The thorax (TH), the thoracic diaphragm (TD), and the abdominal wall (AW) are three sub-systems of the respiratory apparatus whose displacement motion has been well studied with the use of magnetic ...resonance imaging (MRI). Another sub-system, which has however received less research attention with respect to breathing, is the pelvic floor (PF). In particular, there is no study that has investigated the displacement of all four sub-systems simultaneously. Addressing this issue, it was the purpose of this feasibility study to establish a data acquisition paradigm for time-synchronous quantitative analysis of dynamic MRI data from these four major contributors to respiration and phonation (TH, TD, AW, and PF). Three healthy females were asked to breathe in and out forcefully while being recorded in a 1.5-Tesla whole body MR-scanner. Spanning a sequence of 15.12 seconds, 40 MRI data frames were acquired. Each data frame contained two slices, simultaneously documenting the mid-sagittal (TH, TD, PF) and transversal (AW) planes. The displacement motion of the four anatomical structures of interest was documented using kymographic analysis, resulting in time-varying calibrated structure displacement data. After computing the fundamental frequency of the cyclical breathing motion, the phase offsets of the TH, PF, and AW with respect to the TD were computed. Data analysis revealed three fundamentally different displacement patterns. Total structure displacement was in the range of 0.94 cm (TH) to 4.27 cm (TD). Phase delays of up to 90∘ (i.e., a quarter of a breathing cycle) between different structures were found. Motion offsets in the range of -28.30∘ to 14.90∘ were computed for the PF with respect to the TD. The diversity of results in only three investigated participants suggests a variety of possible breathing strategies, warranting further research.
There is a lack of instruments for assessing respiratory muscle activation during the breathing cycle in clinical conditions. The aim of the present study was to evaluate the usefulness of the ...respiratory muscle mechanomyogram (MMG) for non-invasively assessing the mechanical activation of the inspiratory muscles of the lower chest wall in both patients with chronic obstructive pulmonary disease (COPD) and healthy subjects, and to investigate the relationship between inspiratory muscle activation and pulmonary function parameters. Both inspiratory mouth pressure and respiratory muscle MMG were simultaneously recorded under two different respiratory conditions, quiet breathing and incremental ventilatory effort, in 13 COPD patients and 7 healthy subjects. The mechanical activation of the inspiratory muscles was characterised by the non-linear multistate Lempel-Ziv index (MLZ) calculated over the inspiratory time of the MMG signal. Subsequently, the efficiency of the inspiratory muscle mechanical activation was expressed as the ratio between the peak inspiratory mouth pressure to the amplitude of the mechanical activation. This activation estimated using the MLZ index correlated strongly with peak inspiratory mouth pressure throughout the respiratory protocol in both COPD patients (r = 0.80, p<0.001) and healthy (r = 0.82, p<0.001). Moreover, the greater the COPD severity in patients, the greater the level of muscle activation (r = -0.68, p = 0.001, between muscle activation at incremental ventilator effort and FEV1). Furthermore, the efficiency of the mechanical activation of inspiratory muscle was lower in COPD patients than healthy subjects (7.61±2.06 vs 20.42±10.81, respectively, p = 0.0002), and decreased with increasing COPD severity (r = 0.78, p<0.001, between efficiency of the mechanical activation at incremental ventilatory effort and FEV1). These results suggest that the respiratory muscle mechanomyogram is a good reflection of inspiratory effort and can be used to estimate the efficiency of the mechanical activation of the inspiratory muscles. Both, inspiratory muscle activation and inspiratory muscle mechanical activation efficiency are strongly correlated with the pulmonary function. Therefore, the use of the respiratory muscle mechanomyogram can improve the assessment of inspiratory muscle activation in clinical conditions, contributing to a better understanding of breathing in COPD patients.
This work was supported in part by the Secretariat of Universities and Research of the Ministry of Economy and Knowledge of the Generalitat de Catalunya (consolidated research groups GRC 2014 SGR 1569 and 424, and CERCA Programme), the Plan Nacional (SAF2014-54371), and by the Ministry of Economy and Competitiveness of the Spanish Government and the European Regional Development Fund, DPI2015-68820-R (MINECO/FEDER).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Duchenne muscular dystrophy (DMD) is an intractable genetic muscular disorder characterized by the loss of DYSTROPHIN. The restoration of DYSTROPHIN is expected to be a curative therapy for DMD. ...Because muscle stem cells (MuSCs) can regenerate damaged myofibers with full-length DYSTROPHIN in vivo, their transplantation is being explored as such a therapy. As for the transplanted cells, primary satellite cells have been considered, but donor shortage limits their clinical application. We previously developed a protocol that differentiates induced pluripotent stem cells (iPSCs) to MuSCs (iMuSCs). To ameliorate the respiratory function of DMD patients, cell transplantation to the diaphragm is necessary but difficult, because the diaphragm is thin and rapidly moves. In the present study, we explored the transplantation of iMuSCs into the diaphragm. First, we show direct cell injection into the diaphragm of mouse was feasible. Then, to enhance the engraftment of the transplanted cells in a rapidly moving diaphragm, we mixed polymer solutions of hyaluronic acid, alginate and gelatin to the cell suspension, finding a solution of 20% dissolved hyaluronic acid and 80% dissolved gelatin improved the engraftment. Thus, we established a method for cell transplantation into mouse diaphragm and show that an injectable hyaluronic acid-gelatin solution enables the engraftment of iMuSCs in the diaphragm.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To conduct an interdisciplinary literature review on the function of the pelvic floor musculature during respiration and its role in phonation, particularly singing.
This is a literature review.
A ...literature review was conducted using three electronic databases: PubMed, Scopus, and Google Scholar. An index search was also performed for the NATS Journal/Journal of Singing utilizing the keywords from the original search, as these articles did not appear in the original search. Peer-reviewed articles from 1985 to 2017 were gathered on the respiratory musculature and/or support mechanisms for phonation (anatomy and physiology). Articles that pertained to the muscular function of the respiratory system in breathing and/or phonation were utilized in the review. Eighty-five articles were included in this review.
Breathing and support strategies were variable and nonspecific in much of the singing voice literature. The voice science literature was a rich source of articles written about breathing and support for singing. Multiple studies looked at musculature utilized in respiration and breath support and subglottal pressure generation for muscular support. However, little or no mention was made specifically of the pelvic floor. The physical medicine literature includes the pelvic floor musculature as having an important role in respiration, as a key player in the generation of intra-abdominal pressure, and as a primary expiratory muscle.
The information gleaned from this literature review suggests that a cross-pollination between areas of science is needed, because quite obviously, the pelvic floor is a topic in physical medicine, but it is not (so much) in the voice literature. Reaching a consensus on how we describe the function of the respiratory musculature and specifically including the role of the pelvic floor in respiration and phonation deserves future attention. Further research looking specifically at the role of the pelvic floor in phonation is also warranted.
Critical importance of phrenic nerve, in patients with Lyme disease is discussed.
This paper addresses the critical importance of phrenic nerve and Lyme disease.
Medline searches were conducted in ...context of phrenic nerve, Lyme neuroborreliosis, thoracic diaphragm, and respiratory distress.
The advancements in treatment options in Lyme disease were reviewed using current literature. Applied anatomy of the phrenic nerve and its dysfunction in neuroborreliosis is described in the article.
This paper reviews the literature pertaining to the importance of the phrenic nerve in Lyme disease.
This two-volume monograph offers the first critical edition of the medieval Arabic translation of Galen's Commentary on Book 2 of the Hippocratic Epidemics produced by Hunayn ibn Ishaq (d. ca. 870). ...The edition is based on all extant Arabic textual witnesses, including the Arabic secondary transmission. The Greek original of this text is lost; the Arabic translation is therefore the only witness to this important work. The number and extent of quotations from this commentary in medieval Arabic medical writings, which are documented in the introduction to the volume, demonstrate that it became a crucial source for the development of medicine in the Islamic world. It also gave rise to a wide range of didactic writings which illustrate its importance for medical teaching. The English translation that accompanies the edition aims to convey some of the flavour of the Arabic text. It also comes with comprehensive indices that map out the terminology and style of the translation.
PDF
