Advances in Studies on Non-invasive Breath Detection in Screening of Colorectal Cancer / 胃肠病学

The incidence of colorectal cancer is increasing year by year in China, early screening and prevention is the key to improve the prognosis, but there is no ideal screening tool now. Non-invasive breath analysis based on volatile organic compounds (VOCs) has received much attention in recent years as a non-invasive diagnostic tool for a variety of cancers, including colorectal cancer. This article reviewed the current research status of the correlation between VOCs and colorectal cancer, aiming to evaluate the potential value of VOCs in the diagnosis of colorectal cancer, and provide theoretical basis for the exploration of early diagnosis of colorectal cancer.

Between-occasion repeatability of fractional exhaled nitric oxide measurements in children / Repetibilidade de medidas da fração de óxido nítrico exalado em crianças em duas ocasiões

ABSTRACT The aim of the study was to assess short-term repeatability of measurements of fractional exhaled nitric oxide (FENO) and its correlates in children in the 6- to 9-year age bracket participating in a respiratory epidemiological survey. FENO was measured in two sessions one week apart in 101 children. Participants were divided into three groups: asymptomatic (n = 76); symptomatic (n = 14); and asthma (n = 11). Absolute and relative differences between the measurements, as well as concordance correlation coefficients, were used in order to assess repeatability. The two FENO measurements were strongly correlated (0.98). Although intragroup comparisons of the two measurements were not significantly different (p = 0.2), intergroup comparisons were. FENO measurements are reproducible in children in epidemiological settings.

RESUMO O objetivo do estudo foi avaliar a repetibilidade em curto prazo de medidas da fração de óxido nítrico exalado (FENO) e seus correlatos em crianças de 6-9 anos participantes de uma pesquisa epidemiológica respiratória. A FENO foi medida em duas sessões, com uma semana de intervalo, em 101 crianças. Os participantes foram divididos em três grupos: assintomático (n = 76), sintomático (n = 14) e asma (n = 11). A repetibilidade foi avaliada por meio de diferenças absolutas e relativas entre as medidas, bem como por coeficientes de correlação de concordância. As duas medidas da FENO correlacionaram-se fortemente (0,98). Embora as comparações entre as duas medidas em um mesmo grupo não tenham sido significativamente diferentes (p = 0,2), as comparações entre os grupos o foram. Medidas da FENO são reprodutíveis em crianças em cenários epidemiológicos.

Comfort and exertion while using filtering facepiece respirators with exhalation valve and an active venting system among male military personnel

<p><b>INTRODUCTION</b>This study aimed to determine if disposable filtering facepiece respirators (FFRs) that come with an exhalation valve (EV) and a novel active venting system (AVS) provided greater perceived comfort and exertion when compared to standard N95 FFRs without these features among male military personnel performing prolonged essential outdoor duties.</p><p><b>METHODS</b>We used a randomised open-label controlled crossover study design to compare three FFR options: (a) standard FFR; (b) FFR with EV; and (c) FFR with EV+AVS. Male military personnel aged between 18 and 20 years completed a questionnaire at the start of outdoor duty (baseline), after two hours of standardised non-strenuous outdoor duty and after 12 hours of duty divided into two-hour work-rest cycles. Participants rated the degree of discomfort, exertion and symptoms using a five-point Likert scale. The association between outcomes and types of FFR was assessed using a multivariate ordered probit mixed-effects model.</p><p><b>RESULTS</b>For a majority of the symptoms, study participants gave FFR with EV and FFR EV+AVS significantly better scores than standard FFR. Both FFR with EV and FFR with EV+AVS had significantly less discomfort (FFR with EV+AVS: 91.1%; FFR with EV: 57.6%) and exertion (FFR with EV+AVS: 83.5%; FFR with EV: 34.4%) than standard FFR. FFR with EV+AVS also had significantly better scores for exertion (53.4%) and comfort (39.4%) when compared to FFR with EV.</p><p><b>CONCLUSION</b>Usage of FFR with EV+AVS resulted in significantly reduced symptoms, discomfort and exertion when compared to FFR with EV and standard FFR.</p>

Clincal significance of detection of FeNO levels applicated in the treatment of patients with bronchial asthma / 中国基层医药

Objective To investigate the role of exhaled nitric oxide (FeNO) detection in patients with bron-chial asthma,and to observe the correlation between FeNO level and pulmonary function .Methods The clinical data of 61 patients with acute exacerbation of bronchial asthma were retrospectively analyzed .The patients were included in the case group .According to the disease condition ,the patients were divided into mild asthma group ( 30 cases ) and moderate asthma group (31 cases).A total of 60 healthy people were selected as the control group .All the patients were given corresponding symptomatic treatment ,before and after treatment ,the FeNO and lung function were deter-mined in two groups.Results After treatment,the level of FeNO in the mild asthma group was (22.22 ±8.39)ppb, which was significantly lower than (35.21 ±10.84)ppb in the moderate asthma group (t=5.22,P=0.00).The levels of FEV1 and PEF in the mild asthma group were (2.49 ±0.38)%,(3.82 ±0.24)L/min,respectively,which in the moderate asthma group were (2.52 ±0.41)%,(3.74 ±0.35)L/min,respectively,the differences between the two groups were not statistically significant (t=0.29,1.03,P=0.76,0.30).The FeNO levels of the two groups after treatment were significantly lower than those before treatment ,and the FEV1 ,PEF levels were significantly higher than those before treatment (all P<0.05).Before treatment,the levels of FeNO,FEV1 and PEF in the case group were(50.41 ±30.09) ppb,(1.98 ±0.37)%,(3.24 ±0.36) L/min,respectively,which in the control group were (12.59 ±6.39)ppb,(2.79 ±0.34)%,(4.02 ±0.18)L/min,respectively,the differences were statistically signifi-cant between the two groups (t=9.52,12.53,15.03,P=0.00,0.00,0.00).After treatment,the levels of FeNO, FEV1 and PEF in the case group were (23.52 ±10.54)ppb,(2.81 ±0.35)%,(3.91 ±0.40)L/min,respectively, which in the control group were (12.59 ±6.39)ppb,(2.79 ±0.34)%,(4.02 ±0.18)L/min,respectively,the difference of FeNO between the two groups was statistically significant (t=6.88,P=0.00),the differences of FEV1 and PEF were not statistically significant between the two groups (t=0.31,1.94,P=0.75,0.05).The difference of FeNO between males and females was not statistically significant (P >0.05).There was a negative correlation between FeNO and FEV1 before treatment(r=-0.172,P=0.02),and FeNO negatively correlated with FEV (r=-0.163,P=0.01).There was no correlation between FeNO and FEV 1 after treatment(r=-0.031,P=0.754), independent of FEV(r=-0.141,P=0.09).Conclusion The level of FeNO is helpful to evaluate the severity of airway inflammation and lung function in bronchial asthma patients , and it is not related to sex .FeNO level is negatively correlated with pulmonary function ,and is helpful to evaluate the clinical efficacy .

Measurement of Exhaled Nitric Oxide in Children: A Comparison Between NObreath® and NIOX VERO® Analyzers

PURPOSE: Few studies have compared fractional exhaled nitric oxide (FeNO) measurement by NIOX VERO® (NOV) and other devices in children. Moreover, there is no agreement between differences in FeNO values obtained using different devices in adults. Here, we compared FeNO values obtained using NOV and NObreath® (NOB) systems to derive a correction equation for children. METHODS: Eighty-eight participants (age 7–15 years) who were diagnosed with atopic bronchial asthma and visited Sagamihara National Hospital as outpatients between January and April of 2017 were included. We measured FeNO values obtained using NOB and NOV, and analyzed them using Wilcoxon tests and Altman-Bland plots. RESULTS: The median age of the participants was 11.5 years, and the scored Asthma Control Test (ACT) or Childhood ACT (C-ACT) was 25 (interquartile range, 24–25) or 26 (24–27). NOB and NOV values were significantly different (31 [14–52] versus 36 [20–59] ppb; P = 0.020) and strongly correlated (r = 0.92). An equation to convert NOB values into NOV values was derived using linear regression as follows: log NOV = 0.7329 × log NOB + 0.4704; NOB for 20, 40, 58, 80 and 100 ppb corresponded to NOV for 27, 44, 59, 73 and 86 ppb. Thus, NOB 58 ppb suggested NOB > NOV. CONCLUSIONS: NOB and NOV values were strongly correlated. Participants whose FeNO values were relatively low represented NOB NOV.

Effect of independent breath-holding technology on target geometry in radiotherapy for liver cancer / 中华放射肿瘤学杂志

Objective To use the fusion image of the end-inhalation holding (EIH) phase and endexhalation holding (EEH) phase to define the target volume of individual patient with liver cancer,and to evaluate the target geometry,feasibility,and clinical significance of the technology.Methods Eighteen patients with liver caucer who were treated in our hospital from 2012 to 2013 were enrolled as subjects.With the same posture and scan range,all patients underwent contrast-enhanced three-dimensional computed tomography (3DCT) scans in the phases of free breathing (FB),EIH,and EEH.Gross tumor volume (GTV),clinical target volume (CTV),and organ of risk (OAR) were delineated on the above images.CTVFB was defined as GTV on the FB phase image (GTVFB) plus a margin of 10 mm,while planning target volume (PTVFB) was defined as CTVFB plus a margin of 10 mm in the right-left and anterior-posterior directions and a margin of 20 mm in the superior-inferior direction.GTVEI and GTVEE were defined as GTV on the EIH and EEH images,respectively.Based on the EEH images,the registered EEH and EIH images were fused to form GTVEI+EI.CTVEI+EE was defined as GTVEI+EI plus a margin of 10 mm,while PTVEI+EE was defined as CTVEI+EE plus a margin of 5 mm in the right-left and anterior-posterior directions and a margin of 10 mm in the superior-inferior direction.The Pinnacle3 v8.0m treatment planning system was used to design two 3D conformal radiotherapy plans for each patient.The volume,degree of inclusion (DI),matching index (MI),and central displacement of CTVFB and CTVEI+EE,as well as PTVFB and PTVEI+EE,were compared between the two plans.Results In the 18 patients,the mean CTVFB was significantly smaller than the mean CTVEI+EE(149.00±87.54 cm3 vs.188.17± 125.72 cm3,P=0.014);there was no significant difference between the mean PTVFB and PTVEI+EE (276.68± 146.41 cm3 vs.253.66± 117.35 cm3,P=0.080).DI of CTVFB to CTVEI+EF,PTVFB to PTVEI+EE,CTVEI+EE to CTVFB,and PTVEI+EE to PTVFB were (99.83±0.09)％,(84.55±8.45) ％,(80.83± 12.31) ％,and (99.78±0.08) ％,respectively.MI of CTVEI+EE to CTVFB and PTVEI+EE to PTVFB were 0.83± 0.07 and 0.87± 0.03,respectively.The central displacements of CTVEI+EE from CTVFB in x,y,and z axes were 0.55± 1.07 cm,0.76±3.02 cm,and-0.26± 1.98 cm,respectively (P =0.432,0.971,0.587).Conclusions In the treatment of liver cancer,the target volume delineation and image fusion using 3DCT images in EIH and EEH phases may avoid target omission due to respiratory movement,making it possible to increase radiation dose to target volume and improve the efficacy of radiotherapy.

Centro de força corporal, tempos máximos de fonação e pressão sonora de um grupo de mulheres saudáveis / Body power center, maximum phonation time and sound pressure of healthy women

RESUMO Introdução O recrutamento muscular é essencial para a manutenção do sistema respiratório e, em condições fisiopatológicas, reduz sua força muscular, levando à diminuição das pressões respiratórias e pressão aérea subglótica. Objetivo: Verificar e correlacionar a ativação da musculatura que compõe o centro de força corporal, os tempos máximos de fonação e a pressão sonora de mulheres adultas. Métodos Coleta do tempo máximo de fonação de /a/ e pressão sonora modal; avaliação da ativação do músculo transverso do abdome, multífido, assoalho pélvico e da pressão expiratória máxima de dez mulheres de 19 a 28 anos, sem queixas vocais e sem afecções laríngeas diagnosticadas por otorrinolaringologista. Foi aplicado o teste de Spearman. Resultados Cem por cento de ativação satisfatória do transverso do abdome; correlação positiva não significativa entre a pressão sonora, o tempo máximo de fonação e os valores de pressão expiratória máxima; maioria das mulheres com tempo máximo de fonação de /a/ discretamente abaixo do esperado e pressão sonora com valores dentro do esperado; ativação satisfatória do multífido, musculatura do assoalho pélvico e escala de Oxford, com correlação positiva, mas não significativa. Conclusão Neste grupo de mulheres adultas sem queixas vocais e sem afecções laríngeas, não foi verificada correlação entre a ativação da musculatura que compõe o centro de força corporal, os tempos máximos de fonação e a pressão sonora. No entanto, a maioria das mulheres apresentou ativação muscular satisfatória e, ao mesmo tempo, valores discretamente abaixo da normalidade para tempo máximo de fonação e normais, para pressão sonora.

ABSTRACT Introduction Muscle recruitment is essential for the maintenance of the respiratory system, which under pathophysiological conditions reduces its muscular strength, leading to a decrease in respiratory pressures and subglot air pressure. Purpose To investigate the correlation among muscle activation that makes up the center of physical force, the maximum phonation time and the sound pressure of adult women. Methods Collection of maximum phonation time of /a/ and modal sound pressure; assessment of muscle activation transversus, multifidus, pelvic floor and maximal expiratory pressure of ten women (19-28 years old) without vocal complaints and without laryngeal disorders diagnosed by otolaryngologist. The Spearman test was applied. Results A hundred per cent satisfactory activation of the transversus belly, no significant positive correlation among sound pressure, maximum phonation time and the maximal expiratory pressure values; majority of women with maximum phonation time of /a/ slightly below expectations and sound pressure values within the expected activation and satisfactory the multifidus, perineal muscles and Oxford scale, with positive correlation, but not significant. Conclusion Among adult women without vocal complaints and no laryngeal disorders studied, no correlation was found among the activation of the muscles that make up the center of physical force, maximum phonation time and the sound pressure, although most women has made satisfactory muscle activation and while slightly below normal values for maximum phonation time and normal sound pressure.

Comparison of Effects of Exhalation and Inhalation Breathing Exercises on Pulmonary Function and Complications in Elderly Patients with Upper-abdominal Surgery

PURPOSE: The purpose of this study was to identify the effects of exhalation breathing exercises using expirometer and that of inhalation breathing exercises using incentive spirometry on pulmonary function and complications in elderly patients with upper-abdominal surgery. METHODS: The research design was a nonequivalent control group non-synchronized design. Participants were 63 patients who underwent upper-abdominal surgery under general anesthesia (32 in experiment group, 31 in control group). They were recruited at P university hospital from August 1 to November 30, 2015. Effects were evaluated by measuring pulmonary functions (Forced Vital Capacity [FVC], Forced Expiratory Volume in 1 second [FEV1]) and pulmonary complications. Data were analyzed using SPSS/WIN 18.0 program. RESULTS: There was no difference in FVC between the experimental group and the control group, but FEV1 in the experimental group increased significantly compared to the control group by time change (p=.001). Also, there were no pulmonary complications in the experimental group but there were 5 cases (16.1%)(p=.018) in the control group. CONCLUSION: Findings indicate that exhalation breathing exercises by elderly patients following upper-abdominal surgery is an effective nursing intervention in enhancing pulmonary function and preventing pulmonary complications.

Effect of location and type of exhalation valve on carbon dioxide rebreathing during noninvasive positive pressure ventilation：a experimental study / 中华危重病急救医学

ObjectiveTo investigate the influence of exhalation valve location as well as its type on carbon dioxide (CO2) rebreathing during noninvasive positive pressure ventilation (NPPV).Methods With a standardized NPPV experimental model system, the exhalation valve was respectively installed between the ventilator tube and mask (positionⅠ), or on the mask (positionⅡ). This study included four groups according to the position and type of exhalation valve, namely: single-arch exhalation valve was installed on the positionⅠ (A group), and positionⅡ (C group, the distal end of single-arch exhalation valve was blocked); plateau exhalation valve was installed on the positionⅠ (B group) and positionⅡ (D group, the distal end of plateau exhalation valve was blocked). Under standard experimental condition, the pressure of end-tidal carbon dioxide (PETCO2) was monitored in the trachea or the mask through adjusting the expiratory positive airway pressure (EPAP, EPAP was set at 5 cmH2O and 10 cmH2O, 1 cmH2O = 0.098 kPa) and tidal volume (VT, VT was set at 300, 400, 500 mL). Leakage of exhalation valve was monitored when single-arch exhalation and plateau exhalation valves were respectively placed in the positionⅠ through adjusting the inspiratory positive airway pressure (IPAP at 5, 10, 15, 20 cmH2O respectively). Results① Under standard experimental condition, when EPAP was 5 cmH2O, PETCO2 (mmHg, 1 mmHg = 0.133 kPa) in the trachea was 69.6±3.4, 61.4±2.7, 54.8±1.5, 49.8±1.3 in A, B, C, D groups respectively; and it was 24.8±1.9, 21.8±1.6, 2.8±0.8, 1.8±0.8 in the mask, respectively. When EPAP was 10 cmH2O, the PETCO2 in the trachea was 64.2±3.6, 57.2±3.7, 48.8±2.6, 41.8±2.6 in A, B, C, and D groups respectively; and it was 23.0±1.6, 20.2±1.6, 2.2±0.8, 1.2±0.8 in the mask, respectively. For the same exhalation valve type, exhalation valve being installed on positionⅡ could induce significantly lower PETCO2 in the trachea and mask than that being installed on positionⅠ (allP< 0.05). For the same expiratory valve position, plateau exhalation valve produced significantly lower PETCO2 than single-arch valve (allP< 0.05).② As the VT increased, the PETCO2 in the trachea of each group was reduced obviously. When VT was 500 mL, PETCO2 (mmHg) was significantly lower than VT, which were 300 mL and 400 mL (A group: 51.4±2.7 vs. 72.8±2.9, 69.6±3.4; B group: 44.8±2.4 vs. 65.4±2.1, 61.4±2.7;C group: 36.8±1.9 vs. 59.0±1.6, 54.8±1.5; D group: 28.8±1.9 vs. 52.6±2.0, 49.8±1.3; allP< 0.05).③ When exhalation valve type was placed in positionⅠ, the air leakage of single-arch exhalation valve was increased to (15.8±1.9), (20.2±1.9), (23.8±2.8), (28.0±1.6) L/min, and the plateau exhalation valve was essentially unchanged to (24.2±1.6), (23.8±1.6), (25.2±1.6), (25.2±1.6) L/min as the IPAP was increased from 5, 10, 15, to 20 cmH2O. Conclusions Exhalation valve fixing on mask is more appropriate for CO2 discharge than that fixed on tube-mask valve. Plateau exhalation valve as well as moderately increasing VT is beneficial for CO2 discharge and CO2 rebreathing prevention.

Proposal Intensity Adequacy of Expiratory Effort and Heart Rate Behavior During the Valsalva Maneuver in Preadolescents / Proposta de Adequação da Intensidade do Esforço Expiratório e Comportamento da Frequência Cardíaca Durante a Manobra de Valsalva em Pré-Adolescentes

Background: When performing the Valsalva maneuver (VM), adults and preadolescents produce the same expiratory resistance values. Objective: To analyze heart rate (HR) in preadolescents performing VM, and propose a new method for selecting expiratory resistance. Method: The maximal expiratory pressure (MEP) was measured in 45 sedentary children aged 9-12 years who subsequently performed VM for 20 s using an expiratory pressure of 60%, 70%, or 80% of MEP. HR was measured before, during, and after VM. These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests. Results: All 45 participants adequately performed VM in E1 and E2 at 60% of MEP. However, only 38 (84.4%) and 25 (55.5%) of the participants performed the maneuver at 70% and 80% of MEP, respectively. The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM. However, our findings suggest the VM should not be performed at these intensities. Conclusion: HR increased with all effort intensities tested during VM. However, 60% of MEP was the only level of expiratory resistance that all participants could use to perform VM. Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice. .

Fundamento: Durante a manobra de Valsalva (MV), os valores de resistência expiratória utilizados por adultos são os mesmos aplicados em pré-adolescentes. Objetivo: Analisar as respostas da frequência cardíaca (FC) de pré-adolescentes durante a MV e propor nova metodologia para eleição da resistência expiratória. Métodos: Submeteram-se 45 pré-adolescentes com idades entre 9 e 12 anos à avaliação das pressões expiratórias máximas (PEmáx). Valores de 60%, 70% e 80% dessas PEmáx foram selecionados para ser aplicados nas MV, mantidas por 20 s. Batimentos cardíacos foram registrados antes, durante e após a manobra. Trinta dias após, todos os procedimentos foram repetidos, e os dados da primeira (A1) e da segunda (A2) avaliações foram comparados. As análises foram feitas com testes não paramétricos, destacando-se os momentos antes, durante (0-10 s e 10-20 s) e após as manobras. Resultados: Os 45 pré-adolescentes conseguiram realizar adequadamente a manobra à resistência de 60% da PEmáx, enquanto apenas 38 (84,4%) e 25 (55,5%) a realizaram com resistências de 70% e 80% da PEmáx, respectivamente. Os deltas de FC 0-10 s e 10-20 s, calculados durante o esforço, foram significativamente maiores quanto maior foi o esforço expiratório, revelando efetiva resposta autonômica cardíaca durante a manobra. Entretanto, o estudo sugere que essas intensidades não devam ser empregadas. Conclusão: A FC se elevou em todas as intensidades de esforço testadas durante a MV, porém somente quando foi realizada com resistência expiratória de 60% da PEmáx é que todos os participantes conseguiram realizá-la, sugerindo ser a intensidade ideal para ser empregada na prática clínica. .

Calculation and analysis of effect of radon exhalation on external dose model for building materials / 中华放射医学与防护杂志

Objective To study the effect of radon exhalation on the external dose model for building material,so as to provide the scientific and precise assessment of external radiation exposure hazard.Methods The mechanism of exhalation of radon from building material was analyzed,mathematical model of correction factor for the effect of radon exhalation was derived and resolved by Matlab program and the relationship between correction factor and diffusion length,surface emanation coefficient and thickness of building material was discussed.The absorbed dose rate induced by several classical building materials was calculated and compared.Results The radon exhalation correction factor was independent of diffusion length and thickness of building material in most cases.Negative correlation was found between radon exhalation correction factor and radon surface emanation coefficient.Radon exhalation correction factor numerically equals to '1-radon surface emanation coefficient'.The relative percentage deviation between absorbed dose rate induced by several classical building materials was in the range of 2.23％-10.02％,for both corrected and uncorrected radon exhalation effects.Conclusions Radon exhalation from building material has a certain effect on external dose model for building material,which should attract attention.It is important to conduct the correction for external dose model by introducing ‘1 -radon surface emanation coefficient’ as the radon exhalation correction factor,in order for the scientific assessment and control of external radiation exposure hazards from building materials.

Exhaled Breath Analysis System based on Electronic Nose Techniques Applicable to Lung Diseases / 한양의대학술지

Smell used to be a common diagnostic tool in medicine, and physicians were trained to use their sense of smell during their medical training. Latterly, odor disgnostics have been relegated to secondary status as a diagnostic method. Array-based gas sensors ("Electronic Nose") now offer the potential of a robust analytical approach to exhaled breath analysis for medical use. Many diseases are accompanied by characteristic odor, and their recognition can provide diagonostic clues, guide the laboratory evaluation, and affect the choice of immediate therapy. We are developing an intelligent sensor system for non-invasive health care monitoring combined laboratory based sensor module, pattern recognition subsystem and non-invasive sampling of volatile emitted from a patient into a highly intelligent sensor system that allows the rapid processing of these samples. It is capable to assist early and rapid disgnosis of changes in state of patient, and aid decision making by medical personnel in the treatment of such patients. In this paper, we introduce exhaled breath analysis for potential primary lung disease screening using electronic nose system incorporating an automated solid-phase microextraction (SPME) desorption to enable the system to be used. Aiming to increase the sensitivity, SPME preconcentration is used for sampling of headspace air and the response of sensor module to variable concentration of volatile emitted from SPME fiber is evaluated. The initial result shows the distinguished difference between the lung cancer patients and healthy normal individuals according to the analysis of the respective expiratory gases.

Clinical significance on detection of exhaled breath condensate biomarkers in lung cancer / 国际肿瘤学杂志

Exhaled breath condensate(EBC) analysis,as a new technology of studying the respiratory biochemical components in recent years,has the advantages of non-invasiveness,simple collection and good repeatability,etc.The detection of exhaled breath condensate biomarkers plays an important role in screening,early diagnosis,disease monitoring,efficacy and prognosis assessment,following up of lung cancer.

Aeração nasal em crianças asmáticas / Nasal ventilation in asthmatics children

OBJETIVO: identificar a presença de sinais de alterações na expiração de crianças asmáticas. MÉTODO: este estudo foi realizado com 30 crianças com idades entre 6 e 10 anos de ambos os sexos com diagnóstico clínico de asma confirmado pelo prontuário médico e 30 crianças não asmáticas também de ambos os sexos na mesma faixa etária. Foi avaliada a aeração nasal com o espelho milimetrado de Altmann, sendo mensurado o escape de ar nasal objetivando a verificação da saída uni ou bilateral do ar e a relação de simetria entre a narina direita e a esquerda. As imagens foram importadas para o computador por meio do scanner HP da série Scanjet 2400. A análise foi realizada no software Scion Image for Windows (Alpha 4.0.3.2). Para análise das variáveis quantitativas entre grupos foi aplicado o teste t-student e para a análise intragrupos foi aplicado o teste t-Student pareado.Todas as conclusões foram tomadas ao nível de significância de 5 por cento, sendo usados o Excel 2000 e o SPSS v8.0, para as análises. RESULTADOS: não foram encontradas diferenças estatisticamente significantes entre as crianças asmáticas e não-ásmáticas, acerca das mensurações quanto à área total e quanto às áreas das narinas direita e esquerda. CONCLUSÃO: não foi identificada a presença de sinais de alterações na expiração de crianças asmáticas, desta forma, faz-se necessário um estudo mais específico das funções nasal e pulmonar.

PURPOSE: to identify the symptoms of changes in the exhalation of asthmatic children. METHOD: this study was conducted with 30 children from 6 to 10 year-old, of both genders and with asthma clinical diagnosis confirmed by medical records and 30 non-asthmatic children from 6 to 10 year-old, of both genders, and with same age. We evaluated the nasal ventilation with Altmann millimeter nasal mirror measuring the nasal air escape in order to check their unilateral or bilateral air output and the relation of symmetry between the right and left nostril. The images were imported into the computer through HP scanner - Scanjet 2400 series. The analysis was performed by the Scion Image software for Windows (Alpha 4.0.3.2). All conclusions were based on a significance level of 5 percent, using Excel 2000 and SPSS v8.0 for the analysis. RESULTS: there were no significant differences between asthmatic and non-asthmatic children about the measurements of total area and the right and left nostril areas. CONCLUSION: there were no symptoms of changes in the exhalation of asthmatic children, being necessary a more specific study as for the nasal and pulmonary functions.

Changes in pentane concentration in expired air induced by hepatic ischemia-reperfusion injury in rabbits / 中华麻醉学杂志

Objective To investigate the changes in pentane (marker of lipid pemxidation) concentuation in the expired air induced by hepatic ischemia-reperfusion(IR)injury in rabbits.Methods Thirty healthy male Japanese white rabbits weighing 2.4-3.0 kg Were randomly divided into 2 groups(n=15 each):group Ⅰ sham operation and group Ⅱ hepatic IR.Anesthesia was induced with 3% pentobarbital 30mg/kg iv and maintained with The animals were tracheostomized and mechanically ventilated.Femoral artery and vein were cannulated for BP monitoring and blood sampling.Hepatic blood flow was occluded for 25 min followed by 180 min reperfusion.The expired air was collected before(baseline,T0)and at 1,10 and 25 min of ischemia and at 1,10,25,60,120 and 180 rain of reperfusion (T1-9) for determination of pentane concentration which was extracted by solid phase micro-extraction (SPME) and detected by gas chromatography-mass spectrography(GC-MS).Blood samples were also taken at the above time points for measurement of serm ALT,AST and SOD activities and MDA concentration.The animals were killed at the end of 180 min reperfusion.Liver specimens were obtained for histology.Results There was no significant difference in age,body weight,MAP and HR between the two groups.There was no significant change in pentane concentration in the expired air and the ALT,AST and SOD activities and MDA concentration at all time points as compared with the baseline in sham operation group.In IR group the pentane concentration in the expired air was significantly increased at T4,5 and the ALT and AST activities and MDA concentration were significantly increased and SOD activity was significantly decreased at T7-9 as compared with the basehne and the sham operation group.Conclusion The pentane concentration in the expired air can reflect the occurrence of lipid peroxidation during hepatic IR injury.

Diseño y evaluación de un equipo para obtener aire espirado condensado / Design and evaluation of a device for collecting exhaled breath condensate

El análisis de muestras de aire espirado condensado ha cobrado gran relevancia en los últimos años como método no invasivo de estudio de la fisiología y las enfermedades de origen pulmonar. En el presente trabajo se describe un equipo para tomar muestras de aire espirado condensado de bajo costo, fácil de fabricar, de transportar al terreno y que permite tomar muestras en forma simultánea. La concentración de metabolitos relativos a procesos inflamatorios y al daño oxidativo (pH, peróxido de hidrógeno y nitrito) de muestras de aire espirado condensado obtenido con este equipo son comparables a los reportados con otros previamente.

In recent years, the analysis of exhaled breath condensate samples has been given great weight as a noninvasive methodology of studying physiology and lung diseases. The present study describes a device for measuring exhaled breath condensate that is affordable, easily constructed, portable and suitable for use in the field, as well as allowing the collection of simultaneous samples. The results obtained with this device in terms of the concentrations of pH, peroxide oxide and nitrite, metabolites related to inflammatory and oxidative damage, in exhaled breath condensate samples are comparable to those obtained with other devices previously described.

Avaliação de estratégia ventilatória sequencial em pacientes com lesão pulmonar aguda (LPA) / síndrome do desconforto respiratório agudo (SDRA) / Effects of open lung concept following ARDSNet ventilatory strategy in patients with early acute lung injury (ALI) / acute respiratory distress syndrome (ARDS)

A utilização de baixos volumes correntes na Injuria Pulmonar Aguda (LPA) / Síndrome do Desconforto Respiratório Agudo (SDRA) está comprovadamente associada à redução de mortalidade. No entanto, a aplicação de manobras de recrutamento e a utilização de níveis elevados de PEEP ainda são controversos. O objetivo do presente estudo foi comparar os efeitos da estratégia ARDSnet e de uma estratégia baseada no Open Lung Concept (OLC), aplicadas de forma seqüencial, com relação à função pulmonar, imagem tomográfica e atividade inflamatória, em pacientes com LPA / SDRA. Dez pacientes que preencheram os critérios de LPA / SDRA segundo a Conferência de Consenso de 1994 com tempo de evolução até 48 horas foram incluídos. Para seleção definitiva, gasometria arterial para cálculo da relação PaO2/FIO2 foi coletada após 30 minutos de ventilação com volume corrente (VT) = 10 mL/kg, PEEP=5 cmH2O e FIO2 = 100%. Nas primeiras 24 horas os pacientes foram ventilados segundo o protocolo ARDSnet. Após este período, caso PaO2/FIO2 350, adotava-se a estratégia de OLC, que consistia na realização de manobra de recrutamento e titulação de PEEP. A manobra de recrutamento foi realizada em PCV, com delta de pressão de 20 cmH2O, com incrementos seqüenciais de PEEP em 5 cmH2O, partindo-se de 20 cmH2O até 30 cmH2O. O objetivo durante a titulação de PEEP foi alcançar PaO2/FIO2 > 350, sendo três níveis testados (17, 19 e 21 cmH2O). Ventilação segundo OLC (com PEEP determinado durante a titulação e VT = 6 ml/kg) foi mantida por 24 h adicionais. Após 24 h de cada estratégia, TC de todo o pulmão (1,25 mm de espessura com 15 mm de espassamento) foi realizada após 24 h de cada estratégia. A instituição de OLC foi necessária em 9 dos 10 pacientes estudados. PEEP foi significativamente superior com OLC (17 [17 - 19] vs. 8 cmH2O [7,25 - 11]; p = 0,007) e resultou em melhora significativa de oxigenação, sustentada após 24 h de seguimento, sem diferença na pressão de platô, pressão de distensão...

Low tidal volumes are associated with a reduction in mortality in ALI / ARDS. Nevertheless, the application of recruitment maneuvers and high levels of PEEP are still controversial. The aim of this study was to compare the ARDSnet protocol with a strategy based on Open Lung Concept (OLC), applied in a sequential way, in terms of pulmonary function, computed tomography images and inflammation, in patients with ALI / ARDS. Ten patients fulfilling criteria for ALI /ARDS, based on the American-European Consensus Conference, with less than 48 hours of evolution, were included. For definitive selection, blood gas collected after 30 min application of 5 cmH2O PEEP and VT = 10 mL/kg had to demonstrate a PaO2/FIO2 < 300 mmHg. The patients were initially ventilated for 24 hours according to the ARDSnet protocol. After this period, if the PaO2/FIO2 was 350, an OLC strategy was adopted, with recruitment maneuver and PEEP titration. The recruitment maneuver was applied in PCV, with sequential 5 cmH2O increments in PEEP, starting from 20 cmH2O until PEEP = 30 cmH2O, maintaining a delta pressure of 20 cmH2O. The aim of PEEP titration was to reach PaO2/FIO2 > 350 and three levels were tested: 17, 19 and 21 cmH2O. Ventilation according to OLC (VT = 6 mL/kg and PEEP´s level found during titration) was applied for the next 24 hours. Whole lung computed tomography images (1.25 mm thickness with 15mm gap) were acquired after 24 hours of each strategy. The institution of OLC was necessary in 9 of the 10 studied patients. The PEEP was significantly higher during OLC (17 [17-19] vs 8 cmH2O [8-11]; p=0,007) and resulted in a significant improvement on oxygenation sustained for 24 hours of follow-up, with no significant differences in plateau pressure, static compliance, minute-ventilation, PaCO2 and pH (p > 0.05). OLC resulted in a significant reduction of the fraction of total lung volume that was non-aerated, as compared to ARDSnet protocol...

Effect of Temperature and Relative Humidity on Radon Exhalation Rate of Glazed Tile in Hermetic Environment / 环境与健康杂志

Objective To explore the effects of temperature and relative humidity on radon exhalation rate of glazed tile in the hermetic environment. Methods Ordinary glazed tile was used as experimental object to detect radon concentration with Model 1027 continuous radon monitor in a 0.25 m3 simulation chamber at different temperature and humidity,and then calculated the radon exhalation rate. Results In reasonable range,a cubic correlation between radon exhalation rate(ER) and relative humidity(RH) expressed as ER=0.000 2RH3-0.040 2RH2+2.623 9RH-32.303(R2=0.986 6)was found; a cubic function relationship between radon exhalation rate(ER) and temperature(t) expressed as ER=-0.022 5t3+2.016 5t2-58.748t+565.05(R2=0.969 8)was also observed. Conclusion Environmental temperature and relative humidity have great effects on radon exhalation rate of glazed tile.

Clinical significance of forced expiratory wheezing in chronic airflow obstruction / 천식및알레르기

BACKGROUND: Wheezing which is defined as a continuous sound with a musical quality is commonly auscultated in patients with chronic obstructive airway diseases. The correlation between wheezing and airway obstruction is unclear. OBJECTIVE: This study was designed to evaluate the relationships among wheezing, severity of airway obstruction, and pulmonary function tests. METHOD: Forty-one subjects were examined by the same observer. Wheezing during normal breathing and maximal forced exhalation, was auscultated respectively. Posterior lung bases were auscultated bilaterally with the seated patient taking repeated inspiratory capacity breaths through an open mouth. To quantify wheezing intensity, a regional score was assigned for each area after a minimum of 3 breaths, according to the following scale: zero, no wheezing heard: one, faint or intermittent wheezes: two, moderate wheezing during every expiration: three, loud wheezing during every expiration. The lung function tests by standard pneumotachograph were performed by skilled technicians. RESULTS: Wheezing was auscultated more in forced exhalation than in normal breathing in patients with asthma and COPD [8/9(88%) vs 1/9(11%), p<0.01 ll/15(73%) vs 1/15(6%), p<0.05)]. Forced expiratory wheezes group (n=25) compared to no wheezes group (n=16) had significantly lower FEVl (75+-5.8% vs 95.6+-6.6%, p<0.05). Compared to no wheezes group, the group with forced expiratory wheezes had lower FEV1 and FEV1/FVC (50.4+- 21.3% vs 81.15+-27.7%, 70.4+-22.4% vs 92.5+-19.3%, respectively, p<0.05). Bronchial asthma compared with COPD tended to have higher wheezing scores (Wheeze scores Bronchial asthma 3.5 vs COPD 2.4, p=0.08). Wheezing scores were correlated to FEV1 (normal breathing: r=-0.35, p<0.05: forced exhalation: r=-0.45, p<0.05), but no differences were found in wheezing incidence according to severity of airway obstruction. CONCLUSION: These findings suggest that wheezing on maximal forced exhalation may be a useful physical indicator for evaluating the severity of airway obstruction.

The design of high-efficiency exhalation disinfection device for the patient infected with SARS / 医疗卫生装备

High-efficiency exhalation disinfection device for the patient infected with SARS can also meet the disinfection requirements of the patients with severe respiratory communicable diseases. Connected with the exhaust vent of the breathing mask or the respirator by corrugated tubes, this device gathers exhalation containing a large amount of causative agents through the completely leakproof ductwork and then expels purified air after multiplicate disinfection by high temperature, high pressure and chemical disinfectant. The device can prevent the patient with severe respiratory communicable disease from polluting their surrounding air and thus cut off the route of transmission, reduce the infection rate and the death rate of the person and medical personnel who has made intimmate contact with the patient.