = 30, inpatients n = 30). Materials and Methods: Samples were matched by age and body mass index, and had similar diagnostic profiles. Demographic information and history of eating and exercise problems were assessed. All patients completed the quality-of-life for EDs (QOL EDs) questionnaire. Results: Indians felt they overate and binge ate more often than Australians; frequencies of food restriction, vomiting, and laxative use were similar. Indians were less aware of ED feelings, such as, “fear of losing control over food or eating” and “being preoccupied with food, eating or their body.” Indians felt eating and exercise had less impact on their relationships and social life but more impact on their medical health. No differences were found in the global quality-of-life, body weight, eating behaviors, psychological feelings, and exercise subscores for the three groups. Conclusion: Indian and Australian patients are similar but may differ in preoccupation and control of their ED-related feelings. PMID:25657455

  19. A cross-sectional study of breath acetone based on diabetic metabolic disorders.

    PubMed

    Li, Wenwen; Liu, Yong; Lu, Xiaoyong; Huang, Yanping; Liu, Yu; Cheng, Shouquan; Duan, Yixiang

    2015-02-26

    Breath acetone is a known biomarker for diabetes mellitus in breath analysis. In this work, a cross-sectional study of breath acetone based on clinical metabolic disorders of type 2 diabetes mellitus (T2DM) was carried out. Breath acetone concentrations of 113 T2DM patients and 56 apparently healthy individuals were measured at a single time point. Concentrations varied from 0.22 to 9.41 ppmv (mean 1.75 ppmv) for T2DM, which were significantly higher than those for normal controls (ranged from 0.32 to 1.96 ppmv, mean 0.72 ppmv, p = 0.008). Observations in our work revealed that breath acetone concentrations elevated to different degrees, along with the abnormality of blood glucose, glycated hemoglobin (HbA1c), triglyceride and cholesterol. Breath acetone showed obviously positive correlations with blood ketone and urine ketone. Possible metabolic relations between breath acetone and diabetic disorders were also discussed. This work aimed at giving an overall assessment of breath acetone from the perspective of clinical parameters for type 2 diabetes.

  20. Comparisons of Patient Demographics in Prospective Sports, Shoulder, and National Database Initiatives

    PubMed Central

    Saltzman, Bryan M.; Cvetanovich, Gregory L.; Bohl, Daniel D.; Cole, Brian J.; Bach, Bernard R.; Romeo, Anthony A.

    2016-01-01

    Background: There has been increased emphasis in orthopaedics on high-quality prospective research to provide evidence-based treatment guidelines, particularly in sports medicine/shoulder surgery. The external validity of these studies has not been established, and the generalizability of the results to clinical practice in the United States is unknown. Hypothesis: Comparison of patient demographics in major prospective studies of arthroscopic sports and shoulder surgeries to patients undergoing the same procedures in the National Surgical Quality Improvement Program (NSQIP) database will show substantial differences to question the generalizability and external validity of those studies. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study utilized patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR), meniscectomy (MX), rotator cuff repair (RCR), and shoulder stabilization (SS) from the NSQIP database (2005-2013). Two prospective studies (either randomized controlled trials or, in 1 case, a major cohort study) were identified for each of the 4 procedures for comparison. Demographic variables available for comparison in both the identified prospective studies and the NSQIP included age, sex, and body mass index (BMI). Results: From the NSQIP database, 5576 ACLR patients, 18,882 MX patients, 7282 RCR patients, and 993 SS patients were identified. The comparison clinical studies included cohort sizes as follows: ACLR, n = 121 and 2683; MX, n = 146 and 330; RCR, n = 90 and 103; SS, n = 88 and 196. Age differed significantly between the NSQIP and the patients in 6 of the 8 prospective clinical studies. Sex differed significantly between the NSQIP and the patients in 7 of the 8 prospective clinical studies. BMI differed significantly between the NSQIP and the patients of all 4 of the prospective clinical studies that reported this demographic variable. Conclusion: Significant differences exist for patient age, sex

  1. Comparisons of Patient Demographics in Prospective Sports, Shoulder, and National Database Initiatives

    PubMed Central

    Saltzman, Bryan M.; Cvetanovich, Gregory L.; Bohl, Daniel D.; Cole, Brian J.; Bach, Bernard R.; Romeo, Anthony A.

    2016-01-01

    Background: There has been increased emphasis in orthopaedics on high-quality prospective research to provide evidence-based treatment guidelines, particularly in sports medicine/shoulder surgery. The external validity of these studies has not been established, and the generalizability of the results to clinical practice in the United States is unknown. Hypothesis: Comparison of patient demographics in major prospective studies of arthroscopic sports and shoulder surgeries to patients undergoing the same procedures in the National Surgical Quality Improvement Program (NSQIP) database will show substantial differences to question the generalizability and external validity of those studies. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study utilized patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR), meniscectomy (MX), rotator cuff repair (RCR), and shoulder stabilization (SS) from the NSQIP database (2005-2013). Two prospective studies (either randomized controlled trials or, in 1 case, a major cohort study) were identified for each of the 4 procedures for comparison. Demographic variables available for comparison in both the identified prospective studies and the NSQIP included age, sex, and body mass index (BMI). Results: From the NSQIP database, 5576 ACLR patients, 18,882 MX patients, 7282 RCR patients, and 993 SS patients were identified. The comparison clinical studies included cohort sizes as follows: ACLR, n = 121 and 2683; MX, n = 146 and 330; RCR, n = 90 and 103; SS, n = 88 and 196. Age differed significantly between the NSQIP and the patients in 6 of the 8 prospective clinical studies. Sex differed significantly between the NSQIP and the patients in 7 of the 8 prospective clinical studies. BMI differed significantly between the NSQIP and the patients of all 4 of the prospective clinical studies that reported this demographic variable. Conclusion: Significant differences exist for patient age, sex

  2. Methods of intermittent positive pressure breathing.

    PubMed

    Welch, M A; Shapiro, B J; Mercurio, P; Wagner, W; Hirayama, G

    1980-09-01

    Inspiratory capacity (IC) was evaluated in 60 patients during the following four respiratory maneuvers: (1) coached unassisted inspiration; (2) inspiratory positive-pressure breathing (IPPB) at 15 cm H2O with the patient passively inspiring; (3) IPPB at 15 cm H2O with the patient coached to actively inspire; and (4) IPPB at a peak pressure adjusted according to the judgment of the respiratory therapist, with the patient coached to actively inspire. The IC attained with these maneuvers were, respectively, as follows: (1) 1.29 +/- 0.75 L; (2) 1.13 +/- 0.52 L; (3) 1.77 +/- 0.11 L; and (4) 2.27 +/- 0.11 L (mean +/- SE). The peak ventilator pressure for maneuver 4 averaged 30 +/- 7 cm H2O (mean +/- SD), and no patient experienced harmful side effects from these peak pressures. These data indicate that the method of treatment with IPPB has profound effects upon the degree of pulmonary expansion. All research on therapy with IPPB should be carefully controlled for the method of administering IPPB, and the volumes obtained during the treatment should be carefully documented before general conclusions are drawn concerning the effects of IPPB on morbidity. For the present, we suggest that IPPB, when administered clinically, be given as described in method 4.

  3. Free-breathing radial volumetric interpolated breath-hold examination vs breath-hold cartesian volumetric interpolated breath-hold examination magnetic resonance imaging of the liver at 1.5T

    PubMed Central

    Yedururi, Sireesha; Kang, HyunSeon C; Wei, Wei; Wagner-Bartak, Nicolaus A; Marcal, Leonardo P; Stafford, R Jason; Willis, Brandy J; Szklaruk, Janio

    2016-01-01

    AIM To compare breath-hold cartesian volumetric interpolated breath-hold examination (cVIBE) and free-breathing radial VIBE (rVIBE) and determine whether rVIBE could replace cVIBE in routine liver magnetic resonance imaging (MRI). METHODS In this prospective study, 15 consecutive patients scheduled for routine MRI of the abdomen underwent pre- and post-contrast breath-hold cVIBE imaging (19 s acquisition time) and free-breathing rVIBE imaging (111 s acquisition time) on a 1.5T Siemens scanner. Three radiologists with 2, 4, and 8 years post-fellowship experience in abdominal imaging evaluated all images. The radiologists were blinded to the sequence types, which were presented in a random order for each patient. For each sequence, the radiologists scored the cVIBE and rVIBE images for liver edge sharpness, hepatic vessel clarity, presence of artifacts, lesion conspicuity, fat saturation, and overall image quality using a five-point scale. RESULTS Compared to rVIBE, cVIBE yielded significantly (P < 0.001) higher scores for liver edge sharpness (mean score, 3.87 vs 3.37), hepatic-vessel clarity (3.71 vs 3.18), artifacts (3.74 vs 3.06), lesion conspicuity (3.81 vs 3.2), and overall image quality (3.91 vs 3.24). cVIBE and rVIBE did not significantly differ in quality of fat saturation (4.12 vs 4.03, P = 0.17). The inter-observer variability with respect to differences between rVIBE and cVIBE scores was close to zero compared to random error and inter-patient variation. Quality of rVIBE images was rated as acceptable for all parameters. CONCLUSION rVIBE cannot replace cVIBE in routine liver MRI. At 1.5T, free-breathing rVIBE yields acceptable, although slightly inferior image quality compared to breath-hold cVIBE. PMID:27551341

  4. Exhaled breath volatile biomarker analysis for thyroid cancer.

    PubMed

    Guo, Lei; Wang, Changsong; Chi, Chunjie; Wang, Xiaoyang; Liu, Shanshan; Zhao, Wei; Ke, Chaofu; Xu, Guowang; Li, Enyou

    2015-08-01

    Compared with other types of cancer, thyroid cancer incidence rates have increased rapidly worldwide in the past few decades. In recent years, potential thyroid cancer biomarkers have been studied, but these biomarkers have neither specificity nor good positive predictive value. Exhaled breath analysis is a recently developed convenient and noninvasive method for screening and diagnosing the disease. In this study, potential thyroid cancer biomarkers in volatile organic compounds (VOCs) were detected. Exhaled breath was collected from 64 patients with histologically confirmed cases of thyroid disease (including 39 individuals with papillary thyroid carcinoma and 25 individuals with nodular goiters) and 32 healthy volunteers. Solid-phase microextraction-gas chromatography and mass spectrometry was used to assess the exhaled VOCs of the study participants. The statistical methods of principal component analysis and partial least-squares discriminant analysis were performed to process the final data. The VOCs exhibited significant differences between nodular goiter patients and normal controls, papillary thyroid carcinoma patients and normal controls, and papillary thyroid carcinoma patients and nodular goiter patients; 7, 7, and 3 characteristic metabolites played decisive roles in sample classification, respectively. Breath analysis may provide a new, noninvasive, and directly qualitative method for the clinical diagnosis of thyroid disease. PMID:25666355

  5. Evaluation of Patient Perceptions After Vestibuloplasty Procedure: A Comparison of Diode Laser and Scalpel Techniques

    PubMed Central

    Farista, Sana; Koppolu, Pradeep; Baroudi, Kusai; Uppada, Udaykiran; Mishra, Ashank; Savarimath, Abhishek; Lingam, Amara Swapna

    2016-01-01

    Introduction Inadequate vestibular depth results in poor plaque control owing to an insufficient width of keratinized gingiva. Vestibuloplasty provides the necessary vestibular depth and can be performed either with a scalpel, electrocautery or lasers. Aim To evaluate the patient perceptions related to pain and discomfort on the 1st, 3rd and the 7th day post vestibuloplasty and also assess the healing outcomes related to the treatment of inadequate vestibular depth either with the diode laser or the scalpel. Materials and Methods Twenty patients who had inadequate vestibular depth and required vestibuloplasty were assigned randomly to undergo the procedure either with the scalpel or the laser. The data obtained was analysed for intergroup comparison with an independent paired t-test and intragroup comparison was determined by a paired t-test. Results Intragroup comparison within the laser group for VAS scores of pain and discomfort within all the reported days exhibited a significant difference (p<0.05). Inter group comparison revealed that the patients in the laser group had lower VAS cores for pain and discomfort compared to the scalpel group (p<0.05). Analysis of the three pointer scale for healing revealed that the patients in the laser group exhibited better healing outcomes on the 1st, 3rd and the 7th day compared to the scalpel group. Conclusion Observations from the study highlight the opinion that laser can be a safe and effective alternative to traditional vestibuloplasty performed with the scalpel. PMID:27437370

  6. An evaluation of Fourier transform infrared (FTIR) spectroscopy for detecting organic solvents in expired breath.

    PubMed

    Yost, Michael G; Rose, Martin A; Morgan, Michael S

    2003-03-01

    The aim of this study was to test the performance of gas-phase FTIR analysis on human breath samples. Ten volatile organic compounds (VOC) were examined for applicability to FTIR spectroscopy (ethanol, ethylbenzene, n-hexane, methyl ethyl ketone, methyl tert-butyl ether, m-xylene, 1,1,1-trichloroethane, trichloroethylene, tetrachloroethylene, and toluene). Three sets of detection limits (LOD) were determined for comparison. LOD(1) were generated from partial least squares (PLS) calibration methods using spectroscopic software, LOD(2) from spiked breath samples, and LOD(3) from blank breath samples. Mixed expired breath samples from four subjects were spiked at varying levels with four different VOC (hexane, methyl ethyl ketone, m-xylene and 1,1,1-trichloroethane) to validate spectral data and test overall accuracy. Breath samples spiked with m-xylene also were validated by GC/FID analysis. PLS-derived LOD(1) ranged from 0.06-2.47 ppm. Spiked breath sample LOD(2) ranged from 0.52-1.21 ppm. Blank breath LOD(3) measurements ranged from 0.17-1.70 ppm, except for ethanol, which had an LOD of 11.2 ppm. Predicted concentrations for carbon dioxide (slope = 1.06), m-xylene (slopes = 1.19, 1.21), and methyl ethyl ketone (slope = 0.93) were fairly accurate, while concentrations were underpredicted for n-hexane (slope = 0.69) and 1,1,1-trichloroethane (slopes = 0.58-0.66). PMID:12573961

  7. Wash-out of ambient air contaminations for breath measurements.

    PubMed

    Maurer, F; Wolf, A; Fink, T; Rittershofer, B; Heim, N; Volk, T; Baumbach, J I; Kreuer, S

    2014-06-01

    In breath analysis, ambient air contaminations are ubiquitous and difficult to eliminate. This study was designed to investigate the reduction of ambient air background by a lung wash-out with synthetic air. The reduction of the initial ambient air volatile organic compound (VOC) intensity was investigated in the breath of 20 volunteers inhaling synthetic air via a sealed full face mask in comparison to inhaling ambient air. Over a period of 30 minutes, breath analysis was conducted using ion mobility spectrometry coupled to a multi-capillary column. A total of 68 VOCs were identified for inhaling ambient air or inhaling synthetic air. By treatment with synthetic air, 39 VOCs decreased in intensity, whereas 29 increased in comparison to inhaling ambient air. In total, seven VOCs were significantly reduced (P-value < 0.05). A complete wash-out of VOCs in this setting was not observed, whereby a statistically significant reduction up to 65% as for terpinolene was achieved. Our setting successfully demonstrated a reduction of ambient air contaminations from the airways by a lung wash-out with synthetic air.

  8. Assessment of the 14C-Glycocholic Acid Breath Test

    PubMed Central

    James, O. F. W.; Agnew, J. E.; Bouchier, I. A. D.

    1973-01-01

    The 1-(14C)-glycine-glycocholic-acid breath test has been performed on 104 subjects and a normal range established. Abnormal results due to bacterial deconjugation of bile salts were found not only in patients with the “contaminated bowel” syndrome and in those with ileal resection but also in a third group, patients with cholangitis. Abnormal results were also found in patients with gastrocolic fistula and staphylococcal enterocolitis, while mildly abnormal results were also found in some patients with liver disease. PMID:4718834

  9. Anatomic and Pathologic Variability During Radiotherapy for a Hybrid Active Breath-Hold Gating Technique

    SciTech Connect

    Glide-Hurst, Carri K.; Gopan, Ellen; Hugo, Geoffrey D.

    2010-07-01

    Purpose: To evaluate intra- and interfraction variability of tumor and lung volume and position using a hybrid active breath-hold gating technique. Methods and Materials: A total of 159 repeat normal inspiration active breath-hold CTs were acquired weekly during radiotherapy for 9 lung cancer patients (12-21 scans per patient). A physician delineated the gross tumor volume (GTV), lungs, and spinal cord on the first breath-hold CT, and contours were propagated semiautomatically. Intra- and interfraction variability of tumor and lung position and volume were evaluated. Tumor centroid and border variability were quantified. Results: On average, intrafraction variability of lung and GTV centroid position was <2.0 mm. Interfraction population variability was 3.6-6.7 mm (systematic) and 3.1-3.9 mm (random) for the GTV centroid and 1.0-3.3 mm (systematic) and 1.5-2.6 mm (random) for the lungs. Tumor volume regressed 44.6% {+-} 23.2%. Gross tumor volume border variability was patient specific and demonstrated anisotropic shape change in some subjects. Interfraction GTV positional variability was associated with tumor volume regression and contralateral lung volume (p < 0.05). Inter-breath-hold reproducibility was unaffected by time point in the treatment course (p > 0.1). Increases in free-breathing tidal volume were associated with increases in breath-hold ipsilateral lung volume (p < 0.05). Conclusions: The breath-hold technique was reproducible within 2 mm during each fraction. Interfraction variability of GTV position and shape was substantial because of tumor volume and breath-hold lung volume change during therapy. These results support the feasibility of a hybrid breath-hold gating technique and suggest that online image guidance would be beneficial.

  10. Characteristics of Dysphagia in Severe Traumatic Brain Injury Patients: A Comparison With Stroke Patients

    PubMed Central

    Lee, Won Kyung; Yeom, Jiwoon; Lee, Woo Hyung; Seo, Han Gil; Oh, Byung-Mo

    2016-01-01

    Objective To compare the swallowing characteristics of dysphagic patients with traumatic brain injury (TBI) with those of dysphagic stroke patients. Methods Forty-one patients with TBI were selected from medical records (between December 2004 to March 2013) and matched to patients with stroke (n=41) based on age, sex, and disease duration. Patients' swallowing characteristics were analyzed retrospectively using a videofluoroscopic swallowing study (VFSS) and compared between both groups. Following thorough review of medical records, patients who had a history of diseases that could affect swallowing function at the time of the study were excluded. Dysphagia characteristics and severity were evaluated using the American Speech-Language-Hearing Association National Outcome Measurement System swallowing scale, clinical dysphagia scale, and the videofluoroscopic dysphagia scale. Results There was a significant difference in radiological lesion location (p=0.024) between the two groups. The most common VFSS finding was aspiration or penetration, followed by decreased laryngeal elevation and reduced epiglottis inversion. Swallowing function, VFSS findings, or quantified dysphagia severity showed no significant differences between the groups. In a subgroup analysis of TBI patients, the incidence of tube feeding was higher in patients with surgical intervention than in those without (p=0.011). Conclusion The swallowing characteristics of dysphagic patients after TBI were comparable to those of dysphagic stroke patients. Common VFSS findings comprised aspiration or penetration, decreased laryngeal elevation, and reduced epiglottis inversion. Patients who underwent surgical intervention after TBI were at high risk of tube feeding requirement. PMID:27446779

  11. Breath testing for small intestinal bacterial overgrowth: maximizing test accuracy.

    PubMed

    Saad, Richard J; Chey, William D

    2014-12-01

    The diagnosis of small intestinal bacterial overgrowth (SIBO) has increased considerably owing to a growing recognition of its association with common bowel symptoms including chronic diarrhea, bloating, abdominal distention, and the irritable bowel syndrome. Ideally, an accurate and objective diagnosis of SIBO should be established before initiating antibiotic treatment. Unfortunately, no perfect test exists for the diagnosis of SIBO. The current gold standard, small-bowel aspiration and quantitative culture, is limited by its high cost, invasive nature, lack of standardization, sampling error, and need for dedicated infrastructure. Although not without shortcomings, hydrogen breath testing provides the simplest noninvasive and widely available diagnostic modality for suspected SIBO. Carbohydrates such as lactulose and glucose are the most widely used substrates in hydrogen breath testing, with glucose arguably providing greater testing accuracy. Lactose, fructose, and sorbitol should not be used as substrates in the assessment of suspected SIBO. The measurement of methane in addition to hydrogen can increase the sensitivity of breath testing for SIBO. Diagnostic accuracy of hydrogen breath testing in SIBO can be maximized by careful patient selection for testing, proper test preparation, and standardization of test performance as well as test interpretation.

  12. Breath testing for small intestinal bacterial overgrowth: maximizing test accuracy.

    PubMed

    Saad, Richard J; Chey, William D

    2014-12-01

    The diagnosis of small intestinal bacterial overgrowth (SIBO) has increased considerably owing to a growing recognition of its association with common bowel symptoms including chronic diarrhea, bloating, abdominal distention, and the irritable bowel syndrome. Ideally, an accurate and objective diagnosis of SIBO should be established before initiating antibiotic treatment. Unfortunately, no perfect test exists for the diagnosis of SIBO. The current gold standard, small-bowel aspiration and quantitative culture, is limited by its high cost, invasive nature, lack of standardization, sampling error, and need for dedicated infrastructure. Although not without shortcomings, hydrogen breath testing provides the simplest noninvasive and widely available diagnostic modality for suspected SIBO. Carbohydrates such as lactulose and glucose are the most widely used substrates in hydrogen breath testing, with glucose arguably providing greater testing accuracy. Lactose, fructose, and sorbitol should not be used as substrates in the assessment of suspected SIBO. The measurement of methane in addition to hydrogen can increase the sensitivity of breath testing for SIBO. Diagnostic accuracy of hydrogen breath testing in SIBO can be maximized by careful patient selection for testing, proper test preparation, and standardization of test performance as well as test interpretation. PMID:24095975

  13. Differentiation between genetic mutations of breast cancer by breath volatolomics

    PubMed Central

    Hua, Qing-Ling; Pan, Yue-Yin; Kayal, Haneen; Khoury, Kayan; Liu, Hu; Davies, Michael P.A.; Haick, Hossam

    2015-01-01

    Mapping molecular sub-types in breast cancer (BC) tumours is a rapidly evolving area due to growing interest in, for example, targeted therapy and screening high-risk populations for early diagnosis. We report a new concept for profiling BC molecular sub-types based on volatile organic compounds (VOCs). For this purpose, breath samples were collected from 276 female volunteers, including healthy, benign conditions, ductal carcinoma in situ (DCIS) and malignant lesions. Breath samples were analysed by gas chromatography mass spectrometry (GC-MS) and artificially intelligent nanoarray technology. Applying the non-parametric Wilcoxon/Kruskal-Wallis test, GC-MS analysis found 23 compounds that were significantly different (p < 0.05) in breath samples of BC patients with different molecular sub-types. Discriminant function analysis (DFA) of the nanoarray identified unique volatolomic signatures between cancer and non-cancer cases (83% accuracy in blind testing), and for the different molecular sub-types with accuracies ranging from 82 to 87%, sensitivities of 81 to 88% and specificities of 76 to 96% in leave-one-out cross-validation. These results demonstrate the presence of detectable breath VOC patterns for accurately profiling molecular sub-types in BC, either through specific compound identification by GC-MS or by volatolomic signatures obtained through statistical analysis of the artificially intelligent nanoarray responses. PMID:26540569

  14. Medical Diagnostic Breath Analysis by Cavity Ring Down Spectroscopy

    NASA Astrophysics Data System (ADS)

    Guss, Joseph S.; Metsälä, Markus; Halonen, Lauri

    2009-06-01

    Certain medical conditions give rise to the presence of chemicals in the bloodstream. These chemicals - known as biomarkers - may also be present in low concentrations in human breath. Cavity ring down spectroscopy possesses the requisite selectivity and sensitivity to detect such biomarkers in the congested spectrum of a breath sample. The ulcer-causing bacterium, Helicobacter pylori, is a prolific producer of the enzyme urease, which catalyses the breakdown of urea ((NH_2)_2CO) in the stomach as follows: (NH_2)_2CO + H_2O ⟶ CO_2 + 2NH_3 Currently, breath tests seeking altered carbon-isotope ratios in exhaled CO_2 after the ingestion of ^{13}C- or ^{14}C-labeled urea are used to diagnose H. pylori infection. We present recent results from an ongoing collaboration with Tampere Area University Hospital. The study involves 100 patients (both infected and uninfected) and concerns the possible correlation between the bacterial infection and breath ammonia. D. Y. Graham, P. D. Klein, D. J. Evans, Jr, D. G. Evans, L. C. Alpert, A. R. Opekun, T. W. Boutton, Lancet 1(8543), 1174-7 March 1987.

  15. The technology of metered-dose inhalers and treatment costs in asthma: a retrospective study of breath actuation versus traditional press-and-breathe inhalers.

    PubMed

    Langley, P C

    1999-01-01

    This paper reviews the impact of the use of technologically dissimilar beta-agonist aerosols--the Maxair Autohaler (pirbuterol acetate) breath-actuated aerosol and the traditional albuterol press-and-breathe inhaler-on the treatment costs of asthma. If, as clinical evidence would suggest, the breath-actuated aerosol is not only as effective as an albuterol inhaler with a spacer, but is easier to use and results in more optimal beta-agonist use by patients, then one might consider the hypothesis that patients possessing a breath-actuated inhaler would, ceteris paribus, experience lower asthma-related treatment costs-principally, those medical costs associated with fewer emergency room visits and hospitalizations. This hypothesis is considered from the perspective of a retrospective claims database study of patients who used one or the other beta-agonist inhaler exclusively. At the descriptive level, costs of treatment for patients using the press-and-breathe inhaler are estimated to be 16.5% greater than costs for patients using the breath-actuated inhaler. In the multivariate analysis, the presence of the breath-actuated inhaler (in a dummy variable analysis) was not only statistically significant (P < 0.05), but entered with the expected negative sign. Estimated cost impacts under various model specifications are consistent with the magnitude of the cost differences reported in the descriptive analysis. Total cost savings with the Maxair Autohaler ranged from 8.7% to 11.7%, with medical cost savings estimated at 14.6%. PMID:10090438

  16. The effects of breathing with mainly inspiration or expiration on pulmonary function and chest expansion

    PubMed Central

    Woo, Seong-Dae; Kim, Tae-Ho; Lim, Jin-Yong

    2016-01-01

    [Purpose] This study aimed to determine the effects of inspiration- and expiration-oriented breathing on pulmonary function and chest expansion. [Subjects and Methods] Twenty healthy male university students were divided randomly into inspiration-oriented and expiration-oriented breathing groups. Their pulmonary function and chest size during inspiration or expiration were evaluated and then re-evaluated after 15 minutes of breathing exercise five times a week for four weeks. [Results] The breathing with mainly inspiration group (BMIG) showed significant differences in chest size during inspiration (CSI), chest expansion values (CEVs), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF) after four weeks. The breathing with mainly expiration group (BMEG) showed significant differences in all measured variables except CSI. Comparison of the groups after exercise showed that the BMEG demonstrated differences from the BMIG in chest size during expiration (CSE), CEV, and PEF. Comparison of the changes in variables after exercise showed that the BMEG demonstrated significantly different changes in CSE, CEV, FEV1/FVC, and PEF. The BMIG showed a significantly different change in FVC. [Conclusion] Although both groups demonstrated improvements in pulmonary function and chest expansion, inter-group differences were observed. Therefore, inspiration- or expiration-oriented breathing may be recommended differently according to the desired outcome. PMID:27134386

  17. Comparison of hair from rectum cancer patients and from healthy persons by Raman microspectroscopy and imaging

    NASA Astrophysics Data System (ADS)

    Wei, Xiaoli; Wang, Xin; Fang, Yusheng; Huang, Qing

    2013-09-01

    In this work, Raman microspectroscopy and imaging was employed to analyze cancer patients' hair tissue. The comparison between the hair from rectum cancer patients and the hair from healthy people reveals some remarkable differences, such as for the rectum cancer patients, there are more lipids but less content of α-helix proteins in the hair medulla section. Though more statistic data are required to establish universary rules for practical and accurate diagnosis, this work based on case study demonstrates the possibility of applying Raman microspectroscopy to reveal abnormality in non-cancer tissues such as hair in order to predict and diagnose cancers.

  18. Research protocol for a diagnostic study of non-invasive exhaled breath analysis for the prediction of oesophago-gastric cancer

    PubMed Central

    Markar, Sheraz R; Lagergren, Jesper; Hanna, George B

    2016-01-01

    Introduction Despite improvements in a range of chemo, radio and surgical therapies, the overall survival at 5 years from oesophago-gastric cancer remains poor and ranges from 10% to 30%. Early diagnosis is a key strategy to improve survival but early disease stage has non-specific symptoms that are very common while the warning clinical picture often indicates advanced disease. The aim of this research is to validate a breath test to predict oesophago-gastric cancer therefore allowing earlier diagnosis and introduction of treatment. Methods and analysis The study will include 325 patients and be conducted across four major oesophago-gastric cancer centres in London, UK. This research will utilise selected ion flow-tube mass spectrometry (SIFT-MS) exhaled breath analysis, for comparison of predicted cancer risk based on the previously developed volatile organic compound exhaled breath model, with endoscopic findings and histology biopsies. This will determine the overall diagnostic accuracy for non-invasive breath testing for the diagnosis of oesophago-gastric cancer. Ethics and Dissemination Approval was gained from NRES Committee London, on 16 July 2014 (REC reference 14/LO/1136) for the completion of this study. Different methods of dissemination will be employed including international clinical and patient group presentations, and publication of research outputs in a high-impact clinical journal. This is to ensure that the findings from this research will reach patients, primary care practitioners, scientists, hospital specialists in gastroenterology, oncology and surgery, health policymakers and commissioners as well as NHS regulatory bodies. Trials registration number UKCRN18063; Pre-results. PMID:26739727

  19. Qigong--Chinese breathing exercise.

    PubMed

    Koh, T C

    1982-01-01

    Qigong is an ancient Chinese breathing exercise with meditation which is being developed today for therapy of chronic illnesses in the People's Republic of China. It is claimed to cure gastric ulcers, hypertension, anxiety neurosis, otitis media, cancer and has even been used as a form of anaesthesia. Although the physiological effects produced by Qigong resemble those of meditation, there are certain features that are unique and often mysterious. Research in the future may prove Qigong to be a useful adjunct in the practice of medicine.

  20. Tunable fiber laser based photoacoustic spectrometer for breath ammonia analysis during hemodialysis

    NASA Astrophysics Data System (ADS)

    Wang, J. W.; Xie, H.; Liang, L. R.; Zhang, W.; Peng, W.; Yu, Q. X.

    2011-11-01

    A photoacoustic (PA) spectrometer based on a near-IR tunable fiber laser is developed and used for breath ammonia analysis. We successfully measured the breath ammonia level variation of six patients with end-stage renal disease while they were undergoing hemodialysis in the hospital. The measurement results showed that the initial concentration level of the breath ammonia were from 1600 to 2200 ppb before dialysis treatment, the levels decreased to 200-600 ppb in the end stage of dialysis, which close to the levels of healthy persons. Further improvement and applications of this PA spectrometer are discussed.

  1. Effects of tracheostomy in two cases of hypersomnia with periodic breathing

    PubMed Central

    Lugaresi, Elio; Coccagna, Giorgio; Mantovani, Magda; Brignani, Fabrizio

    1973-01-01

    Two non-obese patients suffering from hypersomnia with periodic breathing, who presented predominantly obstructive apnoea persisting throughout sleep, underwent tracheotomy with placement of a permanent tracheal cannula. Before tracheostomy there was a serious state of alveolar hypoventilation with a marked rise in pulmonary arterial pressure which appeared during sleep. After tracheostomy breathing during sleep became regular, pulmonary arterial pressure became normal, and daytime drowsiness disappeared. These observations suggest that the obstruction of the upper air tracts during sleep represents the most important factor in the pathogenesis of hypersomnia with periodic breathing. Images PMID:4691688

  2. Breathing

    MedlinePlus Videos and Cool Tools

    ... size of the thoracic cavity and decreases the pressure inside. As a result, air rushes in and ... volume of the thoracic cavity decreases, while the pressure within it increases. As a result, the lungs ...

  3. Shoulder and hip roll differences between breathing and non-breathing conditions in front crawl swimming.

    PubMed

    Psycharakis, Stelios G; McCabe, Carla

    2011-06-01

    The effects of breathing on body roll have been previously investigated for the roll of the whole trunk only. The purposes of this study were: to calculate separately the shoulder roll (SR) and hip roll (HR) of swimmers during front crawl for non-breathing and preferred-side breathing conditions; to assess the differences in the magnitude and temporal characteristics of these variables between non-breathing and preferred-side breathing conditions; and to examine their association with swimming performance (indicated by swimming speed). Twelve male swimmers who competed at national and international level performed two maximum 25 m front crawl trials: one non-breathing and one with breathing to their preferred side. Performance was recorded with four below and two above water synchronised cameras. SR and HR in both trials were calculated for the breathing and non-breathing sides. The timings of SR and HR peaks to each side and at the positions of neutral roll were also calculated. Swimming speed was significantly slower in the breathing trial (p < 0.01). Swimmers rolled their shoulders and hips to the breathing side significantly more in the breathing than in the non-breathing trial (SR: p < 0.01; HR: p = 0.03). Nevertheless, there were no significant differences in the overall SR or HR between these trials. In the breathing trial, SR was higher in the breathing than in the non-breathing side (p < 0.01) but HR was not significantly different (p = 0.07). There was no evidence to suggest that temporal characteristics of SR or HR were associated with swimming performance.

  4. Clinical Evaluation of CAIPIRINHA: Comparison Against a GRAPPA Standard

    PubMed Central

    Wright, Katherine L.; Harrell, Michael W.; Jesberger, John A.; Landeras, Luis; Nakamoto, Dean A.; Thomas, Smitha; Nickel, Dominik; Kroeker, Randall; Griswold, Mark A.; Gulani, Vikas

    2013-01-01

    Purpose To evaluate image quality when using a CAIPIRINHA sampling pattern in comparison to a standard GRAPPA sampling pattern in patients undergoing a routine 3D breath-held liver exam. CAIPIRINHA uses an optimized phase encoding sampling strategy to alter aliasing artifacts in 3D acquisitions to improve parallel imaging reconstruction. Methods Twenty patient volunteers were scanned using a 3D VIBE acquisition with an acceleration factor of four using a CAIPIRINHA and standard GRAPPA sampling pattern. CAIPIRINHA and GRAPPA images were evaluated by three radiologists in a two alternative forced choice test, and the Wilcoxon signed rank test was performed. Results The CAIPIRINHA sampling pattern was preferred in an average of 68% of the comparisons, and the Wilcoxon signed rank test showed a significant improvement in CAIPIRINHA images (p=0.014). This analysis indicates that in the given sample set, CAIPIRINHA preference over the GRAPPA standard was statistically significant. Conclusion This work shows that for an acceleration factor of four, a CAIPIRINHA accelerated VIBE acquisition provides significantly improved image quality in comparison to the current GRAPPA standard. This allows a further reduction in imaging time for similar spatial resolutions, which can reduce long breath-hold requirements in abdominal imaging, and may be particularly helpful in patients who cannot provide requisite breath-holds with current protocols. PMID:24123420

  5. Dead space in the breathing apparatus; interaction with ventilation.

    PubMed

    Warkander, D E; Lundgren, C E

    1995-09-01

    Dead space in breathing apparatus may cause increased ventilation and/or CO2 retention. Interactions between ventilation and dead space were tested in the breathing apparatus of three divers: a full face mask with an oro-nasal cup (AGA), a full face mask without an oro-nasal cup (EXO-26) but designed to minimize dead space, and one mouthpiece. Experiments were performed at three depths; 0, 30 and 45 m seawater (msw). The breathing gas was air except at 30 msw where it was 36 O2 in N2. Five certified SCUBA divers were exercised at three levels (0, 50 and 100 W). Ventilation and gas exchange were measured. The dead space in the AGA mask was not influenced by either depth or exercise (mean 0.201). The mean dead space of the EXO-26 was 0.341, but it increased with exercise (p < 0.001) and decreased with depth (p < 0.03). Since the dead space can vary with ventilation levels it is not sufficient to test breathing apparatus only at rest as is required by the US National Institute of Occupational Safety and Health. The mean ventilation with the EXO-26 was higher than with the AGA by 10% at 50 W (p < 0.05) and by 12% (p < 0.01) at 100 W. The same comparison for end-tidal CO2 showed mean increase by 0.30 kPa at the 100-W workload (P < 0.05); changes at other workloads were not statistically significant. Comparisons of the mean inspired PCO2 to the maximum values considered acceptable by various organizations showed that the mouthpiece was always acceptable, the AGA mask was marginally acceptable or better, while sometimes the EXO-26 was not acceptable.

  6. 42 CFR 84.81 - Compressed breathing gas and liquefied breathing gas containers; minimum requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... accordance with 5 U.S.C. 552(a) and 1 CFR part 51. Copies may be obtained from American National Standards... 42 Public Health 1 2013-10-01 2013-10-01 false Compressed breathing gas and liquefied breathing... APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Self-Contained Breathing Apparatus § 84.81 Compressed...

  7. 42 CFR 84.81 - Compressed breathing gas and liquefied breathing gas containers; minimum requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... accordance with 5 U.S.C. 552(a) and 1 CFR part 51. Copies may be obtained from American National Standards... 42 Public Health 1 2012-10-01 2012-10-01 false Compressed breathing gas and liquefied breathing... APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Self-Contained Breathing Apparatus § 84.81 Compressed...

  8. 42 CFR 84.81 - Compressed breathing gas and liquefied breathing gas containers; minimum requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... accordance with 5 U.S.C. 552(a) and 1 CFR part 51. Copies may be obtained from American National Standards... 42 Public Health 1 2014-10-01 2014-10-01 false Compressed breathing gas and liquefied breathing... APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Self-Contained Breathing Apparatus § 84.81 Compressed...

  9. COPD Identification By The Analysis Of Breath With An Electronic Nose

    NASA Astrophysics Data System (ADS)

    Capuano, Rosamaria; Santonico, Marco; Martinelli, Eugenio; Paolesse, Roberto; Bergamini, Alberto; Cazzola, Mario; Ciaprini, Chiara; Segreti, Andrea; Di Natale, Corrado; D'Amico, Arnaldo

    2011-09-01

    Chronic obstructive pulmonary disease (COPD) is a non fully reversible pathology characterized by airflow limitation. Spirometry (pulmonary function) is the gold standard to diagnose COPD, but often in the early stage of the pathology breathing symptoms might not be clinically evident. For this reason, there is an increasing demand for non-invasive diagnostic techniques. In this paper an electronic nose has been applied to the breath analysis of COPD patients. Breath samples of COPD patients and control subjects were analyzed with the electronic nose. Classification of sensors data illustrates the ability of this instrument to distinguish between the two groups. Electronic nose data were complemented by GC-MS analysis for a thorough characterization of the breath samples.

  10. Comparison of finger and forehead oximetry sensors in postanesthesia care patients.

    PubMed

    Blaylock, Vicki; Brinkman, Mary; Carver, Sharon; McLain, Penny; Matteson, Stephanie; Newland, Pam; Pettit, Ruth; Schulman, Christine; vanSchijndel, Willy; Watson, Sheri

    2008-12-01

    We compared loss of pulse oximetry signal (dropout rates) for both finger and forehead sensors in postanesthesia patients. Pulse oximetry is a widely practiced method for measuring oxygen saturation. Several studies in various patient populations have demonstrated that low flow states, patient movement, and hypothermia may result in poor signal quality with the use of finger oximetry sensors. These clinical conditions are common in patients as they emerge from anesthesia. New forehead sensors may reduce signal dropout. A method-comparison design was used to compare finger and forehead oximetry signal dropout rates. Of 48 subjects studied, only three had a signal dropout. Overall, there were seven episodes of signal dropout; six of seven occurred with the finger sensor. Signal dropout occurred rarely in PACU subjects. Use of finger sensors for routine postanesthesia monitoring should be adequate in the majority of patients.

  11. Comparison of Manual Refraction Versus Autorefraction in 60 Diabetic Retinopathy Patients

    PubMed Central

    Shirzadi, Keyvan; Shahraki, Kourosh; Yahaghi, Emad; Makateb, Ali; Khosravifard, Keivan

    2016-01-01

    Aim: The purpose of the study was to evaluate the comparison of manual refraction versus autorefraction in diabetic retinopathy patients. Material and Methods: The study was conducted at the Be’sat Army Hospital from 2013-2015. In the present study differences between two common refractometry methods (manual refractometry and Auto refractometry) in diagnosis and follow up of retinopathy in patients affected with diabetes is investigated. Results: Our results showed that there is a significant difference in visual acuity score of patients between manual and auto refractometry. Despite this fact, spherical equivalent scores of two methods of refractometry did not show a significant statistical difference in the patients. Conclusion: Although use of manual refraction is comparable with autorefraction in evaluating spherical equivalent scores in diabetic patients affected with retinopathy, but in the case of visual acuity results from these two methods are not comparable. PMID:27703289

  12. Magnetic resonance imaging in patients with unstable angina: comparison with acute myocardial infarction and normals

    SciTech Connect

    Ahmad, M.; Johnson, R.F. Jr.; Fawcett, H.D.; Schreiber, M.H.

    1988-09-01

    The role of magnetic resonance imaging in characterizing normal, ischemic and infarcted segments of myocardium was examined in 8 patients with unstable angina, 11 patients with acute myocardial infarction, and 7 patients with stable angina. Eleven normal volunteers were imaged for comparison. Myocardial segments in short axis magnetic resonance images were classified as normal or abnormal on the basis of perfusion changes observed in thallium-201 images in 22 patients and according to the electrocariographic localization of infarction in 4 patients. T2 relaxation time was measured in 57 myocardial segments with abnormal perfusion (24 with reversible and 33 with irreversible perfusion changes) and in 25 normally perfused segments. T2 measurements in normally perfused segments of patients with acute myocardial infarction, unstable angina and stable angina were within normal range derived from T2 measurements in 48 myocardial segments of 11 normal volunteers (42 +/- 10 ms). T2 in abnormal myocardial segments of patients with stable angina also was not significantly different from normal. T2 of abnormal segments in patients with unstable angina (64 +/- 14 in reversibly ischemic and 67 +/- 21 in the irreversibly ischemic segments) was prolonged when compared to normal (p less than 0.0001) and was not significantly different from T2 in abnormal segments of patients with acute myocardial infarction (62 +/- 18 for reversibly and 66 +/- 11 for irreversibly ischemic segments). The data indicate that T2 prolongation is not specific for acute myocardial infarction and may be observed in abnormally perfused segments of patients with unstable angina.

  13. Protective supplied breathing air garment

    DOEpatents

    Childers, E.L.; Hortenau, E.F. von.

    1984-07-10

    A breathing air garment is disclosed for isolating a wearer from hostile environments containing toxins or irritants includes a suit and a separate head protective enclosure or hood engaging a suit collar in sealing attachment. The hood and suit collar are cylindrically shaped and dimensioned to enable the wearer to withdraw his hands from the suit sleeves to perform manual tasks within the hood interior. Breathing air is supplied from an external air line with an air delivery hose attached to the hood interior. The hose feeds air into an annular halo-like fiber-filled plenum having spaced discharge orifices attached to the hood top wall. A plurality of air exhaust/check valves located at the suit extremities cooperate with the hood air delivery system to provide a cooling flow of circulating air from the hood throughout the suit interior. A suit entry seal provided on the suit rear torso panel permits access into the suit and is sealed with an adhesive sealing flap. 17 figs.

  14. Protective supplied breathing air garment

    DOEpatents

    Childers, Edward L.; von Hortenau, Erik F.

    1984-07-10

    A breathing air garment for isolating a wearer from hostile environments containing toxins or irritants includes a suit and a separate head protective enclosure or hood engaging a suit collar in sealing attachment. The hood and suit collar are cylindrically shaped and dimensioned to enable the wearer to withdraw his hands from the suit sleeves to perform manual tasks within the hood interior. Breathing air is supplied from an external air line with an air delivery hose attached to the hood interior. The hose feeds air into an annular halo-like fiber-filled plenum having spaced discharge orifices attached to the hood top wall. A plurality of air exhaust/check valves located at the suit extremities cooperate with the hood air delivery system to provide a cooling flow of circulating air from the hood throughout the suit interior. A suit entry seal provided on the suit rear torso panel permits access into the suit and is sealed with an adhesive sealing flap.

  15. Attributional style in delusional patients: a comparison of remitted paranoid, remitted nonparanoid, and current paranoid patients with nonpsychiatric controls.

    PubMed

    Aakre, Jennifer M; Seghers, James P; St-Hilaire, Annie; Docherty, Nancy

    2009-09-01

    Many studies have found that people experiencing persecutory delusions have a marked tendency to use external-personal attributions when establishing the causes of negative events. Although nonclinical populations also tend to attribute negative events to external causes, those causes are typically believed to be universal in nature, rather than personal. The central goal of the present study was to investigate whether individuals with remitted persecutory delusions would display this external-personal bias regarding negative events, in comparison to remitted patients whose delusions were not paranoid in nature and to nonpsychiatric controls. Results indicate that currently paranoid patients were significantly more likely than all other groups, including the remitted paranoid group, to use external-personal attributions in negative events. Interestingly, all patient groups also were found to be significantly more likely than the controls to use internal-personal and internal-universal attributions when explaining negative events.

  16. Submarines, spacecraft and exhaled breath.

    PubMed

    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

  17. Submarines, spacecraft and exhaled breath.

    PubMed

    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

  18. Respiratory Motion of The Heart and Positional Reproducibility Under Active Breathing Control

    SciTech Connect

    Jagsi, Reshma; Moran, Jean M.; Kessler, Marc L.; Marsh, Robin B. C; Balter, James M.; Pierce, Lori J. . E-mail: ljpierce@umich.edu

    2007-05-01

    Purpose: To reduce cardiotoxicity from breast radiotherapy (RT), innovative techniques are under investigation. Information about cardiac motion with respiration and positional reproducibility under active breathing control (ABC) is necessary to evaluate these techniques. Methods and Materials: Patients requiring loco-regional RT for breast cancer were scanned by computed tomography using an ABC device at various breath-hold states, before and during treatment. Ten patients were studied. For each patient, 12 datasets were analyzed. Mutual information-based regional rigid alignment was used to determine the magnitude and reproducibility of cardiac motion as a function of breathing state. For each scan session, motion was quantified by evaluating the displacement of a point along the left anterior descending artery (LAD) with respect to its position at end expiration. Long-term positional reproducibility was also assessed. Results: Displacement of the LAD was greatest in the inferior direction, moderate in the anterior direction, and lowest in the left-right direction. At shallow breathing states, the average displacement of LAD position was up to 6 mm in the inferior direction. The maximum displacement in any patient was 2.8 cm in the inferior direction, between expiration and deep-inspiration breath hold. At end expiration, the long-term reproducibility (SD) of the LAD position was 3 mm in the A-P, 6 mm in the S-I, and 4 mm in the L-R directions. At deep-inspiration breath hold, long-term reproducibility was 3 mm in the A-P, 7 mm in the S-I, and 3 mm in the L-R directions. Conclusions: These data demonstrate the extent of LAD displacement that occurs with shallow breathing and with deep-inspiration breath hold. This information may guide optimization studies considering the effects of respiratory motion and reproducibility of cardiac position on cardiac dose, both with and without ABC.

  19. The effect of breath holding, hyperventilation, and exercise on nasal resistance.

    PubMed

    Hasegawa, M; Kern, E B

    1978-12-01

    A group of 51 patients was studied by a technique of active posterior rhinomanometry that assessed the influence of breath holding, hyperventilation, and exercise on nasal resistance. Breath hodling of 30 seconds or longer produced a decrease in nasal resistance in most of the subjects tested. Hyperventilation had variable effects on nasal resistance, and exercise consistently decreased nasal resistance. These observations are consistent with the proposed effect of chemoreceptor stimulation on nasal airway resistance.

  20. Sleep-disordered breathing after targeted ablation of preBötzinger complex neurons.

    PubMed

    McKay, Leanne C; Janczewski, Wiktor A; Feldman, Jack L

    2005-09-01

    Ablation of preBötzinger complex (preBötC) neurons, critical for respiratory rhythm generation, resulted in a progressive, increasingly severe disruption of respiratory pattern, initially during sleep and then also during wakefulness in adult rats. Sleep-disordered breathing is highly prevalent in elderly humans and in some patients with neurodegenerative disease. We propose that sleep-disordered breathing results from loss of preBötC neurons and could underlie death during sleep in these populations.

  1. Otorhinolaryngological aspects of sleep-related breathing disorders

    PubMed Central

    Virk, Jagdeep S.

    2016-01-01

    Snoring and obstructive sleep apnoea (OSA) are disorders within a wide spectrum of sleep-related breathing disorders (SRBD). Given the obesity epidemic, these conditions will become increasingly prevalent and continue to serve as a large economic burden. A thorough clinical evaluation and appropriate investigations will allow stratification of patients into appropriate treatment groups. A multidisciplinary team is required to manage these patients. Patient selection is critical in ensuring successful surgical and non-surgical outcomes. A wide range of options are available and further long term prospective studies, with standardised data capture and outcome goals, are required to evaluate the most appropriate techniques and long term success rates. PMID:26904262

  2. A comparison of patient satisfaction among prepaid and fee-for-service patients.

    PubMed

    Murray, J P

    1987-02-01

    This study compares levels of patient satisfaction (a valid, indirect measurement of quality of care) between prepaid and fee-for-service patients. A chart audit approach was used to determine whether prepaid and fee-for-service patients seen in an academic family health center at the end of the first six months of a new cost-containment program were comparable in terms of demographic characteristics and indirect measures of health and health behavior. Next, using a 26-item patient satisfaction questionnaire, 436 patients from a single group of providers in the same family health center seen six months after the programs began were randomly surveyed. Sociodemographic and health-related characteristics of prepaid and fee-for-service patients were similar for both groups in the chart audit. There was no statistically significant difference between the overall satisfaction levels of prepaid and fee-for-service patients. Individual constructs that comprise general satisfaction were also statistically similar except for an unexpected finding of dissimilar levels of satisfaction with "physician conduct/humaneness" (P less than .05). Assessed from at least one standpoint, cost containment does not seem to affect overall quality of care, but further investigation is needed, especially in the realm of "physician conduct/humaneness."

  3. Comparison of setup error using different reference images: a phantom and lung cancer patients study

    SciTech Connect

    Jiang Bo; Dai Jianrong; Zhang Ye; Zhang Ke; Men Kuo; Zhou Zongmei; Liang Jun; Wang Lvhua

    2012-04-01

    The purpose of this study was to compare setup errors obtained with kilovoltage cone-beam computed tomography (CBCT) and 2 different kinds of reference images, free-breathing 3D localization CT images (FB-CT) and the average images of 4-D localization CT images (AVG-CT) for phantom and lung cancer patients. This study also explored the correlation between the difference of translational setup errors and the gross tumor volume (GTV) motion. A respiratory phantom and 14 patients were enrolled in this study. For phantom and each patient, 3D helical CT and 4D CT images were acquired, and AVG-CT images were generated from the 4D CT. The setup errors were determined based on the image registration between the CBCT and the 2 different reference images, respectively. The data for both translational and rotational setup errors were analyzed and compared. The GTV centroid movement as well as its correlation with the translational setup error differences was also evaluated. In the phantom study, the AVG-CT method was more accurate than the FB-CT method. For patients, the translational setup errors based on FB-CT were significantly larger than those from AVG-CT in the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions (p < 0.05). Translational setup errors differed by >1 mm in 32.6% and >2 mm in 12.9% of CBCT scans. The rotational setup errors from FB-CT were significantly different from those from AVG-CT in the LR and AP directions (p < 0.05). The correlation coefficient of the translational setup error differences and the GTV centroid movement in the LR, SI, and AP directions was 0.515 (p = 0.060), 0.902 (p < 0.001), and 0.510 (p = 0.062), respectively. For lung cancer patients, respiration may affect the on-line target position location. AVG-CT provides different reference information than FB-CT. The difference in SI direction caused by the 2 methods increases with the GTV movement. Therefore, AVG-CT should be the prefered choice of reference

  4. NASA firefighters breathing system program report

    NASA Technical Reports Server (NTRS)

    Wood, W. B.

    1977-01-01

    Because of the rising incidence of respiratory injury to firefighters, local governments expressed the need for improved breathing apparatus. A review of the NASA firefighters breathing system program, including concept definition, design, development, regulatory agency approval, in-house testing, and program conclusion is presented.

  5. How Does a Hopping Kangaroo Breathe?

    ERIC Educational Resources Information Center

    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…

  6. BREATHING PATTERN DISORDERS AND FUNCTIONAL MOVEMENT

    PubMed Central

    Dr. Esformes, Joseph

    2014-01-01

    Study Design: Experimental design Background: Normal breathing mechanics play a key role in posture and spinal stabilization. Breathing Pattern Disorders (BPD) have been shown to contribute to pain and motor control deficits, which can result in dysfunctional movement patterns. The Functional Movement Screen™ (FMS™) has been shown to accurately predict injury in individuals who demonstrate poor movement patterns. The role BPD play on functional movement is not well established. Furthermore, there is currently no single test to clinically diagnose BPD. A variety of methods are used, but correlations between them are poor. Purpose: To examine the relationship between BPD and functional movement and identify correlations between different measures of BPD. Methods: Breathing was assessed in 34 healthy individuals using a multi‐dimensional approach that included biomechanical, biochemical, breathing related symptoms, and breathing functionality measures. Movement was assessed using the FMS™. Analysis, involving independent t‐tests and Pearson correlation were performed to identify associations between measures. Results: Individuals who exhibited biochemical and biomechanical signs of BPD were significantly more likely to score poorly on the FMS™. These studied measures of BPD correlated highly with each other. Conclusion: These results demonstrate the importance of diaphragmatic breathing on functional movement. Inefficient breathing could result in muscular imbalance, motor control alterations, and physiological adaptations that are capable of modifying movement. These findings provide evidence for improved breathing evaluations by clinicians. Level of Evidence: 2B PMID:24567853

  7. EXHALED BREATH ANALYSIS FOR HUMAN EXPOSURE RESEARCH

    EPA Science Inventory

    Exhaled breath collection and analysis has historically been used in environmental research studies to characterize exposures to volatile organic compounds. The use of this approach is based on the fact that many compounds present in blood are reflected in the breath, and that...

  8. Breath volatile organic compounds for the gut-fatty liver axis: Promise, peril, and path forward

    PubMed Central

    Solga, Steven Francis

    2014-01-01

    The worldwide interest in the gut microbiome and its impact on the upstream liver highlight a critical upside to breath research: it can uniquely measure otherwise unmeasurable biology. Bacteria make gases [volatile organic compounds (VOCs)] that are directly relevant to pathophysiology of the fatty liver and associated conditions, including obesity. Measurement of these VOCs and their metabolites in the exhaled breath, therefore, present an opportunity to safely and easily evaluate, on both a personal and a population level, some of our most pressing public health threats. This is an opportunity that must be pursued. To date, however, breath analysis remains a slowly evolving field which only occasionally impacts clinical research or patient care. One major obstacle to progress is that breath analysis is inherently and emphatically mutli-disciplinary: it connects engineering, chemistry, breath mechanics, biology and medicine. Unbalanced or incomplete teams may produce inconsistent and often unsatisfactory results. A second impediment is the lack of a well-known stepwise structure for the development of non-invasive diagnostics. As a result, the breath research landscape is replete with orphaned single-center pilot studies. Often, important hypotheses and key observations have not been pursued to maturation. This paper reviews the rationale and requirements for breath VOC research applied to the gut-fatty liver axis and offers some suggestions for future development. PMID:25083075

  9. Breath acetone monitoring by portable Si:WO3 gas sensors

    PubMed Central

    Righettoni, Marco; Tricoli, Antonio; Gass, Samuel; Schmid, Alex; Amann, Anton; Pratsinis, Sotiris E.

    2013-01-01

    Breath analysis has the potential for early stage detection and monitoring of illnesses to drastically reduce the corresponding medical diagnostic costs and improve the quality of life of patients suffering from chronic illnesses. In particular, the detection of acetone in the human breath is promising for non-invasive diagnosis and painless monitoring of diabetes (no finger pricking). Here, a portable acetone sensor consisting of flame-deposited and in situ annealed, Si-doped epsilon-WO3 nanostructured films was developed. The chamber volume was miniaturized while reaction-limited and transport-limited gas flow rates were identified and sensing temperatures were optimized resulting in a low detection limit of acetone (~20 ppb) with short response (10–15 s) and recovery times (35–70 s). Furthermore, the sensor signal (response) was robust against variations of the exhaled breath flow rate facilitating application of these sensors at realistic relative humidities (80–90%) as in the human breath. The acetone content in the breath of test persons was monitored continuously and compared to that of state-of-the-art proton transfer reaction mass spectrometry (PTR-MS). Such portable devices can accurately track breath acetone concentration to become an alternative to more elaborate breath analysis techniques. PMID:22790702

  10. Breath acetone monitoring by portable Si:WO3 gas sensors.

    PubMed

    Righettoni, Marco; Tricoli, Antonio; Gass, Samuel; Schmid, Alex; Amann, Anton; Pratsinis, Sotiris E

    2012-08-13

    Breath analysis has the potential for early stage detection and monitoring of illnesses to drastically reduce the corresponding medical diagnostic costs and improve the quality of life of patients suffering from chronic illnesses. In particular, the detection of acetone in the human breath is promising for non-invasive diagnosis and painless monitoring of diabetes (no finger pricking). Here, a portable acetone sensor consisting of flame-deposited and in situ annealed, Si-doped epsilon-WO(3) nanostructured films was developed. The chamber volume was miniaturized while reaction-limited and transport-limited gas flow rates were identified and sensing temperatures were optimized resulting in a low detection limit of acetone (∼20ppb) with short response (10-15s) and recovery times (35-70s). Furthermore, the sensor signal (response) was robust against variations of the exhaled breath flow rate facilitating application of these sensors at realistic relative humidities (80-90%) as in the human breath. The acetone content in the breath of test persons was monitored continuously and compared to that of state-of-the-art proton transfer reaction mass spectrometry (PTR-MS). Such portable devices can accurately track breath acetone concentration to become an alternative to more elaborate breath analysis techniques. PMID:22790702

  11. sup 14 C-urea breath test for the detection of Helicobacter pylori

    SciTech Connect

    Veldhuyzen van Zanten, S.J.; Tytgat, K.M.; Hollingsworth, J.; Jalali, S.; Rshid, F.A.; Bowen, B.M.; Goldie, J.; Goodacre, R.L.; Riddell, R.H.; Hunt, R.H. )

    1990-04-01

    The high urease activity of Helicobacter pylori can be used to detect this bacterium by noninvasive breath tests. We have developed a {sup 14}C-urea breath test which uses 5 microCi {sup 14}C with 50 mg nonradioactive urea. Breath samples are collected at baseline and every 30 min for 2 h. Our study compared the outcome of the breath test to the results of histology and culture of endoscopically obtained gastric biopsies in 84 patients. The breath test discriminated well between the 50 positive patients and the 34 patients negative for Helicobacter pylori: the calculated sensitivity was 100%, specificity 88%, positive predictive value 93%, and negative predictive value 100%. Treatment with bismuth subsalicylate and/or ampicillin resulted in lower counts of exhaled {sup 14}CO{sub 2} which correlated with histological improvement in gastritis. The {sup 14}C-urea breath test is a better gold standard for the detection of Helicobacter pylori than histology and/or culture.

  12. The relationship between aminopyrine breath test and severity of liver disease in cirrhosis

    SciTech Connect

    Morelli, A.; Narducci, F.; Pelli, M.A.; Farroni, F.; Vedovelli, A.

    1981-08-01

    Twenty-two patients with cirrhosis were evaluated by the 2 hr.-(C14)-aminopyrine breath test, the conventional liver tests and two systems for grading the severity of liver disease. Twenty-three patients with noncirrhotic liver disease and 15 controls were also studied. Reduced 14CO2 values were found in 21 of the 22 cirrhotic patients and seven of those had noncirrhotic liver disease associated with severe functional reserve impairment. The values in patients with minor liver diseases or cholestasis were normal. In the cirrhotic patients 2 hr.-(C14)-aminopyrine breath test scores correlated with prothrombin time, retention of bromosulfalein, fasting serum bile acid, albumin, bilirubin, serum aspartate aminotransferase and, above all, with the scores of the two clinical rating systems. The 2 hr.-(C14)-aminopyrine breath test was superior to conventional tests in quantifying the degree of hepatic functional reserve and forecasting the prognosis.

  13. Evaluating patient-derived colorectal cancer xenografts as preclinical models by comparison with patient clinical data.

    PubMed

    Nunes, Manoel; Vrignaud, Patricia; Vacher, Sophie; Richon, Sophie; Lièvre, Astrid; Cacheux, Wulfran; Weiswald, Louis-Bastien; Massonnet, Gerald; Chateau-Joubert, Sophie; Nicolas, André; Dib, Colette; Zhang, Weidong; Watters, James; Bergstrom, Donald; Roman-Roman, Sergio; Bièche, Ivan; Dangles-Marie, Virginie

    2015-04-15

    Development of targeted therapeutics required translationally relevant preclinical models with well-characterized cancer genome alterations. Here, by studying 52 colorectal patient-derived tumor xenografts (PDX), we examined key molecular alterations of the IGF2-PI3K and ERBB-RAS pathways and response to cetuximab. PDX molecular data were compared with that published for patient colorectal tumors in The Cancer Genome Atlas. We demonstrated a significant pattern of mutual exclusivity of genomic abnormalities in the IGF2-PI3K and ERBB-RAS pathways. The genomic anomaly frequencies observed in microsatellite stable PDX reproduce those detected in nonhypermutated patient tumors. We found frequent IGF2 upregulation (16%), which was mutually exclusive with IRS2, PIK3CA, PTEN, and INPP4B alterations, supporting IGF2 as a potential drug target. In addition to maintaining the genomic and histologic diversity, correct preclinical models need to reproduce drug response observed in patients. Responses of PDXs to cetuximab recapitulate also clinical data in patients, with partial or complete response in 15% (8 of 52) of PDXs and response strictly restricted to KRAS wild-type models. The response rate reaches 53% (8 of 15) when KRAS, BRAF, and NRAS mutations are concomitantly excluded, proving a functional cross-validation of predictive biomarkers obtained retrospectively in patients. Collectively, these results show that, because of their clinical relevance, colorectal PDXs are appropriate tools to identify both new targets, like IGF2, and predictive biomarkers of response/resistance to targeted therapies.

  14. Barrett's Oesophagus in an Achalasia Patient: Immunological Analysis and Comparison with a Group of Achalasia Patients

    PubMed Central

    Torres-Landa, Samuel; Coss-Adame, Enrique; Valdovinos, Miguel A.; Alejandro-Medrano, Edgar; Ramos-Ávalos, Bárbara; Martínez-Benítez, Braulio

    2016-01-01

    The aim of the study was to characterize the presence of diverse CD4 and CD8 T cell subsets and regulatory cells in peripheral blood and lower oesophageal sphincter (LES) from a young patient with BE/achalasia without treatment versus achalasia group. In order to characterize the circulating cells in this patient, a cytometric analysis was performed. LES tissue was evaluated by double-immunostaining procedure. Five healthy blood donors, 5 type achalasia patients, and 5 oesophagus tissue samples (gastrooesophageal junction) from transplant donors were included as control groups. A conspicuous systemic inflammation was determined in BE/achalasia patient and achalasia versus healthy volunteer group. Nonetheless, a predominance of Th22, Th2, IFN-α-producing T cells, Tregs, Bregs, and pDCregs was observed in BE/achalasia patient versus achalasia group. A low percentage of Th1 subset in BE/achalasia versus achalasia group was determined. A noticeable increase in tissue of Th22, Th17, Th2, Tregs, Bregs, and pDCregs was observed in BE/achalasia versus achalasia group. Th1 subset was lower in the BE/achalasia patient versus achalasia group. This study suggests that inflammation is a possible factor in the pathogenesis of BE/achalasia. Further research needs to be performed to understand the specific cause of the correlation between BE and achalasia. PMID:27752370

  15. Rapid eye movement sleep in breath holders.

    PubMed

    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.

  16. Computer simulation of breathing systems for divers

    SciTech Connect

    Sexton, P.G.; Nuckols, M.L.

    1983-02-01

    A powerful new tool for the analysis and design of underwater breathing gas systems is being developed. A versatile computer simulator is described which makes possible the modular ''construction'' of any conceivable breathing gas system from computer memory-resident components. The analysis of a typical breathing gas system is demonstrated using this simulation technique, and the effects of system modifications on performance of the breathing system are shown. This modeling technique will ultimately serve as the foundation for a proposed breathing system simulator under development by the Navy. The marriage of this computer modeling technique with an interactive graphics system will provide the designer with an efficient, cost-effective tool for the development of new and improved diving systems.

  17. Maintainance of patients' dignity during hospitalization: comparison of staff-patient observations and patient feedback through interviews.

    PubMed

    Henderson, Amanda; Van Eps, Mary Ann; Pearson, Kate; James, Catherine; Henderson, Peter; Osborne, Yvonne

    2009-08-01

    Patients' rights such as the need for dignity and respect are essential in the provision of quality care. This exploratory clinical study explored patient dignity within the acute hospital environment through observation of staff-patient interactions and interviews with patients. Dignity can be influenced through two major mediums-maintenance of the physical environment and the communication style of the nurse. The findings identified deviations to ideal practice in the maintenance of the physical environment and communication styles of the nursing staff. Maintenance of dignity and privacy were not identified by patients during the interviews as being under threat despite deviations to ideal practice being observed. Patients possibly accept that 'ideal practice' is not always provided to them because nurses are 'busy', or other factors take precedence in this environment. It is possible that a prevailing culture influences patients' perceptions of whether dignity is maintained.

  18. Detection and comparison of Selenomonas sputigena in subgingival biofilms in chronic and aggressive periodontitis patients

    PubMed Central

    Nagpal, Disha; Prakash, Shobha; Bhat, Kishore Gajanan; Singh, Gagandeep

    2016-01-01

    Background: With the advent of DNA-based culture-independent techniques, a constantly growing number of Selenomonas phylotypes have been detected in patients with destructive periodontal diseases. However, the prevalence levels that have been determined in different studies vary considerably. Aim: The present study was undertaken to detect and compare the presence of Selenomonas sputigena in the subgingival plaque samples from generalized aggressive periodontitis (GAP), chronic generalized periodontitis, and periodontally healthy patients using conventional polymerase chain reaction (PCR) technique. Materials and Methods: A total of 90 patients were categorized as periodontally healthy individuals (Group I, n = 30), chronic generalized periodontitis (Group II, n = 30), and GAP (Group III, n = 30). The clinical parameters were recorded and subgingival plaque samples were collected. These were then subjected to conventional PCR analysis. Statistical Analysis Used: Kruskal–Wallis ANOVA test was used for multiple group comparisons followed by Mann–Whitney U-test for pairwise comparison. Results: On comparison between three groups, all the clinical parameters were found to be statistically highly significant. Comparing Groups I-II and I-III, the difference in detection was found to be statistically highly significant whereas in Groups II-III, it was statistically nonsignificant. On comparison of S. sputigena detected and undetected patients to clinical parameters in various study groups, the difference was found to be nonsignificant. Conclusion: S. sputigena was found to be significantly associated with chronic and aggressive periodontitis. Although the difference in its detection frequency in both groups was statistically nonsignificant when compared clinically, S. sputigena was more closely associated with the GAP. PMID:27563202

  19. 46 CFR 197.450 - Breathing gas tests.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... commencement of diving operations, at the umbilical or underwater breathing apparatus connection point for the... underwater breathing apparatus connection point for the diver, for percentage of oxygen....

  20. Particle concentration in exhaled breath

    SciTech Connect

    Fairchild, C.I.; Stampfer, J.F.

    1987-11-01

    Measurements were made of the number of concentration of particles in exhaled breath under various conditions of exercise. A laser light scattering particle spectrometer was used to count particles exhaled by test subjects wearing respirators in a challenge environment of clean, dry air. Precautions were taken to ensure that particles were not generated by the respirators and that no extraneous water or other particles were produced in the humid exhaled air. The number of particles detected in exhales air varied over a range from <0.10 to approx. 4 particles/cm/sup 3/ depending upon the test subject and his activity. Subjects at rest exhaled the lowest concentration of particles, whereas exercises producing a faster respiration rate caused increased exhalation of particles. Exhaled particle concentration can limit the usefulness of nondiscriminating, ambient challenge aerosols for the fit testing of highly protective respirators.

  1. The indoor air we breathe.

    PubMed Central

    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. Images p398-a p399-a PMID:9769764

  2. The indoor air we breathe.

    PubMed

    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.

  3. Preferred patient-rated outcome measure in patients with femoroacetabular impingement: a comparison between selected instruments

    PubMed Central

    Impellizzeri, Franco M.; Naal, Florian D.; Mannion, Anne F.; Leunig, Michael

    2015-01-01

    The first aim of this study was to establish which questionnaire patients with femoroacetabular impingement (FAI) most often preferred out of a set of self-reported generic and region/joint-specific outcome measures. A second aim was to evaluate their preferred type of response scale. One hundred and sixty-two consecutive FAI patients undergoing surgery (51% females, age 32 [SD 12] years, body mass index 24 [SD 4] kg/m2) completed five specific questionnaires [Hip Outcome Score (HOS), Oxford Hip Score (OHS), Hip disability and Osteoarthritis Outcome Score, self-administered Harris Hip Score and Western Ontario and McMaster Universities Arthritis Index] and three generic questionnaires (WHO Quality of Life-BREF, EuroQoL and 12-Item Short Form Survey). In addition, the patients completed the International Physical Activity Questionnaire, a questionnaire on expectation, and two sports activity scales (TEGNER and UCLA). Patients were asked to indicate the questionnaires that best reflected their situation, the most difficult to complete, and had the preferred response scale. 64% indicated a joint specific questionnaire as the one that best addressed their situation, with 27 and 20% choosing the HOS and the OHS, respectively. Most patients (62%) expressed no difficulties completing the questionnaires: just 12% considered the IPAQ difficult to complete, and 6% the HOS. The preferred response scale was the adjectival scale (57%), compared with the Numeric Rating Scale (39%) and the VAS (4%). This study showed that patients with FAI consider joint-specific instruments to be most relevant to them, in particular the HOS and OHS, and generally prefer responding on an adjectival scale. PMID:27011860

  4. First MRI application of an active breathing coordinator

    NASA Astrophysics Data System (ADS)

    Kaza, E.; Symonds-Tayler, R.; Collins, D. J.; McDonald, F.; McNair, H. A.; Scurr, E.; Koh, D.-M.; Leach, M. O.

    2015-02-01

    A commercial active breathing coordinator (ABC) device, employed to hold respiration at a specific level for a predefined duration, was successfully adapted for magnetic resonance imaging (MRI) use for the first time. Potential effects of the necessary modifications were assessed and taken into account. Automatic MR acquisition during ABC breath holding was achieved. The feasibility of MR-ABC thoracic and abdominal examinations together with the advantages of imaging in repeated ABC-controlled breath holds were demonstrated on healthy volunteers. Five lung cancer patients were imaged under MR-ABC, visually confirming the very good intra-session reproducibility of organ position in images acquired with the same patient positioning as used for computed tomography (CT). Using identical ABC settings, good MR-CT inter-modality registration was achieved. This demonstrates the value of ABC, since application of T1, T2 and diffusion weighted MR sequences provides a wider range of contrast mechanisms and additional diagnostic information compared to CT, thus improving radiotherapy treatment planning and assessment.

  5. Clinical implications for breath-powered powder sumatriptan intranasal treatment.

    PubMed

    Tepper, Stewart J

    2013-09-01

    The acute treatment of migraine requires matching patient need to drug and formulation. In particular, nausea and vomiting, quick time to peak intensity, and the common gastroparesis of migraineurs, all call for a variety of non-oral formulations for treatment of attacks. A novel breath-powered powder sumatriptan intranasal treatment offers an improvement, at least in pharmacokinetics, over conventional liquid nasal sumatriptan spray. The device for delivery in this breath-powered nasal sumatriptan uses natural nose anatomy to close the soft palate and propel the sumatriptan high up in the nasal cavity on one side with bidirectional airflow coming out the other side. This approach has the potential to reduce adverse events and improve efficacy. Phase 3 data on this system are in press at the time of this writing and results appear promising. The clinical role for a fast acting non-oral nasal formulation will be in those for whom tablets are bound to fail, that is, in the setting of nausea and vomiting or when the time to central sensitization, allodynia, and disabling migraine is too short for the patient to respond to a tablet. This review provides a clinical perspective on the breath-powered powder sumatriptan intranasal treatment. PMID:23809006

  6. Boundary oscillations at Geotail: Windsock, breathing, and wrenching

    NASA Astrophysics Data System (ADS)

    Shodhan, S.; Siscoe, G. L.; Frank, L. A.; Ackerson, K. L.; Paterson, W. R.

    1996-02-01

    On March 18-19, 1993, when Geotail was beyond 150 RE down the tail, for about 30 hours it frequently transited between magnetosheath-like plasma and lobe-like plasma. The transitions take the form of smooth variation by about a factor of 10 in both density and speed. Some of the transitions are distinctly asymmetric with a fast rise to sheath-like values and a slow decline to lobe-like values. We have suggested that these transitional regions are the plasma mantle, but this raises the question of why the mantle crossed Geotail many times in 30 hours. Three possible causes are flapping of the tail in response to solar wind flow changes (the windsock mechanism), intrinsic expansions and contractions of the tail boundary, perhaps in response to substorm phases (the breathing mechanism), and an IMF-squeezed elliptical tail cross section changing its orientation to follow the IMF (the wrenching mechanism). We test these possibilities here by examining simultaneous solar wind velocity and magnetic field data from IMP 8. For the cases studied, both the windsock and the breathing mechanisms appear to contribute to the motions that cause the transitions, whereas the wrenching mechanism seems less effective. Breathing dominates on a timescale of tens of minutes, and windsock dominates on a scale of hours. Since the windsock mechanism is unavoidable, the important finding here is that the breathing mechanism appears also to operate. We use the windsock variation to estimate the thickness of the mantle at Geotail's position and find that the density drops by a factor of 10 in 9 RE. We model the mantle as a one-dimensional slow-mode expansion fan and use the model to predict the change in plasma parameters that occurs from the outer edge of the mantle to its inner edge. A comparison of the predicted profile with the observed profile shows that the model simulates the observed changes reasonably well.

  7. Do first impressions count? A comparison of subjective and psychologic assessment of spinal patients.

    PubMed

    Grevitt, M; Pande, K; O'Dowd, J; Webb, J

    1998-01-01

    Psychologic factors may have a major influence on the outcome of treatment for back pain. Psychologic disturbance is manifest as emotional distress and may be associated with inappropriate symptoms and signs. Few outcome studies describe the patient population in terms of their psychologic profile. Anecdotal evidence suggested that the routine use of psychologic screening tests in British spine practice was rare. An audit of the prevalent use of psychologic testing amongst a selected group of British spinal surgeons was conducted. This was followed by a prospective, double blind comparison of subjective evaluations of patients with formal psychologic tests. The principal aim was to determine how accurately treating physicians could identify psychologically distressed patients. A postal questionnaire was sent to all consultant members of the British Orthopaedic Spine Society. Details of their current practice and frequency of use of psychologic tests was obtained. In a subsequent study, 125 consecutive new patients attending a back pain clinic were initially evaluated by questionnaires and classified as either psychologically distressed or non-distressed. These patients were then interviewed and examined by treating physicians, who then allocated them to one of four psychologic categories, using predefined criteria. The two results were compared and sensitivity, specificity and predictive values for the subjective evaluations were calculated. Sixty-three percent of respondents to the postal survey either never or only occasionally used any form of psychologic testing in assessing back pain patients. The follow-up prospective study demonstrated that experienced spinal surgeons achieved only a 26% sensitivity when trying to identify distressed patients. The specificity for identifying non-distressed patients was 96%. The predictive value of a "distressed" evaluation was 69%. The predictive value for non-distressed patients was 77%. Subjective psychologic assessment of

  8. Atrial fibrillation and sleep-disordered breathing

    PubMed Central

    Lavergne, Florent; Morin, Laurent; Armitstead, Jeff; Benjafield, Adam; Richards, Glenn

    2015-01-01

    Atrial fibrillation (AF) is a common supraventricular arrhythmia that increases in prevalence with increasing age and in the presence of comorbidities such as heart failure (HF). AF increases the risk of a number of serious complications, including stroke and HF. As a result, the rate of hospitalization is high, making AF a costly disease. Treatment strategies for AF are broadly based around rate and rhythm control, either pharmacological or mechanical. There appear to be a number of links between sleep-disordered breathing (SDB) and AF, although further studies are needed to fully understand the physiological mechanisms that link these conditions. Patients with AF and SDB share a number of risk factors and comorbidities, including age, male sex, hypertension, congestive HF and coronary artery disease (CAD), and the prevalence of SDB in AF is higher than in the general population. Prevalence rates of obstructive sleep apnea (OSA) in patients with AF have been reported to range from 21% to just over 80%. The prevalence of central sleep apnea (CSA) in patients with AF is less well defined, but appears to be particularly high in patients who also have HF and a reduced left ventricular ejection fraction (LVEF). The frequency of apneas can be reduced by effective treatment of AF, while co-existing OSA reduces the effectiveness of treatments for AF and there is an increased risk of arrhythmia recurrence in the presence of SDB. Treating OSA with continuous positive airway pressure (CPAP) therapy has shown the potential to decrease the incidence of AF, improve the effectiveness of AF interventions, and decrease the risk of arrhythmia recurrence, although data from large randomized, controlled clinical trials are lacking. Based on available data, inclusion of SDB recognition and management strategies as part of AF management appears to have the potential to reduce the impact of this arrhythmia at both the individual and societal levels, and has been recognized as important

  9. RESPeRATE: the role of paced breathing in hypertension treatment.

    PubMed

    Cernes, Relu; Zimlichman, Reuven

    2015-01-01

    Despite a good adherence to lifestyle modifications and antihypertensive drugs, hypertension remains resistant in more than one-third of patients, thus creating the need for additional strategies, including non-pharmacologic approaches. Slow and deep breathing ("paced breathing") associated in the past with meditation has a direct antihypertensive effect by increasing baroreflex sensitivity. With the method of guiding the pace of breathing, a US Food and Drug Administration-certified device, RESPeRATE, may offer an easy, efficient, inexpensive, and noninvasive option for treating hypertension. Multiple studies showed a significant reduction of blood pressure when RESPeRATE was evaluated in a home and office setting. In conclusion, this review outlines the pathophysiologic background of paced respiration, describes RESPeRATE clinical trials, and presents briefly other guided breathing alternatives. PMID:25539897

  10. Carotid body denervation improves autonomic and cardiac function and attenuates disordered breathing in congestive heart failure

    PubMed Central

    Marcus, Noah J; Rio, Rodrigo; Schultz, Evan P; Xia, Xiao-Hong; Schultz, Harold D

    2014-01-01

    ± 0.06), and was attenuated in CHF–CBD animals (0.59 ± 0.05) (P < 0.05 for all comparisons). Arrhythmia incidence was increased in CHF–sham and reduced in CHF–CBD animals (213 ± 58 events h–1 CHF, 108 ± 48 events h–1 CHF–CBD, P < 0.05). Furthermore, ventricular systolic (3.8 ± 0.7 vs. 6.3 ± 0.5 ml, P < 0.05) and diastolic (6.3 ± 1.0 vs. 9.1 ± 0.5 ml, P < 0.05) volumes were reduced, and ejection fraction preserved (41 ± 5% vs. 54 ± 2% reduction from pre-pace, P < 0.05) in CHF–CBD compared to CHF–sham rabbits. Similar patterns of changes were observed longitudinally within the CHF–CBD group before and after CBD. In conclusion, CBD is effective in reducing RSNA, SRC and arrhythmia incidence, while improving breathing stability and cardiac function in pacing-induced CHF rabbits. Key points A strong correlation between disordered breathing patterns, elevated sympathetic nerve activity and enhanced chemoreflex sensitivity exists in patients with heart failure. Evidence indicates that disordered breathing patterns and increased sympathetic nerve activity increases arrhythmia incidence in patients with heart failure. Enhanced coupling between sympathetic and respiratory neural drive underlies elevated sympathetic nerve activity in an animal model of sleep apnoea. We investigated the impact of carotid body chemoreceptor denervation on sympathetic nerve activity, disordered breathing and sympatho-respiratory coupling in an animal model of heart failure. Renal sympathetic nerve activity, apnoea/hypopnoea incidence, variability measures of tidal volume and respiratory rate and arrhythmia incidence were quantified during resting breathing in heart failure animals with and without carotid body ablation. Our results indicate that carotid body chemoreceptor denervation reduces sympathetic nerve activity, disordered breathing patterns, arrhythmia incidence and sympatho-respiratory coupling in

  11. Increased oxygen load in the prefrontal cortex from mouth breathing: a vector-based near-infrared spectroscopy study.

    PubMed

    Sano, Masahiro; Sano, Sayaka; Oka, Noriyuki; Yoshino, Kayoko; Kato, Toshinori

    2013-12-01

    Individuals who habitually breathe through the mouth are more likely than nasal breathers to have sleep disorders and attention deficit hyperactive disorder. We hypothesized that brain hemodynamic responses in the prefrontal cortex might be different for mouth and nasal breathing. To test this hypothesis, we measured changes in oxyhemoglobin and deoxyhemoglobin in the prefrontal cortex during mouth breathing and nasal breathing in healthy adults (n=9) using vector-based near-infrared spectroscopy. The angle k, calculated from changes in oxyhemoglobin and deoxyhemoglobin and indicating the degree of oxygen exchange, was significantly higher during mouth breathing (P<0.05), indicating an increased oxygen load. Mouth breathing also caused a significant increase in deoxyhemoglobin, but oxyhemoglobin did not increase. This difference in oxygen load in the brain arising from different breathing routes can be evaluated quantitatively using vector-based near-infrared spectroscopy. Phase responses could help to provide an earlier and more reliable diagnosis of a patient's habitual breathing route than a patient interview.

  12. Differences between roadside and subsequent evidential breath alcohol results and their forensic significance.

    PubMed

    Gullberg, R G

    1991-07-01

    Breath alcohol measurements for forensic purposes are typically not made at the time of a driving incident but at some later time. Therefore, the magnitude of variation in breath alcohol concentration (BrAC) following the time of arrest is of concern. The use of roadside preliminary breath test (PBT) instruments can provide data on BrAC closer to the time of a driving incident and allow for comparison with later evidential analysis. This retrospective study evaluates two distributions (N = 968): differences between PBT results and the first evidential breath test (PBT-BrAC1) and differences between two (duplicate) evidential breath alcohol tests (BrAC1-BrAC2). The two distributions were shown to vary from each other and from the normal with statistical significance (p less than .05). The PBT-BrAC1 distribution had greater variability (SD = .025) than the BrAC1-BrAC2 distribution (SD = .010). An important result was that the PBT was equal to (within duplicate sampling variability) or greater than BrAC1 in approximately 85.5% of the cases. The remaining 14.5% could not be explained by sampling variability within the duplicate test distribution. The variability in both distributions typically exceeds the normally accepted alcohol elimination rates. The conclusion is that differences between roadside and subsequent evidential breath results cannot be attributed solely to absorption or elimination kinetics. Intra-individual breath sample differences can be large and thus obscure the accurate evaluation of absorption and elimination rates. Breath tests conducted within approximately 2 hours of driving will reflect, within experimental uncertainty, the BrAC at the time of driving.

  13. Take a breath and take the turn: how breathing meets turns in spontaneous dialogue

    PubMed Central

    Rochet-Capellan, Amélie; Fuchs, Susanne

    2014-01-01

    Physiological rhythms are sensitive to social interactions and could contribute to defining social rhythms. Nevertheless, our knowledge of the implications of breathing in conversational turn exchanges remains limited. In this paper, we addressed the idea that breathing may contribute to timing and coordination between dialogue partners. The relationships between turns and breathing were analysed in unconstrained face-to-face conversations involving female speakers. No overall relationship between breathing and turn-taking rates was observed, as breathing rate was specific to the subjects' activity in dialogue (listening versus taking the turn versus holding the turn). A general inter-personal coordination of breathing over the whole conversation was not evident. However, specific coordinative patterns were observed in shorter time-windows when participants engaged in taking turns. The type of turn-taking had an effect on the respective coordination in breathing. Most of the smooth and interrupted turns were taken just after an inhalation, with specific profiles of alignment to partner breathing. Unsuccessful attempts to take the turn were initiated late in the exhalation phase and with no clear inter-personal coordination. Finally, breathing profiles at turn-taking were different than those at turn-holding. The results support the idea that breathing is actively involved in turn-taking and turn-holding. PMID:25385777

  14. Take a breath and take the turn: how breathing meets turns in spontaneous dialogue.

    PubMed

    Rochet-Capellan, Amélie; Fuchs, Susanne

    2014-12-19

    Physiological rhythms are sensitive to social interactions and could contribute to defining social rhythms. Nevertheless, our knowledge of the implications of breathing in conversational turn exchanges remains limited. In this paper, we addressed the idea that breathing may contribute to timing and coordination between dialogue partners. The relationships between turns and breathing were analysed in unconstrained face-to-face conversations involving female speakers. No overall relationship between breathing and turn-taking rates was observed, as breathing rate was specific to the subjects' activity in dialogue (listening versus taking the turn versus holding the turn). A general inter-personal coordination of breathing over the whole conversation was not evident. However, specific coordinative patterns were observed in shorter time-windows when participants engaged in taking turns. The type of turn-taking had an effect on the respective coordination in breathing. Most of the smooth and interrupted turns were taken just after an inhalation, with specific profiles of alignment to partner breathing. Unsuccessful attempts to take the turn were initiated late in the exhalation phase and with no clear inter-personal coordination. Finally, breathing profiles at turn-taking were different than those at turn-holding. The results support the idea that breathing is actively involved in turn-taking and turn-holding.

  15. Delayed feedback applied to breathing in humans

    NASA Astrophysics Data System (ADS)

    Janson, N. B.; Pototsky, A.; Parkes, C.

    2013-10-01

    We studied the response of healthy volunteers to the delayed feedback generated from the breathing signals. Namely, in the freely-breathing volunteers the breathing signal was recorded, delayed by τ seconds and fed back to the same volunteer in real time in the form of a visual and auditory stimulus of low intensity, i.e. the stimulus was crucially non-intrusive. In each case volunteers were instructed to breathe in the way which was most comfortable for them, and no explanation about the kind of applied stimulus was provided to them. Each volunteer experienced 10 different delay times ranging between 10% and 100% of the average breathing period without external stimulus. It was observed that in a significant proportion of subjects (11 out of 24) breathing was slowed down in the presence of delayed feedback with moderate delay. Also, in 6 objects out of 24 the delayed feedback was able to induce transition from nearly periodic to irregular breathing. These observations are consistent with the phenomena observed in numerical simulation of the models of periodic and chaotic self-oscillations with delays, and also in experiments with simpler self-oscillating systems.

  16. Decreased chewing activity during mouth breathing.

    PubMed

    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 (P<0.05). Chewing cycle variance during mouth breathing was significantly greater than nasal breathing (P<0.05). Mouth breathing reduces the vertical effect on the posterior teeth, which can affect the vertical position of posterior teeth negatively, leading to malocclusion.

  17. An ultrasonic contactless sensor for breathing monitoring.

    PubMed

    Arlotto, Philippe; Grimaldi, Michel; Naeck, Roomila; Ginoux, Jean-Marc

    2014-01-01

    The monitoring of human breathing activity during a long period has multiple fundamental applications in medicine. In breathing sleep disorders such as apnea, the diagnosis is based on events during which the person stops breathing for several periods during sleep. In polysomnography, the standard for sleep disordered breathing analysis, chest movement and airflow are used to monitor the respiratory activity. However, this method has serious drawbacks. Indeed, as the subject should sleep overnight in a laboratory and because of sensors being in direct contact with him, artifacts modifying sleep quality are often observed. This work investigates an analysis of the viability of an ultrasonic device to quantify the breathing activity, without contact and without any perception by the subject. Based on a low power ultrasonic active source and transducer, the device measures the frequency shift produced by the velocity difference between the exhaled air flow and the ambient environment, i.e., the Doppler effect. After acquisition and digitization, a specific signal processing is applied to separate the effects of breath from those due to subject movements from the Doppler signal. The distance between the source and the sensor, about 50 cm, and the use of ultrasound frequency well above audible frequencies, 40 kHz, allow monitoring the breathing activity without any perception by the subject, and therefore without any modification of the sleep quality which is very important for sleep disorders diagnostic applications. This work is patented (patent pending 2013-7-31 number FR.13/57569). PMID:25140632

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

    PubMed

    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.

  19. Investigation of a breathing surrogate prediction algorithm for prospective pulmonary gating

    SciTech Connect

    White, Benjamin M.; Low, Daniel A.; Zhao Tianyu; Wuenschel, Sara; Lu, Wei; Lamb, James M.; Mutic, Sasa; Bradley, Jeffrey D.; El Naqa, Issam

    2011-03-15

    Purpose: A major challenge of four dimensional computed tomography (4DCT) in treatment planning and delivery has been the lack of respiration amplitude and phase reproducibility during image acquisition. The implementation of a prospective gating algorithm would ensure that images would be acquired only during user-specified breathing phases. This study describes the development and testing of an autoregressive moving average (ARMA) model for human respiratory phase prediction under quiet respiration conditions. Methods: A total of 47 4DCT patient datasets and synchronized respiration records was utilized in this study. Three datasets were used in model development and were removed from further evaluation of the ARMA model. The remaining 44 patient datasets were evaluated with the ARMA model for prediction time steps from 50 to 1000 ms in increments of 50 and 100 ms. Thirty-five of these datasets were further used to provide a comparison between the proposed ARMA model and a commercial algorithm with a prediction time step of 240 ms. Results: The optimal number of parameters for the ARMA model was based on three datasets reserved for model development. Prediction error was found to increase as the prediction time step increased. The minimum prediction time step required for prospective gating was selected to be half of the gantry rotation period. The maximum prediction time step with a conservative 95% confidence criterion was found to be 0.3 s. The ARMA model predicted peak inhalation and peak exhalation phases significantly better than the commercial algorithm. Furthermore, the commercial algorithm had numerous instances of missed breath cycles and falsely predicted breath cycles, while the proposed model did not have these errors. Conclusions: An ARMA model has been successfully applied to predict human respiratory phase occurrence. For a typical CT scanner gantry rotation period of 0.4 s (0.2 s prediction time step), the absolute error was relatively small, 0

  20. Breast cancer patients in Libya: Comparison with European and central African patients

    PubMed Central

    BODER, JAMELA MOSTAFA E.; ELMABROUK ABDALLA, FATHI B.; ELFAGEIH, MOHAMED AHMED; ABUSAA, ABUAGELA; BUHMEIDA, ABDELBASET; COLLAN, YRJÖ

    2011-01-01

    The present study evaluated the incidence of breast cancer in Libya and described the clinicopathological and demographic features. These features were then compared with corresponding data from patients from sub-Saharan Africa (Nigeria) and Europe (Finland). The study consisted of 234 patients with breast carcinoma, admitted to the African Oncology Institute in Sabratha, Libya, during the years 2002–2006. The pathological features were collected from pathology reports, patient histories from hospital files and the Sabratha Cancer Registry. The demographic differences between the Libyan, Nigerian and Finnish populations were prominent. The mean age of breast cancer patients in Libya was 46 years which was almost identical to that of Nigeria, but much lower than that of Finland. The Libyan breast cancer incidence was evaluated as 18.8 per 100,000 female individuals. This incidence was markedly higher in Finland, but was also high in Nigeria. Libyan and Nigerian breast cancer is predominantly of premenopausal type and exhibits unfavorable characteristics such as high histological grade and stage, large tumor size and frequent lymph node metastases. However, the histological types and histopathological risk features show similar importance regarding survival as European breast cancer cases. Survival in Libya ranks between the rates of survival in Nigeria (lowest) and Finland (highest). In conclusion, in Libya and other African countries, premenopausal breast cancer is more common than postmenopausal breast cancer. However, the opposite is true for Europe. Population differences may be involved, as suggested by the known variation, in the distribution of genetic markers in these populations. Different types of environmental impacts, however, cannot be excluded. PMID:22866085

  1. Breast cancer patients in Libya: Comparison with European and central African patients.

    PubMed

    Boder, Jamela Mostafa E; Elmabrouk Abdalla, Fathi B; Elfageih, Mohamed Ahmed; Abusaa, Abuagela; Buhmeida, Abdelbaset; Collan, Yrjö

    2011-03-01

    The present study evaluated the incidence of breast cancer in Libya and described the clinicopathological and demographic features. These features were then compared with corresponding data from patients from sub-Saharan Africa (Nigeria) and Europe (Finland). The study consisted of 234 patients with breast carcinoma, admitted to the African Oncology Institute in Sabratha, Libya, during the years 2002-2006. The pathological features were collected from pathology reports, patient histories from hospital files and the Sabratha Cancer Registry. The demographic differences between the Libyan, Nigerian and Finnish populations were prominent. The mean age of breast cancer patients in Libya was 46 years which was almost identical to that of Nigeria, but much lower than that of Finland. The Libyan breast cancer incidence was evaluated as 18.8 per 100,000 female individuals. This incidence was markedly higher in Finland, but was also high in Nigeria. Libyan and Nigerian breast cancer is predominantly of premenopausal type and exhibits unfavorable characteristics such as high histological grade and stage, large tumor size and frequent lymph node metastases. However, the histological types and histopathological risk features show similar importance regarding survival as European breast cancer cases. Survival in Libya ranks between the rates of survival in Nigeria (lowest) and Finland (highest). In conclusion, in Libya and other African countries, premenopausal breast cancer is more common than postmenopausal breast cancer. However, the opposite is true for Europe. Population differences may be involved, as suggested by the known variation, in the distribution of genetic markers in these populations. Different types of environmental impacts, however, cannot be excluded.

  2. A 20-minute breath test for helicobacter pylori

    SciTech Connect

    Marshall, B.J.; Plankey, M.W.; Hoffman, S.R.; Boyd, C.L.; Dye, K.R.; Frierson, H.F. Jr.; Guerrant, R.L.; McCallum, R.W. )

    1991-04-01

    In this study, we evaluated a simplified rapid {sup 14}C-urea breath test for the diagnosis of Helicobacter pylori. Fasting patients undergoing initial assessment for H. pylori drank 5 microCi of {sup 14}C-urea in 20 ml of water. Breath was collected at intervals for 30 min. Samples were counted in a beta-counter, and the results were expressed as counts per minute (cpm). In the same week, patients underwent endoscopy, and a blinded investigator examined biopsy samples of gastric mucosa by culture and histology for H. pylori. There were 49 H. pylori-negative (HP-) and 104 H. pylori-positive (HP+) patients in the study. HP+ patients expired a mean of 4398 cpm (SD 2468) per mmol CO{sub 2} in a sample taken 20 min after ingestion of the isotope. In contrast, HP--patients expired only 340 cpm (SD 196). If the mean +3 SD of HP- patients was used as a cutoff value, the 20-minute sample gave a sensitivity of 97% and a specificity of 100% for detecting H. pylori. The radiation exposure from this test is less than 1% of that received from an upper gastrointestinal series, and the short collection time makes it both convenient and cost effective.

  3. Constrained optimization for noninvasive estimation of work of breathing.

    PubMed

    Vicario, Francesco; Albanese, Antonio; Wang, Dong; Karamolegkos, Nikolaos; Chbat, Nicolas W

    2015-01-01

    This paper presents a technique for noninvasive estimation of respiratory muscle effort (also known as work of breathing, WOB) in mechanically ventilated patients. Continual and real-time assessment of the patient WOB is desirable, as it helps the clinician make decisions about increasing or decreasing mechanical respiratory support. The technique presented is based on a physiological model of the respiratory system, from which a cost function is constructed as the sum of squared errors between model-based airway pressure predictions and actual measurements. Quadratic programming methods are used to minimize this cost function. An experimental example on animal data shows the effectiveness of the technique. PMID:26737494

  4. Novel Approaches to the Management of Sleep-Disordered Breathing.

    PubMed

    Morgan, Todd D

    2016-06-01

    In the last several years, a variety of novel approaches to the treatment of sleep-disordered breathing have emerged. This new technology holds promise in serving to re-engage with patients who have previously been lost to follow-up due to continuous positive airway pressure intolerance. With more tools at our disposal, in turn more options can be offered to patients' growing demand for alternatives that are tailored to their individual needs. The key to proper deployment of alternative therapies will often depend on identification of certain phenotypic traits that trend toward a reasonable response to a given therapy.

  5. SU-E-T-317: The Development of a DIBH Technique for Left Sided Breast Patients Undergoing Radiation Therapy Utilizing Varians RPM System in a Community Hospital

    SciTech Connect

    Hasson, B; Young, M; Workie, D; Geraghty, C

    2014-06-01

    Purpose: To develop and implement a Deep Inhalation Breath Hold program (DIBH) for treatment of patients with Left-sided breast cancer in a community hospital. Methods: All patients with left sided breast cancer underwent a screening free breathing CT. Evaluation of the conventional tangent treatment fields and the heart was conducted. If the heart would not be excluded using tangents, the patient then received DIBH breathe coaching. The patients returned for a 4D CT simulation. The patients breathing cycle was monitored using the Varian Real-Time position ManagementTM (RPM) system to assess duration of DIBH, amplitude, phase and recovery time to normal breathing. Then a DIBH CT was obtained at the desired amplitude. Duplicate plans were developed for both free breathing and DIBH on the Eclipse planning system and comparison DVH's were created. The plan that provided the prescribed treatment coverage and the least doses to the OAR (heart, Lt. Lung) was determined. Those patients selected to receive treatment with DIBH were set up for treatment, and breathing was monitored using the RPM system. Practice trials were used to confirm that the amplitude, phase and recovery were consistent with findings from simulation. Results: 10 patients have been treated using the DIBH procedure in our clinic. The DIBH patients had an average increase of 80% lung volume on DIBH, decreased lung volume receiving 50% of the dose, and decreases in the V20 dose. Significant reduction in the maximum and mean dose to the heart, as well as the dose to 1CC of the volume for the DIBH plans. Conclusion: Using the RPM system already available in the clinic, staff training, and patient coaching a simple DIBH program was setup. The use of DIBH has shown promise in reducing doses to the critical organs while maintaining PTV coverage for left sided breast treatments.

  6. Applications of breath gas analysis in medicine

    NASA Astrophysics Data System (ADS)

    Amann, Anton; Poupart, Guy; Telser, Stefan; Ledochowski, Maximilian; Schmid, Alex; Mechtcheriakov, Sergei

    2004-12-01

    Volatile organic compounds (VOCs) in exhaled breath gas provide valuable information about the subjects' physiological and pathophysiological condition. Proton-transfer-reaction mass spectrometry (PTR-MS) allows rapid and online measurements of these substances. We present results of three studies illustrating the potential of breath gas analysis by PTR-MS in various contexts: long-time online monitoring of VOCs in sleeping subjects suggests that VOC profiles are related to sleep stages. Analysis of VOC concentrations in the breath of carbohydrate malabsorbers emphasizes the role played by bacteria in the gut. Finally, we demonstrate the large intra- and intersubject concentration variability of VOCs by considering one particular mass.

  7. A comparison of deaf and non-deaf patients with paranoid and affective psychoses.

    PubMed

    Cooper, A F; Garside, R F; Kay, D W

    1976-12-01

    A comparison was made of the social and domestic background, prepsychotic personality and symptomatology of deaf ('hard of hearing') and non-deaf patients aged 50 or over with paranoid or affective psychoses. The deaf patients were found to be a very heterogeneous group in respect of age of onset, duration, severity and pathological basis of their deafness, but there was a substantial subgroup of paranoid patients with deafness beginning before the age of 45 in whom the personality appeared to have been less deviating than in the remainder. It was thought that the deafness in this subgroup had possibly played a relatively specific role in causing the psychosis. Some problems in identifying deafness and assessing its significance are discussed.

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

    PubMed

    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

  9. Comparison of stage at diagnosis of cancer in patients on dialysis versus the general population

    PubMed Central

    Taneja, Shilpa; Mandayam, Sreedhar; Kayani, Zainab Z.; Kuo, Yong-Fang; Shahinian, Vahakn B.

    2008-01-01

    Background The frequent medical encounters in end-stage renal disease (ESRD) patients on dialysis may allow early detection of malignancies despite generally low rates of cancer screening in this population. It is therefore unclear whether dialysis patients are disadvantaged in terms of cancer diagnosis. To address this issue, we compared stage at diagnosis of cancer in a population-based sample of ESRD patients versus the general population. Methods The Surveillance, Epidemiology and End-Results (SEER)-Medicare database was used to identify ESRD patients with incident cancers from 1992 through 1999. Modified Poisson regression models were used to predict non-localized stage of cancer at diagnosis in ESRD patients versus the general population adjusting for demographics, cancer site, region, year of diagnosis and comorbidity. Two general population comparisons were used: standardized SEER public use data and Medicare non-ESRD controls matched 3:1 to ESRD patients. Results A total of 1629 ESRD patients with incident cancer were identified. Overall, the likelihood of non-localized stage at diagnosis was not significantly different for ESRD patients versus the standardized SEER general population (RR 0.90; 95%CI: 0.81-1.01) or matched Medicare controls (RR 0.97; 95%CI: 0.89-1.07). When analyzed by cancer site, colorectal cancers were significantly more likely to be diagnosed earlier in the ESRD group, whereas prostate cancers were significantly more likely to be diagnosed at a later stage. Conclusion In conclusion, this study demonstrates that, with the notable exception of prostate cancer, ESRD patients are not more likely to present with later stage malignancies compared to the general population. PMID:17702737

  10. A comparison of depression scores between aesthetic and functional rhinoplasty patients.

    PubMed

    Naraghi, Mohsen; Atari, Mohammad

    2015-04-01

    Depression is a mood state of sadness, gloom, and pessimistic ideation with loss of interest or pleasure in normal activities. This mood disorder has been reported to occur more frequently among cosmetic surgery patients. The purpose of the current study was to compare the score of depression among aesthetic rhinoplasty candidates and functional rhinoplasty patients as control group. The Beck Depression Inventory (BDI) and Depression (DE) subscale of Symptom Check List-90-Revised (SCL-90-R) were administered on a sample of aesthetic rhinoplasty patients (n=21) as well as a sample of functional rhinoplasty patients (n=21). Those with both cosmetic and functional purposes were categorized regarding their primary objective. Questionnaires were given to patients preoperatively. Cohen's d was also calculated as a measure of Effect Size (ES). BDI and SCL-90-R-DE scores were analyzed using t-test for independent groups. Statistical analyses suggested that the mean BDI and SCL-90-R-DE scores of aesthetic surgery patients were significantly higher than those of functional surgery patients (P<0.05). The results showed that age, sex, and Socio-Economic Status (SES) were not significantly different between the two groups as they can be capable of influencing the depression score. Effect size was above the moderate level: d=0.51, d=0.72 for BDI and SCL-90-R-DE, respectively. Using two different depression instruments, the findings of this study showed that aesthetic rhinoplasty patients were more depressed in comparison with functional rhinoplasty patients. The measures of ES also supported the hypothesis that aesthetic rhinoplasty candidates had higher scores in depression. PMID:25701068

  11. Double-blind, multicenter comparison of sertraline and amitriptyline in elderly depressed patients.

    PubMed

    Cohn, C K; Shrivastava, R; Mendels, J; Cohn, J B; Fabre, L F; Claghorn, J L; Dessain, E C; Itil, T M; Lautin, A

    1990-12-01

    Two hundred forty-one elderly depressed patients entered the 8-week, double-blind phase of this parallel-group, multicenter study; 161 patients were randomized to receive sertraline (50-200 mg/day) and 80 were randomized to receive amitriptyline (50-150 mg/day). Among evaluable patients, there were no statistically significant differences between treatments in any of the primary efficacy variables: change in total Hamilton Rating Scale for Depression (HAM-D) score (17 items), percentage change in HAM-D score, change in HAM-D Item 1, change in Clinical Global Impressions (CGI) Severity score, change in the Depression Factor of the 56-item Hopkins Symptom Checklist, and the CGI Improvement score at the last visit. Similar results were obtained using data from all patients (intention-to-treat analysis), except that amitriptyline was superior in HAM-D Total score (p = .044). The two drugs produced a similar degree of response: on the basis of the HAM-D criterion, 69.4% of sertraline patients and 62.5% of amitriptyline patients responded, and, on the basis of CGI criterion, 79.5% of sertraline and 73.4% of amitriptyline patients responded. Twenty-eight percent of the sertraline patients withdrew from the study because of a treatment-related side effect and 2.5% (4) because of a laboratory abnormality. In comparison, 35% of the amitriptyline patients withdrew because of treatment-related side effects. Sertraline was associated with a statistically lower frequency of somnolence, dry mouth, constipation, ataxia, and pain and a higher frequency of nausea, anorexia, diarrhea/loose stools, and insomnia; thus, anticholinergic effects were less common and gastrointestinal effects were more common with sertraline than with amitriptyline.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2258379

  12. A comparison of depression scores between aesthetic and functional rhinoplasty patients.

    PubMed

    Naraghi, Mohsen; Atari, Mohammad

    2015-04-01

    Depression is a mood state of sadness, gloom, and pessimistic ideation with loss of interest or pleasure in normal activities. This mood disorder has been reported to occur more frequently among cosmetic surgery patients. The purpose of the current study was to compare the score of depression among aesthetic rhinoplasty candidates and functional rhinoplasty patients as control group. The Beck Depression Inventory (BDI) and Depression (DE) subscale of Symptom Check List-90-Revised (SCL-90-R) were administered on a sample of aesthetic rhinoplasty patients (n=21) as well as a sample of functional rhinoplasty patients (n=21). Those with both cosmetic and functional purposes were categorized regarding their primary objective. Questionnaires were given to patients preoperatively. Cohen's d was also calculated as a measure of Effect Size (ES). BDI and SCL-90-R-DE scores were analyzed using t-test for independent groups. Statistical analyses suggested that the mean BDI and SCL-90-R-DE scores of aesthetic surgery patients were significantly higher than those of functional surgery patients (P<0.05). The results showed that age, sex, and Socio-Economic Status (SES) were not significantly different between the two groups as they can be capable of influencing the depression score. Effect size was above the moderate level: d=0.51, d=0.72 for BDI and SCL-90-R-DE, respectively. Using two different depression instruments, the findings of this study showed that aesthetic rhinoplasty patients were more depressed in comparison with functional rhinoplasty patients. The measures of ES also supported the hypothesis that aesthetic rhinoplasty candidates had higher scores in depression.

  13. What are the benefits of early patient contact? - A comparison of three preclinical patient contact settings

    PubMed Central

    2013-01-01

    Background Despite increasing attention to providing preclinical medical students with early patient experiences, little is known about associated outcomes for students. The authors compared three early patient experiences at a large American medical school where all preclinical students complete preceptorships and weekly bedside clinical-skills training and about half complete clinical, community-based summer immersion experiences. The authors asked, what are the relative outcomes and important educational components for students? Methods Medical students completed surveys at end of second year 2009–2011. In 2009, students compared/contrasted two of three approaches; responses framed later survey questions. In 2010 and 2011, students rated all three experiences in relevant areas (e.g., developing comfort in clinical setting). Investigators performed qualitative and quantitative analyses. Results Students rated bedside training more highly for developing comfort with clinical settings, one-on-one clinical-skills training, feedback, active clinical experience, quality of clinical training, and learning to be part of a team. They rated community clinical immersion and preceptorships more highly for understanding the life/practice of a physician and career/specialty decisions. Conclusions Preclinical students received different benefits from the different experiences. Medical schools should define objectives of early clinical experiences and offer options accordingly. A combination of experiences may help students achieve clinical and team comfort, clinical skills, an understanding of physicians’ lives/practices, and broad exposure for career decisions. PMID:23731514

  14. Sleep-Related Breathing Disorders and Bruxism.

    PubMed

    Kostrzewa-Janicka, J; Jurkowski, P; Zycinska, K; Przybyłowska, D; Mierzwińska-Nastalska, E

    2015-01-01

    Obstructive sleep apnea (OSA) syndrome is a sleep-related breathing disorder, due mainly to peripheral causes, characterized by repeated episodes of obstruction of the upper airways, associated with snoring and arousals. The sleep process fragmentation and oxygen desaturation events lead to the major health problems with numerous pathophysiological consequences. Micro-arousals occurring during sleep are considered to be the main causal factor for night jaw-closing muscles activation called bruxism. Bruxism is characterized by clenching and grinding of the teeth or by bracing or thrusting of the mandible. The causes of bruxism are multifactorial and are mostly of central origin. Among central factors there are secretion disorders of central nervous system neurotransmitters and basal ganglia disorders. Recently, sleep bruxism has started to be regarded as a physiological phenomenon occurring in some parts of the population. In this article we present an evaluation of the relationship between OSA and sleep bruxism. It has been reported that the frequency of apneic episodes and that of teeth clenching positively correlates in OSA. However, clinical findings suggest that further studies are needed to clarify sleep bruxism pathophysiology and to develop new approaches to tailor therapy for individual patients with concomitant sleep bruxism and OSA.

  15. 21 CFR 862.3050 - Breath-alcohol test system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Breath-alcohol test system. 862.3050 Section 862....3050 Breath-alcohol test system. (a) Identification. A breath-alcohol test system is a device intened to measure alcohol in the human breath. Measurements obtained by this device are used in...

  16. 21 CFR 862.3050 - Breath-alcohol test system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Breath-alcohol test system. 862.3050 Section 862....3050 Breath-alcohol test system. (a) Identification. A breath-alcohol test system is a device intened to measure alcohol in the human breath. Measurements obtained by this device are used in...

  17. 21 CFR 862.3050 - Breath-alcohol test system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Breath-alcohol test system. 862.3050 Section 862....3050 Breath-alcohol test system. (a) Identification. A breath-alcohol test system is a device intened to measure alcohol in the human breath. Measurements obtained by this device are used in...

  18. 21 CFR 862.3050 - Breath-alcohol test system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Breath-alcohol test system. 862.3050 Section 862....3050 Breath-alcohol test system. (a) Identification. A breath-alcohol test system is a device intened to measure alcohol in the human breath. Measurements obtained by this device are used in...

  19. 21 CFR 862.3050 - Breath-alcohol test system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Breath-alcohol test system. 862.3050 Section 862....3050 Breath-alcohol test system. (a) Identification. A breath-alcohol test system is a device intened to measure alcohol in the human breath. Measurements obtained by this device are used in...

  20. 42 CFR 84.72 - Breathing tubes; minimum requirements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Breathing tubes; minimum requirements. 84.72 Section 84.72 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL...-Contained Breathing Apparatus § 84.72 Breathing tubes; minimum requirements. Flexible breathing tubes...

  1. 42 CFR 84.72 - Breathing tubes; minimum requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Breathing tubes; minimum requirements. 84.72 Section 84.72 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL...-Contained Breathing Apparatus § 84.72 Breathing tubes; minimum requirements. Flexible breathing tubes...

  2. 42 CFR 84.72 - Breathing tubes; minimum requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Breathing tubes; minimum requirements. 84.72 Section 84.72 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL...-Contained Breathing Apparatus § 84.72 Breathing tubes; minimum requirements. Flexible breathing tubes...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing tubes; minimum requirements. 84.72 Section 84.72 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL...-Contained Breathing Apparatus § 84.72 Breathing tubes; minimum requirements. Flexible breathing tubes...

  4. 42 CFR 84.72 - Breathing tubes; minimum requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Breathing tubes; minimum requirements. 84.72 Section 84.72 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL...-Contained Breathing Apparatus § 84.72 Breathing tubes; minimum requirements. Flexible breathing tubes...

  5. A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery

    PubMed Central

    2014-01-01

    Background We aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations. Methods One hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group). In both groups, epidural catheters were administered. Hemodynamic measurements, visual analog scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively. Results The VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2, 4, 8, and 16 hours after surgery (for VAS-R, P = 0.001, P = 0.01, P = 0.008, and P = 0.029, respectively; and for VAS-C, P = 0.035, P = 0.023, P = 0.002, and P = 0.037, respectively). Total 24-hour analgesic consumption was different between groups (175 +/- 20 mL versus 185 +/- 31 mL; P = 0.034). The comparison of postoperative complications revealed that the incidence of hypotension (21/57, 36.8% versus 8/63, 12.7%; P = 0.002), bradycardia (9/57, 15.8% versus 2/63, 3.2%; P = 0.017), atelectasis (1/57, 1.8% versus 7/63, 11.1%; P = 0.04), and the need for intensive care unit (ICU) treatment (0/57, 0% versus 5/63, 7.9%; P = 0.03) were lower in the TEA group in comparison to the LEA group. Conclusions TEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile. PMID:24885545

  6. An introduction to the psychophysiology of breathing.

    PubMed

    Ley, R

    1994-06-01

    Breathing can be viewed as an independent variable which affects emotion, cognition, and behavior as well as a dependent variable which reflects changes in emotion, cognition, and behavior. This bidirectional interaction is basic to an appreciation of the significance of breathing in terms of its relevance in research and application. The underlying premise of the present article is that since breathing is a behavior that is under voluntary as well as reflexive control, it can be modified according to the principles of both instrumental training (operant conditioning) and Pavlovian (classical) conditioning. The implications of this premise are relevant to theory, diagnosis, and treatment of stress and anxiety-related disorders (e.g., panic disorder, phobias, test anxiety, occupational strain, and related psychosomatic disorders), and to basic and applied research in the psychophysiology of breathing.

  7. Portable breathing apparatus for coal mines

    NASA Technical Reports Server (NTRS)

    Vandolah, R. W.

    1972-01-01

    The state of the art in portable oxygen breathing equipment is reported. Considered are self-containing as well as chemically generating oxygen sources and their effectiveness and limitations in mine rescue operations.

  8. Coordination of Mastication, Swallowing and Breathing

    PubMed Central

    Matsuo, Koichiro; Palmer, Jeffrey B.

    2009-01-01

    Summary 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 and larynx serve multiple functions in breathing, speaking, mastication and swallowing. Thus, the fine temporal coordination of feeding among breathing, mastication and swallowing is essential to provide proper food nutrition and to prevent pulmonary aspiration. This review paper will review the temporo-spatial coordination of the movements of oral, pharyngeal, and laryngeal structures during mastication and swallowing, and temporal coordination between breathing, mastication, and swallowing. PMID:20161022

  9. Does a Smaller Waist Mean Smelly Breath?

    MedlinePlus

    ... overnight on the surface of the tongue when saliva production is diminished." ; Tips to combat halitosis: ; 1. Drink ... after meals can help keep bad breath away. Saliva production increases during chewing and this can help neutralize ...

  10. Alcohol breath test: gas exchange issues.

    PubMed

    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. PMID:27197859

  11. Analysis of Breath Specimens for Biomarkers of Plasmodium falciparum Infection

    PubMed Central

    Berna, Amalia Z.; McCarthy, James S.; Wang, Rosalind X.; Saliba, Kevin J.; Bravo, Florence G.; Cassells, Julie; Padovan, Benjamin; Trowell, Stephen C.

    2015-01-01

    Currently, the majority of diagnoses of malaria rely on a combination of the patient's clinical presentation and the visualization of parasites on a stained blood film. Breath offers an attractive alternative to blood as the basis for simple, noninvasive diagnosis of infectious diseases. In this study, breath samples were collected from individuals during controlled malaria to determine whether specific malaria-associated volatiles could be detected in breath. We identified 9 compounds whose concentrations varied significantly over the course of malaria: carbon dioxide, isoprene, acetone, benzene, cyclohexanone, and 4 thioethers. The latter group, consisting of allyl methyl sulfide, 1-methylthio-propane, (Z)-1-methylthio-1-propene, and (E)-1-methylthio-1-propene, had not previously been associated with any disease or condition. Before the availability of antimalarial drug treatment, there was evidence of concurrent 48-hour cyclical changes in the levels of both thioethers and parasitemia. When thioether concentrations were subjected to a phase shift of 24 hours, a direct correlation between the parasitemia and volatile levels was revealed. Volatile levels declined monotonically approximately 6.5 hours after initial drug treatment, correlating with clearance of parasitemia. No thioethers were detected in in vitro cultures of Plasmodium falciparum. The metabolic origin of the thioethers is not known, but results suggest that interplay between host and parasite metabolic pathways is involved in the production of these thioethers. PMID:25810441

  12. Sleep disordered breathing at the extremes of age: the elderly

    PubMed Central

    Morrell, Mary J.

    2016-01-01

    Key points Sleep disordered breathing (SDB) is common and its prevalence increases with age. Despite this high prevalence, SDB is frequently unrecognised and undiagnosed in older people. There is accumulating evidence that SDB in older people is associated with worsening cardio- cerebrovascular, cognitive and functional outcomes. There is now good evidence to support the use of continuous positive airway pressure therapy in older patients with symptomatic SDB. Educational aims To highlight the prevalence and presentation of sleep disordered breathing (SDB) in older people. To inform readers about the risk factors for SDB in older people. To explore the impact of SDB in older people. To introduce current evidence based treatment options for SDB in older people. Sleep disordered breathing (SBD) increases in prevalence as we age, most likely due to physiological and physical changes that occur with ageing. Additionally, SDB is associated with comorbidity and its subsequent polypharmacy, which may increase with increasing age. Finally, the increased prevalence of SDB is intrinsically linked to the obesity epidemic. SDB is associated with serious outcomes in younger people and, likewise, older people. Thus, identification, diagnosis and treatment of SDB is important irrelevant of age. This article reviews the age-related changes contributing to SDB, the epidemiology and the risk factors for SDB in older people, the association of SDB with adverse outcomes, and diagnostic and treatment options for this population. PMID:27064674

  13. The breathing hand: obstetric brachial plexopathy reinnervation from thoracic roots?

    PubMed

    Friedenberg, S M; Hermann, R C

    2004-01-01

    It has been found that in cases of obstetric brachial plexopathy, injured phrenic nerve or C3/4/5 roots may sprout into the adjacent injured upper and middle trunks of the brachial plexus. This aberrant regeneration produces co-contraction of the diaphragm and proximal upper limb muscles. This phenomenon, referred to as respiratory synkinesis or "the breathing arm", may not be limited to the upper cervical roots. We present two cases, identified through electromyographic investigations, of respiratory synkinesis selectively affecting intrinsic hand muscles, and propose that upper thoracic roots and their intercostal nerves may also produce respiratory synkinesis, resulting in a "breathing hand." This novel brand of synkinesis indicates that obstetric brachial plexus neuropathies can have quite proximal nerve injury in all trunks. The findings in our patients may not be entirely unique. The time required to develop distal muscle synkinesis and the subtle nature of our findings may suggest that with time and the assistance of EMG the breathing hand may be more common. When considering brachial plexus surgery, the significance of respiratory synkinesis should not be overlooked as its presence indicates injury at a root or proximal trunk level and may come from either nerves destined for the diaphragm or for the intercostal muscles.

  14. Haemoptysis after breath-hold diving.

    PubMed

    Boussuges, A; Pinet, C; Thomas, P; Bergmann, E; Sainty, J M; Vervloet, D

    1999-03-01

    Pulmonary oedema has been described in swimmers and self-contained underwater breathing apparatus (Scuba) divers. This study reports three cases of haemoptysis secondary to alveolar haemorrhage in breath-hold divers. Contributory factors, such as haemodynamic modifications secondary to immersion, cold exposure, exercise and exposure to an increase in ambient pressure, could explain this type of accident. Furthermore, these divers had taken aspirin, which may have aggravated the bleeding.

  15. Do Weather-Related Ambient Atmospheric-Pressure Changes Influence Sleep Disordered Breathing?

    PubMed Central

    Doherty, Michael John; Youn, Clover E.; Haltiner, Alan Matthew; Watson, Nathaniel Fletcher

    2010-01-01

    Objective: High-altitude studies of sleep disordered breathing (SDB) show increases in apnea hypopnea indices with elevation gains. Hypoxic changes, rather than reductions in atmospheric pressure (AP), are thought to be the driving factor. Ambient pressure-related changes in SDB have not been extensively studied at low altitude. We performed a cross-sectional study of weather-related AP effects on measures of SDB at the University of Washington Medicine Sleep Institute, a Seattle, Washington-based polysomnography lab located 200 feet above sea level. Method: Obstructive, central, and apnea-hypopnea indices from 537 patients were retrospectively correlated to mean 8-hour date-matched overnight AP data. Linear regression analysis and interquartile comparison of AP-related respiratory indices were performed and adjusted for age, sex, and body mass index. Results: The obstructive apnea index increased with lower weather-related APs (p = 0.01 for linear trend), interquartile analysis showed significant worsening with lowered mean, minimum, and maximum nightly APs. Similar changes were not seen with central or apnea-hypopnea indices. Conclusions: The obstructive apnea index is altered by changes in weather-related AP during diagnostic polysomnography performed at 200 feet above sea level. Small changes in ambient atmospheric pressure due to weather systems may be important in the pathophysiology and diagnosis of obstructive sleep apnea. Citation: Doherty MJ; Youn CE; Haltiner AM; Watson NF. Do weather-related ambient atmospheric-pressure changes influence sleep disordered breathing? J Clin Sleep Med 2010;6(2):152-156. PMID:20411692

  16. Extreme human breath-hold diving.

    PubMed

    Ferretti, G

    2001-04-01

    In this paper, the respiratory, circulatory and metabolic adjustments to human extreme breath-hold diving are reviewed. A survey of the literature reveals that in extreme divers, adaptive mechanisms take place that allow prolongation of apnoea beyond the limits attained by non-diving subjects, and preservation of oxygen stores during the dives. The occurrence of a diving response, including peripheral vasoconstriction, increased arterial blood pressure, bradycardia and lowered cardiac output, is strongly implicated. Some peripheral regions may be excluded from perfusion, with consequent reliance on anaerobic metabolism. In addition, extreme breath-hold divers show a blunted ventilatory response to carbon dioxide breathing, possibly as a consequence of frequent exposure to high carbon dioxide partial pressures during the dives. These mechanisms allow the attainment of particularly low alveolar oxygen (< 30 mmHg) and high alveolar carbon dioxide (> 50 mmHg) partial pressures at the end of maximal dry breath-holds, and reduce oxygen consumption during the dive at the expense of increased anaerobic glycolysis (rate of blood lactate accumulation > 0.04 mM.s-1). The current absolute world record for depth in breath-hold diving is 150 m. Its further improvement depends upon how far the equilibrium between starting oxygen stores, the overall rate of energy expenditure, the fraction of energy provided by anaerobic metabolism and the diving speed can be pushed, with consciousness upon emersion. The ultimate limit to breath-hold diving records may indeed be imposed by an energetic constraint. PMID:11374109

  17. Control of breathing in invertebrate model systems.

    PubMed

    Bell, Harold J; Syed, Naweed I

    2012-07-01

    The invertebrates have adopted a myriad of breathing strategies to facilitate the extraction of adequate quantities of oxygen from their surrounding environments. Their respiratory structures can take a wide variety of forms, including integumentary surfaces, lungs, gills, tracheal systems, and even parallel combinations of these same gas exchange structures. Like their vertebrate counterparts, the invertebrates have evolved elaborate control strategies to regulate their breathing activity. Our goal in this article is to present the reader with a description of what is known regarding the control of breathing in some of the specific invertebrate species that have been used as model systems to study different mechanistic aspects of the control of breathing. We will examine how several species have been used to study fundamental principles of respiratory rhythm generation, central and peripheral chemosensory modulation of breathing, and plasticity in the control of breathing. We will also present the reader with an overview of some of the behavioral and neuronal adaptability that has been extensively documented in these animals. By presenting explicit invertebrate species as model organisms, we will illustrate mechanistic principles that form the neuronal foundation of respiratory control, and moreover appear likely to be conserved across not only invertebrates, but vertebrate species as well. PMID:23723022

  18. A CLINICAL GUIDE TO THE ASSESSMENT AND TREATMENT OF BREATHING PATTERN DISORDERS IN THE PHYSICALLY ACTIVE: PART 1

    PubMed Central

    Hansen-Honeycutt, Jena; Nasypany, Alan; Baker, Russell T.; May, Jim

    2016-01-01

    Background Appropriate assessment and interventions for breathing patterns prior to assessment of the patient's musculoskeletal complaint may be beneficial. Breathing pattern disorders (BPDs) are remediable and influenced by biochemical, biomechanical, psychological, and/or unknown factors. The purpose of this clinical commentary is to demonstrate the integratration of a BPD assessment into a standard clinical musculoskeletal orthopedic examination. Clinical Assessment The observation of a patient's breathing pattern begins when they enter the clinic, is followed by palpation and orthopedic tests, which allows for proper classification of BPDs. Outcomes Disease-oriented measures guide the assessment and classification of BPD, while patient-oriented measures describe clinically important differences among patient values. Classification There are many possible variations of classifications of BPD, however, six primary dysfunctions found in the literature have become the foundation of the BPD assessment. Discussion and Conclusion Restoring proper breathing mechanics and neuromuscular motor control patterns during breathing may result in a decrease in pain, improved patient outcomes, and overall patient well being associated with their primary musculoskeletal complaint. A comprehensive evaluation of breathing patterns, as a part of an orthopedic examination, may guide a clinician in providing effective and appropriate treatments to decrease pain and improve function. Level of Evidence 5 PMID:27757292

  19. An experimental comparison of radioactive labels with potential application to lymphocyte migration studies in patients.

    PubMed Central

    Rannie, G H; Thakur, M L; Ford, W L

    1977-01-01

    The suitability of two radionuclides (99mTc, 111In) for labelling lymphocytes have been evaluated in rats by comparison with a standard method using 51Cr. For the study of lymphocyte migration in patients labelling with 111In-labelled oxine is clearly the most promising because both in vivo and in vitro it remains associated with lymphocytes and the labelled cells migrate normally into lymphoid tissues. The physical characteristics of 111In are also favourable. Not only does 99mTc rapidly dissociate from lymphocytes but also it compromises their ability to recirculate from blood to lymph. PMID:589868

  20. When Breathing Interferes with Cognition: Experimental Inspiratory Loading Alters Timed Up-and-Go Test in Normal Humans.

    PubMed

    Nierat, Marie-Cécile; Demiri, Suela; Dupuis-Lozeron, Elise; Allali, Gilles; Morélot-Panzini, Capucine; Similowski, Thomas; Adler, Dan

    2016-01-01

    Human breathing stems from automatic brainstem neural processes. It can also be operated by cortico-subcortical networks, especially when breathing becomes uncomfortable because of external or internal inspiratory loads. How the "irruption of breathing into consciousness" interacts with cognition remains unclear, but a case report in a patient with defective automatic breathing (Ondine's curse syndrome) has shown that there was a cognitive cost of breathing when the respiratory cortical networks were engaged. In a pilot study of putative breathing-cognition interactions, the present study relied on a randomized design to test the hypothesis that experimentally loaded breathing in 28 young healthy subjects would have a negative impact on cognition as tested by "timed up-and-go" test (TUG) and its imagery version (iTUG). Progressive inspiratory threshold loading resulted in slower TUG and iTUG performance. Participants consistently imagined themselves faster than they actually were. However, progressive inspiratory loading slowed iTUG more than TUG, a finding that is unexpected with regard to the known effects of dual tasking on TUG and iTUG (slower TUG but stable iTUG). Insofar as the cortical networks engaged in response to inspiratory loading are also activated during complex locomotor tasks requiring cognitive inputs, we infer that competition for cortical resources may account for the breathing-cognition interference that is evidenced here.

  1. When Breathing Interferes with Cognition: Experimental Inspiratory Loading Alters Timed Up-and-Go Test in Normal Humans

    PubMed Central

    Nierat, Marie-Cécile; Demiri, Suela; Dupuis-Lozeron, Elise; Allali, Gilles; Morélot-Panzini, Capucine; Similowski, Thomas; Adler, Dan

    2016-01-01

    Human breathing stems from automatic brainstem neural processes. It can also be operated by cortico-subcortical networks, especially when breathing becomes uncomfortable because of external or internal inspiratory loads. How the “irruption of breathing into consciousness” interacts with cognition remains unclear, but a case report in a patient with defective automatic breathing (Ondine's curse syndrome) has shown that there was a cognitive cost of breathing when the respiratory cortical networks were engaged. In a pilot study of putative breathing-cognition interactions, the present study relied on a randomized design to test the hypothesis that experimentally loaded breathing in 28 young healthy subjects would have a negative impact on cognition as tested by “timed up-and-go” test (TUG) and its imagery version (iTUG). Progressive inspiratory threshold loading resulted in slower TUG and iTUG performance. Participants consistently imagined themselves faster than they actually were. However, progressive inspiratory loading slowed iTUG more than TUG, a finding that is unexpected with regard to the known effects of dual tasking on TUG and iTUG (slower TUG but stable iTUG). Insofar as the cortical networks engaged in response to inspiratory loading are also activated during complex locomotor tasks requiring cognitive inputs, we infer that competition for cortical resources may account for the breathing-cognition interference that is evidenced here. PMID:26978782

  2. Additional Value of CH₄ Measurement in a Combined (13)C/H₂ Lactose Malabsorption Breath Test: A Retrospective Analysis.

    PubMed

    Houben, Els; De Preter, Vicky; Billen, Jaak; Van Ranst, Marc; Verbeke, Kristin

    2015-09-07

    The lactose hydrogen breath test is a commonly used, non-invasive method for the detection of lactose malabsorption and is based on an abnormal increase in breath hydrogen (H₂) excretion after an oral dose of lactose. We use a combined (13)C/H₂ lactose breath test that measures breath (13)CO₂ as a measure of lactose digestion in addition to H₂ and that has a better sensitivity and specificity than the standard test. The present retrospective study evaluated the results of 1051 (13)C/H₂ lactose breath tests to assess the impact on the diagnostic accuracy of measuring breath CH₄ in addition to H₂ and (13)CO₂. Based on the (13)C/H₂ breath test, 314 patients were diagnosed with lactase deficiency, 138 with lactose malabsorption or small bowel bacterial overgrowth (SIBO), and 599 with normal lactose digestion. Additional measurement of CH₄ further improved the accuracy of the test as 16% subjects with normal lactose digestion and no H₂-excretion were found to excrete CH₄. These subjects should have been classified as subjects with lactose malabsorption or SIBO. In conclusion, measuring CH₄-concentrations has an added value to the (13)C/H₂ breath test to identify methanogenic subjects with lactose malabsorption or SIBO.

  3. Additional Value of CH₄ Measurement in a Combined (13)C/H₂ Lactose Malabsorption Breath Test: A Retrospective Analysis.

    PubMed

    Houben, Els; De Preter, Vicky; Billen, Jaak; Van Ranst, Marc; Verbeke, Kristin

    2015-09-01

    The lactose hydrogen breath test is a commonly used, non-invasive method for the detection of lactose malabsorption and is based on an abnormal increase in breath hydrogen (H₂) excretion after an oral dose of lactose. We use a combined (13)C/H₂ lactose breath test that measures breath (13)CO₂ as a measure of lactose digestion in addition to H₂ and that has a better sensitivity and specificity than the standard test. The present retrospective study evaluated the results of 1051 (13)C/H₂ lactose breath tests to assess the impact on the diagnostic accuracy of measuring breath CH₄ in addition to H₂ and (13)CO₂. Based on the (13)C/H₂ breath test, 314 patients were diagnosed with lactase deficiency, 138 with lactose malabsorption or small bowel bacterial overgrowth (SIBO), and 599 with normal lactose digestion. Additional measurement of CH₄ further improved the accuracy of the test as 16% subjects with normal lactose digestion and no H₂-excretion were found to excrete CH₄. These subjects should have been classified as subjects with lactose malabsorption or SIBO. In conclusion, measuring CH₄-concentrations has an added value to the (13)C/H₂ breath test to identify methanogenic subjects with lactose malabsorption or SIBO. PMID:26371034

  4. When Breathing Interferes with Cognition: Experimental Inspiratory Loading Alters Timed Up-and-Go Test in Normal Humans.

    PubMed

    Nierat, Marie-Cécile; Demiri, Suela; Dupuis-Lozeron, Elise; Allali, Gilles; Morélot-Panzini, Capucine; Similowski, Thomas; Adler, Dan

    2016-01-01

    Human breathing stems from automatic brainstem neural processes. It can also be operated by cortico-subcortical networks, especially when breathing becomes uncomfortable because of external or internal inspiratory loads. How the "irruption of breathing into consciousness" interacts with cognition remains unclear, but a case report in a patient with defective automatic breathing (Ondine's curse syndrome) has shown that there was a cognitive cost of breathing when the respiratory cortical networks were engaged. In a pilot study of putative breathing-cognition interactions, the present study relied on a randomized design to test the hypothesis that experimentally loaded breathing in 28 young healthy subjects would have a negative impact on cognition as tested by "timed up-and-go" test (TUG) and its imagery version (iTUG). Progressive inspiratory threshold loading resulted in slower TUG and iTUG performance. Participants consistently imagined themselves faster than they actually were. However, progressive inspiratory loading slowed iTUG more than TUG, a finding that is unexpected with regard to the known effects of dual tasking on TUG and iTUG (slower TUG but stable iTUG). Insofar as the cortical networks engaged in response to inspiratory loading are also activated during complex locomotor tasks requiring cognitive inputs, we infer that competition for cortical resources may account for the breathing-cognition interference that is evidenced here. PMID:26978782

  5. Critical appraisal of 13C breath tests for microsomal liver function: aminopyrine revisited.

    PubMed

    Pijls, Kirsten E; de Vries, Hanne; Nikkessen, Suzan; Bast, Aalt; Wodzig, Will K W H; Koek, Ger H

    2014-04-01

    As liver diseases are a major health problem and especially the incidence of metabolic liver diseases like non-alcoholic fatty liver disease (NAFLD) is rising, the demand for non-invasive tests is growing to replace liver biopsy. Non-invasive tests such as carbon-labelled breath tests can provide a valuable contribution to the evaluation of metabolic liver function. This review aims to critically appraise the value of the (13) C-labelled microsomal breath tests for the evaluation of metabolic liver function, and to discuss the role of cytochrome P450 enzymes in the metabolism of the different probe drugs, especially of aminopyrine. Although a number of different probe drugs have been used in breath tests, the perfect drug to assess the functional metabolic capacity of the liver has not been found. Data suggest that both the (13) C(2) -aminopyrine and the (13) C-methacetin breath test can play a role in assessing the capacity of the microsomal liver function and may be useful in the follow-up of patients with chronic liver diseases. Furthermore, CYP2C19 seems to be an important enzyme in the N-demethylation of aminopyrine, and polymorphisms in this gene may influence breath test values, which should be kept in mind when performing the (13) C(2) -aminopyrine breath test in clinical practice.

  6. Correlations between blood glucose and breath components from portable gas sensors and PTR-TOF-MS.

    PubMed

    Righettoni, M; Schmid, A; Amann, A; Pratsinis, S E

    2013-09-01

    Acetone is one of the most abundant volatile compounds in the human breath and might be important for monitoring diabetic patients. Here, a portable acetone sensor consisting of flame-made, nanostructured, Si-doped WO3 sensing films was used to analyse the end tidal fraction of the breath (collected in Tedlar bags) from eight healthy volunteers after overnight fasting (morning) and after lunch (afternoon). After breath sampling, the gaseous components were also analysed by proton transfer reaction time-of-flight mass spectrometry (PTR-TOF-MS), and each person's blood glucose level was measured. The portable sensor accurately detected the presence of acetone with fast response/recovery times (<12 s) and a high signal-to-noise ratio. Statistical analysis of the relationship between the PTR-TOF-MS measurements of breath gases (e.g., acetone, isoprene, ethanol and methanol), sensor response and the blood glucose level was performed for both sampling periods. The best correlations were found after overnight fasting (morning): in particular, between blood glucose level and breath acetone (Pearson's 0.98 and Spearman's 0.93). Whereas the portable sensor response correlated best with the blood glucose (Pearson's 0.96 and Spearman's 0.81) and breath acetone (Pearson's 0.92 and Spearman's 0.69). PMID:23959908

  7. Hydrogen sulphide in exhaled breath: a potential biomarker for small intestinal bacterial overgrowth in IBS.

    PubMed

    Banik, Gourab Dutta; De, Anulekha; Som, Suman; Jana, Subhra; Daschakraborty, Sunil B; Chaudhuri, Sujit; Pradhan, Manik

    2016-06-01

    There is a pressing need to develop a novel early-detection strategy for the precise evolution of small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome (IBS) patients. The current method based on a hydrogen breath test (HBT) for the detection of SIBO is highly controversial. HBT has many limitations and drawbacks. It often fails to indentify SIBO when IBS individuals have 'non-hydrogen-producing' colonic bacteria. Here, we show that hydrogen sulphide (H2S) in exhaled breath is distinctly altered for diarrhea-predominant IBS individuals with positive and negative SIBO by the activity of intestinal sulphate-reducing bacteria. Subsequently, by analyzing the excretion kinetics of breath H2S, we found a missing link between breath H2S and SIBO when HBT often fails to diagnose SIBO. Moreover, breath H2S can track the precise evolution of SIBO, even after the eradication of bacterial overgrowth. Our findings suggest that the changes in H2S in the bacterial environment may contribute to the pathogenesis of SIBO and the breath H2S as a potential biomarker for non-invasive, rapid and precise assessment of SIBO without the endoscopy-based microbial culture of jejunal aspirates, and thus may open new perspectives into the pathophysiology of SIBO in IBS subjects. PMID:27163246

  8. Breathing filters for use in inhalation anaesthesia and long-term respirator therapy. An analysis using pall breathing filters as an example.

    PubMed

    Koller, W

    1989-12-01

    The breathing filters tested in this investigation showed a high filtration effect. Therefore these filters can be assumed to protect the patient's airways very effectively from exogenous microbial loads, thus reducing the risk of extrinsic colonisation and infection. Of course intrinsic causes of infection, which prevail in long-term ventilation of patients, will respond neither to the use of breathing filters nor to disinfection of the ventilation equipment. Breathing filters protect both the patient's environment and the ventilation equipment from microbes exhaled by the patient. Hydrophobic filters with large inner surfaces such as those tested also act as heat and moisture exchangers; thus they reduce the need for air-humidification and eliminate a notorious source of respiratory-tract infection. Gain in dead space, blockage by condensed humidity and a tendency for thicker secretions are possible drawbacks which must be kept in mind when using breathing filters. The tested filters may be disposed of safely; neither dipping nor heat-sterilization or incineration will create hazard for the environment. The use of these filters may reduce significantly the frequency of respirator cleaning and disinfection as well as the costs incurred for staff, equipment repair and renewal. On the other hand, purchase, storage and disposal of the filters create running costs. PMID:2627251

  9. Synchronized moving aperture radiation therapy (SMART): improvement of breathing pattern reproducibility using respiratory coaching

    NASA Astrophysics Data System (ADS)

    Neicu, Toni; Berbeco, Ross; Wolfgang, John; Jiang, Steve B.

    2006-02-01

    Recently, at Massachusetts General Hospital (MGH) we proposed a new treatment technique called synchronized moving aperture radiation therapy (SMART) to account for tumour motion during radiotherapy. The basic idea of SMART is to synchronize the moving radiation beam aperture formed by a dynamic multileaf collimator with the tumour motion induced by respiration. The two key requirements for being able to successfully use SMART in clinical practice are the precise and fast detection of tumour position during the simulation/treatment and the good reproducibility of the tumour motion pattern. To fulfil the first requirement, an integrated radiotherapy imaging system is currently being developed at MGH. The results of a previous study show that breath coaching techniques are required to make SMART an efficient technique in general. In this study, we investigate volunteer and patient respiratory coaching using a commercial respiratory gating system as a respiration coaching tool. Five healthy volunteers, observed during six sessions, and 33 lung cancer patients, observed during one session when undergoing 4D CT scans, were investigated with audio and visual promptings, with free breathing as a control. For all five volunteers, breath coaching was well tolerated and the intra- and inter-session reproducibility of the breathing pattern was greatly improved. Out of 33 patients, six exhibited a regular breathing pattern and needed no coaching, four could not be coached at all due to the patient's medical condition or had difficulty following the instructions, 13 could only be coached with audio instructions and 10 could follow the instructions of and benefit from audio-video coaching. We found that, for all volunteers and for those patients who could be properly coached, breath coaching improves the duty cycle of SMART treatment. However, about half of the patients could not follow both audio and video instructions simultaneously, suggesting that the current coaching

  10. Racial comparisons of diabetes care and intermediate outcomes in a patient-centered medical home.

    PubMed

    Simonetti, Joseph A; Fine, Michael J; Chen, Yi-Fan; Simak, Deborah; Hess, Rachel

    2014-04-01

    OBJECTIVE To assess racial differences in diabetes processes and intermediate outcomes of care in an internal medicine, patient-centered medical home (PCMH) group practice. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of 1,457 adults with diabetes receiving care from 89 medical providers within a PCMH-designated academic practice between 1 July 2009 and 31 July 2010. We used mixed models to assess independent associations between patient race (non-Hispanic white or black) and 1) receipt of processes of care (A1C and LDL testing, foot and retinal examination, and influenza and pneumococcal vaccination) and 2) achievement of intermediate outcomes (LDL <100 mg/dL, blood pressure [BP] <140/90 mmHg, A1C <7.0% [<53 mmol/mol], and A1C >9.0% [>75 mmol/mol]), controlling for sociodemographic factors, health status, treatment intensity, and clinical continuity. RESULTS Compared with non-Hispanic white patients, black patients were younger, were more often single, had lower educational attainment, and were less likely to have commercial insurance. In unadjusted analyses, fewer black patients received a retinal examination and influenza vaccination during the study period or any lifetime pneumococcal vaccination (P < 0.05 [all comparisons]). Fewer black patients achieved an LDL <100 mg/dL, BP <140/90 mmHg, or A1C <7.0% (<53 mmol/mol), while more black patients had an A1C >9.0% (>75 mmol/mol) (P < 0.05 [all comparisons]). In multivariable models, black patients were less likely to receive A1C testing (odds ratio [OR] 0.57 [95% CI 0.34-0.95]) or influenza vaccination (OR 0.75 [95% CI 0.57-0.99]) or to achieve an LDL <100 mg/dL (OR 0.74 [95% CI 0.55-0.99]) or BP <140/90 mmHg (OR 0.64 [95% CI 0.49-0.84]). CONCLUSIONS Racial differences in processes and intermediate outcomes of diabetes care were present within this PCMH-designated practice, controlling for differences in sociodemographic, clinical, and treatment factors.

  11. Comparison Between Infrared Optical and Stereoscopic X-Ray Technologies for Patient Setup in Image Guided Stereotactic Radiotherapy

    SciTech Connect

    Tagaste, Barbara; Riboldi, Marco; Spadea, Maria F.; Bellante, Simone; Baroni, Guido; Cambria, Raffaella; Garibaldi, Cristina; Ciocca, Mario; Catalano, Gianpiero; Alterio, Daniela; Orecchia, Roberto

    2012-04-01

    Purpose: To compare infrared (IR) optical vs. stereoscopic X-ray technologies for patient setup in image-guided stereotactic radiotherapy. Methods and Materials: Retrospective data analysis of 233 fractions in 127 patients treated with hypofractionated stereotactic radiotherapy was performed. Patient setup at the linear accelerator was carried out by means of combined IR optical localization and stereoscopic X-ray image fusion in 6 degrees of freedom (6D). Data were analyzed to evaluate the geometric and dosimetric discrepancy between the two patient setup strategies. Results: Differences between IR optical localization and 6D X-ray image fusion parameters were on average within the expected localization accuracy, as limited by CT image resolution (3 mm). A disagreement between the two systems below 1 mm in all directions was measured in patients treated for cranial tumors. In extracranial sites, larger discrepancies and higher variability were observed as a function of the initial patient alignment. The compensation of IR-detected rotational errors resulted in a significantly improved agreement with 6D X-ray image fusion. On the basis of the bony anatomy registrations, the measured differences were found not to be sensitive to patient breathing. The related dosimetric analysis showed that IR-based patient setup caused limited variations in three cases, with 7% maximum dose reduction in the clinical target volume and no dose increase in organs at risk. Conclusions: In conclusion, patient setup driven by IR external surrogates localization in 6D featured comparable accuracy with respect to procedures based on stereoscopic X-ray imaging.

  12. Is breathing rate a confounding variable in brain-computer interfaces (BCIs) based on EEG spectral power?

    PubMed

    Ibarra Chaoul, Andrea; Grosse-Wentrup, Moritz

    2015-08-01

    Brain-computer interfaces (BCIs) enable paralyzed patients to interact with the world by directly decoding brain activity. We investigated if systematic changes in breathing rate affect EEG bandpower features that are commonly used in BCIs. This is of particular interest for the development of cognitive BCIs for patients with artificial ventilation, e.g. for those in late stages of amyotrophic lateral sclerosis (ALS). If subjects can alter the spectrum of the EEG by changing their breathing rate, decoding results obtained with healthy subjects may not generalize to this patient population. We recorded a high-density EEG from twelve healthy subjects, who were instructed to alternate between fast and slow breathing. We do not find any statistically significant modulation of EEG bandpower. As such, changes in breathing rate are unlikely to substantially bias the performance of BCIs based on EEG bandpower features.

  13. Analysis of exhaled breath for diagnosing head and neck squamous cell carcinoma: a feasibility study

    PubMed Central

    Gruber, M; Tisch, U; Jeries, R; Amal, H; Hakim, M; Ronen, O; Marshak, T; Zimmerman, D; Israel, O; Amiga, E; Doweck, I; Haick, H

    2014-01-01

    Background: Squamous cell carcinoma of the head and neck (HNSCC) are wide-spread cancers that often lead to disfigurement and loss of important functions such as speech and ingestion. To date, HNSCC has no adequate method for early detection and screening. Methods: Exhaled breath samples were collected from 87 volunteers; 62 well-defined breath samples from 22 HNSCC patients (larynx and pharynx), 21 patients with benign tumours (larynx and pharynx) and 19 healthy controls were analysed in a dual approach: (i) chemical analysis using gas chromatography/mass spectrometry (GC–MS) and (ii) breath-print analysis using an array of nanomaterial-based sensors, combined with a statistical algorithm. Results: Gas chromatography/mass spectrometry identified ethanol, 2-propenenitrile and undecane as potential markers for HNSCC and/or benign tumours of the head and neck. The sensor-array-based breath-prints could clearly distinguish HNSCC both from benign tumours and from healthy states. Within the HNSCC group, patients could be classified according to tumour site and stage. Conclusions: We have demonstrated the feasibility of a breath test for a specific, clinically interesting application: distinguishing HNSCC from tumour-free or benign tumour states, as well as for staging and locating HNSCC. The sensor array used here could form the basis for the development of an urgently needed non-invasive, cost-effective, fast and reliable point-of-care diagnostic/screening tool for HNSCC. PMID:24983369

  14. Underwater Stroke Kinematics During Breathing and Breath-holding Front Crawl Swimming.

    PubMed

    Vezos, Nickos; Gourgoulis, Vassilios; Aggeloussis, Nickos; Kasimatis, Panagiotis; Christoforidis, Christos; Mavromatis, Giorgos

    2007-01-01

    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. Key pointsThe breathing action increases the duration of the total underwater pull.The breathing action increases the absolute backward displacement of the hand.The breathing action caused significant modifications in the overall motor pattern, possibly due to body roll during breathing. PMID:24149225

  15. Upper limb kinematic differences between breathing and non-breathing conditions in front crawl sprint swimming.

    PubMed

    McCabe, Carla B; Sanders, Ross H; Psycharakis, Stelios G

    2015-11-26

    The purpose of this study was to determine whether the breathing action in front crawl (FC) sprint swimming affects the ipsilateral upper limb kinematics relative to a non-breathing stroke cycle (SC). Ten male competitive swimmers performed two 25m FC sprints: one breathing to their preferred side (Br) and one not breathing (NBr). Both swim trials were performed through a 6.75m(3) calibrated space and recorded by six gen-locked JVC KY32 CCD cameras. A paired t-test was used to assess statistical differences between the trials, with a confidence level of p<0.05 accepted as significant. Swimmers were slower (3%) when breathing. Within the entry phase, swimmers had a slower COM horizontal velocity (3.3%), less shoulder flexion (8%), abduction (33%) and roll (4%) when breathing. The pull phase was longer in duration (14%) swimmers had a shallower hand path (11%), less shoulder abduction (11%), a slower hand vertical acceleration (30%) and slower centre of mass (COM) horizontal velocity (3%) when breathing. In the push phase, swimmers had a smaller elbow range of motion (ROM) (38%), faster backwards hand speed (25%) and faster hand vertical acceleration (33%) when breathing. Swimmers rolled their shoulders more (12%) in the recovery phase when breathing. This study confirms that swim performance is compromised by the inclusion of taking a breath in sprint FC swimming. It was proposed that swimmers aim to orient their ipsilateral shoulder into a stronger position by stretching and rolling the shoulders more in the entry phase whilst preparing to take a breath. Swimmers should focus on lengthening the push phase by extending the elbow more and not accelerating the hand too quickly upwards when preparing to inhale. PMID:26456423

  16. Upper limb kinematic differences between breathing and non-breathing conditions in front crawl sprint swimming.

    PubMed

    McCabe, Carla B; Sanders, Ross H; Psycharakis, Stelios G

    2015-11-26

    The purpose of this study was to determine whether the breathing action in front crawl (FC) sprint swimming affects the ipsilateral upper limb kinematics relative to a non-breathing stroke cycle (SC). Ten male competitive swimmers performed two 25m FC sprints: one breathing to their preferred side (Br) and one not breathing (NBr). Both swim trials were performed through a 6.75m(3) calibrated space and recorded by six gen-locked JVC KY32 CCD cameras. A paired t-test was used to assess statistical differences between the trials, with a confidence level of p<0.05 accepted as significant. Swimmers were slower (3%) when breathing. Within the entry phase, swimmers had a slower COM horizontal velocity (3.3%), less shoulder flexion (8%), abduction (33%) and roll (4%) when breathing. The pull phase was longer in duration (14%) swimmers had a shallower hand path (11%), less shoulder abduction (11%), a slower hand vertical acceleration (30%) and slower centre of mass (COM) horizontal velocity (3%) when breathing. In the push phase, swimmers had a smaller elbow range of motion (ROM) (38%), faster backwards hand speed (25%) and faster hand vertical acceleration (33%) when breathing. Swimmers rolled their shoulders more (12%) in the recovery phase when breathing. This study confirms that swim performance is compromised by the inclusion of taking a breath in sprint FC swimming. It was proposed that swimmers aim to orient their ipsilateral shoulder into a stronger position by stretching and rolling the shoulders more in the entry phase whilst preparing to take a breath. Swimmers should focus on lengthening the push phase by extending the elbow more and not accelerating the hand too quickly upwards when preparing to inhale.

  17. Comparison of three assays for genetic effects of antineoplastic drugs on cancer patients and their nurses

    SciTech Connect

    Krepinsky, A. ); Bryant, D.W.; Davison, L.; McCalla, D.R. ); Young, B. ); Heddle, J. ); Douglas, G. ); Michalko, K. )

    1990-01-01

    Three assays have been compared for their ability to detect genetic damage caused by antineoplastic drugs in cancer patients and possible damage in the nurses who administered these drugs. The assays were sister chromatid exchanges (SCE) and chromosomal aberrations in peripheral blood lymphocytes, and the Salmonella/mammalian microsome assay on urine. Three comparisons were made: (1) patients before versus after treatment; (2) the administering nurses immediately after their work period versus after a few days off that followed (work and off-work); (3) the exposed nurses versus other nurses who did not administer antineoplastic drugs (controls). The SCE assay did not distinguish between the work and off-work samples in either the exposed or control nurses. Chromosomal aberration was the only assay which showed significant difference between the two samples of the exposed nurses and, consequently, between the exposed and control nurses. There is no evidence that the increase was connected to occupational exposure.

  18. Augmenting breath regulation using a mobile driven virtual reality therapy framework.

    PubMed

    Abushakra, Ahmad; Faezipour, Miad

    2014-05-01

    This paper presents a conceptual framework of a virtual reality therapy to assist individuals, especially lung cancer patients or those with breathing disorders to regulate their breath through real-time analysis of respiration movements using a smartphone. Virtual reality technology is an attractive means for medical simulations and treatment, particularly for patients with cancer. The theories, methodologies and approaches, and real-world dynamic contents for all the components of this virtual reality therapy (VRT) via a conceptual framework using the smartphone will be discussed. The architecture and technical aspects of the offshore platform of the virtual environment will also be presented. PMID:24043409

  19. Laser detection of CO2 concentration in human breath at various diseases

    NASA Astrophysics Data System (ADS)

    Ageev, Boris G.; Nikiforova, Olga Y.

    2015-12-01

    Absorption spectra of human breath in 10 μm region were recorded by the use of intracavity laser photo-acoustic gas analyzer based on tunable waveguide CO2 laser. Healthy persons and patients with various diseases were studied. For determination of CO2 concentration in exhalation samples gas analyzer was calibrated by reference gaseous mixture CO2-N2. It was obtained that CO2 concentration values in human breath of healthy persons are greater than that of patients with various diseases.