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Purpose: To investigate the effects of repeated-sprint training with voluntary hypoventilation at low (RSH-VHL) and high (RS-VHH) lung volume on repeated-sprint ability (RSA) in female athletes. Methods: Over a 6-week period, 24 female soccer players completed 12 sessions of repeated 30-m running sprints with end-expiratory breath holding (RSH-VHL, n = 8), end-inspiratory breath holding (RS-VHH, n = 8), or unrestricted breathing (RS-URB, n = 8). Before and after training, a running RSA test consisting of performing 30-m all-out sprints until exhaustion was implemented. Results: From before to after training, the number of sprints completed during the RSA test was increased in both RSH-VHL (19.3 [0.9] vs 22.6 [0.9]; P <.01) and RS-VHH (19.3 [1.5] vs 20.5 [1.7]; P <.01) but not in RS-URB (19.4 [1.3] vs 19.5 [1.7]; P =.67). The mean velocity and the percentage decrement score calculated over sprints 1 to 17 were, respectively, higher (82.2% [1.8%] vs 84.6% [2.1%] of maximal velocity) and lower (23.7% [3.1%] vs 19.4% [3.2%]) in RSH-VHL (P <.01), whereas they remained unchanged in RS-VHH and RS-URB. The mean arterial oxygen saturation recorded during training at the end of the sprints was lower in RSH-VHL (92.1% [0.4%]) than in RS-VHH (97.3% [0.1%]) and RS-URB (97.8% [0.1%]). Conclusions: This study shows that female athletes can benefit from the RSH-VHL intervention to improve RSA. The performance gains may have been limited by the short sprinting distance with end-expiratory breath holding, which provoked only moderate hypoxemia. The increase in the number of sprints in RS-VHH seems to show that factors other than hypoxia may have played a role in RSA improvement. [ABSTRACT FROM AUTHOR]

AbstractBreath-hold divers, also known as freedivers, are at risk of specific injuries that are unique from those of surface swimmers and compressed air divers. Using peer-reviewed scientific research and expert opinion, we created a guide for medical providers managing breath-hold diving injuries in the field. Hypoxia induced by prolonged apnea and increased oxygen uptake can result in an impaired mental state that can manifest as involuntary movements or full loss of consciousness. Negative pressure barotrauma secondary to airspace collapse can lead to edema and/or hemorrhage. Positive pressure barotrauma secondary to overexpansion of airspaces can result in gas embolism or air entry into tissues and organs. Inert gas loading into tissues from prolonged deep dives or repetitive shallow dives with short surface intervals can lead to decompression sickness. Inert gas narcosis at depth is commonly described as an altered state similar to that experienced by compressed air divers. Asymptomatic cardiac arrhythmias are common during apnea, normally reversing shortly after normal ventilation resumes. The methods of glossopharyngeal breathing (insufflation and exsufflation) can add to the risk of pulmonary overinflation barotrauma or loss of consciousness from decreased cardiac preload. This guide also includes information for medical providers who are tasked with providing medical support at an organized breath-hold diving event with a list of suggested equipment to facilitate diagnosis and treatment outside of the hospital setting.

Introduction: Cognitive decline is a significant, persistent issue among breast cancer survivors (BCSs) affecting more than 50% and greatly impacting health and wellbeing, particularly among those who are aging. Scalable, lifestyle interventions to mitigate cognitive decline in this population are needed. This study aimed to explore the effects of Tai Chi Easy (TCE) on perceived cognition function among older BCSs. Methods: The current work was part of a larger NCI-funded trial (R01CA182901, primary results reported elsewhere). Female BCSs, aged 45--75 years, were randomized to one of three conditions: two active interventions, Tai Chi Easy (TCE) or sham Qigong (SQG), or an education control group (EDC). In this exploratory analysis of older female participants (aged 60--75y), perceived cognitive function and performance and related factors (including anxiety, depression, and insomnia symptom severity) were examined. We anticipated TCE and SQG would show greater improvements in perceived cognitive function and performance compared to EDC. Results: A total of 75 female BCS were included in the analysis (TCE = 23; SQG = 22; EDC = 30). Linear mixed model results showed BCS randomized to TCE and SQG reported improvements in perceived cognitive impairment and cognition-related effects on quality of life relative to EDC (with small to medium effect sizes; Cohen's d = 0.46 and 0.76), whereas no results were found for cognitive performance measures. Relative to EDC, TCE did not exact changes in depression, anxiety, and insomnia symptom severity; however, SQG showed decreases in depression and insomnia symptom severity (with corresponding small to medium effect sizes, Cohen's d = -0.36 and -0.56). Discussion: Findings from the current exploratory study suggest that low-exertion, gentle exercise, with or without breath and meditative focus, may improve perceived cognitive function, and, that without breath and meditative focus, may improve depressed mood and insomnia symptoms among older BCS. These promising findings may have immediate and long-term implications on accessible treatment options recommended by geriatricians and oncologists treating older BCS at an elevated risk for cognitive impairment. [ABSTRACT FROM AUTHOR]

"The Life Worth Living in Ancient Greek and Roman Philosophy" by David Machek is a scholarly monograph that explores the concept of a life worth living in ancient philosophy. Machek analyzes various philosophical texts to reconstruct six different theories on what makes human life valuable. He argues that this question is distinct from happiness and has relevance to contemporary issues such as clinical practice and end-of-life care. The book offers a meticulous and analytical approach, making it a valuable resource for scholars of ancient philosophy. It is available through EBSCO inc. and can be accessed through the Philosophy Documentation Center's website. [Extracted from the article]

This article compares the effects of intravenous dexmedetomidine and fentanyl on the hemodynamic stress response to tracheal extubation. The results showed that both drugs attenuated the stress response, but dexmedetomidine was superior in reducing heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure. The study used an optimal dose of dexmedetomidine and measured hemodynamic parameters at various time points. However, the study design was a comparative cross-sectional study, and a randomized controlled trial would be more appropriate for assessing the effectiveness of the drugs. [Extracted from the article]

Seismocardiographic (SCG) signals are chest wall vibrations induced by cardiac activity and are potentially useful for cardiac monitoring and diagnosis. SCG waveform is observed to vary with respiration, but the mechanism of these changes is poorly understood as alterations in autonomic tone, lung volume, heart location and intrathoracic pressure are all varying during the respiratory cycle. Understanding SCG variability and its sources may help reduce variability and increase SCG clinical utility. This study investigated SCG variability during breath holding (BH) at two different lung volumes (i.e., end inspiration and end expiration) and five airway pressures (i.e., 0, ± 2–4, and ± 15–20 cm H2O). Variability during normal breathing was also studied with and without grouping SCG beats into two clusters of similar waveform morphologies (performed using the K-medoid algorithm in an unsupervised machine learning fashion). The study included 15 healthy subjects (11 Females and 4 males, Age: 21 ± 2 y) where SCG, ECG, and spirometry were simultaneously acquired. SCG waveform variability was calculated at each experimental state (i.e., lung volume and airway pressure). Results showed that breath holding was more effective in reducing the intra-state variability of SCG than clustering normal breathing data. For the BH states, the intra-state variability increased as the airway pressure deviated from zero. The subaudible-to-audible energy ratio of the BH states increased as the airway pressure decreased below zero which may be related to the effect of the intrathoracic pressure on cardiac afterload and blood ejection. When combining the BH waveforms at end inspiration and end expiration states (at the same airway pressures) into one group, the intra-state variability increased, which suggests that the lung volume and associated change in heart location were a significant source of variability. The linear trend between airway pressure and waveform changes was found to be statistically significant for BH at end expiration. To confirm these findings, more studies are needed with a larger number of airway pressure levels and larger number of subjects. [ABSTRACT FROM AUTHOR]

The verification and use of the best treatment approach using 3D conformal radiation therapy (3DCRT), intensity modulated radiation therapy (IMRT) and Rapid Arc methods for left breast radiation with dosimetric and radiobiological characteristics. The use of custom-built Python software for the estimation and comparison of volume, mean dose, maximum dose, monitor units and normal tissue integral dose along with radiobiological parameters such as NTCP, tumor control probability, equivalent uniform dose and LKB's effective volume from 3DCRT, IMRT and Rapid Arc planning with deep inspiration with breath holding (DIBH) and free breadth (FB) techniques. Volume growth of three-fourth in DIBH compared with FB causes a decrease in cardiac doses and complications because the left lung expands, pulling the heart away from the chest wall and the treatment area. A tiny area of the left lung was exposed during treatment, which reduced the mean dose. There was little difference in the treatment approaches because the spinal cord was immobile in both techniques. Rapid Arc is the unmatched modality for left-sided breast irradiation with significant patient breath-hold, as shown by the comparison of dosimetric and radiobiological parameters from treatment techniques with a deep inspiration breath-hold approach. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine whether there are proven associations between CO-RADS categorizations and clinical and laboratory findings in children diagnosed with COVID-19 infection. Methods: This is a retrospective observational study that includes the clinical and radiological data of pediatric patients who were admitted to both Minia University Hospital and Minia Insurance Hospital with a confirmed diagnosis of COVID-19, detected via reverse transcriptase PCR (RT-PCR) from nasopharyngeal swabs obtained between June 2022 and February 2023. Patients were divided into 5 groups based on the severity of involvement in chest CT. Results: This study involved a total of 62 children who were confirmed to have COVID-19 infection. The most commonly observed symptoms in these children were fever (91.9%), shortness of breath (88.7%), and cough (87.1%). In addition, vomiting (24.2%), diarrhea (12.9%), impaired consciousness (11.2%), and convulsions (9.7%) were also reported. Significant differences were observed between CO-RADS classes in relation to patient gender, severity of respiratory distress, presence of cough, occurrence of diarrhea, elevated LDH levels, and prognosis. Conclusion: The CO-RADS classification exhibited positive correlations with inflammatory biomarkers such as total leucocytic count, LDH, D-dimer, serum ferritin, and AST. Conversely, the CO-RADS classification showed negative correlations with ionized calcium levels, hemoglobin, and platelet count. [ABSTRACT FROM AUTHOR]

The article focuses on the APUS Analog Research Group (AARG) and its research and outreach initiatives within space analog environments. Topics include the evaluation of digital stress measurement tools in analog astronaut missions, the impact of science communication efforts during analog missions, and the development and testing of supply cache systems for extended human exploration on Mars.

Cardiovascular responses to diving are characterized by two opposing responses: tachycardia resulting from exercise and bradycardia resulting from the apnea. The convergence of bradycardia and tachycardia may determine the cardiovascular responses to diving. The purpose of this study was to investigate the interaction of breath holding and muscle mechanoreflex on cardiovascular responses in breath-hold divers (BHDs) and non-BHDs. We compared the cardiovascular responses to combined apnea and the mechanoreflex in BHDs and non-BHDs. All participants undertook three trials—apnea, passive leg cycling (PLC), and combined trials—for 30 s after rest. Cardiovascular variables were measured continuously. Nine BHD (male:female, 4:5; [means ± SD] age, 35 ± 6 years; height, 168.6 ± 4.6 cm; body mass, 58.4 ± 5.9 kg) and eight non-BHD (male:female, 4:4; [means ± SD] age, 35 ± 7 years; height, 163.9 ± 9.1 cm; body mass, 55.6 ± 7.2 kg) participants were included. Compared to the resting baseline, heart rate (HR) and cardiac output (CO) significantly decreased during the combined trial in the BHD group, while they significantly increased during the combined trials in the non-BHD group (P < 0.05). Changes in the HR and CO were significantly lower in the BHD group than in the non-BHD group in the combined trial (P < 0.05). These results suggest that bradycardia with apnea in BHDs is prioritized over tachycardia with the mechanoreflex, whereas that in non-BHDs is not. This finding implies that diving training changes the interaction between apnea and the mechanoreflex in cardiovascular control. [ABSTRACT FROM AUTHOR]

A two-stream convolutional neural network (TCNN) for breathing pattern classification has been devised for the continuous monitoring of patients with infectious respiratory diseases. The TCNN consists of a convolutional neural network (CNN)-based autoencoder and classifier. The encoder of the autoencoder generates deep compressed feature maps, which contain the most important information constituting data. These maps are concatenated with feature maps generated by the classifier to classify breathing patterns. The TCNN, single-stream CNN (SCNN), and state-of-the-art classification models were applied to classify four breathing patterns: normal, slow, rapid, and breath holding. The input data consisted of chest tissue hemodynamic responses measured using a wearable near-infrared spectroscopy device on 14 healthy adult participants. Among the classification models evaluated, random forest had the lowest classification accuracy at 88.49%, while the TCNN achieved the highest classification accuracy at 94.63%. In addition, the proposed TCNN performed 2.6% better in terms of classification accuracy than an SCNN (without an autoencoder). Moreover, the TCNN mitigates the issue of declining learning performance with increasing network depth, as observed in the SCNN model. These results prove the robustness of the TCNN in classifying breathing patterns despite using a significantly smaller number of parameters and computations compared to state-of-the-art classification models. [ABSTRACT FROM AUTHOR]

Many animal species do not breathe in a continuous, rhythmic fashion, but rather display a variety of breathing patterns characterized by prolonged periods between breaths (inter‐breath intervals), during which the heart continues to beat. Examples of intermittent breathing abound across the animal kingdom, from crustaceans to cetaceans. With respect to human physiology, intermittent breathing—also termed 'periodic' or 'episodic' breathing—is associated with a variety of pathologies. Cardiovascular phenomena associated with intermittent breathing in diving species have been termed 'diving bradycardia', 'submersion bradycardia', 'immersion bradycardia', 'ventilation tachycardia', 'respiratory sinus arrhythmia' and so forth. An examination across the literature of terminology applied to these physiological phenomena indicates, unfortunately, no attempt at standardization. This might be viewed as an esoteric semantic problem except for the fact that many of the terms variously used by different authors carry with them implicit or explicit suggestions of underlying physiological mechanisms and even human‐associated pathologies. In this article, we review several phenomena associated with diving and intermittent breathing, indicate the semantic issues arising from the use of each term, and make recommendations for best practice when applying specific terms to particular cardiorespiratory patterns. Ultimately, we emphasize that the biology—not the semantics—is what is important, but also stress that confusion surrounding underlying mechanisms can be avoided by more careful attention to terms describing physiological changes during intermittent breathing and diving. What is the topic of this review?This review examines the rather confusing semantics that has been used to describe patterns in the field of cardiorespiratory physiology as it applies to intermittent breathing, particularly in diving species.What advances does it highlight?This review highlights the various cardiorespiratory phenomena associated with intermittent breathing and diving. It highlights the semantic issues associated with describing each and offers a rationale for standardizing terms based on underlying mechanisms to reduce confusion and advance the study of cardiorespiratory phenomena in both medical and comparative physiological investigations. [ABSTRACT FROM AUTHOR]

• Many individuals did not change their drinking and driving behaviours during the pandemic. • Individuals reacted differently to COVID and the restrictions put in place early in the pandemic. • Individual factors such as stress influenced drinking and driving behaviours during COVID. • Work, family, and government decisions were reported to influence behaviours during the pandemic. • Factors beyond COVID health concerns influenced individuals' drinking and driving behaviours. COVID-19 influenced life in a multitude of ways beyond immediate health impacts. This included driving behaviours. People drove less often during the early months of the pandemic, yet crash rates increased. There were reports of increased alcohol consumption during this same time which was considered to impact on driving behaviours such as drink driving. This study explores the thoughts and opinions of Queensland, Australian drivers (n = 798) concerning driving behaviours, alcohol consumption, and drink driving behaviours during the early phases of the pandemic (April – August 2020). Participants responded to qualitative questions in online questionnaires over three phases that prompted thoughts in these domains. Bronfenbrenner's bioecological model was found to explain participants' comments with the six layers seeming to impact driving, alcohol consumption, and drink driving behaviours. That is, these behaviours were influenced at an individual level (e.g., coping mechanisms), the microsystem level (e.g., reduced opportunities for socialisation), the mesosystem (e.g., work demands impacting family), the exosystem (e.g., large scale random breath testing was suspended and road police deployed to border control), the macrosystem (e.g., Australian drinking culture), and the chronosystem (the pandemic). Understanding the perspectives of individuals during a sudden shift in life caused by COVID-19 highlights the broader impact of the pandemic on people's behaviours. In addition, this study also provides important insights into the intricacies of driving, drinking and drink driving behaviours. These understandings can inform future research and countermeasures to prevent these risky behaviours. [ABSTRACT FROM AUTHOR]

Introduction: Advanced or metastatic non-small cell lung cancer (NSCLC) is associated with significant symptom burden. It is important to understand the impact of these disease-and treatment-related symptoms on patients' daily lives and explore from a patient perspective what constitutes a meaningful change in NSCLC symptoms. Methods: Patient experience of advanced or metastatic NSCLC was explored in this prospective, non-interventional qualitative research study recruiting patients from the United States (US). Interviews were conducted to explore the most important symptoms, daily life impacts, and patients' perspectives of what constitutes meaningful change when considering their current symptoms versus 6-12 months prior, based on the Patient Global Impression of Severity (PGI-S) and Patient Global Impression of Change (PGI-C) items. Results: Between February and April 2022, 19 US-based patients with Stage IV NSCLC were recruited; 95% were female, 63% were White, 79% had been diagnosed >1 year prior, and 63% were receiving targeted therapy. Over half the patients indicated their most important symptoms were fatigue, shortness of breath, and cough. Patient differentiation between whether symptoms were disease- or treatment-related lacked concordance, and often patients were unable to distinguish the two. The most frequently mentioned impacts of these symptoms on patients' daily lives were difficulty walking, sleep disturbance, anxiety/depression, impact on relationships, and difficulty doing daily tasks. Most patients considered a one-point change on the PGI-S or PGI-C to be meaningful based on rating their symptom severity at the time of the interview compared with 6-12 months before the interview. Conclusion: Based on their own symptom experience, patients with advanced or metastatic NSCLC indicated a one-point threshold for meaningful change, whether improvement or worsening. This suggests a one-point change on the PGI-S or PGI-C may be a potential anchor for patient-reported outcome (PRO) endpoints used in clinical trials. It is important to use PRO instruments that capture the symptoms and impacts identified as most important to patients. These findings highlight the importance of using qualitative methods to assess disease-related symptoms, treatment-related side effects, and the impacts on daily life for patients with advanced or metastatic NSCLC, underscoring how qualitative assessments can complement quantitative PRO instruments for evaluating clinical trials. [ABSTRACT FROM AUTHOR]

Background: Familial Mediterranean fever (FMF) is an auto-inflammatory periodic disorder resulting from mutations in the Mediterranean fever gene. Although it is considered a polyserositis disease, neurological-associated symptoms were also reported among different populations. Aim of the work: To detect the frequency of neurological manifestations among Egyptian children with FMF and to investigate its association with various disease characteristics and various FMF gene mutations. Patients and methods: This is an analytical cross-sectional study that enrolled 300 FMF children. Neurological manifestations such as headache, paresthesia, convulsions, tremors, breath-holding attacks, and syncope were reported. The dose, duration, and compliance with colchicine and the international severity scoring system for FMF (ISSF) were recorded. Serum amyloid A and gene mutations were recorded from patients' files. Results: The mean age of the patients was 10.35 ± 2.89 years; 158 (52.7%) were females, and 142 (47.3%) were males (F:M, 1.1:1), age at onset 4.67 ± 2.35 years and disease duration 3.28 ± 1.31 years. Genetic testing revealed positive MEFV gene mutation in 89.3%. Serum amyloid A was elevated in 33.7%. All patients were treated with colchicine, and 81.3% were compliant. Neurological manifestations were detected in 160 (53.3%) patients. Headache was the most common symptom in 136 (45.3%), followed by paraesthesia in 76 (25.3%). Epilepsy was present in 7 (2.3%) cases. Headaches were most frequent among patients with compound heterozygous mutation, severe ISSF scores, and poor compliance with colchicine. Conclusion: Egyptian children with FMF present with various neurological manifestations. Headache and paresthesia were the most frequent, especially with the compound heterozygous mutations, severe ISSF score, and among colchicine non-compliant patients. Rheumatologists and neurologists should be aware of these manifestations and address the importance of disease control and adherence to colchicine to avoid or decrease these manifestations. Persistent unexplained headache or other neurological manifestations, in the presence of other symptoms suggestive of FMF or high serum amyloid A, should raise suspicion of FMF, and genetic testing should be requested. A multidisciplinary approach must be considered when managing these children. [ABSTRACT FROM AUTHOR]

Thalassemia is a genetic blood disorder characterized by reduced production of hemoglobin and poses a significant risk for the development of anemia and subsequent heart disease. Understanding the mechanism linking thalassemia, anemia, and heart disease, highlighting the impact on cardiac function and the associated clinical implications. This interrelationship is crucial for developing targeted management strategies aimed at mitigating the cardiovascular complications of thalassemia-related anemia, thereby improving patient outcomes and quality of life. Case Report. A female, 22 years old, came to the emergency room at Waikabubak General Hospital with complaints of weakness and pallor that had worsened since 1 week ago. Patients feel shortness of breath after heavy work, which improves after resting, nausea, and heart pounding. The patient has some previous medical history and familial history, Physical examination showed facies cooley appearance, short stature with anemic conjunctiva, icteric sclera, and hepatosplenomegaly. Laboratories showed microcytic hypochromic anemia with elevated liver enzymes. Peripheral blood smear showed microcytic anemia with anisocytosis and poikilocytosis with target cells. CXR showed cardiomegaly and USG showed hepatosplenomegaly. Echocardiography showed LV eccentric hypertrophy, LA dilatation, mild AR, mild MR, mild TR with a low probability of pulmonary hypertension, normal systolic function, grade I LV diastolic dysfunction, and ejection fraction 55,2%. This patient was treated with omeprazole injection, blood transfusion, oxygen supplementation, oral lisinopril, and bisoprolol. Over two weeks showed improvement in symptoms and laboratory. Discussion. The diagnosis is made from anamnesis, physical examination, and limited supporting examination. Determining the exact diagnosis, and management of the underlying disease and complication based on patient symptoms and simple laboratory results. Conclusion. Cardiac involvement in thalassemia is a major complication. Management of complications is difficult in limited resources facilities. Education and pre-marital screening are required to reduce the incidence of underlying disease. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has highlighted the importance of accurately predicting disease severity to ensure timely intervention and effective allocation of healthcare resources, which can ultimately improve patient outcomes. This study aims to develop an efficient machine learning (ML) model based on patient demographic and clinical data. It utilizes advanced feature engineering techniques to reduce the dimensionality of dataset and address the issue of highly imbalanced data using synthetic minority oversampling technique (SMOTE). The study employs several ensemble learning models, including XGBoost, Random Forest, AdaBoost, voting ensemble, enhanced-weighted voting ensemble, and stack-based ensembles with support vector machine (SVM) and Gaussian Naïve Bayes as metalearners, to develop the proposed model. The results indicate that the proposed model outperformed the top-performing models reported in previous studies. It achieved an accuracy of 0.978, sensitivity of 1.0, precision of 0.875, F1-score of 0.934, and receiver operating characteristic area under the curve (ROC-AUC) of 0.965. The study identified several features that significantly correlated with COVID-19 severity, which included respiratory rate (breaths per minute), c-reactive proteins, age, and total leukocyte count (TLC) count. The proposed approach presents a promising method for accurate COVID-19 severity prediction, which may prove valuable in assisting healthcare providers in making informed decisions about patient care. [ABSTRACT FROM AUTHOR]

Diver training improves physical and mental fitness, which can also benefit other sports. This study investigates the effect of eight weeks of static apnea training on maximum apnea time, and on the physiological parameters of runners, swimmers, and sedentary participants, such as forced vital capacity (FVC), minimum heart rate (HR), and oxygen saturation (SpO2). The study followed 19 participants, including five runners, swimmers, sedentary participants, and four competitive divers for reference values. The minimum value of SpO2, HR, maximum duration of apnea, and FVC were measured. Apnea training occurred four times weekly, consisting of six apneas with 60 s breathing pauses. Apnea duration was gradually increased by 30 s. The measurement started with a 30 s apnea and ended with maximal apnea. There was a change in SpO2 decreased by 6.8%, maximum apnea length increased by 15.8%, HR decreased by 9.1%, and FVC increased by 12.4% for the groups (p < 0.05). There were intra-groups changes, but no significant inter-groups difference was observed. Eight weeks of apnea training improved the maximum duration of apnea, FVC values and reduced the minimum values of SpO2 and HR in all groups. No differences were noted between groups after training. This training may benefit cardiorespiratory parameters in the population. [ABSTRACT FROM AUTHOR]

Objectives: Past research has investigated factors that condition the association between self-control and antisocial behavior. Absent from consideration has been the possible moderating effect of alcohol intoxication. Methods: Using a placebo-controlled experimental design, we explore whether alcohol intoxication moderates the association between self-control and two vignette-based measures of reactive aggression. Results: Self-control is negatively associated with reactive aggression among sober participants, but the association is no different from zero among participants assigned to intoxicated and placebo conditions. For the vignette revealing stronger evidence of a moderating effect of alcohol intoxication, the negative effect of self-control on reactive aggression becomes non-significant starting at a breath alcohol concentration that amounts to approximately one alcoholic beverage. Conclusions: This study provides initial evidence that alcohol intoxication diminishes the association between self-control and reactive aggression, adding to existing research focused on factors that condition the association between self-control and antisocial behavior. [ABSTRACT FROM AUTHOR]

"Space to Breathe" is a review of Christina Sharpe's book, "Ordinary Notes," which delves into the lasting effects of slavery and historical trauma on the Black community. The book challenges the idea that Black people must either be pessimistic or optimistic, instead focusing on the structural realities of anti-Blackness while also celebrating the resilience and richness of Black social life. Sharpe's unique approach includes 248 notes on Black life, interspersed with personal reflections, conversations with other writers, and photographs. The use of black censor bars throughout the text serves to highlight the pervasiveness of racial violence, while also creating space for healing and rejuvenation. Similarly, "Ordinary Notes" by Saidiya Hartman explores racial violence, media representation, and the importance of breath and healing in the face of trauma. The book employs the technique of censoring names to underscore the widespread nature of racial violence and the dehumanization of its victims. It also critiques the media's tendency to sensationalize and glorify white male perpetrators of violence, while disregarding the suffering of the victims. Through the use of blank space and silence, the book encourages readers to reflect, meditate, and find solace in the midst of systemic oppression. [Extracted from the article]

The article discusses the Thirty-Fourth Annual Conference of the American Literature Association, which took place in Boston. The conference featured various panels organized by author societies and special-interest groups, focusing on topics such as James Fenimore Cooper, Washington Irving, Charles Brockden Brown, and early African American literature. The panels explored a range of themes, including history, material culture, affect, adaptation, and the use of Afrofuturism as a reading practice. The article also highlights roundtable discussions on navigating the academic job market and engaging students in American literature survey courses. Overall, the conference provided a platform for scholars to share their research and engage in lively discussions. [Extracted from the article]

Hepatic cirrhosis is characterized by fibrosis and formation of liver nodules caused by chronic injury, causing changes in the normal lobular organization of the heart. Hepatic cirrhosis can occur in all genders and about two-thirds occurs in men and one part in women. Diabetic patients can experience insulin resistance, which can be the basis for the development of complications into liver cirrhosis. This case study describes a 55 year old male patient who was diagnosed with hepatic cirrhosis with diabetes mellitus and discussed the course of the disease to the therapy given to the patient. A 55 year old male patient came with complaints of shortness of breath that had been felt for 3 months before entering the hospital. Based on the history, physical examination and search, the patient was diagnosed with liver cirrhosis, multiple liver nodules, type 2 diabetes mellitus and pulmonary tuberculosis. Hepatic cirrhosis can be caused by various diseases, one of which is diabetes mellitus. Diabetes can progress to nonalcoholic fatty liver disease and eventually to cirrhosis and hepatocellular carcinoma. Insulin resistance syndrome is the main factor that can cause cirrhosis in diabetes patients. Early diagnosis, resistance and control of risk factors as well as appropriate treatment also play an important role in reducing the damage to the prognosis of patients with hepatic cirrhosis due to diabetes mellitus. [ABSTRACT FROM AUTHOR]

Purpose: Widely used conventional 2D T2* approaches that are based on breath‐held, electrocardiogram (ECG)–gated, multi‐gradient‐echo sequences are prone to motion artifacts in the presence of incomplete breath holding or arrhythmias, which is common in cardiac patients. To address these limitations, a 3D, non‐ECG‐gated, free‐breathing T2* technique that enables rapid whole‐heart coverage was developed and validated. Methods: A continuous random Gaussian 3D k‐space sampling was implemented using a low‐rank tensor framework for motion‐resolved 3D T2* imaging. This approach was tested in healthy human volunteers and in swine before and after intravenous administration of ferumoxytol. Results: Spatial‐resolution matched T2* images were acquired with 2–3‐fold reduction in scan time using the proposed T2* mapping approach relative to conventional T2* mapping. Compared with the conventional approach, T2* images acquired with the proposed method demonstrated reduced off‐resonance and flow artifacts, leading to higher image quality and lower coefficient of variation in T2*‐weighted images of the myocardium of swine and humans. Mean myocardial T2* values determined using the proposed and conventional approaches were highly correlated and showed minimal bias. Conclusion: The proposed non‐ECG‐gated, free‐breathing, 3D T2* imaging approach can be performed within 5 min or less. It can overcome critical image artifacts from undesirable cardiac and respiratory motion and bulk off‐resonance shifts at the heart–lung interface. The proposed approach is expected to facilitate faster and improved cardiac T2* mapping in those with limited breath‐holding capacity or arrhythmias. [ABSTRACT FROM AUTHOR]

Simple Summary: We studied the feasibility and safety of using bronchoscopically implanted electromagnetic transponders to monitor deep inspiration breath hold (DIBH) for thoracic radiation therapy (RT) of primary lung cancers or lung metastases. Three transponders were implanted near the tumor, followed by CT simulation. The initial gating window was ±5 mm; in a second cohort, the window was incrementally reduced to determine the smallest feasible gating window: this was identified to be ±3 mm. Among the 48 patients enrolled, transponder-guided DIBH was feasible in all but two patients (96% feasible), where it failed because the distance between the transponders and the antenna was >19 cm. Toxicities at least possibly related to transponders or the implantation procedure were grade 2 in six patients, grade 3 in three patients, and grade 4 in one patient. Toxicities at least possibly related to RT were grade 2 in 18 patients and grade 3 in four patients. Transponder-guided DIBH is a feasible and safe approach for delivering thoracic RT. Background: Electromagnetic transponders bronchoscopically implanted near the tumor can be used to monitor deep inspiration breath hold (DIBH) for thoracic radiation therapy (RT). The feasibility and safety of this approach require further study. Methods: We enrolled patients with primary lung cancer or lung metastases. Three transponders were implanted near the tumor, followed by simulation with DIBH, free breathing, and 4D-CT as backup. The initial gating window for treatment was ±5 mm; in a second cohort, the window was incrementally reduced to determine the smallest feasible gating window. The primary endpoint was feasibility, defined as completion of RT using transponder-guided DIBH. Patients were followed for assessment of transponder- and RT-related toxicity. Results: We enrolled 48 patients (35 with primary lung cancer and 13 with lung metastases). The median distance of transponders to tumor was 1.6 cm (IQR 0.6–2.8 cm). RT delivery ranged from 3 to 35 fractions. Transponder-guided DIBH was feasible in all but two patients (96% feasible), where it failed because the distance between the transponders and the antenna was >19 cm. Among the remaining 46 patients, 6 were treated prone to keep the transponders within 19 cm of the antenna, and 40 were treated supine. The smallest feasible gating window was identified as ±3 mm. Thirty-nine (85%) patients completed one year of follow-up. Toxicities at least possibly related to transponders or the implantation procedure were grade 2 in six patients (six incidences, cough and hemoptysis), grade 3 in three patients (five incidences, cough, dyspnea, pneumonia, and supraventricular tachycardia), and grade 4 pneumonia in one patient (occurring a few days after implantation but recovered fully and completed RT). Toxicities at least possibly related to RT were grade 2 in 18 patients (41 incidences, most commonly cough, fatigue, and pneumonitis) and grade 3 in four patients (seven incidences, most commonly pneumonia), and no patients had grade 4 or higher toxicity. Conclusions: Bronchoscopically implanted electromagnetic transponder–guided DIBH lung RT is feasible and safe, allowing for precise tumor targeting and reduced normal tissue exposure. Transponder–antenna distance was the most common challenge due to a limited antenna range, which could sometimes be circumvented by prone positioning. [ABSTRACT FROM AUTHOR]

The microbiology of severe community acquired pneumonia (SCAP) has implications on management, clinical outcomes and public health policy. Therefore, knowledge of the etiologies of SCAP and methods to identify these microorganisms is key. Bacteria including Streptococcus pneumoniae, Staphylococcus aureus and Enterobacteriaceae continue to be important causes of SCAP. Viruses remain the most commonly identified etiology of SCAP. Atypical organisms are also important etiologies of SCAP and are critical to identify for public health. With the increased number of immunocompromised individuals, less common pathogens may also be found as the causative agent of SCAP. Traditional diagnostic tests, including semi-quantitative respiratory cultures, blood cultures and urinary antigens continue to hold an important role in the evaluation of patients with SCAP. Many of the limitations of the aforementioned tests are addressed by rapid, molecular diagnostic tests. Molecular diagnostics utilize culture-independent technology to identify species-specific genetic sequences. These tests are often semi-automated and provide results within hours, which provides an opportunity for expedient antibiotic stewardship. The existing literature suggests molecular diagnostic techniques may improve antibiotic stewardship in CAP, and future research should investigate optimal methods for implementation of these assays into clinical practice. [ABSTRACT FROM AUTHOR]

OBJECTIVE We aimed to report the dosimetric effects of integrating the deep inspiration breath-hold technique (DIBH) into tangential-based volumetric modulated arc therapy (TVMAT) in left breast cancer patients who underwent breast-conserving surgery (BCS). METHODS Sixty-one patients who underwent BCS were included in the study. Patients were divided into two groups according to whether irradiation was applied only to the breast or to the breast + regional lymph nodes (RLN). DIBH-TVMAT and free-breath (FB)-TVMAT plans were generated using a mono-isocentric technique with two partial arc rotations for each patient. The same gantry angles were used for both FBTVMAT and DIBH-TVMAT plans. DIBH-TVMAT and FB-TVMAT plans were evaluated, and dosimetric parameters were compared. RESULTS The mean cardiac dose in the FB-TVMAT and DIBH-TVMAT plans was 8.8 Gy and 5 Gy, respectively, indicating a 42% dose reduction in patients receiving only breast radiotherapy (RT) (p=0.000). Left lung volumes that received 5 Gy and 20 Gy were also significantly in favor of DIBH-TVMAT (p=0.001; p=0.003). A 23% reduction was encountered in the maximum dose applied to the left anterior descending coronary artery (LADCA) after the DIBH-TVMAT plan in patients who received RT to the breast and RLN (p=0.000). The addition of supraclavicular lymph nodes to the treatment field revealed an increase in the heart volume that received 5 Gy and the ipsilateral lung volumes that received 5, 10, and 20 Gy. CONCLUSION The technique integrating DIBH with TVMAT provides a significant dose reduction not only to the heart and LADCA but also to the bilateral lungs and contralateral breast without sacrificing target volume dose coverage. [ABSTRACT FROM AUTHOR]

Most currently available wearable devices to noninvasively detect hypoxia use the spatially resolved spectroscopy (SRS) method to calculate cerebral tissue oxygen saturation (StO2). This study applies the single source—detector separation (SSDS) algorithm to calculate StO2. Near-infrared spectroscopy (NIRS) data were collected from 26 healthy adult volunteers during a breath-holding task using a wearable NIRS device, which included two source—detector separations (SDSs). These data were used to derive oxyhemoglobin (HbO) change and StO2. In the group analysis, both HbO change and StO2 exhibited significant change during a breath-holding task. Specifically, they initially decreased to minimums at around 10 s and then steadily increased to maximums, which were significantly greater than baseline levels, at 25–30 s (p-HbO < 0.001 and p-StO2 < 0.05). However, at an individual level, the SRS method failed to detect changes in cerebral StO2 in response to a short breath-holding task. Furthermore, the SSDS algorithm is more robust than the SRS method in quantifying change in cerebral StO2 in response to a breath-holding task. In conclusion, these findings have demonstrated the potential use of the SSDS algorithm in developing a miniaturized wearable biosensor to monitor cerebral StO2 and detect cerebral hypoxia. [ABSTRACT FROM AUTHOR]

Introduction: A still breath hold from the patient is one of the key requirements for a diagnostic computed tomography pulmonary angiogram (CTPA). It is important for the timely identification and treatment of patients with life threatening pulmonary emboli (PEs). Motion artefact on CTPA can cause blurring, double borders, shading and streaking in the lungs, which can either obscure PEs or create artefact that mimics PEs. This risks patient harm from delayed diagnoses, missed PEs, false positives and extra radiation and contrast exposure due to repeat studies. Methods: We devised local standards and methodology for assessing the presence and degree of motion artefact on CTs. The study consisted of initial data collection, implementation of changes to clinical practice, and subsequent repeat data collection 3 months after implementation of interventions. For each data collection round, 100 consecutive inpatient and emergency CTPAs performed in a UK District General Hospital were retrospectively identified and images reviewed to categorise each as having either: ‘no significant’, ‘minor’ or ‘major’ motion artefact. There were no exclusions. Interventions after initial data collection included a multidisciplinary meeting with radiographers, department assistants, and radiologists to devise changes to workflow and practices to build in 'rehearsal' of a breath-hold and explanation of breathing instructions with patients before scanning. A prompting phrase for this was added to our CTPA scanning protocol. Results: Initial results demonstrated that 50% of CTPA showed either minor or major motion artefact, while 50% showed no significant motion artefact. For 2% with minor motion, a clinical reason for why this was unavoidable was provided. Therefore 52% of studies met the proposed local standards. In total, 45% of CTPA were assessed to have minor motion and 5% had major motion artefact (non-diagnostic). 18% of CTPA were positive for PE. Following implementation of changes to practice, repeat data collection demonstrated that 67% of CTPA showed no significant motion artefact. 3% with minor motion provided a clinical reason why this was unavoidable. Therefore 70% of studies met the proposed standard. The increase in compliance with local standards was statistically significant (p=0.00906). Conclusion: Our interventions improved compliance with local standards from 52% to 70%. We recommend rehearsal of breath-holding with patients before CTPA scans as a quick and easy way to improve the diagnostic quality of scans. A prompting phrase within the CTPA scanning protocol has proven effective.

IntroductionThe analysis of chemoreflex and baroreflex sensitivity may contribute to optimizing patient care and athletic performance. Breath-holding tests, such as the Body Oxygen Level Test (BOLT), have gained popularity as a feasible way to evaluate the reflex control over the cardiorespiratory system. According to its proponents, the BOLT score reflects the body’s sensitivity to carbon dioxide and homeostasis disturbances, providing feedback on exercise tolerance. However, it has not yet been scientifically validated or linked with exercise performance in highly-trained individuals. Therefore, we investigated the association of BOLT scores with the results of standard performance tests in elite athletes.MethodsA group of 49 speedskaters performed BOLT, Wingate Anaerobic Test (WAnT), and cardiopulmonary exercise test (CPET) on a cycle ergometer. Peak power, total work, and power drop were measured during WAnT. Time to exhaustion and maximum oxygen uptake were measured during CPET. Spearman’s rank correlation and multiple linear regression were performed to analyze the association of BOLT scores with parameters obtained during the tests, age, somatic indices, and training experience.ResultsNo significant correlations between BOLT scores and parameters obtained during WAnT and CPET were found, r(47) = −0.172–0.013, p = 0.248–0.984. The parameters obtained during the tests, age, somatic indices, and training experience were not significant in multiple linear regression (p = 0.38–0.85). The preliminary regression model showed an R2 of 0.08 and RMSE of 9.78 sec.ConclusionsOur findings did not demonstrate a significant relationship between BOLT scores and exercise performance. Age, somatic indices, and training experience were not significant in our analysis. It is recommended to interpret BOLT concerning exercise performance in highly-trained populations with a great degree of caution.

The article focuses on investigating whether bottlenose dolphins' circulating factors offer protection against age-related endothelial dysfunction, drawing from their unique physiological adaptations. Topics include the impact of serum from bottlenose dolphins on endothelial function in mice, comparative vascular physiology in dolphins versus humans, and the potential for future studies to explore underlying mechanisms of endothelial protection through a multi-omics approach.

Background: Coronary artery disease (CAD) poses a substantial and increasing public health concern in India, particularly among individuals aged 20 and above. The postoperative phase following coronary artery bypass graft (CABG) surgery presents potential complications, notably impacting the pulmonary system. Emerging evidence suggests that the Buteyko breathing technique not only improves lung function but also positively influences the psychological well-being of CABG patients. This study seeks to assess the impact of the Buteyko breathing technique on pulmonary functions in individuals who have undergone off-pump CABG. Materials and methods: In this randomized controlled trial, patients undergoing off-pump CABG were allocated to either the Buteyko breathing technique group (n = 35) or the control group (n = 35). The intervention group received supervised Buteyko breathing technique sessions twice daily for 15 minutes, concurrently with cardiac rehabilitation from postoperative day (POD-2 to POD-7). The control group underwent phase I cardiac rehabilitation. Outcome measures, including pulmonary function test (PFT), chest expansion, and breath-holding tests were evaluated at baseline (POD-2) and conclusion (POD-7). Results: Statistical analyses were conducted with a significance level set at p < 0.05. Both the control and intervention groups exhibited statistically significant improvements in pulmonary function, chest expansion at three levels, and breath-holding time (p = 0.0001). However, the Buteyko breathing group demonstrated a more significant improvement compared with the control group. Conclusion: The integration of the Buteyko breathing technique into conventional physiotherapy proves to be a beneficial strategy, leading to improvements in pulmonary function, breath-holding duration, and chest expansion for individuals who underwent off-pump CABG surgery. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the acute effect of head impacts, sustained over the course of three rounds of amateur boxing, on indices of cerebrovascular function. Methods: Eighteen university amateur boxers (six female) completed three experimental trials in a randomised order; (1) three rounds of boxing (BOX), (2) an equivalent bout of pad boxing (where no blows to the head were sustained; PAD), and (3) a time-matched seated control trial (CON). Indices of cerebrovascular function were determined immediately before and 45 min after each trial. Specifically, dynamic cerebral autoregulation (dCA) was determined by considering the relationship between changes in cerebral blood velocity and mean arterial pressure during 5 min of squat-stand manoeuvres at 0.05 and 0.10 Hz. Cerebrovascular reactivity was determined using serial breath holding and hyperventilation attempts. Results: Participants received an average of 40 ± 16 punches to the head during the BOX trial. Diastolic, mean and systolic dCA phase during squat stand manoeuvres at 0.05 Hz was lower after BOX compared to pre BOX (P ≤ 0.02, effect size (d) ≥ 0.74). No other alterations in dCA outcomes were observed at 0.05 or 0.10 Hz. The number of head impacts received during the BOX trial was associated with the change in systolic phase (r = 0.50, P = 0.03). No differences in cerebrovascular reactivity to breath holding or hyperventilation were observed. Conclusions: A typical bout of amateur boxing (i.e., three rounds) can subtly alter cerebral pressure-flow dynamics, and the magnitude of this change may be related to head impact exposure. [ABSTRACT FROM AUTHOR]

In response to the specter of looming anthropogenic ecological catastrophe, many Christian thinkers have begun to rethink the God/world relationship and reimagine the ontic cleavage between divinity and creation. The idea of "deep incarnation", which expands the scope of divine incarnation in an attempt to draw God and creation into closer relation, is a prevalent framework for such reimagination. Two historic, underutilized thinkers that might help deep incarnation theologians expand their own theologies and make sense of the conceptual and ethical differences among them are Neo-Platonist philosopher–theologians Nicholas of Cusa and Giordano Bruno. Working within an ecofeminist framework, this article argues that while both Cusanus and Bruno provide significant philosophical grounds for contemporary ecotheologies of deep incarnation, a Brunist perspective is preferable because of its more expansive anthropology and its more inclusive understanding of divinity. [ABSTRACT FROM AUTHOR]

The article discusses the use of the Fitzmaurice Voicework method in the vocal training of Tibetan students at the Shanghai Theatre Academy (STA). The Tibetan students, who historically have had limited proficiency in Chinese, faced challenges in their performing arts education. The Fitzmaurice Voicework method, which focuses on breathing and emotional exploration, was introduced to enhance their vocal training. The article highlights the success of the Tibetan students in their bilingual performance of Hamlet and emphasizes the importance of this unique teaching method in cultivating acting talents from diverse backgrounds. [Extracted from the article]

Letter knowledge and word identification are key skills for reading and spelling. Letter knowledge facilitates the application of sublexical letter-sound mappings to decode words. With reading experience, word identification becomes a key lexical skill to support decoding. In transparent orthographies, however, letter knowledge might be an enduring predictor of decoding and spelling, even in children with some reading experience. This study investigated the association of children's sublexical (letter knowledge) and lexical skills (word identification and vocabulary) with word decoding and spelling accuracy in Spanish, which is a transparent orthography. The sample consisted of 117 Spanish-speaking children, aged 8 to 10. Results revealed that (1) letter knowledge and word identification were independently associated with childre's word spelling; (2) word identification was uniquely associated with word decoding; and (3) children's vocabulary level was associated with word identification. The implications of these findings were examined within the framework of reading models and the characteristics of a transparent orthography. [ABSTRACT FROM AUTHOR]

Simple Summary: Radiation is usually used as a consolidation in early-stage mediastinal Hodgkin lymphomas with excellent cure rates and long-term survival. Patients undergoing mediastinal radiotherapy for Hodgkin lymphoma have a risk of serious radiation-associated late toxicities such as cardiovascular disease and secondary cancers. Historically, mediastinal Hodgkin lymphomas used to be treated via simple conventional AP-PA or 3D-CRT in free breathing. The advent of IMRT and deep inspiration breath hold (DIBH) techniques have allowed more conformal treatment with reduced doses of the organs at risk (OARs). We explored the impact of these techniques in limiting the irradiation of the lungs, heart, and breast without compromising the dose to the target. Plans were calculated using three different IMRT modalities with and without DIBH. The adoption of DIBH resulted in a significantly reduced radiation dose to the OARs for all the IMRT delivery techniques compared with free breathing. Hodgkin lymphomas are radiosensitive and curable tumors that often involve the mediastinum. However, the application of radiation therapy to the mediastinum is associated with late effects including cardiac and pulmonary toxicities and secondary cancers. The adoption of conformal IMRT and deep inspiration breath- hold (DIBH) can reduce the dose to healthy normal tissues (lungs, heart and breast). We compared the dosimetry of organs at risk (OARs) using different IMRT techniques for two breathing conditions, i.e., deep inspiration breath hold (DIBH) and free breathing. Twenty-three patients with early-stage mediastinal Hodgkin lymphomas were accrued in the prospective study. The patients were given treatment plans which utilized full arc volumetric modulated arc therapy (F-VMAT), Butterfly VMAT (B-VMAT), and fixed field IMRT (FF-IMRT) techniques for both DIBH and free breathing methods, respectively. All the plans were optimized to deliver 95% of the prescription dose which was 25.2 Gy to 95% of the PTV volume. The mean dose and standard error of the mean for each OAR, conformity index (CI), and homogeneity index (HI) for the target using the three planning techniques were calculated and compared using Student's t-test for parametric data and Wilcoxon signed-rank test for non-parametric data. The HI and CI of the target was not compromised using the DIBH technique for mediastinal lymphomas. The mean values of CI and HI for both DIBH and FB were comparable. The mean heart doses were reduced by 2.1 Gy, 2.54 Gy, and 2.38 Gy in DIBH compared to FB for the F-VMAT, B-VMAT, and IMRT techniques, respectively. There was a significant reduction in V5Gy, V10Gy, and V15Gy to the heart (p < 0.005) with DIBH. DIBH reduced the mean dose to the total lung by 1.19 Gy, 1.47 Gy, and 1.3 Gy, respectively. Among the 14 female patients, there was a reduction in the mean right breast dose with DIBH compared to FB (4.47 Gy vs. 3.63 Gy, p = 0.004). DIBH results in lower heart, lung, and breast doses than free breathing in mediastinal Hodgkin Lymphoma. Among the different IMRT techniques, FF-IMRT, B-VMAT, and F-VMAT showed similar PTV coverage, with similar conformity and homogeneity indices. However, the time taken for FF-IMRT was much longer than for the F-VMAT and B-VMAT techniques for both breathing methods. B-VMAT and F-VMAT emerged as the optimal planning techniques able to achieve the best target coverage and lower doses to the OARs, with less time required to deliver the prescribed dose. [ABSTRACT FROM AUTHOR]

Purpose: This study seeks to examine the influence of the heartbeat on the position, volume, and shape of the heart and its substructures during various breathing states. The findings of this study will serve as a valuable reference for dose-volume evaluation of the heart and its substructures in radiotherapy for treating thoracic tumors. Methods: Twenty-three healthy volunteers were enrolled in this study, and cine four-dimensional magnetic resonance images were acquired during periods of end-inspiration breath holding (EIBH), end-expiration breath holding (EEBH), and deep end-inspiration breath holding (DIBH). The MR images were used to delineate the heart and its substructures, including the heart, pericardium, left ventricle (LV), left ventricular myocardium, right ventricle (RV), right ventricular myocardium (RVM), ventricular septum (VS), atrial septum (AS), proximal and middle portions of the left anterior descending branch (pmLAD), and proximal portion of the left circumflex coronary branch (pLCX). The changes in each structure with heartbeat were compared among different respiratory states. Results: Compared with EIBH, EEBH increased the volume of the heart and its substructures by 0.25–3.66%, while the average Dice similarity coefficient (DSC) increased by − 0.25 to 8.7%; however, the differences were not statistically significant. Conversely, the VS decreased by 0.89 mm in the left–right (LR) direction, and the displacement of the RV in the anterior–posterior (AP) direction significantly decreased by 0.76 mm (p < 0.05). Compared with EIBH and EEBH, the average volume of the heart and its substructures decreased by 3.08–17.57% and 4.09–20.43%, respectively, during DIBH. Accordingly, statistically significant differences (p < 0.05) were observed in the volume of the heart, pericardium, LV, RV, RVM, and AS. The average DSC increased by 0–37.04% and − 2.6 to 32.14%, respectively, with statistically significant differences (p < 0.05) found in the right ventricular myocardium and interatrial septum. Furthermore, the displacements under DIBH decreased in the three directions (i.e.,− 1.73 to 3.47 mm and − 0.36 to 2.51 mm). In this regard, the AP displacement of the heart, LV, RV, RVM, LR direction, LV, RV, and AS showed statistically significant differences (p < 0.05). The Hausdorff distance (HD) of the heart and its substructures under the three breathing states are all greater than 11 mm. Conclusion: The variations in the displacement and shape alterations of the heart and its substructures during cardiac motion under various respiratory states are significant. When assessing the dose-volume index of the heart and its substructures during radiotherapy for thoracic tumors, it is essential to account for the combined impacts of cardiac motion and respiration. [ABSTRACT FROM AUTHOR]

The article describes the case of a 13-year-old female with chronic medical history of presumed Rett syndrome (RTT) based on developmental regression and behavioral observation, microcephaly, seizure disorder, and gastrostomy tube dependence. Topics discussed include findings on medical examination of the patient, clinical characteristics of Rett syndrome, and differential diagnosis, workup, and outcomes of therapeutic interventions trialed for patient's agitation.