Search Results (1,251)

Many commercial wearable sensor systems typically rely on a single continuous cardiorespiratory sensing modality, photoplethysmography (PPG), which suffers from inherent biases (i.e., differences in skin tone) and noise (e.g., motion and pressure artifacts). In this research, we present a wearable device that provides robust estimates of cardiorespiratory variables by combining three physiological signals from the upper arm: multiwavelength PPG, single-sided electrocardiography (SS-ECG), and bioimpedance plethysmography (BioZ), along with an inertial measurement unit (IMU) providing 3-axis accelerometry and gyroscope information. We evaluated the multimodal device on 16 subjects by its ability to estimate heart rate (HR) and breathing rate (BR) in the presence of various static and dynamic noise sources (e.g., skin tone and motion). We proposed a hierarchical approach that considers the subject’s skin tone and signal quality to select the optimal sensing modality for estimating HR and BR. Our results indicate that, when estimating HR, there is a trade-off between accuracy and robustness, with SS-ECG providing the highest accuracy (low mean absolute error; MAE) but low reliability (higher rates of sensor failure), and PPG/BioZ having lower accuracy but higher reliability. When estimating BR, we find that fusing estimates from multiple modalities via ensemble bagged tree regression outperforms single-modality estimates. These results indicate that multimodal approaches to cardiorespiratory monitoring can overcome the accuracy–robustness trade-off that occurs when using single-modality approaches. Full article

Background/Objectives: To investigate acute caffeine (CAF: 375 mg, ≈4.8 mg/kg body mass) effects on energy expenditure (EE) and substrate kinetics during high-intensity interval exercise in individuals with high (HBAT) versus low (LBAT) brown adipose tissue activity using time-trend polynomial modeling. Methods: This is a randomized, double-blind crossover study in which 35 highly-trained males [HBAT-CAF, HBAT-PLA (Placebo), LBAT-CAF, LBAT-PLA] performed 30-min treadmill HIIE. Infrared thermography (IRT) assessed BAT activity by measuring supraclavicular skin temperature (SST). Breath-by-breath ergospirometry measured EE (kcal/min) and carbohydrate (CHO), lipid (LIP), and protein (PTN) oxidation. We applied second- and third-order polynomial regression models to depict the temporal trajectories of metabolic responses. Results: HBAT groups showed 25% higher sustained EE versus LBAT (p < 0.001), amplified by CAF. CHO oxidation exhibited biphasic kinetics: HBAT had 40% higher initial rates (0.75 ± 0.05 vs. 0.45 ± 0.04 g/min; p < 0.001) with accelerated decline (k = −0.21 vs. −0.15/min; p = 0.01). LIP oxidation peaked later in LBAT (40 vs. 20 min in HBAT), with CAF increasing oxidation by 18% in LBAT (p = 0.01). HBAT-CAF uniquely showed transient PTN catabolism (peak: 0.045 g/min at 10 min; k = −0.0033/min; p < 0.001). Conclusions: BAT status determines EE magnitude and substrate-specific kinetic patterns, while CAF exerts divergent modulation, potentiating early glycogenolysis in HBAT and lipolysis in LBAT. The HBAT-CAF synergy triggers acute proteolysis, revealing BAT-mediated metabolic switching. Full article

Background: Chronic stress in childhood and adolescence leads to excessive cortisol secretion, adipokines production and obesity with all the negative mental and physical effects on the health of individuals and adulthood. Objectives: The aim of the present non-randomized controlled trial was to investigate the effect of a stress management protocol with diaphragmatic breathing (DB) and physiotherapy exercise on stress, body composition, cardiorespiratory and metabolic markers of children and adolescents with morbid obesity. Methods: The study included 31 children and adolescents (5–18 years old) with morbid obesity (22 in the intervention arm and 9 controls). All participants completed anxiety questionnaires and a self-perception scale. Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), blood pressure (BP) and SpO₂ were measured. Fasting glucose, uric acid, triglycerides, HbA1c, (AST/SGOT), (ALT/SGPT), HDL, LDL, insulin, ACTH, cortisol, HOMA-IR, 17-OH, S-DHEA, SHBG were assessed, and anthropometric measurements were also performed. Results: In the intervention group, 4 months after the treatment, an improvement was noted in the BMI, BMI z-score, waist-to-height ratio, FEV1, SpO₂, pulse and systolic BP. HDL increased, ALT/SGPT and insulin resistance improved. Positive changes were observed in temporary and permanent stress and self-esteem of children in the intervention group, including anxiety, self-perception, physical appearance, etc. Conclusions: A combined exercise and DB protocol has a positive effect on stress, by improving body composition, reducing insulin resistance, and ameliorating physical and mental health and quality of life of pediatric patients with morbid obesity. Full article

Nasal obstruction is a common symptom of nasal conditions, with nasal resistance being a crucial physiological indicator for assessing severity. However, traditional rhinomanometry faces challenges with interference, limited automation, and unstable measurement results. To address these issues, this research designed a nasal resistance measurement system based on multi-sensor fusion of pressure and flow. The system comprises lower computer hardware for acquiring raw pressure–flow signals in the nasal cavity and upper computer software for segmenting and filtering effective respiratory cycles and calculating various nasal resistance indicators. Meanwhile, the system’s anti-interference capability was assessed using recall, precision, and accuracy rates for respiratory cycle recognition, while stability was evaluated by analyzing the standard deviation of nasal resistance indicators. The experimental results demonstrate that the system achieves recall and precision rates of 99% and 86%, respectively, for the recognition of effective respiratory cycles. Additionally, under the three common interference scenarios of saturated or weak breaths, breaths when not worn properly, and multiple breaths, the system can achieve a maximum accuracy of 96.30% in identifying ineffective respiratory cycles. Furthermore, compared to the measurement without filtering for effective respiratory cycles, the system reduces the median within-group standard deviation across four types of nasal resistance measurements by 5 to 18 times. In conclusion, the nasal resistance measurement system developed in this research demonstrates strong anti-interference capabilities, significantly enhances the automation of the measurement process and the stability of the measurement results, and offers robust technical support for the auxiliary diagnosis of related nasal conditions. Full article

Malignant mediastinal tumors are a group representing some of the most demanding oncological challenges for early, multi-level, and successful management. The timely identification of any suspicious clinical symptomatology is urgent in achieving an accurate, staged histological diagnosis, in order to follow up with an equally detailed medical therapeutic plan (interventional or not) and determine the principal goals regarding efficient overall treatment in these patients. We report a case of a 24-year-old male patient with an incident-free prior medical history. An initial chest X-ray was performed after the patient reported short-term, consistent moderate chest pain symptomatology, early work fatigue, and shortness of breath. The following imaging procedures (chest CT, PET-CT) indicated the presence of an anterior mediastinal mass (meas. ~11 cm × 10 cm × 13 cm, SUV: 8.7), applying additional pressure upon both right heart chambers. The Alpha-Fetoprotein (aFP) blood levels had exceeded at least 50 times their normal range. Two consecutive diagnostic attempts with non-specific histological results, a negative-for-malignancy fine-needle aspiration biopsy (FNA-biopsy), and an additional tumor biopsy, performed via mini anterior (R) thoracotomy with “suspicious” cellular gatherings, were performed elsewhere. After admission to our department, an (R) Video-Assisted Thoracic Surgery (VATS) was performed, along with multiple tumor biopsies and moderate pleural effusion drainage. The tumor’s measurements had increased to DMax: 16 cm × 9 cm × 13 cm, with a severe degree of atelectasis of the Right Lower Lobe parenchyma (RLL) and a pressure-displacement effect upon the Superior Vena Cava (SVC) and the (R) heart sinus, based on data from the preoperative chest MRA. The histological report indicated elements of a combined, non-seminomatous germ-cell mediastinal tumor, posthuberal-type teratoma, and embryonal carcinoma. The imminent chemotherapeutic plan included a “BEP” (Bleomycin^®/Cisplatin^®/Etoposide^®) scheme, which needed to be modified to a “VIP” (Cisplatin^®/Etoposide^®/Ifosfamide^®) scheme, due to an acute pulmonary embolism incident. While the aFP blood levels declined, even reaching normal measurements, the tumor’s size continued to increase significantly (DMax: 28 cm × 25 cm × 13 cm), with severe localized pressure effects, rapid weight loss, and a progressively worsening clinical status. Thus, an emergency surgical intervention took place via median sternotomy, extended with a complementary “T-Shaped” mini anterior (R) thoracotomy. A large, approx. 4 Kg mediastinal tumor was extracted, with additional RML and RUL “en-bloc” segmentectomy and partial mediastinal pleura decortication. The following histological results, apart from verifying the already-known posthuberal-type teratoma, indicated additional scattered small lesions of combined high-grade rabdomyosarcoma, chondrosarcoma, and osteosarcoma, as well as numerous high-grade glioblastoma cellular gatherings. No visible findings of the previously discovered non-seminomatous germ-cell and embryonal carcinoma elements were found. The patient’s postoperative status progressively improved, allowing therapeutic management to continue with six “TIP” (Cisplatin^®/Paclitaxel^®/Ifosfamide^®) sessions, currently under his regular “follow-up” from the oncological team. This report underlines the importance of early, accurate histological identification, combined with any necessary surgical intervention, diagnostic or therapeutic, as well as the appliance of any subsequent multimodality management plan. The diversity of mediastinal tumors, especially for young patients, leaves no place for complacency. Such rare examples may manifest, with equivalent, unpredictable evolution, obliging clinical physicians to stay constantly alert and not take anything for granted. Full article

Continuous monitoring of respiratory patterns is essential for disease diagnosis and daily health care. Contact medical devices enable reliable respiratory monitoring, but can cause discomfort and are limited in some settings. Radar offers a noncontact respiration measurement method for continuous, real-time, high-precision monitoring. However, it is difficult for a single radar to characterize the coordination of chest and abdominal movements during measured breathing. Moreover, motion interference during prolonged measurements can seriously affect accuracy. This study proposes a dual radar system with customized narrow-beam antennas and signals to measure the chest and abdomen separately, and an adaptive dynamic time warping (DTW) algorithm is used to effectively suppress motion interference. The system is capable of reconstructing respiratory waveforms of the chest and abdomen, and robustly extracting various respiratory parameters via motion interference. Experiments on 35 healthy subjects, 2 patients with chronic obstructive pulmonary disease (COPD), and 1 patient with heart failure showed a high correlation between radar and respiratory belt signals, with correlation coefficients of 0.92 for both the chest and abdomen, a root mean square error of 0.80 bpm for the respiratory rate, and a mean absolute error of 3.4° for the thoracoabdominal phase angle. This system provides a noncontact method for prolonged respiratory monitoring, measurement of chest and abdominal asynchrony and apnea detection, showing promise for applications in respiratory disorder detection and home monitoring. Full article

This study included 221 patients with COVID-19 who were admitted to the emergency department of Avicenne Hospital in Rabat between August 2020 and August 2021. Patients were divided into three groups according to their D-dimer levels (<1, 1–2, and >2 µg/mL). Adjusted and unadjusted logistic regression analyses were performed to assess the association between elevated D-dimer levels and in-hospital mortality. Pearson’s correlation analysis was performed to explore the relationship between D-dimer levels and various biological and clinical parameters. The results revealed a statistically significant difference in the mean (SD) age among the three groups (p = 0.006). Analysis showed a statistically significant difference in the means (SD) of oxygen saturation, duration of hospital stay, and breathing rate among the three independent groups of COVID-19 patients. Patients with elevated D-dimer levels (greater than 2 µg/mL) experienced worse outcomes than those in the other groups, with severity, transfer to intensive care, and in-hospital mortality of 55 (40.7%), 35 (16%), and 24 (11%) patients, respectively, with p-values of 0.048, 0.002, and 0.002, respectively. Patients in the D-dimer > 2 µg/mL group had significantly higher C-reactive protein (CRP), lactate dehydrogenase, urea, cardiac troponin, B-type natriuretic peptide, and ferritin levels than those in the other two groups. The p-value was significant among the three groups (p = 0.044, p = 0.001, and p < 0.001). Age and elevated D-dimer levels (greater than 2 µg/mL) were associated with mortality in patients diagnosed with COVID-19. Correlation analysis indicated that D-dimer in COVID-19 patients is associated with worsening respiratory, hepatic, cardiac, and coagulation parameters, suggesting their utility as an integrative marker of disease severity. D-dimer levels > 2 µg/mL were identified as an independent risk factor for COVID-19 in-hospital mortality. Measuring and monitoring D-dimer levels can assist clinicians in taking timely actions and predicting the prognosis of patients with COVID-19. Full article

The use of implants in the trachea is increasing in respiratory diseases as an alternative to address pathological problems with airway obstruction. This article presents the design and development of a three-way cannula and its evaluation in a testbed capable of emulating the human breathing cycle. The new tracheal cannula allows airflow through a third duct (vertical one) towards the vocal folds, enabling phonation. The testbed assesses Total Lung Capacity (TLC) and endotracheal pressure by considering the cannula inside a replica of a trachea. The flow is generated by a mechanism composed of electronic elements, and the implementation of instruments for measuring pressure and lung capacity enables the visual and continuous collection of data. The three-way cannula offers improvements in airway capacity, with an average of up to 1.766 L of airflow and a pressure of 17.083 mbar. The airflow at the upper branch allows for improvement, enabling the patient to phonate even with the implant in place, while preserving patency due to the biocompatibility and elasticity of platinum silicone. Full article

Background/Objectives: A randomized controlled trial (RCT) was designed to test the emerging role of respiratory mechanics as part of physiotherapy in patients with non-specific chronic neck pain (NSCNP). Methods: Ninety patients with NSCNP and symptom duration >3 months were randomly allocated to three intervention groups of equal size, receiving either cervical spine (according to the Mulligan Concept) and diaphragm manual therapy plus breathing reeducation exercises (experimental group—EG1), cervical spine manual therapy plus sham diaphragmatic manual techniques (EG2), or conventional physiotherapy (control group—CG). The treatment period lasted one month (10 sessions) for all groups. The effect on the cervical spine range of motion (CS-ROM) and on the craniovertebral angle (CVA) was examined. Outcomes were collected before treatment (0/12), after treatment (1/12), and three months after the end of treatment (4/12). The main analysis comprised a two-way mixed ANOVA with a repeated measures factor (time) and a between-groups factor (group). Post hoc tests assessed the source of significant interactions detected. The significance level was set at p = 0.05. Results: No significant between-group baseline differences were identified. Increases in CS-ROM and in CVA were registered mainly post-treatment, with improvements maintained at follow-up for CS-ROM. EG1 significantly improved over CG in all movement directions except for flexion and over EG2 for extension only, at 1/12 and 4/12. All groups improved by the same amount for CVA. Conclusions: EG1, which included diaphragm manual therapy and breathing re-education exercises, registered the largest overall improvement over CG (except for flexion and CVA), and for extension over EG2. The interaction between respiratory mechanics and neck mobility may provide new therapeutic and assessment insights of patients with NSCNP. Full article

Measurement of nitric oxide (NO) concentration in exhaled breath (FeNO) is a quantitative, non-invasive, simple, and safe method for assessing airway inflammation. It serves as a complementary tool to other methods for evaluating airway diseases. However, little is known about the typical NO levels in healthy individuals, including individual differences and the influence of measurement timing. Therefore, this study classified measurement times into four periods and statistically analyzed NO levels in healthy individuals. The mean values among groups were compared using repeated measures ANOVA on six participants. The analysis showed large individual variations in NO levels, resulting in no significant difference (p = 0.29). Notably, greater fluctuations were observed in the morning. These findings align with previous studies suggesting the influence of circadian rhythms and the redundancy of repeated measurements. This study highlights the need to consider timing and individual variability when using FeNO as a physiological marker in healthy populations. Full article

Opto-electronic plethysmography (OEP) is used to measure chest wall compartment volumes and their synchronisation. Breathing pattern disorder (BPD) can be distinguished using the phase angles between these chest wall compartments during exercise. However, the time taken to manually place the standard OEP model involving 89 reflective markers is high during clinical application. The purpose of this study was to investigate the use of a pre-markered T-shirt instead of markers applied directly to the skin at rest, during different exercise intensities and recovery. Thirty-nine healthy participants (24 male, 15 female) aged 18–40 years performed an incremental cycling test with the skin-mounted OEP marker set. Participants then repeated the same cycling test with a pre-markered T-shirt. Across all test conditions, the T-shirt showed a strong level of agreement (Intraclass correlation coefficient (ICC) ≥ 0.9) with the standard breath-by-breath (BbB) gas analyser. Moreover, ICC values exceeded 0.8 for compartment contributions across all test conditions, indicating excellent agreement with the skin-mounted markers. The phase angles between compartments showed the best agreement during the moderate exercise level (0.6 < ICC < 0.8). In conclusion, the pre-markered T-shirt presents a viable solution for the quick monitoring of breathing patterns, as well as an effective tool in diagnosing BPD during exercise. Full article

The early detection of liver cirrhosis (LC) is crucial due to its high morbidity and mortality in advanced stages. Reliable, non-invasive diagnostic tools are essential for timely intervention. Exhaled human breath, reflecting metabolic changes, offers significant potential for disease diagnosis. This paper focuses on the emerging role of sensor array-based volatile organic compounds (VOCs) analysis of exhaled breath, particularly using electronic nose (e-nose) technology to differentiate LC patients from healthy controls (HCs). This study included 55 participants: 27 LC patients and 28 HCs. Sensor’s measurement data were analyzed using machine learning techniques, such as principal component analysis (PCA), discriminant function analysis (DFA), and support vector machines (SVMs) that were utilized to uncover meaningful patterns and facilitate accurate classification of sensor-derived information. The diagnostic accuracy was thoroughly assessed through receiver operating characteristic (ROC) curve analysis, with specific emphasis on assessing sensitivity and specificity metrics. The e-nose effectively distinguished LC from HC, with PCA explaining 92.50% variance and SVMs achieving 100% classification accuracy. This study demonstrates the significant potential of e-nose technology towards VOCs analysis in exhaled breath, as a valuable tool for LC diagnosis. It also explores feature extraction methods and suitable algorithms for effectively distinguishing between LC patients and controls. This research provides a foundation for advancing breath-based diagnostic technologies for early detection and monitoring of liver cirrhosis. Full article

Objectives: New smartphone-based methods for measuring cervical spine range of motion (CS-ROM) and posture are emerging. The purpose of this study was to assess the reliability and validity of three such methods in patients with non-specific chronic neck pain (NSCNP). Methods: The within-day test–retest reliability of CS-ROM and forward head posture (craniovertebral angle-CVA) was examined in 45 patients with NSCNP. CS-ROM was simultaneously measured with an accelerometer sensor (KFORCE Sens^®) and a mobile phone device (iHandy and Compass apps), testing the accuracy of each and the parallel-forms reliability between the two methods. For construct validity, correlations of CS-ROM with demographics, lifestyle, and other cervical and thoracic spine biomechanically based measures were examined in 90 patients with NSCNP. Male–female differences were also explored. Results: Both methods were reliable, with measurements concurring between the two devices in all six movement directions (intraclass correlation coefficient/ICC = 0.90–0.99, standard error of the measurement/SEM = 0.54–3.09°). Male–female differences were only noted for two CS-ROM measures and CVA. Significant associations were documented: (a) between the six CS-ROM measures (R = 0.22–0.54, p < 0.05), (b) participants’ age with five out of six CS-ROM measures (R = 0.23–0.40, p < 0.05) and CVA (R = 0.21, p < 0.05), (c) CVA with two out of six CS-ROM measures (extension R = 0.29, p = 0.005 and left-side flexion R = 0.21, p < 0.05), body mass (R = −0.39, p < 0.001), body mass index (R = −0.52, p < 0.001), and chest wall expansion (R = 0.24–0.29, p < 0.05). Significantly lower forward head posture was noted in subjects with a high level of physical activity relative to those with a low level of physical activity. Conclusions: The reliability of both CS-ROM methods was excellent. Reductions in CS-ROM and increases in CVA were age-dependent in NSCNP. The significant relationship identified between CVA and CWE possibly signifies interconnections between NSCNP and the biomechanical aspect of dysfunctional breathing. Full article

The study at the Peggy Guggenheim Collection in Venice highlights critical interactions between indoor air quality, visitor dynamics, and microclimatic conditions, offering insights into preventive conservation of modern artworks. By analyzing pollutants such as ammonia, formaldehyde, and organic acids, alongside visitor density and environmental data, the research identified key patterns and risks. Through three seasonal monitoring campaigns, the concentrations of SO₂ (sulphur dioxide), NO (nitric oxide), NO₂ (nitrogen dioxide), NO_x (nitrogen oxides), HONO (nitrous acid), HNO₃ (nitric acid), O₃ (ozone), NH₃ (ammonia), CH₃COOH (acetic acid), HCOOH (formic acid), and HCHO (formaldehyde) were determined using passive samplers, as well as temperature and relative humidity data loggers. In addition, two specific short-term monitoring campaigns focused on NH₃ were performed to evaluate the influence of visitor presence on indoor concentrations of the above compounds and environmental parameters. NH₃ and HCHO concentrations spiked during high visitor occupancy, with NH₃ levels doubling in crowded periods. Short-term NH₃ campaigns confirmed a direct correlation between visitor numbers and the above indoor concentrations, likely due to human emissions (e.g., sweat, breath) and off-gassing from materials. The indoor/outdoor ratios indicated that several pollutants originated from indoor sources, with ammonia and acetic acid showing the highest indoor concentrations. By measuring the number of visitors and microclimate parameters (temperature and humidity) every 3 s, we were able to precisely estimate the causality and the temporal shift between these quantities, both at small time scale (a few minute delay between peaks) and at medium time scale (daily average conditions due to the continuous inflow and outflow of visitors). Full article

Background: We evaluated the utility of HNSCC LN R2* relaxation times to infer the oxygenation status of LN non-invasively at baseline and when breathing air and 100% oxygen to predict chemoradiotherapeutic locoregional response at 2 years. Hypoxia within LNs has been associated with poorer outcomes following CRT. Deoxyhaemoglobin decreases MRI transverse relaxation time (T2*) (lengthening inverse, R2*). Methods: A total of 54 patients underwent 1.5T-MRI before CRT. Conventional MR sequences were supplemented with T2* sequences breathing both air and 100% oxygen; pathological nodes identified in consensus were volumetrically contoured to T2* parametric maps. Results: Patients followed-up with for >2 years were categorised by multidisciplinary consensus into post-therapy complete local response (CR; n = 32/54) and local nodal disease relapse (RD; n = 22/54). Our data demonstrated, by R2*, that nodes that sustained post-therapy CR are significantly more hypoxic compared with relapsing nodes and paradoxically demonstrate a significant increase in hypoxia on 100% oxygen. Pre-treatment LN short axis diameter, various qualitative descriptors of malignancy, and quantitative DWI were not useful in discriminating successful response to CRT. Conclusions: This study demonstrates that a significant differential response to 100% oxygen and higher baseline R2* LN measurements could be exploited in risk stratification prior to CRT, and future work could be directed towards understanding the contrast mechanisms of R2* imaging, underpinning the observed differences in the context of hypoxia. Full article