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2.
Int J Pediatr Otorhinolaryngol ; 125: 82-86, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31271972

RESUMO

INTRODUCTION: Adenotonsillar hyperplasia (ATH) causing upper airway obstruction (UAO) may increase pulmonary artery systolic pressure (PASP). Early diagnosis and mouth breathing (MB) management may help in cases of high PASP. Total inspiratory nasal airflow (TINAF) obtained by active anterior rhinomanometry (AARM) is a means to quantify nasal patency. This study aimed to correlate TINAF with high PASP. METHODS: This is a prospective study involving 30 children between two and twelve years of age, with indication for adenotonsillectomy due to ATH, evaluated before and six months after surgery; and 29 nasal breathing (NB) children in the same age group. We obtained the PASP, calculated for tricuspid regurgitation, by means of a transthoracic echocardiography. We assessed nasal patency using the AARM to estimate the TINAF. RESULTS: The mean PASP among mouth breathing children was 25.99 mmHg, with a Standard Deviation of (±) 3.27, p = 0.01 in the preoperative period; and 21.79 mmHg (±2.48; p = 0.01) in the postoperative period. Among nasal breathers, this mean value was 21.64 mmHg (±3.87, p = 0.01). The mean pre-operative TINAF was 266.76 cm3/s (±112.21, p = 0.01); and 498.93 cm3/s (±137.80, p = 0.01) after surgery. Among nasal breathers it was 609.37 cm3/s (±109.16; p = 0.01). The mean nasal patency in the preoperative period was 42.85% (±17.83; p = 0.01); and 79.33% (±21.35; p = 0.01) in the post-op. Among nasal breathers it was 112.94% (±15.88, p = 0.01). There was a significant Spearman correlation value between TINAF and PASP (r = -0.459; p = 0.01) when we analyzed all the groups. CONCLUSION: PASP and TINAF values improved postoperatively and had an inverse correlation. This study suggests that by improving TINAF there was a decrease in PASP.


Assuntos
Adenoidectomia , Inalação/fisiologia , Respiração Bucal/cirurgia , Artéria Pulmonar/fisiologia , Tonsilectomia , Pressão Sanguínea/fisiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Respiração Bucal/fisiopatologia , Estudos Prospectivos , Rinomanometria , Sístole/fisiologia
3.
Physiol Int ; 106(2): 158-167, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31271310

RESUMO

Obesity is related to increased oxidative stress. Although low-intensity physical exercise reduces oxidative stress, obese subjects may show exercise intolerance. For these subjects, inspiratory threshold loading could be an alternative tool to reduce oxidative stress. We investigated the effects of inspiratory threshold loading on biomarkers of oxidative stress in obese and normal-weight subjects. Twenty obese (31.4 ± 6 years old, 10 men and 10 women, 37.5 ± 4.7 kg/m2) and 20 normal-weight (29.4 ± 8 years old, 10 men and 10 women, 23.2 ± 1.5 kg/m2) subjects matched for age and gender participated in the study. Maximal inspiratory pressure (MIP) was assessed by a pressure transducer. Blood sampling was performed before and after loading and control protocols to assess thiobarbituric acid reactive substances (TBARS), protein carbonylation, and reduced glutathione. Inspiratory threshold loading was performed at 60% MIP and maintained until task failure. The 30-min control protocol was performed at 0 cmH2O. Our results demonstrated that inspiratory threshold loading reduced TBARS across time in obese (6.21 ± 2.03 to 4.91 ± 2.14 nmol MDA/ml) and normal-weight subjects (5.60 ± 3.58 to 4.69 ± 2.80 nmol MDA/ml; p = 0.007), but no change was observed in protein carbonyls and glutathione in both groups. The control protocol showed no significant changes in TBARS and protein carbonyls. However, reduced glutathione was increased across time in both groups (obese: from 0.50 ± 0.37 to 0.56 ± 0.35 µmol GSH/ml; normal-weight: from 0.61 ± 0.11 to 0.81 ± 0.23 µmol GSH/ml; p = 0.002). These findings suggest that inspiratory threshold loading could be potentially used as an alternative tool to reduce oxidative stress in both normal-weight and obese individuals.


Assuntos
Inalação/fisiologia , Peroxidação de Lipídeos/fisiologia , Obesidade/fisiopatologia , Adulto , Biomarcadores/metabolismo , Exercício/fisiologia , Feminino , Glutationa/metabolismo , Humanos , Masculino , Obesidade/metabolismo , Estresse Oxidativo/fisiologia , Carbonilação Proteica/fisiologia , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismo , Pesos e Medidas
4.
Nat Hum Behav ; 3(5): 501-512, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31089297

RESUMO

Olfactory stimulus acquisition is perfectly synchronized with inhalation, which tunes neuronal ensembles for incoming information. Because olfaction is an ancient sensory system that provided a template for brain evolution, we hypothesized that this link persisted, and therefore nasal inhalations may also tune the brain for acquisition of non-olfactory information. To test this, we measured nasal airflow and electroencephalography during various non-olfactory cognitive tasks. We observed that participants spontaneously inhale at non-olfactory cognitive task onset and that such inhalations shift brain functional network architecture. Concentrating on visuospatial perception, we observed that nasal inhalation drove increased task-related brain activity in specific task-related brain regions and resulted in improved performance accuracy in the visuospatial task. Thus, mental processes with no link to olfaction are nevertheless phase-locked with nasal inhalation, consistent with the notion of an olfaction-based template in the evolution of human brain function.


Assuntos
Ondas Encefálicas/fisiologia , Córtex Cerebral/fisiologia , Conectoma , Inalação/fisiologia , Rede Nervosa/fisiologia , Reconhecimento Visual de Modelos/fisiologia , Percepção Espacial/fisiologia , Análise e Desempenho de Tarefas , Pensamento/fisiologia , Adulto , Expiração/fisiologia , Feminino , Humanos , Linguagem , Masculino , Cavidade Nasal/fisiologia , Fatores de Tempo , Adulto Jovem
5.
Neuromodulation ; 22(5): 586-592, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31136053

RESUMO

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common esophageal disorder. Transcutaneous electrical acustimulation (TEA), as a needleless method of electroacupuncture (EA) has been reported to improve hypotensive lower esophageal sphincters pressure (LESP) in GERD. Synchronized TEA (STEA) with inspiration has been revealed to be more effective than TEA in enhancing vagal tone. AIM: To explore the effect of STEA on LESP in GERD and possible mechanisms involving autonomic functions. METHODS: Sixty patients were randomly allocated into a STEA group (45 patients) and sham-TEA group (15 patients). The ECG was recorded for the assessment of the autonomic function, followed with an esophageal high-resolution manometry (HRM) test. When the test was completed, the STEA or sham-TEA treatment was performed for 30 minutes. Then the HRM test was repeated. RESULTS: STEA increased LESP from 21.9 to 31.9 mmHg in GERD patients (p < 0.001). A negative correlation between the percentage of STEA-induced increase in LESP and basal LESP was observed (R = -0.471, p = 0.001). STEA reduced the number of ineffective esophageal contractions (p < 0.05). STEA rather than sham-TEA increased vagal activity (0.27 ± 0.14 vs. 0.36 ± 0.18, p < 0.001) and decreased sympathetic activity (0.73 ± 0.14 vs. 0.64 ± 0.18, p < 0.001). CONCLUSIONS: Acute STEA augments LESP in GERD and the percentage of the increase in LESP was negatively correlated with basal LESP. The effect of STEA on LESP might be mediated via autonomic function. CONFLICT OF INTEREST: The authors reported no conflict of interest.


Assuntos
Esfíncter Esofágico Inferior/fisiologia , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/terapia , Inalação/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Refluxo Gastroesofágico/fisiopatologia , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Projetos Piloto , Método Simples-Cego
6.
Physiother Res Int ; 24(3): e1777, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31090181

RESUMO

BACKGROUND: Individuals with Parkinson's disease (PD), in addition to motor impairment, may evolve with respiratory and autonomic nervous system disorders. Currently, there are few studies with emphasis on muscle and pulmonary dysfunction and that verify the benefits of inspiratory muscle training (IMT) in this population. AIM: The aim of this study was to evaluate whether IMT is effective for the improvement of respiratory muscle strength, lung function, thoracic mobility, functional capacity and cardiac autonomic function in PD. METHODS: A randomized and controlled trial will be conducted with 26 participants with idiopathic PD, with aged between 50 and 65 years, in the Stages I to III by the Modified Hoehn and Yahr Scale. Respiratory muscle strength will be performed by manovacuometry and lung function by spirometry. Functional capacity will be evaluated by the 6-min walk test and autonomic cardiac function by heart rate variability. In addition, thoracic mobility measurement will also be performed. After the evaluations, these participants will be randomly assigned to two groups: the IMT group with Powerbreathe® , which will perform the eight series of 2 min each, with 1 min of rest between them, totaling 30 min, at 60% of the maximum inspiratory pressure and the control group, who will perform the same training protocol but with the load maintained at 9 cmH2 O. All participants will be submitted to the same motor training protocol. CONCLUSION: It is expected that IMT increases the inspiratory muscle strength, contributing to the improved expiratory muscle strength, lung function, thoracic mobility, functional capacity and cardiac autonomic function in individuals with mild to moderate PD.


Assuntos
Exercícios Respiratórios/métodos , Força Muscular/fisiologia , Doença de Parkinson/reabilitação , Músculos Respiratórios/fisiologia , Idoso , Sistema Nervoso Autônomo/fisiologia , Feminino , Humanos , Inalação/fisiologia , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Espirometria , Teste de Caminhada
7.
Crit Care ; 23(1): 111, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953553

RESUMO

BACKGROUND: Microaspiration of gastric and oropharyngeal secretions is the main mechanism of entry of bacteria into the lower respiratory tract in intubated critically ill patients. The aim of this study is to determine the impact of enteral nutrition, as compared with parenteral nutrition, on abundant microaspiration of gastric contents and oropharyngeal secretions. METHODS: Planned ancillary study of the randomized controlled multicenter NUTRIREA2 trial. Patients with shock receiving invasive mechanical ventilation were randomized to receive early enteral or parenteral nutrition. All tracheal aspirates were collected during the 48 h following randomization. Abundant microaspiration of gastric contents and oropharyngeal secretions was defined as the presence of significant levels of pepsin (> 200 ng/ml) and salivary amylase (> 1685 UI/ml) in > 30% of tracheal aspirates. RESULTS: A total of 151 patients were included (78 and 73 patients in enteral and parenteral nutrition groups, respectively), and 1074 tracheal aspirates were quantitatively analyzed for pepsin and amylase. Although vomiting rate was significantly higher (31% vs 15%, p = 0.016), constipation rate was significantly lower (6% vs 21%, p = 0.010) in patients with enteral than in patients with parenteral nutrition. No significant difference was found regarding other patient characteristics. The percentage of patients with abundant microaspiration of gastric contents was significantly lower in enteral than in parenteral nutrition groups (14% vs 36%, p = 0.004; unadjusted OR 0.80 (95% CI 0.69, 0.93), adjusted OR 0.79 (0.76, 0.94)). The percentage of patients with abundant microaspiration of oropharyngeal secretions was significantly higher in enteral than in parenteral nutrition groups (74% vs 54%, p = 0.026; unadjusted OR 1.21 (95% CI 1.03, 1.44), adjusted OR 1.23 (1.01, 1.48)). No significant difference was found in percentage of patients with ventilator-associated pneumonia between enteral (8%) and parenteral (10%) nutrition groups (HR 0.78 (0.26, 2.28)). CONCLUSIONS: Our results suggest that enteral and parenteral nutrition are associated with high rates of microaspiration, although oropharyngeal microaspiration was more common with enteral nutrition and gastric microaspiration was more common with parenteral nutrition. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03411447 . Registered 18 July 2017. Retrospectively registered.


Assuntos
Vias de Administração de Medicamentos , Terapia Nutricional/normas , Choque/dietoterapia , Idoso , Secreções Corporais , Estado Terminal/terapia , Feminino , Suco Gástrico , Humanos , Inalação/fisiologia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Terapia Nutricional/instrumentação , Terapia Nutricional/métodos , Estudos Retrospectivos , Fatores de Tempo
8.
Curr Med Sci ; 39(2): 310-316, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31016527

RESUMO

The change of vocal function after vocal fold dehydration due to dryness was discussed along with the treatment effect of different atomizing agents. Forty-eight staffs from The Central Hospital of Wuhan were recruited. All volunteers breathed dry air for vocal fold dehydration. After dry air inhalation, the subjects were randomly divided into four groups, with 12 cases each. Three groups were treatment groups, receiving 0.9% normal saline (IS), 5% hypertonic saline (HS) and double-distilled water (SW) atomizing inhalation therapy, respectively, and the last group was the control group without treatment. Voice data were collected for all subjects before and immediately after dry air inhalation using the Multi-Dimensional Voice Program (MDVP) system. Atomizing inhalation therapy was given 10 min after dry air inhalation, and voice data were collected using MDVP system at the following time points after atomizing inhalation treatment: 5 min, 20 min, 35 min, 50 min, 65 min, 80 min, 95 min, 110 min. In the control group, voice data were collected at the same time points and compared with those of treatment groups. The vocal function parameters collected before and after dry air inhalation as well as after treatment were subjected to test using SPSS 16.0 software. In the four groups, jitter (fundamental frequency perturbation), shimmer (amplitude perturbation), and amplitude perturbation quotient (APQ) were significantly increased after dry air inhalation (P<0.05). In IS, HS and SW groups, after atomizing inhalation treatment, there was an obvious reduction in jitter, shimmer and APQ, showing significant differences as compared with those after dry air inhalation (P<0.05). Moreover, these parameters were significantly lower than those in the control group (P<0.05). The jitter, shimmer and APQ in the IS group were significantly lower than those in the HS and SW groups (P<0.05). We are led to a conclusion: Vocal fold dehydration induced by dryness can reduce the stability of voice; such decreased voice stability can be improved by atomizing inhalation therapy; without proper treatment, voice stability caused by vocal fold dehydration cannot heal spontaneously; of three atomizing agents namely, IS, HS and SW, IS had the best treatment effect for decreased voice stability caused by vocal fold dehydration.


Assuntos
Desidratação/fisiopatologia , Desidratação/terapia , Prega Vocal/fisiopatologia , Adulto , Método Duplo-Cego , Feminino , Humanos , Inalação/fisiologia , Masculino
9.
Neuroscience ; 406: 467-486, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30930131

RESUMO

Obstructive sleep apnea patients face episodes of chronic intermittent hypoxia (CIH), which has been suggested as a causative factor for increased sympathetic activity (SNA) and hypertension. Female rats exposed to CIH develop hypertension and exhibit changes in respiratory-sympathetic coupling, marked by an increase in the inspiratory modulation of SNA. We tested the hypothesis that enhanced inspiratory-modulation of SNA is dependent on carotid bodies (CBs) and are associated with changes in respiratory network activity. For this, in CIH-female rats we evaluated the effect of CBs ablation on respiratory-sympathetic coupling, recorded from respiratory neurons in the working heart-brainstem preparation and from NTS neurons in brainstem slices. CIH-female rats had an increase in peripheral chemoreflex response and in spontaneous excitatory neurotransmission in NTS. CBs ablation prevents the increase in inspiratory modulation of SNA in CIH-female rats. Pre-inspiratory/inspiratory (Pre-I/I) neurons of CIH-female rats have a reduced firing frequency. Post-inspiratory neurons are active for a longer period during expiration in CIH-female rats. Further, using the computational model of a brainstem respiratory-sympathetic network, we demonstrate that a reduction in Pre-I/I neuron firing frequency simulates the enhanced inspiratory SNA modulation in CIH-female rats. We conclude that changes in respiratory-sympathetic coupling in CIH-female rats is dependent on CBs and it is associated with changes in firing properties of specific respiratory neurons types.


Assuntos
Potenciais Pós-Sinápticos Excitadores/fisiologia , Hipóxia/fisiopatologia , Inalação/fisiologia , Rede Nervosa/fisiopatologia , Neurônios/fisiologia , Animais , Corpo Carotídeo/fisiopatologia , Feminino , Ratos , Ratos Wistar
10.
Proc Natl Acad Sci U S A ; 116(15): 7493-7502, 2019 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-30918122

RESUMO

The ability of neuronal networks to reconfigure is a key property underlying behavioral flexibility. Networks with recurrent topology are particularly prone to reconfiguration through changes in synaptic and intrinsic properties. Here, we explore spatial reconfiguration in the reticular networks of the medulla that generate breathing. Combined results from in vitro and in vivo approaches demonstrate that the network architecture underlying generation of the inspiratory phase of breathing is not static but can be spatially redistributed by shifts in the balance of excitatory and inhibitory network influences. These shifts in excitation/inhibition allow the size of the active network to expand and contract along a rostrocaudal medullary column during behavioral or metabolic challenges to breathing, such as changes in sensory feedback, sighing, and gasping. We postulate that the ability of this rhythm-generating network to spatially reconfigure contributes to the remarkable robustness and flexibility of breathing.


Assuntos
Inalação/fisiologia , Modelos Neurológicos , Rede Nervosa/fisiologia , Animais , Feminino , Camundongos , Camundongos Transgênicos , Rede Nervosa/citologia
12.
Respir Physiol Neurobiol ; 262: 40-48, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30710649

RESUMO

The respiration flow pattern plays a key role in fluid flow, heat and mass transfer in human lung airway. To reveal the complex flow pattern within human lung multiple-generation airway, both the steady inspiration and expiration flows are comprehensively studied using laser Doppler velocimetry technique and computational fluid dynamics method for an idealized human tracheobronchial three-generation airway model at two flow rates, corresponding to an adult male breathing under light activity and moderate exercise conditions, respectively. The comparison of mainstream velocity between the measurements and simulations are generally good. Both of the inspiration and expiration flows are heavily influenced by the combination of geometrical bifurcating/merging, local wall curvature, limited generation length and multi-generation interaction. The mainstream flow is non-uniform and behaves as skewed, double-peaked and M-shaped patterns. The secondary flow is complex and characteristic of Dean-type two-vortex, four-vortex, six-vortex and eight-vortex patterns. This work is of scientific significance for a deep understanding of respiratory flow physics and of certain application values for clinical diagnosis and remedy of respiratory deceases.


Assuntos
Expiração , Inalação , Pulmão , Modelos Biológicos , Adulto , Simulação por Computador , Expiração/fisiologia , Humanos , Inalação/fisiologia , Pulmão/anatomia & histologia , Pulmão/fisiologia , Masculino
13.
Gait Posture ; 68: 449-452, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30597447

RESUMO

BACKGROUND: There is a link between breathing and balance and posture. When the inspiratory loads are increased by pathologies, there is a decrease of postural control. The increase of the inspiratory load on respiratory muscles is a common feature in various chronic pulmonary pathologies. Consequently, the balance of those patients is likely affected. RESEARCH QUESTION: The aim of this study is to validate the use of the Nintendo Wii Balance Board (WBB) to assess balance modifications induced by increased respiratory loads in healthy subjects. METHODS: Thirty-seven healthy young participants (25 ± 4 years old, 17 women) participated in this study. Five different conditions were tested: without anything (control), throughout a mouthpiece, and throughout three inspiratory threshold loads (ITL) at 10% (low), 40% (mid) and 60% (high) of the maximal inspiratory pressure. Each trial lasted for 60 s. Nine parameters were extracted based on center of pressure displacement based on a previously-validated method. ANOVA tests were used to compare the different conditions followed by Bonferroni's corrections. RESULTS: Highly statistically significant differences (all p < 0.01) and large effect sizes (all ω2 > 0.24) were obtained for all parameters between the different loads and the mouthpiece condition. There is a linear relationship between the load and balance perturbation. SIGNIFICANCE: In this study, we demonstrated the validity of the WBB to detect the effect of the inspiratory load on balance in young healthy subjects. Further studies are needed to determine if such a kind of evaluation can be used in clinics with patients suffering from chronic respiratory disease.


Assuntos
Inalação/fisiologia , Equilíbrio Postural/fisiologia , Postura/fisiologia , Jogos de Vídeo , Adulto , Análise de Variância , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pressões Respiratórias Máximas , Adulto Jovem
14.
Respir Physiol Neurobiol ; 261: 9-14, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30583067

RESUMO

The role of pulmonary stretch receptor discharge and volume feedback in modulation of tracheobronchial cough is not fully understood. The current study investigates the effect of expiratory occlusion with or without preceding inspiratory resistance (delivery of tidal or cough volume by the ventilator lasting over the active cough expiratory period) on the cough motor pattern. Experiments on 9 male cats under pentobarbital sodium anesthesia have shown that inspiratory resistance followed by expiratory occlusion increased cough inspiratory and expiratory efforts and prolonged several time intervals (phases) related to muscle activation during cough. Expiratory occlusion (at regular cough volume) decreased number of coughs, increased amplitudes of abdominal electromyographic activity, inspiratory and expiratory esophageal pressure during cough and significantly prolonged cough temporal features. Correlation analysis supported major changes in cough expiratory effort and timing due to the occlusion. Our results support a high importance of volume feedback, including that during cough expulsion, for generation and modulation of cough motor pattern with obstruction or expiratory airway resistances, the conditions present during various pulmonary diseases.


Assuntos
Músculos Abdominais/fisiopatologia , Tosse/fisiopatologia , Expiração/fisiologia , Inalação/fisiologia , Músculos Respiratórios/fisiopatologia , Anestesia , Animais , Brônquios/fisiopatologia , Gatos , Eletromiografia , Masculino , Movimento/fisiologia , Reflexo/fisiologia , Volume de Ventilação Pulmonar/fisiologia , Traqueia/fisiopatologia , Ventiladores Mecânicos
15.
J Neurol ; 266(1): 133-147, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30430231

RESUMO

BACKGROUND: In patients with late-onset Pompe disease, progressive respiratory muscle weakness with predominantly diaphragmatic involvement is a frequent finding at later stages of the disease. Respiratory muscle training (RMT) is an established therapy option for patients with several neuromuscular disorders including Duchenne muscular dystrophy. Forced voluntary muscle contractions of inspiration and/or expiration muscles enhance ventilation by increasing respiratory coordination, endurance, and strength. Efficacy of RMT in LOPD is rarely examined, and the clinical studies performed are difficult to compare because of different training programs and protocols. This impedes a useful statement and recommendation about the safety and efficacy of respiratory muscle training. METHODS: We conducted a monocentric unblinded single-arm pilot study in patients with LOPD to evaluate the safety and efficacy of inspiratory muscle training (IMT). The primary objective was to determine the efficacy of a 6-week repetitive IMT with a gradual increase of inspiratory resistance, measured by MIP (maximum inspiratory pressure) in the upright position. For statistical analysis, we used an A-B-C single subject design. The 6-week training-period A was followed by a 6-week non-training period B and an optional training period of 40 weeks in period C. The total study duration for the periods A, B and C was 52 weeks. Throughout the study, spirometry assessments (FCV, FEV1) and measurements of respiratory strength (MIP, MEP) were performed at defined time points, as well as capillary oximetry and capnometry, motor function test and patient's questionnaires for quality of life and dyspnea, measured by St. George's Respiratory Questionnaire (SGRQ) and MMRC-Dyspnea scale. For the cross-sectional comparison, a paired two-sided t test, and for the longitudinal comparison, a two-sample, two-sided t test were used. When data were not normally distributed, a Wilcoxon-Mann-Whitney test was added. Finally, the annual decline in FVC and FEV1 before and after IMT was compared. FINDINGS: 11 subjects were included in this pilot study. Overall, IMT was well tolerated. In four subjects, a total of six adverse events related to the study procedures were noticed. Training compliance was excellent in the first weeks of training, but declined continuously in the extension period. There was a significant increase in our primary outcome measure MIP within the 6-week period of frequent IMT with a mean of 15.7% (p =0.024; d =0.402). A significant increase was also seen after week 52 by a mean of + 26.4% (mean + 13.4 cmH2O, p =0.001, d =0.636). In the 6-week non-training interim-period (period B), the values remained stable, and there was no clinically meaningful decline in secondary outcome measures. The increase in MIP did not have any effect on secondary outcome measures like spirometry tests (FVC, FEV1), capillary blood gas analysis, motor function tests, patient's perceived quality of life or any significant change in dyspnea score. CONCLUSIONS: Frequent IMT improves MIP and thereby stabilizes and decelerates the decline of the diaphragm strength. The gradual increase of inspiratory resistance is well tolerated without any increase of side effects, as long as IMT is supervised and resistance is individually adjusted to the patient's perceived grade of exhaustion. Although we could not detect a significant impact on secondary outcome measures, IMT should be offered to all LOPD patients, especially to those who demonstrate a progressive decline in respiratory muscle function or are unable to receive ERT.


Assuntos
Exercícios Respiratórios , Doença de Depósito de Glicogênio Tipo II/terapia , Inalação , Gasometria , Exercícios Respiratórios/efeitos adversos , Exercícios Respiratórios/métodos , Estudos Transversais , Dispneia/fisiopatologia , Feminino , Doença de Depósito de Glicogênio Tipo II/fisiopatologia , Humanos , Inalação/fisiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Atividade Motora , Fadiga Muscular , Debilidade Muscular/fisiopatologia , Debilidade Muscular/terapia , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida , Músculos Respiratórios/fisiopatologia , Espirometria , Resultado do Tratamento
16.
Neuroscience ; 397: 1-11, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30500613

RESUMO

The inspiratory motor activities are greater in the intercostal muscles positioned at more rostral thoracic segments. This rostro-caudal gradient of the thoracic inspiratory motor activity is thought to be generated by the spinal interneurons. To clarify the involvement of the inhibitory thoracic interneurons in this rostro-caudal gradient, we examined the effects of 10 µM strychnine, an antagonist of glycine and GABAA receptors, applied to the neonatal rat thoracic spinal cord. The respiratory-related interneuron activities were optically recorded from thoracic segments in the isolated neonatal rat brainstem-spinal cord preparations stained with voltage-sensitive dye, and the electrical inspiratory motor activities were obtained from the third and eleventh thoracic ventral roots (T3VR, T11VR). Although strychnine caused seizure-like activities in all of the ventral roots recorded, the inspiratory motor activities continued. The inspiratory optical signals in the rostral thoracic segments (T2-T5) were significantly larger than those in the caudal thoracic segments (T9-T11) regardless of the existence of strychnine. Similarly, the percent ratio of the amplitude of the inspiratory electrical activity in the T3VR under control and strychnine was significantly larger than that in the T11VR regardless of the existence of strychnine. Strychnine significantly increased the inspiratory activity in both the T3VR and T11VR. These results suggest that the glycinergic and GABAergic inhibitory interneurons are not essential to generate the rostro-caudal gradient in the neonatal rat thoracic inspiratory motor outputs, but these interneurons are likely to play a role in the inhibitory control of inspiratory motor output.


Assuntos
Inalação/fisiologia , Interneurônios/fisiologia , Movimento/fisiologia , Inibição Neural/fisiologia , Músculos Respiratórios/fisiologia , Raízes Nervosas Espinhais/fisiologia , Animais , Animais Recém-Nascidos , Tronco Encefálico/efeitos dos fármacos , Tronco Encefálico/fisiologia , Glicina/metabolismo , Inalação/efeitos dos fármacos , Interneurônios/efeitos dos fármacos , Movimento/efeitos dos fármacos , Inibição Neural/efeitos dos fármacos , Neurotransmissores/farmacologia , Ratos Wistar , Receptores de GABA-A/metabolismo , Receptores da Glicina/antagonistas & inibidores , Receptores da Glicina/metabolismo , Músculos Respiratórios/efeitos dos fármacos , Músculos Respiratórios/inervação , Convulsões/fisiopatologia , Raízes Nervosas Espinhais/efeitos dos fármacos , Estricnina/farmacologia , Vértebras Torácicas , Técnicas de Cultura de Tecidos , Imagens com Corantes Sensíveis à Voltagem , Ácido gama-Aminobutírico/metabolismo
17.
Exp Physiol ; 104(2): 180-188, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30462876

RESUMO

NEW FINDINGS: What is the central question of this study? Increased respiratory muscle activation is associated with neural and cardiovascular consequences via the respiratory muscle metaboreflex. Does increased sympathetic vasoconstriction originating from the respiratory musculature elicit a reduction in blood flow to an inactive limb in order to maintain blood flow to an active limb? What is the main finding and its importance? Arm blood flow was reduced whereas leg blood flow was preserved during mild leg exercise with inspiratory resistance. Blood flow to the active limb is maintained via sympathetic control of blood flow redistribution when the respiratory muscle-induced metaboreflex is activated. ABSTRACT: The purpose of this study was to elucidate the effect of increasing inspiratory muscle work on blood flow to inactive and active limbs. Healthy young men (n = 10, 20 ± 2 years of age) performed two bilateral dynamic knee-extension and knee-flexion exercise tests at 40% peak oxygen uptake for 10 min. The trials consisted of spontaneous breathing for 5 min followed by voluntary hyperventilation either with or without inspiratory resistance for 5 min (40% of maximal inspiratory mouth pressure, inspiratory duty cycle of 50% and a breathing frequency of 40 breaths min-1 ). Mean arterial blood pressure was acquired using finger photoplethysmography. Blood flow in the brachial artery (inactive limb) and in the femoral artery (active limb) were monitored using Doppler ultrasound. Mean arterial blood pressure during exercise was higher (P < 0.05) with inspiratory resistance (121 ± 7 mmHg) than without resistance (99 ± 5 mmHg). Brachial artery blood flow increased during exercise without inspiratory resistance (120 ± 31 ml min-1 ) compared with the resting level, whereas it was attenuated with inspiratory resistance (65 ± 43 ml min-1 ). Femoral artery blood flow increased at the onset of exercise and was maintained throughout exercise without inspiratory resistance (2576 ± 640 ml min-1 ) and was unchanged when inspiratory resistance was added (2634 ± 659 ml min-1 ; P > 0.05). These results suggest that sympathetic control of blood redistribution to active limbs is facilitated, in part, by the respiratory muscle-induced metaboreflex.


Assuntos
Exercício/fisiologia , Extremidades/fisiologia , Músculo Esquelético/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Músculos Respiratórios/fisiologia , Trabalho Respiratório/fisiologia , Adulto , Pressão Arterial/fisiologia , Teste de Esforço/métodos , Artéria Femoral/metabolismo , Artéria Femoral/fisiologia , Humanos , Inalação/fisiologia , Joelho/fisiologia , Masculino , Fadiga Muscular/fisiologia , Músculo Esquelético/metabolismo , Oxigênio/metabolismo , Reflexo/fisiologia , Respiração , Músculos Respiratórios/metabolismo , Descanso/fisiologia , Sistema Nervoso Simpático/metabolismo , Sistema Nervoso Simpático/fisiologia , Resistência Vascular/fisiologia , Adulto Jovem
18.
Physiology (Bethesda) ; 34(1): 14-29, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30540236

RESUMO

Air-breathing in vertebrates has evolved many times among the bony fish while in water. Its appearance has had a fundamental impact on the regulation of ventilation and acid-base status. We review the physico-chemical constraints imposed by water and air, place the extant air-breathing fish into this framework, and show how that the advantages of combining control of ventilation and acid-base status are only available to the most obligate of air-breathing fish, thus highlighting promising avenues for research.


Assuntos
Expiração/fisiologia , Inalação/fisiologia , Vertebrados/fisiologia , Ar , Animais , Humanos , Respiração , Água/metabolismo
19.
Arch Dis Child Fetal Neonatal Ed ; 104(3): F280-F284, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30032105

RESUMO

OBJECTIVE: To describe the incidence of patient-ventilator asynchrony and different types of asynchrony in preterm infants treated with non-synchronised nasal intermittent positive pressure ventilation (nIPPV). DESIGN: An observational study was conducted including preterm infants born with a gestational age (GA) less than 32 weeks treated with non-synchronised nIPPV. During 1 hour, spontaneous breathing was measured with transcutaneous electromyography of the diaphragm simultaneous with ventilator inflations. An asynchrony index (AI), a percentage of asynchronous breaths, was calculated and the incidence of different types of inspiratory and expiratory asynchrony were reported. RESULTS: Twenty-one preterm infants with a mean GA of 26.0±1.2 weeks were included in the study. The mean inspiratory AI was 68.3%±4.7% and the mean expiratory AI was 67.1%±7.3%. Out of 5044 comparisons of spontaneous inspirations and mechanical inflations, 45.3% of the mechanical inflations occurred late, 23.3% of the mechanical inflations were early and 31.4% of the mechanical inflation were synchronous. 40.3% of 5127 expiratory comparisons showed an early termination of ventilator inflations, 26.7% of the mechanical inflations terminated late and 33.0% mechanical inflations terminated in synchrony with a spontaneous expiration. In addition, 1380 spontaneous breaths were unsupported and 611 extra mechanical inflations were delivered. CONCLUSION: Non-synchronised nIPPV results in high patient-ventilator asynchrony in preterm infants during both the inspiratory and expiratory phase of the breathing cycle. New synchronisation techniques are urgently needed and should address both inspiratory and expiratory asynchrony.


Assuntos
Recém-Nascido Prematuro/fisiologia , Ventilação com Pressão Positiva Intermitente/efeitos adversos , Mecânica Respiratória/fisiologia , Ventiladores Mecânicos/efeitos adversos , Eletromiografia , Expiração/fisiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Inalação/fisiologia , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/métodos , Ventilação com Pressão Positiva Intermitente/métodos , Masculino
20.
Respir Physiol Neurobiol ; 259: 45-52, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30041019

RESUMO

OBJECTIVES: To assess the correlation between surface respiratory electromyography(sEMG) and esophageal diaphragm electromyography(EMGdi) at different levels of neural respiratory drive (NRD). DESIGN: Randomised parallel design controlled trial. SETTING: The First Affiliated Hospital of Guangzhou Medical University. PARTICIPANTS: 15 healthy subjects and 1 severe to very severe stable COPD patients were studied. INTERVENTIONS: 15 healthy subjects performed incremental inspiratory threshold loading (ILT) and 15 stable COPD patients underwent noninvasive positive pressure ventilation (NPPV).The correlation between EMGdi and sEMG at different NRD levels was analyzed. EMGdi was performed with a multi-pair esophageal electrode catheter; sEMG were was performed by surface diaphragm EMG(located in right anterior axillary line and left anterior axillary line respectively expressed as sEMGdi(r) andsEMGdi(l))、surface parasternal EMG(sEMGpara),and surface sternocleidomastoid EMG(sEMGsc).Signals were normalized using the peak EMG expressed as EMG%max. PRIMARY AND SECONDARY OUTCOME MEASURES: The mean ± standard deviation resting EMGdi%max was higher in patients with COPD than in healthy subjects (57.26%±15.45% vs13.64% ±4.96%, respectively; p < 0.001).During ILT and NPPV, EMGdi was correlated with sEMGdi (r), sEMGdi (1), sEMGpara and sEMGsc (r = 0.90, 0.87, 0.90, 0.90 and r = 0.92, 0.83, 0.92 and 0.71, respectively; all P < 0.001). CONCLUSION: A strong relationship is present between NRD measured by EMGdi%max and NRD measured by sEMG%max. sEMG%max serves as a non-invasive marker of NRD.


Assuntos
Correlação de Dados , Diafragma/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/patologia , Corticosteroides/uso terapêutico , Adulto , Idoso , Diafragma/efeitos dos fármacos , Eletromiografia , Feminino , Humanos , Inalação/efeitos dos fármacos , Inalação/fisiologia , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica/terapia , Testes de Função Respiratória
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