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Diaphragm Dysfunction

Miguel Goulão, Biswarup Ghosh, Mark W Urban, Malya Sahu, Christina Mercogliano, Brittany A Charsar, Sreeya Komaravolu, Cole G Block, George M Smith, Megan C Wright, Angelo C Lepore
Stem/progenitor cell transplantation delivery of astrocytes is a potentially powerful strategy for spinal cord injury (SCI). Axon extension into SCI lesions that occur spontaneously or in response to experimental manipulations is often observed along endogenous astrocyte "bridges," suggesting that augmenting this response via astrocyte lineage transplantation can enhance axon regrowth. Given the importance of respiratory dysfunction post-SCI, we transplanted glial-restricted precursors (GRPs)-a class of lineage-restricted astrocyte progenitors-into the C2 hemisection model and evaluated effects on diaphragm function and the growth response of descending rostral ventral respiratory group (rVRG) axons that innervate phrenic motor neurons (PhMNs)...
December 11, 2018: Glia
Tom Schepens, Martin Dres, Leo Heunks, Ewan C Goligher
PURPOSE OF REVIEW: Diaphragm dysfunction is common in mechanically ventilated patients and predisposes them to prolonged ventilator dependence and poor clinical outcomes. Mechanical ventilation is a major cause of diaphragm dysfunction in these patients, raising the possibility that diaphragm dysfunction might be prevented if mechanical ventilation can be optimized to avoid diaphragm injury - a concept referred to as diaphragm-protective ventilation. This review surveys the evidence supporting the concept of diaphragm-protective ventilation and introduces potential routes and challenges to pursuing this strategy...
December 5, 2018: Current Opinion in Critical Care
J Ricoy, N Rodríguez-Núñez, J M Álvarez-Dobaño, M E Toubes, V Riveiro, L Valdés
The diaphragm is the main breathing muscle and contraction of the diaphragm is vital for ventilation so any disease that interferes with diaphragmatic innervation, contractile muscle function, or mechanical coupling to the chest wall can cause diaphragm dysfunction. Diaphragm dysfunction is associated with dyspnoea, intolerance to exercise, sleep disturbances, hypersomnia, with a potential impact on survival. Diagnosis of diaphragm dysfunction is based on static and dynamic imaging tests (especially ultrasound) and pulmonary function and phrenic nerve stimulation tests...
November 30, 2018: Pulmonology
Pia Sjöberg, Johannes Töger, Erik Hedström, Per Arvidsson, Einar Heiberg, Håkan Arheden, Ronny Gustafsson, Shahab Nozohoor, Marcus Carlsson
Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in patients with repaired tetralogy of Fallot (rToF) to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and pulmonary regurgitation (PR) > 20% ( n = 18) and healthy control subjects ( n = 15) underwent MRI, including four-dimensional flow...
December 1, 2018: American Journal of Physiology. Heart and Circulatory Physiology
Pongdhep Theerawit, Dararat Eksombatchai, Yuda Sutherasan, Thitiporn Suwatanapongched, Charn Kiatboonsri, Sumalee Kiatboonsri
BACKGROUND: Diaphragmatic dysfunction remains the main cause of weaning difficulty or failure. Ultrasonographic measurement of diaphragmatic function can be used to predict the outcomes of weaning from mechanical ventilation. Our primary objective was to investigate the performance of various sonographic parameters of diaphragmatic function for predicting the success of weaning from mechanical ventilation. METHODS: We prospectively enrolled 68 adult patients requiring mechanical ventilation who were admitted to the intensive care unit from June 2013 to November 2013...
November 23, 2018: BMC Pulmonary Medicine
Ewan C Goligher, Laurent J Brochard, W Darlene Reid, Eddy Fan, Olli Saarela, Arthur S Slutsky, Brian P Kavanagh, Gordon D Rubenfeld, Niall D Ferguson
Several mechanisms of diaphragm muscle injury (myotrauma) can result in ventilator-induced diaphragm dysfunction, including ventilator over-assistance, under-assistance, eccentric contractions, and end-expiratory shortening. In this Personal View, we summarise the evidence for the clinical relevance of these mechanisms, and present new data based on mediation analysis supporting the hypothesis that myotrauma due to ventilator over-assistance and under-assistance contribute, in part, to the effect of mechanical ventilation on clinical outcomes...
November 16, 2018: Lancet Respiratory Medicine
Yung-Yang Liu, Li-Fu Li
Mechanical ventilation (MV) is life-saving for patients with acute respiratory failure but also causes difficult liberation of patients from ventilator due to rapid decrease of diaphragm muscle endurance and strength, which is termed ventilator-induced diaphragmatic damage (VIDD). Numerous studies have revealed that VIDD could increase extubation failure, ICU stay, ICU mortality, and healthcare expenditures. However, the mechanisms of VIDD, potentially involving a multistep process including muscle atrophy, oxidative loads, structural damage, and muscle fiber remodeling, are not fully elucidated...
November 19, 2018: Experimental Biology and Medicine
Ashish K Solanki, Ehtesham Arif, Thomas Morinelli, Robert C Wilson, Gary Hardiman, Peifeng Deng, John M Arthur, Juan Cq Velez, Deepak Nihalani, Michael G Janech, Milos N Budisavljevic
Introduction: Tubular dysfunction is characteristic of Dent's disease; however, focal segmental glomerulosclerosis (FSGS) can also be present. Glomerulosclerosis could be secondary to tubular injury, but it remains uncertain whether the CLCN5 gene, which encodes an endosomal chloride and/or hydrogen exchanger, plays a role in podocyte biology. Here, we implicate a role for CLCN5 in podocyte function and pathophysiology. Methods: Whole exome capture and sequencing of the proband and 5 maternally-related family members was conducted to identify X-linked mutations associated with biopsy-proven FSGS...
November 2018: KI Reports
Diego Pozzer, Ersilia Varone, Alexander Chernorudskiy, Silvia Schiarea, Sonia Missiroli, Carlotta Giorgi, Paolo Pinton, Marta Canato, Elena Germinario, Leonardo Nogara, Bert Blaauw, Ester Zito
Selenoprotein N (SELENON) is an endoplasmic reticulum (ER) protein whose loss of function leads to human SELENON-related myopathies. SelenoN knockout (KO) mouse limb muscles, however, are protected from the disease, and display no major alterations in muscle histology or contractile properties. Interestingly, we find that the highly active diaphragm muscle shows impaired force production, in line with the human phenotype. In addition, after repeated stimulation with a protocol which induces muscle fatigue, also hind limb muscles show altered relaxation times...
October 26, 2018: Redox Biology
Eric D Buras, Kimber Converso-Baran, Carol S Davis, Takeshi Akama, Fumihito Hikage, Daniel E Michele, Susan V Brooks, Tae-Hwa Chun
Respiratory dysfunction is a common complication of obesity, conferring cardiovascular morbidity, increased mortality and often necessitating mechanical ventilatory support. While impaired lung expansion in the setting of increased adipose mass and reduced central response to hypercapnia have been implicated as pathophysiological drivers, the impact of obesity on respiratory muscles-in particular, the diaphragm-has not been investigated in detail. Here, we demonstrate that chronic high-fat diet (HFD)-feeding impairs diaphragm muscle function, as assessed in vivo by ultrasonography and ex vivo by measurement of contractile force...
October 25, 2018: Diabetes
Alain Boussuges, Fabienne Brégeon, Philippe Blanc, Jean-Marie Gil, Laurent Poirette
BACKGROUND: M-mode ultrasonography might be useful for detecting hemidiaphragm paralysis. The objective of the present study was to describe the motion recorded by M-mode ultrasonography of both diaphragmatic leaves in patients with a pre-established diagnosis of hemidiaphragm paralysis. METHODS: A study was conducted in 26 patients (18 men, 8 women) with unilateral diaphragmatic paralysis. They were referred to two different rehabilitation centres after thoracic surgery in 23 cases and cardiac interventional procedures in three cases...
October 16, 2018: Clinical Physiology and Functional Imaging
Víctor Lago Leal, Luis Martínez Cortés, Carlos Seco Del Cacho
Congenital high airway obstruction syndrome (CHAOS) is a rare sequence due to a complete obstruction of the fetal airway that blocks the larynx or trachea, either intrinsic atresia or extrinsic compression (e.g., congenital neck mass). Despite the true incidence of CHAOS is unknown, an incidence of 1 per 50,000 newborns is described. If any obstruction occurs in the tracheobronchial airway, this secretion cannot be extricated. Because of this situation, a knock-on effect starts: the enlargement of the lungs squeezes the heart and great veins, what results in a replacement of the heart to the center of the chest becoming small and dysfunctional...
July 2018: Indian Journal of Radiology & Imaging
Thomas Breuer, Christian S Bruells, Klemens Horst, Christoph Thiele, Frank Hildebrand, Stephan Linnartz, Tom Siegberg, Nadine Frank, Ghislaine Gayan-Ramirez, Lukas Martin, Dirk H Ostareck, Gernot Marx, Tim-Philipp Simon
INTRODUCTION: Mechanical ventilation is known to activate oxidative stress and proteolytic pathways in the diaphragm. Trauma by inducing inflammation and activating proteolytic pathways may potentiate the effects of mechanical ventilation on the diaphragm. In a blunt chest trauma with concomitant injuries we tested the hypothesis that trauma via inflammation further activates the proteolytic pathways and worsens atrophy in the diaphragm. MATERIAL AND METHODS: Piglets were separated into 2 groups and underwent 72hrs of mechanical ventilation...
October 8, 2018: Shock
Hannah Horris, Barton E Anderson, R Curtis Bay, Kellie C Huxel Bliven
CONTEXT: Altered diaphragm function is linked to decreased core stabilization, postural changes, and decreased function. Two clinical tests used to assess breathing are the hi-lo and lateral rib expansion (LRE) tests. It is currently unknown how breathing classification based on these tests differ, and how their results are affected by varying test positions. OBJECTIVE: To compare results of breathing tests when conducted in varying test positions. DESIGN: Prospective cross-sectional study...
October 9, 2018: Journal of Sport Rehabilitation
Pia Sjöberg, Johannes Töger, Erik Hedström, Per Martin Arvidsson, Einar Heiberg, Hakan Arheden, Ronny Gustafsson, Shahab Nozohoor, Marcus Carlsson
Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in repaired tetralogy of Fallot (rToF) patients to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and PR>20% (n=18) and healthy controls (n=15) underwent magnetic resonance imaging (MRI) including 4D-flow. A subset of patients (n=8) underwent PVR and MRI after surgery...
September 28, 2018: American Journal of Physiology. Heart and Circulatory Physiology
Diana Jansen, Annemijn H Jonkman, Lisanne Roesthuis, Suvarna Gadgil, Johannes G van der Hoeven, Gert-Jan J Scheffer, Armand Girbes, Jonne Doorduin, Christer S Sinderby, Leo M A Heunks
BACKGROUND: Diaphragm dysfunction develops frequently in ventilated intensive care unit (ICU) patients. Both disuse atrophy (ventilator over-assist) and high respiratory muscle effort (ventilator under-assist) seem to be involved. A strong rationale exists to monitor diaphragm effort and titrate support to maintain respiratory muscle activity within physiological limits. Diaphragm electromyography is used to quantify breathing effort and has been correlated with transdiaphragmatic pressure and esophageal pressure...
September 27, 2018: Critical Care: the Official Journal of the Critical Care Forum
Bruno Bordoni, Bruno Morabito
Irritable bowel syndrome (IBS) is one of the most debilitating and common gastrointestinal disorders; nevertheless, its pathophysiology is still unclear. It affects 11% of the world's population, and is characterized by alternating periods of pain and/or motility disorders with periods of remission and without any evidence of any structural and functional organic variation. It has been recently proposed that an altered contractile ability of the diaphragm muscle might adversely influence intestinal motility...
July 23, 2018: Curēus
M A Mukhamedyarov, P N Grigor'ev, E A Ushanova, T L Zefirov, A V Leushina, A L Zefirov
The function of synaptic transmission and presynaptic vesicular cycle in the neuromuscular synapses of the diaphragm was studied in transgenic APP/PS1 mice (Alzheimer's disease model). The decrease in the quantal content of end-plate potential, intense depression of the amplitude of terminal plate potentials under conditions of lasting high frequency stimulation (50 Hz), a drastic prolongation of the synaptic vesicle recycling time in APP/PS1 mice in comparison with wild type mice were detected. Manifest dysfunction of the neuromuscular synapses, caused by disordered neurosecretion and recycling of the synaptic vesicles in the presynaptic nerve endings, was detected in the Alzheimer's disease model on transgenic APP/PS1 mice...
September 2018: Bulletin of Experimental Biology and Medicine
Heather A Ballard, Olga S Leavitt, Anthony C Chin, Rashmi Kabre, Debra E Weese-Mayer, John Hajduk, Narasimhan Jagannathan
BACKGROUND: Congenital Central Hypoventilation Syndrome and Rapid-Onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation are rare neurocristopathies characterized by autonomic dysregulation including bradyarrhythmias, abnormal temperature control, and most significantly, abnormal control of breathing leading to tracheostomy and ventilator dependence as life support. Surgical advancements have made phrenic nerve-diaphragm pacemakers available, to eliminate the tether to a mechanical ventilator for 12-15 hours each day...
November 2018: Paediatric Anaesthesia
Z H Lu, F Guo, G Zhang, H Q Ge, L L Xu, Y L Chen
Objective: To investigate the prevalence of diaphragmatic dysfunction in mechanical ventilated subjects with sepsis and the relationship between diaphragmatic dysfunction and clinical outcomes. Methods: Newly intubated patients with sepsis diagnosed according to "Sepsis-3" were enrolled from January 2017 to October 2017 in Intensive Care Unit (ICU) of Sir Run Run Shaw Hospital. Diaphragm thickness was recorded ultrasonographically at end-inspiration and end-expiration when the patients' spontaneous breathing recovered...
September 12, 2018: Chinese Journal of Tuberculosis and Respiratory Diseases
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