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Purpose: Individuals with drug-resistant epilepsy may benefit from epilepsy surgery. In nonlesional cases, where no epileptogenic lesion can be detected on structural magnetic resonance imaging, multimodal neuroimaging studies are required. Breath-hold-triggered BOLD fMRI (bh-fMRI) was developed to measure cerebrovascular reactivity in stroke or angiopathy and highlights regional network dysfunction by visualizing focal impaired flow increase after vasodilatory stimulus. This regional dysfunction may correlate with the epileptogenic zone. In this prospective single-center single-blind pilot study, we aimed to establish the feasibility and safety of bh-fMRI in individuals with drug-resistant non-lesional focal epilepsy undergoing presurgical evaluation. Methods: In this prospective study, 10 consecutive individuals undergoing presurgical evaluation for drug-resistant focal epilepsy were recruited after case review at a multidisciplinary patient management conference. Electroclinical findings and results of other neuroimaging were used to establish the epileptogenic zone hypothesis. To calculate significant differences in cerebrovascular reactivity in comparison to the normal population, bh-fMRIs of 16 healthy volunteers were analyzed. The relative flow change of each volume of interest (VOI) of the atlas was then calculated compared to the flow change of the whole brain resulting in an atlas of normal cerebral reactivity. Consequently, the mean flow change of every VOI of each patient was tested against the healthy volunteers group. Areas with significant impairment of cerebrovascular reactivity had decreased flow change and were compared to the epileptogenic zone localization hypothesis in a single-blind design. Results: Acquisition of bh-fMRI was feasible in 9/10 cases, with one patient excluded due to noncompliance with breathing maneuvers. No adverse events were observed, and breath-hold for intermittent hypercapnia was well tolerated. On blinded review, we observed full or partial concordance of the local network dysfunction seen on bh-fMRI with the electroclinical hypothesis in 6/9 cases, including cases with extratemporal lobe epilepsy and those with nonlocalizing 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). Conclusion: This represents the first report of bh-fMRI in individuals with epilepsy undergoing presurgical evaluation. We found bh-fMRI to be feasible and safe, with a promising agreement to electroclinical findings. Thus, bh-fMRI may represent a potential modality in the presurgical evaluation of epilepsy. Further studies are needed to establish clinical utility. [ABSTRACT FROM AUTHOR]

The performance of a visual guidance patient-controlled (VG-PC) respiratory gating system for magnetic-resonance (MR) image-guided radiation therapy (MR-IGRT) was evaluated through a clinical trial of patients with either lung or liver cancer. Patients can voluntarily control their respiration utilizing the VG-PC respiratory gating system. The system enables patients to view near-real-time cine planar MR images projected inside the bore of MR-IGRT systems or an external screen. Twenty patients who had received stereotactic ablative radiotherapy (SABR) for lung or liver cancer were prospectively selected for this study. Before the first treatment, comprehensive instruction on the VG-PC respiratory gating system was provided to the patients. Respiratory-gated MR-IGRT was performed for each patient with it in the first fraction and then without it in the second fraction. For both the fractions, the total treatment time, beam-off time owing to the respiratory gating, and number of beam-off events were analyzed. The average total treatment time, beam-off time, and number of beam-off events with the system were 1507.3 s, 679.5 s, and 185, respectively, and those without the system were 2023.7 s (p < 0.001), 1195.0 s (p < 0.001), and 380 times (p < 0.001), respectively. The VG-PC respiratory gating system improved treatment efficiency through a reduction in the beam-off time, the number of beam-off events, and consequently the total treatment time when performing respiratory-gated MR-IGRT for lung and liver SABR. [ABSTRACT FROM AUTHOR]

Background: The aim of this work was to investigate the serum amino acid (AA) changes after a breath-hold diving (BH-diving) training session under several aspects including energy need, fatigue tolerance, nitric oxide (NO) production, antioxidant synthesis and hypoxia adaptation. Twelve trained BH-divers were investigated during an open sea training session and sampled for blood 30 min before the training session, 30 min and 4 h after the training session. Serum samples were assayed for AA changes related to energy request (alanine, histidine, isoleucine, leucine, lysine, methionine, proline threonine, valine), fatigue tolerance (ornithine, phenylalanine, tyrosine), nitric oxide production (citrulline), antioxidant synthesis (cystine, glutamate, glycine) and hypoxia adaptation (serine, taurine). Main results: Concerning the AA used as an energy support during physical effort, we found statistically significant decreases for all the investigated AA at T1 and a gradual return to the basal value at T2 even if alanine, proline and theonine still showed a slight significant reduction at this time. Also, the changes related to the AA involved in tolerance to physical effort showed a statistically significant decrease only at T1 respect to pre-diving value and a returned to normal value at T2. Citrulline, involved in NO production, showed a clear significant reduction both at T1 and T2. Concerning AA involved in endogenous antioxidant synthesis, the behaviour of the three AA investigated is different: we found a statistically significant increase in cystine both at T1 and T2, while glycine showed a statistically significant reduction (T1 and T2). Glutamate did not show any statistical difference. Finally, we found a statistically significant decrease in the AA investigated in other hypoxia conditions serine and taurine (T1 and T2). Conclusions: Our data seem to indicate that the energetic metabolic request is in large part supported by AA used as substrate for fuel metabolism and that also fatigue tolerance, NO production and antioxidant synthesis are supported by AA. Finally, there are interesting data related to the hypoxia stimulus that indirectly may confirm that the muscle apparatus works under strong exposure conditions notwithstanding the very short/low intensity of exercise, due to the intermittent hypoxia caused by repetitive diving. [ABSTRACT FROM AUTHOR]

Purpose: Serum erythropoietin (EPO) concentration is increased following static apnoea-induced hypoxia. However, the acute erythropoietic responses to a series of dynamic apnoeas in non-divers (ND) or elite breath-hold divers (EBHD) are unknown.Methods: Participants were stratified into EBHD (n = 8), ND (n = 10) and control (n = 8) groups. On two separate occasions, EBHD and ND performed a series of five maximal dynamic apnoeas (DYN) or two sets of five maximal static apnoeas (STA). Control performed a static eupnoeic (STE) protocol to control against any effects of water immersion and diurnal variation on EPO. Peripheral oxygen saturation (SpO2) levels were monitored up to 30 s post each maximal effort. Blood samples were collected at 30, 90, and 180 min after each protocol for EPO, haemoglobin and haematocrit concentrations.Results: No between group differences were observed at baseline (p > 0.05). For EBHD and ND, mean end-apnoea SpO2 was lower in DYN (EBHD, 62 ± 10%, p = 0.024; ND, 85 ± 6%; p = 0.020) than STA (EBHD, 76 ± 7%; ND, 96 ± 1%) and control (98 ± 1%) protocols. EBHD attained lower end-apnoeic SpO2 during DYN and STA than ND (p < 0.001). Serum EPO increased from baseline following the DYN protocol in EBHD only (EBHD, p < 0.001; ND, p = 0.622). EBHD EPO increased from baseline (6.85 ± 0.9mlU/mL) by 60% at 30 min (10.82 ± 2.5mlU/mL, p = 0.017) and 63% at 180 min (10.87 ± 2.1mlU/mL, p = 0.024). Serum EPO did not change after the STA (EBHD, p = 0.534; ND, p = 0.850) and STE (p = 0.056) protocols. There was a significant negative correlation (r = - 0.49, p = 0.003) between end-apnoeic SpO2 and peak post-apnoeic serum EPO concentrations.Conclusions: The novel findings demonstrate that circulating EPO is only increased after DYN in EBHD. This may relate to the greater hypoxemia achieved by EBHD during the DYN. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis investigated post-biopsy manoeuvres to reduce pneumothorax following computed tomography-guided percutaneous transthoracic lung biopsy. Twenty-one articles were included with 7080 patients. Chest drain insertion rates were significantly reduced by ninefold with the normal saline tract sealant compared to controls (OR 0.11, 95% CI 0.02-0.48), threefold with the rapid rollover manoeuvre to puncture site down (OR 0.34, 95% CI 0.18-0.63), threefold with the tract plug (OR 0.33, 95% CI 0.22-0.48) and threefold with the blood patch (OR 0.39, 95% CI 0.26-0.58). The absolute chest drain insertion rates were the lowest in the normal saline tract sealant (0.8% vs 7.3% for controls), rapid rollover (1.9% vs 5.2%), deep expiration and breath-hold on needle extraction (0.9% vs 1.8%) and standard rollover versus no rollover (2.6% vs 5.2%). These findings highlight post-biopsy manoeuvres which could help reduce pneumothorax and chest drain insertions following lung biopsies. LEVEL OF EVIDENCE: Level 1/no level of evidence, systematic review. [ABSTRACT FROM AUTHOR]

Purpose: Splenic contraction induced by repeated apneas has been shown to increase oxygen availability. Our aim was to determine whether repeated maximal voluntary apnea enhances the performance of cyclists in a subsequent 4-km time trial. Methods: Seven male cyclists [age: 27.1 ± 2.1 years; height: 182 ± 8 cm; body mass: 74.8 ± 9.2 kg; peak oxygen uptake: 56.9 ± 6.6 mL min kg (mean ± SD)] performed a 4-km time trial on an ergometer with and without four prior maximal bouts of apnea interspersed with 2 min of recovery. Results: The average power output during the time trial was similar with (293 ± 48 W) and without (305 ± 42 W) prior apnea ( P = 0.11, d = 0.27). The spleen was reduced in size after the fourth bout of apnea (−12.4 ± 9.0 %), as well as one (−36.6 ± 10.3 %) and 10 min (−19.5 ± 17.9 %) after the time trial, while with normal breathing the spleen was smaller one (−35.0 ± 11.3 %) and 10 min (−23.4 ± 19.7 %) after the time trial. Heart rate; oxygen uptake and carbon dioxide production; tissue oxygen saturation; and the lactate concentration, pH, oxygen saturation, level of hemoglobin and hematocrit of the blood were similar under both conditions. Conclusions: Our present findings reveal that four apneas by cyclists prior to a 4-km time trial led to splenic contraction, but no change in mean power output, the level of hemoglobin, hematocrit, oxygen saturation of the m. vastus lateralis or oxygen uptake. [ABSTRACT FROM AUTHOR]

Purpose: To develop an objective and less invasive method for evaluating breath-hold status, and to investigate breath-hold reproducibility during voluntary breath-holding irradiation. Materials and methods: We enrolled 20 patients who were treated using a voluntary breath-holding technique. Four or five sessions of cone beam computed tomography (CT) were performed during the radiotherapy session. An image of the lung with respiratory tract was extracted from the CT findings. The rigid registration of subsequent CT findings was completed using the first fraction CT findings. Next, subsequent CT images already subjected to rigid registration were deformed using the first CT images. We compared the differences in the subsequent CT images before and after the deformable registration. Results: We were able to complete the method to evaluate breath-hold status without having to consider set-up uncertainty, manual processes, visual estimates, or excessive patient cooperation. Tumor dislocation was almost within 3 mm in all directions and deformation was much smaller than 30 % period of free breathing. Conclusion: This method we have developed may have great potential for the objective verification of breath-hold reproducibility in a less invasive manner. This method assumed that the voluntary breath-hold status was reproducible enough at a clinically satisfactory level. [ABSTRACT FROM AUTHOR]

Purpose In left-sided breast cancer radiotherapy, tangential intensity modulated radiotherapy combined with breath-hold enables a dose reduction to the heart and left anterior descending (LAD) coronary artery. Aim of this study was to investigate the added value of intensity modulated proton therapy (IMPT) with regard to decreasing the radiation dose to these structures. Methods In this comparative planning study, four treatment plans were generated in 20 patients: an IMPT plan and a tangential IMRT plan, both with breath-hold and free-breathing. At least 97 % of the target volume had to be covered by at least 95 % of the prescribed dose in all cases. Specifically with respect to the heart, the LAD, and the target volumes, we analyzed the maximum doses, the mean doses, and the volumes receiving 5-30 Gy. Results As compared to IMRT, IMPT resulted in significant dose reductions to the heart and LAD-region even without breath-hold. In the majority of the IMPT cases, a reduction to almost zero to the heart and LAD-region was obtained. IMPT treatment plans yielded the lowest dose to the lungs. Conclusions With IMPT the dose to the heart and LAD-region could be significantly decreased compared to tangential IMRT with breath-hold. The clinical relevance should be assessed individually based on the baseline risk of cardiac complications in combination with the dose to organs at risk. However, as IMPT for breast cancer is currently not widely available, IMPT should be reserved for patients remaining at high risk for major coronary events. [ABSTRACT FROM AUTHOR]

Hemodynamic responses to combined heavy dynamic leg exercise (hiP), breath holding (BH) and gravity-induced blood volume shifts direction were studied. Thirteen subjects were studied at normal gravity and 12 during parabolic flight, performing 20 s hiP or combined hiP&BH (stimulus period) from a baseline of 30 W at normal gravity (1 G(z+)). Heart rate and mean arterial pressure responses to BH were similar between gravity conditions, but stroke volume (SV) differed markedly between gravity conditions: at 1 G(z+) SV was higher [112 +/- 16 ml (mean +/- SD)] during BH, than during eupnea [101 +/- 17 ml (P < 0.05, N = 13)]. In weightlessness the corresponding SV values were 105 +/- 16 and 127 +/- 20 ml, respectively (P < 0.05, N = 6). Transthoracic electrical conductance (TTC) was used as index for intrathoracic volume. TTC fell significantly during BH. This decrease was attenuated in weightlessness. It is concluded that the transient microgravity temporarily reduces the efficiency of the muscle pump so that the deep inspiration at the onset of the high-intensity exercise and breath-hold period cannot augment venous return as it could during identical manoeuvres at normal gravity. [ABSTRACT FROM AUTHOR]

The incidence and nature of cardiac arrhythmias during static apnea were studied by monitoring the electrocardiogram (ECG) and oxygen saturation (SaO(2)) of 16 recreational breath-hold divers. All subjects completed a maximal apnea with a mean (+/-SD) breath-hold duration of 281 (+/-73) s without clinical complications. Both heart rate (HR) and SaO(2) decreased significantly with breath-hold duration. The decline in SaO(2) was inversely related to the decline in HR (r = -0.55, P < 0.05). Cardiac arrhythmias (supraventricular and ventricular premature complexes, right bundle branch block) occurred in 12/16 (77%) subjects and were related to breath-hold duration. Subjects with atrial premature complexes (n = 9) had a reduced BMI (P = 0.016) and a higher decline of the terminal SaO(2) (P = 0.01). In conclusion, ectopic arrhythmias were common during maximal static apneas for training purposes. The results indicate that the occurrence of ectopic beats is associated with individual factors such as the tolerable SaO(2) decrease. [ABSTRACT FROM AUTHOR]

Increased hemoglobin concentration (Hb) and hematocrit (Hct), attributable to spleen contraction, raise blood gas storage capacity during apnea, but the mechanisms that trigger this response have not been clarified. We focused on the role of hypoxia in triggering these Hb and Hct elevations. After horizontal rest for 20 min, 10 volunteers performed 3 maximal apneas spaced by 2 min, each preceded by a deep inspiration of air. The series was repeated using the same apneic durations but after 1 min of 100% oxygen (O(2)) breathing and O(2) inspiration prior to each apnea. Mean apneic durations were 150, 171, and 214 s for apneas 1, 2, and 3, respectively. Relative to pre-apnea values, the mean post-apneic arterial O(2) saturation nadir was 84.7% after the air trial and 98% after the O(2) trial. A more pronounced elevation of both Hb and Hct occurred during the air trial: after apnea 1 with air, mean Hb had increased by 1.5% (P < 0.01), but no clear increase was found after the first apnea with O(2). After the third apnea with air Hb had increased by 3.0% (P < 0.01), and with O(2) by 2.0% (P < 0.01). After the first apnea with air Hct had increased by 1.9% (P < 0.01) and after 3 apneas by 3.0% (P < 0.01), but Hct did not change significantly in the O(2) trial. In both trials, Hb and Hct were at pre-apneic levels 10 min after apneas. Diving bradycardia during apnea was the same in both trials. We conclude that hypoxia contributes to spleen contraction during apnea, likely through chemosensor-related sympathetic output. There are, however other factors involved that trigger spleen contraction even in the absence of hypoxia. [ABSTRACT FROM AUTHOR]

Recently, a new method for acquiring SPECT data in deep inspiratory breath hold with a high-speed rotation (HSR-SPECT) technique was developed for pulmonary perfusion scintigraphy. Our purpose in this study was to apply this method to hepatic-function scintigraphy. A phantom study was performed for determining data acquisition times. The coefficient of variation (CV) value was used for evaluating nonuniformity of radioactivity in the liver area. Data acquisition times were determined based on the CV value. According to the results of the phantom study, this method needs at least ten projection data sets for acquiring sufficient counts for a proper diagnosis. Under clinical conditions, breath-holding HSR-SPECT can suppress the respiratory motion effects, better than the conventional method can. In addition, the fusion images made from breath-holding HSR-SPECT images match excellently with CT images. [ABSTRACT FROM AUTHOR]

The aim of this study was to present the technical aspects of the breath-hold technique with respiratory monitoring and visual feedback and to evaluate the feasibility of this system in healthy volunteers. To monitor respiration, the vertical position of the fiducial marker placed on the patient’s abdomen was tracked by a machine vision system with a charge-coupled device camera. A monocular head-mounted display was used to provide the patient with visual feedback about the breathing trace. Five healthy male volunteers were enrolled in this study. They held their breath at the end-inspiration and the end-expiration phases. They performed five repetitions of the same type of 15-s breath-holds with and without a head-mounted display, respectively. A standard deviation of five mean positions of the fiducial marker during a15-s breath-hold in each breath-hold type was used as the reproducibility value of breath-hold. All five volunteers well tolerated the breath-hold maneuver. For the inspiration breath-hold, the standard deviations with and without visual feedback were 1.74 mm and 0.84 mm, respectively ( P = 0.20). For the expiration breath-hold, the standard deviations with and without visual feedback were 0.63 mm and 0.96 mm, respectively ( P = 0.025). Our newly developed system might help the patient achieve improved breath-hold reproducibility. [ABSTRACT FROM AUTHOR]

Professor Piergiorgio Data, who passed away in September 2005, was a professor of physiology and of diving and hyperbaric medicine. The Diving and Subaquatic Activities Postgraduate Course of the Medical School at Gabriele D’Annunzio University, in Chieti, a small city in central Italy, started as a result of his extremely enthusiastic and charismatic care and, for almost 25 years, this specialty has been the most important reference for the three-year training of diving and hyperbaric doctors in Italy. In the field of the subaquatic activities, Professor Data was the concept designer and the practical developer of various research projects. He reported fundamental results especially regarding breath-hold diving and his work always reflected his scientific methodological strictness. He created innovative technological equipment, including the underwater radiographic apparatus and the subaquatic polygraph, as well as various underwater techniques used with well-known athletes such as Jacques Mayol. This review aims to pay homage to an unforgettable teacher. [ABSTRACT FROM AUTHOR]

Increased hematocrit (Hct) attributable to splenic contraction accompanies human apneic diving or apnea with face immersion. Apnea also causes heart rate reduction and peripheral vasoconstriction, i.e., a cardiovascular diving response, which is augmented by face immersion. The aim was to study the role of apnea and facial immersion in the initiation of the hematological response and to relate this to the cardiovascular diving response and its oxygen conservation during repeated apneas. Seven male volunteers performed two series of five apneas of fixed near-maximal duration: one series in air (A) and the other with facial immersion in 10 degrees C water (FIA). Apneas were spaced by 2 min and series by 20 min of rest. Venous blood samples, taken before and after each apnea, were analysed for Hct, hemoglobin concentration (Hb), lactic acid, blood gases and pH. Heart rate, skin capillary blood flow and arterial oxygen saturation were continuously measured non-invasively. A transient increase of Hct and Hb by approximately 4% developed progressively across both series. As no increase of the response resulted with face immersion, we concluded that the apnea, or its consequences, is the major stimulus evoking splenic contraction. An augmented cardiovascular diving response occurred during FIA compared to A. Arterial oxygen saturation remained higher, venous oxygen stores were more depleted and lactic acid accumulation was higher across the FIA series, indicating oxygen conservation with the more powerful diving response. This study shows that the hematological response is not involved in causing the difference in oxygen saturation between apnea and apnea with face immersion. [ABSTRACT FROM AUTHOR]

Breath holding is normally terminated due to the urge to breathe, mainly caused by the increasing carbon dioxide level. It was recently shown that a combination of 18 h of carbohydrate-free diet and prolonged exercise prior to breath holding lowered the respiratory exchange ratio (RER) and end-expiratory PO(2 )at maximal breath-hold break-point (MBP). Current hypothesis: fasting will result in longer breath-hold duration than will fasting followed by carbohydrate intake. It was also hypothesized that breath-holds during carbohydrate supplementation would be ended at a higher alveolar PO(2). Ten male non-divers performed multiple breath-holds either to the first diaphragmatic contraction (PBP), or to MBP. The breath-holds were performed during normal diet (control; C), twice during fasting (F14 h, F18 h), followed by post fasting carbohydrate consumption (PFCC) and a repetition of the breath-hold testing 1-2 h after ingestion of carbohydrates. Duration, RER, end-tidal PO(2) and PCO(2), SaO(2) and blood glucose were determined. RER and blood glucose increased after PFCC compared with fasting and control conditions (P < 0.001). PBP breath-hold duration increased from 129 +/- 34 s at C to 148 +/- 33 s at F18 h, and was reduced during PFCC to 122 +/- 30 s (P < 0.001). End-tidal PO(2) was higher at PFCC compared to F18 h (10.4 +/- 1.2 vs. 9.5 +/- 1.2 kPa at PBP, P < 0.05). Similar trends in breath-hold duration and physiology were seen in breath-holds that were terminated at MBP. Dietary restriction can affect breath-hold duration. The lower O(2) level at breakpoint during fasting suggests that breath holding may be less safe during fasting; the increased risk may be mitigated by ingestion of carbohydrates before breath holding. [ABSTRACT FROM AUTHOR]

Object: Multiple contrasts are often helpful for a comprehensive diagnosis. In 3D abdominal MRI, breath-hold techniques are preferred for single contrast acquisitions to avoid respiratory artifacts. In this paper, highly accelerated parallel MRI is used to acquire large 3D abdominal volumes with two different contrasts within a single breath-hold. Material and methods: In vivo studies have been performed on six healthy volunteers, combining T 1- and T 2-weighted, gradient- or spin-echo based scans, as well as water/fat resolved imaging in a single breath-hold. These 3D scans were acquired with an acceleration factor of six, using a prototype 32-element receive array. Results: The presented approach was tested successfully on all volunteers. The whole liver area was covered by a FOV of 350 × 250 × 200 mm3 for all scans with reasonable spatial resolution. Arbitrary scan protocols generating different contrasts have been shown to be combinable in this single breath-hold approach. Good spatial correspondence with negligible spatial offset was achieved for all different scan combinations acquired in overall breath-hold times between 15 and 25 s. Conclusion: Enabled by highly parallel imaging technology, this study demonstrates the technical feasibility and the promising image quality of single breath-hold dual contrast MRI. [ABSTRACT FROM AUTHOR]

To assess the stability and reproducibility of different breath-hold levels in healthy volunteers and patients using dynamic MRI (dMRI). In ten healthy volunteers and ten patients with pulmonary hypertension (PH) and normal lung function craniocaudal intrathoracic distances (CCD) were measured during inspiratory and expiratory breath-hold (15 s) (in healthy volunteers additionally at a self-chosen mid-inspiratory breath-hold) using dMRI (trueFISP, three images/s). To evaluate stability and intraobserver reproducibility of the different breath-hold levels, CCDs, time-distance curves, confidence intervals (CIs), Mann-Witney U test and regression equations were calculated. In healthy volunteers there was a substantial decrease of the CCD during the inspiratory breath-hold in contrast to the expiratory breath-hold. The CI at inspiration was 2.84+/-1.28 in the right and 2.1+/-0.68 in the left hemithorax. At expiration the CI was 2.54+/-1.18 and 2.8+/-1.48. Patients were significantly less able to hold their breath at inspiration than controls (P<0.05). In patients CI was 4.53+/-4.06 and 3.46+/-2.21 at inspiration and 4.45+/-4.23 and 4.76+/-3.73 at expiration. Intraobserver variability showed no significant differences either in patients or in healthy subjects. Reproducibility was significantly lower at a self-chosen breath-hold level of the healthy volunteers. DMRI is able to differentiate stability and reproducibility of different breath-hold levels. Expiratory breath-hold proved to be more stable than inspiratory breath-hold in healthy volunteers and patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the usefulness of deep inspiration breath-hold SPECT (BrST, a method for201T1 SPECT) in the diagnosis of solitary pulmonary nodules (SPN). Methods: Ten patients with malignant lesions and five with benign lesions were enrolled in this study. Early SPECT acquisition was performed 15 min after injection of201T1, while delayed SPECT images were acquired 3 h after injection. The first 15-sec acquisition was done using the BrST technique, and the second with the conventional free breathing (FB) method. We performed this technique alternately, and therefore, the odd data were from BrST and the even data were from FB. We referred to the T/N ratio of the early images as the ER and to the T/N ratio of the delayed images as the DR. To semi-quantitatively evaluate the degree of retention in the lesion, the retention index (RI) was calculated. Results: The RI of BrST indicated greater accuracy than that of FB in the differential diagnosis of SPN. For the benign and malignant lesions, the RI of BrST was -3.07 ± 31.51 and 29.86 ± 25.01, respectively (p < 0.05). The sensitivity, specificity, and accuracy of BrST (80%, 80%, and 80%, respectively) were significantly higher than those of FB (p < 0.05). Conclusion: The BrST method is more accurate than that of the conventional FB method in the differential diagnosis of SPN. [ABSTRACT FROM AUTHOR]

Diving mammals may enhance dive duration by injecting extra erythrocytes into the circulation by spleen contraction. This mechanism may also be important for apneic duration in humans. We studied the speed and magnitude of spleen volume changes evoked by serial apneas, and the associated changes in hematocrit (Hct) and hemoglobin (Hb) concentration, diving response and apneic duration. Three maximal apneas separated by 2 min rest elicited spleen contraction in all ten subjects, by a mean of 49 (27) ml (18%; P<0.001). During the same period, Hct and Hb rose by 2.2 and 2.4% respectively (P<0.01 and P<0.001), and apneic duration rose by 20 s (22% P<0.05). The mean heart rate reduction of the diving response was 15%, which remained the same throughout the apnea series. While the diving response was completely reversed between the apneas, spleen size was not recovered until 8-9 min after the final apnea corresponding with recovery of Hct and Hb. Thus, although the spleen contraction may be associated with the cardiovascular diving response, it is likely to be triggered by different mechanisms, and it may remain activated between dives spaced by short pauses. The two adjustments may provide a fast, quickly reversed, and a slow, but long-lasting, way of shifting to a diving mode in humans. [ABSTRACT FROM AUTHOR]

Coronary angiography (CA) is presently considered the gold standard for the assessment of the coronary arteries. However, the presence of ionizing radiation, its invasiveness and the small associated risk of morbidity prompted long ago the development of more patient-friendly imaging modalities. A promising technique, magnetic resonance imaging (MRI), has been regarded as the major modality in the coming decade. Although still in its infancy qualitatively, its flexibility and non-invasiveness opens the door for a comprehensive evaluation of the heart and the coronary arteries in one single sitting with high anatomical definition and excellent soft tissue contrast capabilities, double-oblique tomographic sections and the possibility to quantify an innumerable number of cardiovascular physiological parameters. Numerous ideas have been assessed, comprising breath-hold and free-breathing two-dimensional and three-dimensional measurements. New ongoing trials with intravascular contrast agents may provide for all these techniques the long-awaited essential boost for reliable magnetic resonance coronary angiography (MRCA). Introduction of parallel MRI acquisition techniques, such as simultaneous acquisition of spatial harmonics (SMASH) and sensitivity encoding (SENSE) may provide the speed enhancement required to shorten imaging time for all techniques explored to date. [ABSTRACT FROM AUTHOR]

Conventional coronary angiography (CA) is the standard of excellence for the evaluation of coronary artery disease. However, non-invasive imaging modalities have developed that can play an important clinical role in the diagnosis. Magnetic resonance imaging (MRI) can offer a comprehensive evaluation of the heart and the coronary arteries by virtue of its high soft tissue contrast capabilities, double-oblique tomographic sections and the possibility of quantifying physiological parameters without need of ionizing radiation. Magnetic resonance coronary arteriography (MRCA) using breath-hold and free-breathing techniques has been investigated but is still in the experimental phase; its precise role for the assessment of coronary stenosis must still be identified. Nonetheless, MRCA has proven clinically relevant in determining the course of anomalous coronary arteries and the patency of coronary artery bypass grafts. Novel intravascular contrast agents promise faster coverage of the cardiac anatomy and may provide a long-awaited boost for MRCA. Contrast-enhanced electron-beam computed tomography (EBT), another competing imaging modality, is now being subjected to widespread evaluation following initially encouraging results. [ABSTRACT FROM AUTHOR]

Cardiac output was measured by the thermodilution method in three young harbor seals, at rest and while swimming up to the maximum effort for which they could be trained. Stroke volume was determined by counting heart rate simultaneously with determination of cardiac output. Cardiac outputs varied widely between surface breathing (7.8 ml · kg · s) and breath-holding while swimming under water (1.8 ml · kg · s). Stroke volume while at the surface was almost twice the volume white submerged. Surface cardiac output was always near maximal despite work effort, whereas submerged cardiac output gradually increased at higher work efforts. The cardiovascular performance of seals at the maximum MO we could induce from them is equivalent to that of the domestic goat. [ABSTRACT FROM AUTHOR]

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Copyright of Pflügers Archiv: European Journal of Physiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)