Exercise-Induced Dyspnea in Collegiate Athletes: Are We Missing the Diagnosis?

OBJECTIVES: Exercise-induced dyspnea (EID) can disrupt an athlete's participation and performance in their given sport. Differential diagnosis of EID is often completed using subjective report and may be inaccurate, therefore increasing the frustration and stress of the athlete. This nonexperimental research study was used to determine prevalence of EID and related respiratory symptoms in athletes at a small, Division I university. METHODS: An anonymous survey was provided to athletes at Murray State University as they registered for participation in sports for the 2020-2021 school year. Data from this survey was analyzed as to reported physician-given diagnosis of a respiratory disorder as well as reported symptoms of EID. RESULTS: Results showed that athletes with a physician-given diagnosis often did not report symptoms or responses to medications that support that diagnosis. Additionally, athletes frequently reported symptoms of EID without a formal diagnosis of a respiratory disorder. CONCLUSIONS: These findings provide preliminary insight and pilot data that may be used to understand the prevalence of EID in collegiate athletes and the need for improved methods of diagnosis for etiologies of EID.

A portable single-sided magnet system for remote NMR measurements of pulmonary function.

In this work, we report initial results from a light-weight, low field magnetic resonance device designed to make relative pulmonary density measurements at the bedside. The development of this device necessarily involves special considerations for the magnet, RF and data acquisition schemes as well as a careful analysis of what is needed to provide useful information in the ICU. A homogeneous field region is created remotely from the surface of the magnet such that when the magnet is placed against the chest, an NMR signal is measured from a small volume in the lung. In order to achieve portability, one must trade off field strength and therefore spatial resolution. We report initial measurements from a ping-pong ball size region in the lung as a function of lung volume. As expected, we measured decreased signal at larger lung volumes since lung density decreases with increasing lung volume. Using a CPMG sequence with ΔTE=3.5 ms and a 20 echo train, a signal to noise ratio ~1100 was obtained from an 8.8mT planar magnet after signal averaging for 43 s. This is the first demonstration of NMR measurements made on a human lung with a light-weight planar NMR device. We argue that very low spatial resolution measurements of different lobar lung regions will provide useful diagnostic information for clinicians treating Acute Respiratory Distress Syndrome as clinicians want to avoid ventilator pressures that cause either lung over distension (too much pressure) or lung collapse (too little pressure).

Single-breath xenon polarization transfer contrast (SB-XTC): implementation and initial results in healthy humans.

PURPOSE: To implement and characterize a single-breath xenon transfer contrast (SB-XTC) method to assess the fractional diffusive gas transport F in the lung: to study the dependence of F and its uniformity as a function of lung volume; to estimate local alveolar surface area per unit gas volume S(A)/V(Gas) from multiple diffusion time measurements of F; to evaluate the reproducibility of the measurements and the necessity of B(1) correction in cases of centric and sequential encoding. MATERIALS AND METHODS: In SB-XTC three or four gradient echo images separated by inversion/saturation pulses were collected during a breath-hold in eight healthy volunteers, allowing the mapping of F (thus S(A)/V(Gas)) and correction for other contributions such as T(1) relaxation, RF depletion and B(1) inhomogeneity from inherently registered data. RESULTS: Regional values of F and its distribution were obtained; both the mean value and heterogeneity of F increased with the decrease of lung volume. Higher values of F in the bases of the lungs in supine position were observed at lower volumes in all volunteers. Local S(A)/V(Gas) (with a mean ± standard deviation of S(A)/V(Gas) = 89 ± 30 cm(-1)) was estimated in vivo near functional residual capacity. Calibration of SB-XTC on phantoms highlighted the necessity for B(1) corrections when k-space is traversed sequentially; with centric ordering B(1) distribution correction is dispensable. CONCLUSION: The SB-XTC technique is implemented and validated for in vivo measurements of local S(A)/V(Gas).

Measurement of infant tongue thickness using ultrasound: a technical note.

Novel uses of ultrasound include obtaining images of intra-oral structures to further research in speech production and feeding. In this technical note we describe a noninvasive, cost-effective, and reliable method for measuring infant tongue muscle thickness. The current pilot study demonstrates high reliability of a trained ultrasonographer to obtain adequate images of the infant tongue and the ability to measure reliably between two anatomic landmarks to determine tongue thickness and investigate a potential relationship between tongue size and tongue force.

The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus.

OBJECTIVES: Chronic subjective tinnitus is a prevalent condition that causes significant distress to millions of Americans. Effective tinnitus treatments are urgently needed, but evaluating them is hampered by the lack of standardized measures that are validated for both intake assessment and evaluation of treatment outcomes. This work was designed to develop a new self-report questionnaire, the Tinnitus Functional Index (TFI), that would have documented validity both for scaling the severity and negative impact of tinnitus for use in intake assessment and for measuring treatment-related changes in tinnitus (responsiveness) and that would provide comprehensive coverage of multiple tinnitus severity domains. DESIGN: To use preexisting knowledge concerning tinnitus-related problems, an Item Selection Panel (17 expert judges) surveyed the content (175 items) of nine widely used tinnitus questionnaires. From those items, the Panel identified 13 separate domains of tinnitus distress and selected 70 items most likely to be responsive to treatment effects. Eliminating redundant items while retaining good content validity and adding new items to achieve the recommended minimum of 3 to 4 items per domain yielded 43 items, which were then used for constructing TFI Prototype 1.Prototype 1 was tested at five clinics. The 326 participants included consecutive patients receiving tinnitus treatment who provided informed consent-constituting a convenience sample. Construct validity of Prototype 1 as an outcome measure was evaluated by measuring responsiveness of the overall scale and its individual items at 3 and 6 mo follow-up with 65 and 42 participants, respectively. Using a predetermined list of criteria, the 30 best-functioning items were selected for constructing TFI Prototype 2.Prototype 2 was tested at four clinics with 347 participants, including 155 and 86 who provided 3 and 6 mo follow-up data, respectively. Analyses were the same as for Prototype 1. Results were used to select the 25 best-functioning items for the final TFI. RESULTS: Both prototypes and the final TFI displayed strong measurement properties, with few missing data, high validity for scaling of tinnitus severity, and good reliability. All TFI versions exhibited the same eight factors characterizing tinnitus severity and negative impact. Responsiveness, evaluated by computing effect sizes for responses at follow-up, was satisfactory in all TFI versions.In the final TFI, Cronbach's alpha was 0.97 and test-retest reliability 0.78. Convergent validity (r = 0.86 with Tinnitus Handicap Inventory [THI]; r = 0.75 with Visual Analog Scale [VAS]) and discriminant validity (r = 0.56 with Beck Depression Inventory-Primary Care [BDI-PC]) were good. The final TFI was successful at detecting improvement from the initial clinic visit to 3 mo with moderate to large effect sizes and from initial to 6 mo with large effect sizes. Effect sizes for the TFI were generally larger than those obtained for the VAS and THI. After careful evaluation, a 13-point reduction was considered a preliminary criterion for meaningful reduction in TFI outcome scores. CONCLUSIONS: The TFI should be useful in both clinical and research settings because of its responsiveness to treatment-related change, validity for scaling the overall severity of tinnitus, and comprehensive coverage of multiple domains of tinnitus severity.

Toward 13C hyperpolarized biomarkers produced by thermal mixing with hyperpolarized 129Xe.

The (13)C NMR signal of acetic acid 1-(13)C-AcH is enhanced by polarization transfer from hyperpolarized (129)Xe using a thermal mixing procedure. 1-(13)C-AcH acid and hyperpolarized (129)Xe are mixed as gases to disperse (129)Xe in the acetic acid. The mixture is frozen with liquid N(2) at 0.5 T. The magnetic field is then momentarily dropped to allow for exchange of spin polarization between (13)C and (129)Xe. After polarization exchange the magnetic field is raised to its original value and the mixture is thawed, resulting in a solution of polarization enhanced 1-(13)C-AcH. A (13)C nuclear spin polarization enhancement of 10 is observed compared to its thermal polarization at 4.7 T. This polarization enhancement is approximately three orders of magnitude lower than that predicted by theory. The discrepancy is attributed to the formation of either an inhomogeneous solid matrix and/or spin dynamics during polarization transfer. Despite the low polarization enhancement, this is the first report of polarization transfer from (129)Xe to (13)C nuclear spins achieved by thermal mixing for a proton-containing molecule of biomedical importance. If future work can increase the enhancement, this method will be useful in hyperpolarizing a wide range of (13)C enriched compounds important in biomedical and biophysical research.

Human pulmonary imaging and spectroscopy with hyperpolarized 129Xe at 0.2T.

RATIONALE AND OBJECTIVES: Using a novel (129)Xe polarizer with high throughput (1-2 L/hour) and high polarization (approximately 55%), our objective was to demonstrate and characterize human pulmonary applications at 0.2T. Specifically, we investigated the ability of (129)Xe to measure the alveolar surface area per unit volume of gas, S(A)/V(gas). MATERIALS AND METHODS: Variable spin echo time (TE) gradient and radiofrequency (RF) echoes were used to obtain estimates of the lung's contribution to both T(2)* and T(2). Standard multislice ventilation images were obtained and signal-to-noise ratio (SNR) determined. Whole-lung, time-dependent measurements of (129)Xe diffusion from gas to septal tissue were obtained with a chemical shift saturation recovery (CSSR) method. Four healthy subjects were studied, and the Butler et al CSSR formalism (J Phys Condensed Matter 2002; 14:L297-L304) was used to calculate S(A)/V(gas). A single-breath version of the xenon transfer contrast (SB-XTC) method was implemented and used to image (129)Xe diffusion between alveolar gas and septal tissue. A direct comparison of CSSR and SB-XTC was performed. RESULTS: T(2)*=135+/-29 ms amd T(2)=326.2+/-9.5 ms. Maximum SNR=36 for ventilation images from inhalation of 1L 86% (129)Xe and voxel volume =0.225 mL. CSSR analysis showed S(A)/V(gas) decreased with increasing lung volume in a manner very similar to that observed from histology measurements; however, the absolute value of S(A)/V(gas) was approximately 40% smaller than histology values. SB-XTC images in different postures demonstrate gravitationally dependent values. Initial comparison of CSSR with XTC showed fairly good agreement with expected ratios. CONCLUSIONS: Hyperpolarized (129)Xe human imaging and spectroscopy are very promising methods to provide functional information about the lung.

T(1) and T(2) measurements of the fine structures of the in vivo and enucleated human eye.

PURPOSE: To measure T(1) and T(2) of the fine structures of the in vivo eye. MATERIALS AND METHODS: Involuntary saccades make it difficult to obtain artifact-free images. Using a method recently reported (Bert et al, Acad Radiol 2006;12:368-378), near artifact-free spin-echo images were obtained. Both an isolated enucleated eye and eight human subjects were studied at 1.5 T. Spin-echo variable TR/TE data was acquired for T(1)/T(2) determination. Average relaxation times were calculated two ways. First, an arithmetic average over different subjects was computed. Second, all data was normalized using the fitted amplitudes of each data set and pooled to obtain a single least squares fit. RESULTS: In vivo T(1)/T(2) (msec) are: arithmetic average T(1), T(2), normalized data T(1), T(2). Anterior chamber: 6233 +/- 979, 468 +/- 149, 5053 +/- 1052, 450 +/- 49. Ciliary body: 1916 +/- 184, 80 +/- 7, 2038 +/- 114, 76 +/- 3. Chorioretina: 1717 +/- 500, 72 +/- 25, 1511 +/- 230, 78 +/- 3. Extraocular muscle: 1581 +/- 646, 41 +/- 7, 1470 +/- 231, 41 +/- 1. Iris: 3334 +/- 989, 163 +/- 63, 3376 +/- 338, 153 +/- 10. Lens cortex: 1712 +/- 466, 93 +/- 36, 1413 +/- 177, 100 +/- 5. Lens nucleus: 1133 +/- 40, 26 +/- 3, 1138 +/- 47, 25 +/- 0.4. Optic nerve: 1906 +/- 301, 68 +/- 16, 1805 +/- 244, 71 +/- 2. Posterior chamber: 7915 +/- 4897, 241 +/- 14, 3323 +/- 2154, 251 +/- 38. Vitreous humor: 5768 +/- 1190, 756 +/- 804, 4855 +/- 1846, 390 +/- 8. CONCLUSION: In vivo T(1) and T(2) for many of the fine structures of the human eye have been measured.