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COPD patients requiring chronic nocturnal noninvasive ventilation
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Marieke L. Duiverman, Peter J. Wijkstra
There are several theories that might explain why especially HI-NIV is of benefit in severe stable COPD (Figure 46.1). First, it is hypothesized that chronic hypercapnic respiratory failure (CHRF) ensues once progression of the disease leads to an imbalance between the inspiratory muscle capacity and the load placed on the respiratory system. Lung hyperinflation, leading to flattening of the diaphragm, but also intrinsic changes in diaphragm muscle fibres, such as loss of myosin content, increased oxidative stress, and sacromeric should be sarcomeric injury, or the use of systemic corticosteroids, contribute to a diaphragm with a decreased force-generating capacity (22). On the other hand, the load placed on the inspiratory muscles is increased due to shortening of inspiration, airway obstruction, and intrinsic positive end-expiratory pressure (PEEPi).
The Diaphragm Muscle
Published in Alan D. Miller, Armand L. Bianchi, Beverly P. Bishop, Neural Control of the Respiratory Muscles, 2019
The diaphragm muscle (DIAm) is a complex structure separating the thoracic and abdominal cavities, hence the Greek meaning “to span a partition”. The DIAm appears rather late in evolution, being present only in mammals, while other vertebrates use different means of ventilation. The DIAm is embryologically derived from the mesoderm, with the muscular and tendonous portions having a composite origin. The central tendon arises from the septum transversum which also contributes to the derivation of the pericardium and connective tissue of the liver, thus the close association between the DIAm and these thoracic and abdominal structures. The muscular portion of the DIAm derives from myotomes of the cervical spinal cord, and then makes its long descent to ultimately gain a broad range of attachment at the thoracic and lumbar levels. The innervation of the DIAm arises from its cervical site of origin and follows the long descent of the muscle. The mechanical actions of the DIAm are as complex as its multiple sites of origin and insertion. Its major function is in inspiration, although the DIAm is also involved in several nonventilatory motor behaviors including coughing, defecation, emesis, micturition, parturition, sneezing, vocalization, and weight lifting.
Relaxation and Chronic Pain
Published in Keren Fisher, Susan Childs, Lance McCracken, Glyn Towlerton, The Practical Pain Management Handbook, 2018
Keren Fisher, Susan Childs, Lance McCracken, Glyn Towlerton
Diaphragmatic breathing is a very effective way of managing stress as a first response. Use it on its own or with other forms of relaxation. When we feel stress, breathing tends to be shallow and we feel dizzy.Attend to your breathing and slow it down.Make full use of the diaphragm muscle between your chest and your stomach.
Prospective analysis of a surgical algorithm to achieve ventilator weaning in cervical tetraplegia
Published in The Journal of Spinal Cord Medicine, 2022
Matthew R. Kaufman, Thomas Bauer, Stuart Campbell, Kristie Rossi, Andrew Elkwood, Reza Jarrahy
For the most severe cases of neuromuscular degeneration, muscle replacement may be considered for the potential to wean to a pacemaker. Diaphragm replacement using vascularized muscle flaps is based on the work of Barnhart et al.19 and others, who reported the successful use of abdominal muscle flaps to repair large congenital diaphragmatic hernias.8,9 In the current study both of the patients receiving this treatment had failed prior pacemaker attempts. One of these patients had a pre-operative EMG with evidence of severe neuromuscular degeneration, and the second patient was 48 months post-injury. Both have achieved PW at 2-year follow-up. The application of diaphragm muscle replacement in this patient population is novel and further investigation is necessary to validate these early results.
Investigating the correlation between pulmonary function tests and ultrasonographic diaphragm measurements and the effects of respiratory exercises on these parameters in hemiplegic patients
Published in Topics in Stroke Rehabilitation, 2022
Mehmet Serkan Kılıçoğlu, Ozan Volkan Yurdakul, Yusuf Çelik, Teoman Aydın
In the literature, several studies show that breathing exercises improve respiratory muscles.11,15,16 The healing effect of these exercises on respiratory muscles has been observed in patients with chronic obstructive pulmonary disease, cystic fibrosis, myotonic muscular dystrophy, quadriplegia, multiple sclerosis, and stroke. To the best of our knowledge, although certain studies have evaluated diaphragm muscle thickness measurement with B–mode ultrasound to show diaphragm dysfunction,12-14 no study has examined the effects of the breathing exercise program on B-mode ultrasound diaphragm thickness measurements and/or examined the correlation of these values with PFT together with an evaluation of these parameters pre- and post-treatment. In this context, the present study has two objectives. The first is to examine the correlation between diaphragm thickness measurements via PFT and B-mode ultrasound in stroke patients. The second objective is to apply a breathing exercise program in these patients in addition to the standard neurological rehabilitation therapy and investigate the effect of these exercises on diaphragm thickness measurements using B-mode diaphragm ultrasonography and its correlation with PFT.
Proteomic profiling of fatty acid binding proteins in muscular dystrophy
Published in Expert Review of Proteomics, 2020
Paul Dowling, Stephen Gargan, Margit Zweyer, Dieter Swandulla, Kay Ohlendieck
Systematic mass spectrometric surveys of contractile tissues and muscle cell cultures have identified FABP3 and varying amounts of FABP1, FABP2 and FABP4 to FABP7 proteoforms in various subtypes of animal and human skeletal muscles [51–65], as listed in Table 2. The FABP3 isoform was clearly shown to be of highest abundance in slow skeletal muscles and identified as a proteomic marker of aerobic capacity and fast-to-slow muscle transitions [51–54,58–60], which agrees with greater intra-myocellular lipid droplet accumulation and high levels of oxidative metabolism in slow-twitching fibers [7]. In Mus musculus, the mixed-fiber gastrocnemius muscle contains besides its characteristic heart/muscle FABP3 isoform also adipocyte FABP4 and epidermal FABP5. Of note, the diaphragm muscle contains a larger variety of isoforms, including liver FABP1, intestinal FABP2, heart/muscle FABP3, adipocyte FABP4 and epidermal FABP5 (Table 1). These proteomic surveys demonstrate the complexity of FABP expression patterns, which is evident in the below sections on the effects of muscular dystrophy on the body-wide distribution of FABP proteoforms.