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South Dakota Medicine : the Journal of... Mar 2023With increasing uncertainty surrounding female reproductive rights, patient education about contraceptive options is of paramount importance. Although traditional oral... (Review)
Review
With increasing uncertainty surrounding female reproductive rights, patient education about contraceptive options is of paramount importance. Although traditional oral contraceptive pills (OCP) are often used to prevent pregnancy, they require precise, daily effort and have continual monetary maintenance costs for patients. Long-acting reversible contraceptives (LARCs) - intrauterine devices and the contraceptive implant - are effective and reliable alternatives to OCPs that are gaining popularity in the U.S. These contraceptive options do not require continual patient maintenance and are overall cost-effective. Physicians should be well versed in what contraceptive options are available for their patients and comfortable providing education and recommendations. This analysis will cover what LARCs are on the U.S. market, risks and benefits of each, as well as the CDC's medical eligibility criteria.
Topics: Pregnancy; Humans; Female; Pregnancy, Unplanned; Long-Acting Reversible Contraception; Contraception; Contraceptive Agents; Intrauterine Devices
PubMed: 36898201
DOI: No ID Found -
Equine Veterinary Journal Mar 2023Limited information exists regarding changes in the size of respiratory and locomotor muscles in response to exercise training in the Thoroughbred racehorse.
BACKGROUND
Limited information exists regarding changes in the size of respiratory and locomotor muscles in response to exercise training in the Thoroughbred racehorse.
OBJECTIVES
To describe and compare the responses of the respiratory and locomotor muscles to conventional exercise training and inspiratory muscle training (IMT).
STUDY DESIGN
Prospective randomised controlled trial.
METHODS
Thoroughbred racehorses, in training for competition in National Hunt races, were recruited from two training establishments. Ultrasonographic images were obtained for selected muscles of the upper airway, diaphragm, accessory respiratory, and locomotor systems and their sizes measured. Examinations were performed at three timepoints: (A) when unfit, (B) following 12 weeks of conventional exercise training and (C) following 10-12 weeks continued training at race fitness. In addition, horses at yard 1 performed IMT, between timepoint B and C, and were randomly assigned into high-load (treatment) or low-load (control) group. Repeated measures models were constructed to compare the change in muscle measurements over time, and to investigate the effects of yard, previous airway surgery and IMT on the change in ultrasonographic size measurements obtained.
RESULTS
Upper airway muscle size increased in response to conventional race training between timepoints A-C, and B-C. Diaphragm size increased in response to conventional exercise training between timepoints A and B. The diaphragm size of horses that undertook high-load IMT was either maintained or increased, whereas diaphragm size decreased in horses that undertook low-load IMT or no IMT between timepoints B and C. A significant interaction between gluteal muscle size and airway surgery status was observed, with greater gluteal muscle thicknesses measured in horses that had not previously undergone airway surgery (left gluteal 3.9%, p < 0.001; right 4.5%, p = 0.04).
MAIN LIMITATIONS
Low number of horses underwent IMT.
CONCLUSIONS
Respiratory and locomotor muscles increase in size in response to conventional exercise training, with a further change in diaphragm size in response to inspiratory muscle training.
Topics: Horses; Animals; Prospective Studies; Breathing Exercises; Inhalation; Respiratory Muscles; Diaphragm
PubMed: 35575148
DOI: 10.1111/evj.13598 -
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue May 2021In recent years, point of care ultrasound (POCUS) has developed rapidly in the fields of anesthesia and critical care. POCUS is widely used in clinic to monitor the... (Review)
Review
In recent years, point of care ultrasound (POCUS) has developed rapidly in the fields of anesthesia and critical care. POCUS is widely used in clinic to monitor the function of human tissues and organs such as the heart, lungs, and diaphragm due to its visual, non-invasive, portable, and repeatable characters at the bedside. Diaphragm is an important structure to maintain respiratory function. Diaphragm paralysis or dysfunction can cause a significant decrease in inspiratory function. The patient's diaphragm function can be assessed through monitoring diaphragm thickness and activity by POCUS, and combined with other clinical indicators, the patient's recovery of respiratory function can be comprehensively evaluated, and rapidly identify the pathological conditions, such as diaphragm paralysis, diaphragm atrophy, diaphragmatic hypoplasia and amyotrophic lateral sclerosis. Dynamic evaluation of the process from diaphragmatic dysfunction to recovery can provide guidance for weaning and extubation, and real-time feedback on the treatment effect. This article reviews the ultrasound evaluation methods and clinical applications to the diaphragm, in order to guide clinicians to use relevant indicators to comprehensively evaluate the structure and function of the diaphragm, and then diagnose and treat diaphragm dysfunction, which may help making clinical decision.
Topics: Airway Extubation; Critical Care; Diaphragm; Humans; Respiration, Artificial; Ultrasonography
PubMed: 34112310
DOI: 10.3760/cma.j.cn121430-20200824-00591 -
European Journal of Pediatrics Jun 2023Diaphragmatic thickness (Tdi) and diaphragm thickening fraction (dTF) are widely used parameters in ultrasound studies of the diaphragm in mechanically ventilated...
Diaphragmatic thickness (Tdi) and diaphragm thickening fraction (dTF) are widely used parameters in ultrasound studies of the diaphragm in mechanically ventilated children, but normal values for healthy children are scarce. We determined reference values of Tdi and dTF using ultrasound in healthy children aged 0-8 years old and assessed their reproducibility. In a prospective, observational cohort, Tdi and dTF were measured on ultrasound images across four age groups comprising at least 30 children per group: group 1 (0-6 months), group 2 (7 months-1 year), group 3 (2-4 years) and group 4 (5-8 years). Ultrasound images of 137 healthy children were included. Mean Tdi at inspiration was 2.07 (SD 0.40), 2.09 (SD 0.40), 1.69 (SD 0.30) and 1.72 (SD 0.30) mm for groups 1, 2, 3 and 4, respectively. Mean Tdi at expiration was 1.64 (SD 0.30), 1.67 (SD 0.30), 1.38 (SD 0.20) and 1.42 (SD 0.20) mm for groups 1, 2, 3 and 4, respectively. Mean Tdi at inspiration and mean Tdi at expiration for groups 1 and 2 were significantly greater than those for groups 3 and 4 (both p < 0.001). Mean dTF was 25.4% (SD 10.4), 25.2% (SD 8.3), 22.8% (SD 10.9) and 21.3% (SD 7.1) for group 1, 2, 3 and 4, respectively. The intraclass correlation coefficients (ICC) representing the level of inter-rater reliability between two examiners performing the ultrasounds was 0.996 (95% CI 0.982-0.999). ICC of the inter-rater reliability between the raters in 11 paired assessments was 0.989 (95% CI 0.973-0.995). Conclusion: Ultrasound measurements of Tdi and dTF were highly reproducible in healthy children aged 0-8 years. Trial registration: ClinicalTrials.gov identifier (NCT number): NCT04589910. What is Known: • Diaphragmatic thickness and diaphragm thickening fraction are widely used parameters in ultrasound studies of the diaphragm in mechanically ventilated children, but normal values for healthy children to compare these with are scarce. What is New: • We determined normal values of diaphragmatic thickness and diaphragm thickening fraction using ultrasound in 137 healthy children aged 0-8 years old. The diaphragmatic thickness of infants up to 1 year old was significantly greater than that of children from 2 to 8 years old. Diaphragmatic thickness decreased with an increase in body surface area. These normal values in healthy children can be used to assess changes in respiratory muscle thickness in mechanically ventilated children.
Topics: Infant; Humans; Child; Infant, Newborn; Child, Preschool; Diaphragm; Reference Values; Reproducibility of Results; Prospective Studies; Ultrasonography; Respiration, Artificial
PubMed: 36939879
DOI: 10.1007/s00431-023-04920-6 -
Chest Jan 2020This prospective observational study reports on diaphragm excursion, velocity of diaphragm contraction, and changes in pleural pressure that occur with thoracentesis. (Observational Study)
Observational Study
BACKGROUND
This prospective observational study reports on diaphragm excursion, velocity of diaphragm contraction, and changes in pleural pressure that occur with thoracentesis.
METHODS
Twenty-eight patients with pleural effusion underwent therapeutic thoracentesis. Diaphragm excursion and velocity of diaphragm contraction were measured with M-mode ultrasonography of the affected hemidiaphragm. Pleural pressure was measured at each aliquot of 250 mL of fluid removal. Fluid removal was continued until no more fluid could be withdrawn, unless there was evidence of nonexpandable lung defined as a pleural elastance greater > 14.5 cm HO/L and/or ipsilateral anterior chest discomfort.
RESULTS
Twenty-three patients had expandable lung, and five patients had nonexpandable lung. Velocity of diaphragm contraction (mean ± SD) increased from 1.5 ± 0.4 cm/s to 2.8 ± 0.4 cm/s pre-thoracentesis and post-thoracentesis, respectively (CI, 0.93-1.61; P < .001) in subjects with expandable lung. Velocity of diaphragm contraction (mean ± SD) increased from 2.0 ± 0.4 cm/s to 2.3 ± 0.4 cm/s pre-thoracentesis and post-thoracentesis (P = .45) in subjects with nonexpandable lung. Diaphragm excursion was significantly increased in subjects with expandable lung at the end of thoracentesis; diaphragm excursion did not increase to a significant extent in patients with nonexpandable lung.
CONCLUSIONS
The velocity of diaphragm contraction and diaphragm excursion increased in association with fluid removal with thoracentesis in patients with expandable lung, whereas it did not significantly change in patients with nonexpandable lung. This may derive from improvement in loading conditions of the diaphragm in patients with expandable lung related to its preload and length-tension characteristics.
Topics: Adult; Aged; Aged, 80 and over; Diaphragm; Female; Humans; Male; Middle Aged; Pleura; Prospective Studies; Thoracentesis; Ultrasonography
PubMed: 31398347
DOI: 10.1016/j.chest.2019.07.019 -
Asian Journal of Surgery Dec 2022
Topics: Humans; Fibromatosis, Aggressive; Diaphragm
PubMed: 35835675
DOI: 10.1016/j.asjsur.2022.06.104 -
Jornal Brasileiro de Pneumologia :... Sep 2020
Topics: Diaphragm; Humans; Pulmonologists; Ultrasonography
PubMed: 32965297
DOI: 10.36416/1806-3756/e20200367 -
Pain Research & Management 2022It is reported that impaired postural control in patients with non-specific chronic low back pain (NCLBP) was associated with "core" trunk muscle incoordination....
Ultrasonography Comparison of Diaphragm Morphological Structure and Function in Young and Middle-Aged Subjects with and without Non-Specific Chronic Low Back Pain: A Case-Control Study.
BACKGROUND
It is reported that impaired postural control in patients with non-specific chronic low back pain (NCLBP) was associated with "core" trunk muscle incoordination. However, as the diaphragm is an important component of the "core" deep trunk muscle group, we still know little about the potential relationship between diaphragm dysfunction and NCLBP.
OBJECTIVES
This case-control study is intended to investigate the changes of diaphragm morphological structure and function in young and middle-aged subjects with and without NCLBP by ultrasound evaluation and its possible validity in predicating the occurrence of NCLBP.
METHODS
31 subjects with NCLBP (NCLBP group) and 32 matched healthy controls (HC group) were enrolled in this study. The diaphragm thickness at the end of inspiration ( ) or expiration ( ) during deep breathing was measured through B-mode ultrasound, and the diaphragm excursion ( ) was estimated at deep breathing through M-mode ultrasound. The diaphragm thickness change rate ( ) was calculated by the formula: =( - )/ × 100%.
RESULTS
Compared with the HC group, the NCLBP group had a significant smaller degree of T ( = -3.90, < 0.001), ( = -2.79, =0.005), and ( = -2.03, =0.047). However, there was no statistical difference in between the two groups ( = -1.42, =0.161). The binary logistic regression analysis indicated that (OR = 16.038, =0.014) and (OR = 7.714, =0.004) were potential risk factors for the occurrence of NCLBP.
CONCLUSIONS
The diaphragm morphological structure and function were changed in young and middle-aged subjects with NCLBP, while the diaphragm thickness change rate ( ) and diaphragm thickness at the end of expiration ( ) may be conductive to the occurrence of NCLBP. Furthermore, these findings may suggest that abnormal diaphragm reeducation is necessary for the rehabilitation of patients with NCLBP.
Topics: Middle Aged; Humans; Low Back Pain; Case-Control Studies; Diaphragm; Muscle, Skeletal; Ultrasonography
PubMed: 36569461
DOI: 10.1155/2022/7929982 -
Radiographics : a Review Publication of... Jun 2024Acute diaphragmatic abnormalities encompass a broad variety of relatively uncommon and underdiagnosed pathologic conditions, which can be subdivided into nontraumatic... (Review)
Review
Acute diaphragmatic abnormalities encompass a broad variety of relatively uncommon and underdiagnosed pathologic conditions, which can be subdivided into nontraumatic and traumatic entities. Nontraumatic abnormalities range from congenital hernia to spontaneous rupture, endometriosis-related disease, infection, paralysis, eventration, and thoracoabdominal fistula. Traumatic abnormalities comprise both blunt and penetrating injuries. Given the role of the diaphragm as the primary inspiratory muscle and the boundary dividing the thoracic and abdominal cavities, compromise to its integrity can yield devastating consequences. Yet, diagnosis can prove challenging, as symptoms may be vague and findings subtle. Imaging plays an essential role in investigation. Radiography is commonly used in emergency evaluation of a patient with a suspected thoracoabdominal process and may reveal evidence of diaphragmatic compromise, such as abdominal contents herniated into the thoracic cavity. CT is often superior, in particular when evaluating a trauma patient, as it allows rapid and more detailed evaluation and localization of pathologic conditions. Additional modalities including US, MRI, and scintigraphy may be required, depending on the clinical context. Developing a strong understanding of the acute pathologic conditions affecting the diaphragm and their characteristic imaging findings aids in efficient and accurate diagnosis. Additionally, understanding the appearance of diaphragmatic anatomy at imaging helps in differentiating acute pathologic conditions from normal variations. Ultimately, this knowledge guides management, which depends on the underlying cause, location, and severity of the abnormality, as well as patient factors. RSNA, 2024 Supplemental material is available for this article.
Topics: Humans; Diaphragm; Diagnosis, Differential; Acute Disease; Female; Hernias, Diaphragmatic, Congenital
PubMed: 38781091
DOI: 10.1148/rg.230110 -
Shear Wave Elastography, a New Tool for Diaphragmatic Qualitative Assessment: A Translational Study.American Journal of Respiratory and... Oct 2021Prolonged mechanical ventilation is often associated with either a decrease (known atrophy) or an increase (supposed injury) in diaphragmatic thickness. Shear wave... (Observational Study)
Observational Study
Prolonged mechanical ventilation is often associated with either a decrease (known atrophy) or an increase (supposed injury) in diaphragmatic thickness. Shear wave elastography is a noninvasive technique that measures shear modulus, a surrogate of tissue stiffness and mechanical properties. To describe changes in shear modulus (SM) during the ICU stay and the relationship with alterations in muscle thickness. To perform a comprehensive ultrasound-based characterization of histological and force production changes occurring in the diaphragm. Translational study using critically ill patients and mechanically ventilated piglets. Serial ultrasound examination of the diaphragm collecting thickness and SM was performed in both patients and piglets. Transdiaphragmatic pressure and diaphragmatic biopsies were collected in piglets. We enrolled 102 patients, 88 of whom were invasively mechanically ventilated. At baseline, SM was 14.3 ± 4.3 kPa and diaphragm end-expiratory thickness was 2.0 ± 0.5 mm. Decrease or increase by more than 10% from baseline was reported in 86% of the patients for thickness and in 92% of the patients for SM. An increase in diaphragmatic thickness during the stay was associated with a decrease in SM (β = -9.34 ± 4.41; = 0.03) after multivariable analysis. In the piglet sample, a decrease in SM over 3 days of mechanical ventilation was associated with loss of force production, slow and fast fiber atrophy, and increased lipid droplets accumulation. Increases in diaphragm thickness during critical illness is associated with decreased tissue stiffness as demonstrated by shear wave ultrasound elastography, consistent with the development of muscle injury and weakness. Clinical trial registered with www.clinicaltrials.gov (NCT03550222).
Topics: Adult; Animals; Biomechanical Phenomena; Biopsy; Critical Illness; Diaphragm; Elasticity Imaging Techniques; Female; Humans; Male; Middle Aged; Prospective Studies; Qualitative Research; Respiration, Artificial; Swine; Translational Research, Biomedical
PubMed: 34255974
DOI: 10.1164/rccm.202011-4086OC