A 3D Reconstruction Algorithm for Real-time Simultaneous Multi-Source EIT Imaging for Lung Function Monitoring

Monitoring regional pulmonary ventilation and pulsatile perfusion changes in a 3D region of interest (ROI) of the lung is a promising application for electrical impedance tomography (EIT). This paper describes a 3D analytical reconstruction algorithm that was embedded in a prototype EIT system to enable a real-time image reconstruction at nearly 20 frames per second for monitoring impedance changes in the chest in real-time. The derivation and results of the 3D analytical forward solution and inverse solution and details of the real-time reconstruction algorithm are given. The algorithm and EIT system are validated with simulated data, in-vitro phantoms, and finally shown to be capable of imaging ventilation and pulsatile perfusion in human subjects. The human subject data was obtained using a high-precision, high-speed and simultaneous multiple current source (SMS-EIT) developed by GE Research. Data was collected using four rows of 8 electrodes for a healthy adult male subject and 2 rows of 16 electrodes for six healthy human female subjects, with one row placed above the breasts and a second row placed at the infra-mammary fold. Each of the female subjects performed a breathing maneuver with a volumetric incentive spirometer, and the volume of air inhaled was calculated from the EIT images. Pulsatile perfusion images were computed from this data, and regional lung filling was also analyzed.

Hyperventilation-induced heart rate response as a potential marker for cardiovascular disease

An increase of heart rate to physical or mental stress reflects the ability of the autonomous nervous system and the heart to respond adequately. Hyperventilation is a user-controlled breathing maneuver that has a significant impact on coronary function and hemodynamics. Thus, we aimed to investigate if the heart rate response to hyperventilation (HRRHV) can provide clinically useful information. A pooled analysis of the HRRHV after 60 s of hyperventilation was conducted in 282 participants including healthy controls; patients with heart failure (HF); coronary artery disease (CAD); a combination of both; or patients suspected of CAD but with a normal angiogram. Hyperventilation significantly increased heart rate in all groups, although healthy controls aged 55 years and older (15 ± 9 bpm) had a larger HRRHV than each of the disease groups (HF: 6 ± 6, CAD: 8 ± 8, CAD+/HF+: 6 ± 4, and CAD−/HF−: 8 ± 6 bpm, p < 0.001). No significant differences were found between disease groups. The HRRHV may serve as an easily measurable additional marker of cardiovascular health. Future studies should test its diagnostic potential as a simple, inexpensive pre-screening test to improve patient selection for other diagnostic exams.

Nanoparticle Deposition in Rhythmically Moving Acinar Models with Interalveolar Septal Apertures

Pulmonary delivery of nanomedicines has been extensively studied in recent years because of their enhanced biocompatibility, sustained-release properties, and surface modification capability. The lung as a target also offers many advantages over other routers, such as large surface area, noninvasive, quick therapeutic onset, and avoiding first-pass metabolism. However, nanoparticles smaller than 0.26 µm typically escape phagocytosis and remain in the alveoli for a long time, leading to particle accumulation and invoking tissue responses. It is imperative to understand the behavior and fates of inhaled nanoparticles in the alveoli to reliably assess therapeutic outcomes of nanomedicines or health risk of environmental toxins. The objective of this study is to numerically investigate nanoparticle deposition in a duct-alveolar model with varying sizes of inter-alveolar septal apertures (pores). A discrete phase Lagrangian model was implemented to track nanoparticle trajectories under the influence of rhythmic wall expansion and contraction. Both temporal and spatial dosimetry in the alveoli were computed. Wall motions are essential for nanoparticles to penetrate the acinar region and deposit in the alveoli. The level of aerosol irreversibility (i.e., mixing of inhaled nanoparticles with residual air in the alveolar airspace) is determined by the particle diffusivity, which in turn, dictates the fraction of particles being exhaled out. When deposition in the upper airways was not considered, high alveolar deposition rates (74–95%) were predicted for all nanoparticles considered (1–1000 nm), which were released into the alveoli at the beginning of the inhalation. The pore size notably affects the deposition pattern of inhaled nanoparticles but exerts a low impact upon the total deposition fractions. This finding indicates that consistent pulmonary doses of nanomedicine are possible in emphysema patients if breathing maneuver with the same tidal volume can be performed.

The The Impact of Upper Limb Training with Breathing Maneuver in Lung Function, Functional Capacity, Dyspnea Scale, and Quality of Life in Patient with Stable Chronic Obstructive of Lung Disease

BACKGROUND: Exercise tolerance is one of the main impacts of COPD. COPD patients often experience dyspnea and fatigue after doing daily activities using their limb parts, even in simple thing such as lifting or grooming. Nowadays, many pulmonologists concerned in pulmonary rehabilitation to modify some limb training with breathing manoeuvre to get positive impact in stable COPD patient. AIM: The purpose of this study is to examine the impact of this modified upper limb training in lung function, functional capacity, dyspnea scale, and quality of life in patients with stable COPD. METHOD: This was a quasi-experimental study held in 2017 on 22 stable COPD patients (based on GOLD 2018 criteria). Patients were given modified upper limb training with breathing manoeuvre that leads and monitored by a physiotherapist and physician in 10-20 minutes twice a week for 8 weeks. Before and after completed all sessions of training, we measured pulmonary functions test include FEV1 and FVC, functional capacity by 6 MWT, dyspnea scale by mMRC, and quality of life by CAT assessment. Statistical analysis was performed by Wilcoxon and paired t-test. RESULTS: There was an improvement of lung function, both FEV1 (40.7 ± 13.8 to 47.3 ± 14.2; p-value 0.001) and FVC (50.7 ± 14.1 to 54.1 ± 14.7; p-value: 0.207) after training. There was a significant change of functional capacity in 6 MWT mean (277.3 ± 80.8 to 319.1 ± 78.3; p-value: 0.001). There was an improved quality of life after training, measured by decreasing in CAT score (23.9 ± 5.5 to 18.3 ± 5.2; p-value: 0.000). There was no significant change in the mMRC scale (p-value: 0.429) CONCLUSION: There was an improvement of lung function, functional capacity, and quality of life in stable COPD after upper limb training with breathing manoeuvre in stable COPD patients.

The Impact of Pursed-lips Breathing Maneuver on Cardiac, Respiratory, and Oxygenation Parameters in COPD Patients

BACKGROUND: Respiratory system, together with the cardiovascular and central nervous system, is responsible for all processes related to oxygenation and hemodynamics and the defect in the functioning of each of these systems, along with ageing, can have mutual effects on their performance and physiological symptoms. The use of Pursed-lips Breathing (PLB) training is an essential part of the treatment of patients with the obstructive pulmonary disease, PLB stimulates the autonomic nervous system and causes relaxation and improvement of physiological parameters. AIM: This study was conducted to evaluate the effect of PLB on cardiac, pulmonary and oxygenation level in patients with Chronic Obstructive Pulmonary Disease (COPD). METHODS: A three-group clinical trial study with experimental and control which was purposefully conducted with the participation of patients with COPD and healthy individuals referring to Madani hospital Khoy, in 2017. The sample size was selected to be 60 subjects. The patients were randomly allocated to two groups of intervention and control with 20 patients, and 20 healthy subjects were assigned to the healthy intervention group. The demographic, anthropometric information form and checklist recording changes in levels of oxygenation, respiration, temperature, heart rate and blood pressure with cardiopulmonary follow up in three stages before, during and after PLB were used for data collection. Data were analysed using descriptive statistics, repeated measure test, ANOVA, and Chi-square. RESULTS: On evaluation within the COPD patient intervention group in Saturation of Peripheral Oxygen (SPO2) index with the mean difference of 2.05 percent, Respiratory Rate(RR)-0.65 minute and Pulse Rate(PR)-1.6 bpm was significant (p ≤ 0.05), and systolic blood pressure index in healthy subjects was increased (3.35 mmHg). CONCLUSION: The results of this study indicated that using effective PLB as an easy, inexpensive, non- invasive and non-pharmacological method is considered as an important factor in improving the status of oxygenation and physiological indicators in patients with COPD and should be considered as an important part of rehabilitation programs for these patients.

Acute Effect of Slow Deep Breathing Maneuver on Patient with Essential Hypertension Stage 1 and 2

Background: Hypertension remains one of the most common health issues in Indonesia. Slow deep breathing maneuver is a non-pharmacological therapy that achieves systolic and diastolic blood pressure lowering effect through sympathetic and parasymphathetic firing rate.Methods: This study was done using cross-sectional design, with consecutive sampling. Sample population was patients with hypertension stage 1 and 2, age range 40-55 years old, who came to Puskesmas Balaraja.Results: Systolic blood pressure lowered from 148.04+5.82 mmHg to 138.15+5.9 mmHg (p<0.05) and diastolic pressure lowered from 85+5.05 mmHg to 78.47+5.46 mmHg (p<0.05). This study showed that there is a relation between the manuever and lowering the systolic and diastolic blood pressure (p=0.000, on T-Test analytical study).Conclusion: Based on the data, the slow deep maneuver can be used as a non-pharmacological therapy for patients with hypertension. Because the effect is acute, it can be considered for hypertension crisis, but further studies are still needed.