High-frequency and low-frequency chest compression: effects on lung water secretion, mucus transport, heart rate, and blood pressure using a trapezoidal source pressure waveform

High-frequency chest compression (HFCC), using an appropriate source (pump) waveform for frequencies at or above 3 Hz, can enhance pulmonary clearance for patients with cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD). Using a trapezoidal HFCC source pressure waveform, secretion of water from epithelial tissue and transport of mucus through lung airways can be enhanced for patients with CF and COPD. At frequencies below 3 Hz, low-frequency chest compression (LFCC) appears to have a significant impact on the cardiovascular system. For a trapezoidal source pressure waveform at frequencies close to 1 Hz, LFCC produces amplitude or intensity variations in various components of the electrocardiogram time-domain waveform, produces changes at very low frequencies associated with the electrocardiogram frequency spectra (indicating enhanced parasympathetic nervous system activity), and promotes a form of heart rate synchronization. It appears that LFCC can also provide additional cardiovascular benefits by reducing peak and average systolic and diastolic blood pressure for patients with hypertension.     

Mathematical Modeling of Pulmonary Airway Dynamics

A mathematical model has been derived that describes the pressure-flow relationship in the ventilatory system under conditions of constant lung volume. The parameters of the model include small airway resistance, large airway resistance, and lung elastic recoil. A collapsible airway segment is included to model compression of the airways during expiration.     

Convective gas mixing in the airways of the human lung--comparison of laminar and turbulent dispersion

A mathematical model of gas transport in the airways of the human lung with numerical solution of the corresponding differential. equation is presented. The model takes into account, along with the summed cross section of. the Weibel lung model, both convection and longitudinal dispersion of helium and sulphur hexafluoride in air. Simulation was performed using two dispersion coefficients corresponding to laminar and disturbed flow. Moreover, since the dispersion coefficients are closely related to the velocity, five constant flow rates were used for each computation and each simulation. Comparison between the model responses to laminar and turbulent dispersion was made in order to determine which plays the preponderant role in gas transport in the human lung. In addition, agreement between the experimental time constant of CO2 elimination during high-frequency ventilation and the predicted mixing time constant was satisfactory. It is concluded that Taylor laminar dispersion cannot play a significant role in the human airways; however, it seems that convective gas mixing with disturbed dispersion-corresponding to a quasi-steady state?can account for most observed gas transport phenomena during spontaneous breathing and high-frequency ventilation.     

Cilia‐Inspired Flexible Arrays for Intelligent Transport of Viscoelastic Microspheres

Anisotropic microstructures are widely used by being cleverly designed to achieve important functions. Mammals' respiratory tract is filled with dense cilia that rhythmically swing back and forth in a unidirectional wave to propel mucus and harmful substances out of the lung through larynx. Inspired by the ciliary structure and motion mechanism of the respiratory tract systems, a viscoelastic microsphere transporting strategy based on integration of airway cilium‐like structure and magnetically responsive flexible conical arrays is demonstrated. Under external magnetic fields, the viscoelastic microspheres can be directionally and continuously transported alongside the swing of the cilia‐like arrays that contain magnetic particles. This work provides a promising route for the design of advanced medical applications in directional transport of microspheres, drug delivery systems, ciliary dyskinesia treating, and self‐cleaning without liquid.     

Rule-based detection of intrathoracic airway trees

New sensitive and reliable methods for assessing alterations in regional lung structure and function are critically important for the investigation and treatment of pulmonary diseases. Accurate identification of the airway tree will provide an assessment of airway structure and will provide a means by which multiple volumetric images of the lung at the same lung volume over time can be used to assess regional parenchymal changes. The authors describe a novel rule-based method for the segmentation of airway trees from three-dimensional (3-D) sets of computed tomography (CT) images, and its validation. The presented method takes advantage of a priori anatomical knowledge about pulmonary airway and vascular trees and their interrelationships. The method is based on a combination of 3-D seeded region growing that is used to identify large airways, rule-based two-dimensional (2-D) segmentation of individual CT slices to identify probable locations of smaller diameter airways, and merging of airway regions across the 3-D set of slices resulting in a tree-like airway structure. The method was validated in 40 3-mm-thick CT sections from five data sets of canine lungs scanned via electron beam CT in vivo with lung volume held at a constant pressure. The method's performance was compared with that of the conventional 3-D region growing method. The method substantially outperformed an existing conventional approach to airway tree detection.     

Limitations of Frequency Dependence as a Measure of Airway Obstruction

The purpose of this study is to develop a pulmonary model and determine the frequency response sensitivity of mechanical parameters such as impedance, dynamic compliance, and dynamic resistance as a function of individual airway properties. Computer simulations of a three compartment model of various physiological cases were used to determine lung parameters as a function of frequency, peripheral airway contribution to total airway resistance, and relative percent obstruction of the peripheral airways. Provided our present concepts of the lung are valid and adequately incorporated into the present model, our results indicate the utility of frequency dependence as a measure of airway obstruction.     

Mass-Balance Model of Pulmonary Oxygen Transport

A dynamic lumped-parameter model for pulmonary gas transport has been developed to characterize the lung and predict the effect of various parameter changes. The gas side of the lung is modeled as a series and parallel arrangement of five perfectly mixed, variable-volume compartments that correspond roughly to airway and alveolar regions. The blood side of the lung is modeled as a series of perfectly mixed, constant-volume compartments that represent the pulmonary capillary bed. From nonsteady mass balances, equations are derived which yield the time course of concentration for each compartment. Model simulations indicate that the oxygen-hemoglobin reaction does not reach equilibrium in the pulmonary capillaries, an assumption commonly made in analyses of pulmonary oxygen transport. Simulations also show the extent to which breathing amplitude and rate can affect the oxygen level in the blood leaving the lung. A comparison of simulations for a normal state and chronic obstructive lung disease (COLD) with identical input conditions demonstrates that the oxygen level in the blood leaving the lung is much lower in COLD. Also, the simulations are compared with experimental findings.     

Simulation of lung function evolution after heart-lung transplantation using a numerical model

A morphometry-based computational model for expiratory flow in humans was used to study the unusual configuration of the maximum expiratory flow-volume (MEFV) curve associated with alterations in lung function after heart-lung transplantation (HLT). The postoperative MEFV curve showed a peak, followed by a gently sloping plateau over the midvolume range, ending in a knee where the flow suddenly fell, instead of the usual observed uniform decrease in expiratory flow. We have tested several hypotheses about the relationship between the pattern of changes in the configuration of the MEFV curve and pathological changes in the airway mechanics through computer simulations. Principally, effects of lung denervation and airway obstruction, associated with the development of bronchiolitis obliterans in the lung periphery, have been investigated. The calculated curves are similar in appearance to the measured postoperative flow-volume curves and confirm reliability of the earlier hypotheses. We conclude that the plateau-knee configuration of the MEFV curve can result from flow limitation in one of the first airway generations, that this flow limitation coupled with an increase in peripheral airway resistance results in plateau shortening, and that flows exceeding predicted values during the second part of expiration may be produced by lung denervation. Additionally our results demonstrate that airways larger than the transitional and respiratory bronchioles can be involved in pulmonary function deterioration observed in patients affected with obliterative bronchiolitis. Our findings indicate that the computational model, based on a symmetrical dichotomous branching structure of the bronchial tree, along with pathological data, can be employed to evaluate the effects of heterogeneous changes in the lung periphery. Index Terms-Airway mechanics, forced expiration, lung transplantation, mathematical modeling, maximal expiratory flow-volume curve.     

经鼻内窥镜下鼻甲外移术联合Nd:YAG激光插入法治疗慢性鼻炎

目的 :探讨对保守治疗无效的慢性鼻炎的一种微创手术治疗方法 :经鼻内窥镜下鼻甲外移术联合Nd :YAG激光插入法。方法 :采用经鼻内窥镜下鼻甲外移术联合Nd :YAG激光插入法治疗对保守治疗无效的慢性鼻炎 84例。治疗前后采用糖精试验评定鼻粘膜纤毛功能。结果 :经 1至 3年随访 ,总有效率达 10 0 %。无并发症发生。治疗前后粘液纤毛传输速率差异无显著性 (P >0 .0 5 )。结论 :该术式视野清晰 ,操作简单 ,术后反应轻 ,病人痛苦小 ,门诊即可完成 ,疗效极佳 ,是一种对鼻粘膜纤毛功能无损伤的治疗慢性鼻炎的微创手术方法 ,值得推广应用。     

Accurate measurement of intrathoracic airways

Airway geometry measurements can provide information regarding pulmonary physiology and pathophysiology. There has been considerable interest in measuring intrathoracic airways in two-dimensional (2-D) slices from volumetric X-ray computed tomography (CT). Such measurements can be used to evaluate and track the progression of diseases affecting the airways. A popular airway measurement method uses the “half-max” criteria, in which the gray level at the airway wall is estimated to be halfway between the minimum and maximum gray levels along a ray crossing the edge. However, because the scanning process introduces blurring, the half-max approach may not be applicable across all airway sizes. The authors propose a new measurement method based on a model of the scanning process. In their approach, they examine the gray-level profile of a ray crossing the airway wall and use a maximum-likelihood method to estimate the airway inner and outer radius. Using CT scans of a physical phantom, the authors present results showing that the new approach is more accurate than the half-max method at estimating wall location for thin-walled airways     

A model of acoustic transmission in the respiratory system

A theoretical model of sound transmission from within the respiratory tract to the chest wall due to the motion of the walls of the large airways was developed. The vocal tract, trachea, and the first five bronchial generations are represented over the frequency range from 100 to 600 Hz by an equivalent acoustic circuit. This circuit allows the estimation of the magnitude of airway wall motion in response to an acoustic perturbation at the mouth. The radiation of sound through the surrounding lung parenchyma is represented as a cylindrical wave in a homogeneous mixture of air bubbles in water. The effect of thermal losses associated with the polytropic compressions and expansions of these bubbles by the acoustic wave is included and the chest wall is represented as a massive boundary to the wave propagation. The model estimates the magnitude of acceleration over the extrathoracic trachea and at three locations on the posterior chest wall in the same vertical plane. The predicted spectral characteristics of transmission are consistent with previous experimental observations. This theoretical approach suggests that the locations of the spectral peaks are a strong function of the geometry and the wall properties of the airways, while the attenuation at higher frequencies is primarily associated with the absorption of sound in the parenchyma.     

Intrathoracic airway trees: segmentation and airway morphology analysis from low-dose CT scans

The segmentation of the human airway tree from volumetric computed tomography (CT) images builds an important step for many clinical applications and for physiological studies. Previously proposed algorithms suffer from one or several problems: leaking into the surrounding lung parenchyma, the need for the user to manually adjust parameters, excessive runtime. Low-dose CT scans are increasingly utilized in lung screening studies, but segmenting them with traditional airway segmentation algorithms often yields less than satisfying results. In this paper, a new airway segmentation method based on fuzzy connectivity is presented. Small adaptive regions of interest are used that follow the airway branches as they are segmented. This has several advantages. It makes it possible to detect leaks early and avoid them, the segmentation algorithm can automatically adapt to changing image parameters, and the computing time is kept within moderate values. The new method is robust in the sense that it works on various types of scans (low-dose and regular dose, normal subjects and diseased subjects) without the need for the user to manually adjust any parameters. Comparison with a commonly used region-grow segmentation algorithm shows that the newly proposed method retrieves a significantly higher count of airway branches. A method that conducts accurate cross-sectional airway measurements on airways is presented as an additional processing step. Measurements are conducted in the original gray-level volume. Validation on a phantom shows that subvoxel accuracy is achieved for all airway sizes and airway orientations.     

Autoregressive modeling of lung sounds: characterization of sourceand transmission

In this communication, we discuss the application of autoregressive modeling to lung sounds analysis. The lung sounds source in the airway is modeled as a white noise source, consisting of one or a combination of the following sources: random white noise sequence, periodic train of impulses, and impulsive bursts of energy. The acoustic transmission through the lung parenchyma and chest wall is modeled as an all-pole filter. Using this method, the source and transmission characteristics of lung sounds are estimated separately, based on the lung sounds at the chest wall. To illustrate the potential validity of the model, lung sound segments in known disease conditions were selected from teaching tapes and the source and transmission characteristics were estimated by applying the model. The estimated characteristics were found to be consistent with current knowledge of the generation and transmission of lung sounds in the known conditions.     

Segmentation of intrathoracic airway trees: a fuzzy logic approach

Three-dimensional (3-D) analysis of airway trees extracted from computed tomography (CT) image data can provide objective information about lung structure and function. However, manual analysis of 3-D lung CT images is tedious, time consuming and, thus, impractical for routine clinical care. The authors have previously reported an automated rule-based method for extraction of airway trees from 3-D CT images using a priori knowledge about airway-tree anatomy. Although the method's sensitivity was quite good, its specificity suffered from a large number of falsely detected airways. The authors present a new approach to airway-tree detection based on fuzzy logic that increases the method's specificity without compromising its sensitivity. The method was validated in 32 CT image slices randomly selected from five volumetric canine electron-beam CT data sets. The fuzzy-logic method significantly outperformed the previously reported rule-based method (p<0.002)     

Miniature acoustic guidance system for endotracheal tubes

Ensuring that the distal end of an endotracheal tube (ETT) is properly located within the trachea, and that the tube is not obstructed by mucus deposition, is a major clinical concern in patients that require mechanical ventilation. A novel acoustic system was developed to allow for the continuous monitoring of ETT position and patency. A miniature sound source and two sensing microphones are placed in-line between the ventilator hose and the proximal end of the ETT. Reflections of an acoustic pulse emitted into the ETT lumen and the airways are digitally analyzed to estimate the location and degree of lumen obstruction, as well as the position of the distal end of the tube in the airway. The system was evaluated through in vitro studies and in a rabbit model. The system noninvasively estimated tube position in vivo to within roughly 4.5 mm, and differentiated between proper tracheal, and erroneous bronchial or esophageal intubation in all cases. In addition, the system estimated the area and location of lumen obstructions in vitro to within 14% and 3.5 mm, respectively. These findings indicate that this miniature technology could improve the quality of care provided to the ventilated adult and infant.     

Segmentation and analysis of the human airway tree from three-dimensional X-ray CT images

The lungs exchange air with the external environment via the pulmonary airways. Computed tomography (CT) scanning can be used to obtain detailed images of the pulmonary anatomy, including the airways. These images have been used to measure airway geometry, study airway reactivity, and guide surgical interventions. Prior to these applications, airway segmentation can be used to identify the airway lumen in the CT images. Airway tree segmentation can be performed manually by an image analyst, but the complexity of the tree makes manual segmentation tedious and extremely time-consuming. We describe a fully automatic technique for segmenting the airway tree in three-dimensional (3-D) CT images of the thorax. We use grayscale morphological reconstruction to identify candidate airways on CT slices and then reconstruct a connected 3-D airway tree. After segmentation, we estimate airway branchpoints based on connectivity changes in the reconstructed tree. Compared to manual analysis on 3-mm-thick electron-beam CT images, the automatic approach has an overall airway branch detection sensitivity of approximately 73%.     

New model of LPE growth: Growth rate calculation

Expressions for the LPE growth rate are developed on the basis of the new steady-state growth model assuming nucleation in the solution. The solution thickness can be calculated at which the LPE growth rate reaches a maximum for any solution cooling rate. The initial and the volume nucleation parameters, formation times, critical supersaturations and supercoolings of the solution have been determined from experimental GaP and GaAs LPE data. Calculated growth rates fit very closely with experimental rates of GaP and GaAs LPE growth.     

Physiological interpretations based on lumped element models fit torespiratory impedance data: use of forward-inverse modeling

Respiratory impedance (Zrs) data at lower (less than 4 Hz) and higher (greater than 32 Hz) frequencies require more complicated inverse models than the standard series combination of a respiratory resistance, inertance, and compliance. In this paper, a forward-inverse modeling approach was used to provide insight on how the parameters in these more complicated inverse models reflect the true physiological system. Forward models are set up to incorporate explicit physiological and anatomical detail. Simulated forward data are then fit with identifiable inverse models and the parameter estimates related to the known detail in the forward model. It is shown that inverse fitting of low frequency data alone will not allow a distinction between frequency dependence due to airway inhomogeneities and frequency dependence due to tissue viscoelasticity. With higher frequency data, a forward model based on an asymmetric branching airways network was used to simulate Zrs from 0.1-128 Hz with increasing amounts of nonuniform peripheral airway obstruction. Here, inverse modeling is more amenable to sensibly separating estimates of airway and tissue properties. A key result, however, is that changes in the tissue parameters of an inverse model (which provides an excellent fit to Zrs data) will appropriately occur in response to inhomogeneous alterations in airway diameters only. The apparent altered tissue properties reflect the decreased communication of some tissue segments with the airway opening and not an explicit change at the tissue level. These phenomena present a substantial problem for the inverse modeler. Finally, inverse model fitting of low and high frequency Zrs data simultaneously with a single model is not helpful for extracting additional physiological detail. Instead, separate models should be applied to each frequency range.     

Pulmonary airways: 3-D reconstruction from multislice CT and clinical investigation

In the framework of computer-aided diagnosis, this paper proposes a novel functionality for the computerized tomography (CT)-based investigation of the pulmonary airways. It relies on an energy-based three-dimensional (3-D) reconstruction of the bronchial tree from multislice CT acquisitions, up to the sixth- to seventh-order subdivisions. Global and local analysis of the reconstructed airways is possible by means of specific visualization modalities, respectively, the CT bronchography and the virtual bronchoscopy. The originality of the 3-D reconstruction approach consists in combining axial and radial propagation potentials to control the growth of a subset of low-order airways extracted from the CT volume by means of a robust mathematical morphology operator-the selective marking and depth constrained (SMDC) connection cost. The proposed approach proved to be robust with respect to a large spectrum of airway pathologies, including even severe stenosis (bronchial lumen obstruction/collapse). Validated by expert radiologists, examples of airway 3-D reconstructions are presented and discussed for both normal and pathological cases. They highlight the interest in considering CT bronchography and virtual bronchoscopy as complementary tools for clinical diagnosis and follow-up of airway diseases.