Objective To investigate the protective effects of recombinant human insulin-like growth factor-1 ( rhIGF-1) on apoptosis of diaphragm in rats with COPD and its impact on pulmonary function. Methods Forty-five male Wistar rats were randomly divided into three groups, ie. a normal control group, a model group, and an IGF-1 intervention group, with 15 rats in each group. The rats in the model group and IGF-1 group were exposed to 5% smoke ( 30 min perday, lasting 28 days) in a sealed box, and 200 μg lipopolysaccharide was injected intratracheally on the 1st and 14th day. The rats in the IGF-1 group were given rhIGF-1 ( 60 μg /100 g) additionally by subcutaneous injection once a day, lasting 28 days. On the 1st, 14th, 28th day, 5 rats from each group were sacrificed. The weight, rate of apoptosis, Fas gene and Fas protein expression of isolated diaphragms were detected. The pulmonary function was measured on the 28th day before sacrificed. Results The mass of diaphragms, minute ventilation ( VE) , peak expiratory flow ( PEF) , inspiratory capacity ( IC) , forced expiratory volume in 0. 3 second ( FEV0. 3) of themodel groupand IGF-1 group were all decreased compared with the control group ( P lt; 0. 05) . The mass of diaphragms, VE, IC of the IGF-1 group were higher than those of the model group ( P lt;0. 05) , and the differences of PEF and FEV0. 3 were not significant ( P gt; 0. 05) . On the 14th, 28th day, rate of apoptosis, Fas gene and protein expressions in the IGF-1 group were lower than those in the model group, and still higher than those in the control group ( P lt; 0. 05) . Conclusions Fas/FasL mediated apoptosis way is involved in the diaphragm apoptosis. rhIGF-1 may reduce the apoptosis of the diaphragmand improve the VE and IC of rats with COPD by intervening Fas/FasL pathway.
ObjectiveTo investigate the relationship of diaphragmatic mobility (ΔM) evaluated by ultrasonography with quality of life and athletic ability in patients with chronic obstructive pulmonary disease (COPD) , and analyze the factors those affect the diaphragmatic mobility.MethodsA total of 48 male patients with stable COPD were recruited in the study. The body height, body weight, diaphragmatic mobility, airflow obstruction (FEV1%pred), and exercise capacity (6MWD) were measured. The quality of life was assessed using the St. George’s Respiratory Questionnaire (SGRQ).ResultsThe minimum value of ΔM was 1.89 cm and the maximal value was 8.11 cm in the COPD patients. There were significant correlationship between ΔM and the SGRQ score of the total score, symptom score, impact points, activity points and 6MWD, with correlation coefficients of –0.474, –0.416, –0.432, –0.502 and 0.536, respectively. Multivariate stepwise regression analysis showed that the factors influencing ΔM were height (β=0.407, P=0.021) and FEV1%pred (β=–0.391, P=0.035).ConclusionsDiaphragmatic mobility and quality of life are closely related in COPD patients. The height and FEV1%pred have the greatest effect on diaphragmatic activity. The smaller diaphragm mobility is relevant to the worse quality of life and the smaller activity capacity.
ObjectiveTo observe the curative effect of pulmonary rehabilitation in patients with stable moderate to severe chronic obstructive pulmonary disease (COPD).MethodsSixty-four patients with stable moderate to severe COPD who visited during January 2016 and December 2017 were recruited in the study. They were randomly divided into an observation group and a control group, with 32 cases in each group. The spirometry was conducted in all patients. The right deep inspiratory end diaphragm thickness and the quiet end expiratory diaphragm thickness were measured by ultrasound, and the diaphragm thickness fraction (DTF) was calculated. The routine drug treatment was given in both groups. The comprehensive pulmonary rehabilitation treatment was given in the observation group (include breath training, exercise training, health education and nutrition guide). The pulmonary function, diaphragm function, severity and quality of life were evaluated before and 6 months later after the treatment.ResultsIn the observation group, the predicted value of forced expiratory volume in one second (FEV1%pred), FEV1/FVC ratio and DTF were all significantly improved compare with before treatment and the control group (all P<0.05). While the BODE index was significantly declined compare with before treatment and the control group (all P<0.05).ConclusionPulmonary rehabilitation treatment can help improve pulmonary function, diaphragm function, condition of the disease and quality of life.
ObjectiveTo explore the effects of volume mechanical ventilation with different tidal on the diaphragm discharge in rats.
MethodsTwenty-four SD rats were randomly divided into three groups, namely a high tidal volume group, a low tidal volume group, and a control group. The rats in the high tidal volume group and the low tidal volume group underwent volume controlled ventilation with tidal volume of 10 mL/kg and 5 mL/kg, respectively. The rats in the control group breath spontaneously after anesthetization. The EMGdi frequency, diaphragm discharge area, product of diaphragm discharge amplitude and diaphragm discharge rate (A×R) were measured every 2 hours to analyze the characteristics of diaphragm of rats under different duration of ventilation.
ResultsCompared with the control group, there was no statistical difference of A×R in the high tidal volume group, but the frequency of the diaphragm discharge reduced and the discharge diaphragm area increased. When compared the low tidal volume group with the control group, only the A×R increased significantly. The transcutaneous oxygen saturation (SpO2) and end-tidal CO2 pressure (PetCO2) in the high tidal volume group decreased significantly compared to the control group while the other indexes had no difference.
ConclusionsThe effects of mechanical ventilation with different tidal volume on the rat diaphragm discharge are different. The low tidal volume mechanical ventilation can excite the respiratory center and strengthen the diaphragm discharge with the stabilization of physiological index while the high tide volume inhibits diaphragm function and damages the oxygenation.
ObjectiveTo evaluate the predictive value of the diaphragm ultrasound for weaning from mechanical ventilation.MethodsThe patients who received mechanical ventilation in Fujian Provincial Hospital between February 2016 to December 2017 and met the criteria for a T-tube spontaneous breathing trial were included in the study. Then right diaphragmatic displacement (DD) and diaphragmatic thickening fraction (DTF) were evaluated using M-mode ultrasonography as well as the rapid shallow breathing index (RSBI, the ratio of respiratory rate to tidal volume). A new index was named as the diaphragmatic-RSBI (D-RSBI, the ratio of respiratory rate to DD). The patients were classified into a success group or a failure group according to the weaning outcomes. The receiver operating characteristic (ROC) curves were calculated to evaluate the predictive performance of each index.ResultsFifty-nine patients were weaned successfully and failure of weaning was found in 29 patients. There were no statistically significant differences in pre-weaning parameters including age, sex, systolic blood pressure, diastolic blood pressure, blood lipid index (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride), or fast blood glucose between the weaning success group and the weaning failure group (P>0.05), but there were statistically significant differences in body mass index and acute physiology and chronic health condition Ⅱ score between two groups (P<0.05). DD [(13.44±3.23)mm vs. (10.28±2.82)mm, DTF [(32.43±12.35)% vs. (27.64±5.77)%, P<0.05] and D-RSBI [(1.49±0.47) breaths·min–1·mm–1 vs. (2.55±0.87) breaths·min–1·mm–1, P<0.05] differed significantly between the weaning success group and the weaning failure group. A cutoff of DTF≥27.9% yielded a sensitivity of 98.3%, a specificity of 62.1%, and an area under the ROC curve (AUC) of 0.873. A cutoff of D-RSBI≤1.73 breaths·min–1·mm–1 yielded a sensitivity of 76.3%, a specificity of 93.1%, and an AUC of 0.887. By comparison, when RSBI was ≤50.9 breaths·min–1·mm–1, there was a sensitivity of 91.5%, a specificity of 86.2%, and an AUC of 0.927. There was no statistically significant difference in AUC between D-RSBI and RSBI (P>0.05).ConclusionsDiaphragm ultrasound is feasible to predict the outcome of weaning. DTF and D-RSBI are as same accurate as the traditional RSBI in predicting the weaning outcome, but more objective and suitable for clinical application.
Objective To explore the application value of shear wave elastography (SWE) combined with diaphragmatic thickening fraction (DTF) and rapid shallow breathing index (RSBI) in predicting the results of weaning of patients with mechanical ventilation. Methods Fifty-two patients with severe illness who were hospitalized in this hospital from January 2022 to September 2022 were treated with mechanical ventilation. After meeting the conditions for weaning, they underwent spontaneous breathing test, and the diaphragm function of patients was evaluated by measuring DTF using ultrasound technology and shear modulus (SM) using SWE technology. According to the weaning results, they were divided into weaning success group and weaning failure group, The differences of mechanical ventilation time, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, respiratory rate, RSBI, oxygenation index, DTF, SM and other parameters between the two groups were compared. Multivariate logistic regression was used to analyze the factors affecting the withdrawal results. The receiver operator characteristic (ROC) curve was used to evaluate the predictive value of potential influencing factors on the withdrawal results. Results There were 39 cases of successful withdrawal and 13 cases of failure. There were significant differences in mechanical ventilation time, respiratory rate, RSBI, DTF and SM between the successful weaning group and the failure group (P<0.05). Through multivariate logistic regression analysis, RSBI [area under the ROC curve (AUC)=0.771, 95% confidence interval (CI) 0.589 - 0.953], DTF (AUC=0.806, 95%CI 0.661 - 0.951), SM (AUC=0.838, 95%CI 0.695 - 0.981) were independent factors that affected the results of withdrawal. The single parameter AUC was smaller than the combined index with RSBI≤70.48 times·min–1L–1, DTF≥30.0%, SM≥10.0 kPa as the cutoff value (AUC=0.937, 95%CI 0.714 - 1.0, diagnostic sensitivity, specificity and accuracy were 94.9%, 84.6% and 92.3% respectively). Conclusions SWE technology provides a new quantitative index for evaluating diaphragm function by evaluating diaphragm stiffness. Diaphragm stiffness combined with DTF and RSBI can better predict the successful withdrawal in patients with mechanical ventilation.
