Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality

BackgroundChest ultrasonography has proven to be useful in the diagnosis of diaphragm dysfunction. The aim of the present study was to determine the normal values of the motion of both hemidiaphragms recorded by M-mode ultrasonography.MethodsHealthy volunteers were studied while in a seated position. Diaphragmatic excursions and diaphragm profiles were measured during quiet breathing, voluntary sniffing, and deep breathing. Diaphragmatic excursions were assessed by M-mode ultrasonography, using an approach perpendicular to the posterior part of the diaphragm. Anatomical M-mode was used for the recording of the complete excursion during deep breathing.ResultsThe study included 270 men and 140 women. The diaphragmatic motions during quiet breathing and voluntary sniffing were successfully recorded in all of the participants. The use of anatomical M-mode was particularly suitable for measurement of the entire diaphragmatic excursion during deep breathing. The statistical analysis showed that the diaphragmatic excursions were larger in men compared to women, supporting the determination of normal values based on gender. The lower and upper limits of normal excursion were determined for men and women for both hemidiaphragms during the three maneuvers that were investigated. The lower limits of normal diaphragmatic excursions during deep breathing should be used to detect diaphragmatic hypokinesia, i.e., 3.3 and 3.2 cm in women and 4.1 and 4.2 cm in men for the right and the left sides, respectively.ConclusionThe normal values of the diaphragmatic motion and the lower and upper limits of normal excursion can be used by clinicians to detect diaphragmatic dysfunction.

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Ultrasound Assessment of Diaphragm Thickness and Thickening: Reference Values and Limits of Normality When in a Seated Position

Frontiers in Medicine ◽

10.3389/fmed.2021.742703 ◽

2021 ◽

Vol 8 ◽

Author(s):

Alain Boussuges ◽

Sarah Rives ◽

Julie Finance ◽

Guillaume Chaumet ◽

Nicolas Vallée ◽

...

Keyword(s):

Healthy Volunteers ◽

Normal Values ◽

Deep Breathing ◽

Diaphragm Thickness ◽

Quiet Breathing ◽

Men And Women ◽

Mean Values ◽

Diaphragmatic Function ◽

The Mean ◽

The Right

Background: Diagnosing diaphragm dysfunction in the absence of complete paralysis remains difficult. The aim of the present study was to assess the normal values of the thickness and the inspiratory thickening of both hemidiaphragms as measured by ultrasonography in healthy volunteers while in a seated position.Methods: Healthy volunteers with a normal pulmonary function test were recruited. The diaphragmatic thickness was measured on both sides at the zone of apposition of the diaphragm to the rib cage during quiet breathing at end-expiration, end-inspiration, and after maximal inspiration. The thickening ratio, the thickening fraction, and the thickness at end-inspiration divided by the thickness at deep breathing were determined. The mean values and the lower and upper limits of normal were determined for men and women.Results: 200 healthy volunteers (100 men and 100 women) were included in the study. The statistical analysis revealed that women had a thinner hemidiaphragm than men on both sides and at the various breathing times studied. The lower limit of normality of the diaphragm thickness measured at end-expiration was estimated to be 1.3 mm in men and 1.1 mm in women, on both sides. The thickening fraction did not differ significantly between men and women. In men, it ranged from 60 to 260% on the left side and from 57 to 200% on the right side. In women, it ranged from 58 to 264% on the left side and from 60 to 229% on the right side. The lower limits of normality of the thickening fraction were determined to be 40 and 39% in men and 39 and 48% in women for the right and left hemidiaphragms, respectively. The upper limit for normal of the mean of both sides of the ratio thickness at end-inspiration divided by the thickness at deep breathing was determined to be 0.78 in women and 0.79 in men.Conclusion: The normal values of thickness and the indexes of diaphragmatic function should help clinicians with detecting diaphragm atrophy and dysfunction.

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Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease: the utility of ultrasound imaging

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562015000000266 ◽

2016 ◽

Vol 42 (2) ◽

pp. 88-94 ◽

Cited By ~ 16

Author(s):

Pauliane Vieira Santana ◽

Elena Prina ◽

André Luis Pereira Albuquerque ◽

Carlos Roberto Ribeiro Carvalho ◽

Pedro Caruso

Keyword(s):

Interstitial Lung Disease ◽

Lung Disease ◽

Ultrasound Imaging ◽

High Sensitivity ◽

Deep Breathing ◽

Diaphragm Thickness ◽

Quiet Breathing ◽

Diaphragmatic Dysfunction ◽

Lung Capacity ◽

Residual Capacity

Objective: To investigate the applicability of ultrasound imaging of the diaphragm in interstitial lung disease (ILD). Methods: Using ultrasound, we compared ILD patients and healthy volunteers (controls) in terms of diaphragmatic mobility during quiet and deep breathing; diaphragm thickness at functional residual capacity (FRC) and at total lung capacity (TLC); and the thickening fraction (TF, proportional diaphragm thickening from FRC to TLC). We also evaluated correlations between diaphragmatic dysfunction and lung function variables. Results: Between the ILD patients (n = 40) and the controls (n = 16), mean diaphragmatic mobility was comparable during quiet breathing, although it was significantly lower in the patients during deep breathing (4.5 ± 1.7 cm vs. 7.6 ± 1.4 cm; p < 0.01). The patients showed greater diaphragm thickness at FRC (p = 0.05), although, due to lower diaphragm thickness at TLC, they also showed a lower TF (p < 0.01). The FVC as a percentage of the predicted value (FVC%) correlated with diaphragmatic mobility (r = 0.73; p < 0.01), and an FVC% cut-off value of < 60% presented high sensitivity (92%) and specificity (81%) for indentifying decreased diaphragmatic mobility. Conclusions: Using ultrasound, we were able to show that diaphragmatic mobility and the TF were lower in ILD patients than in healthy controls, despite the greater diaphragm thickness at FRC in the former. Diaphragmatic mobility correlated with ILD functional severity, and an FVC% cut-off value of < 60% was found to be highly accurate for indentifying diaphragmatic dysfunction on ultrasound.

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Diaphragmatic dysfunction associates with dyspnoea, fatigue, and hiccup in haemodialysis patients: a cross-sectional study

Scientific Reports ◽

10.1038/s41598-019-56035-4 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Bin Wang ◽

Qing Yin ◽

Ying-yan Wang ◽

Yan Tu ◽

Yuchen Han ◽

...

Keyword(s):

Cross Sectional Study ◽

Deep Breathing ◽

Sectional Study ◽

Quiet Breathing ◽

Diaphragmatic Dysfunction ◽

Cross Sectional ◽

Diaphragm Dysfunction ◽

Mortality And Morbidity ◽

Lung Capacity ◽

Diaphragmatic Function

AbstractMuscle wasting is associated with increased mortality and morbidity in chronic kidney disease (CKD) patients, especially in the haemodialysis (HD) population. Nevertheless, little is known regarding diaphragm dysfunction in HD patients. We conducted a cross-sectional study at the Institute of Nephrology, Southeast University, involving 103 HD patients and 103 healthy volunteers as normal control. Ultrasonography was used to evaluate diaphragmatic function, including diaphragm thickness and excursion during quiet and deep breathing. HD patients showed lower end-inspiration thickness of the diaphragm at total lung capacity (0.386 ± 0.144 cm vs. 0.439 ± 0.134 cm, p < 0.01) and thickening fraction (TF) (0.838 ± 0.618 vs. 1.127 ± 0.757; p < 0.01) compared to controls. The velocity and excursion of the diaphragm were significantly lower in the HD patients during deep breathing (3.686 ± 1.567 cm/s vs. 4.410 ± 1.720 cm/s, p < 0.01; 5.290 ± 2.048 cm vs. 7.232 ± 2.365 cm; p < 0.05). Changes in diaphragm displacement from quiet breathing to deep breathing (△m) were lower in HD patients than in controls (2.608 ± 1.630 vs. 4.628 ± 2.110 cm; p < 0.01). After multivariate adjustment, diaphragmatic excursion during deep breathing was associated with haemoglobin level (regression coefficient = 0.022; p < 0.01). We also found that the incidence of dyspnoea and hiccup and the fatigue scores, all of which were related to diaphragmatic dysfunction, were significantly higher in HD patients than in controls (all p < 0.01). Improving diaphragm function through targeted therapies may positively impact clinical outcomes in HD patients.

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Comparison of the Aditus ad Antrum Diameter on CT between Patients with Chronic Otitis Media and Healthy Individuals

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405615666190327110216 ◽

2019 ◽

Vol 15 (10) ◽

pp. 990-993 ◽

Cited By ~ 1

Author(s):

Elif Gündoğdu ◽

Uğur Toprak

Keyword(s):

Computed Tomography ◽

Otitis Media ◽

Middle Ear ◽

Healthy Subjects ◽

Normal Values ◽

Chronic Otitis Media ◽

Healthy Individuals ◽

Inner Diameter ◽

Male Patients ◽

The Right

Background: The middle ear cavity is ventilated through the aditus ad antrum. Aditus blockage contributes to the pathology of otitis media. Objective: To determine the normal values of the aditus ad antrum diameter on computed tomography and to investigate its relationship with chronic otitis media and related pathologies (tympanosclerosis and myringosclerosis). Methods: The temporal CT images of 162 individuals were evaluated retrospectively. In the axial sections, the inner diameter of the aditus was measured at the narrowest point at the cortex. The differences in diameter were compared between diseased and healthy ears. Results: In healthy individuals, the diameter was narrower in women. There was no difference between the right and left ears in healthy subjects. No correlation was found between age and diameter. In male patients with myringosclerosis, the diameter was slightly narrower on both sides but more marked on the left. In female patients with myringosclerosis, the diameter in both ears was slightly narrower. In cases of otitis media and tympanosclerosis, the diameter was less than that of healthy individuals, despite the lack of statistically significant result in all cases. Conclusion: The aditus ad antrum was narrower in diseased ears, indicating that a blocked aditus may contribute to the development of otitis media, as well as mucosal diseases.

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Feasability of Diaphragmatic Speckle Tracking In Intensive Care Units

10.21203/rs.3.rs-957574/v1 ◽

2021 ◽

Author(s):

Michael Poette ◽

Laure Crognier ◽

Fanny Vardon-Bounes ◽

Stéphanie Ruiz ◽

Bernard Georges ◽

...

Keyword(s):

Intensive Care ◽

Strain Rate ◽

Intensive Care Units ◽

Strongly Correlated ◽

Diaphragmatic Dysfunction ◽

Good Reliability ◽

Diaphragmatic Function ◽

Strain And Strain Rate ◽

Measured Strain ◽

The Right

Abstract Background: Diaphragmatic dysfunction is a common condition in intensive care units (ICU). Its presence correlates with prolonged weaning from mechanical ventilation and mortality. Diaphragmatic excursion (EXdi) and thickening fraction (TFdi) are the 2 main measures currently described in diaphragmatic ultrasound, but each has its limitations. Strain and strain rate are already used cardiac sonography and could be of interest in the assessment of diaphragmatic function in ICU. The aim of this work was to evaluate the feasibility of diaphragmatic strain and strain rate in ICU and to describe their distribution, reproducibility and agreement with existing parameters. Methods: All patients who underwent a T-tube weaning test were prospectively included. Ultrasound loops were recorded on each side of the patient during the last 30 minutes of the weaning test. Two operators measured strain, strain rate, EXdi, and TFdi blind to each other in post-treatment analysis. Results: Thirty patients were analyzed. The median values for strain and strain rate were -6.74% and -0.23.s-1 on the left side and -8.17% and -0.22.s-1 on the right side. Concerning strain and strain rate, intra-class coefficients showed systematically a very good reliability between operators. Conclusion: Diaphragmatic strain and strain rate measurements appeared feasible in an ICU environment and seemed reproducible and not strongly correlated with EXdi and TFdi. An improvement of the analysis software is needed to improve the ease of interpretation. The interest of these parameters in clinical practice should be explored in forthcoming studies.

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The selective contribution of the right cerebellar lobule VI to reading

10.31234/osf.io/2fxvs ◽

2021 ◽

Author(s):

Hehui Li ◽

Rebecca A. Marks ◽

Lanfang Liu ◽

Jia Zhang ◽

Hejing Zhong ◽

...

Keyword(s):

Phonological Processing ◽

Posterior Part ◽

Chinese Characters ◽

Functional Magnetic Resonance ◽

Resonance Imaging ◽

Viewing Condition ◽

Activation Patterns ◽

English Bilingual ◽

Passive Viewing ◽

The Right

Extensive studies have reported significant cerebellar activation during reading tasks. However, it is still unclear which regions in the cerebellum are specifically involved in reading and what this involvement entails. With functional magnetic resonance imaging, we compared Chinese-English bilingual children’s cerebellar neural activity between reading and non-reading conditions and between Chinese characters and English words in a passive viewing paradigm. We observed that the posterior part of the right lobule VI showed greater activation in the reading compared to non-reading tasks. Reading specificity index was significantly in this region. Functional decoding via Neurosynth further showed that this region was responsible for phonological processing and connected with the cerebral reading areas. These results suggest that the posterior part of the right lobule VI might be a reading-selective region in the cerebellum. However, we did not observe any significantly separable activation patterns in the cerebellum between Chinese characters and English words, indicating that the region preferentially responding to reading may not be able to differentiate scripts in a passive viewing condition. In general, these findings deepen our understanding of how the cerebellum contributes to reading.

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Regional ventilation characteristics during non-invasive respiratory support in preterm infants

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-320449 ◽

2020 ◽

pp. fetalneonatal-2020-320449

Author(s):

Jessica Thomson ◽

Christoph M Rüegger ◽

Elizabeth J Perkins ◽

Prue M Pereira-Fantini ◽

Olivia Farrell ◽

...

Keyword(s):

Oxygen Saturation ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Repeated Measure ◽

Regional Ventilation ◽

Quiet Breathing ◽

Impedance Tomography ◽

Non Invasive ◽

Ventilation Inhomogeneity ◽

The Right

ObjectivesTo determine the regional ventilation characteristics during non-invasive ventilation (NIV) in stable preterm infants. The secondary aim was to explore the relationship between indicators of ventilation homogeneity and other clinical measures of respiratory status.DesignProspective observational study.SettingTwo tertiary neonatal intensive care units.PatientsForty stable preterm infants born <30 weeks of gestation receiving either continuous positive airway pressure (n=32) or high-flow nasal cannulae (n=8) at least 24 hours after extubation at time of study.InterventionsContinuous electrical impedance tomography imaging of regional ventilation during 60 min of quiet breathing on clinician-determined non-invasive settings.Main outcome measuresGravity-dependent and right–left centre of ventilation (CoV), percentage of whole lung tidal volume (VT) by lung region and percentage of lung unventilated were determined for 120 artefact-free breaths/infant (4770 breaths included). Oxygen saturation, heart and respiratory rates were also measured.ResultsVentilation was greater in the right lung (mean 69.1 (SD 14.9)%) total VT and the gravity-non-dependent (ND) lung; ideal–actual CoV 1.4 (4.5)%. The central third of the lung received the most VT, followed by the non-dependent and dependent regions (p<0.0001 repeated-measure analysis of variance). Ventilation inhomogeneity was associated with worse peripheral capillary oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (p=0.031, r2 0.12; linear regression). In those infants that later developed bronchopulmonary dysplasia (n=25), SpO2/FiO2 was worse and non-dependent ventilation inhomogeneity was greater than in those that did not (both p<0.05, t-test Welch correction).ConclusionsThere is high breath-by-breath variability in regional ventilation patterns during NIV in preterm infants. Ventilation favoured the ND lung, with ventilation inhomogeneity associated with worse oxygenation.

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Upper limits on the water vapour content of the β Pictoris debris disk

Astronomy and Astrophysics ◽

10.1051/0004-6361/201935655 ◽

2019 ◽

Vol 628 ◽

pp. A127 ◽

Cited By ~ 3

Author(s):

M. Cavallius ◽

G. Cataldi ◽

A. Brandeker ◽

G. Olofsson ◽

B. Larsson ◽

...

Keyword(s):

Solar System ◽

Far Infrared ◽

Kinetic Temperature ◽

Line Flux ◽

Water Vapour Content ◽

Water Ice ◽

Upper Limit ◽

Upper Limits ◽

Debris Disk ◽

Lower Limits

Context. The debris disk surrounding β Pictoris has been observed with ALMA to contain a belt of CO gas with a distinct peak at ~85 au. This CO clump is thought to be the result of a region of enhanced density of solids that collide and release CO through vaporisation. The parent bodies are thought to be comparable to solar system comets, in which CO is trapped inside a water ice matrix. Aims. Since H2O should be released along with CO, we aim to put an upper limit on the H2O gas mass in the disk of β Pictoris. Methods. We used archival data from the Heterodyne Instrument for the Far-Infrared (HIFI) aboard the Herschel Space Observatory to study the ortho-H2O 110–101 emission line. The line is undetected. Using a python implementation of the radiative transfer code RADEX, we converted upper limits on the line flux to H2O gas masses. The resulting lower limits on the CO/H2O mass ratio are compared to the composition of solar system comets. Results. Depending on the assumed gas spatial distribution, we find a 95% upper limit on the ortho-H2O line flux of 7.5 × 10−20 W m−2 or 1.2 × 10−19 W m−2. These translate into an upper limit on the H2O mass of 7.4 × 1016–1.1 × 1018 kg depending on both the electron density and gas kinetic temperature. The range of derived gas-phase CO/H2O ratios is marginally consistent with low-ratio solar system comets.

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Vertical zonation of the hydroid Dynamena crisioides (Hydrozoa, Sertulariidae) in a mangrove ecosystem at Twin Cays, Belize

Canadian Journal of Zoology ◽

10.1139/z91-422 ◽

1991 ◽

Vol 69 (12) ◽

pp. 2993-2999 ◽

Cited By ~ 6

Author(s):

Dale R. Calder

Keyword(s):

Intertidal Zone ◽

Prime Factor ◽

Good Condition ◽

Mangrove Ecosystem ◽

Lower Half ◽

Upper Limits ◽

Shallow Subtidal ◽

Lower Limits ◽

Transplantation Experiments ◽

Number Of Branches

Dynamena crisioides is generally restricted to lower intertidal and shallow subtidal habitats along tropical and subtropical coasts. The hydroid was abundant during this study on prop roots of red mangroves (Rhizophora mangle) at Twin Cays, Belize, where it ranged vertically from 1.1 m below mean tide level (MTL) to 2–3 cm above MTL. The estimated percentage cover of the hydroid was maximal in the lower half of the intertidal zone (MTL and 0.1 m below MTL) and declined rapidly above and below that level. Colony height and number of branches per colony were also consistently highest in hydroids from the lower half of the intertidal zone. The percentage of colonies with gonophores was lowest at the lower and upper vertical limits of the species. Field observations and transplantation experiments suggest that the lower limits of D. crisioides are established by competition for space (with algae, sponges, and ascidians), smothering (by algae, sponges, ascidians, and other hydroids), and predation (by fishes). Desiccation was considered the prime factor determining the upper limits of the hydroid. Colonies transplanted to the supratidal zone were in good condition after 24 h, alive but in poor condition after 48 h, and dead after 72 and 96 h of exposure.

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A new genus Turneroconcha (Bivalvia: Vesicomyidae: Pliocardiinae) for the giant hydrothermal vent clam ‘Calyptogena’ magnifica

Zootaxa ◽

10.11646/zootaxa.4808.1.4 ◽

2020 ◽

Vol 4808 (1) ◽

pp. 79-100 ◽

Cited By ~ 1

Author(s):

ELENA M. KRYLOVA ◽

HEIKO SAHLING

Keyword(s):

Morphological Analysis ◽

New Genus ◽

Posterior Part ◽

Morphological Characters ◽

Morphological Data ◽

Monotypic Genus ◽

East Pacific ◽

Inhalant Siphon ◽

The Right ◽

Galapagos Rift

A new monotypic genus, Turneroconcha, is established for T. magnifica (Boss & Turner) which was originally assigned to the genus Calyptogena Dall. The distinguishing morphological characters of the new genus are the combination of both conchological and anatomical features including: the presence of only two tooth elements in the right valve; submerged location of the posterior part of the posterior lamellar ligament layer; the absence of a subumbonal pit, lunular incision, escutcheon and pallial sinus; the presence of both pairs of demibranchs; the tubular structure of marginal parts of the interlamellar septa in gills; an inner valve of the inhalant siphon without processes; tentaculate inner mantle fold 3 and a Z-shaped digestive tract. Analysis of morphological data on Recent and fossil pliocardiines shows that Turneroconcha gen. nov. can be presently considered as a monotypic genus. The comparative morphological analysis of the new genus with described pliocardiine genera is consistent with available molecular results. Turneroconcha gen. nov. is endemic to the East-Pacific Rise and Galapagos Rift and occurs at water depths of 2251 to 2791 m. It is the only pliocardiine genus known so far with a mainly epifaunal life habit. No fossils of Turneroconcha gen. nov. are known.

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