Hypoxia and cardiac arrhythmias in breath-hold divers during voluntary immersed breath-holds

The incidence and nature of cardiac arrhythmias during static apnea were studied by monitoring the electrocardiogram (ECG) and oxygen saturation (SaO₂) of 16 recreational breath-hold divers. All subjects completed a maximal apnea with a mean (±SD) breath-hold duration of 281 (±73) s without clinical complications. Both heart rate (HR) and SaO₂ decreased significantly with breath-hold duration. The decline in SaO₂ was inversely related to the decline in HR (r = −0.55, P < 0.05). Cardiac arrhythmias (supraventricular and ventricular premature complexes, right bundle branch block) occurred in 12/16 (77%) subjects and were related to breath-hold duration. Subjects with atrial premature complexes (n = 9) had a reduced BMI (P = 0.016) and a higher decline of the terminal SaO₂ (P = 0.01). In conclusion, ectopic arrhythmias were common during maximal static apneas for training purposes. The results indicate that the occurrence of ectopic beats is associated with individual factors such as the tolerable SaO₂ decrease.     

Studies on inspiratory and expiratory glossopharyngeal breathing in breath-hold divers employing magnetic resonance imaging and spirometry

Competitive breath-hold divers use glossopharyngeal breathing in order to increase their performance. Glossopharyngeal inhalation (GI) increases the volume of air in the lungs above the total lung capacity, thereby increasing the volume of gas available for pressure equalization at great depth. The reverse procedure, glossopharyngeal exhalation (GE), is used to suck air out of the lungs at great depth when the lungs are compressed, thus providing air in the mouth for equalization of pressure in the middle ear. Five Swedish apnea athletes were tested. Their vital capacity (VC) and the volume of air exhaled after GI were measured with a turbine spirometer, while the residual volume (RV), and the volume of gas in the lungs following GE was determined using a helium dilution procedure. Thereafter subjects performed these maneuvers during magnetic resonance imaging (MRI) of the thorax. All subjects exhibited a higher VC + GI (7.8–11.9l) than VC (6.2–9.5l) and lower RV–GE (1.16–1.77l) than RV (1.37–2.40l). MRI revealed pronounced changes in the volume of intrathoracic blood, with a small heart and compressed vessels following GI and the opposite, i.e., enlarged vessels during GE. MRI also showed an invagination of the posterior wall of the trachea, in connection with GE in certain subjects.     

The pattern of breathing and the ventilatory response to breathing through a tube and to physical exercise in sport divers

Summary Well-trained divers can be expected to differ from healthy controls in their ventilatory response to breathing through a tube and to physical exercise. Therefore, we measured their minute ventilation ( ) at rest and during breathing through a tube combined with two levels of physical exercise (1 or 2 W·kg body weight⁻¹). For breathing through a tube an additional dead space of 600 ml was used. All divers were trained in the breath-hold technique and in the use of the breathing apparatus. Their mean period of training as divers was 9±6 years. The approximate age of the subjects was 25 years. The pattern of breathing and the oxygen uptake were measured by spirometer, the end-tidal concentration of CO₂ was measured and all experiments were carried out above sea level. The ventilation of the divers at rest was comparable to that of the controls. During physical exercise it was smaller whether during breathing through a tube or not. The inadequate increase of during exercise in divers was associated with hypercapnia only at a higher physical work intensity (of 2 W·kg⁻¹). This finding is interpreted as a lower chemoregulatory response to the combined stimuli of hypercapnia, hypoxia and physical exercise. In some situations significant bradypnoea and higher tidal volumes were found in the divers.     

Mechanical impedance of the respiratory tract in divers before and after simulated deep dives

Previous studies have inconsistently shown changes in expiratory flows and volumes as well as diffusion capacity of the lungs after single dives and several diving related occupational conditions were considered as possible underlying factors. In this study mechanical impedance of the airways was measured before and after simulated dives to non-invasively determine whether there is evidence for lung function impairment due to hyperbaric exposure. Thirty-three healthy male divers employing air self-contained underwater breathing apparatus were randomly assigned to dry and wet chamber dives in a cross-over design to 600 kPa ambient pressure (total duration 43 min, bottom time 15 min, water temperature 24°C). Immediately before and after diving, oscillometric parameters—e. g. resistance and reactance of the respiratory tract—were measured at defined frequencies (5, 20 Hz). Spirometry was carried out as well (FVC, FEV₁, MEF 25–75). No significant changes between post-exposure values and baseline values were detected by respiratory impedance and spirometry. Diving in accordance to diving regulations and without excessive workload is not a source for acute obstructive lung function changes as the obtained oscillometric data suggested. Moreover this study could not confirm changes in spirometry after simulated diving exposure.     

Redox modulation of contractile function in respiratory and limb skeletal muscle

For the last half century, scientists have studied the biological importance of free radicals in respiratory and limb muscles. We now know that muscle fibers continually produce both reactive oxygen species (ROS) and nitric oxide (NO) and that both cascades play critical roles in contractile regulation. Under basal conditions, muscle-derived ROS and NO exert opposing effects. Low-level ROS activity is an essential part of the homeostatic milieu and is required for normal force production whereas NO derivatives function as a brake on the system, limiting force. The modulatory effects of ROS and NO are disrupted by conditions that exaggerate production including mechanical unloading, inflammatory disease, and strenuous exercise. Marked increases in ROS or NO levels cause contractile dysfunction, resulting in muscle weakness and fatigue. These principles provide a foundation for ongoing research to identify the mechanisms of ROS and NO action and develop interventions that protect muscle function.     

Stimulation of the rat medullary raphe nuclei induces differential responses in respiratory muscle activity

Neural control circuits that coordinate the motor activity of the diaphragm (DIA) and the geniohyoid muscle (GH) are potentially involved in pathological conditions such as various forms of sleep apnea. Here we investigated a differential role of the raphe magnus (RMg), pallidus (RPa) and the obscurus (ROb) nuclei in the neural control of DIA and GH muscle activity in rats under volatile anesthesia. In order to characterize a topographical organization of the raphe nuclei we analyzed changes in DIA and GH during high-frequency stimulation (HFS, 10–130 Hz, 60 μs pulse width, 40–160 μA, 30 s). HFS of the RMg and the ROb induced apnea, in the latter case apnea was associated with massive tonic discharge in the GH. By contrast, HFS of the RPa induced tachypnea. At caudal stimulation sites the tachypnea was accompanied by tonic DIA activity and cessation of GH. These data suggest a differential distribution of inhibitory and excitatory drives of DIA and GH muscles within distinct raphe nuclei.     

Design of a new artificial breathing system for simulating the human respiratory activities

The purpose of this work is the conception and implementation of an artificial active respiratory system that allows the simulation of human respiratory activities. The system consists of two modules, mechanical and electronical. The first one represents a cylindrical lung adjustable in resistance and compliance. This lung is located inside a transparent thoracic box, connected to a piston that generates variable respiratory efforts. The parameters of the system, which are pressure, flow and volume, are measured by the second module. A computer application was developed to control the whole system, and enables the display of the parameters. A series of tests were made to evaluate the respiratory efforts, resistances and compliances. The results were compared to the bibliographical studies, allowing the validation of the proposed system.     

新生儿呼吸窘迫综合征患儿肺功能的动态变化

目的总结呼吸窘迫综合征(RDS)患儿肺功能的动态变化规律,指导临床的诊断与治疗。方法我院2001年6月~2003年9月期间新生儿病房收治日龄小于12h的早产儿44名。其中RDS患儿22名,非RDS早产儿22名。于入院后1h到生后7d进行肺动态顺应性(CL),呼吸功(WOB),气道阻力(Raw),潮气量(VT)及每分通气量(VE)等肺功能指标测试。结果RDS患儿的CL生后24h内为0.41±0.20m l/cm H2O/?明显低于非RDS患儿的CL3.20±3.28m l/cmH2O/kg,有非常显著性差异(P<0.01),在生后4d内RDS患儿的CL显著低于非RDS(P<0.05),在生后5天内RDS组患儿WOB高于非RDS组(P<0.01)。RDS组Raw,VT及每VE无统计学意义。结论揭示RDS患儿肺功能的动态变化规律,可用于早期诊断RDS及指导临床治疗。     

Effects of static forehead and forearm muscle tension on total respiratory resistance in healthy and asthmatic participants

The impact of static muscle tension on total respiratory resistance (TRR) was examined. Participants (24 healthy, 24 asthmatic) performed biofeedback-assisted sequences of tensing (15 s) and relaxing (20 s) forehead and forearm muscles. Muscle tension levels were 40% or 80% of the maximum individual force. Oscillatory TRR, electromyograms, ventilation, heart period, and respiratory sinus arrhythmia were recorded. Baseline TRR did not change over the session as a whole. Decreases in TRR during forehead tension in both groups were accompanied by increases in end-expiratory volume, which could have mediated TRR changes. During forearm tension, decreases in TRR with minimal ventilation changes were only observed in healthy participants, whereas asthmatic patients revealed marked increases in respiratory volume and flow. These results indicate that static muscle activity and TRR are negatively related. Ventilatory changes can exaggerate or diminish evidence for this relationship.     

Estimating respiratory mechanical parameters of ventilated patients: a critical study in the routine intensive-care unit

Airflow and pressure were measured post-operatively in eight mechanically ventilated patients in the routine intensive care unit. Analysis of the input impedance spectra versus frequency suggested that respiratory data cannot be adequately reproduced using the classic two-element R-C model, as the real part of input impedance decreases with frequency. To fit in with this behaviour, we adopted a three-element model with an additional parallel compliance. The three parameters of this model were estimated separately in the frequency and time domains by minimising suitable least-square criterion functions. The results demonstrate a good agreement between the parameter estimates in the frequency and time domains, and show that the three-element model reproduces the input impedance frequency pattern in the range 0.2–8 Hz. Comparison of different linear models in the time domain demonstrated that the precision of parameter estimates and the quality of best fitting sharply increase from the two-element to the three-element model. The addition of a fourth resistive parameter, like in the Mead model, does not lead to appreciable improvement and makes the model almost unidentifiable. The possible contribution of a ventilator-patient circuit of the upper airway shunting and of the peripheral airway obstruction are also discussed.     

Effects of concurrent inspiratory and expiratory muscle training on respiratory and exercise performance in competitive swimmers

The efficiency of the respiratory system presents significant limitations on the bodys ability to perform exercise due to the effects of the increased work of breathing, respiratory muscle fatigue, and dyspnoea. Respiratory muscle training is an intervention that may be able to address these limitations, but the impact of respiratory muscle training on exercise performance remains controversial. Therefore, in this study we evaluated the effects of a 12-week (10 sessions week^–1) concurrent inspiratory and expiratory muscle training (CRMT) program in 34 adolescent competitive swimmers. The CRMT program consisted of 6 weeks during which the experimental group (E, n=17) performed CRMT and the sham group (S, n=17) performed sham CRMT, followed by 6 weeks when the E and S groups performed CRMT of differing intensities. CRMT training resulted in a significant improvement in forced inspiratory volume in 1 s (FIV_1.0) (P=0.050) and forced expiratory volume in 1 s (FEV_1.0) (P=0.045) in the E group, which exceeded the S groups results. Significant improvements in pulmonary function, breathing power, and chemoreflex ventilation threshold were observed in both groups, and there was a trend toward an improvement in swimming critical speed after 12 weeks of training (P=0.08). We concluded that although swim training results in attenuation of the ventilatory response to hypercapnia and in improvements in pulmonary function and sustainable breathing power, supplemental respiratory muscle training has no additional effect except on dynamic pulmonary function variables.     

Effect of salbutamol on respiratory muscle function and ventilation in awake canines

The effect of the beta-agonist bronchodilator salbutamol on respiratory muscles and ventilation is uncertain. The presence of beta2 receptors on skeletal muscles and increased diaphragm contractility in vitro with salbutamol predict a significant effect that has not been confirmed, in vivo in non-fatigued diaphragm or in clinical studies using standard bronchodilator dosages. Therefore, we infused salbutamol at a higher dosage (23.3 microg/min) used clinically for treatment of respiratory emergencies, while measuring directly the length, shortening and EMG activation of costal and crural diaphragm, parasternal intercostal and transversus abdominis muscles, in 10 awake canines. At this salbutamol dosage, ventilation and tidal volume increased significantly during both resting and CO2-stimulated breathing. Salbutamol elicited significant increases in respiratory muscle shortening with much smaller increases in EMG activity, so the proportionally greater muscle shortening per unit EMG showed increased muscle contractility. The effects of salbutamol were not extinguished by inspiratory flow resistance or fluid challenge but were reversed specifically by the beta-blocker, propranolol. This study demonstrates that, in sufficient intravenous dosage, the beta-agonist salbutamol elicits increased ventilation and a beta2 receptor-mediated increase in contractility of respiratory muscles.     

Serotonergic and noradrenergic effects on respiratory neural discharge in the medullary slice preparation of neonatal rats

Rhythmically active medullary slice preparations isolated from neonatal rats (postnatal days 0-3, P0-P3) were used to study the modulation of respiraory rhythmogenesis and hypoglossal (XII) nerve discharge by serotonin (5-hydroxytryptamine, 5-HT) and noradrenaline (NA). 5-HT, NA and their respective receptor agonists and antagonists were applied either to the bathing medium or focally via pressure injection into regions encompassing the pre-Bötzinger complex or XII motoneurons. The effects of endogenously released 5-HT were also studied by chemical stimulation of neurons within the raphe obscurus. The frequency of respiratory burst discharge was increased when 5-HT was applied: (1) to the bathing medium (37±16%; 30 µM; P < 0.05); (2) via pressure injection into the region of the pre-Bötzinger complex (22 ± 14%; < 25 pmol; P < 0.05); or (3) endogenously released in response to activation of neurons within the raphe obscurus via pressure injection of (R,S)-a-amino-3-hydroxy-5-methylisoxazole-4-propionic acid hydro-bromide (AMPA, 34 ± 15%; P < 0.05) or 5-HT (33 ± 5%; P < 0.05). All of these effects were antagonized by bath application of methysergide (30-40 µM). NA caused a reduction of respiratory burst frequency when applied to the bathing medium (40 ± 15%; 100 µM; P < 0.05) or when pressure injected into the region of the pre-Bötzinger complex (22 ± 11 %; < 25 pmol; P < 0.05). These effects were blocked by the bath application of the a₂-receptor antagonist idazoxan (2 µM). 5-HT and NA both caused an augmentation of tonic discharge of XII nerves when applied either to the bathing medium or via pressure injection into the XII motoneuron pool. The 5-HT-induced XII nerve tonic discharge was mimicked by the 5-HT₂ receptor agonist R(-)2-(2,5-dimethoxy-4-iodophenyl) (DOI.HC1, 5 µM) and blocked by the 5-HT₂ receptor antagonist ketanser-ine tartrate (30-40 µM). The NA-induced XII nerve tonic discharge was mimicked by the α₁-receptor agonist phenylephrine HC1 (500 µM) and blocked by the α₁-receptor antagonist prozasin HC1 (@#@ 1 µM).     

Development and testing of a PC-based system with menu-driven software for evaluating lung function in ICU patients

This paper describes a portable PC-based system for measuring respiratory system resistance (Rrs) and dynamic lung compliance (Cdyn) in intubated and mechanically ventilated patients. A pneumotachometer placed immediately proximal to the endotracheal tube measures flow, and a pressure catheter with its tip at the distal end of the endotracheal tube measures lateral airway pressure. The software is menu driven and allows the user to select from options including patient information display and entry, data collection, data editing, and waveform display. Up to ten consecutive breaths can be analyzed per run. Rrs and Cdyn are calculated on a breath by breath basis. Results are displayed to the screen, output to the system printer, and written to a user-specified ACSII data file. The system was tested by measuring resistance and compliance in a model of the lung, and results compared with those calculated from analog signals. It was then used to make measurements in intubated post-operative patients. Results were comparable to those previously reported in intubated ICU patients without primary lung disease. We conclude that our system provides reliable measurements of lung mechanics in the intubated patient, and represents an inexpensive and more versatile alternative to microprocessor-based ventilator systems currently being marketed.     

中等强度训练干预大鼠骨骼肌抗增殖蛋白PHB1表达及线粒体呼吸功能的变化

背景:研究显示长期中等强度规律运动可以改善骨骼肌细胞线粒体电子呼吸链复合体酶的活性,从而提高其做功能力和抵抗疲劳能力。目的:探讨中等强度训练对大鼠骨骼肌内抗增殖蛋白及线粒体呼吸功能的影响。方法:32只健康雄性SD大鼠随机分为2组:安静对照组、中等强度训练组,每组16只。中等强度训练组的训练方案:第1周以10 m/min速度跑,每周6 d,每天10 min,坡度10°;第2周以15 m/min速度跑,每周6 d,每天增加10 min至60 min结束,坡度10°;第3-8周以15 m/min速度跑,每周6 d,每天60 min,坡度10°。末次实验后48 h处死大鼠,提取骨骼肌以及线粒体,检测线粒体呼吸控制率、ATP含量、活性氧水平、复合体V活性及PHB1蛋白表达。结果与结论:①与安静对照组相比,中等强度训练组骨骼肌线粒体呼吸控制率显著性升高(P<0.001)、ATP含量显著性升高(P<0.05)、活性氧水平显著降低(P<0.001)、复合体V活性显著升高(P<0.05)、PHB1表达显著升高(P<0.01);②通过相关性分析得出:经过8周中等强度训练后大鼠骨骼肌内PHB1的表达分别与ATP含量、复合体V活性呈正相关,与活性氧水平呈负相关;③结果表明,中等强度训练通过促进PHB1表达提高线粒体氧化磷酸化功能,维持线粒体膜结构,增强线粒体呼吸功能。     

Effect of isometric strength training on mechanical,electrical, and metabolic aspects of muscle function

Summary Monozygous twin pairs (two female and four male) were used in a strength training study so that one member of each pair served as training subject (TS) and the other members as nonexercising controls (CS). TS trained four times a week for 12 weeks with maximal isometric knee extensions of the right leg. The parameters studied included muscle strength, endurance time, electromyographic activity, and activities of several key enzymes in nonoxidative and oxidative muscle metabolism. The results disclosed that in addition to a 20% increase in isometric knee extension strength in the trained leg of TS, an average increase of 11% was observed in strength of TS untrained leg. CS did not demonstrate any change in muscle strength. Training also included an improvement in the maintenance of a static load of 60% of the pretraining maximum. Increase in the maximum integrated electromyographic activity (IEMG) of the rectus femoris muscle occurred concomitantly with the knee extension strength. Training also caused reduction in the IEMG/tension ratio at submaximal loads indicating a more economical usage of the rectus femoris muscle. Muscle biopsies taken from the vastus lateralis muscle showed that the enzyme activities of MDH, SDH, and HK were higher, and LDH and CPK lower in the trained leg as compared to the nontrained control leg of TS or to the values of the untrained member of the twin pair. It is concluded that isometric strength training as used in the present study can cause increased recruitment of the available motor unit pool, improved efficiency at submaximal loads, and surprisingly also enchancement of the oxidative metabolism in the muscle.This study was supported in part by a grant (9287/79/72) from the Ministry of Education (Finland)     

Effects of exposure to gas cooking in childhood and adulthood on respiratory symptoms, allergic sensitization and lung function in young British adults

BACKGROUND: There is evidence that people who use gas for cooking have reduced lung function and experience more respiratory symptoms than those who use other fuels for cooking. OBJECTIVES: To study the effect of the presence of a gas cooker in the home, during both childhood and adulthood, on respiratory symptoms, allergic sensitization and ventilatory function among young adults. METHODS: A sample of 1449 young adults born in Britain 3-9 March 1958, who have been followed from birth to ages 7, 11, 16, 23 and 33 years, were examined at home at age 34-35 years. FEV1 and FVC were measured before and 20 min after inhalation of 400 microg salbutamol, and skin prick tests performed with three allergen extracts (grass, Der p 1 and cat). An interview on respiratory symptoms and indoor environmental exposures was included. RESULTS: No association was found between gas cooking in childhood or adulthood and incidence or prognosis of asthma/wheeze, allergic sensitization or current severity of respiratory symptoms. Subjects who currently used gas for cooking had a significantly reduced FEV1 (- 70 mL, 95% CI +/- 56) but not FVC (- 35 mL, 95% CI +/- 61) compared with those who used electricity for cooking. This reduction in FEV1 was concentrated among men and current asthmatics. CONCLUSION: The use of gas for cooking is unlikely to be a major influence on respiratory morbidity in young adults.     

慢性精神分裂症患者胸部X线表现及特点分析

目的探讨慢性精神分裂症患者胸部X线表现及其特点。方法选择100例慢性精神分裂症患者为病例组,同期健康志愿者100例为健康组,均行胸部X线检查,对肺叶面积和肺部结构表现进行观察。结果病例组胸部X线异常表现率为81.00%,与健康组32.00%比,明显更高(P<0.05);病例组首次胸片和末次胸片与健康组对比差异有统计学意义,且病例组末次胸片肺叶面积较初次胸片肺叶面积明显减小(P<0.05);病例组中,男性与女性双隔顶上升、心脏旋转、肺门淤血、左心室增大发生率对比无明显差异(P>0.05),女性心脏淹没征发生率明显较男性高(P<0.05)。结论慢性精神分裂症患者通常伴有胸部X线异常表现,临床可加强对患者X线胸片检查,及时了解疾病发展,为临床治疗方案制定提供指导依据。     

Transpulmonary pressure and lung volume of the cat and the newborn: removal of cardiac effects with a digital filter

Dynamic lung compliance is a measure of the elastic properties of the lungs in the normal breathing range and is measured as the relationship between the transpulmonary pressure changes and the corresponding changes in lung volume. This relationship is given as a pressure-volume loop, from which the compliance is calculated as the slope of the line joining the end points of the loop. Owing to cardiac interference, which is superimposed on the normal pressure and volume signals, the compliance loops are often severely distorted, making it difficult to establish the end points in the loop. Therefore it is necessary to preprocess the measured data so that the superimposed cardiac pulsations are eliminated. In the investigations that are described in this paper, we have applied digital filtering techniques to recover compliance loops resulting solely from respiratory origin. The design method of a digital filter based on ‘windowing’ technique is discussed. The method is applied for filtering transpulmonary-pressure and lung-volume data obtained from experiments with cats and neonates. The effectiveness of digital filtering in recovering the compliance loops which are contaminated by the presence of cardiac pulsations is shown.