Search Results (23)

Closed-circuit rebreather diving has opened new opportunities for direct observation of the rich biodiversity of unexplored mesophotic coral ecosystems. We recently encountered four specimens of a rare benthic ctenophore genus, Lyrocteis. The specimens were found on the east coast of Réunion Island off the harbor of Sainte Rose at ~95 m. This finding contributes to the limited number of records of the genus in the Indian Ocean. Continued exploration of mesophotic zones remains essential, as each dive has the potential to reveal remarkable and unexpected discoveries. Full article

Background: The US Food and Drug Administration (FDA) and International Organization for Standardization (ISO) clearance standards for the clinical use of smart device pulse oximetry require in-laboratory human hypoxemia testing in healthy human individuals using arterial blood gas analysis. Methods: We evaluated the SpO₂ measurements of the Samsung smartphone (Galaxy S9/10) and smartwatch (Galaxy 4) at stable arterial oxygen saturations (SaO₂) between 70 and 100% in 24 healthy participants. Testing followed FDA/ISO-stipulated procedures for pulse oximetry performance validation, which include questionnaire estimation of skin tone based on Fitzpatrick estimation of skin types I–VI. During testing, inspired oxygen, nitrogen, and carbon dioxide partial pressures were monitored and adjusted via partial rebreathing circuits to achieve stable target arterial blood oxygen (SaO₂) plateaus between 70% and 100%. Arterial blood samples were taken at each plateau, with device SpO₂ readings taken at each sample extraction. An ABL-90FLEX blood gas analyzer determined arterial blood sample SaO₂. Bias, calculated from device readings minus corresponding arterial blood measurements, was reported as root mean square deviation (RMSD). Results: Combined Participants demographics were: 62.5% female; median age 26 years (range 21–46); and race/ethnicity 16.7% African American, 33.3% Asian, 12.5% multi-ethnic, and 37.5% Caucasian. Fitzpatrick Skin Scale-identified skin tones were: white–fair (I&II), 20.8%; average–light brown (III–IV), 54% and brown–black (V–VI), 25%. There were no adverse events. The RMSD values of SpO₂ measurements were: smartphone 2.6% (257 data pairs) and smartwatch 1.8% (247 data pairs). Conclusions: Device SpO₂ demonstrated RMSD < 3.0% to SaO₂, meeting FDA/ISO clearance standards at the time of study. However, additional testing in persons with darker skin tones is necessary. Smartphones and paired wearables, when cleared for clinical use following revision of FDA clearance standards, may expand access to remote pulse oximetry. Full article

Background: The Apple Watch provides promising health data that could aid in increasing exercise adherence; regular exercise can help individuals manage and prevent diseases such as obesity and cardiovascular disease. However, the impact of skin pigmentation on the accuracy of the Apple Watch Series 9 for measures of energy expenditure (EE) and heart rate (HR) is unknown. Purpose: The purpose of this study was to determine the accuracy of the Apple Watch Series 9 on various skin pigmentations for measures of EE and HR. Methods: Thirty young, healthy individuals were assigned to one of three groups based on their scores on the Fitzpatrick skin survey. Participants completed a 10 min treadmill protocol with varying speeds and inclines while wearing an Apple Watch Series 9, a two-way non-rebreathing mouthpiece connected to a Parvo Medics metabolic cart, and a Polar H7 chest strap to measure EE and HR. Results: Overall, EE was found to be inconsistent for all skin pigmentation groups. However, for HR, the Apple Watch Series 9 was more variable (i.e., less accurate) for darker skin pigmentations compared to lighter skin pigmentations. Conclusions: The Apple Watch Series 9 was found to vary in both EE and HR measures from criterion across intensity and skin pigmentation, with greater discrepancies for individuals in Group 3 for measures of HR. Further investigation might aim to study the impact of skin pigmentations and wrist subcutaneous fat on the accuracy of the latest Apple Watch Series 9 for measures of EE and HR. Full article

This literature review focuses on diagnostics of equine asthma (EA), possible influencing factors on diagnostic techniques and latest developments in diagnosing horses during EA remission or with subclinical disease. Routine EA diagnostics include a clinical examination of the respiratory system with percussion and auscultation including a rebreathing examination, and clinical pathology including white blood cells and arterial blood gas analysis. Subsequent diagnostics include bronchoscopy to evaluate the amount and viscosity of respiratory secretion, bronchoalveolar lavage, and the cytology of tracheal aspirates (TAs) and bronchoalveolar lavage fluid (BALF). The grading of EA severity is built on respiratory effort at rest, which is increased in severe equine asthma. The inflammatory subtype is based on BALF cytology, while TA cytology helps to rule out previous bacterial infections. Different factors have an impact on the airways regarding the structure of the epithelium, cytology, and inflammatory markers possibly influencing the diagnosis of EA. Short-term exercise increases the total cell count and inflammatory mediators identified in the BALF of human patients, asymptomatic horses, and other species. Other factors involve cold or chlorinated air, long-term training effects, and concurrent additional respiratory disease, in particular exercise-induced pulmonary hemorrhage. As BALF cytology may be unremarkable during EA remission and low-grade disease, exercise tests and other factors stressing the bronchial epithelium may help to diagnose these patients. Full article

The diaphragm is the primary muscle of respiration. Here, we disclose a fascinating patient’s perspective that led, by clinical reasoning alone, to a novel mechanism of spontaneous respiratory arrests termed diaphragm cramp-contracture (DCC). Although the 7-year-old boy survived its paroxysmal nocturnal “bearhug pain apnea” episodes, essentially by breathing out to breathe in, DCC could cause sudden unexpected deaths in children, especially infants. Diaphragm fatigue is central to the DCC hypothesis in SIDS. Most, if not all, SIDS risk factors contribute to it, such as male sex, young infancy, rebreathing, nicotine, overheating and viral infections. A workload surge by a roll to prone position or REM-sleep inactivation of airway dilator or respiratory accessory muscles can trigger pathological diaphragm excitation (e.g., spasms, flutter, cramp). Electromyography studies in preterm infants already show that diaphragm fatigue and sudden temporary failure by transient spasms induce apneas, hypopneas and forced expirations, all leading to hypoxemic episodes. By extension, prolonged spasm as a diaphragm cramp would induce sustained apnea with severe hypoxemia and cardiac arrest if not quickly aborted. This would cause a sudden, rapid, silent death consistent with SIDS. Moreover, a unique airway obstruction could develop where the hypercontracted diaphragm resists terminal inspiratory efforts by the accessory muscles. It would disappear postmortem. SIDS autopsy evidence consistent with DCC includes disrupted myofibers and contraction band necrosis as well as signs of agonal breathing from obstruction. Screening for diaphragm injury from hypoxemia, hyperthermia, viral myositis and excitation include serum CK-MM and skeletal troponin-I. Active excitation could be visualized on ultrasound or fluoroscopy and monitored by respiratory inductive plethysmography or electromyography. Full article

Background: Coronavirus disease 2019 (COVID-19) is a disease with a broad clinical spectrum, which may result in hospitalization in healthcare units, intensive care, and progression to death. This study aimed to describe and compare the clinical and epidemiological profile of COVID-19 during the three waves of the disease, in patients admitted to a public hospital in the city of Belém, Pará, in the Amazon region of Brazil. Methods: This descriptive, observational, and cross-sectional study was population-based on individuals who were hospitalized with a diagnosis of COVID-19, confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR), and who were interviewed and monitored at the public hospital, from February 2020 to April 2022. Results: The prevalence was male patients, older than 60 years. The most frequent symptoms were dyspnea, cough, and fever. Systemic arterial hypertension was the most prevalent comorbidity followed by diabetes mellitus. Less than 15% of patients were vaccinated. The nasal oxygen cannula was the most used oxygen therapy interface followed by the non-rebreathing reservoir mask. Invasive mechanical ventilation predominated and the median time of invasive mechanical ventilation ranged from 2 to 6 days among waves. As for the hospital outcome, transfers prevailed, followed by deaths and discharges. Conclusion: The presence of comorbidities, advanced age, and male sex were important factors in the severity and need for hospitalization of these patients, and the implementation of the vaccination policy was an essential factor in reducing the number of hospital admissions. Full article

Plasma volume (PV) undergoes constant and dynamic changes, leading to a large intra-day variability in healthy individuals. Hydration is known to induce PV changes; however, the response to the intake of osmotically different fluids is still not fully understood. In a randomized controlled crossover trial, 18 healthy individuals (10 females) orally received an individual amount of an isotonic sodium-chloride (ISO), Ringer (RIN), or glucose (GLU) solution. Hemoglobin mass (Hbmass) was determined with the optimized carbon monoxide re-breathing method. Fluid-induced changes in PV were subsequently calculated based on capillary hemoglobin concentration ([Hb]) and hematocrit (Hct) before and then every 10 minutes until 120 min (t_0–120) after the fluid intake and compared to a control trial arm (CON), where no fluid was administered. Within GLU and CON trial arms, no statistically significant differences from baseline until t₁₂₀ were found (p > 0.05). In the ISO trial arm, PV was significantly increased at t₇₀ (+138 mL, p = 0.01), t₈₀ (+191 mL, p < 0.01), and t₁₁₀ (+182 mL, p = 0.01) when compared to t₀. Moreover, PV in the ISO trial arm was significantly higher at t₇₀ (p = 0.02), t₁₁₀ (p = 0.04), and t₁₂₀ (p = 0.01) when compared to the same time points in the CON trial arm. Within the RIN trial arm, PV was significantly higher between t₇₀ and t₉₀ (+183 mL, p = 0.01) and between t₁₁₀ (+194 mL, p = 0.03) and t₁₂₀ (+186 mL, p < 0.01) when compared to t₀. These results demonstrated that fluids with a higher content of osmotically active particles lead to acute hemodilution, which is associated with a decrease in [Hb] and Hct. These findings underpin the importance of the hydration state on PV and especially on PV constituent levels in healthy individuals. Full article

Underwater activities are characterized by an imbalance between reactive oxygen/nitrogen species (RONS) and antioxidant mechanisms, which can be associated with an inflammatory response, depending on O₂ availability. This review explores the oxidative stress mechanisms and related inflammation status (Oxy-Inflammation) in underwater activities such as breath-hold (BH) diving, Self-Contained Underwater Breathing Apparatus (SCUBA) and Closed-Circuit Rebreather (CCR) diving, and saturation diving. Divers are exposed to hypoxic and hyperoxic conditions, amplified by environmental conditions, hyperbaric pressure, cold water, different types of breathing gases, and air/non-air mixtures. The “diving response”, including physiological adaptation, cardiovascular stress, increased arterial blood pressure, peripheral vasoconstriction, altered blood gas values, and risk of bubble formation during decompression, are reported. Full article

Background and Aims: As there is growing interest in the application of cardiopulmonary exercise test (CPX) in chronic kidney disease (CKD), it is important to understand the utility of conventional exercise test parameters in quantifying the cardiopulmonary fitness of patients with CKD. Merely extrapolating information from heart failure (HF) patients would not suffice. In the present study, we evaluated the utility of CPX parameters such as the peak O₂-pulse and the estimated stroke volume (SV) in assessing the peak SV by comparing with the actual measured values. Furthermore, we compared the anaerobic threshold (AT), peak circulatory power, and ventilatory power with that of the measured values of the peak cardiac power (CPO_peak) in representing the cardiac functional reserve in CKD. We also performed such analyses in patients with HF for comparison. Method: A cross sectional study of 70 asymptomatic male CKD patients [CKD stages 2–5 (pre-dialysis)] without primary cardiac disease or diabetes mellitus and 25 HF patients. A specialized CPX with a CO₂ rebreathing technique was utilized to measure the peak cardiac output and peak cardiac power output. The peak O₂ consumption (VO_2peak) and AT were also measured during the test. Parameters such as the O₂-pulse, stroke volume, arteriovenous difference in O₂ concentration [C(a-v)O₂], peak circulatory power, and peak ventilatory power were all calculated. Pearson’s correlation, univariate, and multivariate analyses were applied. Results: Whereas there was a strong correlation between the peak O₂-pulse and measured peak SV in HF, the correlation was less robust in CKD. Similarly, the correlation between the estimated SV and the measured SV was less robust in CKD compared to HF. The AT only showed a modest correlation with the CPO_peak in HF and only a weak correlation in CKD. A stronger correlation was demonstrated between the peak circulatory power and CPO_peak, and the ventilatory power and CPO_peak. In HF, the central cardiac factor was the predominant determinant of the standard CPX-derived surrogate indices of cardiac performance. By contrast, in CKD both central and peripheral factors played an equally important role, making such indices less reliable markers of cardiac performance per se in CKD. Conclusion: The results highlight that the standard CPX-derived surrogate markers of cardiac performance may be less reliable in CKD, and that further prospective studies comparing such surrogate markers with directly measured cardiac hemodynamics are required before adopting such markers into clinical practice or research in CKD. Full article

Background: The use of inert gas rebreathing for the non-invasive cardiac output measurement has produced measurements comparable to those obtained by various other methods. However, there are no guidelines for the inert gas rebreathing method during a cardiopulmonary exercise test (CPET). In addition, there is also a lack of specific standards for assessing the non-invasive measurement of cardiac output during CPET, both for healthy patients and those suffering from diseases and conditions. Aim: This systematic review aims to describe the use of IGR for a non-invasive assessment of cardiac output during cardiopulmonary exercise testing and, based on the information extracted, to identify a proposed CPET report that includes an assessment of the cardiac output using the IGR method. Methods: This systematic review was conducted by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) guidelines. PubMed, Web of Science, Scopus, and Cochrane Library databases were searched from inception until 29 December 2022. The primary search returned 261 articles, of which 47 studies met the inclusion criteria for this review. Results and Conclusions: This systematic review provides a comprehensive description of protocols, indications, technical details, and proposed reporting standards for a non-invasive cardiac output assessment using IGR during CPET. It highlights the need for standardized approaches to CPET and identifies gaps in the literature. The review critically analyzes the strengths and limitations of the studies included and offers recommendations for future research by proposing a combined report from CPET-IGR along with its clinical application. Full article

We wanted to determine the influence of total blood volume (BV) and blood lactate quantity on lactate concentrations during incremental exercise. Twenty-six healthy, nonsmoking, heterogeneously trained females (27.5 ± 5.9 ys) performed an incremental cardiopulmonary exercise test on a cycle ergometer during which maximum oxygen uptake ($\stackrel{·}{\mathrm{V}}$O_2max), lactate concentrations ([La⁻]) and hemoglobin concentrations ([Hb]) were determined. Hemoglobin mass and blood volume (BV) were determined using an optimised carbon monoxide-rebreathing method. $\stackrel{·}{\mathrm{V}}$O_2max and maximum power (P_max) ranged between 32 and 62 mL·min⁻¹·kg⁻¹ and 2.3 and 5.5 W·kg⁻¹, respectively. BV ranged between 81 and 121 mL·kg⁻¹ of lean body mass and decreased by 280 ± 115 mL (5.7%, p = 0.001) until P_max. At P_max, the [La⁻] was significantly correlated to the systemic lactate quantity (La⁻, r = 0.84, p < 0.0001) but also significantly negatively correlated to the BV (r = −0.44, p < 0.05). We calculated that the exercise-induced BV shifts significantly reduced the lactate transport capacity by 10.8% (p < 0.0001). Our results demonstrate that both the total BV and La⁻ have a major influence on the resulting [La⁻] during dynamic exercise. Moreover, the blood La⁻ transport capacity might be significantly reduced by the shift in plasma volume. We conclude, that the total BV might be another relevant factor in the interpretation of [La⁻] during a cardio-pulmonary exercise test. Full article

Most of the published reviews about non-invasive home ventilation mainly reflect the technical aspects of ventilators. There is much less information about the consumables most used at home. However, the choice of a good interface or tubing system can lead to physiological changes in the patient–ventilator interaction that the clinician should be aware of. These physiological changes may affect the performance of the ventilator itself, the reliability of monitoring and, of course, the comfort of the patient. The use of different circuits, masks or filters is therefore related to the concepts of rebreathing, compressible volume, instrumental dead space or leak estimation and tidal volume. Through certain bench experiments, it is possible to determine the implications that each of these elements may have in clinical practice. Full article

Blood-borne extracellular vesicles and inflammatory mediators were evaluated in divers using a closed circuit rebreathing apparatus and custom-mixed gases to diminish some diving risks. “Deep” divers (n = 8) dove once to mean (±SD) 102.5 ± 1.2 m of sea water (msw) for 167.3 ± 11.5 min. “Shallow” divers (n = 6) dove 3 times on day 1, and then repetitively over 7 days to 16.4 ± 3.7 msw, for 49.9 ± 11.9 min. There were statistically significant elevations of microparticles (MPs) in deep divers (day 1) and shallow divers at day 7 that expressed proteins specific to microglia, neutrophils, platelets, and endothelial cells, as well as thrombospondin (TSP)-1 and filamentous (F-) actin. Intra-MP IL-1β increased by 7.5-fold (p < 0.001) after day 1 and 41-fold (p = 0.003) at day 7. Intra-MP nitric oxide synthase-2 (NOS2) increased 17-fold (p < 0.001) after day 1 and 19-fold (p = 0.002) at day 7. Plasma gelsolin (pGSN) levels decreased by 73% (p < 0.001) in deep divers (day 1) and 37% in shallow divers by day 7. Plasma samples containing exosomes and other lipophilic particles increased from 186% to 490% among the divers but contained no IL-1β or NOS2. We conclude that diving triggers inflammatory events, even when controlling for hyperoxia, and many are not proportional to the depth of diving. Full article

Background and Objectives: The use of closed-circuit rebreathers (CCRs) in recreational diving is gaining interest. However, data regarding its physiological effects are still scarce. Immersion, cold water, hyperoxia, exercise or the equipment itself could challenge the cardiopulmonary system. The purpose of this study was to examine the impact of CCR diving on lung function and autonomous cardiac activity after a series of CCR dives in cold water. Materials and Methods: Eight CCR divers performed a diving trip (one week) in the Baltic Sea. Spirometry parameters, SpO₂, and the lung ultrasonography score (LUS) associated with hydration monitoring by bioelectrical impedance were assessed at the end of the week. Heart rate variability (HRV) was recorded during the dives. Results: No diver declared pulmonary symptoms. The LUS increased after dives combined with a slight non-pathological decrease in SpO₂. Spirometry was not altered, and all body water compartments were increased. Global HRV decreased during diving with a predominant increase in sympathetic tone while the parasympathetic tone decreased. All parameters returned to baseline 24 h after the last dive. Conclusions: The lung aeration disorders observed seem to be transient and not associated with functional spirometry alteration. The HRV dynamics highlighted physiological constraints during the dive as well as environmental-stress-related stimulation that may influence pulmonary changes. The impact of these impairments is unknown but should be taken into account, especially when considering long and repetitive CCR dives. Full article

The global automotive industry is undergoing a significant transition as battery electric vehicles enter the market and diesel sales decline. It is widely recognized that internal combustion engines (ICE) will be needed for transport for years to come; however, demands on ICE fuel efficiency, emissions, cost, and performance are extremely challenging. Gasoline compression ignition (GCI) is one approach for achieving the demanding efficiency and emissions targets. A key technology enabler for GCI is partially-premixed, compression ignition (PPCI) combustion, which involves two high-pressure, late fuel injections during the compression stroke. Both NOx and smoke emissions are greatly reduced relative to diesel, and this reduces the aftertreatment (AT) requirements significantly. For robust low-load and cold operation, a two-step valvetrain system is used for exhaust rebreathing (RB). Exhaust rebreathing involves the reinduction of hot exhaust gases into the cylinder during a second exhaust lift event during the intake stroke to help promote autoignition. The amount of exhaust rebreathing is controlled by exhaust backpressure, created by the vanes on the variable nozzle turbine (VNT) turbocharger. Because of the higher cycle temperatures during rebreathing, exhaust HC and CO may be significantly reduced, while combustion robustness and stability also improve. Importantly, exhaust rebreathing significantly increases exhaust temperatures in order to maintain active catalysis in the AT system for ultra-low tailpipe emissions. To achieve these benefits, it is important to optimize the rebreathe valve lift profile and develop an RB ON→OFF (mode switch) strategy that is easy to implement and control, without engine torque fluctuation. In this study, an engine model was developed using GT-Suite to conduct steady-state and transient engine simulations of the rebreathing process, followed by engine tests. The investigation was conducted in four parts. In part 1, various rebreathe lift profiles were simulated. The system performance was evaluated based on in-cylinder temperature, exhaust temperature, and pumping work. The results were compared with alternative variable valve actuation (VVA) strategies such as early exhaust valve closing (EEVC), negative valve overlap (NVO), positive valve overlap (PVO). In part 2, steady-state simulations were conducted to determine an appropriate engine load range for mode switching (exhaust rebreathing ON/OFF and vice-versa). The limits for both in-cylinder temperature and exhaust gas temperature, as well as the external exhaust gas recirculation (EGR) delivery potential were set as the criteria for load selection. In part 3, transient simulations were conducted to evaluate various mode switch strategies. For RB OFF, the cooled external EGR was utilized with the goal to maintain exhaust gas dilution during mode switches for low NOx emissions. The most promising mode-switch strategies produced negligible torque fluctuation during the mode switch. Finally, in part 4, engine tests were conducted, using the developed RB valve lift profile, at various low-load operating conditions. The mode switch experiments correlated well with the simulation results. The tests demonstrated the simplicity and robustness of the exhaust rebreathing approach. A robust engine response, low CNL, high exhaust gas temperature, and low engine out emissions were achieved in the low load region. Full article