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The use of medical imaging as a non-invasive or minimally invasive method to assess disease or treatment response continues to grow. A similar trend is observed in pre-clinical research, in general, and more specifically in macaques, enabling longitudinal assessment of disease in individual animals. Computed tomography (CT) is such an imaging technique used to obtain clinically applicable data. To acquire a chest CT using a cone beam tomography system, some kind of respiration control is needed. A commonly used technique for this is endotracheal intubation and mechanical ventilation. However, although routinely performed this can increase the risk of impact on welfare in comparison with non-invasive imaging. Therefore, we studied the option of retrospectively gated CTs: acquiring high resolution chest CTs in freely breathing macaques. For this, we compared 748 CTs obtained during free breathing with 881 CTs obtained with mechanical ventilation in combination with a breath-hold procedure predominantly on the appearance of misregistration artifacts. The scans were obtained during different stages of multiple experimentally induced respiratory diseases. The comparison shows that although there are still streaking artifacts present in the retrospective gated scans, the amount of shading artifacts is reduced to such a level that it possibly dominates underlying lesions, causing misdiagnosis. Our data reveal that the use of retrospective gating in high resolution CTs for macaques can be successfully applied. With the use of this technique, artifacts due to free breathing are reduced to a diagnostically appropriate level. Most importantly, this technique makes chest CTs with this instrumentation a non-invasive modality.

Purpose: The impact of typical respiratory motion amplitudes (∼2 mm) on partial breast irradiation (PBI) is minimal; however, some patients have larger respiratory amplitudes that may negatively affect dose homogeneity. Here we determine at what amplitude respiratory management may be required to maintain plan quality., Methods and Materials: Ten patients were planned with PBI IMRT. Respiratory motion (2-20 mm amplitude) probability density functions were convolved with static plan fluence to estimate the delivered dose. Evaluation metrics included target coverage, ipsilateral breast hotspot, homogeneity, and uniformity indices., Results: Degradation of dose homogeneity was the limiting factor in reduction of plan quality due to respiratory motion, not loss of coverage. Hotspot increases were observed even at typical motion amplitudes. At 2 and 5 mm, 2/10 plans had a hotspot greater than 107% and at 10 mm this increased to 5/10 plans. Target coverage was only compromised at larger amplitudes: 5/10 plans did not meet coverage criteria at 15 mm amplitude and no plans met minimum coverage at 20 mm., Conclusions: We recommend that if respiratory amplitude is greater than 10 mm, respiratory management or alternative radiotherapy should be considered due to an increase in the hotspot in the ipsilateral breast and a decrease in dose homogeneity., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective To investigate the effects of esketamine on respiration, complications and acute phase inflammatory factors in patients undergoing single-port thoracoscopic surgery under general anesthesia with preserved spontaneous respiration. Methods Ninety patients, aged 16 ~ 74 years, BMI 18 ~ 28 kg/m2, ASA physical status ? or ?, who were scheduled to undergo single-port thoracoscopic surgery under general anesthesia were selected. Patients were randomly divided into two groups by random number table: esketamine group (group E, n = 45) and control group (group C, n = 45) . Esketamine 0.5 mg/kg was given for induction of anesthesia, and 0.25 mg/kg again before cutting skin. In group C, sufentanilwas given at 0.15 μg/kg for induction of anesthesia. Other anesthesia induction and maintenance durgs in both groups were the same.Sp02, PaCO2 and PaO2 were recorded at the patient's entrance (T0), before pleuraopening (T1), 15 min after pleuraopening (T2), 30 min after pleuraopening (T3), and beforelaryngeal mask removal (T4) . 3 mL of blood was extracted from themedian cubital vein at T0 and 24 h after surgery (T5) to detect the concentrations of TNF- α and IL-6. The length of spontaneous respiration recovery and laryngeal mask removal, the number of respiratory intervention, the incidence of body movement during operation, nausea, vomiting, psychiatric symptom, awareness, the length of hospital stay was recorded. Results Compared with group C, PaO2 was significantly decreased and PaCO2 was significantly increased in group E at T1, PaO2 was significantly increased and PaCO2 was significantly decreased at T2 (P < 0.01). Compared with group C, the length of spontaneous respiration recovery was significantly shortened and the number of respiratory intervention was significantly decreased in group E (P < 0.01). Compared with group C, the concentrations of TNF-α and IL-6 in venous blood in group E at T5 was significantly decreased (P < 0.01). There were no significant difference in the length of laryngeal mask removal, and the incidenceofcomplications,hospitalstay between the two groups. Conclusion Esketamine reducesintraoperative respiratory depression, shortens spontaneous respiration recovery, maintains respiratory stability and reduces acute inflammatory response in patients under general anesthesia with preserved spontaneous respiration for single-port thoracoscopic surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND: Duchenne muscular dystrophy (DMD) is characterized by progressive degeneration, wasting, and weakness of skeletal musculature, including respiratory muscles. Cough is also compromised with disease progression. Among cough-augmentation techniques, mechanical insufflation-exsufflation (MI-E) has demonstrated several clinical benefits in patients with chronic airway secretion obstruction and muscular weakness. In clinical practice, the use of MI-E in DMD patients is also suggested when they are stable with no airway infections. However, there is a paucity of studies that consider the effect of MI-E specifically on stable DMD patients who have adapted to the use of MI-E. METHODS: Twenty subjects with DMD with no active upper airway or lung infections, who used MI-E device regularly at home, were enrolled. They received a single MI-E treatment consisting of 5 cycles of 5 insufflations-exsufflations with their customary settings. Volume variations during quiet breathing, vital capacity, and cough before and after treatment were measured with optoelectronic plethysmography (OEP). RESULTS: A decrease in breathing frequency (P = .001) and the rapid shallow breathing index emerged (P = .007), while cough peak flow (Spirometer P = .86, OEP P = .58), vital capacity (Spirometer P = .78, OEP total chest wall P = .57), and end-expiratory volumes (Total chest wall P = .97, Ribcage P = .14, Abdomen P = .10) were not affected by the treatment. An increment of the chest wall volume variation during the expiratory cough phase was identified (P = .001), particularly due to an increase in abdominal expansion (P = .005). CONCLUSIONS: A single treatment of MI-E in subjects with stable DMD already adapted to the device can provide beneficial changes in breathing pattern through a significant decrease in breathing frequency and rapid shallow breathing. These findings suggest an improvement in short-term dyspnea, although there were no changes in lung-volume recruitment or unassisted cough peak flow. [ABSTRACT FROM AUTHOR]

Spinal injuries without neurological damage have little effects on respiratory function unless associated with injury to the chest wall. Early verticalisation or mobilisation of these patients is safe and likely to improve vital capacity. Spinal injury with cord damage has a profound effect on the mechanics of respiration and on respiratory function particularly in cervical cord injuries. Around 40% of spinal cord injuries occur in the cervical spine, a trend that is steadily increasing, with respiratory causes being responsible for death in over 20% of individuals. Loss of lung volumes and relative hypoxemia contribute to global hypoxaemia, exacerbating cord ischaemia in the acute period. Respiratory compromise results in the loss of muscle strength generation capacity and reduced lung volumes and in particular vital capacity, of up to 70%, ineffective cough and secretion clearance abilities; reductions in both lung and chest wall compliance and an additional oxygen cost of breathing due to changes in respiratory mechanics, with obstructive sleep apnoea evident in over 50% of acute tetraplegics. While some countries have specialist spinal centres to manage such catastrophic trauma with a demonstrable improvement in health outcomes attributed to their contribution, many individuals are initially admitted to local hospitals where healthcare professionals are less likely to fully appreciate the significant and continued vulnerabilities of such individuals. This article aims to provide a basic understanding of the causes and identification of the main principles of the respiratory management strategies required to maintain pulmonary health for cervical spinal cord injury patients during the initial and early post trauma phase. [ABSTRACT FROM AUTHOR]